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. VIII. Of the Affects which are vulgarly call'd Hysterical.

IF at any time an unusual sort of Sickness, or of a very Secret Origine occurs in the Body of a Woman, so that its Cause lies hid, and the Therapeutick Indication be wholly uncertain, presently we accuse the evil influence of the Womb (which for the most part is guiltless) and in any unusual Symptom, we cry out that there is somewhat Hysterical in it; and consequently the Physical intentions and the uses of Remedies are directed for this end, which often is only a starting hole for Ignorance.

The passions which are wont to be rank't in this number are found to be various andmanifold, which seldom agree in divers Women, or happen wholly after the same manner: the most common of them, and which are vulgarly said to Constitute the formalstate of an Hysterick affect, are these, viz. A Motion in the lower part of the Belly, and an Ascent as it were of some round thing there, then a Belching or Straining to Vomit, a distention of the Hypochondres and a Rumbling with a Belching forth of Wind, an uneven and for the most part a letted Respira∣tion, a Suffocation in the Throat, a Giddiness, an Inversion, or Rotation of the Eyes, often Laughing, or Weeping, a Talking Idly, sometimes a Speechlesness and Immobility with an ob∣scure or no Pulse, and a Cadaverous aspect, sometimes Convulsive Motions rais'd in the Face, and Limbs, and sometimes in the whole Body: But universal Convulsions seldom happen, and not unless the disease be raised to its worst state, for the Tragedy of the Fit is acted through for the most part without any contraction of the Members only in the Belly, Breast and Head, viz. one of them, or successively in all. Women of all Ages and Con∣ditions are obnoxious to these affects, to wit Rich and Poor, Virgins, Wives, and Widows: I have observed those Symptoms in Girls before the time of Puberty, and in old Women after their Menses ceast to Flow, nay and men are sometimes troubled with such kind of Passions, instances of which are not wan∣ting.

The cause of these Symptoms must not be imputed to the Ascent of the Womb, and to vapours rais'd from the same; nor to the Impetuous rushing of the Blood into the Lungs, as the Learned Highmore has Judg'd; But we say that the affect call'd Hysteri∣cal,

chiefly, and primarily is Convulsive, and depends principally on the Brain and Genus Nervosum being affected, and is produc't wholly by the exposions of the Animal Spirits, as o∣ther Convulsive Motions. And whatever disorder or irregula∣rities happen else about the Motion of the Blood, they are only secondary and depending on the Convulsions of the Viscera. The way of the difference whereby the kinds of this disease both differ from each other, and from the other Convulsive affects is taken from the various Origine, and chiefly from the extension of the Morbisick Cause: for the Origine of this, as of many o∣ther Convulsive affects sometimes resides in the Head, the Womb being wholly without fault: Though sometimes this affect hap∣pens through the fault of the Womb, and sometimes through that of other parts: As to the extension of the Disease, from whatever Origine it proceeds, for the most part it chiefly af∣fects the Interiour Nerves, to with those that particularly regard the Viscera and Precordia and their appendixes, and chiefly troubles the Spirits lying in them: Sometimes also, though rare∣ly, the Spirits that presides in the Exteriour Nerves and likewise those in the Brain and Cerebellum, are involv'd in the same affect.

As to the Morbifick Matter, or Explosive Combination, which, accruing to the Spirits within the Brain, and deriv'd with them in∣to the Processes of the Nerves, often is the cause of the af∣fects, which are vulgarly call'd Uterine, or of the Mother: We say this to be Heterogeneous Particles sent from the Blood, as in other kinds of Convulsions; and which are wont to be made to cleave to the Spirits that pass into the Origines of the Nerves, on two chief occasions, viz. either through the fault of the Spirits themselves, or through the great force of the Matter: in∣stances of both kinds every where occur: Through the fault of the Spirits themselves as when through a sudden Passion, suppose of Fear, Anger, Sadness, they are very much Troubled and forc't into Irregularities; through the Exorbitant force of the Matter, as in the evil Crises of Fevers, also in any Malignant, and Scorbutical, and other Chronical affects of an ill Determina∣tion: these causes are much upheld and promoted by an ill or weak Constitution of the Brain and Genus Nervosum, whe∣ther it be hereditary, or acquir'd by an ill dyet, hence Women are more obnoxious to Convulsive affects than Men, and those one more then another.

Tho' these they call Hysterical affects very often arise from the Brain, yet sometimes they are rais'd by a cause beginning either in the Womb, or in other of the Viscera; and this either by rea∣son of a solution of continuity, through a Tumor or Ulcer,

or Stimulation of the part; or by reason of the obstruction of the Nervous Juice in its Circulation; thus when some accusto∣med evacuation, whereby the superfluities of the Nervous Li∣quour were wont to be discharged, is stop'd, as upon the sudden stopping of Issues, or drying up of old Ulcers without Purging, many have fallen into Convulsive affects, which sometimes also happen to Virgins and widows through a retention of the Se∣mianl homour, which ought to be Voided its proper way: And sometimes the Nervous Juice regurgitates toward its Origine, because its passage is somewhere stop't by a Cancrous or Scirr∣hous Tumour. To illustrate our doctrine of the, vulgarly call'd, Passions of the Womb; I shall now give an instance of a person troubled with them.

A Renowned Lady, extreamly beautiful, and endowed with an excellent temper of mind and manners, lately lived in these parts, who for many years was obnoxius to Convulsive affects, she having contracted this valetudinary disposition fro her Birth, or Hereditarily, and having found in herself these fruits of the morbid root almost every fourth year of her Age; but especially as often as she conceived with Child (as she often had, and undergone frequent Abortions) she was wont to be extraor∣dinarily troubled with Convulsive passions, in a manner Hysteri∣cal: For presently upon the stopping of the Menses, the Hete∣rogeneous Particles being convey'd to the Brain, and Genus Ne∣vosum, brought violent Fits of the distemper.

After that she had last conceived, in the first Months accor∣ding to her ancient wont, she was often troubled with Convulsive affects, about the uinth week of her being with Child, upon taking Cold, she fell into a dangerous Fever, in which very acute Pains sorely infesting her in the Loins, and about the lower part of the Belly, seem'd to threaten an Abortion: But those Pains, as it appear'd at last, being rather to be judg'd of the Co∣lick, proceeded from a Sharp humor, falling from the Brain into those parts by the Ductus's of the Nerves; for about the de∣clining of the Fever, that matter being convey'd elsewhere, a Diarrhaea, Pains of the Feet, and a Blistering as it were ensued.

As soon as this Lady grew well of her Fever, and Pains, the Convulsive affects returned, for every morning as she awaked from her sleep, she was wont to undergo violent Contractions and Convulsions about the parts of the Mouth and Face, and also in the Arms and Legs, which Syptoms doubtless arose from the Serous filth heap'd together in the Head about the Origines of the Nerves; and deeply Imbib'd by them during the sleep, toge∣ther with the Juice that passes in them; and when afterward the same matter was caryed again by the conveyance of the In∣teriour

Nerves, into the Plexus's of the Mesentery, and the Loins, most violent Pains of those parts, and likewise Fits as it were Hysterical sorely infested her.

For those Convulsive Motions of the Face and Members ceast in a short time, yet she continued still Weak and Infirm, with a Pale Countenance, Trembling as she went, and having a mind to no Food but such as was improper, and to hot Liquors: a∣bout the end of the third Month, at which time she used con∣stantly to Abort, her Menses broke forth, which passing from her for two or three days together, with pieces of broken Mem∣branes, she expected the Abortion: But the Flu ceasing, Pains, like those of a person in Labour, arose in the Abdomen and Loins as before, and miserably tormented her day and night for a week: At length having us'd a Bath of Emollient Herbs, and then being put to bed to sweat, she was delivered of the burthen of her Womb: the Conception thus passing from her with a mighty torture was as a Pea-hens Egg in bigness and figure; the outward coat of this was ragged and broken; the inward coat remaining whole, contained about half a pound of clear Water, and nothing else: And no rudiments, of a Faetus that was form'd, or about ot be form'd, did appear: Afterward for four or five days the Lochia flowed from her with some pieces of Membranes: Mean while Pains troubled her with their wonted violence: And in regard that after a week was past, they did not cease of their own accord, at length remedies were desir'd for appeasing them.

For this end in the first place, Liniments, Fomentations, Baths, and Glysters were freuently administred: And Medi∣cines cleansing the filth of the Womb, on which the cause of the whole distemper was charg'd, were inwardly taken: Upon the use of the former, short intermissions of the Pains followed: But now and then the affect returned and was mighty tedious: Nay and within three weeks, the disease growing much worse brought many other horrible Symptoms along with it: For besides the Pains in the Abdomen and Loins, which grew daily more vio∣lent, she was now troubled likewise with a great torture in her Back, Neck, Shoulder Blades, also in the Arms and Leggs, and that more severely as often as she grew warm in her Bed: More∣over she was afflicted with a frequent Giddiness, a Vomiting and Nauseousness, and often in a day with vehement Convulsive Fits, viz. First a great heavy thing seeming to Ascend in the lower parts of the Belly, presently raised up the Belly with violence: By and by, respiration being stopt, she became senceless with a Cadaverous aspect: After that she had lain thus dead, as it were, for three or four minutes of an hour, she was wont to start up

on a sudden, that she could scarce be kept down or held by persons present: Then followed violent contractions and distor∣tions in all the parts of the Mouth and Face, and in all the Mem∣bers of the Body. These Symptoms were judg'd really Hysteri∣cal, because the noble Lady had so lately Aborted.

But considering all these things, I was at length of this opi∣nion, That the cause of both Fits, viz. the Paining, and Convul∣sive, depended wholly on the evil affects of the Brain and Genus Nervosum, without any fault in the Womb, to wit, that the sharp humour heapt together within the Brain, descended thence, by the passages of the Nerves, into parts very remote, and lying in the Membranes and Fibres, and fermenting with the humour coming to it from the Mass of Blood, irritated them very much, and caus'd violent pains: then afterwards, when the heterogeneous and explosive Particles, admitted into the Brain with that Hu∣mour, and entring the Ductus's of the Nerves, joyn'd with the Spirits, thereupon the Convulsive disposition, now and then break∣ing forth into violent Fits, was caus'd, as it will by and by appear more at large.

Directing my curative intents according to this Aetiology, I ordered the sick Lady, at the time she was extreamly ill, that Blood should be drawn from the Saphaena Vein, That a gentle Purge should be given her within two days, and that it should be repeated once or twice a Week: Also on other days I gave her, Morning and Evening, Spirit of Harts-horn; and at other hours, twice or thrice in a day, Powder of Pearl and Crabs-eyes, with a Dose of the following Julape.

Take Water of Snails, Magisterial Water of Earth-Worms, of each three Ounces, Water of Saxifrage, and of Black-Cherries, of each four Ounces; Hysterick Water, an Ounce; Syrup of Coral, an Ounce and a half; Tincture of Castoreum, a Dram: mix them.

She us'd frequently a Bath of fresh Herbs when necessity requi∣red it; she took Opiats always with good success: Vesicatories were applied to the inward part of each Thigh, and to her Neck. Moreover Fomentations, Liniments, Glysters, Cupping-glasses, Sneezing-powders, and many other ways of Administration were prescrib'd, according to the exigency of Symptoms.

After this method of Curing used about fourteen days, the no∣ble Lady, being very much relieved, was wholly without the Convulsive Fits; nay, and the pains of the Bowels and Members, and other Symptoms, being very much mitigated, gave us a ve∣ry fair hope of a speedy Recovery; but after this, partly by rea∣son of an ill Dyet, to which the Diseased, upon never so little an amendment, always indulg'd herself, but especially by reason of a sudden passion of terriour or sadness, which a severe accident

happening within her own House, had rais'd, falling into a Re∣lapse, the Disease was presently brought to a much worse condi∣tion; for both the Convulsions, and Pains troubled her in a more violent manner, nay, and the Stomach, being stirr'd up in a man∣ner with a continual Vomiting, neither admitted Food nor Me∣dicines: she took Asses Milk for some days, with some Benefit; yet in regard it turn'd to Choler in her Stomack, and gave her some offence, it was soon left off. At length, in despite of all Remedies prescrib'd with all diligence by the advice of many Physitians, the noble Patient languish't daily more and more, and by degrees drew near to Death. Two days before her De∣cease, the pains of her Belly and Loyns remitted very much, and becoming more chearful than her wont, she had some hope of her Recovery; but in the mean while she complain'd of a pain and a mighty oppression of her Head; and falling into a profound Sleep, about the beginning of the Night, upon her awaking, she fell into a very horrible Convulsive Fit, which presently past into a mortal Apoplexy, for becoming insensible and speechless, she departed this Life within twelve hours. The Body of this person being open'd after her Decease, the Womb was found wholly without fault, tho' many of the Viscera were preternatu∣rally dispos'd: in the Mesentery, about the midst of it, where it is fixt to the Back, and contains great Plexus's of the Nerves, a lax substance, and blown up as it were with many Bladders, was seen, it equalling a hands breadth in extent: opening this place, I found no Humour in it, but only that the Membranes were separated from each other, and that nothing was included in the spaces betwixt them but a Wind, which Separations doubt∣less were caused by the Convulsions and Explosions of the Spi∣rits, sent from the Head into those Plexus's: and as to those pains in the Belly, and the ascent of the great heavy thing, as it were, and the Inflation of the Abdomen in the Convulsive Af∣fects, it is not to be doubted but the Seat of the morbifick Cause lay hid in that part of the Mesentery.

As to the method of Curing to be us'd in the Passions vulgar∣ly call'd Hysterical, since the greatest part of the Symptoms of this Disease are Convulsive, it is thence plain that anticonvulsive Remedies, such as above written, are chiefly indicated. Ne∣vertheless, since these Affects very often happen to the Female Sex, in which the Menses, and other accidents of the Womb, are most commonly taken in as a part of the Morbifick Cause; there∣fore Medicines having regard to various dispositions of the Womb ought to be added to the former, and be sundry ways complicated with them. The Therapeutick Indications are ei∣ther Curatory, to be us'd in the Fit, or Preservatory, which be∣ing

prosecuted out of the Fit, remove the cause of the Disease, and prevent its Accesses. As to the former, if the Fit be but small, let it pass off of its own accord, without any farther per∣turbation of the Spirits; but if it so forely presses that it is need∣ful to give aid to Nature, as being greatly opprest, let this one thing be endeavoured, That the Spirits being made free from the Embraces of their Heterogeneous Combination, remit of their Disorders and Explosions: For this end it is very usual in the first place to apply to the Nostrils stinking and strong-smel∣ling things, the effluvia's of which repress and reduce to order the Spirits, which are grown too wild and apt to make exorbi∣tant efforts, nay and discuss their Heterogeneous Combination, and often wholly exterminate it. Assa Foetida, Castoreum, Gal∣banum, tyed in a fine Linnen Cloth, and held to the Nostrils, are proper; also the Feathers of Partridges, or old Shoes burnt, or Sulphur kindled: moreover the Spirit and Oyl of Soot, or of Harts-horn, often give help; tho' I have known that these kinds of Suffurnigations have prov'd very offensive to some Women, and have encreas'd the Fit; it's probable that sometimes they irritate the Spirits too much, and force them into greater dis∣orders. As stinking things held to the Nostrils, so the like be∣ing pour'd into the Mouth, often give help; wherefore we of∣ten give with good success, to Hysterical persons, the Tincture of Castoreum, Solutions of Assa Foetida, and of Galbanum, also the Spirits of Harts-horn and of Soot, with appropriated Wa∣ters.

Take Spirit of Harts-horn, from twelve drops to fifteen or twenty, let them be taken in a little Draught of the following Julape.

Take Water of Penny-royal and Mugwort, of each four Ounces, Wa∣ter of Bryony compound, two Ounces; Castoreum tyed in a Nodulus, and hung in the Glass, half a Dram; double refined Sugar, an Ounce; Mix them.

Take Tincture of Castoreum; from, a Scruple to half a Dram; let it be taken in a little Draught of Small-beer. Take Assa Foetida, or Galbanum, two Drams; let them be dissolved in Spirit of Wine till a red Tincture be extracted: the Dose is a Scruple in two or three Spoonfuls of Water of Featherfew, Riverius greatly extols that of Solenander; Take Musk, Dragons-blood, of each a Scruple; let more or less be taken in three or four Ounces of Water of Navews. Jo∣hannes Anglicus commends the Seeds of Parsnips, or of Columbines in Wine, or an appropriated Water, as most certain Remedies. If the Fit, continuing a long time, renders the Person senseless, or without any Pulse, let smart Clysters, as of the Roots of Bri∣ony, with Carminatives boil'd with them in Water, be injected; let Frictions be us'd to the Legs and Feet; and if we must pro∣ceed

to stronger things, let Cupping-glasses be applied to the Belly or Groin, nay and let sneezing be often provok'd: it is good for some to give them, in the midst of the Fit, a Draught of cold Water, either simple, or in which Camphire has burnt.

The preservatory Indication comprehends these three chief in∣tents, viz. First, To take away, or to drive to some place else, the impurities of the Blood, which are apt to be discharg'd on the Brain and Genus Nervosum. Secondly, To fortifie the Brain, and so strengthen the Spirits in it, that they either admit not at all the Heterogeneous Combination, or readily shake it off. Third∣ly, to amend whatsoever is amiss in the Womb, and contributes to the Convulsive Disposition.

1. The first Intention is perform'd by Purging and Bleeding, and other common ways of Cleansing and Purging the Blood and Humours. If there be room for a Vomit, I Judge we must al∣ways begin with that, especially in Cacochymical persons, or such as are troubled with the longing disease, in whom a migh∣ty load of Viscous Phlegm, sticking in the Folds and Coats of the Stomach, hinders the vertues of other Medicines: Within a few days after the Vomit, (unless somewhat indicates the contra∣ry,) let Blood be drawn, in Women of a hot temperament, presently from the Arm, and afterward, if need be, from the Foot, or from the Veins of the Fundament, by Leeches; but in Bodies troubled with obstructions and less hot, let Blood be drawn more sparingly and rarely, and only in places seated below the Womb. After these evacuations (provided always that they are indicated) being duly perform'd, let a Purge be given once within six or seven days according to the forms following.

Take Pil. Foetidae Majores a Dram and a half, Rosin of Jalap twelve Grains, Tartar Vitriolated, Castoreum of each a Scruple, Ammo∣niacum dissolved in Hysterick Water what suffices, make twelve Pills for three Doses. (Or)

Take Rosin of Jalap eighteen Grains, Calomelanos a Dram, Castoreum a Scruple, make a Powder, divide it into three parts for three Doses, give it in the Pap of a boil'd Aple, or in Conserve of Borage: To persons of a Hot temperament a dose of our Extract, or Loosning Syrup may be properly given: For the revulsion of the Morbisick mat∣ter from the Head an Issue in the Leg, or Thigh, and somtimes Vesicatories, Ligatures and Painful Frictions are wont to be us'd. Nor must we only have regard here to the cleansing of the Blood, and to the Revulsion of its superfluous Dreggs from the Head, but likewise to the alteration of its Liquor, and the reducing of it to its due Crasis: Wherefore in certain Hysterical persons Chalybeats prove beneficial, in others Mineral Waters or

Whey, in some the use of Hot Baths are wont to do mighty good.

2. The second intention, viz. the rectifying of the Brain, and of the Animal Spirits, is perform'd by Cephalick and Particularly by Anticonvulsive Medicines, and let them be carefully given al∣most every day when there is no Purging, or Bleeding; There being various kinds and ways of Administration of such Medi∣cines, I shall here give you some of the more choice forms of them.

Take Faecula of Briony, Assa Foetida, Castoreum, of each a Dram, Salt of Coral, Amber, and of Jupiter of each half a Dram; Galba∣num dissolv'd in Hysterick Water what suffices, made a Mass; the Dose is from half a Scruple to a Scruple, Morning and Evening, Drinking after it a Dose of an appropriated Liquor.

Or, Take seeds of Wild Parsnips and of Nettles of each two Drams, Vitriol of Mars a Dram, extract of Gentian and Feverfew, of each a Dram and a half, with a sufficient quantity of a Syrup of Mugwort make a Mass, let it be taken to half a Dram after the same manner.

If the form of a Powder be more grateful. Take roots of Vir∣ginia Serpentary and Contrayerva of each a Dram and a half, Co∣ral prepar'd, Pearl, White Amber of each a Dram, mix them, make a Powder, the Dose is from a Scruple to half a Dram Morning and Evening with an appropriated Liquour.

Let Opiates be made after this manner. Take Conserves of the Flowers of Lillies of the Valley, Male Peony, and Betony of each two Ounces; Peony Seeds, Red Coral prepar'd of each two Drams, Powder of Bastard Dittany a Dram and a half, Salt of Wormwood two Drams, with a sufficient quantity of Syrup of Citron Pills, make an Electuary. The Dose is Morning and Evening the quantity of a Nutmeg. After the same manner to the Poor, let Conserves of the Leaves of the Tree of Life, or of the Leaves of Rue be given twice aday.

The Liquours appropriated to Hysterical affects, and to be Drank after the foresaid Medicines are either Distilled Waters, which may be taken by themselves, or with others in the Form of a Julape, or they are Decoctions, or Tinctures and Infusions.

Take Water of Mugwort and Pennyroyal of each half a Pound, Hysterick Water four Ounces, Tincture of Castoreum half an Ounce, Syrup, of Coral an Ounce and a half mix them; the Dose is from an Ounce to an Ounce and a half with any of the Medicines above prescribed.

Take Leaves of Penny-royal, Feverfew, both Southernwoods, Cala∣mint, Nep, both Horehounds, of each a Handful; Briony Roots four Ounces, Parsnip-Seeds two Ounces, being Slic't and Bruis'd, pour to them of White-wine or Sider six pounds distil them according to Art.

Take roots of Male Peony, Angelica, Valerian, of each half an Ounce, Leaves of Mugwort, Ground Pine, Calamint, Peny-royal, Misteltoe, of the Oak of each a handful; Seeds of both the Wild Carrots of each three Drams, Raisins a handful; let them Boyl in four Pounds of Fountain Water till half be Consum'd; add of Whitewine two Pound and a half: Strain it, Let it be kept in Vessels close stopt. The Dose is three or four Ounces twice a day.

Take Seeds of Wild Carrots bruis'd two Ounces, Castoreum an Ounce, put them in a Glass with two Pounds of White-wine. The Dose is two Ounces twice a day.

3. As to the third intent, which putting a stop to the disor∣ders of the Womb, advances the Cure of the Hysterick affect: I say in the first place that what was formerly believ'd concerning the Cause of the Disease, and the Scope of Curing it, viz. That the Womb did Ascend, and therefore that it ought to be restor'd to its due place, is altogether Fictitious, as we have shewn else∣where: The descent, or falling forth of the Womb often hap∣pens, but this seldom or never produces Hysterical affects: More∣over a Dislocation of the Womb sometimes happens to Child∣bearing Women presently after Child-birth, viz. When the body of the Womb being enlarged and newly emptied, does not settle in a right place within its Cavity, but leans high, sometimes to the right side of it, sometimes to the left, and there be∣ing Constring'd like a Purse is folded up in a great Lump, which Lump lying a long time in the side of the Inguen, is wont to Cause suspicion of another Foetus, or of the after Birth being left be∣hind, or also of a Scirrhous Tumour there Growing but afterward, when upon the Lochia's passing away freely, the Womb is re∣duc't to its due magnitude, that Tumour vanishes by degrees: And whilst it continues there, unless haply the Lochia are there∣by stop't, it does not cause Hysterick Passions: For the quick re∣ducing of this part to its due position, Fomentations, Liniments, and Plaisters contribute much: But very often that Symptom passes away of its own accord without any further offence: We have shewn elsewhere ex professo to what affects else the Womb is obnoxious after Child-birth, and with what methods of Physick we must obviate them: As to the other Distempers of this part, which happen to other Women, viz. to such as do not Bear Children; we observe those chiefly to be either a Disease of the Womb caus'd by a Solution of continuity, which is either a Tumour or an Ulcer; or to be a Stoppage of some usual Excre∣tion, viz. either of the Sanguis Menstruus, or of the Fluor albus, or of the Seminal Humour; by reason of the Menses retain'd the Heterogeneous particles being often discharged on the Head

Cause Convulsive Passions: In like manner when the White Hu∣mour is stop't the Excrementitious Matter being drank in again by the Blood is delivered to the Brain and Genus Nervosum. Moreover when a wonted evacuation of the Seed is stop't, the superfluities of the Nervous Humour Regurgitate into the Brain, and infect the Spirits in it with a Morbifick and Explosive Tincture. It will not be necessary for us to discourse particular∣ly and at large on these particular affects of the Womb, but to Complicate Medicines and Physical Administrations appropriated to Womens Diseases, with Anticonvulsive Remedies.