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. 3. Of the Stoppage, or Obstruction of the Liver.

THe Obstruction of the Liver is a preternatural closing or straightness of the Branches of the Vena Porta, and Cava, that is, of the Gate and Hollow Vein, and somtimes of the substance of the Liver, hindering the passage of Natural Humors, and the distribution of the Nourishment, coming from some Matter which filleth their Cavities.

Hence it is that Obstruction is an Organical Disease, namely, in the way and passage obstructed, which hinders the distribution of Blood for the Nourishment of the parts. These waies or passages are not only the Veins which are dispersed through the whol substance of the Liver; but also the Pores and insensible Passages, with which the whol substance of the Liver, and also of other parts, is very full; which being shut up by a preternatural Humor; neither can the heat of the Liver be coo∣led, nor can the thin vaporous Excrements be evacuated.

The Matter that Causeth the Obstructions, commonly is a gross Excrement, viscous and clammy, which being not able to pass freely, sticks in the passage, and is more and more thickned by the heat of the part, so that the longer Obstructions continue, the worse they are.

Somtimes plenty of Humors cause an Obstruction, as Galen sheweth, 10. meth. cap. 2. in there words, Of Obstructions some come of abundance of Humors, and some from the Quality, as when they are gross or clammy; Blood letting is the best Remedy against those which come from plenty, and the use of attenuating things is best against those that come of Quality.

This Obstruction which comes from plenty of Humors, happens chiefly in the Vessels and their cavities when being too full, they are so distended, that they cannot contract themselve for the sending forth of the Matter contained: As we may observe by the Bladder when it is stretched ou•• by long retention of too much Urin, that it cannot contract it self; from whence there comes a stoppage of Urin, or difficulty of voiding thereof.

Not only Humors, but also somtimes many gross Vapors, which cannot easily be discussed (be∣cause the way is not open, as in the Chollick) may be the Cause of Obstruction, as Galen teacheth, 3. de loc. aff. which Causes are very rare, and absolutely denyed of some.

The Humors which stoppeth with its thickness is chiefly Flegm, which wil easily grow gross and clammy. Melancholly is next, which by its coldness, thickness, and drossiness, may cause Ob∣structions: Also Blood may do the same by its quantity and thickness: And lastly, Choller staying long in the Liver grows thick, and breeds dangerous Obstructions. The Antecedent and Princ••pal Causes, are al things that produce thick and clammy Humors, and thick and cloudy Air, Meats of gross Juyce, viscous, hard of Concoction, and distribution, astringent, cold, and not fit for to be eaten, as Pears, quinces, Services, Medlars, Mushrooms, Cheese, Pulse, Pease or Beans, Beef and Pork, slymy Fish, and dryed in the smoak, Bread not wel baked, Rapes, Chessnuts, thick, red, and astringent Wine, and muddy Ale.

Also an evil Disposition of the Liver, especially a cold distemper, which may also produce Ob∣structions from good Juyce, as when it doth not wel Concoct, but turns the meat into a salt tarta∣rous and mucilagnous or slymy Matter.

Also the Distemper of the Stomach may be a Cause of Obstructions, when it begets too crude a Chyle, which cannot after be wel ordered by the Liver, because the sault of the first Concoction is not amended by the second.

The Signs of this Disease are to be divided into divers sorts, some signifie the kind of the Disease, o∣thers the part affected, and others the cause that produce it.

The Signs that shew the kind of the Disease are common to al natural parts that are subject to Ob∣structions: for they shew only Obstructions lying in the lower Belly, and these therefore wil serve for the knowledg of the Obstructions of the Spleen, and Mesentery especially.

These Signs shew that there are Obstructions in the said parts,

The Excrements of the Belly being out of their natural condition, especially when they are moist, white, chylous, or bloody: white Urine, thin and watery, and as it were strained, because the thicker parts cannot pass through by reason of the Obstructions, but only the pure water comes through un∣mixed; and it may be yellow if there be heat.

Difficulty of Breathing, especially when the Patient walketh fast, or goes up a hill, or pair of stairs, because the parts obstructed do draw the Midriff down-wards, and hinder its free motion; the Face is pale; there is leanness and dulness over the whol body; the Pulse is unequal; and last∣ly, there is such a sense of weight in the Hypochondria as they who have been feeding very hard; Therefore Hippocrates, 4. de victus ratione in acut. calls that heavines a fulness of the Hypochon∣dria, attributing that Disease to the Hypochondria, which properly belongs to the Stomach: for as often as the Spleen and Liver are filled with evil Humors, and swel, they are pressed and feel a hea∣viness, after the least eating of the lightest meats, as they who have over-gorged themselves. This Sign doth so surely declare the Obstruction of the Hypochondria, although there be neither pain nor apparent swelling, that Prosper Martianus in his Comment upon the aforesaid Book of Hippocra∣tes, assirmeth, That he hath concluded that the Bowels were obstructed, before ever he handled the Hypochondria.

The stretching of the right Hypochondrion sheweth the part affected, together with the other signs, and somtimes pain, that is heavy and dul, which encreaseth after meat, especially if exercise immediately follow; somtimes a dry Cough; difficulty of Breathing by reason of the neerness of the Diaphragma, and a greater weight of that part than of any other.

The Signs of the Causes are if it come from Humors, the pain is more heavy, extending and fixed: if from Wind, it is sharper and more moveable: if from cold Humors, there is more sense of weight in the right side, the Face is more pale; there is no Feaver nor thirst; there was a cold and thick diet without exercise that preceded: if it comes from hot Humors, there is less weight, more thirst, the

Face is yellow by reason of Choller, or red by reason of Blood, there is a Feaver and a pricking pain somtimes, and hot diet went before.

The Prognostick of this Disease is to be made thus,

A New Obstruction is easily taken away, an Old hardly.

An Obstruction of the Liver, except it be speedily and wholly taken away, useth to bring many Evils, namely, Putrefaction of Humors, Feavers, Inflamations, divers Fluxes of the Belly, con∣stant and vehement, because the nourishment can pass to the parts: the Chollick, Jaundice, Evil Habit of body, Dropsie, Scirrhus, and other infinite Diseases, so that Avicenna calls Obstructi∣ons the Mother of Diseases.

An Obstruction made by Humors, is worse than that which comes of Wine.

That which comes of Crude and Flegmatick Humors, or of Wind, is somtimes cured by a Fea∣ver; because the Heat doth discuss the Flatus, or Wind; makes Flegm thin, and more apt to flow.

The Cure of an Obstruction is to be begun with an universal Evacuation of the whol body; by a Potion agreeable to the nature of the Disease: Afterwards if there be signs of Plethory or sulness, and if the body be not very thin, you must draw blood out of the Liver Vein in the Right Arm.

Then prescribe this Apozeme,

Take of Smallage, Parsley, and Fennel Roots, infused a whol night in white Wine, of each one ounce: the Roots of the greater Celandine, two ounces: Fearn Roots, Elicampane barks, the Roots of Capars, the inward bark of an Ash, and Tamarisk, of each half an ounce: Wormix ood, Agrimony, Maiden-hair, Germander, the tops of Saint Johns-wort, and the Lesser Centaury, of each one handful: Smallage, Parsley, annis, and Fennel seeds, of each half an onnce: clean Senna, Polypody of the Oak, and the Kernels of Carthamus seeds, of each two ounces: Epythi∣mum, or Dodder of thyme, one ounce: Ginger and Cloves, of each one dram: the flowers of Ta∣marisk, Marigolds, and Red Fitches, of each one pugil: make a Decoction to a Pint and a quar∣ter, dissolve in the straining of the Syrup of the Five Roots, and of Roses Solutive, of each two ounces: make an Apozeme, clarified and aromatized with two drams of Cinnamon for four mor∣nings draughts, adding to every Dose one dram of Cream of Tartar, salt of Wormwood and Ta∣marsk, of each half a scruple.

In the last Dose (if the first hath not sufficiently purged) dissolve of the Electuary of Citrons Solutive and Diacarthamum, of each one dram and an half.

Somtimes we put white Wine in the Decoction before mentioned. Somtimes a little Vinegar, ac∣cording to the nature of the Patient.

If the Patient be dainty, and will not take an Apozeme, instead thereof you shal give these Broths,

Take of Smallage, Parsley, and Sparagus Roots, of each half an ounce: Agrimony, Hysop, Maidenhair, of each one handful Cristal of Tartar one dram: boyl them with a Chicken or a neck of Mutton, make Broth for nine dayes together every morning.

The Cristal of Tartat dissolved in new made Broth and strained is better, for when the Decoction is cold, for the most part it congealeth again, and is separated from it: and when you give it in the Broth, you must stir it about well with a Silver Spoon afore it be taken, or you will leave the greater part in the bottom of the Dish.

Every other day, infuse in his Broth, half an ounce of Senna and one dram of Annis seeds.

As long as he taketh these Medicines, and after, as often as need requires, let the Region of the Li∣ver be somented every morning one hour before he taketh his Broth, and every evening one hour be∣fore Supper, with this following Fomentation:

Take of Marsh-mallow, and Briony Roots, of each one ounce and an half: the Roots of Dane∣wort, Cypress, Eryngus, the Barks of the Roots of Capars, and the middle rind of Tamarisk, of each one ounce: the Leaves of Mallows, Marsh-mallows, Violets, Agrimony, Germander, Mints, and Wormwood, of each one handful: Lin-seed, Foenugreek, and Juniper Berries, of each half an ounce: Coriander seeds, and yellow Sanders, of each three drams: Broom, Elder, Chamomel, and Melilot flowers, of each one pugil: boyl them all in two parts of Chalybeate Water, and one of white Wine, added in the end: and when it is strained, add half a pint of Vinegar: Foment the part as aforesaid.

After the Fomentation, let the part be anointed with the following Oyntment.

Take of Oyl of Lillies and Capars, of each two ounces: the Juyce of the Roots of Briony and Smallage, of each three ounces: Boyl them till the Juyces are consumed, adding the Oyntment of Marsh-mallows, and Gum Ammoniack dissolved in Vinegar, and strained, of each one ounce: Carrot seeds and Spicknard, of each one dram and an half: yellow Wax as much as will make an

Ʋnguent. Ʋse it as aforesaid, adding in the time of anointing, a little Vinegar of Roses.

After the use of these Remedies, this Opiate following is good to wear away the reliques of the Obstructions, and recover strength to the part.

Take of Conserve of Wormwood, Maiden-hair, and the Flowers of Tamarisk, of each one ounce: the Conserve of Elicampane Roots, and Citron peels candied, of each half an ounce: one candied Myrobalan: candied Nutmegs three drams: Confection Alkermes two drams: the Pouder of Diarrhodon Abbatis, one dram: Salt of Wormwood, and Tamarisk, of each two scru∣ples: Saffron one scruple: Amber-greece half a scruple: with the Syrup of Citrons make an O∣piate, of which let him take the bigness of a Chesnut every morning two hours before meat, and drinking after it, a little Hippocras.

Warm Baths are also very good, in which softening and opening things have boyled.

If the Obstructions are very stubborn, these following Pills are very good.

Take of the best Aloes infused in the Joyce of Wormwood very well, half an ounce: Gum Ammo∣niack dissolved in Vinegar and strained, three drams: Myrrh dissolved in warm Wine, and strai∣ned, two drams: the pouder of the three Sanders, and Crystal of Tartar, of each one scruple: A∣garicknewly made into Troches, and of the best Rhubarb, of each two drams: the Salt of Worm∣wood and Tamarisk, of each half a dram: Saffron half a scruple: With the Syrup of Roses so∣lutive, make a Moss of Pills, of which let him take half a dram two hours before dinner twice in a week.

Instead of the Apozeme aforesaid, you may make an old Cock Broth, when the Obstructions are old and stubborn.

Take of Polypody of the Oak, and Carthamus seeds, of each one ounce and an half: the tops of Time and Epithimum, of each one pugil: Annis, Fennel, and Caraway seeds, of each two drams: clean Senna two ounces: Crystal of Tartar half an ounce: beat them, and fill the Belly of an old Cock therewith: boyl them in three parts of Water, and one of white Wine, till the flesh of the Cock fall from the Bones. Make Broth, and let the Patient take it four mornings.

Or (which is better) make a Decoction for one draught every day of the fourth part of the Ingredients.

To this Broth you may ad Herbs, and opening Roots in a smal quantity.

Quercetan commends exceedingly in his Dispensatory, the Compound Pouder of the Root of Cuckoo-pintle, to open Obstructions; of which you may give two drams for divers daies together, in a convenient Decoction.

But of all Remedies, to take away old Obstructions, Medicines made of Tartar, Vitriol, and Steel, are the best.

Of Tartar there is made Crystal, Salt, and Spirit, which are to be given in divers forms.

The use of Crystal of Tartar is formerly mentioned in the Apozeme, and Physick Broths, made either of a Chicken, or old Cock.

Concerning this Medicien, yong Physitians are to be admonished, that it is of more-force than it is commonly supposed to be, although we seldom observe it in Practice, by reason of the negligence of Apothecaries, the deceit of false Chymists, and vulgar Distillars, which still Chymical Medicines to the Apothecaries, of which, few are good, but most adulterate.

The negligence of Apothecaries for the most part is, That they had rather buy Crystal of Tartar of such fellows, than make it themselves (though it be the easiest of all) because they sell it chea∣per than they themselves can make it: for those Impostors wil sell a pound for seven pence, or eight pence, from which alone the Apothecaries might argue deceit, perceiving that they would be loosers in so selling, if it were rightly made.

The deceit lieth here, Those Impostors put a little Tartar, and a great deal of Allum into their Decoctions; not because Tartar is sold dearer, but because it yields but a little Crystal; but Allum will run all into Crystal. Hence it is that the Physitians are deceived of their intentions, because Allum is astringent, which is contrary to the opening Faculty which they desire.

Moreover, There is another wrong done to this Medicine, when it is made in a Brass Kettle, which leaves a malignant quality upon the Medicine; for it is a known and vulgar saying among Apotheca∣ries, You must not boyl sharp things in Brass Vessels, because they easily pierce, and attract a noxious Tincture from them. But the Crystals of Tartar are most sharp, called by some Acidum Tar∣tari, or the sharpness of Tartar.

This Error is often made by Apothecaries; and almost all they who make this Crystal themselves use Brass Vessels, so that I have seen some Tartar look Skie-colored from the Verdugreece which it hath taken from the Copper. Therefore Physitians shall do conscienciously, honorably, and for the good of their Patients, if they cause their Apothecaries to make Crystal of Tartar themselves, and in Glass, Iron, or Earthen Vessels glassed.

The Salt of Tartar hath great power to open Obstructions, and may well be mixed with Apozems,

Opiates, and opening Pills. But the chief use of it is in a loosening Ptisan, or Barley Water, made of two drams of Senna, infused in eight ounces of cold Water, with one scruple, or half a dram of Salt of Tartar, by which the Tincture of the Senna will be powerfully extracted; so that this Ptisan shal work better than any ordinary one; and continued many daies it takes away all Obstructions: we have seen Quartan Agues cured, by the use of it fifteen daies together. If you fear the sharpness of the Salt of Tartar, you may correct it with the Spirit of Sulphur, or of Vitriol, putting fifteen drops of Spirit, to half a dram of Salt.

You may find the use of the Spirit of Tartar in our Observations for the Cure of the Dropsie, un∣der the Title of a Diuretical Spirit.

Of Vitriol, only the Oyl or Spirit is used in Apozemes, Syrups, and other Forms of Me∣dicines.

This following Syrup, which is good against all Obstructions of the Liver, Mesentery, and Veins, may be for an Example, by which, many through continual Feavers falling into evil Habits and Dropsies, have been perfectly cured.

Take of the Roots of Smallage, Elicampane, Sparagus, Eringus, of each one ounce: Leaves of Agrimony, Ceterach, Maiden-hair, Dodder, Carduus, of each one handful: the tops of Sea Wormwood, and of the lesser Centaury: of each half a handful: Winter Cherries one ounce: Spring Water six pints: boyl them till two pints of the straining remain; in which dissolve of the Juyce of Succory, and Burnet refined, of each one pint: the juyce of Fumitory and Hops, of each six ounces: Fennel and Parsley juyce, of each three ounces: Vinegar of Squils one pint and an half: white Sugar six pound: make a Syrup, to which add of the Oyl of Vitriol as much as will make it sharp; of which let the Patient take three spoonfuls before Break-fast, and as much before Dinner and Supper.

The Natural sharp Baths shew the Efficacy of Vitriol, the use whereof is frequent and profitable in all Diseases coming of Obstructions.

But the Spirit of Vitriol mixed with the Salt or Spirit of Tartar, is much commended by the Chy∣mists, and of them they make Tartar Vitriolate, and that rare mixture of Spirit of Vitriol, Tartar, and Treacle which may be mixed with other openers.

Lastly, There are divers Medicines made of Steel, both by Galenists, and Paracelsians, which plainly opening Obstructions presently, compel al men to use them, even those who reject all Medi∣cines made of Mettals, as Enemies to our Natures.

These Medicines of Steel are made either in the Form of Wine, Syrups, Opiates, Pills, or Lo∣zenges.

Steeled Wine is made thus:

Take of the Filings of Steel four ounces: Eryngo Roots, and Elicampane, of each one ounce and an half: yellow Sanders one ounce: red Coral and shavings of Ivory, of each six drams: Cloves, Nutmeg, and Cinnamon, of each two drams: Flowers of Broom, Rosemary, and Epi∣thimum, of each two pugils: the best white Wine six pints: steep them eight daies in Balneo Ma∣riae, or behind an Oven: then strain them through a Hippocras bag, and let the Patient take two or three ounces every morning two hours before meat for fifteen daies, or more if need require. Or make it thus:

Take of Steel prepared with Sulphur, one ounce: Elicampane, and the middle rind of Tamarisk, of each half an ounce: Senna three ounces: Epithimum one ounce: Foecula Brioniae, and Cin∣namon, of each two drams: Pouder of the three Sanders, one dram and an half: Agrimony Wa∣ter, and white Wine, of each one pint: Infuse them three daies in Balneo Mariae. Let him take three or four ounces when it is strained, three hours before meat.

Commonly they use the Infusion of Steel in white Wine, or Claret, for ordinary Drink, with much Water for two or three months together.

You may make a Syrup of Steel thus:

Take of Filings of Steel steeped in Vinegar, two ounces: the inward rind of Tamarisk half an ounce: Ceterach half a handful: Cinnamon three drams: Wormwood and Agrimony Water, of each half a pint: white Wine one pint: Infuse them six daies in a warm place: add to the stai∣ning, Sugar one pound and an half: make a Syrup. Let the Patient take every morning two or three ounces.

For the Preparation aforesaid of Steel, you must steep it in Vinegar in the Sun, while the Vinegar is consumed three times, and then grind it upon a Marble.

This Syrup may be made Purging, and better, if you dissolve the Sugar with a pint of Water where∣in three ounces of Senna, and half an ounce of Rhubarb have been steeped a whol night.

The Pouder of Steel is made thus, taken out of Quercetan's Dispensatory.

Take of the shavings of Steel, either commonly prepared, or with Sulphur, one ounce: the faecula of the Root of Cuckow-pintle one dram and an half: Amber-greece half a dram (for the Poor, a

Cordial Species will serve instead of Ambergreece) Coral and Pearl prepared, of each two drams: Amber prepared and Cinnamon, of each four scruples: Sugar as much as is sufficient to make a pleasant Pouder, of which let him take half a spoonful, or two drams with Wine for fifteen dayes.

Of the same Pouder and Sugar dissolve in Turnep Water and Confection Alkermes, may be made very pleasant Lozenges to be taken as the former: Or,

Take of Steel prepared with Brimstone half an ounce: confection Alkermes two drams: Am∣bergreece one scruple: Sugar dissolved in Rose Water four ounces: make Lozenges: Let him take two drams every morning.

Instead of the Pouder the Extract of Steel may be used, made in white Wine for those who are dainty.

Divers Opiates are made also of Steel; these following are best.

Take of the conserve of the Flowers of Tamarisk and Maiden-Hair, of each one ounce and an half: conserve of the Roots of Elicampane six drams: Steel prepared either with Sulphur or Vine∣gar one dram: Salt of Tamarisk one dram: Spirit of Vitriol half a scruple: with the syrup of candied Citrons make an Opiate, of which let him take two or three drams every mor∣ning: Or,

Take of the filings of Steel half a pound: white Wine one Pint and an half: mix them in a Glass, set it to the fire, let be boyled gently, stirring it up and down, till a scum arise, then take the frothy and fat part of the Steel which is separated by the heat, and put it with Wine into another Glass: do thus four times, adding fresh Wine, heating, and separating them, set it on a gentle fire, till it be hot and grow thick as Honey, keep it for your use, which is this,

Take of Steel so prepared six drams: Parsley and Carrot seeds, the species of Diacurcuma, and Diarrhodon Abbatis, of each one dram: Cinnamon half a dram: with clarified Honey make an Opiate, of which take three drams or half an ounce every morning. Or,

Take of Steel prepared with Brimstone one ounce: the best Senna, Rhubarb, and Agarick, of each two drams: Diarrhodon Abbatis one dram: Saffron one scruple: with syrup of Roses solu∣tive, make an Opiate: of which let him take two drams every morning for fifteen dayes, three hours after meat.

Pills of Steel are as good as the rest, and they may be made thus,

Take of Steel prepared with Brimstone half an ounce: the best Aloes, Senna, Agarick and Rhu∣barb, of each one dram: Diarrhodon Abbatis half a dram: Saffron half a scruple: with syrup of Roses solutive make a mass of Pills: of one dram whereof make six guilded Pills, which give in the morning for fifteen dayes, three hours afore meat.

To these Pills you may ad according to the kind of the Disease and the Patients occasion, of Gum Ammoniack, Sagapenum, Opopanax, Myrrh, Gentian, Birth-wort, Mastich, Nutmeg, and the like.

In all Medicines made of Steel, this is alwayes to be observed, That Exercise be used after them, as Walking, to make the strength of the Medicine to go into the parts obstructed: This Walking must befor two hours after; after which give a little Broth, in which opening Herbs and Roots have been boyled.

Besides al these Remedies, the Chymists commend Mercurial Purges, of Mercurius dulcis, especi∣ally given with ordinary Pills, or Extracts, because Mercury doth violently penetrate, and open Ob∣structions.

The Bezoard Mineral is very much commended, and given with Mercurius dulcis: You may give it thus made.

Take of Bezoard mineral twelve grains: Mercurius dulcis six grains: conserve of Roses one or two drams: make a Bolus which must be given many dayes.

If there be an Obstruction of the Liver in a Chollerick body, with a hot and dry distemper of the part, then must you give cooling or temperate Openers, which shal be shewed in the Cure of Flatus Hypochondriacus, mentioned among the Diseases of the Spleen.

For his ordinary drink let him take Water and smal Wine wherein Steel hath been infused: Or, a weak Decoction of Tamarisk, Agrimony, Ceterach, Maiden-hair, Burnet, all or some with Wine,

Some commend the Infusion of the Wood against the Stone called Lignum Nephriticum for ordi∣nary drink: Others the Decoction of Eglentine or Sweet-bryer which opens very powerfully, and strengtheneth; and they say that many have been Cured of desparate Diseases by that alone.

But the Infusion of the filings of Steel made in white Wine, or thin red Wine, doth open better mixed with the aforesaid Waters, or with ordinary Water: for by this Medicine alone many Virgins have been Cured of the Green Sickness, and this Wine wil work better, if they take every morning two ounces of cleer Wine, besides the ordinary drink.