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 ...

THE THIRTEENTH BOOK OF THE PRACTICE OF PHYSICK. Of the Diseases of the Mesentery, Sweet-bread, and Caule. (Book 13)

The PREFACE.

MAny Authors are very short in the explaining of the Diseases of the Mesentery, Sweet-bread, and Caul; and the most of them have left them out, because they are hard to be known, and for the most part only from Dissection of dead Bodies; as appears by stories in Schenkius, Sennertus, and others. Yet they are very ordinary and usual: from whence Fernelius saith, That oftentimes there are causes of many Diseases in the Mesentery: as of Choller, Melancholly, Diarrhoea, Dysentery, evil Habit, Consumption, Faintness, of lingering Feavers, Vomitings, Chollicks, Tu∣mors, and Imposthumes. And Sylvius called the Mesentery, the Mother of many Diseases: by o∣thers she is called the Physitians Nurse. We may say the same of the Sweet-bread and Caul; for they are ignoble parts, and as it were sinks of the Body, to which the noble Members do send their Excrements. And although these parts (as all other) are subject to all kinds of Diseases, Simi∣lary, Organical, and Common, and many Symptomes arise from them; yet we will only speak of those which are most in practice, and comprehend this Book in five Chapters. The first shall be of the Obstruction of the Mesentery. The second of the Inflamation of the Mesentery. The third of the Imposthume, Scirrhus, and Ʋlcer of the Mesentery. The fourth of the Diseases of the Sweet∣bread. The fifth of the Diseases of the Caul.

Chap. 1. Of the Obstruction of the Mesentery.

THese Obstructions in the Mesentery, come of the same Causes which are mentioned in the Ob∣structions of the Liver and Spleen; but they happen more easily, and more often, by reason of the straitness of the Meseraick Veins, and especially of the Milky Veins, which carry the Chylous Matter to the place of the second Concoction: and when that Chylous Matter is filled with crude and

thick juyce it comes to pass that not having a free passage, it sticks in those little Veins and makes Ob∣structions. Also the Meseraick Veins are stopped by thick Humors sent from the Liver, Spleen, and other parts, and there continuing till they grow thicker, so that somtimes they cause a Scirrhus. With these Humors somtimes gross Vapors are mixed, which use to be the cause of great Symptomes. To the Obstruction, or rather making narrow of these Veins, we refer compression, which comes from the Glandles which are spread through the whol substance of the Mesentery: for when these grow be∣yond measure, as in those who have the Kings Evil, or Struma, they compress the Meseraick Veins, and hinder both the passage of the Chylus, and of the Blood.

The Signs of these Obstructions are to be divided into three kinds, as we did in the Obstructions of the Liver; namely, into such as shew the Disease, the Part affected, or the Cause.

The Signs of the Disease (that is) of the Obstructions lying in the Hypochondria, and also the Signs of the Causes are the same with the Obstruction of the Liver and Spleen, and are from that Chapter to be taken. But those Signs which properly shew the peculiar Disease of the Mesentery, are stretching, and resistance in the middle of the Belly, and under the Stomach, and about the Na∣vel; a weight in the same parts, and somtimes a dull pain, and somtimes a most sharp, when wind is contained in those parts; somtimes there is pain in the back, because the Mesentery is tied to that part: there is rumbling in the Belly, belching, and vapors flying to the Head, from whence come divers Symptomes: and lastly, all those which use to happen in Hypochondriack Melancholly, sig∣nifie Obstruction of the Mesentery, because that also proceeds, and is maintained by the same Obstru∣ctions.

As for the Prognostick: This Disease of its self, is not dangerous, because an ignoble part can en∣dure great evils without danger of death: moreover, you may apply strong Medicines for the Cure, which being well administred, do commonly bring about the desired effect; except Hypochondriack Melancholly rise from thence, which useth to be called the shame of Physitians, by reason of the re∣bellious Nature of the Melanchollick Humor. But because this part hath not exquisite sence, and the Obstructions do not alwaies greatly disturb the Patient, they are often neglected, and become the causes of other most dangerous diseases.

The Cure of this Disease is the same with that of the Obstruction of the Liver, and you must fetch it from the Chapter treating thereof.

Chap. 2. Of the Inflamation of the Mesentery.

WHen the Mesentery, as I said, is as it were the sink into which the Noble Parts do send their superfluous Excrements, which afterwards are sent forth by Nature, either by Vomit or Stool; as you may see in some who send abundance of Humors forth at divers times by Vomit and Stool: if those Evacuations be hindered by stoppage of the waies by which they are made, or by a∣ny other cause, those Humors which are there detained, staying long in the part, do get a preternatu∣ral heat, from whence come putrefactions, inflamations, divers Feavers, and imposthumes. But an Inflamation is peculiarly made, when blood heaped up in the Meseraick Veins, by the opening of some branch is sent into the substance of the Mesentery: but because by reason of Obstructions it is chiefly gathered in those Veins, therefore all the causes of Obstructions may be referred to the Causes of Inflamation.

For the making of this Inflamation, that sharpness and gnawing of the Humors gathered together, do much conduce, a fall or stroak upon the Belly, the weakness of the attractive concoction, or re∣tentive faculty of the Liver; too much heat of the body, or inordinate use of cooling things; the critical motion of Nature in malignant Diseases, or smal Pox, by which it sends the peccant Hu∣mors into this sink; a Diarrhoea, or Dysentery suddenly stopped.

The signs of the Inflamation of the Mesentery are, a lingering Feaver without Thirst, and great Symptomes, want of Appetite, a sence of stretching and heaviness beneath the Stomach, without great hardness, and which is not felt but by the hand pressing of it, and without pain, worth the spea∣king of, because the part is of dull sence; Chollerick stools, which commonly hath thin matter, without pain, somtimes pure, somtimes mixed with Excrements.

If the Mesentery be only inflamed, all the aforesaid Symptomes are milder: But if the Liver or Spleen, or Guts, are also inflamed, all the Symptomes are stronger: And besides, the signs of the aforesaid parts affected will appear, which are to be taken out of their proper Chapters.

And because the Inflamation and Imposthume of this part, are very hard to be known if they be alone, by reason of the dull sence of the part, and because it performeth no action in the body, whose hinderance may be perceived; but only serveth for the distribution of the Chylus and the Blood: therefore they are rather to be discovered by consequence, than directly, and according to artificial

conjecture; namely, when there is a Feaver and other Symptomes, and no sign of the Liver, Spleen, or Guts distempered. A half Tertian Ague sheweth that the Guts are inflamed with the Mesentery; which Spigelius observed to come commonly from the Inflamation of these parts. Also this Difease is distinguished from the inflamation of the Muscles of the Belly, because the Tumor and pain is en∣larged according to their proportion, and they are commonly long, or over the whol belly, and more in the outward parts, so that they are perceived by the least touch, and they use to bring great pain, and a Feaver.

Lastly, This Disease is to be distinguished from the Humors of the Midriff, which have been, as yet, known to few Physitians: for in them there is alwaies great difficulty of breathing, removing of the Hypochondria, a Pulse hard and smal, without any sence of Tumor in the Hypochondria. And if the Tumor come of a hot cause, a sharp Feaver, great pain, doting, and Convulsions do follow▪ which Symptomes never happen when the Mesentery is only inflamed.

As for the Prognostick: This Disease is very dangerous; for it either ends in an imposthume, or there follows a rottenness, and corruption of the Mesentery. Oftentimes the Matter of the Disease is sent by Nature another way, and yet is not clean taken away, whence the Disease returns, and continues for many yeers, somtimes till death, now with a Feaver, then a Chollick, or Infla∣mation.

The Cure of the Inflamation of the Mesentery, is not unlike to that of the Liver and Spleen, and therefore you must peruse that.

Chap. 3. Of the Imposthume, Ʋlcer, and Scirrhus of the Mesentery

THe Inflamation of the Mesentery often turneth into an Imposthume, yet every Imposthume thereof is not from Inflamation, but many times from vitious Humors therein contained, which putrefie, so that these Imposthumes come by degrees without a Feaver afore going, or other great Symptomes; as we see in other parts, when Atheromata, Steatomata, and Melicerides, and other kinds of Imposthumes are bred without Inflamation going before. And when they are broken, the Matter being voided, there remains an Ulcer which is hard to be cured. ••••t if those Humorsare very flegmatick, or Melanchollick, and resist putrefaction, they grow, and somtimes are hardened, and turn to a Scirrhus: somtimes they are as hard as a stone, as many affirm who have fou•• ston•••• in the Mesentery.

The Knowledg of the Imposthume in the Mesentery, is somtimes easie, somtimes hard; for if it comes from an Inflamation of that part, that being perceived by the ••igns in the former Chapter, it is a sign that the Inflamation could not be discussed, but suppurated and turned into an Imposthume. But when an Imposthume comes from evil Humors remaining long in the Mesentery, and at length putrefying, it is hard to know it; so that many Authors who have written Observations upon such kind of Imposthumes, say, that they never were known, but after death, when the Bodies were open∣ed. For although for the most part, they may be known by the touch, yet somtimes they lie so deep, that they cannot be touched, and the part being dull in sence, that they will not be discovered by pain. But because they come divers waies, they must be thus distinguished.

If the Imposthume of the Mesentery, hath a visible Tumor, it is first to be di••cerned from an Infla∣mation and a Scirrhus: It is distinguished from an inflamation if it come not from it, when there is no Feaver, or at least but smal, when none went before, nor any other signs that may s••ew an Inflamation; but if it follow an Inflamation, it can no other waies be distinguished than by hardness & continuance; for if the signs of Inflamation have continued twenty or thirty daies, it is a sign that it is turned into an Imposthume. It is distinguished from a Scirrhus by hardness, which is great in a Scirrhus, but in an Im∣posthume there is some kind of softness, as also by the want of pain altogether; for in an Imposthume there is alwaies some pain, especially if it be pressed hard. Moreover, this Tumor is distinguished from the Tumor of other parts, by the Scituation thereof, as we said before of the Inflamation of the Mesen∣tery. But if the Imposthume lie in the Mesentery without any visible Tumor, there can be no certain sign, but by an artificial conjecture we may suspect, namely, if there be loathing of Meat, or vomiting without manifest fault of the Stomach, and a great fulness after little Meat, weariness of the whol Body, and fainting without manifest cause, if the Belly be unaccustomarily bound, or loose, and void stinking Excrements, and somtimes bloody, without suspicion of a Dysentery. To these you may add great watchings, and if they sleep they faint, and have great Sweats. And though somtimes there appear neither Feaver nor pain, yet there is commonly an obscure one; of which, if there appear no manifest cause, we must conjecture that it comes from this Disease, especially if any of the aforesaid

signs be joyned there with; as also if the Abdomen be violently pressed, the Patient will perceive some inward pain: it is true, that by violent compression you may cause pain in sound places; but if you perceive more pain in one part than in another, after all parts have been pressed, and when that part is alwaies most pained, and the more by pressing, you may strongly conjecture that the impost∣hume is there.

If at length there come forth Matter, then the Imposthume will be manifest. Commonly it is voi∣ded by stool of divers sorts according to the disposition of the part affected, and of those adjacent.

Hence one while the Matter is pure and white in great plenty, without sence of pain, when it is sent by the Meseraick Veins into the Guts, somtimes when the Imposthume is in the thick and low∣est Guts, the Matter is mixed with the Excre••ents, somtimes it is sent to the Reins, and cast forth by Urine; somtimes being sent in great quantities between the Peritonaeum, and the Muscles of the Ab∣domen, it falls into the Cavity of the Belly by breaking of the Peritonaeum, or breaks outwardly by an Imposthume, so that a great quantity of Matter flows from the Navel, and somtimes Worms there∣with, through the corruption of the Mesentery. And that which sent forth by stool (which is the u∣sual) is somtimes white and laudable, as was said; somtimes mixed with blood or water, somtimes black blood, and stinking, somtimes other black Matter, or of divers colors. But whether this puru∣lent Matter come from the Mesentery, Liver, Spleen, or other part, it is known by the proper signs of every part affected.

When the Imposthume is broken, and the Matter floweth, it is certain that there is an Ulcer in the Mesentery, which somtimes is quickly cured, and somtimes it is of long continuance, and brings rot∣tenness upon the whol part, and a Gangrene.

As for the Prognostick: The Imposthume of the Mesentery is dangerous; for if it continue long in the part, as it often happens, it breeds filthy rottenness, or a Gangrene, or brings the Patient into a Consumption or Dropsie. If it break, and the Ulcer be not quickly cured, but gets an evil condition, it hath the like event, a Gangrene, Consumption, or Dropsie. Somtimes when the Imposthume is bro∣ken, and very stinking Matter is sent into the Cavity of the Belly, the Patient dies suddenly. The Scirrhus, or hard Tumor of the Mesentery is lest dangerous, and if it be new will admit of a Cure; but if it be old, it brings the Patient to a Dropsie.

The Cure of these Diseases, is to be varied according to the diversity of them. And first, an Im∣posthume bred requires opening and evacuation, and it must be softened with opening and purging Medicines, such as are laid down in the Obstructions of the Liver and Spleen, not omitting outward Softeners and Looseners, Fomentations, Cataplasms, and Liniments, which do make the Matter of the Imposthume thin, and open the passages that the Matter may better be voided.

After the Imposthume is opened, you must clense the Ulcer and heal it; for which purpose the Remedies mentioned in the Cure of the Ulcers of the Stomach, Liver, Reins, and Womb, are very good; of which a wise Physitian may take his choyce according to the divers dispositions both of the Bodies, and the Diseases.

And a Scirrhus of the Mesentery is cured with the same Medicines, which are set down for the Cure of the Scirrhus or hard Swelling of the Liver and Spleen.

Chap. 4. Of the Diseases of the Pancreas, or Sweet-bread.

THe Ancient Anatomists knew no action of the Pancreas, or Sweet-bread, but the use only▪ namely, to prop the Vessels, least they should be in danger of breaking, and to be instead of a Pillow to the Stomach, least when it is full it should be hurt by the hardness of the Vertebrae or Back-bone. But the Modern Anatomists have ascribed very great action unto it; namely, the first preparation of the Chyle, and clensing of it, so that it may be brought to the Liver more pure; which the milky Veins seem to confirm, because they are dispersed through the Pancreas. Besides, in the middle of it there is an open passage which goes to the Guts, by which it is probable that the Excre∣ments of the Chyle are purged; therefore the Pancreas hath its Diseases, which hurt the whol Body, especially Obstructions and Tumors, as the Mesentery hath; namely, when the Chylous Matter is crude and thick, and is brought to it from the Stomach, not sufficiently digested, and when it doth not freely flow from it.

Riolanus observed a Scirrhus of the Pancreas, in Augustine Thuanus, that wrote the History of his Times most elegantly in Latin; who when he had for four yeers, among other Symptomes, a hea∣viness continually in his Stomach, especially when he walked or stood still, without Swelling or hardness in the Hypochondria, had a Pancreas as big as his Liver, after he was dead, hard and Scir∣rhus, full of knots like Pidgeons Eggs.

But because the Pancreas is covered with the Stomach, its Tumors are scarce to be felt; and this is

the cause because there is no mention commonly of them, and they have been found only after death: Yet you may make a handsom Conjecture of them, from what Riolanus observed in Thua∣nus, namely, If there be a sence of weight or heaviness in the Stomach, and no Tumor or hardness in the Hypochondria; and other signs of Obstructions than are mentioned in the Obstructions of the Liver, Spleen, and Mesentery. To which you may add pain, and other Symptomes of the Stomach, by reason of its neerness, shortness of breath, by reason of the compression of the Diaphragma; By which signs we suppose that the Lord Audeyerius, President of the Senate of Gratianopolis, had a Scirrhus of the Pancreas, and we could perceive it by touching, by putting our hand deep to the sides of the Stomach about the middle, because he was lean; and we found a hardness there, which being touched, pained him: the story whereof, is at larger related in our 81. Observation, Cent. 3. And in the knowledg of the Scurvy we observed (which none that ever wrote thereof did) That in all Scurvyes there is a Tumor of the Pancreas, because you may find a straightness, oppression, and weight in the Region of the Stomach: And this Sign is laid down for a cleer one by Eugalenus, Sen∣nertus, and others.

There are some stories in Authors, of Imposthumes found in the Pancreas, which were not discove∣red while the Patients lived. But by the Symptomes they had they may be partly known; as some like those of the Scirrhus; to which you may joyn these, a lingering Feaver, which is the companion of almost all inward Imposthumes, much watching, short sleep, and after it, pain, swooning, and cold sweats.

The Cure of the Obstruction, Scirrhus, and Imposthume of the Pancreas, is the same with those of the Liver, Spleen, and Mesentery. There you may fetch Medicines from the Chapters concerning them.

Chap. 5. Of the Diseases of the Caul, or Omentum.

BEcause the Omentum is a soft part and fat, fit by reason of its loosness to receive Humors that come from other parts: It is subject to divers Diseases, as the Mesentery and Pancreas: And these are not described by Authors, because they can scare be seen in living men, but only by Ana∣tomy, as you may see in some Stories in our Observations. Vesalius saith that he saw in a Body o∣pened, an Omentum so swoln that is weighed five pounds, when in its Natural condition it would weigh scare half a pound. Roussetus in lib. de partu Caesareo, reports that in Paris there was found a great Imposthume in the Omentum. Riolanus in his Anthropographia, saith that he saw an O∣mentum in a Noble Youth of ninteen yeers of age, so full of kernels, by which it received abundance of filthy Humors, the Mesentery and Pancreas being imposthumated, and the Spleen almost consu∣med. We also saw a Scirrhus Omentum in a Fryar of Montpelior all over the lower part of the Belly, and four fingers thick; it was of the color of the Spleen, so that it was probable that it was caused by Melancholly from thence, because he was of a Melanchollick temper, and the passage is ve∣ry open by the branches of the Spleen Veins, to the Omentum; by which branches (as Hippocrates teacheth, the water in a Dropsie is brought from the Spleen to the Omentum, from which by degrees it distils into the Cavity of the Abdomen.

But because the swelling of the Omentum can by no means be distinguished from that of the Mesen∣tery, therefore we cannot appoint a distinct knowledg. It is true, that the Tumors of the Omentum are easier known at the first touch, because it is immediately under the Peritonaeum; but the Me∣sentery is so united to it, and the Muscles of the lower Belly, that they are sent forth by suppuration through the Navel, or other external parts.

Yet this Difficulty of Knowledg, doth not hinder the Cure, because the same Medicines serve for all Tumors that are alike in all the parts of the belly: but the Cure is worse to be made in the Omen∣tum, because it hath not fit way, as other parts have for the purging of its self.

The End of the Thirteenth Book.