commonly called Stitches Pains are incident to these Muscles from external injuries as contusions and impressions of cold or else internal causes and these are either by defluxion of humors that may flow in as most frequently from an abounding serosity being thin sharp and extravasated falls in amongst these Muscles or else by congestion matter is accumulated which Nature not being able to discharge lyes there as a burden impeding the muscular motions and causeth pain Sometimes from flatulency and wind getting into the Interstitia of the Muscles thereby causing intercurrent and fleeting pains And for remedy in such cases Fomentations and hot Bags applied are advantageous Evacuations being premitted according to the condition of the Body requiring We come now to consider of Pleurisies or pains in the Pleura that inward Membrane that does invest or line the Breast a disease very eminent and frequently occurring that both Hippoc. and Galen often mention it by way of example These pains are acute and sharp like punctures and have no constant place but in some persons they seize the right side in others the left in some the pain is higher in others lower towards the Hypochonders sometimes more backward and sometimes forward and although chiefly and more manifestly the pain be here or there to be pointed at yet the whole Membrane by reason of continuity is thereby affected and the parts adjacent do suffer by consent from whence various Symptoms as concomitants and attendants do inseparably accompany and consort with this pleuritic pain Hence it is that difficult and short breathing is constantly annexed to it and this because the parts for respiration are hereby impeded and have not their due motions and liberty of extension but are restrained and curbed which is done in favour to avoid compressing the grieved part otherwise would exasperate and increase the pain and therefore the sick fetch their breath short and quick because they cannot take it fully and largely and do repeat it the oftner by way of recompence To this and by consent of parts is adioyned a short and dry Cough which irritates and provokes the pain by moving and straining those parts and therefore is very troublesom and grievous to the Patient Here also a continual acute Feaver does necessarily follow as inseparable for the Archaeus or vital Principle being invaded in those parts by something hostile does therefore insurge becomes inraged grows hot and fiery raising a burning distemper throughout the body To these we may add another constant Character namely a hard swift but small Pulse And these are the pathognomonical signals that are always attending upon and do distinguish Pleurisies from other diseases of adjacency or affinity and likeness with them for when pains fall in amongst the intercostal Muscles although there may be some punctures or prickings because of the Membranes there yet not so great the Feaver not so high nor the breath so short nor the Cough so troublesom if any If the Lungs be inflamed only the pain is but little not punging but obtuse not in the circumference or sides but in the cavity or middle of the Breast yet the difficulty of breathing is greater here than in Pleurisies from angustness that seizeth the parts of respiration Pleurisies differ from Inflammations of the Diaphragma because in this there is no pain in the sides but only at the end of the short Ribs and the upper part of the Belly is extended and with it a Delirium Pleurisies also are distinguished from Inflammations of the Liver in the seat or place of pain which always is in the right side under the short Ribs the pain not punging but heavy and obtuse the Cough less difficulty of breathing less but the Urine higher-coloured or tinged red And now I see the reason though very weak why some Authors have distinguished Pleurisies or differenced them into legitimate and spurious which indeed is a division of Pleurisies into Pleurisies and no Pleurisies for I account no disease to challenge that denomination but such as have their foundation in the Pleura else by the same reason all diseases may admit of the same distinction of legitimate and spurious for as much as every disease hath some Symptom which is common to other diseases that may give them some resemblance or affinity with each other or be affected by consent from another but I pass it over and come to examine the causes from whence pleuritic pains do arise These causes are external and internal External causes are such as remotely prepare and dispose the body to a likely capacity of reception or aptness to this disease laying the foundation for internal causes and they do arise out of or from the irregular unfit or improper use of the Diaetetics which leads to a morbific or unsound state For example violent exercise or otherwise raising great heat in the Body and opening the Pores by neglect upon it as not to preserve that warmth for some time and suffering it gradually to abate and go off by keeping on cloaths and forbearing cool drinks this may introduce a Pleurisie So likewise in the heat of Summer to throw off cloaths and be exposed to the wind at a Casement or the cool Air in the evening To over-heat the Body with strong Liquors and suddenly endeavor to cool it again with small Beer may effect the like Cold North-winds after Southerly and hot weather does alter the texture of the blood and is previous to pleuritic or similar pains But here you must take notice and know that quicquid recipitur recipitur per modum recipientis all Bodies are not alike nor equally disposed for reception for in some these causes produce Pleurisies in others Angina's in some Dysenteries in others Arthritic pains c. According to the aptitude and disposition of Bodies in fabrication or organization and peculiar properties have the same general external causes various and divers effects being determined and specificated by different states of Body more liable and apt to this or that disease rather than another Hence it is that external causes as Diaetetic errors have heterogeneous effects and procure dissimilar diseases according to various constitutions purity and impurity stability or debility concurring with or resisting their influence which consideration brings me directly to the next stage being the latter part of the preceding division Internal causes are antecedent or conjunct Antecedent as plethory being fulness of blood or Cacochymy a depraved or degenerate blood both which are previous states or conditions of Body disposing or rendring more liable to this disease for the great Vessels being full and distended upon any Effervescence and Superfermentation of the blood this impetuously like a torrent is impelled into the smaller Pipes as those of the Pleura where not having a free passage it does cause pain by distension and Inflammation Now this plenitude is brought on or aggravated and increased sometimes by a suppression of some accustomed Evacuation as those that are wont
them do gangrene by concreting and condensing the blood stopping the canals and suffocating the life as the Venom of a Scorpion and Asp others by putrifying and corrupting the blood or some other part where they chiefly discharge their venom Internal and conjunct causes of Gangrenes are Inflammation corrupt venenous or malignant matter that preys upon and destroys the vital Principle stagnation of the blood or what else may intercept commerce and supply from the fountain of life The Characters or signs declaring a Gangrene are these the sense of feeling decays the colour changeth and inclines to be livid or blackish the flesh grows flaccid and frigid but when the Gangrene proceeds on to a Sphacelus or perfect mortification these Symptoms then are aggravated and appear more eminent sense is quite abolished and the part becomes fetid and cadaverous Gangrenes are very seldom mentioned in Practice and you shall rarely hear of any person to dye of a Gangrene yet I must believe and not without good grounds that many thousands dye by an internal Gangrene not taken notice of for if the major part at least a great part do dye with a high Feaver or Phlogosis we may rationally then conclude that a Gangrene is frequently conjoyned as the last Actor in the Tragedy and immediate cause of death for Gangrenes do commonly supervene Inflammations where they are mortal and thus also Inflammations from fractures and dislocations often bring on a Gangrene And in malignant high Feavers there are sometimes such vibices marks of mortified blood and black mouths which do strongly suggest a Gangrene within the body And for those that perish by the Plague in so short a time whose venemous matter shews it self by Spots Vesicles Buboes and Carbuncles most of these dye gangrened And many of those that expire by the small Pox have a Gangrene in some part the putrid matter being lodged there Nature not able to protrude and bring it forth and it is very reasonable to assert this for if a Gangrene will arise out of a very small portion of matter extravasated defluxed or congested in a part then where the whole body abounds with malign putrefaction and overflows with it any part thereof remaining within the body may and does very often corrupt and gangrene that part That our Opinions are not so extravagant and excentric from the Judgment of all Learned men as some perhaps inconsiderately may censure take notice what Arnisaeus an eminent Physician in Germany Professor in the University of Julia writing to Gregor Horstius about a Person of Quality that dyed of the small Pox queried or rather concluded that the Liver was gangrened and farther saith Verisimile est multis idem accidere qui ex variolis moriuntur To which Horstius answers by Letter and consents with his determination in these words Cùm autem necessariò febris sanguinea cum putredine majori concurrunt in tali casu facillimè fieri poterit ut praevalente calore febrili 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in viscere sanguificationis prae caeteris corrumpatur inprimis cùm propter cutem undique pustulis exulceratam incrustatam transpiratio eventilatio difficilior fit Si enim inflammationes internae ipsiusque jecoris juxta communem nostrum amicum Guil Fabr. non rarò desinunt in gangraenam non video cur non idipsum saepiùs etiam fieri possit tunc temporis ubi variolis undique satìs quidem expulsis gravissima symptomata partium internarum inflammatarum nihilominus perdurant eo usque donec aegrum penitùs jugulent Horst Institut Med. Disp 3. coron 1. additament And in many other acute malign Diseases either the morbific matter is not discussed and discharged from the seat of the disease or else is expulsed thence into some other perhaps a remote part where it corrupts the member and extinguisheth the vital Principle called by some the innate Spirit Now concerning the curability and incurability of Gangrenes take these instructions before the disease be undertaken or left for desperate and hopeless First Consider the duration or time of the disease the age and strength of the Patient for a Gangrene in the beginning is more easie and hopeful than after continuance because it proceeds on commonly and draws nearer to a Sphacelus which is incurable also young persons vegete and vigorous in spirit are more hopeful than others aged or worn out by long or enervated by acute sickness Secondly Examine into the essence nature and rise of the disease which will lay open much of the difficulty thereof for Gangrenes from a primitive cause as Contusion Fracture Section Vstion Caustic or other erosion c. are more curable and less dangerous than those that arise and depend upon antecedent internal causes for Gangrenes of this sort do declare a cachectic depraved habit of body and that some of the internal Viscera are damnified and vitiated from whence a supply of ill matter and therefore in Hydropic Scorbatic and Hectic febrile bodies also in malign and contagious diseases small Pox Venereal Lues Plague c. Gangrenes are more desperate Thirdly The part affected or seat of the disease is to be noted for if a principal part be gangrened recovery is very rare also in the Guts a Gangrene is mortal by reason of continual moisture there and imbecillity of these also in the Vagina Vteri and Glandules of the body a Cure is seldom performed Now as touching the Cure of Gangrenes there is not any one Method or particular Medicine for Gangrenes but they require such variation of Cure according to the difference of their causes from whence they do arise with respect to the part affected And therefore we cannot point out any general course that may be applicable to this great disease but indications of particular and special cases must vary and will make exceptions against it So that the rational Physician perpending and duly considering the nature of the disease and variations thereof as aforesaid with the Symptoms and circumstances attending must design such a Method and adapt such Medicines pro re nata as may best suit with the urgency of this dangerous and threatning Malady The means required and useful in these emergencies are taken some from Pharmacy and some from Chirurgery Pharmaceutic Remedies are both internal and external Internal are select and choice Purgatives Diaphoretics and Cardiacs elaborated and prepared according to latter inventions and the best Rules of Art Topical and external are Fomentations Liniments and Cataplasms specificated and appropriated to these purposes Chirurgical helps are Phlebotomy Cupping Scarification Canteries c. and therefore an expert Chirurgeon must here be assisting to perform these operations Now all these various means are not to be used to every person gangrened but each case will require some of these more or less as the Judgment of a skilful Physician in this disease shall determine and appoint But if the Gangrene by continuance and neglect or from acuteness by great
remove the disease or retard its course To set forth and make evident the truth of our first Position you must know that Pain is commonly the first Symptom of most diseases and if it does not appear as a leader yet very frequently it comes in early or soon after the disease hath discovered it self and few that complain of sickness but complain of some pain that attends it and this our Practice must owne and confirm and taking a survey of the Catalogue of Diseases belonging to mans Body you will find no Symptom so frequently adjoyned and appertaining to them as that of pain and the reason hereof in part may be this That all the Symptoms of diseases are the objects of sense that is they do come under or are discernable by some of the senses which being compared amongst themselves are of greater and lesser latitude now pain belongs to and is adjudged by the sense of feeling only which sense is of the largest capacity of all the rest being extended throughout the body even through the Organs of all the other senses whereas the rest are confined to particular parts the Eye the Ear c. and have no larger extent or place of residence as hereafter we shall have further occasion to discourse For instance seeing may discover what is amiss upon the external parts or superficies of the body and discern what comes forth that it may be adjudged but feeling takes cognisance of inside and outside and what we cannot see we feel and are sensible of by pain even amongst the most secret and hidden parts of the body so that pain is known to be and does manifest it self whether it be within or without Hence it is that pain is the most usual and most frequent Symptom amongst diseases Pain therefore belonging to this capacious sense and being an appertainer thereto and having admission into all its quarters and confines no wonder then if pain so frequently occurs and is the most usual attendant or most troublesom intruder upon the sick Having thus proved and might farther confirm it if needful that pain is the most general and frequent complaint of the diseased we shall proceed and inquire farther how Tumors Inflammations c. do follow thereupon and how pain introduceth and ushers in the rest of its fellows and how pain is introduced sometimes by them and how they appear very often with their consorts having relation to and dependence upon each other by way of causation that some of them and sometimes all are principal Actors in the Tragedy of most mortal diseases though seldom discerned Mortal diseases I said because where diseases are stopt in their progress and have not their full course but are taken off by effectual means or great Providence the links of this chain is broken and then perhaps pain may exercise its power singly and alone for a time and by intervals or pain may contract or associate a Tumor and sometimes an Inflammation and yet all end well these may go off or be sent off by Medicine and proceed no farther and the Patient recover or return to a good and sound state of Health but too often it proves otherwise either by neglect and delay by improper methods and erroneous proceeding or for want of exquisite means the progress goes on gradually to the last and ends with Death In this train of Diseases pain for the most part is a leader and sometimes a follower but seldom misseth to be the discoverer Pain begins and gives the Alarm discovering a disorder or disease in this or that internal and hidden part of the body gives warning betimes and implores aid but none coming at least not sufficient and effectual the pain continues as the cause is yet remaining if the help of Art be wanting yet Nature is not wanting to her self but summoneth all her power and endeavors to dislodge and expel this morbific cause and raiseth all her Spirits though in a febrile disturbance and confusion against this common enemy to the part grieved these Spirits resort plentifully and with them the blood is conveyed which flowing in and remaining there a Tumor is generated and by this concourse of Spirits the part grows fiery and an Inflammation is planted here and superadded The case remaining thus for a while and this confluence not dispersed discussed or drawn off the Tumor perhaps grows cancerous afterwards gangrenes and mortifies then death immediately ensues and concludes all But sometimes the Tumor suppurates or apostemates and then the contained purulent matter breaks forth and begets an Vlcer if the Patient survive and hold it out and with this the diseased may continue a longer or shorter time according to the nature of the Vlcer and as it is more or less dangerously seated for if it be a principal part or adjacent or this ulcerous matter issuing falls into some inconvenient cavity where it is lodged again and finds no Emunctory or passage out or erodes and rots some choice vessel of great use the case is deplorable and scarce remediable Now to comment a little upon this series and progress consider that where there is pain and it continues especially in a high degree you may rationally expect a Tumor or flux of Humors congregated to be the consequent if not prevented which is brought to pass and effected after this manner or upon a threefold account First Because Nature in a time of exigence and need does endeavor to help her self and exerts her power to the utmost and therefore when pain afflicts a member the Spirits resort thither and with them the blood also to relieve it Secondly The part pained by reason of this plenitude of blood and confluence of Spirits does wax hot and this heat begets an attraction and draws more humors to the part Thirdly Pain debilitates and disables the part whereby it is become uncapable to defend it self but lyes obnoxious to this flux of humors which being out of their proper place and remaining in a distempered part they degenerate variously Now upon a survey of the whole matter although Nature intends well in this hurry and bustle being rouzed up and pricked by pain and success sometimes happens upon it or no damage yet commonly it falls out otherwise and there is an oppression and over-charge brought upon the part The confluence of Spirits together with the innate tumultuate and inflame the grieved member which being thus discomposed and out of order cannot moderate and check the flux and attraction of humors but is over-loaded crowded therewith and distended And unless the help of Physick directed by a prudent hand steps in to appease and allay this disturbance by casting out the morbific seminary or matter and reduce this disorder it goes on from bad to worse frequently and from thence to extremity and perhaps to an irrecoverable state in manner and by such gradations as before related And besides what pain does thus effect as a leader Tumors sometimes do take their
errour and folly of the rest for by insisting so much upon this heat the supposed obstacle of Cure or the thing to be cured the opportunity perhaps may be lost but the Patient certainly injured by the vain use of Medicines levelled at this mark Few diseases there are amongst the Chronic or slow of motion but some febrile or preternatural heat more than the ordinary and natural temper does attend them especially at such times if the disease have any manifest intentions of degrees or Paroxysms of pain and scarce any among the acute or swift but a brisk and high Feaver does always accompany for in all cases where pain is continuing especially if severe a Feaver is adjoyned and they become fratres in malo or rather a branch from that stock and the order of causation runs thus First there is the morbific cause planted in this or that part or transient which is either some degenerate or peccant humor there infesting or corruptive seminary the fundamental matter of Pains Tumors c. or some extraordinary production as stones worms c. These preternatural causes do seldom lye dormant but raise pain by obstruction by oppression or compression by convulsion distention corrosion putrefaction c. The parts being thus affected and grieved the vital principle residing as governor there is hereby excited and irritated to remove expel and cast off the offending cause this strugling and irritation of the life is the very pain and anguish that is felt in the part for the Organ is not capable of pain of it self but the life inhabiting and inabling the part to perform vital offices that does dolere and aestuare Now a Feaver which is pain diffused ariseth from particular pains thus As the members or parts of the body being many do consent with one another some more immediately and peculiarly than with the rest by vessels of communication partnership in office or vicinity yet the life being one entity or common being extended and expanded throughout the whole fabrick of the body cannot suffer here or there but the whole is injured disturbed and drawn into consent more or less manifestly or secretly and the Spirits upon great occasisions are raised up in commotion throughout the body as instruments to vindicate the publick from an enemy invading And farther take notice that particular pains beget the general a Feaver greater or less sooner or flower upon a double account 1. From the Nature and Quality of the Part in formation and office 2. From the greatness or inconsider ableness fierceness or mildness of the morbific cause For example Sickness which is pain at the Heart or Stomach raiseth a Feaver great and soon and this by reason of the excellency and necessity of their offices whereby the whole body consents forthwith that what afflicts these is a general complaint more immediately but other parts in a lower station subservient and ministerial whose function being not so general but of particular and private use do not communicate their diseases so soon nor the whole body so highly resenting their ill affects because the publick can spare their offices and be without their exquisite or compleat assistance for a time without great complaint or manifest want Secondly the cause or morbific matted being greater or less in any part does thereby affect more or less sooner or later and therefore sand or small gravel in the Kidneys do not afflict the part nor raise so great a disturbance in the body as a stone there that obstructs the ducture and stops the current of the Urine and is much more difficult to be removed And sickness or pain at the Stomach by little over-drinking of good liquor Wine or Beer c. is not so lasting nor molesting nor preading in the effects over the whole body â—s a surfeit of meat fruit or an over-charge of bad liquors these shall produce not only sickness or pain in the stomach but sickness or a hot pain in the whole body which is called a Feaver and this sickness may be dangerous as sometimes it proves mortal Pain is fixed in one part but the Feaver is universal spread throughout the body for from this pain of a particular part the whole life estuates is incensed and disquieted as if a cord be tyed or fastned at both ends of great length and strait strike it hard in one place and it jarrs the whole length but at the place struck the vibration is greater and more manifest So where the disease is seated the pain is more apparent and that part most sensible where the wound is given where the oppression lyes where the obstruction is where the humor is corroding putrifying c. there pain is eminenter limited or bounded and to be pointed at particularly here and not there eminently but from hence ariseth the Feaver which is pain diffused in a remiss degree and seemingly of another nature or quality a different thing supposed by some therefore denominated a Feaver This Feaver although it be a pain yet it is not so felt by the Patient nor so understood by others because of the greater particular pain that drowned it and because of its expansion and latitude all parts bearing their proportion and share so that where a Feaver stands alone without a particular pain in this or that part yet the Feaver the general pain is not so manifest to the sense of the Patient because every part hath its portion and therefore is not so discernable and uneasie for a Feaver is pain expatiated through the body and you are not so sensible of it as when pain is contracted into a narrow compass the rest being free and at ease That all Feavers are pains greater or less examine but the definitions of Febris and that of Dolor Feaver and pain you will be fully informed how they agree a Feaver being comprised under pain as a Species of that Genus being a hot pain or the pain of heat Dolor est tristis sensatio in tactu Gal. Febris est calor contra naturam in corde accensus ex eo in totum corpus diffusus which is Hippocratic and Galenic Doctrine Now where there is heat higher or exceeding that which is natural it must affect the sense of feeling and cause pain and although I do not like the definition of Febris yet it will serve my turn here being right in the opinion of those Galenists with whom I now contend From hence we must understand and be untaught again that Dolor and Febris do differ as genus and species a Feaver being contained under and is one sort of pain viz. a hot scorching pain and sometimes a Feaver is a cold pain as the rigor of intermitting Feavers called Agues do testifie And since that all Feavers we pains little or great we shall not need to institute a Method of Cure different upon the notion of a Feaver but only having respect unto the cause that raiseth this feaverish or hot pain and therefore
hands again and the same especially that cured him of the dangerous Feaver and thus the supposed good Physician drives on and is thought a very necessary Advisor and an able Assistant upon all occasions emerging Truly this is according to the homely Proverb but Tinkerly doings stop a Feaver if it can be this way and introduce what is more contumacious difficult and worse to be dealt with But some may object and say That Lemons and Oranges are used in Feavers and with good effects from their cooling I answer That Lemons Oranges Barberries and such like are allowable and what good ariseth from thence is not to be ascribed to their cooling virtue if any but to their acidity which acuates and sharpens the ferment of the stomach by whose reinforcement and strength regained by this means the whole body is refreshed fares the better and some allay at least more ability to bear the febrile heat and therefore likewise such Liquors are to be granted the Patient for refreshment and support as are most agreeable to the stomach and desired and the dictates of Nature in these cases are to be marked who prompts for her own help and satisfaction and generally the Drinks so desired by them are fermented Liquors no Juleps Beer Ale Cider Wine c. and such are most agreeable to the stomach which discreetly used are no promoters nor continuers of the Feaver but beneficial in their kind and a relief to the sick but always to impose medical drinks upon a weak sick man as if he were to be nourished and live by Physick is very absurd and irrational And here pertinent to our Discourse I must recite what I have formerly noted elsewhere but by the way I must tell you wherein I differ from other Physicians when I grant my Patients cooling Drinks as Whey Cider or such like when desired in Feavers or hot bodies they lay a stress upon Coolers as principal means against the Disease and to reduce the distemper I allow them not as Physick against the Disease but as refreshment to Nature being delighted therewith and coveted So that I do not impose them as of necessity because the Disease does not require it but observing the propriety of the body being comforted and refreshed with such of such cooling Liquors So that these are not given as Medicine for they cure not nor is heat to be regarded otherwise than as signal but they may be allowed as refreshment A labouring man that toils and heats himself must have drinks to refresh him even so it is with a man in a Feaver his Spirits labour more than at another time and more thirsty he is requiring drink more than at another time and it must be such as delights him that Nature does desired not Barley water Juleps and such slops that the Patient nauseats and give him no satisfaction Tract Of the Scurvy Chap. 11. Edition 4. And in the same Chapter controverting with Dr. Willis about Antiscorbutic Remedies there is much more to this purpose shewing the indirect proceeding against Feavers with repeated Phlebotomy and cooling Medicines whither I refer the Reader And here I might animadvert and take notice of the strange invention and irrational use of epispastic or blistering Plasters to draw away a Feaver shewing thereby also that Feavers are wholly mistaken in the notion of them but I must wave the Argument as collateral which otherwise would interrupt our present occasion and divert me from the direct prosecution of the business in hand Now in tlje close to observe the order and dependence of this Discourse and to take a review of the whole matter compendiously drawn up you will find we have not deviated from the subject proposed but prosecuted directly the scope of this designment which in short is thus That this latent internal Series of Diseases more frequent than discerned their dangerous transition and complication is masked and covered with an apparent or outside garb of a Feaver or febrile preternatural heat which signature and external character hath so ingrossed the Physicians endeavors and taken up the Practice of this Art that little hath been done in searching out the radix of diseases and opportunity neglected for prosecution against the morbific causes And for as much as this Feaver being only the estuation of the vital Principle throughout the body generally attending these and most other diseases is no farther to be taken notice of than as signal shewing the cause to be greater or less in provocation as the heat is more intense or remiss and does in no wise divert the Physicians intentions and design of Cure nor ought to be applied unto since it is only a consequent and dependent occasionally from the morbific cause which febrile heat riseth and falleth as the said cause does more or less provoke and irritate and vanisheth quite away when that cause is removed or ceaseth to disturb It necessarily then follows that these Coolers generally used and mainly insisted on are generally noxious often mortal giving great advantage to the train of diseases our subject towards a Cure whereof they contribute nothing but è contrà promote the progress I might have amplified and inlarged thisDiscourse in several parts thereof but this will suffice at present for a dawning and discovering light which hereafter may appear with greater lustre as occasion shall be offered by any opponent to these Truths And thus much in general touching this Series of Diseases their latency their frequency the danger by in advertency and improper mistaken means and too late discovery Our next undertaking is to view more particularly the gradations of this progress tracing from stage to stage and remarking the capital occurrences the chief causes antecedent and conjunct beginning with Pain the common leader or warning Sympton Pains afflicting humane Bodies the different Nature and Causes thereof OF all Symptoms that attend or are the consequents of Diseases Pain is the most troublesom and irksom to bear Weakness and languishing are tolerable evils but pain is restless tormenting and full of complaints And although this be the worst in extremity to abide and the most mournful accident that befals mans Body yet no part thereof hath a priviledge by Nature to be exempt or protection from this calamity the reason whereof we will inquire into All parts of the Body wherein is the sense of feeling are liable to pain and by virtue of this sense pain is communicated to this or that part and therefore dead Bodies parts paralytic benummed or mortified are not capable of pain because in them there is not that sense of feeling and although the Organs of the other senses are subject to pain as the Eyes Ears c. yet pain is not proper to them quatenus as they belong to those senses but as the sense of feeling is seated there also having a greater latitude than the other and is extended through the Organs of all those Senses True it is the other senses have
their inconvenient and disturbing objects as the Philosopher says Excellens sensibile laedit sen sum as the light of the Sun or flame is troublesom to the Eyes and great noise as of a Bell or Gun if near especially sudden and unexpected does offend the Ears and a strong or stinking scent is offensive to the Nose and an ungrateful taste as too salt too sowre or bitter is unpleasant to the Palate but pain affects the sense of feeling Parts therefore that are capable of pain are endowed with the sense of feeling and those parts are membranous that is they are invested with or lined with some Membrane by which the sense of feeling is communicated and hence the Bones are capable of pain by the Periosteum that Membrane which covers them And this sense as it is more general extending through all parts and more useful than the rest of the senses so the disturbance arising thence is more insufferable and grievous to be endured and better it is to want any other sense than this yea all for where feeling is departed the life is ceased in that part This sense therefore being supreme the defections and disturbances thereof must be of greater importance and concernment than the rest The other Senses are confined to and exercise their functions in one Organ or part of the Body the Eye the Ear c. but feeling is not restrained to so narrow a compass but is seated in all parts of the Body even in the Organs of those other senses The great Prerogative of this sense above the rest having no limits but reaching through the whole Body and exercising its power among the other senses and an inseparable consort with the life were worth inquiring into the reasons thereof if time would give leave for that diversion What pain is scarce any one but can tell and some by woful Experience whereby they will consent with the definition thereof dolor est tristis sensatio in tactu pain is a trouble arising in the sense of feeling but that which is so plainly felt is not very easie to be understood from whence it does arise The Causes of pain are as various as the Objects of the sense of Feeling for whatever objects assault that sense violently or extremely as too hot cold hard sharp heavy c. are offensive to the Organ of Feeling and do raise pain Concerning the approximate cause of Pain there are several opinions I wave the more extravagant and improbable and shall recite those in which the most Philosophers and eminent Physicians do consent and pitch upon as most agreeable to reason One Party asserts That a sudden and violent mutation of the active qualities or the tactil qualities suddenly and violently acting upon the sense of feeling are the approximate cause of pain The other Party determines That solutio continui a solution or disjunction of continuity is the immediate cause of all pain The third Opinion joyns these two together and will have pain to arise from them both according to the definition of Plato Est itaque dolor tristis in sensu tactûs affectio à membri intemperie continuitatis divortio subitò facta And Hippoc. before him taught the same doctrine Quae naturam inquit mutant ac corrumpunt dolores excitant To which Galen does subscribe Now to comment a little upon these different Judgments I cannot but observe and do owne that there is something of probability and reason in these several sentiments but not a full satisfaction to the matter queried nor the whole truth rightly stated and for this reason I am the more nice and strict in this inquiry because from hence the nature of Anodynes or asswagers of pain are discovered and this is the ground-work upon which they are formed and rightly adapted I allow that unity is the perfection of Bodies and is necessary to perfect sanity disjunction or separation dissolves the harmony and leads or is the progress to destruction for whatever tends to disjoyn or make a separation of parts does threaten to ruine the whole And true it is that the active qualities or tactil objects do cause pain as they do make their impulsions violently upon the Organ of Feeling which when they do it moderately placidly and amicably they cause pleasure or no pain But whether the impetuous and vehement acts of those Agents raising pain do always cause a solution of continuity approximately and immediately is much to be doubted I yield that the vehemency of these tactil objects may procure a solution of continuity sometimes as we see from pain that Imposthumes Vlcers Gangrenes and Mortifications do follow but these are not inseparable and necessary consequents for they happen but sometimes pain may continue for a time cease again and no breach of continuity remain a◠an effect thereof To which our Adversaries have this evasion by way of Reply That pain is caused à continui solutione non à soluta unitate which as I conceive the meaning is as much as to say solution of continuity in fieri is sufficient though it be not in facto esse But to pass over this Sophistry as not worth the expence of time to lay it open and if we make appear that the whole matter or controversie is bottomed upon this error mistaking the cause for the effect and the effect for the cause Cujus contrarium then the pleadings of our Antagonists will be put to silence as absurd the doctrine laid aside and practice grounded upon better principles They affirm solution of continuity to be the approximate cause of pain the contrary whereof we will set forth and prove that pain is the cause of solution of continuity And here we must first distinguish between violent external Agents as sword staff bullet fire c. causing wounds contusions fractures combustions c. and internal causes gradually arising in the Body as products of a degenerate state In the first cases solution of continuity causeth pain as when the wound is given pain follows as an effect so likewise upon a sudden fracture or rupture in the latter pain precedes as the approximate cause solution of continuity comes after as the product or consequent For example some indigested or degenerate matter lodgeth or fixeth in this or that part of the Body Nature not able to subdue or transmit it away this like a thorn irritates and provokes the vital principle to a disquietness and disturbance which is pain this pain draws a confluence of humors to the part grieved and increaseth the first offending matter causing Inflammation and Tumors this apostemates and then breaks forth into an Vlcer Observe the Series first here is peccant matter as the occasional cause raising pain this pain attracts humors from other parts which being transplanted out of their proper place they degenerate corrupt and then produce an Imposthume and Vlcer Thus you see pain goes before solution of continuity follows after and therefore it is plain as in
will receive some ease and benefit by that which is good soon after it is received into the Stomach long before it can make a progress the common way out of the stomach And this consent likewise is between the Oesophagus the mouth of the Stomach and the Heart and thus it is between the Bladder and the Intestinum rectum the last Gut and from hence pains of the Bladder are mitigated and eased by Clysters through insensible passages and not by any manifest ducture or Vessel of communication From hence we may learn by such Examples that Sympathy and consent of parts is strictly to be marked else it is not possible to know where the root of a Disease is and from whence pain or other Symptoms do arise for one part may be pained and the disease lye in another and if this be not rightly distinguished there cannot be a true adaptation of Medicines nor due application made where it ought to be which renders all endeavors frustraneous But to descend from generals and to make our Discourse more profitable and satisfactory to the particular cases of the Reader inquiring after his own peculiar concern and present complaint we will take notice of some pains incident to particular and principal parts of the Body remarkable and frequently occurring examining their causes Pains of the Head THat the Head akes every one can tell that suffers under it but the causes and the parts affected distinctly are known only to the Physician and he by questioning and examining the Patient draws his conclusions by collating the several answers and makes Judgment thereupon All which depends upon a due observance of these four Particulars rightly to determine the case First Inquiry is to be made of the Patient concerning his course of life for some time before whether regular or irregular in labour exercise or ease if thereby any thing hath been done to procure or introduce the present complaint and of his former state of Health and Sickness Secondly Of his state and condition of Body as it now is Thirdly The place or seat of pain the compass and extent of it Fourthly The quality or condition of the pain vehement or moderate continual or intermitting acute or obtuse c. Having made disquisition by these Topicks and traced the Patient through these grand inquiries you will then understand something of the rise and progress of the pain sought after giving you then occasion to take a farther prospect and consideration of the various differences of pains in the Head wherein your present case will be found and exhibited to your view as followeth Head-aches are either more general and dilated affecting the whole or else one side of the Head or some particular part as Forehead Temples c. 2. Head-pains are either internal or external 3. Idiopathical or Sympathical 4. Recent and of late standing or inveterate and of long continuance Pain of the whole Head or major part does denote the cause to be more general and of large extent as in Feavers and plethoric persons wherein the whole body is distempered and from thence the whole Head or most part therewith affected Pain in particular places as of the right or left side fore-part or hind-part the top or the crown signifies the cause to be or act there only and does arise from some defect or trouble in the part it self by some peccant humor there bred or by transmission of morbific matter from or by consent with some other part diseased adjacent or remote As more particularly hereafter Now you must understand that although every person seems to be equally disposed alike and liable to these pains yet it is much otherwise for some are often complaining of Head-ach some rarely or never and this by reason of the different fabrication and formation of parts as well within as without the man and also by reason of the soundness and strength of parts that some have above another by which they endure long and free from pain or other infirmities Internal pain is seated within the Cranium or Skull and signifies the Brain it self or Membranes investing the Brain or some Vessel Vein Artery or Nerve to be affected if the Brain akes the pain is obtuse and heavy the Patient is much inclining to sleep or drowsiness so likewise when the Veins are molested the pain is remiss but if the Membranes or Nerves be the complaining parts the pain is more acute and punging and then it reacheth commonly to the roots of the Eyes because these Membranes do cover the Optick Nerves which lead to the Eyes and it may be known what Nerve is affected by the part consenting which that Nerve does supply and serve and thus sometimes the Ear or Tongue sometimes the Shoulders or Breast complains by that Nerve inserted into them for their use but if an Artery be the place then the pain is beating Pulse-like External pain is superficial and without the Skull shewing that the Pericranium or Membrane covering the Skull is the part grieved and sometimes the Cutis or outward skin only and then the pain is more remiss but both are known and aggravated by compressing the part or place and if the pain be in the fore-part of the Head and extend to the Eye-brow the Periosteum is affected Pains of the Head per essentiam or Idiopathical are when the cause of pain is seated in the part pained by reason of debility or dyscrasie and infirm state thereof from whence ill matter is congested and accumulated causing a disturbance or distemper and sometimes pains fixed from extraordinary productions there ingendred and bred as worms stones c. as hath been noted by Authors of repute and credit Hollerius Schenkius Kentman and others Pains of the Head sympathical are when the cause lyes remote and the part pained suffers by Sympathy transmission or consent from other members and not by any proper defect or disability of its own And thus the Head is very apt compati to suffer and condole with most parts of the Body by reason the Nerves are branched forth and dispersed in all parts of the Body from the Brain and spinal Marrow which being of exquisite sense does affect their original and fountain by this communication and intercourse with other parts and not only by the Nerves coming from the Head is this consent maintained but also by the Veins and Arteries going from other parts up to the Head conveying good or ill Hence it is that very frequently the Head is pained from distempers of the Stomach sometimes from the Spleen Womb Intestines c. Having given you the various differences of Head-pains as to the quality or condition of them and also pointed at the several parts affected per se per consensum I come now to set forth the causes or rise of these pains from whence they spring whether generated in the Head or communicated to it from other parts Causes of Head-achs or pains are external and internal External
pressure here raiseth a fainting pain the Cartilage yielding and giving way to any force But sometimes a pain is planted here not always by any external manifest cause but from internal and preternatural state of the parts and this pain is rarely taken notice of by Physicians and mentioned but by a few practical Authors Now to examine into the cause of pain you must know that this Cartilage is flexible and yielding in its natural condition being of a middle nature between a Bone and a Ligament and therefore may be curvated and bent inward upon a threefold account By Laxation Exsiccation and external depression 1. By Laxation as when too much moisture resides here mollifying and loosning the part from any small occasion the Cartilage may be inflexed and turned inward changing its due position and rectitude and from the like cause Ligaments are sometimes relaxed which renders Junctures ready and apt for dislocation and disjuncture and upon this score the Vertebrae of the Spine have been displaced also the Hip and Ancles 2. By Exsiccation this Cartilage may be distorted and wrested from its posture as sometimes that which was straight green and pliable by drying and shrinking becomes crooked bent and drawn aside So this Cartilage that was a Grisle tender and pliable sometimes becomes dry hard and bony and fixed upon distortion or writhing as not returning to its rectitude or straightness and distance from the subjacent parts over which and for whose guard it is placed 3. By external Depression as from a blow or fall any thing too much or too long pressing upon that part may pervert and alter the situation and due posture and those whose business or imploy keeps them bending or pressing forward too much and constant renders them liable to this inconvenience and therefore Students and Clerks that write much pressing upon this part are injured thereby and find it upon age though youth bears it off for a time Now since this Cartilage is thus exposed to depression and bending inward and thereby the tender parts subjacent to be pressed upon and molested the cause of pain and manner how is made evident and which most commonly is felt after eating and upon a full stomach when the parts are dilated and swelling up to this Cartilage And farther as all parts of the Body in several persons do vary and differ much in figure position magnitude and distance so thereby some are more liable and apt for this pain than others although subject to the same external procuring or internal antecedent causes And so I dismiss this particular pain and pressure and must take cognizance briefly of that which is more general upon the whole Breast The Thorax or Breast suffers by compression or constriction whereby a general obtuse pain of angustness is perceived and that chiefly upon inspiration and drawing in of the breath and why now more than at another time is because the inspired air fills and distends the Breast which makes opposition to or resists the compressing causes Now the cause of angustness or coarctation is from the Genus nervosum that gives motion to the Muscles and other parts of the Breast which Nerves sometimes are impedited and contracted that their functions are not freely executed and therefore to this Symptom of compression is commonly adjoyned shortness or difficulty of breathing upon the same score and sometimes spasms or convulsive motions And this complaint of straitness or contraction of the Breast does frequently happen to scorbutic persons whose nervous juyce being degenerate and tainted their Organ or Vessels perform not their office duly as they ought in giving the full motion and extension or every part for this nervous liquor being fed and supplied from the mass of blood which is scorbutic feculent and depauperated in spirit that also which is extracted thence must be answerable and of a degenerate nature so then this nervous juyce which should be vegete noble and spirituous for putting the motive faculties into action with vigor and briskness is become dispirited flat and depraved and the Organs acted thereby move heavily and irregularly so that upon inspiration or filling the Breast with Air the parts do not readily give way by expansion to let in hence the Patient feels himself girt or strait-laced It remains now in the last place that we finish this second division in examining and searching into the nature and causes of those pains that more peculiarly and eminently afflict the Heart The Heart being a noble or the noblest and principal part is as the Sun of the Microcosm whose irradiating lustre and beams of vital heat enlivens and refresheth all the regions and parts thereof the Eclipses storms and clouds then that happen as the consequents of its distempers and sufferings must needs be eminent and remarkable This supreme Organ that bears the government of vitality is so generally concerned in all diseases and discomposures of the Body that few there are but the Heart is made sensible thereby and gives notice thereof by variation of the Pulse as a sigrial from thence And not only distempers of the Body or the defect and decay of some particular member or faculty does affect the Heart but also the disorders and passions of the Mind have influence thereon that from thence the Heart akes beats or suffers pain and restless disturbance hence it is that grief anger fear desire c. Changeth the regular motion of the Heart and the Pulse alters as a token and manifest character of its sufferings Now the Heart is made thus sensible of the Bodies infirmities and preternatural mutations from the vital government that is planted here having commerce and communication with every member from the circulating afflux and reflux of the crimson vital stream continually transmitted through this Organ which thereby is affected well or ill as the blood is better or worse in the current and quality thereof And the Heart is also affected from the mind for as much as the Soul exerciseth her power more eminently here and if a particular part may bee assigned this may be said to be the seat or Throne of Regality The Heart being of a solid fibrous flesh the pain thereof is obtuse not so accurately perceptible so acute and sharp as those of the nervous parts notwithstanding the effects and consequents thereof are impressed upon the whole Body and each member is impaired in its vivacity and vigor and although this Heart pain by the nature and substance of the Organ is not so great commonly and perceptible as that of some other parts yet when this pain does arise to some degree a Syncope seizeth the Patient a deprivation or cessation of life for a time that what it wants as to sense is doubled in the consequents as threatning and endangering the life so that extremity of pain is not perceived here because sense decays as the cause of pain increaseth The Heart is molested and suffers pain these several ways by extension
thinness of blood the terminations or mouths of the Veins are opened and some effusion made which then being out of its proper place does degenerate and corrupt and affords matter for Inflammation Thus by Ruptures Punctures and Wounds extravasated blood is the material cause of Inflammations Fourthly but matter alone cannot produce an Inflammation nor any other disease being inactive and a dead thing of it self except some vital Agent works upon it forms and moves it who or what this Agent is we are to inquire farther Since then Inflammation is not procured by matter alone nor can it exist only by matter there must then be an internal efficient and movent Principle joyned with this matter that fabricates and generates of this matter an Inflammation But understand me rightly I do not mean that this matter takes fire and is kindled as if it were a sulphurous and combustible matter and so cause an Inflammation or scorching heat no such thing but this morbific hostile matter stirs up the vital heat by way of irritation provokes the vital principle to estuate and wax hot for from hence does all heat emanare stream and issue forth whether it be a temperate and natural warmth or a preternatural and inflaming heat both proceed from this fountain So that hereby you must distinguish between the occasional matter of Inflammations and the internal efficient that does excandescere inflammare This inflaming heat ariseth from a principle much different from the materia morbifica occasionalis this great heat does not rise out of the morbific matter inflamed but from the vital Principle incensed A Stone in the Kidneys by raising great pain may cause an Inflammation there and this stone is the occasional and material cause thereof but none can think that this contains fire in it or is capable to be inflamed or to communicate any heat to the containing parts save only what it hath received from the vital heat residing in the body And thus it is in all other cases of Inflammation in any part of the body from what cause soever This vital Principle is seated in every member of the body and does preside as Governor and not only for defence thereof but also to move and act in it so as no vital office or function can be performed without the assistance and power of this internal invisible Agent nor is there any heat but what ariseth from hence And this is that which Hippocrates calls the impetum faciens Helmont the Archaeus which I chuse rather to call the vital Principle When any thing happens out of order in the body a Vessel obstructed or some liquor extravasated or what else that may disturb and interrupt any member in its office soon the vital Principle is affected and concerned therein and if the matter be considerable and contumacious pain ariseth there and this pain is the suffering and anguish of the vital Regent strugling to resist the injury and labouring to remove the impediment hence the Inflammation and preternatural heat arising from this vital power Fifthly and in the last place from the doctrine preceding we are to make some observations that may be useful for guidance in Practice and to remark some pernicious errors that pass undiscerned And first here you must take notice of the affinity between Inflammations and Feavers that most Feavers do arise from Inflammations of some particular part and are the off-spring from thence or springing from that root For the quòd sit Practice does affirm it for rarely you shall meet with any considerable Feaver but some particular part is chiefly complained of and as the grief or pain does abate there the Feaver is remiss and slackens also Secondly you are to note that Feavers are erroneously defined à calore praeter naturam in corde accenso assigning the Heart to be the Focus where febrile heat is first kindled and from whence it is maintained when almost in any other part of the body if an inflammation happen there a Feaver will certainly follow taking its rise from thence not from the Heart so that the Heart then suffers sympathically by consent not idiopathically and originally And whereas I said almost any part intimating thereby that a slight Inflammation may be in the small and capillary Veins of short continuance which may not communicate a Feaver to the whole body and such inflammations we see externally planted sometimes the capillary Veins of the Cutis being affected calore rubore which either spontaneously vanish or soon yield to some outward application only Thirdly From the denominations of Feaver and Inflammation you may observe the parity or near relation they have to each other for from the Etymon of the words they seem to import much what the same thing denoting only an extraordinary heat 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ignis and in the Latine Febris à ferveo 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 inflammatio from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro Fourthly We shall not depend upon Etymologies which are allegorical and often strained but inquire into the nature and extent of each and know what is meant by the one and the other and then what difference between them Feavers are known and defined by preternatural heat and effervescency through the whole body Inflammation is a preternatural heat of a particular part Hence we remark that Feavers are general Inflammations or inflammations dilated Inflammations particular Feavers of a member thus differing in extent and latitude but withal observe the order of causation Inflammation precedes and lays the foundation in this or that part there is the fomes and miner a morbi a Feaver follows upon the whole body caused only by consent from thence and condolency Now if all or most Inflammations cause Feavers and Inflammations so frequent as being the certain consequents of great pain then two things are to be noted first that upon the appearance or discovery of a Feaver you may suspect an Inflammation couched under it from whence as the spring this Feaver does arise Secondly that the Cure of most Feavers ought to be designed and managed so as respecting and aiming chiefly at a particular Inflammation upon which the Feaver does depend sublatâ causâ and when a Feaver ariseth upon this account as for the most part it doth then little regard is to be had to the general Feaver but die stress of Cure lyes upon removing the occasional and material causes of Pain and Inflammation in the particular part the foundation of all the rest which being removed the depending Feaver falls of course Thus all our Discourse tends to make a true discovery of causes that when preternatural heat does arise in the body and beget a Feaver we may know not only what to call it but also what to do by levelling at the right mark But by the way I must tell you also how a Feaver sometimes does arise and not from Inflammation of a pained part and that is when some
chosen as not to displace or put by a curing Medicine for no Opiate or Anodyne is curative but palliative and for allaying the extremity of pain and to give rest only for pain keeping the sick from natural and wonted rest does bring great weakness and lassitude of spirits Since pain therefore and long watching enervates and debilitates Nature greatly on the contrary sleep refresheth and restores much that the enfeebled Patient then may gain respite from pain and refreshment by rest when the sick is in danger as being tyred out for want of ease and sleep then the case calls for Anodynes and ought to be made use of But because Opiates and Anodynes do not remove the morbific cause therefore they are not to be insisted upon or relyed on as curing means but they are to be used in cases of extremity for mitigation and ease and at such due times as not to hinder the operation of any curative Remedy Tumors Internal Scirrhous Apostemate and Cancerous TVmors may fitly be placed next to Inflammations because Inflammations are the foundation or occasion of many Tumors though Tumors sometimes arise not procured or cause by Inflammation preceding but most frequently Tumors grow up and take their rise from pain and where pain is Inflammation in our sense follows of course and there is much reason for it because pain and heat does arise from one and the same principle as already set forth and when this painful inflaming heat continues you may rationally expect a Tumor by fluxion to follow if not prevented by good means to pluck out the spina morbifica the thorn in the flesh or Nature so powerful and prevalent to free her felf Tumors have their denomination à tumeo to swell and the Greek word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fignifies protuberance or expansion so that by Tumor you may understand a part enlarged and increased in bigness preternaturally for natural extensions are not to he called Tumors as the dugs or belly of a woman with child though they be extended bigger than ordinary yet it is natural or by the course of Nature You are not to expect here a Chirurgical Treatise of Tumors as if tire Cures hereof were to be performed by manual operation but I shall shew you some differences of external Tumors that require such management only that you may the better apprehend and judge of internal for as external Tumors do arise from internal matter and present outwards so hidden internal Tumors are formed of the like matter and from such occasions much what as the external save only some outward injuries that may affect the superficial and hot the interior parts as Contusion Scalding Cupping Vesicatories c. Galen in his Book de Tumoribus reckoning up all sorts of Tumors as he supposed gives in the account to be sixty one but Ingrassias in his Survey of Tumors afterwards adds art hundred sixty five more to them and gives particular names but examining the reason hereof we find the advance of number not any way to promote their Cures but makes confusion and perplexity in Practice for this variety is not from any real difference in their nature but from some accidental difference between them in appearance as magnitude figure situation c. so that the same in kind is repeated by another name therefore this vast number will admit of a great abatement and the designment of their Cures much easier and better managed when all are reduced under a few general heads respecting their continent matter and many joyned together under one name by the union and similitude of their nature The difference therefore of Tumors arising from the variety their material causes and the modus generandi are chiefly to be lookt it for from thence is the designment of Cures more especially bottomed but with some respect to the seat or part affected The general division of Tumors from their material causes in the common received Practice is sixfold First from Blood which makes a Phlegmon Second from Choler which generates an Erysipelas Third from Phlegm which begets an Oedema Fourth from Melancholy which makes a Scirrbus Fifth from serous or watry humor which generates watry Tumors as Hydrocephalus Sixth from Flatulency and this Tumor is called Emphysema Inflatio Tumor flatulentus Under these six general Heads are comprised alfo several other subdivisions as first such as arise from the degenerate and depraved condition of these simple and single humors secondly such as spring from the composition and mixture of the simple humors one with another How far I can comply with this specious Doctrine whether it be not more notional than practical and my exceptions against it I shall not declare now in regard time and the intended conciseness of this Work will not give me leave to establish my own opinion and judgment dissenting in this matter nor is it necessary to lay open the intricacy of out design in hand by debating and controverting this Doctrine which relates chiefly to external Tumors and Chirurgical Practice And although internal Tumors are generated of the same matter as external yet all these differences supposed to be true cannot so nicely and certainly be adjudged and determined but indications from thence must be more general and at large for dislodging cleansing and carrying off any such material cause that infests and tumifies a member or part Since therefore internal Tumors do not present themselves to the eye for a more certain and exact knowledge we are to make judgment of them and determine from the fabrication and office of the part affected and complaining which gives some intimation thereof what Succus or depraved and preternatural matter may reside there as also from the general constitution and disposition of the body antecedently disposing thereto for that Cacochymy which is predominant in the body is most likely to be the cause or matter of the hidden Tumor except some other circumstances and probabilities do mainly suggest another morbous matter From the nature and condition of the part affected you may sometimes conclude the Tumor there to be of such a kind as when the left Hypochonder is preternaturally extended you may rationally judge flatulency and melancholy feculency to be the matter and cause thereof From the signals of a serous Cacochymy or abounding serosity in the body you may conclude if swelled legs or feet do happen hereupon the Tumor is hydropic For the modus generandi and the occasional causes of internal Tumors they may be reduced to these five 1. Attraction 2. Transmission 3. Congestion 4. Obstruction 5. Extravasation First By Attraction humors are brought to any part and there accumulated and thus pain increasing heat preternaturally like a Ventose or a Vesicatory does attract from the adjacent parts and procures a confluence of humors to the part pained and thereby forms a Tumor Now if pain be so apt to beget a conflux and consequently a Tumor then you ought to beware and often suspect
such a product for as much as pains are very frequent in most diseases as before proved Then also remember upon a cessation of pain there ought to be care taken by proper means for the recession and dissipation of confluxed matter and not imagine upon a presumption that when the pain is gone all is gone and the Patient secure Secondly Transmission procures a Tumor when the expulsive faculty of some parts is vigorous and strong to send off any excrementitious matter and deposite it upon a weaker which being not able to expel it lodgeth there and generates a Tumor Thus the principal and more noble parts have a natural robor and fortitude to send off their superfluous and noxious matter and transmit it to the inferior and ignoble Now there are some parts that are weak by Nature and some by Accident By Nature those are weak that are designed ministerial and subservient and therefore liable to transmited matter from their superiors thus the Glandules are all weak parts lax and spongious apt to receive and imbibe hence it is that the Heart transimts to the Glandules in the Arm-pits the Brain behind the Ears the Liver to the Groins and the Glandules of the Mesentery are very apt to tumifie and are the latent causes of some difficult abstruse diseases The Skin also is a weak part and general Emunctory for the whole body and therefore many Eruptions and Tumors are there visible By Accident some parts are weak as when by a disease inordinate living or casual injury some particular part though strong by nature and original formation may be vitiated debilitated and made feeble Thirdly By Congestion Tumors are sometimes bred as when a part or member does not transmute the alimentary supply into its own substance but suffers it to degenerate there and accumulate into a Tumor or else the expulsive faculty may be weak and not able to send off the excrementitious part which remaining there may produce the like or sometimes the fault may be in the nutritious supply not being capable of a good transmutation as in cacochymical and foul bodies Sometimes the relicts of an acute sickness not well cured by congestion in this of that part does afford matter to beget internal Tumors and therefore after the small Pox Agues Feavers c. purgation and cleansing ought well to be performed else chronic diseases commonly do succeed them from peccant matter lodged here or there and therefore upon such neglects or insufficient performance thereof we find commonly big and hard Bellies or swell'd Legs some part or other pained tumified or hard And these are the effects of imperfect Cures when the morbific matter is only abated and the storm laid but the remainder accumulates by collection and congestion to produce a dissease of another nature Fourthly By Obstruction Tumors or extensions are begotten for when the current is stopt in any Vessel and by the Law of Circulation the continent Succus or humor is still moving forwards to this place obstructed the Vessel or containing part must needs tumifie and swell as not able to receive and contain the additional flowing matter in its former dimensions And this is apparent to the eye in external parts which must needs prove the internal for a strait Ligature upon the Arm or Leg does cause the part below the binding to swell and for this reason because the Vessels are obstructed by compression that the blood cannot circulate and move on And the case is the like in effect when obstruction of a Vessel is made from coagulation incrassation or grossness or any concreted matter within the ducture or cavity to obstruct and stop the stream Now obstructions are generally acknowledged to be the frequent causes of many or most-most-diseases and few cases do present in Practice but obstruction bears a part and sometimes the solitary cause or else obstruction is very much wronged for nothing more frequent in Physicians mouths than obstructions and yet nothing more seldom mentioned than an internal Tumor from whence we may well conclude it is rarely thought on or not at all suspected But obstructions are so familiar and frequent in discourse that they are little accounted of at least not thought to be of any dangerous consequence not considering that this obstruction may and does often being contumacious beget a Tumor and this Tumor may cause a long and difficult or dangerous acute sickness if not mortal for the progress may go on still from Tumor to Apostem or suppuration and then plant an Vlcer there or this Tumor may become scirrhous and hard then perhaps cancerous gangrened and then you know what follows next mortification From hence it is very reasonable to judge of the series and course of many chronic or long lingering diseases as also or the acute mortal sicknesses most of which do make their progress by these stages have these commutations and transition at last their fatal termination because this latent train of diseases was not suspected But all this while the Feaver was the disease feared and vainly endeavoured against and the Patient is said to dye of a Feaver because a Feaver did attend the life did estuate and was disquieted in the whole course and every transition of the sickness even to death Fifthly By Extravasation a Tumor is sometimes generated as when the Vessels are replete and full causing tension by thinness heat and sharpness of blood or a preternatural and turgid fermentation distending the Vessels the mouths of the Veins are hereby opened sometimes and a stillicidium or effusion of the contained liquor procured which being lodged out of its proper place does corrupt inflame and produce a Tumor Now concerning the signs of an internal Tumor they are not only extension and increase of magnitude which is apparent when it makes a protuberance upon the superficies but also a fixed heaviness or hardness or pain upon pressure with the hand does give great suspicion and probable conjecture of a latent internal Tumor lying deep and obscure especially and by way of confirmation when the preceding causes apt to generate Tumors do concur to strengthen the probability But before we conclude this Discourse of Tumors something more is to be said and that touching a Scirrhus and Apostem which are comprehended under Tumors and do signifie only the distict and special condition thereof and here we have occasion to take notice of the different state of Tumors and their way of resolution fixation or translation Tumors do either wear away and spend by discussion and transpiration or they recede by a translation of matter into another part or they apostemate and come to suppuration or they indurate and become scirrhous or they tabefie and corrupt the part where they are seated Discussion of a Tumor is the best that can be expected and this ought chiefly to be aimed at in Practice the next to be hoped for and endeavoured is dislodging of it and removal from a noble to an
part affected is debilitated and overcome by this depraved malign matter that it cannot exercise its transmutative and digestive power nor will this cancerous matter obey Discussives by reason of the viscidity and grossness thereof wherefore Hippocrates gave sentence That such are not cured but by section or ustion and yet this is not to be done except the Cancer be small and in such a part as will admit of amputation If Cancers external are thus difficult to be managed although they appear to the eye and are subject to manual operation and tractation the internal must be greater and more hazardous where they cannot be applied unto after this manner with convenient Topical Medicines therefore prevention in time is mainly to be endeavoured when a Tumor is generated lest it change into this dangerous condition for I find by the design of Practisers in the Remedies appointed that palliation is sought for the Cure not hoped for The grand intention to be prosecuted for Cure is to change the condition of the blood which does feed and supply this Cancer so that the antecedent cause being taken away the continent will then more likely abate and until that be done this cannot be expected The means indicated for Cure of these cancerous Tumors are branched into three parts Dieatetic Pharmaceutic and Chirurgical but I shall not enlarge upon the Indications for Cure for that these cases are so nice and difficult as not to be handled with generals but from a collation of all the circumstances attending the Patient which varies every particular case And so I pass from Tumors to remark their usual commutation and transition into Vlcers the next considerable in order to be treated of Ulcers internal THE Latine word Vlcus is derived of 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying a disjunction of parts or solution of continuity but to distinguish this from other solutions of continuity an Ulcer does yield a Sanies or purulent matter so that a Wound coming to digestion and affording pus may then be called an Vlcer and any part that is gauled raw and tender the covering Membrane being fretted and eaten away by some sharp humor or other cause it stiled Excoriation only until it produce corrupt matter and then it is properly called an Vlcer thus internal parts are sometimes excoriated raw and painful but cicatrized or skinned again before it arrive to the degree of an Vlcer And thus it is most frequently in the urinary ductures or passages and sometimes in the Guts but such Excoriations are not to be slighted or neglected lest they beget Vlceration as sometimes it falls out so By external or outward Vlcers which are manifest to the eye you may conceive of internal Vlcers for they arise from the same causes and have the same accidents but I shall not inlarge upon all the accidental differences that attend upon and distinguish external Ulcers as not so pertinent and necessary to our subject in hand The essential and most considerable difference of Vlcers does arise from their causes and from the part affected which bears the great sway in curing and from whence the chief indications are taken for although in external Vlcers other accidental differences may be observed and noted yet in internal Vlcers such differences cannot be regarded as being obscured or hid so that whether they be broad or narrow deep or shallow fistulous or otherwise is hot positively to be said and if it were known institution or method of Cure could not be so varied as external are capable of by reason these are subject to manual tractation The continent causes of Vlers are such matter as emane and flow from thence and that is of three sorts Ichor Pus and Sordes The first is an ichorous or sanious matter being thin indigested and watry or diluted bloody The second is a Pus or purulent matter of a betted consistence and concocted thicker The third is a sordid foul matter more thick and glutinous The ichorous thin matter usually issues in the beginning of Vlcers and denotes indigestion and also at any time afterwards does declare the same that the Vlcer is not in a good healing condition The Pus or purulent matter signifies the Vlcer to be in a better state of healing and if it be white and sweet these are good signs The sordid gross matter does intimate a preternatural heat of the parts strongly exsiccating but not healing for as much as this matter is foul and stinking Vlcers for their manner of generation and rise may be caused these four ways by Erosion by Frication Apostemation and Contagion 1. By Erosion Ulcers are begotten in any part of the body when a sharp corrosive humor does excoriate and eat into the substance of any part and being thus injured is thereby perverted in its office and self-preservation converting that nutritious Succus which comes for its supply into an ulcerous degenerate matter no way useful but to be excreted and voided And thus a Phthisis an Vlcer of the Lungs is sometimes generated from a sharp Serum invading that tender part and thus a Dysentery is sometimes begotten being an ulceration of the Guts from sharp excoriating humors and thus an ulceration in the Meatus Penis is bred from a sharp eroding Gonorrhaea and an Ulcer in the neck of the Bladder may be planted there by a sharp gauling Urine 2. By Frication or attrition as when any hard bony or stony substance does fret raze and excoriate a part and thus a stone begets an Vlcer in the Kidneys or Bladder and sometimes in other parts of the body 3. By Apostemation as when any Apostem breaketh and dischargeth its matter an Vlcer is left behind though the Apostem be gone and thus are Vlcers generated sometimes in the Ear from a preceding Apostem in the aspera Arteria after an Angina or Squinance in the Breast after a Pleurisie in the Lungs from a Tumor suppurated there also in the Liver Spleen Womb or other parts apostemated 4. By Contagion or infection and thus women whole Privities are infected do communicate this virulency or venom and seize the Genitals of their Partner from whence venereal Vlcers do arise and thus men whole Seed is tainted do infect sound women and cause virulent Vlcers in their Privities which malignity not being well managed and mastered by skill and efficacious Medicines it spreads breaks forth and begets Vlcers in many other parts of the body as at large I have set forth in another Tract entituled The Mystery of the Venereal Lues Internal Vlcers though they disappear yet are known to be by these signs First Pain which is more or less according to the nature and sensibility of the part Secondly From preceding causes as Inflammation or Tumor preceding whose Symptoms being allayed and ceased yet pain remains Thirdly and manifestly From excretion of ulcerous matter where there is any ducture or outlet for discharge by the Intestines by the Privities the Nose Ears or Mouth but where there
is no passage or vent it corrupts the containing part and is mortal except a passage can be made by section Vlcers from their causes their aptness and inaptness for healing some are benign mild and tractable others are malign very difficult or incurable The benign and mild are such as arise in sanguine sound bodies and the younger people having no ill Symptoms or adjuncts of impediment the matter of such Vlcers is a laudable Pus or otherwise apt for digestion more yielding and readily commanded by Medicines Malign Ulcers and contumacious difficult or intractable are such as are sordid fetid ichorous unctious dolorous corroding and depascent of long continuance virulent cancerous fistulous cavernous the products or effect of malignant diseases as venereal Lues Leprosie Pestilence c. in cachectic habits of body hydropic hectic aged consumptive and decayed persons in principal and difficult parts of the body as the Brain Lungs Liver Spleen c. the Spondyls of the Back and great Junctures Since Vlcers are thus various in their nature from the several conditions of bodies and diseases that they arise from or depend on and the difference of parts wherein they are seated a general Method of healing and course of Medicines cannot be instituted and appointed but every case hath its peculiar complication of circumstances as directory indications to be remarked from whence a designment method and adaptation of Medicines is formed suitable to the particularity and different case of every individual Patient and therefore I have not proceeded to the Rules and Medicines for Curation Only thus much I shall note to you as a grand observable in the Cure of these Vlcers That such as arise from some remarkable disease as Dropsie Scorbute Venereal Lues or other malign and Cacochymical habits of body that these Vlcers are not to be cured until the disease and evil state of the body on which they do depend be reduced to a good condition or mediocrity of constitution for the antecedent cause which first produced the Vlcer must be removed before the Vlcer is capable of healing because of the continual supply of peccant matter brought to the ulcerated part and therefore application is first to be made there else all endeavours will be frustrate And further the designment of these Cures are not to be paralleled with nor levelled by the methods and intentions that the common Rules in Chirurgery have laid down for as much as many of them are erroneously grounded and deserve great correction and amendment which hereafter will be pointed out and discussed for we have not room here nor time now to ingage in that Cantroversie and must refer it to the next opportunity Gangrenes and Mortification THE last and worst transition of this dangerous train of Diseases and the ne plus ultrà in vitality is a Gangrene being a borderer upon or next adjoyning unto Mortification or the beginning thereof And although Gangrenes are thus ranked next to Vlcers and it falls out so sometimes in the preternatural course of Nature if I may so speak yet it is not always so but a part may and does gangrene sometimes before it be ulcerated for Inflammations and Tumors do gangrene as oft as Ulcers but Gangrenes are placed in this order after Vlcers as being the worst and last morbous state that can come and beyond this there is no disease for although Mortification be set down after Gangrene yet this is no disease vita extincta non est morbus for diseases are seated in the life corpus vivens est domicilium morborum and where no life is there is no disease but Mortification is posited here as the center to which diseases move and as bounds to stop all farther disquisition A Gangrene is a corruption and change of a part or member into such a degree or state as beginning to mortifie or is mortifying But Sphacelus with the Greeks Syderatio in the Latine which we call Mortification in English is when a part is perfectly mortified and dead and therefore a Gangrene is capable of Cure but a Sphacelus not because the part is dead A privatione ad habitum non datur regressus The external and primitive causes of Gangrenes are Contusion Vulneration Congelation Combustion Constriction Poyson Contusion sometimes introduceth a Gangrene by coagulating and fixing the blood so firmly in the part contused that thereby the life is supprest and overcome for communication and intercourse with other parts of the body which is requisite being thus denied the life extinguisheth besides the coagulated bruised blood remaining long undiscussed does putrifie and gangrene Vulneration or section sometimes procures a Gangrene when the vital Principle is so debilitated or enormous by the wound that instead of a good suppuration and vigorous transmutation a depraved matter is generated which corrupts and gangrenes the part and thus a small cut of a finger or Toe hath gangrened and killed the person but in greater Wounds the danger is greater as more frequently to happen Congelation by extremity of cold hindring Transpiration and condensing the blood rendring it stagnant in the Vessels suffocates the life and gangrenes the member thus in extreme cold Countries people by casualties exposed have their Limbs mortified sometimes and thus a Gangrene is brought upon an Inflammation or Erysipelas sometimes by incautelous and pernicious application of great refrigerating or cooling Medicines thereby incrassating the blood and prohibiting transpiration And this is very hazardous though advised and practised frequently by some Chirurgeons in these cases using cold astringent emplastic Cataplasms ex farin hord bolo armen album ovor aceto c when an Inflammation appears Combustion sometimes begets a Gangrene and destroys the life of the part when by neglect thereupon or improper means used relief is not duly afforded and thus by Cauteries and Caustics sometimes a member becomes mortified Now Vstion or great hurt by burning causeth Gangrenes by corrugating shrinking and searing up the Vessels that they cannot bring supply of vital Spirits and nutriment to the part Constriction or compression procures a Gangrene by intercepting of vital communication so that the member thereby is as it were separated and cut off from the body and fountain of life for the parts are maintained by influxed rays and streams of vital heat and moisture to the remotest parts of the body but being deprived thereof they dye thus a Ligature drawn strait about the Arm or Leg and continuing too long may gangrene and mortifie the part by excommunicating it from commerce with and participation of the general life And thus sometimes internal scirrhous Tumors do compress the Vessels and obstruct them of this Fabricius Hildanus gives an example of one that a Gangrene seized both his legs of which he dyed the cause was latent until by dissection he found a scirrhous Tumor about the Vena cava descending between the Reins where this great Vein divides into two parts to supply both legs Poysons some of
THE Frequent but unsuspected PROGRESS OF Pains Inflammations Tumors Apostems Ulcers Cancers Gangrenes and Mortifications internal THEREIN Shewing the secret Causes and Course of many lingering and acute mortal Diseases rarely discerned Initia Morborum quamvìs levia serpunt WITH A TRACT OF Fontanels or Issues and Setons By Everard Maynwaringe M. D. LONDON Printed by J. M. for Henry Bonwicke at the Red Lion in St. Pauls Church-yard 1679. EMMANUEL Collegium Emmanuelis Cantabrigiae LICENSED Roger L'Estrange Septemb. 16. 1678. THE DESIGNMENT AND NECESSARY USE OF THIS WORK FEW there are that think themselves concerned in this train of dangerous diseases because they judge themselves clear at present and do suppose these rarely to happen for that they seldom hear of any to dye upon these accounts and therefore do not imagine that such ill Fate should befal them but Feavers Scurvy Dropsies Consumption or such like common diseases they expect to be their lot but when you come to understand as by the discovery following you will plainly perceive that few sicknesses or infirmities you can fall into if they be not radicated in or grounded upon some of these latent or lurking destroyers yet there is a tendency towards them for a complication therewith and their terminations therein as the last Scene especially if the disease or sickness be contumacious and of long continuance or acute dangerous and mortal so that upon a true information you will find such probability to be ingaged here when any infirm or sickly state shall alter your present healthful condition of body And for such as have already some warnings by pain and a valetudinary state may seasonably inquire and consult some sagacious and solid Judgment from whence it does arise whither it tends what progress probably it will make if not prevented a resolve upon the question very likely will fix here if the case be throughly examined and duly searcht into Considering that pain most frequently either ariseth from some of these already begun to act their parts or that some of them will most likely follow thereupon although veiled under the covering of a more known and familiar Disease as fully declared in the subsequent Discourse for whether the manifest Disease afflicting be the Scurvy Consumption Dropsie Ague Spleen Pox or other chronic Disease very often it falls out though seldom taken notice of that some of this train is complicated and joyned therewith if good Medicines or great Providence stop not the progress And if the sickness be acute malign pestilential or other as small Pox spotted Feavers Plague or any general Phlogosis and febrile scorching distemper they come on commonly by Inflammation in some particular part and proceed on to tumifie apostemate and gangrene when such a disease is not checkt but grows desperate and becomes fatal to the sick and thus Pleurisies Angina's Peripneumonia's Inflammations of the Brain Ventricle Liver Spleen Mesentery c. they go on in this road by these stages and transitions from Inflammation to Tumor and so forward finishing the course with a Gangrene and Mortification if good means take not good effect to prevent and stop the progress Observing therefore in constant Practice the frequency latency and danger of this association and confederate train disguised and couched under some more appearing and known disease I thought it a Work necessary and grateful to unmask and lay open such secret destroyers that in the designments and methods of Cure they may strictly be sought after and aimed at thereby preventing the danger threatned and securing the Patient Novemb. 15th 1678. Wine-Office Court in Fleet-street The principal Occurrences and chief Heads treated of PAins Inflammations c. their order connexion commutation and transition The frequency and latency of this train in most Sicknesses or Diseases The disguised Progress thereof The danger and frequent Mortality from not discerning them Feavers mistaken and the common courses for Cure erroneous Pains in general their different nature causes and tendency to farther mischief Pains of the Head the causes and various parts affected Pains in the Breast and the several causes thereof Pains of the Dugs of the intercostal Muscles of the Pleura or Pleurisies pains of the Lungs of the Heart Mediastinum Diaphragma and Cartilago mucronata Pains in the Abdomen or Belly and various causes thereof Pains of the Stomach of the Guts Colic-pains Dysenteric and Haemorrhoidal pains of the Spleen an eminent Cure and how performed pains of the Liver pains of the Reins and Bladder Gout-pains and Rheumatism their causes and indications of Cure Inflammations internal what they are how they arise what parts they possess the material and efficient causes thereof directions for Cure Tumors internal the occasional causes thereof the modus generandi how to know them their way of resolution fixation and translation their different state and condition scirrhous apostemate and cancerous cautions in Cure Vlcers internal the essential differences their manner of generation the continent causes the manifesting signs Gangrenes and Mortification what they are the difference between them the external and primitive causes of Gangrenes the internal and conjunct causes the Characters declaring a Gangrene their state of curability and incurability many thousands dye gangrened not taken notice of instructions before curing amputation when and where to be made The Result of the whole matter Fontanels and Setons what they are how made where to be placed for whom beneficial the due ordering them in several conditions the time when to heal them safely THE ORDER AND DEPENDENCE OF Pains Inflammations Tumors c. internal cautioning their proceeding and complication THE natural oeconomy and government of humane Bodies may well be compared to a body Politick subjected to State-discipline Order and Conformity the former hath a regular course instituted and implanted by Nature the latter hath Laws imposed and injoyned by humane Authority to be observed In both these Governments so long as Order and Laws are obeyed and kept the whole is preserved sound safe and in quietness but when the subjected parts of either do mutiny rebel and shake off the Government refusing to act in their stations and subserviency the whole then is put into disorder the union of Community is broken and the publick safety endangered thereby If a part of the body decline its office and performance of duty acts perversly and inordinately the mischief stops not there but other parts also are perverted thereby and drawn into consent likewise if one Member of State be sick of tranquillity and peace be disturbed at the Government and begins to be dissenting disobedient or mutinous ten to one but this infection begets another of the same mind and faction and the second makes a third and thus the malignity spreads When any part of the body begins to fail and be out of order it seldom stops at its first degree of declension but makes a progress from bad to worse if not remedied and prevented So a Member of State
this so in all other cases where separation of unity does happen from an internal cause arising in the body that it is the consequent of pain and not as those learned men would have it the approximate cause of pain To illustrate this truth a little farther and that you may the better understand and have a clearer satisfaction herein practice depending upon it I mean the allay or remove of pains consider and know that the sense of Feeling being spread through the whole body is as the last or inmost covering that does inwrap or infold the life and is as it were the watch or guard upon the confines thereof Now any thing that does stir up Feeling that thus nearly and intimately approaches the life if it exceed the bounds of moderation and is violent if it be any way unnatural or injurious it raiseth a disturbance in the vital principle of that part which is pain so that the assault is first made upon the life which governs and preserves unity and continuity of parts but that vital principle being fretted distracted and put by its placid regular oeconomy and government the Organ perisheth as the life of the part decays or is out of course being then unable to protect and preserve it From hence I am perswaded to believe and must assert That the approximate cause of pain is every thing that does intimately and approximately affect and disgust the vital principle in every part pained which pain is the estuation anguish and fury of the life or vital principle which does dolere being exasperated and provoked by those causes and if solution of continuity does happen upon this disturbance it is wrought and caused by the exorbitance and enormity of the vital principle deserting or being put by the charge and due management of the part Moreover pain sometimes continues long by intervals and remissions to molest a part and no separation of unity to be caused thereby although it is an interruption and breach of Harmony so that this ira sive dolor this pain of the vital principle does not always arise to the height of producing discontinuity and is so far from being the approximate cause of all pain that many times it never happens either before or after pain to be a cause or an effect Now what this vital principle is residing in and governing every part in their several functions of vitality whether it be Anima or Archaeus according to Helmonts doctrine or spiritus impetum faciens according to Hippocrates I shall not enter into the controversie because it will require a large discourse or rather a peculiar Tract to determine this Problem and clear up the truth of our novel opinion disintangling it from the objections and prejudice of ancient received doctrine which will disjoyn and delay our matter chiefly intended therefore I forbear the digression and proceed Pains are various or do affect the sense in a different manner and this either from the nature of the part grieved or from the variety of causes or both Now the nature and condition of parts are different and various these ten several ways or may be reduced to these heads Ducture Figure Situation Composition Beginning Progress Substance Temperature Number and Office And as parts are varied by these differences so pains thereby are made various and not only pains but also all other Symptoms and diseases have a specification from hence Pain sometimes is obtuse or heavy as if a weight were pressing upon the part pained as when the Parenchyma of the Liver spleen Lungs or Kidneys is grieved and this by reason they hang or depend on Ligaments and Membranes Pain sometimes is acute sharp and punging as if the part were perforated or pricked with a Needle as in a Pleurisie and this is caused from a thin acrid or acrimonious humor penetrating the Pleura for nothing but what is subtile and acute can procure this or the like punctures and invade the dense substance of a Membrane Pain sometimes is with pulsation that is a beating pain like to the motion of the Pulse and this pain happens commonly upon an Inflammation and also where an Artery is seated in the part for where there is no Artery there is no pulsation it being the office of this Vessel only to make a pulse From hence Galen 2. de loc affect 3. took notice that upon an Inflammation of the Lungs or the Pleura there was no pulsation or beating pain because there were no Arteries in the parts Pain sometimes is mordacious or biting from sharp humors vellicating the sensible parts Pain sometimes is frangitive as if grinding or bruising and this is proper only to the bones or rather the Periosteum that covers the bone by which Membrane the bone is made sensible and the pain lyes deep Pain sometimes is tensive or stretching and this happens from a repletion or fulness of some humor wind or vapor filling and extending the part if this stretching pain be cum gravitate pondere with heaviness or weight then you may conclude it is humoral or something of more solid substance but if the extensive pain be without weight then it signifies wind or vapor as very often such are Colic pains from a collection of wind between the tunicles of the guts Pain sometimes is convulsive and this is proper to the Nerves and Tendons because the nervous filaments are so united that they cannot be torn but are contracted to their original Pain sometimes is lacerating or tearing and this is proper to the flesh because the flesh hath Fibres and small Nerves not so united as the Membranes and therefore à causa solvente continuum are easily lacerated And thus much for the various kinds or different sort of pain next the situation or extension and the duration is to be regarded Pain is either universal affecting the whole body from some general cause as in Feavers Agues c. Or else pain is seated in some particular region or part of the body as the Head Breast Stomach Belly c. Pain sometimes is more outward ot external upon the superficies of the body whose seat is more easily discovered and known laying hand upon the place by the Patients direction Sometimes pain is internal and deep with difficulty to be certainly determined which part is grieved and requires good anatomical judgment to assign the part or member From hence pains some may be said to be manifest others abstruse as also from their causes evident and latent Pains some are constant as to place or fixed others erratic or shifting from one place to another Pains some are constant as to time or continual others intermitting and by intervals having cessation for a time and returning again In all pains there ought to be considered these four things the Greatness the Kind the Property the Place Greatness and vehemency of pain does arise from the greatness of the offending cause and the sensibility called tenderness of the part All pain
Causes may be such as these as when the Head is exposed to heat or cold a strong scent sweet or stinking Fumes or smoke a blow or fall c. occasioning disturbance of the Spirits Obstructions in the Pores and Vessels Inflammations Tumors or Imposthumes Internal Causes are sometimes plenitude or fulness of blood which then upon small occasions is ready to estuate and ferment causing extension of the Vessels and Membranes or else depravation and foulness of the blood which may offend the Brain or other parts of the Head by its noxious properties Now the degeneration of the blood from its due and laudable state to an evil and bad condition is various and does manifest it self by divers Symptoms in several parts of the Body and also when it is let out of the body by colour sapor consistence heat c. Either the blood is impoverished and deficient in vital Spirits and heat slow in motion feculent gross or grumous and thereby apt to be stagnant or obstruct or else too hot and fiery causing inquietude of the Spirits and irregular motions of that vital stream disturbing the Head with pain and watchfulness Secondly The blood degenerates sometimes from its Balsamic qualities into an acrid sharp or acrimonious condition and then most commonly there is an abounding serosity or a superfluous latex or water which state of the blood as very remarkable causing many diseases I shall set forth in another Work Deo volente to be made publick Thirdly The blood may be contaminated with a contagious malignant or virulent Miasm and taint as in the Plague small Pox highly graduate Scorbute Venereal Lues as more fully appears in my Tracts of the Scurvy and that of the Venereal Lues In all which cases the Head frequently is offended and suffers pain And here also we must account amongst the internal causes Impotency and weakness of some Organical parts of the Head not performing their office Obstructions of some ducture or porosity by constriction compression or coagulation Congested matter infesting any part of the Head raiseth pain Wind or flatulent Spirits roving here and there may produce the like Watching unseasonably which tires the Spirits causeth disturbance in the Head Immoderate study or cogitation weakens the Brain and renders it liable to pain Violent motion agitating the Spirits furiously and driving the humoral currents out of their natural placid course discomposeth the Head and may cause pain Immoderate Venus or long forbearance the first by too great exhaustion and draining the Nerves the latter by plenitude over-charging the Genital Vessels reverberating back or by consent affects the Head And now briefly I shall shew here what parts chiefly and frequently the Head consents with from whence internal causes of pain are communicated and as these parts are well or ill by intervals so the Head is better or worse thereby The Stomach in the first place as being the general and grand office of preparation to supply the whole body with nutriment so is it the part that most frequently afflicts the Head by communication through Vessels of intercourse conveying to each other The Head complains from the Stomach either before meat when supposed to be empty or after meat when replete and filled If the Head complains before eating it argues the Stomach to have some remainders or relicts from former digestions not wrought off that does disturb the Stomach and from thence the Head if after meat the Head akes it does declare the Stomachs indisposition to digest and imbecillity to overcome what is received and labouring under the burden the Head suffers also Now to know that the Stomach is not in good order or ability for the true performance of its office in digestion is manifest by these signs Vomiting or nauseating pain oppression or heaviness eructation or belching want of appetite or thirstiness But here by way of caution in this consent between the Stomach and the Head you must rightly distinguish lest it happen as sometimes it doth that the Stomach suffers from the Head and not the Head from the Stomach and since the consent is reciprocal and mutual you must nicely observe which is the part primarily affected and which the part by consent else endeavors of relief will be frustrate if you begin not with the part primariò diseased to free and set that right for then the other spontaneously and of course will be reduced The Spleen being ill-affected draws the Head into consent sometimes and participates of its evil and this is to be known by examining the Spleen whether any Symptom of disorder or distemper is manifest there or from thence Now the signs of a diseased Spleen are these pain hardness tumor or extension flatulent motions in the left Hypochonder or side under the short Ribs And most commonly the Head is affected or pained on the same side or else the forepart If the Liver occasions the disturbance or pain in the Head for the most part the pain is seatted on the right side and then some Symptoms of a distempered Liver will appear as heaviness or fulness in the right side hardness pain or heat affecting also the Stomach and causing thirst also driness or heat in the palms of the hands and soles of the feet and as these signs have their intention or remission so the Head is better or worse If the Womb be in fault and cause pain of the Head as frequently it doth by the great communication and consent between these parts then either there is a suppression of the menstrual purgation or irregular and out of due course not keeping the due times or insufficient in quantity or abounding or too long retension of semen or too great a profusion and wasting Some of these causes are sufficient not only to disturb the Head but also divers other parts of the body and these pains of the Head arising by consent from the Womb do most commonly affect the top or hind-part of the Head If from the Intestines pains of the Head do proceed then either worms are bred there or the Guts are troubled with sharp or corrupt humors or else there is costiveness and siccity of the Bowels whereby the Excrements are baked and hardned causing too long retention and from hence by Vessels of communication the Head complains also If from the Kidneys the Head is grieved then inquire into the condition of the Kidneys and you will find some signals of a Disease there either stone or gravel or a sharp Serum an Inflammation or preternatural heat an Vlcer or Excoriation Now as concerning the Cure of Head-achs and likewise of all pains that arise by consent from other parts take this general Rule That in the first place application be made to the part primarily affected to reduce that into a state of integrity then consider the part that suffered by communication and participation if by continuance or length of time any impressions remain there or debility that may require help although
to discharge and abate blood by the Nose by the Haemorrhoids or Menstrual purgations sometimes by plentiful feeding and too much ease so that evacuation and transpiration is not proportionable in abatement and to balance the imported food Conjunct causes are such as more immediately and nearly concur or conspire actually in forming of these pleuritic pains and they are either acidity or viscidity within the Vessels of the Pleura or a violent fluxion from the larger Vessels too great for the capacity and reception of these exiguous canals 2. Acidity or an acrid serosity does sometimes fabricate and finish this disease by punging and lancinating the Pleura for omne acidum extra stomachum corpori est hostile says Helmont thereby irritating and exciting the vital spirit to estuate and be incensed and from this focus a febrile heat is kindled and communicated to the whole Body and that oftentimes and for the most part it is a sharp serous humor predominant in the blood which caused this disturbance in the Pleura is confirmed by the manner of solution or termination of the disease which most frequently is by a sudorific evacuation or insensible transpiration and therefore Hippoc. in his Predictions says Sudores urinas in Pleuritide probè fieri bonum esse salutare Friendly Sweats and effusion of Urine presageth a good event 2. Viscidity or grumosity of the blood does sometimes cause pleuritic pains for by obstructing those small ductures of the Pleura and stopping the Circulation a Tumor thereby is raised within this double Membrane for the Veins Arteries and Nerves lye between these two Coats of the Pleura And that the blood is thus apt to be stagnant especially in the smaller Vessels by coagulation grossness or congelation is confirmed by Phlebotomy for being let out of the body it is sometimes found destitute of its Serum or Latex that keeps it fluxile thin and transient and also is manifest so to be when it is in the Vessels as in Gangrenes where the blood is fixed and the part almost mortified and when Pleurisies do happen upon this cause of concretion they commonly tend to suppuration as not capable of being discussed or put into motion for a discharge of the part Now the Blood becomes thus incrassated gross and viscous from every cause that does too much exhaust and expend the serosity thereof as too great transpiration or sweating or immoderate making of urine and sometimes from a malignant or a venemous Miasm that curdles or congelates the blood 3. Fluxion or ebullient and preternatural Fermentation causeth pleuritic pains and thus it happens when a Pleurisie is the consequent or appendent to a Feaver preceding for sometimes a Pleurisie does precede and is the cause of a Feaver as when the dart is felt to strike the Pleura before any febrile distemper appears sometimes a Pleurisie does supervene and follow a Feaver as an effect from that general ebullition the hot spumous blood rushing into the Pleura Having established these causes in their due Series presenting them in the method and order of their causation and action we shall not trouble our selves with Choler Flegm and Melancholy the supposed materials of every disease nor shall I controvert the insufficiency of that doctrine here For Indications of Cure prompting what is to be done which way and with what they are various as the case presents 1. Plethory indicates Phlebotomy and requires a depletion or abatement of the redundance of blood that there may be room for the peccant matter to retire and for a revulsion and derivation thereof as also to avert the current and flux tending towards the pained part 2. Purgation by sedate and amicable Cathartics if you can procure such else by Clysters the best substitutes in that defect is necessary to absterse and cleanse the whole Body thereby subducting fuel from the fire and for rendring the Patient not so liable to effervescency and turgid estuation and for a retraction from the part affected 3. Topical Discussives are available and contribute to the remove of the morbific cause both as defensatives giving robor to the grieved part for resistance of the humors flowing in and also for a transmission and discharge of the conjunct matter residing 4. Diaphoretics to rarifie dissipate and set open the Pores for a free transpiration and exsudation are not only safe but exceeding necessary thereby to avert the antecedent cause resorting to the pained place and to disperse and scatter the morbific conjunct cause from the part affected if possible to prevent suppuration which is very dangerous and commonly mortal 5. Anacathartics or proper and truly expectorating Medicines are auxiliary and profitable in promoting expectoration by digesting the peccant matter and rendring it more apt and easie to be brought up and of these some are attenuating others incrassating to be used pro re nata suitable to the offending cause which if it yields soon and freely and Nature throws it up by cough and spitting it portends good promising shortness of the disease and a prosperous event which Hippoc. 1. Aphor. 12. confirms 6. Anodynes elected by a discerning Judgment and cautiously used may be of good advantage in some cases and at some times else may prove very pernicious Having dispatched these pleuritic pains we are next to take notice what other pains are incident to the Thorax or Breast And here we find pain to arise from Inflammations of the Lungs of the Mediastinum and of the Diaphragma whereof an account will be given in their proper places hereafter when we treat of Inflammations But the Lungs do suffer pain also from other causes as from Tumors not inflamed sometimes from adhesion or sticking of the Lungs to the sides of the Breast sometimes from stones and worms that have bred there observed and found upon Dissections and sometimes by Erosions and Vlcers of which in their due place following Back-pains of the Thorax are either upon the Spine between the shoulders or upon the Scapulae the shoulder blades And these pains do arise from some impressions of cold lately taken or from defluxion of a serous humor from the Head or sometimes from a maligne Miasm Venereal or Scorbutic that infests those parts Pain sometimes is seated at the bottom of the Sternum between the short Ribs under the Cartilage mucronata vulgarly called the Pit of the Stomach but improperly This Cartilage hangs down being as it were a defensative to the subjacent parts namely the Stomach and Liver yet is flexible to give way to the extensions of the stomach without compression This place is very tender at all times insomuch that a blow here is ready to make a strong man faint the part being thus sensible pain therefore here must be very troublesom Now this place is of acute sense or feeling in regard the upper Orifice of the Stomach being very nervous and almost subjacent to this Cartilage and the Heart adjacent hence it is that a blow or
constriction obstruction inflammation or intemperate heat Imposthumation by erosion by exotic generation 1. The Heart is pained by extension from a sudden ebullition and turgid fermentation of the blood raised by passion or otherwise whereby the Vessels are suddenly forced upon distension to receive and transmit the inundation and swelling current of the blood and from hence pain and trouble ariseth at the Heart 2. By constriction the Heart is pained and that from external and internal cause externally from the Pericardium compressing whereby the Heart is denied the full liberty of its Diastole or expansion and this may arise upon a double account either from the Pericardium being too replete and full or too much exhausted and empty You must understand therefore that this Pericardium or Capsula cordis is a Membrane designed by Nature to involve and inclose the Heart for its defence as also being a moist Bath to irrigate and keep it souple containing a Serum or water and this Membrane should extend and be enlarged according to the motions of the Heart being greater or less now when this water does abound filling the cavity of this inclosure the Heart thereby is prohibited its full expansion and è contrà when this water is too much wasted and dryed up the Pericardium cleaves to the Heart and impedes its pulsific motion thus either plenitude or vacuity begets anxiety and trouble at the Heart Internal cause of constriction is when the Heart it self is seized with a Tabes or vehement exsiccation and the fibres so contracted that it hath no capacity or less for dilatation and permission of the transient blood 3. Obstruction causeth pain and trouble at Heart when the free current of the blood is impeded from within due Vessels and this is procured sometimes from a perturbation of the movent spirits and sometimes from an indisposition of the impulsed blood First from a sudden and violent recurrence of Spirits from other parts and tumultuous confluence at the Heart whereby the circulation is checkt and the blood stopt in the Ventricles causing a suffocation for a time and this happens upon vehement passions and consternations of the mind Secondly From an inhability and incapacity of the blood being gross concreted or grumous that it hardly or with difficulty passeth through this Organ causing thereby an obtuse pain oppression or heaviness at the region of the Heart and sometimes a Lipothymy or Syncope fainting or swooning 4. By Inflammation or intemperate heat the Heart is pained as in most Feavers where intensness of heat is accompanied and this heat continuing does exsiccate and contract the heart and brings a Tabes or Consumption upon the whole Body 5. By Imposthumation the Heart is pained sometimes as also by other Tumors there bred Which by dissection hath appeared after death 6. By Erosion or Vlceration sometimes the Heart is pained and suffers by continual palpitation 7. By exotic Generations and strange productions the Heart sometimes is pained as when worms stones or bony substance is bred in the Parenchyma of ' the Heart which hath been found there upon dissection after death and to these diseases and such as most of the forementioned the Symptom of Palpitation does necessarily belong shewing the continual molestation and trouble the Heart lyes under who endeavors to acquit and extricate it self by laborious lofty and strong pulsations Pains in the Abdomen or lower Region of the Body NOW we have done with those pains incident to the middle Cavity namely the Thorax or Breast I come in the next place and by the order proposed to the lower Region called the Abdomen or Belly containing the Stomach Liver Spleen Kidneys c. And here first as the principal member we shall inquire into pains belonging to the Stomach or Ventricle being the great Office and Laboratory to prepare Aliment to supply and maintain the whole Body therefore if this part be pained and out of order all the rest must needs fare the worse for it every part having a concern from hence Pains of the Stomach are various both in respect of their causes and also from the different parts of the Ventricle where they do infest and those are three the upper Orifice called Os Ventriculi the lower Orifice called Pylorus and the whole cavity of the Stomach The upper Orifice or mouth of the Stomach is subject to great pain as being very tender and sensible in regard it is very nervous and this pain is the more eminent and remarkable for that commonly two principal parts are hereby affected and drawn into consent the Brain and the Heart the former by the Nerves of the sixth conjugation derived from the Brain whose ramifications are wreathing or twining about this Orifice and therefore from hence Head-aches Vertigoes and Epilepsies do often arise The Heart also is affected both in respect of vicinity as near adjoyning to this Orifice and also for that the same pair of Nerves doth serve both the Heart and Stomach whereby of necessity there must be a communication of pain and therefore it is that this pain in extremity causeth Fainting and Swooning and hence it is that this pain by a peculiar distinguishing title is called Cardialgia and also for that the ancient Greeks called the mouth of the stomach 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 As for the causes of this Cardialgia or stomach-pain sometimes they are sharp acrid and hot biting humors fluctuating and rising up to the Orifice of the stomach where they cause an eroding or gnawing pain and sometimes a scalding or heat there and this vulgarly is called the Heart burning Sometimes flatulency and wind causeth this pain by way of distension and a swelling fulness and the Orifice is constringed and shut up so as denying vent in this case the Patient labours and strains to belch but cannot unlock or loosen the Orifice of the stomach but so soon as the Orifice does slacken and give way the wind breaks forth and ease followeth Sometimes Worms do cause this pain having gotten up to the mouth of the Ventricle where they gnaw and bite Sometimes churlish and deleterious or ill prepared Physick or discordant food having such properties as may irritate and provoke this tender part or food received in too great a quantity above what the stomach is able to master and digest then it riseth up to the mouth of the stomach causing oppression and pain there until it be discharged upwards or downwards by the strength of Nature or the assistance of Art Besides this Cardialgia there is also another sort of pain that afflicts the mouth of the stomach and that is Singultus a Hicket or Hickop and although the whole Ventricle be molested therewith yet the chief pain or trouble is at the Orifice or mouth of the stomach This Hickop is a convulsive motion of the stomach thereby causing pain The general causes assigned by Hippocrates are two repletion and inanition under repletion is comprehended whatever humor or vapor is in the
they are various and may be ranked under these Heads 1. Obstruction of the Meatus felleus 2. Wind and flatulent Vapors 3. Acrid punging and sharp Humors 4. Indurated Excrements 5. Stones generated in the Colon. 6. Worms 7. Compression 8. Inflammation 9. Venenous and malignant Matter 10. Apostems and other Tumors By the first it appears that Obstruction in the Guts which produceth Colic pains does sometimes arise from an antecedent obstruction in another part as when the Meatus cysticus the passage of the Gall into the jejunum is stopt it causeth also a stoppage in the Guts for the Gall being naturally discharged into the Guts does stimulate them to expulsion and moves the excrements downwards but for want of this exciting and provoking matter the Guts fill up are obstructed and distended thereby raising pain Wind and flatulency begets Colic-pains sometimes and these are not fixed but roving here and there and commonly attended with a rumbling and noise in the belly and this is an effect of crudities and weak digestion rising from a natural debility or occasioned by intemperance and a bad diet And this flatus is either in the cavity of the Colon involved in a viscous tough flegm inclosed as in a Bladder or sometimes shut up within the Tunicles of the Intestine where forcing its way out does cause great pain in the part Sharpness of an humor indigested or degenerate does sometimes cause Colic pains and this is either a mordant biting Choler or an acid serosity Driness and hardness of Excrements do cause Colic-pains sometimes for as much as they stop the passage and extend the Intestines denying vent to any sudden fermenting humor wind c. that should freely pase away This costiveness and constipation is acquired by ill diet in the use of hot dry astrictives by watching or sleeping too much immoderate Venus by heating the body and sweating much through exercise labour intemperate Air c. These are great dryers and take off the lubricity of the Guts that they perform not their office as they ought thus excrements not being transmitted and sent away duly they accumulate fill up distend and obstruct the Intestines and give great occasion to Colic-pains Stones sometimes are generated in the Colon and do cause Colic-pains also a clot of worms gathered and twisted together obstructing the Guts have raised Colic pains Compression and contraction by Inflammations and Tumors in the Guts or parts adjacent do sometimes cause Colic pains Also malignant and venenate matter hath procured the like as Paulus Aegineta relates of a pestilential Colic that arose in Italy and afflicted many of the Roman Provinces Fluxes of the Belly HAving spoken something concerning pains of the Guts Iliac and Colic attended with astriction of the Belly and costiveness I shall briefly set forth those pains that are accompanied with a Flux or loosness There are three sorts of Fluxes of the Belly distinguished by several names Lientery Diarrhoea and Dysentery The first is a Flux of indigested or semidigested food passing away before its due time from an imbecillity of the digestive faculty But this not being dolorous or painful we shall pass it by as not our subjevt in hand The Diarrhoea is a flux of humors depraved and injurious which stimulates Nature to expulsion and is for the most part painful and irksom to bear 1. This kind of Flux is various in the matter of 2. Different in the efficient cause as some are of opinion 3. Unlike in the manner and circumstances 4. Various in respest of place as issuing from several parts of the body Touching the diversity of matter in this flux physicians have distinguished it into phlegmatic choleric melancholic and serous or watry which distinction is not simply manifest but a complication and mixture of many sorts whereof one may abound and be predominant yet the denomination and character of the whole is hard to be given The variety of depraved matter that happens in mans body is not to be reduced to four Heads nor three times so many for this stimulating matter thus sent forth by a Flux is the manifold different material cause of hundreds of diseases which preternatural variation of humors or juyces are not to be comprised within so narrow a compass nor reducible to four Cardinal points for admit there were four natural constituent humors in mans body as common doctrine teacheth yet these in their sundry variations and complicate degenerations would be so variously changed as not to retain any relict or smack of their original descent that a denomination from thence if possible to be distinctly given would no way answer in the similitude or nature thereof and consequently of no use in practice In respect of the efficient cause Authors have distinguished these Fluxes into critical and symptomatical by critical they understand when Nature in due time and with good success throws off and expels any peccant matter and finds relief by it in any case A symptomatical Flux they mean when Nature irritated untimely or immoderately is not benefited thereby but rather injured and endangered The 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of this is true and it often falls out thus but the distinction of critical and symptomatical relating to the efficient cause and the reason thereof I do not assent to nor comply with since every Flux is symptomatical whether it produce good or evil for that which they call Critical and is seasonable and duly performed with good effects attending is but symptoma morbi the Symptom of some disease as well as the other so that the difference is in the nature of the disease afflicting the matter excreted or voided the fortitude of Nature the time where the way by which it ought or ought not to pass which does distinguish these Fluxes in their effects to be good or ill but shews no diversity in efficient causes which is one and the same for Nature is efficient whether irritated unseasonably and frustrated of her end or performing these endeavors in due time and to good purpose But although the efficient cause of Diarrhoea's be simple and single yet the occasional causes are many for these Fluxes are occasioned sometimes by change of air or place and variation of the seasons by some kind of meats or drinks taking cold or other casualties and accidents which puts Nature upon some disorderly fermentation and excretion and this commotion occasions and stirs up any morbific matter and noxious humors which before perhaps lay dormant and still now to grow turgid and active contributing to advance and promote the Flux begun but this managed by a discreet hand may not prove injurious but some advantage gained which if neglected and Nature not governed and guided in this prodigal expence much detriment may come thereby an exhaustion of nutritious Juyce with great debility and weakness As this Flux Diarrhoea is various in the matter discharged so likewise in the manner and circumstances as greater and more violent or
of Urine This disease is always accompanied with an acute Feaver great Thirst astriction of the Belly heat of Vrine and great pain about the Loins and if the Arteries be affected the pain will be with pulsation Sometimes a Delirium attends with long watching and if the Inflammation be in the Membrane the Patient is scarce able to sit upright because the pain thereby is exasperated If the right Kidney be affected pain extends upwards to the Liver and short Ribs and downwards to the Genitals also a stupor seizeth the right Thigh by consent the Nerve being compressed that passeth thence down to the Thigh But if the left Kidney be the part affected that side is most grieved and in like manner but if both the Kidneys be attacked then the Symptoms on both sides are equal The termination of these Inflammations are either by an Apostem or Abscess by induration and a scirrhous hardness or by Transpiration and resolution which last is the only safe and secure way and this the Physician ought to design for and aim at in his administrations But if contrary to his endeavors the Inflammation apostemates suppurates and breaks evacuating the purulent matter by the Vreters into the Bladder there is good hopes of safety but if it be discharged inwards by the emulgent Veins the case is desperate Scirrhous Tumors in the next place come to be viewed and these are hard Tumors very difficult to be removed being the relict of an Inflammation or other Tumor preceding and not well cured or formed by gross matter congested and accumulated there causing contumacious obstructions for humoral matter flowing thither and being obstructed in the transition the heat of the part does exsiccate and harden it by time more and more and then by accumulation and addition forms a Tumor This causeth heaviness about the Loins but little pain the Urine is but little also and that pale and watry in regard the office of the Kidneys is debilitated and by reason of the angustness of the passages letting pass the thinner but retaining the thicker part of the Urine The longer this Tumor continues the more difficult and incurable it becomes and withal it brings on hydropic Cachexies for the superfluous serosity not being drained away regurgitates back into the body The Cure is to be set upon with internal and external Medicines Aperitives Resolvents Discussives and Emollients Apertion of the Vessels contrary to Nature somtimes does threaten danger by the appearance of blood staining the Vrine and this proceeds from a weakness of the Vessels being relaxed in their retentive faculty or by a plenitude and fulness of blood or because the blood is thin and sharp which causeth the mouths of the Vessels to open On the contrary Angustness or straitness sometimes does incommode the Vessels appertaining to the Reins which hinders the free ransmission of the Vrine Now this angustness of the Vessels does arise either by compression from some Tumor or distended part that presseth upon the Vessels and straitens them from without Or by contraction or constriction of the Vessels that are shrunk as by great heat in long Feavers or a Tabes that seizeth the Kidneys Or lastly by obstruction within from some viscous matter grumous or clotted blood sand gravel stone c. The Sign declaring these obstructions is a suppression of Vrine with pain or an abatement of the usual quantity not answerable to the drink received The place or part affected whether in the Kidneys or Vreters is known by the seat of pain The causes that obstruct are known by their proper signals and by examining into the preceding state of the Patient The place or part grieved with these obstructions whether in the Kidneys or Vreters pain discovers and the dislodging or shifting thereof Of all the obstructions that infest the Kidneys the most frequent and saddest complaint is from the Stone this being the most contumacious obstruction the most painful being a hard solid body and the most uncertain Remedies for relief Concerning the generation of these Stones there have been various Opinions amongst Learned men in short the difference and contest hereupon may be reduced to these two Heads what the material cause of the Stone is and what the efficient For the material cause or matter whereof the Stone is bred Galen and most of his Disciples will have it to be a phlegmatic gross or viscous humor apt for condensation and induration and the efficient to be heat exsiccating this matter and bringing it to a stony hardness but others of them will have this to proceed from cold by way of congelation But this Doctrine cannot hold as rational nor does it answer experience as for the matter we cannot allow it to be such for as much as many that abound with a viscous tough Phlegm and slimy matter as most ancient people do yet many of them are never trouble with stone or gravel And for a concurrence of both the causes material and efficient we have examples of the Aged who are most cold and phlegmatic and for abounding heat with the like matter we may produce Feavers yet no stony concretion or signs thereof to be found from such sicknesses So that we are now to seek for other causes both material and efficient whereon to ground our endeavors for the relief of such as are afflicted with this disease The matter therefore and substance of the Stone is from a tartarous and saline succus with the addition of a terrestrial feculency concreted or petrified by a lapidifactory Spirit or disposition of the Reins which is the efficient and seminal being of that production The concurrence of both these causes does much produce the Stone and afflict the Patient in a high degree but one of them is sufficient viz. this petrifying power of the Reins to coagulate any laudable good matter imported there into a stony substance To confirm this Fernelius relates upon his own knowledge of one that for three or four months together above a dozen small stones came from him every day all which time notwithstanding he eat nothing but Broths and Panadoes being confined to his Bed by weakness and pain But allowing this to be true from the credit of the Author yet we must owne and acknowledge that besides this principal cause of a petrifying Spirit in the Reins there are also antecedent and procatarctic causes adjuvant and promoting as some sorts of meats and drinks and other errours in the Diaetetics that increase and set forward this disease which otherwise might be much slower in generation nor yet arrive to so high a degree of torture also the Stomach Spleen or Liver not performing their functions rightly may contribute matter to the promotion hereof For relief of the diseased in this case there are two grand intentions to be prosecuted and aimed at a dissolution of the body of the stone already generated and secondly the taking away of the petrifying disposition of the Reins and abolition of
ignoble part or to such place where means can better be used and more apt for recession or egression of the continent material cause but if the Tumor apostemates the danger is greater or less according to the nature and condition of the member or part if it indurates the danger is delayed but if it corrupts the part the danger is greater and more speedy in execution Apostem is that degree or state of a Tumor when it is maturated or ripe which is called Suppuration the material or humoral cause being then converted into a Pus or purulent matter and while this is in fieri doing all Symptoms are aggravated pain heat pulsation tension are greater but being perfected they all decrease again and the Patient finds ease but not out of danger in these internal Apostems for if it be so seated where there is no convenient vent or Emunctory to discharge it the case is desperate As the humoral matter that formed the Tumor was more benign and good as pure blood so the converted Pus or purulent matter from thence does commonly answer it in goodness for of good blood and in sound bodies the maturation is more kindly the Pus white mild and not endangering to corrupt the part but in foul depraved bodies and malignant diseases apostemated matter is more putrid stinking and venenous and does threaten a Gangrene or mortification of the part and therefore such internal collections of matter in pestilential and malignant Feavers Venereal Pox small Pox and such like are commonly mortal Scirrhous Tumors are such as when the continent matter does not maturate and become soft fit to break and discharge but grows hard and fined in the part not apt to be discharged or removed by discussion or suppuration And this the word Scirrhus imports from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 induro Tumors in some parts of the body are apt to suppurate as in the carnous or fleshy in other parts as the Joynts Tendons and Ligaments more inclined to indurate and become scirrhous and the reason may be this that those parts which take their origine from blood are more prompt and ready to suppurate as the flesh but those which take their rise from seminal matter as the Tendons Ligaments Nerves c they are more inclinable to scirrhosity or hardness But besides this disposition of the parts affected there is also and chiefly a propension in the congested or influxed matter of these Tumors for by the different nature of humoral matter some is more fluxible and thin participating much of serosity and apt to transpire or be discussed other more yielding to a preternatural digestion and suppuration as the blood that is pure and good other inclining to be viscous coagulated and consequently to indurate as a feculent grumous or gross blood deprived of its serosity And farther besides the disposition of parts and that of the material cause inclining to this scirrhosity there may also come in and be joyned with these a third promoter which in some cases may be the chief cause and that is an ill method and injurious Medicines so endeavouring to remove may thereby fix and fasten the matter for thus a Tumor which might probably be dispersed may be changed from its own capacity and tendency and become scirrhous and indurate as when constant or great Coolers are administred to abate the symptomatical or concomitant Feaver the matter of the Tumor is thereby fixed and impacted which otherwise might have surrendred unto proper and powerful Medicines duly used And e contrà by too great Dryers and Heaters the thinner part is evaporated and the grosser remains therefore medio tutissimus ibis good resolutive transpiring Medicines taking their turns with the use of proper Cathartics is the safe and bed way These scirrhous Tumors although they are not so dangerous for the present except they be very great or cancerous yet they are the foundation of some chronic or lingering diseases which proves very contumacious and sometimes incurable especially if the Tumor be latent and concealed and Hectic Feaver sometimes takes its rise from hence which if you think to cure by Emulsions Restauratives and cooling Drinks you will be much mistaken in your purpose and endeavours These scirrhous Tumors some are with pain some without those that have pain are more hopeful except they be cancerous but those which are insensible upon pressure are more difficult or incurable Now according to the nature and degree of depravedness in the continent matter and from the part affected so are these Tumors better or worse to be dealt with And because these Tumors are internal and hid from the eye therefore judgment is to be given of them from their situation and from the constitution with other circumstances of the Patients body But although these scirrhous Tumors are thus difficult to be undertaken and managed yet these are not the worst and they may arrive farther and to a more dangerous state as when Tumors in their variation and degeneration do turn cancerous and this is apt to be in such bodies as abound with a black feculent blood or a thick blood adust by intemperate heat and by how much the blood thus exceeds in this preternatural condition by so much the Cancer is compleated confirmed and the worse and this supervenes a Scirrhus commonly as being an apt previous disposition but may happen also without a Scirrhus preceding from other Tumors degenerating into Cancers and therefore in the Cure of scirrhous Tumors great circumspection and diligence is to be used lest by their delay add continuance or improper usage of Medicines these Tumors do not become cancerous and desperate as sometimes it falls out so Now a Tumor is said to be cancerous when it turns into a dark reddish or livid and blackish colour declaring this transmutation and degenerate state The beginning of these Cancers are very small in compass as those that present outwards do manifest their gradual inlargement but by time they increase and grow big with tumified Veins round about These cancerous Tumors may happen to any part of the body but chiefly and molt frequently in the upper parts about the Face as Nose Lips c. or the Dugs and other glandulous parts also the Womb is thus affected sometimes from Tumor there bred venereal or other degenerating cancerous These Tumors sometimes are occasioned from the menstrual suppression in women and Heamorrhoidal in men and when it happens so those causes are to be removed with speed Great skill and circumspection is to be used in Tumors of this nature lest provoking the continent matter it grow more fierce eating and ulcerating and from a cancerous Tumor it become a cancerous presiding Vlcer which is worse now the signs of this Tumor inclining to break and ulcerate are great heat and pulsation in the part The difficulty or incurability of Cancers lye here for that the cancerous matter will not yield to digestion or discussion and this because the