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 curing the Le∣thargy.

HItherto we have described with what Disease chiefly, and how diversly the precincts of the Head, or the Coverings of the Brain are wont to be affected: Now, descending to its inward Parts, and to its cortical Substance, which immediately lyes under those Coverings, let us see to what affects chiefly this Part is found to be obnoxious. We have shewn elsewhere that the Cortex of the Brain is the Seat of Memory, and the Entry of Sleep; wherefore we justly ascribe to the cortical part of the Brain that Disease which is wont to cause an excess of Sleep, and a defect, or eclipse of the Memory, to wit, the Lethargy.

The word Lethargy is wont to signifie two kinds of affects, which are only the act and disposition of this Disease; for those that are said to be troubled with a Lethargy, either altogether keeping their Beds, through a very great Invasion of it, are so far overwhelm'd with Sleep, that they are scarce able to be rais'd by any impression of a sensible Ob∣ject: nay, and if hapy they open their Eyes, or raise their Limbs up∣on pricking, or a smart stroak, presently becoming insensible again, they sink down, and often, when they are left to themselves, falling into a perpetual Sleep they dye out right: which kind of Fit has very often a Fever joyn'd with it, though when the diseased awake, and come perfectly to themselves, for the most part it ceases of its own ac∣cord. Or secondly, those are accounted for Lethargical, who being opprest with an immoderate deadness of the Senses, are in a manner

always prone to sleep: so that in walking, nay whilst they are eating or doing any other thing, they now and then fall into a dead Sleep: and since there are divers degrees of this Sleepiness, and various manners of affecting, hence also there are made many Species of the Lethargick Disposition. at present we shall speak of the former Lethargy, and so properly called, and afterward of the continual Sleepiness, also of the Coma, Carus, and other sleepy affects allyed to them: and likewise of continual Watching.

Mean while you may observe, that almost in every kind of Lethargy, a Drowsiness or Sleepiness, and Forgetfulness are always present, as Pathognomick Signs, and equally attend it. Wherefore, that the for∣mal Nature and Causes of the Lethargy may the better be known, We must first enquire here concerning Sleep and Oblivion, what they are, and for what causes they are rais'd.

The Essence of Sleep consists in this, that the corporeal Soul with∣drawing it self a little, and contracting the Sphere of its Irradiation, in the first place renders destitute the outward part of the Brain or its Cortex, and then all the outward Organs of Sense and Motion of the Emanation of the Spirits, and closes the Doors as it were; so that they being called in for refreshment sake, lye down, and indulge them∣selves to rest: mean while the pores and passages of the outward part of the Brain being free, and void of the Excursions of the Spirits af∣ford a passage to the Nervous Liquor distilled from the Blood for new Stores of Spirits. In natural and usuall Sleep, these two concauses conspire and happen together as it were by some mutual compact of Nature: viz. at the same time the Spirits recede, and that nervous Humour enters: but in nonnatural, or extraordinary Sleep, sometimes this cause, sometimes that is first: for either the Spirits being weary or called away withdraw themselves first, and afford an entrance to the Nervous humour heaped together in a readiness for it: or a plenty of Nervous humour coming to those Places, and making a way by force as it were, repells the Spirits, and entring their Passages, floats them as it were. Concerning Oblivion, or the Eclips or defect of Me∣mory, the cause of this is wholly the same as of immoderate Sleep, viz. an Exclusion of the animal Spirits from the passages of the outward part of the Brain, which are filled with some Humour, and their return prohibited for a time.

Preternatural Sleep or insatiable Sleepiness (which is the chief Symp∣tom in the Lethargy and in the sleepy Effects) seems to arise wholly from the same causes as non-natural Sleep, rais'd to a greater Energy, viz. either the animal Spirits being first affected leave the outward part of the Brain, and yeild an entrance not only to the Nervous, but like∣wise to the Serous, or otherwise vitious Humour, or the serous and excrementitious Humours together with the Nervous force open the cortical Gates of the Brain, and floating as it were its Pores and Passages,

repell and drive away the Spirits thence: sometimes this Cause, some∣times that is the first and chief, and sometimes both happen toge∣ther.

Therefore the conjunct Causes of the Lethargy are, 1. a heaping together of a redundant or incongruous Humour within the Pores of the cortical part of the Brain; which depends on other, both proca∣tarctick and evident causes: As to the former, both the Blood uses to be in fault, in that it sends morbifick matter to the Part affected, and the Brain it self, in that it admits it too easily. The evident causes which joyn with these are chiefly, Over-eating, Drunkenness, and espe∣cially immoderate drinking of Wine and hot Waters, then upon such an Excess to sit up all night, or to sleep in the open Air: Moreover, a long suppression of an usual evacuation of Serum by other ways; Also if Spaw-waters, drank in a large quantity, are not presently discharg'd again by Urine, they threaten a Lethargy; the same also is caused by the recrements of other Diseases, coming to an ill or no Crisis, convey'd to the Head: so that a Lethargy happens upon acute, or long continued Fevers, and other Cronick Diseases, and very often upon a Head-ach, Frensie, Empyema, and Cholick.

2. In regard, as non-natural, so sometimes preternatural sleep be∣gins from the Spirits being first dejected; therefore the other Conjunct cause of the Lethargy consists in a stupefaction inflicted on the Spirits, which proceeds either from Opiats taken inwardly, or from narcotick particles engendred in the Body.

The sum of what is said concerning the Lethargy, is this, that the animal Spirits residing in the outward part of the Brain being stop'd from their wonted motion and emanation, yield to a profound and in∣satiable Sleep; Now they are stop'd either through their own fault, in as much as being spent, or affected with a stupefactive force, they are congeal'd as it were; or because their Paths or tracts are obstruct∣ed in the outward part of the Brain, and are possess'd by a strange guest, so that they have not a space granted them fit for their ex∣panson.

The chief Symptoms of this Disease, are Sleep and Forgetfulness; a cessation of every other knowing, or spontaneous function, an uneven and slow respiration, a Fever, and often the affect growing worse, Cramps, leapings of the Tendons, and lastly, universal and mortal Con∣vulsions.

The prognostick of the Lethargy is included in very narrow bounds; for the Fit of the Disease being for the most part acute, is soon termi∣nated in Death, or a Recovery, and most commonly is wont to give more cause of fear than hope.

If it happens upon a Fever that is malignant, or of a difficult deter∣minations, or if upon other cephalick or convulsive Diseases, as the Head-ach, Frensy, Mania, Epilepsy, or also if on a long continued or

severe Cholick or Gout, the Physician can prognostick nothing but ill, nor is it less to be fear'd, if it happens in a cacochymical Body, or in one long subject to sickness, and in old age.

In like manner, it is an ill Omen, if the Diseas'd being presently overwhelm'd with a great deadness, and becoming almost Apoplecti∣cal, cannot be awak'd, if he breaths unevenly and flowly, or with great snoarings: Moreover, if the Disease growing worse and worse, the sick Person be affected with Tremblings, Cramps, leapings of the Tendons, and lastly, with convulsive motions, he is to be look'd up∣on as in a desperate condition.

But if the affect without any great Procatarxis, be rais'd by an evi∣dent Cause alone, as from over-eating, drunkenness, the use of Nar∣coticks, or from a stroak or wound of the Head that are not very dan∣gerous, we may expect a less fatal event. Moreover, if the affect ari∣sing on such an occasion, happens to a Body which was sound and robust before, if at the first invasion it does not wholly take away the Sense and Memory, and after a little time the symptoms begin to remit, we may not despair of such a sick Person.

In any Lethargy, if the cause of the Disease seems somewhat to be shaken and mov'd, so as plentiful and laudable evacuations by Sweat, Urine, or Seige happen by the help of Medicines, or by the instinct of Nature, and give ease; if upon the application of Vesicatories, a great glut of filthy Waters flows forth; if inflamed swellings, or great pushes arise behind the Ears, or in the Neck; if a great sneezing with a dropping at the Eyes or Nose shall happen, we may thence conceive some hope of recovery. And sometimes an Empyema hapning upon a Lethargy, puts an end to it, viz. inasmuch as the morbifick matter which was fix'd in the Head, and first caus'd the Lethargy, being af∣terward drank up again by the Blood, and depos'd in the Breast, pro∣duces the Empyema: In the description of the Epidemical sleepy Fe∣ver, which reign'd An. 1661. we have observed that this hapned to many.

Concerning the Cure of this Disease, since it allows no truce, we must not be long deliberating: After the injection of a smart clyster, presently let a Vein be open'd; for the Vessels being emptied of Blood, more readily drink up again the Serum, or other humours de∣pos'd in the Brain: Moreover, I advise in this case the Jugular Vein to be open'd, rather than a Vein of the Arm, because by this means the Blood very much heap'd together, and haply stagnating within the Sinus's of the Head, will be more easily reduc'd to an even circu∣lation.

After Bleeding, other Remedies of every kind are presently to be applied to use; let large Visicatories be applied to the Neck and Legs; the Faces and Temples are to be anointed with Oyl of Amber, or Ce∣phalick Balsams; let Cataplasms of Rue, Pepperwort, or Crowfoot, well

pounded together with black Soap and Sea-Salt be applyed all over the Feet, let smart frictions be us'd to the Limbs, let Salt of Ʋrine, or Spirit of Sal Armoniack be frequently held to the Nostrils.

In the mean while let Cephalick Remedies be now and then taken.

Take Water of Peony Flowers, Black Cherries, Rue, Walnuts sim∣ple, of each three ounces, compound Peony Water two ounces, Ca∣storeum tyed in a Nodulus and hung in the Glass, two drams, Su∣gar three drams, mix them, make a Julep; let four or five spoon∣fuls be taken every third or fourth hour; moreover, to each dose of this add from twelve to fifteen drops of Spirit of Harts-horn, Amber, or Sal Armoniack, or a paper of the following Powder.

Take Powder of Male Peony Roots, Mans Scull, Roots of Virginia Ser∣pentary, Contrayerva, of each a dram; Bezoar, Pearl, of each half a dram; Coral prepar'd a dram, make a Powder, divide it into twelve parts.

Moreover, it is here to be considered, whether a purging by Vo∣mit or Seige ought not to be ordered just at the beginning. I know that this is variously controverted amongst Authors, and I have known it us'd in practice with a various success: which being considered, and compared betwixt themselves, I shall briefly declare what is my opinion.

If a Lethargy has arose from a fresh over-eating, or being drunk, or if from taking improper and narcotick things, presently let a vomit be raised: Wherefore, let Salt of Vitriol be given, with Wine and oximel of Squils; or in robust Persons, an infusion of Crocus Methallorum, or Mer∣curius Vitae, with Black-Cherry Water: and afterward, unless it works of its own accord, let a Vomit be provoked, by thrusting a Quill into the Throat.

But if the invasion of the Disease happens upon a Feaver, or other Cephalick affects; or if it be raised primairly, or per se, by reason of a Procatarxis first laid in the Blood, or in the Brain, Vomits and Purges given presently at the beginning, whilst the matter is flowing, are wont oftner to do more hurt than good: to wit, inasmuch as whilst the humours are in motion, those Medicines more exagitate them; and since they are not yet able to subdue them, and lead them forth, they drive them into the part affected.

On the second day, if the dead sleepiness be not yet remitted, let bleeding, in case the Pulse indicates it, be repeated, or in its stead let Blood be taken away in the Shoulder-blades by Cupping-glasses af∣ter Scarification: Then a little afterward let an Emetick Medicine (if nothing prohibits it) or a Cathartick, be given.

Take Sulphur of Antimony five grains, Scammony sulphurated eight grains, Cream of Tartar six grains; mix them, make a Powder, let it be given in a spoonful of the Julep prescribed.

Or, Take Scammony sulphurated twelve grains, Cream of Tartar fifteen grains, Castoreum, three grains, make a Powder: give it after the same manner: Mean while let the same, or the like altering or deriving Remedies be still continued.

On the third day, and afterward, those things which at the begin∣ning of the Disease were forbidden for fear of a new fluxion, viz. Err∣hines, Sneezers, and Apophlegmatisms ought to be us'd. Moreover, then it will be sometimes profitable to apply the warm Viscera of a fresh kill'd Animal to the Sinciput, after that the Hair is shav'd or cut, and now and then to change it; and sometimes also to foment those pla∣ces with a cephalick and discussing Decoction: But beyond other To∣picks, I have known great relief given by a large Vesicatory, raising Sores that ran very much all over the Head: I saw two Lethargical Persons cured chiefly by this Remedy, after that the Disease was protracted in length, and therein having lost not only the memory, but even all knowledge: for in both, the excoriated places, in regard they could not easily be covered with an Eschar, discharg'd a vast quantity of a thin Ichor, to wit, daily about half a pound. It will not be needful for us to describe or set down other Medicines of this kind, they being vulgarly and every where to be found, what remains, for the illu∣strating of what is said before, I shall give you some Histories of sick Persons.

A Husbandman about thirty years of age, of a phlegmatick tempe∣rament, inclining to a sanguine, being long obnoxious to requent Head-aches, about the beginning of Winter became very sleepy and drowsy; afterward, on a certain day when he was tilling a field, he laid himself on the ground, and fell into a profound Sleep; and when he could not be awak'd by a Servant, and other Persons call'd, being carried home he was put to bed: his Friends in the mean while expecting that the Sleep being at length ended, he would awake of his own ac∣cord. After the space of twenty four hours was past, when they were not able to awake him by pinching, pricking, making a noise, and other wayes, they call me; when I came, I applied a large Vesica∣tory presently to all the hinder part of his Neck, then Blood being drawn to sixteen ounces, I ordered a smart Clyster to be given, his Face and Temples to be anointed with Oyl of Amber, Frictions, and painful Ligatures to be used to his Legs: Moreover, I prescribed Spirit of Soot to be taken often in a day with a cephalick Julep: notwith∣standing he lay stupid all that day, without any sense, if, being irrita∣ted by hard pinching, he raised himself a little, and opened his Eyes, presently falling down and closing them, he yielded again to his Le∣thargy. About the Evening I ordered Cupping-glasses with much flame to be applied to his Shoulder-blades, which being done, he began to become a little awake; and as about that time he purg'd freely by Seige, and the Plaisters being taken off, a great deal of Serum flowed from

the little bladders, we had thence a great hope of his Recovery. There∣fore Remedies being frequently used afterward that night, awaking the morning following, he knew his Friends, and answered well to what was askt him: but the whole cloud did not yet vanish, for he continued sleepy and forgetful for many dayes, till being twice purg'd he perfect∣ly recovered.

An Oxford Gardener, sick of a putrid Fever, and about the height of the Disease, instead of a Crisis falling into a Lethargy, was overwhelmed with a drowsie evil for three or four Dayes afterward, that he could not be so roused from his Sleep by the use of any Remedy, as to become perfectly awake: but at length, when his Head being shaved, and Vesica∣tories being applied almost all over it, had raised a grea many Sores that flowed plentifully, awaking from his Sleep, he recovered some sort of Sense: nevertheless his Memory being almost wholly abolisht, he was so stupid, that remembring no ones Name, or Words, he had scarce more apprehension than a Brute. When he had lain after this manner for almost two Months void of Understanding, and full of Sleep, the cloud began by degrees to be disperst; and he at length re∣turning to his wonted Labours became indifferently well, though he never got again the same Vigour of Mind, and former quickness of Sence, which he enjoyed before the Disease.

As for a Lethargy arising from the use of Opiats, I remembr I for∣merly observ'd a good exact type of it in a Country Village, in which I was sorc'd to stay a night, my Journey being stopt by reason of bad Weather: For as I was just a going to bed, my Host intreated me that I would go and see two poor People in the Neighbourhood, who were affected after such a strange and miserable manner; which Of∣fice being induc'd to perform, not only through Charity but also Cu∣riosity, I was willingly led to a very small and low Cottage, where I found an aged Father and his Daughter (in two little Beds plac'd here and there in the same Cell) overwhelm'd with a most profound Sleep, which had oppress'd them the day before, after they had eaten Henbane-roots, then freshly dugg up in their little Garden, which they mistook for Parsneps.

To both these, after a Vomiting plentifully rais'd by pouring Oyle and Oximel into their Mouths; and thrusting a Feather into their Throats, I prescribed tincture of Castoreum to be given frequently during the whole Night in a Spoonful of treackle-Water (which Remedies I then casually had by me); moreover that their Temples and Nostrils should be anointed with the same Tincture, and if it could be done, that a smart Clister should be injected: the day following, first the old man, and afterward the Daughter, awaking, came to themselves, the dead sleep being wholly shaken off, in these Persons, after the remainder of the Narcotick being cast up by Vomit, lest it did farther mischeif, it was only needful that

the Spirits being raised up by fit Remedies (in the number of which Castoreum is justly accounted against the Poysons of Opiats) they should be freed from the Stupefaction inflicted on them.