Pharmaceutice rationalis: or, The operations of medicines in humane bodies. The second part. With copper plates describing the several parts treated of in this volume. By Tho. Willis, M.D. and Sedley Professor in the University of Oxford.

SECT. I. CHAP. XIII. Of a Dropsie of the Breast.

IT is clearly manifest by certain and manifold discoveries,* 1.1 that the Region of the Breast is sometimes affected with a Dropsie; for the sense and sound of water fluctuating, do most evidently demonstrate it in living bodies; and Anatomical inspection in the defunct. But yet concerning the cause of this Disease, and manner of coming to pass, to wit, by what ways, and after what manner disposed, the ac∣cumulation of water first begins within the hollow of the breast, as also how it is sensibly augmented, and frequently insensibly continued untill the Disease becomes desperate, is a thing yet in the dark. Whenas there is a general distemper of a Dropsie or an Anasarca appearing, and hath seized on the flesh and cavities of the bowels every where, or in most places, we are not to admire if that illuvies of waters seize also upon the Pectorals: But besides, sometimes it happens, that the Region of the Thorax, is either first or only overflown, the other parts in the mean time remaining sound enough, or only hurt secondarily.

About the origine of this Disease,* 1.2 and the manner of generation it is much dispu∣ted whence, and by what passages that illuvies of water being found every where in the hollowness of the Thorax, doth come thither. Some Authors do derive it from above, viz. that it descends from the head by the Trachea; and others deducing its Spring from beneath, from the cavity of the Abdomen, also sometimes from the Liver and Spleen, by I know not what blind ways, judge those waters to be conveyed into the hollowness of the Breast. But neither of these Opinions challenge our assent, or de∣serve our arguments to disprove them: for none considering the passage of the blood and humours will acknowledge either this or that way of commerce. We cannot but affirm, that the serous humour, raising a Dropsie of the breast, does arrive thither either in a kind of vapour, which being exhal'd from the Precordia and sides of the Thorax, is easily condensed into water;* 1.3 or secondly, that the Serum is there deposited under its own proper form, inasmuch as it flows into that cavity from the mouths of the Ves∣sels, i.e. of the Arteries being open. We will anon enquire whether the Lymphaducts or vessels bringing chyle, being any where open, or broke, do sometimes produce that disease.

1.* 1.4 As to the former, it is so very probable that a Dropsie of the breast takes some∣times its origine from vapours condensed within its cavity, that it is a wonder how it should be otherwise at any time, or that any should live exempt from such an ef∣fect. For how much is there of vapour that separates from the boyling blood? and when it waxes cold in the precordia, how can it come otherwise to pass but that the abundant vapour should be condensed in this enclosure into water, even as if shut with∣in a Still? And truly it will not be easie to determine, when the vaporous steams are so uncessantly heaped within the cavity of the breast, what may become of them, how they are consumed, or from thence discharged abroad. Surely we must affirm, they either penetrate the sides of the Thorax, or (which rather seems to be) they in∣sinuate into the pores of the Lungs, and so fly away in breathing. Certainly by either way, the vapours of the breast may exhale: and perhaps if either be defective, or hindred, by that means a Dropsie of the Breast may be caused.

2.* 1.5 But moreover, I am apt to think, that this Disease also sometimes happens in another manner (inasmuch as the Serum distills from the vessels in its proper form.) For in a cacochymical constitution of body, or a person very scorbutical, where the watery and weak blood every where casts off its superfluous Serum from its own consistence, and every where ejecting it from the little mouths of the Arteries being loosed and open, excludes it from the clew of circulation, nothing is more usual, than for the cavities not only of the Bowels, but also of the Precordia, yea the Brain it self, to be overflown with that watery collection;* 1.6 moreover in so general a disposition to a Dropsie, that one while this region, another while that, or another should be first and almost onely possess'd; and that also sometimes the inmost parts being untoucht,

the outward flesh, viz. the muscles and their interspaces are overflown with that serous illuvies.

3. Among the vessels that pour in the dropsical matter into the cavity of the breast,* 1.7 the Lymphaducts and parts bringing the chyle, do justly fall under a suspicion. What relates to the former, it appears by anatomical inspection, that a great company of these do creep thorough the whole Lungs, and do tend from their outer parts, stretch∣ing out themselves inwards towards the passages of the breast, and for the most part pour out into them their liquour, which being superfluous, they every where suck up from te arterious Blood. Therefore whenas these vessels are obstructed, or are by any means impeded from discharging their function, it must needs be that a heap of water be accumulated in the Lungs, which afterwards falling into the cavity of the breast, will excite a Dropsie in that region. For in truth, this Lympha restagnating within the consistence of the Lungs, it often happens that the little bladders called Hy∣datides, in the outer superficies of the Viscera are raised up, which afterwards being broke, discharging the waters into the cavities of the Thorax, they produce there an Ascites. A distemper of this kinde is often discovered in Sheep, when they dye by heaps of a Dropsie, by reason of a moist season and watery pasture.* 1.8 And surely the following History doth clearly seem to argue, that the Ascites of the breast proceeds from the like cause sometimes in a man, (there being yet a living example of this disease.) Lately a young man healthful enough and strong, having accustom∣ed himself to hunting and insatiable riding, and other exercises of the body very immoderate, a while without detriment, at length he perceived a fulness in his Tho∣rax as if it were a kind of swelling; insomuch that the left side of his Lungs seem'd to begin to swell, and his heart to be thrust out of its place towards the right side; for that he perceived the pulsation thereof to be on that part chiefly. After he had been for some time in this condition, on a certain day he felt as if a Vessel had been burst asunder within the cavity of the Thorax, and from thence for the space of half an hour, in that place, as it were the dropping of a humour falling from above into the bottome of his breast, was not only felt by himself, but could be heard also by the standers by. Although he was at first surprized with the rarity of this affect, yet for that he was well enough as to strength, appetite, sleep, and other natural functi∣ons, immediately after he became secure, and negligent of Medicines; But after∣wards by any motion, bending or stirring of his Body, a fluctuation of water ga∣thered within on his left side, was felt by him; moreover, the motion and sound was evidently perceived by others, either by handing, or by the ear. As without doubt this Gentleman was affected with a Dropsie of the Breast, so it seemed most probable that the disease had its original from thence, in regard the lymphaducts relating to the left side of the lungs, being first obstructed near their insertions into the passage bringing the chyle, did swell up to a great bulk, and afterwards being broken di∣still'd their humour into the cavity of the Thorax.

When now an Inundation of the Precordia, and so of the vital Fort, was imminent,* 1.9 this Gentleman at length, thinking it time to provide for himself, entered into a course of Physick, and carryed certain Medicines into the Countrey for his cure, yet with∣out any signal success. Afterwards coming to London, he first consulted the worthy Dr. Lower, being of his former acquaintance. He proposing the opening of the Thorax for his only remedy, took care that the worthy Dr. Micklethwait and my self should be sent for to the consultation.* 1.10 Immediately an incision was appointed by the consent of us all: wherefore, after provision for the whole being made, a Chirurgeon apply∣ed a Cautery between the sixth and seventh Vertebra, and the next day he put his Pipe into the Orifice cut into the cavity of his Breast; which being done, immediate∣ly a thick liquor whitish like Chyle, and as it were milkie, flowed out. There was about six ounces only taken from him the first time, and the next day as much more. The third day when a little greater quantity was suffered to come out, being affected immediately with great fainting, and afterwards being feaverish, he was ill for a day or two. Wherefore it seemed good to stop the issue of that matter till he recovered his temperament and strength: but afterwards a sparing evacuation of the same mat∣ter being daily made, the cavity of his breast was wholly emptyed: but as yet he wears a pipe in the orifice with a tap, which being opened once in a day and a nights space, a very little of the humour flows out; in the mean while, being well in stomach, visage, and strength, he walks abroad, rides, and performs all exercises he was formerly ac∣customed

to, vigorously enough. He used not (neither was there need of) much medi∣cine, only after the Incision we advised temperate Cordials, viz. powder of Pearles, Juleps, and sometimes Hypnoticks, and afterwards a vulnerary decoction to be taken twice a day.

By this method, and these forms of Medicines sometimes continued, this worthy person seemed to recover his temper, and his strength, and the habit of his body, and his breast exempt from the Dropsie. Notwithstanding he still wore a silver Pipe in the orifice of his side (out of which ichor daily flowed): and when after some months this being withdrawn, the Issue was shut up, a gathering of the same hu∣mour was made within the hollow of his breast, perceivable by the sound and fluctu∣ation thereof: but when that the disease returning, the same medicine was to be used, and incision of his side appointed, (Nature by chance discharging the function of a Chirurgeon) the matter being prone to burst out, and flowing to the place made its own way. He is now necessitated (for preventing the illuvies of his Breast) to keep that orifice constantly open like a sink.

From these things I think it manifest enough, that an Ascites of the Breast, some∣times arises from the lymphatick vessels burst asunder within the Lungs; neither doubt I less but that the same affection may be caused from the chyliferous passages being broke within the Thorax; notwithstanding, this chance so rarely happens, that as yet I have not known it by my own observation, or others relation. Moreover, it little avails to make inquisition into the Aetiologie of such a disease, because it is not only apparently incurable, but in a short time mortal; because the Precordia are in∣continently overflown by the inundation of the chyle, and also the blood and the ani∣mal spirits being defrauded of their wonted supply of nutritious Juice, are immedi∣ately dissolved.

From the various causes of this Disease even now set down,* 1.11 it will be easie to col∣lect its differences: For first a Dropsie of the Breast, is either simple and primary, peculiar to this Region; or secondary, coming upon a general Dropsie, as it is wont often to be in cachectic presons. Secondly, this Disease is distinguished as to the pla∣ces affected, viz. forasmuch as water is either collected in the whole breast, or only in one side thereof. Thirdly, as to the matter accumulated in a pectoral Ascites, which one while is limpid and plainly waterish, another while more thick, whitish, and as it were milkie, such as we have described in the foregoing History.

The diagnostick signs do manifestly enough discover this disease:* 1.12 viz. the fluctua∣tion of water is perceived by handling, and by feeling at every bending of the body, and the sound is clearly heard. Moreover they are affected much with a dry and empty Cough, as also with a Dyspnoea almost continual and painful, especially while they ascend steep places; Besides, they have a thirst, with a little feaver, and in the night after the first sleep, great disquiet and tossing of the body, proceeding from the vapours being elevated by the heat being more intense. Sometimes there comes upon these a Palpitation of the heart, an intermitting or disturbed Pulse, and frequent faintings of the spirit. As to the prognostick, this disease is always difficult to cure, and among the vulgar accounted incurable. And surely if it come upon an Ascites of the Abdomen or an Anasarca throughout the whole body, it is judged not with∣out cause desperate; But if the affection be primary, and happen to a body other∣wise sound, we are not altogether to despair of Cure.

What relates to the curatory part of this Disease,* 1.13 the chief Indications will be three, Curative, Preservative, and Vital, according to the common method of curing in most other Distempers.

The first has regard that the water heaped up in the cavity of the Breast by any means be evacuated. The Second provides, that afterwards a new illuvies be not ga∣thered in the same place. The Third procures the restoration of strength, and the sym∣ptoms impairing it to be removed with expedition.

To satisfie the first Indication,* 1.14 and that an Ascites of the Breast may be emptyed, there are but two ways or means of evacuation to be met with, whereby this collecti∣on of waters may be drayn'd, viz. Either that the vessels of the Breast, and the pas∣sages of the humours, being emptyed, might suck up that Lympha being rarified, and afterwards by the passages of the blood or air convey them forth: or secondly, that by an incision of the side, those waters may be drained forth plentifully in their own Species.

That former manner although more seldom, yet sometimes succeeds;* 1.15 which I can attest out of my own observation. For the consistence of the Lungs being spongy within, and externally very porous, while by every turn of the Diastole, they are drenched in the underlying waters, they sometimes imbibe them being turn'd into va∣pour; and so dispatch them to the blood, or continually exhale them with aire coming out at the mouth. That an effect of this sort may more easily happen to cure this disease, medicinal aids are taken: For that intention therefore the passages of blood, aire, and humours ought to be emptyed as much as may be, and to be kept so empty. For this purpose, Purges, Diureticks, and more mild Diaphoreticks are methodically, and alternately exhibited; also remedies for the breast, and expectorating, challenge here their place; let the Diet be slender and warming, and a government appointed as to all other things of that nature, that the blood may be made to exhale the more, and all the superfluous humours to evaporate. I think good to annex some forms of Medicines accommodated to these uses.

Take of Chervil-roots, Knee-holme, Polypodie of the Oak, of each an ounce, Agrimony,* 1.16 white Maidenhaire, Oak of Jerusalem, Ground Ivy, of each one handful, Carthamus∣seeds one ounce, Florence Orris half an ounce, seeds of Danewort 5 drams, Calamus Aro∣maticus half an ounce, boyl them in four pound of Spring-water, to the consumption of a third part, adde to it being strained Senna one ounce and a half, Agarick tow drams, Mechoacan and Turbith, of each half an ounce, yellow Sanders a dram and a half, Ga∣langal the less one dram, boyl them two hours gently, and close covered, afterwards strain it and adde of Honey two ounces, clarifie it with the white of an Egge, make a purging Hy∣dromel. The Dose is from six ounces to eight, in the morning, twice or thrice in a week. Or,

Take Mercurius Dulcis one scruple, Resine of Jallap half a scruple, Balsam of Peru∣what suffices to make four Pills, to be taken in the morning, and to be repeated within five or six dayes.

Take Tincture of Sulphur three drams, take from seven drops to ten,* 1.17 at night and in the morning, in a spoonfull of the following mixture, drinking after it three spoon∣fulls.

Take of the water of Snails, Earth worms, and compound rhadish water,* 1.18 of each four ounces, water of Elder-berries fermented one pound, Syrup of Juice of Ground-Ivy two ounces, mix them for a Julep. Or,

Take of Tincture of Ammoniacum, or Galbanum, take twenty drops evening and morn∣ing in the same mixture. Or,

Take of Hog-lice prepared two drams, flower of Sulphur two scruples,* 1.19 flower of Ben∣zoin one scruple, powder of wild Carrot and Burdock-seeds, of each half a dram, Turpen∣tine of Venice, enough to make a mass. Make small Pills. Take four evening and morn∣ing, drinking after them a small draught of the Julep.

At Nine a Clock in the Morning, and Five in the Afternoon,* 1.20 let him take four onces of the Compound Lime-water, by it self, or with any other proper remedy.

For ordinary drink take the following Bochete.

Take Sarsaperilla six ounces, China two ounces, white and yellow Sanders,* 1.21 of each six drams, shavings of Ivory and Hartshorn, of each three drams, Calamus Aromaticus half an ounce, Raisins half a pound, Liquorish three drams, boyl and infuse them in twelve pound of Spring-water to six pound, strain it.

Formerly about twenty five years since, when I resided at Oxford,* 1.22 I was sent for to a young Scholar, who suffered for three weeks space under a pain of the Thorax, and a most grievous Dyspnoea constantly troubling him in the evening, moreover, from a more quick motion of body, or going more hastily than usually up any steep place, he laboured extreamly, he could not ly down long on either side, but was necessitated to lye in his bed supone, and his head erect; if perhaps he attempted to lye on either side, immediately pain followed that position of bo∣dy, and if perhaps he roll'd himself from one side to another, the pain being also presently translated, he felt as it were water to wave from place to place. Hence I had a just suspicion of a Dropsie of the Breast, whereof that I might be more assu∣red, I order'd that lying upon his back on his bed, he would suffer his head to bend backward from the bed-side to the floor, immediately he had a plain perception

of water running towards the Clavicles, together with a change of the pain thi∣ther. Moreover if at any time he grew more hot than usual, from motion, or in his bed, or by the fire, he presently felt sensibly in his breast, as it were water boyl∣ing over the fire, and also complained of a Vertigo, and a small decay of Spirits. Wherefore, when we might lawfully collect out of these things rightly considered, that he was affected with a dropsie of the breast, I prescribed the following method and medicines with success.

Take of Mercurius Dulcis fifteen grains,* 1.23 Resine of Jallap half a scruple, Syrup of Roses solutive what suffices, make three Pills. He took them early in the morning and had twelve stools with great ease; afterwards on the third day by the same Medicine he had but four, but with greater benefit; he took afterwards for many dayes six ounces of the Pectoral and Diuretick Apozeme twice in a day, and lastly repeating the Purge he perfectly recovered.

Notes

• * 1.1

  A Dropsie of the Breast is easily known.
• * 1.2

  Its cause is hid∣den.
• * 1.3

  How many wayes it may be produced.
• * 1.4

  1. By Vapours condensed there.
• * 1.5

  2. By Serum deposited there.
• * 1.6

  Which some∣times breaks out from the Ar∣teries.
• * 1.7

  3. And some∣times from the Lymphaducts.
• * 1.8

  A remarkable history of the like case.
• * 1.9

  The reason thereof.
• * 1.10

  The Cure by a Paracentesis of the breast.
• * 1.11

  The differences of this disease.
• * 1.12

  The Diagnostick signs.
• * 1.13

  The Cure.
• * 1.14

  What Intentions of healing the first Indication suggests.
• * 1.15

  The first Inten∣tion.
• * 1.16

  A Purging Hy∣dromel.
• * 1.17

  Tinctures.
• * 1.18

  Julep.
• * 1.19

  Pills.
• * 1.20

  A Lime-water.
• * 1.21

  A Bochet.
• * 1.22

  A History of a Patient.
• * 1.23

  The Cure of him.