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. 6. Of the Scurvy.

THe Scurvy is usual in the North, in most places thereof Common, but almost unknown in the South; so that al Writers that have Practiced in these Parts, have never mentioned it: and we may wel leave it out, because in our Preface to this Book we promised to meddle only with the usual Diseases of the Spleen; but Experience hath taught us, That our Country is not altogether without it, for though it be not in every Symptom the same with that of the North, yet it hath enough to confirm it to be the same: for the aforesaid Authors say that one Symptome is sufficient to discover it; we have seen many Symptomes of it in many people, but because it is not familiar here, and al our Physitians say we have it not, we would not absolutely cal it a Scurvy, but we thought it better to cal it a Scorbutical Disease, such an one as comes next to it, though it be not a true Scurvy.

For the Scurvy is nothing else but an Hypochondriack Disease, having a peculiar degree of Malig∣nity from which more Symptomes arise than in the Hypochondriack Disease: this malignity comes from the putrefaction of Melancholly, not of every kind of melancholly, for it is often corrupted, from which other Diseases arise and not the Scurvy, as a Quartan Ague •••• Imposthume in the Mesen∣tery, and other parts; but of a peculiar and proper Melancholly which is a••••••••able to that Malignity. This is known by the Infection which is found in this Disease, because author•• hold it to be infe∣ctious. And because al the degrees of malignity which lie in the Humors and produce divers Diseases are unknown unto us and 〈◊〉〈◊〉, therefore is this of the Scurvy obscure 〈◊〉〈◊〉 hidden; and it is won∣derful that so many Diseases should arise from the variety of malignity which is in the Humors, as malignant Pestilential Feavers, 〈◊◊◊〉〈◊◊◊〉 Measels, Cancers and Elephantiasis, the Pox, and ma∣ny others. And especially Elephantiasis comes from a peculiar malignity in a Melanchollick Humor, and so doth the Scurvy, and yet these two Diseares differ so much, that none can tel their divers de∣grees of malignity.

Divers Symptomes common to both, do shew a great likeness of the Scurvy and Hypochondriack Melancholly: for al they which were mentioned in the former Chapter, are found in this Disease, as crudities and want of Concoction in the stomach, often spitting, flegmatick, sharp, and stinking vo∣mitings, noise in the Hypochondria, belchings, breaking of Wind downwards, vomiting of blood, and purging of blood, pains from wind under the ribs and in the stomach, somtimes Costiveness, and somtimes Looseness, heat in the Hypochondria, beating of the Left side, Urine now thin, than thick, heart beating, thirst, drought of the mouth, short breath, head-ach, noise in the ears, dimness of sight, giddiness, sorrow and sadness, and divers dolings, convulsions, falling-sicknes, numbness, coma, wat∣chings, troubled sleep, and terrible dreams: The Reasons of al which were shewed in the Chapter above, and they may agree with this of the Scurvy.

But if any Symptomes appear besides these, which are not found in that, nor mentioned by Au∣thors, nor belong to another Disease; you may conjecture that it is the Scurvy: The Chief are these, which are not al sound in one Patient; but one of them is sufficient to shew that the Disease is such.

The First most remarkable Sign is in the Gums, Mouth, and Teeth, in the Gums redness, itching, and putrefaction, and somtimes bleeding and stink, which are somtimes in the Palate, Jaws, and Teeth, which are loose and black.

The Second, which is an evident Sign also, is Spots in the Legs which at first are Red, and after Purple, blue, and black: Somtimes there are in the Legs broad spots, black or blue, or both; these come from the serous filthy part of the blood which is unfit to nourish the body, and therefore is sent by nature out of the Veins to the Skin, by the Nausiosis of the Veins, as Hippocrates saies of Fra∣ctures, and this happens often in the Shins and Legs, because nature useth to send the worst Humors

to the most ignoble and remotest parts; somtimes when there is more plenty of matter you shal find them in the back, arms, neck, and face.

The third sign is shortness of Breath, and straightness of the Breast, which comes commonly from thick vapors, arising from the Hypochondria, that get to the Midriff, as also from Tumors and swel∣lings by wind of those parts that press upon the Midriff, especially from the Twelling of the Sweet∣bread, which commonly in this Disease is fulled with gross Melancholly: Hence the Patients com∣plain not of their Breast, but of the part affected, whereby they feel the weight, and by reason where∣of the Breath is short, as Eugalenus noted well, who was much acquainted with this Disease, and ma∣ny Observations therein: yet he knew not the cause of this weight, namely, the swelling of the Sweet-bread; nor doth any that write hereof make mention of it. Yet we observed it in My Lord Audeyer, President of the Senate of Gratianopolis, whom we thought had the Scurvy, as you may reade in his History, at length, in our Observations, Cent. 3. Obs. 85. For being very lean, we did easily perceive with our fingers, a hardness in the Sweet-bread; and by handling of the part, he con∣fessed that all his shortness of Breath and straightness came from thence.

The fourth sign, is Laziness, and heavine••s of Body, especially in the Legs, which comes from wa∣tery and foul Humors, which come through the Veins to the Muscles, and the whol Body.

The fifth sign is in the Urine, which is divers, as in Hypochondriack Melancholly; but in this they somtimes differ, because they are cleer and red like a Lye, from the plenty of salt Humors. The redness is higher and inclining to black, by how much the more salt humor there is. As in a Lixivium somtimes the Urine is very thick, with a red thick sediment, like the Pouder of Bricks, and somtimes this Humor is so much, that it causeth burning and pissing by drops, especially in them who have this Disease from stoppage of the Hemorrhoids; and after it is setled, the third or fourth part of the U∣rinal is filled with thick and black filth, which makes some think it to be the Stone or Ulcer of the Bladder.

Somtimes the Urine varieth without manifest cause; to day thick, to morrow thin; now pale, then yellow, or red.

The sixth sign is from the Pulse, which is now weak and unequal, leaping, or formicans, that you would wonder he should live with it; anon it is great and hard, without Inflamation. And this is to be observed, That in time of fainting and swooning, with which he is often troubled, his Pulse is greatest and strongest. Which comes from the Heart contending to cast out those vapors with which it is oppressed.

The seventh sign, is pain in divers parts: in the Thighs heavy, and somtimes stretching; somtimes Ostokopos, or at the bone; somtimes in the Shins, Ankles, Soals of the Feet, in the taps of the Fin∣gers, in the Hips, Knees, and other Joynts, or parts to which the Salt Humors flow; somtimes in the Belly, like the Chollerick Chollick; and it comes from these Humors flowing upon the Caul: these in the Arms, Thighs, and Legs, are like those of the Pox, and may wel deceive a Physitian in France, where the Scurvy is rare, and the Pox common.

But they may be thus distinguished; The pains in the Pox are between the Joynts and if they stay long, make knots, and there are, or have been then also other Symptomes of it, as running of the Reins, Ulcer of the Yard, Bubo, and the like, or Uncleanness with Women. But the Scurvy pains seize up∣on al parts indifferently; and then there are other signs of it, or at least a Melanchollick Constituti∣on; and the Matter is certainly known, if the Patient wil truly say that he hath not been with un∣clean Women. Which caused our suspicion in a Magistrate, who had a long time great pain in his Feet, Shins, and Thighs, and was brought very lean, ••o that you would have thought that he had the Marasmus, or Consumption: And when no Medicines for a long time would do him good, we from his Melanchollick Complexion, and other signs, especially because he le•• a ••ost chast life, and because for many yeers his Gums did bleed at certain times, conjectured that it was the Scurvy, and by using of things against that Disease for some time, he was cured.

Somtimes those pains remain in the Hypochondria, somtimes in the Loyns, so that they are weak, and can scarcego. Hence this Disease is called Lumbago.

Somtimes the pains are like the Stone, and the Urine is very red or black; and if you do not dili∣gently observe, you will think they are bloody, and that it comes from the Reins wounded by the Stone, when it is from a scurvy salt Matter in the Spleen, and parts adjacent, sent into the Urine.

Some have Head-ach, and heat at nights, if they caught this Disease from stoppage of the Hemor∣rhoids, by reason of the vapors which ascend, and all the night after they are as in a Feaver all over their Bodies, which the next morning vanisheth by sweating.

They have often the Tooth-ach, without any evident reason or cause; and it is not in one place, but movable from one Tooth to another, making them loose, and they again fix of their own accord, the pain and tumor being discussed.

Somtimes the pain of the Scurvy is in the sides, imitating the Pleurisie; from which it is easily di∣stinguished, because it is without a Feaver, at least a strong one; the breath is not hindered, there is no Cough, no spitting, nor is the pain constant, but coming by fits.

Also it will be in the Joynts; and we must declare how it is distinguished from a true Arthritis, or Joynt-gout. The pain of the Joynts in the Scurvy, is not fixed and constant in the same place, but runs from one Joynt to another, either on the same, or on the contrary side; somtimes it vanisheth, and then returns; so that he which now seems free, and in perfect health, is suddenly taken with pain, somtimes with swelling, somtimes without. But a true Joynt-gout seldom changeth the place.

The Joynt Scurvy hath this peculiar distinction: It is for the most part joyned with a smal Palsey, by reason whereof the Patient can hardly move the part affected; and when the Passey seizeth or returneth, the pain doth so also.

The eighth sign is from the divers hinderances of Motion, they have a bastard Palsey; the Exam∣ples whereof we laid down in our Observations: and it is distinguished from a true Palsey, because this is constant; but in the Palsey from the Scurvy, he that yesterday could scarce set one foot be∣fore another, can now stand, and walk with a little help, and it may be presently after he cannot move at all: and somtimes the motion is trembling, and with Convulsion, which doth not happen in a true Palsey. And this kind of Palsey cometh from a filthy kind of Matter or vapor, which gets in∣to the Nerves and Muscles. And if the Matter be sharp, it causeth trembling and Convulsion by pul∣ling the Nervous parts.

And Convulsions are not only in some peculiar part, but somtimes in the whol Body like an E∣pilepsie, by a windy or watery matter full of sharpness, and malignity, which is sent to the Brain, which being discussed doth give ease, and gathered again, maketh new Convulsions.

Also in this Disease there is a Contraction of the Members, somtimes of all; so that the Patient cannot move one Joynt; somtimes of one, and that principally in the Leg, when the Tendons which are made to move the Leg grow hard and stiff in the Hams. This contraction comes by reason of the salt Humor that flows with much moisture to the Nerves and Tendons; and when the thin and wa∣tery part, through continuance of time is consumed, the thick is dried and made hard; from whence come these contractions of Nerves and Tendons.

Somtimes there is a contraction in the Gullet, so that the Patient can scarce swallow, and is in fear of strangling. And this comes from astringent vapors, which contract the Oesophagus, or Gullet.

The ninth sign, is the Flux of the Belly, either with, or without blood. The simple Flux which is without blood, is distinguished from others, in that the Excrements are thicker, and more than the quantity of meat that is taken; when a common Flux is more thin, and of Humors only.

The Flux of blood in this Disease is distinguished from a Dysentery, because it is without pain of the belly, and it is thick blood which is sent into the Guts by the Meseraick Veins. Somtimes the Hemorrhoid Veins do receive that filthy blood, and send it forth: but if this flux of the belly conti∣nues long, the Vein••swell, and send forth not only much blood, but also other salt and slimy Humors.

The tenth sign, is a stinking Breath, which is common to all in the Scurvy, as Eugalenus witnes∣seth, so that they which stand by cannot endure it, but must turn aside their Nose.

The eleventh sign, is often shivering, with none or little heat following it.

The twelfth sign, is an intermitting Feaver, which somtimes they have, which are unlike the o∣ther ordinary Agues of Feavers: for in them the Pulse is weak, slow, and unequal, especially in the declination; but in the height it is commonly great and hard. Besides, at the first coming there is such a twitching in divers parts, especially the Legs, that they suppose their flesh to be torn; and somtimes they have convulsive motions therewith. And though somtimes this Ague is a Quotidian, Tertian, or Quartan, yet somtimes the fits are disorderly, coming once it may be, or twice in a month, without certainty.

The Thirteenth Sign is Tumors in divers parts; somtimes hard, somtimes soft like bladders, and somtimes like an Erysipelas, or red Tumor.

The Fourteenth Sign is Atrophy or Consumption; which is so great in this Disease somtimes that they are nothing but skin and bones like a Sceleton or Anatomy; especially after long sickness, which comes from the evil blood; so changed from its natural Condition that it cannot be made like unto the parts which should nourish.

Eugalenus propounds many other Signs of the Scurvy, and Sennertus with others: some whereof are Common to many other Diseases, which we will Conceal, least they breed Confusion.

And though (as we said before) the Scurvy is not ordinary in France, as in Poland and other Northren parts, and almost unknown; yet if any in Practising Physick shal observe al the Symp∣tomes of Melancholly he shal find some inclining to the Scurvy, in whom some of the former Symp∣tomes proper to the Scurvy wil appear.

As to the Prognostick: This Disease is hard to be Cured, as al other that come of Melancholly, and here much more hard, because of the malignity in the Melancholly which doth more cruelly o∣verthrow the body, and wil not obey the greatest part of Medicines.

It is also dangerous because it many times brings a Consumption or Dropsie, and destroyes others by sudden death, by an Apoplexy, Swooning, and other acute Diseases.

Yet somtimes they who have seemed desperate have been Cured, and oftener in this Disease than in any other: And we have seen some brought to a Consumption by long pain, and bloody Flux (which by many circumstances we conclude to be from the Scurvy) to have been perfectly Cured.

Moreover, The Pulse is deceitful, especially in the Fits; it wil be so quick, smal, and unequal somtimes that the Patient seems to be at deaths door; yet after his Fit he wil rise from his bed, and is as formerly; As we peculiarly observed in a Dutch Schollar, unto whom we being sent for in the time of his Fit, thought that he would presently die; but the next day we saw him seemingly in ve∣ry good health; and when we had examined the Circumstances of the Disease, we Concluded that he had the Scurvy, which he brought out of his own Country where it is very usual.

The same Cure is to be used in this Disease as in Hypochondriack Melancholly: because as we said at the first it comes from the same Humor more differing from its natural state; therfore for the most part it needs stronger Medicines.

But because this is a general Rule in Physick, That we alwaies begin with the weakest Medicines, and so proceed to stronger, if the former will not cure: It will be good in this Disease to appoint the whol course of Cure for Hypochondriack Melancholly, because a stubborn disease requires a long course; and if that will not root out the Disease, let us then use the Medicines more specifically proper: Aud it will not be amiss to mix some such with the other at the beginning.

These Specifical Medicines are called Antiscorbutica, or Medicin•••• proper for the Scurvy, and there are many of them in Authors that have written of this Disease; whose strength chiefly de∣pends upon a Volatile or flying Salt, of which they are very full, by which means they make thin and fluid, that thick, earthy, and salt humor, and at length discuss it. Moreover, they have a cer∣tain preservative and opposing Vertue against the poyson of the Scurvy which is in the Melanchollick Humor. Among these, the chief is Dutch Scurvy-grass, which is not in France. Another is, Cres∣ses of both sorts (but the Water-cress is best) Brooklime, Hors-Rhadish, the lesser Celandine, Wo••mwood, and Fumitory. To which may be added many others, but of less vertue, and all they are such which can prepare, correct, and tame the Melanchollick Humor. Hence it is that we directed the Cure against Hypochondriack Melancholly to be used here: Those are, Carduus, Ceterach, all the Capillar Herbs, Hysop, Germander, Bettony, Agrimony, Borrage, Bugloss, Elicampane, Asarum, Ditch Dock, Polypody of the Oak, Capar, Ash, and Tamarisk barks, Flowers of Elder, Tamarisk, and Dodder of Time.

In the choyce of these Plants, you must alwaies observe this, That you give the least quantity of hot things, and that you alwaies mix with them cold or moderate things, and in a greater quantity, espe∣cially in hot Countries, in which Melancholly is burnt. And besides the Capillar Herbs with Bor∣rage, Bugloss▪ and Agrimony before mentioned, when there is a Feaver, or we fear heat, you may ad Endive, Succory, Sorrel, Juyce of Citrons, Lemmons, Orrenges, and also Spirit of Sulphur, or Vi∣triol, or whey.

Of these former Plants you may make many sorts of Medicines, which are all gathered by Senner∣tus out of all Authors, which every man may imitate as he pleaseth. Yet this we must mark, which all Authors mention, That the aforesaid Plants work more powerfully if you ••ake their Juyce, or make them into Conserves; because the flying salt wherein all their vertue remaineth is gone by de∣coction, as also if the Plant be dried.

We have used these following forms with good success.

Take of c••eer Juyces, of Water-cresses, and Brook-lime, of each one ounce: the Juyce of Fumi∣tory two ounces: white Sugar two drams. Make a Potion.

Or,

Take of the Juyce of Fumitory, and Water-cresses, of each two ounces: mix them.

Or,

Take of the Juyces of Sorrel, Fumitory, and Water-cresses, of each two ounces. Mi•• them.

You may give more Juyce of Sorrel, if you desire to cool more, or Juyce of Lemmons▪ o•• th•• like.

The power of the Medicines, will be more to dissolve that sticking clammy Tartar, if you add one dram of Salt of Tartar with Spirit of Sulphur, or Vitriol, one scruple or half a dram; and because in the use of these Medicines, we purge often, it is good to infuse one dram or two of Senna all night in the said Juyces, and give it every other day, or every third day.

It is worth your while to give somtimes also some steeled Medicines, such as we prescribed in Hy∣pochondriack Melancholly; as also the strengthening and opening Opiates, and others, as in wisdom you shall think fit.

And last, Mineral Waters that are sharp, and of Vitriol, used in due season, are very beneficial for the Cure of this Disease.