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. 2. Of the Palpitation, or Breathing of the Heart.

AS in a Synoope the motion of the Heart is diminished, so in this Disease it is depraved. It i•• wrongly stiled by some a trembling of the Heart, when trembling is a passion of the Animal and voluntary motion, and is not proper to any parts but such as have voluntary motion.

Galen in his Book of Trembling, Palpitation, and Convulsion, saith, That Palpitation comes on∣ly from the Disease that is from the Cause which lifteth up, and depresseth the part, without any help of the Faculty; but Trembling comes partly from the Faculty, partly from the Disease. Hence it is that many using the word Palpitation indifferently to any part, think it is in the Heart, as in the Skin and Muscles, in which it comes from wind driven violently thither: for if the Heart be moved as a Bladder by water or wind, they suppose that to be a Palpitation. But the reason is different; for the Skin and Muscles cannot naturally dilate and contract themselves, but by Diseases. But the Heart hath a Natural Faculty to contract and dilate it self, therefo••e a Palpitation cannot be without its motion. And they do in vain muster up Galens Reasons, so thought by them, to prove that the Palpitation of the Heart comes not by Nature, but by a Di••ease, or cause of a Disease. For Galen in all those places speaks of no other Palpitation than that which is in the Skin and other external parts, and not of the palpitation of the Heart, which is of another Nature; and Galen 2. de sympt. caus. cap. 2. saith that the Palpitation of the Heart and Arteries, is different from that of the other parts.

Therefore the Palpitation of the Heart is an immoderate and preternatural shaking of the part, with a great Diastole or Dilatation, and a vehement Systole or contraction which somtimes is so great that as Fernelius observes, it hath often broken the Ribs adjoyning, & somtimes displaced them which are over the Paps; and somtimes it hath so dilated an Artery forth into an Aneurism as big as ones fist, in which you might both see and feel the pulsation.

This immoderate shaking of the Heart comes from the Pulsative Faculty provoked.

But here may be objected, That in Feavers all these things are found, for this is an immoderat•• Systole and Diastole, by the provocation of the Faculty through some troublesom matter, or by en∣crease of heat in the Heart.

To this we answer, That the motion of the Heart in Feavers is distinguished from Palpitation, on∣ly by its degrees, and the depraved motion of the Heart when it is vehement, is called Palpitation; but if it be not vehement, it is called a quick, great, and swift Pulse, and is referred to the difference•• of Pulses.

Now the Efficient Causes of this Palpitation may be referred to Three Heads: Either it is som∣what which troubleth and pricketh; or necessity of Refrigeration; or defect of Spirits: which two latter may be referred to the encrease of Custom.

The Molesting Cause is most usual, so that many Authors knew no other, the other are rare, and that is either a vapor or wind which troubleth the Heart either in quantity or quality, or both. The quality is either manifest or occult▪

A vapor troublesom in a manifest quality, is either in the Heart and its parts adjoyning; or it is sent from other parts; and this suddenly getting to the inmost parts of the Heart, doth stir up the Expul••ive Faculty, which being Naturally very strong, ariseth powerfully with all its force to ex∣pel the enemy.

In the Heart, and thereabout, especially in the Pericardium, are gathered somtimes cold and thick Humors, which send up vapors to the Ventricles of the Heart, which cause Palpitation.

But from more remote parts, vapors and wind are sent to the Ventricles of the Heart; as from the Stomach, Spleen, Mother, and the other parts of the lower Belly.

Many times a Vapor that troubles the Heart by an occult quality, ariseth in malignant Feavers, Plague, and after Poyson, and somtimes from Worms putrified, and the terms stopped from corrupt feed, or other putrid matter which do much stir up the Expulsive Faculty thereof.

Divers Humors do molest the Heart, either with their quantity or quality; so too much Blood oppres••ing the Veins, Arteries, and Ventricles of the Heart, so that they cannot move freely, makes a Palpitation by hindering motion, which that the Faculty may oppose it moveth more violently. So Water in the Pericardium, being in great quantity, doth compre••s the substance of the Heart and its Ventricle, so that they cannot freely dilate themselves. The same do Humors flowing in abundance to the Heart, as it happens somtimes in Wounds, Fear, and Terror.

Humors offending in quality, hurt the Heart, if they be venemous, putrid, corrupt, sharp, or too hot, especially burnt Choller coming to the Heart, and provoking its Expulsion.

Also Tumors, though seldom, cause this Disease; as Inflamation of the Heart, Imposthumes, or Swelling in the Arteries of the Lungs neer the Heart; which Galen saith befel Antipater the Physi∣tian, 4. de▪ loc. aff. by which, after an unequal Pulse, he fell into a Palpitation and an Asthma, and so died: so Dodonaeus reports that he found a Callus in the great Artery next to the Heart, which cau∣sed a Palpitation for many yeers. Also Tumors in the Pericardium, whether they be without hu∣mors and scirrhus, or with humors in them, as the Hydatides or watery Pustles, and little stones, bones, and pieces of flesh are somtimes growing in the Heart, which cause Palpitation. So Platerus reports, that in one who had a long Palpitation, and died thereof, there was found a bone in his Heart. But Schenkius reports, that in a Priest who was from his youth to the age of forty two trou∣bled with a Palpitation, there was found in the bottom of his Heart an Excrescens of flesh which weighed eight drams, and resembled another Heart.

The Second Cause of Palpitation is necessity of refrigeration, which is, when there is a pret••••na∣tural heart in the Heart, by which the Spirits are inflamed within, and therefore the motion of the Heart and Arteries is encreased, that what is spent, may be restored, and the heat cooled; and this comes somtimes from an internal cause, which is rare, but oftener of an external, as anger, vehement exercise, and the like. As Platerus observed in a yong man, who being hot and angry at Tennis, fell into a Palpitation of the Heart, and so died.

The third Cause, is the defect of Spirits which comes by hunger, watching, anger, Joy, fear, shame, and great Di••eases, and other causes which do suddenly dissipate the Spirits, which defect the Heart laboring to repair, that it may beget more quick and plentiful▪ and send them into the whol Body sooner, it doth enlarge its motion, and make it quicker.

You must observe for conclusion that it is more ordinary to see a Palpitation which comes by con∣sent from other parts, than from the Heart it self: For it hath a consent with all parts by the Veins and Art••ries, by which, Vapors, Wind, and Humors are sent. Which all shall be shewed in the Diagnosis following:

The Diagnosis or knowledg of this Disease, is directed either to the Disease, or the Causes which produce it.

The Disease is subject to sence; it may be felt with the hands, somtimes seen and heard; for the Artery may be seen to leap especially in the Jugular. And Forestus saith it may be heard, by an Ex∣ample of a yong man, that they who passed by might hear it by laying their Ear to the Window.

Also the Causes are distinguished by their Signs: A hot distemper is known by the greatness of the Pulse and swiftness, by a Feaver and heat of the Breast, by great and often breathing, and desire of cold things.

If the Palpitation come of wind, it quickly comes and goes, and is presently raised by little moti∣on, and the Breath is difficult, with trembling somtimes at the knees, mists in the Eyes, noise in the Ears, and somtimes pain of some part, which quickly is gon••; but you must gather the Nature and quality of the Vapor by the signs of the Humor which aboundeth in any part, because vapors do alwaies arise from Humors.

If the Palpitation come from Humors in the Heart, the Disease doth not come so suddenly, and continueth longer, and you may know what kind of humor it is by the signs of the Humor which a∣bounds throughout the whol Body. And especially if it be from Blood, from which it most often proceedeth; and this is known by a divers and unequal Pulse, somtimes great, somtimes smal, slow, and swift, to which the Breathing answereth in proportion; the Patients heart seemeth to be bound and oppressed, as appears by the exceeding heat, distension of the Veins, redness of Face, the time being Spring, the Age, Region, and Diet causing Blood to abound▪

That which comes by consent from other parts, is known by the proper signs of the parts affected, so we know that it is from the stomach, when there is want of Appetite, loathing, vomiting of base Humors, and gnawing at the Stomach. A troublesom breathing about the Pancreas or Spleen, or a∣ny other disease of the Spleen, sheweth that the matter lurketh there, from whence the vapors fly to the Heart; so suppression of the Terms, and Hysterical fits, declare that it comes from the Womb.

The Water abounding in the Pericardium is harder to be known, but we may conjecture, if the Pulse be weak and faint, and the Patient bemoaneth himself, that his heart as it were is somtimes in Water, and is suffocated, and if it be constant, and he incline to an Atrophy or Hectick.

If malignant humors cause it, there will be great change in the Pulse, a loss of strength, somtimes fainting, and other signs of malignity.

If it come from a Tumor there is remarkable variety in the Pulse, and the motion of the Heart is different from the natural, very unequal and inordinate, and if the humor be hot, there will be great inflamation in the Body, great thirst, difficulty of breathing and fainting will follow with death: but if the Tumor be hard, and in the Pericardium, the disease is constant, and the Patient de∣cayes by degrees without any manifest cause: if flesh, or any more solid thing grow to the heart, there will be a continual Palpitation from the beginning of the Disease to the end of Life.

Lastly, You may know when it comes by want of Spirits, by the precedent causes, which destroy∣ed the Spirits, and by the quick and smal pulse, and when it comes from the least labor or motion. Somtimes the like befals them that are well from walking or other motion, with a change of Pulse, and a resembling Palpitation.

The Prognostick is to be taken thus: It is dangerous from the hinderance of the motion of the Heart, by which Life is preserved, and it brings Syncopes and death: For it is a true Observation of Galen, Com. Aph. 41. Sect. 2. and 5. de loc. aff. cap. 2. All that in youth, or in declining age are troubled with the Palpitation of the Heart very much, die before they are old; for the often Palpi∣tation is a sign that the Vital faculty was very weak.

A Palpitation by Propriety is worse than by consent, and somtimes deadly. And that which is of an internal, is worse than that which comes of an external Cause, unless it be from poyson, or some great wound.

If it come from a Tumor, or solution of Unity, it is incurable.

The Cure is various, according to the variety of the Causes: and first that which comes from a pe∣culiar distemper of the Heart and Pericardium, is incurable; therefore we must look only at the Cure of that which is by consent, which depends upon the divers diseases of the parts, whose Cure must be sought in their proper Chapters.

But besides those Remedies which take away the Cause, you must use those which asswage the Symptomes by refreshing the Heart, and strengthening it, and which discuss the vapors which arise from melancholly, or crude & waterish Humors; as Cordial Juleps, Opiates, Epithems, & Perfumes, which are prescribed in weakness, and these that follow.

Take of Conserve of Balm, Rosemary-flowers, Borrage-flowers, and Clove-gilly-flowers, of each one ounce: Confection of Acorns and old Treacle, of each one dram: the Pouder of Diam∣ber, and Diamoschi dulcis, of each one scruple: with the Syrup of Citron Barks make an Opiate, which let him take often.

Take of Bugloss, Rose, and Orenge-flower Water, of each two ounces: the syrup of Clove∣gilly-flowers, one ounce and an half: Cinnamon Water half an ounce: the spirit of Roses two drams: Confection of Acorns one dram: mix them and give two spoonfuls now and then.

This following Liquor which immitateth the Juyce of Hearts described in the following Chapter, is good.

Take of Hogs or Sheeps Hearts three: Cinnamon and Cloves of each one dram: Lettice and Sorrel seeds, of each one dram and an half: white Wine two ounces: Borrage, Scabious, and Rose Water, of each one ounce and an half: Confection of Alkermes, one dram: boyl them all between Two Dishes, and let him take two spoonfuls of the Liquor morning and evening.

Take of Red Roses and Rosemary-flowers of each two drams: Lavender flowers one dram: Angelica seeds, Citron peels, Cloves, Cinnamon, and Mace, of each half a dram: Saffron one scruple: Musk and Amber-greece of each six grains: Make a Bag with red Silk and sprinkle it with Rose water and white Wine, and apply it warm to the Heart.

Take of Oyntment of Roses half an ounce: Oyl of Cinnamon and Cloves of each six drops: Musk and Amber-greece of each four grains: Mix it for a Liniment for the heart.

Purging Clysters and Carminative to expel Wind are often to be given.

But in the Fit it is best to open a vein; And Galen witnesseth 5. de loc. aff. cap. 2. That he never did it without profit.

Some apply Cupping Glasses without Scarrification to the Breast, which they say are excellent to discuss Wind there contained. Others to the Hypochondria, when the matter of the Disease is there.

But Zacutus Lusitanus applied a Cupping Glass with Scarrification to the heart with wonderful success, as you may read in prax. admir. obs. 133. lib. 1.

Others commend true Rhapontick given to two scruples in Wine, or Wine wherein the same hath been steeped.