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. VIII. Instructions and Prescripts for Curing the Dropsie of the Breast.

IF at any time the affect of the Dropsie or Anasarca, being ge∣neral, has taken possession every where, or in most places of the Flesh, and Cavities of the Viscera: Its no wonder if that filthy Mass of Waters gets possession also of the Breast; but besides this, it sometimes happens that the Region of the Thorax is either o∣riginally or alone overwhelm'd with waters, the other parts in the mean time being every where sound enough, or injur'd only Secondarily.

That Serous humour causing the Dropsie of the Breast, arises there either in the Form of a Vapour, which exhaling from the Praecordia and Sides of the Thorax is readily condens'd into Water, or Secondly, the Serum is there depos'd in its proper Form as it distils into that Cavity from the Mouths of the Vessels, viz. of the Arteries there open'd: Or Thirdly, the Lymphaeducts, or some∣times, though rarely, the Chyle Vessels, somewhere opening themselves, or being broken may produce that affect.

A young Man of a healthy and strong constitution, who had long us'd himself to violent exercises, both by riding and other ways, perceiv'd at length a fulness, or as it were a certain windy rising in his Thorax, insomuch that the left side of his Lungs seem'd to swell, and his Heart to be thrust forth of its place to∣wards the right side; for in that part it was perceiv'd to beat most: After he had continued in this condition some time, he perciv'd on a certain day a Rupture as it were of some Vessel

within the Cavity of his Thorax, and after it for half an hours space, he could not only perceive in that Region a dropping of humour as it were from the top to the bottom of his Brest, but it could also be head by the standers by. Notwithstanding this, finding himself otherwise well dispos'd, he slighted Physick; but afterward upon motion, stooping, or any stirring of his Body, he perceiv'd in his left side a floating of waters inwardly gathered together: Nay, and the motion and sound of it was most mani∣festly perceiv'd of others, both by handling, and by the ear: Hence as it was plain that this Person had a Dropsie of the Breast, so it seemed most probable that this Disease took its rise from this, that the Lymphaeducts appertaining to the left side of the Lungs being first obstructed near their Insertions into the Du∣ctus Chyliferus, had swollen up to a vast bigness, and afterwards being broken, distill'd forth their humour into the Cavity of the Thorax.

This Gentleman not perceiving himself in danger, and having try'd some Medicines without any good effect, was advised upon a consultation of Physicians, to have his Side open'd: Wherefore provision for the whole being made, a Chyrurgion apply'd a Cautery betwixt the sixth and seventh Vertebrae, and the day following he put a Pipe into the Orifice, cut into the Cavity of his Brest, up∣on which presently a thick Liquor, whitish like Chyle, and as it were Milky issued forth: There were only about six Ounces ta∣ken from him the first time, and the day following as much: On the third day somewhat a larger quantity being let forth, he was presently seiz'd with a great fainting, and afterwards being Feaverish, he was ill for a day or two: Wherefore till he recove∣red his due temper and strength, it was thought fit to stop the egress of that matter, and afterwards a small evacuation only of the same being daily made, the Cavity of his Brest was in a man∣ner wholly emptied, though he still carries the Pipe in the Ori∣fice with a Tap, which being drawn forth once in twenty four hours, a little gleeting of humour still issues out: In the mean time being well dispos'd as to his Stomack, Countenance and Strength, he Walks and Rides abroad, and performs other exer∣cises which he had been formerly us'd to with vigour enough: He us'd not much Physick, nor did he need it: After the Incision we prescrib'd him temperate Cordials, viz. Powder of Pearl, Julapes, and sometimes Hypnoticks, and afterwards a vulnerary Decoction to be taken twice every day.

By this Method and Form of Medicines continued for some time the Person seem'd to recover his due temper, strength, and habit of Body, nay and to be sound in his Breast; yet he still car∣ried the Silver Pipe in the Orifice of his Side, out of which an

Ichor continually issued: And when after some Months this being taken forth, that Issue was clos'd up, there was a gathering again of the same humour within the hollow of the Breast, as was per∣ceivable by the sound and floating of it: But afterwards as upon the return of the Disease the same Remedy presented it self, and consequently the opening of the Side was ordered (Nature as it fell out performing the Office of a Chyrurgion) it happened of its own accord, and gave way for the matter which was ready to break forth; and now he is fain to keep that Orifice constant∣ly open as a sink to prevent that gathering of nastiness in his Brest.

As to the Cure of the Dropsie of the Brest, the Primary Indi∣cations, as usually in Curing most other Diseases, are three, viz. Curatory, Preservatory, and Vital.

The First endeavours that the Waters gathered in the Cavity of the Breast be some way or other evacuated. The Second pre∣vents the gathering of new matter. The Third takes care to restore strength, and speedily to remove the Symptoms that in∣jure it.

To satisfy the First Indication, there are only two ways or manners of evacuation, by which that filthy Mass of Waters may be clear'd forth, viz. either that the Vessels of the Breast, and Du∣ctus's of the humours being emptied, drink up again that Lympha when Rarifyed, and then convy it forth, either by the way of the Blood, or of the Breath: or Secondly that the water be all let forth in its proper Species by an Incision of the Side.

The former way, though seldom, yet sometimes to my know∣ledge succeeds: For the Texture of the Lungs being spongy with∣in, and outwardly very Porous, whilst upon every Diastole it is dip'd in the waters lying under it, it sometimes imbibes them being converted into vapour, and so either returns them to the Blood, or exhales them with the Air continually breath'd forth at the Mough; that this effect may more readily happen for Cu∣ring this Disease, Physical Aids are here us'd: Therefore for that intent the passates of the Blood, Air, and humours, ought to be emptied as much as may be, and to be kept open and free: For this end let gentle Purges, Diureticks and Diaphoreticks be methodically given by turns, also Thoracical and Expectorating Remedies must be us'd: Let the Diet be thin and heating, and let such a method be ordered in all things which may promote the exhalation of the Blood, and cause all the superfluous humours to evaporate. I shall set down some Forms of Medicines pro∣per for these purposes.

Take Roots of Chervil, Butchers-broom, Polypody of the Oak, of each an Ounce, Leaves of Agrimony, Maiden-hair, Oak of Hierusa∣lem, ground Ivy, of each a handful, Carthamus-seeds an Ounce, Roots of Florentine Orris half an Ounce: Boil them in four pounds of foun∣tain water till a third part be consum'd, then add to the straining Sena Leaves an Ounce and a half, Agarick two Drams, Mechoacan, Turbith, of each half an Ounce, yellow Saunders a Dram and a half, Roots of the lesser Galingal a Dram: Boil them close cover'd for two hours, then strain it, add of the best Honey two Ounces, and Cla∣rify it with the white of an Egg: Make a Purging Hydromel, the Dose is from six Ounces to eight in the Morning, twice or thrice a Week. Or,

Take Calamelanos a Scruple, Rosin of Jalap half a Scruple, Balsam of Peru what suffices: Make four Pills, let them be taken in the Mor∣ning, repeating the Dose within five or six days.

Take Tincture of Sulphur three Drams, give from seven drops to ten going to Bed, and early in the Morning in a spoonful of the following Mixture, drinking after it three spoonfuls.

Take the waters of Snails, Earth-worms, and Compound Radish wa∣ter, of each four Ounces, water of the Juice of Elder-berries fermented a pound, Syrup of the Juice of ground Ivy two Ounces,: Mix them, make a Julape. Or,

Take Tincture of Gum Ammoniacum, or of Galbanum: Give to twenty drops at Night, and early in the Morning with the same Mixture. Or,

Take Millepedes prepar'd two Drams, Flowers of Sulphur two Scru∣ples, Flowers of Benzoin a Scruple, Powder of wild Carrot, and Bur∣dock-seeds, of each half a Dram, Venice Turpentine what suffices: Make a Mass, form it into little Pills, take four at Night and early in the Morning, drinking after it a little draught of the same Ju∣lape.

At nine a Clock in the Morning, and five in the Afternon drink a draught of the water of Quick-lime Compound, to four Ounces, by it self, or with some other appropriate Medicine.

For ordinary drink take the following Bochete.

Take Roots of Sarsaparilla six Ounces, China two Ounces, the Woods of white and yellow Saunders, of each six Drams, shavings of Ivory and Hartshorn, of each three Drams, Roots of Calamus Aro∣maticus half an Ounce, Raisins ston'd half a pound, Licorice three Drams: Let it infuse according to Art, and boil it in twelve pounds of fountain water to six pounds, strain it.

I was call'd to a young Scholar at Oxford, who had been ill for three Weeks of a pain of his Thorax, and of a great difficulty of Breathing that constantly followed him in the Even∣ing,

which also upon a quick motion of his Body, or his go∣ing up a steep Ascent tormented him above measure; he could not rest long on either side, but was forc'd to lye always on his Back, and with his Head raised: And if he try'd to lye on either side, presently a pain followed the Position of his Body; and if haply he rolled himself from one side to the other, the pain also being presently remov'd, he felt as it were wa∣ters floating from one place to another: So if he let his Bo∣dy hang downwards over the Bedside, he presently felt wa∣ters falling towards his Clavicular Bones. Moreover, if at any time his Body was heated more than ordinary by motion, the heat of a Bed, or of a Fire, presently he felt in his Brest a boiling as it were of waters on the Fire, and at the same time complained of a Giddiness, and of a little fainting of his Spirits. Being well satisfied by a due consideration of these things that he had a Dropsie of the Brest, I prescrib'd the Me∣thod and Medicines following with success.

Take Calamelanos fifteen Grains, Rosin of Jalap half a Scruple, Syrup of Roses solutive what suffices, make three Pills. He took them early in the Morning, and had twelve Stools, which gave him great ease. Then again on the third day he had only four Stools by the same Medicine, though with greater relief to him than before. He took afterwards for many days of a Diuretick and Pectoral Apozeme six Ounces: And Lastly, the same Purge being repeated, he grew perfectly ivell.