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. III. Instructions and Prescripts for Curing a Peripneu∣monia.

THe Peripneumonia is an Inflammation of the Lungs with an Acute Feaver, a Cough, and a difficulty of Breathing; it is caus'd by a rushing of the Blood into the Ductus's of the Lungs, and its being there inflam'd and obstructed.

The Primary Indication in order to the Cure of a Peripneu∣monia is, that the Blood forc'd into the Vessels of the Lungs, and causing there an Obstruction with an Inflammation, be thence discust, and restor'd to its former Circulation, which if it may not be done, the Second Indication will be, that that matter be duly Concocted or Suppurated, and with all expedition voided by Spittle.

1. Whilst the former Indication holds good, the Intentions of Curing will be these following: In the First place, That the excessive current of the Blood to the part affected be cut off, or some way hindred. Secondly, We must endeavour that the mat∣ter stagnating in the Lungs, or extravasated, be suck'd up again by the Veins into the rest of the Mass, and restor'd to its Circu∣lation: Which the better to effect. Thirdly, The Blood must be freed of its clamminess, or viscous nature, whereby its fluidity is hindred. And Fourthly, We must obviate by fit Remedies those Symptoms that are very pressing: viz. the Feaver, Cough, Watch∣ings,

and difficulty of Breathing: But if notwithstanding all this, the other Indication must be pursued, we must add to the Re∣medies before mentioned, such as they commonly call Maturating and Expectorating Medicines.

1. To satisfy the First and Second Intentions together, Blood∣ing is requisite almost in every Peripneumonia, nay sometimes it ought to be often repeated: For the Vessels being emptied of Blood, they do not only withdraw the matter which maintains the Disease, but likewise drink up again what was forc'd into the part affected: Wherefore if the strength holds, and the Pulse be of a sufficient vigour, its good to bleed freely at the very begin∣ning, but otherwise you must do it in a moderate quantity, and repeat it now and then as occasion requires: In this Distemper the Vein should always be open'd with a large Orifice, and the Blood should not only Issue forth in a full stream, but its running should be continued; for otherwise if in the midst of bleeding, whilst the vitiated Blood flows forth, the Orifice be stop'd with the Finger, (as some are wont to do to prevent fainting) when its open'd again, a pretty good Blood will Issue forth next, the vitiated Blood, if any such be remaining, being fallen back, and not presently returning to the Orifice. Besides Bleeding, many other Remedies are here to be us'd, viz. such as repress the turgid motion of the Blood, and empty its Ductus's, whereby the Morbifick matter may be drank up again: Wherefore a very thin Diet is prescrib'd, consisting almost meerly of Barley and Oat-meats. And though Catharticks are wholly forbidden, be∣cause they strongly exagitate the Blood, and force it more violently into the part affected: Nevertheless Glysters ought to be daily Administred which gently ease the Belly, and draw the dreggy Excrements of the Blood downwards. Moreover qualifying Julapes and Apozemes, which allay the fervour of the Blood, and pleasant∣ly lead off its superfluous Serosities, and likewise gently open the passages of the Brest, are taken with good effect.

The Third Intention of Curing which has regard to the take∣ing away of the obstructing clamminess, or viscous nature of the Blood, it perform'd wholly by those Remedies which loosen its over-close Texture, and dissolve the Combinations of its Salts. And truly those Remedies which Reason and Analogy might di∣ctate in this respect, are us'd even at this time after a long expe∣perience: For Powders of Shells, the Tusk of a Boar, the Jaw∣bone or a Pike, and other things endow'd with an Alkalisate Salt; also Sal Prunella are prescrib'd by all Practitioners, both Ancient and modern. I have known Spirit of Sal Armoniack, and of Hartshorn, to have done great good in this Disease: And for the same Reason it is (viz. Because of the good effect of the

Volatile Salt) that an Infusion of Horse-dung, though a vulgar Remedy, has often given great relief.

Fourthly, As to the Symptoms and their Cures, a great many Remedies appropriated to these, are Coincident with the former: For the same Julapes and Apozemes which appease the fervour of the Blood, and also restore the Animal Spirits, are in most common use against the Feaver: To which also in respect of the Cough, and the diffculty of Breathing, temperate Pectorals are joyn'd: The greatest difficulty is, what must be given against want of sleep, it at any time the Person be very much molested by it: For Opiats adding to the prejudice of Respiration, which is under some stress from the beginning of this Disease, may scarce be taken with safety, nay sometimes they become pernici∣ous: Wherefore Laudanum's, and the stronger preparatious of Opium must be utterly avoided in a Peripneumonia; though in the mean time Anodines, and the more gentle Hypnoticks, as especially the Water and Syrup of red Poppies are not only al∣low'd, but accounted Specificks in this Disease, and in the Pleu∣risy: Moreover we may sometimes use Diacodiats so the strength holds, and the Pulse be strong, and in a good temper: For the pain of the Brest, if at any time it proves troublesome, its pro∣per to use sometimes Oyntments, Fomentations, and Cata∣plasms.

The Secondary Therapeutick Indication, whereof the Intenti∣ons are to Concoct, and to discharge by Spittle, the matter sticking in the Lungs, (since it cannot be discust, or drank up again) requires Medicines commonly call'd Maturatives and Ex∣pectoratives; but they must both be temperate, to wit, such as rather appease than exasperate the Thirst and Feaverish heat. We have given you before in the Chapter of the Cough, the kinds of these Medicines, which are properly call'd Pectorals. We shall now set down the choicest Prescripts, and most proper for this affect.

Prescripts of Medicines.

1.2. Medicines Conducing to the First and Second Intention, are prescrib'd according to the Forms following.

TAke Water of Ladies Thistle ten Ounces, of red Poppies three Oun∣ces, Syrup of the same an Ounce, Pearl prepar'd a Dram: Make a Julape, the Dose is six spoonfuls every fourth hour.

Take the Waters of Black-Cherries, Carduus Benedictus, and Baum, of each four Ounces, Powder of a Boars Tusk a Dram, Syrup of Violets ten Drams: Make a Julape, and take it after the same manner.

Take Grass Roots three Ounces, shavings of Ivory and Hartshorn, of each three Drams, Raisins ston'd an Ounce and a half, Licorice two Drams; boil them in three pounds of fountain water to two pounds, to the straining add Syrup of Violets an Ounce, Sal Prunella a Dram: Make an Apozeme, take to three or four Ounces thrice a day.

For the same Intention, viz. that the emptied Vessels may withdraw the matter maintaining the Disease, or may drink up again the Morbifick matter it self, a Purge also is prescrib'd by some: In the Practise of the Ancients, it was a thing in constant use after bleeding, to Order Preparatives and Purgers against this Disease, as well as against most others: And Chymists of late with a greater confidence give Vomits, and cry them up before all other Remedies in a Peripneumonia. Nay further, neglecting bleeding, or forbidding it, they lay the chief stress of their Cure in Antimonial Emeticks, though I know not whether any thing can be imagin'd more pernicious than that their rash proceeding. In rustick and robust Bodies sometimes this Medicine is given without harm, but in tender Constitutions it may be reckon'd little Inferiour to poyson: And as to purging, though it be not proper in the very beginning, but in a manner always does harm, yet the Morbifick matter ceasing to flow to the part, and the effer∣vescence of the Blood being appeas'd, you may empty the Body gently with a Purging Medicine.

Take Gereons Decoction of Sena four Ounces, Syrup of Roses Solu∣lutive and Ounce: Mix them, make a Potion.

Take the best Sena three Drams, whole Cassia, Tamarinds, of each half an Ounce, Coriander-seeds two Drams: Boil them in a suffi∣cient quantity of fountain water, to six Ounces; to the straining add Syrup of Violets an Ounce, Clarifie it with the White of an Egg, and give it.

Let not Purges be given always, nor ever in this Disease with∣out consideration, but Glysters must be given frequently, nay for the most part every day; but let them be only Lenitive and Emollient, so that they gently loosen the Belly without much stirring the Blood and Humours: For this end Milk, or Whey with brown Sugar, or Syrup of Violets often do well. Or,

Take the Leaves of both Mallows, Melilot, and Mercury, of each a handful, Linseed, and sweet Fennel-seeds, of each half an Ounce, sweet Prunes, in number six: Boil them in a sufficient quantity of fountain water to a pound, to which add Syrup of Violets an Ounce, Sugar ten Drams, Sal Prunella a Dram: Make a Glyster.

3. Medicines for the Third Intention, viz. For dissolving the clamminess of the Blood, are usually given in the Form of a Powder, Spirit, Draught, or Bolus according to the Forms fol∣lowing.

1. Powders.

TAke Crabs Eyes powdred two Drams, Sal Prunella a Dram and a half, Sugar of Pearl a Dram: Make a Powder, divide it into six parts, take one every sixth hour, with some proper Julape or Apozeme.

Take Powder of a Boars Tusk (or of the Jaw-bone of a Pike) Crabs Eyes, of each a Dram and a half, Flowers of Sal Armoniack, Powder of red Poppy Flowers, of each half a Dram: Mix them for four Doses.

2. Chymical Spirits and Liquors.

TAke Spirit of Sal Armoniack distill'd with Olibanum three Drams: The Dose is from twelve to fifteen, or twenty Drops thrice a Day.

Take Spirit of Ʋrine, or of Soot three Drams, give it after the same manner.

Take Spirit of sweet Nitre, viz. often Cohobated with Spirit of Wine three Drams: The Dose is from six drops to ten, after the same manner.

Take Spirit of Tartar half an Ounce: The Dose is from fifteen drops to twenty, or twenty five, with a fit Vehicle.

Take of the simple Mixture an Ounce: The Dose is from a Scruple to half a Dram after the same manner.

3. Draughts.

TAke Carduus water a pound, fresh Horse-dung three Ounces, dis∣solve it warm, and filter it: The Dose is three or four Ounces twice or thrice a day, adding Syrup of Violets, or of red Poppies half an Ounce.

Take Leaves of Dandelion two handfuls, being bruis'd, pour to them Water of Ladies Thistle half a pound, Treacle water half an Ounce: Wring it forth hard, to which add Powder of Crabs Eyes a Dram, take four or six spoonfuls thrice a day.

The Fourth Intention of Curing, having regard to the most urgent Symptoms, suggests to us various preparations of Medi∣cines. 1. In respect of the Feaver, the Julapes and Apozems be∣fore set down are proper. Moreover you must frequently use Sal Prunella. 2. For the Cough and difficulty of Breathing, Lin∣ctus's, Lohochs, and Decoctions, or Pectoral Julapes are given with success.

Take Syrup of Jujubes, of Maiden-hair, of each an Ounce and a half, Syrup of Violets an Ounce, Flowers of Nitre a Scruple: Make a Linctus to be taken now and then with a stick of Licorice.

Take Syrup of Dialthea an Ounce, Diacodium, Syrup of red Poppies, of each half an Ounce, Crabs Eyes finely powdred two Scruples: Make a Linctus to be taken as the other.

Take Syrup of Hyssop, of Licorice, of each an Ounce and a half, Powder of red Poppy Flowers a Scruple, Crabs Eyes a Dram, Lohoch de Pino six Drams: Mix them, make a Lohoch, of which take the quantity of a Nutmeg four times, or oftner in a day.

Take Roots of Grass, Chervil, Marsh-mallows, of each an Ounce, Figgs in number four, Jujubes, Sebestens, of each in number six, Rai∣sins of the Sun an Ounce, Licorice three Drams, Barley half an Ounce, boil them in three pounds of fountain water to two pounds: Strain it, the Dose is three or four Ounces.

Take Raisins ston'd an Ounce and a half, Filberts slic'd in number four, Licorice slic'd three Drams, Hyssop-water a pound and a half: Make a close and warm Infusion according to art for six hours, to the straining add Syrup of Althea an Ounce and a half: Make a Julape, the Dose is three or four spoonfuls often in a day, swallowing it down by little and little.

3. Against want of Sleep, Take of red Poppy water three Ounces, Syrup of the same six Drams, Plague water two Drams: Make a draught to be taken going to Bed.

It the Pulse be strong, and the strength holds, Take Cowslip water three Ounces, Syrup of Meconium half an Ounce: Mix it, and drink it going to Bed.

4. If the pain be pressing about the part affected, Take of the Oyntment of Marsh-mallows two Ounces, Oyl of sweet Almonds an Ounce and a half: Mix them for a Liniment to be apply'd with thin Lawn Paper.

Take Oyntment of Marsh-mallows, and the Pectoral Oyntment, of each an Ounce and a half, Oyl of Linseed fresh drawn a Dram, to which add of the Emplaister of Mucilages what suffices: Make a Plaister for the Region of the Brest, to be apply'd on the part affected.

Fifthly, For the last Intention of Curing, which answering the Secondary Indication prescribes ripening and expectorating Medi∣cines, the Forms following are proper.

Take Linseed Oyl fresh drawn three Ounces, Syrup of Violets two Ounces, Hyssop water half a pound: Mix them in a Glass, take two or three Ounces thrice a day, shaking the Glass first.

Take Olibanum powdred a Dram, put it in an Apple made hollow, and let it Roast in hot Embers: Let it be eaten going to Bed, and let the person do this three or four times.

Take Oyl of sweet Almonds fresh drawn, Syrup of Maiden-hair, of each an Ounce and a half, Sugar Candy two Drams: Bruise them in a Glass Mortar, till they are throughly mixt: Make a Linctus, and take of it often with a stick of Licorice. Take also a spoonful of it thrice a day, in a draught of Posset-drink.

As to the rest, the Remedies prescrib'd in a beginning Phthisick are good also here.

I shall now give you an example or two of Persons affected with a Peripneumonia: Whilst I was writing these things, I was call'd to one very ill of a Peripneumonia: This Person being a∣bout Fifty Years of Age, of a lean Body, and a Bilious tempera∣ment; upon taking Cold fell into a Feaver with a Cough, a pain in his Brest, and a difficulty of Breathing: Having so lain ill four days without any Remedy or Physical Administration; I found him in a high Feaver with a Thirst, and mighty Inflamma∣tion of his Praecordia, and fetching Breath with great Pain and difficulty, his Thorax much labouring, and being troubled with a wheezing in the Wind-pipe, so that he seem'd manifestly in the very Agony of Death: His Pulse, though quick and troubled, yet being strong enough, I presently ordered eight or ten Ounces of Blood to be taken from him: By which finding some ease, after three hours intermission, a Glyster being first Administred, I or∣dered him to Bleed again to twelve Ounces. Moreover, I di∣rected him to take twelve drops of Spirit of Hartshorn every sixth Hour with a proper Julape, and betwixt whiles, a Dose of the following Powder.

Take Powder of Crabs Eyes, and Sal Prunella, of each a Dram and a half, Pearl a Dram, Sugar Candy two Scruples: Make a Powder, divide it into eight parts.

He took also a Draught of a Pectoral Apozeme often at plea∣sure; by the use of these things, all the Symptoms began to a∣bate within three days, and the night following he sweated and

slept a little: The Day after he was Blooded again, and after∣wards the same Medicines being continued, he perfectly recove∣red within four or five days: The Blood taken from him was al∣ways in its surface viscous and ill coloured.

A Gentleman of a Sanguine Complexion, and a strong habit of Body after immoderate drinking of Wine, fell into a Feaver with a dangerous Peripneumonia; so that thirst and heat very much pressing him, and sitting upright always in his Bed, or in his Chair, and almost continually panting, he had very much a∣do to draw in Air enough to support Life: He being not able to lose much Blood at a time, I drew Blood twice or thrice from him one day after another, frequent Glysters were Administred. More∣over Apozemes, Julapes, also Spirit of Sal Armoniack, and Pow∣ders of Shells were given him by turns: Within four or five days the Feaver abated somewhat, and he began to breath better, and to take now and then short sleeps, though he complain'd still of a mighty heaviness upon his Breast, and an intolerable oppression of his Lungs. Wherefore bleeding being no longer safe, I ap∣ply'd large Vesicatories to his Arms and Legs: The Blisters in his Arms dry'd up in a short time; but those on his Legs did not only continue open, but ran mightily after five or six days, and so for near a Month daily discharg'd a vast quantity of a most sharp humour: In the mean time his Lungs grew better by little and little, and at length were wholly freed of their in∣cumberance. Lastly, The Blisters rais'd by the Vesicatories, could very hardly be throughly Cur'd, and not without frequent Purging.