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. VII. Instructions and Prescripts for the Cure of the Asthma.

AN Asthma is a difficult, short, thick, and pursy Breathing, with a great Agitation of the Brest, and for the most part without a Feaver: And its either meerly Pneumonick, proceed∣ing from some stoppage in the Vessels that convey the Air, or meerly Convulsive, arising from some fault in the Organs of mo∣tion, or mixt when both parts are joyntly faulty.

As to its Cure there are two Primary Indications, or rather so many distinct methods of proceeding, viz. the one Curatory, the other Preservatory: The First teaches what is to be done in the Fit, to free the Patient from present danger; the other what out of the Fit, to take away the Cause of the Disease.

1. In the Fit there are two chief Intentions of Curing, viz. First, That care being taken as well of the Air, as of the Lungs, a more free Breathing be procur'd, at least as much as may suf∣fice to support Life: And Secondly, That the Organs of Respi∣ration be reclaim'd and made to cease from the Convulsions they are fallen into, and which are wont to be continued with obstinacy.

As to the former, in the First place let the Patient be set in an upright Posture of Body, in a pretty open place somewhat Airy, and free from Smoak, and the Breath of By-standers; then endeavour that the Lungs being freed of all inward stuffing and oppression, as well as outward compression, may be able to draw and return the Breath deeper: For these ends, lest the weight of the inferiour Viscera press down, and straiten the Praecordia, let the Belly be loosen'd by a Glister, and let the Garments and all other things covering or binding the Thorax be slacken'd. More∣over since in this case the Lungs are usually opprest, either from the Blood growing too turgid within the Pneumonick Vessels, or from the Serum distilling forth of the Arteries and Glands into the Ductus's of the Trachea, the Sallies and Impetuosities of both humours ought to be restrain'd and appeas'd: Hence if the strength will bear it, and the Pulse be strong enough, Bleeding is often proper. Again let those things be carefully given, which

discharge the Serum, and the superfluities of the inflamed Blood by Urine and Sweat: For which end Julapes, Apozems, and Pecto∣rals, commonly so call'd, are of excellent use. Moreover Pow∣ders of shells, preparations of Millepedes, Volatile Spirits and Salts are taken with good effect. In the mean time let there be like∣wise given things that open the Ductus's of the Trachea, and make them slippery, and provoke expectoration; and such also if need be, as stop the Catarrh distilling on them; for which ends Linctus's, Lohoch's, Pectoral Decoctions, and Suffumigations are proper.

As to the other intent of Curing in Fits of the Asthma, viz. That the Organs of Respiration being reclaim'd from the Con∣vulsions they are fallen into, return calmly to their ordinary Fun∣ctions (unless this follows of its own accord, after that the tur∣bulent boiling of the Blood and Serum within the Lungs is ap∣peas'd:) We must use Anti-Convulsive and Anodine Remedies; for Medicines wont to be given in Hysterick passions, are also proper in a Convulsive Asthma.

The Spirit of Hartshorn, of Soot, and especially Spirit of Sal Ar∣moniack distill'd with Gum Ammoniacum; also the Tincture of Gum Ammoniacum, of Sulphur, Castoreum, Assa-foetida, the Syrup of Am∣moniacum, of Sulphur, Oxymel of Squills, and the like; which be∣ing of an ungrateful tast or smell, dissipate the Spirits as it were, and withdraw them from tumultuary Efforts, prove sometimes of notable use: But if the raging Spirits cannot be appeas'd by this means, we must come to Narcoticks, that some of them be∣ing destroyed, the rest may return into order. For Opiats some∣times are mighty beneficial, unless a stopping of the Lungs, and a great oppression of the Praecordia forbid their use: In horrible sits of this Disease, when other Medicines have availed nothing, I have often given Diacodium, nay Laudanum Tartariz'd with good success: Nevertheless these may not be taken without great cau∣tion; for Respiration which is difficult and clogg'd before, being hindred more, and that very much by them, they often put the Patient in danger of Life. Moreover to reclaim the Pnenmonick Spirits from their Convulsions; its good sometimes to put the Spirits to torture in some other part, for when some of them are any where tormented, all the rest for the most part, being in a concern at it, quit their disorderly motions. Wherefore Vesica∣tories, Cupping-glasses, Ligatures, and Painful Frictions give relief: Nay for this reason Vomits taken in the midst of the fit do good. I shall now set down certain Select Forms of Remedies appropri∣ated to each of those ends.

First therefore to restrain the Fluxions of the Blood and Se∣rum, and to discharge their superfluities, deriv'd from the Lungs, by Sweat and Urine; let the following things be pre∣scrib'd.

Take Leaves of ground Ivy eight Ounces, Rue, Penny-royal, and Dragons, of each two Ounces, Sal Prunella a Dram and a half, Srru∣pus Byzantinus, Syrup of red Poppies, of each an Ounce: Mix them, make a Julape; let three or four Ounces be taken thrice or oftner in a day.

Take Grass Roots three Ounces, Roots of Butchers-Broom two Oun∣ces, Candied Elecampane an Ounce and a half, Barley half an Ounce, Raisins of the Sun an Ounce: Boil them in three pounds of fountain water to two pounds, to the straining add of Sal Prunella a Dram and a half, sweeten it if it be needful, with a sufficient quantity of Syrupus Byzantinus, or of Syrup of Violets.

Take Tincture of Sulphur three Drams: The Dose is from six drops to ten at Night, and early in the Morning in a spoonful of the Syrup of the Juice of Ivy, or of Violets.

Take Feculae of Aron and Briony, of each a Dram and a half, Flow∣ers of Sulphur a Dram, Flowers of Benzoin half a Dram, Sugar Can∣dy half an Ounce, Licorice two Drams: Make a Powder to be taken to half a Dram, or two Scruples twice a day, with the foregoing Ju∣lape or Apozeme. Or,

Take of the foresaid Powder two Ounces, Honey or Oxymel what suffices: Make a Linctus, take at Night and early in the Morning, about half a spoonful, at other times take it with a stick of Lico∣rice.

Take Syrup of Hore-hound, and of Garlick, of each an Ounce and a half, Tincture of Saffron, and of Castoreum, of each two Drams: Mix them, take about a small spoonful in the fits.

Take Spirit of Sal Armoniack with Gum Ammoniacum three Drams, the Waters of Snails, and of Earth-worms, of each three Ounces, Sy∣rup of Horehound two Ounces: Mix them, take a spoonful once in four or five hours.

Take Powder of Hedg-mustard, or of ground Ivy gathered in the Summer Sun an Ounce, Oxymel simple what suffices: Make a Linctus.

So much concerning the Medicines and method requisite in a fit of the Asthma. The other Indication which is for preservati∣on, undertaking to remove the Morbifick cause, and the whole Morbid Root has two parts, or distinct Intents of Curing, which for the most part are both set upon together; one of these en∣deavours to amend the Conformation of the Lungs, if it be any way prejudiced or faulty, and the other to take away the Irre∣gularities of the parts for motion, and of the Spirits appointed

for them: Both these Intents will very well be answered, if Pe∣ctoral Remedies commonly so call'd are joyn'd with Anti-Con∣vulsives, and are us'd interchangeably with other Medicines which have regard to the preparation of the whole Body, and to Emer∣gent Symptoms; for which ends the following Method and Forms of Medicines may be us'd.

Take Aloe Rosata a Dram and a half, Flowers of Sulphur a Dram; Salt of Amber half a Dram, Tar what suffices: Make Pills, in number twenty four; take four in the Evening every Night, or every other, or third Night. Or,

Take Gum Ammoniacum, and Bdellium dissolv'd in Vinegar of Squills, of each half an Ounce, Flowers of Sulphur three Drams, Powder of the Leaves of Hedg-mustard, and of Savory, of each half a Dram, with a sufficient quantity of Syrup of Diasidphur, or of Oxy∣mel of Squills: Make a Mass, form it into little Pills, and take three every Evening. Or,

Take Millepedes prepar'd two Drams, Flowers of Benzoin half a Dram, Salt of Amber two Scruples, Extract of Elecampane half a Dram, Castoreum half a Dram, Saffron a Scruple, Venice Turpentine what suf∣fices: Make a Mass, and form it into small Pills; take four every Evening and Morning, unless when you Purge.

If Pills are not grateful, or the foresaid Medicines will not do; then let the following be try'd to free the Lungs from obstru∣ction.

Take Spirit of Gum Ammoniacum, distill'd with Sal Armoniack three Drams, Syrup of the Juice of Ivy three Ounces, Magisterial wa∣ter of Snails, and of Earth-worms, of each an Ounce, Tincture of Saf∣fron two Drams: Mix them, take a spoonful going to Bed, and early in the Morning. Or,

Take Tincture of Gum Ammoniacum three Drams: The Dose is from fifteen Drops to twenty in a spoonful of Oxymel, or Syrup of ground Ivy. Or,

Take Tincture of Sulphur three Drams: The Dose is from seven Drops to twelve or twenty at the same hours, with a fit Ve∣hicle.

After the like manner also other Spirits endow'd with a Vola∣tile Salt, and mixt with Pectoral Syrups, and Cephalick waters may be usefully prescrib'd Morning and Evening.

Instead of a Mixture or Asthmatical Julape of distill'd waters of the shops, the following Magisterial may be prepar'd to be us'd frequently, and upon several occasions.

Take Roots of Elecampane, Florentine Orris, Angelica, Masterwort, of each four Ounces, of Briony a pound, Leaves of white Horehound, Hyssop, Savory, Penny-royal, ground Ivy, of each four handfuls, fresh Juniper and Ivy Berries, of each a pound, Lawrel Berries half a

pound, Seeds of sweet Fennel, Caraway, Annise, Lovage, Dill, of each an Ounce, Cubebs two Ounces, long Pepper, Cloves, Mace, of each an Ounce; all of them being slic'd and bruis'd, pour to them of Brunswick Beer eight pounds; distill them with common Organs: Let the whole Liquor be mixt, and when its used, let it be sweeten'd at pleasure with Sugar, or the Syrup of the Juice of ground Ivy, or with Oxy∣mel.

Moreover, instead of Oxymel, or of any common Pectoral Syrup, let the following Forms of Medicines be prescrib'd which are more appropriated to an Asthma: And in the First place the Syrup of Elecampane, invented by Horatius Augenius, and afterwards re∣commended by Platerus, Sennertus, Riverius, and other famous Practitioners shall be set down here, and ought to be frequently made use of.

Take Roots of Elecampane, and of Polypody of the Oak prepar'd, of each two Ounces, Currans two Ounces, Sebestens in number fifteen; Coltsfoot, Lungwort, Calaminth, Savory, of each a handful, one large Tobacco Leaf, Licorice two Drams, Seeds of Nettles, and of Cotton∣plant, of each a Dram and a half; boil them in Wine and Honey diluted, to a pound and a half, and with the like quantity of Sugar make a Syrup: Let it be taken either by it self in the Form of a Linctus, or a spoon∣ful at a time Mornings and Evenings, or put a spoonful of it to a Dose of the distill'd water or Apozeme.

Take Roots of Florentine Orris, and of Elecampane, of each half an Ounce, Garlick pill'd four Drams, Cloves two Drams, white Benzoin a Dram and a half, Saffron a Scruple, being slic'd and bruis'd, let them digest warm in a pound of rectified spirit of Wine for twenty eight hours: To the straining add of the finest Sugar a pound, put it in a silver Bason on hot Coles, then the liquor being fired, keep stirring it as long as it will burn, and then the flame going out, it will become a Syrup; let it be given after the same manner as the former.

Moreover, in this place we may aptly insert the Decoctions of an old Cock so much commended by famous Physicians, both ancient and modern, for the Cure of the Asthma. These Broaths are of two kinds, viz. with or without Purgers, and we find various and differing sorts of both amongst Practical Authors, though I shall only give you a form or two.

Without Purgers this is a common Form:

Take Roots of Elecampane, and of Florentine Orris, of each half an Ounce, Leaves of Hyssop, and of Horehound dry'd, of each six Drams, Carthamus-seeds an Ounce, Anniseeds and Dillseeds, of each two Drams, Licorice slic'd, and Raisins cleans'd, of each three Drams; let them be prepar'd and sewed up in the Belly of an old Cock, which must be boil'd in fifteen pounds of fountain water till the flesh falls from the Bones, strain it and let it settle: The Dose of the clear Liquor is

six Ounces, with an Ounce of Oxymel simple; or if you would have it purge, in each draught dissolve fresh Cassia and Manna, of each half an Ounce: Let it be taken for many days together, sometimes for a whole Month.

Riverius prescribes a good Form of this sort of Purging Broath.

Take Roots of Elecampane, and of Florentine Orris, of each a Dram and a half, Leaves of Hyssop and Coltsfoot, of each a handful, Li∣corice slic'd, Raisins clean'd, of each two Drams, Figs in number four, Senna cleans'd three Drams, Roots of Polypody of the Oak, Carthamus∣seeds of each half an Ounce, Anniseeds a Dram and a half: Boil them with a third or fourth part of an old Cock according to art, and make a Broath for one Dose to be taken in a Morning; let it be continued for twelve or fifteen days.

I shall now give you a Relation of a Person, who was subject to fits of this Disease, which were meerly Convulsive, and of an∣other, who was subject to fits of the same, which were partly Convulsive, and partly Pneumonick.

A Noble Man of a tall Stature, and full and strong grown, ha∣ving bruis'd is left Side by a fall, found himself injur'd upon it, and afterwards fell into an Asthmatick Distemper, so that now and then, though at no set times, First a pain would seize him about that place, and presently after a great straitness of Breath followed, with a vehement and long continued straining of all the parts of Respiration, so that during the Fit, the Patient seem'd to be in the very Agony of Death: I was first call'd to him after he had lain ill of such an Asthmatick Fit for two days, and was look'd upon as almost past Cure. Nevertheless finding his Lungs to be without hurt, our Prognostick bid us still hope well, and presently other Physicians being joyn'd with me in Consultation, it was prescrib'd as follows.

Take Spirit of Gum Ammoniacum distill'd with Sal Armoniack three Drams: Let him take from fifteen drops to twenty, in a spoon∣ful of the following Julape, drinking after it five spoonfuls; let it be repeated every sixth hour.

Take the waters of Elder Flowers, Cammomil and Penny-royal, of each four Ounces, Snail water two Ounces, Sugar an Ounce, mix them: Between whiles he took a Dose of the following Powder with the same Julape, or Pectoral Decoction.

Take Powder of Crabs Eyes two Drams, Sal Prunella a Dram and a half, Salt of Amber half a Dram, max them: Divide it into eight parts for as many Doses.

Large Vesicatories were apply'd in the inside of his Arms near his Armpits; Glisters were daily administred, and frequent Fricti∣ons: By the use of these things he received a sudden and unexpe∣cted

ease, and within a few days got wholly free of that Fit, and afterwards as often as he perceiv'd a little touch of the said Di∣stemper coming, he presently took a large Dose of that Spirit, with the same Julape thrice or four times a day: By which Re∣medy, being frequently taken sometimes for preservation, and sometimes for Cure, he has now past above two years without any great and terrible fit of his Asthma, which before was habi∣tual, though he has now and then undergone some light touches of it, but easily blown off.

An Honourable old Gentleman (upon taking cold as 'tis judg∣ed) found himself ill; for he complain'd of a pain in the middle of his Brest by his Sternum, which at Night as soon as he was warm in his Bed, growing worse, disturb'd his sleep, and was very troublesome to him for the most part of the Night: Never∣theless without any straintness of Breath, or evident sign of an Asthma: To take away this pain he was both Purg'd and Blood∣ed, Pectorals and Antiscorbuticks were daily given him, Oyntments and Fomentations were apply'd to the place pain'd, yet without any great good or ease: For the change that happen'd after, was rather for the worse; for the pain being a little abated, he was seiz'd with a laborious and troubled Respiration, so that after his first sleep, or as he began to slumber, he was taken with a fit of the Asthma, and being out of Breath, and opprest about the Praecordia, was forc'd to sit upright in his Bed: Moreover this painful Breathing, and Convulsive agitation of the parts for Re∣spiration did not only return every Night, but daily grew more violent, and continued longer upon him: Insomuch that one Night awaking from his first sleep, he was seiz'd with a most vi∣olent fit of the Asthma which lasted for many hours, and brought him as near death as a Man might be and live. No Physician be∣ing present, a Barber then let him Blood, which gave him some relief; in the Morning upon a consultation of Physicians, he was ordered for that day a thin Diet, and a loosning Glister: At Night and the Morning following, he took twelve drops of Spirit of Gum Ammoniacum distill'd with Sal Armoniack in a Vehicle proper in that case, and continued its use afterwards for many days: Vesicato∣ries were apply'd to the insides of his Arms near his Arm-pits: Moreover Julapes and Pectoral Decoctions, Lohoch's, Glisters, nay and sometimes gentle Purges had their truns; Bleeding also was repeated after two days. Whereas before he was wont to drink for his Mornings draught about a pint of Beer with Wormwood and Scru∣vygrass, Instead of this, he took about eight of the Clock, fifteen drops of Elixir Proprietatis tartariz'd in a draught of Coffee prepar'd with a Decoction of Sage: By these Remedies the Asthmatick Fits presently abated of their wonted fierceness; insomuch that the

beginning and end of every Night were quiet enough, though about the middle of it some uneasiness about the Praecordia kept him waking, and made him sit upright in his Bed for an hour or two; at length growing weary of Physick, he took only now and then some of the Medicines above mentioned: But in the mean time, though his Asthmatick Fits troubled him little or not at all by Night as before, yet by reason of his Lungs being very much stuffed, and a Serous humour falling into his Feet he could not walk fast, or go up any steep Ascent without a great diffi∣culty of Breathing, and danger of being choak'd; and at present an Asthma or Phthisick is not so much fear'd as a Dropsie.