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. III. Of Vesicatories.

HAving treated of the Emission, and stopping of the Blood, according to occasion, there ramain certain other Humours, to wit the Nervous and Nutritious Homours, and likewise the Serous and other Excrementitious ones which are wont to a∣bound within the Brain, Nerves, and within the Nervous and Fleshy Fibres, and even in the Pores of the Skin, and of the Solid parts, which being often deparved or letted in their Mo∣tion, require an Emission, being otherwise apt to prove greatly prejudicial, and often to cause dangerous Distempers: Where∣fore for a seasonable prevention of affects arising, or which are apt to arise from such cause, Physick has found out certain other Emissaries to derive immediately, or meidately the fore∣said Homours from the parts and places where they prove offensive: And those Emissaries are either coutinual, viz. Issues of various kinds, which as everlasting Soures continually dis∣charge that Ichor or Excrementitious Humidity; or they are Temporary, when upon occasion the Scarf Skin being remov'd in some part of the Body, the extremities of the Vessels in the Skin are laid naked, and withal so irritated, that they dis∣charge in a great abundance Serous Homours of a verious Ori∣gine and Nature, and continue so too Evacuate them for some time, sometimes longer, and sometimes a shorter while. Now such a manner of drawing forth Serous Homours from the Ex∣teriour Surface of the Body, or of some certain part of it is wont to be effected by Medicines call'd by the Ancients Phae∣nigms, or Synapisms, by the Modern Vesicatories; of which (be∣cause their knowledge prepares the way to the Doctrine of Issues) we shall in the first place treat here, and shall parti∣cularly insist on the explication of, these three things, viz. first it shall be shewn of what substances, and after what manner ordered, Vesicatories are prepar'd. Secondly, they being of va∣rious kinds, we shall declare what are the ways and manners of working in each, or at least in the chief of them: And Thirdly, we shall enquire for the Cure of what sort of affects they ought to be us'd, and to what places apply'd.

1. As to the first, the most simple Blisterers are either Fire,

or Solid Bodies, or Liquors endued with Fiery Particles, which nevertheless are seldom put to this use by reason of the Terrour they give, and the Imminent danger lest being roughly apply'd they do not so much Blister the Scarf-skin, as burn both this and the Skin, and other parts: What therefore is more safe and less to be dreaded, let Epithems made of Concrets which have smart Particles, or (as is said) Potentially Fiery, be ap∣ply'd to the places to be Blistered; which being either more mild were call'd by the Ancients Phaenigms, because the Scarf∣skin being remov'd they made the part red: Or in respect of the matter they were call'd Synapisms, and were wont to be prepar'd of Mustard, Pigeons-dung, Squills bruis'd, Garlick, Milk of the Fig-tree, and the like; or they were more strong and for the most part consisted of Euphorbium, Cantharides, Flam∣mula Jovis, Batrachion, water Plantain, with many other things, which being endow'd with a certain Burning or Corrosive qua∣lity are outwardly apply'd for the said use, but inwardly taken are Poysonous and often Mortal.

The Compositions and Forms of Blisterers are manifold and of sundry sorts: Though one, or two, and the more simple the better, may suffice here, and in most cases it's all one which you use: According to our wont we shall here set down some of the more select, and most useful prescripts of these sorts of Medicines: And to say little here os Dropax's, Synapisms, and Phaenigms, which are now in a manner out of use: Almost all Vesicatories at this time made use of, have Cantharides for their Basis.

Take Powder of Cantharides from half a Dram to a Dram, Pow∣der of Ameos-seed a Scruple: Stale Leaven wrought with Vinegar what suffices; make a Mass for a Playster, spread part of it on Leather, and apply it to the part for twelve hours. This works infallibly and strongly enough; but because it is not compact, and sticking, but is apt to slide from the place where it is put, or to crumble, therefore for a more convenient application the following does very well, and is now every where in use amongst most per∣sons.

Take Cantharides three Drams, Euphorbium half a Dram, Pow∣der of Ameos-seeds a Dram, Melilot Playster what suffices; let them be incorporated with a warm hand, using as much of the Powder as the Mass of Playster will receive. Let a sufficient-quantity of this be spread on Leather, and be apply'd for twelve or sixpeén hours,

Some use to incorporate as much of the said Powder with Burgundy-pitch as it will receive, and to spread it on Leather, and then to cover the edges of this Playster with another

Mass of Playster, made of Powder of red Saunders incorpo∣rated with Burgundy-pitch, so administring a Dropax and Vesicatory together: Moreover by applying continually the said Playster to the place rubified and ulcerated after the Scarf-skin is Blistered and remov'd, and by wiping it clean only once or twice a Day, and presently applying it again, they make the little Ulcers, rais'd by Blistering, to run as long as they please, nay sometimes above a Month, and to discharge a great plenty of Ichor, or Excrementitious Humidities,

Others sew up Cantharides bruis'd and sprinkled with Vine∣gar in a little Bag of very fine Silk, and apply them to the place to be Blistered,

Some Empiricks instead of Cantharides lay on the place to be Blistered a Mass of the Leaves of Batrachion, or Flammula∣jovis bruis'd, by which the Scarf-skin being Blistered, or ra∣ther eaten away, the Skin it self, as if toucht with an actual Fire, is often mightily inflam'd, and deeply ulcerated; whence not only a great discharge of Ichor, but sometimes an Inflam∣mation of the whole Member, and a Feverish Disposition en∣sue, wherefore those things must not be us'd without con∣sidertation.

2. If we enquire into the manner and way how these and other Vesicatories operate, First we must shew after what manner actual Fire, and things endued with Particles proceeding from Fire, cause a Blistering; and then by an easy Analogy we shall come to know the force and manner of working of those sorts of Medicines which are said to contain a Potential Fire: Therefore concerning the former we observe that Fiery Par∣ticles, not apply'd too roughly, Penetrating the Scarf-skin without Solution of Continuity, enter the Skin it self, where the extremities of the Blood Vessels, Nerves, and Nervous Fi∣bres, are terminated; and there altering these from their Po∣sition, wrest them sundry ways, and pervert the Conformation of the whole Texture of the Skin: So that from all the Ves∣sels being mightily irritated, a Watery Humour fill'd with Fiery Particles, and therefore rejected both from the Blood, and from the Nervous Juice, is voided in a great abundance: That Lym∣pha, because it cannot pass through the Scarf-skin, separates it from the Skin and raises it into a Blister.

Hence it will be easy to understand after what manner Ve∣sicatories perform their operation: viz. Cantharides (and so all other things of the same vertue) being outwardly apply'd, and coming to be made warm by the Effluviz's of the part they lie on, and so stirr'd up to exert their force, emit from them a great plenty of Smart and Fiery Particles as it were, which

penetrating the Scarf-skin without breaking it, strongly fix themselves in the Skin: Where sirst they act on the Spirits and then by their means on the Humours and Solid parts: Those Particles very much irritate the Spirits and make them cause painful Convulsions of the Fibres, and they fuse the Humours and make them separtate into parts, so that the Watery part being mightily fill'd with those Smart, and as it were Ve∣nemous Particles, is thrown off on every side by the rest of the Latex: And the extremities of the Vessels and Fibres be∣ing either in the mean time Eaten away by Burning, or open'd and emulg'd as it were by Twitching, that Ichor is voided in a plentiful measure from their little Mouths carrying with it the offensive Particles. Which Ichor afterwards separates the Impervious Scarf-skin from the Skin, and raises it into a little Blister. And after this is broken and remov'd, is plentifully voided for some time from the Ulcerated Skin.

But this is not only so done, because the Serous La∣tex inbibing the Smart Particles of the Medicine, and con∣veying them forth, does not always carry them back all the same way that they came in; but sometimes being imbued with those Particles it regurgitates into the Mass of Blood, and afterwards being circulated with it, and voided with its offensive Load by other Emunctories, it offends in its passage or as it goes forth certain weak, or tender Ductus's. Hence many after the use of great or many Vesicatores having their Urinary passages there∣by affected with an Acrimony or Erosion, get a Strangurie which in some is most sharpe and intolerable: Again in o∣thers troubled with the Stone that application sometimes cau∣ses Bloody Urine: Hence also it may be suspected, that tender Lungs, or such as are inclin'd to a Consumption, may be much endangered by the outward application of this Medicine: Which nevertheless I have not hitherto known happen to any; but rather on the contrary I can testifie by frequent trials that it rather proves to their advantage than to their prejucice: For the smart Particles of the Catharides, upon long application being sometimes plentifully imbib'd by the Blood, infect its whole Serum; which Latex nevertheless so aculeated, as long as it is mixt with the Balsamick Blood, offends no part; but being separated from it by the Reins, it sometimes hurts them, and often not only twitches the Neck of the Bladder with its Acrimony, but sometimes Corroding it fetches thence a Mucus, and little Schims, and even Blood it self: But in the Mass of Blood, those same sharpe Salino Volatile Particles often do great good; be∣cause they destroy the fixt and acid Salts in it, and likewise open the too close Texture of the Blood, and so cause its Serous

and other Morbifick Particles before fast bound in it, to be separated from it, and to be readily sent forth by Urine and Sweat; hence in Fevers, Vesicatories long apply'd cause a large Evacuation by Urine and a free Sweat: Moreover the same open the Obstructed passages, and stir up the Portions of the Blood and Serum stagnating in any place, or extravased, and restore them to Circulation: Wherefore they are wont to do good not only in Distempers of the Serum, but also of the Blood, nay in the Pleurisie, Peripneumonia, and in any other Fevers whatsoever.

Hitherto having shewn after what manner Vesicatories work, first on the Spirits, and then on the Humours and Solid parts; I must next set down their effects both good and evil; also the manner of using them: That they work first on the Spirits it is plain from hence, that they exert no power on the Dead: And its an ill Omen in very weak persons when Vesicatories do not work, because it's a sign that the Animal Spirits are mightily dejected, or lessen'd in their store.

Therefore to explain well the Energy, or Vertue of this Medi∣cine, we must consider what Humours it evacuates, or alters immediately or mediately: And then in what Diseases, and in Bodies how dispos'd it does good or hurt.

As to the first, the Humours immediately let forth by a Vesicatory partly issue from the Pores and Glands of the Skin, and partly from the Mouths of the little Arteries, and partly from the extremities of the Nervous Fibres; haply some little of the Juice fresh receiv'd may be cast back again from the little Mouths of the Veins, though much of it cannot: The Humours mediately voided by a Vesicatory are those which the foresaid parts being emptied receive from elswhere, and convey forth.

1. The Scarf-skin being remov'd by a Vesicatory from the Skin a Serous Humour is drawn from the Glands and Pores, and this not only from the place Blistered, but those Pores being pervious to others, a Portion of Serum coming from other Pores sometimes succeeds in the Cells of the first drain'd, and thence also distill forth, wherefore in an Anasarca the little Ulcers rais'd by a Vesicatory empty waters on every side in great plenty, and derive them from all the Neighbouring parts, nay some∣times from those that are very remote.

2. The Mouths of the Arteries do not only Spew forth the Portion of Serum brought to them according to common course, but the Serous Latex being imbued with the irritative force of the Medicince in the whole Mass of Blood is thereby separ∣ated from the Blood in a more plentiful manner, and carried

forth by the said Mouths of the Arteries, and with it other Excrements, and sometime the Morbid matter it self in a large measure: Hence in Malignant Fevers, nay and in some Putrid Fevers of a difficult Crisis, when the Refuse and Cor∣ruptions of the Blood unapt for separation threaten the Prae∣cordia, or Brain-vesicatories deriving it forth continually and by degrees, often give great relief: To which may be added that the same also (as we have hinted before) alter and restore the Blood degenerated or deprav'd as to its Salts, and likewise by opening or rarifying its Texture, dispose it to a Eucrasy: Where∣fore this kind of Remedy often agrees excellently well, not only in a Feverish State of the Blood, but likewise when it is otherwise vitiated, or Cacochinical.

3. Reason and Experience convince us that Vesicatories draw from the extremeties of the Nerves, and Nervous Fibres the Latex contain'd within their Ductus's, and free it from Stag∣nation, and that they exagitate the Heterogeneous Particles mixt with the Latex, and deriving them from the Brain convey them forth, whence they are found of excellent use in Con∣vulsive affects.

From these things we may gather for the Cure of what Dis∣eases this kind of Remedy is chiefly conducing; for in order to an Evacuation from the Pores and Glands of the Skin as often as a Serous, sharpe or otherwise offensive Humour is gathered together in or near them, and being excluded from Cir∣culating with the Blood obstinately sticks there, certainly there is no readier, or easier way of clearing the same forth than by applying a Vesicatory on or beneath the place affected; wherefore it is not only indicated in an Anasarca, and all Cu∣taneous foulnesses and breaking forth; but a Vesicatory is like∣wise requir'd in Pains either of the Gout, or Scurvy any where sixt in the outward habit of the Body, or in some Member.

Secondly, Vesicatories are always us'd in Malignant Fevers in respect of the Blood, both to Purge it by degrees from all Heterogeneous and Morbifick matter, and to alter it from its two Acid, or Salt, or otherwise vitiated Disposition into a due Temperament: Nay they are of most excellent use in all Pu∣trid Fevers threatning ill, and of a difficult Determination: Therefore also in the Scurvy, Leucophlegmatia, the Longing Disease of Maids, and in any other Cacochimia that kind of Remedy does often great good: Again, Vesicatories are generally apply'd with good success not only for correcting the Blood it self, but likewise as often as being deprav'd it pours its Corruptions on the other parts, and so gives a beginning to Diseases, and cause Fits of them in the Head, Thorax, Belly, or Members.

Wherefore in Head-aches, Vertigo's, and Sleepy affects this is a known and vulgar Remedy; and so in a Catharrh, and any Defluxion either into the Eyes, Nose, Palate, or Lungs, every ordinary Man Prescribs Cantharides for a Revulsory without ad∣vising with a Physitian. I must own that my self having been often seiz'd with a violent Cough accompanied with much and thick Spittle (to which I am Originally inclin'd) have not found more good from any Medicine than from Vesicatories; there∣fore I am wont when that Distemper presses, first to apply Blister∣ing-plaisters on the Vertebrae of the Neck, then those little Ulcers being heal'd, I apply them behind the Ears, and after∣wards if need requires on the Shoulder-blades; for so the Se∣rous Filth breaking forth in abundance from the dissolv'd Tex∣ture of the Blood, is deriv'd from the Lungs, nay and the mix∣ture of the Blood sooner recovers its Crasis, its irregular Salts being by this means destroyed.

3. In respect of the Humour to be evacuated or deriv'd from the Genus Nervosum and the Brain it self, Epispasticks as they are of most common use in Sleepy, Convulsive, and Pain-causing affects, so they often prove mighty beneficial: Was ever any one seiz'd with a Lethargy, Apoplexy, or Falling∣sickness, but presently his Freinds or Attendants, though never so ignorant, flead his Skin with Cantharides? In strange Con∣vulsive Motions, usually ascrib'd to no less than Witchcraft, I have apply'd Vesicatories with great success to many parts of the Body together, and by renewing them now and then in fresh places, I have continued them above a Month: Again fixt and cruelly tormenting Pains in the Membranous parts are seldom Cur'd without this AdminiAstration: For sometimes Hu∣mours and Morbifick Particles, which being throughly radi∣cated, yield not at all to Catharticks, or Medicines working by Sweat, or Urine, seem to be utterly rooted out by Vesica∣tories, laying hands, as it were, on the Disease.

Yet this Remedy though very general, does not work so rea∣dily and successfully in some Diseases and Constitutions; where∣fore we must not use it inconsiderately, or indifferently to all persons; for those that have the Stone, and are subject to fre∣quent and great Fits of the Strangury scarce ever undergoe its application without prejudice. Wherefore in persons so affected we must not use Vesicatories but in Malignant Fevers, or in Acute Diseases of the Head to prevent a greater Mischeif.

As to the various Temperaments and Constitutions of Men, in respect of which Vesicatories agree or dissagree, more or less: Concerning these things this threefold notable difference pre∣sents it self, fiirst some in a manner always bear the use of

this Medicine well, and the little Sores made in the Skin by it distill forth the Excrementitious Humidities plentifully e∣nough without any Disury or great Inflammation of the place Blistered, and then heal of their own accord: Which effect happens only in a Blood of a good Temperament, where the Salt and Sulphur being in a moderate quantity and in a due state, there is a good plenty of Serum; whose Latex re∣ceding readily and in a copious manner from the rest of the Blood takes with it the smart Particles of the Medicine im∣bib'd, and partly distills them forth by the place Blistered, and partly conveys them out by the Urinary passages without of∣fending them: On this account also those good effects before mention'd are puoduc't in the Mass of Blood.

But Secondly, this Medicine does neither agree, nor work well with others, for it makes the place on which it is apply'd mighty red, or rather excoriats it with a violent Pain, and a great In∣flamation: And yet the little Sores there made, though they torment the Patient a good while, cast forth but a very little Ichor, or scarce any at all: Moreover in those to whom Blister∣ing always proves so torturing, a cruel Stangury for the most part succeeds it: This troublesome and withal unprofitable use of Vesicatories happens very frequently to Men of a hot and cholerick Temperament, whose Blood contains Salt, and Sul∣phur, in a great plenty, and but a little Serum, which is wholly tainted with the others: Wherefore when its Latex which ought to carry off the smart Particles of the Medicine, does not part readily, nor in a plentiful manner from the rest of the Blood (to wàsh them away presently) those Particles still sticking in the Skin, Taint and Poyson, as it were, the Blood in its pas∣sage, and being thereby hindred in its Circulation, they cause it to gather together and stagnate within the extremities of the Vessels, whereby they are inflam'd: Moreover the Serous Latex at length separated by the Reins, being but in a small quantity and sharpe of it self, and made more sharpe by the Particles of the Medicine, irritate the Neck of the Bladder, and often corrode it with its Acrimony.

There remains a Third, though more rare case, of persons Blist∣ered, in whom the little Sores rais'd in the Skin presently pour forth the Serous Humour in such abundance, that there is streight way need of repelling Medicines, and such as close the Mouths of the Vessels; otherwise upon the too great Efflux of waters a Dissolution of the strength, and a failing of the Spirits are endanger'd to ensue: I have known this to have happen'd so constantly in some, that they were forc't for the time to come to abstain from the use of Cantharides, how great soever the

need were of them: The reason of which seems to be that the Blood being endowed with an Over-salt and sharpe Serum had its Texture too easy to be dissolv'd: Besides this great Efflux of Serum rais'd upon the first application of a Vesica∣tory, it hapning sometimes late in Malignant Fevers, and in others of an ill or no Cirsis, and continuing for some time, wholly drains the Morbifick matter, and often frees the Patient from the very Jaws of Death: In such a case after that the little Sores have voided little, or an indifferent quantity of I∣chor the first Days, at length nature attempting a Crisis this way, a vast quantity of Serous-filth flows from the same; and so continues to flow forth for many Days, nay sometimes Weeks, till the Patient lookt upon before as given over, recovers his perfect Health: As it is not easy to heal the little Sores so flowing in abundance, so it is not safe to do it before the whole Seminal Root of the Disease be spent: Not long since a famous Dr. of Physick of London recovering with much a∣doe of a Malignant Fever, had in many parts of his Body places Blistered, daily distilling forth a plenty of Ichor, after some time (they being troublesome and tedious to him) he apply'd strong Repercussives to them all, and so presently stopt all Issue of Matter: Those Sources had been scarce stopt two Days, but falling into a Relapse of his Disease, on a sudden he was seiz'd with a Languor of the Spirits, and frequent Fainting Fits, with a cold Sweat, and a low and weak Pulse; and not being able to be reliev'd by any Remedies, however cordial they were, he died within three Days: The cause of which seems to be that the Malignant matter suddenly struck back into the Nervs of the Heart; whose action being thereby hindred, the Vital Function soon fail'd.