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 Curing the Tympany.

A Tympany may be thus defin'd, or at least describ'd, viz. that it is a fixt and continued tumour of the Abdomen, equal, hard, stiff, yielding a sound upon striking, taking its rise from a sort of Convulsive Inflation of the Membranous Parts and Viscera, by reason of the Animal Spirits being driven into those Fibres in too great a plenty, and there hindred from a Recess, through the fault of the Nervous Juice obstructing it: To which affect a gathering of Winds in the empty places is consequently added for compleating it.

That we may have timely notice of its beginning, we must understand that there are some previous affects which dispose to it, as especially a Hypochondriack, Colick, Hysterick, and some∣times an Asthmatick disposition: And if after frequent returns of Fits in any of these Distempers, a tumour of the Abdomen fol∣lows, though never so small at first, a Tympany is presently to be fear'd.

A Tympany seldom kills of it self, but after it has continued a long time, to make more sure work, it joyns to it self at length an Ascites as a forerunner of death.

In order to the Cure of a Tympany, as in most other Diseases, there are three primary Indications, whereof the first and always the most pressing being Curatory, endeavours to remove the tu∣mour of the Abdomen, by recalling the Animal Spirits from that Convulsive extention, and reducing them to order: The Second being preservatory, keeps those Spirits or others from inordinate excursions into the Nervous Fibres of the Belly, and at the same time corrects the faults of the Nervous Liquor accompanying them, as to its Crasis or Motion: The Third is Vital, and by removing the Symptoms that are most pressing, relives and up∣holds as much as may be all the functions that are opprest or weakned.

The First Indication is always of chiefest moment, the whole stress of the Cure consisting in it, but its very difficult to be per∣form'd: For it does not readily occur to us with what remedies or ways of Administration it ought to be attempted. Bleeding has no place here, but in a manner always is shun'd as hurtful; also Catharticks for as much as they irritate the affected Fibres,

and trouble the Spirits, and drive them more violently into those Fibres, do rather increase than diminish, or Cure the tumour of the Belly: So likewise Diaphoreticks force the Spirits together with the Morbifick Particles deeper into those Fibres, from which they ought to be summon'd forth and withdrawn. The chief means of Cure seems to be plac'd in the use of Diureticks and Glisters; and great things are likewise expected from Topicks, because they are apply'd more immediately, and by contact to the Disease it self, and because we see they excellently dissolve or discuss tumours in other places; but all dissolvents are not pro∣per here, even though in other tumours they are very Medicin∣able: For those that are hot, being accounted discussors, most commonly rather do hurt than good in a Tympany, whether they are us'd as a Fomentation, or Liniment, or apply'd in the Form of a Cataplasme or Plaister: For they both open and di∣late the Ductus's of the Fibres, so that they lye more open to the Inroads of the Spirits; and at the same time rarify the Parti∣cles sticking in them, so that they coming to occupy a greater space, the Inflation and Swelling of the Belly is augmented. Last∣ly as to Alteratives, even of those which do good against other affects of the Genus Nervosum, only some few are proper in a Tympany; for where the Morbifick matter sticking within the strait Ductus's cannot be driven forwards or quite through, Ela∣stick Medicines, by fastning the matter deeper, render the obstru∣ction still greater or more fixt: Wherefore the Spirits of Harts∣horn, Soot, Sal Armoniack, and so Tinctures, Elixirs and other Medicines endowed with a Volatile Salt, or Particles otherwise active, do not only cause a very troublesome heat and drought in persons troubled with a Tympany, but also make the Abdomen swell more, because they trouble the Spirits, and fuse the Blood and Nervous Juice, so that the Particles deposed by each of these are forc'd into the parts affected.

Nowwithstanding Physick can do so little against this Disease we must not cease to move every stone in order to Cure, or give ease to the Patient: Therefore in the First place (because it is the Custom to begin with Evacuatives) though strong Ca∣tharticks always do hurt, and the more gentle are scarce ever able to carry off the Conjunct Cause; yet these latter, for as much as they withdraw somewhat of that which feeds the Di∣sease, and prepare the way for other Medicines to exert their E∣nergies more freely, ought to have their turns in the Practice of Physick, viz. once in six or seven days; and at other times let Glisters (the use of which is much better) he frequently Admi∣nistred: Hydroticks being forbidden, let moderate Diureticks be diligently plyed, to which at the same time let such things be

joyn'd which regard the altering and reducing of the Spirits and Humours, which truly make up the chiefest part of Pharmacy for a Tympany: Moreover in the mean time let not the use of Topicks be neglected. We shall set down certain Select Forms of Medicines appropriated to each of these ends: For a Medicine gently loosening, use the Laxative Wine prescrib'd for a Tym∣pany by the famous Greg. Horstius in the Fourth Book of his Ob∣servations, Chap. 30. or instread of it, let the following be pre∣scrib'd in a shorter Form.

Take Flowers of Peaches, and of Damask Roses, of each two Pugils of Broom, Elder, and the lesser Centory, of each a Pugil, Leaves of Agrimony and Sea Wormwood, of each a handful, of the best Sena an Ounce, Rhubarb six Drams, Carthamus-seeds half an Ounce, of Dwarf-elder two Drams, yellow Saunders three Drams, Galingal Roots two Drams, being slic'd and bruis'd, sew them up in a Silken Bag, and put it in a Glass with two pounds of Whitewine, Saxifrage water a pound, Salt of Tartar a Dram and a half; let them stand for forty eight hours, then let the Patient begin to drink it, taking about four or six Ounces every third or fourth day.

In a hotter constitution let the following Form be given, which I have sometimes try'd with good success.

Take of Purging Mineral waters eight pounds, Salt of Wormwood two Drams, let it evaporate with a gentle Bath-heat to two pounds: To this I use to add of water distill'd from Purgers with Wine four Ounces: The Dose is from four Ounces to six.

Or to that Liquor evaporated to two pounds, add of the Roots of Mechoacan and Turbith, of each half an Ounce, Rhubarb six Drams, yellow Saunders two Drams, Cloves a Dram: Let there be a close and warm digestion for two hours filter it warm through lawn paper, the Dose is three or four Ounces.

Glisters are of frequent use in this Disease, because they loosen the Belly without any great irritation of the Fibres.

Take water of the Infusion of Stone-Horse-dung with Cammomile Flowers a pound, Honey of Herb Mercury two Ounces: After the same manner also let Decoctions or Infusions be prepar'd of Dogs-turd with Carminatives.

Take of the Emollient Decoction a pound, Sal Prunella, or Sal Armoniack, from a Dram to a Dram and a half: Make a Glister.

Take of the Ʋrine of a sound Man a pound, Sal Prunella a Dram, Ve∣nice Turpentine dissov'd with the Yolk of an Egg an Ounce and a half: Make a Glister.

2. Dinreticks, If any other Remedies, premise help in this Di∣sease.

Take live Millepedes cleans'd three Ounces, one Nutmeg slic'd, be∣ing bruis'd together, pour to them of the following Diuretick water a pound, express it strongly: The Dose is from three Ounces to four twice a day.

Take of the green Berries of Juniper and Elder of each six pounds, Firr tops four pounds, green Wallnuts two pounds, Winters Bark four Ounces, the outward Rinds of six Oranges and four Limons, the Seeds of Ameos, Rocket, and Water-cresses, of each an Ounce and a half, Dill-seeds two Ounces, being slic'd and bruis'd, pour to them of Whey made with Whitewine eight pounds, distil it with common Or∣gans: Let all the Liquor be mixt.

Take Crystal Mineral half an Ounce, Volatile Salt of Amber two Drams, Powder of wild Carrot-seeds a Dram, Venice Turpentine what suffices: Take small Pills, take three at Night, and in the Morning, drinking after it of the foresaid water three Ounces.

Take sweet Spirit of Salt half an Ounce, give from eight drops to twelve twice a day with a Draught of the same water, adding Syrup of Violets a spoonfull.

Take Spirit of Salt of Tartar an Ounce; give from a Scruple to half a Dram, twice a day after the same manner: So also Spirit of Nitre, and Tincture of Salt of Tartar may be given.

Take Leaves of Plantain, Chervil, and Clivers, of each four hand∣fuls, being bruis'd together, pour to them of the former distill'd wa∣ter a pound, express it strongly: The Dose is three Ounces twice or thrice a day with some other Medicine.

Take Grass Roots three Ounces, Roots of Butchers-broom two Oun∣ces, Chervil and Candied Eringo's, of each an Ounce, shavings of Hartshorn and Ivory, of each two Drams, burnt Hartshorn two Drams and a half, Burdock-seeds three Drams; boil them in three pounds of fountain water to two pounds: In the warm straining put Leaves of Clivers and Watercresses bruis'd, of each a handful, adding of Rhenish Wine six Ounces; let there be a close and warm Infu∣sion for two hours; then strain it again, and add of the Magisterial water of Earth-worms two Ounces, Syrup of the five Roots an Ounce and a half, make an Apozeme, the Dose is four Ounces twice a day, with some other Medicine.

Whilst these things are taken inwardly, let Topicks also, and outward applications be carefully Administred, not such as are hot and discussing, but such as are endow'd with Particles of a Volatile and Nitrous Salt, which destroy the combinations of the other Salts, and make void the efforts of the Spirits, for which ends we propose the following things: If Fomentations ought to be us'd at all, let them not be apply'd too hot, and let them not be prepar'd of the vulgarly call'd Carminatives, but chiefly of Salts and Minerals. Cabrotius (quoted by Helmont) says, he Cur'd a Person eighty years of Age, whose Belly he somented

twice a day with a Lixivium, in which he boil'd Salt, Allum, and Sulphur, and after apply'd Cow-dung, for a Cataplasm, I use to prescribe as follows.

Take Flowers of Sal Armoniack an Ounce, Crystal Mineral two Ounces, small Spirit of Wine containing much Phlegm in it two pounds: Mix them, and dissolve them in a Glass.

Let a Woolen Cloath dipp'd in this warm, be apply'd on the whole Abdomen, and be chang'd now and then, dipping it afresh: Let it be done twice a day for half an hours space, afterwards let there be apply'd either a Cataplasm of Cow-dung, with the Pow∣der of Dogs-turd, or the Plaister following.

Take Emplastrum Diasaponis, that is, of Minium with Venice Soap what suffices: Let it be thin spread on thin Leather, and apply'd to the whole Belly, renewing it within ten or twelve days.

The Second Indication requires chiefly altering Medicines, viz. such as put a stop to the Fermentations of the humours in the Viscera of the Belly, and to the wild Efforts, and irregular excur∣sions of the Spirits, and which likewise procure the even mix∣tures and due motions of the Chyle and Nervous Juice: For which ends Chalybeats are principally us'd; and truly not only for this Disease, but for many others belonging to the Viscera of the Belly, it's usual to have recourse to Steel Medicines, though in the mean time many Empyricks confidently prescribing them, do not consider after what manner such Medicines work, or what alterations for the better may be expected from them: And in∣deed it very often falls out, that nature her self is destroyed, and not the Disease, when Chalybeats, of which there is a great variety, and of diversified Operations, are given without any distinction or choice, or without respect to the Temperament, Constitution, and state of the Disease in Patients.

We have treated elsewhere ex professo concerning Medicines prepar'd of Iron and Steel, and of their vertues and manners of working; so that it's needless to repeat the same here: As to this Disease, if any of them are proper for it, certainly they are not all: For those in which the Sulphur still remains, and being free, predominates over the other principles after that the texture of the mixt Body is open'd, must be wholly excluded from this number; for by their powerful fermentation, they greatly fer∣ment the Juices of the Viscera, and put the Blood and Spirits in such a Commotion, that the whole Region of the Belly is puft up in a greater Bulk, as though some Spirit rush'd violently into it.

Nor are those more proper here, from which the Sulphureous Particles are wholly driven away with the Saline, as in Crocus Martis prepar'd by a very strong and long Calcination; for as this Medicine is good to stay all fluxions, so it sixes more

any Impactions of Spirits and humours, and renders them more obstinate.

But there remains a Martial Remedy of a middle kind, in which the Sulphur being wholly, or for the greatest part expell'd, the Vitriolick Salt remains, and has for the greatest part the Predo∣minancy, as it has in a Solution of the Filings of Iron, or in its Infusion either simple, or in Mineral waters, in Salt or Vitriol of Mars, in our preparation of Steel, with many others, preparations and compositions of which have been often found by experience to have done great good in some cases; for these destroy the Exotick, and restore the Genuine Ferments of the Viscera; open their Obstructions, fix the Blood, and keep its Texture from much dissolution: Wherefore Chalybeate Medicines, as also some other Alteratives have haply some effect against the Procatarctick and more remote Causes of a Tympany, but do little or no good at all against its Conjunct Cause.

Take of our Steel ground very fine two Drams, of the Distill'd water above written two Pounds, Syrup of the five Roots two Ounces, mix them in a Glass, and let it Clarifie by setling; the Dose is three or four Ounces in the Morning and at five in the Afternoon.

Take Powder of Aron Roots, and of Crabbs Eyes of each three Drams, Chrystal Mineral two Drams, Vitriol of Mars a Dram and a half, Sugar of Rosemary Flowers two Drams: Mix them, the Dose is half a Dram, twice a Day with a fit Vehicle.

Hartman highly extolls the Liquor of the Flowers of the Herb Mullein as a Specifick Remedy in this Disease: Put those Flowers fresh gather'd into an Alembick and press them in hard, then the Ves∣sell being carefully stopt that nothing can breath forth, let it stand in an Oven whilst bread is bak't, and afterwards the Flowers being taken forth press forth the Liquor very hard, and let it be Distill'd in Bal∣neo: The Dose is a Scruple in Decoction of the Seeds and Roots of Fennel. Certainly if this Medicine can do any thing, it ought to be given in a greater Dose.

Johannes Anglicus Commends the Electuary Rosata Novella with Diatrion Santalon and Ants Eggs; which Medicine truly being probable enough seems to promise something: In Imitation of these I shall here propose the following.

Take Conserve of the Flowers of Cichory and Indian Cress of each three Ounces, Powder of Aron Roots, Lignum Aloes, yellow Saunders of each a Dram, Crabbs Eyes a Dram and a half, Salt of Worm∣wood an Ounce, Ants Eggs an Ounce, Liguor of male Mullein half a Dram, with a sufficient quantity of Syrup of Citron Pills make an Electuary, the Dose is two Drams, twice a Day, Drinking after it of the former Distill'd water, or of the following Julape three Ounces.

Take water of the Leaves of Aron, of the Juice of Elderberryes, water of Juniper and of Elder Flowers of each six Ounces Magisteriall waters of Snails and of Earth-worms of each two Ounces, Syrup of the Juice of Elderberryes two Ounces, mix them, make a Julape.

The third Indication being vital Prescribes Remedies chiefly against Faintings of the Spirits, and difficulty of Breathing, and against Watching and Thirst: I shall briefly set down certain Forms of both kinds.

1. Cordials.

TAke water of Navews, of Marigold and Cammomill Flowers of each three Ounces: Dr. Stevens's water two Ounces, Tincture of Saffron two Drams, Sugar an Ounce. Pearl a Dram; make a Julape, the Dose is four or five Spoonfuls thrice or oftener in a Day in Faintings.

Take Conserve of Marigold Flowers two Ounces, Confection of Alkermes and of Hyacinth of each two Drams, Pearl Powdred an Ounces, of the Juice of Citrons what suffices; make a Confection, take the quantity of a Nutmeg Evening and Morning drinking after it a Draught of the Julape.

2. Hypnoticks.

TAke Aqua Hysterica six Drams, Syrup de Meconio half an Ounce; mix them, take it late at Night, Or,

Take small Cinnamon water an Ounce, Diacodium three Ounces, Tincture of Saffron two Drams, mix them, take to the quantity of a Spoonfull late at Night if Sleep be wanting. Or,

Take Syrup of Cowslip Flowers three Spoonfulls, Compound Peony water one Spoonfull, Laudanum Tartarizd a Dram, take a Spoonfull late at Night if you cannot Sleep.

Quenchers of Thirst must be frequently given in this most Thir∣sty Disease, but it must be in a very small quantity, that we may allay that most troublesom Symptom without much Drink, which is always pernicious: For which end,

Take Conserve of Wood-Sorrel passed through a Sieve three Ounces, Pulp of Tamarinds two Ounces, Sal Prunella a Dram, Syrup of the Juice of Wood-Sorrel what suffices, make a soft Lohoch of which let him lick often.