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. X. Of the Convulsive Cough and Asthma.

IT is Usual in Children (and I have known it also sometimes in Men) for a Cough to arise from Mass of Serous Filth flow∣ing in the Lungs: Which being at first Simple and Moderate af∣terward becomes vehement, and Convulsive, so that in Cough∣ing the Diaphragm being contracted upward, and so held by a long, or very often repeated Systole; the Lungs are greatly straitned and very much hindred, in their motion: Mean while by reason of the respiration being hindred, and the Blood being restrain'd within the Praecordia, and con∣sequently its Stagnating in other places, the Diseas'd are in danger of being Suffocated and often turn of a Livid or Cadave∣rous aspect: Moreover in this case, besides Convulsions with a violent Coughing, rais'd about the Praecordia, the Stomach also being often drawn in as a party concern'd, throws up all by Vo∣miting that is contain'd within it; nay and I have known, in some Tenderlings affected after this manner, that the Disease now and then passing into other parts, has rais'd Convulsive Motions in the Face, Eyes and Limbs, and at length has become Mortal. This Convulsive Cough happens very often amongst Children, and in certain years it seizes so many, that it seems plainly Epidemical, when it has got a Root, it is very difficultly con∣quered with remedies, but commonly drawing out in length, is scarce ever Cured but upon the change of the season of the year.

The cause of this Distemper seems to be from the Redun∣dancy of the Scrous Humour in the Mass of Blood, and in some measure in the whole Body: A portion of which matter Di∣stilling from the Mouths of the Arteries on the Lungs, creates an ordinary Cough; afterward when the Serous Filth, still aboun∣ding in the Blood, and being fill'd with Convulsive Particles, is conveyed also into the Head, the same entring the Nerves of the Lungs, raises the Simple Cough to a Convulsive one: Moreover, when it sometimes happens, that the same Matter gathered together in the Head, enters some other Nerves; then other sorts of Convulsive affects often ensue upon the Convulsive Cough.

As a Cough arises, neither only, nor always through a fault in the Lungs, but sometimes from a Convulsive cause alone, though oftner from this coming upon an affect of the Lungs: So we may say the same of the Asthma; for whether this Dis∣ease be continual or periodical, in both cases the Symptom which chiefly presses, is a difficulty of Breathing; which indeed seems therefore to be rais'd, because the Lungs being too much puft up and Distended greatly, Fill the Cavity of the Thorax, and do not subside by turns as they ought: Hence neither can the Breath which lies within be freely sent forth, nor indeed the fresh Air be easily introduc't, by reason of the space being fill'd before. Whilst the Lungs are thus detain'd, for a long time in a continued, or little remitted dilatation, oftentimes the Dia∣phragm, against its Custom, is forc't to a violent Systole, and being contracted upward, is wont to raise the Lungs more and more, and to withstand their Subsiding: Whence it happens that the Breathing becomes yet more difficult and laborious.

That this affect of difficult Breathing sometimes happens through the fault of the Lungs, it has plainly appear'd to us by an Anatomical Inspection; for if a mighty Mass of Serous Filth depos'd in the Thorax, very much stuffs the Lungs, that the Blood being letted in its Circulation, does not pass freely the Pneumonick Vessels, then persons so affect∣ed are always short and thick Breath'd. Again, as often as the Blood becoming too Hot, or being rarified by exer∣cise, or the heat of a Bed requires a larger space for its Cir∣culation, Then presently on such an occasion every thick Breathing, or an Asthmatick Fit is rais'd, which often becomes Terrible and almost Suffocative when the Serum Boyls very much within the Lungs. Moreover sometimes besides the Roots of an Asthma fixt about the Praecordia, some Branches of the same disease springing from the Brain meet with the former, and being Complicated with them, produce more Terrible fruits of a difficult breathing.

There are Instances enough of these affects, viz. of a diffi∣culty of Breathing, rais'd through the Single and Partial fault of the Lungs: For nothing is more usual than that persons troubled with an inveterate Cough, or with some other evil disposition of the Lungs, at length upon the access of a Drop∣sie or Scurvy, become Asthmatical, to wit, when the Blood be∣ing rendred very impure deposes also its Serous Filth in the Head, this enters more readily and easily the Nerves of the Lungs than others, as being become Weak, and frequently Ir∣ritated in their extremities, and heaps together in them a mat∣ter for a Convulsive straitness of Breath.

Moreover I have sometimes observed that great Fits of the Asthma have happen'd without any considerable fault in the Lungs, so that I have really judg'd this Disease sometimes to be meerly Convulsive, and that its Fits are only rais'd because a Se∣rous Filth, fill'd with explosive Particles, entring the Nerves that serve for the Dilatation of the Lungs, joyn'd with the Spirits there abounding, which afterward through a fulness, or Irritation being exploded together, and for some time, the Lungs are held as it were stiff, and blown up, that they can neither perform the functions of Expiration nor Inspiration: But the Fit being ended, and also before it is begun, the Breath is drawn free and evenly enough, there appearing no signs of a Cough, or of a Valetudi∣nary disposition of the Lungs: I shall give an Instance of a person troubled with this Shortness of Breath.

A Gentleman of a Robust and Gross Habit of Body having us'd for some time a full and disorderly dyet, without any exer∣cise, about the beginning of Winter began to find himself ill: First he was affected with a Heaviness and Pain of his Head, with a mighty Giddiness, and danger of Swooning, believing himself now and then, even a Dying, being otherwise sound e∣nough; within a few days these Symptoms past into a manifest Stupor or rather Lethargy; Being let Blood in the Arm, I ordered that Cupping Glasses, Vesicatories, smart Glysters, with many o∣ther remedies shoul'd be carefully administred to him: With∣in the space of twenty four hours, coming to himself, he was sound in his mind and shook off all Stupidness: But though his Brain came to be clear, he was seiz'd with a great Weakness and Deadness in his Members: which affects nevertheless were Cur'd in a short time with Antiparalytick, and Antiscorbutick remedies: But after a fortnight he complain'd again of the heaviness of his Head, and the Giddiness, and the next day after he fell into a horrible Asthma, so that the Lungs were blown up on a sudden, and rise upward; and being scarce at all able to draw his Breath, which was very short, painful, and greatly letted, he was in danger of being Suffocated every minute of an hour. This fit, as Violent as it was, past off within twelve hours with∣out a Cough, Spittng, or Vomit, and for above a week afterward he was without any impediment in his Thorax: But then a like fit of the Asthma returning, treated him a little more mildly, and afterward he was wont to be troubled with a like assault of the Asthma upon great changes of the Air, especially when an intense Cold and Snow were at hand.

Moreover we judge that sometimes this Convulsive straitness of Breath is rais'd by reason of the Bronchia of the Trachea being too much straitn'd, and often wholly clos'd by the Constriction

of the Nerves and stocks of Nervous Fibres, which every where compass about the Ramifications of the Aspera Arteria, that Con∣striction happening when those Nerves are forced to frequent Convulsions from a Morbifick matter besetting them.

A fine young Virgin, of a soft and tender Constitution, and of a florid Countenance, was scarce turn'd of eight years of age but began to be sorely troubled with Asthmatick Fits; and she lived at least four years obnoxious to them before she was com∣mitted to my care; sometimes she continues two or three Months free from any Invasion of this Disease, yet oftentimes, by reason of errors committed in Dyet, or upon great changes of the Year, or of the Air, she falls into cruel Fits of straitness of Breath, so that the Lungs being blown up and raised towards the Throat, and there held by an almost continual dilatation, the Diseased can scarce breath at all: mean while the Diaphragm and Muscles of the Breast are laboriously occupied in thick repeated efforts of motion, in order to draw the Breath by one means or other; this access, within seven or eight hours, remitting by degrees, ceases a while; but now and then within a Week or two it is wont to return either of its own accord, or on any light occasion being offer'd: after the violence of the Disease is past, its matter being spent in many such Fits, the young Lady continues well enough for many Weeks, nay sometimes Months, and being free from any Distemper of the Thorax, she Breaths freely. I order'd her Spring and Fall the following Method of Cure; and now she has been without any Fit of the foresaid Affect above two Years.

Take our Sulphur of Antimony six Grains; Cream of Tartar, six Grains; mix them: Let it be given in the Pap of a boiled Apple. After taking this Medicine, she is wont to Vomit four or five times: After four days, she takes this Purge, which also she is wont to repeat twice, allowing six or seven days betwixt whiles.

Take Calomelanos twelve Grains; Rosin of Jalap five Grains; Castoreum four Grains; with a sufficient quantity of Ammoniacum dissolved: make three Pills. She takes besides every day, Morning and Evening, twelve Grains of Tincture of Antimony in a Spoonful of the following Julape, drinking after it six or seven Spoonfuls of the same.

Take Water of Snails, six Ounces; of Earth-worms, four Ounces; Water of Pennyroyal and Rue, of each four Ounces; Hysterick Water, three Ounces; Castoreum tyed in a Nodulus, and hung in a Glass, half a Dram, double refined Sugar, an Ounce: Mix them in a Glass; make a Julape.

About Autumn the last Year, another young Girl of Quality, being ill after the like manner, viz. with a Periodical Asthma,

was brought to me to be cured, who using the foresaid Reme dies in a little less Dose, and repeating the same the last Spring found a mighty Relief.

As to the Remedies and Method of Cure that ought to be us'd, if at any time to a Cough, or straitness of Breath, first raised through a fault in the Lungs, Convulsive Symptoms also super∣vene, by reason of an injury communicated to the Brain; let care be taken that Anticonvulsive Medicines be aptly complica∣ted with such as have regard to any intents whatsoever of the Thorax; and also sometimes, That one while, these, another while the others being given apart, the times of Curing be in∣terchangeably observed. It will be needless to give here Bechick or Pneumonick Medicines and their forms, whereof there is a vast store every where to be found amongst Physical Authors; it will be more to our purpose to set down a method of Physick, and some select Remedies that are proper in a Cough and Asthma, which are meerly Convulsive.

As to the former Affect, which is chiefly familiar to Children, and for the most part is not Cured but with difficulty, and after a long time; the chief Indications will be, both to purge the se∣rous and sharp Humours from the Blood and Viscera, for pre∣venting their Incursion and discharge on the Brain, and some∣times haply on the Breast, and to strengthen these parts that they do not easily admit into them the Superfluities of the boiling Serum: for these ends Vomits and gentle Purges in a manner always are conducing, and ought by some means to be re∣peated. Vesicatories are often beneficial; and if the Disease be obstinate, let Issues be made in the Nape of the Neck, or in the Arm, or about the Arm-pits: Let Drink and Liquid Food be taken in a less quantity than usual; instead of Drink, let a Bochet of Sarsa, China, the Saunders, Shavings of Ivory and Harts-horn, with Diuretick and Anticonvulsive Ingredients, be used. In this case certain specifick Remedies as it were are greatly commended, of which kind are Cup Moss, given in Powder, or boil'd in Milk, and so given frequently every day; the Decoction, or Syrup, of Ca∣storeum and Saffron, the Decoctions of Peony-Root, Misteltow of the Oak, also of Hyssop, have helpt many; Water of Black-Cherries, of Saxifrage, Water of Snails distilled with Whey, and appropriated Ingredients, are often given with success.

2. I have shewn you before by what method, and with what Bemedies I have Cured a Periodical Asthma in some; but besides, the famous Riverius has observ'd that Vomits do most good to many affected with this Disease; for that Medicine, greatly sha∣king and irritating the Emunctories that are seated about the

first Passages, strongly expresses and draws away from the same the filthy Dregs of the Blood and Nervous Juice, which were apt to be forc'd into, or to stagnate in the Brain and Genus Nervo∣sum. Zacutus Lusitanus greatly extols, and not without reason. Cauteries burnt, sometimes in the Bregma, sometimes in the Nape of the Neck, or about the Arm-pits: Preparations of Millepedes, viz. in the form of a dry Powder, or of a Distill'd Liquor, seldom want success; for such withdraw the superfluities of the Serum or Genus Nervosum from the Head, and convey them to the Urinary Passages: For the same reason gentle Purges, and such as evacuate per Epicrasin, are frequently used: for this purpose the Decoction of an old Cock, with altering and gently Purging Medicines, sown up in the Belly of it, is commended by many. Besides the Remedies hitherto mentioned, some are said to be ap∣propriated to, and as it were Specificks for the Asthma, such as are Balsam of Sulphur Teribinthinated; also Spirit of Harts-horn, or of Soot, impregnated with the same; Syrup of Tobacco, of Ammo∣niacum, our Syrup of Diasulphur, Lohoch de allio, Pills of Elecampane Roots, Milk of Sulphur, Flowers of Benzoin, made up with Tar or liquid Amber; with many other things, which it would be tedious here particularly to enumerate.

And now having given you the ways of curing the chief kinds of Convulsions, it seems time to put an end to this Tract; but since there remains another kind of Disease, viz. the Scurvy, which contains Passions of a mixt nature, viz. partly Convulsive, and partly arising immediately from the Dyscrasies of the Blood and Viscera, I think it expedient to give you briefly the way of Cu∣ring that; for both these Affects, viz. the Scorbutick, and Con∣vulsive, being placed together, will mutually illustrate each other.