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. II. Instructions and Prescripts for stopping an Eruption of Blood.

There being various and manifold kinds of Haemorrhagies or Eruptions of Blood, Physick is not needful to all of them: If a great Effusion of Blood happens through a Wound, &c. Chi∣rurgery undertakes to stop it: Moreover an Eruption of Blood, if it be Critical, ought not to be disturb'd by any Medicine but to be left wholly to the governance of nature (so she be free and enjoys her power) nay in Symptomatick Bleeding, so long as it is but small, or not very prejudicial Physick is not re∣quired: But then chiefly and in a manner only it is needsul, if at any time the Flux of Blood be either immoderate, or breaks forth in improper places.

Bloody Eruptions of the latter kind require help chiefly if haply the Blood be cast forth upwards by coughing, or vomit∣ing, or be voided downwards by the Fundament, or the Uri∣nary passages, for in these cases though the quantity of Blood voided be not commonly much fear'd, yet because a danger∣ous

or pernicious Ulcer often follows the Solution of Unity so made in the Lungs, or in the Stomack, or Intestines, or in a Vein; therefore we must diligently take care of those Haemorrhagies from their very first appearance, and therefore such Bloody Ex∣cretions are ranged amongst the Diseases of those parts, and we have already delivered elsewhere the Theories and Cures of Blood∣spitting, and the Bloody Flux, so that there is no need for us to repeat them here, no more than that of Pissing Blood which belongs to the Pathology of Nephritick affects, wherefore I shall pass to those Passions, in which there being an immode∣rete Fffulx of Blood, there is a particular necessity for Medicines to stop it.

The chiefest kinds of those sorts of affects are these three, viz. an Eruption of Blood from the Nostrils, and of the Men∣ses, and immoderate Fluxes of the Haemorrhoides. The Cure of this latter belongs rather to Chirurgery than Physick, and we have thought fitting to refer the consideration of the other to the Pathology of the Womb: An Effusion of Blood by the Nostrills is the most general kind of those sorts of Passions, and what I shall here deliver for the Cure of this Eruprion of Blood may be apply'd to all other Haemorrhagies whatsoever.

Therefore concerning the Cure of an excessive Bleeding at the Nose there are three primary Indications, viz. Curatory, Vi∣tal, and Preservatory: The two former have regard to the im∣mediate sptopping of the Symptom as often as it presses; and the la∣ter undertakes to remove the cause of the Disease that the returns of the Eruption of Blood may abate of their violence, or wholly cease: Again this Eruption of Blood must be manag'd one way if without a Fever, and somewhat after a different manner if joyn'd with it.

If at any time therefore without a Fever much Blood flows from the Nostrils, presently as there will be need of Remedies to stop the Blood, there will be three chief intents of Curing, all of them to be put in Practice together, viz. the Turgescency of the Blood must be so allay'd that it be not prone to make disorderly Sallyes: We must farther take care that its Fluxion being withdrawn from the Nostrils, be diverted eisewhere, and that the gaping Mouths of the Vessels within the Nostrils be clos'd: For which ends a great many Remedies both External and In∣terna, and of divers kinds are wont to be administred, we shall speak of the former in order and briefly.

First, therefore let the Patient keep himself quiet with his Head in an upright posture, then let the Joynts of his Arms and Thighs, many of them together, but not all of them be bound with strait Ligatures, which must now and then be loosn'd

and remov'd to other parts; for upon their being bound all at once, and so continued a long time, I have known that terrible Swound∣ings have happen'd, by reason of the Bloods being detain'd in the outward parts, and kept too much from the Heart: Though otherwise this Remedy being prudently administred gives often relief. For since by this means the Blood which passes into the Members by the Arteries, is hindred from its quick return by the Veins, its violent taking to the head is stay'd: More∣over by the painful Ligatures of the Joynts the Muscular Fi∣bres of the Carotide Arteries from whose Branches the Blood issues at the Nostrils are freed from the Convulsion which they often fall into.

2. To withdraw the course of the Blood from the Nostrils, sometimes it's proper to open a Vein in the Arm, or Foot, for the more Blood is carried by the Arteries to the place where a Vein is open'd, the less will flow to the Nostrils: Yet this Administration does not always prove so successful but its con∣trary effect sometimes happens; as we have observ'd before, where we treat of Spitting Blood: The reason whereof is that the Vessels being suddenly, and not sufficinetly emptryed, draw in∣to them again the disagreeing Homours before ejected, and stag∣nating within the Pores, by which the Blood is presently stirr'd up again to a greater Turgescency for Eruption.

3. Cold things apply'd to the Forehead and Temples, also to the Nape of the Neck where the Vertebral Arteries ascend, constringe the Vessels, and somewhat repress or repel the Flux of Blood: But it is ill done of some who advise topical coo∣lers to be apply'd to the Jugular Veins, for this retarding the course of the Blood in its return, causes it to flow more plen∣tifully out at the Nostrils: Moreover as to the usual way of ap∣plying a Linnen-cloath or a Spunge dipt in Vinegar to the Share and Genitals, it gives relief only, as a Ligature of the Members, viz. in as much as it hinders the return of the Blood of the Veins. A sudden and unexpected Sprinkling of cold water on the Face by striking a Terrour often stops an Eruption of Blood.

4. Cupping-glasses applyed to the Hypochondres, Flanks, in∣ward parts of the Thighs, and to the Soles of the Feet, have been accounted both by Ancient and Modern Physicians a fa∣mous Remedy for withdrawing an Eruption of Blood from the Nostrils.

5. Frictions of the extream parts are commended in this af∣fect by some Practitioners, which nevertheless we judge not so very good, nay scarce safe: For though they cause a greater confluence of Blood to the Hands and Feet, yet they so ac∣celerate

its return, that it endangers a more violent Sally of it to the Nostrils.

6. Zacutus Lusitanus among Revulsory Remedies proposes an actual Cautery to be apply'd to the Soles of both Feet, and Cra∣to the bending of the little Finger of the same side, which last you may do well to try in regard it is done easily: Though I do not advise so of the other Remedy, unless the Cure by it were more certain, which might recompence the Pain, and Lameness that will ensue.

7. A Swounding by what means soever caus'd, stops present∣ly for the most part an Eruption of Blood, be it never so refractory: Wherefore when persons seiz'd with an Eruption of Blood and grown weak by it are pull'd out of Bed, or if Blood be taken from them though in a small quantity by opening a Vein, they apprehending a danger in it, or if their Members are long bound, or they are suddenly put in a fright with some feigned Rumour, and upon any other occasion fall into a Swound, or a Fainting Fit, the Eruption of Blood from the Nostrills presently ceases: The reason whereof it evident enough, because as soon as the Motion of the Heart fails both the Blood and Spirits presently rush thither, so that all out∣ward Effusion is incontinently stopt and that which before was immoderate does not begin afresh.

8. In the last place we must take a view of those Remedies for repressing an Eruption of Blood from the Nostrils which are said to work after an Occult manner, and by Sympathy, and An∣tipathy: Of which kind chiefly are the Sympathetical Powder, made of Roman Vitriol Calcin'd to whiteness by the Sun in the Summer: Also a piece of the Wood of a Maiden or young Ash, cut about the moment that the Sun enters Taurus: The efficacy of which Remedy is attested by many credible witnesses to have been prov'd in stopping Eruptions of Blood in wounded Souldiers during the late Civil Wars. So a dry'd Toad sewed up in a Silk Bag and worn on the Pit of the Sto∣mack is said to stop any Flux of Blood, and to prevent its return.

There are many other famous Medicines for stopping Blood, whose operation is wont to be referr'd to Occult causes, and to some secret Vertue: As Neck-laces of the Blood-stone worn about the Neck, also Ʋsnea, or the moss of a Mans Skull car∣ried in the hand: Epithems of the Leaves of Netles stampe and apply'd to the Soles of the Feet, and the Palms of the Hands; which Empirical Administrations being to be try'd without trou∣ble or charge, we have no reason to reject them, especially since in a dangerous case we ought to leave nothing unattempted,

and in regard that those applications may do good sometimes in this respect, that they fortify the imagination of the Pa∣tient.

Whilst these outward Administrations are us'd for repelling or withdrawing the Flux of Blood from the Nostrils, let Topicks also be put into the Nostrils to close the Gaping Mouths of the Vessels, for which use Injections of Liquid things, Pledgets, Powders to be blown in, and Fumes are wont to be prescrib'd, which failing of effect we must come at last to Escharoticks.

9. Amongst Liquids, a Solution of Vitriol made in fountain water, is accounted not only the chief, but as good as all the rest: Some boast of this as of a great secret, and an infalli∣ble stopper of Blood: Indeed the same apply'd to a fresh Wound, for as much as by corrugating the extremities of the cut Ves∣sels it closes them, it keeps back the Flux of Blood and power∣fully stops it: But in regard in an Eruption of Blood from the Nostrils (where the Blood is convey'd to the gaping Mouths of the Arteries and ought to be receiv'd by the Veins, this application closes these as well, or rather than those, it does here little, or no good at all, as I have often known it try'd. This Medicine is prepar'd of green Vitriol, viz. the Hungarian, or of that of our own Country, also of the Factitious Vitriol of Mars dissolv'd in a sufficient quantity of fountain water. I know some commend a Solution of Roman Vitriol, which they are wont to use not only by injecting it, but by applying it Sym∣pathetically to a Bloody Linnen-cloath: I have also known a Water prepar'd of an Infusion of white Vitriol with Bole and Camphire us'd successfully to Wounds, and often to other E∣ruptions of Blood.

But in regard a water injected into the Nostril does not stick enough to the Mouths of the Vessels, but is washt away by the Bloods breaking forth before it can exert its Vertue; there∣fore it is better either that a Stiptick Powder be blown into it, or that a Pledget dipt in the water of Vitriol be thrust in∣to the Nostril to the upper part of it, either by it self, or strew'd to the Nostril to the upper part of it, either by it self, or strew'd with an Astringent Powder. Many Stiptick Powders and of divers kinds are wont to be prescrib'd for this purpose: I com∣monly use either Crocus Martis Calcin'd to the highest reduess, or the Powder of Vitriol Camphorated, or a Vitriolick Soot scrap't from the bottom of an old Brass Kettle, the Powder of which I have often try'd with success in this case. In obstinate Hae∣morrhagies and not yielding to other Remedies, let a Pledget having on its top a Caustick Colcother be thrust up into the No∣strils as far as it will go, that the little Mouths of the Vessels be∣ing burnt, and covered with an Eschar, all Eruption of Blood

may be presently stopt. There are many other Errhines famous amongst Practitioners for stopping Blood, as Hogs-dung thrust up into the Nostrils, which is thought meerly by the Nastiness of its Odour to repel the Blood ready to burst forth: Also the Fume of the Blood dropping on a red-hot Iron and return'd up into the Nostrils, the Powder of which also when burnt is blown up into them. Ʋsnea or the growing Moss on a Mans Scull which has not been inter'd is highly commended by some for this effect.

So much of outward Remedies for stopping Bleeding, whose Vertue ought likewise to be promoted by inward things season∣ably given and cooperating.

Therefore a thin Dyet being prescrib'd, and the Patient or∣dered to keep himself in an erect posture, or not much leaning back, whilst the foresaid Administrations are orderly apply'd, let Medicines appropriated to the same end be prescrib'd also to be inwardly taken: Remedies of this kind have two chief scopes, viz. First to cause the Blood being kept within its Vessels to be quietly Circulated, its Effervescence, whether happning through its Accension or Fermentation, being supprest. Secondly, to retard by fit Remora's, the violent Motion of the Heart, driving round the Blood too rapidly.

1. The first intention requires those kinds of Medicines which suppress the too great Accension of the Blood, and appease its undue Fermentation; for which uses I am wont to prescribe the following.

Take the waters of Plantain, red Poppies, Purslain, and of the Spawn of Froggs of each four Ounce, Syrup of Water-lillies two Ounces, Sal Prunella a Dram; mix them, make a Julape, the Dose is three Ounces thrice or four times a Day.

Take Barley-water two Pounds, red Rose-leaves a handful, Spirit of Vitriol as much as will give it a grateful Acidity, or about half a Dram, make a warm Infusion for extracting the Tincture, add Syrup of the Juice of St. John's Wort two Ounces; the Dose is three or four Ounces to take at pleasure often in the Day time, or by Night.

Take Leaves of stinging Nettles, and of Plantain of each three handfuls, being bruis'd pour to them of Plantain water four Ounces, express it strongly, and take it.

2. For the Second intention, viz. to retard the over-violent beat of the Heart, Hypnoticks and Opiats are proper.

Take red Poppy-water three Ounces, Syrup of Diacodium half an Ounce: Mix them, make a Draught to be taken going to Bed. (Or)

Take Conserve of red Roses an Ounce and a half, Powder of the

Seeds of Henbane and of white Poppies, of each two Drams, Syrup of Poppies what suffices. Maek an Opiate. The Dose is the quan∣tity of a Nutmeg every six or eight hours (Or)

Take Laudanum Cydoniated a Dram, the Dose is fifteen Drops twice a Day in a proper Vehicle.

So much of an immoderate Eruption of Blood, and its Cure, whilst it happens without a Fever, but when it happens in a Fever, and must be stay'd because of too much loss of Blood, it is either Critical, growing to be immoderate by reason of some Accident, to which the Method and Medicines even now prescrib'd may be accommodated, though with some caution and a due respect to the State of the Fever: Or it is meerly Symp∣tomatical, which hapning in a Malignant, or Spotted-fever, the Small-pox, Meazles, or Plague, it scarcely either can or ought to be repell'd or stopt by the foresaid Remedies: For letting Blood is not proper; repelling Topicks, also cooling Julapes or Decoctions, or Narcoticks have no place: The chief intention of Curing will be to change the Eruption of Blood into a Sweat, for upon raising a gentle Sweat, the Flux of Blood, if it be not extreamly dangerous, ceases of its own accord.

Take water of Meadow-sweet and Tormentil of each four Ounces: Of the cold Cordial of Saxonius two Ounces. Treacle-water an Ounce and a half. Bezoartick Vinegar three Drams, Syrup of Coral an Counce and a half, Confection of Hyacinth two Drams, make a Ju∣lape; the Dose is six spoonfuls every third hour.

Take Powder of Toads prepar'd half a Dram, Camphire two Grains; let it be taken with the foresaid Julape every sixth hour. (Or)

Take Pulvis Pannonici Rubri from half a Dram to two Scruples give it after the same manner.

Take Confection of Hyacinth three Drams, Pulvis Pannonici Rubri a Dram, Syrup of Coral what suffices; make a Confection, the Dose is the quantity of a Nutmeg every other hour.

Take Roots of Bistort and Tormentil of each an Ounce, Leaves of Meadow-sweet, Burnet, Wood-sorrel of each a handful, burnt Harts-horn two Drams, Shavings of Ivory and Harts-horn of each two Drams, boyl them in three Pounds of Fountain water to two Pounds, add towards the end Conserve of red Roses three Ounces, sirain it, the Dose is three Ounces often in a Day.

So far of the first Indication which is Curatory together with the scopes of Curing and the forms of Medicines destinated for an Eruption of Blood from the Nostrils, hapning either with, or without a Fever. The second Indication which is Vital prescribes only a thin Dyet, temperate Cordials, and a fit or∣dering of the Patient: The provision for the two For former is so small and easy, that it seems not necessary to set down a form

and rules particularly for them: Concerning the latter the chief question is whether we ought to keep those that are seiz'd with an Eruption of Blood either in Bed, or out of it: It's an un∣question'd thing that those that are weak, and subject to fall often into Swounding Fits, ought not to be stir'd from Bed, unless haply it, be to try a Cure (as we have intimated before: As to others that are not so weak, we say thus, those whose Blood has not an easy Transpiration by reason of the Consti∣pation of the Pores, and upon its being put in a stronger Mo∣tion by the heat of the Bed is dispos'd to greater Turgescen∣cies, and to Eruptions, it will be good for them not only to stay out of Bed, while Bleeding, but likewise sometimes to be cool'd by outward Applications in the whole habit of the Body, or at leastwise in most of its Members: Wherefore Fabritius Hildanus relates how he presently Cur'd one of a violent Bleed∣ing at Nose, after many ordinary Remedies try'd in vain, by putting him into a Vessel of cold water: with the like suc∣cess also Riverius having ordered another affected in like man∣ner to be taken forth of his Bed, and laid on a Woolen Rugg in the Floor, fomented his whole Body with Linnen-cloaths wetted in an Oxicrate: Yet this method is not generally proper for all Persons, and at all times: But on the contrary those whose Blood being of a free Transpirable disposition, and en∣joying open Pores, readily evaporates, and is wont upon any moderate ambient heat to be resolv'd into Sweat, and conse∣quently to become more calm, it's good for such to continue in Bed, not only whilst Bleeding, but as long as that Eruption is in danger of returning in a short time after: For this rea∣son it is that many Persons subject to violent Eruptions of Blood live free from that Distemper during the Summer, whilst they have a free Transpiration, but when the cold of the Winter presses them, their Pores being stopt, they undergo more fre∣quent and dreadful Fits of it.

3. The third Indication being for Preservation, which re∣garding the removal of the cause of the Distemper, either hin∣ders the Eruptions of Blood, or renders them less frequent or less considerable, suggests to us these two chief intents of Curing: viz. First, that the Blood being restor'd to its due Temperament and Mixture, be quietly circulated within its Ves∣sels without Turgescencies and Eruptions; And Secondly, that the Blood Vessels be kept in their due State as to their Con∣formations of their little Months, and the Tones of their Mus∣cular Fibres, so that those Vessels neither cause those disorderly Sallyes of the Blood to the Head, or give way to its Eruption from the Nostrils: For both these ends, in the first placelet the

Redundancy of the Blood, and its great foulness be provided a∣gainst by a seasonable Administration of Phlebotomy and Purga∣tion; and then forprocuring and preserving its right Temperament let the following Alteratives be given in fit seasons for Physick.

Take Conserve of red Roses, and of the wild Rose, of each three Ounces, Powder of all the Saunders, of each half a Dram, of Co∣ral prepar'd a Dram, of the reddest Crocus of Mars two Drams, Sal Prunella four Scruples. With a sufficient quantity of Syrup of Coral, make an Electuary, take early in the Morning, and going to Bed the quentity of a Chesnut either by it self; or Drinking af∣ter it of the following distill'd water three Ounces.

Take of the tops of Cypress and Tamarisk of each eight handfuls, tops of St. John's-wort and of Horse-tayl of each four handfuls, all the Saunders bruis'd, of each an Ounce, Pith of White-bread two Pounds, being slic't very small pour to them of New-milk eight Pounds, distill it with common Organs: Sweeten each Dose as you take it with a sufficient quantity of the Syrup of the Juice of Plan∣tain.

Take Leaves of Plantain, Brooklimes, and stinging Nettles of each four handfuls, being bruis'd pour to them of the foregoing water half a Pound, small Cinnamon water two Ounces, express it strong∣ly; the Dose is three or four Ounces in the Morning at nine of the clock, and at five in the Afternoon.

Let Medicines of this kind be taken Spring and Fall for twenty or thirty Days, giving sometimes a gentle Purge between whiles: But in the Summer let Mineral Chalybeat waters be Drunk for a Month, than which there is not a more excellent Remedy in this case. I shall now give you an example of one Cured of an Eruption of Blood, whose case was somewhat particular.

I was lately sent to for advice for a Gentleman living far off who had been troubled a good while with frequent and vio∣lent Eruptions of Blood, sometimes from the Nostrils, some∣times from the Heamorrhoids; this person had been often let Blood by the advice of his friends, but found no good there∣by, nay most commonly after opening a Vein falling into cold Sweats, and Swounding Fits, and still as liable to Eruptions of Blood, he was wont to be much worse: To this Person (not having seen him) I prescrib'd Julapes, and cooling Decoctions, and Anodyns, also Juicy expressions of Herbs, and other things to cool the Blood, but these things also (as though all yet were far from the makr) had nothing a better success; at length being call'd into the country to see him, I found the affect with which he was seiz'd to be meerly or chiefly Convulsive, for the Blood breaking forth daily, his Pulse was weak, his Extream parts cold, and all the Vessels were fallen, as though too much

emptied: Moreover the Patient was troubled with a continual Giddiness, and a Trembling of the Heart, and was taken now and then with Swounding Fits, or with the apprehension of it: Truly it was so far from it that the Blood should break forth of the Vessels by reason of any Redundancy or Turgescency, that ra∣ther on the contrary its Current was so extreamly low and small, that it seem'd scarce able to maintain the Stream of Circulation: But the thing was, that often in a Day he sensibly pervceiv'd somewhat on a sudden to pass privately sometimes up, and sometimes down his Body like a wind, and for the most part an Eruption of Blood from the Nostrils or Haemorrhoids followed the Tendency of that Motion. So that it was easy hence to conclude, that the moving Fibres of the Blood Vessels, by which they are contracted, being seiz'd with Convulsions, drew suddenly every way in a disorderly manner the Stream of the Blood, as small and low as it was, and forc't it now and then to an Eruption: Which also was the easier done, because the Lax and Gaping Mouths of the Vessels permitted the Blood dri∣ven to them to flow forth without any due stay: A Method of Cure ordered pursuant to this Aetiology confirm'd it by its good success: For Bleeding, and the use of Blood-stopping Me∣dicines being thenceforwards omitted, I prescrib'd the use of the following Powder whereof he took a Dose every sixth hour with a proper Julape.

Take Powder of the Roots of Male Peony, red Coral, and Pearl of each a Dram, Ivory, Crabbs Eyes, Blood-stone, of each half a Dram, Sal Prunella a Dram, make a Powder, the Dose is half a Dram.

Take black Cherry water eight Ounces, Balm water and small Cinna∣mon water, of each two Ounces. Treacle water an Ounce, Syrup of Coral an Ounce and a half.

I farther ordered that Ligatures should be us'd in due course to certain places, and now and then to others as occasion re∣quir'd, both to stop, and to intercept the Convulsions of the Vessels: And by these Remedies and ways of Administrations he soon grew well without any Relapse.