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. IV. Instructions and Prescripts for curing the Watch∣ing Evil, and the Watching Coma.

AS Light and Darkness, so Sleep and Watching being set toge∣ther, excellently illustrate each others natures.

Concerning a continual waking, or the Watching-Evil, we must in the first place here distinguish, that either it is a symptom which happens upon some other Disease, as a Fever, Frensy, Mania,

or Colick, Gout, and the like; and then its consideration and cure belong to that affect, whose offspring it is; or else immoderate Watch∣ings arising alone with out any other known cause, seems to be a Di∣sease as it were of it self, as I have known it in some Persons, and some of these Watchers, tho destitute of Sleep, seem scarce to want it, For the Spirits appear not thereby either torpid, or wearied, or exhausted: but others bearing ill watching, soon become thereupon languid, and lose their Stomacks, and are forc'd to have recourse to Opiats, which sometimes they use daily, and in a large dose without hurt.

We have intimated before, that the cause of natural waking, which has Sleep interlaced with it, consists in these two things, viz. in one of them or both together; To wit, first, that the animal Spirits being suffi∣ciently refresht, and freed from the fetters of the Nervous Liquor, vi∣gorously exert themselves, and are expanded every way, and especi∣ally from the middle part of the Brain to its circumference; then se∣condly, tho they enjoy a clear space every where, and especially in the outmost part of the Brain, being then free from the incursions of the Nervous Juice; yet lest this expansion of the Spirits (which is being awake) be any where protracted longer than is fitting, to their too great loss, both the Spirits being now and then weary, flagg, and as it were repose themselves of their own accord, and withall the Ner∣vous Liquor coming to overspread the Cortex of the Brain, stuffs and closes their Passages. Hence it follows that preternatural and immode∣rate watching depends also on one or both of those two; for either the Spirits being two exhorbitant, and struck as it were with a rage, do not retreat of their own accord, and withall the Nervous Liquor does not so fill and stop the Pores of the outward part of the Brain, that the Spirits may be forc'd thence inward to a repose: Types of both these every where present themselves to be observed.

And first we may observe that the Animal Spirits becoming some∣times exhorbitant, and so elastick, or otherwise irregular, cannot only be appeased and repose themselves, but are scarce able to be contained within the proper Sphere of their emanation; Wherefore being ex∣panded in a continual watching, they so fill the Brain, and keep it extended, that the nervous Juice, tho heapt together in a great plenty at the entrance, cannot be admitted; and if the Spirits are recall'd in∣ward from the Cortex of the Brain, for that to enter, presently being there restained, or making a tumult within the midst of the Brain, they raise a thousand, and often horrible Fantasms, with which Sleep is kept off; or directing farther their Tendency into the Genus Nervosum, they raise there great disorders which continually drive away, and break off Sleep, tho seeming never so much to be stealing on, or to be at hand.

As for the former of these, I have often observed some troubled with watching, who dreaded to begin Sleep, tho it came on according to

desire: for as soon as being about to sleep, they closed their Eyes, presently starting up again they cryed out that a confused multitude of Fantasms made them mad, so that they found themselves necessitated to abstain from Sleep.

Secondly, when the Spirits being become exhorbitant, are called from the circumference of the Brain towards the inward parts in order to Sleep, sometimes they convert their Sallies into the Genus Nervosum, and then either rushing in a tumultuous manner into the Nerves that go to the Precordia, or Viscera, they cause disorders in the respective Parts; (hence to such as are so affected, as often as closing their Eyes they invite Sleep, either Tremblings, Leapings, and Constrictions of the Heart, with Failings of the Spirits, and a letted Respiration happen or inflations and Swellings of the Viscera, a Sense of Suffocation, and other Symptoms vulgarly accounted for hysterical) or secondly, the Spirits being called from their Watchings, and converted to the Genus Nervosum, sometimes transfer their Sallies into the spinal Marrow, and thence into the Nerves that pass into all the outward Members: where∣fore to some, when being a Bed they betake themselves to sleep, pre∣sently in the Arms and Leggs Leapings and Contractions of the Tendons, and so great a Restlessness and Tossings of their Members ensue, that the diseased are no more able to sleep, than if they were in a Place of the greatest Torture. Sometime since I was advised with for a Lady of Quality, who in the day time was wont to be afflicted with a Cardi∣algia, and a Vomiting, and in the Night was hindred from Sleep by reason of those spasmodick affects which came upon her as now and then she was upon the point of rest: nor indeed was she able to sleep all Night, unless she took first a pretty good dose of Laudanum: Where∣fore of this Medicine which at first was allowed her only twice a Week, she took afterward daily for about three Months, receiving no injury thereby, either in the Brain, or about any other function, and when in the mean while by the use of other Remedies, the discrasies of the Blood and Nervous Juice being corrected, the animal Spirits became more benign and mild, she afterward leaving off wholly the Opium, was able to sleep indifferently well.

As to the cure of the VVatching-evil (which we even now describ'd) because it cannot be long endured, therefore those things are chiefly to be given, which give a present relief: for this end those things are proper which sooth the Spirits, and gently appease their Disor∣ders, as the vulgarly called Anodines, viz. distilled waters, Decoctons, Syrups, and Conserves of Flowers of Nymphea, Cowslips, Mallows, Violets, Knapweed, the Leaves of Lettice, Purslan, the Willow, also Emalsions, or juicy Expressions. And if the restles Spirits will not be mitigated by fair means, we must force them to be quiet, by imposing Fetters as it were, and using Severity: their stores ought to be diminish'd, and withall the spaces in which they may freely, and

without tumult expand themselves, ought to be dilated, and cleared from the stuffings of other humours, viz. of Blood and Serum: for which ends opening a Vein sometimes is proper, Vesicatories in a manner always have place; moreover let Diacodium and Laudanum, in case they agree well, be frequently taken; and mean while that the Opats give truce from the violence of the Disease, let the cause of it be eradicated by the use of other Remedies, as much as may be: Wherefore day after day, at Physical hours, let things be given that take away the sharpness of the Blood and Nervous Juice, and restore them to sweetness. In which rank we account Testaceous Powders, Apozemes and altering distilled Waters of temperate Antiscorbuticks, gentle preparati∣ons of Steel, spirit of Harts-horn, of Soot, and above all things, tincture of Antimony.

There remains another kind of Watching-evil, whose cause consists for some part, if not mostly, in the almost continual opening or too great gaping of the Pores or Passages in the cortical part of the Brain: for besides that the animal Spirits being sharp and somewhat exhorbi∣tant, refuse to lye down of their own accord, and to yeild to rest; and that they are not kept down or subjugated by the Nervous Liquor entring the Pores of the Brain, but being free and exempt from all imposed Bur∣then, they are expanded also within the outward spaces of the Brain which are every where open for them, for which cause those that have the watching evil perceive no drowsiness or heaviness of the Sinciput, no appulse or desire of Sleep. I have known some affected after this manner, who when they had past many Nights one after the other wholly without Sleep, yet being still chearful and brisk, having a good Stomack, and ready at business, seemed not as yet to have wanted Sleep. The cause of this doubtless is a burnt and melancholy Blood, which supplies the outward part of the Brain with a Nervous Juice, not mild and benign, but too much scorcht and filled with adust Particles, which consequently is neither apt to flay long within the Pores of the Brain, nor kindly to receive and contain the Animal Spirits: Moreover the Spirits themselves ingendred from it become too elastick and restless in their Nature, so that they are neither easily appeased, nor inclin'd for Sleep of their own accord. Never∣theless, being of a fixt Nature, they do not readily fly away, nor are soon tired so as to flag, but last a long time and continue vigorous without any great refreshment. Concerning this sleepless Disposition of the animal Spirits, since it is the same as in Persons troubled with melancholy, we shall have a fit place of speaking somewhat more largely of it in the sequele. We may observe that Coffee also on the same account keeps Persons from Sleep, for that Drink insinuates its adust Particles (with which we find it to abound both by the tast and smell) first into the Blood, and then into the Nervous Juice, which thereupon by their Agility and Restlessness both keep the Pores

of the Brain still open, and add spurs and a certain rage to the Spirits (all other Combination and Stupefaction being deposed) by which they are stirred up to a longer execution of their Functions. Again, as to what regards the prophylactick cure of this Watching-evil, or the removal of the morbifick cause; we shall give it you in the Sequel, where we shall treat of Melancholy mean while for the immediate removal of that Symptome as often as it sorely presses, we observe that Opiats will not do; for being given in a good large quantity they seldom cause Sleep, and render the affected more faint and weak. It often succeeds better if going to bed they take some gentle and pleasant drink, as es∣pecially our Ale being clear and mild, or also posset drink with Cowslip Flowers boyled in it, or an emulsion of the Seeds of Melons and Almonds in a great quantity, viz. to two or three pounds.

I was advis'd with some time since for an old hypochondriacal man, who, besides other symptoms usual in that case, had liv'd for many years obnoxious to a frequent, loud, and very troublesome belching: He was wont every day to fall a belching twice or thrice, for about two hours together, and with so great a noise that he was heard to a great distance: But sometimes for a week or two, and sometimes for a month, that belching was chang'd into a watching; for the former affect becoming much more remiss, the worthy man past often whole nights without sleep; and when sometimes he had been con∣stantly waking for three or more days, not yet seeming to want sleep, he complain'd of no drowsiness, dulness, or failing of the Spi∣rits. Narcoticks having seldome or never given him relief, he took sometimes in the evening Posset-drink made with Ale, or Canary; at the beginning of the night he drank sometimes Ale, sometimes Distill'd Waters, by the use of which a little sleep often followed; then after∣ward the Watching-evil vanishing by degrees, the belching return'd. Whence it may appear that the cause of both was the same, viz. adust and irritating Particles sent from the mass of Blood, sometimes into the Coats of the Stomach, sometimes into the cortical part of the Brain.

2. Besides these distinct affects or exorbitancies of sleep and wa∣king, there remain other conjunct or complicated irregularities of them, in which the acts of both functions are perverted together, which we may observe in the affect vulgarly call'd the VVatching Coma; concerning which we shall now speak in short.

Those that are troubled with the VVatching Coma, tho they are always inclin'd to sleep, yet they can scarce sleep at all, but seem, like Tantalus, to stand always up to the Lips in the River Lethe, for sipping of which, whenever they sink themselves deeper, the yielding Waters always subside lower. They feel a very great heaviness of the Head, with a drowsiness of the senses, and all the faculties; so that they are troubled to move themselves any way in their Bed, or to be disturb'd by the

speech of standers by, that speak to them, still expecting to fall pre∣sently into a quiet sleep: to which nevertheless when they wholly yield up themselves, and endeavour straitly to embrace it, various phantasms presenting themselves to their mind, keep them still waking, nor permit them at all to enjoy that Sleep which seems always to be ready for them. To this often is added a Delirium, so that whilst the Dis∣eased lye with their Eyes clos'd, they talk always absurdly and at ran∣dom, and throw their Arms and Legs this way and that in a disor∣derly manner, and being awak'd, look gastly. It's a usual thing for such as are in Fevers to continue all night overwhelm'd with a sleepi∣ness, as it were; but so that in the mean while they are scarce silent for a quarter of an hour, but mutter various things with themselves, nay, sometimes cry out, howl, and leap out of Bed. If the reason of this be enquir'd into, it seems that we ought to say, that the Pores and Passages in the Brain, which are the avenues of the Spirits, are very much possest by a gross and soporiferous matter, sent from the mass of the Blood, so that the Spirits being very much letted from their wont∣ed expansion and mutual commerce, a great and invincible Sleep seems presently to be at hand: but in as much as certain sharp and very active Particles stick to those Spirits as so many stings, they are in∣cessantly incited to motion, and therefore some of them forcibly pass the wayes, however stopt and beset with fence, and meet against each other directly or obliquely, according as they can find a way: and such their motion, tho it be not able to procure a compleat exercise of the animal function, yet it easily hinders its rest and cessation, so that those that are troubled with this Disease keep betwixt Sleep and wake.

The VVatching-coma is seldom a Disease of it self, but for the most part is a symptom, and happens upon other affects, as a Fever, the Frensy, Lethargy, and the like, wherefore, it does not require a pe∣culiar method of Cure; but it seems only to be needful, that to the Remedies primarily indicated, other Cephalicks be joyn'd, which may disperse these meteors, as it were, like Clouds and Lightning; or if both of them cannot be exterminated together, let the Medicine joyn it self to the aid of one affect, by which that being becom su∣perior, let it presently overcome the other; so in a sleepy Watching it is proper to procure either a perfect Sleep or a perfect Watching; and in this case I have often given Narcoticks with good success.