hands again and the same especially that cured him of the dangerous Feaver and thus the supposed good Physician drives on and is thought a very necessary Advisor and an able Assistant upon all occasions emerging Truly this is according to the homely Proverb but Tinkerly doings stop a Feaver if it can be this way and introduce what is more contumacious difficult and worse to be dealt with But some may object and say That Lemons and Oranges are used in Feavers and with good effects from their cooling I answer That Lemons Oranges Barberries and such like are allowable and what good ariseth from thence is not to be ascribed to their cooling virtue if any but to their acidity which acuates and sharpens the ferment of the stomach by whose reinforcement and strength regained by this means the whole body is refreshed fares the better and some allay at least more ability to bear the febrile heat and therefore likewise such Liquors are to be granted the Patient for refreshment and support as are most agreeable to the stomach and desired and the dictates of Nature in these cases are to be marked who prompts for her own help and satisfaction and generally the Drinks so desired by them are fermented Liquors no Juleps Beer Ale Cider Wine c. and such are most agreeable to the stomach which discreetly used are no promoters nor continuers of the Feaver but beneficial in their kind and a relief to the sick but always to impose medical drinks upon a weak sick man as if he were to be nourished and live by Physick is very absurd and irrational And here pertinent to our Discourse I must recite what I have formerly noted elsewhere but by the way I must tell you wherein I differ from other Physicians when I grant my Patients cooling Drinks as Whey Cider or such like when desired in Feavers or hot bodies they lay a stress upon Coolers as principal means against the Disease and to reduce the distemper I allow them not as Physick against the Disease but as refreshment to Nature being delighted therewith and coveted So that I do not impose them as of necessity because the Disease does not require it but observing the propriety of the body being comforted and refreshed with such of such cooling Liquors So that these are not given as Medicine for they cure not nor is heat to be regarded otherwise than as signal but they may be allowed as refreshment A labouring man that toils and heats himself must have drinks to refresh him even so it is with a man in a Feaver his Spirits labour more than at another time and more thirsty he is requiring drink more than at another time and it must be such as delights him that Nature does desired not Barley water Juleps and such slops that the Patient nauseats and give him no satisfaction Tract Of the Scurvy Chap. 11. Edition 4. And in the same Chapter controverting with Dr. Willis about Antiscorbutic Remedies there is much more to this purpose shewing the indirect proceeding against Feavers with repeated Phlebotomy and cooling Medicines whither I refer the Reader And here I might animadvert and take notice of the strange invention and irrational use of epispastic or blistering Plasters to draw away a Feaver shewing thereby also that Feavers are wholly mistaken in the notion of them but I must wave the Argument as collateral which otherwise would interrupt our present occasion and divert me from the direct prosecution of the business in hand Now in tlje close to observe the order and dependence of this Discourse and to take a review of the whole matter compendiously drawn up you will find we have not deviated from the subject proposed but prosecuted directly the scope of this designment which in short is thus That this latent internal Series of Diseases more frequent than discerned their dangerous transition and complication is masked and covered with an apparent or outside garb of a Feaver or febrile preternatural heat which signature and external character hath so ingrossed the Physicians endeavors and taken up the Practice of this Art that little hath been done in searching out the radix of diseases and opportunity neglected for prosecution against the morbific causes And for as much as this Feaver being only the estuation of the vital Principle throughout the body generally attending these and most other diseases is no farther to be taken notice of than as signal shewing the cause to be greater or less in provocation as the heat is more intense or remiss and does in no wise divert the Physicians intentions and design of Cure nor ought to be applied unto since it is only a consequent and dependent occasionally from the morbific cause which febrile heat riseth and falleth as the said cause does more or less provoke and irritate and vanisheth quite away when that cause is removed or ceaseth to disturb It necessarily then follows that these Coolers generally used and mainly insisted on are generally noxious often mortal giving great advantage to the train of diseases our subject towards a Cure whereof they contribute nothing but è contrà promote the progress I might have amplified and inlarged thisDiscourse in several parts thereof but this will suffice at present for a dawning and discovering light which hereafter may appear with greater lustre as occasion shall be offered by any opponent to these Truths And thus much in general touching this Series of Diseases their latency their frequency the danger by in advertency and improper mistaken means and too late discovery Our next undertaking is to view more particularly the gradations of this progress tracing from stage to stage and remarking the capital occurrences the chief causes antecedent and conjunct beginning with Pain the common leader or warning Sympton Pains afflicting humane Bodies the different Nature and Causes thereof OF all Symptoms that attend or are the consequents of Diseases Pain is the most troublesom and irksom to bear Weakness and languishing are tolerable evils but pain is restless tormenting and full of complaints And although this be the worst in extremity to abide and the most mournful accident that befals mans Body yet no part thereof hath a priviledge by Nature to be exempt or protection from this calamity the reason whereof we will inquire into All parts of the Body wherein is the sense of feeling are liable to pain and by virtue of this sense pain is communicated to this or that part and therefore dead Bodies parts paralytic benummed or mortified are not capable of pain because in them there is not that sense of feeling and although the Organs of the other senses are subject to pain as the Eyes Ears c. yet pain is not proper to them quatenus as they belong to those senses but as the sense of feeling is seated there also having a greater latitude than the other and is extended through the Organs of all those Senses True it is the other senses have
they are various and may be ranked under these Heads 1. Obstruction of the Meatus felleus 2. Wind and flatulent Vapors 3. Acrid punging and sharp Humors 4. Indurated Excrements 5. Stones generated in the Colon. 6. Worms 7. Compression 8. Inflammation 9. Venenous and malignant Matter 10. Apostems and other Tumors By the first it appears that Obstruction in the Guts which produceth Colic pains does sometimes arise from an antecedent obstruction in another part as when the Meatus cysticus the passage of the Gall into the jejunum is stopt it causeth also a stoppage in the Guts for the Gall being naturally discharged into the Guts does stimulate them to expulsion and moves the excrements downwards but for want of this exciting and provoking matter the Guts fill up are obstructed and distended thereby raising pain Wind and flatulency begets Colic-pains sometimes and these are not fixed but roving here and there and commonly attended with a rumbling and noise in the belly and this is an effect of crudities and weak digestion rising from a natural debility or occasioned by intemperance and a bad diet And this flatus is either in the cavity of the Colon involved in a viscous tough flegm inclosed as in a Bladder or sometimes shut up within the Tunicles of the Intestine where forcing its way out does cause great pain in the part Sharpness of an humor indigested or degenerate does sometimes cause Colic pains and this is either a mordant biting Choler or an acid serosity Driness and hardness of Excrements do cause Colic-pains sometimes for as much as they stop the passage and extend the Intestines denying vent to any sudden fermenting humor wind c. that should freely pase away This costiveness and constipation is acquired by ill diet in the use of hot dry astrictives by watching or sleeping too much immoderate Venus by heating the body and sweating much through exercise labour intemperate Air c. These are great dryers and take off the lubricity of the Guts that they perform not their office as they ought thus excrements not being transmitted and sent away duly they accumulate fill up distend and obstruct the Intestines and give great occasion to Colic-pains Stones sometimes are generated in the Colon and do cause Colic-pains also a clot of worms gathered and twisted together obstructing the Guts have raised Colic pains Compression and contraction by Inflammations and Tumors in the Guts or parts adjacent do sometimes cause Colic pains Also malignant and venenate matter hath procured the like as Paulus Aegineta relates of a pestilential Colic that arose in Italy and afflicted many of the Roman Provinces Fluxes of the Belly HAving spoken something concerning pains of the Guts Iliac and Colic attended with astriction of the Belly and costiveness I shall briefly set forth those pains that are accompanied with a Flux or loosness There are three sorts of Fluxes of the Belly distinguished by several names Lientery Diarrhoea and Dysentery The first is a Flux of indigested or semidigested food passing away before its due time from an imbecillity of the digestive faculty But this not being dolorous or painful we shall pass it by as not our subjevt in hand The Diarrhoea is a flux of humors depraved and injurious which stimulates Nature to expulsion and is for the most part painful and irksom to bear 1. This kind of Flux is various in the matter of 2. Different in the efficient cause as some are of opinion 3. Unlike in the manner and circumstances 4. Various in respest of place as issuing from several parts of the body Touching the diversity of matter in this flux physicians have distinguished it into phlegmatic choleric melancholic and serous or watry which distinction is not simply manifest but a complication and mixture of many sorts whereof one may abound and be predominant yet the denomination and character of the whole is hard to be given The variety of depraved matter that happens in mans body is not to be reduced to four Heads nor three times so many for this stimulating matter thus sent forth by a Flux is the manifold different material cause of hundreds of diseases which preternatural variation of humors or juyces are not to be comprised within so narrow a compass nor reducible to four Cardinal points for admit there were four natural constituent humors in mans body as common doctrine teacheth yet these in their sundry variations and complicate degenerations would be so variously changed as not to retain any relict or smack of their original descent that a denomination from thence if possible to be distinctly given would no way answer in the similitude or nature thereof and consequently of no use in practice In respect of the efficient cause Authors have distinguished these Fluxes into critical and symptomatical by critical they understand when Nature in due time and with good success throws off and expels any peccant matter and finds relief by it in any case A symptomatical Flux they mean when Nature irritated untimely or immoderately is not benefited thereby but rather injured and endangered The 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of this is true and it often falls out thus but the distinction of critical and symptomatical relating to the efficient cause and the reason thereof I do not assent to nor comply with since every Flux is symptomatical whether it produce good or evil for that which they call Critical and is seasonable and duly performed with good effects attending is but symptoma morbi the Symptom of some disease as well as the other so that the difference is in the nature of the disease afflicting the matter excreted or voided the fortitude of Nature the time where the way by which it ought or ought not to pass which does distinguish these Fluxes in their effects to be good or ill but shews no diversity in efficient causes which is one and the same for Nature is efficient whether irritated unseasonably and frustrated of her end or performing these endeavors in due time and to good purpose But although the efficient cause of Diarrhoea's be simple and single yet the occasional causes are many for these Fluxes are occasioned sometimes by change of air or place and variation of the seasons by some kind of meats or drinks taking cold or other casualties and accidents which puts Nature upon some disorderly fermentation and excretion and this commotion occasions and stirs up any morbific matter and noxious humors which before perhaps lay dormant and still now to grow turgid and active contributing to advance and promote the Flux begun but this managed by a discreet hand may not prove injurious but some advantage gained which if neglected and Nature not governed and guided in this prodigal expence much detriment may come thereby an exhaustion of nutritious Juyce with great debility and weakness As this Flux Diarrhoea is various in the matter discharged so likewise in the manner and circumstances as greater and more violent or
Dysentery sending forth blood and corrupt matter Sometimes a bloody Flux continues a while without Vlceration and afterwards ulcerates the guts and makes a Dysentery that is when this extravasated blood lodging in the guts degenerates and putrifies it does thereby erode and plant an Vlcer which compleats a Dysentery Now this kind of Dysentery ariseth from an impurity or corruption of the blood which causeth a preternatural fermentation or effervescence in the whole mass but Nature not being able to depurate and separate from this degenerate admixture either by Transpiration or Vrine is forced upon this emission by the Intestines without a secretion and throws out both the good and bad together In the prosecution of Cure as these causes are rightly adjudged and Medicines adapted thereto depends the success and therefore that course and Method which is advantageous and proper to one may be injurious and altogether disagreeing to another And here you must take notice that Dysenteries are sometimes malignant as commonly when Epidemical and then Alexipharmacal Medicines are not to be omitted Now concerning the degrees of Dysenteries as to a better and worse curable or deplorable state and the signals declaring them as also several Queries that might be raised and satisfaction given to each the conciseness of this Work will not admit to inlarge thereon In the next place and of great affinity with Dysenteries is a Tenesmus agreeing in the causes and Symptoms but differing in the part affected a Tenesmus being seated at the lower end of the right Gut or Fundament The Etymologie of the word imports something of the nature of the disease being a frequent desire and straining downwards to the stool but instead of excrements blood and mucous matter is brought forth and with great pain This ariseth from an Ulceration of the last Intestine procured from the same causes as Dysenteries which we need not repeat This disease is most dangerous to women with child for that it causeth abortion but to all persons it is very troublesom and painful and if it continues long the Vlcer becomes fistulous and difficult to be cured And now I remember the Cure of an old Vlcer in this part notwithstanding the contumacy and difficulty thereof In the year 1653. when I was but a young Practiser yet by the blessing of God upon my endeavors I cured a Gentlewoman afflicted with an Ulcer in ano for seven years who could not in all that time receive help though she had tryed many Physicians and Chirurgions having a plentiful Fortune to allow it She was aged between fifty and sixty an Aldermans Wife of Maxfilde in Cheshire where I happened to stay in that Town for some time whereby this Gentlewoman beyond her expectation received a perfect Cure To finish our Discourse of Pains belonging to the Intestines we shall conclude with the Haemorrhoids A disease frequent and sometimes of great complaint The word Haemorrhois signifies a Flux of Blood in general but custom hath restrained it and amongst Physicians it is used and understood only that effusion of blood by the Haemorrhoid Veins which Veins terminate at the lower end of the last Intestine and about the Fundament These Haemorrhoid Veins are internal and external although most of the Ancients and some modern Authors acknowledge only the internal but erroneously The internal and external Haemorrhoid Veins do differ much As first in their rise or descent for the external do proceed from the Hypogastric branch of the Vena cava and the internal from the Vena portae and commonly from the splenical branch thereof Secondly in number the internal being but one though orbicularly multiplied and divided about the Anus The external are threefold Thirdly in their insertions the internal being inserted into the membranous substance of the right Gut the external into the musculous substance of the Anus or Fundament Fourthly they differ in their contents the internal carrying a gross and blacker blood the external more thin and ruddy Fifthly in their office and use the internal evacuates the Vena porta and splenical Arteries thereby advantageous in some diseases of the Spleen and Cacochymies The external do empty the Vena cava and correct such diseases that depend upon Plethory or redundance Sixthly they differ in evacuation the internal not so copious the external commonly large in the profusion and sometimes very injurious and to some mortal Seventhly in pain the internal for the most part painful the external not in evacuation Lastly they differ in association the internal descending without Arteries the external are adjoyned with Arteries to the Anus The Haemorrhoid Veins are liable to contrary affects and the diseased do suffer in a different way sometimes these Veins abound with blood and swell for want of apertion and a discharge and this is called the blind Haemorrhoids è contrà sometimes the mouths of these Veins do open and pour out too plentifully either suddenly or by too long continuance and this is called the open Haemorrhoids Both these extremes are grievous to suffer The swelling of the Haemorrhoid Veins and pains from thence have the same causes as provoke and continue the Haemorrhoidal Flux viz. blood offending in quantity or quality which if it find not vent by the terminations or mouths of the Veins they are extended and swell big and sometimes inflame which if it continue is dangerous lest it become cancerous and gangrene On the other side an immoderate Flux is very pernicious and induceth Dropsies Consumptions Cachexies c. by exhausting the treasury of life These Haemorrhoidal Fluxes continuing unduly and injuriously argue the blood to be hot and sharp or too thin abounding with an acrid serosity which provokes the expulsive faculty and opens the mouths of the Veins But the blind swelling Haemorrhoids denote the blood to be gross and thick or the coats that cover the extreme ends or mouths of those Veins to be dense and impenetrable not permitting an exsudation Here it may be queried how it comes to pass that these Haemorrhoid Veins should be more troubled with blood and more frequently suffer an apertion since many other places of the body receive the extremities or terminations of the Veins and so equally capable of effusion In answer hereunto you must understand that although Nature hath formed the like and planted them in divers parts of the body which sometimes though more rarely do issue and send forth blood yet these Haemorrhoids are placed more commodiously for voiding of superfluous and feculent blood being near the common vent and outlet for excrements to pass away and their situation being downwards together with the straining upon occasions at the stool the extremities of these Veins are filled and sometimes forced to evacuate more frequently than others Now concerning the blind Haemorrhoids you may take notice and know that there is this difference sometimes the Tumor or extension is in the trunk or cavity of the Veins and then there is no apertion and sometimes the
not found this new vent-hole you must then wait with patience for the desired effect and use such means as hereafter is prescribed for a dry Issue but if after six months you find not some reasonable discharge of matter here let this Issue heal up and set another in some place else where the humors may more freely resort If an Issue runs but little and begins to grow dry as sometimes it happens so then put in a pellet made of Ivy-wood Orris-root Gentian or Hermodactyl When your Fontanel is inflamed round about by reason of Plethory or a febrile turgid blood causing extravasation and fluxion about the orifice then apply Emplastr è mucilaginibus to the place but if it continue pertinaciously and threatens farther mischief as sometimes a Gangrene hath happened hereupon then bleed and purge which will empty the Vessels retract and give room for retirement and is the best way to prevent danger If a Fontanel by time shifts its place and settles lower as sometimes it doth in the Arm or Thigh and comes too near the Juncture then you must suffer this to close or heal up and another must be made higher in the proper place convenient The closing or healing up of an Issue not substituting another elsewhere is warily to be done by advice else you may run a hazard and be in danger thereby for some upon this account have lost their lives for Nature having found such a conveniency and help does expect and requires it to be continued until the occasion be otherwise prevented and cause removed by Medicine or Nature better able to discharge and free her self by the Emunctories and outlets of her own appointment Now if prematurely and unseasonably this artificial passage be denied and stopt up there being cause for the contrary the confluence of humors then meeting and gathering at the place regurgitates back again with united force and greater current at which Nature being surprised unexpectedly and having made no provision to secure her self from such a Reflux the same preternatural Symptoms and ill affects against which the Issue was first appointed or rather much worse will ensue thereupon Before the closing up of an Issue these things are to be considered the cause for which it was appointed what effects alteration or abatement of the infirmities since the age of the person whether in youth strength of Nature or declining years and what state of health the person hath for some time enjoyed and is now in which are to be adjudged and determined variously as particular cases and their circumstances collated do suggest but generally the body is to be accounted in a better or worse condition as the humor issuing does appear ichorous sharp bloody and sordid matter smelling strong or stinking much in quantity declare the body to be cacochymical and foul the Juyces depraved and degenerate and require the Issue to be continued but the matter issuing white reasonable thick sweet little quantity not sharp or painful nor causing Inflammation about the place these are good signs and shew soundness of body the nutritious Juyces to be in their natural condition amicable and friendly to the body and permit an Issue to be healed caeteris paribus but withal let due Purgation succeed by intervals and a spare diet for some time London from my House in Wine-Office Court in Fleet-street FINIS Books lately Printed and Publish-by the Author Morbus Polyrhizos Polymorphaeus A Treatise of the Scurvy examining the different Opinions and Practice of the most solid and grave Writers concerning the Nature and Cure of this Disease with Instructions for Prevention and Cure thereof The fourth Edition By E. Maynwaringe Dr. in Physick Tabidorum Narratio A Treatise of Consumptions Scorbutic Atrophies Tabes Anglica Hectic Feavers Phthises Spermatic and Venereous wastings radically demonstrating their Nature and Cures from vital and morbific Causes By the same Author The Mystery of the Venereal Lues Gonorrhoea's c. disclosed comparing the dissenting Judgments of most eminent Physicians hereupon and the various Methods of Cure practised in Foreign Countries Resolving the Doubts and Fears of such as are surprised with this secret perplexing Malady By the same Author Vita Sana Longa. The Preservation of Health and Prolongation of Life proposed and proved in the due observance of some considerable Precautions and daily practicable Rules relating to Body and Mind compendiously abstracted from the Institutions and Law of Nature By the same Author Medicus Absolutus ' 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 The compleat Physician qualified and dignified the Rise and Progress of Physick Historically Chronologically and Philosophically illustrated Physicians of different Sects and Judgments charactered and distinguished the abuse of Medicines Imposture of Empirics detected c. By the same Author Praxis Medicorum Antiqua Nova The Ancient and Modern Practice of Physick examined stated and compared the Preparation and Custody of Medicines proved the Physicians Charge and grand Duty c. By the same Author Sold by the Book-sellers
THE Frequent but unsuspected PROGRESS OF Pains Inflammations Tumors Apostems Ulcers Cancers Gangrenes and Mortifications internal THEREIN Shewing the secret Causes and Course of many lingering and acute mortal Diseases rarely discerned Initia Morborum quamvìs levia serpunt WITH A TRACT OF Fontanels or Issues and Setons By Everard Maynwaringe M. D. LONDON Printed by J. M. for Henry Bonwicke at the Red Lion in St. Pauls Church-yard 1679. EMMANUEL Collegium Emmanuelis Cantabrigiae LICENSED Roger L'Estrange Septemb. 16. 1678. THE DESIGNMENT AND NECESSARY USE OF THIS WORK FEW there are that think themselves concerned in this train of dangerous diseases because they judge themselves clear at present and do suppose these rarely to happen for that they seldom hear of any to dye upon these accounts and therefore do not imagine that such ill Fate should befal them but Feavers Scurvy Dropsies Consumption or such like common diseases they expect to be their lot but when you come to understand as by the discovery following you will plainly perceive that few sicknesses or infirmities you can fall into if they be not radicated in or grounded upon some of these latent or lurking destroyers yet there is a tendency towards them for a complication therewith and their terminations therein as the last Scene especially if the disease or sickness be contumacious and of long continuance or acute dangerous and mortal so that upon a true information you will find such probability to be ingaged here when any infirm or sickly state shall alter your present healthful condition of body And for such as have already some warnings by pain and a valetudinary state may seasonably inquire and consult some sagacious and solid Judgment from whence it does arise whither it tends what progress probably it will make if not prevented a resolve upon the question very likely will fix here if the case be throughly examined and duly searcht into Considering that pain most frequently either ariseth from some of these already begun to act their parts or that some of them will most likely follow thereupon although veiled under the covering of a more known and familiar Disease as fully declared in the subsequent Discourse for whether the manifest Disease afflicting be the Scurvy Consumption Dropsie Ague Spleen Pox or other chronic Disease very often it falls out though seldom taken notice of that some of this train is complicated and joyned therewith if good Medicines or great Providence stop not the progress And if the sickness be acute malign pestilential or other as small Pox spotted Feavers Plague or any general Phlogosis and febrile scorching distemper they come on commonly by Inflammation in some particular part and proceed on to tumifie apostemate and gangrene when such a disease is not checkt but grows desperate and becomes fatal to the sick and thus Pleurisies Angina's Peripneumonia's Inflammations of the Brain Ventricle Liver Spleen Mesentery c. they go on in this road by these stages and transitions from Inflammation to Tumor and so forward finishing the course with a Gangrene and Mortification if good means take not good effect to prevent and stop the progress Observing therefore in constant Practice the frequency latency and danger of this association and confederate train disguised and couched under some more appearing and known disease I thought it a Work necessary and grateful to unmask and lay open such secret destroyers that in the designments and methods of Cure they may strictly be sought after and aimed at thereby preventing the danger threatned and securing the Patient Novemb. 15th 1678. Wine-Office Court in Fleet-street The principal Occurrences and chief Heads treated of PAins Inflammations c. their order connexion commutation and transition The frequency and latency of this train in most Sicknesses or Diseases The disguised Progress thereof The danger and frequent Mortality from not discerning them Feavers mistaken and the common courses for Cure erroneous Pains in general their different nature causes and tendency to farther mischief Pains of the Head the causes and various parts affected Pains in the Breast and the several causes thereof Pains of the Dugs of the intercostal Muscles of the Pleura or Pleurisies pains of the Lungs of the Heart Mediastinum Diaphragma and Cartilago mucronata Pains in the Abdomen or Belly and various causes thereof Pains of the Stomach of the Guts Colic-pains Dysenteric and Haemorrhoidal pains of the Spleen an eminent Cure and how performed pains of the Liver pains of the Reins and Bladder Gout-pains and Rheumatism their causes and indications of Cure Inflammations internal what they are how they arise what parts they possess the material and efficient causes thereof directions for Cure Tumors internal the occasional causes thereof the modus generandi how to know them their way of resolution fixation and translation their different state and condition scirrhous apostemate and cancerous cautions in Cure Vlcers internal the essential differences their manner of generation the continent causes the manifesting signs Gangrenes and Mortification what they are the difference between them the external and primitive causes of Gangrenes the internal and conjunct causes the Characters declaring a Gangrene their state of curability and incurability many thousands dye gangrened not taken notice of instructions before curing amputation when and where to be made The Result of the whole matter Fontanels and Setons what they are how made where to be placed for whom beneficial the due ordering them in several conditions the time when to heal them safely THE ORDER AND DEPENDENCE OF Pains Inflammations Tumors c. internal cautioning their proceeding and complication THE natural oeconomy and government of humane Bodies may well be compared to a body Politick subjected to State-discipline Order and Conformity the former hath a regular course instituted and implanted by Nature the latter hath Laws imposed and injoyned by humane Authority to be observed In both these Governments so long as Order and Laws are obeyed and kept the whole is preserved sound safe and in quietness but when the subjected parts of either do mutiny rebel and shake off the Government refusing to act in their stations and subserviency the whole then is put into disorder the union of Community is broken and the publick safety endangered thereby If a part of the body decline its office and performance of duty acts perversly and inordinately the mischief stops not there but other parts also are perverted thereby and drawn into consent likewise if one Member of State be sick of tranquillity and peace be disturbed at the Government and begins to be dissenting disobedient or mutinous ten to one but this infection begets another of the same mind and faction and the second makes a third and thus the malignity spreads When any part of the body begins to fail and be out of order it seldom stops at its first degree of declension but makes a progress from bad to worse if not remedied and prevented So a Member of State
Feavers are to be cured as other pains are that is by adapting Medicines to remove the morbific matter or cause of pain and not otherwise And here by the way I must observe the error and mistake of Authors distinguishing Feavers into essential and symptomatical whereas no Feavers are essential but all dependent upon some disease morbific Miasm or seminary and is a Symptom thereof Where the seminary or morbific cause is fixed or seated there is particular pain eminenter to be pointed at and there is a febrile or inflaming heat occasioned by this Spina thorn in the flesh which provokes the vital principle to estuation this heat is carried and spread more remote and conveyed by the venal and arterial current through the whole body so that this pain being spread or scattered loseth its denomination of pain and then takes up the title of a Feaver as Tradition will have it which deludes most Practisers thinking now they have some new thing to deal with and another disease when indeed Dolor and Febris do not differ at that rate and we may say that pain is a Feaver contracted a Feaver is pain diffused Now whereas it is vulgarly said sometimes that the Patient hath no pain but only sick at the Heart or the Stomach this is very improper and cannot truly be said for Stomach-sickness or Heart-sickness is nothing but pain and anguish of those parts which is tristis sensatio in tactu it is feeling that makes you sensible of sickness at the Heart or Stomach and by no other sense and this is pain but different from other pains by reason of the Organ differing from the rest in structure and office and also from their causes which makes these sick pains to be various and different in themselves So that all sickness of this nature and kind is pain tending towards and bringing on this Series of Diseases the subject and design of our Discourse but in regard these sicknesses are often taken off and checkt the progress is prevented and it goes no farther than the attempt And farther the reason why these sick pains do not produce and bring forth Tumors Inflammations c. more frequently in the parts where they are seated is because the humor or matter offending is not always fixed in the Parenchyma fleshy substance of the member or any solid containing part thereof but floating in some vessel or cavity so that having no root and solid foundation it cannot form a Tumor otherwise than by obstruction and distention of the cavous part having no seminary for augmentation planted in the substance of the Organ But this may happen as sometimes it doth that any sharp serosity or eroding putrid matter may excoriate the concave superficies of any ducture vessel or cavity of a member planting an Ulcer there which may produce sad effects and compleat the course of our Series proposed per saltum omitting these gradations of Tumor and Inflammation The result of our Discourse upon this second Theorem we shall draw out and sum up into six Corollaries for the more distinct and clear understanding of this Doctrine 1. That Diseases or Intemperatures of the first Classis being most discernable and apparent do interpose too often and cover the common Series of Diseases chiefly to be feared 2. That hot and cold distempers generally attending most diseases have diverted and biassed Practisers from a true course against those diseases and causes thereof for the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of distempers being obvious and manifest to sense the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 abstruse upon a general false notion thereof the process of Cure necessarily must be erroneous not discerning from whence they did arise nor upon what they do depend 3. That these distempers of hot and cold do not arise elementally from any corporal constitution or composition of the four Elements so supposed their variations and predominations but only as effects and signals discovering the Crasis and state of the vital principle whether vigorous or depressed whether in a natural placid condition or disturbed and forced into a preternatural fiery temper 4. That inequal Temperaments or Distempers of the first general Classis of Diseases have so ingrossed the Practice of Physick that most endeavors are spent thereupon much time lost and the more considerable and important overseen as witness this our frequent Series of Diseases seldom under consideration 5. That where pain is seated in any part being a warning-piece or the first manifest gradation or step of this common Series of Diseases regard there is mainly to be had for precaution to obviate and prevent a farther progress of Inflammation Tumor c. 6. That this latent and dangerous progress of diseases being frequent but rarely discovered or sought for hath brought more to the grave than any complication or transmutation of diseases whatever for although there be a vast number of diseases whereunto humane bodies are liable and many of them do come and go in the course of life yet most of them in their height and contumacy and such as become mortal do terminate in this series as the Catastrophe and last Scene Having proved in our first Position the frequency of this dangerous Series as also in the second the latency thereof and the disguises that cover their transition from knowledge I come now to the third and last Thesis briefly to declare from thence the fatal consequents of not discerning this lurking train but adapting Medicines to other purposes and diseases supposed the grand complaint of the sick Many people upon the first seizure of sickness and some a while after complain of a pain particularly in the Head Breast Bowels c. here or there this pain especially if great takes off the appetite prevents sleep and procures a Feaver for all acute diseases are accompanied with Feavers and most of the chronic at least in their Paroxysms of intension and exacerbations have a febrile heat attending them This is the common road of diseases that are any thing severe and such as are acquainted but with the common road of Practice have their eyes upon this external appearance and general outward garb by which as their compass they steer and direct their course This Feaver a great Bug-bear not known but by its name a general Symptom of all sharp distempers and dolorous diseases being obvious to the standers by and confirmed by sentence of the Physician takes up most of their thoughts in design how to master and secure this common enemy that stands foremost in view and as their eyes are most or chiefly upon the Feaver so their fears are from thence and their endeavors are bent to suppress and abate this heat and their aims levelled at this mark and where this preternatural estuation is coming on and feared only or if already raised to a degree all helps are then thought of and used to damp and extinguish this kindling flame as great and threatning danger from thence which byasseth the Physician from
his right aims at the morbific cause Hence ariseth all the inventions of cooling and so frequently used in most cases repeated Phlebotomies Ptisans Juleps Emulsions cooling Apozems Embrocations Liniments c. which make the great clutter of Pots and Glasses about the sick and nothing more advantageous to the Apothecary than trifling away the time thus with a number of these hazardous but many times and too often pernicious Medicines This mode of Practice and these devices for cooling feaverish bodies I suppose are taken up in imitation of Galen a famous Master of this Art who appoints exhaustion of blood by Phlebotomy ad animi deliquium until the Patient faints and large draughts of cold water until the Patient turns pale shakes or quivers and the whole body cooled And an Author of our time in his Writings de Febribus appoints the casements to be set open to cool the sick upon what design I know not except to fan the house lest the heat of the Feaver should fire the chamber And a late Author of great Fame in his Works de Febribus supposing Feavers to arise à sulphure accenso exaltato from a sulphurous deflagration of the blood prosecutes upon the indication of refrigerating and quenching this fire by cooling Liquors and for incouragement herein gives an example I suppose his own Patient of a young man about twenty years old that by immoderate drinking of Wine fell into a Feaver with thirst and insignal burning about the Heart who after Phlebotomy and plentiful drinking of water aquae fontanae ingentem quantitatem ebibit the Authors words he recovered The success was good and I may say wonderful but whether from the means or Providence judge you but I shall not imitate the Practice lest ten dye for one that lives but this learned Doctor hath highly deserved in some other parts of his Writings and therefore I tread softly Now to consider all this in gross for brevity sake and apply it to our purpose in hand these ways truly are very probable not rational to cool a feaverish hot sick man and to make him in a short time stone-cold and the probability thereof upon good ground does appear thus First Upon the account of this latent Series and progress Inflammations Tumors c. ushered in by pain more frequently than discerned as already proved this refrigerating course the insisting upon or intermixing these cooling Medicines now and then to quench a preternatural heat is destructive at best a great delay and impediment in the Cure and this is the common way of Practice which needs no farther confirmation but a review Secondly In all other cases and from what cause soever a Feaver doth arise this juleping and cooling mode of Practice is dangerous more or less as the case is in it self but in no wise advantageous making acute diseases to commute and terminate in chronic and chronic or lingering diseases to hold on their course and become more contumacious To prove the first we shall compare that series and commutation of diseases with the designment and nature of these cooling Medicines and by that you shall see what probability and season there is to expect from thence any good effect but rather the contrary promoting of mischief begun and setting forward those diseases Whatever causeth pain whether it be obstruction in the part or oppression by indigested or degenerate incongruous matter by wind and flatulency by any exotic generation as worms stones c. any Tumor or Apostem breeding Inflammation or Vlcer planted c. these cooling and cold inventions touch not the disease except to do mischief and exasperate and remove no morbific cause for the nature of these causes and diseases requires Aperitives Abstersives Catharticks Discussives Diaphoreticks Dissolvents Sarcoticks c. pro re nata each case requiring some or more Medicaments of these Operations But these Coolers è contrà stand in opposition and act repugnant to these properties and consequently to the Cures of those infirmities by obstructing of Ductures and Pores incrassating what should be attenuated coagulating what should be kept fluid condensing what ought to be rarified and discussed fixing and retaining what should be moved and sent off impeding transpiration but promoting putrefaction generally they check and damp the power of Nature endeavouring to extricate and quit her self from those incumbrances and growing evils that assault and beset her To make good the second part that in what other case soever a Feaver or vehement heat shall arise with ebullition of the blood and preternatural fermentation cooling Medicines are very prejudicial in many cases mortal for whether it be a pestilential or other maligne Miasm seminary or taint or other impurity and feculency of the blood that Nature intends by this febrile disturbance and irritation to throw off and separate which Nature sometimes without help does perform and makes a good Crisis but these Coolers act counter to and prevent Natures good work checking the fermentation and thereby hindering the separation of any degenerated or noxious admixture And the reason of these ill consequents from Coolers does mainly lye here for as the stomach doth preside over and hath great influence upon the other faculties and subsequent digestions whose briskness and vigorous performance depend much thereon so likewise whatever subverts the tone of the Stomach and flats the acuteness of this principal part and prime office of digestion injures allays and abates the energy of the rest impedes the fermentation of the blood for depuration in such cases as also for conservation and. supply in the constant daily work And although the Patient escapes this Feaver and comes off with life yet by this male Practice they fall into Dropsies Scurvies Jaundies and cachectic foul habits of body an obstructed or tumified Spleen Liver Mesentery c. Or it breaks out upon the Skin and some eruption or cutany defedation will appear in time or it settles in some Limb and disables the part And it is but reasonable to expect that Patients thus cured should soon be Patients again upon the old account the relicts of the former sickness for that morbific matter and cause of Feaver being retained by checking and cooling the febrile fermentation and not observing Hippoc. advice Quò natura vergit this morbous impurity and foulness must precipitate and settle somewhere and then you may well imagine it will make some appearance or alteration in time upon some part or other and then an after-game is to be played for not having its due fermentation secretion and pass-port formerly when it did turgere and was upon the flight only wanted the Physician 's direction and guidance hinted by Hippoc. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Aphor. 21. Sect. 1. Now a hole in the skin perhaps is thought on an Issue for a tedious and troublesom vent to discharge the matter which a good laudable course in due time might have prevented And thus or by this means the Patient comes into the Physicians
the foundation or first cause of complaint be removed else you begin at the wrong end for in vain it is to endeavor amendment in the part consenting until the other be in its rectitude sublatâ causâ tollitur effectus For example if the Head complain from the Stomach let the Cure be designed upon the Stomach and that being performed the work is done Thus you see plainly that the Cure of Head-pains by consent is as various and different as the parts of the Body are different in organization situation and office whereby they become liable and are seized with various diseases requiring a different manner or methods of curing which are to be treated of in their proper places Touching the Cure of Head-pains that are the products or consequents of essential or idiopathical Diseases seated in the Head the removing or taking away those pains depends upon the Cure of those Diseases whereof they are the effects and concomitants and do require their due and regular course of means suitable to the nature of the disease but in cases of extremity and for mitigation of pain and the inconveniencies arising thence as long watching or want of rest and prostration of strength there are such good Remedies as Anodynes prudently to be used for allay and giving ease or respite until the causes can be eradicated and a perfect Cure wrought Pains in the Thorax or Breast AMongst the several divisions of mans Body into parts we may observe three insignal Cavities each containing principal Members of the Body the first and supreme is the Head and all contained therein the middle cavity is the Breast which contains the Lungs and Heart the lower region called the Abdomen or Belly comprehends the Stomach Liver Spleen Guts Kidneys c. And having taken cognizance of those pains incident to the Head we now come to remark what pains happen to the containing and contained parts of the Breast Hence we may note that these pains from their situation and place may be distinguished into external and internal External pains we may call such as are outward amongst the musculous and fleshy parts as the Paps Dugs and intercostal Muscles Internal pains are such as seize the Heart Lungs Mediastinum c. parts contained The Breast is circumscribed thus the upper part is from the two Canal-bones called Claviculae about the bottom of the Neck the lower part is bounded by the Diaphragma or Midriff spread just above the Stomach and Liver from side to side the fore-part is the Sternon or Breast-bone seated in the middle which joins and fastens the Ribs on the back-part is the Vertebrae or Spine consisting of many bones knit together where also the Ribs have their articulation the sides are compassed with Ribs swelling outwards and they reach from the Spine to the Sternon And this is the extent or limits of the Breast Pain may fall into the Paps or Dugs of both Sexes but most commonly it happens so to women except from external causes blows or falls and thus it is upon a sixfold account First Because those parts are more capacious and swelling outwards in Women which being glandulous spongy soft and porous are thereby apt to imbibe or receive any vagrant humor coming to this part Secondly More liable to the impressions of cold from its tender soft nature and being by them more frequently exposed to the air which may occasion and lay a foundation for pain and other Symptoms to follow Thirdly In Women these parts being furnished with more Vessels of use for lactation or suckling are thereby more liable and obnoxious to disorder Fourthly From the communication and intercourse between this part and the Womb whose diseases and distempers may affect the other by consent Fifthly From the attraction of suckling ill humors may be drawn and gathered there which otherwise would not resort to that part Sixthly Pain seizeth this part in Women from the various conditions of their milk Now the variations of milk causing this effect arise upon a double account redundance or plenitude and Cacochymy or alienation Sometimes by plenitude for milk abounding and distending the Vessels causeth pain and trouble in the part Sometimes by alienation of milk from its natural good condition to a degenerate state and this proceedeth from a cachectic or vicious habit of body for as the blood is good or bad so likewise the milk which is sanguis dealbatus blood changed white by another digestion This milky substance being balsamic dulcid and pure in its integrity yet is very subject to alterations and change from distempers and various dispositions of the Body as sometimes from thence being not so sweet but saltish bitter acrid and punging sometimes curdling and coagulating thereby not flowing freely in the Vessels but causing obstructions in those small ductures hence arise pains inflammations hardness tumors c. if not prevented by a due course with good means And such inconveniencies as these are frequent to Women after the birth of children when milk flows plentifully into those parts and this many times or for the most part does proceed from the imprudent custom of managing Women in child-bed especially some Nurses who would be thought more careful kind and diligent to their Mistresses do feed them too plentifully giving them Caudle at every 〈◊〉 or after every short sleep night and day telling them they are empty and must fill up again and make up their loss which after this manner being done too hastily and the body changing from a large evacuation to a sudden â—epletion the Stomach thereby fails and is clogâ—â—… the blood ferments into disorder causing â—â—…e and dangerous Feavers of which the milk â—â—…ticipates and thereby degenerates endangerâ—â—g both the Mother and the infant But indeed by experience I have found and reason urgeth the same that nothing is more safe than a spare diet which preserves the Stomach quick and sharp and keeps the whole body in a moderate temper and a regular condition not occasioning such overflowings of milk or otherwise flouding and this I have cautioned and made some Nurses sensible of who by observance thereof afterwards found their offices more successful and have given me thanks for my advice as being the safest and best way to discharge the trust and care reposed in them In the next place we are to take notice of pains that are seated in the musculous parts namely the intercostal Muscles in number 44 so called from Costae the Ribs which these Musc les do cover and also are inserted filling up the spaces between each Rib. In these parts pains sometimes do fix and settle and are most perceived upon drawing in of the breath when the Muscles are upon extension and swelling outward These pains are called by some Bastard Pleurisies though improperly and by mistake for pains of the Pleura are different Sometimes these pains are not of continuance as to time nor constant as to place but move here and there and these are
stomach and disgustful to irritate and provoke the expulsive faculty but a Singultus by inanition is a vellication of of the retentive faculty and is the effect of exhaustion and large evacuations and accounted more dangerous than the former Therefore Hickops after great vomiting or purging Hectick Feavers and long-wasting sicknesses are very bad signs There is also a pain belonging to the mouth of the stomach which although it be a real pain and properly so called according to the definition of dolor yet Physicians have given it another denomination and that is Nauseousness or a nauseating sick pain at the Orifice of the stomach The causes of this nauseating pain are various as whatever is disgustful there whether it be meat or drink offending in quantity or quality or indigested depraved matter the relicts after former digestions floating upon the stomach or only imbecillity and weakness of the stomach being not able to close with and digest although good food be sent in and thus it is when the Tone of the stomach is altered by intemperance and ill usage by great or long sickness or decayed and worn out by age Sometimes the cause is organical as when a Tumor or Apostem is forming there And not only thus idiopathically but also sometimes the stomach complains and nauseates sympathically by consent from other parts by reason of vicinity or communication and thus a Tumor of an adjacent part may molest and afflict the stomach and other remote parts discharging and emptying themselves into the stomach by Vessels of intercourse Veins Arteries and Nerves In the cavity of the stomach there is sometimes a pain of oppression or heaviness being over-charged or loaded and grieved with something difficult to be digested and sent off or a pain of distension and inflation from wind and phlegmatic turgid humors or a punging and pricking pain in this or that part of the Ventricle from some acetous sharp humor or an eroding and gnawing pain from worms or a mordicant fretting bilious matter Pain of the stomach ariseth sometimes from Inflammation accompanied with very severe Symptoms but of this in its proper place hereafter where we treat of Inflammations Pain also afflicts the stomach from Apostems and Vlcers of which in their due place also Pains of the Intestines or Guts HAving gone through those Pains belonging to the Stomach or Ventricle in the next place and in order we come to treat of pains incident to the Intestines or Guts being derived from the Ventricle and are one continued body and passage from the Pylorus to the Anus notwithstanding for distinction sake and because this long cavity is different in several parts thereof as to magnitude substance figure place and office therefore it is divided into parts having several names for a more distinct knowledge both in relation to the different formation thereof as also to point particularly where a disease is in any part thereof The division is made into small and great Guts the small or thin are three Duodenum jejunum and Ileon the great or thick are three also caecum Colon and rectum and in this order they lye from the Ventricle to the Fundament The three first are circumvolved about the Vmbilicus or Navel and take up the centre of the Abdomen the other are subjacent and circumferential Pains do frequently molest the small Guts but chiefly the Ileon which when they arise to extremity the disease is called Iliaca passio from that Gut most affected The seat of these pains are above the Navel chiefly extending to the Hypochonders These pains differ in their causes and therefore some are weak and transient arising from wind and acidities which cause some punctures gripes or distensions and continue not but sometimes these pains are more grievous depending upon causes greater and more contumacious and therefore attended with other Symptoms in great rigor as constipation of the Belly violent heat fainting vomiting and casting up whatever is received nothing passing downwards but moves upwards that sometimes the excrements are voided by the mouth About the causes of these violent pains Physicians do not concur The general opinion taken from Galen will have these pains to arise from an Inflammation of the Guts others modern Authors from a peristaltic motion or the motion of the Guts inverted for whereas in the course of Nature the expulsive faculty moves downward by a contraction of Fibres from the Ventricle to the Anus è contrà in this case the Fibres contract below and drive upwards But this difference may be reconciled and neither opinion to be faulted being rightly underftood for Inflammation may begin and cause the motion of the Intestines which naturally tends or moves downwards to be changed upwards by a different contraction of Fibres So that Inflammation causeth mediately peristaltic motion immediately and sets forth the order of causation the one superior the other subordinate Quod est causa causae est etiam causa causati All the Guts are capable of Inflammation but the small Guts more usually as being most liable for having more Veins and Arteries than the rest These Iliac pains from Inflammation are very dangerous if they arise to a great height because the Inflammation is apt to make a mortal transition into a Gangrene and indeed all Inflammations of the Guts are difficult and doubtful because they easily gangrene and mortifie And not only Inflammation inverts the motion of the Guts but also other causes may beget this Iliac passion or joyn with it as partial causes as an Apostem or other sort of Tumor a Rupture an Exulceration indurated Excrements causing great obstruction also whatever by compression or constriction of the Guts constipation or coalescence may cause contortion and turn the natural course and motion thereof and of these frequent examples in practice do manifest and confirm Pains of affinity and adjacency to the Ileon and which are often complicated therewith are Colic pains so called from the Gut Colon the part wholly or chiefly affected This Intestine is last but one and more capacious than any of the rest furnished with many little cells or private receptacles to receive the excrements and retain them else they would pass away too frequently and inconveniently This Gut is seated almost round the Abdomen or Belly so that Colic pains are not easily distinguished by the place being sometimes here and sometimes there left side right side or under the Ventricle hence it is that Colic pains do counterfeit sometimes the stone or pain in the Kidneys left and right and sometimes they are supposed to be pains of the spleen but most frequently these pains are towards the left side near the flank where the Colon is more angust tortuous and circumflected and therefore when the excrements are hardned in the superior and more capacious part of the Colon and are then forced down by wind or otherwise into the narrower great pain must needs arise thereupon But concerning the causes of Colic-pains
praep â„¥ ii vin alb lib. iv Diger sâ—…a in balneo Mariae per dies iv colat duleoret syr byzantin simp The aperitive Pills were these following R. Gum. ammonias acet scillit solut Ê’ ii myrrhae rub tart chalybeat anaÊ’ ss croci ℈ j. ol foenic. dulc chym gut viii succi cochlear q. s Fiat massa During which time from the beginning she was anointed with a Liniment all over her belly morning and evening The Liniment was this R. Ol. cappar unguent è succis aperit ana â„¥ j. Misce After this a Cataplasm was applied to the region of the Spleen every day for a week The Cataplasm was made thus R. Panis alb farin sem lini ana â„¥ iv farin hord â„¥ jss lactis vaccin lib. jss Coq ad exsiccationem adde mucilag rad althaeae foenugr ana â„¥ j. ol chamaem cappar ana â„¥ j. gum ammoniac acet scillit solut Ê’ iii. galban bdellii styracis liquid anaÊ’ ii crociÊ’ ss Misce f. Cataplasma After this the pain was gone and the Spleen began to be soft and yielding Then I appointed the former Apozem to be repeated which being taken the swelling of her belly was much gone down After this I caused a Fomentation to be applied morning and evening for some days and then ordered the Chalybeat Wine to be repeated The Fomentation was this R. Rad. bryon ireos nostr ana â„¥ iv rad cyclamin cucum agrest filicis mar ana â„¥ ii fol. lauri abrotan absinth menthae salviae hyssop ana M.ii. sem cymin foenugr ana â„¥ j. flor chamaemel melilot ana M.j. Coq in aq fabror lib. x. acet vin alb sub finem addit lib. ii ad tertiae partis consumpt pro Fotu After which one purging Potion was given and an Emplaster applied to the Spleen and then both the Spleen and Abdomen the whole belly as flat and soft as ever she was and perfectly cured and returned home All which was performed in the space of about seven weeks and two months after she conceived with child as I was informed by her relations and she stood firm in health long after Notwithstanding the success was very good and the Medicines well designed as such preparations will afford yet in the like cases I do not use the same now This in short and I could not rehearse the particulars so exactly being twenty years since but that I have the whole story with the several Medicines in writing now by me and this I have related to confirm what I asserted here before that a diseased Spleen may lay the foundation for and introduce a Dropsie and now I proceed on to set forth the causes of a pained Spleen which being rightly stated applications may more successfully be made in that complaint The most frequent and apparent Symptom that afflicts the Spleen is Pain and this doth arise and depend upon some of these several diseases Obstruction Tumor Inflammation Apostemation Compression Vlceration Obstruction in some of the Vessels of the Spleen is a frequent cause that produceth pain and this obstruction is procured from a feculency and grossness of blood which ariseth either from a natural debility of the Spleen not able to perform its office duly or occasioned by a melancholy disposition a studious sedentary inactive or a careful and afflicted life to which or singly an evil bad diet and irregular diaetetic customs may contribute or effect as more fully you may be informed in a late Tract of mine entituled The Preservation of Health and Prolongation of Life All which impedes the due fermentation and volatization of the blood in the Spleen from whence it becomes thick and foul and begets a stoppage or too slow a motion and fulness in those Vessels And whereas the office of the Spleen as before determined is to ferment anew spiritalize exalt and rarifie the thick indigested and melancholy blood sent thither for a farther elaboration and depuration it is most rational that this not being performed from some of the impediments aforesaid obstruction and stagnation there will be the consequent and the Patient from hence will feel a pain and heaviness about those parts But for a more promptness or aptness to these obstructions angustness and straitness of the Vessels so formed by Nature does render some persons more prone than others to obstruction and these splenetic pains And farther this obstruction does arise not always from the causes aforesaid but sometimes from a compression of other parts adjacent that may incommode and offend the Spleen or by contusion from a blow or fall or by an injurious dress and too strait lacing or girding as frequently amongst the female Sex These obstructions when continuing and contumacious are so aggravated and increased with additional influx that they form a Tumor this distension being perceptible by sight sometimes but always by seeling is to be adjudged and distinguished whether soft and flatuous or hard and scirrhous the former sooner yielding to means but the latter more difficult of cure Inflammation though rarely yet sometimes does affect the Spleen and this inflammation does arise from obstruction for the blood being stopt in its current and passage and upon some extraordinary causes being more hot and fiery does make a sudden ebullition and inflame causing great pain heat and extension and this pain is distinguished by pulsation and beating of the part having many Arteries This Inflammation not rightly applied unto by diligent and good means does make transition and passeth into Apostemation and sometimes terminates in a scirrhous Tumor but these two dangerous commutations are to be prevented with great care and industry therefore before the disease arrives to this height and when only pain or heaviness gives warning and tells you of a distempered Spleen it is then most seasonable and opportune to apply the means and then a little may prevent that which afterwards perhaps a great deal cannot cure And first the procuring causes if any there be apparent are to be avoided as a sedentary slothful life intemperance and gross feeding or unseasonable eating as late suppers immoderate study melancholy grief or care which introduce sometimes but always contribute to aggravate splenetic distempers and although a natural debility and infirm constitution of the Spleen may procure the effects aforesaid without other provocations yet most frequently they are so caused at least much heightned thereby and therefore for prevention as also for cure those injurious habits are to be abandoned and such a diaetetic course of life observed as may check this disposition of body as at large you may be directed in the fore-mentioned Book The preservation of Health and prolongation of Life c. For Pharmaceutic Remedies that are made publick I shall commend the aperitive Tincture of Mars Pil. Antihypochondriac Swelferi chalybeated Tartar Sal volatil Succini Spir. Veneris rightly prepared which prudently used pro re nata as the several cases require may prove advantageous Pains of the
is no passage or vent it corrupts the containing part and is mortal except a passage can be made by section Vlcers from their causes their aptness and inaptness for healing some are benign mild and tractable others are malign very difficult or incurable The benign and mild are such as arise in sanguine sound bodies and the younger people having no ill Symptoms or adjuncts of impediment the matter of such Vlcers is a laudable Pus or otherwise apt for digestion more yielding and readily commanded by Medicines Malign Ulcers and contumacious difficult or intractable are such as are sordid fetid ichorous unctious dolorous corroding and depascent of long continuance virulent cancerous fistulous cavernous the products or effect of malignant diseases as venereal Lues Leprosie Pestilence c. in cachectic habits of body hydropic hectic aged consumptive and decayed persons in principal and difficult parts of the body as the Brain Lungs Liver Spleen c. the Spondyls of the Back and great Junctures Since Vlcers are thus various in their nature from the several conditions of bodies and diseases that they arise from or depend on and the difference of parts wherein they are seated a general Method of healing and course of Medicines cannot be instituted and appointed but every case hath its peculiar complication of circumstances as directory indications to be remarked from whence a designment method and adaptation of Medicines is formed suitable to the particularity and different case of every individual Patient and therefore I have not proceeded to the Rules and Medicines for Curation Only thus much I shall note to you as a grand observable in the Cure of these Vlcers That such as arise from some remarkable disease as Dropsie Scorbute Venereal Lues or other malign and Cacochymical habits of body that these Vlcers are not to be cured until the disease and evil state of the body on which they do depend be reduced to a good condition or mediocrity of constitution for the antecedent cause which first produced the Vlcer must be removed before the Vlcer is capable of healing because of the continual supply of peccant matter brought to the ulcerated part and therefore application is first to be made there else all endeavours will be frustrate And further the designment of these Cures are not to be paralleled with nor levelled by the methods and intentions that the common Rules in Chirurgery have laid down for as much as many of them are erroneously grounded and deserve great correction and amendment which hereafter will be pointed out and discussed for we have not room here nor time now to ingage in that Cantroversie and must refer it to the next opportunity Gangrenes and Mortification THE last and worst transition of this dangerous train of Diseases and the ne plus ultrà in vitality is a Gangrene being a borderer upon or next adjoyning unto Mortification or the beginning thereof And although Gangrenes are thus ranked next to Vlcers and it falls out so sometimes in the preternatural course of Nature if I may so speak yet it is not always so but a part may and does gangrene sometimes before it be ulcerated for Inflammations and Tumors do gangrene as oft as Ulcers but Gangrenes are placed in this order after Vlcers as being the worst and last morbous state that can come and beyond this there is no disease for although Mortification be set down after Gangrene yet this is no disease vita extincta non est morbus for diseases are seated in the life corpus vivens est domicilium morborum and where no life is there is no disease but Mortification is posited here as the center to which diseases move and as bounds to stop all farther disquisition A Gangrene is a corruption and change of a part or member into such a degree or state as beginning to mortifie or is mortifying But Sphacelus with the Greeks Syderatio in the Latine which we call Mortification in English is when a part is perfectly mortified and dead and therefore a Gangrene is capable of Cure but a Sphacelus not because the part is dead A privatione ad habitum non datur regressus The external and primitive causes of Gangrenes are Contusion Vulneration Congelation Combustion Constriction Poyson Contusion sometimes introduceth a Gangrene by coagulating and fixing the blood so firmly in the part contused that thereby the life is supprest and overcome for communication and intercourse with other parts of the body which is requisite being thus denied the life extinguisheth besides the coagulated bruised blood remaining long undiscussed does putrifie and gangrene Vulneration or section sometimes procures a Gangrene when the vital Principle is so debilitated or enormous by the wound that instead of a good suppuration and vigorous transmutation a depraved matter is generated which corrupts and gangrenes the part and thus a small cut of a finger or Toe hath gangrened and killed the person but in greater Wounds the danger is greater as more frequently to happen Congelation by extremity of cold hindring Transpiration and condensing the blood rendring it stagnant in the Vessels suffocates the life and gangrenes the member thus in extreme cold Countries people by casualties exposed have their Limbs mortified sometimes and thus a Gangrene is brought upon an Inflammation or Erysipelas sometimes by incautelous and pernicious application of great refrigerating or cooling Medicines thereby incrassating the blood and prohibiting transpiration And this is very hazardous though advised and practised frequently by some Chirurgeons in these cases using cold astringent emplastic Cataplasms ex farin hord bolo armen album ovor aceto c when an Inflammation appears Combustion sometimes begets a Gangrene and destroys the life of the part when by neglect thereupon or improper means used relief is not duly afforded and thus by Cauteries and Caustics sometimes a member becomes mortified Now Vstion or great hurt by burning causeth Gangrenes by corrugating shrinking and searing up the Vessels that they cannot bring supply of vital Spirits and nutriment to the part Constriction or compression procures a Gangrene by intercepting of vital communication so that the member thereby is as it were separated and cut off from the body and fountain of life for the parts are maintained by influxed rays and streams of vital heat and moisture to the remotest parts of the body but being deprived thereof they dye thus a Ligature drawn strait about the Arm or Leg and continuing too long may gangrene and mortifie the part by excommunicating it from commerce with and participation of the general life And thus sometimes internal scirrhous Tumors do compress the Vessels and obstruct them of this Fabricius Hildanus gives an example of one that a Gangrene seized both his legs of which he dyed the cause was latent until by dissection he found a scirrhous Tumor about the Vena cava descending between the Reins where this great Vein divides into two parts to supply both legs Poysons some of
them do gangrene by concreting and condensing the blood stopping the canals and suffocating the life as the Venom of a Scorpion and Asp others by putrifying and corrupting the blood or some other part where they chiefly discharge their venom Internal and conjunct causes of Gangrenes are Inflammation corrupt venenous or malignant matter that preys upon and destroys the vital Principle stagnation of the blood or what else may intercept commerce and supply from the fountain of life The Characters or signs declaring a Gangrene are these the sense of feeling decays the colour changeth and inclines to be livid or blackish the flesh grows flaccid and frigid but when the Gangrene proceeds on to a Sphacelus or perfect mortification these Symptoms then are aggravated and appear more eminent sense is quite abolished and the part becomes fetid and cadaverous Gangrenes are very seldom mentioned in Practice and you shall rarely hear of any person to dye of a Gangrene yet I must believe and not without good grounds that many thousands dye by an internal Gangrene not taken notice of for if the major part at least a great part do dye with a high Feaver or Phlogosis we may rationally then conclude that a Gangrene is frequently conjoyned as the last Actor in the Tragedy and immediate cause of death for Gangrenes do commonly supervene Inflammations where they are mortal and thus also Inflammations from fractures and dislocations often bring on a Gangrene And in malignant high Feavers there are sometimes such vibices marks of mortified blood and black mouths which do strongly suggest a Gangrene within the body And for those that perish by the Plague in so short a time whose venemous matter shews it self by Spots Vesicles Buboes and Carbuncles most of these dye gangrened And many of those that expire by the small Pox have a Gangrene in some part the putrid matter being lodged there Nature not able to protrude and bring it forth and it is very reasonable to assert this for if a Gangrene will arise out of a very small portion of matter extravasated defluxed or congested in a part then where the whole body abounds with malign putrefaction and overflows with it any part thereof remaining within the body may and does very often corrupt and gangrene that part That our Opinions are not so extravagant and excentric from the Judgment of all Learned men as some perhaps inconsiderately may censure take notice what Arnisaeus an eminent Physician in Germany Professor in the University of Julia writing to Gregor Horstius about a Person of Quality that dyed of the small Pox queried or rather concluded that the Liver was gangrened and farther saith Verisimile est multis idem accidere qui ex variolis moriuntur To which Horstius answers by Letter and consents with his determination in these words Cùm autem necessariò febris sanguinea cum putredine majori concurrunt in tali casu facillimè fieri poterit ut praevalente calore febrili 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in viscere sanguificationis prae caeteris corrumpatur inprimis cùm propter cutem undique pustulis exulceratam incrustatam transpiratio eventilatio difficilior fit Si enim inflammationes internae ipsiusque jecoris juxta communem nostrum amicum Guil Fabr. non rarò desinunt in gangraenam non video cur non idipsum saepiùs etiam fieri possit tunc temporis ubi variolis undique satìs quidem expulsis gravissima symptomata partium internarum inflammatarum nihilominus perdurant eo usque donec aegrum penitùs jugulent Horst Institut Med. Disp 3. coron 1. additament And in many other acute malign Diseases either the morbific matter is not discussed and discharged from the seat of the disease or else is expulsed thence into some other perhaps a remote part where it corrupts the member and extinguisheth the vital Principle called by some the innate Spirit Now concerning the curability and incurability of Gangrenes take these instructions before the disease be undertaken or left for desperate and hopeless First Consider the duration or time of the disease the age and strength of the Patient for a Gangrene in the beginning is more easie and hopeful than after continuance because it proceeds on commonly and draws nearer to a Sphacelus which is incurable also young persons vegete and vigorous in spirit are more hopeful than others aged or worn out by long or enervated by acute sickness Secondly Examine into the essence nature and rise of the disease which will lay open much of the difficulty thereof for Gangrenes from a primitive cause as Contusion Fracture Section Vstion Caustic or other erosion c. are more curable and less dangerous than those that arise and depend upon antecedent internal causes for Gangrenes of this sort do declare a cachectic depraved habit of body and that some of the internal Viscera are damnified and vitiated from whence a supply of ill matter and therefore in Hydropic Scorbatic and Hectic febrile bodies also in malign and contagious diseases small Pox Venereal Lues Plague c. Gangrenes are more desperate Thirdly The part affected or seat of the disease is to be noted for if a principal part be gangrened recovery is very rare also in the Guts a Gangrene is mortal by reason of continual moisture there and imbecillity of these also in the Vagina Vteri and Glandules of the body a Cure is seldom performed Now as touching the Cure of Gangrenes there is not any one Method or particular Medicine for Gangrenes but they require such variation of Cure according to the difference of their causes from whence they do arise with respect to the part affected And therefore we cannot point out any general course that may be applicable to this great disease but indications of particular and special cases must vary and will make exceptions against it So that the rational Physician perpending and duly considering the nature of the disease and variations thereof as aforesaid with the Symptoms and circumstances attending must design such a Method and adapt such Medicines pro re nata as may best suit with the urgency of this dangerous and threatning Malady The means required and useful in these emergencies are taken some from Pharmacy and some from Chirurgery Pharmaceutic Remedies are both internal and external Internal are select and choice Purgatives Diaphoretics and Cardiacs elaborated and prepared according to latter inventions and the best Rules of Art Topical and external are Fomentations Liniments and Cataplasms specificated and appropriated to these purposes Chirurgical helps are Phlebotomy Cupping Scarification Canteries c. and therefore an expert Chirurgeon must here be assisting to perform these operations Now all these various means are not to be used to every person gangrened but each case will require some of these more or less as the Judgment of a skilful Physician in this disease shall determine and appoint But if the Gangrene by continuance and neglect or from acuteness by great
remove the disease or retard its course To set forth and make evident the truth of our first Position you must know that Pain is commonly the first Symptom of most diseases and if it does not appear as a leader yet very frequently it comes in early or soon after the disease hath discovered it self and few that complain of sickness but complain of some pain that attends it and this our Practice must owne and confirm and taking a survey of the Catalogue of Diseases belonging to mans Body you will find no Symptom so frequently adjoyned and appertaining to them as that of pain and the reason hereof in part may be this That all the Symptoms of diseases are the objects of sense that is they do come under or are discernable by some of the senses which being compared amongst themselves are of greater and lesser latitude now pain belongs to and is adjudged by the sense of feeling only which sense is of the largest capacity of all the rest being extended throughout the body even through the Organs of all the other senses whereas the rest are confined to particular parts the Eye the Ear c. and have no larger extent or place of residence as hereafter we shall have further occasion to discourse For instance seeing may discover what is amiss upon the external parts or superficies of the body and discern what comes forth that it may be adjudged but feeling takes cognisance of inside and outside and what we cannot see we feel and are sensible of by pain even amongst the most secret and hidden parts of the body so that pain is known to be and does manifest it self whether it be within or without Hence it is that pain is the most usual and most frequent Symptom amongst diseases Pain therefore belonging to this capacious sense and being an appertainer thereto and having admission into all its quarters and confines no wonder then if pain so frequently occurs and is the most usual attendant or most troublesom intruder upon the sick Having thus proved and might farther confirm it if needful that pain is the most general and frequent complaint of the diseased we shall proceed and inquire farther how Tumors Inflammations c. do follow thereupon and how pain introduceth and ushers in the rest of its fellows and how pain is introduced sometimes by them and how they appear very often with their consorts having relation to and dependence upon each other by way of causation that some of them and sometimes all are principal Actors in the Tragedy of most mortal diseases though seldom discerned Mortal diseases I said because where diseases are stopt in their progress and have not their full course but are taken off by effectual means or great Providence the links of this chain is broken and then perhaps pain may exercise its power singly and alone for a time and by intervals or pain may contract or associate a Tumor and sometimes an Inflammation and yet all end well these may go off or be sent off by Medicine and proceed no farther and the Patient recover or return to a good and sound state of Health but too often it proves otherwise either by neglect and delay by improper methods and erroneous proceeding or for want of exquisite means the progress goes on gradually to the last and ends with Death In this train of Diseases pain for the most part is a leader and sometimes a follower but seldom misseth to be the discoverer Pain begins and gives the Alarm discovering a disorder or disease in this or that internal and hidden part of the body gives warning betimes and implores aid but none coming at least not sufficient and effectual the pain continues as the cause is yet remaining if the help of Art be wanting yet Nature is not wanting to her self but summoneth all her power and endeavors to dislodge and expel this morbific cause and raiseth all her Spirits though in a febrile disturbance and confusion against this common enemy to the part grieved these Spirits resort plentifully and with them the blood is conveyed which flowing in and remaining there a Tumor is generated and by this concourse of Spirits the part grows fiery and an Inflammation is planted here and superadded The case remaining thus for a while and this confluence not dispersed discussed or drawn off the Tumor perhaps grows cancerous afterwards gangrenes and mortifies then death immediately ensues and concludes all But sometimes the Tumor suppurates or apostemates and then the contained purulent matter breaks forth and begets an Vlcer if the Patient survive and hold it out and with this the diseased may continue a longer or shorter time according to the nature of the Vlcer and as it is more or less dangerously seated for if it be a principal part or adjacent or this ulcerous matter issuing falls into some inconvenient cavity where it is lodged again and finds no Emunctory or passage out or erodes and rots some choice vessel of great use the case is deplorable and scarce remediable Now to comment a little upon this series and progress consider that where there is pain and it continues especially in a high degree you may rationally expect a Tumor or flux of Humors congregated to be the consequent if not prevented which is brought to pass and effected after this manner or upon a threefold account First Because Nature in a time of exigence and need does endeavor to help her self and exerts her power to the utmost and therefore when pain afflicts a member the Spirits resort thither and with them the blood also to relieve it Secondly The part pained by reason of this plenitude of blood and confluence of Spirits does wax hot and this heat begets an attraction and draws more humors to the part Thirdly Pain debilitates and disables the part whereby it is become uncapable to defend it self but lyes obnoxious to this flux of humors which being out of their proper place and remaining in a distempered part they degenerate variously Now upon a survey of the whole matter although Nature intends well in this hurry and bustle being rouzed up and pricked by pain and success sometimes happens upon it or no damage yet commonly it falls out otherwise and there is an oppression and over-charge brought upon the part The confluence of Spirits together with the innate tumultuate and inflame the grieved member which being thus discomposed and out of order cannot moderate and check the flux and attraction of humors but is over-loaded crowded therewith and distended And unless the help of Physick directed by a prudent hand steps in to appease and allay this disturbance by casting out the morbific seminary or matter and reduce this disorder it goes on from bad to worse frequently and from thence to extremity and perhaps to an irrecoverable state in manner and by such gradations as before related And besides what pain does thus effect as a leader Tumors sometimes do take their
errour and folly of the rest for by insisting so much upon this heat the supposed obstacle of Cure or the thing to be cured the opportunity perhaps may be lost but the Patient certainly injured by the vain use of Medicines levelled at this mark Few diseases there are amongst the Chronic or slow of motion but some febrile or preternatural heat more than the ordinary and natural temper does attend them especially at such times if the disease have any manifest intentions of degrees or Paroxysms of pain and scarce any among the acute or swift but a brisk and high Feaver does always accompany for in all cases where pain is continuing especially if severe a Feaver is adjoyned and they become fratres in malo or rather a branch from that stock and the order of causation runs thus First there is the morbific cause planted in this or that part or transient which is either some degenerate or peccant humor there infesting or corruptive seminary the fundamental matter of Pains Tumors c. or some extraordinary production as stones worms c. These preternatural causes do seldom lye dormant but raise pain by obstruction by oppression or compression by convulsion distention corrosion putrefaction c. The parts being thus affected and grieved the vital principle residing as governor there is hereby excited and irritated to remove expel and cast off the offending cause this strugling and irritation of the life is the very pain and anguish that is felt in the part for the Organ is not capable of pain of it self but the life inhabiting and inabling the part to perform vital offices that does dolere and aestuare Now a Feaver which is pain diffused ariseth from particular pains thus As the members or parts of the body being many do consent with one another some more immediately and peculiarly than with the rest by vessels of communication partnership in office or vicinity yet the life being one entity or common being extended and expanded throughout the whole fabrick of the body cannot suffer here or there but the whole is injured disturbed and drawn into consent more or less manifestly or secretly and the Spirits upon great occasisions are raised up in commotion throughout the body as instruments to vindicate the publick from an enemy invading And farther take notice that particular pains beget the general a Feaver greater or less sooner or flower upon a double account 1. From the Nature and Quality of the Part in formation and office 2. From the greatness or inconsider ableness fierceness or mildness of the morbific cause For example Sickness which is pain at the Heart or Stomach raiseth a Feaver great and soon and this by reason of the excellency and necessity of their offices whereby the whole body consents forthwith that what afflicts these is a general complaint more immediately but other parts in a lower station subservient and ministerial whose function being not so general but of particular and private use do not communicate their diseases so soon nor the whole body so highly resenting their ill affects because the publick can spare their offices and be without their exquisite or compleat assistance for a time without great complaint or manifest want Secondly the cause or morbific matted being greater or less in any part does thereby affect more or less sooner or later and therefore sand or small gravel in the Kidneys do not afflict the part nor raise so great a disturbance in the body as a stone there that obstructs the ducture and stops the current of the Urine and is much more difficult to be removed And sickness or pain at the Stomach by little over-drinking of good liquor Wine or Beer c. is not so lasting nor molesting nor preading in the effects over the whole body â—s a surfeit of meat fruit or an over-charge of bad liquors these shall produce not only sickness or pain in the stomach but sickness or a hot pain in the whole body which is called a Feaver and this sickness may be dangerous as sometimes it proves mortal Pain is fixed in one part but the Feaver is universal spread throughout the body for from this pain of a particular part the whole life estuates is incensed and disquieted as if a cord be tyed or fastned at both ends of great length and strait strike it hard in one place and it jarrs the whole length but at the place struck the vibration is greater and more manifest So where the disease is seated the pain is more apparent and that part most sensible where the wound is given where the oppression lyes where the obstruction is where the humor is corroding putrifying c. there pain is eminenter limited or bounded and to be pointed at particularly here and not there eminently but from hence ariseth the Feaver which is pain diffused in a remiss degree and seemingly of another nature or quality a different thing supposed by some therefore denominated a Feaver This Feaver although it be a pain yet it is not so felt by the Patient nor so understood by others because of the greater particular pain that drowned it and because of its expansion and latitude all parts bearing their proportion and share so that where a Feaver stands alone without a particular pain in this or that part yet the Feaver the general pain is not so manifest to the sense of the Patient because every part hath its portion and therefore is not so discernable and uneasie for a Feaver is pain expatiated through the body and you are not so sensible of it as when pain is contracted into a narrow compass the rest being free and at ease That all Feavers are pains greater or less examine but the definitions of Febris and that of Dolor Feaver and pain you will be fully informed how they agree a Feaver being comprised under pain as a Species of that Genus being a hot pain or the pain of heat Dolor est tristis sensatio in tactu Gal. Febris est calor contra naturam in corde accensus ex eo in totum corpus diffusus which is Hippocratic and Galenic Doctrine Now where there is heat higher or exceeding that which is natural it must affect the sense of feeling and cause pain and although I do not like the definition of Febris yet it will serve my turn here being right in the opinion of those Galenists with whom I now contend From hence we must understand and be untaught again that Dolor and Febris do differ as genus and species a Feaver being contained under and is one sort of pain viz. a hot scorching pain and sometimes a Feaver is a cold pain as the rigor of intermitting Feavers called Agues do testifie And since that all Feavers we pains little or great we shall not need to institute a Method of Cure different upon the notion of a Feaver but only having respect unto the cause that raiseth this feaverish or hot pain and therefore
commonly called Stitches Pains are incident to these Muscles from external injuries as contusions and impressions of cold or else internal causes and these are either by defluxion of humors that may flow in as most frequently from an abounding serosity being thin sharp and extravasated falls in amongst these Muscles or else by congestion matter is accumulated which Nature not being able to discharge lyes there as a burden impeding the muscular motions and causeth pain Sometimes from flatulency and wind getting into the Interstitia of the Muscles thereby causing intercurrent and fleeting pains And for remedy in such cases Fomentations and hot Bags applied are advantageous Evacuations being premitted according to the condition of the Body requiring We come now to consider of Pleurisies or pains in the Pleura that inward Membrane that does invest or line the Breast a disease very eminent and frequently occurring that both Hippoc. and Galen often mention it by way of example These pains are acute and sharp like punctures and have no constant place but in some persons they seize the right side in others the left in some the pain is higher in others lower towards the Hypochonders sometimes more backward and sometimes forward and although chiefly and more manifestly the pain be here or there to be pointed at yet the whole Membrane by reason of continuity is thereby affected and the parts adjacent do suffer by consent from whence various Symptoms as concomitants and attendants do inseparably accompany and consort with this pleuritic pain Hence it is that difficult and short breathing is constantly annexed to it and this because the parts for respiration are hereby impeded and have not their due motions and liberty of extension but are restrained and curbed which is done in favour to avoid compressing the grieved part otherwise would exasperate and increase the pain and therefore the sick fetch their breath short and quick because they cannot take it fully and largely and do repeat it the oftner by way of recompence To this and by consent of parts is adioyned a short and dry Cough which irritates and provokes the pain by moving and straining those parts and therefore is very troublesom and grievous to the Patient Here also a continual acute Feaver does necessarily follow as inseparable for the Archaeus or vital Principle being invaded in those parts by something hostile does therefore insurge becomes inraged grows hot and fiery raising a burning distemper throughout the body To these we may add another constant Character namely a hard swift but small Pulse And these are the pathognomonical signals that are always attending upon and do distinguish Pleurisies from other diseases of adjacency or affinity and likeness with them for when pains fall in amongst the intercostal Muscles although there may be some punctures or prickings because of the Membranes there yet not so great the Feaver not so high nor the breath so short nor the Cough so troublesom if any If the Lungs be inflamed only the pain is but little not punging but obtuse not in the circumference or sides but in the cavity or middle of the Breast yet the difficulty of breathing is greater here than in Pleurisies from angustness that seizeth the parts of respiration Pleurisies differ from Inflammations of the Diaphragma because in this there is no pain in the sides but only at the end of the short Ribs and the upper part of the Belly is extended and with it a Delirium Pleurisies also are distinguished from Inflammations of the Liver in the seat or place of pain which always is in the right side under the short Ribs the pain not punging but heavy and obtuse the Cough less difficulty of breathing less but the Urine higher-coloured or tinged red And now I see the reason though very weak why some Authors have distinguished Pleurisies or differenced them into legitimate and spurious which indeed is a division of Pleurisies into Pleurisies and no Pleurisies for I account no disease to challenge that denomination but such as have their foundation in the Pleura else by the same reason all diseases may admit of the same distinction of legitimate and spurious for as much as every disease hath some Symptom which is common to other diseases that may give them some resemblance or affinity with each other or be affected by consent from another but I pass it over and come to examine the causes from whence pleuritic pains do arise These causes are external and internal External causes are such as remotely prepare and dispose the body to a likely capacity of reception or aptness to this disease laying the foundation for internal causes and they do arise out of or from the irregular unfit or improper use of the Diaetetics which leads to a morbific or unsound state For example violent exercise or otherwise raising great heat in the Body and opening the Pores by neglect upon it as not to preserve that warmth for some time and suffering it gradually to abate and go off by keeping on cloaths and forbearing cool drinks this may introduce a Pleurisie So likewise in the heat of Summer to throw off cloaths and be exposed to the wind at a Casement or the cool Air in the evening To over-heat the Body with strong Liquors and suddenly endeavor to cool it again with small Beer may effect the like Cold North-winds after Southerly and hot weather does alter the texture of the blood and is previous to pleuritic or similar pains But here you must take notice and know that quicquid recipitur recipitur per modum recipientis all Bodies are not alike nor equally disposed for reception for in some these causes produce Pleurisies in others Angina's in some Dysenteries in others Arthritic pains c. According to the aptitude and disposition of Bodies in fabrication or organization and peculiar properties have the same general external causes various and divers effects being determined and specificated by different states of Body more liable and apt to this or that disease rather than another Hence it is that external causes as Diaetetic errors have heterogeneous effects and procure dissimilar diseases according to various constitutions purity and impurity stability or debility concurring with or resisting their influence which consideration brings me directly to the next stage being the latter part of the preceding division Internal causes are antecedent or conjunct Antecedent as plethory being fulness of blood or Cacochymy a depraved or degenerate blood both which are previous states or conditions of Body disposing or rendring more liable to this disease for the great Vessels being full and distended upon any Effervescence and Superfermentation of the blood this impetuously like a torrent is impelled into the smaller Pipes as those of the Pleura where not having a free passage it does cause pain by distension and Inflammation Now this plenitude is brought on or aggravated and increased sometimes by a suppression of some accustomed Evacuation as those that are wont
pressure here raiseth a fainting pain the Cartilage yielding and giving way to any force But sometimes a pain is planted here not always by any external manifest cause but from internal and preternatural state of the parts and this pain is rarely taken notice of by Physicians and mentioned but by a few practical Authors Now to examine into the cause of pain you must know that this Cartilage is flexible and yielding in its natural condition being of a middle nature between a Bone and a Ligament and therefore may be curvated and bent inward upon a threefold account By Laxation Exsiccation and external depression 1. By Laxation as when too much moisture resides here mollifying and loosning the part from any small occasion the Cartilage may be inflexed and turned inward changing its due position and rectitude and from the like cause Ligaments are sometimes relaxed which renders Junctures ready and apt for dislocation and disjuncture and upon this score the Vertebrae of the Spine have been displaced also the Hip and Ancles 2. By Exsiccation this Cartilage may be distorted and wrested from its posture as sometimes that which was straight green and pliable by drying and shrinking becomes crooked bent and drawn aside So this Cartilage that was a Grisle tender and pliable sometimes becomes dry hard and bony and fixed upon distortion or writhing as not returning to its rectitude or straightness and distance from the subjacent parts over which and for whose guard it is placed 3. By external Depression as from a blow or fall any thing too much or too long pressing upon that part may pervert and alter the situation and due posture and those whose business or imploy keeps them bending or pressing forward too much and constant renders them liable to this inconvenience and therefore Students and Clerks that write much pressing upon this part are injured thereby and find it upon age though youth bears it off for a time Now since this Cartilage is thus exposed to depression and bending inward and thereby the tender parts subjacent to be pressed upon and molested the cause of pain and manner how is made evident and which most commonly is felt after eating and upon a full stomach when the parts are dilated and swelling up to this Cartilage And farther as all parts of the Body in several persons do vary and differ much in figure position magnitude and distance so thereby some are more liable and apt for this pain than others although subject to the same external procuring or internal antecedent causes And so I dismiss this particular pain and pressure and must take cognizance briefly of that which is more general upon the whole Breast The Thorax or Breast suffers by compression or constriction whereby a general obtuse pain of angustness is perceived and that chiefly upon inspiration and drawing in of the breath and why now more than at another time is because the inspired air fills and distends the Breast which makes opposition to or resists the compressing causes Now the cause of angustness or coarctation is from the Genus nervosum that gives motion to the Muscles and other parts of the Breast which Nerves sometimes are impedited and contracted that their functions are not freely executed and therefore to this Symptom of compression is commonly adjoyned shortness or difficulty of breathing upon the same score and sometimes spasms or convulsive motions And this complaint of straitness or contraction of the Breast does frequently happen to scorbutic persons whose nervous juyce being degenerate and tainted their Organ or Vessels perform not their office duly as they ought in giving the full motion and extension or every part for this nervous liquor being fed and supplied from the mass of blood which is scorbutic feculent and depauperated in spirit that also which is extracted thence must be answerable and of a degenerate nature so then this nervous juyce which should be vegete noble and spirituous for putting the motive faculties into action with vigor and briskness is become dispirited flat and depraved and the Organs acted thereby move heavily and irregularly so that upon inspiration or filling the Breast with Air the parts do not readily give way by expansion to let in hence the Patient feels himself girt or strait-laced It remains now in the last place that we finish this second division in examining and searching into the nature and causes of those pains that more peculiarly and eminently afflict the Heart The Heart being a noble or the noblest and principal part is as the Sun of the Microcosm whose irradiating lustre and beams of vital heat enlivens and refresheth all the regions and parts thereof the Eclipses storms and clouds then that happen as the consequents of its distempers and sufferings must needs be eminent and remarkable This supreme Organ that bears the government of vitality is so generally concerned in all diseases and discomposures of the Body that few there are but the Heart is made sensible thereby and gives notice thereof by variation of the Pulse as a sigrial from thence And not only distempers of the Body or the defect and decay of some particular member or faculty does affect the Heart but also the disorders and passions of the Mind have influence thereon that from thence the Heart akes beats or suffers pain and restless disturbance hence it is that grief anger fear desire c. Changeth the regular motion of the Heart and the Pulse alters as a token and manifest character of its sufferings Now the Heart is made thus sensible of the Bodies infirmities and preternatural mutations from the vital government that is planted here having commerce and communication with every member from the circulating afflux and reflux of the crimson vital stream continually transmitted through this Organ which thereby is affected well or ill as the blood is better or worse in the current and quality thereof And the Heart is also affected from the mind for as much as the Soul exerciseth her power more eminently here and if a particular part may bee assigned this may be said to be the seat or Throne of Regality The Heart being of a solid fibrous flesh the pain thereof is obtuse not so accurately perceptible so acute and sharp as those of the nervous parts notwithstanding the effects and consequents thereof are impressed upon the whole Body and each member is impaired in its vivacity and vigor and although this Heart pain by the nature and substance of the Organ is not so great commonly and perceptible as that of some other parts yet when this pain does arise to some degree a Syncope seizeth the Patient a deprivation or cessation of life for a time that what it wants as to sense is doubled in the consequents as threatning and endangering the life so that extremity of pain is not perceived here because sense decays as the cause of pain increaseth The Heart is molested and suffers pain these several ways by extension
moderate and gentle making a profitable secretion without gripes or pains but for the most part with these more or less which by continuance and shaving the guts so thin at last do come to the quick and cause excoriations and this difference ariseth from the nature and quality of the humors or stimulating cause which sometimes is so extreme sharp introducing a Dysentery or bloody Flux These Fluxes sometimes produce good effects when the peccant matter of any disease or an exuberant humor is timely and moderately discharged and sent off but otherwise not and therefore saith Hippoc. In turbationibus alvi vomitibus sponte contingentibus siquidem qualia purgari oportet purgentur confert leniter serunt sin minùs vice versâ In respect of place or parts mandant from whence these Fluxes take their rise and the terminus à quo they proceed sometimes from morbific matter congregated and concentred issuing from the whole body and of this take the example of Hippoc. giving a Prognostic in this case 7. Aphor. 29. Si Leucophlegmatiâ detento fortis Diarrhoea supervenerit malum solvit Which is to be understood in the beginning of the disease strength firm and the Viscera sound else it is commonly mortal But sometimes also these Diarrhoea's do emerge from particular parts as the Ventricle Brain Spleen Liver Mesentery c. and therefore in the Cure of these Fluxes regard must be had to the part principally affected from whence as the original and fountain these Diarrhoea's do assurge And therefore examination is to be made by the Diagnostic signs of every principal part discovering thereby which performs their offices in integrity and which of them decline their functions and are depraved as being the Authors of this disturbance The third sort of Flux is a Dysentery or bloody Flux which is a dolorous and frequent excretion of blood from an Exulceration of the Guts There are several voidings of blood by stool that are to be distinguished and know from Dysenteries Galen mentions four others add two more The first is a profusion of blood arising from plenitude or fulness of good blood Nature over-burdened dischargeth her self this way by the Guts The second is an evacuation of crude and watry blood not having its full tincture The third is of a feculent and foul blood The fourth of an acrid and salt blood The fifth is of a tabefied blood in acute diseases The sixth which is Galens fourth is a Dysentery distinguished from the rest by Ulceration and great pain To examine this division in the several parts thereof and to set forth what truth and errour it contains therein is not our business at this time I shall only discourse upon the last viz. a Dysentery being painful and grievous to bear which kind of bloody Flux ariseth from and is accompanied with an Exulceration and commonly is the consequent of long or severe Diarrhoea's for those Fluxes not being checkt do sometimes make their transition and terminate in Dysenteries This word Dysentery taking its name from the part affected imports only a difficulty of the Intestines but may as properly be used for other diseases and pains there but Authors having fixed it to bloody Fluxes from Exulceration its general signification is restrained and custom amongst Physicians hath fastned it here as the character of this disease only The parts affected are the Guts either the small or the great and sometimes both but pains of the small are more grievous than those of the great the small Guts being of more exquisite sense The external and procatarctic causes that predispose and introduce a dysenterical disposition or promote and set forwards an inclination already begun are First the constitution of the Air. Secondly a bad Diet conspiring therewith or some unwonted kind of Meats or Drinks and therefore it is that many people upon the change of Climate and a new sort of Food do fall into bloody Fluxes hence it is also that these Fluxes are sometimes epidemical and malignant infesting many together in a City or Country as of late years in London and some other parts of England this disease was raging These epidemical Dysenteries arise sometimes to to the height of pestiléntial and are very contagious that it is not safe to converse with or be near the diseased but especially such as attend upon the sick are in most danger from the Excrements that send forth a pernicious and infectious vapor For the time of the year Autumn is most ready and does more frequently produce these Fluxes partly from the change of the season and partly from the effects of Summer fruits to which many are intemperately given the consequents whereof are commonly Diarrhoea's and Dysenteries Now the reason why these Fluxes do break out more frequently at this time of the year is because the external ambient Air and cool blasts condensing and incrassating the Juyces of the body as also occluding and shutting up the Pores denying and hindring the former Transpiration which in the Summer and hot weather did spend and evaporate that way much superfluous matter which vents being stopt humors accumulate ferment and grow turgid and forceth a discharge inwards by the Guts And not only this change of Air from hot to cold or Summer fruits are procuring causes but also some astral and inimical influences drawn in with our breath may deprave and alter the Crasis of the blood and nervous juyce as to effect this disease and make it popular in like manner as other Epidemical diseases are sometimes procured Also some sorts of Meats in quantity or quality offending and disagreeing and for want of good digestion may corruption and dispose to these Fluxes To these we may add as procurers some ill prepared Medicines and medicinal Drugs not well corrected that have and will produce a Dysentery But concerning the proximate cause and manner of generation of this disease we must farther declare And whereas before we mentioned several sorts of bloody excretions or fluxes not dolorous nor depending upon or conjoyned with exulceration of the Intestines and therefore not denominated nor to be understood as Dysenteries in the strict and present sense therefore I must wave the mentioning of their causes and only give an account of Dysenteries in the usual acceptation of the word In the forming or generating of this Dysentery you must understand that sometimes the Vlceration is planted first and hath the priority and a Flux of blood follows as the consequent but sometimes the voiding of blood precedes and an Vlcer or Vlcers is procured thereby as the effect and this consideration is not of small moment in the designment and intentions of curing for both the former and the latter happen in several persons Sometimes Vlceration is made by sharp corrosive humors as in Diarrhoea's which ulcerate the guts first then a Dysentery of blood follows Or Sometimes from an Inflammation of the Intestines or other Tumor coming to suppuration which breaks and makes a
Liver BEfore I inquire into the nature and causes of these pains it will be necessary to let you know the office and use of this member its situation figure and vessels for hereby the disease upon which pains depend will be more manifest and apparent as also such parts as suffer by vicinity connexion and consent from hence To enumerate the various Opinions that have been held by Learned men in all Ages concerning the office of this member would be too tedious therefore I shall only mention what latter discoveries have proved most rational from the motion of the Chyle and Blood which is this That the Liver primarily is appointed to receive the blood coming from the Heart to give it a farther digestion and depuration by separating the bilious matter and secondarily by embracing the Ventricle to cherish and promote the stomachs digestion or chylification for which purposes this member is fitly seated formed and furnished with vessels to import and export The Liver is placed in the right Hypochonder under the Diaphragma covered in part by the short Ribs and covering the upper and forepart of the Ventricle and for firmness of situation it is fastned by three Ligaments to the Abdomen to the Cartilage ensiformis and to the Diaphragma The figure of this member upon the superior part is convex or round the better to give way to the motion of the Diaphragma but the under side is concave or hollow fitly to apply to the extension of the Ventricle As for magnitude it is various in divers persons greater and less and also different in the same persons in health and sickness this member sometimes being wasted and shrunk and sometimes swelled or increased wonderfully big This Organ hath vessels appertaining to it as Veins Arteries and Nerves the two eminent great Veins of mans Body Vena cava and Vena portae having their roots variously dispersed here through the Parenchyma or body of the Liver the trunk of the former rising out of the superior gibbous part the latter from the concave and under-side The Liver being designed for the use aforesaid seated and accommodated after this manner we shall inquire into the impediments and preternatural conditions from whence pain and trouble ariseth for many complain of pain and heaviness in their right side about the short Ribs sometimes more forward sometimes backward sometimes inward and sometimes more outward To what parts these pains belong and the causes from whence they arise is worth our labour to be resolved for sometimes pains of the Liver have erroneously been taken for Pleurisies because the pain hath extended upwards and affected the Thorax by reason of vicinity and sometimes the muscular pains of the Abdomen in the right Hypochonder have been adjudged to be hepatic not rightly discerning the diagnostic signs Diseases which the Liver is most subject to and procuring pain are these Obstruction Adhesion Inflammation Inflation scirrhous Tumors Apostems Vlcers From hence we may understand that as these pains are various in their causes so are they dissimilar and unlike in the sense of feeling and differently seated Obstructions that impede and injure the office of the Liver and producing pain are frequent and these are either in the outmost gibbous part and do belong to the trunk of the Vena cava or else in the hollow inferior part and the Vena portae is concerned herein or else the obstructions are fixed in the body of the Liver and then the small ramifications of either or both Veins are affected Hence it is that this member is most frequently infested with obstructions because it is stored with so many vessels as none more But besides these obstructions of the Vessels there are also obstructions in the Parenchyma or substance of this Organ that is when the small Meatus or Pores are shut up that ventilation and transpiration is denied hence it is that this member sometimes is preternaturally extended and increased in magnitude through all its dimensions for having a continual supply of additional matter and not duly expended the part of necessity must be augmented and inlarged And it is observed by some that those have the greatest Livers that are of a colder temperature and such as are great eaters of this Cornelius Gemma gives an example of an Old woman that could not forbear eating and drinking scarce a moment but with great trouble and anguish and being opened after her death her Liver was found to be wonderfully big Signals declaring the Liver to be obstructed are a heaviness fulness or an obtuse pain in the right Hypochonder and chiefly after meat or exercise and upon more than ordinary motion the face is apt to be high-coloured the hands to look red and the breath to be short and they are apt to be feaverish upon small occasions but upon rest and ease commonly they are inclined to be pale Causes from whence these obstructions arise and do depend are first such as remotely dispose as a plentiful and bad Diet or a gross feeding upon such meats as are difficult to be digested and distributed what those are you will find in the Preservation of Health c. also a thick unwholesom Air to be without exercise and to indulge sleep too much which over-clogs the body makes a Plethory and fulness whereby the circulation is retarded laying the foundation and an aptness for obstructions in general Secondly and more immediately from a viscidity and grossness of the blood rendring it influid slow of motion and apt to stop in the vessels and this is generated in the Liver from its distemper debility and decay of the faculty or is transmitted from other parts and brought in from the antecedent causes aforesaid to which we may add angustness of the vessels in some persons disposing to this inconvenience Obstructions of the Liver are carefully to be lookt after and removed because they introduce many other diseases as Jaundice Dropsies Feavers Inflammations scirrhous Tumors c. Adhesion or Coalescence sometimes is the cause of pain in the right Hypochonder as when the Liver sticketh to or groweth together with the Peritonaeum And this may happen from too much and constant lying on the right side or by the magnitude of the Liver extending to the Peritonaeum whether tumified preternaturally or increased by a natural nutrition and growth Now pain ariseth hence the Membrane that invests and covers the Liver being very sensible as all Membranes are that cleaving to the Peritonaeum is disturbed and strained by motion or shaking of the body or by lying on the contrary side the weight of the Liver endeavouring a separation Inflammation sometimes seizeth the Liver and causeth great pain and this commonly proceeds from or is the consequent of obstructions for the blood being stopt in its current and overflowing especially being more hot and fiery is then apt to inflame the part and this is manifest to sense by heat and tension of the right Hypochonder Inflammation is known from
of Urine This disease is always accompanied with an acute Feaver great Thirst astriction of the Belly heat of Vrine and great pain about the Loins and if the Arteries be affected the pain will be with pulsation Sometimes a Delirium attends with long watching and if the Inflammation be in the Membrane the Patient is scarce able to sit upright because the pain thereby is exasperated If the right Kidney be affected pain extends upwards to the Liver and short Ribs and downwards to the Genitals also a stupor seizeth the right Thigh by consent the Nerve being compressed that passeth thence down to the Thigh But if the left Kidney be the part affected that side is most grieved and in like manner but if both the Kidneys be attacked then the Symptoms on both sides are equal The termination of these Inflammations are either by an Apostem or Abscess by induration and a scirrhous hardness or by Transpiration and resolution which last is the only safe and secure way and this the Physician ought to design for and aim at in his administrations But if contrary to his endeavors the Inflammation apostemates suppurates and breaks evacuating the purulent matter by the Vreters into the Bladder there is good hopes of safety but if it be discharged inwards by the emulgent Veins the case is desperate Scirrhous Tumors in the next place come to be viewed and these are hard Tumors very difficult to be removed being the relict of an Inflammation or other Tumor preceding and not well cured or formed by gross matter congested and accumulated there causing contumacious obstructions for humoral matter flowing thither and being obstructed in the transition the heat of the part does exsiccate and harden it by time more and more and then by accumulation and addition forms a Tumor This causeth heaviness about the Loins but little pain the Urine is but little also and that pale and watry in regard the office of the Kidneys is debilitated and by reason of the angustness of the passages letting pass the thinner but retaining the thicker part of the Urine The longer this Tumor continues the more difficult and incurable it becomes and withal it brings on hydropic Cachexies for the superfluous serosity not being drained away regurgitates back into the body The Cure is to be set upon with internal and external Medicines Aperitives Resolvents Discussives and Emollients Apertion of the Vessels contrary to Nature somtimes does threaten danger by the appearance of blood staining the Vrine and this proceeds from a weakness of the Vessels being relaxed in their retentive faculty or by a plenitude and fulness of blood or because the blood is thin and sharp which causeth the mouths of the Vessels to open On the contrary Angustness or straitness sometimes does incommode the Vessels appertaining to the Reins which hinders the free ransmission of the Vrine Now this angustness of the Vessels does arise either by compression from some Tumor or distended part that presseth upon the Vessels and straitens them from without Or by contraction or constriction of the Vessels that are shrunk as by great heat in long Feavers or a Tabes that seizeth the Kidneys Or lastly by obstruction within from some viscous matter grumous or clotted blood sand gravel stone c. The Sign declaring these obstructions is a suppression of Vrine with pain or an abatement of the usual quantity not answerable to the drink received The place or part affected whether in the Kidneys or Vreters is known by the seat of pain The causes that obstruct are known by their proper signals and by examining into the preceding state of the Patient The place or part grieved with these obstructions whether in the Kidneys or Vreters pain discovers and the dislodging or shifting thereof Of all the obstructions that infest the Kidneys the most frequent and saddest complaint is from the Stone this being the most contumacious obstruction the most painful being a hard solid body and the most uncertain Remedies for relief Concerning the generation of these Stones there have been various Opinions amongst Learned men in short the difference and contest hereupon may be reduced to these two Heads what the material cause of the Stone is and what the efficient For the material cause or matter whereof the Stone is bred Galen and most of his Disciples will have it to be a phlegmatic gross or viscous humor apt for condensation and induration and the efficient to be heat exsiccating this matter and bringing it to a stony hardness but others of them will have this to proceed from cold by way of congelation But this Doctrine cannot hold as rational nor does it answer experience as for the matter we cannot allow it to be such for as much as many that abound with a viscous tough Phlegm and slimy matter as most ancient people do yet many of them are never trouble with stone or gravel And for a concurrence of both the causes material and efficient we have examples of the Aged who are most cold and phlegmatic and for abounding heat with the like matter we may produce Feavers yet no stony concretion or signs thereof to be found from such sicknesses So that we are now to seek for other causes both material and efficient whereon to ground our endeavors for the relief of such as are afflicted with this disease The matter therefore and substance of the Stone is from a tartarous and saline succus with the addition of a terrestrial feculency concreted or petrified by a lapidifactory Spirit or disposition of the Reins which is the efficient and seminal being of that production The concurrence of both these causes does much produce the Stone and afflict the Patient in a high degree but one of them is sufficient viz. this petrifying power of the Reins to coagulate any laudable good matter imported there into a stony substance To confirm this Fernelius relates upon his own knowledge of one that for three or four months together above a dozen small stones came from him every day all which time notwithstanding he eat nothing but Broths and Panadoes being confined to his Bed by weakness and pain But allowing this to be true from the credit of the Author yet we must owne and acknowledge that besides this principal cause of a petrifying Spirit in the Reins there are also antecedent and procatarctic causes adjuvant and promoting as some sorts of meats and drinks and other errours in the Diaetetics that increase and set forward this disease which otherwise might be much slower in generation nor yet arrive to so high a degree of torture also the Stomach Spleen or Liver not performing their functions rightly may contribute matter to the promotion hereof For relief of the diseased in this case there are two grand intentions to be prosecuted and aimed at a dissolution of the body of the stone already generated and secondly the taking away of the petrifying disposition of the Reins and abolition of
that coagulating ferment and for these purposes were Paracelsus his Ludus and Aroph also the Alkahest cannot fail herein But such as have not acquired the great Arcana's and cannot procure a dissolvent for the Stone that is to make an Analysis or resolution of it into a liquid juyce and reduce it back again to its humoral flowing state capable of abstersion and cleansing out must endeavor to facilitate the exclusion of this hard body by the best and most hopeful means for that purpose by lubrifying relaxing and dilating the passages and asswaging the Spasm and contraction of the Vreters that the stone may slide away much sooner and with less pain hence by way of caution observe That Diuretics and provokers to expulsion are not to be given before this preparation be made else you precipitate the Patient into danger and increase his torment dislodging and forcing the stone through angust and very tender cavities not provided to give passage without detriment to this unwelcome stranger And thus much briefly concerning petrifaction or the production of Stones in the Kidneys I proceed on to the next a most difficu't and painful disease belonging to this Member namely Vlcers Vlcers of the Kidneys are introduced several ways or take their rise from several causes 1. Acrimony and sharpness of humor passing this way and continuing long does excoriate which not timely observed and remedied because pains at first are but small does corrode farther eat into the flesh and plants an Vlcer 2. The Kidneys are ulceratedsometimes from an Inflammation or other Apostem there coming to suppuration and breaking which dischargeth the matter by Urine or otherwise but leaves a putrid Vlcer behind 3. Sometimes from a clot of blood extravasated or out of its place putrifying does infect the part tabifie and ulcerate and not to be neglected lest this be the consequent 4. Sometimes a Stone being rough angular or sharp frets or grates upon the parts and makes a solution of continuity which at first sends forth a bloody Urine afterwards purulent and begets an Vlcer and this last is the most frequent cause that generates Vlcers in the Kidneys These Vlcers are discovered by pain about the Loins a purulent Vrine and sometimes Caruncles or small fleshy rags or strings of concreted blood is brought forth with the Urine accompanied commonly with heat in the Back and sometimes faint Sweats which continuing bring on a Consumption and Hectic Feaver Of these Vlcers some are more sordid foul and stinking as the Urine does declare others not ill scented the Pus white not viscous but cloudy and light The difficulty of these Cures lyes here for that the Urine which is acrid flowing always by the Vlcer hinders the consolidation of the part besides the situation being remote the virtue of a Medicine is much altered before it arrive to the part but in the designment and managing of these Cures the body must be well cleansed not with the common deleterious Purgers but balsamic Detersives and so kept with a proper Diaetetic regimen as no impurity or sharp humors disturb or abate the power or Medicines which must be truly balsamic and healing The experience of these Ulcers I have had several times both many years since and lately I remember in the year 1652. I cured an Ulcer of the Kidneys in a man about thirty years of age living near Sheffield in York-shire who came to me four miles twice a week during his Cure I being then for a while at Norton upon the edge of Darby-shire His Urine was hot sharp and stinking with a great purulent sediment a great pain in his Back with scorching heat and often flushing faint Sweats all over his Body Indeed I have wondered since how I did perform such a difficult Cure then having so little practical knowledge I being but a Tyro in this Art it being in the first year of my Practice and newly graduated Batchellor in Physick but Providence had appointed me the instrument to free this poor man out of his pain and languishing condition Since I have been acquainted with several of the like cases and may with better assurance promise a Cure from tryed Medicines acquired by experience beyond what Book-practice does communicate and this last year here in London I cured a Gentlewoman of an Ulcer in the Kidneys In the next place we are to take notice of Pains belonging to the Bladder The Bladder is the last receptacle for the Urine and performs the office of a Cistern to the Body for keeping and discharging the Urine at convenient times and therefore is capable of distension and contraction being a membranous bag furnished with right transverse and oblique Fibres for that purpose and hath two Muscles at the neck of it to let go or retain the Urine This part is liable to great grievances and painful infirmities as Distension Obstructions Inflammation Excrescences Vlcers scirrhous hardness From hence come suppressions of Urine imminution or small quantity ardor or heat of Urine Strangury or dolorous emission and dropping incontinency of Urine or difficulty of retaining it Distension of the Bladder happens from too long retaining of the Urine whether it be voluntary or involuntary so that afterwards the Fibres do not recover again the power of contracting the Bladder and this may prove of dangerous consequence and to some it hath proved mortal Obstructions of the Bladder causing a suppression of Urine or diminution dolorous or difficult excretion does arise from many causes as a stone in the Bladder or gravel coagulated blood worms a viscous humor or purulent matter a Caruncle or Tumor in the neck of the Bladder or by compression from a tumified part adjacent as the Womb or right Intestine Inflammation sometimes happens from extremity of pain by the Stone Vlcer or other torturing cause and these Inflammations are commonly mortal Vlcers do possess the Bladder sometimes and most commonly in the neck thereof caused by a stone or gravel excoriating and wounding the part or by an eroding purulent matter coming from other parts and lodged there or by a continued Acrimony and sharpness of Urine corroding sometimes from an Inflammation or Abscess more rarely but it hath happened sometimes from a Gonorrhoea ill cured and I may say very ill indeed for the Ulcer thus procured is of far greater difficulty and danger than the Gonorrhoea Not long since an Ulcer of the Bladder was committed to my care being the relict of a Gonorrhoea ill managed by a Chirurgeon using Restringents unseasonably Ulcers in the meatus Penis as also in the Prostates are more frequently offered to our help as lately another person applying to me having an Ulcer procured in the Prostates from the like improper and pernicious course and although Gonorrhoea's are frequently cured and may with much certainty and safety in skilful hands yet there are many that patch up a seeming Cure for the present but future consequents are sad memento's of their Undertakers folly And at this
a few years since now dead being often and much afflicted with the Gout his Physicians told him that the Gout kept him alive and if he were cured thereof he would dye soon after To obviate these objections I answer and part hereof I grant that some have dyed by their endeavours for Cure and this not so strange for the like may be said in all other diseases that some have dyed by their Physicians or such as they intrusted as Physicians and not solely or chiefly by their disease Examples we have had in the most if not all diseases the most curable and facile to be dealt with so that by unskilful men improper courses or designments and by bad Medicines or casualties happening by the Patients folly or their Tenders many have dyed in the prime and strength of their age by endeavoring for Cure in Diseases not mortal nor of sudden danger in their own Nature and amongst those the Gout may be reckoned So that if you will plead for no Physick no tampering as you call it with the Gout by the same argument you may abandon Physick in all other sicknesses for the adventure is equal and the security depends only upon the judgment and ability of the Physician and no more hazard in this disease than in another I say therefore in case of the Gout as also in all other diseases if you will securely proceed take a knowing man well grounded in the Theory and through paced in the Practice of this Art Having a frequent experience in the progress and Cure of Diseases and a critical Observator of the Gout in particular this man you may as freely trust and safely yield obedience to in managing a Cure for the Gout as you can do to other Physicians in all cases whatsoever Now as for those Physicians if there be any such so ignorant or fallacious that alledge the Gout to be any way a Preservative of Life and pretend not to cure it for that cause I must tell them plainly first that this is only a pretence to palliate their inability and a crafty evasion to shift off the censure that may fall upon them for not curing what they ought and would willingly do if they could Secondly To shew the pretence is erroneous and void of truth we will search the Gout and see if there be any thing in it or appertaining to it that is a Preservative of mans life or conducing to his health and a sound state of being In the Gout there is no pleasure nor recreation either of Mind or Body both which are promoters of Health and consequently prolongers of Life but on the contrary the Gout is attended with a sedentary inactive confinement melancholy pain watching and unseasonable sleep the consequents and effects of which are debility ot all the faculties and enervation of strength which as these continue longer or more violent and return more frequently and often by so much more is the Patient damnified both for the present and the future and rendred more infirm and liable to the decays of Nature But perhaps you will say this serosity and sharp punging humor falling into an ignoble part and far off from the Vitals is much better and safer there than to wander up and down the body which as it hath happened sometimes may invade a principal part and there threaten or cause death therefore so long as this humor hath a recourse to the Joynts and is not turned off from that current the Patient is not in such great danger as otherwise To this I reply That true it is if there were a necessity that this Tartarous gouty humor must invade one part or other better it is that it passeth a safer way and lodgeth in an ignoble and remote part and better it is that the Physician does nothing than do hurt or run a hazardous course If he cannot eradicate this morbific matter stop the spring and fountain from whence it does arise and where it is generated or this being too hard and difficult a work if he cannot derive the stream and issue thereof to the vents and outlets that Nature hath appointed and framed for a discharge of superfluous and degenerate humors but lets them have their course because not mortal to the constant trouble and damage of this or that part in particular and consequently makes the whole to suffer sympathically and by consent such a Physician either hath not a true notion of this disease the Gout or else he wants commanding Medicines elaborated by his own hands exquisite and effectual to answer the indications that this disease and causes thereof will put him upon for relief of the Patient but to pretend that this disease must not be cured because it spends or employs the humor in a safe way so called is much what alike but very unlike a good Physician as to suffer a man to continue languishing in a Loosness or Vomiting because it dischargeth some peccant stimulating matter but in this case as also in that of the Gout the extravagancy and irritation of noxious humors are to be checkt collected and sent forth by good Medicines in a placid gentle way through convenient ductures and outlets and not let to continue in a detrimental extravagant course Now concerning the curability and incurability of the Gout I do owne that some are much more capable of Cure than others by the nature and condition of their bodies and some are not curable as age and other cirumstances have reduced them to an incurable state yet I say in the worst of cases there are mitigations and helps that check and tame the fierceness of the disease render it more tolerable and easie and such Prophylactics or Preventives there are with a due Regimen of life that will keep off the frequency and retard the returns of this painful Malady Thus much concerning the Gout fixed or constant to a part it remains that I deliver my thoughts and experience touching the Rheumatism or running Gout so called because it shifts from part to part invading not only the Joynts but also the membranosum Genus the Membranes both of the Muscles Viscera and Bones Hence it is that sometimes these pains are external in the Muscles and habit of the Body sometimes internal when the Viscera are assaulted as the Lungs Liver Intestines Spleen c. sometimes these pains affect the Bones by pricking the Periosteum that Membrane which covers and enwraps the bone Some complain of their Arms others of their Shoulder-blades some the Bach others or at other times the Breast sometimes the Thighs and sometimes the Legs the humor shifting and moving from one place to another and this upon changes of the weather turning of the wind and seasons of the year these pains do go and come afflicting more or less and yet no swelling Inflammation or outward appearance upon the part grieved These pains continuing or frequently infesting do debilitate and disable the parts affected insomuch that some go
such a product for as much as pains are very frequent in most diseases as before proved Then also remember upon a cessation of pain there ought to be care taken by proper means for the recession and dissipation of confluxed matter and not imagine upon a presumption that when the pain is gone all is gone and the Patient secure Secondly Transmission procures a Tumor when the expulsive faculty of some parts is vigorous and strong to send off any excrementitious matter and deposite it upon a weaker which being not able to expel it lodgeth there and generates a Tumor Thus the principal and more noble parts have a natural robor and fortitude to send off their superfluous and noxious matter and transmit it to the inferior and ignoble Now there are some parts that are weak by Nature and some by Accident By Nature those are weak that are designed ministerial and subservient and therefore liable to transmited matter from their superiors thus the Glandules are all weak parts lax and spongious apt to receive and imbibe hence it is that the Heart transimts to the Glandules in the Arm-pits the Brain behind the Ears the Liver to the Groins and the Glandules of the Mesentery are very apt to tumifie and are the latent causes of some difficult abstruse diseases The Skin also is a weak part and general Emunctory for the whole body and therefore many Eruptions and Tumors are there visible By Accident some parts are weak as when by a disease inordinate living or casual injury some particular part though strong by nature and original formation may be vitiated debilitated and made feeble Thirdly By Congestion Tumors are sometimes bred as when a part or member does not transmute the alimentary supply into its own substance but suffers it to degenerate there and accumulate into a Tumor or else the expulsive faculty may be weak and not able to send off the excrementitious part which remaining there may produce the like or sometimes the fault may be in the nutritious supply not being capable of a good transmutation as in cacochymical and foul bodies Sometimes the relicts of an acute sickness not well cured by congestion in this of that part does afford matter to beget internal Tumors and therefore after the small Pox Agues Feavers c. purgation and cleansing ought well to be performed else chronic diseases commonly do succeed them from peccant matter lodged here or there and therefore upon such neglects or insufficient performance thereof we find commonly big and hard Bellies or swell'd Legs some part or other pained tumified or hard And these are the effects of imperfect Cures when the morbific matter is only abated and the storm laid but the remainder accumulates by collection and congestion to produce a dissease of another nature Fourthly By Obstruction Tumors or extensions are begotten for when the current is stopt in any Vessel and by the Law of Circulation the continent Succus or humor is still moving forwards to this place obstructed the Vessel or containing part must needs tumifie and swell as not able to receive and contain the additional flowing matter in its former dimensions And this is apparent to the eye in external parts which must needs prove the internal for a strait Ligature upon the Arm or Leg does cause the part below the binding to swell and for this reason because the Vessels are obstructed by compression that the blood cannot circulate and move on And the case is the like in effect when obstruction of a Vessel is made from coagulation incrassation or grossness or any concreted matter within the ducture or cavity to obstruct and stop the stream Now obstructions are generally acknowledged to be the frequent causes of many or most-most-diseases and few cases do present in Practice but obstruction bears a part and sometimes the solitary cause or else obstruction is very much wronged for nothing more frequent in Physicians mouths than obstructions and yet nothing more seldom mentioned than an internal Tumor from whence we may well conclude it is rarely thought on or not at all suspected But obstructions are so familiar and frequent in discourse that they are little accounted of at least not thought to be of any dangerous consequence not considering that this obstruction may and does often being contumacious beget a Tumor and this Tumor may cause a long and difficult or dangerous acute sickness if not mortal for the progress may go on still from Tumor to Apostem or suppuration and then plant an Vlcer there or this Tumor may become scirrhous and hard then perhaps cancerous gangrened and then you know what follows next mortification From hence it is very reasonable to judge of the series and course of many chronic or long lingering diseases as also or the acute mortal sicknesses most of which do make their progress by these stages have these commutations and transition at last their fatal termination because this latent train of diseases was not suspected But all this while the Feaver was the disease feared and vainly endeavoured against and the Patient is said to dye of a Feaver because a Feaver did attend the life did estuate and was disquieted in the whole course and every transition of the sickness even to death Fifthly By Extravasation a Tumor is sometimes generated as when the Vessels are replete and full causing tension by thinness heat and sharpness of blood or a preternatural and turgid fermentation distending the Vessels the mouths of the Veins are hereby opened sometimes and a stillicidium or effusion of the contained liquor procured which being lodged out of its proper place does corrupt inflame and produce a Tumor Now concerning the signs of an internal Tumor they are not only extension and increase of magnitude which is apparent when it makes a protuberance upon the superficies but also a fixed heaviness or hardness or pain upon pressure with the hand does give great suspicion and probable conjecture of a latent internal Tumor lying deep and obscure especially and by way of confirmation when the preceding causes apt to generate Tumors do concur to strengthen the probability But before we conclude this Discourse of Tumors something more is to be said and that touching a Scirrhus and Apostem which are comprehended under Tumors and do signifie only the distict and special condition thereof and here we have occasion to take notice of the different state of Tumors and their way of resolution fixation or translation Tumors do either wear away and spend by discussion and transpiration or they recede by a translation of matter into another part or they apostemate and come to suppuration or they indurate and become scirrhous or they tabefie and corrupt the part where they are seated Discussion of a Tumor is the best that can be expected and this ought chiefly to be aimed at in Practice the next to be hoped for and endeavoured is dislodging of it and removal from a noble to an
ignoble part or to such place where means can better be used and more apt for recession or egression of the continent material cause but if the Tumor apostemates the danger is greater or less according to the nature and condition of the member or part if it indurates the danger is delayed but if it corrupts the part the danger is greater and more speedy in execution Apostem is that degree or state of a Tumor when it is maturated or ripe which is called Suppuration the material or humoral cause being then converted into a Pus or purulent matter and while this is in fieri doing all Symptoms are aggravated pain heat pulsation tension are greater but being perfected they all decrease again and the Patient finds ease but not out of danger in these internal Apostems for if it be so seated where there is no convenient vent or Emunctory to discharge it the case is desperate As the humoral matter that formed the Tumor was more benign and good as pure blood so the converted Pus or purulent matter from thence does commonly answer it in goodness for of good blood and in sound bodies the maturation is more kindly the Pus white mild and not endangering to corrupt the part but in foul depraved bodies and malignant diseases apostemated matter is more putrid stinking and venenous and does threaten a Gangrene or mortification of the part and therefore such internal collections of matter in pestilential and malignant Feavers Venereal Pox small Pox and such like are commonly mortal Scirrhous Tumors are such as when the continent matter does not maturate and become soft fit to break and discharge but grows hard and fined in the part not apt to be discharged or removed by discussion or suppuration And this the word Scirrhus imports from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 induro Tumors in some parts of the body are apt to suppurate as in the carnous or fleshy in other parts as the Joynts Tendons and Ligaments more inclined to indurate and become scirrhous and the reason may be this that those parts which take their origine from blood are more prompt and ready to suppurate as the flesh but those which take their rise from seminal matter as the Tendons Ligaments Nerves c they are more inclinable to scirrhosity or hardness But besides this disposition of the parts affected there is also and chiefly a propension in the congested or influxed matter of these Tumors for by the different nature of humoral matter some is more fluxible and thin participating much of serosity and apt to transpire or be discussed other more yielding to a preternatural digestion and suppuration as the blood that is pure and good other inclining to be viscous coagulated and consequently to indurate as a feculent grumous or gross blood deprived of its serosity And farther besides the disposition of parts and that of the material cause inclining to this scirrhosity there may also come in and be joyned with these a third promoter which in some cases may be the chief cause and that is an ill method and injurious Medicines so endeavouring to remove may thereby fix and fasten the matter for thus a Tumor which might probably be dispersed may be changed from its own capacity and tendency and become scirrhous and indurate as when constant or great Coolers are administred to abate the symptomatical or concomitant Feaver the matter of the Tumor is thereby fixed and impacted which otherwise might have surrendred unto proper and powerful Medicines duly used And e contrà by too great Dryers and Heaters the thinner part is evaporated and the grosser remains therefore medio tutissimus ibis good resolutive transpiring Medicines taking their turns with the use of proper Cathartics is the safe and bed way These scirrhous Tumors although they are not so dangerous for the present except they be very great or cancerous yet they are the foundation of some chronic or lingering diseases which proves very contumacious and sometimes incurable especially if the Tumor be latent and concealed and Hectic Feaver sometimes takes its rise from hence which if you think to cure by Emulsions Restauratives and cooling Drinks you will be much mistaken in your purpose and endeavours These scirrhous Tumors some are with pain some without those that have pain are more hopeful except they be cancerous but those which are insensible upon pressure are more difficult or incurable Now according to the nature and degree of depravedness in the continent matter and from the part affected so are these Tumors better or worse to be dealt with And because these Tumors are internal and hid from the eye therefore judgment is to be given of them from their situation and from the constitution with other circumstances of the Patients body But although these scirrhous Tumors are thus difficult to be undertaken and managed yet these are not the worst and they may arrive farther and to a more dangerous state as when Tumors in their variation and degeneration do turn cancerous and this is apt to be in such bodies as abound with a black feculent blood or a thick blood adust by intemperate heat and by how much the blood thus exceeds in this preternatural condition by so much the Cancer is compleated confirmed and the worse and this supervenes a Scirrhus commonly as being an apt previous disposition but may happen also without a Scirrhus preceding from other Tumors degenerating into Cancers and therefore in the Cure of scirrhous Tumors great circumspection and diligence is to be used lest by their delay add continuance or improper usage of Medicines these Tumors do not become cancerous and desperate as sometimes it falls out so Now a Tumor is said to be cancerous when it turns into a dark reddish or livid and blackish colour declaring this transmutation and degenerate state The beginning of these Cancers are very small in compass as those that present outwards do manifest their gradual inlargement but by time they increase and grow big with tumified Veins round about These cancerous Tumors may happen to any part of the body but chiefly and molt frequently in the upper parts about the Face as Nose Lips c. or the Dugs and other glandulous parts also the Womb is thus affected sometimes from Tumor there bred venereal or other degenerating cancerous These Tumors sometimes are occasioned from the menstrual suppression in women and Heamorrhoidal in men and when it happens so those causes are to be removed with speed Great skill and circumspection is to be used in Tumors of this nature lest provoking the continent matter it grow more fierce eating and ulcerating and from a cancerous Tumor it become a cancerous presiding Vlcer which is worse now the signs of this Tumor inclining to break and ulcerate are great heat and pulsation in the part The difficulty or incurability of Cancers lye here for that the cancerous matter will not yield to digestion or discussion and this because the
part affected is debilitated and overcome by this depraved malign matter that it cannot exercise its transmutative and digestive power nor will this cancerous matter obey Discussives by reason of the viscidity and grossness thereof wherefore Hippocrates gave sentence That such are not cured but by section or ustion and yet this is not to be done except the Cancer be small and in such a part as will admit of amputation If Cancers external are thus difficult to be managed although they appear to the eye and are subject to manual operation and tractation the internal must be greater and more hazardous where they cannot be applied unto after this manner with convenient Topical Medicines therefore prevention in time is mainly to be endeavoured when a Tumor is generated lest it change into this dangerous condition for I find by the design of Practisers in the Remedies appointed that palliation is sought for the Cure not hoped for The grand intention to be prosecuted for Cure is to change the condition of the blood which does feed and supply this Cancer so that the antecedent cause being taken away the continent will then more likely abate and until that be done this cannot be expected The means indicated for Cure of these cancerous Tumors are branched into three parts Dieatetic Pharmaceutic and Chirurgical but I shall not enlarge upon the Indications for Cure for that these cases are so nice and difficult as not to be handled with generals but from a collation of all the circumstances attending the Patient which varies every particular case And so I pass from Tumors to remark their usual commutation and transition into Vlcers the next considerable in order to be treated of Ulcers internal THE Latine word Vlcus is derived of 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifying a disjunction of parts or solution of continuity but to distinguish this from other solutions of continuity an Ulcer does yield a Sanies or purulent matter so that a Wound coming to digestion and affording pus may then be called an Vlcer and any part that is gauled raw and tender the covering Membrane being fretted and eaten away by some sharp humor or other cause it stiled Excoriation only until it produce corrupt matter and then it is properly called an Vlcer thus internal parts are sometimes excoriated raw and painful but cicatrized or skinned again before it arrive to the degree of an Vlcer And thus it is most frequently in the urinary ductures or passages and sometimes in the Guts but such Excoriations are not to be slighted or neglected lest they beget Vlceration as sometimes it falls out so By external or outward Vlcers which are manifest to the eye you may conceive of internal Vlcers for they arise from the same causes and have the same accidents but I shall not inlarge upon all the accidental differences that attend upon and distinguish external Ulcers as not so pertinent and necessary to our subject in hand The essential and most considerable difference of Vlcers does arise from their causes and from the part affected which bears the great sway in curing and from whence the chief indications are taken for although in external Vlcers other accidental differences may be observed and noted yet in internal Vlcers such differences cannot be regarded as being obscured or hid so that whether they be broad or narrow deep or shallow fistulous or otherwise is hot positively to be said and if it were known institution or method of Cure could not be so varied as external are capable of by reason these are subject to manual tractation The continent causes of Vlers are such matter as emane and flow from thence and that is of three sorts Ichor Pus and Sordes The first is an ichorous or sanious matter being thin indigested and watry or diluted bloody The second is a Pus or purulent matter of a betted consistence and concocted thicker The third is a sordid foul matter more thick and glutinous The ichorous thin matter usually issues in the beginning of Vlcers and denotes indigestion and also at any time afterwards does declare the same that the Vlcer is not in a good healing condition The Pus or purulent matter signifies the Vlcer to be in a better state of healing and if it be white and sweet these are good signs The sordid gross matter does intimate a preternatural heat of the parts strongly exsiccating but not healing for as much as this matter is foul and stinking Vlcers for their manner of generation and rise may be caused these four ways by Erosion by Frication Apostemation and Contagion 1. By Erosion Ulcers are begotten in any part of the body when a sharp corrosive humor does excoriate and eat into the substance of any part and being thus injured is thereby perverted in its office and self-preservation converting that nutritious Succus which comes for its supply into an ulcerous degenerate matter no way useful but to be excreted and voided And thus a Phthisis an Vlcer of the Lungs is sometimes generated from a sharp Serum invading that tender part and thus a Dysentery is sometimes begotten being an ulceration of the Guts from sharp excoriating humors and thus an ulceration in the Meatus Penis is bred from a sharp eroding Gonorrhaea and an Ulcer in the neck of the Bladder may be planted there by a sharp gauling Urine 2. By Frication or attrition as when any hard bony or stony substance does fret raze and excoriate a part and thus a stone begets an Vlcer in the Kidneys or Bladder and sometimes in other parts of the body 3. By Apostemation as when any Apostem breaketh and dischargeth its matter an Vlcer is left behind though the Apostem be gone and thus are Vlcers generated sometimes in the Ear from a preceding Apostem in the aspera Arteria after an Angina or Squinance in the Breast after a Pleurisie in the Lungs from a Tumor suppurated there also in the Liver Spleen Womb or other parts apostemated 4. By Contagion or infection and thus women whole Privities are infected do communicate this virulency or venom and seize the Genitals of their Partner from whence venereal Vlcers do arise and thus men whole Seed is tainted do infect sound women and cause virulent Vlcers in their Privities which malignity not being well managed and mastered by skill and efficacious Medicines it spreads breaks forth and begets Vlcers in many other parts of the body as at large I have set forth in another Tract entituled The Mystery of the Venereal Lues Internal Vlcers though they disappear yet are known to be by these signs First Pain which is more or less according to the nature and sensibility of the part Secondly From preceding causes as Inflammation or Tumor preceding whose Symptoms being allayed and ceased yet pain remains Thirdly and manifestly From excretion of ulcerous matter where there is any ducture or outlet for discharge by the Intestines by the Privities the Nose Ears or Mouth but where there
course this Vlcer if not of a very malign nature or very ill seated is yet curable and the Patient may do well and recover by care and skill of the Physician and tractability of the diseased but else this does corrupt and mortifie the part and then there must be dismembring if capable which is hazardous and doubtful or mortification of the whole will soon follow which is certain Thus you see some go half the way some but a quarter and come off well others that are ingaged in a fatal sickness must go through and finish the whole course by these gradations or else per saltum although they may step over and miss some of them yet they do arrive at the period of mortification I have now finished what I intended briefly upon this Subject having given you a prospect of this secret and lurking train of Diseases discovering them in their causes and disguises under what distempers they commonly are vailed and obscured their signal distinguishing Characters their dependence and complication their manner of commutation and transition from one to another the Indications belonging to each state and gradation prompting a designment and method for redress to obviate these dangerous and growing evils Of Fontanels or Issues and Setons Shewing the right Use and true Effects thereof BY the course of Nature humane Bodies are nourished and maintained by a continual supply of necessary food daily to be received in which before it be assimilated and incorporated into the substance of the body this Aliment must undergo several transmutations and digestions in which previous disposition and gradual preparation for nutrition there is a separation made the nutritive and useful part from the excrementitious and unnecessary the defecated utile part designed for aliment is still conveyed from one digestion to another for a farther elaboration until it hath received the complement and full perfection intended by Nature the excrementitious and inutile part separated in this course is transmitted and received by sinks chanels and vent-holes peculiarly appointed and framed for such conveyance and discharge out of the body as the Guts urinary Ductures Nose Ears Pores of the Skin which passages if at any time obstructed and stopt the detriment and sensible damage soon confirms the necessity of their use and office And as Nature hath thus appointed and framed in the body these Vents and Outlets for the daily discharging of excrementitious and superfluous matter which else would deprave and corrupt the body suffocate and stifle the life if not in some measure duly evacuated in imitation therefore of Natures contrivance Art hath invented Fontanels and Setons as Ports and Vents to be placed here or there as the variety of occasions require to supply Natures insufficiency and inability to help her self in the discharge and emission of superfluous or depraved matter which produceth various diseases and Symptoms according to the several proprieties of their nature and degeneration or from organical difference and peculiar offices of the parts they invade and infest And having such artificial passages of egress set open by which Nature finds her self alleviated and disburdened thereby does daily transmit and send any exuberant morbific humors to this new Outlet as to other common conveyances for excretion by her own institution and fabrication But for a fuller information and satisfaction in the use of these Fontanels and Setons we shall consider First What these are and the manner how they are made Secondly What matter is usually discharged and evacuated thereby Thirdly For whom and in what cases they are beneficial Fourthly The places and parts of the body where they are to be set Fifthly The due ordering and dressing of them with observations upon their various conditions and accidents Lastly The Time convenient and signs when to close them safely with the circumstances thereto belonging Vesicatories Cupping Cauterizing and Scarification are used upon emergent occasions for a more speedy and present help and do shew their effects sooner but Issues and Setons are planted upon a future expectation and their effects are matter of time and therefore they are continued longer and because they are used sometimes by way of precaution therefore they are designed to be of continuance and constancy Fontanels are so called from Fontinella or Fonticulus because as a Spring they send out their moisture continually and they are also called Issues from such issuing forth A Seton in Latine Setaceum is so called because that which was drawn through the Seton and remains to keep it open was made of hair but now we commonly use silk Issues and Setons are used for the same purposes but Setons having two Orifices and by drawing the silk to and again do cause a greater discharge of humors if the morbific matter be brought to the superficies as in cutany affects but these being more troublesom than Issues they therefore are seldomer used Fontanels are made by Section or Caustic but Setons are always made by a perforating Instrument which being well known to the Chirurgeon I need not say more For the nature and quality of humors issuing forth they are divers according to the various disposition of bodies diseased or sound such as the body abounds with and is superfluous such is transmitted thither for emission And that the humor evacuated is not good and useful for the body appears by the concomitant signs manifesting the nature of it itching pricking sharp pain about the place Inflammation and spongious proud flesh rising in some more in others less which are not signs of a natural good humor but a hot fretting sharp preternatural humor flowing thither degenerate and corrupt Also any extravasated humor proceeding from the Veins and Nerves does move and flow thither sometimes ichorous or serous and sometimes bloody And such humors as were wont to resort to and infest any infirm part an Issue well placed does intercept and evacuate and although the matter that issues forth is little to behold yet because this evacuation is constant it amounts to something considerable From hence we may understand for whom and in what cases these Fontanels are beneficial For corpulent and plethoric bodies such as feed high and live a sedentary inactive life whereby a liberal and free Transpiration is restrained Issues may be good for them by way of precaution for they are in danger of some sudden disease For several diseases of the Head idiopathically affected Convulsions Vertigoes Pains lethargic and sleepy disposition sore Eyes c. Fontanels or Setons may be used with benefit In cachectic depraved bodies and diseases from putrid humors Issues make an abatement of the morbous matter and give some mitigation of the effects For Revulsion Derivation or Interception of a humor injuriously resorting to an eminent or an infirm part Issues are advantageous to alter the course and current thereof For erratic pains cutany defedations or eruptions and Tumors in any part Fontanels are beneficial In most chronic diseases that give time and
liberty for the use of various means a deliberate way of Cure and gradual spending of the morbific matter Issues do contribute assistance herein but in acute diseases that require speedy help they are not a proper Remedy But although these Fontanels are of good use in the cases aforesaid yet they are not to be relied on as curative Remedies that is they do not eradicate a disease because they do not apply to the spring where it does arise but they give vent and turn the current of a humor this way or that way that it shall not overflow to do hurt other ways They minorate and lessen the morbific matter and abate the extravagant productions and growth of a luxuriant humor and are but remedia à posteriori So that these Issues do not hinder must not justle out the use of good Medicines that must take away the antecedent cause and radically cure by applying to the fountain and rise of a disease the part primarily affected and deficient in office that is the original cause of any producted noxious matter For the right placing of Issues that they may prove advantageous for the purposes intended you are to consider whether the case requires a general evacuation only or revulsion and evacuation or derivation and evacuation If only a general evacuation answers your intention then set your Fontanel in the left Arm but if for revulsion of a humor it must be remote from the part affected or complaning but if derivation be most convenient then the Issue must be near the part affected Sometimes an Issue is placed in the part affected to empty and evacuate a morbific humor lodged there Secondly Having thus determined the part or member you are then to chuse a fit place for the Issue observing diligently the position and motion of the Muscles else your Issue will not be so beneficial nor lye easie for if it be set upon or too near a Tendon or in the body of the Muscle the motion and attrition of the Muscle will molest and disturb it with pain and the evacuation will be but little therefore you must place them in interstitiis Musculorum in the place or distances between the Muscles where the extravasated humors are most frequent in their motions and perambulations and therefore this operation is not rashly to be attempted but considerately to be performed by good advice and a skilful hand in Anatomy Fontanels being thus appointed for several purposes and cases will require a different situation some in one part of the body and some in another For diseases that are seated in the Head Fontanels or Setons may be placed in the hind-part of the Neck but because they appear more in sight there and also are troublesom Issues may with the like benefit be set inter Scapulas between the shoulders one of each side the Spine or else in the Arm between the two Muscles Deltoides and the Biceps about four or five fingers breadth below the shoulder-joynt and this is the most frequent place because the Patient may dress this Issue without help But Fontanels in the Back do not only contribute help to infirmities of the Head but also they are beneficial for Arthritic or Gout-pains by intercepting and evacuating the morbific humor that tends towards the Joynts also Fontanels thus placed do divert and turn off a defluxion or current of humors that invade the Lungs and therefore such as are troubled with Coughs from a destillation of Rheum into the Breast and are inclining to be consumptive will find benefit thereby In the Groin Issues may be set for diseases of the Liver or Spleen observing the rectitude of parts the right side for the Liver the left side for the Spleen this place also is convenient for derivation of the morbific humor that causeth Sciatica-pains and pains of the Back towards the lower end of the Spine and about the Loins The Glandules in the Groin are appointed to receive superfluous and excrementitious humors which being readily discharged again by Issues the current of morbific matter will then more freely resort thither and exonerate such parts adjacent as are infested and oppressed therewith The Thigh and Leg also are places for Fontanels to make a revulsion of humors that molest and injure the superior parts and also may serve for a general evacuation In the Thigh an Issue is usually placed a little above the Knee as being most fit there for a binding to keep on as also in the Leg a little below the Knee the inside of the gartering place The Issue being made whether by Caustic or Section the orifice must be kept open with some pellet for which commonly the largest sort of Pease is made use of and so continued except some occasion by alteration or condition of the Fontanel causeth variation and then sometimes little balls are made of Ivy-wood Gentian-root Orris or Hermodactyls c. as the case may require The first dressings of the Issue for two or three days a digesting Plaster is to be laid on afterwards an Ivy-leaf may be used which attracts a serous humor and provokes the Issue to run and over this is laid a thin paper but for a constant wearing and common use a piece of varnish or oil'd cloth such as the coverings or riding Hat-cases are made of is very commodious and easie to provide very necessary for journies or voyages where the other is not to be had and this you need to change but once in a week or more wiping and turning it every dressing For the due ordering and keeping of Issues you are to observe the times of dressing such as run sparingly or but little once in 24 hours is sufficient but those that send forth matter more freely and plentifully dress them morning and night that is to take out the Pease wipe the place and put in another If the Issue fills up at the bottom and makes the Pease to start then lay a Groat upon the place next under the binding which will keep in the Pease and continue the Fontanel deep If the brim or edge of the Issue rise high with proud flesh sprinkle a little powder of burnt Alum upon it for one or two dressings which will bring it down even with the Cuticula When your Fontanel abounds and runs much with a sharp or stinking ichorous humor that excoriates round about the Orifice and causeth pain to abate and take off the antecedent cause you must purge sometimes with a proper and good Medicine avoid also intemperate or often drinking between meals be sparing in your diet especially at nights and keep seasonable hours for bed-time When you desire and the case requires an Issue to evacuate more inlarge the Orifice and Cavity thereof by putting in pellets bigger than pease as Horse-beans and if that be not sufficient you may put in two An Issue sometimes at the first making will not run well the morbific matter being accustomed to frequent other places and having