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. IV. Instructions and Prescripts for the Cure of the Pleurisie.

THe Pleurisie is an Inflammation of the Pleura caus'd by a boiling Blood flowing into it through the Vertebral Arte∣ries, and there growing clammy, with a continual and acute Feaver, a pricking pain of the side, a Cough, and a difficulty of breathing.

When a Pleurisie commencing passes into a Peripneumonia; or an Empyema, or inclines to a Phthisick, there is a proper method of Cure particularly set down in each of those Diseases for it: But as to what concerns our present purpose, Three Indications present themselves for a primary and simple Pleurisie, viz. a Cura∣tory, Preservatory and Vital one.

The First Indication takes care that the Inflammation or Ob∣struction of the Blood in the Lungs be remov'd by all possible means as soon as may be: Wherefore in a Pleurisie let a Vein be open'd, and so the strength holds, and the Pulse be strong, let the Person bleed freely; and truly it is much better to take a large quantity of Blood at first, and every time after (as often as there is need to repeat it) than to Bleed often, and to draw a a little at a time; because a great many portions of the Blood grown clammy and degenerated into a viscous nature, are gathe∣red together about the part affected; which unless withdrawn from thence, upon a great emptying of the Vessels by a large emission of Blood, so that the greatest part of them flow forth, the bleeding will be frustrated of its desired affect: Its all one in which Arm the Vein be open'd, though its now common∣ly done on the side affected.

But if by reason of the weakness of the Pulse, and the failing of the Animal faculty, you ought neither to Bleed at First, nor to repeat it though the pain be very urgent; then Cupping-Glas∣ses with a Scarification being apply'd to the place griev'd, may very well supply its place. Moreover to take away the Inflam∣mation of the Pleura, besides an Evacuation of Blood by breath∣ing a Vein freely, or by Scarification, its Serous and other Ex∣crementitious humours must also be set upon, and be gently purg'd forth of its Mass, and from the Bowels by Siege, Urine, and Sweat Strong Purges are justly forbidden, because they

trouble the Blood, and force it farther into the Places affected; and Antimonial Vomits (though approved by some) are neither safe, nor grounded upon reason. Let Glysters be frequently, or rather daily Administred; nay and sometimes gentle Purges may be allow'd so the Feaver be not very great, qualifying Julapes and Decoctions, and things gently moving Sweat or Urine, such as before prescrib'd for the Peripneumonia, are also proper here. Let all hot things of a sharp or smart nature, whether they are Spices, or things containing a Vinous Spirit, be carefully a∣voided.

The Second Indication being for preservation, and directed a∣gainst the clamminess and effervescency of the Blood, prescribes those Medicines, which consisting of a Volatile, or Alkalisate Salt, destroy the Combinations entred into by the Acid, sixt, and other∣wise Morbifick Salts, with other more gross Particles: In which respect the Eyes and Claws of Crabs, the Tusk of a Boar, the Stone of Carps, the Jaw-bone of a Pike, the Bone in the Heart of a Stag, the Pisle of a Deer, Sal Prunella, Salt of Coral, the Vo∣latile Salt of Urine, or of Hartshorn, Powder of Goats Blood, Infusion of Horsedung, Spirit of Hartshorn, of Sal Armoniack, Spirit of Tartar, Mixtura Simplex, Bezoartick Mineral, Antimo∣ny Diaphoretick, Flowers of Sal Armoniack, are very famous Remedies in the Pleurisie.

The Third and Vital Indication, which takes care that the strength and Vital heat be preserv'd in their due Tone and State, during the Course of the Disease, prescribes principally a fit Diet, and likewise Cordial Remedies and Anodines, and things which seasonably afford Relief to other Symptoms, if haply they present: First, in a true Pleurisie you must order a most thin Diet, viz. consisting of meer Oat, and Barley-meats, and for ordinary drink, Ptisan or Posset-drink is more proper than Beer alone, though in a mignty thirst, this also may be allow'd in a moderate quantity. Moreover to quench thirst, Julapes, Apozemes and Emulsions may be taken at set times, to all which let Sal Prunella be added. Secondly, let only temperate Cordials be given, which may gent∣ly refresh the Animal Spirits, and not add to the Accension of the Blood which burns before too fiercely: For these intents the Waters of Ladies Thistle, Carduus Benedictus, Bawm, Borage, Cow∣slips, and Black-Cherries, are usually given with good success, to which the Powders of Pearl and Coral may be added. Thirdly, Anodines must be used both inwardly to procure sleep, if at any time it be very much wanted; as also outwardly to ease the pain of the side: The most usual things of the former kind are the di∣still'd water, Syrup, and Powder of the red Poppy, which are ac∣counted Specificks in the Pleurisie, as well as in the Peripneumo∣nia.

Moreover, when a very acute pain and watchings press ve∣ry much, we may give also Diacodiats: Against Pains, Oynt∣ments, Fomentations, Cataplasms, and sometimes the warm In∣wards of Animals newly kill'd, are proper to be applyed.

I shall now give you Select Forms of Medicines adapted to each of these Indications.

First, Therefore about the beginning of the Disease, to take a∣way the Inflammation, Julapes, Apozemes, Powders, Glysters, and gentle Purges are wont to be prescrib'd.

Take Water of Ladies Thistle eight Ounces, Water of red Poppies four Ounces, Syrup of the same an Ounce, Sal Prunella a Dram: Make a Julape, the Dose is two or three Ounces every third hour.

Take Grass Roots four Ounces, Barley half an Ounce, parings of Apples a handful, Raisins of the Sun an Ounce, Licorice two Ounces; boil them in three pounds of fountain water to two pounds: To the cleer straining add Syrup of Violets an Ounce and a half, Sal Pru∣nella a Dram and a half: Make an Apozeme, the Dose is two or three Ounces often in a day.

Take Sal Prunella two Drams, Flowers of Nitre a Dram, Powder of the Flowers of red Poppies two Scruples, Sugar Candy four Scruples: Make a Powder, the Dose is half a Dram, three or four times a day.

Take of the Decoction of Mallows Roots and all, together with sweet Prunes a pound, Syrup of Violets three Ounces, Sal Prunella a Dram: Make a Glyster.

Take of whole Cassia bruis'd two Ounces, Tamarinds an Ounce, white Rose Flowers a handful, Coriander-seeds two Drams; boil them in a sufficient quantity of fountain water to a pound: To the straining add Syrup of Cichory with Rhubarb two Drams: Clarify it with the White of an Egg, the Dose is five or six Ounces in the Morning, for two or three days one after the other.

Secondly, To dissolve the clamminess or coagulating Viscous∣ness of the Blood, the following things are of use, viz. in the Form of a Drink, Powder, and Spirit.

Take fresh Horsedung four Ounces, Carduus water a pound and a half; make a close and warm Infusion for two hours, then filter the Liquor, to which add Syrup of the Juice of Dandelion, or of Cichory two Ounces, Spirit of Sal Armoniack a Dram, give five or six spoon∣fuls three or four times a day

For this end Water of Horsedung does admirably well.

Take Horsedung four pounds, Leaves of Carduus Benedictus, Ladies Thistle, Scabious, Pimpernel, of each three handfuls; being slic'd and mixt together, pour to them of fresh Milk six pounds, distil them

with common Organs: The Dose is two or three Ounces, either alone, or with other distill'd Waters in the Form of a Julape.

For the same use the Tinctures or Solutions of other Dungs are given by some Physicians, and are highly magnifyed by them. Helmont deservedly commends in the Pleurisie the Dung of an Ox, Panarolus Pidgeons Dung, others the White of Hens Dung: Epipha∣nius Ferdinandus usually gave with good success in the Pleurisy, the Decoction of Tobacco macerated in new Wine. Valeriola used the Decoction of the Flowers of red Poppies, as a try'd and familiar Re∣medy. Sylvius prescribes the following mixture to be taken one spoonful after another, by little Intervals of time.

Take the waters of Stone-Parsly and Hyssop, of each two Ounces, Fennel-water an Ounce, simple Treacle water half an Ounce, Lauda∣num Opiatum four Grains, Sal Armoniack half a Dram Syrup of red Poppies an Ounce: Mix them.

To this composition, Frederick Deckers adds Powder of Crabs Eyes, and Bezoartick Mineral of each a Scruple.

Medicines very efficacious for this use, are wont to be given in the Form of a Powder; for Example,

Take Powder of Crabs Eyes two Drams, Sal Prunella a Dram and a half, red Poppy Flowers half a Dram: Mix them, make a Powder, the Dose is half a Dram, three or four times in a day, with a fit Ve∣hicle.

Instead of Crabs Eyes, you may use the Powder of the Jaw-bone of a Pike, or of a Boars Tusk, or of a Stags or Bulls Pisle, and if these do not succeed, you may try what follows.

Take Antimony Diaphoretick, or its Ceruse, or Bezoartick Mineral two Drams, Volatile Salt of Hartshorn half a Dram, Powder of red Poppy Flowers two Scruples: Make a Powder, the Dose is a Scruple or half a Dram, thrice or oftner in a day.

It is for the same Intention of Curing, that Riverius gives Powder of Chimney Soot, from half a Dram to a Dram, and that others give the Powder of Pigeons or Hens Dung. Nay farther, according to this Analogy by which the Dungs of Animals stor'd with a Vola∣tile Salt give relief in this Disease; its probable that the Dung of a Dog may prove no less successful in Curing the Pleurisie than in the Squinancy; and so much the more likely, because these Disea∣ses often interchange their Types, and the one assumes the like∣ness of the other: Chymical Liquors endow'd with a Volatile Salt, sometimes also work great effects in the Pleurifie.

Take Spirit of Blood two Drams, Red Poppy water three Ounces, Syrup of the same an Ounce: Mix them; give a spoonful of it every other while.

Take Spirit of Sal Armoniack distill'd with Olibanum three Drams, the Dose is from twelve drops to fifteen or twenty, three or four times

a day in a fit Vehicle. After the same manner you may give Spirit of Ʋrine, of Soot, or of Hartshorn.

Take Spirit of Tartar three Drams: The Dose is a Scruple in a fit Vehicle.

Take Mixtura Simplex three Drams: The Dose is from a Scruple to half a Dram.

3. As to the Third Indication, besides a thin Diet, Cordial Re∣medies, and Anodines are prescrib'd: Forms of the former kind may be supply'd by the Julapes and Apozemes prescrib'd for the first Indication, and by the Spirits and Powders for the Second: In∣ward Anodines to be given in Watchings, and in a very Intense pain are prescrib'd according to the Forms following.

Take red Poppy water two Ounces, Syrup of the same six Drams, Spirit of Hartshorn twelve drops: Make a draught to be taken going to Bed.

If we must go higher, Take Carduus water two Ounces, Diacodi∣um from three Drams to half an Ounce, or six Drams, Spirit of Sal Armoniack with Frankincense half a Scruple: Make a draught. Some∣times, though rarely, its necessary to rise to Laudanum's, which being seasonably given, have a mighty good effect, inasmuch as they procure Sleep, and move Sweat and Ʋrine.

Take water of Cowslip Flowers two Ounces, Laudanum Tartariz'd, from sixteen drops to twenty, Spirit of Blood half a Scruple, Syrup of Violets two Drams: Mingle them, make a draught.

Outward Anodines are usually prescrib'd in the Form of an Oyntment, Fomentation, and Cataplasm.

Take Oyntment of Marsh-Mallows two Ounces, Oyl of sweet Almonds an Ounce, Album Graecum two Drams: Mix them by braying them together.

Take of the Emplaister of Mucilages two Ounces and a half; Malax it with Oyl of Linseed, and let it be apply'd upon Lawn Paper.

Take the tops of Both Malbows, Leaves of Mercury and Beets, of each three handfuls: Boil them in a sufficient quantity of fountain water; let the straining be us'd for a Fomentation.

Take the remaining faeces of the Herbs, after the Liquor is wrung forth, and being bruis'd, add to it of Oat-meal six Drams, Linseed, Fenugreek-seeds, of each two Ounces, Oyntment of Marsh-Mallows two Ounces: Make a Cataplasm.

I need not go far for Stories and Instances of persons troubled with the Pleurisie; for I have a notable Example of this Disease now under Cure, viz. a very fine young Woman, subject most frequently, and as it were habitually to that affect, is committed to our care. This Virgin, who is very fair, of a Sanguine Com∣plexion,

but of a weakly Constitution, has been wont for many years past upon every slight occasion, viz. upon taking Cold, or by errours in any of the six nonnatural things, nay sometimes upon the meer change of the Season, or of the Air, to fall into a Feaver, presently accompanied with pains of the Pleura, a Cough, and a difficulty of Breathing, and for the most part horrible Convulsi∣ons following them. She has been taken so very ill formerly of this Distemper, that she has been often forc'd to keep her Cham∣ber six Months or more every year; but of late, though she be not freed from this affliction, yet she is seldomer tormented with it: The last year she was pretty well all the Summer, and well near all the Autumn; about the beginning of Winter she fell sick of that Disease, and now towards the end of it, is fallen ill again. The Pleuritick pain constantly possesses the right side, where the Blood sticking, and being extravasated in its passage about the Intercostal Muscles, the Irritated Fibres commence a most tor∣menting pain, together with a Convulsive motion of Coughing which they reiterate almost perpetually: In the mean time the Lungs being found enough, and open in their passages, readily con∣vey the Blood, as clammy as it is, without any lett or stay, which often is the cause of a Peripneumonia. No Remedies are wont to do good to this person without Bleeding, which is always so particularly necessary, that every time she is ill, we are forc'd even whether we will or no, to repeat it two or three times, nay some∣times oftner: The Blood emitted has constantly a Viscous and whitish Film on its surface. This Disease was always a simple Pleurisie without any Peripneumonia, and for its Cure she con∣stantly us'd the following method with success.

Take Spirit of Sal Armoniack with Gum Ammoniacum three Drams, give from fifteen drops to twenty thrice a day, with the follow∣ing Julape.

Take Carduus water, Black-Cherry water, of each six Ounces, Hyste∣rick water a Dram, Sugar six Drams: Betwixt whiles she took a Dose of Powder with three Ounces of an Apozeme.

Take the Powders of Crabs Eyes, of a Bores Tusk, of Sal Pru∣nella, of each a Dram: Make a Powder, divide it into six parts.

Take Grass Roots three Ounces, Candied Eringo's an Ounce, sha∣vings of Ivory and Hartshorn, of each two Drams, parings of Apples a handful, Raisins of the Sun an Ounce: Boil them in three pounds of fountain water to two pounds; add to the straining, Syrup of Violets an Ounce, Sal Prunella a Dram: Mix them, make an A∣pozeme.

Glisters of Milk with Syrup of Violets were administred some∣times every day, and sometimes every other day; if at any time Opï∣ats, though never so gentle, were given her to allay pain, commonly afterwards an aking and heaviness of the Head, and Convulsive Affects most sorely tormented her.