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. II. CHAP. III. Of Remedies for the Dropsie called Ascites.

AFter the Jaundies and the Remedies thereof, our method leads us to treat of a Dropsie; not because of the Vulgar opinion, that it always arises from the fault of the same bowel; but because that former disease having long continued, for the most part concludes in this: which happens so, not so much from the fault of the Liver, as from the whole Blood, for this and not that perform san∣guification, Wherefore, when the masse hereof hath for a long time been filled with cholerick excrements, and at length degenerating from its temper, accumulates also watery humours, then doth a Dropsical Disposition come upon the Jaundies.

But whereas three sorts of Dropsies are vulgarly supposed, viz. Ascites, Tympanites, and Anasarca, we will at present handle only the two former, appertaining to the * 1.1 Splanchnick or Pathologie of the nether Belly. And first what relates to an Ascites, this disease as to its matter and formal reason is manifestly known by the sign of even many senses together, viz. it is a Tumour of the Abdomen, from a waterish tu∣mour * 1.2 contained within the cavity thereof. The water making this tumour, some∣times encreases to a huge inundation, and scarce credible quantity. I have once seen a Tub would hold 15 gallons filled with water taken out of the Abdomen of a wo∣man dead of a Dropsie. But whence that humour proceeds, also by what manner, and from what causes it gathers together in the belly first, and afterwards is sensibly augmented; and lastly by what passages, and by what vertue and operations of Hy∣dragogue Remedies, it may again be taken from thence, and evacuated, seems most difficult to be unfolded.

As to the former, viz. the encrease of water, some have thought it to descend from the Liver, and others from the Spleen distempered, into the cavity of the Ab∣domen; * 1.3 and so this bowel, or that being vitiated, always to be the cause of an Ascites. But that this is otherwise, Anatomies of many dead of this disease, do manifestly declare: when after the inundation of the belly, the Liver and Spleen are found often without fault. And truly these bowels do not seem the Springs of any such illu∣vies, being endowed with no cavityes, wherein waters might be accumulated toge∣ther: wherefore the origine of an Ascites, as of a standing Pool or Lake, is to be de∣rived from a River, or at least a glutt or inundation of some Humour.

The humours that flow within the passages, or Vessels as Brooks, are chiefly these three, viz, the Blood, the milkie Humour, and the Lympha. The showering or distilling of water may come to pass from the nervous Liquor which sometimes slowly and insensibly sweats out of the Fibres and Membranes, and from vapours condensed * 1.4 within the hollowness, or some Cavity of the Body. Whether by these ways an Ascites doth rather, and oftener proceed, we will now search.

And in the first place as to what relates to the blood, it is without doubt, the Se∣rum * 1.5 falling from the mass thereof, too much dissolved, as it doth excite Fluxions and Catarrhs of various kinds, so it sometimes stirs up the greater illuvies of waters, viz. Dropsical: wherefore when an Anasarca proceeds altogether from this cause, and when oftentimes an Ascites comes upon that disease not immediately healed, we may well enough inferr that either distemper is induced from a watery humour, every where poured out from the little mouths of the Arteries. Moreover, it is not much improbable, that the Serum of the dissolved Blood is first and solitarily poured out of some end of the Coeliac and Mesenteric Arterie being open into the Cavity of the Abdomen, and so brings on an Ascites without an Anasarca going before; and so especially if perhaps it happen, that schirrhous Tumours, Ganglion's, little swell∣ings, or preternatural Concretions of another manner, are first raised about the Me∣sentery, the Spleen, the Liver, the Womb, or any of the other bowels of the nether belly: for, because the Circulation of the blood is hindred in those places, that the blood being carryed through the arteries, may be some way brought back, the ferous part being thrust out from its company, falls into the cavity. For truly it is most evi∣dently manifested, that it so comes to pass, by this Experiment mentioned by us in another place, viz. If in a living animal, the jugular veins being taken up and bound with a thred, the reduction of the blood be stopt, the whole Region of the head swells in a short space, with a water between the skin, and clearly hydropical. And truly I have more frequently observed that an Ascites hath followed upon secret tumours gathered and raised in some places in the lower belly: which certainly happens for the reason above recited. When the course of blood being obstructed, the watery part is extravasated in a short space, that humour is not meerly serous, but besides, the nutritious Liquor, ordained to nourish all the solid parts, is emptyed into the belly: wherefore, while this Region swells up, the members are extenuated, and the Lym∣pha taken out from an Ascites, with heat thickens and grows white, like the white of an Egg.

It is also very probable, that the milkie Vessels being burst asunder, pour out their humour into the cavity of the abdomen. Truly the most renowned Sylvius thought * 1.6 this disease most frequently engendered from such a cause. And truly as out of the milkie or watery Vessels, viz. one of them or both together, being divided or opened, we may well suspect the illuvies of water or chyle sometimes to overflow the bowels of the nether belly; so the following observation seems to confirm the same thing. Of late one that had been long sick of the Jaundies, and in the mean time temperate and abstemious of drink (to which he was not prompted by thirst) contracted an Ascites, increased in a short time hugely. After that Medicines were administred in vain, a Paracentesis is attempted according to the manner of Sylvius, with a hollow Needle; out of the orifice, not icterical water, but lympid and thin flowed out abun∣dantly; from whence we may inferr, that Hydropic humour flowed not out of the mass of blood, for then it had been coloured, but distill'd out of the lymphic or milkie vessels into the cavity of the abdomen. We have join'd together as akin the ways of the milkie and lymphic Vessels in propagating an Ascites, because both ves∣sels do convey the chyle, or what is analogous to it, to the common Receptacle; and many branches or leading Pipes of either kind, are distributed about the bowels of the nether belly; in the mean time, it is not improbable but that a solitary fault of either vessel may sometimes produce an Ascites.

As to the other ways of generating an Ascites, proposed in the beginning, I am scarce induced to think, such an inundation of the belly can easily arise from the distilling of a nervous humour, or by reason of vapours there condensed: although perhaps in a Tym∣pany where the cavity of the abdomen is enlarged, and transpiration hindred, the efflu∣via that were wont to exhale, being forced inwards, are changed into Lympha or wa∣ter, wherefore for the most part an Ascites is ever conjoyn'd with that disease.

The immediate or conjunct causes of an Ascites being design'd after this manner, which indeed seem to be, either a watery humour poured out of the Vessels bringing * 1.7 Blood, or Lympha or Chyle poured out of the proper passages of them both; now we must in the next place inquire about the more remote causes of this disease, viz.

for what occasions and after what manner, the vessels affected of either sort deposite their burdens into the cavity of the belly.

First therefore, that the watery part of the blood sweats out into the Aqualiculum or belly, either the very Blood, or vessels containing it, or both together, are in * 1.8 fault. The Blood is in fault, when being depraved in its Crasis it doth not rightly contain within its consistence the constitutive parts, but being apt to be dissolved, it every where rejects its serosities from the mixture; which either it drives out by Urine or Sweat, or permitting them to reside within, pours them out into the Pores of the flesh, or the cavity of the bowels. The vessels bringing blood grow faulty for a second reason, for that their extremities or little mouths either are too much loose, or altogether shut up. In the former state the clew or Circulation of blood is not entirely and firmly continued; but the thinner and more crude part of the blood * 1.9 being apt to depart, is suffered to flow out near to the interspaces or inosculations of the Arteries and Veins; likewise on the other side, when the course of blood is hindred, by reason of a tumour or obstruction of some vessels, their little mouths being thoroughly clos•…•…d; to this being so straitned that a passage may be made open by some means that which is thin and watery is extravasated, and sent away into the neighbour∣ing places, as we have shewed above.

2, & 3. But an Ascites beginning alone, doth often arise, by reason of the milkie or lymphatic vessels being depraved; wherefore seeing we suppose the cause of this * 1.10 kind of disease to be oftentimes conjunct, we must enquire, by what means, and for what occasions, these vessels are wont to be so opened or burst asunder, that they pour out their liquor into the cavity of the belly.

First therefore as to what belongs to the Lymphaducts, these vessels may be in fault after a diverse manner, but chiefly, either that being obstructed or compressed near their origine, they do not receive the humour, or being burst about the middle or extream parts, do pour it out into the belly. There are many causes and rea∣sons of effecting of either of these, for it may be viscous matter obstructs their be∣ginnings, or glandulous, scirrhous, and other preternatural Tumours compress them, as also a vast inundation of Lympha flowing out, moreover vehement motions of the Body, or passions of the mind, may burst them asunder.

2. The milkie Vessels, no less than Lymphatick, are in danger to be broke, and so by pouring out their liquor into the cavity of the Belly, do excite the Dropsie called * 1.11 Ascites; and truly they are wont to be hurt for the like reason, in regard their middle passages, or their ends, either are obstructed by a more viscous chyle brought into them, or by Phlegm from the intestines, or they are compressed by Tumours bred in the Mesenterie: for forthwith the chyle entering into the beginnings of the vessels, and not finding a passage, first very much distends them, and afterwards breaks them. There are many causes and occasions, for which the thicker and obstructing humours are driven forwards into the milkie Vessels; for besides an irregular Diet, and for the most part from meats hard to be digested, this evil is frequently caused by too much drink, or immoderate exercise immediately after Food, also from cold drink while the Bowels are very hot; for so the passages of the Vessels before gaping are suddenly shut, and afterwards more narrowly closed, wherefore the chyle sticking within their straitned chanels, doth throughly fill and obstruct them in a short space.

As to what belongs to the differences of this Disease, besides them already cited, viz. that it comes after an Anasarca, or comes solitary; that this also is manifold * 1.12 and after a diverse manner, according as the Vessels bringing blood, or water, or milk, are found in fault; Moreover we observe, that the Dropsie called Ascites sometimes proceeds from a meer watery homour filling and distending the parts of the nether belly; but sometimes there happens to this diluge an extension of the mem∣branes, or inflations made by the irregularities of the inmate spirits, and so they do encrease the swelling of the Abdomen; and in this case a certain Tympanites comes upon an Ascites, even as more frequently on the contrary, this is the offspring of that.

Moreover, in an Ascites meerly watery, sometimes the Lympha only fluctuates within the Cavity of the Abdomen, so that in the mean time the bowels being soakt in it, continue still entire, or little or nothing encreased in their bulk; but sometimes besides the inundation of the Lympha in the hollow of the Belly, the blood being slowly circulated there, and almost stagnating it is much diluted with water. Moreover the Parenchyma of the bowels, and the sides of the Vessels and of the membranes, and chiefly the Glandules every where numerous, being moisten'd, do swell with the flowing

water, and so the tumour of the belly consisting as it were of many pools of water and moorish Contents, rises into a vast bulk.

The Prognostick of this Disease, is always suspected and accounted of an ill omen: for none of the vulgar but will pronounce the obstinate tumour of the belly to be very dangerous and difficult to cure: If any seem to be affected with a Dropsie, or a Consum∣ption, * 1.13 with them presently the next question is, Who shall be his heir.

An Ascites beginning after an Anasarca (which proceeds commonly from the whole mass of blood being pour'd forth into serosities, and sweating them out of the little mouths of the Arteries into the cavity of the Abdomen) is accounted of easier cure, or at least of more promising hope, than that solatary disease coming from tumours about the Bowels, or from the Lymphatick or Lacteal Vessels being burst asunder; for as well the conjunct as procatarctick cause of the former Disease, oftentimes is used to be removed wholly, or in part; but in the other case, both for the most part exist incurable. A reddish Urine, lixivial, and little, in an Ascites is of ill signification, for 'tis a sign that the mass of blood, being repleated with a scorbutick Salt and Sulphur boyled together, is too much bound up in its substance; insomuch that it doth not well separate the feculencies, nor discharge them by fit and convenient Sinks, which notwithstanding it doth evilly dispose by constraint into the Cavity of the Belly, for∣asmuch as it is hindred in its Circulation in the very same place. For in an Ascites the blood is not always dissolved as in an Anasarca, but sometimes appears too much com∣pacted in its temper, yet so, that the salt Serum being denied to the Pores of the skin, and to the Urinary passages, by reason of the Obstructions of the Bowels is forced to break out within the abdomen.

If in an Ascites, by a Purge taken, the waters are evacuated with ease plentifully by stool, and from thence the swelling of the belly is somewhat diminished, we are not to despair of the Cure; but if Purgers bring out little or nothing of the Serum, or Lympha, and thence by reason of the Nervous Fibres being irritated, and driven into extensions or inflations of the Bowels and Membranes (as it uses frequently to be) the belly swells the more, and grows like a Drum, we may expect only a fatal event of the Disease.

About the curing of the Dropsie called Ascites it behoves us chiefly to consider by * 1.14 what ways the waters heaped within the Abdomen, may be thence brought out, and evacuated, for such an evacuation ought to be attempted only by possible ways. And here presently is to be observ'd, that the remedies used for Hydragogues according to the ordinary practice of Medicine, intend to accomplish that end by purging, by Urine, by Sweating, and by insensible transpiration: In some cases of the Sick you * 1.15 ought to proceed by this way, and in other cases rather by that way, or another, and if none of these seem fesiable, or succeed well, let mature consultation be had for a Paracentesis. It will be worth our labour to weigh every of these kinds of Medicines, and the reasons of every one, and the manner of their operations, and with how much vertue Hydragogues are endowed.

First, therefore as to what relates to Purging, we have in another place shewed that, * 1.16 from the irritation of the Physick made in the belly and guts, as well the Contents and wind of these bowels, as moreover the humours driven into their Coats and Glandules, and which are heaped up in the Vessels and Pipes in the neighbouring parts, are disquieted, and partly streined into the passages of the guts, and partly returned in∣to the mass of blood; insomuch that the tumour of the abdomen arising from the stoppage, and as it were a waterish affection of those kind of Parts, is often abated by Purgatives seasonably administred, and sometimes wholly removed; but it doth not so succeed when it proceeds from a Lympha fluctuating within the cavity of the abdomen, or from an inflammation of the Membranes, or from a tympanitic exten∣sion: because Hydragogues do little or nothing bring out those waters, and if they be of the stronger sort, they increase this passion and exasperate it by inflaming the part.

Catharticks used for Hydragogues, are either Vomits, or Purges; they exert their * 1.17 power in the stomach, and these rather in the Intestines; insomuch that they power∣fully provoke and twitch the Nervous Fibres; and together pour forth the blood and nervous liquor by a certain septick force, and do cause the serous humours wherever impacted to be stirr'd, and do cause them plentifully to be sent away by the passage granted. Either are reckon'd of a various kind, viz. either simple or compound, gen∣tle or strong, by the Ancients as well as by the Moderns; some of which that are most chiefly noted, we will here briefly observe.

1. Emetick Hydragogues, chiefly famous, are Gambugia, Esula, Spurge, and their se∣veral Preparations, as also the Hercules of Bavius, and the Pilulae Lunares.

2. Purgers are Elder, and Dwarf-Elder, Soldanella, Gratiola or Hedge-hysop, the Juice of Orris, and Elaterium. We will briefly prescribe some methods either of pre∣paring or compounding or administring each of these.

1. Gambugia, first an Indian Medicine, being from thence brought by our Coun∣trey-men, from the Painters Shops coming into the Apothecaries, began to be in use, and * 1.18 is much magnified for Purging out serous humours. But forasmuch as taken by it self it vehemently disturbs the Stomach, and often weakens it, therefore, that the * 1.19 outragious and violent Vomiting force may be somewhat abated, there are divers ways of its Preparation invented; but truly it is best corrected with an acid Spi∣rit, or with an alcalizate Salt, or by thoroughly mixing and correcting it with aro∣maticks.

Adrian a Mynsicht, extolls the magistery thereof, which is made by a dissolution in * 1.20 Spirit of Wine, and after drawing it off, and precipitating it with Spring-water; also dissolving it with Spirit of Wine vitriolated, and with Tincture of Roses, and red Sanders, and after by evaporating it: others prepare it with the fume of Sulphur after the manner of Scammonie sulphurated; others grind it on a Marble, moistening it with Oyl of Cinnamon, or Cloves, or other Chymical Aromaticks. I use most the Solution thereof made with a tincture of Salt of Tartar, the dose from 15 drops to 20 or 30.

Take of Gum-gutta, gr. 6. Mercurius dulcis, gr. xv. Conserve of Violets, a dram and a half, make a Bolus. * 1.21

Take of Gambugia twelve grains, Salt of Wormwood fiften grains, Oyl of Mace one drop, Conserve of Damask-Roses one dram, make a Bolus: and it is wont to be given with Tartar vitriolate or Cream of Tartar, and powder of Rhubarb.

Take of Gum-gutta sulphurated, or vitriolated, fifteen grains, Cream of Tartar half a scruple, Extract of Rhubarb one scruple, Oyl of Cinnamon, gut. 2. make 4 Pills.

Lately, a Woman afflicted with a most painful Ascites, and most desperate, as it seemed to me, the ensuing Medicine being taken for 6 days successively, she began to be much better, and in a short time afterwards recovered her health entirely.

Take of powder of Gum-gutta twelve grains, Oyl of Cinnamon one drop, with syrup of Buck-thorn, make a Bolus, the dose daily to be augmented, ascending from twelve grains to twenty.

Take of our Tincture of Gum-gutta one scruple, water of Earth-worms one ounce, Syrup of Rhubarb half an ounce, mix them, and let it be taken with government.

2. Whereas there are several species of Spurge, or Tithymalus, and all of them work * 1.22 more violently either by Vomit or Stool, by reason of the notable provocation they * 1.23 make in the bowels; and for that cause do abundantly bring out serous humours; yet by reason of the too outragious force of many of them, the lesser Spurge for the most part only is now in use, and the preparations thereof most of all magnified are, the powder of the bark of the Roots, and the Extract, and we think fit to add the tincture inferiour to none of the rest.

Take of Spurge with the Roots cleansed four handfuls, Lignum-Aloes and Cloves, of each one dram, bruise them and boyl them in four pound of Spring-water, to half, the strained Li∣quor clarifie by separation or settling in a long glass, afterwards evaporate the clear liquor in a Bath heat, to the consistence of an Extract, the dose one scruple.

Take of this Extract half an ounce, pour upon it into a matrass of the Tincture of Salt of Tartar 6 ounces, digest them in a Sand-bath to the Extraction of a Tincture, the dose from 20 * 1.24 drops to 30 in a convenient vehicle.

Take of the Powder of Spurge from seven grains to ten, Cinnamon half a scruple, Salt of Tartar eight grains, mix them together in a glass mortar, give it by it self or mixed with a fit Conserve, or Syrup, make a Bolus or Pills.

2. Precipitate of Mercury with Gold, or the Hercules of Bovius which is much * 1.25 extolled by the Author for curing Dropsies; it is described in a former Treatise in the Chapter of Vomits, and the manner of preparing, and the working thereof, and the Reasons are there delivered. This Medicine, inasmuch as it twitches the sto∣machical fibres by its acrimony, and pours out the blood by reason of the mercurial and salt particles, causes or stirrs up a fierce Vomit, and thereby causes the serous hu∣mours, violently strained into the Cavities of the bowels, to be ejected.

3. The Pills called Lunares produce the same effect in like manner, by reason of

the vitriolate particles of Silver sharpened with other saline menstruums, viz. by wrink∣ling of the fibres of the Bowels very much, they force the serous humors to be strongly strained into their passages, and so to be evacuated.

A Solution of Silver made in Stygian water, and well cleansed, and by a little evaporation is reduced into pleasant Crystals, which by themselves (or with an addition of Salt Nitre to * 1.26 abate the fierceness of the Lunar Vitriol) are made into Pills with crums of bread: the dose is one Pill, sometimes two or three, respecting the ability of strength and working. Medicines of this kind are exhibited sometimes with success in a strong constitution, and bow∣els strong, and a good habit; but they are scarce ever conveniently or rarely without prejudice taken by tender and cachectical persons.

Hydragogues meerly or chiefly purging, are either of a more mild sort, as Elder, * 1.27 Dwarf-Elder, Soldanella, and juice of English Orris, which seldom being administred by themselves, do want the stirring up of sharper Medicines, and on the other side they blunt their too much fierceness; or they are of a stronger sort, as Gr•…•…tiola or Hedge-hysop, Jallap, and Elaterium.

The seeds or grains of Elder and Dwarf-Elder being dryed, are reduced into a * 1.28 powder, which being taken to the weight of one dram, doth gently bring forth se∣rous humours by siege; Water and Spirits are distilled of the juice of either sorts of Berries fermented, also Robs and Syrups are made of them; which with many other Preparations of those Vegetables, are much magnified for all hydropical Distem∣pers,

Soldanella and Gratiola, are rarely used by themselves in our age, neither are any * 1.29 neat and very efficacious Medicines prepared out of those Simples; they are frequent∣ly mixt with certain other Hydragogues, and chiefly are ingredients in compounding Apozems.

The Juice of English Orris is a very profitable Medicine, and because to be easily * 1.30 procured for the Poor, is the more to be esteemed: It is given from six drams to an ounce and a half, or two ounces, either by it felf in a fit vehicle, or with other things appropriated thereunto. Jalap is a most known Medicine against every Dropsie, and common enough. And one of the common People suffering under that disease, pre∣sently takes of the powder of the root of Jalap a Pennyworth, mixt with Ginger and White-wine, and the desired effect doth frequently follow this remedy used with in∣termission.

Elaterium is rightly esteemed the most powerful Hydragogue, for that it most pain∣fully * 1.31 provoking the splanchnick Fibres and together melting the blood and humours by a certain corrosive force, compells whatsoever serosities the Coats of the Bowels, Membranes, Vessels, also the Glandules, and flesh do contain in themselves, to be poured out into the cavities of the Stomach and guts: by which Medicine happily working, the asswaging of the Abdomen doth sometimes succeed. Truly this is the chief weapon of the Empirical Magazine against any Ascites; which they notwith∣standing using in all cases, do oftener administer to the hurt than benefit of the Pa∣tient: the dose is from three grains to ten or fifteen, taken either by it self, only with correcting spices added, or it is given with other hydragogues in form of a Powder, Pills, or Electuary. The tincture and essence of it are extracted with Spirit of Wine, or with tincture of Salt of Tartar.

These are the chief simple Hydragogues, from which being prepared with the ad∣dition * 1.32 of others, many compounded ones as well Magistral as common in Shops are made, and are every where in use; moreover, very many more might be prescribed extemporarily, as occasion serves. Of these we will here annex a few more select forms, and chiefly those that are taken in the form of Potions, Powders, Electuary and Pills.

Take of Dwarf-Elder, English Orris, of each an ounce and half, leaves of Soldanella and Gra∣tiola * 1.33 i. e. Hedge-hyssop of each one handful, Asarum, and Asse Cucumber-roots of each two ounces, roots of lesser Galangal six drams, choice Jalap half an ounce, Elaterium three drams, Cubebs two drams, shred and bruise them, and pour upon them three pound of small Spirit of Wine tartarizated, digest it stopt close in Sand for two days, strain it clear and depu∣rate it by settling. The dose from two spoon-fuls to three, in a convenient vehicle.

Take of Elaterium, Soldanella, Ginger, of each one scruple, Galangal, Cloves, Cinamon, * 1.34 of each half a scruple, Salt of Tartar fifteen grains, make a powder for two doses.

Take powder of Jalap one dram, Ginger one scruple, Cream of Tartar 15 gr. make a powder to be given in a draught of White-wine. * 1.35

Take of Rhubarb one scruple, Elaterium 5 grains, Tartar vitriolated half a scruple, Spick∣nard three grains, with Syrup of Buckthorn make four Pills.

Take of Pill Aloephanginae half a dram, Elaterium half a Scruple, Oyl of Cloves gut. 3. make four Pills.

Bontius hydropick Pills are given from half a scruple to half a dram, prepared thus:

Take of Aloes two drams and a half, the preparation of Gum-gutta one dram and a half, Diagridium corrected one dram, Gum Ammoniacum dissolved, one dram and a half, Tartar vitriolated half a dram, make a mass, and form it into Pills.

Certain hydragogue Electuaries are now every where in use, and celebrated by practi∣sers. Of which sort are, 1. One described by the renowned Sylvius, and the other by * 1.36 Zwelfer, This following pleases us.

Take of Resine of Jalap two drams, Tartar Vitriolate one dram, Extract of Rhubarb two drams, of Spurge a dram and a half, lesser Galangal one dram, beat them in a mortar, and lastly add of Conserve of the flowers of English Orris, four ounces, and with Syrup of Peach-flowers make an Electuary, the dose from half a dram to a dram and a half, or two drams.

I might here set down or describe many other purging Hydragogues, but Cathar∣ticks do not always cure an Ascites, yea oftentimes exasperate it, and (if they be long * 1.37 continued) render it incurable; hence it is necessary to have recourse to other Remedies for the Cure of this disease. Wherefore, let us next enquire whether Diureticks do here profit or not?

And truly any one may easily think that Remedies moving Urine conduce very much for draining waters out of every place or cavity of the body. In truth it is ma∣nifest by frequent experience, these do often cure an Anasarca before any other Re∣medy; let us see what they may effect for the emptying the Cavity of the Abdo∣men.

As to this it first appears, that there is no passage immediately open from an Asci∣tick pool to the Reins, although contiguous; but that whatsoever waters are trans∣ferred * 1.38 from hence thither, must of necessity first be drunk up in the mass of blood, and from thence be poured out of its bofom into the sink of Urine; and truly it is but a little which the gaping little mouths of the veins about the superficies of the bowels can receive (if perhaps they are open at all) and Diureticks can but effect this one thing, that by pouring forth the blood, and forcing its serosities more plentifully to the Kidnies, they cause the waters fluctuating in the belly to be allured to it being so emptyed; in the mean time there is no less danger, lest Diureticks being unsea∣nably administred, while they dissolve the blood too much, they constrain the serum to depart into the seat of the Ascites, more than into the Reins, and so rather aug∣ment than remove the inundation of the belly. For that it sometimes so happens, I have often found by experience; wherefore when Diureticks are prescribed to cure an Ascites, we must chiefly provide against such a contrary effect. For this reason indeed Astringents and Corroboratives are always mixt in Remedies for the Dropsie (founded on experience, and the Authority and Practice of the Ancients) not that such (as is commonly said) do confirm the Tone of the Liver, but conserve the temperature, and mixture of the blood, lest it be wholly dissolved by too great a fu∣sion. Wherefore in an Ascites which chiefly or in part happens by reason of the frame of the bowels and vessels, and chiefly the Coats, Glandules, and their little strings, and their interspaces being stuffed by a serous humour, and therefore very much swell'd up, as Catharicks so also Diureticks profit, and are frequently taken with success; forasmuch as by the use of these the mass of blood being emptyed, (the serum being more plentifully derived to the Kidneys) doth easily receive unto it self those waters every where stagnating about their little mouths, and conveys it towards the urinary sink: but on the contrary, in a meer Ascites where the heap of waters do overflow the Cavity of the Belly, the Textures of the bowels being free from the serous stuffing; Diureticks are given in vain, or incommodiously; inasmuch as they express nothing from this Lake of the belly, and most frequently by dissol∣ving the blood more impetuously drive together the waters apt to be instill'd there.

Not all Diureticks of every kind are equally convenient in an Ascites, neither ought they indifferently to be administred; for we must observe, the affected in this * 1.39 disease for the most part make a little, reddish Urine, and as it were lixivial; which truly is an indication that the temperature of the blood is too much bound in

them, by reason of the fixt and sulphureous Salt exalted and combined together: and therefore that the Serum is not duely separated within the reins; which notwithstand∣ing is shook off about the windings of the obstructed bowels, and so is deposited in the Cavity of the Belly. Wherefore in this Case it will be convenient to drink only those things to excite Urine, which so restore and amend the Constitution of the blood, that the enormities of the fixed Salt and Sulphur being taken away, the serous part might be separated within the reins, and more plentifully discharged; for which purpose, not acid or lixivial things, but those endowed with a volatile Salt are appointed. For I have often observed in Patients of that kind, when the Spirit of Salt, and other acid drops of Minerals, and when the Dissolutions and Deliqui∣ums of Salt of Tartar, Broom and other things, have done more hurt than good, that the Juice of Plantane, Brooklime, and other Herbs abounding with a volatile Salt, have much helped, as also the expressions of Millepedes: for the same reason Salt of Nitre throughly purified or Crystal Mineral doth often profit. Forms of Medicines more accomodate for this use are extant in our former Treatise, where, viz. ex∣amples of Diureticks are described, in which both volatile and nitrous Salts are the Basis. Moreover, hither ought to be referred the notable experiment, by which Joannes Anglus affirms himself often to have cured the Ascites from a hot cause, which * 1.40 Medicine also that expert Physitian Dr. Theodore Mayern was wont to magnifie and prescribe in the like •…•…ase.

Take of the juice of Plantane and Liverwort, and fill an Earthen pot to the top, which being stopt close, put in a hot Oven after the Bread is drawn, and make a little fire on the sides of the pot to continue the Heat of the Oven; after it is so boyl'd strain it, and being sweetned with Sugar, drink of it Morning and Evening, and it cures. In imitation of this I have often with success prescribed as followeth.

Take of green Plantane-leaves four handfuls, Liverwort, Brooklime, of each two handfuls, bruise them together, and pour upon them half a pound of small compound Radish-water, or other appropriate Magistral, express it strongly, the dose three ounces three times in a day.

Although Diaphoreticks are most efficacious in an Anasarca, yet in an Ascites they are rarely or not at all used for being unseasonably offered, they impress oft-times * 1.41 great hurt on the Patient without any avail; forasmuch indeed as by heating the blood, they cause the fluctuating waters to grow hot, and as it were to boyl in the hollowness of the belly; so that the spirits and humours are disturbed by vapours raised from thence; and so a disorder of all the functions follows, and the very bow∣els being as it were boyled, are much prejudiced. Moreover from sweating unadvi∣sedly instituted, the blood being forced into a fusion and precipitation of the Serum throws it off the more into the nest of the Ascites. Wherefore when some prescribe fomentations, and liniments, and bathing, to be applyed to the swelling Paunch of the Belly, for the most part it turns to the worse in such Patients; for besides a little Feaver, a Vertigo, fainting of the spirits, and other ill symptomes of the brain and heart, being most frequently so raised, even the belly also doth from thence swell the more: forasmuch as the Blood being agitated and poured out, deposits in that place more largely the Serum; and for that cause the mouths of the Vessels are more loose∣ned and opened, so that they may more readily let fall water prone to depart from the mass of blood. But the Remedies which are chiefly wont to be administred with success near the places affected (when a Cure is intended without a Paracentesis) are Clysters and Plaisters.

The former draw the Serum out of the Vessels and Glandules of the Guts and Me∣sentery without fusion of the whole mass of blood, (which the stronger purging Me∣dicines * 1.42 do excite,) which being so emptyed do imbibe a little the extravasated Lym∣pha. For this purpose the ensuing Clyster, wont to be prescribed by us in this case, is most fit, in regard it contracts the intestinal fibres together, and draws the Serum im∣bibed by the blood, or contained formerly therein, towards the Reins.

Take a pint of Urine of a sound man that drinks Wine, Venice Turpentine dissolved with the Yolk of an Egg, an ounce and a half, Sal Prunella one dram and a half, make a Clyster, * 1.43 which repeat daily. Sometimes Plaisters yield help in an Ascites, yet let them be such, as by a certain restringent and comfortable virtue strengthen the bowels and bind toge∣ther the mouths of the Vessels, lest they too much spue out their serosities for this purpose, I use to apply the Plaister Diasaponis with success. Or,

Take of the Plaister of Minium, Paracelsus Plaister, of each what suffices, make a Plaister to be applyed to the Abdomen. If this disease is accompanied with a Tympany, Epithemes of another manner are fit, as we shall hereafter declare.

The great and most present Remedy of an Ascites, is, that the waters may be drawn out by a Paracentesis being made; which administration however doth not oftner cure the disease, than kill the Patient; wherefore there is need of exact caution to whom, and at what time of the disease it ought to be administred: to persons of an ill habit, who have been long ill, in whom the conformation and temper of the bowels is wholly depraved, it will be in vain to have the Lympha drawn out by the Paunch being pier∣ced; for thereupon immediately the Spirits faint and the strength is dissolved, and af∣ter a while a new illuvies of the morbific humour succeeds. But those who being for∣merly * 1.44 of sound bowels, and healthful enough, as to other parts, when they fell into an Ascites from some great and evident cause, as we are not at first presently to make a Paracentesis, so neither if it be needful ought we to defer it too long: for an incorri∣gible depravity of the Bowels is contracted by a longer delay, while they remain a long while drowned, and as it were boyled in water.

It is beside our purpose to describe here the administration of a Paracentesis, whe∣ther it be done after the ordinary manner, or by a hollow Needle according to Sylvius; this part of Chirurgery, as dangerous, when Physitians seldom prescribe, yet Quacks and Empiricks rashly and unluckily essay it, Artists not being consulted: we will re∣late here for conclusion the History of a true and huge Ascites, lately cured without any Paracentesis.

A young Woman wife to a Merchant, being slender and proper, while she gave suck to her Child, to encrease her milk day and night did immoderately guzzle one while * 1.45 plain Ale, another while Posset drink. After having used this kind of dyet for a fort∣night, she contracted a vast Ascites in a short time, the beginning whereof she was not in the least sensible of; for her Abdomen being great with water fluctuating within, did much swell up, and its bulk when she turned from one side to the other, fell with∣out the Ileon and borders of the rest of the body: when in the mean while the flesh of all her Members was very much consumed, that she seemed no less in a consumpti∣on than a Dropsie.

The Child being weaned, and a better course of Diet being appointed, she betook her self to Medicines, and took in the first place the more mild Hydragogues, as well purgative as diuretical, but without any advantage; also she was worse after every purge; but being committed to our care, and almost desperate, I handled her after the ensuing method.

I prescribed these Medicines, for the most part forbidding Ale, and any potulent liquor (medicines excepted.)

Take of the leaves of Plantane, Brooklime, Clivers, of each 4 handfuls bruised, and pour upon them of water of Earth-worms and Rhadish compound of each three ounces, press them, take it twice aday, viz. at Eight in the Morning, and at Five in the Afternoon. She con∣tinued long in the use of this Medicine, but did sometimes vary the Composition, sometimes changing the herbs, sometimes the Liquor poured on them.

Take of the reddest Tincture of Salt of Tartar an ounce and a half, she took 20 drops at night, and early in the morning, in two spoonfuls of the following Julep, drinking seven spoon∣fuls after it.

Take water of Elder-flowers, Saxifrage, of each six ounces, water of Snails, Earthworms, and Rhadish-compound, of each two ounces.

She wore a Plaister of Minium and Oxycroceum upon her Belly.

The following Clyster was given first daily, afterwards every two or three days.

Take Urine of a healthy man one pound, Turpentine dissolved with the Yolk of an Egg an ounce and a half, Sugar an ounce, Sal Prunella one dram, make a Clyster.

By the constant use of these things her Belly asswaged within a fortnight, but her flesh daily wasting, a Consumption was threatned. Wherefore, going into the Coun∣trey to avoid this, she drank Asses milk; by the benefit of which Nutriment and of purer Air, continually taking the above-mentioned Medicines, she recovered her en∣tire health within three or four weeks, and lives yet in health.

Notes

• * 1.1

  The more remote causes of an Ascites.
• * 1.2

  First in respect of blood.
• * 1.3

  It doth not al∣ways proceed from the Liver and Spleen.
• * 1.4

  The •…•…umours by which it is pro∣duced are,
• * 1.5

  First the Blood.
• * 1.6

  2, & 3. The milkie and wa∣tery humour.
• * 1.7

  An Ascites often the product of the Jaundies.
• * 1.8

  The kinds of a Dropsie.
• * 1.9

  The Description of an Ascites.
• * 1.10

  2. In respect of the Lympha∣ducts.
• * 1.11

  3. In respect of the milkie ves∣sels.
• * 1.12

  The differences of this disease.
• * 1.13

  The Prognostick.
• * 1.14

  The cure of an Ascites.
• * 1.15

  By what and how many re∣medies the e∣duction of the water is to be endeavoured.
• * 1.16

  First by purging.
• * 1.17

  Catharticks are either Vomits or Purges.
• * 1.18

  The chief medi∣cines of either kind.
• * 1.19

  1. Gummi guttae.
• * 1.20

  Its various Pre∣parations.
• * 1.21

  The forms of Hy∣dragogues pre∣pared thereof.
• * 1.22

  2. Spurge.
• * 1.23

  The Preparati∣ons thereof.
• * 1.24

  Forms.
• * 1.25

  The Hercules of Bovius.
• * 1.26

  Pilulae Lunares.
• * 1.27

  Purging Hydra∣gogues.
• * 1.28

  Elder and Dwarf-Elder.
• * 1.29

  Soldanella.
• * 1.30

  The juice of Orris.
• * 1.31

  Elaterium.
• * 1.32

  The forms of Hydragogues.
• * 1.33

  A Tincture.
• * 1.34

  Powder.
• * 1.35

  Pills.
• * 1.36

  Electuaries.
• * 1.37

  2. Diuretick Hydragogues.
• * 1.38

  What Profit they bring in an Ascites.
• * 1.39

  With what choice and dif∣ference they ought to be ad∣ministred.
• * 1.40

  John English his Empyrical remedy.
• * 1.41

  How beneficial Diaphoreticks are in an Asci∣tes.
• * 1.42

  Clysters and Plaisters.
• * 1.43

  Forms thereof.
• * 1.44

  When and to whom a Para∣centesis is con∣venient in an Ascites.
• * 1.45

  A history of a cure.