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 Curing the Anasarca.

AN Anasarca is describ'd after this manner, that it is a white and soft Tumour of the whole outward part of the Body, or of some parts of it, yielding to the Touch, and leaving a Pit up∣pon Compression, proceeding from an Aqueous Homour extra∣vasated and heapt together, both within the Interstices of the Muscles, and within the Pores of the Flesh and Skin, and even of the Glands and Membranes.

That watery Humour proceeds wholly or for the greatest part from the Blood, for being continually produc't within the Mass of Blood through the defect and fault of Sanguification, it is pour'd forth of the Mouths of the Arteries in a greater quantity than that it can be receiv'd and carried back by the Veins and Limphaeducts and be sent forth by the Reins and Pores of the Skin, and other Emissaries of the Serous Latex.

And Anasarca whilst it is simple, is the least dangerous amongst all the species of Dropsies: And a particular Anasarca oc∣cupying only the Inferior Members, so the Belly do not swell withal, is much safer than an Universal one.

In order to a right proceeding towards a Cure, two chief scopes of Curing here present themselves, viz. First we must take Care that the water betwixt the Skin and the Flesh be some way E∣vacuated and Consum'd; and Secondly that a new supply be not continually engendred and heapt together: For which end we must use what means we may both that the Viscera of Concoction being cleans'd from Excrements, and free from Obstructions, prepare always a good Chyle, and supply the Mass of Blood with it in a due quantity, and likewise that the Blood, (its Principles being restor'd to their fermenting Power) may duly ferment and convert into its own Nature the Juice of the Chyle continually sent into it. The Vital Indication seems not necessary in this Disease as in many others, because Faintings of the Spirits, or Watchings, for which Cardiacks, and Hypnoticks are required, seldom happen here: And there is little need of restoring Diets because Fasting and Abstinence do more good, and most com∣monly are the greatest part of the Cure; the reason is that the Vessels being drain'd by Fasting, drink up the waters Stagnating

betwixt the Skin and the Flesh, or elsewhere, and send them forth partly by the Reins, the Pores of the Skin, and other Emissaries, and partly employ them most Advantageously for nourishing the Body, they being yet full of a Nutritive Juice. First, to per∣form the first Indication which is for the Evacuation of the Mor∣bifick matter, all Hydragogue Medicines both Simple and Com∣pound, and likewise the Forms of Medicines set down before in the Chapter of the Ascites ought to be apply'd to use: Moreover not only Catharticks and Diureticks, but likewise Diaphoreticks have often place in the Cure of the Anasarca, though for the most part they are forbidden in other kinds of the Dropsie.

In a simple Anasarca you may Purge Strongly, and it often does much good.

I have given you before Forms of Hydragogue Catharticks of both kinds. viz. of such as exert their force both upwards and downwards, and both of a gentle and strong Operation; from whence you may take them, and apply them to the present Method of Curing.

If you ask how Catharticks work in this Disease, and where∣fore they carry forth waters better and more efficaciously than in other kinds of the Dropsie: I say that in an Anasarca the Morbifick matter (which is a Lympha) resieds partly in the Mass of Blood, and partly in the habit of the Body within the Pores and empty Spaces lying betwixt the Vessells: Wherefore a strong Cathartick being given, it presently Exagitates the Mass of Blood, fuses it, and moves it to an Excretion of any supersluous or he∣terogeneous thing: And at the same time irritates the Mouths of the Arteries which lye open towards the Cavityes of the Intestines, that the water cast out of the Blood may find a way forth ra∣ther by these Emissaries. Hence in the fust place the waters floating within the Mass of Blood are clear'd forth in a plen∣tifull manner, and then the Vessells being drain'd soon drink up the waters betwixt the Flesh and the Skin, and presently send them forth partly by seigh, and partly by Urine or Sweat: There is no fear in the mean time, lest, as in an Ascites, the Morbifick matter being Exagitated, and put in Fusion by the Medicine, be driven from the Blood into the places affected, whence it cannot easily get out again; or lest, as in a Tympany, the Vis∣cera by reason of the Fibres of the Ventricle and Intestines be∣ing too much irritated, are mov'd into Convulsive Extensions; for whilst the Viscera are sound, and in a good state, the Par∣ticles of the Medicament do them no hurt, but being car∣ryed thence into the Blood, do not only fetch waters from it, but by Exagitating its Mass, raise up its Active Particles be∣fore

opprest, and dispose them for recovering their power of Fermentation.

Secondly, I have also set down before the Hydragogues o∣perating by Urine, both simple and compound, and have given you Forms of Medicines prepar'd of both, and the ways of give∣ing them: Wherefore I shall not repeat them here: But be∣cause all Medicines of this kind do not good alike in all affects we must here observe that Lixivials (as I have often found by experience) far exceed the rest of Diureticks in Curing the Ana∣sarca. And now it's a much us'd and common Remedy for a∣ny one who has his Members swell'd, to Purge first, and then to take twice or thrice a Day six or eight Ounces of a Lixi∣vium made of White-wine with the Ashes of Wormwood or of Broom, and to continue its use for some Days: This Medicine as I have observ'd in many, powerfully provok's Urine, nay some∣times in such Abundance that the Patients within the space of twenty four hours making above a Gallon and a half of water, have presently recover'd almost to a miracle.

The reason why Medicines containing a fixt and lixivial Sal expell Urine more in an Anasarca than such as are endow'd with an Acid, or Alchalisate or Volatile Salt, is, that in this Disease the watery Homours which upon failing of the Fermentation of the Blood, and of its sanguifying Vertue, are gathered to∣gether as well within its Mass as in the habit of the Body, up∣on stagnating there some time are turn'd somewhat sharp: Where∣fore the Lixivial Particles of the Medicine entering the Blood presently grow in a heat with the Acids of the waters, which as they exagitate and ferment, they cause a mighty Fermentation in the whole Mass of the Blood and a following excretion.

Take of the Ashes of Broom, or of Wormwood, or of the Prunings of Vines calcin'd to a whiteness and sifted, four Ounces, put them in a Glass-bottle with two Pounds of White-wine; let there be a close and warm Digestion for three or four hours, then strain it, the Dose is from six Ounces to eight twice a Day.

Take white Tartar calcin'd with Nitre, and after melted in a crucible till it look blew, three Ounces, small Spirit of Wine a pound and half, water of Snails and Earth-worms, of each four Ounces, let them digest close luted in a sand-furnace for two Days, the Dose of the clear Liquor is two or three Ounces, with four Ounces of the Decoction of the Roots of Butchers Broom and Burdocks made in Ale.

For Ordinary Drink.

TAke white Ashes of Broom cleans'd two Pounds, put them in a Bag, with Raspings of Sassafras three Ounces, Roots of the lesser Galingal an Ounce, Juniper berryer and wild Carrot Seeds of each an Ounce and a half, make a Bag for four Gallons of Ase, after seven or eight Days begin to draw it.

Diaphoreticks often do excellently well in a Leucophlegmatia (which begins or concludes an Anasarca) and they usually a∣gree better in this Disease when confirm'd than in other kinds of the Dropsie: And though at the beginning they are not able to move Sweat because the habit of the Body is invested with a deal of waters, however by exagitating the Blood they are a means that the active Particles implanted in it, which were dull'd before, and almost overwhelm'd, are rais'd up again, and dispos'd to a Fermentation, and that all the dreggy Excre∣ments, especially such as are Aqueous, are put in Motion, so that presently breaking forth of their Receptacles in a plentiful man∣ner, they readily pass off by Seige, or Urin, and often in some measure by transpiration: But after that the waters being well clear'd by Purging, the Morbifick matter is so far diminisht that the bulk of the Body and the swelling of the Members begin to abate, the remainder of the Humour is excellently con∣sum'd by moderate Sweats, and by a constant perspiration.

We have given you before a List and Forms of Hydroticks; but as to our present purpose for the Cure of an Anasarca, those things are most proper which are given in somwhat a large Dose; for as to such as are prescrib'd in a small quantity, their active Particles being immerg'd in the waters are over∣whelm'd before they can be diffus'd in the Blood so as to exert their force; wherefore Spirits whether Armoniack, or Vinous, also Tinctures and Elixirs, nay and Powders, seldom come in use against this Disease; because in a small Dose they do little, and if it be made very large, they often offend the bowels by their excess in operation, therefore let those things rather be made choice of which being taken in a full Draught and warm may be able to pass the whole Blood uncorrupted, as chiefly the Decoctions of Woods and Roots, whose Particles agreeing well enough with the Blood, but being not to be mastered by it, pass through its whole Mass, and exert an Elastick force, putting all the Humours in a Commotion.

Take Raspings of Guaiacum six Ounces, Sassafras two Ounces, all

the Saunders of each six Drams, shavings of Ivory and Harts-horn of each three Drams, let them infuse according to Art, and boyl in eight Pounds of fountain water till half be consum'd, addïng Roots of Calamus Aromaticus, the lesser Galingal, Burdocks and Butter∣burr of each an Ounce, Leaves of Woodsage and Germander dryed of each two handfulls, let the straining be kept for use, the Dose is from eight Ounces to ten twice a Day warm; to each Dose may be added Spirit of Sal Armoniack succinated, or of Soot from twenty to twenty five Drops: Or Tincture of Salt of Tartar from half a Dram to a Dram.

So much of Hydragogue Medicines to be taken inwardly, which cause waters to be evacuated either by drawing them inwardly towards the Intestines, or by driving them out to the Reins, or to the Pores of the Skin: Moreover there are certain outward Administrations us'd, by which waters gather'd together within the habit of the Body are put in motion, and so dispos'd either generally to pass off by Sweat, or Urine, or particularly, are presently let forth, a Vent being made in some peculiar places.

In the first rank, we place Frictions, Liniments, Fomentations, Baths both dry and moist: And particular things to evacuate waters are Vesicatories, Escharoticks, and prickings by a Needle, I shall speak of each of these, or at least of the chief of them as far as they regard this Disease.

Frictions prove often of good effect in a Leucophlegmatia and an Anasarca: For as the habit of the Body is not only so charg'd with a Glut of filthy waters there heapt together, that nothing can breath through them, but even the outward parts grow cold upon the Blood's being hindred of an access to them, frequent and strong Frictions give a motion to the stagnating waters, and in some measure dissipate them from thence, and by opening the passages call again the Blood into those parts whence it was banisht, wherefore it is good not only to rubb the swollen Member, but even the whole Body once or twice a Day with a course Cloath, or with a little brush now commonly made for that purpose.

In rubbing, or after it, Liniments and Fomentations are som∣times proper: They are prepar'd either of Salts and other Mi∣nerals dissolv'd, or of hot and discussing Vegetables boil'd with Lees of Wine in water; and being apply'd hot open the Pores, give a farther motion to the accumulated Waters and discuss them, and enlarge the compass of the Blood's circuit, the watery Mass being in some measure dissipated. The Liniments consist of Sulphur and Salts of divers kinds, or of Quick-lime and other Minerals, which being powdred and mixt with the

Mucilaginous extracts of Smart Herbs, are made into an Oint∣ment: To which for their better consistency let a fit quan∣tity of Oyl of Scorpions be added: Nay this Oyl apply'd by it self (so it be right) gives often great relief. I knew a Boy swollen very much with an Universal Anasarca, who was Cur'd by this only Remedy: For his Mother (I know not how ad∣vis'd) anointed his whole Body Mornings and Evenings with Oyl of Scorpions, chafing well the parts with her warm hand: Upon which within three Days he began to make a vast quan∣tity of water, and having continued to make water so for some Days, the swelling vanishing by degrees, he grew well.

Baths are scarce proper for any Dropsie but an Anasarca, nor for this but in the first Disposition to it, or as it goes off: For since by the heat of Baths encompassing the whole Body, the Blood being made very hot and instigated, puts the waters every where in motion which were stagnating before, and drinking them into it self conveys them sundry ways, there is danger lest (as it frequently happens) receiving them from the habit of the Body into its Mass, it presently deposes them in the Praecordia, or the Brain; for there is nothing more usual than that the affects of those parts, viz. an Asthma, or Apoplexy happen to Hydropical persons after bathing: But when the conjunct cause of the Disease (viz. the swelling) is moderate, or not very great, a Bath of water impregnated with Salts and Sulphur, or also a hot-house promoting a gentle Sweat, are often us'd with good effect. Instead of a hot-house it's better that the Patients be plac't in some convenient Cells in a Salt-house near the Furnaces, in which the Mineral water is boil'd into Salt, which often proves of mighty benefit to them.

Vesicatories let forth the waters betwixt the Flesh and the Skin in a plentiful manner, and somtimes too profusely, these are to be apply'd to Hydropical persons with very great caution, for such an Epispastick apply'd to swollen places makes a vent too wide; upon the opening of which the water first breaking forth, often draws after it from the whole Neighbourhood a great Glut of it, whence presently follows a great Conster∣nation of the Spirits: Moreover somtimes the place so drain'd on a sudden, being depriv'd of Heat and Spirits, in a short time becomes mortifyed: Wherefore this Medicine is sel∣dom apply'd to the Leggs or Feet of hydropical persons where the neat is weak, and the swelling very great, but somtimes to the Thighs and Arms with security, when need requires.

Escharoticks are apply'd somwhat more safely to the swollen Places than Vesicatories, because the Flux of waters out of this

Vent is not so violent and in such Abundance presently at first: But beginning moderately it grows after by little and little to a great Current, which nature (after being accustom'd to it by degrees) bears better: Moreover there is less danger of a Gangrene after an Escharotick than after a Vesicatory, because in that Application, the part whose Union is dis∣solv'd is fortify'd by the Eschar against the loss of heat. I knew an illiterate Empyrick who often by an Echarotick suc∣cessfully evacuated the Members of Hydropical peasons, though never so much swollen, after the following manner. viz. First he fomented their Leggs Morning and Evening with a De∣coction of Dwarfe-elder, Wormwood Camomill, and other hot Herbs, the Lees of Wine or Ale being added to them, and be∣twixt the times of fomenting he apply'd a Cataplasm made of the Faeces of that Decoction with Bran: After these things had been us'd three Days he covered both Leggs and Feet with a Plaister of Burgundy-Pitch, leaving only a small hole on each Calf to the bigness of a small Nut, in which places he put an Escharotick of the Ashes of Ashen Bark to the naked Skin: which being remov'd after twelve hours a small Eschar was left, out of whose Pores the Matter first Sweated gently, then daily distill'd forth somwhat more freely, and at length (the Eschar falling off) it flow'd forth in a plentifull Stream as from an open Source, till it was drawn from the whose Legg both above and beneath.

There remains yet another way of drawing forth waters from betwixt the Flesh and the Skin, not inferior to the for∣mer, though less in use, viz. by the pricking of a Needle: Which also much be done very cautiously and by little and little, lest a head-strong and excessive Flux of waters be rais'd by it. Take an ordinary Needle, such as Taylors use, and prick the Skin over with it in the place most swell'd, but let it not en∣ter so far as to draw Blood, and so make six or seven little holes at a time about an inch distant the one from the other: The water will Issue by drops forth of each little hole and so will continually Distill forth till all the swelling be gone from the place prickt: Then the next time, after somtimes twelve, somtimes eighteen, somtimes twenty four hours prick again in some other part either of the same Leg, or of the other, and so continue to make such Vents for the waters once or twice a Day in this Member, or that, one alone, or two, or at the same time in many: For after this manner the Hydro∣pical Corruption may be drayn'd more freely and safely than by any other exteriour operation whatsoever; and if in the mean time its flesh supply be provided against by inward Phy∣sick,

Physick, the Disease will be the more easily Cur'd: Moreover in a desperate Dropsie that Administration serves very well to prolong Life, because the waters being continually emptied forth by those outward Vents, the inward and vital Inunda∣tion is the longer delay'd: A Man of late seventy years of Age, plung'd in a Dropsie over his whole Body has continued in Life and kept his head above the waters for these many Months beyond the expectation of all Men by the means of this only Remedy.

So far of the kinds and forms of Remedies prompted to us by the first, that is, the Curative Indication: As for the Preservative Indication which takes care to restore the Crasis, and fermenting or Sanguifying Vertue of the Blood, it sug∣gests to us those Medicines with being endowed with hot and elastick Particles, raise up the active or deprest Principles of the Mass of Blood, or repair them being wasted; for which ends the vulgarly call'd Altering Remedies are wont to be pre∣scrib'd in the Form of an Electuary, Powder, Pills, Distill'd waters, Julapes, Apozemes, and Dyets, to which also Spirits, Tinctures, Elixirs are somtimes added for the greater Effica∣cy: I shall give you an example or two of each of these.

1. Take Conserves of Sea-Wormood, Scurvy-grass, and the yellow Coats of Oranges of each two Ounces, Winters-Bark two Drams, Species Diacurcumae a Dram and a half, Steel prepared with Sulphur three Drams, Salt of Wormwood two Drams, Syrup of Citron Pills what suffices, make an Electuary: The Dose is two Drams in the Morning and at five in the Afternoon, drinking after it a Draught of Julape, or of the Distill'd water to three or four Ounces.

Chalybeats very often do great good in this Disease, as in the Green-sickness: Insomuch that the whole, or at the least the chief scope of Curing Falls frequently on this Remedy: But we must note that these kinds of Medicines do not all equally a∣gree in these cases: For those that are chiefly in use, viz. Salt of Steel, or Vitriol of Mars, and others prepar'd with Acids, and wholly depriv'd of Sulphur, do no good at all, be∣cause they do not promote the Fermentation of the Blood, but on the contrary rather fix it when too Exorbitant, or Elastick: But for an Anasarca, and any other oedematous Cachexia in the habit of the Body, let those Chalybeats be given, in which the Sulphury Particles are left, and are Praedominant, as especially in the Filings of Iron, and in its Scales reduc't into a fine Powder, and in-Steel melted with Sulphur and Powdred; these Powders being taken are presently dissolv'd by the Acid Salts within our Body, upon which the Sulphureous Metallick Particles

being set free and convey'd into the Blood, ferment its whole Mass, raise up the Symbolous Particles there, before lying dor∣mant, and being joyn'd with them give a vigour to the Blood, and renew its fermenting or sanguifying power before deprest: Wherefore we find after a little use of these Chalybeats the pal∣lid colour in the Green-sickness goes off, and turns to a Florid Aspect.

2. Take compound Powder of Aron Roots, and Winters-bark of each three Drams, Roots of the lesser Galingal, Cubebs of each a Dram and a half, Steel prepar'd with Sulphur half an Ounce, Sugar of Rosemary Flowers six Drams, make a Powder, divide it into twenty parts, the Dose is one part every Morning, and at five in the Afternoon with a Draught of the Sudorifick Decoction pre∣scrib'd before.

3. Take of the Gummous extract remaining after the Distillation of the Elixir Vitae of Quercetan half an Ounce, powder of Earth∣worms prepar'd two Drams, Roots of the lesser Galingal, Winters∣bark of each a Dram and a half, Salt of Wormwood two Drams, Iron Rust two Drams and a half, Balsam of Peru a Dram, Tincture of Salt of Tartar two Drams, Balsamum Capivii what suffices, make a Mass, form it into little Pills, the Dose is half a Dram at Night and early in the Morning, Drinking after it of the Julape or distill'd water following three Ounces.

4. Take Elder Flower water, and the Fermented Juice of its Berryes of each a Pound, Magisteriall water of Earth-worms, Rad∣dish water compound, Aqua Mirabilis of each two Ounces, Syrup of the Juice of Elderberryes two Ounces, mix them make a Julape.

5. Take Leaves of Garden Scurvygrass, Rochet, Pepperwort of each six handfulls, Roots of Calamus Armaticus, the lesser Galingal, Zedoary, Florentine Orris, Elder, Aron, of each six Ounces, Winters∣barke, Jamaica Pepper of each three Ounces, Juniper Berryes four Ounces, Cloves, Ginger, Nutmeggs of each an Ounce. Being slic'd and bruis'd pour to them of old Rhenish-wine eight Pounds; distill it in common Organs, let the whole Liquor be mixt.

6. 7. An Antihydropick Decoction is Prescrib'd before amongst Diaphoreticks: A Dyet-drink to be taken instead of Beer may be made according to the Form following.

Take Raspings of Guaiacum and Sassafras of each four Ounces, Roots of Florentine Orris, Calamus Aromaticus, the lesser Galingal, Ele∣campane, of each an Ounce and a half, Juniper and Lawrell berryes of each two Ounces, Seeds of Anise, Caraway, sweet Fennell, Cori∣ander, Dill, of each an Ounce, long Pepper, Cubebs of each an Ounce and a half, Cloves, Nutmeggs, Ginger of each half an Ounce, Ja∣mainca Pepper two Ounces, dry'd Leaves of Salvia Acuta, Wood-sage

Calamint, Agrimony of each a handful, Licorice four Ounces, being slic'd and bruis'd. Let them boyl in four Gallons of fountain water to half; when the straining is cold, let it be put up in Glass-bottles for use: I have known many persons almost given over in an Ana∣sarce who by the constant use of this Drink have perfectly recover'd. Of many examples of persons Cur'd of Dropsies I shall now give you one.

A certain Robust Man, of a middle Age, after having gotten an Epidemical Quartan Ague, and being ill manag'd at first, had lain under it above a year, and in the mean time had us'd an ill Dyet, fell into an Anasarca, which afterward upon his indulging himself to Drink very freely for quenching his Thirst, (which was exceeding great) grew in a short time to a vast height; so that all his Members from the Head to the Foot, and his Belly likewise being swollen, he was not able to turn himself from ont side to the other in his Bed without the assistance of Servants.

As I first visited him, and despairing of Cure, I plainly told him that unless he would abstain from Drink, he must die in a short time; upon which he promis'd, so I could save his Life, that he would Drink no more in a Weeks time, and was as good as his word, for though very Thirsty he scarce took any Liquid thing into him but Physick for six or seven Days: And during that time by carefully taking Hydragogue Catharticks and Diureticks, and all other things Prescirb'd, he grew much better; and afterwards a Method as above Prescrib'd being som∣time followed, he was restor'd to his perfect Health, and now lives a sound Man after five years past.

There remains certain other affects of the Viscera of the Belly, of the Remedies of which according to a due Method I should have treated here; but I have already perform'd this Task for the greatest part elsewhere; for we have deliver'd most of the Medicines that concern the Reins amongst Diureticks, and those that concern the Stomach and Intestines among the number of Emeticks and Purgers: As for what respect the Spleen and the Womb we have fully set them forth in our Hypochondriack and Histerick Pathology: As for what regards the Genital parts and their Diseases, and Cure, we have thought fit to reserve it for another time and place: It concerns us next after having treated hitherto of inward Pharmacy; to discourse somwhat of outward Medicines, which we shall do in the next Section beginning with the great Remedy Phlebotomy.