Dr. Willis's practice of physick being the whole works of that renowned and famous physician wherein most of the diseases belonging to the body of man are treated of, with excellent methods and receipts for the cure of the same : fitted to the meanest capacity by an index for the explaining of all the hard and unusual words and terms of art derived from the Greek, Latine, or other languages for the benefit of the English reader : with forty copper plates.

SECT. I. CHAP. II. Of the sundry kinds of Breathing hurt, and their causes, with the accounts of their Symptoms.

HItherto we have strictly viewed the Lungs, and the parts any way serving their motions, and consequently the vital function; which being many and different, and the provision of the Organs as many very accommodate to breathing; so the same are many ways in hazard to be perverted or vitiated, upon sundry occasions. Truly a Watch framed with the greatest artifice with a Spring, with wheels plain and toothed, with chain and ballance, is not more prone or easie to be obnoxious to depravation than this Pneumonic machine of the breast, through * 1.1 which by sucking in air we preserve the vital flame of the blood with its motion and heat. For whereas the vessels of the Lungs belong to the function of breathing, viz. the Trachea, with the Bronchii and little bladders; also the heart with arteries and veins, besides which there are nerves with fibres as well musculous as nervous, Lym∣pheducts and Glandules; also the contents of these Vessels, viz. Air, the old and fresh blood, with its Serum, the Lympha, and the animal Spirits; any fault happening in any of these doth oftentimes discompose the whole Pneumonic function. Nor less also the moving Organs of the breast, viz. the muscles with the Diaphragma, and the nerves appointed to their use. And likewise sometimes the animal spirits be∣fore they enter into those nerves, being ill disposed, often cause great disorders in breathing.

When the chief function and uses of the Lungs have been to convey the blood * 1.2 and air through the whole frames of the parts and their inmost recesses, and every their smallest passages, and every where to mingle them; namely for that purpose, that the venal blood returning from its circuit, and diluted with fresh juice, and thereby crude and as it were half extinct, may as well be more perfectly mix'd and wrought together, as more effectually kindled afresh in all its parts by the nitrous air; from hence the chief faults about this business or function of the Lungs do most of all consist in these two things. First, that the blood hath not due passage through the Sinus of the heart, and the pneumonic vessels: And secondly, because the Air is not drawn in and breathed out in a due manner into the Trachea and its passages.

There are two parts of either of these: For first as to the passage of the blood, some∣times the fault is caus'd within the right Sinus of the heart, or the pneumonic Arte∣ries; and also sometimes caused within the pulmonary veins, or the left Ventricle of the heart: Secondly, as to the Air, the failure is chiefly in inspiring and exspiring; * 1.3 although each function offends sometimes equally. There are divers accidents of each and many causes and ways of its being done, whereof we will here briefly touch upon the chief.

Therefore first, when the blood doth not duly pass through the right Ventricle of the * 1.4 Heart and thePneumonic Arteries, either it happens by its own fault, or by the sault of those passages, and sometimes by the fault of further passages. For sometimes the stream of blood stops in the nether region of the Praecordia, by reason of obstruction in the other; moreover, sometimes the defect or fault of the air breathed in stops the free passage of the blood.

What relates to that fault of the blood, when it passes not quick enough through the * 1.5 right Sinus of the Heart and Pneumonick Arteries, the opinion of the Renowned Sylvins should here be discoursed, but that it would be too tedious, and from our purpose. For he supposes, The descending branch of the venal blood, moistned with chyme together with the lymphatic humour returning from the whole body, hath the nature of an acid-sweet spirit; and in the mean time its branch ascending impregnated with choler from the bladder of the gaul mixt into the mass of blood, does participate of an oily volatile salt; and so by the meeting together of these something contrary to themselves, a gentle and friendly contention or boiling is stirred up in the right ventricle of the heart, in which and for which the fiery parts lurk∣ing and being shut up in each, being freed and set at liberty, do rarifie the chyle and blood, and so change and alter them, that they exercise the function of life and heat as well as motion and nourishment through the whole body. There are many reasons why I assent not to this * 1.6 ingenious and neatly-framed Hypothesis. For besides that many do far otherwise de∣termine about the origine and dispensation of Choler, and so not without strong rea∣sons and experiments are thorowly perswaded, (by eye-sight) that there is not any such boiling up of the blood of a different quality, and striving or contending in the right ventricle of the Heart: Our judgment continues still, as it hath been, that both streams of blood, washed thorowly with the fresh chyme, do consist altogether of one kind; and * 1.7 for that cause the milky Vessels of the Chest carry about part of the Chyle so long a journey, which they pour into the descending trunk of the Vena cava, just as the Mese∣raick Veins pour the other part into its ascending trunk: also that the lymphatic hu∣mor together with the Chyle is poured into the subclavian Vessels, so that it may very commodiously be reduced into blood; neither truly doth there seem need of other or more passages. Moreover we determine that that humor rightly constituted doth agree with, and is easily assimilated to the mass of blood, as well as the Chyle it self made sweet, without any contention raised in the heart. But if the lymphatic humor re∣turning from the Brain and nervous kind as well as from the Glandules, degenerate from its due temperature, and contract a sowrness (as it often comes to pass) then being re-infused into the venal blood it overcomes it, and precipitates it into serosities, and from thence great streamings of urine do ensue. Moreover we have shewed else∣where, that the Diabetes is provoked from such a cause. But such a flux of the lym∣phatic humor is so far from exciting a greater boiling up of the blood in the right ventricle of the Heart, that rather on the contrary from thence often chilness of the whole or stifness, with a weak Pulse, and sometimes swoonings or convulsive fits are provoked, accompanied with a plentiful and pale urine. The reason whereof without doubt is, that then the clear humor flowing from the brain and nervous parts, turns the blood into serosities, and cools it by too much diluting; and for that cause the animal spirits being destitute of their vehicle, either faint or run into irregular motions.

But truly as we altogether deny an Elastic effervescence of the blood in the right * 1.8 Ventricle of the Heart from contention of dissimular parts; so as often as from thence the blood is not cast out into the Lungs after a due manner, we determine it to happen not so much from the proper fault and defect of the blood it self as from the animal faculty. For if the spirits actuating the moving Fibres of the Heart, either grow wea∣ry, or are forced into convulsive disorders; for that cause the Heart beating in dis∣order, drives out before it the blood either infirmly or irregularly.

But that the blood issuing out of the Heart doth not always with expedition pass through the Pneumonic Arteries, that sometimes happens from its own proper fault,

• 2. Sometimes by the fault of the blood.
• 3. Sometimes by reason of passa∣ges obstructed.

and also sometimes from the passages obstructed, and also by reason of other causes. The blood it self in a double respect hinders its own passage through the Lungs, viz. either offending as to its kindling, or as to its temperature. There are sundry acci∣dents of either of these. For first, even as the blood is more or less kindled than is con∣venient,

it is hindred or obstructed in the pulmonary circuit: if at any time the watry, earthy, or fixt saline parts are predominant in the blood, the spirit and sulphur being consumed or brought low; by reason hereof its liquor being not well or less kindled by the nitrous air, is not easily rarified in the pulmonary passage, and scarce passes through them like a flame of its own accord, but it sticks still in its passages, heavy and muddy, and creates much trouble and labour to the Heart wheresoever it is circu∣lated. Hence as often as the blood is a little more plentifully forced into the Praecor∣dia by the quicker motion of the whole body, or of its parts, the Heart and Lungs la∣bour hard for its driving about, and that with the utmost endeavours. And in this * 1.9 case it is probable, that the blood carried more rapidly into the right Ventricle of the Heart, doth somewhat stagnate; because it cannot presently be carried into the passa∣ges obstructed before it. Moreover from this cause those grumous or fleshy concretions called the Polypi of the Heart sometimes seem to arise. Hence both in the Pica, Leu∣cophlegmatie, Dropsie, and inveterate Scurvy from the quicker motion of the body a∣rises difficult and painful breathing.

2. Sometimes the blood is too much kindled, and breaking out almost into a flame, and being above measure expanded, it can scarce be contained in the pulmonary passa∣ges * 1.10 (which it very much blows up and extends) but endangers them to be inflamed or kindled; wherefore lest it should tarry longer in them, the Praecordia beat with most frequent and strong endeavours, that the blood so over-much kindled might be ventila∣ted and circulated: for otherwise it being carried within the Lungs and inflaming them all over, would quickly destroy the vital function.

Besides these things which concern the kindling of the blood, there are other faults as to its temperament or mixture, by reason of which it less freely or expeditely is conveyed through the pneumonic passages. For when its consistence is either too laxe * 1.11 or too close, it will not easily pass through the small passages of the Lungs; but often∣times is in hazard to stick and stagnate in them, and also run out and be extravasated.

The blood being in a diverse manner made loose in its consistence, either deposites its Serum, or its dregs, or its putrefaction in the Lungs; which being lodged in the re∣cesses of the Vessels, or affixed unto their sides, do variously stop or pervert the course of the blood.

1. The dissolution of blood, which is most commonly injurious to the Lungs, (al∣though not very dangerously) is wont to happen, for as much as the ferosities being un∣apt to be contained within the mass thereof, and when they are not presently sent away * 1.12 by sweating or urine, they separate from the blood within the Lungs; and so boiling up, and breaking out from their proper vessels, do as well disturb and stop the passage of air, as that of blood; so that for the sake of expelling those ferosities and continua∣tion of the circulation of blood, the Lungs are provoked into a frequent and very trou∣blesom Cough. What the formal reason of this Cough is, and the manner of its being brought about, we shall declare hereafter.

Though there are many causes and occasions, by which the serous liquor, departing from the loosned consistence of the blood, flows out abundantly into the Lungs; yet for the most part it happens from one of these three, viz. first and most frequently, because * 1.13 the Pores outwardly bound up by cold, cast back the ferosities which were wont to be sent away by perspiration, into the mass of blood; which compel it presently to boil up, and cast off the serous superfluities in the Lungs. From this kind of cause Ca∣tarrhs and Coughs frequently arise, insomuch that the beginning of every cough by the * 1.14 vulgar is always imputed to such an occasion, to wit, catching cold. 2. The drinking of sharp and thin liquors, as Cider, Rhenish Wine, white Wine, Paris Claret common∣ly causes to some a Cough, or catarrhal distemper: the reason whereof is, for that the blood, weak in temperament, is presently dissolved and precipitated into serosities like milk by sowre things cast into it, which flow plentifully from the mouths of the in∣ward Arteries. I have experimented this upon my self yearly, when in the Summer season (when the blood abounds with sulphur) I have drank Cider and tartish Wines safely, yea frequently to advantage, the same in winter (when the blood is prone to sowreness) but moderately tasted of, do presently provoke a Cough. 3. There is ano∣ther cause of this serous inundation flowing out upon the Lungs, viz. when the Lympha watering the nervous and solid parts, doth suddenly suffer a flux; and for that cause it streams back into the blood out of the Fibres and Glandules, and other passages and receptacles; whose liquour it presently dissolves, and precipitates into serosities, which often infests the Lungs.

For this reason a sudden and troublesom Cough frequently accompanies convulsive distempers, which being commonly called a vaporous Cough is ascribed unto vapours. Moreover in great alterations of air, especially when the season varies from dry into

moist, and the volatile and fixed salts do thereby melt, the Cough and Catarrhs increase very much.

Neither doth the serous liquor only, but also many other humors or recrements of the blood lodged in the Lungs frequently stuff up their passages; so that by obstructing both the passages of air and of blood, they cause difficult breathing or a cough. This is every where perceived in ill-habited bodies, also in Gluttons and Drunkards, and others leading an inordinate and sloathful life. Wherefore Foot-men use a thin and spare diet, that they may have their Lungs free from the fil th and recrements of the blood. I have observed some melancholly persons, the adust faeces abounding in the pulmonary passages, to have voided blackish spittle like ink; also others cholerick, and inclining to the Jaundice to void yellow, and sometimes very bitter, as if it had been meer choler.

3. Moreover many instances manifestly declare, that sometimes the Lungs are taint∣ed * 1.15 by the corruption and putrefaction of the blood. For the blood, toucht with an infe∣ction or a pestilent or venomous contagion, begins to be corrupted, and withdraw into clotted and corrupted portions; from thence the Lungs undergo the chief taint, from whence the greatest danger of life is threatned. This is too well known in the Mea∣sles, small Pox, Plague, and malignant Feavers, for me now to undertake to explicate it: by which maladies as often as the sick die, it seems to come to pass, either be∣cause the blood clodding in the vessels of the Heart or Lungs, obstructs the way of its proper course, so that presently its influx into the Brain is hindred, or because the cor∣ruption of the blood, affixt to the sides of the pulmonary passages, causes a Phlegmon as it were; and therefore provokes a most troublesom cough or difficult breathing, and frequently bloody spittle. So much for the impediments of the circulation of the blood, which happen in the Lungs by reason of the mass of blood too much dissolved, and apt to depart into parts and portions, (which being there left obstruct their passages.) * 1.16 There remain other no less prejudices to the Praecordia, which proceed from the con∣sistence of the blood too much bound up together, and sending nothing from it self: by which a burning Feaver, Plurisie, or Peripneumony arise.

In the former distemper the blood being more sulphurous than it ought, and there∣withal being thick, is not diluted enough with its Serum; and those particles of it con∣tained * 1.17 within it self, it puts away with great difficulty: wherefore it is more plentifully kindled in the Lungs; and when it passes through the passages hereof with more diffi∣culty, by reason of its greater boiling, and its thickness, the Heart beating quick and most vehemently, endeavours its circumpulsion with all its might; notwithstanding from its greater flame growing hot within the Praecordia, heat and a most troublesom thirst, with roughness, and as it were a certain parching of the tongue arises.

In the other kind of distemper, viz. a Pleurisie and Peripneumony, the blood is * 1.18 alike thick, but less sulphuruous, and inflammable; wherefore it doth not participate of such a burning: yet by reason of its thickness it doth not so easily and quickly pass through the Chest or Lungs, is frequently extravasated, and sticking to the inter∣spaces or sides of the passages, causes obstructions, and soon after an inflammation, to which pain often succeeds with bloody or discoloured spittle. We may observe in blood-letting in these kind of distempers, that after it hath settled, its superficies is co∣vered with a little within Skin, or otherwise discoloured, but always with a thick and viscous: the reason whereof is, that the blood, when it doth not send away in the circu∣lation its old particles, nor doth admit enough of new, it is thickned with a conti∣nual boiling, and like boiled flesh changed from a bloody colour into a whitish; in which state, passing with difficulty through the small passages of the vessels, it is in danger to be extravasated, and easily provokes a Pleurisie or Peripneumony.

Besides these stoppages of the Blood, caused by its own fault, while it passes through the Praecordium, there are also other impediments, which happen either by the defect of * 1.19 the Heart, or its passages, or by the fault of the air inspired. By what means and for what cause the Heart offending in its motion, forces the blood from its right Ventricle through the Lungs into the lest irregularly, we have clearly shewn in our late Tract of Cardiack Distempers: to wit, that muscle sometimes labouring for want of spirits doth not vigorously and strongly enough perform its beatings. For when in corporal exercise * 1.20 the blood more plentifully than usual, is forced from the Vena cava into the Ventricle of the Heart; if this cannot sirmly contract it self, labouring according to its strength, it causes frequent and weak Pulses: moreover to help this as well the Pneumonic Arteries, as others in sundry parts of the body, which drive about the blood every way, do cause frequent and inordinate contraction. Thus I have observed in Virgins af∣flicted with the Green-sickness, and in other cachectical bodies, from a quick motion of the body, not only a palpitation of the Heart, but in the neck, temples, and other pla∣ces

the Arteries to have beaten irregularly. Neither is it the want of spirits only, but their disorder is sometimes the cause that the Proecordium doth with less strength con∣vey the blood; for sometimes the spirits, the inmates of the Cardiacal nerves, being stirred up by an incongruous conjunction, and affected convulsively, do impress their irregular contractions upon the Heart or Arteries, whereby the progress of the blood * 1.21 is several ways perverted or hindred, as it often happens in Palpitation of the Heart, T rembling, intermitting Pulse, and other the like pass•…•…ons.

3. The Pneumonic process of the blood is variously stopt, because the passages are not * 1.22 open enough: which impediments happen often as the Pores of those passages are ei∣ther stopt or broken. Of the former there are two reasons viz. sometimes the ways are shut, for as much as the passages of the vessels, contracted by the carneous fibres, are brought nearer one another; as we have elsewhere shewed, doth sometimes happen in Palpitation of the Heart, and a convulsive Asthma. The affects of which sort, by rea∣son of the stream of blood shut within the Praecordia, difficult or hard breathing, a small Pulse, and chilness of the whole body are wont to accompany. Moreover sometimes the course of the blood is shut up, because the passages of the vessels are pressed together by a body, or by some humor from without: wherefore when the little Cells or bronchial Pipes (as is usual) are filled with a viscous flegm, purulent matter, or blood extravasa∣ted, as the free passage of the air is hindred in them, so also the passage of blood is stopt in the vessels adjoyning. On the same account come tumors, little swellings, worms, also stony, sandy, and curdly concretions, and others of another kind are in diverse manners excited; the chief whereof we shall touch on hereafter. Moreover we some∣times * 1.23 see the canals as well of an Artery as of the Pneumonic Vein, made very bony in some part, and their sides so compressed, that a very small chink remains for the blood to pass. Not long since we dissected a young man who died by reason of an ill forma∣tion of the Pneumonic Vein, in whom the Trunk of this vessel growing stony near the * 1.24 juncture to the heart, did stick so close, that the blood did drop into the heart only by drops, or by a very little stream. 2. That the passages bringing blood are often filled and stopt, insomuch that the stream of blood is obstructed or straitned, many anotomi∣cal instances and observations manifestly declare. From thence it appears, that gru∣mous, or as it were carnous concretions of the blood do frequently so stop the ven∣tricles * 1.25 of the heart, and the roots of its larger vessels, that the course of the stream of blood is almost entirely stopt, Moreover reason perswades, and experience concludes this more frequently to happen in the lesser vessels: for seeing (as we have even now inti∣mated) the blood emitted by Philebotomy in Rheumatisms, Peripneumonies, and Pleuri∣sies, when it is cold is covered all over with a thin skin altogether of the like substance with those concreted Polypus's; it plainly appears, that it passes with difficulty through the passages of the lesser vessels by reason of those viscous excrements: wherefore that it may pass by some means, it distends them very much, and sometimes breaks quite through them, also it frequently unlocks their mouths, and opens gapes into the Tra∣chea, insomuch that portions of the extravasated blood are by coughing frequently eje∣cted. We have known some to have died Asthmatic or short-winded, whose Lungs being free from an Ulcer, or any more grievous wound, have swelled so much, that they wanted room for their motion within the cavity of the Chest: the reason whereof doubtless was, that the thicker and more feculent blood, for that cause not easily passing through those vessels, ev•…•…ry where extended the Arteries and Veins, and caused it to stagnate in the lesser Pipes, Moreover the feculencies of blood one while salt of different kinds, another while sulphureous or earthly being combined with them, and thrust into the small passages of the vessels, and fixed there, do altogether obstruct them; insomuch that the Pneumonic circulation of the blood is contracted into a shorter space, and consequently the function of breathing is straitned in the compressed Pipes or little Cells. There are many kinds and sundry ways of such an obstruction, which if all or the chief should be enumerated, such a Pathology would swell into too great a bulk. 3. The Pneumonic passage of blood is not truly hindred by reason of the passages shut and obstructed, but sometimes also being burst asunder. For those vessels being small, or tender, or very loose in some persons, are frequently opened by the force or acrimo∣ny * 1.26 of blood; so that the blood either bursting into the Trachea, is ejected by spitting, or heaped up in the interspaces of the passages, causes Preripneumony, or falling down into the cavity of the Chest, produces an Empyema. Of all these we shall treat singly in the Chapter of spitting of blood.

3. There remains as yet a third impediment of blood in the Pneumonic passages, which happens for the want or fault of Air. If at any time the blood is not kindled after a due * 1.27 manner within the passages of the Lungs, from air breathed in by the Trachea; for that cause as presently its flame is irregular, so likewise its motion is variously stopt or

perverted: for although the blood is forced through the Lungs by the meer impulse of the heart, notwithstanding the Pulse hereof is proportioned according to the tenour of its being kindled by the air; wherefore when the flame of blood is diminished, or sup∣prest, for want or through the fault of the air, presently the Pulse proves languid or unequal, and by reason of the bloods course being troubled, or stopt, presently a paleness and coldness succeeds throughout the whole body, with enervation of the members. But if inspiration be wholly intercepted or frustrated (because the nitrous particles are wanting) presently the pulse ceases, and anon life is lost. The reason of all which is, both because the blood being much impeded in its ascension, or extinct, like Must given over working presently subsides, and is unapt for any motion; and chiefly because the flame of the blood failing, and being substracted from the brain, presently the Hypostasis of the. Animal Spirits, as it were light streaming from thence, immediately fails, and together with it the exercise or actions of all faculties do cease. But if the blood is too much kindled, the Sulphur of the Blood, and the Nitre of the Air running together more than it ought; for that cause presently, that this too much burning may be eventilated enough, the Pulse of the heart is increased to its utmost. We might adde many instances of this kind; but truly this consideration of the blood leads us to the second thing proposed of Respiration hurt; namely that we may duly weigh, what sort of failings or defects do happen about the inspira∣tion as well as exspiration of the Nitrous air, requesite for the preserving the nitral flame of blood; that is to say from what causes they proceed, and also what effects they are wont to produce; in which search we will first treat of Inspiration hurt.

Notes

• * 1.1

  The organs of breathing being hurt, the breath∣ing is hurt als•…•….
• * 1.2

  The uses and ends of breath∣ing which use to be hurt.
• * 1.3

  The defects and failings of the Lung in its of∣fice.
• * 1.4

  First in respect of the blood.
• * 1.5

  The opinion of the famous Syl∣vius concerning the blood fer∣menting in the Lungs.
• * 1.6

  Which seems not likely to betrue.
• * 1.7

  Our opinion hereof.
• * 1.8

  The pneumonic circulation of the blood is stopt sometimes by the fault of the heart it self.
• * 1.9

  The blood hin∣dred in the Lungs sometimes because not kin∣dled enough;
• * 1.10

  Sometimes too much.
• * 1.11

  It is also stopt through its tem∣perament being vitiated.
• * 1.12

  When the blood is too much loo∣sened in its con∣sistence.
• * 1.13

  Why it lodges the Serum in the Lungs.
• * 1.14

  The various cau∣ses and ways of doing it.
• * 1.15

  The blood dissol∣ved also lodges in the Lungs infections that cause corruption.
• * 1.16

  The blood is hin∣dred in the Lungs by reason of the too thick consistence of the blood;
• * 1.17

  As is perceived in a Feaver.
• * 1.18

  In a Pleurisie and Peripneu∣mony.
• * 1.19

  The blood is hin∣dred in the Lungs by the fault of the heart.
• * 1.20

  1. When the spi∣rits thereof are wanting.
• * 1.21

  2. Because mo∣ved inordinate∣ly.
• * 1.22

  3. The blood is hindred from obstruction of the passages. Which are shut up divers ways. For divers cau∣ses here rehear∣sed.
• * 1.23

  The bronchial Pipes are filled.
• * 1.24

  Sometimes wax hard.
• * 1.25

  The vessels are stuffed with con∣cretions resem∣bling the Poly∣pus.
• * 1.26

  The blood is al∣so hindred be∣cause the passa∣ges are burst a∣sunder, as in spitting blood.
• * 1.27

  One impediment of the blood is want or default of air.