they were big with winde are ignorant both of the manner and time of its conception Wherefore its cause is occult Truly I therefore judge the nature and causes of this disease to lye concealed because whereas its first beginnings are not observed it suddenly augments prodigiously so that they who are affected do scarce sooner perceive themselves to be sick than that they are become almost incurable Moreover a Tympanie its station being accomplished degenerating into an Ascites or rather procuring it to its self seems to lose its own nature and truly after death Anatomical inspection scarce discovers any thing more in bodies dying with a Tympany than with an Ascites Commonly ascribed to Winde But that many Physical Authors do readily declare this Distemper to be raised by wind enclosed within the cavity of the abdomen doth not at all satisfie a mind desirous of the truth because it seems altogether improbable that winds should be produced so suddenly and in so great plenty in that place or admit they were that so hard unmovable and constant a tumour should be raised Moreover they do not easily agree concerning the seat of the disease Authors do not agree about the seat of the Windes where the wind is supposed to be included for some affirm that this place is determinate in the concave of the Peritonaeum and by the convex superficies of the Intestines and other bowels of the lower part of the belly but affer what manner such a heap of winds can be therein collected in my opinion it cannot be manifested by any reason example or parallel instance Besides if the case were such it might be more easily cured by pricking than an Ascites by a Paracentesis which yet I never heard accomplisnied Helmont reports a stinking wind was vented by a Paracentesis Not without the guts in the cavity of the Abdomen in one esteemed Hydropick that suddenly his abdomen sunk and the man dyed immediately But Platerius and Smetius no less worthy of credit do affirm They discovered in some who wore thought to have the Tympaine and dissected after death that no wind broke forth out of the hollow of the belly neither that it fell but that especially the smaller guts being distended and strutting with winde burst out so that they could not be put up again into the same belly But truly neither is this observation an argument to me Nor within their passages that the cause of the disease of which we treat remains within the Cavities of the guts and that the winds accumulated in that place do often or most of all raise a Tympanitick swelling of the belly For besides that a disease taking rese from such an occasion would not be of immovable and frequently incurable moreover I am induced to think that the Intestines are not so greatly dilated by winds shut up in them but that they often of their own accord swelling out give occasion to those winds consequently and secondarily to be produced by which the spaces enlarged might be filled as we shall by and by more clearly demonstrate But what is asserted by others Not between the coats of the bowels that the windes which are the cause of a Tympany are engendered among the Coats of the Mesentery and Guts seems yet much more improbable because when there is no cavity in that place preexistent after what manner can the winds so tear those parts and separate them froom one and another so that from such formed Denns the whole region of the Belly should grow into so vast a bulk by accumulated windes there laid up Certainly so many and so great divulsions could not be made without continual torment and most sharp pains Wherefore omitting these opinions already spoken of about a Tympanie By what and how wany causes the Belly swells let us proceed another way to the more assured searching out its Pathologie viz. by thorowly weighing by what means and by what evident causes the Abdomen is wont to swell up Wherefore we advertise there are four kinds of things contained from which proceeds a tumour in the nether Belly of the living why the Abdomen swells in dead personns the reasons follow hereaster which kinds are solid humid wind and Spirits First It is obvious enough that the inward tumours of the bowels 1. From tumours of the Bowels in that place viz. scirrhous strumous cancrous and glandulous and some perhaps of another kinds when they rise to any notable bulk do swell the whole belly yet in the mean time as long as they are simple and new they may be perceived and circumscribed by the touch yet afterwards growing inveterate they cause other evils to the neighbouring parts yea over the whole Region of the Abdomen Truly these as they are sometimes the procuring cause of an Ascites so of a Tympany from the beginning to which afterwards for a complement of either disease another conjunct cause gains access viz. an illuvies of waters or an irregularity of the Spirits Secondly a watery humour gathered within the Cavity of the abdomen 2. From waters gathered as in an Ascites or being impacted in the membranous or glandulous parts thereof frequently produces an Ascites the reasons whereof and the manner of its coming to pass are at large set domn before Thirdly Winds within the bowels of Concoction being reised from crudities 3. From winds ill concoction or fermentation of heter ogeneous humours do frequently puff up the Cavity of the guts and for the most part produce a short and transitory tumour of the belly For the fermentation of the Juices ceasing and eruption of wind being procured immediately succeeds an asswaging of the Belly To this cause both the Colick and Tympanie not only by the vulgar but by Physicians of great note are imputed but in our judement when it is solitary it produces neither of these distempers Fourthly There yet remains another sudden and vast swelling of the belly 4. From the inflation of the Fibres by reason of the Spirits being disturbed which the animal Spirits not for nothing styl'd by Hippocrates violent seem to procure For when these in heaps and inordinately rush into the nervous fibres belonging to the bowels of the lower belly presently the parts that these weave together are caused to be puffed up and extended every where round about For truly from this cause as we have often shewed in another place a swelling and as it were a tympanitical puffing up of the whole abdomen as well in the Colick as in Hysterical fits vulgarly so called doth often happen And truly these distempers are so allyed to a Tympany that they srequently end in it for I have oft observed that those who have been obnoxious to the Colick and hysterical passion long and grievously unless they receive cure do become Tympanitical And then the greatest of the difference will be that the swelling of the belly which before was a wandring Symptom
not always round or of a regular Figure but diversly formed Moreover there is no stop in this condition but the distemper unless it be restrained with Medicine breaking out still in more places and creeping on every where in broadness at length not only covers over the whole member but also the whole body with a leprous dry scurf and this kind of Impetigo the Ancients call'd by reason of its outrage 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and for the most part accounted it incurable From hence the chief differences of this disease are made known The differences of this disease and in the first place as it is less or more malignant according to the fashion thereof it is distingushed as it comes nearer the nature of the Scab or Leprosie or as it is in a middle condition between both We are also to note this distemper sometimes infests some particular members as the Arms or Thighs the rest of the body being untoucht but sometimes it begins together in all parts and every where excites scatrteringly little Pimples or Clusters thereof Also eruptions of this kind are in some for a season or periodical and for the most part infest these persons during Winter only vanishing away about Summer likewise on the contrary in others they abhorre Winter and are wont to observe the season of the Swallow going and coming but in most others the Disease being continual grants no truce yea it hat neither remission nor mediocrity Moreover How it differs from the Psora and Leprosit we must distinguish an Impetigo from other Diseases a-kin to it and first from the Scab and the Leprosie It differs from the former as to the form of the Pustules for every where in the Psora they are single and remote from one another although by small spaces here most of them break out in Clusters concurrently and as it were disjoyned by branches with great interspaces But between these distempers a notable difference yet arises in that the Scab is wont easily or scarce otherwise to be propagated or arise but by Contagion but the infection of an Impetigo is so seldom or never that the Miasma from the Husband doth not pass to the wise or from her to him though they lye together Also this Disease differs from the Leprosie as well in respect of the form of its eruption as of its contagion which is likewise active in this as in the Psora and the breaking out is much larger and more horrid viz. it is every where shelly and scaly without intermission and diffused through the whole body From hence it is manifest that the material cause of an Impetigo The material cause not a humour of the skin is not merely a cutaneous humour by reason of effluvia's or a taint received from without or depraved by reason of other accidents and degenerated from its temperament because it is not easily communicated to others by Contagion as in the Psora neither is it immediately dispersed throughout the whole body But tartarous Concretions begot in the blood But indeed little Pustules breaking out first about the initiations of the Disease seem therefore to proceed for that certain acid salt Concretions happen to be in the mass of Blood like Tartar in Wine which when they can neither be concocted or again dissolved are here thrust out into the skin as there into the sides of the Vessel As long as these Concretions are small and few they are conveyed into the skin in this or that member and by one or two branches of an Artery then as Nature is wont to continue the same manner of excretion as it began the matter being carryed every where by the same vessels to the same nests near the first wheals it causes heaps of others round about therm but afterwards when the dyscrasie of the blood is daily augmented and that Tartarous matter is generated more plentifully in the mass thereof more portions are conveyed by other Arteries and still by more to the outward places and for that cause also more pimples break out both in the same and in other members which a new matter coming continually by the same Arteries and being placed close to the former enlarges them every day and every where dilates them by the addition of other pustules and at length if this sort of Tartar of the blood augment hugely being carryed out by more or all the Arteries together it is fastened in the skin and in process of time covers over all the superficies thereof with a scaly or downright leprous shell And then that cutaneous humour being wholly corrupted promotes the disease it self for it causes the stock of the morbific matter to be encreased by polluting more or rather poysoning the blood and humours whilest they pass in Circulation moreover dismissing the corruptive steams from it self it renders the Contagion of the same disease unto others Wherefore both the procuring and conjunct causes of this Disease consist in this The next cause of it for that without any fault of the skin it happens that the blood is filled with salt Particles of a various disposition and condition into the preceding cause of which disposition we will anon inquire and where those fixt and acid Salts are especially predominant as the manner is they mutually embrace one another and so grow together into Tartarous Concretions which being thrust forth into the blood cause eruptions of wheals as it were nests of the Disease then they being daily and leisurely encreased both in number and largeness according to the supply of matter they produce the beginning augmentation and state of this disease As to what relates to the antecedent and evident causes The evident Causes there are two chief kinds of occasions from which this distemper for the most part derives its origine to wit an evil manner of Diet or a taint of the Scurvy or Pox or other Diseases left in the body being ill or not at all cured We will weigh a little the reasons of each of these As to the former besides the common irregularities in Diet Irregularities in Diet. wherein some being too much addicted to eating of flesh salted and afterwards dryed in the Sun or Smoak and the drinking of acid Wines do easily contract this malady Also it is a vulgar observation The daily eating of Pork or Fish that very many are disposed thereunto by the too frequent or daily feeding on Pork and Fish and especially Shell-fish There is a notable instance of the former which is that that food was chiefly forbidden the Jews for prevention of this disease Also there is an example of the other that in time past the Inhabitants of Cornwal for the most part dwelling on the Sea-coast inasmuch as the poorer sort were fed with Fish became very obnoxious to Leprous Distempers The reason thereof inquired into insomuch that for their relief many Hospitals were erected in that Countrey That I may hint in a few
PHARMACEVTICE RATIONALIS OR THE OPERATIONS OF MEDICINES IN Humane Bodies The Second Part. With Copper Plates describing the several Parts treated of in this Volume By THO. WILLIS M.D. and Sedley Professor in the University of OXFORD LONDON Printed for Thomas Dring Charles Harper and John Leigh Booksellers in Fleet-street 1679. THE PREFACE TO THE READER SInce first I began to consider the Operations of Medicines in humane Bodies and their manner of working and for some time meditating upon the entire Subject at length published an Essay of the Rational Curatory part I became affected with so vehement a desire of farther prosecuting that Speculation that in all spare hours to wit as frequently as I might be vacant from my practice I could hardly intend or admit thoughts of any other thing And that not so much that I might please others as by often turning in my mind and writing my Meditations of this Subject I might be better instructed to prescribe to my Patients For certainly the not duely weighing the Reasons by which Medicines operate renders all Physick to be Empirical and to be governed rather by Chance or Fortune than by Advice and it frequently comes to pass that a Medicine rashly administred is but casting a Die for a mans Life Wherefore that I might satisfie my self and practise Physick as is usually said with a safe Conscience it pleased me to bestow more labour in the search of the true Reasons of physical Energies and Efficacies And because in this Treatise we chiefly consider Medicines respecting certain private parts or Regions of the body and their proper Diseases therefore we have endeavoured in the first place to perform these three things viz. First that a most accurate Anatomical Description might be given of the parts if not already extant whose distempers and remedies are treated of as to the Fabrick and uses of all their Vessels Wherefore turning over the Breast and Lungs and most diligently viewing their inward recesses and apartments what thing soever observable either the Ancients or Moderns have published about these and whatsoever further by Knife or Microscope we have detected we have here set forth In which task as formerly in some others of the same nature more exactly done I must confess I owe much to the sedulous labour of my most learned Friend Dr. Edmund King and to his most dexterous Dissections And really I esteem it so necessary to lay the History of the parts as a foundation to our Rational Curatory Method that without it I did believe the whole Superstructure would be meerly phantastical and altogether unstable or at least unprofitable For surely either to practise Physick or demonstrate its Operations on humane Bodies without an exact knowledge of the parts and passages on which and by which they work would seem equally absurd as if a Philosopher ignorant of Mechanical affairs should go about to unfold and explicate the Artifice and cunning Workmanship of a Clock moving of it self according to the Theory of Natural Motion delivered by Aristotle Wherefore we have view'd with most exact diligence in the first place the Subjects of Physick or the places of Operation in our Bodies as the Circuit in which we are to move Then secondly we have not been less solicitous that according to the Phaenomena of all parts lately detected by Anatomical observation the true and real Hypotheses of Diseases should be built whereof we have designed the Remedies that not still persisting in the thread-bare paths of Ancient Physick by a certain blind and implicite obsequiousness after the manner of Beasts according to the proverb to be only guided by our Ancestors footsteps but deriving the Causes and formal Reasons of Diseases from their very Springs we every where endeavour to shew from what Disposition of Blood and Humours from what affection of Animal Spirits from what habitude of Fibres and of other solid parts every disease proceeds And these things so premised and laid instead of a solid Foundation at length in the third place that the structure of our Curatory method being rightly compacted may happily rise up and firmly consist we have gathered together most of the Medicines respecting most of the private parts and regions of the body and the peculiar Distempers thereof viz. both Simple and Compound both Old and New both Dogmatical and Empirical gathered out of the Physick-books of every Age as also those chiefly celebrated by Quacks and Nurses more choice forms of all which or at the least the chief of them and manner of using we have aptly assign'd and annex'd the reasons as to the Preparations as also the Operations and Effects of them But that all is not comprehended in this Tract that was omitted in the former which yet I had hoped might have been happens from the plenty of matter and the bulk of the work encreasing upon our hands For assuredly it is more than the task of one Man or Generation to exhibit a compleat Curatory Method and absolute in all points For if this Disquisition were more fully instituted as to its Latitude not only all the Materia Medica which is almost infinite but also the whole Body of Physick offers it self Wherefore these our Attempts court not the name of Treatises but of Essays Truly it will not be needful for many Physicians especially those who neglect the Phaenomena of Nature being intent only on their Practice and Gain to be learned about the Reasons of all Remedies but to the genuine Sons of Art this will be of value if not to direct at least to incite them to the Knowledge and serious weighing always of those things they take in hand And if these small endeavours shall instigate others better to polish that Study whatsoever Reviling I may reap from the malevolent and envious it shall never repent me of my labour For when I shall be well conscious to my self that I have not suffered my Faculties although small as the Talent entrusted with me by God Almighty to perish through sloth nor suffered them to be buryed in the earth but that they may be rendred with some Interest beside the Principal it will much please me nay I shall seriously rejoyce and triumph POSTSCRIPT WHile these were Printing the most sad message arrives that the Author most worthy of Immortality oppressed by the irresistible assault of a Pleurisie is departed from among the Living neither did the Arts profit their Master which did all others The Reader will pardon us if we for a little space celebrate the Funeral of so Sacred a Memory nor esteem it superfluous to hear in a few words what manner of person he was who wrote such things yea he will rejoyce to understand that he was equally Good as Learned that he also exercised himself in the Practice of Piety who was most conversant in that in Physick The matter requires a just Commentary but we shall briefly propound what at first came into our sudden thought while our mind
obnoxious to depravation than this Pneumonic machine of the breast The organs of breathing being hurt the breathing is hurt also through which by sucking in air we preserve the vital flame of the blood with its motion and heat For whereas the vessels of the lungs belong to the function of breathing viz. the Trachea with the Bronchii and little bladders also the heart with arteries and veins besides which there are nerves with fibres as well musculous as nervous Lympheducts and Glandules also the contents of these Vessels viz. Air the old and fresh blood with its Serum the Lympha and the animal Spirits any fault happening in any of these doth oftentimes discompose the whole Pneumonic function Nor less also the moving Organs of the breast viz. the muscles with the Diaphragma and the nerves appointed to their use And likewise sometimes the animal spirits before they enter into those nerves being ill disposed often cause great disorders in breathing When the chief function and uses of the Lungs have been to convey the blood and air through the whole frames of the parts and their inmost recesses The uses and ends of breathing which use to be hurt and every their smallest passages and every where to mingle them namely for that purpose that the venal blood returning from its circuit and diluted with fresh juice and thereby crude and as it were half extinct may as well be more perfectly mix'd and wrought together as more effectually kindled afresh in all its parts by the nitrous air from hence the chief faults about this business or function of the Lungs do most of all consist in these two things First that the blood hath not due passage through the Sinus of the heart and the pneumonic vessels And secondly because the Air is not drawn in and breathed out in a due manner into the Trachea and its passages The defects and failings of the Lung in its office There are two parts of either of these For first as to the passage of the blood sometimes the fault is caus'd within the right Sinus of the heart or the pneumonic Arteries and also sometimes caused within the pulmonary veins or the left Ventricle of the heart Secondly as to the Air the failure is chiefly in inspiring and exspiring although each function offends sometimes equally There are divers accidents of each and many causes and ways of its being done whereof we will here briefly touch upon the chief Therefore first First in respect of the blood when the blood doth not duly pass through the right Ventricle of the Heart and the Pneumonic Arteries either it happens by its own fault or by the fault of those passages and sometimes by the fault of further passages For sometimes the stream of blood stops in the nether region of the Pracordia by reason of obstruction in the other moreover sometimes the defect or fault of the air breathed in stops the free passage of the blood What relates to that fault of the blood The opinion of the famous Sylvius concerning the blood fermenting in the Lungs when it passes not quick enough through the right Sinus of the Heart and Pneumonic Arteries the opinion of the Renowned Sylvius should here be discoursed but that it would be too tedious and from our purpose For he supposes The descending branch of the venal blood moistned with chyme together with the lymphatic humour returning from the whole body hath the nature of an acid-sweet spirit and in the mean time its branch ascending impregnated with choler from the bladder of the gaul mixt into the mass of blood does participate of an oily volatile salt and so by the meeting together of these something contrary to themselves a gentle and friendly contention or boiling is stirred up in the right ventricle of the heart in which and for which the fiery parts lurking and being shut up in each being freed and set at liberty do rarifie the chyle and blood and so change and alter them that they exercise the function of life and heat as well as motion and nourishment through the whole body Which seems not likely to be true There are many reasons why I assent not to this ingenious and neatly-framed Hypothesis For besides that many do far otherwise determine about the origine and dispensation of Choler and so not without strong reasons and experiments are thorowly perswaded by eye-sight that there is not any such boiling up of the blood of a different quality and striving or contending in the right ventricle of the Heart Our opinion hereof Our judgment continues still as it hath been that both streams of blood washed thorowly with the fresh chyme do consist altogether of one kind and for that cause the milky Vessels of the Chest carry about part of the Chyle so long a journey which they pour into the descending trunk of the Vena cava just as the meseraick Veins pour the other part into its ascending trunk also that the lymphatic humor together with the Chyle is poured into the subclavian Vessels so that it may very commodiously be reduced into blood neither truly doth there seem need of other or more passages Moreover we determine that that humor rightly constituted doth agree with and is easily assimilated to the mass of blood as well as the Chyle it self made sweet without any contention raised in the heart But if the lymphatic humor returning from the Brain and nervous kind as well as from the Glandules degenerate from its due temperature and contract a sowreness as it often comes to pass then being re-infused into the venal blood it overcomes it and it precipitates it into serosities and from thence great streamings of urine do ensue Moreover we have shewed elsewhere that the Diabetes is provoked from such a cause But such a flux of the lymphatic humor is so far from exciting a greater boiling up of the blood in the right ventricle of the Heart that rather on the contrary from thence often chilness of the whole or stiffness with a weak Pulse and sometimes swoonings or convulsive fits are provoked accompanied with a plentiful and pale urine The reason whereof without doubt is that then the clear humor flowing from the brain and nervous parts turns the blood into serosities and cools it by too much diluting and for that cause the animal spirits being destitute of their vehicle either faint or run into irregular motions But truly as we altogether deny an Elastic effervescence of the blood in the right Ventricle of the Heart from contention of dissimilar parts The pneumonic circulation of the blood is stopt sometimes by the fault of the heart it self so as often as from thence the blood is not cast out into the Lungs after a due manner we determine it to happen not so much from the proper fault and defect of the blood it self as from the animal faculty For if the spirits actuating the moving Fibres of
insomuch as some do affirm that the meer relaxations of the moving parts whereby the dilatation of the breast in discharged doth suffice for its constriction Hence when in the agony of death the ultimate labour is to open the breast and fetch breath by which the flame of life may be continued as soon as that endeavour is become frustrate the animal exspires and is readily extinct But truly we have already clearly enough evinced that the tasks of breathing out no less than those of breathing in are performed by the help of peculiar muscles Wherefore when it happens that the Organs of Expriation are either hurt of prejudiced there must needs follow difficulty or depravation of that function The moving parts which bind together the breast and straiten the cavity thereof are especially the inward muscles of the breast some belonging to the Loyns and others to the Abdomen as also the muscular fibres of the Larynx and Trachea by reason of some faults occupying sometimes these anon them either single or many together exspiration is wont to be stopt or perverted after a diverse manner Expiration hurt sometimes proceeds from the fault of inspiration Although the hurt of this function frequently depends upon inspiration being prejudiced notwithstanding it sometimes happens alone so that when we suck in Air easily and duely enough we return it disturbed or perversly which truely is wont to come to pass through divers causes and after many manners the chief of which we shall here briefly touch upon 1. Sometimes being alone depends on various causes For first when a wound or convulsive or paralytical distemper happens in one muscle which causes exspiration or in more for that cause the cavity of the Thorax cannot be so freely drawn together and compress'd for the more full breathing out air or breath 1. On the wound of a part moving Hence not only such as labour in a Pleurisie but in a tumour or wound in the intercostal muscles or the Abdomen cannot easily couth or sing or perform other acts of stronger expiration Neither is the due drawing together of the Thorax less stopt by reason of the moving fibres of those parts affected either by a resolution or a cramp 2. 2. In a Cough The act of expiration whereas it is variously perverted or disturbed so it chiefly happens in a cough in sneezing in laughing in crying and in Hiccough into the reason and manner whereof we will briefly enquire And first we shall speak of a Cough A Cough may be described The description of a Cough that it is a vehement more frequent unequal and loud expiration stirred up either for the quieting of some troublesome and provoking thing or for expelling of it out of the Lungs through the passage of the Trachea For air being violently excluded and dash'd in the way on the sides of the Tracheal passages whatsoever is in any place impacted in them if it be easily moved it discusses and wipes it away and frequently sends it out of doors For the exciting of a Cough It s formal reason and the manner of its being done both the muscles contracting the Thorax and also the moving fibres of the Bronchii do concur in motion with a joynt force together For while the muscles straiten the cavity of the breast and every where squeeze the whole lungs these fibres one while contracting these tracheal passages another while them closing behind the air while it is driven forwards do endeavour its expulsion more quick and vehement A more intense sudden inspiration precedes every act of a Cough to wit that the air being admitted in greater plenty may presently be more violently driven out with noise in which endeavour not onely the new that is fresh breathed in but also the old being heaped up before in the tracheal little bladders is driven forth together with a noise for the encrease of breath blown out and when what is troublesome is not settled nor removed at the first assault the vehement exspiration of this kind is repeated by a frequent course even to the great wearying of Nature The first cause of every Cough is an irritation of the nerves or sibres belonging to the lungs concerning the nerves we are to observe It s primary cause that not onely the branches and their slips inserted into the Lungs but others from which they do arise or with which they do intimately communicate being provok'd in places far distant from the breast immediately cause a cough for which cause oftentimes a sharp humour being lodged within the Brain and from thence falling down into the little head of the pectoral nerves is wont to produce a most troublesome Cough or Asthmatick distempers as not long since we have declared by notable instances For the same reason a pain inflicted on the nostrils palate or Gula provokes a Cough or rather a vain attempt of coughing Moreover a little Serum distilling from the Arteries into the upper parts of the Gula or Larynx produces a frequent and very troublesome Cough without any notable prejudice of the Lungs But truly this provocation inflicted on the nerves and fibres distributed in the Lung it self more frequently and truly more violently provokes an endeavour of Coughing which is repeated by courses till what is troublesome be turned forth or the provocation restrained Of this kind of Cough from the nerves a notable Example shall be after set before you The provoking causes producing a Cough are manifold The evident causes thereof and make their stay in several places for besides that the nerves as we but now intimated and also the membranes with which there is an intimate communication with the Lungs being provoked in the open Nostril give an impression of that passion at a distance to the Lungs most frequently that irregular exspiration is stirr'd up by reason some incongruous or in some measure unproportion'd thing is cast into the Lungs For in the first place that this troublesome thing may be removed the nerves and the nervous fibres dispersed about the Lungs are irritated afterwards by the consent of these the muscles of the breast that draw it together and the moving fibres of the Trachea at once are forced into vehement and often repeated contractions Every Cough is either moist or dry The kinds thereof in the former a certain humour being deposited in some place within the tracheal passages is shaked by coughing and being to be thrown out upwards is cast into the mouth That humour whereas it is manifold and after divers sorts for the most part it is either call'd serous or nutritious or purulent or bloody Of the former there are many kinds and differences namely as to its consistence it is either thin or thick or crude or digested as to its colour it is either white or yellow or somewhat greenish also sometimes it is blewish or black Moreover A moist Cough a moist Cough is variously distinguished as to
be far from our purpose to deliver the true cause of the above-mentioned affects and to put our sickle not only into another mans harvest but also one far remote 2. Moreover there is another state of blood unfit for nourishment quite contrary to this to wit when being above measure hot and sulphureous and from thence always violently burning out it consumes the nutritious juice by its effervescence and raging and causes it too much to evaporate so that the solid parts being defrauded of their provision pine away The persons obnoxious to this distemper have large vessels and much distended with blood but their flesh withered and hardned by heat Though persons so affected seldom pine away to death yet they grow old sooner and end their life in a shorter space 2. The blood not only from its proper indoles This proceeds sometimes from a fault of the bowels or solid parts but also by reason of a Consumption elsewhere and chiefly communicated from the bowels and nervous juice is often unfit to nourish And first this frequently happens by fault of the bowels for these being ill-affected sometimes do not duly digest the Chyme to be conveyed over to the blood also oftentimes they pervert and defile it with their extraneous and heterogene ferments insomuch that the functions are frustrated in the faculties of breeding good blood and nourishment Moreover sometimes by reason of the Vessels bringing the Chyle obstructed within them though much be eaten yet little or less than due is conveyed into the bloody mass Also in the bowels of concoction sometimes Tumors Imposthumes and Ulcers happen from whose corruption the blood being infected in its passage contaminates the rest of the mass and renders it unapt to the work of nourishing How often do we see from a Schirrus happening in the Spleen Liver Pancreas or Mesentery or by an Ulcer or cancrous Tumour of some Gut as also of a Kidney Womb or Bladder or otherwise malignant Sore a deadly Atrophy to have succeeded without any notable fault of the Breast or Lungs Yea Tumors Imposthumes or cancrous and strumous Ulcers happening in the outward parts and especially in the Back do frequently end in a pernicious Consumption The reason whereof is plain viz. in as much as in such distempers both great plenty of the nutritious juice brought to the affected part through the Arteries is either entirely bestowed in the same place or from thence is poured forth abroad insomuch that all the other parts of the whole body are defrauded of their due provision as also that the virulent or very incongruous matter there engendered and lodged is swallowed up by again the Veins which defiles the blood by an impure black gore and from thence renders it altogether unapt to discharge the faculty of nourishing Neither only from the bowels and solid parts Or from the nervous juice but also from the nervous juice the stain by which it becomes unfit to nourish is frequently communicated to the blood For when this liquor degenerates from its genuine temper to wit sweet and volatile into an acid presently flowing out of the fibres and nervous parts and flowing back into the blood it doth precipitate the liquor thereof and compels it into fluxes whereby all the nutritive matter is cast forth and one while poured forth by Urine or Sweat another while by Vomit or Loosness The reasons of all these and how they come to pass we have explicated in a late Treatise But the nervous liquor sometimes by it self departing from its good temper The nervous juice sometimes of it self is chiefly the cause of an Atrophy and being vitiated in its temperament is a cause of want of nourishment which also happens to be made in a twofold respect or two manner of ways For sometimes that Juice being very much vitiated and degenerate proves as it were vappid and decayed so that it doth not actuate enough the fibres as well nervous as carnous and inlighten them with an animal spirit wherefore as the motive virtue so also the nutritrive fails in the solid parts From hence either the entire body or certain members and parts thereof being for some while affected with a Palsie at length they wither away as we have at large declared the reason thereof in another place 2. We have also observed that many labouring with a slow Feaver or as called by us a nervous do presently languish and in a short time become much emaciated In either case the same reason ought to be assigned for as is shewed in another place seeing the animal spirits together with the nervous liquor their vehicle which is as it were the masculine seed do actuate the nutritive humour every where collected by the solid parts even as the feminine seed and render it as it were pregnant with a nutritive faculty for that cause if that nervous liquor becomes either depraved or vappid the bulk of the solid parts pines away as if it were made barren So much of these things touching an Atrophy Two chief kinds of Atrophies or waxing lean and the formal reasons thereof the causes and various manners of its coming to pass in general Of this disease as there are many kinds and differences so two chiefly and more observably occurr whereof either will deserve a particular consideration viz. Tabes or Phthisis Dorsalis commonly so called Tabes Dorsalis and a Consumption of the Lungs This latter which properly belongs to this place shall be discussed in the following Chapter in the mean time concerning that because the knowledge thereof doth illustrate the Pathology of this we shall speak in a word Tabes Dorsalis Two kinds although it hath almost lost its name in this our Age or perhaps changed it into a Gonorrhoea yet Hippocrates makes mention of it and handling it avowedly From the nervous juice stopt or depraved in the loyns he assigned a twofold kind thereof viz. one from immoderate Venery and the other from a destillation into the Spine of the Back What relates to the latter I have often observed some to be most grievously vexed with a pain about their Loyns yea sometimes in the whole Back which when for some time some have so laboured under they afterwards come to be lame or crooked and at last fall away in the whole body all but the head The cause of which disease doubtless consists in this viz. first a humour or a certain incongruous morbific matter descending with the nervous juice through the spinal marrow did run into the branches of the vertebral Nerves and therefore from the beginning by reason of the Fibres being twitched a continual pain almost did arise afterwards by reason of some Fibres being resolved the opposite ones more vehemently contracted distort certain Vertebra's of the Spine and lastly seeing the animal Spirits cannot actuate enough the Nerves and Fibres belonging to the trunk and members by reason of the nourishment frustrated the withering of
the entire body succeeds Surely when the nervous liquor and animal spirits pass not fully and freely out of the Dorsal Spine into the whole body from thence oftentimes a pining doth arise hence Imposchumes and Ulcers arise about the Loins or the Os sacrum which in as much as they consume or pour forth the nervous liquor too much cause an Atrophy in the whole or at least in the lower parts 2. From the expense of the humour through the genital parts That humour is first either seed a too great expence whereof induces an Atrophy Another kind of Tabes Dorsalis far more frequent is also twofold viz. it either ariseth from the great or too-often loss of the genital humor or from a continual corrupt flux from the genital parts 1. As to the first it is manifest by vulgar observation that the immoderate use of Venery yea involuntary efflux of the seed if it be either great or continual produce a faintness in the whole body and at length a pining away The reason of this as we have intimated in another place is not that the seed according to the opinion of some descends from the Brain through the Nerves into the spermatic bodies and from thence by reason of a great loss thereof first the Brain and then the parts all depending on the influence of the Spirits springing from thence become infirm and pine away But seeing we have sufficiently evinced that the seminal matter is immediately supplied out of the mass of blood into the genital parts and that it is altogether the same with that out of which the animal Spirits instilled into the Brain are proceated it will necessarily follow by now much the greater portion is got to the Testicles for repairing the loss of seed by so much is the Brain defrauded of its due share and therefore at length the sunction in the whole body as well motive as nutritive doth waver and diminish Our furious Whoremongers are sensible of a great debility about their Loins and the parts placed below them to wit the Thighs and Legs do chiefly wither away the reason is because as well the provision of the animal Spirits in its first spring viz. in the Brain failing the outmost chanels viz. the ends of the spinal marrow and the Nerves springing from it do suffer first and chiefly for this defect and moreover because near the Loins the arterious blood gives out to the Testicles more excellent particles and chiefly restaurative being destined to nourish the Back and in the mean time the venous blood being for that cause decayed or consumed is enfeebled and steals from the Loins as much as possibly may be The loss of the seed causing a Consumption is sometimes voluntary The losses whereof are voluntary or involuntary of which sort the salacious and prone to Venery do suffer sometimes involuntary of which affects there are divers kinds For in some it only happens by dreams or obscene phantasms but in others besides those occasions every endeavour of the Back whether through bearing a weight or excretion of Urine or the faeces of the Belly causes the genital humor to be thrust out the cause whereof is both because the seed is watry and thin and at once sharp and provocative also because the parts are weak and not able duly to digest or retain it In the other Tabes Dorsalis above-mentioned not the seed it self 2. Or Ichor flowing into those parts from solution of continuity but an ichor or a certain putrilage is cast out abundantly from the genital parts the efflux whereof if it the great and continual doth frequently impair the strength of the whole body and by withdrawing and prodigally removing the nutritive matter it induces an Atrophy or consumption For near the spermatic Vessels or in passage from them as well in men as women there are certain Emunctories placed whose faculty is to receive the superfluous humour from the seed formed and when it abounds to send it abroad through the genital parts For this cause that those passages in either Sex may be made slippery and moist lest they grow dry The formal reason of a virulent Gonorrhea and become less sensible the Prostates in men and the Glandules about the horns of the womb in women are constituted out of both which always in the act of coition and sometimes without when the spermatic bodies abound with too much moisture a certain serous liquor sweats out and in women whose bodies are more moist and in whom nature hath made these ways for their menstrual excretion this doth oftner and more plentifully happen than to men But if these Emunctories be affected with a great debility or a certain virulency so that they corrupt this liquor sent or do not retain it enough it is not only sent away incessantly and flows out plentifully through the Pudendum but also other superfluous humours or recrements of the whole body flowing together to those weak parts are thrown forth together Also the nutritious Juice destined to the neighbouring parts flows thither and presently goes out together so that at length by reason of the loss of the nutritious Juice which flowing to the same place is corrupted and continually sent away not only pains of the neighbouring parts but of the whole body and a pining doth succeed These things are commonly known in a Gonorrhoea also in fluore muliebri or those affects from an impure bed or immoderate Venery or are caused by a blow a bruise violent exercise or any other hurt inflicted upon the Loins It is not proper to this place to deliver particularly the true rendring of the cause and curatory method of healing of this sort of passions we shall proceed to treat of a Phthisis or Tabes properly so called viz. which arises from the only or chief fault of the Lungs which was the business of our design SECT I. CHAP. VI. Of a Phthisis properly so called or of a Consumption arising by fault of the Lungs A Consumption doth so frequently and usually proceed from the Lungs being depraved that some have termed it the peculiar Disease of this Bowel and that it very often so comes to pass the reason is because as we have shewed before the pining of the body doth for the most part more immediately proceed from the blood depraved and unapt for nourishment it is manifest that as its perfection is acquired in the Lungs so from these being ill-affected the same is most of all vitiated and degenerates into a languishing and corruptible state For in the Lungs rather than in the Heart or Brain the threads of life are spun and there they are oftnest defiled or broken A Phthisis is usually defined to be A pining away of the whole body The definition of a Phthisis taking its rise from an Ulcer in the Lungs But less true because I have opened the dead bodies of many that have died of this disease in whom
difficulty ariseth The reasons of the case viz. whereas his Lungs were found altogether free from any Ulcer or notable wound whence that most dire stench of spittle and breath always a forerunner and companion of the bloody spittle the last invasion of this disease only excepted proceeded We have in another place given remarks upon all these things as that Ulcers of the Lungs and the purulent spittle of consumptive persons seldom or never stink but the matter cast out of an Imposthume of the Lungs doth frequently stink but that in the sick Doctor the Lungs being free from either affect breathed out so horrible a breath the reason will best of all appear if we inquire of the manner and cause of a stench in general For we observe this to be excited when the impure Sulphur is dissolved either by a lixivial or an acid Salt and is precipitated by the other Let common Sulphur or Sulphur of Antimony be dissolved by Oil of Tartar or Stygian water afterwards if you pour on this solution a dissolution of fixed Salt and upon that Vinegar a most hideous stench will arise In like manner we may conceive in the case proposed that the sulphureous particles of the blood being very impure were corroded by the fixt Salt with which its juice abounded very much afterwards when the acid humor having endured a flux reflows from the nervous parts into the mass of blood it precipitates the dissolved Sulphur and so causes that stench to be exhaled from the Lungs and whilst it forces the blood into a turgency a little after it compels to a spitting of blood I have known some endued with a breast firm enough and free from all Coughs and consumptive disposition who have for the most part breathed out a most hideous stench which could proceed from no other cause besides what even now we have observed The impure blood abounding with Sulphur dissolved with Salts if perhaps while it is rarified within the Lungs and loosned in its frame it meets with an acid humor it will exhale in breathing putrid and horrid effluvia's It happens by the like reason of the blood otherwise disposed that as the breath of some persons is very stinking so of others very sweet And indeed the breath or air reciprocated through Respiration for that it carries out with it the effluvia's of blood highly rarified within the Pracordia one while disperses a grateful vapor another while a most unpleasant SECT I. CHAP. VIII Of a Peripneumony or Inflammation of the Lungs APeripneumony is usually defined to be The description of a Peripneumony an inflammation of the Lungs with an acute Feaver a Cough and difficult breathing They who labour with this distemper are greatly sensible of a notable inflammation in their breast with a swelling of the Lungs and sometiems a pricking pain they draw a painful and short breath or as Hippocrates affirms a deep breath the Feaver presses with great thirst watching and painful Cough whereto also bloody spittle or streakt with blood succeeds By which Symptoms it clearly appears that this disease arises in as much as the blood boiling feaverishly doth not easily pass through the lesser pneumonic Vessels but sticking in their passages begets first an obstruction afterwards being more heaped and extravasated propagates a Phlegmon or inflammation with heat a Cough and discoloured spittle Moreover in as much as the blood so accumulated and stagnating puffs up these passages of the Lungs and compresses them a difficulty of breathing is caused and in as much as it pulls or distends the nervous Fibres a pain frequently arises But if it be asked After what manner a Phlegmor is bred in the Lungs how a Phlegmon should grow together in the frame of a Lung meerly bladdery and excarnous and after what manner it is distinguished from that distemper which is wont to be stirred up in musculous flesh or the substance of a bowel We must answer although the above-mentioned parts vary as to the texture notwithstanding the reason of the affect is altogether the same in each of them For the small sanguiferous vessels do every where alike embrace bind and variously gird about both all the Tracheal passages in the Lungs and also the fleshy fibres in the Muscles and lastly the little fibres and nervous threds with the thickest foldings like clusters of the Parenchyma But that which produces a Phlegmon is the blood it self which while it grows very hot and is hindred in its passage every where and especially in the Lungs whose vessels branch into very small foldings doth first beget an obstruction and then an inflammation Wherefore the formal reason and conjunct cause of a Peripneumony consists in these two things The conjunct cause of a Peripneumony consists in two things 1. That the blood boils 2. That it sticks in the passages Sometimes this disposition sometimes that is first viz. that the blood boils feaverishly and sticking also within the more narrow passages of the Lungs engenders there an obstruction causing inflammation Unless these two things concur there is an exemption from this disease for in many other Feavers especially in a burning Ague though the blood most intensly heated and inflaming all the Praecordia as also in the longing of women the Green-sickness and the Dropsie of the breast is very clammy yet though sticking very much in the passages of the Lungs it does not stir up a Peripneumony to produce which both distempers must concur and join their strength Nevertheless when there is an indisposition of both these one while this another while that is first in act and after a sort one is the cause or at least the occasion of the other For sometimes the blood irritated into a Feaver causes an obstruction of the Lungs and the blood also sometimes finding a remora in the Lungs receives a feaverish boiling from its proper obstruction Notwithstanding for the constituting the procatarctic cause of this disease the blood ought to be fitted as well for the boiling as for the obstructing the vessels of the Lungs Though it will not be easie to shew what this disposition of the bloody liquor is inclining to a Peripneumony What that is Phlebotomy discovers yet the reason thereof doth something appear by Phlebotomy always made use of in this disease with the best success For the blood being drawn from any labouring with this disease as also from those in a Pleurisie after it grows cold in its superficies instead of a Scarlet cream it hath a little film somewhat white or otherwise discoloured growing on it which also is very tough and viscous whence we may conjecture that the mass of blood being too strait in its frame whilst that in the circulation it doth not discharge its recrements grows too thick and as it were clammy and for that cause becomes too prone as well to boil as to stick within the narrow passages and especially of the Lungs But if farther inquisition be
some persons obnoxious to the Scurvy and the affects of the nervous kinde sometimes it happens that a sharp humour and very painful descends into the Pleura or intercostal Muscles and being fixt there produces most fierce tortures which distemper is yet discriminated from the Pleurisie inasmuch as it is void both of Feaver and Thirst the Pulse always abides moderate and laudable frequently the appetite and strength endure moreover the pain is not long fixed or limited to one place but sensibly creeps hither and thither into the neighbouring parts as the matter slides down through the passages of the fibres out of one place into another We meet not with many differences of this disease The differences of it notwithstanding it is used to be distinguished viz. to be either true and exquisite even as we have now described or spurious which having its seat in the intercostal muscles or their interspaces proceeds from winde or a serous and sharp humour heaped up in the same place and raises a pain less sharp without so much as an inflammation or feaver And whereas the grief is planted externally the Patient for the most part lyes better on the opposite side otherwise than in a true Pleurisie Secondly a Pleurisie is either single or complicated with a Peripneumonie or some other distemper and so it is either primary or secondary or join'd with some other affection As to the Prognosticks of this disease The Prognosticks Hippocrates hath observed many certain tokens whereby a good or evil event is signified to patients sick of the Pleurisie To run through each of these and to unfold them with Commentaries added to them we have neither leisure nor doth it seem worth our endeavours The chief thing of all in a Pleurisie is that the disease be presently dispatch'd partly with a free and frequent bleeding and partly by a Critical Sweat arising about the fourth day or before the eighth or these things not duely succeeding it will be prolonged and then most frequently a Peripneumonie or Empyema or a collection of corrupt matter between the Breast and Lungs or both distempers do arise upon this disease from which there follows a solution of the disease but slow and incertain and most frequently full of dangerous chances A Peripneumonie coming upon a Pleurisie not presently cured as it is often wont to be all our hope is placed in digesting maturely the Spittle and quick Expectoration thereof for if this be laudable and plentiful and easily and hastily thrown off it doth often finish both diseases intirely Notwithstanding it is not therefore a consequent that the matter of a Pleurisie is derived from the side into the Lungs by I know not what blinde passages or that the same being sweat out of the Pleura into the cavity of the breast is imbibed by the Lungs and at length drawn upwards through the passages and excern'd forth But when a Peripneumonie arises on a Pleurisie and the matter impacted in the Lungs begins to be evacuated by Spittle so that the affected places of the Lungs are continually emptyed the blood resumes the other matter fixed in the Pleura and carryes it to the Lungs where the places of conveyance are open to be ejected by Spitting But if the Pleurisie be cured neither by it self nor associating with a Peripneumonie then at length either by an Imposthume made in the Pleura or in the Lungs an Empyema or corruption between the Breast and Lungs succeeds or all the matter being brought into the Lungs and there putrified loosning the unity of the Viscera it propagates a mortal or scarce curable Consumption As to the cure of a Pleurisie forasmuch as the state of this Disease The Cure thereof the Crisis and tendencies are manifold divers curatory Indications offer themselves according to their various regards and as occasion serves according to the advice of a prudent Physician they ought to be appointed in the beginning and sometimes altered or continued For surely one Method is convenient for a solitary and simple Pleurisie and another if it be complicated with a Peripneumonie Besides it behoveth to ordain another and another if perhaps a Crisis be expected by Spitting or matters growing worse the disease is either passing into an Empyema or tends to a Consumption As to the three later cases that is to say when a Pleurisie commencing passes into a Peripneumonie or Empyema or lastly into a consumptive disposition there is designed an appropriate way of curing in the pathologies of each of these diseases particularly delivered But as to what appertains to our present purpose three Indications offer themselves for a primary and simple Pleurisie and they are curatory preservatory and vital I. The first Indication takes care that the Inflammation or obstruction of blood in the Lungs by all manner of means with all expedition be removed The first Indication for which intent phlebotomie in every Age by all physicians excepting some Fanatick or false Chymists is wont to be prescribed as a principal remedie Phlebotomie necessary almost in all Pleurisies The reason of which is altogether the same as in a Peripneumonie and many other distempers caused by reason of a stop of blood in some place and so an accumulation Because that the vessels bringing blood being much emptyed do not only rescind the nourishment of the disease but drink up the matter which is the conjunct cause thereof and convey it to another place Wherefore blood is to be freely drawn away in a Pleurisie if the strength endure it and the Pulse be strong And surely it is far better that the first time and every time after as often as there is need to repeat it blood be more largely emitted than to do it more often and more sparingly For very many portions of the blood growing clammy and degenerating into viscousness are heaped up about the place affected which unless they are call'd away from thence by emptying the Vessels through large phlebotomie and in a great part let forth the letting of blood will be frustrated of its desired effect Wherefore that Physicians prescribe blood in a Pleurisie to be drawn out even to swooning seems not incongruous to reason although that practice is not rashly to be attempted for that every evacuation ought to be proportioned to the tenour and tolerance of the strength which rule such a phlebotomy doth exceed But though there is almost a general consent of all Physicians to breath a vein in a Pleurisie notwithstanding there was ever an earnest contention about the place What Vein is to be opened in a Pleurisie what Vein ought to be opened Hippocrates and Galen opened a Vein on the same side of the patient afterwards the Arabians and their followers the Italians and French did either open the Saphene or the Basilica of the opposite side damning the phlebotomy of the same side by Bell Book and Candle Yet in the later generation the practice of the Ancient
Greeks by little and little revived Various opinions are recited so that some did dare to make incision on the same side yet always one side judged the others of the opposite perswasion as it were guilty of murder as often as any unlucky event did happen So that while among Physicians about phlebotomy there was no less a contention than among the Jews and Samaritans about the Sacred place of Worship at length the Doctrine of the Circulation of the Blood held out like a new Light by the most renowned Harvey discuss'd all the clouds of this Controversie so that immediately it clearly appeared to be almost the same thing whether incision be made in the Vein on the affected or opposite side of a patient sick of a pleurisie although in our Age Custom hath prevailed first and rather to open the Vein of the affected side Notwithstanding a Vein being opened in either Arm draws nothing at all immediately from the vertebral Arterie or from the pleura they are only the branches of the Azygos or of the vertebral vein that receive the blood out of the place affected but that they may accomplish this they are not unloaded in any other manner but that the quantity of the whole blood be abated by phlebotomie wheresoever made Onely this may be affirmed for opening rather the vein of the affected side that the Basilick vein being unloaded the Arteries of the Arm receive the more ample provision of blood from hence the bloody stream of the vein Aorta runs down more swistly from that side towards the branches of the Arm and perhaps in the interim of its quick passage it infuses less blood into the vertebral Arteries for the nourishment of the disease As to that opinion that the blood is sometimes more plentifully carryed from place to place that from hence the right Lung or Liver being beset with an inflammation or obstruction the right part of the head is in pain and of the face grows more red I say this sometimes is brought to pass because the patients do constantly lie in their bed on the side affected wherefore the Vessels being compress'd the blood stays longer in other parts of the same side while it is circulating But of these things we will make a more diligent search when we shall render the History and Aetiologie of phlebotomy But if phlebotomy by reason of a weak pulse Cupping-glasses with Scarification supply the place of blood-letting and fainting of the animal function neither ought to be at first administred nor repeated though the pain be most urging Cupping-glasses with Scarification do well supply the turn hereof being applyed to the place pained Riverius and Zacutus Lusitanus have cited notable Examples of cures effected by this remedy And surely this practice seems to lean upon a reason strong enough for the blood being drawn away from the side affected that which is lodged in the neighbouring vessels being the conjunct cause of this disease is moved with it and partly drawn away and partly turned to its Circulation Moreover to remove an inflammation of the Pleura besides withdrawing blood by a free Phlebotomy or Scarification also the serous and other excrementitious humours ought to be gently solicited and excerned as well out of the mass thereof as out of the bowels by Stool Urine and Sweat The more strong purgatives are deservedly prohibited because they disquiet the blood and constrain it to be impacted more deep into the places affected And that certain renowned Chymists viz. Angelus Sala Hartman M. Rulandus with many others do audaciously exhibit Vomits of Stybium to any afflicted with a Pleurisie and magnifie it for the best remedy seems to me neither safe nor congruous to reason Whether Purges and Vomits are to be taken in a Pleurisie the only reason of helping as I think and that very uncertain and full of danger may be viz. that the medicine operating more vehemently while the patients suffer exolution of spirits or swoonings all the vigour and turgescence of the blood abates and for that cause the nervous Fibres remit their wrinklings or painfull contractions and the Vessels carrying blood being much emptyed do suck up the morbifick matter In the mean time there is danger lest the humours being violently disturbed rush more impetuously to the part affected at least lest the Spirits being too much dejected and the work of Nature disquieted about the digesting or separation of the morbific mater strength should utterly fail before the disease be cured Yet in the mean time Clysters are of frequent or daily use yea sometimes more benigne solutive purgatives are allowed provided that the Feaver be not very intense Julips and temperating Decoctions and things gently moving Sweat and Urine What other kind of Remedies are convenient in this disease as we have prescribed before for a Peripneumonie are also here convenient but let all hot and sharp things whether aromatick or endowed with a vinous spirit be carefully declined II. The second Indication preservatory The second Indication preservatory designed against the clamminess and boyling up of the blood prescribes Medicines of that sort which consisting of a volatile or alcalizated Salt do destroy the combinations entered into of the acid and fixed or otherwise distempered Salts with the other more thick particles For which intent the eyes or claws of Crabs the tooth of a Boar the Stone of Carps the jaw of a Pike Fish the Bone in the heart of a Stag the Priapus of a Hart Sal Prunella Salt of Coral Salt of Urine or volatile salt of Harts-horn powder of Goats-blood infusion of Horse-dung Spirit of Harts-horn of salt Armoniack Spirit of Tartar the simple mixture mineral Bezoar Diaphoretick Antimony flowers of salt Armoniack are very famous Remedies in a Pleurisie III. The third Indication vital The third Indication vital which provides that the strength and vital heat be preserved during the course of the Disease in due tune and state gives in precept first an apt kind of food and moreover Cardiac and Anodyne remedies and those which seasonably occur to other symptomes if perhaps they arise First in a true Pleurisie a most thin Diet ought to be appointed viz. of meer Oatmeal and Barley and for ordinary drink a Ptisan or Posset-drink rather than Beer alone is convenient although in an outragious thirst this also is to be allowed of in a moderate quantity Moreover for quenching thirst Juleps Apozemes and Emulsions are taken by turns to all which adde Sal Prunella Secondly Cardiacks let only the temperate Cordials be administred which mildly do recreate the animal spirits and not at all intend the kindling of the blood burning out of its due proportion For these intentions the water of Carduus Mariae Carduus Benedictus of Balm Borage Cowslips Black-cherries are usually given with success whereto let the powder of Pearls and Coral be added Thirdly It behoveth to administer Anodynes both inwardly to provoke sleep in
lymphaducts relating to the left side of the lungs being first obstructed near their insertions into the passage bringing the chyle did swell up to a great bulk and afterwards being broken distill'd their humour into the cavity of the Thorax When now an Inundation of the Precordia and so of the vital Fort was imminent The reason thereof this Gentleman at length thinking it time to provide for himself entered into a course of Physick and carryed certain Medicines into the Countrey for his cure yet without any signal success Afterwards coming to London he first consulted the worthy Dr. Lower being of his former acquaintance He proposing the opening of the Thorax for his only remedy took care that the worthy Dr. Micklethwait and my self should be sent for to the consultation The Cure by a Paracentesis of the breast Immediately an incision was appointed by the consent of us all wherefore after provision for the whole being made a Chirurgeon applyed a Cautery between the sixth and seventh Vertebra and the next day he put his Pipe into the Orifice cut into the cavity of his Breast which being done immediately a thick liquor whitish like Chyle and as it were milkie flowed out There was about six ounces only taken from him the first time and the next day as much more The third day when a little greater quantity was suffered to come out being affected immediately with great fainting and afterwards being feaverish he was ill for a day or two Wherefore it seemed good to stop the issue of that matter till he recovered his temperament and strength but afterwards a sparing evacuation of the same matter being daily made the cavity of his breast was wholly emptyed but as yet he wears a pipe in the orifice with a tap which being opened once in a day and a nights space a very little of the humour flows out in the mean while being well in stomach visage and strength he walks abroad rides and performs all exercises he was formerly accustomed to vigorously enough He used not neither was there need of much medicine only after the Incision we advised temperate Cordials viz. powder of Pearles Juleps and sometimes Hypnoticks and afterwards a vulnerary decoction to be taken twice a day By this method and these forms of Medicines sometimes continued this worthy person seemed to recover his temper and his strength and the habit of his body and his breast exempt from the Dropsie Notwithstanding he still wore a silver Pipe in the orifice of his side out of which ichor daily flowed and when after some months this being withdrawn the Issue was shut up a gathering of the same humour was made within the hollow of his breast perceivable by the sound and fluctuation thereof but when that the disease returning the same medicine was to be used and incision of his side appointed Nature by chance discharging the function of a Chirurgeon the matter being prone to burst out and flowing to the place made its own way He is now necessitated for preventing the illuvies of his Breast to keep that orifice constantly open like a sink From these things I think it manifest enough that an Ascites of the Breast sometimes arises from the lymphatick vessels burst asunder within the Lungs neither doubt I less but that the same affection may be caused from the chyliferous passages being broke within the Thorax notwithstanding this chance so rarely happens that as yet I have not known it by my own observation or others relation Moreover it little avails to make inquisition into the Aetiologie of such a disease because it is not only apparently incurable but in a short time mortal because the Precordia are incontinently overflown by the inundation of the chyle and also the blood and the animal spirits being defrauded of their wonted supply of nutritious Juice are immediately dissolved From the various causes of this Disease even now set down The differences of this disease it will be easie to collect its differences For first a Dropsie of the Breast is either simple and primary peculiar to this Region or secondary coming upon a general Dropsie as it is wont often to be in cachectic presons Secondly this Disease is distinguished as to the places affected viz. forasmuch as water is either collected in the whole breast or only in one side thereof Thirdly as to the matter accumulated in a pectoral Ascites which one while is limpid and plainly waterish another while more thick whitish and as it were milkie such as we have described in the foregoing History The diagnostick signs do manifestly enough discover this disease The Diagnostick signs viz. the fluctuation of water is perceived by handling and by feeling at every bending of the body and the sound is clearly heard Moreover they are affected much with a dry and empty Cough as also with a Dyspnoea almost continual and painful especially while they ascend steep places Besides they have a thirst with a little feaver and in the night after the first sleep great disquiet and tossing of the body proceeding from the vapours being elevated by the heat being more intense Sometimes there comes upon these a Palpitation of the heart an intermitting or disturbed Pulse and frequent faintings of the spirit As to the prognostick this disease is always difficult to cure and among the vulgar accounted incurable And surely if it come upon an Ascites of the Abdomen or an Anasarca throughout the whole body it is judged not without cause desperate But if the affection be primary and happen to a body otherwise sound we are not altogether to despair of Cure What relates to the curatory part of this Disease The Cure the chief Indications will be three Curative Preservative and Vital according to the common method of curing in most other Distempers The first has regard that the water heaped up in the cavity of the Breast by any means be evacuated The Second provides that afterwards a new illuvies be not gathered in the same place The Third procures the restoration of strength and the symptoms impairing it to be removed with expedition To satisfie the first Indication What Intentions of healing the first Indication suggests and that an Ascites of the Breast may be emptyed there are but two ways or means of evacuation to be met with whereby this collection of waters may be drayn'd viz. Either that the vessels of the Breast and the passages of the humours being emptyed might suck up that Lympha being rarified and afterwards by the passages of the blood or air convey them forth or secondly that by an incision of the side those waters may be drained forth plentifully in their own Species That former manner although more seldom yet sometimes succeeds The first Intention which I can attest out of my own observation For the consistence of the Lungs being spongy within and externally very porous while by every turn of the Diastole they are drenched
by the common consent of most is judged to arise in as much as the yellow choler not at all or not enough received The Jaundies from the ends of vena porta into the passages of the cholerick pore overflows into the mass of blood and pollutes it with its greenness whereby also the very skin is discolour'd That obstruction is wont to happen after many manners and in various places The cause of it For sometimes it happens near the extream ends of either kind of vessels viz. the end of the vena porta and the porus bilarius the interspaces whereof happen frequently to be compressed and stopt by reason of the Parenchyma of the Liver being tumefied or otherwise vitiated wherefore the humour of the gall not being transferred out of the separating vessels of the porta into the other receiving vessels turns back upon the blood Secondly the passage of the humour of the gall is sometimes intercepted in the middle passages of the cholerick pore for that the cavities of these are filled either with a viscous or sandy and sometimes with a stony matter as is plainly discerned in the Livers of beasts in the winter senson while they are fed with hay and straw Thirdly it is also manifest by Anatomical observation sometimes an obstruction in the very bladder or the gall or in the cystic passage is the cause of the Jaundies for if at any time it being filled with stones receive not the choler or being here shut up or grown together it restrains the descent of the choler towards the guts that humour although well separated from the blood is constrained to flow black into the mass thereof and so propagates the Jundies Against this most received opinion by which it is judged The opinion of Sylvius of the cause of the Jaundies that the cause of the Jaundies for the most part consists on this side the vesica fellis or about it towards the Liver the most Renowned Sylvius altogether places it without this viz. in the Cystic or common passage For supposing the choler not to be separated from the blood within the passages of the Liver but in the very bladder of the Gall to be propagated of a humour brought thither by the Arteries He judged the greatest part being carried upwards by the passage of the pori bilarii to be poured into the blood for some notable uses and also another part to descend beneath to the Intestines also for necessary uses wherefore if this latter sluce be shut all the choler is carried upwards into the blood and filling it too much with this humour perverts it from its genuine temper into an Icterical But truly lest the stopping of the passage of the bladder or of the common passage neither of which easily happens or from any light occasion may seem less efficacious to excite any Jaundies therefore whether such an obstruction hath place or no the most Renowned man ingeniously supposes besides The choler while it is generated in the bladder does undergo sometimes a notable change by which it is moved and is born about more plentifully and impetuously towards the blood with which yet it is less mingled than is was wont to be but only confounded together with it and so more easily departs from it and infects and tinges the solid parts with its colour But that the choler in the Jaundies may be rendred unfit a mix with the other humours or to be nearly united he determines it to be done by a spirit too valatile mixed plentifully with it and so making it more spirituous and immiscible with others He confirms this assertion by two instances viz. in as much as the most spirituous poison from the biting of a Viper and the too much use of the more generous drinks viz. Wine and Strong-waters causes sometimes the Jaundies Moreover he endeavours to procure credit to this Hypothesis for that this disease is wont to be cured not only by medicines opening obstructioins but by them which blunt the force of a raging volatile salt of which sort are the decoction of Hemp-seeds also Venice soape with many other things of the same sort It belongs not to this place neither is it to our purpose to descend to end this contention nor dare I now rashly determine it since it hath tired so many Renowned Wits of the Moderns whether really the choler be made in the bladder of the Gall or whether it be only separated from the blood in the Liver the great organ of separation I confess this latter opinion best pleases me The Authors opinion And weighing these things seriously I am induced to think the cause of the Jaundies to consist chiefly in this that the choler being sever'd in the Liver is not by reason of the ways being obstructed at all or not enough conveyed to the bladder of the Gall but that it must of necessity regurgitate into the mass of blood notwithstanding in the mean while we deny not but this affect may sometime arise although more rarely from the Cystic passage or common pipe being obstructed But also we think the fault of the blood to preceed in part and perhaps sometimes wholly for the morbific cause when to wit from its sulphurous and fixt Saline Particles above measure exalted the choler is more plentifully or quicklier generated in the mass of blood than can be separated or discharged forth by the ordinary ways wherefore this separating every where from the blood with the Serum The cause of this disease sometimes in the blood is affixed to the solid parts and impresses its tincture upon them And without doubt it is for this reason that some poisons and chiefly the biting of Vipers and the dayly use of more generous drinks induces the Jaundies in bodies before sound for whose cure sometime Phlebotomie and medicines reducing the blood to a right temper are wont to profit more than those opening obstructions Moreover it seems for this reason that a tertian intermiting Feaver so frequently terminates in the Jaundies for we may not suspect the passages of the Liver can be by any means obstucted since in all fits so great an agitation of the blood and humours by cold and heat and such an-evacuation of them happens either by vomit or sweat and truly even as feaverish fits are caused inasmuch as the sulphurous part of the blood being too much advanced in the first place perverts the nutritious juice into a morbific matter and afterwards being inflam'd consumes and exterminates it so when the fixt salt is at last exalted together with the sulphur in the blood and for that cause meer choler is abundantly engendered the feaversh enkindling of the blood ceases by reason of the restrictive force of the fixt salt and in place thereof the distemper of the Jaundies doth succeed But as the blood being too much advanced to a sulphureo-saline distemperature causes the Jaundies in any though least predispos'd to it so in others
many senses together viz. it is a Tumour of the Abdomen First in respect of blood from a waterish tumour contained within the cavity thereof The water making this tumour sometimes encreases to a huge inundation and scarce credible quantity I have once seen a Tub would hold 15 gallons filled with water taken out of the Abdomen of a woman dead of a Dropsie But whence that humour proceeds also by what manner and from what causes it gathers together in the belly first and afterwards is sensibly augmented and lastly by what passages and by what vertue and operations of Hydragogue Remedies it may again be taken from thence and evacuated seems most difficult to be unfolded As to the former viz. the encrease of water It doth not always proceed from the Liver Spleen some have thought it to descend from the Liver and others from the Spleen distempered into the cavity of the Abdomen and so this bowel or that being vitiated always to be the cause of an Ascites But that this is otherwise Anatomies of many dead of this disease do manifestly declare when after the inundation of the belly the Liver and Spleen and found often without fault And truly these bowels do not seem the Springs of any such illuvies being endowed with no cavityes wherein waters might be accumulated together wherefore the origine of an Ascites as of a standing Pool or Lake is to be derived from a River or at least a glutt or inundation of some Humour The humours that flow within the passages or Vessels as Brooks The humours by which it is produced are are chiefly these three viz. the Blood the milkie Humour and the Lympha The showering or distilling of water may come to pass from the nervous Liquor which sometimes slowly and insensiby sweats out of the fibres and membranes and from vapours condensed within the hollowness or some Cavity of the Body Whether by these wayes an Ascites doth rather and oftener proceed we will now search And in the first place as to what relates to the blood it is without doubt First the Blood the Serum falling from the masse thereof too much dissolved as it doth excite Fluxions and Catarrhs of various kindes so it sometimes stirs up the greater illuvies of waters viz. Dropsical wherefore when an Anasarca proceeds altogether from this cause and when oftentimes an Ascites comes upon that disease not immediately heald we may well enough inferr that either distemper is induced from a watery humour every where poured out from the little mouths of the Arteries Moreover it is not much improbable that the Serum of the dissolved Blood is first and solitarily poured out of some end of the Coeliac and Mesenteric Arterie being open into the Cavity of the Abdomen and so brings on an Ascites without an Anasarca going before and so especially if perhaps it happen that scirrhous Tumours Ganglion's little swellings or preternatural Concretions of another manner are first raised about the Mesentery the Spleen the Liver the Womb or any of the other bowels of the nether belly for because the Circulation of the blood is hindred in those places that the blood being carryed through the arteries may be some way brought back the serous part being thrust out from its company falls into the cavity For truly it is most evidently manifested that it so comes to pass by this Experiment mentioned by us in another place viz. If in a living animal the jugular veins being taken up and bound with a thred the reduction of the blood be stopt the whole Region of the head swells in a short space with a water between the skin and clearly hydropical And truly I have more frequently observed that an Ascites hath followed upon secret tumours gathered and raised in some place in the lower belly which certainly happens for the reason above recited When the course of blood being obstructed the watery part is extravasated in a short space that humour is not meerly serous but besides the nutritious Liquor ordained to nourish all the solid parts is emptyed into the belly wherefore while this Region swells up the members are extenuated and the Lympha taken out from an Ascites with heat thickens and grows white like the white of an Egge It is also very probable 2 3. The milkie and watery humour that the milkie Vessels being burst asunder pour out their humour into the cavity of the abdomen Truly the most renowned Sylvius thought this disease most frequently engendred from such a cause And truly as out of the milkie or watery Vessels viz. one of them or both together being divided or opened we may well suspect the illuvies of water or chyle sometimes to overflow the bowels of the nether belly so the following observation seems to confirm the same thing Of late one that had been long sick of the Jaundies and in the mean time temperate and abstemious of drink to which he was not prompted by thirst contracted an Ascites increased in a short time hugely After that medicines were administred in vain a Paracantesis is attempted according to the manner of Sylvius with a hollow Needle out of the orifice not icterical water but limpid and thin flowed out abundantly from whence we may inferre that hydropic humour flowed not out of the mass of blood for then it had been coloured but distill'd out of the lymphic or milkie vessels into the cavity of the abdomen We have joyn'd together as akin the ways of the milkie and lymphic Vessels in propagating an Ascites because both vessels do convey the chyle or what is analogous to it to the common Receptacle and many branches or leading Pipes of either kind are distributed about the bowels of the nether belly in the mean time it is not improbable but that a solitary fault of either vessel may sometimes produce an Ascites As to the other wamys of generating an Ascites proposed in the beginning I am scarce induced to think such an inundation of the belly can easily arise from the distilling of a nervous humour or by reason of vapours there condensed although perhaps in a Tympany where the cavity of the abdomen is enlarged and transpiration hindred the effluvia that were wont to exhale being forced inwards are changed into Lympha or water wherefore for the most part an Ascites is ever conjoyn'd with that disease The immediate or conjunct causes of an Ascites being design'd after this manner An Ascites often the product of the Jaundies which indeed seem to be either a watery humour poured out of the Vessels bringing Blood or Lympha or Chyle poured out of the proper passages of them both not we must in the next place inquire about the more remote causes of this disease viz. for what occasions and after what manner the vessels affected of either sort deposite their burdens into the cavity of the belly First therefore The kinds of a Dropsie that the watery part of
of small Cinnamon-water one ounce Diacodium three ounces Tincture of Saffron two drams Mix them and take one spoonfull at night if sleep be wanting Or Take Syrup of Cowslip-flowers three spoonfuls compound Poeony-water one spoonful Laudanum tartarized one dram take one spoonful if Watchings require it 3. Extinguishers of Thirst in this Disease being very thirsty Things mitigating Thirst ought frequently and in small quantities to be administred that that troublesom symptom may be restrained without much drink which is perpetually pernicious For which purpose Take of Conserve of Wood-sorrel passed through a Sieve three ounces Pulp of Tamarinds two ounces Sal Prunella one dram with a sufficient quantity of Syrup of the juice of Wood sorrel make a Lohoch of which let him lick often SECT II. CHAP. V. Of an Anasarca NOw two kinds of Dropsies viz. Ascites and Tympanie according to common reckoning being finisht although the third to wit an Anasarca for that it is an affection rather of the whole body than of the nether Belly appertains not properly to this place notwithstanding the Pathologie thereof having some affiance with the former we think sit to deliver here also its Cure in short The description of an Anasarca An Anasarca is described after this manner That it is a white soft Tumour of the whole outward Body or of some of its parts yielding to the touch and leaving a dent upon compression proceeding from a watery humour extravasated and accumulated as well within the interspaces of the Muscles as within the pores of the flesh and skin yea of the Glandules and Membranes It differs from an Ascites as to its outward form and appearance How it differs from an Ascites yet not as to its morbific matter which being the same in both distempers as it is heaped within the greater or lesser hollownesses it gains divers Appellations of the Disease The watery humour procuring an Anasarca The Original from the blood doth proceed altogether or for the most part from the blood for it being continually produced within the mass of blood by the fault and defect of sanguification it is poured out in greater abundance from the extremities of the Arteries than can be received or brought back by the Veins or the Lymphaducts or can be discharged by the Reins or pores of the skin and other vents of the serous Juice From these it follows that the material cause of this Disease is a watery humour The material and efficient cause and the efficient is blood which engenders waters and deposits them in the places affected We will exactly weigh the reasons of either of them and the manner of becoming and effecting it and first we will treat of the efficient Cause of an Anasarca 1. The affection of the Blood or rather the Hydropical brood The Blood its efficient cause in a double respect consists in these two things to wit First by reason of a failure or fault of sanguification it doth not rightly assimilate the nutritious Juice perpetually infused into its mass but suffers it to degenerate into a watery humour Then secondly by reason of the too loose mixture thereof it doth not retain that humour so degenerated so long within its consistence untill it might be discharg'd through fit Emunctories or Emissaries but lets it out every where near to the ends of the Arteries into the inter-spaces of the Vessels and there leaves it Either of these vices of the Blood we will consider a little more In the first place as to the former for the most part it is confessed by all First that it doth not rightly sanguifie that the Blood it self and not the Heart or Liver sanguifies by what of late is plainly understood concerning the functions of these parts yet by what means the Blood assimilates Chyle infused to it self and converts it into fresh blood to be bestowed to so many and diverse sorts of uses doth not easily lie manifest to us But what some affirm that it is made only by the exact comminution and commixtion of particles and for that cause the particles of either kinde being confused together they think that within the straiter passages of the Liver and Lungs they are kneaded and wrought together as it were with little pestils seems little probable to me but on the contrary I think these bowels as I have shewed already are constituted the Organs rather of separation than of mixture The reason whereof enquired into but the reason of sanguification altogether consists in this that the active particles of the old blood to wit the saline and sulphureous being placed in vigour with the spirituous immediately act upon the like particles of the infused Chyle as yet existing in an inferiour state and do so stir them up and ferment them that thereupon being extricated from the coverings of the thicker parts they are carryed into a like degree of exaltation or perfection with the former and being at length associated with them and made also homogeneous they put on the same nature of Blood the more thick and heterogeneous particles being removed thence to another place from those which they had deserted and gone away from For truly Sanguification is altogether finisht by Fermentation even as the maturation of the Must into Wine or Ale but the reason of the difference is that Wine being shut up in the Tub still remaining entirely in the same Mass is flowly fermented as to its whole consistence and is not accomplished but in a long space of time but the Blood constituted in a perpetual flux by the loss of some parts and the reparation of others is fermented by the parts still received fresh and is generated anew The old Blood for the most part affords the same thing towards the fresh Chyle The reason and manner of sanguification explained as Ferment from the flower or faeces of old Ale being put into new Ale notwithstanding as it were by a contrary manner because the huge mass of blood being formerly fermented doth suddenly ferment and alter the small portions of the Chyle continually brought in but the fermenting liquor in Ale in a very little quantity is put to the great mass of the other liquor to be fermented which it brings not to maturity under a long space of time After the rudiments of blood are so cast by fermentation the conclusion and perfect assimilation into blood is acquired by accension for surely that it is so enkindled as I think I have formerly shewed by demonstration which arguments chiefly taken from its proper passion although many have cavil'd at none have been yet able to overthrow Wherefore while the whole mass of blood consists of Blood and Chyle confusedly mixt together it is fermented while it is circulating andbeing divided into most minute portions is spread through the whole Lungs that it might be kindled successively according to all its parts by the nitrous air suckt in for by that means both the
furrow the skin Neither only the humour being too much exhausted out of the pores but also retained in the same either unduely or above measure From the sudden shutting up of the pores doth render the skin rough and unequal The hairy pores which though they are not the only yet are much the passages of Sweat do constantly send out more plentiful Effluvia's for the sake of transpiration wherefore they ever seem greater and more open but if it shall happen that these are suddenly obstructed by any outward cold the Vapours being restrained within In the larger pores are the roots of the hairs they do every where swell up the skin about the places where they break out and lift it up into little heaps from hence of at any time our bodies are exposed naked to the Northern wind or are plunged in a River the exterior Superficies before smooth and soft will become rough and rugge like the skin of a a Goose new pull'd Without doubt those greater pores being according to the furrows of the skin planted parallel and as it were in a rank after the manner of a Quincunx or exact Square are made as so many pitts for the planting of hairs as it were trees for so they appear in four-footed Beasts and in some hairy parts of men These things being thus briefly declared concerning the Cuticula and Skin as touching their frame and uses there is way enough made to search and unfold the Diseases of the same parts and the reasons of healing them Wherefore first scarce any Diseases properly belong to the Cuticula No Diseases of the Scars-skin it being devoid of life and sense This sometimes being too thick hinders Transpiration and also sometimes by reason of accidents in some places it grows too thick and callous but it self being clearly unsensible it is never sick notwithstanding this is a cause that some distempers which might be blown off by Transpiration do cleave to the superficies of the skin inasmuch as the dregs of the blood and humours and recrements being thrust forward outwards The cause of some having passed through the whole skin when they cannot evaporate wholly by reason of the thickness of the Scarf-skin being fastened in the outed skin produce various discolourations and stains thereof of which fort are those spots called Heat spots Freckles or Ephelides as also scorbutical and malignant spots also Pimples and whatsoever other stains without any swellings or roughness do seem to besprinkle the skin or outward Scarf-skin with marks or some little disfigurings The Cutaneous distempers reckoned up But truly as to what belongs to the distempers of the Skin it self in general since they are various and manifold they are wont to be distinguished under a various respect and chiefly that they are either with or without a Tumour we have but now taken notice of these latter ones Distempers of the Skin with a Tumour Distempers in the skin with or without a tumour are either universal dispersed throughout the whole body or are particular being raised in these or those members dispersed or as it were by chance The former either happen upon a Feaver as chiefly the Small-pox Measles or other malignant wheals whereto also may be added the fleeting pushes of Infants or happening without a feaver as the Itch Tetters and leprous distempers The outward particular Tumours or dispersed ones for the most part do not seize upon the skin only but also upon the parts subjected viz. now the carneous another while the tendinous or membranous or glandulous and for that cause do exist of a sundry disposition and of a diverse form To discourse particularly concerning all these and to assign the reasons of their Causes and Cure of every one would be a matter not only of an entire Tract but of a great Volume Wherefore for the present we will only briefly speak of the Distempers merely or for the most part Cutaneous of which sort are all spots and Pimples as also the Scab or Itch Tetters or leprous Maladies perhaps an opportunity may happen when I may treat more specially of Tumours of every kind First then that we may begin with Spots as Affections of lesser moment those offer themselves called Ephelides because they are chiefly caused from the Suns heat 1. Spots call'd Ephelides for that cause frequent in the Spring and increase most in Summer again in Winter they soon vanish Moreover whereas they happen in the more beautifull persons The description of the Ephelides and of a thinner skin they break out chiefly in those places where the Cuticula is most thick and is exposed to the Sun and Air viz. the face and hands of a colour yellowish or brown in magnitude of a Flea-bite but they exist unequal and irregular as to their Figure These differ little or nothing from those brownish or yellowish spots which some call Lentigines or Freckles which consisting of the bigness of a Lentil mark the parts of the face as it were with many drops The matter of these seems to be a more thin portion of the cholerick humour The matter and cause thereof allured outwards by the force of the Sun attenuating it and opening the pores of the skin which beginning to be evaporated is fixt to the inside of the outmost skin or Cuticula which it cannot pass through Surely it is a sign these spots proceed from Choler or other yellow scums of the blood because they are chiefly familiar to them whose hair is yellow Moreover the reason is manifest enough because they arise more often in a fair Complexion and in those parts exposed to the Sun and Air for their more thin skin transmits the humour rarified by the solar heat so far untill it is retained by the thicker Scarf-skin near the places of issuing out This affection presages or indicates no evil as to the state of health and although in appearance it represents something of deformity notwithstanding that is made good again insomuch that it signisies them so spotted to be endued with a more pure Constitution Besides these small freckly spots there are others much larger Lenticular Spots above a hands breadth in magnitude which deform the skin in divers places especially about the breast and back one while with brown another while with pale or blackish spots These at certain times as I have observed in many being wont to arise in certain parts and vanish again are commonly called Liver-spots Liver Spots falsly so called and those most markt with them are thought to have a Liver less sound or at least not well sanguifying which not withstanding is not true on this account but only inasmuch as the cholerick humours when they are not enough separated from the mass of blood within the Liver being thrust for ward to the skin do so discolour it which fault also is imputed to the Spleen for truly this deformity arises because that the feculencies and
the face especially the Nose and Forehead are markt with most thick Specks looking black as if burnt by Gunpowder which proceeds from hence because the sudatory pores are sometimes fill'd with a more thick black humour another while with little worms with black heads which little Insects being squeezed out of the pores and exposed to the Sun are easily seen to live and to move themselves and in such a malady of the skin no Lotion or Oyntments are wont to profit but what are Mercurial notwithstanding to this Hony there is a Thorn at hand more than enough malignant It s familiar use is not safe For the particles of the Mercury together with its Salts by which they are divided and sharpened into small bits being applyed to the face do shake off the peccant and uncleanly matter out of the Pores and expell it thence but having driven it back they pursue it in and readily insinuate with the Blood and nervous Liquor whose temperaments they prejudice Yea by meeting with these they imprint very often on the Brain and sometimes on the Praecordia and other parts their virulency that can never be wiped out From hence it is frequently observed that women or men that have long used Mercurial Cosmeticks are troubled with a Vertigo and convulsive Distempers or are obnoxious to paralytical and their Teeth grow black and sometimes fall out SECT III. CHAP. VI. Of the Mange or Scab with the Itch. AFter the more simple maladies of the skin viz. those which happen without any Tumour and Ulceration and only deform it with spotted appearances Psora a disease properly cutaneous we will now in order treat of the more grievous Affections and those which dissolve the Unity and especially of the Psora or Scab which in sundry and srequent places of the whole Body doth much infest the skin with a painful Itch and with small Pustles and breakings out being sometimes dry and often scaly and another while moist and disposed to ulceration and a malady of this sort is most properly the Disease of that part considering it frequently begins in the very skin by reason of some outward Contagion and often receives Cure by certain Remedies applyed to the skin only at least the reason of both holds so far that it is seldom otherwise undertook or perfectly cured The Psora or Scab is vulgarly described to be a breaking out of Pustules and wheals throughout the whole body here and there It s description procured from a sharp and salt humour heaped up in the Pores of the skin and that it may be discussed from thence induces a notable Itch and a necessity of scratching That we may search duly into the causes of this Disease and the reason of the symptoms we will more deeply enquire concerning the matter effecting and the conjunct cause thereof that it may certainly be known of what sort that humour is which is heaped up within the skin by what means it is either generated there or comes from some other parts afterwards in what pores or little places it is contained and how endeavouring to break out it doth create so troublesom an Itch. Wherefore about the origine of this Disease What humour its matter is of that we may not impute the fault with the Ancients to the Liver or Spleen the matter thereof is not any particular humour of the four commonly supposed ones not Phlegme nor yellow Choler nor black Not any of the four common humours neither also the blood apt of it self to be extravasated moreover neither doth it seem to consist of two or more of these humours mixt together For though such humours be granted notwithstanding if this Disease always consist of them it would not so easily be catch'd by a meer and light contagion But a humour plac'd in the Glandules of the skin or receive Cure by an Oyntment alone Wherefore it is rather to be supposed that the morbific matter is the humour of the Lympha constantly resting in the glandules of the skin notwithstanding degenerating from its genuine disposition that is to say its volatile-salt into an acid or otherwise offending disposition For when the continual Supplements from the blood come to this so depraved and uncessantly evaporating these Juices new and old do not easily agree or are united but boyling together after the mutual custom of dissimilar Salts they are coagulated into a recrementitious matter which filling and distending the pores of the skin every where raises it into Tumours Moreover it something hinders the Blood in its passage and constrains it to be extravasated From hence thick Pustules are raised and because that matter passing into an Ichor is compelled by the Serum and Blood pursuing it still forward they rise up into little heaps afterwards the Animal Spirits entring inordinately into the nervous Fibres that they may promote the throwing off that ichor do cause the sense of that troublesome itch Indeed an inspection with a Microscope doth most clearly discover that there is a lymphous humour in the glandules of the skin which lye under all the sweating pores treasured up for some uses The description of that Juice or Humour so that according to the plenty and diverse stay thereof these Glandules exist more or less turgid This Juice is laid aside by the Blood through the Arteries in these Glandules that this little burthen being cast off it might return more easily through the veins in the mean time being reposed there it hath its uses viz. In the first place continually moistening the miliarie Teats which lying under the nervous little Fibres are the proper Sensory of Touching it preserves them from dryness which would hinder the Sense also it imbues the adust effluvia's passing uncessantly from the blood being kindled in their passage near the skin with a certain moisture and renders them fit to be voided by the pores and whilest part of this humour doth so continually evaporate with the Effluviums of the blood those expenses are repaired by the Lympha continually fresh being deposited by the Arterial blood as is abovesaid Notwithstanding this occonomy of the Region of the skin is not always so regularly kept How it degenerates but that the glandulous humour falling from its own disposition and function not only will provoke in the skin but sometimes in the whole body preternatural affections of divers sorts This growing clammy and cleaving more obstinately in the little Cells obstructs transpiration and immoderate sweating proceeds from its too plentifully flowing out and from the same restagnating inwards a more than usual Diuresis This is done three ways Moreover as to what belongs to the Scab and pustulous eruptions that humour as it is wont to be depraved many ways so chiefly these three and is wont to enter into a coagulative disposition with the Serum being fresh poured out from the blood 1. By reason of impure Blood viz. First the Blood it self being very
impure and also dissolved it leaves its corruptions and superfluous dross in the cutaneous Glandules which in the same place putting on the nature of more corrupted ferment they boyl up with other adventitious Juices or passing by these and are diversly thickened and so they beget not only pustulous affections but also leprous of divers kinds From hence the daily and often eating of Shell-fish and also of others and of salted meats that have been hung in the Sun or Smoak also the taking disagreeing Drinks and venemous Medicines do cause cutaneous and frequently dreadful eruptions Secondly 2. By mere stagnation The humour being heaped within the cutaneous Glandules sometimes doth not only become pustulous by a mere stagnation but also frequently Lousie Wherefore not only they that have been long in prison but also those who being of a sedentary life are used to nastiness and sluttishness do live obnoxious to the above-mentioned maladies inasmuch as the cutaneous humour being not at all eventilated is corrupted by mere standing after the manner of putrefying water and so it puts on the disposition of a corrupting ferment 3. By Contagion received from without to which moreover Supplements of putrefraction come from the blood in the like manner depraved Thirdly If perhaps these Canses are wanting that the glandulous humour of the skin neither contracts any stain from fault of the blood nor its own proper stagnation notwithstanding virulent steams communicated from without render it no less prolific as to those diseases This is manifest by common observation especially forasmuch as they that have health most and are endowed with the best Constitutions scarce ever escape free from the same if they lye in the same Bed either with a scabby person or where he hath lately lain and not only so but moreover the Linnen of the Scabby oftentimes washed with other Linnen have bestowed the contagion upon others Surely the taint of no disease the Plague only excepted is more easily or certainly propagated than this of the Mange If the reason of this be enquired into The reason of its most sudden contagion is unfolded we presently say that the liquour susceptive of the scabby taint is mightily exposed and most easily disposed unto it and indeed much more ready to either than the Blood or Nervous Juice For the glandulous humour of the skin abounding in the outer superficies of the body first imbibes every atome let in by holes and pores every where open and anticipates them from the blood Moreover that this is so soon infected with a scabby Contagion both the activity of the ferment communicated causes it and also the proneness of the glandulous liquor to degenerate For indeed the effluvia's falling from the breaking out of the scabby skin are aptly enough compared to the Yest of Ale remaining on the top as it were its outmost Coat of which if the least portion be taken from thence and mixed with other new Ale unfermented presently it ferments the whole mass how great soever and changes it into the disposition of the liquor from whence it was taken Certainly there is a very considerable energy which the particles however so small and little carryed to the highest activity are able to perform but especially if they fall into a liquor of which sort is the cutaneous made up together of subtile particles of several sorts as well partaking of the blood as of the nervous Juice and for that cause most readily apt to be fermented The Contagion when any where received presently spreads over the whole skin Wheresoever therefore these effluvia's of the Contagion abovesaid hit against any outward part of a healthful body first they will infect the cutaneous humour only planted in that place but then the particles of this so corrupted being received by the venous blood and presently delivered to the Arteries are diffused through the entire habit of the body and in a short time defile the whole mass of this Humour and make it scabby From these Causes of a Psora as well adjunct as procuring being unfolded Of the Itch. the reason of the first symptoms or breaking out in Pustules is manifest enough but as to the other viz. the Itch as it is troublesome to Sense that the formal reason thereof may be known we ought to consider to what Sensory or organ of sense it properly belongs and of what sort its passion or affection should be Concerning these things first it is sure it belongs to the sense of touching It belongs to the Sense of Feeling and that the first Instruments hereof are Teats fashioned like a Millet and their little Fibres dispersed through the whole skin as we have before declared Moreover with this sense all the nervous fibres are endowed being diffused throughout the whole body Notwithstanding whereas there are two supream passions of Touching Of what sort its Affection is and as it were generical viz. Pain and Pleasure it is deservedly doubted to which of these Itching ought to be related For the solution of which we ought to shew by what means the Animal Spirits being inmates to the organ of Touch are affected in Pain and also after what manner in Pleasure then their demeanour also as to the Itching being design'd it will easily be manifest of what Province this Passion is The chies Affections of feeling are Pain and Pleasure and in what things the nature of it and the manner of its acting do consist Let the Reader pardon me if I should by way of digression expound this more at large and even to tediousness because this Aetiology seems very necessary both to the understanding and curing of most outward distempers Pain being distinct from Sadness and belonging to the Touch is used to be defined Atroublesome feeling proceeding from the dissolution of Vnity And indeed it takes its origine as often The formal reason of Pain and in as much as any sensible thing disagreeable or improportionate being applyed to that organ of fense divides and separates the fibres one from the other and for that cause repelling the animal spirits inhabiting in them from their wonted and quiet emanation distracts them from one another and as it were puts them to flight then presently forasmuch as that outward repulse of the spirits is communicated by a continued order of other spirits to the first organ of Sense it stirres up the Spirits dwelling there into the like confusions so a perception is caused of grief or pain inflicted outwardly In truth the whole series of animal spirits which are affected with pain as it were some singular member of the sensitive Soul conceiving trouble as it were from the impression of the object is forced to be wrinkled with pain and to contract in self into a lesser dimension When a dissolution of Unity is said to be the cause of pain we must not understand it so as if this affection only were caused from a wound
and their functions and uses that they may more clearly be manifest it seems to be material to expose to your view the forms of some of their chiefest parts described to the life together with the explication of their Figures yet it seems proper first to insert a few things concerning the Lymphaeducts and interspaces of the Lobes omitted in the former Discourse The most renowned Malpighius first discovered these little Lobes of the Lungs and their interspaces but to what uses they serve he hath not clearly enough shewed Haply it may seem that these little places and empty spaces within the Lungs are certain receptacles of the air that there may be a larger store of it Notwithstanding it is evidently manifest upon experiment frequently made that the air pufft into the Pipe of the Trachea which is the only entrance into the Lung doth not enter or blow up these interspaces of the little Lobes The interspaces of the little Lobes have passage one into the other and from thence into the Lymphaeducts notwithstanding if you blow into the hole of any of these interspaces immediately all these spaces pufft up do swell in the whole lobe of the Lungs so that all the little lobes distinct by great interspaces will appear with a pleasant prospect as is expressed in the second Figure of the third Table Moreover the Lymphaeducts creeping through the superficies of the Lungs seem to be every where included in little Membranes covering those interspaces and to end in them But as the lymphatic Vessels are all furnished with little valves so those which appertain to the Lungs are furnished with almost infinite as is to be seen in the warm large lobe of an Ox and expressed to the life in Tab. 1. d d d d. That I may dare to conjecture concerning the use of these things Which therefore is done that the vaporous steaming of the blood being received by the interspaces and condensed into water in the Lymphaeducts may be conveyed out it is probable that those cavities intercepting each little lobe do receive the vapors flowing copiously every where from the blood being kindled when they cannot any where else be better thrust down or separated which sweat through their slender Coats into these cavities out of the ends of those Vessels and thence being forced further they are condensed into water to be carried out of the Lungs through those appropriate Vessels moreover lest the Lympha's caused from vapors within those passages and so being made thick should whirle again back into the Lungs which would bring great prejudice to them the thickest obstacles of the valves do hinder For I have frequently admired what becomes of the vaporous steams which incessantly flow in great plenty and sometimes most impetuously out of the blood burning ardently in the Praecordia For although very many of them flye away through the passages of the Trachea together with the air while we breathe notwithstanding one only way of passage or particular sluice doth not suffice to them from every place breaking forth wherefore these little places or empty spaces are every where placed that they may receive those vapors shut up in the Lungs and may drop out the same immediately condensed through the Lymphaeducts as if through so many noses of an Alembick The lymphic Vessels having their passage out of the Lungs incline towards the passages of the Thorax with their numerous branches The progress and distribution of the pulmonary Lymphaeducts and are for the most part mingled with them but they climb upon the Oesophagus in their way as also the trunks of the Trachea and the Aorta and do lose many slips in them by a various insertion likely for this cause that some of the lymphatic humor may be bestowed for making slippery the sides of those Vessels The Explication of the Figures THE first Table shews one entire lobe of the Lungs upon whose superficies the Lymphaeducts are seen spread through every where A. The Orifice of the Trachea being cut lying in the midst of the Vessels B. The Orifice of the Pneumonic Artery lying under C. The Orifice of the Pneumonic Vein placed above it d d d d. The outer Lymphaeducts spread abroad through the superficies of the Lobe e e e e. More Lymphaeducts meeting on the back of this Lobe from whence they pass into the Thoracick ducts The second Table shews one lobe of a Sheeps Lung cut in the midst that the upper part wherein is the trunk of the Vein being removed and the trunk of the Aspera Arteria laid by it self the branching of the Pneumonic Artery is shewn throughout its whole frame viz. through the small and least little Lobes All the passages of this viz. the slips and twigs how small soever being filled and coloured by any liquid thing cast into them are drawn to the life A A A A. The nether half of the Lobe divided containing the branching of the Pneumonic Artery B B B. The Trunk of the Pneumonic Artery belonging to this Lobe C. A hole from whence it s other branch was cut off and removed D D D D. The Trunks from which its other branches because they could not be expressed in this Table were cut off E E E E. The arterious stems thereof stretcht forward into length the side-branches on both parts stretcht out into the right and left side F F F F. The twigs and lesser slips which are every where intermingled with the like from the Veins and Bronchials and at last woven together with the Veins every where encompass the orbicular little Bladders and bind them as it were in clusters G G G G. The Bronchial branches which being cut from the stem of the Trachea laid aside and entring secretly into this lobe of the Lungs are accompanied with branches that bear blood H H. The stem of the Trachea appertaining to this Lobe which lay upon the Pneumonic Artery cut and laid aside f f f f. The stems of the Bronchial branches which are immersed partly in this portion of Lobe described G G G G and are partly distributed in the other half cut off The first Figure of the third Table expresses one lobe of the Lungs according to the branchings of the Aspera Arteria divided into lesser and less lobes the twigs and slips of which Vessel being filled by a liquid first injected and afterwards separated from among themselves towards the little lobes are also drawn to the life A. The Trunk of the Aspera Arteria being cut from the rest of his body B B B. The inner part being cut open that as well the holes leading into all its branches as it s straight muscular Fibres are viewed together a a a. The abve-mentioned holes leading into the every where stretched out branches b b b. The straight muscular Fibres upon which the other circular do lye C C. The upper part of this Tracheal stem being whole or shut that the Ring-like Grisles might appear D D D
cholerick and inclining to the Jaundice to void yellow and sometimes very bitter as if it had been meet choler 3. The blood dissolved also lodges in the Lungs infections that cause corruption Moreover many instances manifestly declare that sometimes the Lungs are tainted by the corruption and putrefaction of the blood For the blood toucht with an infection or a pestilent or venemous contagion begins to be corrupted and withdraw into clotted and corrupted portions from thence the Lungs undergo the chief taint from whence the greatest danger of life is threatned This is too well known in the Measles small Pox Plague and malignant Feavers for me now to undertake to explicate it by which maladies as often as the sick die it seems to come to pass either because the blood clodding in the vessels of the Heart or Lungs obstructs the way of its proper course so that presently its influx into the Brain is hindred or because the corruption of the blood affixt to the sides of the pulmonary passages causes a Phlegmon as it were and therefore provokes a most troublesom cough or difficult breathing and frequently bloody spittle So much for the impediments of the circulation of the blood which happen in the Lungs by reason of the mass of blood too much dissolved The blood is hindred in the Lungs by reason of the too thick consistence of the blood and apt to depart into parts and portions which being there left obstruct their passages There remain other no less prejudices to the Pracordia which proceed from the consistence of the blood too much bound up together and sending nothing from it self by which a burning Feaver Pleurisie or Peripneumony arise In the former distemper the blood being more sulphureous than it ought and therewithal being thick As is perceived in a Feaver is not diluted enough with its Serum and those particles of it contained within it self it puts away with great difficulty wherefore it is more plentifully kindled in the Lungs and when it passes through the passages hereof with more difficulty by reason of its greater boiling and of its thickness the Heart beating quick and most vehemently endeavours its circumpulsion with all its might notwithstanding from its greater flame growing hot within the Pracordia heat and a most troublesom thirst with roughness and as it were a certain parching of the tongue arises In the other kind of distemper In a Pleurisie and Peripneumony viz. a Pleurifie and Peripneumony the blood is alike thick but less sulphureous and inflammable wherefore it doth not participate of such a burning yet by reason of its thickness it doth not so easily and quickly pass through the Chest or Lungs is frequently extravasated and sticking to the interspaces or sides of the passages causes obstructions and soon after an inflammation to which pain often succeeds with bloody or discoloured spittle We may observe in blood-letting in these kinds of distempers that after it hath setled its superficies is covered with a little whitish skin or otherwise discoloured but always with a thick and viscous the reason whereof is that the blood when it doth not send away in the circulation its old particles nor doth admit enough of new it is thickned with a continual boiling and like boiled flesh changed from a bloody colour into a whitish in which state passing with difficulty through the small passages of the vessels it is in danger to be extravasated and easily provokes a Pleurisie or Peripneumony Besides these stoppages of the blood The blood is hindred in the Lungs by the fault of the heart caused by its own fault while it passes through the Praecordium there are also other impediments which happen either by the defect of the Heart or its passages or by the fault of the air inspired By what means and for what cause the Heart offending in its motion forces the blood from its right ventricle through the Lungs into the left irregularly we have clearly shewn in our late Tract of Cardiac Distempers to wit that muscle sometimes labouring for want of spirits doth not vigorously and strongly enough perform its beatings 1. When the spirits thereof are wanting For when in corporal exercise the blood more plentifully than usual is forced from the Vena cava into the ventricle of the Heart if this cannot firmly contract it self labouring according to its strength it causes frequent and weak Pulses moreover to help this as well the Pneumonic Arteries as others in fundry parts of the body which drive about the blood every way do cause frequent and inordinate contraction Thus I have observed in Virgins afflicted with the Green-sickness and in other cachectical bodies from a quick motion of the body not only a palpitation of the Heart but in the neck temples and other places the Arteries to have beaten irregularly Neither is it the want of spirits only 2. Because moved inordinately but their disorder is sometimes the cause that the Praecordium doth with less strength convey the blood for sometimes the spirits the inmates of the Cardiacal nerves being stirred up by an incongruous conjunction and affected convulsively do impress their irregular contractions upon the Heart or Arteries whereby the progress of the blood is several ways perverted or hindred as it often happens in Palpitation of the Heart Trembling intermitting Pulse and other the like passions 3. The pneumonic process of blood is variously stopt 3. The blood is hindred from obstruction of the passages Which are shut up divers ways For divers causes here rehearsed because the passages are not open enough which impediments happen as often as the Pores or those passages are either stopt or broken Of the former there are two reasons viz. sometimes the ways are shut for as much as the passages of the vessels contracted by the carneous fibres are brought nearer one another as we have elsewhere shewed doth sometimes happen in Palpitation of the Heart and a convulsive Asthma The affects of which sort by reason of the stream of blood shut within the Praecordia difficult or hard breathing a small Pulse and chilness of the whole body are wont to accompany Moreover sometimes the course of the blood is shut up because the passages of the vessels are pressed together by a body or by some humor from without wherefore when the little Cells or bronchial Pipes as is usual are filled with a viscous flegm purulent matter or blood extravasated as the free passage of the air is hindred in them so also the passage of blood is stopt in the vessels adjoining On the same account come tumors little swellings worms also stony sandy and curdly concretions and others of another kind are in diverse manners excited the chief whereof we shall touch on hereafter The bronchial Pipes are filled Moreover we sometimes see the canals as well of an Artery as of the pneumonic Vein made very bony in some part and their sides so compressed
Secondly the Nitrous particles of Air are wont to be obscured or blunted by other accessories also sometimes they are too much sharpened For as often as the South-wind blows the Air is too moist and thick inasmuch as the Nitrous particles are seiz'd upon by the watry and sulphureous and are much blunted so that while it is drawn in the blood is not vigorously kindled but like green wood put into fire it rather smokes than burns bright wherefore during such a state of Air we become stupid and dull and unapt for motion but on the contrary the North-wind blowing the cooling sharp and most nipping particles are adjoined to the Nitrous and the blood is enough kindled and we breathe freely yet the Vital flame is every where restrain'd by intense frost disproportion'd thereunto and unless refresh'd by motion and heat it is frequently entirely extinguished 2. Besides these faults of the Air whereby breathing is wont to be hurt The defect of air hurting breathing proceeds from the pneumonic Organs moreover this evill sometimes proceeds from its defect inasmuch as it cannot be drawn in in plenty enough Of which effects though there are many and divers causes yet for the most part it happens in respect of the organs of breathing either hindred as to their motion or their passages obstructed 1. The Organs of breathing are either meerly passive viz. which are moved as the Lungs or are Active and move themselves and those together as the muscles of the Chest and Diaphragma In every of these the impediments of the motion by which breathing is hurt happen variously And first what respects the Lungs we mentioned before that they sometimes very much swell by reason of the vessels being much distended and fill'd with blood insomuch as being stiffe and inflexible they obey not the turns of the Systple and Diastole of the Chest Moreover it happens sometimes through a phlegmon little swellings and other concretions of divers forms that a like stiffeness is caused in them Secondly the active organs of breathing or the moving parts viz. the muscles of the Chest and Diaphragma are wont to be perverted or stopt from their moving function by divers causes A solution of continuity made in any part of these either by clotting of blood or by falling down of the Serum and other homors as in the Pleurisie and Scurvy or in those that are wounded or bruised doth every where cause pain in the place affected with impotency of motion and difficult breathing Moreover sometimes without pain or any evident cause those parts being hindned from their motion do produce a most heavy pursiness As is frequently seen in an Asthma Suffocation of the womb and in certain other convulsive or hypochondriac distempers The reason of which passion without doubt consists in this for that the animal spirits appointed to the moving function of those parts are disturbed about their Origine or hindered in the passages of the Nerves and are turned aside from their due influx into the moving fibres Insomuch as many who are sound enough as to their Lungs and only obnoxious to affects of the Brain and Nerves are frequently surprized with horrid fits of an Asthma as we have at large declared in another place 2. The stopping of air hindering breathing whereby it less freely enters the Lungs frequently happens by reason of the Conveyances viz. the passages of the Trachea being shut or not enough open For indeed those passages are wont to be stopt as we have formerly observed touching the Vessels bringing Blood and prohibit the full entrance of air when they are either obstructed or compressed or more narrowly contracted The various ways of Obstructions Though there are many causes and wayes whereby the passages of the Trachea are wont to be obstructed yet chiefly and most often a Catarrhal distillation of the Serum while it departs from the blood and flows out of the vessels bringing blood into these parts which being first thin and sharp produces a troublesome Cough afterwards thickening by digestion and cleaving to the sides of the Trachea exceedinly straitens the ways of inspiration A Catarrb and shortens them by quite stuffing up their extremities In like manner the sweating out of extravasated blood as also of Pus or ichorous matter out of the Lympheducts or Veins into the tracheal little bladders doth frequently produce an Asthma and often a Consumption the reason of which sort of distempers shall be more largely explained hereafter Secondly it is manifest enough by common observation that the Tracheal passages as well the last as the intermedial often-times are straitened or shut The swelling of blood by which the passages are press'd together by compression For after a plentiful meal or abundant drinking of Wine or strong Ale inasmuch as the pneumonic vessels are very much distended by reason of the turgency of blood and the sides of the Trachea being press'd together do not admit of a free and usual entrance of air men otherwise healthful enough do breathe difficultly and painfully Which truely we esteem to happen from the lungs being filled and extended rather than from a cram'd stomach hindering the Systole of the Diaphragma Moreover for this reason even in the very paroxysmes of feavers a frequent and painfull breathing is manifest Neither onely from the turgency of blood but also from the same stagnating or extravasated and also from stony concretions and divers other manners the vessels of the Trachea being pressed together cannotdischarge a free breathing 3. The passages of the Trachea being sometimes more nearly contracted and closed from their fibres convulsively disposed deny a passage to the Air for due breathing The Cramps of the tracheal passages From hence when there is no obstruction or ill conformation in the lungs as also no consumptive disposition yet from those fibres preternaturally convulsed and drawa together dreadful fits of an Asthma frequently arise Whereas we have in another place discoursed of these passions it will not be requisite here again to repeat that discoure Resides these accidents of breathing hurt there are certain others which are stirr'd up by reason of the Air prohibited in its frist entrance viz. in the Nostrils the throat the Larynx from a tumour or ill conformation For the Polypus in the Nose the Quinzy in the Throat or inflammation of the Tonsils do render a difficult breathing in the same manner as a heap of sand about a Haven obstructs the ingress and regress of Ships But truly since the reasons of those passions and their manner of being made are exposed to sense it seems superfluous here to deliver their causes SECT I. CHAP. IV. Of Expiration hurt AS Expiration is much easier The act of expiration is easier than of inspiration and with lesser trouble performed than Inspiraration so it is less endangered to be stopt or perverted as to its function for in truth the contractive endeavours of fewer muscles are required to perform that
the Lungs were free from any Ulcer yet they were set about with little swellings or stones or sandy matter throughout the whole for from thence the blood because it could neither be freely circulated in the Praecordium nor animated enough by the nitrous air and when in the mean time it is perpetually polluted by its proper dregs deposited in the Lungs is frequently vitiated and made incapable of nourishing thereby wherefore a Phthisis is better defined that it is a withering away of the whole body arising from an ill fromation of the Lungs The Ancients following Hippocrates The cause assigned by the Ancients for the most part have assigned only two causes of this disease viz. a Catarrh and the breaking of a Vein to which some have added an Empyema and others exclude a Catarrh from this number for what is vulgarly affirmed that flegm falling from the Head into the Lungs and abiding there putrifies is most commonly the cause of a Phthisis or is often brought by it we have formerly intimated to be altogether erroneous and shall presently shew it more clearly In the mean time to shew what the matter is that generates a Consumption as often as it arises without an Empyema or Haemoptoe going before What the consumptive matter is it must be considered after how may manners and by what ways any thing disagreeable or heterogene can enter into the Lungs which diligent search being made it will easily appear that any thing that is an enemy to the Lungs creeps in and is admitted chiefly either by the Trachea or by the pneumonic Arteries By what ways it enters the Lungs yea and sometimes haply by the Nerves but nothing by the Veins or Lymphaeducts whose function is only to carry back or away the blood or Lympha and to leave there nothing at all As to the Trachea it is manifest it is ordained for this end that by its passages or pipes the air might be conveyed in or presently carried back by a constant recourse from whence it comes Sometimes by the Trachea yet not destilling from the head moreover whether any matter being hurtful or mortal to the Praecordia may be admitted the same way shall be now our present disquisition And that the Lungs frequently incur a pernicious pollution by this entrance is clear from hence because the moist air of some regions repleat with fumes or abounding with malignant vapours doth frequently induce the consumptive inclination nevertheless the affection thereof is wont to be communicated only by aerial minute particles whereby either the temperament of the blood or the conformation of the Lungs or both are prejudiced But whether besides this a serous matter or some humor corrupting the Lungs doth enter them through this passage is not without reason doubted although many do determine a Catarrh or a destillation of the Serum from the Brain into the Lungs by the passages of the Trachea the principal cause of a Phthisis Which opinion being erroneously delivered by the Ancients I admire any either of our modern Physicians or Philosophers have admitted thereof for it is manifest by anatomical observations that nothing from the Brain by the Glandula pituitaria which seems the only passage from thence falls down into the Palate or Breast but that the Serum there deposited is conveyed by appropriate passages to the jugular Veins and is remanded to the blood Moreover it is manifest to sight that whatsoever relique of Serum is laid aside in the Glandules of the Ears Mouth Nose or Face is conveyed from them all by peculiar passages insomuch that no humor whatsoever destils from the Brain or the Palate into the Lungs But although matter exciting a Congh doth not destil from the Head by the Trachea into the Lungs yet sometimes falling down from the sides of the Trachea into their cavities But sweating out of the sides of the Trachea it produces that disease commonly called a Catarrh For the Aspera Arteria like the Arteries beinging blood are endued with a nervous and musculous Coat and so do occasionally enjoy sense and motion having also a glandulous Coat and full of little vessels to sustain the vital heat and nourishment These last Coats make those interspaces and as it were cover the Cartilages Moreover the superfluous serosities proceeding from the blood watering the Trachea are deposited into this glandulous Coat which for the most part presently sweating into the cavities of the Trachea serves chiefly to make them slippery and most but if the mass of blood be poured out too much and precipitated into serosities as it frequently happens a cold being taken or the swallowing down of acid things and on many other occasions for this cause a great plenty of watry matter sweats out of the Glandules of the Trachea and mouths of the little Arteries into its cavities which soon doth cause a most troublesom Cough and often much spittle which afterwards comes to be consumptive But surely this cause of Spittle and as it were a Catarrhal Cough very rarely comes alone The consumptive matter brought into the Lungs rather by the pneumonic Arteries because while the blood watering the Trachea having suffered solution throws in its serosities into the Glandules whence presently they sweat into its cavities and also the remaining blood being in like sort dissolved it insinuates its Serum set apart within the pneumonic arteries partly into the tracheal hollownesses and partly into the Lympheducts by the overflowing whereof the Lungs are as it were overwhelmed and much incited for the most part provok'd to Cough and continual spitting A Cough and spitting of this kind as long as moderate A Cough and spitting sometimes healthful only throwing off the serosities of the blood rather are beneficial than prejudicial because the mass of blood and the very lungs being throughly purged after this sort those symptoms for the most part spontaneously abate and from thence ensues a more perfect health But if they be protracted a long time the serous humour being on both sides laid aside into the tracheal passages and from thence more plentifully daily heapt up at length it will change into corruption because as well the free enjoyment of air is impeded as also the motion of the blood and its temperature wholly perverted from hence a Cough becomes more fierce and breathing more difficult nay rather the whole mass of blood in as much as it is defiled by the foul blood which the Veins receive from the Lungs degenerating by degrees from its benign properties and being depraved it not only continually pours forth the super fluous Serum but also the nutritive Juice which it cannot assimilate out of the pneumonic Arteries into the tracheal passages Yet often being too much is dangerous and so this mass of consumptive matter is daily increased till the Lungs being more and more obstructed and filled and the blood being defiled and rendred unfit to perform any of its functions the Cough
and Spittle become worse and worse and presently become dangerous Moreover breathing being hurt the faintness and pining away of the whole body the debility of all the functionx and at length a hectick feaver and a hasty declination to death follows When by the long continuance of a Cough and Spitting leasurely encreasing Why the Consumptive matter affects and by degrees hurts the lungs the humour is more plentifully deposited out of the mass of blood into the lungs it first of all enters into the tracheal little bladders and at length fills them and somewhat distends them from which while every morning by expectoration then more copiously performed it is almost entirely cast out from them thence the Thorax is exempt for a short space from the burden and respiration seems more free yet a little afterwards the blood being stuff'd again with Serum or nutritive juice it pours down new matter into the lungs and from thence again after meat or sleep the little bladders are fill'd and the humours by the afflux daily encreased are more distended and enlarged and at length the sides of two or more of the little bladders being burst many little bladders are here and there framed as it were into one lake within which the consumptive matter being more abundantly collected there it putrifies for it is not entirely prefently cast out and from thence it corrupts the substance of the lungs to which it is joined and imparts a putrid defilement to the blood passing through it This breach thus made in the lungs is daily encreased and frequently more are at the same time formed in divers places and by reason of the great plenty of humours heaped up and putrified in them a heaviness of the breast is felt like a weighty burden upon them the breathing is more hindrd moreover from the tabid blood being more plentifully intermix'd with the mass of blood frequent effervescences of it destruction of the nutritive juice also thirst heat loss of appetite nightly sweats and a pining of the whole body do arise How an Vlcer of the Lungs is made But the blood being polluted from the lungs causes them to be punished with a reciprocal affection that is to say from its peculiar pollution because the blood in the veins receiving this purulent matter in every circuit it immediately delivers it into the arterial from whence whereas it cannot be sent enough away by sweat or by Urine it is brought back by the pneumonic arteries to the lungs where again being separated from the blood it is every where conveyed as well into the little bladders of the Trachea as into the lesser passages insomuch that at length the whole frame of the lungs being filled clefts or ulcers are formed consequently in many places and all the other hollownesses are stufft with frothy quitter But sometimes it happens that there is one Ulcer or hole or happily two formed in the Lungs and the sides grow callous round about so that the matter being there gathered together is not conveyed into the mass of blood but is daily expectorated though in a vast plenty They that are so affected as if they had but an issue in the lungs An ulcer of the lungs covered with a callus less prejudicial although they cast up much Spittle and thick and yellow matter every morning and a little sometimes all day yet otherwise they live well enough in health they breathe eat and sleep well are well in flesh or at least remain in an indifferent habit of body and frequently arrive to old age insomuch that some are said to have been consumptive thirty or forty years and to have prolonged the disease even unto the term of their life for that cause not being shortened And in the mean time others who cough or spit less within a few months fall into a hectick feaver and in a short while are hurried into their grave Hitherto touching the conjunct cause and formal reason of a Phthisis or pulmonary Consumption The evident causes of a consumption what belongs to the other causes that is to say procatarctic and evident ones they truly are various and manifold inasmuch namely as they are more near or more remote inward or outward and lastly connatural or adventitious That I may undertake to design the powers operations and modes of effecting of all these in producing a Phthisis primarily it is requisite that I shew by how many modes and by reason of what occasions the serous humour of as folks commonly say the Catarrhal is laid apart out of the mass of blood into the little bladders of the lungs and into other passages of the Trachea The primary causes of a Consumption some from the blood others in part from the lungs Upon diligent search of this it is obvious to any one to percieve the morbific cause consists of two parts and that the fault is in the ill temper of the blood sending an offending matter to the Thorax and also the weakness or ill tone of the lungs easily receiving it As to the former it is manifest enough by common observation that the mass of blood being stuft with incongruous particles viz. it s proper ones degenerated or with others from other places intermingled The ill temper of the blood disposes to it doth boyl up for the expurging of them and what is to be separated when it is not easily sent away by any other ways it is spread abroad into the lungs if they are of a weaker constitution and cleaves to them There are many dyscracies of the blood and those of divers kinds and affections by by which its liquor being dissolv'd in its consistence and as it were curdled doth not rightly contain the serous and nutritive juice within it self moreover sending away these and other excrementitions humours uncessantly from it self as sometimes it deposits them among other parts so more often into the lungs 1. The blood sometimes like Milk grown sour of it self is depraved by little and little and at length departing from its genuine faculty into a sourness and being dissolv'd in its existence doth cast abroad its serosities too easily prone to separate themselves out of the Pneumonic and also Tracheal Arteries into the tracheal passages Thus to some it is ordinary once or twice in a year without any manifest cause to be afflicted with a grievous and troublesome Cough with copious spitting which in a certain process of time after the blood purged from its dregs and excrements recovers its temperature doth spontaneously abate and after doth succeed a more firm and durable health By reason of such a Cough serving for a purge to the blood I have known some often in a day and especially every morning who were wont to spit out spittle like black Ink with a small endeavour of the Trachea which distemper when for many months they had constantly labour'd under after a greater Cough occasionally contracted with much and yellow spittle they
after I repeated Phlebotomy and after continuing the same Remedies in four or five dayes he intirely recovered his health The blood we took from him was alwayes in the Superficies viscous and discoloured A certain Gentleman of a sanguine Complexion and a strong habit of body The second History after an immoderate drinking of Wine contracted a Feaver with a most painful Peripneumonie insomuch that thirst and heat mightily pressing him sitting always upright in his bed or Chair and breathing short and very frequent he could scarcely yea almost not at all suck in air enough to sustain the vital flame Because he could not undergoe a large Phlebotomy I drew blood twice or thrice day after day frequent Clysters were administred Moreover Apozemes Juleps also Spirit of Armoniack and powders of Fish-shells were administred by turns Within four or five dayes the Feaver somewhat abated also he began to breathe better and sometimes to take short sleeps yet he did always complain of a notable heaviness of his breast and intolerable oppression of the Lungs wherefore when Phlebotomy was no longer safe I applyed very large Vesicatories to his Arms and Thighs the blisters in his arms dry'd up in a short space but those on his legs did not only remain open but after five or six days did run hugely and afterwards almost for a month daily discharged great plenty of a most sharp ichor in the mean time his lungs sensibly amended and at length were delivered from all their burden lastly the little sores raised by the Vesicatories very painfully and not without frequent Medicines could be cured SECT I. CHAP. IX Of a Pleurisie HOw great affinity there is between a Pleurisie and Peripneumonie The diseases of a Pleurisie and Peripneumonie are akin we have hinted before viz. although either distemper is sometimes solitary and exists separately from the other yet they often happen together or one while this another while that come one upon the other or succeeds it The foregoing cause is the same of both viz. a disposition of the blood to be clammy and boyl up withall also the conjunct cause is the same viz. an obstructing Phlegmon in some part of the lesser Vessels by reason of such a disposition of blood Moreover the same method of Cure is prescribed by most modern Physicians for either disease The chief reason of the difference whereby they are distinguished one from the other is taken from the places affected which their Names denote How they differ betwixt themselves For the blood predisposed to the enkindling in some place an enflaming obstruction therefore often plants the nest of the disease in the breast because here it burns out more hideously by reason of the Hearth of vital fire and also is not freed from the vaporous Effluviums and other Recrements which hinder Circulation To all which there ensues that in this Region the mass of blood being shut up and not able to pass through the more strait Conveyances is not as in the bowels of the lower Belly opened with any ferment or new washt with any watery juice wherefore if perhaps the blood carried through the vertebral Arteries into the membrane encompassing the ribs shall stick in its passage about the narrowness of the Vessels or inter-spaces the Distemper of which we now treat succeeds In like manner if an obstruction happen within the passages of the Lungs a Peripneumonie will ensue as we have declared before Wherefore according to the Pathologie of this disease before delivered those things which belong to the Theory of a Pleurisie as well as the Curatory method may with small labour be designed Both the sense of pain The seat of a Pleurisie as well as Anatomical Observations taken from the Patients dead of a Pleurisie do plainly attest the feat of this Disease as often as it exists primarily and solitarily consists in the Pleura or Membrane environing the inside of the ribs And a true and singular Pleurisie is an inflammation of the Pleura it self from the abundant flowing in of inflamed blood growing clammy withall taking its motion through the vertebral Arteries with a continual and acute Feaver a pricking pain of the side a Cough and difficulty of breathing The next Cause is the blood obstructed by reason of its clamminess in the lesser vessels and interspaces of that membrane in like manner as it is in a Peripneumonie or being extravasated being heaped in the same place more plentifully The next cause of it by reason of the swelling up for that cause exciting an inflammation An acute pain ariseth upon this by a wound in a part highly sensible also there ariseth a Cough by reason of a provocation giving impression to the intercostal muscles moreover a difficult breathing by reason of the muscular fibres being hurt as to their action which because they cannot perform long and strong contractions they are constrained to undergoe weak although more frequent Contractions otherwise than in a Peripneumonie in which that symptome ariseth from a Lung too much fill'd and stuffed The Feaver is caus'd from effervescence of blood and is for the most part rather the associate than the effect of a Pleurisie For the blood from what cause soever driven into a feaverish turgescency if it be bound up together in its mass will be apt to grow clammy which together with the Feaver most often induces a Pleurisie or a Peripneumonie or both of them From hence we may observe this disease doth frequently vary its kind and change its place viz. from a Pleurisie into a Peripneumonie and on the contrary afterwards it passes from both or either into a Frenzy or a Squinancy for that the blood while it is boyling throws off its viscous recrements one while in this part another while in that another while in more together and lastly it reassumes them again and variously transferrs them The more remote causes of a Pleurisie are the same as of a Peripneumonie viz. whatsoever stirs up the blood The more remote causes of this Disease predisposed to grow clammy and also to boyl up and provokes a feaverish turgescency Hither appertains excess of heat and cold a sudden constipation of the pores surfeit drinking of Wines or Strong-waters immoderate exercise sometimes the malignant constitution of the Air brings this disease almost on every body and renders it Epidemical whereto may be added that this disease is very familiar to some from their constitution or custome so that a distemperature of blood induced almost by any occasion immediately passes into a Pleurisie From what we have already said the signs of this disease do appear manifest enough by which it is well known as to its Essence and is distinguished from other diseases and especially from a Bastard Pleurisie and a Peripneumonie But it is to be observed that a pain in the side arises sometimes very troublesome which while it counterfeits a Pleurisie is sometimes taken for it although falsly For in
three dayes it flowed out without any stench but afterwards as often as the Orifice was opened a most horrid smell came forth exceeding the stench of any Jakes though ne're so stinking and infected the whole Chamber with the ill scent Moreover it remain'd so for many days untill by injections made of Myrrh and bitter herbs boyl'd in Water and Wine and very often administred every day at length it was extinguished by the daily use of which the morbific matter and at length all the fordidness being washed away all flowing out ceased and last of all the Orifice being closed the patient recovered his entire health I dissected the dead bodies of those who dyed when by no perswasion of Physician or Friends they would admit of the opening of their side One I have spoke of otherwhere The History of one who dyed because he was not cut the result whereof was the Pus streaming from the Imposthume raised in the Pleura and in the intercostal Muscles and broken internally had wasted part of the affected place and of the contiguous Lung with a Sphacelus or Gangrene and so corroding the Diaphragma and a hole being made on the right side thereof it had descended into the Viscera or bowels of the lower belly and there in the whole passage of the Ventricle and Intestines the outer Coats on which the purulent matter had fallen appeared eaten and discoloured and at length the purulent matter corroding and boring through the intestinum rectum it came forth through the fundament together with his excrement The sick man being strong and impatient of any medicine endured the tyranny hereof for about two months but in the mean while he lived miserably afflicted with a light Feaver thirst inquietude pain of the stomack and frequent tumbling up and down and almost with continual watchings His body being opened after his decease a most horrid stench exceeding any Jakes diffused it self throughout the whole Chamber The Anatomy of another who dyed by an Empyema A fourth History like the former afforded not so vast an effusion of purulent matter This indeed had its nest in his side from whence falling into the cavity of the Thorax and there accumulated in a vast heap and continually defiling his Lungs drenched therein it caused a slow and as it were a hectick Feaver whereby the patient being very old dyed SECT I. CHAP. XI Of an Imposthume of the Lungs A Vomica of the Lungs is something a-kin to Empyema or Peripneumonie Vomica Pulmonis a disease seldom observ'd considering that the morbific matter is always meer Pus which notwithstanding is generated in the Lungs without a Feaver and Phlegmon yea without any great Cough or Spittle as it were silently and without noise and frequently this evil doth not discover it self before it kills the patient Galen makes mention of this in lib. 1. de locis affectis but among Authors who have written Systemes and the Practical parts of Physick mention thereof is seldom of scarce to be met with Tulpius in lib. 2. chap. 10. describes this distemper after this sort This evil meaning an Imposthume of the Lungs lurks in the beginning so secretly that it scarce discovers any signs of it self besides in the first place a little dry Cough and presently moist which continuing for some time the breath is drawn with difficulty the spirit fails and the body withers by degrees although in the mean time the Spittle makes no shew either of pus or blood and if the Imposthume break by way of surprisal the man is kill'd immediately It is wont sometimes so to happen but I have known many who in an Imposthume rising insensibly being maturated and at length breaking have spit up gâ—â—t plenty of fetid corruption and though with voiding daily such a Spittle for many weeks nay months they became very weak and as it were consumptive yet at length by the help of Medicines after the Ulcer hath been mundified and dryed they have recovered their health entirely This disease The formal reason and conjunct cause thereof if we search into the formal reason and conjunct cause thereof is in truth a concourse of ill humours gathered in some part of the Lungs whose matter although it be heterogene and an enemy to nature notwithstanding from the beginning appears not sharp or irritative For when at first being separated from the blood it is deposited in some hollow place of the Lungs perhaps in some bladdery cell it doth neither raise a Cough nor produce a Feaver but after wards when sensibly encreased it compresses the neighbouring Vessels bringing blood and moreover insinuates into the very blood passing by incongruous Effluviums from thence a small Feaver succeeds with a certain disquietude and feebleness and at length being accumulated to its fulness and maturated by a long digestion into mere pus breaking its nest very much distended before it flows out every where all about But if the ways are not open for the issuing of the pus it incontinently mingles it self with the blood and either empoysons it or impedes it from Circulation or rushing by heaps into the Tracheal passages it doth fill most of them at once and so stuffs them that a sufficient entrance is denyed to air to kindle the blood and presently the viatl flame expires but if this matter find passage and flow by degrees into the Trachea from whence again it may be presently carryed away and spit out there will be then some truce of life with hope and opportunity of cure And indeed I have known may cur'd of this disease The usual matter of an Imposthume of the Lungs is meer Pus The morbifick matter which often stinks notably and by that differs from the Spittle which is ejected in a Peripneumonie or a Consumption of the Lungs But whence that matter proceeds in the beginning thereof and of what disposition it was before it was ripened into pus I cannot so easily determine because the seeds of this disease being privily sow'd and growing up secretly spring wholly from an occult original wherefore its procatarctick or more remote causes lye conceal'd yea while it begins and increases can neither be discovered by any pathognomical Signs nor can any prognostick be devised before it discovers it self with a mortal stroak but the whole procedure thereof is treacherous Now if after the Imposthume is broke and the spitting up of pus with an easie discharge being begun with a constancy of strength there be means offer'd for some method of cure the chief Indications according to the common custom in most diseases will be these viz. Curatory preservatory and vital The first commands the matter of the Imposthume speedily to be discharg'd by Spittle and that the sides thereof should be cleansed and healed as much as is possible The second Indication provides against the conflux of new matter to that nest or other adjoyning places of the Lungs whence a Consumption may be engendred The
of a defect of fault in the motive organs or mixt when either parts conspire in the fault which origine every great and inveterate Asthma is wont to have of each of these we will treat in order 1. The ancient Physicians The Ancients allowed the cause of it only from the Bronchia obstructed and for the most part hitherto the Moderns have only acknowledged the first kind of Asthma judging the next cause and almost the only cause of this Disease to be the straitness of the Bronchis viz. inasmuch as the spaces of those passages being either straitned together by obstruction or compression as often as the use of breathing is required do not admit of plenty enough of Aire wherefore for the more free inspiration of aire as shall be needfull the organs of breathing do most difficultly labour with throes most frequently repeated But that some are found obnoxious to fits of an Asthma Or vapours from the Spleen or Womb but erroneously without manifest taint of the Lungs it was wont to be ascribed to vapours from the Spleen Womb Mesentery or some other bowel undeservedly enough but surely that passion without the straitness of the Bronchia or fault of those bowels we have in another place sufficiently evidenced to arise from Cramps of the moving parts and shall be presently clearly made out But in the mean time by what means it may arise also from the passages of the Trachea obstructed or compressed it lyes upon me to declare The straitness of the Bronchia After what manner the straitness of the Bronchis arises inducing the first kind of an Asthma is supposed to come to pass by an obstruction as often as either thick humours and viscous or purulent matter or blood extravasated are forced in upon them or that little swellings or Schirrus's or little Stones stop up their passages or finally that a Catarrh of a serous humour suddenly distills upon them Moreover the same distemper is thought to be raised by compression as often as matter of that kind and of every kind of them shall cleave to the passages of the pneumonic Arterie or vein Surely an asthmatical disposition depends upon these various causes and manners of disturbance but all invasions of the disease or at least the greater fits are usually provoked by reason of some accidents or occasions For while the stream of blood sliding and running down gently can be content with a small breathing it passes through the precordia without great labour either of Lungs or Breast But being boyling and passing through the Lungs more impetuously it requires a more full inspiration of aire for the freer admittance of this through strait passages presently all the breathing organs are alarmed into most frequent throes Whatever causes an effervescence of the blood is the evident cause of an Asthma Whatsoever therefore makes the blood to boyl or raises it into an effervescence as violent motion of the body or minde excess of extern cold or heat the drinking of Wine Venery yea sometimes mere heat of the Bed doth cause asthmatical assaults to such as are predisposed It is usual that those who are obnoxious to this disease oftentimes dare not enter into a Bed only sleep in a Chair or on a bed being covered with garments The reason whereof is Why Asthmatical Persons are worse in bed that the body covered and heated with bed-cloaths the blood being a little raised into a more quick motion and grown hot requires a more plentifull sucking in of air than may be supplyed from the passages of the Trachea being straitned for the more blood passes the Lungs each Systole and Diastole by so much for the enkindling and eventilation thereof the air ought to be more plentifully and quickly brought in and sent forth to which task when by reason of impediments it is not easily dispatched yet in some manner to be performed the ultimate endeavors of all the parts appointed for breathing are made use of with a great contention of the whole breast Moreover the blood being stirr'd is not only an occasion but also in some part a cause in those that are asthmatically predisposed for the vessels bringing blood being thereby more fill'd and distended within the lungs compress the Tracheal passages being already very strait and render them much more close II. A convulsive Asthma which we judged to be the second kind of this disease A convulsive Asthma and to be raised without any great obstruction or compression of the Bronchia from the mere Cramps of the moving fibres is not limited to one place or to any peculiar organ but being of a diffused energy it is extended to almost all the parts employed in breathing whereof one while this another while that or some other is in fault It s Seat manifold and diffused For a convulsive affection inciting an Asthmatical invasion hath regard to the moving fibres of the vessels of the Lungs to the Diaphragma to the muscles of the breast to the Nerves which belong unto the Breast or Lungs nay to the origine of those Nerves planted within the Brain and whilest the morbisic matter dwells in every of these places hindering or perverting the work or breathing it brings on the fits of this Disease as in another Tract we have somewhile since plainly demonstrated For the animal Spirits destin'd to the function of breathing if at any time they are very much molested and constrained into irregular motions enter inordinately into the fibres as well nervous as moving of the organs of breathing and make them for that cause one while to be contracted another while to be distended irregularly as also their solemn and equal turns of Systole and Diastole to be variously disturbed or hindered The morbific cause or matter provlking the Spirits prepared for the pneumonic work as in divers places so chiefly in these three The morbific matter consists in several places is wont to advance its force or power viz. 1. Either in the muscular fibres themselves or 2. In the branches or nervous slips or lastly within the Brain by the origine of the Nerves 1. As to the former 1. In the muscular fibres the heterogene matter being inimical to the Spirits is sometimes shaken off from the Brain into the trunks of the Nerves and from thence by their passages and slips if perhaps it shall be in very little quantity without very great or sensible hurt slides down to their lower ends And when it falls in the nervous fibres and being heaped up daily shall at length sensibly increase unto a great quantity it begins to trouble the inmate Spirits and to provoke them into asthmatical Convulsions which forthwith infest and are encreased by reason of evident causes neither do they utterly cease untill the stock of matter so accumulated be wholly dispers'd and consumed afterwards when it being renewed arises to a fulness the fits of that disease return and are for that cause
most frequently periodieal as is manifest to common observation According to this account we do deservedly suspect the cause of a convulsive asthma sometimes to lurk in the muscular coats of the pneumonick vessels also sometimes in the fibres of the Diaphragma or the Processes thereof towards the loyns It is not very probable that the nest of this disease consists within the fibres of this or that pectoral muscle although in Scorbutical persons from these also possessed with a convulsive matter we have known pains to have risen with breathing being hurt 2. But truly even as in another place we have not only demonstrated by reason 2. Within the Nerves and their ensoldings but by the observations and Histories of the sick a convulsive asthma is often incurred as often as the morbific matter sliding down into the pneumonic Nerves sticks in some place within their passages and especially about their foldings whence as often as it is accumulated to a plenitude it begins to be mov'd and shaken wherefore the spirits lying lurking and flowing into the ongans of breathing disturbed are forced into irregularity and those spirits presently affect other inmates of the fibres of the Lungs and breast and provoke them into unequal and asthmatical convulsions For this cause and the reason of the disturbance we have declared that not only invasions of this disease but also the precordia being disturb'd thereby the Cardiack passions do arise 3. 3. Near the Origines of the Nerves We have clearly unfolded by anatomical observations that the cause of a convulsive Asthma sometimes consists in the hinder part of the head near the origines of the nerves Surely I have observ'd some patients who when lying sick of other desperate diseases they were also asthmatick found it necessary to be whether in bed or chair with their head always erect or looking down but lying on their back or leaning backwards incontinently they gaped for breath as if they were dying and hardly breathed the cause whereof as appear'd by dissection after they were dead was only a huge collection of sharp Serum which was gather'd within the cavities of the brain which if by reason of the head inclining back wards it fell into the origine of the Nerves of the eighth pair presently the precordia and chiefly the breathing organs were affected with horrid cramps Moreover sometimes for this very reason it seems that Orthopnoick persons cannot lie down in their bed without danger of choaking but are constrain'd to sit up with an erect body III. 3. A mixt Asthma or partly Pneumonic and partly Convulsive Although an Asthma is sometimes simple from the beginning viz. either merely pneumonical or convulsive notwithstanding after either disease hath for some time encreafed for the most part it gains the other to it self hence it may be concluded every inveterate Asthma to be a mixt affection stirr'd up by the default partly of the Lungs ill fram'd and partly by default of the Nerves and nervous fibres appertaining to the breathing parts For when the pneumonic passages being straitned or obstructed from some cause do not admit of a free sucking in and breathing out of the air for that cause also the blood yea and nervous humour being hindred in their courses and compell'd to proceed slowly and to stagnate do fasten their feculency and dregs upon the nervous parts whence the passages of the spirits are obstructed or perverted and at length a convulsive taint accrues to them Moreover the blood being not duly inspir'd and eventilated within the precordia at length being vitiated in its temperament supplies the brain and nervous stock but with a depraved juice whose faults do chiefly punish the organs of respiration before hurt and debilitated In like manner also the evil is reciprocrated on the contrary part as oft as this disease begins by fault of the nervous stock for as much as the motion of the Lungs is often stopt or hindered by reason of Convulsions in the muscular fibres both the blood and the nervous juice being restrain'd from their usual motions do heap up dregs and filths fastening them to the parts containing them by which not only viscous humours and obstructing of the passages but even Tumours and other more solid concretes vitiating the structure of the Lungs are produced Therefore if when an Asthma being for some time confirmed and become habitual The causes of an Asthma recited shall attain to frequent fits and those emergent upon every occasion the conjunct cause thereof and also the procuring cause is placed as well inwardly in the lung it self as outwardly in the Fibres and Nerves and in the spirits imploy'd for the function of breathing Neither will it be difficult by seeking diligently each of these things to find in any case of the patient as well the chief nests as nourishment of this morbifick matter But as to the evident causes they are very many and also of diverse sorts For hitherto ought to be referred whatsoever move either the blood and the other humours or trouble the animal spirits and force them into irregularities Asthmatical persons can indure nothing violent or unaccustomed from excess of cold or heat from any vehement motion of body or mind by any great change of air or of the year or from the slightest errors about the things not natural yea from a thousand other occasions they fall into fits of difficult breathing As to the prognostick part The Prognosticks of the Disease an inveterate Asthma is difficulty or scarce ever cured notwithstanding the medicines and method of healing being rightly ordered oftentimes great succour is afforded viz. the fierceness of the fits is diminish'd longer respites are procured yea even the dangers of life it self seeming frequently to be imminent are removed This disease growing worse either threatens a Consumption or a Dropsie or some drowzy or convulsive affect accordingly as the Serum by reason of perspiration being hindred being more abundantly accumulated because the sick cannot sleep enough in their beds it is either fixed in the lungs or transfer'd into the habit of the body or into the brain it self For this very reason the diseased do find themselves better in Summer when they breath more freely than in Winter likewise better in hot countries than in cold the South or West wind blowing than the North or East Of the curatory method of an Asthma there will be two chief indications Two chief Indications or rather so many distinct methods of healing viz. Curatory and preservatory The first instructs what is to be perform'd in the fit it self that the Patient may be delivered from present danger the other by what out of the fit we ought to endeavour the taking away the morbifick cause lest that distemper be repeated more often or more heavily 1. Therefore a fit urging there will be two chief intentions of curing viz. first What is to be done in the fit that a more free
the blood sweats out into the Aqualiculum or belly either the very Blood or Vessels containing it or both together are in fault The Blood is in fault when being depraved in its Crasis it doth not rightly contain within its consistence the constitutive parts but being apt to be dissoved it every where rejects its serosities from the mixture which either it drives out by Urine or Sweat or permitting them to reside within pours them out into the pores of the flesh The Description of an Ascites or the cavity of the bowels The vessels bringing blood grow faulty for a second reason for that their extremities or little mouths either are too much loose or altogether shut up In the former state the clew of Circulation of blood is not entirely and firmly continued but the thinner and more crude part of the blood being apt to depart is suffered to flow out near to the interspaces or inosculations of the Arteries and Veins likewise on the other side when the course of blood is hindred by reason of a tumour or obstruction of some vessels their little mouths being throughly closed to this being so straitned that a passage may be made open by some means that which is thin and watery is extravasated and sent away into the neighbouring places as we have shewed above 2 2. In respect of the Lymphaducts 3. But an Ascites beginning alone doth often arise by reason of the milkie or lymphatic vessels being depraved wherefore seeing we suppose the cause of this kind of disease to be oftentimes conjunct we must enquire by what means and for what occasions these vessels are wont to be so opened or burst asunder that they pour out thei liquor into the cavity of the belly First therefore as to what belongs to the Lymphaducts these vessels may be in fault after a diverse manner but chiefly either that being obstructed or compressed near their origine they do not receive the humour or being burst about the middle or extream parts do pour it out into the belly There are many causes and reasons of effecting of either of these for it may be a viscous matter obstructs their beginnings or glandulous scirrhous and other preternatural Tumours compress them as also a vast inundation of Lympha flowing out moreover vehement motions of the Body or passions of the mind may burst them asunder 2. The milkie Vessels no less than Lymphatick are in danger to be broke 3. In respect of the milkie vessels and so by pouring out their liquor into the cavity of the Belly do excite the Dropsie called Ascites and truly they are wont to be hurt for the like reason in regard their middle passages or their ends either are obstructed by a more viscous chyle brought into them or by Phlegme from the intestines or they are compressed by Tumours bred in the Mesenterie for forthwith the chyle entering into the beginnings of the vessels and not finding a passage first very much distends them and afterwards breaks them There are many causes and occasions for which the thicker and obstructing humours are driven forwards into the milkie Vessels for besides an irregular Diet and for the most part from meats hard to be digested this evil is frequently caused by too much drink or immoderate exercise immediately after Food also from cold drink while the Bowels are very hot for so the passages of the Vessels before gaping are suddenly shut and afterwards more narrowly closed wherefore the chyle sticking within their straitned chanels doth throughly fill and obstruct them in a short space As to what belongs to the differences of this Disease besides them already cited The differences of this disease viz. that it comes after an Anasarca or comes solitary that this also is manifold and after a diverse manner according as the Vessels bringing blood or water or milk are found in the fault Moreover we observe that the Dropsie called Ascites sometimes proceeds from a meer watery humour filling and distending the parts of the nether belly but sometimes there happens to this deluge an extension of the membranes or inflations made by the irregularities of the inmate spirits and so they do encrease the swelling of the Abdomen and in this case a certain Tympanites comes upon an Ascites even as more frequently on the contrary this is the offspring of that Moreover in an Ascites meerly watery sometimes the Lympha only fluctuates within the Cavity of the Abdomen so that in the mean time the bowels being soakt in it continue still entire and little or nothing encreased in their bulk but sometimes besides the inundation of the Lympha in the hollow of the belly the blood being slowly circulated there and almost stagnating it is much diluted with water Moreover the Parenchyma of the bowels and the sides of the Vessels and of the membranes and chiefly the Glandules every where numerous being moisten'd do swell with the flowing water and so the tumour of the belly consisting as it were of many pools of water and moorish Contents rises into a vast bulk The Prognostick of this Disease is always suspected and accounted of an ill omen The Prognostick for none of the vulgar but will pronounce the obstinate tumour of the belly to be very dangerous and difficult to cure If any seem to be affected with a Dropsie or a Consumption with them presently the next question is Who shall be his heir An Ascites beginning after an Anasarca which proceeds commonly from the whole mass of blood being pour'd forth into serosities and sweating them out of the little mouths of the Arteries into the cavity of the Abdomen is accounted of easier cure or at least of more promising hope than that solitary disease coming from tumours about the bowels or from the Lymphatick or lacteal Vessels being burst asunder for as well the conjunct as procatarctick cause of the former Disease oftentimes is used to be removed wholly or in part but in the other case both for the most part exist incurable A reddish Urine lixivial and little in an Ascites is of ill signification for 't is a sign that the mass of blood being repleated with a scorbutick Salt and Sulphur boyled together is too much bound up in its substance insomuch that it doth not well separate the feculencies nor discharge them by fit and convenient Sinks which notwithstanding it doth evilly dispose by constraint into the Cavity of the Belly forasmuch as it is hindred in its Circulation in the very same place For in an Ascites the blood is not always dissolved as in an Anasarca but sometimes appears too much compacted in its temper yet so that the salt Serum being denyed to the pores of the skin and to the Urnary passages by reason of the Obstructions of the bowels is forced to break out within the abdomen If in an Ascites by a Purge taken the waters are evacuated with ease plentefully by stool and from thence
the swelling of the belly is somewhat diminished we are not to despair of the Cure but if Purgers bring out little or nothing of the Serum or Lympha and thence by reason of the Nervous fibres being irritated and driven into extensions or inflations of the bowels and membranes as it uses frequently to be the belly swells the more and grows like a Drum we may expect only a fatal event of the Disease About the curing of the Dropsie called Ascites it behoves us chiefly to consider by what ways the waters heaped within the abdomen The Cure of an Ascites may be thence brought out and evacuated for such an evacuation ought to be attempted only by possible ways And here presently is to be observ'd that the remedies used for Hydragogues according to the ordinary practice of Medicine intend to accomplish that end by purging by Urine By what and how many remedies the eduction of the water is to be endeavoured by Sweating and by insensible transpiration In some cases of the Sick you ought to proceed by this way and in other cases rather by that way or another and if none of these seem feasible or succeed well let mature consultation be had for a Paracentesis It will be worth our labour to weigh every of these kinds of Medicines and the reasons of every one and the manner of their operations and with how much vertue Hydragogues are endowed First First by purging therefore as to what relates to purging we have in another place shewed that from the irritation of the Physick made in the belly and guts as well the Contents and winde of these bowels as moreover the humours driven into their Coats and Glandules and which are heaped up in the Vessels and Pipes of the neighbouring parts are disquieted and partly streined into the passages of the guts and partly returned into the mass of blood insomuch that the tumour of the abdomen arising from the stoppage and as it were a waterish affection of those kind of Parts is often abated by Purgatives seasonably administred and sometimes wholly removed but it doth not so succeed when it proceeds from a Lympha fluctuating within the cavity of the abdomen or from an inflammation of the membranes or from a tympanitic extension because Hydragogues do little or nothing bring out those waters and if they be of the stronger sot they encrease this passion and exasperate it by inflaming the part Catharticks used for Hydragogues Catharticks are either Vomits or Purges are either Vomits or Purges they exert their power in the stomace and these rather in the Intestines insomuch that they powerfully provoke and twitch the Nervous fibres and together pour forth the blood and nervous liquor by a certain septick force and do cause the serous humours wherever impacted to be stirr'd and do cause them plentifully to be sent away by the passage granted Either are reckon'd of a various kinde viz. either simple or compound gentle or strong by the Ancients as well as by the Moderns some of which that are most chielfy noted we will here briefly observe 1. Emetick Hydragogues chiefly famous are Gambugia Esula Spurge and their several Preparations as also the Hercules of Bovim and the Pilulae Lunares 2. The chief medicines of either kinde Purgers are Elder and Dwarf-Elder Soldanella Gratiola or Hedge-hyssop the Juice of Orris and Elaterium We will briefly prescribe some methods either of preparing or compounding or administring each of these 1. 1. Gummi guttae Gambugia first an Indian Medicine being from thence brought by our Countrey-men from the Painters Shops coming to the Apothecaryes began to be in use and is much magnified for purging out serous humours But sorasmuch as taken by it slef it vehemently disturbs the Stomach and often weakens it therefore that its outragious and violent vomiting force may be somewhat abated there are divers ways of its Preparation invented but truly it is best corrected with an acid Spirit or with an alcalizate Salt or by throughly mixing and correcting it with aromaticks Adrian à Mynsicht It s various Preparations extolls the magistery thereof which is made by a dissolution in Spirit of Wine and after drawing it off and precipitating it with Spring-water also dissolving it with Spirit of Wine vitriolated and with Tincture of Roses and red Sanders and after by evaporating it others prepare it with the fume of Sulphur after the manner of Scammonie sulphurated others grinde it on a Marble moistening it with Oyl of Cinnamon or Cloves or other chymical Aromaticks I use most the Solution thereof made with a tincture of Salt of Tartar the dose from 15 drops to 20 or 30. Take of Gum-gutta gr 6. Mercurius dulcis gr xv Conserve of Violets The forms of Hydragogues prepared thereof a dram and a half make a Bolus Take of Gambugia twelve grains Salt of Wormwood fifteen grains Oyl of Mace one drop Conserve of Damask Roses one dram make a Bolus and it is wont to be given with Tartar vitriolate or Cream of Tartar and powder of Rhubarb Take of Gum-gutta sulphurated or vitriolated fifteen grains Cream of Tartar half a scruple Extract of Rhubarb one scruple Oyl of Cinnamon gut 2. make 4 Pills Lately a woman afflicted with a most painfull Ascites and most desperate as it seemed to me the ensuing Medicine being taken for 6 days successively she began to be much better and in a short time afterwards recovered her health entirely Take of powder of Gum-gutta twelve grains Oyl of Cinnamon one drop with syrup of Buck-thorn make a Bolus the dose daily to be augmented ascending from twelve grains to twenty Take of our Tincture of Gum-gutta one scruple water of Earth worms one ounce Syrup of Rhubarb half an ounce mix them and let it be taken with government 2. Whereas there are several species of Spurge or Tithymalus 2. Spurge The Preparations thereof and all of them work more violently either by Vomit or Stool by reason of the notable provocation they make in the bowels and for that cause do abundantly bring out serous humours yet by reason of the too outragious force of many of them the lesser Spurge for the most part only is now in use and the preparations thereof most of all magnified are the powder of the bark of the Roots and the Extract and we think fit to adde the tincture inferiour to none of the rest Take of Spurge with the Roots cleansed four handfuls Lignum-Aloes and Cloves of each one dram bruise them and boyl them in four pound of Spring-water to half the strained Liquor clarifie by separation or settling in a long glass afterwards evaporate the clear liquor in a Bath heat to the consistence of an Extract the dose one scruple Take of this Extract half an ounce Forms pour upon it into a matrass of the Tincture of Salt of Tartar 6 ounces digest them in a Sand-hath to the Extraction
of a Tincture the dose from 20 drops to 30 in a convenient vehicle Take of the Powder of Spurge from seven grains to ten Cinamon half a scruple Salt of Tartar eight grains mix them together in a glass mortar give it by it self or mixed with a fit Conserve or Syrup make a Bolus or Pills 2. Precipitate of Mercury with Gold The Hercules of Bovius or the Hercules of Bovius which is much extolled by the Author for curing Dropsies it is described in a former Treatise in the Chapter of Vomits and the manner of preparing and the working thereof and the Reasons are there delivered This Medicine inasmuch as it twitches the stomachical fibres by its acrimony and pours out the blood by reason of the mercurial and salt particles causes or stirs up a fierce Vomit and thereby causes the serous humours violently strained into the Cavities of the bowels to be ejected 3. The Pills called Lunares produce the same effect in like manner Pilulae Lunares by reason of the vitriolate particles of Silver sharpened with other saline menstruums viz. by wrinkling of the fibres of the Bowels very much they force the serous humours to be strongly strained into their passages and so to be evacuated A Solation of Silver made in Stygian water and well cleansed and by a little evaporation is reduced into pleasant Crystals which by themselves or with an addition of Salt Nitre to abate the fierceness of the Lunar Vitriol are made into Pills with crums of bread the dose is one Pill sometimes two or three respecting the ability of strength and working Medicines of this kinde are exhibited sometimes with success in a strong constitution and bowels strong and a good habit but they are scarce ever conveniently or rarely without prejudice taken by tender and cachectical persons Hydragogues meerly or chiefly purging are either of a more mild sort as Elder Purging Hydragogues Dwarf-Elder Soldanella and juice of English Orris which seldom being administred by themselves do want the stirring up of sharper Medicines and on the other side they blunt their too much fierceness or they are of a stronger sort as Gratiola or Hedge hyssop Jallap and Elaterium The seeds or grains of Elder and Dwarf-Elder being dryed Elder and Dwars-Elder are reduced into a powder which being taken to the weight of one dram doth gently bring forth serous humours by siege Water and Spirits are distill'd of the juice of either sorts of Berries fermented also Robs and Syrups are made of them which with many other Preparations of those Vegetables are much magnified for all hydropical Distempers Soldanella and Gratiola Soldanella are rarely used by themselves in our age neither are any neat and very efficacious Medicines prepared out of those Simples they are frequently mixt with certain other Hydragogues and chiefly are ingredients in compounding Apozems The Juice of English Orris is a very profitable Medicine The juice of Orris and because to be easily provured for the poor is the more to be esteemed It is given grom six drams to an ounce and a half or two ounces either by it self in a fit vehicle or with other things appropriated thereunto Jalap is a most known Medicine against every Dropsie and common enough Any one of the common people suffering under that disease presently takes of the powder of the root of Jalap a Pennyworth mixt with Ginger and White-wine and the desired effect doth frequently follow this remedy used with intermission Elaterium is rightly esteemed the most powerful Hydragogue Elaterium for that it most painfully provoking the splanchnick fibres and together melting the blood and humours by a certain corrosive force compells whatsoever serosities the Coats of the Bowels Membranes Vessels also the Glandules and flesh do contain in themselves to be poured out into the cavities of the Stomach and guts by which Medicine happily working the asswaging of the Abdomen doth sometimes succeed Truly this is the chief weapon of the Empirical Magazine against any Ascites which they notwithstanding using in all cases do oftener administer to the hurt than benefit of the Patient the dose is from three grains to ten or fifteen taken either by it self only with correcting spices added or it is given with other hydragogues in form of a Powder Pills or Electuary The tincture and essence of it are extracted with Spirit of Wine or with tincture of Salt of Tartar These are the chief simple Hydragogues The forms of Hydragogues from which being prepared with the addition of others many compounded ones as well Magistral as common in Shops are made adn are every where in use moreover very many more might be prescribed extemporarily as occasion serves Of these we will here annex a few more select forms and chiefly those that are taken in the form of Potions Powders Electuary and Pills Take of Dwarf-Elder A Tincture English Orris of each an ounce and half leaves of Soldanella and Gratiola i.e. Hedge-hyssop of each one handful Asarum and Asse Cucumber-roots of each two ounces roots of lesser Galangal six drams choice Jalap half an ounce Elaterium three drams Cubebs two drams shred and bruise them and pour upon them three pound of small Spirit of Wine tartarizated digest it stopt close in Sand for two days strain it clear and depurate it by settling The dose from two spoon-fuls to three in a convenient vehicle Take of Elaterium Powders Soldanella Ginger of each one scruple Galangal Cloves Cinamon of each half a scruple Salt of Tartar fifteen grains make a powder for two doses Take powder of Jalap one dram Ginger one scruple Cream of Tarar 15 gr make a powder to be given in a draught of White-wine Take of Rhubarb one scruple Pills Elaterium 5 grains Tartar vitriolated half a scruple Spicknard three grains with Syrup of Buckthorn make four Pills Take of pill Aloephanginae half a dram Elaterium half a scruple Oyl of Cloves gut 3. make four Pills Bontius hydropick Pills are given from half a scruple to half a dram prepared thus Take of Aloes two drams and a half the preparation of Gum-gutta one dram and a half Diagridium corrected one dram Gum Ammoniacum dissolved one dram and a half Tartar vitriolated half a dram make a mass and form it into Pills Certain hydragogue Electuaries re now every where in use and celebrated by practisers Electuaries Of which sort are 1. One described by the renowned Sylvius and the other by Zwelfer This following pleases us Take of Resine of Jalap two drams Tartar Vitriolate one dram Extract of Rhubarb two drams of Spurge a dram and a half lesser Galangal one dram beat them in a mortar and lastly adde of Conserve of the flower of English Orris four ounces and with Syrup of Peach-flowers make an Electuary the dose from half a dram to a dram and a half or two drams I might here set down or describe many other
from the other and flying about seek vent in every place and distend greatly all obstacles and chiefly the sides of the Cavities which doth not at all happen in living bodies wherefore as all Carkases do not putrifie alike so their bellies swell sooner or later more or less But while life endures no rottenness or dissolution of particles is made in an animated body that can bring about a splanchnick fermentation or swelling In the mean while we deny not that winds are generated within the offices of concoction fanguification and separation yea within all the particular cells and recesses of our whole body notwithstanding from them all unto the winds wheresoever engendred whilest the Spirits have their due influence and actuate the nervous as well as moving fibres that the sides of the howels be not kept distended and rigid and easie vent does every where lye open And the truth is in a Tympany we allow the wind to fill up the empty spaces but the spirits inasmuch as they extend the bowels by their irregularity do first cause those vacuities wherein the winds secondarily and consequently are engendreed and they inasmuch as the same bowels are still kept strutted and distended do hinder those winds from being removed And now I judge it is plain enough by what we have said The Animal Spirits and not winde the cause of the Tympanie that the animal spirits rather than the wind do raise swellings of the belly in that fort at least such short and transitory ones as happen in Hysterical and Colick fits Notwithstanding there yet remains a great difficulty after what manner the Tympanitical swelling of the Abdomen which is fixt and permanent yea for the most part immpovable can proceed from any such cause especially because the Animal Spirits being of their own nature active and very apt to motion do for the most part so affect removal that unless they be wearyed or become defunct they scarce ever lie still That I may loosen this knot by reasoning it becomes us to consider the Nervous Juice together with the substance of the Animal Spirits which is every where a vehicle to them and also a bridle for the Spirits enjoying the most subtile stream thereof do freely expatiate and lest being dissipated from one another they might fly away they are contained in and entire series When therefore theat Juice is faulty as to its temper or motion immediately the animal spirits become diversly delinquent or are perverted in the exercises of their functions as we have at large expounded in our Treatise of Paslions And lest by repeating them now I should make long Preambles I will contract into a few words what belongs to the present purpose Wherefore in the first place it is to be observed This happens by the fault of the Nervous juice that the contents of the nether belly excepting only the Liver Spleen and Kidneys are furnished with many membranous bowels which the nervous fibres for the most part weave together whence it follows that the nervous Juice whose journey is longer and the passages straiter in these parts doth find here many remora's which also may be proved from the effect forasmuch as the convulsive invasions every where stirr'd up in the Hypochondriack Colick Nephritical and Hysterical Passions do so grievously infest the Abdomen When therefore that Juice watering the nervous fibres of these parts shall be either viscid or tenacious of it self or fill them with very many feculencies for that cause it will come to pass that all the animal spirits will not easily return from thence as oft as they are hurl'd into these fibres in some part obstructed and when in this manner there is a full incursion and a small return of them at length it will happen that great abundance of the spirits remain in these fibres every day more and more impacted and hold them always distended and very much pufft up and at length by reason of the ways of their ingress and regress in those fibres being obstructed they become immovable in that place and keep the affected parts always extended and stiffe in the mean time because these Spirits there impacted within the nervous passages By the obstruction whereof the Spirits whthin the fibres are detained and made immovable and cramm'd thick have commerce whit others that flow to them in their dens therefore the affected part although it be stiffe and almost immovable yet however enjoys sense This Pathologie although it may seem to some a Paradox and uncouth I doubt not but it will deserve assent from many if it be throughly weighed that those who have been a long time obnoxious to Hypochondriack Colick and other convulsive distempers of the nether Belly do at length become sick of a Tympany The formal reason and conjunct cause of a Tympanie being delineated after this manner before we proceed to trace out diligently the more remote causes thereof it may be lawfull for us from what we have said to deliver a definition of at least a certain description of this disease viz. That it is a fixt and constant Tumour of the Abdomen equal A description of the disease hard stiff and yielding a noise upon striking taking its origine from a convulsive inflation of the parts and membranous bowels by reason of the Animal Spirits being driven into those fibres in too great abundance and through the fault of the nervous juice obstructing being hindred from their return back to which disease consequently an accumulation of winds in the empty places accrues as a complement As to what appertains to the procuring and evident causes of this disease it very seldom happeneth that they are altogether observed It s procuring causes but that insinuating it self by silent beginnings it frequently is finished or becomes deplorable before it is perceived insomuch that against this disease scarce any antidote can be appointed for while the ordinary functions are not much prejudiced the swelling of the belly is presumed only to have its origine from winde and while it is expected to vanish spontaneously it often grows into a Tympanie Wherefore that we may have timely notice of its beginning we may take notice that some previous affects dispose to it Other previous convulsive affections of this sort is first an Hypochondriack Colical and Hysterical disposition yea and sometimes an Asthmatical whose fits when they are used to be frequently raised if at length a tumour of the Abdomen follow it though it be small in the beginning a Tympany forthwith may be feared Of the former of these affects cases every where are to be met with and stand fair to common observation of the later Scherichius reports The case of an Asthma ending in a Tympanie That a man of Sixty years of age was infested with this symptome some months before his Belly was swell'd into any manifest tumour that as often as he sate at meat beginning to eat also when
composing himself for sleep he began to sleep soundly he was surprized with such a difficulty of breathing that the frequency of it threatned the danger of choaking at which time also he perceived a certain palpitation about the Hypochondria as if some living Animal were underneath the midriff this distemper afterwards ended in a Tumour of the Abdomen by which he dyed In this and other cases now cited the same reason holds viz. that the animal spirits being used to make irregular excursions into the nervous Fibres of the lower belly at length do not only more often and abundantly enter into them but being impacted and hindered they abide in them and so at length induce tympanitic inflations of the bowels Truly this morbific beginning happens sooner of later The evident causes of this disease if thereupon do come the evident causes which disturb the Spirits in the bottom of the belly and compel them to frequent disorders and also do either stop the motion or pervert the temperature of the nervous Juice flowing within those Fibres in which rank are accounted irregularities in the six Non-naturals immoderate Passions and chiefly of grief and usual evacuations suppress'd drinking of cold water after some great heat or any sudden cold induced on the belly either from air or water As to the Prognosticks The Prognosticks thereof this disease is always accounted of so bad an omen that commonly the name is abhorr'd insomuch that frequently when there is no suspicion of ill from the tumour of the belly if perhaps that swelling be call'd by the Physitian a Tympanie forthwith it is concluded desperate Notwithstanding this Disease rarely kills of it self but being protracted a long space of time that it may at length more certainly kill it gains to it self an Ascites as a Harbinger of Death That we may search into the reason thereof it will be obvious enough to conceive while all the bowels are distended in the lower belly and are held as it were stiffe the passages of the blood and nervous and lymphatic humours being too much extended or compressed are much straitened and for that cause cannot freely and readily transmit its Juice from whence it follows that every humour being straitned in the passage that at length it may pass by some means it shakes off a certain serosity from its masse wherever way is given and those droppings of the humours falling into the hollow of the Abdomen excite an Ascitick Dropsie What relates to the Curatory part of this Disease The Cure the whole scope of healing is commonly bent against wind viz. Indications inculcated by practical Authors suggest the matter to be evacuated from whence the winds are raised and to remove the cause that lifts them up and the winds to be discuss'd and dissipated which do already distend the belly For these ends Purgers appointed against the humour chiefly suspected are wont to be prescribed with great confidence although with small or ill success that is to say Phlegmagogues so called another while those that purge Melancholy another while those that purge Choler whereto also are joyn'd purgers of water as weapons intended against every enemy For this disease as is manifest by our observation is wont for the most part to be exasperated with strong Purgers and seldom alleviated the reason whereof is evident enough because the nervous fibres being provok't by a sharp Medicine the animal Spirits renew their irregular excursions Remedies designed against Wind profit not and do every where more and more stretch them out rather than give any remission to them wherefore although frequent and abundant watery and flatulent stools are procured notwithstanding the Belly swells the more Moreover to dispell discusse and bridle the winde there is a more than Aeolian power prescribed Medicines commonly call'd Carminatives almost of every kind or form are sedulously administred within and without above and beneath and upon the part affected notwithstanding this disease for the most part is untamed by all these whence we may suspect that the true cause of the disease lyes as yet conceal'd because Medicines profit not that are administred indicated or suggested according to the ordinary Aetiologie or reason of it Although I cannot challenge a better successe in curing this disease or a more certain method of healing attested from experience notwithstanding in the mean while we will here proffer another way of curing accommodated to our Hypothesis and established by reasons strong enough Wherefore in a Tympany as in most other affections 3. Curatory Indications there will be three chief indications Whereof the first and chiefly insisted on is the Curatory that by recalling the animal Spirits from their convulsive affection and reducing them into order endeavours the removal of the swelling of the Belly The second Preservatory which restrains those or other Spirits from their irregular excursions into the lower Belly and together corrects the faults of the nervous liquor watering it both as to its temper or motion The third Vital by removing the Symptoms urging doth succour and sustain all the functions oppressed or weakened as much as possible may be I. The first Indication is of greatest moment The first Indication hardest on which the hinge of the whole Cure turns but it is most difficultly performed for it doth not easily appear by what remedies or wayes of administration it ought to be attempted when most weapons or medicines do little or nothing prevail against this inviolable enemy What and what sort of Medicines are good or hurtful in this Disease Phlebotomie assumes no place here but is declined for the most part as prejudicial also Catharticks insomuch as they provoke the affected fibres and disturb the Spirits and hurry them more impetuously do increase rather than diminish or cure the Tumour of the Belly in like manner Diaphoreticks impell the Spirits and the morbific particles deeper into them whereas they ought to be allured and call'd out of the Fibres The chief order of healing seems to be placed in Diureticks and the use of Clysters and also great things are expected from topical Applications because they are more immediately exhibited to the disease and as it were by contact and because they do best discusse Tumours in other places Yet not all Dissolvents are here fitting nor those which profit most in other Tumours for the more hot being given for discussing whether they are applyed by fomentation Liniments or in the form of a Cataplasm or Plaister oftner afford hurt than succour in a Tympanie for the both open and dilate the passages of the fibres that from thence they may lye more open to the incursion of the Spirits and also rarifie the particles impacted so that while they occupy a larger space an inflation and intumescency of the Belly is augmented Lastly what appertains to Alteratives which succour against other affections of the nervous kinde only a certain few are fit in a Tympanie for where
particles and he complying therewith incontinently fell into a mortal Dropsie But the third cause or occasion disposing to that Disease the most common and notable consists in this that the active Particles of the Blood being involved with other more dull or heterogeneous ones or being dissipated from one the other lose their fermentative power or cannot enough exercise it But such an affection of them as it is wont to be raised from various causes and accidents so chiefly from these three Whereof there are three causes one while solitary another while united together to wit First from the Non-naturals immoderately received Secondly from the Naturals unduely retain'd or Thirdly from the Preternaturals corruptly generated in the body The errors of Diet deservedly may be referred to the first rank of these whereby the stock of that Disease is always most abundant For it is a common Prognostick and in every bodies mouth First from Non-naturals immoderately ingested that Gluttons and great Drunkards dye at length of a Dropsie to which moreover not only Surfeits and immoderate and daily Tiplings incline but also frequent and unseasonable Treats and moreover the continual pouring in of absurd and hard to be digested Nourishment For from the evil course of Diet of each kind used any while whenas the Juice of the Chyle oftentimes crude incongruous and above measure plentiful is poured into the masse of blood it of necessity follows that it is first burdened and afterwards its Consistence being loosened the more noble Particles being forced asunder it is so involved or abated by the other heterogeneous ones that being hindred it desists from its fermentative or sanguisying virtue insomuch that the bowels being in a short time hurt by its assaults a Cachexia and then a Dropsie sollowes whereof that is alwayes a forerunner Secondly Secondly From Naturals unduely retained in this place are put all ordinary accustomed and solemn Evacuations suppressed It is observable enough that a Cachexie and often a Dropsie doth arise from a menstruous or Hemorrhoidal flux dimmished or stopt no less than from a too immoderate one by reason of the fermentation of blood impeded by the heterogeneity of Particles Moreover the same is often wont to be effected from Issues suddenly stopt or eruptions of the Skin suddenly repercuss'd Lastly suppression of Urine and sweating much hindred do render the blood more watery by an immediate and necessary affection and incline to the Dropsie Also it is an observation frequent enough fo healthful Persons who being compelled for some time to abstain from going to Bed that their feet have swoln Thirdly Thirdly From Preternaturals generated in the Body Preternatural things generated within the Body but especially Tumours and Humours do hinder the motion of the blood or pervert its temper and so induce an Hydropical disposition Tumours stirred up in some place about the Bowels inasmuch as they hinder or straiten the circuit of the Blood do cause its Serum to be there extravasated and poured out by the accumulation whereof within some cavity in the first place an Ascites as we have shewn above and at length an Anasarca a consequent of that doth frequently ensue Different manners hereof are reckoned Moreover Humours of divers sorts being engendred in divers places within and transferred into the blood do first pollute the masse thereof and defile it with heterogeneous Particles whereby at length it is so depraved in its temperament that it perverts the Juice of the Chyle brought in when it cannot further ferment and assimilate it into an hydropical liquor For this reason nothing is more usual than that Consumptive persons and those that are affected with strumous and cancrous Ulcers nay of any sort within the Reins Mesentery Guts or other Bowels of the lower Belly after they have been long consuming dye at length hydropical Hitherto concerning the next efficient cause of this Disease The material cause of an Anasarca is partly the Serum of the Blood and partly the nutritious Juice also of the chief remote ones as well procuring as evident But as to what appertains to the material cause it is obvious unto the Sense that it is a meer Lympha accumulated within the pores of the Skin and of the other outward parts which being deposited there by the blood the liquor thereof being partly serous and partly chylous Juice but failing in Sanguification and Nourishment of the body to which it was destinated it is cast off like recrements into the vacuous spaces of every vessel And though the matter of the Dropsie proceed from the Blood and Chyle yet it is no wonder if it appear neither like blood nor milkie but only limpid because the Urine even of healthful people after more plentiful drinking is rendred crude as well as watery and therefore it is manifest it is nothing changed by the blood but leaves in that place whatsoever of colour or thicker consistence it brings to its masse And although a reason may be given in either case that the Urine inasmuch as it is streined through the Kidneys and the hydropic matter thorough the pores of the solid parts even so become limpid and watery notwithstanding it is evident by observation that the watery part of the Chyle even while it is confounded with the blood is not intimately mixt with it but being deprived of its colour and consistency it remains under the form of Lympha within the pores of the blood the sure sign of which is that the blood taken from any Animal by Phlebotomy after being cold it is divided into parts Why the hydropick humour is limpid and not milkis nor bloody exhibits a watery liquor which consists of Serum and Nutritious Juice plainly limpid and separate from the other blood It will be from our present purpose to enquire any further into the reasons hereof and manner of being so and wherefore blood which being poured into water doth presently tinge the same and bloodies all solid bodies whensoever it is sprinkled thereon yet dyes the Serum of no colour with which it is intimately confounded and a long time circulated From the AEtiologie of this disease now delivered The Differences of the Disease the differences of it may easily be collected to wit first it is either universal when the whole habit of the body and all the members swell up or it is particular wherein for the most part the inferiour members only suffer in the mean time the rest of the body pining away for want of Nourishment which kind of distemper and not a Tympanie Prosper Martianus will have Hippocrates style the dry Dropsie in which what is reported of the Syren the dry is joyned to the watery Secondly an Anasarca whether universal or particular is either simple of conplicated with an Ascites and then either an Anasarca ensnes an Ascites or this disease follows that Moreover an Anasarca may be distinguished many ways in respect as well of the procatarctick as
no measure of flowing out and therefore being stirr'd into violence it flows out too much or secondly because the mouths of the vessels once opened do not presently close again nor are able to be shut or Thirdly because Nature endeavouring an excretion of blood doth it by places more open but often inconvenient as when an Hemorrhage happens through the Lungs the Kidneys Guts or other Bowels which therefore pass from a Critical into a Symptomical and often into a malignant Haemorrhage Neither only by these means but by many other failings of Nature or impediments 2. Symptomatical Hemorrhagies arise either do Symptomatical Haemorrhagies happen in all which either the Blood it self or the Vessels containing it or both of them together are wont to be chiefly in fault 1. In the first place the Blood besides the reasons above mentioned First by the fault of the blood to wit forasmuch as it becomes inflammable or fermentable above measure is apt also to be extravasated because either its liquor being empoisoned or otherwise corrupted cannot retain its due mixture but being apt to coagulate or putrifie divides it self into parts and whilst some of them being here and there planted sending forth spots wheals and other brands of Malignity do discolour the Flesh and the Skin and obstruct the proper passages others otherwise running out an breaking forth wheresoever there is a vent found do produce bloody Excretions in divers places as is commonly discerned in the Plague Small-pox Measles and malignant Feavers yea perhaps this in some measure is the reason why in scorbutick Distempers as spots and marks so also Haemorrhagies are so familiar 2. Secondly The vessels bringing Blood being faulty many and divers ways Secondly The fault of the Vessels for that they are ill formed but chiefly in these three do appear the cause of a symptomatical Haemorrhage viz. In the first place if perhaps any where some of them are obstructed as often as the blood assumes a more rapid motion either in the same place or in the contiguous parts and also sometimes in remote parts it is constrained to burst out Frequently from such a cause an Haemoptoe proceeds moreover Spitting of blood and the Haemorrhage of the Nostrils do often follow the suppression of the Terms and Hemorrhoids Secondly the little mouths of the vessels by reason of the fleshy Fibres being loosened or resolved by which they are clos'd sometimes are ill formed so that when the ends of the Arteries do gape too much the little mouths of the veips do close By reason of this affection Scorbutical and Cachectical persons are found obnoxious to Haemorrhagies as we have remarkt in another place But Thirdly Thirdly Forasmuch as they are convulsively affected it frequently comes to pass that the Vessels being so evilly formed are also convulsively affected and so the morbific cause being as it were doubled this evil is much encreased insomuch that the muscular fibres of the Vessels being inordinately contracted cause sudden and violent fluxes of the blood one while towards the upper parts anotehr while to wards the lower and so their little mouths being open in the mean time they provoke prodigious Haemorrhagies For I have observed in some persons when the current of blood was small enough with a small and weak pulse the Convulsions of the Vessels generated in some place and propagated under the likeness of wind running to and fro in the body to drive more impetuously the blood however slow of it self and to constrain it into violent eruptions and in cases of this sort when Phlebotomies and Medicines refrigerating and tempering the blood have not at all profited the greatest relief hath been found from Narcoticks Antispasmodicks and Ligatures 3. 3. From the blood and vessels being both in sault Thirdly If perhaps it shall happen that these faults of the Blood and Vessels are complicated and put forth their mischiefs joyntly at once from thence it will be of necessity that this evil will be more intense and more frequent and prodigious Haemorrhagies will be raised the reasons of which as they appear plain enough by what goes before it will be neither necessary nor seasonable here longer to dwell upon explicating of them but rather whereas we have designed hitherto the acts of Nature about spontaneous effusion of Blood and its courses both rightly instituted and also wrongfully and evilly constrained now it behoves us next to declare how far Art for the most part the Ape of Nature and sometimes Mistris or Moderatrix thereof can act likewise well or better about letting of blood and how sometimes it is wont to succeed worse We advertise of these things in general Emission of the Blood procured by art that a Physitian imitates Nature in some cases of letting blood exceeds her in other cases and frequently regulates and reduces her when acting amiss Moreover ther are some cases wherein Nature excells far the efficacy or Art concerning bloody excretions briefly of each of these Therefore in the first place 1. It either imitates Nature in whatever affects spontaneous Haemorrhagies are wont to bring help when these are wanting Physick the Handmaid of Nature rightly substitutes Phlebotomie Therefore if perchance the Blood be immoderately kindled by reason of its Sulphur being too much loosened and advanc'd by breathing a vein what is superfluous of that inflammable fuel will flow out as also the immoderate turgescency of Blood by reason of somewhat untamable being mixed with it will be allay'd by this course Wherefore letting of blood is advantageously administred as well against continual Feavers which proceed from the former cause as intermittent Feavers whose fits proceed from the latter cause Also in like manner as often as an accustomed evacuation being suppressed or a humour driven back from the ourward parts or a sudden stoppage of the pores or if a Surfeit drinking of Wine or other accidents of this nature cause a turgescency of blood inasmuch as they dash heterogeneous particles against it Phlebotomie is usually the most ready Remedy Secondly 2. Or excells and regulates it Physick in Blood-letting not only imitates Nature but often excells it and also succours her being weakened and reduces her often erring For if at any time the blood struck with violence rushes in a heap against any part and either presently breaks out in the same place or abundantly gathered together engenders an Inflammation a vein being pierced in a remote place stops that preternatural tendency of the blood and frequently carryes away the bleeding or inflammation Wherefore in a Pleurise a Squinancy a Peripneumonia in spitting or vomiting of blood when Nature is vanquished or being outragious seems to cast violent hands upon her self Chirurgery recalling the blood to another part and sending it out restores the matter that was almost desperate Moreover Physick frequently restrains or reduces Nature when too prodigal or prevaricating in pouring out of the blood for in truth all immoderate Haemorrhagies
as it is not easie They are not to be cured so it is not safe to stop them before the whole Mine of theDisease be consumed Not long since a famous Doctor of Physick in London An Example is shewn searcely recovering from a malignant Feaver did copioufly sweat out lchor daily from places blistered in several parts of his body after some time they being troublesome and tedious he did apply stronger Repercussives to them all and immediately restanined their flux Those sluces were scarce two days stopt but his disease revived and on the sudden he was affected with sainting of Spirits and often swooning a cold Sweat and a low weak Pulfe and whereas he could not be relieved by any Remedies however cordial they were hd dyed within three days the cause of which seems to be that the malignant matter being suddenly repercussed fell into the Cardiac Nerves whose action being hindred the vital function quickly failed SECT III. CHAP. IV. Of Fontinels or Issues BEsides Vesicatories which being as it were the extemporary Emissaries of the Serum and other humours externally to be brought forth are only raised upon some occasions and then after their efficacy a little shewed are permitted to be dryed up there are others esteemed as it were continual Foutains Issues rather a preservatory than curatory Remedy therefore named Fonticuli or Issues out of which the Ichor or ferous houmour flows with a constant Sping Those former as they are requisite for the most part for Cure-sake in acute or other Diseases whose morbifick matter requires a quick dispatch in the first place respect the conjunct cause of the Disease to be removed and therefore being more broad are made only superficial that such little Ulcers being large may evacuate much and then easily be healed but on the other side Issues being chiefly indicated for preservation are ordained to remove or vanquish the procatarctick cause of the Disease wherefore they consist of a more narrow orifice but made more deep through the thickness of the whole skin to the end that while they send out the morbifick matter in lesser quantity they may derive it further and continue longer to purge it out There are three chiefheads of disquisitions concerning Issues viz. First About these three things are to be enquired into what humours these Emissaries chiefly evacuate and whence they bring them Secondly in what Diseases or Constitutins they better or worse agree Afterwards Thirdly in what places in what from and with what instruments they ought to bre made 1. As to the former Issues like Blisters 1. What humours they evacuate purge out all humours fixt within the skin although in a less compass or brought through it as well by the sanguiferous as nervous Vessels not only as they provoke or as it were suck the outer superficies of the skin but by piercing through the whole hide or skin they convey out whatsoever flows from the sides of the orifice through the broken Vessels also whatsoever slides down elsewhere beneath the orifice Wherefore not only humours accumulated within the pores of the skin or glandules or brought thither by the Arteries or Nerves have conflux to Issues but moreover the serous recrements under the skin that are wont to be tranferr'd or creep between the interspaces of the muscles and membranes from place to place tend every where unto them and find passage Moreover an Issue appointed in the way anticipates morbifick humours which were formerly wont to be conveyed to other weak and long afflicted parts and by such means exempts one while this part another while that from their invasion Hence either a Gouty or Nephritick or Colick matter and sometimes a Paralytical or otherways scorbutical are frequently intercepted by Fontinels in their passage from their Source to their nests or places of residence and so are conveyed forth and the usual assaults of a disease declined Neither doth this Emissary less purge from thence by degrees the humours impacted in any part or region of the body and there causing prejudice than water-furrows made for derivation of moisture and so prevent or cure a sickly disposition 2. 2. In what diseases they chlefly prevail From these several accounts of assistance whereby Issues in general are wont to help it is easily collected for what distempers they are chiefly required for although there is scarce any disease happens wherein this remedy is either hurtfull or unprofitable notwithstanding it seems rather more necessary in some cases than in others It is commonly prescribed for almost every disease of the head whether outward or in ward Every one of the ordinary people procures an Issue as equal to all other Remedies for the Convulsions of Infants or Youths for Sore-Eyes Kings-Evil as also for Head-ache in persons adult or ancient for drousie vertiginous or Cramp like distempers Neither is it less celebrated against diseases of the Breast As who is obnoxious to a Cough bloody or consumptive Spitting or an Asthma that long enjoys his skin whole In like manner Issues are commended in affects of the lower Belly scarce any Hypochondriacal person or Hysterical woman in like manner no Gouty or Cachectical person but hath his skin pierc'd in many places like a Lamprey It would be a vast work to recount here particularly all the Distempers for which Fontinels are helpfull 3. 3. In what Bodyes they agree not But really this remedy nt however advantagious and benign of it self doth not agree with all persons nor is it indifferently to be prescribed to every one For there are two sorts of men which though sick are to be excused from Issues inasmuch as this Emissary evacuates too much in some and too little in others or less than is convenient and in the mean while remains very painful and intolerable Sometimes a Fontinel is not convenient Viz. First where they evacuate too much because it too much evacuates or consumes the humour or Spirits For I have observed in some that an Issue made in any part of the body pours out an immoderate quantity of Ichor and peccant in quality for out of it by often turns if not continually a watery thin and fetid Juice oftentimes discolouring the Pea and Coverings with blackness flows out in great abundance and so the strength and flesh is impaired by too great an Efflux thereof The reason whereof seems to be this Why they often pour out the humour too much that in some persons end ued with an ill dispositon of blood and humours a wound being made and hindred from healing up degenerates straightways into a silthy and malignant Ulcer the sides whereof put on the nature of an acid corruptive ferment whereby the portions of blood continually forced thither are so tainted and dissolved that the Serum thereof imbued with the dissolved Sulphur and other Corruptions being refused by the Veins flows out there copiously Moreover this putrifying pollution of an Issue being communicated to the
This excrescency is easily enough cured by sprinkling thereon Escharotick powders of burnt Alum Colcothar or Mercury precipitate for remedies of this kind do eat away the flesh so luxuriating by their acrimony as well as stiptickness repel the nutritious humour The reason thereof delivered and lock up the mouths of the Vessels As often as that superfluous flesh encreases about the sides of the Issue it is a sign that the nutritious humour flows thither more plentifully than the excrementitious and for that cause in Patients so affected that vent proves not always so benign Wherefore under pretext of this reason many are averse to that remedy though surely it is harmless to most although not alike usefull and advantageous to all We have before considered the chief disadvantages thereof as likewise the scandals objected thereunto yet there remains another thing according to the opinion or rather error of the Vulgar a notable objection against Issues which we will here discuss for a Conclusion With many in England a contumacious opinion is grown up I know not whether it be so in other Countreys That one or more Fontinels dispose to barrenness The common error is that Issues dispose to barrenness Wherefore this kind of remedy however otherwise conducible to health is scrupulously forbidden to all marryed Women that desire Children of which Prohibition there is no reason as yet made out but only Stories related of certain Women that have been barren having Issues when it were as easie to enumerate more barren women without Issues and many others that have been fruitfull with them and truly I use to retort whenas there is no need of any other refuting this as a chief Argument against that opinion SECT III. CHAP. V. Of the Diseases of the Skin and of their Remedies AFter Attractive Remedies of the Cuticula and Skin namely Issues and blistering Medicines delivered before by a certain Law of Method we are induced to handle Diseases of those parts and other kinds of Remedies of divers sorts the true Aetiology of which will afford matter of most pleasant as well as profitable speculation As for the fabrick and uses of those parts A Description of the Cuticula it needs not that I should here repeat all things already accurately described and well known in Books of Anatomy It may suffice us to note concerning the Cuticula that this outward skin is thin and dense without blood and without sense as destitute of Vessels and Fibres which cleaving to the inward skin coners and defends it from outward injuries This is every where full of pores into whose orifices the Vessels discharging sweat do open which Malpighius viewing more accurately with a Microscope a little before their gaping or opening affirms to be endued with little Valves for the retaining or free breating forth of sweat but I consess they lye hid to me The Cuticula being taken away by Fire or Phaenigmons the skin appears naked Of the Skin and looks red by reason of the sanguiferous vessels But this is a thicker membrane as to its greatest parts formed of filaments of Vessels bringing blood of Nerves and of nervous Fibres variously interwoven and complicated among themselves among which numerous Glandules and Lymphaducts or Vessels discharging Sweat and Vapours are thickly interposed The substance hereof is related to be double by most Anatomists the outer is nervous the inner fleshy or rather glandulous for an example of which the Rind of an Orange is brought If the skin be viewed naked by a Microscope by the renowned Malpighius's observations The pyramidal Papillae the Organ of feeling First there presents it self a body in form of a Net in whose thick holes are contained not only passages of Sweat but also very many Teats in form of a Pyramid rising out of the skin in parallel ranks and passing into the Cuticula where being stretcht out in length they are divided as it were into many little Fibres which the same Author hath determin'd to be the sense of touching Besides these the substance of the skin contains very many Glandules by which means the Lympha or watery matter is carryed by the Lymphaducts or excretory Vessels out of the Arteries to the Pores The Pores and Glandules of the Skin For indeed the most accurate Stenon hath observed that its Glandules lye under every pore which become either greater or lesser according to the use of sweating the sweat or vapours continually streaming out of these by the excretory vessels avoiding the excrements do moisten the nervous Teats in their passages lest perchance they should grow dry As to the pores or passages of Sweat The Pores twofold greater and lesser they are discovered by a Microscope to be of two kinds viz. The greater in most of which the roots of the hairs are implanted and by interspaces on both sides of each wrinkle of the skin are disposed in a parallel rank Or secondly they are the lesser Pores which being numberless do fill up all the spaces between the former in most thick Punctums or pricks For indeed the whole skin with its wrinkles appears like a Field furrowed by a Plow and after wards harrowed with the ranks turned or rather oblique so that its ground being eminent above the surrows of either kind there remain in its plain Figures very much of a Rhomboidal or a Diamond-fashion The wrinkles and furrows of the Skin and accordingly as those furrows with their banks or flattes are either shorter and less or deeper and greater the texture of the skin appears either delicate and thin or thick and course This kind of Constitution although it be most owing to ones birth and to the primogenial growing together of the humours is however manifoldly altered by reason of the various accidents of the ensuing life A more gross Diet difficult labour injury of Air From whence the Roughness or Fineness of the skin and chiefly excess either of heat or cold render a skin more rough also contrariwise a nice and delicate education renders its tone more fine and soft That the skin may become more neat smoothe and equal it avails much that all its pores be filled with a benign mild and unctuous humour for so whilest all its pores become full Depends much on the Humours filling the pores and extended the level of the whole skin appears more smooth Notwithstanding if a vicious humour furnish those pores or the benign humour that was in them be too much exhausted for that cause the skin will become rough and full of wrinkles Wherefore if any endowed with a most soft and even skin shall wet their hands in a Soap Lather Lie or Lime-water or also for some time in warm Blood presently the furrows and wrinkles will grow greater and deeper the saline humour being drawn out by the other Salts out of the pores wherefore more delicate women scrupulously decline washing with Soap or any other things that
or blow inflicted upon the body The Solution of the Vnity always the cause of it for the same thing is used to be induced from cold heat wind from the extravasating of the blood and of other humours or their being heaped up together in several places oftentimes the fashioning of the member remaining as yet entire in which cases although the continued parts and chiefly the fibres and filaments are not at all cut off notwithstanding they are in every Affection of grief pulled from their usual position either by the oppression of the object or by strange particles forced like wedges and are compelled into too much tension or distorsion or divulsion and for that cause the inmate spirits being pulled from their mutual embraces and dissipated are ill at case and incur the passion of pain or grief Pleasure is opposed to Pain What Pleasure is and is a manner of Feeling clearly contrary thereunto which takes its origine inasmuch as a pleasant stroaking being made upon the organ of Sense the spirits flock thither and presently being thickly gathered together and overspread with a certain delight they do as it were exult and rejoyce together in the organ afterwards inasmuch as the spirits enter into the like triumph or rejoycing within the Corpus striatum a perception of pleasure is stirred up The greatest pleasure which is offered to the Touch It s formal Reason consists in this that the cause of Pain being removed the parts formerly affected by it may recover their wonted temper and frame for so the animal spirits being before put to flight and dispersed from one another It chiefly consists in removing of Pain they recollect themselves and rushing into the places from which they were banished with reinforced strength they prepare themselves to rejoyce From hence the Peripateticks placed the formal reason of Pleasure only in the removal of something that was troublesome as when the excesse of cold or heat is received by an opposite and more agreeable state Indeed the tangible object because it is alwayes thick and dull doth scarce any way else excepting Venery allure the animal spirits into heaps to the organ of Sense unless for that it removes their former confusion From these things so described concerning those passions What the Itch is it is easily manifest that the Itch according to the formal account thereof is neither perfectly nor fully either Pain or Pleasure but imperfectly and as beginning partakes of both For really the scabby matter being heaped up within the pores of the skin and making the solutin of Unity in many places enclines towards pain yet as it is volatile moving and hastens towards vent How the Spirits are moved in it for that cause the Animal spirits are not put to flight from the Fibres although pulled asunder neither are they driven back with sense of pain but the contrary as if being stronger than the humour infesting they were able to cast it forth they being wrapp'd up more thick but irregularly within the cutaneous fibres do twitch them together variously and draw them on that they may the sooner discharge the morbific matter and expell it forth Wherefore inasmuch as the Animal spirits being neither put to flight nor repulsed but flowing together in crouds into the organs of Touching they manage themselves there tumultuously and disorderly and as it were by tickling the sensible fibres do provoke them into small Convulsions no pleasure but a troublesom feeling nor also is it Pain but a Passion clearly diverse arises from it But as soon as by rubbing or scratching the plenty of Spirits assembled about the organ of Sense begin to be better disposed and as it were reduced into order from thence a thorough feeling of Pleasure is introduced Wherefore the Itching seems to be a middle-state between the betginning of Pain and Pleasure A certain medium between Pain and Pleasure or a passage of the Spirits from the rudiments of that towards the full compleating of this But from this Physical discourse by the by let us return to our Pathologie or discourse of the distemper From what is above said it is easie to collect the differences of this disease In the first place therefore the Psora as to its origine either is got by Contagion The difference of the Psora as to its origine or by reason of an ill Course of Diet the fierceness and supply thereof is communicated by the Chyle and Blood being vitiated or it is generated in the skin it self by reason of filth and the defect of Transpiration Whereto we may adde that sometimes Infants acquire this taint hereditarit contracted from their Parents Secondly These cutaneous Eruptions as to their form 2. As to its form vary according to the diverse Constitutions of the persons affected for in some persons of a cholerick dryer Temperament or Melancholy only a dry Scab is stirred up and inasmuch as it evaporates lessby reason of the defect of the Serum with an stching not altogether so troublesome but in others of a moister Temperament and of more unclean blood very many wheals and pustules imbued with schor and most of all itching do very much provoke to scratching and by reason of the Ulcers stirred up therewith the Itch is immediately altered into pain As to the Prognosticks although this Disease is never of it self mortal or very dangerous and always easie of Cure yet frequently it contains an evil event The Prognosticks of it inasmuch as being long continued it utterly depraves the blood and nervous Juice and from it hastily cured by reason of the matter received within while it is discuss'd from the Pores a pernicious taint is brought upon the Praecordia and Brain and other noble parts The greatest hazard from a Scab threatens Children and Cachectick persons Most dangerous to Children and ill juiced or cachictick persons as in both of which the taint is more easily impressed from this Cutaneous humour upon the nobler parts which afterwards when the outward malady is removed remaining within cannot be vanquished entirely but by a very long Course of Physick of which neither is capable nor patient wherefore such persons It s Cure all care and diligence being administred ought to be preserved from the infection of the Scab as from the Plague Coucerning the Cure of a Scab or Psora two chief Indications present themselves The first Indication curatory and each of them two-fold viz. The first intention Curatory respects these two things First that the glandulous Humour its corruptive ferment being wholly extinct may be reduced to a due temper Secondly afterwards that the Pores and passages of the skin being freed from those schorous congealings may recover their pristine frame or good temper The Second Indication Freservatory takes care to prevent these two things The second Indication preservatory viz. First lest the impurity of the Psora or corrupting Miasma's of the skin being discuss'd
words the reason hereof I am apt to think whether that food is rancid or otherwise improportionate that it conveys particles not rightly mixed nor easily to be subdued to our blood which being so heterogeneous and largely heapt up by a long use of such Diet the saline particles of which kinde do easily associate themselves and so do constitute Tartarous Coagulations to be exterminated in the skin and the seeds of the Leprosie or of the Impetiginous Evil. But yet a plentiful Crop is begot from the taint of the Scurvy and Pox left in the body It often follows the Pox and Scurvy and afterwards by the combination of Salts and Sulphur exalted to extremity We have elsewhere discovered the reasons of the former disease and especially of the foresaid symptome coming after it which being accommodated to our present Hypothesis do make it more clear And it so often happens that pustulous eruptions of this sort do follow an inveterate Pox although it seem to be cured that none distempered almost with these wants the suspicion of that shamefull Disease so that the first Question of a Physician in such a case being consulted is Whether the Patient have not at some time formerly contracted that Distemper For surely the Corruptions of the blood after they are by a long stay become altogether heterogeneous and indomitable at length acquire to themselves salt Particles wherewith growing into such like Tartarous Concretes and being thrust forth into the skin produce those Impetiginous Pustules As to the Prognostick part of this Disease Its Prognosticks although it seldom threatens death or imminent danger yet after it hath taken deep root the Cure is very difficult if at all The Impetigo first beginning and exciting a few Pustules and knots of them perhaps in one or two members sometimes admits of Cure but hardly without a most efficacious remedy But if the Disease proceed so far that the frequent and broad clusters of wheals appear dispers'd throughout the body then small remedies effect nothing and the great ones howsoever diligently observed will not easily perform a Cure But if the Disease maugre all remedies advance daily and encrease at length into a Leprosie Celsius judges it impossible to be cured and therefore we must wholly abstain form it There are two chief Indications concerning the Cure of an Impetigo The Cure viz. Preservatory which respects the cause of the Disease and the Curatory which relates to the symptomes Two chief Indications viz. the pustulous Eruptions The vital Indication hath seldom place here unless in a desperate condition where sleep and strength fail The Method of Curing ought to begin with the Preservatory Indication which takes away the Causes of the Disease by inward remedies for otherwise external as in the Psora are never administred with success but the roots of the disease in the blood being cut off the cutaneous sproutings quickly consume away for the taking them away we must proceed in one manner when the Impetigo begins by it self and in somewhat a different manner when it follows an inveterate Scurvy or Pox being ill or not at all cured We will consider each case throughly by it self and distinctly Therefore whensoever this Disease is simple How to be cured the Disease beginning of it self and primarie and being yet New let the evident and extern Causes be removed let the manner of Diet and unwholsomness of Air be corrected therefore those that have been lately too much accustomed to salt Diet and the flesh of Pork and Fish let them change to Diet of good Juice and easie of digestion The evident causes to be first removed They that inhabit the Sea-coast or Fenny places let them remove to a dry and clear Air in the mean while let no less care be had to their Drink by declining thick and foggy Ale and small and acid Wines too much abounding with Tartar at length let care be taken lest their Drink or Food be dressed with any mineral waters that are apt to petrisie Secondly The conjunct Causes how taken away In respect of the conjunct and procuring Cause there are two chief Intentions of Cure viz. that the impurities of the bowels and humours be quickly purged out also that the acid faline distemperatures of the blood and nervous Juice be altered whereby the Tartarous matter may be the less engendred in them for these purposes Medicines both evacuating and altering are prescribed of several kinds Notwithstanding because not all but the greatest remedies are here convenient those which are most chiefly of use and available are Catharticks Phlebotomy Whey Chalybeate Waters The chief Remedies made known Juicy expressions of Herbs Decoctions of Woods steel'd Medicines and Salivation Some certain Models of each of these and the manner of using them we will annex Wherefore in the first place 1. A Purge universal purging and bleeding being celebrated as in the Cure of the Psora we appoint the following Tincture or purging Infusion whose dose is from six to eight ounces to be repeated in six or seven days Take of the roots of sharp-pointed Docks dryed Polyodie of the Oak A purging Infusion of each half an ounce Senna ten drams Epithymum six drams Rhubarb Mechoacan of each half an ounce yellow Sanders two drams Celtick Nard half a dram Salt of Tartar one dram and a half put them in a glass with three pints of White-wine water of Elder-flowers one pound let them stand stopt in a cold place three dayes pour off daily as much of the clear liquor as is sufficient Secondly For sweetning of the Blood and washing of the Salts thereof 2. Whey let simple Whey two or three pints or with the infusion of Fumitory Chicory and sharp-pointed Docks be drunk every morning for twenty or thirty dayes if the Stomach will bear it and likewise evening and early in the morning let a dose of the ensuing Electuary be swallowed Take Conserve of the roots of sharp-pointed Docks six ounces Crabs-eyes Coral prepared An Electuary of each two drams Ivory one dram Powder of Lignum Aloes yellow Sanders of each a dram and a half Sal Prunella two drams Vitriol of Mars a dram and a half Syrup of juice of Wood-sorrel what suffices to make an Electuary the dose two drams Thirdly For the same reason that Whey 3. Steel'd Waters your Iron Mineral waters are prescribed bed for this Disease and do oft notably help for when all the other remedies have been in vain I have with those alone cured a painfull and almost leprous Impetigo Moreover for more efficacy sake let the use of Sal Prunella or Vitriol of Mars or of the Electuary but now mentioned be dexterously adjoyned Fourthly In some endued with too much Serum and a watery Constitution 4. Decoctions of Woods where the drinking Whey or Mineral waters are less requisite it is sometimes expedient that a Decoction of the Woods be assumed at