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. XCVII. Of Hysterick and Hypochondriack Diseases.

THese Diseases, if I calculate right, are the most frequent of all chronical Diseases; and as Fevers, with those Diseases that appertain to them, if they are compared with chronical, taken altogether, make two thirds; so, Hysterical Diseases, at least those that go under that Name, are half the remaining third, that is, chronical Diseases are half Hysterick; for very few Wo∣men, which Sex contains half of grown People, are wholly free from all kinds of Hysterick Diseases, if you except those who being accustomed to Labour live hardly; yea, many of those Men that live sedentary Lives, and are wont to study hard, are afflicted with the same Disease; and though, heretofore, Hysterical Symptoms were always reckoned to proceed from a vi∣cious Womb, yet if we compare Hypochondriack Sym∣ptoms, which were supposed to proceed from Obstru∣ctions of the Spleen or Bowels, or from some other I know not what Obstructions, with Women's Hysterick Symptoms, an Egg is scarce more like an Egg, than these Symptoms are like one another in all respects: But it must be confessed, that Women are much more subject to this kind of Disease, than Men.

This Disease is not only frequent, but so wonder∣fully various, that it resembles almost all the Diseases poor Mortals are subject to; for whatever Part it seats it self in, it presently produces such Symptoms as be∣long to it; and unless the Physician be very sagacious and very skilful, he will be mistaken, and suppose that t••ese Symptoms proceed from an essential Disease of this or that part, and not from an histerical Distemper.

Sometimes, for instance, it possesses the Head, and occasions an Apoplexy, which also ends in an Hemi∣pl••gy, and this seizes Women very often after Delivery; or it is occasioned by hard Labour, or some violent com∣motion of the Mind.

Sometimes it produces violent Convulsions very like an Epilepsy, the Belly and Bowels swelling toward the Throat, the Patient strugling so violently, that though at other times her Strength is but ordinary, she now can scarce be held by all the strength of the By-standers, uttering some odd and inarticulat sounds, and striking her Breast. Women who are accustomed to this Di∣sease, commonly called Mother-fits, are generally ex∣traordinary Sanguine, and have a habit of Body almost like that of a Virago.

Sometimes it possesses the outward part of the Head, betwixt the Pericranium and Skull, causing violent Pain continually fixed in one part, which may be covered with the top of your Thumb, and violent Vomiting ac∣companies this Pain: I call this Species Clavus Hysteri∣cus, chiefly afflicting those that have the Green-sick∣ness.

Sometimes falling upon the vital Parts, it occasions so great a palpitation of the Heart, that the Women who are afflicted with it, may verily believe that the By-standers may hear the sound of the Heart thumping upon the Ribs. This kind chiefly afflicts those that are of a thin habit of Body and of a weak Constitution, and who look almost tabid; and also, young Maids that have the Green-sickness.

Sometimes the Patient coughs almost without inter∣mission, but expectorates nothing. This kind of Hy∣sterick-cough is very rare, and chiefly invades Women that abound in Flegm. Sometimes rushing vio∣lently upon the Colon, and the Region under the Scrobiculum Cordis, it occasions violent Pain, much like the Iliack Passion, and the Woman vomits exceed∣ingly, ejecting a certain green Matter somewhat like that they call porraceous Bile; and sometimes Matter of an unusual colour: And often after the Sick have been almost destroyed by the said Pain, which would tire a stoical Apathy, and reachings to vomit for many days, at length it is carried off by the Jaundice tincturing the superficies of the Body like Saffron. Moreover, the Sick is oppressed by an anguish of mind, and wholly despairs of recovery, with dejection of mind, and as it were a certain desperation; as certainly accompanies

this kind of Hysterick Disease, as the Pain and Vomi∣ting above-mentioned. This kind chiefly invades those that are of a lax and crude habit of Body, and those that have suffered much in bringing forth great Child∣ren.

When this Disease falls upon one of the Kidnies, it plainly represents, by the Pain it causes there, a Ne∣phritick Fit; and not only by that sort of Pain, and by the place it rages in, but also by the violent Vomitings that accompanies it, and for that sometimes the Pain extends it self through the passage of the Ureter; so that it is very difficult to know whether these Symptoms proceed from the Stone, or from some Hysterick Di∣sease; unless, perchance, some unlucky Accident di∣sturbing the Woman's mind, a little before she was taken ill of the vomiting of green Matter, shews that the Symptoms rather proceed from an Hysterick Disease, than from the Stone. Nor is the Bladder free from this false Symptom; for it does not only cause Pain there, but it also stops the Urine, just as if there were a Stone, whereas there is none: But this last kind seizing the Bladder, happens very seldom. That which resembles the Stone in the Kidnies is not so rare; both use to invade those Women, who are much weak'ned by Hysterick Fits coming frequently, and whose health of Body is much impaired.

Sometimes falling upon the Stomach it causes c••nti∣nual Vomiting, and sometimes a Looseness, when it is setled upon the Guts. But no Pain accompanies either of these Symptoms, though oftentimes in both the green Humours appear. Both these kinds are familiar with those that are weak'ned by the Hysterick Fits coming frequently.

And as this Disease afflicts almost all the inward Parts, so sometimes it seizes all the outward Parts, and the musculous Flesh occasioning Pain, and sometimes a Tumour in the Jaws, Shoulders, Hands, Thighs, Legs, in which kind that Tumour which swells the Legs, is more conspicuous than the rest. But whereas in Hydropical Swellings, these two things may be always taken no∣tice of, viz. That the swelling is most in the Evening, and that the Finger prest upon it, leaves a pit: In this

Tumour the swelling is most in the Morning, nor does it yield to the Finger, or leave any mark behind it, and for the most part it only swells one of the Legs. As to other things, if you mind the largeness of it, or its su∣perficies, it is so very like Hydropical Swellings, that the Patient can scarce be brought to believe that it is any other Disease; nor can the Teeth free themselves from the assaults of this Disease, tho' they are not hollow, and tho' there is no apparent defluxion that may occasion the Pain, yet it is no whit gentler, nor shorter, nor easier cured. But these Pains and Tumours which afflict the outward Parts, chiefly seize those Women that are in a manner quite destroyed by a long series of Hyste∣rick Fits, and by the force of them.

But among all the Torments of this Disease, there is none so common as a pain in the Back, which most cer∣tainly all feel, how little soever they are afflicted with this Disease. Moreover, this is common to the foresaid Pains, that the place on which they were, will not bear touching after they are gone; but is tender, and akes just as if it were soundly beaten: But this tenderness goes off by degrees.

And this is worth observing, That often a notable Cold of the external Parts makes way for these Sym∣ptoms, which for the most part does not go off till the Fit ends; which Cold I have observed is almost like that by which a Carcass grows stiff, yet the Pulse is good.

And moreover, all Hysterick Women which I have hitherto taken care of, complain of a dejection and sink∣ing of the Spirits; and when they would shew the place where the sinking of the Spirits is, they point to the re∣gion of the Lungs.

Lastly, every one knows that Hysterick Women some∣times laugh excessively, and sometimes cry as much, without any real cause for either.

But among all the Symptoms that accompany this Disease, this is the most proper, and almost inseparable, viz. a Urine as clear as Rock-water, and this Hysterick Women evacuate plentifully; which I find, by diligent Enquiry, is in almost all the pathognomonic sign of this Disease, which we call Hysterick in Women, and Hy∣pochondriack

in Men; and I have sometimes observed in Men, that presently after making Water of a Citron colour (yea, almost the next moment) being suddenly seized with some violent commotion of the Mind, they make Water as clear as Cristal, and in a great quantity with a continued violent Stream, and continue ill till the Urine comes to its wonted colour, and then the Fit goes off.

And it happens to all Hysterical and Hypochondriacal People, that sometimes they belch up ill Fumes as often as they eat, tho' they eat only moderately, and accord∣ing as they have an Appetite; and sometimes the Wind that comes from the Stomach is sower just like Vine∣gar.

Nor are they unhappy upon this account only, viz. That their Bodies are so ill affected, and as it were tot∣tering like ruined Houses just about to fall; for their Minds are more diseased than their Bodies, and an incure∣able desperation is mixed with the very nature of the Disease; and what the Roman Orator said of the Su∣perstitions exactly agrees with these melancholy People, Sleep, says he, seems to be a Refuge to the Laborious and Careful, but from thence Cares and Fears arise, whilst only Funerals and Apparitions of their deceased Friends are represented in Dreams, and they are so tormented in Body and Mind that one would think their Lives were a Purgatory, wherein they were to purifie them∣selves, and to expiate Crimes committed in some other State. Nor does this happen only to mad People, but also to those who, if you except those Impetuosities of Mind, are very prudent and judicious, and who much excel for deep thought and wisdom in Speech, others, who's Minds were never excited by these Provokments to thinking. But this dreadful condition of Mind which we have above described, seizes on those only that have much and a long while conflicted with this Disease, and have been at length wholly vanquished by it, espe∣cially if Adversity, care or trouble of Mind or hard Study, or the like, join'd with an ill habit of Body, have added Oil to the Flame.

A day would scarce be sufficient to reckon up all the Symptoms belonging to Hysterick Diseases, and I think Democritus reckoned pretty right (though he mi∣stook the cause of the Disease) when he said in an Epi∣stle to Hippocrates, That the Womb was the cause of six hundred Miseries, and of innumerable Calamities.

The procatarctick or external causes of this Disease are either violent motions of the Body, or which is much oftener, vehement commotions of the Mind. But to these disorders of the Mind, which are usually the oc∣casions of this Disease, is to be added emptiness of the Stomach, by reason of long Fasting, immoderate Bleed∣ing, and a Vomit or Purge that works too much.

As to the internal, efficient Causes, in my Opinion▪ those Diseases which we call Hysterick in Women, and Hypochondriack in Men, proceed from a confusion of the Spirits. The origin and antecedent cause of this confusion, is a weak constitution of the Spirits.

In order to the Cure, I order, That 8 ounces of Blood be taken from the right Arm, and that the following Plaster be applied to the Navel.

Take of Galbanum, dissolv'd in tincture of Castor and strain'd, three drachms, of Tacamacha two drachms; mix them, make a Plaster.

The next Morning, let her make use of the follow∣ing Pills.

Take of the Pill Coch. major two scruples, of Castor powder'd two grains, of peruvian Balsam four drops; make four Pills, let her take them at five in the Morning, and sleep after them. Repeat them twice or thrice every Morning, or every other Morning, ac∣cording to their operation and the strength of the Patient.

Take of the Waters of black Cherries, Rue and com∣pound Briony, each three ounces; of Castor, tyed up in a Rag and hanged in the Glass, half a dram; of fine Sugar a sufficient quanity, make a Julep, where∣of let her take four or five Spoonfuls when she is faint, dropping into the first Dose, if the Fit is violent, twenty drops of the Spirit of Harts∣horn.

After the Purging Pills just described are taken, let her use the following.

Take of the filings of Steel eight grains, with a suffici∣ent quantity of extract of Wormwood; make two Pills, let her take them early in the Morning, and at five in the Afternoon, for thirty days, drinking upon them a draught of Wormwood-wine.

Or, if she like a Bolus better.

Take of conserve of Roman-wormwood, and of the con∣serve of the yellow rind of Oranges, each one ounce; of candied Angelica, and Nutmogs candied, and of Venice Treacle, each half an ounce; of candied Gin∣ger two drachms; make an Electuary, with a sufficient quantity of Syruy of Oranges.

Take of this Electuary one drachm and an half, of the fi∣lings of Steel well rubbed eight grains; make a Bo∣lus, with a sufficient quantity of Syrup of Oranges, to be taken in the Morning, and at five in the Even∣ing, drinking upon it a Glass of Wormood-wine.

Take of choice Myrrh and Galbanum, each one drachm and an half; of Castor fifteen grains, with a sufficient quantity of Balsam of Peru; make twelve Pills of every drachm. Let her take three every Night, and drink upon them three or four Spoonfuls of compound Briony-water, through the whole course of this Pro∣cess.

But if the Pills last prescribed move the Belly, which sometimes happens in Bodies that are very easily purged, by reason of the Gum that is in them; the following may be used instead of them.

Take of Castor one drachm, of volatil Salt of Amber half a drachm, with a sufficient quantity of extract of Rue; make twenty four small Pills: Let her take three every Night.

But here you must take notice, That Chalybeats, in whatsoever Form or Dose they are taken, occasion some∣times in Women great disorders both of Body and Mind, and that not only on the first days, which is usual al∣most in every Body, but also all the time they are taken; in this case, the use of Steel must be interrup∣ted at those times; but Laudanum must be given every

Night for some time, in some Hysterick Water, that they may better bear it.

But when the Symptoms are mild, and it seems that the business may be done without taking Steel, I think it sufficient to bleed and to purge three or four times, and then to give the altering Hysterick Pills before∣mentioned, Morning and Evening, for ten days; which method seldoms fails, when the Disease is not violent; yea, the Pills alone, bleeding and purging being omit∣ted, oftentimes do a great deal of good.

Yet we must take great notice, That some Women, by a certain Ideosyncrasy, so abhor Hysterical Medi∣cines (which give ease in most of the Symptoms of this Disease) that they don't only not receive benefit, but are much injur'd thereby; therefore, they must not be given to such; for Hippocrates says, 'Tis in vain to do any thing contrary to Natures inclination.

Which Ideosyncracy is so great and so frequent, that if we have not regard to it, the Lives of the Sick may be hazarded.

And so Hysterical Diseases are most commonly cur'd and most Obstructions of Women, especially the Green Sickness; and also, all Suppressions of the Courses. But if the Blood is so very feeble, and the confusion of the Spirits so great, that Ste••l order'd to be us'd ac∣cording to the Method prescrib'd, is not sufficient to cure the Disease, the Patient must drink some mineral Wa∣ters impregnated with an Iron Mine, such as are Tun∣bridge, and some others lately found out, for the Cha∣lybeat Vertue of these is better mingl'd with the Blood, by reason of the great quantity that is taken of them, and also because they are more agreeable to Nature, and they cure Diseases more effectually than Iron how much soever exalted by Art.

But this is more especially to be observ'd, in drink∣ing of them, that if any Sickness happens that is to be referr'd to Hysterical Symptoms, in this case the Pati∣ent must forbear drinking them a day or two, till that Symptom that hinder'd their Passage is quite gone; and it is to be noted, that Purging must be avoided all the time the Patient drinks these Waters.

But if this Disease, by reason of its Obstinacy does not yield to Steel-waters, the Sick must go to the Bath, and when she has used them inwardly three mornings following, the next day let her go into the Bath, and the day following let her drink them again, and so let her do by turns for two months; for in these and in others, of what kind soever they are, this must be care∣fully noted, That the Patient must persist in the use of them, not only till she perceives some benefit, but till she is quite well, that the Symptoms may not return again in a short time. Venice-Treacle alone if it is us'd often and a long while, is a great Remedy in this Di∣sease; and not only in this but in very many other Di∣seases, that proceed from want of heat, or concoction or digestion, 'tis perhaps the most powerful that has been hitherto known. Spanish Wine medicated with Gen∣tian, Angelica, Wormwood, Centory and other Corrobo∣ratives infus'd in it, does a great deal of good, some Spoonfuls of it being taken thrice a day, if the Woman be not of a thin and cholerick habit of Body; and tru∣ly, a large Draught of Spanish Wine by it self taken at Bed-time for some Nights, by my Advice, has been very beneficial to some Women; for by it the habit of the whole Body was render'd stronger, and they who be∣fore were Cachectical, became fresh-colour'd and brisk.

Moreover, sometimes we find that the Peruvian Bark wonderfully comforts and invigorates the Blood and Spirits, a Scruple of it being taken Morning and Even∣ing for some Weeks; but it succeeds best in that kind of Hysterick Diseases, wherein VVomen are afflicted with Convulsions. But if any of the Remedies above-mentioned don't agree well, which often happens in cholerick and thin Constitutions, then a Milk-diet may be us'd, for some VVomen (which one wou'd wonder at at first) that have been conflicted a long while with Hysterick Diseases, and even such as have frustrated all the endeavours of Physicians, yet have recover'd by dieting themselves for some time only with Milk; and especially those that labour with that Disease, I call an Hysterick Cholick; which can't be appeas'd by any thing but Narcoticks, to which, repeated by Intervals,

the VVomen are much accustom'd, the Pain returning assoon as the Vertue of the Anodyne fades.

But nothing of all I have hitherto mention'd does so much comfort and strengthen the Blood and Spirits as riding on Horse-back every Day for a long while, but though it may be inconvenient for Women that are ac∣custom'd to a slothful and delicate way of living, for they may be injur'd by Motion, especially at the begin∣ning, yet 'tis very proper for Men, and soonest reco∣vers their Health. One of our Right Reverend Bi∣shops, famous for Prudence and Learning, having stu∣died too hard a long while, fell at length into an hy∣pochondriac Disease, which afflicting him a long Time▪ vitiated all the Ferments of the Body, and wholly sub∣verted the Concoctions; he had passed through long Courses of Steel more than once, and had tried almost all mineral Waters, with Purging often repeated, and antiscorbuticks of all kinds, and very many testaceous Powders, which are reckoned proper to sweeten the Blood, and so being in a manner quite worn out, partly by the Disease, and partly by Physick, used con∣tinually for so many Years, he was at length seized with a colliquative Loosness, which is wont to be the forerunner of Death in Consumptions, and other chro∣nical Diseases, when the Digestions are wholly destroy'd. At length he advised with me; I presently considered that there was no more room for Medicine, he having taken so many already without any Relief; for which reason I persuaded him to ride on Horse-back, and that first he should take such a small Journey as was agree∣able to his weak condition. Had he not been a very judicious Man, and one that weighed things well, he would not have been persuaded so much as to have tryed such a kind of Exercise: I intreated him to per∣sist in it daily, till in his own Opinion he was well, going daily furthur and further, till at length he went so many miles in a Day as prudent and moderate Tra∣vellers, that go a long Journey upon Business, use to do, without any regard to Meat, Drink or the Wea∣ther: But that he should take every thing as it hap∣pened: To be short, he continued this Method, in∣creasing his Journies by degrees, till at length he rode

twenty or thirty miles daily; and when he found him∣self much better in few Days, being encouraged with such wonderful Success, he continued this course a pret∣ty many Months; in which Time, as he told me, he rode many thousand Miles, till at length he did not only recover, but also gained a strong and brisk habit of Body.

This is the general way of Curing this Disease, which is applied to the original Cause, viz. the weak Crasis of the Blood, and so is to be used only when the fit is off: Therefore as often as the Fit invades, joined with any one of the foresaid Symptoms, if the Disease be such, or so great an one, that it will not bear a Truce, till it may be cured by Medicines that corroborate the Blood and Spirits, we must presently make use of hysterick Remedies, which by their strong and offensive Smell recal the exorbitant and deserting Spirits to their proper Stations, whether they are taken inwardly, or smell'd to, or outwardly applied: Such are Assa Foetida, Galbanum, Castor, Spirit of Sal Armo∣niack, and lastly, whatever has a very ungrateful and offensive smell.

In the next place, you must take notice, that if some intollerable Pain accompanies the Fit, in whatever part it is; or violent Vomiting or a Loosness, than besides the Hystericks above-mentioned, Laudanum must be used, which only is able to restrain these Sym∣ptoms.

But in quieting the Pains, which Vomiting occasions, we must take great care that they are not mitigated either by Laudanum, or any other Paregorick, before due Evacuations have been made, unless they almost exceed all human Patience. First, because sometimes there is so great a quantity of Blood and Humours heap'd up (especially in sanguine Women, and in Men of a proper Habit) that is able to withstand the Operation of the most effectual Narcotick, though it be often repeat∣ed, and therefore in such Blood must necessarily be evacuated from the Veins of the Arm, and a Purge must be given before we come to use Laudanum; for when these things are duly performed, that which be∣fore given in a large Dose would do no good, does now

perform the Business in a moderate Dose; and then because I have found by frequent Experience, that when the Sick has been accustomed by little and little to Laudanum, and has not been duly evacuated before she was forced, by reason of the return of the Pain presently after the Vertue of the Medicine vanished, to take a Paregorick again, and so daily for some Years, the Dose being sometimes by degrees increased, so that at last they can by no means abstain from Lau∣danum, though thereby all the Digestions are vitiated, and the natural Functions weakned; though I do not think that the use of Laudanum does immediately hurt the Brain, or Nerves, or the animal Faculties: There∣fore I judge and speak what I have found, That Eva∣cuation ought to go before Anodynes, viz. in Virago's, and in Women that abound with Blood, a Vein must be opened, and the Body purged, especially if they have been lately seized with the Fit: But if weak Women, and those of a quite contrary Constitution, labour with such a Fit and Pain, and have been not long ago afflicted with it, it will be sufficient to cleanse their Stomachs with a gallon of Posset-drink, more or less, taken in and ejected by Vomit, and then to give a large Dose of Venice Treacle and a few Spoon∣fuls of some Spirituous Liquor, that is pleasing to the taste, with a few Drops of Liquid Laudanum to be ta∣ken presently after it.

But if the Sick has vomited a great while before the Physician was called, and there is danger, lest by fur∣ther Provocation, by Emeticks, the Spirits should be put in a rage, and the Sick too much weakned: In this case you must give Laudanum without delay, and such a Dose that is not only suitable to the Violence and Duration of the Symptom, but such an one as is suf∣ficient to vanquish it.

But here two things are to be chiefly noted; First That when you have once begun to use Laudanum after due and necessary Evacuations, it must be taken in that Dose, and often repeated till the Symptom is quite conquered; only such a space must be betwixt each Dose, that we may know what the former has done before we give another: And then when we treat the

Disease with Laudanum, we must do nothing else, and nothing must be evacuated, for the gentlest Glister of Milk and Sugar is sufficient to spoil whatever has been repaired by the Paregoric, and to occasion the return of the Vomiting and Pain. But though the Pains above-mentioned, as we have said, are apt to overcome the Vertue of the Anodyne, yet violent Vo∣miting indicates the largest Dose of it, and that it should be very often repeated; for by the inverted peristaltick Motion of the Stomach (by which that which is con∣tained in it ought to be carried downwards) the Pare∣gorick is ejected through the Oesophagus, before it can do any good, unless after every time the Sick vomits the Narcotick be given afresh, and chiefly in a solid form, or if it be given in a Liquor the Vehicle must be so small, as that it must but just wet the Stomach, so that by reason of the small quantity of the Matter it cannot be cast up. For instance, some Drops of liquid Laudanum in one spoonful of strong Cinnamon-Water, or the like; and the Sick must be admonished to keep her self quiet, presently after taking the Laudanum, and that she keep her Head, as much as possible, im∣moveable, for the smallest motion of the Head pro∣vokes Vomiting more than any thing else, and then the Medicine, just taken, is ejected; and when the Vo∣miting ceases, and is, as it were, tamed, it is expedi∣ent to give an Anodyne morning and evening for a few days, to prevent a Relapse, which also ought to be observed after a loosness, or an hysterick Pain taken off by a Narcotick; and so at length by this method we may readily cure the symptomatick Pain and Vomiting, whereby, because they are very often like other Disea∣ses, Physicians are easier imposed upon than by any other Symptoms whatever.