The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 4. Of Empyema, or matter in the hollow of the Thorax.

ALthough the word Empyema signifie all Suppuration, yet Custom hath prevailed so that it is taken only for a Collection of matter in the Cavity of the Thorax.

Now there is a Three-fold Cause of the gathering of matter between the Lungs and the Thorax.

The first is an Inflamation suppurated, which happens in a Pleurisie or Peripneumonia; and when the Imposthume is broken, the matter falls into the Cavity of the breast. The same may be in a Squinzy, as Hippocrates teacheth, Aph. 10. Sect. 5. in these words: Whosoever is freed from an

Angina, they have a Disease in the Lungs, and die within seven daies; but if they live longer, it comes to suppuration.

The second is blood falling into the Thorax, where by continuance it must needs come to Suppura∣tion. So Hippocrates, Aph. 20. Sect. 6. If blood be sent into the Belly besides Nature, necessari∣ly it is suppurated. But this suppuration is not alwaies true, and properly so called, a•• Hippocrates teacheth, but rather to be called a corruption, of which there is matter like quittor produced. This Blood may come from a Vein wounded.

The third Cause is flegm falling from the Head & other parts into the Breast, and there putrifying. So Hippocrates, Aph. 38. Sect. 7. The distillations into the upper Belly are suppurated in twenty dales. Galen in his Commentaries, by the upper Belly understands the Breast. But the flegm there putrifying doth not beget a true Pus, or matter, but something like it; as we observe in flegmatick Tumors, as Atheroma, Steatoma, Meliceris, which are kinds of Imposthumes.

The Diagnostick signs are of two sorts: Some declare the disease to be in the beginning; others that it's old, and confirmed.

Hippocrates layeth down Three signs of this Suppuration, beginning 2. Progn.

The first is when the Feaver groweth stronger, because the Pleurisie, or Peripneumonia is not pur∣ged, for while the matter is turning into Pu•• the feaver is encreased, Hipp. Aph. 47. Sect. 1.

The Second is a quaking, which comes when the sharpness of the matter doth twitch the Membra∣nous parts.

The Third is weight, and sence of heaviness in the part; for the humor being contained in the Gavity doth weigh heavier than when it is diffused. Galen addeth in 4. de loc. asf. cap. 9. fluctua∣tion or routing: For (saith he) if any one is forced to turn in his bed, and perceive something to slow down at that time, it is no doubt but that there is much matter contained there. And you may often hear the fluctuation, unless the thickness or plenty of the matter, which fills the whol Cavity of the Thorax, do hinder the sluctuation. To these you may ad dissiculty of Breathing. For although after the Imposthume is broken, the pain of the side ceaseth, and the Diaphragma and Muscles of the Thorax move more freely; yet because the Lungs are oppressed with matter round about them, so that they cannot move freely, and some part of the matter is sucked into the substance of the Lungs, from whence it is that the Lungs are so heavy, and the Bronchia is obstructed, thence is short brea∣thing. For the purulent spittle comes from the filth sent into the Lungs and Bronchia, which shews an Empyema; but this is not alwaies a spitting of matter by reason of its thickness, which keeps it from coming to the Bronchia.

But a long lingering Feaver, partly putrid, partly Hectical, milder in the day, and sharper at night, much sweat, especially at night, a constant troublesom Cough, signifie that the Disease is old and confirmed; as also when the Cheeks grow red, and the Eyes hollow, the Nails crooked, the Legs swel, and Pustuls break forth of the Breast by reason that the sharpest part of the matter breaks out of the Skin; these signifie the Disease confirmed.

You may know which side is affected from Hippocrates, 2. Progn. text. 21: If (saith he) an Empyema be only in one part, you must turn the Patient, and learn whether he be pamed, or hotter in one side than the other, and to ask him if he perceives any burden to hang on the side that is up∣ward, and if it be so, in which side soever the weight is, the suppuration is on the other; as if heat and weight be in both sides, the Pus is contained in the whol Cavity of the Breast. Also Avicen adds a Conjecture which he took from Hipp. 3. de morb. Apply (saith he) a linnen cloth wet to both sides, and that will be dry s••onest which lieth upon the part where the matter is contained. We may lay down another sign from our own Experience, which was not observed by Authers, namely, In the side affected there will he an Oedematory Tumor, from a Potion of the thinnest mat∣ter breathing through the Museles of the Thorax. And when, in suspition thereof there appears such a Tumor, and blowing up of the skin on either side, you may certainly pronounce that the Empyema is there, and you may safely open the side.

The chief Prognostick Signs are given by Hippocrates, 2. Progn. Text. 63. in these words: In Suppurations they chiesly escape, whom the feaver left the same day they broke; and they who pre∣sently desire meat; and are freed from thirst, and have smel, and laudible excrements: and if the Pus be white and even, and of the same color, and when it is voided without pain or great Cough∣ing. But they die whom the feaver leaveth not, or to whom seeming to leave them it returns again, and who are thirsty and have no appetite, have a loose Belly, the Pus green, and livid, or srothy. They die who have all these signs: But they who have but some of them, some die, and some lie long sick.

To these we will adjoyn these following Prognosticks.

They who have an Empyema, and by reason of the abundance of matter, lift up their whol Breast when they Breath, are quickly choaked. Galen, 4. de Loc. Aff. Cap. 7.

If an Empyema is not spit forth in forty daies, it turns into a Consumption, which brings death. Hipp. Aph. 15. Sect. 5.

A Suppuration on both sides of the Thorax, is more dangerous than in one; also that on the l••f•• side is more dangerous than on the right: by reason of the left Ventricle of the heart, which is more greivously affected with the matter gathered on that side.

Whosoever are Burnt or Cut for a Suppuration, if the Matter cometh forth pure and white, they escape: but if it be bloody, foul, and stinking, they die. Aphor. 44. Sect. 7.

If the Matter flow plentifully by Stool and Urine, and the Patient continue strong, it is a sign o•• Recovery, although this Evacuation is very seldom: yet is it spoken of by Galen, Aetius, and Paulus: As also the way declared by Galen through which it passeth, 3. de loc. affect. cap. 4. and com. in aphor. 30. sect. 3. In the first place he speaks thus, This question doth not a little disturbe th•• followers of Erasistratus, who think that there is nothing but spirits in the Arteries. But we find no difficulty in it, because we know that the smooth Artery in the Lungs, so much Pus as it received from an Imposthume broken, can carry the same into the left Ventricle of the heart, which after goe•• to the Re••ns by the great Artery. In the last place, he saith, That the matter▪ contained in the Lung•• doth first come to the Ventricles of the Heart, and then to the great Artery; or by the hollow Vei•• to the outside of the Liver, from thence to the inside, and so to the Guts. From which you may easily see the way by which an Empyema may be purged by stool and urine.

If the Patient grow better, and be almost clensed, and then again raiseth stinking Spittle, he dieth of that which remaineth and returneth. Hipp. in Coac.

For the Cure of this Disease: First, if you cannot hinder the Suppuration of the matter in the Thorax, you must further it by convenient Cataplasms. As,

Take of Marsh-mallow Roots three ounces: fat Figs ten: Raisons stoned one ounce: Cha∣momel and Melilot flowers, of each one pugil. Boyl them all well, then beat them and strain them▪ then ad the flower of Line, Foenugreek seed, and Wheat, of each one ounce: Oyl of Lillies, sweet Almonds, and fresh Butter, and Turpentine, of each one ounce. Make a Cataplasm.

Also to help Concoction, and maturation within, you may give this following Apozeme:

Take of Marsh-mallow Roots, and of the greater Comphry, of each one ounce: Agrimony, Colt••∣foot, Scabious, and Maiden-hair, of each one handful: the four great cold seeds, of each one ounc••▪ Annis seeds one dram: Liquoris and Raisons of the Sun stoned, of each one ounce: the three Cor∣dial Flowers, and Chamomel, of each one pugil: Make a Decoction to one pint and an half; dis∣solve in the straining, Syrup of Colts-foot, Liquoris, and Sugar-candy, of each two ounces. Ma•••• an Apozeme perfumed with the Pouder of Flower deluce Root one dram; for five mornings draughts.

This following Eclegma is good for the same purpose:

Take of the pulp of fat Figs one ounce: fresh Butter two ounces: Oyl of sweet Almonds newly drawn without fire, one ounce: Sugar candy two ounces: Starch two drams. Make a Lo∣hoch.

Venice Turpentine washed with Barley Water given to the quantity of three drams with the pou∣der of Liquoris, doth much profit for Maturation, Discussion, and Clensing.

But if the Empyema will not be spit up (as somtimes it will not) you must come to opening of it, which you must do between the fourth and fifth Ribs, beginning to count from below, with many Cautions, which are elegantly set down by many Chyrurgions, especially by Hierom•• Fabricius ab Aquapendente, in his Book of Manual Operations. But it is more profitable to open the Imposthume which comes from a Pleurisie before it break, and the Pus flow into the Cavity of the Breast, which is known by the Tumor which is against the place of Suppuration, and by other signs of an Empyema. And then you must not open it below, and between the fourth and fifth Rib, be∣cause if you make an orifice far from the imposthume, there wil no matter come forth; but you must open it in the middle of the Tumor, first applying a Caustick. But if no Tumor appear, it is hard to open it before the Imposthume be broken.

But if any will t••y, he must find out the place in which the Patient finds weight, pain, and heat.

And it must be made between two Ribs upon the higher part of the Rib, because there is a Vein and Artery neer the Inferior; which you must observe in the opening of every Empyema. While the matter is taken forth by degrees, let the Patient take a Wound Drink twice a day, which will purge the blood, clense the Ulcer, and hinder putrefaction: As

Take of Sanicle, Bugle, Scabious, Bettony, St. Johns wort, Carduus, Mousear, Burnet, Pere∣winkle, Agrimony, Plantane, of each one handful: the seeds of St. Johns wort, and Carduus be∣nedictus, of each half a dram: Cordial Flowers one pugil: Boyl them in Hydromel to a pint and an half. Take six ounces every time.

With this same Decoction Injections may be made into the Cavity of the Breast.

For his Drink, let him take Hydromel, or Barley Water, or Spring Water with Sugar.

If after the Breast is opened the matter do not flow freely, you must draw it forth with the follow∣ing Plaister, which doth powerfully draw from all Imposthumes.

Take of Rozin of the Pine-tree that is fresh, cleer, and sweet, half a pound: Oyl of Bayes and ••urpentine, of each one ounce: Gum Elemi two ounces. First let the Rozin and the Gum be ••elted and mixed; then ad the Turpentine and the Oyls, and let them boyl a little; then strain ••••em. Make a Plaister thereof for the part: change it once a day in Winter, and twice in Sum∣••er; cut it in two or three places that the matter may pass through.