The store-house of physical practice being a general treatise of the causes and signs of all diseases afflicting human bodies : together with the shortest, plainest and safest way of curing them, by method, medicine and diet : to which is added, for the benefit of young practicers, several choice forms of medicines used by the London physicians / by John Pechey ...

CHAP. LVIII. Of an Empyema.

AN Empyema is a Collection of Matter within the Cavi∣ty of the Breast, whereby the Organs of Respiration are oppressed. This Collection of Matter is occasioned either by a Pleurisie, Peripneumonia, or Angina, suppura∣ted and broken.

The Signs of an Empyema, either shew it is coming, or that it is already perfectly formed. Of the former kind are these Diseases going before, from whence this usually arises, as a Pleurisie, Peripneumonia, and Angina; and sometimes also a Bruise or Wound in the Breast, and sometimes also other Diseases not well carried off; from whence there will be a greater Suspicion of an Empyema, if after a Week or two passed without plentiful Spitting, Shaking and a Feaver, and Faintness of the Spirits super∣vene; and then after fourteen or twenty Days, the Signs of a confirmed Empyema will appear, viz. Difficulty of Breathing, a Weight upon the Breast, Fluctuation of the Matter, an uneasiness from Motion, Thirst, and almost always a small Feaver, Redness of the Cheeks, Restles∣ness, and Watching.

As to the Cure of an Empyema, you must first consider whether the Signs of its being already made be certain or dubious; in the former Case there is not much use of Me∣dicines; but the Body being well prepared, we must pre∣sently open the Side; wherefore if from a Pleurisie, or a Peripneumonia not well cured, or if by reason of Blood extravasated by a Blow, a Fall, or Wound, a Fluctua∣tion of Pus, of Purulent or Bloody Matter be perceived, and the Spittle lessened, or none at all, it is to no purpose to wast Time in using expectorating and maturating Me∣dicines; but having loosned the Belly, and attemperated

the Blood and Humours, by Juleps, Apozems, and Ano∣dyns, an Aperrion must be undertaken, either by the Knife, or in tender and timerous People by applying a Caustick betwixt the sixth or seventh Vertebra; and when the Eschar is made, we must divide it gently with a Knife, and pass the Knife gently into the Cavity of the Breast; then having put in a Silver Pipe, the Matter must be eva∣cuated by degrees; but it must be let out as hastily as the Strength of the Patient will permit; for that which re∣mains within, will stink horridly in a few days; to pre∣vent which a cleaning and Traumatick Liquor must be in∣jected, with a Syringe twice or thrice a day. It is not necessary to describe particularly the Manner of the Ope∣ration, it being well known, and often practiced by skil∣ful Chirurgions, and daily practiced. After it is cut open and dressed as it ought to be, there is little more to be done by the Physician. An exact Course of Diet, a fre∣quent Loosning of the Belly (so oft as there is Occasion) by Glisters, and also these Remedies, which are Vulgarly called Traumatick, which do hinder the Dissolution of the Blood, and keeps the Seresities of it from falling upon the Breast to hurt it, ought to be prescribed. But if the Signs of this Disease are uncertain, or altogether doubtful, the Breast ought not to be opened too soon or rashly. I have known some have their Breasts opened to no purpose, when they have spit stinking Pus, and they have also la∣boured under a Dyspnaea, and a Difficulty of Breathing; therefore when an Empyema is not evident by Pathogno∣mick Signs, Medicines (such as are prescribed for the Cure of a Peripneumonia) which help Expectoration, and evacuate gently by Sweat and Urine, ought to be used for some time: If these do not any Good, and the Empyema still remains, or Augments, then the Breast must be opened.

As to the Forms of the Medicines requisite for the Cure of an Empyema before Section, the same Remedies which were prescribed for a Peripneumonia, are to be used: but after the opening of the Breast the following are chief∣ly to be used.

To prevent Fainting which may happen either in the Operation or after it, the following Julep must be in Readi∣ness, and four or five Spoonfuls of it must be taken upon occasion.

Take of the Waters of Balm, and Black Cherries, each six ounces; of Aqua-mirabilis one ounce, of Pearl powdered one dram, of Syrup of Gilly-flowers one ounce, mingle them, make a Julep.

The following Decoction must be taken twice or thrice in a day.

Take of the Leaves of Harts-tongue, Speedwell, Hemp, Agrimony, Colts-foot, Mouse-ear, Sanicle, each one handful; of the Roots of Madder, and Chervil, each one ounce; of Barley half an ounce, of red Cicers half an ounce, Raisons of the Sun one ounce and an half; boil them in two Quarts of Fountain-water till half is con∣sumed, sweeten it with Clarified Honey, or with the Sy∣rup of Mouse-ear as it is taken.

If there be no Feaver the following Pills may be used.

Take of the Powders of Crabs-eyes two drams, of Flowers of Sulphur one dram, of Sal-Prunella half a dram, of the Species Diarrhodon-abbatis one Scruple, of venice Tur∣pentine washed a sufficient quantity; make a Mass, make small Pills, take a Scruple or half a dram of them Morning and Evening; or the Turpentine being omitted, half a dram or two Scruples may be taken in the Form of a Powder twice a Day.