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. Instructions and Prescripts for curing certain other sleepy affects, viz. the continual Sleepiness, the Coma, and the Carus.

TO begin with the first; many Authors call this not a Disease, but a drawsie Disposition; for the affected as to other things are well enough, they eat and drink well, they walk abroad, they take care indifferently of their houshold Affairs, but in speaking, or walking, or eating, nay their Mouths being full of Meat, they now and then nod, and unless they are stirred by others, they are presently over∣whelmed with Sleep: and after this manner they Sleep almost a con∣tinual Sleep, not only for some Dayes or Months, but for many years (as it is reported of Epimenides.) Wherefore we judge this Affect by which we are defrauded of more than half of our Life, to be really a Disease and to deserve a cure.

The seat of sleepiness, as of the Lethargy, is to be plac'd in the out∣ward part of the Brain, but with this difference, that the material or conjunct cause of this Disease, tho always pressing at the entrances of the Brain, does not penetrate so deep as it is wont to do in the Lethar∣gy; but affects in a manner only the surface of the Brain, or the meer cortical substances of the Anfractus, the medullary part within being as it were untouched; in which regard it differs not only from the Le∣thargy, but also from the Coma, for in the affect which we describe, tho Sleep be continually pressing, yet it is easily broken off: and more∣over being perfectly awak'd the diseased remember a great many things, discourse with the Friends, being presently ready to fall again into their sleepiness: whence it appears that the cause of the Disease sticks only in the outward border of the Brain, nor does it enter deeply its substance, as in other sleepy affects.

This affect, as I have observed in many, is not very dangerous; for either (as it is often done) it is perfectly cured, or at leastwise conti∣nuing for many years, without a Carus or Apoplexy (which are wont to be feared) it does not presently become mortal or terrible: the re∣lease of this affect often happens upon the change of the seat of the

Disease: to wit, the Brain becoming clear, the morbifick matter is con∣veyed to the Cerebellum, where lying, it produces Tremblings of the Heart, the Asthma, Faintings of the Spirits, and other troublesome Symptoms accounted for Hypochondriacal.

The Therapeutick method suggests chiefly these intentions, viz. that after a provision being made for the whole by bleeding (if it be pro∣per) and by purging, these Remedies may be afterward carefully given, with which the Blood and Brain may be freed from their watery filth, and the later may be corroborated, that it may not for the future re∣ceive and retain serous Superfluities. For these ends let the Pilulae de Succino, or Cochiae, be given with Rosin of Jalap once or twice a Week: at other times going to bed, and early in the Morning, let a dose of a Cephalick Electuary, or of the Spirit, or Tincture of Sal Armoniack, Amber, Soot be daily taken, with a Cephalick Julep. The Forms of which may be chosen from those before written: At eight a Clock in the Morn∣ing, and at five in the Afternoon, let a draught of Coffee be taken, first boyling in the Liquour of which it is prepar'd, Leaves of Sage or Rose∣mary, till it acquires a green Tincture: for ordinary Drink let a Decocti∣on of Guaiacum be taken, adding about the end, Leaves of Sage, Betony, and other Cephalicks. Moreover it will be profitable to make two large Issues betwixt the Shoulder blades, and likewise frequently to apply Vesicatories about the Neck; the Hair of the Head being cut off, let a little Cap of Cephalicks and Armoaticks be worn. Let a Vessel filled with Salt of Ʋrine, or Spirit of Sal Armoniack, be now and then held to the Nostrils. Moreover an exact form of dyet being ordered, let some Servants, attending the Diseased, not only stir him up now and then as he falls asleep, but keep him waking daily for some set Hours.

A certain Gentleman, of a sanguine temperament, and, whilst he was young, of an acute and subtle understanding; afterward, in his decli∣ning age, being given to Idleness and Drunkenness, became dull and torpid, and likewise Hydropical with a great Paunch, and swellings of the Thighs and Leggs: but from these Diseases (into which he fre∣quently fell) if at any time he abstained for some while from his drinking, and applyed himself to Physick, he both often and soon re∣covered: but at length tho free from his Dropsy, he was opprest with so great and almost perpetual Sleep, that he would be sleeping in all places, and doing any thing; moreover, being awak'd by his Servants or Friends, he was wont to be present enough to himself, and to discourse well enough for some Minutes of an Hour, of things proposed, falling presently again into his Sleep: To this Person, after many Medicines tryed almost to no purpose, I prescribed at length that he should take every Morning and Evening a Spoonful of the Powder of the Leaves of Betony dried in the Summer Sun, and kept in a Glass, in a little Draught of Water distilled from the Flowers of Lavender: by which Remedy re∣ceiving ease within a few days, he was perfectly cured within a Months space, and enjoyed an entire Health for four years from that time. Af∣terward

when by reason of an ill course of Diet the same evils re∣turned, he repeated the same Remedy, tho not with so great success. But besides there being need also of other Medicines, he took sometimes Spirit of Harts-horn or of Soot, with an appropriate Julep; sometimes Electuaries of Cephalick Conserves and Powders, adding sometimes steel. As often as he would indulge himself to his wonted genius of drinking, instead of Wine or Beer, he drank Coffee: moreover for his ordinary drink, he had some∣times Ale with the Leaves of Scurvy-grass, Sage and Aromaticks infused in it, sometimes a Decoction made physical with Woods, Spices and Cephalick Herbs, for many years. Afterward, being in a Manner always intemperate and cacochymical, yet he lived free from the Lethargy; at length a Cachexia seizing his Breast, being cast down by degrees by a Cough with an Asthma, he dyed.

The next sleepy affect, viz. somewhat greater than the former, and less than the Lethargy, is that which is vulgarly called the sleepy Co∣ma: those that are obnoxious to this, for the most part are opprest with a great sleepiness, to which in a manner always giving themselves over, they lye with the mouth open, and the lower Jaw fallen, more like to Persons dead than living: being stirr'd up by hard pinching or pricking, they look about them, speak to the standers by, answer to things askt, but presently sleeping again, they seem very much trou∣bled to be hindred or disturbed from Sleep, thus pleasingly stealing up∣on them: and being indispos'd after this manner, they continue in a sleepiness for many dayes, nay, and sometimes Months, without a Fe∣ver accompanying it, or following it, or an injur'd respiration, and being easie to be awak'd, and not very forgetful, in which things they differ from Lethargical Persons: mean while they differ no less from others troubled with the affect even now described: for as much as those that have the Coma, keeping for the most part to their Bed, or a Chair, do not walk abroad, or take care of domestical Concerns, as the others. They answer appositely to some short Questions, but are not able to hold a Discourse, or deliberate of things to be done.

The cause of this doubtless is of the same kind as of the former Diseases, but of a middle degree betwixt both before described. For we may conjecture that in this affect the morbifick matter penetrates the Brain a little farther than in the continual Sleepiness, viz. that it invades the outward parts of the Anfractus or Gyri, together with the lesser Branches of the Medulla inclosed: but that it does not reach to the greater Sinus's of the Medulla joyning to the Corpus Callosum, and which are wont to be possest in the Lethargy.

The Coma sometimes beginning primarily and of it self, as the Le∣thargy, either proceeds from a serous filth discharged from the Blood on the Cortex of the Brain, or from a stupefaction inflicted on the Spirits there residing: and then this affect, by how much less it is than the Le∣thargy, by so much is it accounted less dangerous, but more commonly

this Disease ensues upon other Cronick or acute distempers, viz. the Head-ach, Convulsions, and most frequently upon Fevers of an ill crisis, especially in Children, old, and phlegmatick people. Some years since, in an Epidemick Fever, hapning through the affect of the Nerves (which we have elsewhere describ'd) as I observed some to be Lethargical, so many to be troubled with the Coma: of whom a great many recover'd, the morbifick matter being conveyed from the Head into the Breast: Moreover, in other cases this affect being of a doubt∣ful event, betwixt hope and fear, requires the sedulous care of a pru∣dent Physician.

In a Primary Coma the Therapeutick method suggests to us the like, and in a manner the same intentions of healing as in the Lethargy: As to the morbifick matter, we must endeavour, both that its new afflux to the Brain, and that which is already sticking in it, be discuss'd, or drawn away: Moreover, the Animal Spirits ought to be raised up, and all drowsiness or stupefaction ought to be shaken off from them. For this end we must order Purging, Blooding, Cupping-glasses, Vesica∣tories, Revulsing and discussing Topicks, give Cephalick Medicines, and especially such as are endowed with a Volatile Salt, and use many other ways of administrations before-mentioned.

But if this Disease ensuing upon other affects, happens to any Person whose Body is much worn away, the Blood vitiated, or greatly de∣pauperated, we must seriously deliberate concerning letting Blood; and Purging before we order them, nay, and for the most part we must abstain from them: tho sometimes, that the conjunct cause of the Disease, or the matter sticking in the Brain may be put in motion, it may be convenient to draw Blood in a small quantity from the Fore∣head, or from the Temples by Leeches, or from the Shoulder-blades by Cupping glasses, with a Scarification: Vesicatories have a chief place here, not only to be applied to the Neck or Head, but to the Legs and Arms, and to other parts of the Body by turns. Moreover, let Spirit of Harts-horn, of Soot, or of Sal Armoniack, impregnated with Amber, Mans Scull, Coral, and other Cephalick things be frequently given, with an appropriated Julep, or other Liquor. Forms of these, and of other Medicines usual in these cases, together with stories of sick Persons, and examples of their Cures, are to be found in the description of the fore∣said sleepy Fever; so that I need not here again inculcate the same, or the like.

There remains yet another sleepy affect, or kind of the Lethargy, vulgarly called a Carus, which being greater than the Lethargy, and somewhat less than the Apoplexy, is so allyed to this, that it often passes into it, but is wont to be distinguished from both: for those that have the Carus for the most part breath well, if at any time they are hard pinched, they move their members, sometimes raise up themselves, open their Eyes, and often speak, which Apo∣plectical

Persons do not do; but the same, tho stirred or roused up, scarce understand, or plainly discern any thing, in which respect they are distinguished from those that have the Lethargy.

From what is said it seems to be manifest, that the conjunct cause, or morbifick matter of the Carus, penetrates somewhat more deep toward the middle of the Brain, and to have its seat at least in the out∣ward border of the Corpus callosum; and sometimes, as that matter gra∣dually advances from one part to another, the Diseases before-menti∣oned successively arise, and each last is only the encrease of the other.

But sometimes the morbifick cause, without a gradual progress through those Parts, at the first assault affects the middle part of the Brain, and there (as it sticks shallower or deeper) causes a Carus, or Apoplexy. In which case it must not be thought that the whole cir∣cumference of the Corpus Callosum, as also of the cortical part of the Brain is possest by the soporiferous matter; for it suffices, that rushing into any one place, it has seized some part of the middle, for there∣upon presently in all that Region follows an eclipse, or at least a pro∣sternation of the Spirits.

The Prognostick of a Carus for the most part is ill, especially if the Disease happens upon a malignant or long continued, or a slow Fever not determined, or on that which happens in Childbirth: Nor is less danger threatned, if it succeeds other Cephalick Diseases, or is rais'd by reason of a wound in the Head; though in these cases some∣times there is a Cure.

The event of this Disease either for death or recovery is wont to be various: The Carus often passes into an Apoplexy, which soon kills; so that after the loss first of the animadversive faculty, in a while a depriva∣tion of sense and mortion, and then by reason of the taint convey'd to the Cerebellum, alterations of the Pulse and Respiration, and in a short time Death it self follows.

But sometimes the morbifick matter sinking deeper, and falling from the Corpus Callosum into the Corpus Striatum, one, or both toge∣ther, the Brain becomes a little clear; so that the Diseas'd look about them, speak and know things; nevertheless, in the whole Body besides, the Palsey, or Hemiplegia ensues: Neither are thus things in safety, as to Life; for often when the Brain begins to be restor'd, the Cerebellum is worse; so that thereupon the Spirits which execute the offices of the Vital, and meer Natural function being there ill affected, either Convulsions in the Viscera and Praecordia, or mortal lettings of the Pulse and respiration are caus'd: tho sometimes when the morbi∣fick matter is neither too redundant, nor too malignant, it is partly drank up again into the Blood, and partly discuss'd, so that the Dis∣eased perfectly recover.

The Therapeutick method suggests the same intentions of Healing, and indicates altogether the sanie Remedies, which are wont to be

used in the Apoplexy: Wherefore it will not be needful to set down here Classes of Indications, or to heap together a mighty mass of Me∣dicines, but that which seems more to the purpose: I shall here pro∣pose a story or two of Persons diseased, whereof I have a great many ready to relate.

A worthy man, about forty years of age, having lost his health through intemperance, when he had begun to use I know not what Remedies, prescribed by an Empirick, fell into a Carus; haply be∣cause the morbifick matter being stirr'd, and agitated by the Medi∣cine, rush'd into the Brain. Going to see him the second day, I found him buried in a profound sleep, and almost insensible; for tho upon hard pinching or pricking he opened his Eyes, and mov'd his Limbs, yet presently falling asleep again, he perceiv'd nothing at all of what he did, or endur'd. In this case, tho declaring a sad Prognostick, however I did not forbear to use Physical means; abstaining from Phle∣botomy, by reason of his strength being much spent, and his Blood depauperated, I presently ordered a large Vesicatory to be applied to his Neck, and a smart Clyster to be given him, of a decoction of Briony Roots, with Carminative Flowers and Seeds, adding likewise two drams of the species of Hiera: His Temples and Nostrils were anointed with Balsams: Cataplasms of Rue and Briony Roots were applied all over his Feet: Moreover, every other or third hour I gave him a dose of Spirit of Harts-horn, with a Cephalick Julep; and many other admi∣nistrations, usual in this case, were carefully put in practice. To which nevertheless the Disease not at all yielding, the day following I prescrib'd him a Purge of Scammony prepar'd, to be taken in a spoonful of Broth: After which, when he had frequently and freely Purg'd, he began to open his Eyes, to speak, and to know standers by, and a little after, coming to himself, he fully awaked. This Disease (as I ghess) was therefore cur'd more easily, and sooner than was hop'd, be∣cause that cloud sent haply into the Brain by a Medicine, could the better be drawn thence by the help of another Medicine.

A renowned man, fifty years of age, of a gross Body, and formerly abnoxious to a Vertigo, and asthmatick affects, had lived very sound for two years, having used Physick Spring and Fall, and having a large Issue near both Shoulder-blades: At the beginning of Summer, he living in the Country, and his Issues being neglected for many weeks, the filth which was wont to be purg'd forth, ran much less from them; yet he was still in good health, till about the Solstice, when as he was sitting one morning in a Porch, and talk'd cheerfully with his friends, arising on a sudden he complained that he was ill: going in a doors, and setting himself down in a Chair, he vomited very much, then presently leaning to one side, he fell into a profound sleep, and lay so overwhelmed with it, that he could scarce be raised from it all that day. Coming in the Evening, I ordered Blooding, a Clyster, Vesica∣tories,

and many other Remedies proper in such a case, carefully to be administred: The next day after, his Brain began to grow a little clear; so that he looked about, and spake distinctly a few words: Seeming to know his Friends, he could tell no ones name; but by reason of this matter sinking deep in the Brain, a Palsey of the whole right side seized him. Moreover, a mighty sleepiness yet persisting, on that day Blood was taken from the other Arm: Other Remedies also being continued as before, on the third day, becoming less drowsie, he began to know many, and to call some by their names, to perceive his illness, and to be sollicitous for Reme∣dies: But whilst the Brain grew better, the injury communicated to the Cerebellum and Genus Nervosum discovered it self; for on the fourth day his breathing became uneven and difficult, and his Pulse weaker: Moreover, he was often affected with a shivering, and a Convulsive concussion of the whole Body: On the fifth day, the Cramps and Convulsions becoming more violent, oftner infested him; then the Pulse growing weaker by degrees, on the sixth day, tho more free from sleepiness, he dyed: In this, and other the like cases, it's probable that the morbifick matter invades the Brain and Cerebellum together; but whilst it sticks in the Cortex of this (contrary to what happens in the Brain) it causes no very sensible injury, because here the parts offended are neither the seats of sleep, nor memory: but afterward, haply about the fourth or fifth day, the matter sinking further to the Medulla of the Ce∣rebellum; whilst as to other things the Diseased was better, the Vital function, by reason of the Spirits appointed for it being op∣prest in their very source, began to fail, and afterward declining on a sudden, unexpectedly cut off all hope of recovery, which before was great.