The London practice of physick, or, The whole practical part of Physick contained in the works of Dr. Willis faithfully made English, and printed together for the publick good.

CHAP. XI. Instructions concerning Opiats, or Medicines that cause Sleep, with their good and ill Effects; to∣gether with Prescripts of them.

OPiats exert their Force not by raising vapours to the Head, nor by opening the Pores of the Brain, for any vapours or other Soporiferous matter to be admitted into it, but only by destroy∣ing some of the Animal Spirits, so that the residue being in a con∣sternation, or forc'd inward, or at least called back from their wonted Emanation into the nervous parts, quit their office, or in some measure remit of it.

The Narcotick force of Opiats consists in this, that as the Ani∣mal Spirits are most subtile Corpuscles, compos'd of Spirit and a volatile Salt united together, and exalted to a very high pitch; so Opiats on the contrary consist of a fetid Sulphur, that is, of a Sulphur, together combin'd with a fixt Salt, and an Earthy matter, and carried up to a most high degree in like manner: Which sort of Concrets are well known to be so contrary to the subtile Texture of the Animal Spirits, that sometimes they put them to flights, or subvert them at a distance by meer Effluvia's, which are very hardly, or indeed not at all perceivable by the smell.

Opiats given in a small quantity chiefly and in a manner only regard those Spirits to which the particular charge of natural and ordinary sleep is committed, the rest being either untouch'd, or little letted by them: Wherefore after a Dose of Laudanum is taken, both the inward and outward senses are bound, but the Pulse, Respiration, also the functions of Concoction and Separa∣tion are continued after their usual manner, and after some time the Spirits of the first employ return to their wonted Post.

But if an Opiat be stronger than it ought, it extends its Force father into the Province of the Animal government, so that an over-great Dose of it being taken, the Appetite for the most part is dull'd, Respiration is much streightn'd, and rendred not only difficult, but likewise uneven or interrupted, and sometimes also the motion of the Heart is so far debilitated, that the Pulse pre∣sently grows weaker, with a cold Sweat, a deadness, and an E∣clipse as it were, of all the faculties, so that a perpetual sleep sometimes follows this Medicine.

The good Effects of Opiats.

FIrst then, Opiats are most properly and necessarily Indicated, in case of want of sleep, for then being seasonably and duly Administred, they give a refreshing repose.

Secondly, In Delirous affects Opiats are given with good ef∣fect, (though sometimes they rather do hurt than good, as we shall shew hereafter) because the Spirits being then mov'd with too much eagerness within the Brain, and as it were struck with a rage, and passing their wonted bounds, the Opiats repress them, and make them quietly retreat into their former sta∣tions.

Thirdly, Opium is accounted of most excellent use for appea∣sing all sorts of Pains: For since Pain cannot be caus'd or con∣tinued, but a great plenty of Spirits must always abound in the part affected, in case the Nerves are so clos'd, that the passing of the Spirits to the place griev'd be hindred, or much diminish'd, (which Opium effects) it follows of necessity that the Pain must cease: For the Particles of this Medicine besetting the extream parts of the Brain, do not only quell the forlorn Spirits in its out∣most part, but likewise strongly suppress them in their Original source within the Brain, and in the midst of the Cerebellum, and consequently hinder their Emanations from thence into the Genus Nervosum; so that during the Energy of the Opium, they are sent more sparingly and thinly into the Precordia and Viscera, nay, and into all other parts. Hence the Pulse and Breathing remit of their vehemency and frequency; many times also all the Members and Limbs are seiz'd with a Languor and Lassitude. Moreover, hence the Viscera before irritated into Convulsions, either tending to Excretions, as by Vomit, or seige, or causing Pain, as in the Colick or Stone, depose their disorders.

Again, the good effect of Narcoticks is notoriously known in the Cure of the Scorbutick Colick: In Pains of the Gout they also do excellently well, and so in the Pain of the Stone in the Bladder, which Disease, when it cruelly torments Old Men, and cannot be Cur'd by Cutting, admits no ease from any other Remedy, but from Narcoticks: Wherefore in this case I have advis'd some to the constant and daily use of Laudanum and Diacodium, which they have put in practice, to the great comfort of their life, re∣ceiving no hurt thereby, though sometimes augmenting its Dose, they have taken to a great quantity.

Fourthly, Opiats are seasonably given, if at any time the Pulse

or Breathing are more quick or vehement than they ought; for when in Feavers the Motion of the Heart and Lungs being made more intense, give a most rapid Circulation to the Blood, so that it is greatly perverted, both as to its Accension, and as to its Cra∣sis, and is not able to separate its drossy Excrements, which are so throughly mixt with it: After a Narcotick is given, presently the Impetus of those parts is somewhat broken, so that the Blood coming then to a gentle and moderate Circulation, diffuses a less intense heat, and being loosen'd in its Texture, it purges its Serum and impurities by Sweat and Urine.

Respiration not only as it is urgent, but moreover as the same is interrupted, Convulsive, or otherwise variously irregular, often requires a Narcotick Medicine: In a violent or very frequent Coughing always troubling us, this uses to give relief before all other Remedies. Again, in fits of the Asthma, when the Organs of Respiration are so laboriously exercis'd, that the Person affe∣cted seems to be brought to the Agony of Death, a Dose of some proper Opiat, makes all things presently serene and calm. More∣over in horrible Vomiting, in excessive or violent Purging, this usually gives great ease. Fluxes can scarce be Cur'd without O∣pium, not that this Medicine fixes the boiling and raging Juices and Humours, but stops the Excretory Convulsions of the Fibres, and that partly within the Cavities of the Viscera themselves, it stupifying by its meer contact the Spirits there Implanted, and partly by suppressing the Spirits within the Cerebellum, which con∣tinually flow to those parts, whereby the others being destitute of supplys from them readily remit of their Convulsive rage.

Fifthly, In Catarrhs and Defluxions of all kinds, we often fly to Opiats, as to our last refuge, they powerfully stay excretions of Blood, and moderate and restrain serous Evacuations, when at any time they are excessive, and tend to a Colliquation. They repress the Immoderate Ebullition of the Blood in a burning Feaver, and lessen its excessive Accension. Briefly they most readily appease all turbulent commotions in our Body from what cause soever they arise, and let the Blood be never so much disturb'd, they most commonly reduce it to a calm and quiet state.

Opiats, where they agree, most commonly fuse the Blood, and after the manner of Alexipharmicks powerfully provoke Sweat, and move Urine, as Dr. Willis gives us here an Instance of a Person troubled with the Dropsy, and severely tormented with Night-pains caus'd by the Pox, who by the constant use of Lau∣danum, fell at length into great Sweats and Evacuations of Urine every Night, and so was Cured.

A Lady, who for many years was subject at times to cruel pains of the Colick, as often as she fell ill of that Disease, and

found the pains grow intolerable, could get no ease from any Re∣medy but from Opium: Wherefore she took a Dose of this each Night, till the Morbifick matter being consum'd by degrees, she became at length free from all grief and pain.

Of the evil Effects of Opium, with cautions concern∣ing its Ʋse.

WE have found, by sad experience in many, the Use of Opi∣um to be sometime hurtful and destructive; for that some presently after taking it, have fallen into a perpetual sleep, and others by taking a Dose of it too great, or unseasonably, have either shortn'd their Lives, or by injuring their principal facul∣ties, have rendered it afterwards uneasie and burthensome. I have known some, who upon taking a Pill of Laudanum, have fallen presently into so profound a sleep, that they could never be rais'd from it, they liv'd indeed for three or four days, and as to their Pulse, Respiration, and Heat were pretty well, but could never be brought again to sense, and waking, by any Remedies or tor∣tures. I have observ'd others, who after taking Opium, have slept but moderately, nay sometimes little or scarce at all; but as to their Pulse, Respiration, and Heat presently grew worse; so that incontinently after the Medicine, they began to have a failing of strength, and then, growing short and thick Breath'd, to de∣cay more and more, nor could their vigour be renew'd by any Cordials, but fainting by degrees they died. I have elsewhere related a story of a robust man kill'd by Opium, who had no sleep at all after it, till his last and mortal sleep, viz. Death it self fol∣lowing it; this Man presently after he had taken the Medicine, complained of a great heaviness upon his Stomack, and of Cold, then he was taken with a great Languor, and a Consternation of all his Spirits, with a coldness of his extream parts, and within some hours complaining that his Eyes grew dim, and at length that he was quite blind, he died.

I shall now relate what evils from the improper, or unseason∣able use of Opium, sometimes happen in the Head, what in the Brest, and what in the Belly.

As to the first, it's well known that the principal functions of the Soul, viz. the Memory, the Reason, and the Acuteness of the understanding are very often extreamly injur'd by Narcoticks. A frequent use of them weakens the Memory in many persons; I knew a person, who by taking a great Dose of it in a Feaver,

wholly lost the use of that faculty, and after some weeks, when the use of it began to return, he remembred only things done within a peculiar tract of time, and nothing of those that were done before or after. I have known some that have grown dull and stu∣pid by this Medicine, and others that have grown mad. And it's observ'd, that those Turks that eat much Opium, though they seem to be well, and not injur'd by it, yet they are rendred more cold, and their functions become worse; they appear always as though they were drunk and besotted, and are affected with a Coma, or a continual inclination to sleep, being stupid and uncon∣stant, sometimes affirming a thing, and sometimes denying it, so that they are unfit to deal or converse with men.

Secondly, We find that Opiats are sometimes hurtful to the Precordia and Brest, because they depress and lessen the Pulse and Breathing, sometimes also (as we have said before) they make them faulter, and by degrees wholly to cease: Wherefore in Fea∣vers, when the Blood being mightily deprav'd, seems to admit of no Crisis, or not a good one, and that at the same time it fur∣nishes but very few and weak Spirits to the Animal Oeconomy. Narcoticks are in a manner always destructive, and as it were poysons: For though in the Plague and Malign Feavers, whilst the Pulse and Respiration are strong, Treacle, Mithridate, and Di∣ascordium, nay and Laudanum are often given with good effect, yet if at any time in those Diseases, and in other Feavers that do not carry so much malignity, the vital faculty languishes, those famous Antidotes must be us'd but very sparingly, and the stron∣ger Opiats not at all. Moreover in a violent Cough, the Phthisick, Plurisy, Empyema, and other Diseases of the Brest, viz. in what ills soever nature is stirr'd up to discharge it self on a sudden of that which is offensive, and oppresses the Brest, and lifts at it with its greatest effort, and at the same time the Organs of Respirati∣on being destitute of a sufficient plenty of Spirits, faulter and per∣form their work with great pain and difficulty; we must in such a case forbear Opium no less than poyson, for then Narcoticks increase and fix the weight to be remov'd, and lessen the strength of the parts that labour to throw it off.

Thirdly, As to the parts within the Belly, we find that Narco∣ticks often taken, proved sometimes very injurious to the princi∣pal faculty, viz. the appetite of food (on which all nutrition, and the Root of Life depends) because they very much blunt it, and often wholly destroy it: For when the Spirits residing in the in∣teriour Coat of the Ventricle are stupified, or destroyed by the Particles of the Opiat; so that those Nervous Fibres though em∣ptied, no longer are corrugated, then all hunger ceases, and there is no appetite to food, nay the same being then offer'd to the

Stomack, proving rather troublesome than delightful to it, is presently thrown up again. Moreover, for the same reason the concoctive force of the Ventricle is weakn'd, and the excretory motions as well of this, as of the Intestines grow tardy; for it's a common observation, that a slowness of concoction, and a tar∣diness of going to stool, are the familiar effects of an Opiatick Medicine.

From what is said, it will not be difficult to draw Physical Precepts and cautions concerning the right use of Opiats, which we may do by observing the four following things, viz. before a Narcotick Medicine be given, we must consider, First, What kind of constitution the Patient is of. Secondly, What kind of Disease it is he labours under. Thirdly, In what state the Ani∣mal Spirits are, in respect both of the Animal and Vital functi∣ons. Fourthly, In what condition the Blood and other humours are.

1. As to the first, when a Hypnotick is indicated, see that the temperament, habit of Body, or Indisposition, Custom, or man∣ner of Life of the Patient do not indicate the contrary. For ex∣ample, those that are of a mean stature, have a strong, well-set, and square Body, with a hot Blood, and a lively or quick aspect are wont to bear this Medicine best, and most commonly re∣ceive benefit thereby; which also they may much more securely adventure upon, if they have been us'd to it before; on the contrary it does not agree with, nay sometimes it proves very prejudicial to those who are too corpulent or very thin; also to those who being of a subtle texture of Body, have their Spirits easily dissipable, or being of a cold temperament, have their Flesh soft and flaggy, and being of a sluggish and intractable Nature, are of themselves dull and sleepy; to which this thing may be ad∣ded, and it augments the weight of the rest, if they never made a Trial of that Medicine before.

The nature of the Disease is sometimes of great moment for, or against the use of Opiats. None but flattering Physicians will make use of them in slight affects. Moreover in some great Di∣stempers they are either forbidden, or their use is much suspect∣ed: In the Palsy, Vertigo, Incubus, Apoplexy, Orthopnaea, the Dropsy of the Brest, or of the Abdomen in the numbness and trembling of the Limbs, in very malign Feavers, and in the fits of intermitting Feavers, or in the Crisis of others, Narcoticks are most common∣ly forbidden. Again, in a Cough with much and thick Spittle, the Asthma, and in any other affects of the Brest, with an oppres∣sion of the Lungs, and in Hysterick and other Convulsive Passi∣ons, they are to be given but rarely, and not without caution, and the advice of some prudent Physician: But in a violent Head∣ach,

Catarrhs, the Colick, Plurisy, ordinary Feavers, in Vomiting, the Bloody Flux, in Nephritick Fits, or fits of the Gout, and in any pains whatsoever, Opiats are not only allow'd, but we have re∣course to them as to a Divine Panacaea.

3. But as often as an Opiat is propos'd, or comes to be deli∣berated on, we must farther consider in what state the Ani∣mal Spirits presiding in each faculty are, for if they are but few, or being opprest, flag already, and do not sufficiently display them∣selves, certainly they must by no means be farther lessen'd, or put in a consternation by a Medicine: Wherefore whilst the Animal faculties do not appear quick, nor with sufficient vigour exert themselves as to sense or reason; or when the Pulse and Respi∣ration have the courses of their Reciprocations but weak, also more quick or slow than usually, or disturb'd, and inequal: And lastly, if a stupor and enervation with an unwonted Languor has seiz'd the Members and Parts for Motion, we must wholly forbear Hypnotick Medicines; but we may be free to use the same, if at any time they are Indicated by reason of some great affects, and that the Animal Spirits at the same time are strong enough, ac∣cording to these and the other respects, or also if they are too much expanded, or grown too raging and unruly.

4. In the mean time the state of the Blood and humours is not to be neglected, for sometimes the uneven, or ill condition of these wholly forbids Opiats, or permits them to be taken but spa∣ringly, and with some restriction. The Blood Indicates against their use when it is amiss either in its quantity, or in its quality, or Crasis: As to the former, the bloody Latex either abounds, or is deficient, and in both respects it excludes Narcotick Medicines. For first, if at any time the Blood grown turgid through its plenty, and withal boiling in a Feaver, so exceedingly extends the Vessels as to make them strout forth; and therefore the precordia mighti∣ly labour to circulate it as quick as possible, by most swiftly repeat∣ed turns of the Systoles, lest it somewhere stagnates or overflows; then certainly to give a Narcotick, whereby that labour and last effort of the Heart, so necessary for preserving Life, would be hindred, were rather the Office of a Poysoner, than of a Physici∣an. Wherefore in an over fullness of Blood, Phlebotomy ought always to precede the use of Opiats. Secondly, No less damage is threatn'd from Narcoticks, if given when there is a want or scar∣city of Blood, as after great Haemorrhagies, long Fastings, or long sicknesses: For when the current of the Blood is very slender, and by reason of its smallness scarcely continued, the Heart being mov'd with as quick a beat as may be, endeavours (as it were with redoubled efforts) to give it a most quick Circulation, lest its course be interrupted, and consequently ceases: Hence it is ob∣vious

to conceive how greatly prejudicial Opiats are, which put a stay, or lett to this endeavour of the Heart, so very necessary in such a juncture. And indeed it seems to be for this reason, that we forbid sleep to Women presently after Child-birth, when the Lochia flow in abundance, and to all others when a conside∣rable quantity of Blood has been taken from them, and in great Hemorrhagies, to wit, lest the Heart be deserted by the Spirits during sleep, with which it swiftly circulates the lessen'd current of the Blood. Moreover sometimes the Blood being faulty in its quality, or (to speak more properly) in its Crasis, Indicates a∣gainst the use of Opiats; for when in a Cacochymia, or Feaver, the Blood being mightily fill'd with drossy Excrements, ought to be agitated with a greater effort of the Heart, and be more swift∣ly circulated, to wit, that the Heterogeneous Particles may be subdued, and soon evaporate; the Operation of a Narcotick in∣tervening, puts a stop to these endeavours of the Praecordia, and consequently retards the Purification of the Blood, and sometimes disappoints it.

As to other Excrementitious humours usually heap'd together in the Ventricle, or the Intestines, these also must be purg'd forth by Vomit or Seige before an Opiat be given: For other∣wise being there fixt, they will stick more pertinaciously: For the Fibres of those parts being stupified by the Medicine, are not irritated as before; nor do they readily set upon excretory Con∣vulsions for expelling those drossy superfluities, or perform it with any vigour. Wherefore according to the ancient Precept; If any thing be to be Evacuated, let it be done before a Narcotick be given.

The Kinds and Prescripts of Opiats.

THe safest Narcotick, and which is generally approv'd of by long experience is the Poppy and preparations of it: Where∣fore as often as we endeavour effectually and safely to provoke sleep, the whole stress of the Medicine is Plac'd in Opium or Dia∣codium.

As to the Heads of white Poppies, with the Seeds out of which Diacodium, also Decoctions, Emulsions, and other Hypnotick Confections are made; it plainly appears that these have much less of a Narcotick Sulphur in them, than the concreted Juice of Opium; and what they have of it, is much more pure and inno∣cent: Wherefore we give oftner, and with more safety Medicines

made of these, nor ought we to use Laudanum, but when through the violence of Symptoms, Diacodiats will not serve: Again since these have in them less of virulency, they do not want much preparation, but either a simple Decoction, or Infusion, or Ex∣pression being made of them, they may be apply'd to Physical use. Now Opium is seldom prescrib'd simply, and by it self, but is wont to be corrected and compounded after a various and diversifyed manner of preparation, that it may become a safe A∣nodine.

The wild Poppy has a certain Hypnotick vertue, but much more mild and gentle than that other; wherefore in certain ca∣ses it agrees excellently well, and we may be more secure as to its use. Of this a Syrup and a distill'd water is always ready pre∣par'd in Apothecaries Shops, which in many continual Feavers are often given with good success, and they are judg'd to have a certain specifical virtue in Curing the Pelurisy, because they take away pains, and by putting some stay to the Pulse, abate the Feaverish boiling of the Blood. Moreover a Tincture is made of its Flowers Infus'd in Brandy, which is a famous Medicine a∣mongst Empiricks and good Women, and is averr'd to be good against Surfeits. The reason of which effect seems to be, that the Spirit of Wine frees the Contents of the Stomack from pu∣trefaction, and the Narcotick force of the Flowers prevents the Invasion of the Feaver.

I shall now set down certain Select Forms of Narcoticks; which I shall also digest into certain Classes, according as the O∣piats have for their Basis, either the Syrup or distill'd water of the wild Poppy, or Diacodium, or Laudanum Extractum, or Li∣quidum, or Pilul. de Styrace, or de Cynoglosso, or lastly, Philo∣nium.

Take the water of wild Poppies, and Cowslip water, of each six Oun∣ces, Syrup of red Poppies two Ounces, Sal Prunella half a Dram, mix them: Make a Julape, the Dose is three or four Ounces thrice a day in the Pleurisie, Pains, watching without a Feaver, or any mani∣fest Cause.

Take of Poppy water, from four Ounces to six: Let it be taken now and then by it self twice or thrice a day for the same in∣tent.

Take Diacodium, from half an Ounce to an Ounce, Cowslip water three Ounces, Treacle water three Ounces: Make a Potion.

Take Carduus water three Ounces, Diacodium half an Ounce, Spi∣rit of Hartshorn, from half a Scruple, to a Scruple: Make a draught for procuring sleep and sweat.

Take Diascordium half a Dram, Gascoins Powder a Scruple, Diaco∣dium two Drams, mix them: Let it be taken in a spoon.

Take Diacodium three Ounces, Snail water an Ounce, mix them: Its proper in the Cough and Phthisick: The Dose is a spoonful going to Rest, and if need be, take it again after Midnight.

Take London Laudanum a Grain, Powder of Claws Compound from half a Scruple, to a Scruple, with a sufficient quantity of Syrup of Clove-Gillyflowers: Make three Pills to be taken going to Rest.

Take Laudanum a Grain, Stomack Pills with Gumms half a Dram: Make four Pills to be taken going to rest, in the Colick.

Take Laudanum, from a Grain, to a Grain and a half, Diascordium a Scruple: Make a Bolus, instead of Diascordium, you may put the Con∣fection of Alkermes, or of Hyacinth.

Take Laudanum a Grain, dissolve it in a spoonful of Treacle water, add of Cowslip water two Ounces: Make a draught.

Take of our Liquid Laudanum tartariz'd twenty Drops, give it in a spoonful of Aqua Mirabilis, or of Cinnamon water, or of any other fit Vehicle: Its proper in Colick, Nephritick, or Gouty pains.

Take Species of Hiera half a Dram, of the foresaid Laudanum twenty drops: Make four Pills, let them be taken going to rest, for Purging, and easing pains of the Colick at the same time.

Take Liquid Laudanum Cydoniated, from fifteen Drops to twenty: Give it in a spoonful of small Cinnamon water for the Flux.

Take Conserve of red Roses an Ounce, Venice Treacle, Confection of Hyacinth, of each two Drams, Pulvis Pannonici Rubri a Dram, Lau∣danum Cydoniated two Drams, Syrup of Coral what suffices: Make an Electuary, the Dose is a Dram every fourth or fifth hour, in a vio∣lent Bloody Flux with Gripes.

Take Pilul. de Styrace, from five Grains to six, Lac Sulphuris half a Scruple, Oyl of Anniseeds a Drop, Balsam of Peru what suffices: Make three Pills to be taken in the Cough, Asthma, &c.

Take Pilul. de Cynoglosso, from six Grains to eight: Make two Pills to be taken going to rest for the same intents.

Take Philonium Romanum, from one Scruple to two, Conserve of Clove-Gillyflowers half a Dram, mix them: Make a Bolus to be taken going to rest. Its proper for the Colick in a cold temperament.

I shall now say something concerning the Effects of the great Anti-Hypnotick Coffee.

Coffee, though in some cases it be very profitable and Physical, in others it is hurtful and unwholesome; for we see that great Coffee-drinkers become lean, and are very often subject to be Pa∣ralytick, and grow impotent for generation.

Yet as to Affects of the Brain, and the Genus Nervosum, I very often prescribe this Drink for them.

For indeed in very many Cephalick Diseases and Infirmities, viz. in Head-aches, Giddiness, the Lethargy, Catarrhs, and the like, where with a full habit of Body, and a cold temperament, or

one that is not hot, and a watery Blood, there is a moist Brain with a sluggishness and dullness of the Animal Spirits, Coffee has often a very good effect, for being daily drank, it wonderfully clears and enlightens each part of the Soul, and disperses all the Clouds of every function. But on the contrary, those who being thin, and of a Bilious, or Melancholick temperament, have a sharp, or burnt Blood, a hot Brain, and the Animal Spirits too much stirr'd and restless, ought to forbear this Drink altogether, as be∣ing apt to pervert both the Spirits and humours in a greater measure, and to render them wholly unfit, and unable to perform any functions: For I have observ'd many, not having a sufficient plenty of Spirits, and being also subject to the Head-ach, Verti∣go, Palpitation of the Heart, and a trembling or numbness of the Limbs, who presently after drinking Coffee became worse as to those Affects, and suddenly found an unusual Languor in their whole Body.