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. V. Instructions and Prescripts for the Cure of an Empyema.

BY the word Empyema, according to its usual acceptation, is denoted a Collection of Pus, or corrupted matter within the Cavity of the Thorax, by which the Organs of Respiration are opprest: That Pus commonly flowing thither, either from a Pleurisie, or a Peripneumonia (and sometimes haply from a Squi∣nancy) suppurated and broken.

As to the Cure of an Empyema, we must in the First place con∣sider whether the signs of this Disease, as to the reality of its present Being, be certain or doubtful; if certain, there will not be much need of Physick, but only the Body being prepar'd, you may presently proceed to open the side. Therefore if after a Pleurisie or Peripneumonia not rightly Cur'd, or after an inward effusion of Blood occasion'd by a stroak, fall, or wound, there be perceiv'd a floating of Pus, or of corrupted or bloody matter within the Cavity of the Thorax, and this with little or no Spit∣ting, we need no longer think of Maturating or Expectorating Medicines; but the Belly being loosen'd, and the Blood and hu∣mours duly qualified by Julapes, Apozemes, and Anodines, either order a bare Incision; or in tender and timorous persons, First, let a Cautery be apply'd betwixt the sixth and seventh Vertebrae, and after the Eschar being rais'd, let the Incision Knife be entred obliquely towards the hinder and upper parts, and that leisurely, and by little and little, till it penetrate into the Cavity of the Thorax, and then a little silver Pipe being put in, let the matter within contain'd, be let forth some at one time, and some at an∣other, but so that as far as the strength will bear, the evacuation of the whole humour be as quick as may be; for a portion of it being left within, upon frequent admission of air to it, will stinch most horridly within a few days; to prevent which evil, or sudden∣ly

to remove it, let a vulnerary and adstersive Liquor be injected with a Syringe twice or thrice a day. After the Incision is duly perform'd with what else belongs to it, well known to skilful Chirurgions, there will not be much more left for a Physician to do: He must prescribe a proper Diet, frequent Glisters to loosen the Belly (as often as occasion requires) and likewise vulnerary Medicines commonly so call'd, which hinder the dissolution of the Blood, and its running into Serosities prejudicial to the Brest.

But if the Signs of this Disease are not certain, and (as it u∣sually happens when a Peripneumonia, or an Impostume of the Lungs precede it) are wholly doubtful, you must not proceed to an Incision too hastily or inconsiderately: For I have known some Spitting forth a purulent matter, nay a faetid Pus, to whom an Incision of the Thorax has prov'd of no good effect, and not without some prejudice. Therefore till it shall appear by infal∣lible Signs that it is an absolute Empyema you may use for a while expectorating Medicines (such as before prescrib'd for Curing a Peripneumonia) and also things gently moving an Eva∣cuation by Urine and Sweat: But these at length availing nothing and the Empyema still continuing or encreas'd (since it is better, so there be strength, to try a doubtful Remedy than none) you may proceed to the Incision.

As to Forms of Medicines requisite for Curing an Empyema; before the Incision the same Remedies are proper, which are pre∣scrib'd for a Peripneumonia, but the incision being over, the fol∣lowing will be of particular use.

Against Faintings and Swoonings, which happen during that Operation, or after it: Let the following Julape be al∣ways in a readiness to be taken now and then to four or five spoonfuls.

Take the Waters of Bawm, and of Black Cherries, of each six Ounces, Aqua Mirabilis an Ounce, Pearl powdred a Dram, Syrup of Clove Gilly-flowers an Ounce: Mingle them, make a Julape.

Let the following Decoction be taken three or four times a day.

TAke Leaves of Harts Tongue, Speedwel, Agrimony, Colts-foot, Mous-ear, Sanicle, of each a handful, Roots of Madder and Cher∣vil, of each an Ounce, Barley half an Ounce, red Ciches half an Ounce, Raisins of the Sun an Ounce and a half: Boil them in four pounds of fountain water till half be consum'd; when it is taken, let it be sweeten'd at pleasure with Clarified Honey, or with Syrup of Mous-ear. If there be no Feaver, let the following Pills be ta∣ken at Night, and early in the Morning, to a Scruple or half a Dram.

Take Powder of Crabs Eyes two Drams, Flowers of Sulphur a Dram, Sal Prunella half a Dram, Species of Diarrhodon Abbatis a Scruple, Ve∣nice Turpentine wash'd, what suffices: Make a Mass, and form it into Pills: or the Turpentine being omitted let the same Medicine be taken in the Form of a Powder, from half a Dram to two Scruples twice a day.