and weakning the Lungs that serve for Respiration which are the Seat and Theatre of this Distemper 7. An Hereditary Disposition Seventhly An Hereditary Disposition from the Parents does very often bring a Consumption of the Lungs when every Body knows very well that those who come of Consumptive Parents are apt to fall into the same Distemper 8. An ill formation of the Breast Eighthly an ill formation of the Breast whether it be Natural or Accidental is another cause of this Disease I call that Natural where the Breast is narrow the Neck long and the Shoulder-blades stand out like Wings And that I call Accidental where there is a crookedness or distortion of the Breast whereby not only the parts of the Breast and especially the Lungs being once weakned in their Tone are rendred subject to the Flux of Rheumes but also the Lungs wanting their necessary expansion and being streightned do heap up in themselves and retain the vitiated Serum of the Blood from whence it comes to pass that at length they come to have Obstructions Ninthly 9. Infection This Disease is also propagated by Infection For this Distemper as I have observed by frequent Experience like a Contagious Fever does infect those that lye with the Sick Person with a certain taint Tenthly 10. Chalky stones and such like in the Lungs also Chalky Stones that are Preternaturally bred in the Lungs or Nails and other hard Bodies slipping down into the Lungs when Persons laugh are to be reckoned among the Causes of a Consumption of the Lungs By which not only a troublesome Cough provoking a Flux of the Humours is caused but also Apostemes and Ulcers where also for the most part a spitting of Blood preceding does dispose the Lungs to those Apostemes and Ulcers Of which I shall afterwards give some Histories Eleventhly 11. Some preceding Distemper Also some particular Diseases which corrupt and overthrow the Nature of the Blood and Spirits do occasion this Distemper From whence there follow a Symptomatical Consumption of which I shall make it my business to discourse in the end of this Treatise as the Scurvy Kings-Evil Convulsive and especially Hysterical Affections if they have been of a long continuance also Fevers and especially Intermitting and Scarlet Fevers and such as proceed from a Surfeit so the Small-Pox Measles Stone in the Kidneys the French Pox an Asthma spitting of Blood Inflammation of the Lungs Pleurisie and other Distempers of the Breast ill cured likewise the Green-sickness a sixt Melancholy Gout and Rheumatism The more immediate cause is taking of cold The Body being thus predispos'd to a Consumption by these and other such-like Procatarctick Causes the more immediate cause of this Distemper is for the most part the taking of Cold from whence it comes to pass that in the Body disposed in such a manner by a load of Humours or Water continually deriv'd from the distemper'd Habit of the Body into the Lungs a Cough is caused that is not easily shaken off as that is wont to be which happens from a meer accidental Cold where the Matter is concocted within a few days into a putrid Flegm and upon that is all perfectly thrown out by a Cough as I shall shew more largely in the Chapter of a Catarrh Moreover from a stock of very sharp and Malignant Humours which were gathered before in the Habit of the Body as there is a continual supply of new Matter from the Circulation of the Blood there is a continual and troublesome Cough produced and sticks upon the Patient to his dying day The Serum or Water of the Blood being separated as it were in a perpetual stream by the Glandulous parts of the Lungs and not admitting of any Concoction until the Lungs especially the Glandulous parts of them swell from their being stufft and grow hard and at length the Tone of the parts is quite destroyed and they are ulcerated by the sharpness of the Humour that is separated by these tender and soft ways Which indeed is the immediate Cause of a Consumption of the Lungs CHAP. II. Of the degrees of an Original Consumption of the Lungs and the Signs which give us warning of it together with the Preservatory Indications or what we are directed to do in order to prevent it THE degrees of this Distemper are these which follow to wit first The first degree is a stuffing of the Lungs 2. A Swelling a stuffing of the Lungs from the Serum or Water of the Blood that is plentifully separated in them Secondly a hard Swelling but more especially in the Glandulous parts of the Lungs arising from the same Serum distending those parts too much and not having a free passage out of them Which Tumour I take to be the crude Tubercle mentioned by Galen which Tubercles or crude and glandulous Swellings I have often found in the dead Bodies of Consumptive Persons when the other parts of the Lungs have been full of Apostemes and Ulcers Thirdly 3. An Inflammation an Inflammation of the Lungs arising from the heat and sharpness of this Serum And lastly 4. An Impostumation and Exulceration an Impostumation and Exulceration of these inflamed Parts when the Distemper comes once to its height and extremity The signs which respect a Consumption of the Lungs are either the Prognostick or Diagnostick and Pathognomonick signs Those of the first sort are these which follow First Prognostick Sign being born of Consumptive Parents First the being born of Consumptive Parents for this Distemper so far as I have been able to observe is more Hereditary and oftner propagated from the Parents than any other 2. An ill figure of the Breast 3. A shrill squeaking Voice Secondly an ill conformation and figure of the Breast whether it be Natural or Accidental Thirdly a Voice that is naturally small and squeaking or at least so by use and a habit as being that which proceeds either from a Natural weakness of the Lungs or from an Obstruction of the Glandulous Coat of the Wind-pipe and the branches of it caused by a glutinous and tough Phlegm But from which soever of these Causes that appearance arises still it threatens a Consumption of the Lungs which is afterwards like to follow 4. A white soft Skin 5. A blouted habit of the fleshy parts Fourthly a white and soft Skin together with a thin Habit of Body Fifthly a soft and blouted habit of the Muscular Parts proceeding from their being much stufft with old and dispirited Nutritious Juice 6. Melancholick Oppressions about the Breast Sixthly long Hypochondriacal Oppressions about the Region of the Breast that feel heavy like some troublesome weight as also Hysterical Choakings that are frequent of long continuance and unusual being in the same places 7. Thoughtfulness and some Passions of the Mind 8. The stopping of Customary Evacuations 9. Spitting of Blood 10. The hawking of black and tough Phlegm Seventhly Thoughtfulness
that is plentifully supplyed from the Glandulous Coat of the Wind-pipe Neither indeed can the Patient when the Distemper comes to be a Fatal Case be ever freed from this Cough by any Art till Death effectually stops it But let no one admire how those Tubercles or Swellings that are placed in the Lobes of the Lungs far from the top of the Wind-pipe can provoke this dry Cough together with a tickling in the upper part thereof when he may every day observe the same kind of Chronical dry Cough caused and continued a long time by chalky stones generated in the substance of the Lungs Yea and once I observed the same Symptom to happen from three Nails that slipt by chance as the Person was laughing through the Wind-pipe down into the Lungs and to continue for a whole Year the sick Person all that while being in other respects very well How the Tubercles which are remove from the top of the Wind-pipe do affect that part And indeed the thing it self shews it for the Wind-pipe is every where divided through all the Lobes of the Lungs into many branches which are a great way distant from one another so that the very fine and small Pipes of those branches are propagated to the very extremities of the Lungs by the continuity of those Membranes which had their Original from the beginning or upper part of the very Wind-pipe From whence it necessarily follows that as those Tubercles in what part soever of the substance of the Lungs they happen to be bred cannot but make a troublesome compression upon some of these small Pipes and straighten them So that troublesome sense by reason of the continuity of the Membranes does affect the upper extremity or beginning of the very Wind-pipe by a consent of parts as we commonly say whereby it provokes the Wind-pipe to cast out its Enemy by a vain and dry Cough Just as we see every day in a Strangury or difficulty in making Water from a stone pressing uneasily upon the Ureter yea if it be the very Kidney a great pain felt in the extremity of the Yard it self from the continuity of the Membrane For in Nature's endeavouring to expel the Stone there arises a Spasmodick Contraction of the whole Urinary passage from the very Kidneys which yet does very much affect the extremity of the Yard with a kind of heat of Urine The Nature of this Cough shews it to be from the Tubercles And even the Nature of this Consumptive Cough does likewise favour much this Opinion whilst it yet continues to be dry as being caused only by Tubercles and before a disposition to a Catarrh does in progress of time come upon it For as it is dry and without any expectoration so it is not great nor the Fits long and is rather made of its own accord to relieve the Oppression of the Lungs then excited by a violent tickling or accompanied with that great straining which usually accompanies a Catarrhous and fierce Cough that is caused by the continual excretion of a Waterish Humour by the Wind-pipe and the branches of it But if any one should be inquisitive about the Original of the Tubercles in the Lungs A general Account of the Original of the Tubercles in the Lungs which are the first occasion of this dry and truly Consumptive Cough I shall give this general Answer That the substance of the Lungs not only seems more obnoxious to a flux of Humours as the Ancients love to Phrase it than any other parts of the Body from the continual motion of these parts caused in respiration but also by reason of its spungy softness because it consists wholly of small Bladders and Vessels is wont to suck in and retain the Humours And therefore when all the internal and external Parts as well those that are Muscular as those that are Glandulous are very often affected with several sorts of such Swellings why should it be strange if they are frequently found here also as they are in other parts of the Body Yea when I consider with my self how often in one Year there is cause enough ministred for producing these Swellings even to those that are wont to observe the strictest Rules of Living I cannot sufficiently admire that any one at least after he comes to the Flower of his Youth can dye without a touch of a Consumption And without doubt the breeding of these Swellings is so frequent and common The breeding of these swellings is very common that a Consumption of the Lungs would necessarily be the common Plague of Mankind if those Swellings did not vanish or were not removed by Art as easily as they are bred at first And indeed I have been used to think not without Reason that as the more Benign Tubercles are wont to go off of their own accord and that quickly so none of them lay the Foundation of this great Disease And when they are Malignant they occasion a Consumption of which I am now treating but only those which are in some degree Malignant and ill-natur'd and that are wont to putrefie sooner or later from some peculiar quality in their Nature from what part soever of the Body they have their Original But that I may more particularly say something of the beginning and rise of these Tubercles A particular Account of the beginning of them As far as I have been able hitherto to learn either from the inspection of the dead Bodies of such as have had a Consumption or by Reasoning a crude Tubercle or Swelling is bred from the Obstruction of some Glandulous part of the Lungs to wit when a greater quantity of Serum or Water is separated from the Blood than is thrown out by the Duct of the Glandule From whence it comes to pass that as the Part affected being too much distended by the Humour that is imprisoned in it is deprived of its Natural Tone and thereupon is no longer able to spew or throw out the Serum or Water that flows into it or is separated so likewise the Humour that is so shut up not being any more renewed by an influx of fresh Humor does by degrees grow dry and hard from the Natural heat of the Part From whence arises a hardness that resists a pressure or a Tubercle of which we are now speaking which in progress of time after the Natural Tone of the Part is in this manner destroyed is wont to be inflam'd and to turn to an Apostem sooner or later according to the Nature of the Lympha or included Humor and of the Blood from which it is separated which indeed is the whole immediate cause of a Consumption of the Lungs and of the dry Cough which attends it The causes of that Obstruction which produces the Tubercles There remains yet some Enquiry to be made from what cause this Obstruction or Stagnation of the Humour in the Glandulous parts of the Lungs does proceed And this is
Tone of the Stomack so also the Assimilation the Fermentation and Volatilization of the Nutritious Juice are hindred in the whole Habit of the Body from the distemper'd state of the Brain and Nerves The Causes which dispose the Patient to this Disease I have for the most part observed to be violent Passions of the Mind the intemperate drinking of Spirituous Liquors and an unwholsom Air by which it is no wonder if the Tone of the Nerves and the Temper of the Spirits are destroy'd This Distemper as most other Nervous Diseases is Chronical but very hard to be cured The Prognosticks unless a Physician be called at the beginning of it At first it flatters and deceives the Patient for which reason it happens for the most part that the Physician is consulted too late And at last it terminates in an Hydropical and Oedematous swelling of the Body especially of the lower and depending Parts in which case there remain no hopes of the Patient's Life neither is there any thing more to be done for his Cure than giving him some ease whereby his Miserable Life may be lengthened for some days The Cure The business of Cure if it be so that the help of our Art is called in in due time consists in the convenient use of Stomack-Medicines and such as comfort and strengthen the Nerves such are Chalybeates Antiscorbutick Cephalick and bitter Medicines of all sorts As for Example let the Patient if his Body be costive take every third or fourth Morning four Ounces of the bitter Decoction with Senna or every fourth Night two Ounces of the Sacred Tincture or of our Sacred Cephalick Tincture made with Hiera Picra infused in Rue-water Black Cherry-water and strong Piony-water For his common Drink let him use Ale in which a Bag of Cephalick and Antiscorbutick Ingredients has been hung An hour before Dinner let him take xxx drops of Elixir Proprietatis in a draught of Wormwood-White-wine To the Region of the Stomack let there be applyed the Magisterial Stomack-Plaister with some Drops of the Chymical Oyl of Cinnamon and Oyl of Wormwood Or let the Stomack be fomented every day with some Aromatick Bags made of the Leaves of Mint Wormwood Cinnamon Mace Zedoary Galingale Cyprus-roots Calamus Aromaticus boyl'd in Claret If it be in the Summer let him use the Chalybeate Waters But if it be the Winter time let him make use of a Chalybeate Syrup or our Chalybeate and Aromatick Wine made with the Filings of Steel quenched three or four times in strong White-Wine and with Zedoary-roots Galingale Nutmegs the best Cinnamon Mace Cubebs Cloves bruised and steeped in the same Wine But for Chalybeates I do prefer Mynsicht's Extract before any other which I order to be given for xx or xxx days in the form of a Bolus or Pills As for Example Take of Mynsicht's Extract half a Scruple Balm of Gilead which in this case is very proper and beneficial because it is not a little grateful to the Stomack and Nerves seven Drops Old Conserve of red Roses a Dram mix them and make them up into a Bolus to be repeated every day Or if the Patient chooses to take Pills let the Extract be made up into that form in the manner following Take of Mynsicht's Extract half a Scruple of Balm of Gielead seven Drops of Haly's Pouder six Grains of the compound Pouder of the Roots of Wake-Robin four Grains of Pouder of Liquorice so much as will make them into the due consistence of Pills and make the Mass into Pills of a middle size let them be gilded and repeated once every day Also Natural Balsam by it self as likewise Spirit of Hartshorn and Spirit of Sal Armoniack are of use in this case because they are good for the Nerves As for Example Let the Patient take viij or x. drops of Natural Balsam or Spirit of Hartshorn in a convenient quantity of Sugar-candy twice a day Rules for Exercise Diet c. Let the Patient endeavour to divert and make his Mind chearful by Exercise and the Conversation of his Friends For this Disease does almost always proceed from Sadness and anxious Cares Let him also enjoy the benefit of an open clear and very good Air which does very much relieve the Nerves and Spirits And because the Stomack in this Distemper is principally affected a delicious Diet will be convenient and the Stomack ought not to be too long accustomed to one sort of Food History 1. Mr. Duke's Daughter in St. Mary Axe in the Year 1684. and the Eighteenth Year of her Age in the Month of July fell into a total suppression of her Monthly Courses from a multitude of Cares and Passions of her Mind but without any Symptom of the Green-Sickness following upon it From which time her Appetite began to abate and her Digestion to be bad her Flesh also began to be flaccid and loose and her looks pale with other Symptoms usual in an Universal Consumption of the Habit of the Body and by the extream and memorable cold Weather which happened the Winter following this Consumption did seem to be not a little improved for that she was wont by her studying at Night and continual poring upon Books to expose her self both Day and Night to the injuries of the Air which was at that time extreamly cold not without some manifest Prejudice to the System of her Nerves The Spring following by the Prescription of some Emperick she took a Vomit and after that I know not what Steel Medicines but without any Advantage So from that time loathing all sorts of Medicaments she wholly neglected the care of her self for two full Years till at last being brought to the last degree of a Marasmus or Consumption and thereupon subject to frequent Fainting Fits she apply'd her self to me for Advice I do not remember that I did ever in all my Practice see one that was conversant with the Living so much wasted with the greatest degree of a Consumption like a Skeleton only clad with skin yet there was no Fever but on the contrary a coldness of the whole Body no Cough or difficulty of Breathing nor an appearance of any other Distemper of the Lungs or of any other Entrail No Loosness or any other sign of a Colliquation or Preternatural expence of the Nutritious Juices Only her Appetite was diminished and her Digestion uneasie with Fainting Fits which did frequently return upon her Which Symptoms I did endeavour to relieve by the outward application of Aromatick Bags made to the Region of the Stomack and by Stomack-Plaisters as also by the internal use of bitter Medicines Chalybeates and Juleps made of Cephalick and Antibysterick Waters sufficiently impregnated with Spirit of Salt Armoniack and Tincture of Castor and other things of that Nature Upon the use of which she seemed to be much better but being quickly tired with Medicines she beg'd that the whole Affair might be committed again to Nature whereupon consuming
Whites that are of an ill Nature and Venereal when the Impurity proceeding from that Venom has once infected the Humors do often terminate in a Consumption of the Lungs unless they are timely and perfectly cur'd But of this kind of Consumption and of the Causes Degrees and Cure of it I shall Discourse more fully in its proper place to wit in the latter part of this Treatise when I shall professedly speak of a Symptomatical Consumption of the Lungs But for the present I do from a long Experience and Observation affirm that a Consumption does often arise from a simple or benign Gonorrhoea and Whites A Consumption sometimes proceed from a simple Gonorrhoea c. and therefore this sort arising from the continual substraction of the Nutritious Juice by the Seminal Glands must be reckoned under the Head of an Originary Consumption For in a Gonorrhoea and the Whites sometimes the Flux is so extraordinary and continues so long that the Mass is thereby plainly dispirited and rendred unfit for Nourishment whereupon the Blood being loaded with Heterogeneous and disagreeable Particles grows hot and at length a Hectick Disposition is by degrees brought upon the solid Parts and the Habit of the Body which is the same sort of Consumption that we are now treating of The presaging signs of this Consumption The Symptoms which presage this Consumption I have for the most part observed to be these to wit an Hypochondriacal Oppression Melancholy and too much Thoughtfulness with a decay of Strength and loss of Appetite in Men that are affected with a plentiful Running of the Reins but in Women that have been long afflicted with the Whites flowing in a great quantity a soft and blouted Habit of the Body a squalid and pale Countenance together with Hysterical Fits a remarkable Weariness and decay of Strength all which Symptoms proceed from the same cause to wit from the poor dispirited Nature of the Blood caused by a want of new Chyle whereby not only the Spirits are weakned and opprest but also the Habit of the Body is rendred Oedematous from the waterish disposition of the Blood as it is full of old and dispirited Chyle And therefore the Signs which presage this Consumption are as I said before Hypochondriacal Oppressions Hysterical Affections a decay and want of Strength a blouted habit of the Body and a want of Appetite Which Symptoms in progress of time that is when the Distemper comes to be confirm'd are followed also by some others as a Thirst a Hectical disposition Atrophy and wasting of the Flesh till at length the Body is plainly brought to the highest degree of a Consumption and that very often without any Cough or any other remarkable sign of a Consumption of the Lungs This Distemper is easily cured if the antecedent cause of it can be removed that is if the Gonorrhoea and Whites can be cured When confiâ—med it is incurable But when it comes once to be confirmed it is plainly incurable And therefore a Prudent and Honest Physician that is carefully concern'd for his own Reputation will not do well to undertake the Cure of it but ought rather to take his leave and walk off from such a Patient after he has made a Prognostick of his Death and so he will be just to his Art and may satisfie his Conscience though he loses some Fees and defrauds his own Pocket But if the Physician be sent for in time What a Physician is to do in the Cure of it when he is sent for in time he ought to do all he can by all proper means and a convenient Method to stop the Gonorrhoea or Whites which are the cause of this Consumption Which thing we shall speak of at some other time and shew how it is to be done in the Chapters of a Gonorrhoea and of the Whites This efflux of the Nutritious Juice being once stopt by Art we must endeavour with all our Power to replenish the dispirited and impoverisht Blood as soon as may be with new oily and benign Chyle And therefore as we hinted in the former Chapter such Food as is delicious and affords a good Juice and is most grateful to the Patient's Palate and Stomack must be given often in a day though in a little quantity at a time And that his Appetite may be the more excited let him be advised to be chearful For there is nothing that destroys the Appetite and confirms a Consumption more than Grief and Sadness Let him also enjoy the advantage of an open and benign Air which is very beneficial to the Nerves and consequently to the Appetite and Stomack Let him likewise use Exercise every day and rubbing of his Body even to the procuring of moderate Sweats if his strength will bear it that the load of old dispirited and unprofitable Chyle with which the Blood-Vessels and Habit of the Body are stufft may be sweated out to make more room for new and useful Chyle and consequently for the improvement of the Appetite in the Stomack But he must Religiously abstain from the liberal use of Wine Spirituous Liquors are to be avoided and Spirituous Liquors which are wont to put the Blood which is before become too hot No considerable Evacuations are to be made into a greater flame Let the Physician also take heed he does not prescribe any Purges or any Medicines whatsoever to procure any other considerable Evacuation which may create farther Expences to Nature when she is already weak But if a Hectical heat even in the least degree be kindled in the solid Parts he must presently endeavour with all his Industry to quench this flame by the use of Asses Milk a Milk Diet and of such Mineral Waters as are Chalybeate CHAP. V. Of a Consumption proceeding from Apostemes and large Vlcers I Have always observed that Apostemes Large Vlcers in any part may cause a Consumption and large Ulcers let them happen to any part whatsoever of the Body whether external or internal if they continue long and throw out much Serum or waterish Matter have at length rendred the Body of the Patient Consumptive and that even to the degree of a Fatal Consumption and I can say I have taken notice that these kind of Ulcers do bring on a Consumption as well when they are in the Muscles of the Back and in the Testicles yea in the Knee and the Foot as when they are in the Kidneys or Liver or in the Lungs themselves Besides that I have often observed that a Consumption of the Lungs has come upon these large and old Ulcers The cause of this Consumption without all question is the long and plentiful substraction of the Nutritious Juice continually flowing out of the Mass of Blood by the Ulcers The reason of this Consumption whereby the Blood which remains in the Vessels being deprived of its Oily Nutritious Juice does grow sour and contracts a Preternatural heat and is
apply'd to his Belly and the Julep I just now mentioned in the last History which was made very strong of the Salt of Amber to be drank as often as he would take it What I have been telling of the former Patient the same thing did happily fall out here in this For the Boy refusing all other Liquors did covet the Julep Day and Night so that he drank almost four and twenty Ounces every day By which means it came to pass that in the space of a fortnight or less his Stools were brought to a Natural consistence colour and quantity His Urine also flow'd plentifully The swelling of his Belly went down to a Miracle Neither could I any more perceive any Swellings that lay conceal'd within it though I strictly examin'd with my fingers His Appetite and desire of Drink were Natural and as they ought to be His Flesh likewise seem'd gradually to increase every day And now his Melancholy and Weariness being overcome the Boy seems to recover not only the wonted vigour and activity of his Body but also a good Look and a fresh Colour in some measure so that I am not at all sollicitous about what remains to compleat the Cure A TREATISE OF Consumptions The Second BOOK Of an Original Consumption of the Lungs What a Consumption of the Lungs is A Consumption of the Lungs is a Consumption of the whole Body with a Fever proceeding first from an ill Affection and at length an Exulceration of the Lungs Which indeed is the most Famous Consumption and that which is called so by way of Eminence and of which Authors use to treat as if there were no other kind of Consumption and therefore I shall now speak more largely of it It is either Original or Symptomatical This Consumption of the Lungs is either Original which from the very beginning depends upon an ill disposition and an Exulceration of the Lungs Or Secundary and Symptomatical when ever the Lungs receive any great Injury from preceding Distempers But seeing that we ought always in the Cure of a Symptomatical Consumption of the Lungs to have a particular regard to the Primary Distemper from which this Consumption has its Origine and the Cure of it does require a variation in some things according to the Nature of that Distemper I shall make it my business in the last Book of this Treatise to treat of the Cure of this kind of Consumptions having first given in this Second Book so far as I have been able to observe a general Account of the Nature Causes Differences Diagnostick and Prognostick Signs Indications of Cure and the Method of Curing an Original Consumption of the Lungs CHAP. I. Of the Causes of an Original Consumption of the Lungs The general cause of a Consumption THE cause of a Consumption of the Lungs in general is a vitiated disposition of the Mass of Blood and of the Spirits in the Nerves contracted gradually from several Procatartick or predisposing causes in which the sharp or Malignant Serum or Water of the Blood being separated by the soft and Glandulous substance of the Lungs does stuff inflame and at length also exulcerate the Lungs themselves which is the immediate cause of this Distemper The Procatarctick causes of a Consumption First the stopping of Evacuations The Procatartick causes or those which give the first occasion to this Disease are First the stopping of some usual and necessary Evacuations as the Monthly Courses Child-bed Purgations Old Sores and especially Fistula's Issues Sweating in the soles of the Feet or any other parts of the Body a Gonorrhoea the Whites and other Evacuations of that kind when they are stopt without correcting or removing the causes upon which they depend From whence it comes to pass that even the Blood it self is polluted and distemper'd by those Humours which are condemned by Nature to be thrown off or banisht but by some Bars and Impediments lying in their way are stopt and retain'd in the Mass of Blood longer than is convenient 2. Passions of the Mind Secondly troublesome Passions of the Mind but especially Fear Grief Anger too much Thinking and Sollicitude as also unseasonable and too long Studies with other things of this Nature which contribute very much to this Distemper not only by vitiating the Animal Spirits and thereupon hindring the Natural Fermentation of the Blood but also by fixing almost a continual Spasmodick Contraction or Convulsion upon the soft substance of the Lungs Thirdly 3. Intemperance in eating and drinking a too plentiful and an unseasonable gorging of Meat and Drink and also an imprudent choice of such Meats and Liquors as abound with Excrementitious parts and are not very easie to be digested but especially the drinking too much Wine and Liquors that are very Spirituous Which when it is joyn'd with Cares and Grief and other such-like Passions of the Mind so far as I have been able to observe is commonly the cause of a Consumption of the Lungs For the Habit of the Body being from hence filled with a load of dispirited and unprofitable Humours as it is when it is Oedematous the whole Mass of Blood is polluted and rendred waterish and sharp and at length is disposed to a Hectical heat Fourthly the neglect of due Exercise 4. Want of due Exercise for want of which the Excrements which ought by the usual Law of Nature to be thrown out by the Skin being detained in the Blood are wont by degrees to destroy the Crosis or mixture of it For want of this the Humours also are wont to stagnate in the Habit of the Body and various Obstructions to arise here and there in the small Fibres themselves which contribute very much to the corrupting of the Blood and the weakning of the Spirits Fifthly Night-studies 5. Night Studies and long Watchings and long Watchings which not only weaken the Animal Spirits which are necessary for the Fermentation of the Blood but also keep within the Body those Excrementitious parts which are wont to be thrown out in the Bed by Sweat or Perspiration and who will think it strange that the whole Mass is by degrees vitiated by this means Sleeping in the day To this we may also add sleeping in the Day and sleeping much but especially presently after eating which as it dispirits the Mass of Blood and fills it with useless Chyle by hindring the Digestion of the Food from which cause frequent and troublesome Coughs are wont to proceed So by putting the Animal Spirits to sleep at an unseasonable time and thereupon hindring the Fermentation and Volatilization of the new Chyle it makes the whole Mass of Blood too waterish and sharp 6. An ill Air. Sixthly also a foggy and thick Air and that which is filled with the smoak of Coals does extreamly promote a Consumption by vitiating the Animal Spirits which are so necessary to the Natural Fermentation of the Blood and also by stuffing
by Spitting of Blood p. 225 Chap. 6. Of a Consumption caused by Stones bred in the Lungs and by things slipt down into them from without as also by the Stone in the Kidneys and Bladder p. 238 Chap. 7. Of a Consumption proceeding from the French-Pox p. 250 Chap 8. Of a Consumption proceeding from the Suppression of a virulent Gonorrhoea of the Running of Old Ulcers but especially Fistula's in the Fundament and Scrophulous Ulcers Issues and the Whites p. 254 Chap 9. Of a Consumption proceeding from the Green-Sickness and a Suppression of the Monthly Purgations in Women p 258 Chap. 10. Of a Consumption caused by a Peripneumony and a Picurisie p 263 Chap. 11. Of a Consumption proceeding from the Gout and from a Rheumatism p. 276 Chap. 12. Of a Consumption proceeding from Fevers especially such as are from Surfeits Scarlate and Intermitting Fevers as also from the Small-Pox and Measles p. 294 Chap. 13. Of an Icterical or Hepatick Consumption p. 307 Chap. 14. Of a Consumption of the Lungs proceeding from Internal Ulcers of the Viscera and Membranous Parts p. 340 A TREATISE OF Consumptions The First BOOK Of Consumptions in general and particularly of a Consumption proceeding from the whole Habit of the Body or an Atrophy both that which is Nervous and that which is caused by Evacuations THAT I may give such a Scheme of this whole Work as will lye under a single View and open a Prospect into my Design I shall here by way of Preface first give a Definition and make a Division of the Subject about which we are to treat whereby as by Ariadne's Thread we be easily and safely directed to and proceed through all the parts of the Work The Definition of a Consumption in general A Consumption in general is a wasting of the Muscular parts of the Body arising from the Substraction or Colliquation of the Humours and that either with or without a Fever and it is either Original or Symptomatical Of an Original Consumption An Original Consumption is that which arises purely from a Morbid Disposition of the Blood or Animal Spirits which reside in the System of the Nerves and Fibres and is not the effect of any other preceding Disease Of which there are two sorts to wit an Atrophy and a Consumption of the Lungs Of an Atrophy An Atrophy is an Universal Consumption proceeding from the whole Habit of the Body and not from any Distemper of the Lungs or of any other Entrail without any remarkable Fever and is either Nervous or the effect of Evacuations Of a Nervous Consumption A Nervous Atrophy or Consumption is that which ows its Original to an ill and morbid state of the Spirits and to the weakness or destruction of the Tone of the Nerves from whence as an imbecillity and an Universal Consumption in the whole Habit of the Body upon the want of a due assimulation of the Nutritious Juice do at length proceed so from the beginning of the Disease there is to be found a want of Appetite and a bad Digestion in the Stomack from an imperfect Fermentation and Volatilization of the Chyle Which sort of Atrophy may justly be reckoned one of the Fatal Symptoms of the Scurvy An Atrophy from Inanition or an Expense of the Humours Of an Atrophy from Evacuations is that which derives its Original from a preternatural Defect or Evacuation of the Nutritious Juice and that long and habitual which differs according to the variety of the passages formed in the Body either by Nature or Art by which this precious Liquor either has or may run off and be wasted A Consumption of the Lungs is an Universal wasting of the Parts of the Body Of an Original Consumption of the Lungs caused by some Distemper of the Lungs as a stuffing swellings inflammation and exulceration of them and thereupon it is attended with a Cough difficulty of Breathing and other Symptoms of the Breast and accompanied with a Fever which at first is slow and Hectical afterwards Inflammatory and at last Putrid and Intermitting A Symptomatical Consumption is that Of a Symptomatical Consumption which although it does immediately proceed from a Preternatural and ill state of the Blood and Spirits yet has a mediate dependance upon some other preceding Diseases which had given that ill Tincture to the Spirits and Humours And because it is necessary if we would be successful in the Cure of this kind of Consumption to have a respect to the Disease which the Patient first laboured under I shall in the end of this Treatise speak of all the several kinds of this Consumption which I have hitherto had an Opportunity to observe in my Practice but I shall begin and discourse first of an Original Consumption CHAP. I. Of a Nervous Consumption A Nervous Atrophy or Consumption is a wasting of the Body without any remarkable Fever Cough or shortness of Breath but it is attended with a want of Appetite and a bad Digestion upon which there follows a Languishing Weakness of Nature and a falling away of the Flesh every day more and more A Nervous Consumption that which Virginians are most incident to Which kind of Consumption I have sometimes observed in England but most frequently amongst those that have lived in Virginia after they have come over hither In the beginning of this Disease the state of the Body appears oedematous and blouted and as it were stufft with dispirited Chyle the Face is pale and squalid the Stomack loaths every thing but Liquids the strength of the Patient declines at that rate that before the fleshy Parts of the Body are evidently consum'd he is render'd plainly feeble and almost always confin'd to his Bed The Urine also keeps not constant to any colour though for the most part it be high-colour'd and but little in quantity Yet it is sometimes as it happens commonly to be in Nervous Distempers though seldom pale and plentiful But there is no considerable Fever to be discovered either by the Pulse or a Thirst or Heat how high-colour'd soever the Urine appears So that the Pathognomonick Signs or those which do evidently manifest the beginning of this Consumption are a decrease of the Patient's Strength and a loss of Appetite without any remarkable Fever Cough or shortness of Breath though in the Progress of the Distemper when a Consumption of the Flesh has gradually affected the whole Habit of the Body there is some difficulty and trouble in breathing to be observed as it uses to happen to all those who are under a great Weakness The immediate cause of this Distemper I apprehend to be in the System of the Nerves proceeding from a Preternatural state of the Animal Spirits The Causes and the destruction of the Tone of the Nerves whereupon I have used to call this a Consumption in the Habit of the Body For as the Appetite and Concoction are overthrown by the weak and infirm
Tonsils and Palate of her Mouth and the Parts which serve for swallowing the same that I observed to happen to Mrs. Thompson and to almost all Women that have a Consumption from giving of Suck Which appearance to me seemed to arise from the impoverisht and heated state of the Blood by reason of too great an expence of the Milk At length though too late following my Advice she weaned her Child and made use of a Milk Diet and the Chalybeate Waters with very much benefit But her Appetite not being restored by these means as not being made use of in time she could not make up a sufficient quantity of new Chyle to recruit the Mass of Blood and thereupon loathing all sorts of Medicines at length though she had the Advice of very good Physicians falling into a Consumption of her Lungs with a Cough shortness of Breath and Hectick Fever she dyed plainly choak'd CHAP. VII Of a Consumption from a Bloody-flux and from a Looseness MANY times in a Scorbutical Disposition of the Body A sharpness of the Blood often arises from the Scurvy the Blood grows sharp to that degree that being disturbed upon every little occasion it cannot assimilate the new Chyle to it self whereby it comes to pass that it is thrown out by the Glands of the Intestines in a continual flux like a stream Which Chyle if it is benign and more mild Which in a lower degree causes a Looseness In a higher a Bloody-flux forms a Distemper in the manner of a Looseness but if it be sharp and of a Malignant Nature produces one in the form of a Bloody-flux By this continual efflux of the Chyle the Blood is much impoverisht and grows hot so that although the Bloody-flux or Looseness be overcome by the use of Opiates and binding Medicines such as are particularly to be described in a Chapter of a Bloody-flux Which cause a Hectick heat c. and Looseness yet a Hectical heat still remains in the Blood together with an Atrophy and dryness of the Skin arising from the impoverisht and dispirited state of the Blood As it happened to mine only and most beloved Son and to very many others And this Consumption often terminates in a Consumption of the Lungs Which Consumption does very often terminate in a Consumption of the Lungs But the way to prevent it is after the Looseness and Bloody-flux are cured by proper Medicines by a long use of a Milk Diet the Peruvian Bark the Mineral Waters which are Chalybeate and of the white Decoction for ordinary Drink It often happens to Childrâ—n 〈…〉 of their Teeâ—â— This Consumption often happens to Children that breed their Teeth But by the long use of the white Drink of Pearl Juleps and binding Medicines mixt with some little Opiate it is easily cured History 1. Mr. Tindal's only Daughter a very fine Young Woman but Scorbutical and something Melancholick about Eighteen Years of Age upon the suppression of her Monthly Courses fell into a Colliquative Looseness with Stools that came away like Water which by degrees brought her in the space of a Year into an Universal Atrophy even to the degree of a Marasmus but without any sensible Fever or Cough or shortness of Breath or any other sign of any Distemper of the Lungs so that she was not at all taken for a Consumptive Body by the Physician under whose care she was before I was concern'd Being called to go and see her as one that had only a Looseness when she was now by reason of her Weakness almost always confin'd to her Bed I found her worn away clearly with a Consumption even to a Marasmus and that I plainly told her Friends as my Opinion although her Lungs did as yet seem sound neither was there any sign of a Hectick Fever But when this expensive Looseness which the former Physician for want either of skill or care had suffered to run on so long came once to be stopt by a due government and the use of Efficacious Medicines presently a Hectick Flame began to be kindled in the Habit of her Body and her Lungs also began to be affected with a Cough that was almost perpetual and a shortness of Breath which Symptoms being at length followed by Colliquative Sweats a swelling of the Legs and other signs of a Fatal Consumption of the Lungs soon brought the fair Virgin amidst the Lamentation of her Friends to the last period of her Life Two things were here particularly worthy of a Remark First that the more her Looseness was stopt so much the more always were her Lungs presently affected And Secondly that although this Consumption had prevailed upon her almost for the space of a Year even to a Marasmus before the Lungs did seem to be in the least touch'd yet in the Body when it came to be opened after 't was dead the Lungs appeared full of little swellings here and there and that not only such as were crude and hard but also some that were ripened into Apostemes History 2. My only Son before he was Eight Years old whilst I was out of Town was taken with a most severe Bloody-flux by which he seemed to be brought into a Consumption even to a Marasmus before I returned But after the Bloody-flux was plainly overcome by the diligent use of all sorts of convenient Remedies and his Body with respect to his Stools was reduced to its Natural state there still remained a Hectical heat a dryness of his Skin a quick Pulse with other signs of a Hectical heat Moreover his Appetite failed him very much a dry Cough came upon him and a thickness of Hearing with a dulness of his Brain But yet with the choice of a wholsom Air the use of a Milk Diet and afterwards of the Peruvian Bark and of a Plentiful Nourishment which afforded a good Juice he recovered a good Colour and his Flesh within the space of three or four Months without any other inconvenience but only that he has been ever since very subject to an Asthmatical Cough upon the least occasion CHAP. VIII Of a Consumption from a Diabetes or too great a Flux of Vrine A Diabetes is commonly called a Dropsie of the Chamber-pot What a Diabetes is and it is a continual Flux of the Nutritious Juice running down through the Kidneys The Causes of it which for the most part happens to those that are very thoughtful and to such as are drinkers of French Wines and Diuretick Liquors Whereupon the Urine by reason of the great quantity of new Chyle which flows to it and mixes it self with it being deprived of its Saltness becomes sweet even like Honey A Diabetes causing a poorness of the Blood and a Hectical heat produces a Consumption By this continual efflux of the Chyle the Blood is impoverisht and thereupon the Strength of the Patient grows extreamly languid By the burning Flame of the Blood a Preternatural Heat is kindled in the
compressure are at length broken This Distemper is very hard to be cured neither indeed is there any possibility of doing it without healing and closing the Breaches in the Lympheducts or Lacteal Vessels and consequently taking down the swelling of the Glands which causes the rupture of the small Vessels by compressing them The Indications of Cure Therefore in this case the Indications of Cure are these which follow 1. To evacuate the extravasated Humours First to bring down and evacuate that load of the Nutritious Juice that is extravasated with Cathartick Medicines that purge off Water as Rosin of Jalap Gum Gottae and others of that sort which are more particularly to be specified in the Chapter of a Dropsie as also by Diureticks as Salt of Amber Wood-Lice c. 2. To open the Obstructions Secondly to open the Obstructions of the swell'd Glands and to dissolve their swellings which cause the Obstruction of the Chyle and upon that to restore and strengthen the Tone of the Parts that were swell'd by a long continued use of Chalybeates Which being done the Sick Person must be plentifully Nourisht with Food that affords good Juice and at length be sent into a free and benign Air and drink the Chalybeate Waters not only for the farther temperating of the heat and sharpness of the Blood but also in order to the perfect opening of the Obstructions of the Glands But in this case we must carefully abstain from a Milk Diet because it does stuff the Glands that are already obstructed more and consequently promote the cause which disposes the Patient to this Distemper A History The Son of Thomas Lechmere Esq being about two Years and breeding of his Teeth fell into an Inflammation of his Lungs upon taking of cold and was treated very ill by an Apothecary who had omitted Bleeding and other things that were very requisite to a true and skilful Method of Cure But at length I and my Famous Colleague Dr. Croen though we were called in late recovered him in some measure by taking away some Blood and the application of Blisters and Liniments that were convenient for his Breast as also by giving inwardly such Medicines as were proper for his Lungs But yet he continued sickly with a Cough and difficulty of Breathing for the space of a Twelve Month at least from which time the poor Child began to be seized with a Hectick Fever which intermitted every day which although it was several times taken off with the Peruvian Bark yet soon return'd again and indeed came upon him by uncertain intervals for a whole Year even to his dying day But at the very beginning of the Fever his Belly began to be distended with a Dropsical swelling which increased strangely every day his Cough and shortness of Breath at the same time growing worse All which Symptoms were at length accompanied with an Atrophy of the Parts even to the degree of a Marasmus But yet when his Body was a perfect Skeleton and the Dropsie at a high Tide which was very remarkable he had a brisk and healthful look and a lovely Countenance without the least Tincture of a Yellowness and a good or rather greedy Appetite and that to the very day he dyed From whence I did rightly conjecture and always told his Friends as my Opinion that his Dropsie was truly Chylous caused by the Chyle flowing into the cavity of the Belly by the Lacteal Vessels which were broke by some Accident and that the Consumption which accompanied it was not a true Consumption of the Lungs but such as proceeded merely from an inanition that is the draining of the due Nutritious Juice out of the Lacteal Vessels upon some rupture that had been made in them which appeared very plainly from the Event For in Tapping of the Child's Belly whilst he was yet alive we took out several Pints of Milky Chyle and very sweet such as is found in the Duct it self which conveys the Chyle But when we opened the Body after he was dead we found for all the difficulty of Breathing and long Cough he had had the Lungs themselves sound without any Distemper but only that in the hinder part near the Wind-Pipe there appeared a great many Glands and those pretty large and hard which made a hard and very considerable pressure upon the Chyle-duct it self almost in that Part where it arrives at the Subclavian Vein and they were of so great a weight and bulk that it seemed very difficult if not plainly impossible for the Chyle to pass into the Blood by reason of the pressure they had made upon the Duct which had straightned it as if it had been tied with a string And thereupon without doubt it came to pass that the tender and thin Lacteal Vessels which are in the Belly the Chyle continually pressing and not finding a free passage above by the Chyle-duct being distended beyond their Tone did at length break and so threw the Chyle which was design'd for the reparation of the Blood as it were in a continued stream into the cavity of the Belly From what I have now said it is plain almost to a demonstration first that these Tubercles or tumify'd Glands of the Lungs did at first proceed from the ill Method of Curing the Inflammation of his Lungs that is for want of timely Bleeding and Expectoration Secondly that as the troublesome and dry Cough was caused by the constriction of the Vessels of the Lungs which convey the Air by these swellings so the difficulty of Breathing proceeded from the pressure of the extravasated Chyle below the Midriff Thirdly that this Consumption was not a true Consumption of the Lungs because tho' there were Tubercles or Swellings in the Lungs yet they were not like Apostemes nor Ulcerated But this desperate Consumption did really proceed from that Chylous Dropsie upon which that Nutritious Juice which ought to have been employ'd for the reparation of the Blood and the Nutrition of the Parts was continually substracted and carried another way Fourthly that this Dropsie did proceed from a rupture of the small Lacteal Vessels that are in the Belly and lastly that this rupture of the small Lacteal Vessels was caused by that continual pressure which the swellings in the Lungs had made upon the upper part of the Chyle-duct CHAP. XI Of a Consumption caused by profuse Sweats Profuse and long sweats often turn Colliquative SUch Sweats as are profuse and last long do very often become colliquative that is they carry off a great quantity of the Nutritious Particles as if they were melted and more fluid than ordinary For by these Sweats not only the load of old dispirited and unprofitable Chyle but also a great quantity of that Chyle which is fresh and Oily is readily cast out by the pores of the Skin by reason the Blood cannot assimilate it from its own too great and Scorbutical sharpness which it had contracted by degrees From whence it comes
and Chronical it may be because strictly speaking the Part affected or seat and source of both Distempers are not the same The beginning is known by a Cough different from an ordinary Cough For a Consumptive Cough proceeds from a Glandulous Swelling or Tubercle of the Lungs themselves and that with the sense as it were of some heavy weight in the Breast as also a difficulty of Breathing and other Symptoms of the same Nature which I shall by and by particularly though briefly run thorough But on the contrary a simple Catarrh owes its Original from a distillation of Rheum cast out as it were in continual drops by the Uvula and Almonds and the other Glands seated in the upper part of the Wind-pipe yea and by all the glandulous Coat of the Wind-pipe it self For the Wind-pipe by a certain Providence of Nature is covered on the inside with a Nervous Membrane that has a very exquisite sense which will by no means admit of any thing but the Air it self no not a drop of the clearest Water without grievous trouble and opposition and therefore when it is tickled by the going down but of the least disagreeable Particle it presently endeavours with all its might to throw it up again by Coughing And indeed Nature has made this Provision for very great Reasons For if a free and quiet passage were every day allowed but to the smallest Body or Particles that are heterogeneous how soon would there be an end of Man's Life by the stuffing of the small branches of the Wind-pipe which by reason of the straightness of the passages use sometimes to be stufft and Asthmatically stopt even by the Air it self when it is thicker than ordinary But how fierce soever and continual this Catarrhous Cough is as being provok'd by a tickling from a continual Excretion and Distillation of Rheum from the Glands in the Wind-pipe yet as it is always at the beginning moist and joyned with a great flux of Humours so likewise it is accompanied with no weight or oppression of the Lungs or shortness of Breath which for the most part are obvious to our Observation in a Consumptive Cough and that in the very beginning Therefore this I make to be the first distinguishing sign of a Consumptive Cough to wit This dry Cough from Tuberâ—lâ—s of the Lungs that it is dry at least in the beginning because it proceeds from a swelling of the Lungs rather than from any thin Rheum owzing out of the Internal Membrane of the Wind-pipe and the Glandules seated in the upper part of it Yet it cannot be denyed but these Patients in the beginning of this Distemper Yet these Patients spit a great deal of thin Rheum whenever the Lungs happen to be violently moved by an extream and deep Cough so as to make them Vomit either after eating or from any other Accident I say these Patients do throw out a great plenty of thin clear Spittle from the Salivatory Ducts and likewise hawk up from the Tonsils some Glutinous Phlegm that is sometimes salt sometimes insipid which may happen also to those that are well sometimes from the same cause to wit by reason the Salivatory Ducts and Glandulous Parts seated in the Throat are squeez'd and as it were milkt by this violent motion But yet it is a dry Cough But nevertheless this Cough is to be reckoned a dry one because there is no Rheum or Phlegm thrown out of the Wind-pipe or the branches of it And it is as true that this dry Cough uses sometimes to turn to a Catarrhous Cough and such as is attended with a flux of Rheum as the Wind-pipe and the branches of it supply a continual flux of Humour which is sometimes crude sometimes in the form of concocted Phlegm as it uses to be in a true and genuine Catarrh Which comes to pass from hence because the Glandulous Coat of the Wind-pipe it self and the branches of it being irritated by this long and violent motion of the Lungs in the Nature of a dry Cough caused by the Swellings dispersed here and there through their whole substance is continually emptied of its Liquor as if it were milkt and thereupon does throw out daily an abundance of Serum or Water almost in the same manner as Milk is fetcht out of the Breasts and Spittle from the Salivatory Ducts by drawing them in a manner continually or as an involuntary flux of the Seed in a simple Gonorrhoea proceeds from the Glandulous seminal Parts by frequent fribling How it may be distinguisht from a true Catarrh But yet this Consumptive Cough when it is attended with a Catarrh may be distinguisht from a genuine Catarrh especially two ways First in that a Consumptive Cough is from the very beginning dry for some Months and sometimes it may be for some Years whereas a simple Catarrh is at first humorose as I said before Secondly in that a simple Catarrh goes off in a few Days at most in a few Weeks to wit so soon as ever that accidental Feverish Ferment occasioned by taking of cold does by degrees once cease to put the Mass of Blood any longer into an extraordinary motion Which being once done the Glandulous Coat of the Wind-pipe does no more separate or spew out any Humour but what it does Naturally From whence it comes to pass that what remains of that Rheum which is separated by these Glands being no longer attenuated with a new flux of the Humours is by degrees concocted by the Natural heat of the parts into a Phlegm that resembles purulent Matter and is cough'd up in that form and thereupon the Serum or Humour being thrown out when it is first separated the Glandules quickly recover their Natural Tone without any hard Swelling or Tubercle remaining By which means it also comes to pass that the Cough together with the tickling wheesing shortness of Breath c. cease of their own accord But on the contrary in a Consumptive Cough as the lasting and inexhausted Fountain does supply a distempered Humour to the Glandulous Parts from the Mass of Blood predispos'd by a long abuse of those six things which we call not Natural and put continually into an inordinate motion by a Feverish Ferment habitually fixed in it So from the Swellings dispersed here and there through the substance of the Lungs and compressing the branches of the Wind-pipe not without some trouble the Wind-pipe it self is provok'd to cough by a certain continual tickling And this causes as continual a spewing out of a sharp and distemper'd Humour all along the inside of the Wind-pipe until at length those Tubercles growing very large begin to be inflam'd and to turn to Apostemes Whereupon as soon as any one of the Bags or Cavities which contain the Matter breaks there is plainly in coughing if there be a passage for it a true and stinking Corruption thrown out from these ulcerated Swellings mixt with some thin Humour or Phlegm
sometimes from the thickness and glutinous quality of the Lymphatick Juice that is separated in the Glandules from whence it comes to pass that it is not easily driven on nor thrown out by the very small and straight pore or passage of the Glandule And this is wont to happen to those that have the Kings-Evil swellings and such as have the Scurvy by reason of the great quantity of fixt Salt which their Blood has too much of From whence it comes to pass that Persons so distemper'd are more subject than other People to fixt and cold Swellings and those in the Lungs as well as in other parts of the Body and sometimes they dye of a very Chronical or lingring Consumption Sometimes also there is so great a quantity of Humour separated in the Glandules from a violent and great Catarrh that the excerning Faculty or Power by which the Part empties it self is plainly unable to throw it out From whence it comes to pass that the way by which new Serum should flow into it being stopt the Water which is then retain'd within the Glandules and stagnates there does by the Natural heat of the Part gradually turn to a dryer Matter and so into a substance that looks like Honey or is of the Nature of a Suet until the Tone of the Part being at length perfectly overthrown by being too much distended there follows an Inflammation and an Apostem upon it And for this reason a Consumption of the Lungs does often succeed to a Catarrh it self when a dry and hesky Cough comes in the room of that which was Catarrhous Which dry Cough is caused by a Tubercle or Glandulous Swelling occasioned by a Catarrh upon taking of Cold. Moreover it is easie to observe that a dry Cough The ill Cure of a Pleurisy c. sometimes occasions them and a very Acute Consumption do often come from an Inflammation of the Lungs a Pleurisy or some other Disease of the Lungs to wit because either through the neglect of the Physician or the timorousness of the Patient's Friends such timely or frequent or such plentiful Bleeding as is necessary to answer to the greatness of the Inflammation is omitted From whence it comes to pass that the Tone of the Parts especially those that are Glandulous being destroyed are never able to recover their Natural state again but here and there in those places where the Inflammation has before for some time prevailed there are hard Tubercles to be found dispersed up and down together with a dry Cough and a continual Hectick Fever from whence such Patients being once seized with a very Acute Consumption dye within a few Weeks for the Lungs having been before inflamed do very quickly Apostemate which brings on the last Scene of this Distemper with all the usual and fatal Symptoms accompanying it There is another Error in the Cure of this kind of Distemper no less fatal and that is Sometimes from the want of Pectoral Medicines when the necessary clearing of the Lungs from the Phlegm with which the Glandulous Parts especially are stufft is plainly omitted for want of using Pulmonary and Expectorating Medicines or when these Remedies are administred with too sparing a hand And much more Or from the unseasonable use of Opiates when that plenty of Lymphatick Juice which is separated in the Glandules is kept lockt up there by the unseasonable and indeed fatal use of Opium given in order to ease the pain From whence it comes to pass that although the Patient be delivered from the danger of the present Distemper which yet is very seldom the effect of it yet by those Tubercles or Glandulous Swellings which are left by this Method a ready way is made to a Fatal and Acute Consumption Which shews it self first by a Cough shortness of Breath and a Hectick Fever but afterwards does quickly bring on all the direful and fatal Symptoms of this Disease The most usual couse is some Spasmodick contraction of the Lungs But the most usual cause of these Tubercles is some little Spasmodick or Convulsive Contraction of the Lungs that is long and continual with the sense of a weight and oppression caused by Grief Fear Cares too much Thinking and other such-like Passions of the Mind For as the soft substance of the Lungs when they are contracted so long and continually comprest or squeez'd together is wont to grow hard of its own accord so likewise the Glandulous Parts of them being once deprived of their usual expansion are not able to throw or spew out be sure in a sufficient quantity that Lymphatick Liquor which was separated in them Wherefore no body has any reason to wonder that as a stuffing of their whole substance so likewise a hardness in the Glands themselves that resists a pressure follows upon it And thereupon it is easie to observe that as Hypochondriacal and Hysterical Persons are more subject than other People to a Consumption though it be a Chronical and lingring one so likewise that Distemper seizes them for the most part from the occasion of some Misfortune which thing does first cause Fear Grief Thoughtfulness or some other grievous Passions of the Mind and that long and fixt Secondly A Consumptive Cough 2. A Consumptive Cough is moderate in the day time in the very beginning as it is for the most part dry so in the beginning of the Distemper at least in the day-time it is mild and without any very great and vehement irritation and often returns by long and uncertain intervals But a Catarrh is in the very beginning fierce and almost continual It must indeed be confest that both Coughs are violent and troublesome enough in the night-time to wit a Catarrhous Cough because all separation of the soul Serum by the glandulous Coat of the Wind-pipe and its branches is more plentiful at the time of lying down in our Beds but a Consumptive Cough because the Lungs are more constring'd and straightned in this posture of the Body Whereupon as the branches of the Wind-pipe being more comprest by the glandulous Swellings have upon this occasion more trouble from their compression So likewise there is a greater quantity of glandulous Liquor at such a time prest out of the Glands into the branches of the Wind-pipe by which the Lungs are more stufft and thereupon are likewise more provoked to cough And from this continual motion of the Lungs caused by the Cough proceed those pertinacious Watchings which contribute more than a little to the increase of the Fever which at first depended upon the Colliquative and Tumultuos state of the Blood Though I have sometimes observed especially in Consumptive Persons that have been Hypochondriacal long and troublesome Watchings without any Cough especially after their first sleep 3. A Vomiting after eating discovers a Consumptive Cough Thirdly as there is almost always a want of Appetite and a Thirstiness accompanying a Consumptive Cough so likewise a Vomiting
two Scruples of London Laudanum one Grain mix and make them up into four Pills to be gilt which must be repeated every third Night for three times Yea if the flux of Rheum be violent An Opiate must be given every Night conditionally and a shortness of Breath or weight or straightness of the Breast does not follow upon the use of them some Opiate must be given every Night because it may not only procure sleep and so hinder the Effervescence of the Humours and Blood but also by stopping a new influx of the Humours into the Lungs may promote the Incrassation Concoction and Expectoration of those Humours which are already lodged there So that I can from Experience confidently affirm that although Opiates are for the most part of some use in the whole course of the Cure of a Consumption yet they are more safe beneficial and necessary in the beginning and without the use of them no great matter can be done in preventing the progress of this Distemper Fourthly Diaphoreticks are very useful in this state of the Disease Diaphoretick Medicines are likewise very profitable because they plentifully carry off the Serum which is continually colliquated from the Blood by the Pores of the Skin whereby it comes to pass that the flux of it into the Lungs being lessened that which was fixed there before is more easily concocted But yet in the use of Sudorifick Medicines we must diligently observe these following Rules But in the use of them 1. An Opiate must be always mixt with them 1. That Diaphoretick Medicines have always something of an Opiate in them lest by a new Colliquation caused in the Mass of Blood by them a fresh stream of colliquated Serum by the Lungs as well as the Pores of the Skin should be produced and the Cough too thereupon should be increased Which I have always observed to happen from the imprudent use of Diaphoreticks that have been given by Women and Quacks in this case without mixing an Opiate with them But now with a convenient quantity of Laudanum mixt with a Diaphoretick the Lungs are quiet so long as the Sweat lasts Whereby it comes to pass that the stream of the Lympha of the Blood is turned from the Lungs by the Pores of the Skin with great benefit the Cough is then easie and the Serum that is lodged in the Lungs is concocted 2. We choose such as are least hot 2. We must choose such Diaphoreticks as have the least heat such as may cause the least Effervescence or new Commotion in the Blood that the old load of Humours that had been collected before may be evacuated by the Pores of the Skin without breeding more of them by a new Effervescence 3. We must not give them before convenient Evacuations by bleeding c. 3. We must never give Diaphoretick Medicines before the use of Bleeding Vomits and Purges whenever these are necessary For I have always observed a new Colliquation to arise from a Commotion of the Blood that has been made before the Vessels have been emptied together with an increase of the Cough and other Symptoms that depend upon it yea and sometimes with new Accidents of a spitting of Blood of Rheumatick and Pleuritick Pains and other dreadful Symptoms The Diaphoretick Medicines that I commonly use are these which follow Take of Venice-Treacle half a Dram or two Scruples of Old Conserve of Red Roses half a Dram mix them for a Bolus Or Take Diascordium Conserve of Wood-Sorrel of each a Dram. Mix them together Or Take of Matthew's Pills fifteen Grains make them into two Pills to be gilt and taken when the Patient should go to sleep Or Take of the Cynogloss Pill twelve Grains of Antimonium Diaphoreticum a Scruple of the Tincture of Saffron a sufficient quantity Make them into four Pills to be gilt The most seasonable time to give these Diaphoreticks is at Night What is the best time to give Diaphoreticks and that presently after an Evacuation by Bleeding Purging or Vomiting because they procure sleep The Patient also must be freed from his Sweats with a great deal of care lest by the Pores being suddenly stopt in this colliquated state of the Blood he should take new Cold and thereupon the Cough and other Symptoms should be increased During the use of these kind of Evacuations Whilst these Evacuations are making there are other things to be done the Application of Vesicatories to the Arms and between the Shoulders is very beneficial for diverting the violent flux of the Humours from the Lungs But when we are making these Evacuations which are very useful for lessening the colliquated Serum of the Blood and so for the Concoction of the Humours that are already lodged in the Lungs we must not by any means neglect the frequent use of those Medicines which are commonly called Pectoral or Pulmonary Pectoral Medicines must be given plentifully which in the time between Evacuations must be given very plentifully as it were in the manner of a Diet but always in such a form as is most grateful to the Patient For there must always be a peculiar respect had to the Stomack which in this Distemper is commonly affected with a Sickness want of Appetite and Vomiting lest being offended with the form and tired with the great quantity of them it should be used to a Habit of nauseating and throw up not only the Medicines but also the most grateful Food The best Medicines in the beginning of this Distemper are such as are Incrassating and Lubricating What of this fort are best in the beginning which by softning the Serum of the Blood conduce very much not only to the allaying of the Cough but likewise to the Concoction and Expectoration of the Humours that cause the Cough But these Incrassating and Expectorating Medicines may be given sometimes separately but for the most part mixt together in a compound form that we may answer both Indications at once So for Incrassating Medicines let the Patient be enjoyn'd the frequent use of Sugar-candy Saccharum Penidiatum and Sugar of Roses as also Old Conserve of Red Roses Juice of Liquorice the black Lozenges for a Cough which must be often and gently swallowed down that they may retund the Acrimony of the Humours that ouze out by the Wind-pipe by their soft mucilaginous and incrassating quality and so mitigate the troublesome Cough For Lubricating Medicines let the Patient plentifully use New Butter that has not been salted in all his Spoon-meat Butter'd-Ale and if he bears it well common Sweet Oyl or rather Oyl of Sweet Almonds but especially Linseed-Oyl fresh drawn without Fire of which let him take a Spoonful every hour unless there be a Looseness or some other Symptom that forbids it Let him also chew Raisins of the Sun Figgs c. But the Medicines compounded of Lubricating and Incrassating Ingredients and which satisfie both Indications now mentioned are those which
Negligence of the Physician when timely and plentiful Bleedings which are not only necessary to relieve the Pain but also absolutely requisite from the degree and exigence of the Fever and the Inflammatory disposition of the Blood are wholly omitted For in this case there still remains a Hectick Heat in the Habit of the Patient which disposes him to a sudden Consumption after a due Concoction and Expectoration of the Matter which was gathered in the Lungs The second Reason want of due Expectoration Secondly When the Matter that is gathered in the Lungs is not at all concocted and expectorated or not in a sufficient quantity or at least not so soon as it ought to be And this is wont to come to pass from several causes As first when the parts of the Lungs that are inflamed are the Vesicles or Air-Glands and thereupon the Matter that is lodged in them though it be concocted as it should be yet being contained in its proper Cystises does not find a passage out notwithstanding the most diligent use of Expectorating Medicines For though there is a greater quantity of purulent Matter concocted and gathered in the Glandules with the use of those things and thereupon there follows an Aposteme of a great bigness Which occasions an Aposteme yet because the Matter does not find an immediate Vent no Expectoration succeeds and so the Lungs are not able to clear themselves whereby it comes to pass that after the Aposteme is broke there remains a foul Ulcer in the Lungs proportionate to the largeness of the Aposteme And upon this breaking of the Aposteme the Matter that is contained in it Which when it brea kt empties itself either outwardly is wont to empty it self either outwardly or inwardly according to the Situation of the suppurated part For if the affected Glandules are placed near the branches of the Wind-pipe when the Cystis is broke the Matter easily finds a vent into the Wind-pipe And many times the Patient is suddenly strangled or ready to be choaked with the violent gushing out of the Matter And sometimes the Patient is suddenly choaked flowing out all together this way Which I sometime since found in Mr. White 's Son whose case I shall give an Account of in the end of this Chapter But if these Glandules are placed at that distance Or inwardly that the Matter cannot find a passage into the branches of the Wind-pipe it self those parts do in progress of time swell to a great bigness whereupon at length when the Cystis breaks the Matter diffusing it self every where through the whole substance of the Lungs does perfectly destroy their Tone Yea sometimes I have observed the Lungs to be so much distended with it that partly from their distention and partly from the Acrimony of the Matter that has insinuated it self into them the outward Membrane which invests the Lungs being once broken or eroded the matter has fallen continually and plentifully out of the Lungs into the Cavity of the Breast And thereupon in the dead Body when it has been opened though we found an Ulcer only in the upper part of the Lungs and the Tone of the Lungs every where corrupted with the Matter passing through them yet we met with several Pints of purulent Matter which was faln into the Cavity of the Breast through the broken Membrane after the manner of an Empyema And from hence it came to pass that when the Physician had done all he could in prescribing and the Patient had been as diligent in the taking of Expectorating Medicines yet we did no good with them The Expectoration is hindred by very profuse and unseasonable Bleedings Secondly When with unseasonable and very profuse Bleedings the Blood is grown so cold that the suppuration of the inflamed part is either hindred or at least comes to be late For every one that understands any thing of Surgery or Physick knows that Bleeding causes a suppuration to be slower than otherwise it would be And that famous Aphorism of Hippocrates is no less true That unless those that have a Pleurisy do expectorate in fourteen days if they live so long they will be Empyical upon the fortieth day so great a quantity of true Matter being in that space of time collected in the Lungs that by reason of the quantity and Acrimony of it it is apt to make its way through the broken and eroded Membrane of the Lungs into the very Cavity of the Breast From the want of Pectoral Medicines Thirdly this also sometimes happens through the carelesness of the Physician or else the perverseness of the Patient from the neglect of the use of Expectorating Medicines in the beginning of a Pleurisy and Peripneumony Fourthly in fine this often happens to Infants for want of Understanding because they have not wit enough to raise and spit out the Purulent Phlegm which is lodged in their Lungs This Consumption is always very Acute This Consumption is always Acute because it proceeds from an Acute Distemper preceding by which not only the Patient has been very much weakned but likewise the Mass of Blood has been left in a Colliquative state yea and very often there has happened to be a Collection of Matter made in the Lungs So that this Consumption has scarcely gone by the Name of a Consumption before the Patient has arrived plainly to the state of a Marasmus The Cure of this Consumption when 't is from a Colliquative state of the Blood If this Consumption has had its beginning from a Colliquative and too hot a state of the Blood caused by the preceding Distempers we must not only continue the use of Expectorating and other Antiphthisical Medicines which yet must be of those that are more mild and not very hot but we ought also to prescribe Temperate Pearl Juleps to be taken plentifully to temper the heat of the Blood as also Milk-water Snail-water yea and the Chalybeate Waters if it be a time of the Year proper for the use of them but above all we must have recourse to Bleeding however the Patient is weakned and his Body brought into a Tabid state by his former Distemper and that not once only but frequently and we must repeat it too if it be necessary not with too sparing a Hand But if this Consumption proceeds from the breaking of the Glandulous Aposteme emptying it self by the Wind-pipe The Cure when 't is from the breaking of an Aposteme we must promote the Purgation of the Lungs by this High-way with the plentiful use of Expectorating Medicines And if there is any fear that the Patient will be choak'd after the first breaking of the Abscess with the Matter rushing too fast and in too great a quantity into the branches of the Wind-pipe which I remember happened to Mr. White 's Son and to some others we must hasten the Expectoration by giving Oxymel of Squills and other gentle Vomits and then provoking
beyond the Sphere of Surgery And not to be cured without healing the Original Vlcer And indeed to Cure this Consumption perfectly without healing of the Ulcers from from which it takes its Original is the same thing as to take away an Effect whilst the Cause of that Effect remains It is true indeed that so often as these Ulcers happen to be small and benign and are likewise placed in the Kidneys Bladder Testicles Ovaries the Vagina Uteri or in other Membranous Parts and Entrails that are more remote from the Heart as the Ulcers themselves which here assume the Nature of a Cause do sometimes admit of a perfect Cure so likewise the Pulmonary Consumption it self which depends upon them may as well be cured But this Consumption whether it be capable of a Cure or not does nevertheless almost always assume the Nature of a Chronical Disease in some measure And from hence I have found some of this sort of Patients for several Months When this Consumption is Chronical yea and sometimâ— several Years languishing with a Consumption pining away by degrees and dissolv'd by Colliquations but especially when the source of the Disease has been in one of the Kidneys the Bladder or Vagina Uteri that have been ulcerated A Consumption proceeding from an Ulcer of the Ovaries in Women or the Testicles in Men I have observed to have been of a middle Nature but for the most part to carry off the Patient within the space of a Year But that which arises from an Exulceration of the Womb it self When Acute the Stomack Liver or other Entrails or Membranous Parts of the greatest note I have observed to put an end to the Patient's Life in the space of a very few Months or even Weeks after the manner of a very Acute Consumption because it has been immediately attended first with an extraordinary Inflammatory Fever and after that with a Putrid Intermitting Fever and an universal Colliquation together with a want of Rest Light-headedness Spasms and other direful Symptoms of the Nerves But yet by reason of the sudden Destruction brought on from the Nature of the Original Disease I have found by inspecting into Bodies after they have been dead that the Lungs have not been so much affected as they used to be in other Consumptions that are more Chronical to wit where by reason that the Original Distemper has suffered the Patient to live long enough the Lungs have happen'd not only to be stufft but likewise to have Tubercles bred in them and those Tubercles at length have happen'd to turn to Apostems But generally speaking The more Acute it is the harder to Cure as every Consumption of this kind is very hard to Cure so it is so much the harder as it is more Acute because it has its Original from more considerable Ulcers Neither indeed does it ever admit of a perfect Cure without the healing of the Ulcers whatever they are and in whatsoever Entrail or Membranous Part those Ulcers are bred which gave the first occasion to this Disease From what I have now said it is plain enough even to Reason what are the Indications of Cure in this kind of Consumptions which likewise the happy Success of our Practice is wont daily to present to our very sight that is whenever the Distemper does in its own Nature admit of a Cure The Indications of Cure And they must respect the Original Disease as well as the Lungs themselves first by promoting as much as we can the healing of the Ulcers in what part soever of the Body they have been bred with the plentiful use of Balsamick and Vulnerary Medicines which indeed ought to be of the milder sort lest by increasing the Feverish Flame that is already kindled in the Blood they should do more hurt than good Secondly by taking timely care of the Lungs with the use of Pulmonary Remedies to wit Opiate and Expectorating Medicines given alternately by which the mischief which they have got may be taken off or at least as little as may be promoted by the Original Distemper Thirdly by mixing always with the Pectoral and Balsamick Medicines those things which may restore and confirm the Tone of the Part which was first of all affected and which have a particular respect to it as Uterines Hepaticks Diureticks and other such-like Medicines as the case may require Fourthly by tempering the Hectick heat which is already kindled in the Blood and Spirits with a strict Milk Diet the Chalybeate Mineral Waters Vulnerary Decoctions of Sarsa Lime-water and other things of the like Nature so far as the present state of the Patient can bear them as also by taking off the Putrid Intermitting Fever with the plentiful use of the Peruvian Bark and with repeating of it often enough at due intervals And lastly by relieving with the most diligent application the most urgent Symptoms and those which weaken the Patient most whether they arise from the Original Ulcer or from the Lungs As for Example The Method of Cure If the Original Ulcer is so benign and small that there appear any hopes of a perfect Cure and it has not continued so long that the Patient is brought very weak with it and if it is not seated in so Noble a Part as to make us fear the sudden destruction of the Person from an Acute Consumption it is plainly convenient in the very beginning of the Cure to endeavour the healing of the Original Ulcer by giving Calomelanos plentifully and that not only mixt with Purges and therefore at due intervals but likewise by it self in Doses repeated quickly one after the other with a design to raise a Salivation by which if the Patient has strength enough to bear so great an Evacuation and it be convenient in other respects we shall take much better Measures as for the healing of the Ulcer so likewise for the preventing of the Consumption which is like to follow than by any other Apparatus of Medicines But if that be contraindicated by the Patient's Weakness the intense degree of the Fever and the very Acute Nature of the Consumption at least as Antimonial so Mercurial Medicines may be so disposed at due intervals in the Method of Cure that they may successfully exert their extraordinary Healing Vertue without any expensive Evacuation excited thereby As for Example Let the Patient take every Night xv or xx Grains of Antimonium Diaphoreticum in a little bit of Old Conserve of Red Roses mixt with Leucatellus's Balsam And every third or fourth Morning a Scruple or half a Dram of Mercurius Dulcis in a spoonful of Milk Let him also drink a Vulnerary Decoction of Sarsa described in another place for his ordinary Drink adding always at the time when he takes it of the Balsamick Syrup so much as will serve to make a Draught of it grateful to the Patient's Palate My Balsamick Pills are likewise very good in this case being ordered so
at length wholly given over the vain hopes of being with Child I was sent for though too late to visit this miserable Patient Whom I found in a Tabid state and afflicted every day with a Putrid Intermitting Fever which moreover was accompanyed with the Gripes vast Colliquative Sweats a Dropsical Swelling of the Legs as well as of the Belly a perpetual Catarrhous Cough a shortness of Breath and the other usual Symptoms of a Fatal Consumption of the Lungs With which the Patient being at length brought into the state of a Marasmus in the space of six Weeks or somewhat more notwithstanding the plentiful use of Pulmonary and Uterine Medicines of the Peruvian Bark Laudanum Pearl Juleps Vesicatories and other Remedies respecting the Original Disease as well as the various Symptoms proceeding from it and she wasting away by degrees went off plainly in the same manner as those use to do who dye of a Consumption of the Lungs The Body being opened after she was dead we found the Lungs contrary to our Expectation not very much affected with the Stigmes of a Consumption For though we found them stufft adhering to the Ribs and ting'd with several Colours yet so far as I remember there were no Tubercles either crude or ripe found in them But the Substance of one Ovary was plainly eaten away and consumed by an Exulceration and the outward Membrane in a wonderful manner distended with a Dropsical Humour so that we took out of it which now took up the greatest part of the Belly several Pints of Water somewhat purulent together with a great quantity of little Bones and small Fibres or as I judg'd threads which had made up the Glandulous Substance that look'd like yellow Hair From whence it seemed plain to me that that Mortal Fever accompanyed with the fatal Colliquation though this Consumption was Pulmonary only Secondarily and Symptomatically and the Cough and in some measure the difficulty of Breathing too had their rise from the stuffing and adhesion of the Lungs had its Original from the Inflammation and Exulceration of the Ovary it self By which Colliquative Fever as also by the substraction of the Nutritious Juice by the large Dropsical Swelling of the Ovary such a quick Consumption and so grievous a difficulty of Breathing were caused that her Life being thereby brought all of a sudden into extream danger there was not time enough given for that Consumption which was imprest upon the Lungs to be advanced beyond the first degree of a Pulmonary Consumption though there seemed to be all the usual Symptoms of a Fatal Consumption of the Lungs History 3. A certain Merchant of London before the Fortieth Year of his Age when he had now lived almost two Years somewhat sickly and with little and uncertain Appetite which perhaps he procured to himself by his immoderate use of Wine and Women at length asked my Advice about a Swelling and a painful Inflammation arising from thence with which the right Testicle had been now affected for almost the space of three Months and that as he told me occasioned by some Contusion he had got in Riding Indeed that Swelling to me seemed to be a kind of Sarcocele The Testicle swell'd to the bigness of ones fist There was likewise no small Inflammation upon the Scrotum it self as well as upon the Testicle But with repeated Bleedings the application of Cataplasms made of Barley-meal and Oxycrate the Parts affected being likewise kept up with a Truss to prevent the flux of Humours into the place frequent Purging with Calomelanos and Confectio Hamech and also drinking plentifully of Emulsions of the four greater cold Seeds made with Barley-water and of a Decoction of Sarsa and China ordered for his common Drink the painful Inflammation plainly vanish'd But the Swelling still continued though without any pain and the bigness of it was uncertain being sometimes greater sometimes less and easily yielding to a pressure of ones fingers so that at length the Judgment of two very skilful Surgeons being taken and that Swelling being supposed to be a Hydrocele it was justly thought fit to open it But when it was solemnly opened with an Incision-Knife there came out scarce any Water and no Matter Also the whole Substance of the Testicle seemed to have been eaten away and perish'd for some time but the Investing Coats were hard and incrassated so that the Testicle being once opened look'd like an empty Egg-shell or rather a Pomegranate-shell when the Meat or that which was contained in it is taken out From the Fistulous state of this Swelling it came to pass that the Surgeons being deceived and taking it because it yielded to the pressure of their Fingers for a Hydrocele opened it by Incision though indeed after they had once opened it it soon appeared to be in truth a Venereal Fistula proceeding from some virulent and old Gonorrhoea that had been ill cured But from that Wound there arose a large Ulcer which every day ran a great quantity of Ichorous or gleety Matter Which though many times it deluded us for several times with the vain hopes of Curing it having ordered the Sarsa Drink now again for his ordinary Drink when at the same time he was purged with the bitter Decoction repeated at due intervals that is so often as there was occasion and every Night he had a Paregorick Draught given him with Syrup of Diacodium But yet from an unexpected flux of the Humours which as I always told the Surgeons it was impossible to prevent without castration or cutting out of the Fistulous Testicle the Ulcer very often broke out again so that the Patient being quickly brought into a Tabid and Hectick state by the contiual and plentiful substraction of the Nutritious Juice through the Wound and the expences arising from it which Nature was not able to bear as he began to have a great Thirst so likewise to lose his Stomack and at length to be afflicted with a troublesome Cough a shortness of Breath and the other usual Symptoms of the Lungs when they are distemper'd continually wasting away more and more with the sudden Ruin of Nature which was much promoted by the Fits of a Putrid Intermitting Fever coming upon all which returned every day at a stated hour with a Chilness Heat and Sweats succeeding one another till at length the Patient being brought to the utmost degree of a Marasmus was forced to yield to Fate With the repeated use of the Peruvian Bark I very often took off his Putrid Fever which nevertheless the cause of it still remaining in the Wound returned as often after the interval of a Week or two Likewise the Hectick heat which was kindled in his Blood was much mitigated with the use of a Milk Diet of Asses Milk and by the benefit of the open Country Air though it could never be perfectly extinguished because the Procatartick Cause of it to wit the Malignant and Incurable Ulcer was plainly too much for
the Art of Surgery Whereupon at last the ulcerated part being gangren'd after he had lain six Months he was reduced to a very Skeleton and carryed off not only with an Universal Consumption but also a true Consumption of the Lungs though it was a Symptomatical one History 4. Mr. Nye the Son of Philip Nye the Famous Nonconformist Minister as they are called when he had now about the Thirtieth Year of his Age been troubled almost continually for the space of a Year with a Swelling that grew in his Stomack a Cardialgia and Vomiting from which Symptoms he could not be freed neither by the frequent use of Calomelanos the Purging Mineral Waters Chalybeates Wood-lice the Decoctions of Sarsa prepared Coral Pearl Crabs-eyes prepared nor of other Medicines of all sorts ordered even by the most learned and skilful Physicians at length the Swellings beginning to be inflamed and ulcerated he being presently taken with an Inflammatory Fever which was afterwards succeeded by a Putrid Intermitting Fever he not only ran apace into a Consumptive state with an Universal Colliquation but also being troubled with a pertinacious Cough a difficulty of Breathing and all the other Symptoms of a very Acute Consumption of the Lungs at length he sent for me though 't was to no purpose For I found him Sick in Bed in the last degree of a Symptomatical Consumption of the Lungs which as it was in its own Nature fatal so likewise very quick And therefore when I had once given him my helping Hand as much as I could for the Relief of the urgent Symptoms I presently took my leave of him having first made a Prognostick of his Death Neither indeed did this miserable Patient continue many days But not having the liberty of opening the Body after he was dead though there were all the Symptoms of a Pulmonary Consumption yet as it did not appear to me as an Eye-witness so I cannot confidently affirm how much the Lungs themselves had happened to be affected and injured thereby History 5. A certain Old Gentlewoman a Lawyer 's Wife that lived in Shoe-Lane when as she told me she had for the space of Twenty Years been hardly able to sleep half an hour at a time by reason of a violent and continual pain in making of Water with which and with other direful Symptoms accompanying of it she having been very much and continually weakned and that notwithstanding she had taken the Advice of the most able Physicians and thereupon being brought at length into a plain Consumptive and Hectick state and being continually confin'd to her Bed by reason of her Weakness she sent for me not long before she dyed now when by reason of the loss of her Appetite she had for a long time abhorred Food as well as Physick When I came I found her really an extraordinary Woman that adorn'd her Old Age with Fortitude and Prudence beyond what is common to that Sex but yet as I guest even at the first sight by her extream Emaciation Cough Fever and difficulty of Breathing I found her lying very miserably in the last degree of a Consumption Because she was obliged almost perpetually to conflict not only with the usual Symptoms of a Pulmonary Consumption and a Hectick Fever but also with a frequent and dreadful Spasmodick Colick of her Stomack from the motion of some Stones out of the Gall-Bladder as likewise with a continual pain in making of Water caused by a Stone and an Ulcer of the Kidneys From whence it came to pass that her Urine when 't was first made was whitish and afterwards had a very great a fetid and truly purulent Sediment But upon looking on the Urine I presently found there was a pretty large Ulcer caused by a Stone in the Kidney affected and I did think that a Pulmonary Consumption had been brought on Symptomatically by that Ulcer Nature having been now for some time weakned opprest and sinking under so many and such great Evils it happened likewise that her Brain and the whole Genus Nervosum were so remarkably and continually affected that laying aside all her other Complaints of her Consumption Ulcer and Stone she desired only this that I would do something to help her against her Swoonings and Faintness which often returned as also against delirousness and the cold and hot Vapours as she called them which did continually both Night and Day alternately succeed each other which seemed to be more troublesome to her than all the other miserable Symptoms Presently I did all I could to relieve those troublesome Symptoms with the use of Spirit of Hartshorn of Salt Armoniack Tincture of Castor Antihysterick Juleps and other things of that Nature Neither indeed did I plainly neglect her distempered Lungs and her ulcerated Kidneys where the first Original of this Distemper lay but I took care of these too with the use of Emulsions Balsamick and Pectoral Medicies that is so far as the extenuated Habit of her Body and of her bad Stomack would bear But yet all these things were now ordered to no purpose For as the Ulcer of her Kidney was now for a long time become plainly incurable so likewise the Secundary Affections of the Lungs and Genus Nervosum which were the Effects of it seemed to be rather the Trophies of conquer'd and yielding Nature than either accidental Oppressions or any accidental Diseases that Art could overcome But a little before she dyed when Death seemed to be near at hand this Virago desired me very earnestly and indeed made me promise that I would take care that her Body should be opened after she was dead that for the good of the Living she might when she was dead be serviceable to that Art of Physick from which she received no Benefit whilst she lived The Husband having given leave though with much ado that the Body should be examined after she was dead she was opened very Solemnly several Eminent Physicians being present The first thing that was Remarkable was that though all the Limbs and the Face of this Tabid Woman were emaciated yet the Adipose Membrane of the Belly was strangely thick with Fat as it commonly happens to Calculous Persons it may be from a slower motion of the Blood through the Neighbouring Parts and a smaller secretion of the Serum by the Kidneys than there ought to be but we found the outward Membrane of the left Kidney sticking firmly to it as being something swelled from its Distemper But the Substance of it being opened it looked like a Honey-Comb being every where full of Stones and Cavities or certain little Cells out of which some Stones had been formerly extruded but without the least Exulceration But the right Kidney we found like a Purse not only full of Stones and Matter but likewise very much distended the whole Substance also which had been contained within the investing Membranes having been before by degrees corrupted and consumed and likewise the Membranes themselves being filled