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. IV. Of Expiration hurt.

AS Expiration is much easier,* 1.1 and with lesser trouble performed than Inspira∣ration, so it is less endangered to be stopt or perverted, as to its function: for in truth the contractive endeavours of fewer muscles are required to per∣form that, insomuch as some do affirm that the meer relaxations of the moving parts, whereby the dilatation of the breast in discharged, doth suffice for its constriction. Hence when in the agony of death, the ultimate labour is to open the breast, and fetch breath, by which the flame of life may be continued; as soon as that endea∣vour is become frustrate, the animal exspires, and is readily extinct. But truly we have already clearly enough evinced, that the tasks of breathing out, no less than those of breathing in, are performed by the help of peculiar muscles. Wherefore, when it hap∣pens that the Organs of Expriation are either hurt of prejudiced, there must needs fol∣low difficulty or depravation of that function. The moving parts, which bind together the breast, and straiten the cavity thereof, are especially the inward muscles of the breast, some belonging to the Loyns, and others to the Abdomen; as also the muscu∣lar fibres of the Larynx and Trachea; by reason of some faults, occupying some∣times these, anon them, either single or many together, exspiration is wont to be stopt or perverted after a diverse manner.* 1.2 Although the hurt of this function frequently de∣pends upon inspiration being prejudiced; notwithstanding it sometimes happens alone; so that when we suck in Air easily and duely enough, we return it disturbed or per∣versly, which truely is wont to come to pass through divers causes, and after ma∣ny manners (the chief of which we shall here briefly touch upon.)

1.* 1.3 For first, when a wound, or convulsive or paralytical distemper happens in one muscle (which causes exspiration) or in more, for that cause the cavity of the Thorax cannot be so freely drawn together and compress'd, for the more full breathing out air or breath.* 1.4 Hence not only such as labour in a Pleurisie, but in a tumour or wound in the intercostal muscles or the Abdomen, cannot easily couth, or sing, or perform other acts of stronger expiration: Neither is the due drawing together of the Thorax less stopt, by reason of the moving fibres of those parts affected either by a resolu∣tion, or a cramp.

2.* 1.5 The act of expiration, whereas it is variously perverted or disturbed, so it chiefly happens in a cough, in sneezing, in laughing, in crying, and in Hiccough; into the reason and manner whereof we will briefly enquire; And first we shall speak of a Cough.

A Cough may be described,* 1.6 that it is a vehement, more frequent, unequal and loud expiration, stirred up either for the quieting of some troublesome and provo∣king thing, or for expelling of it out of the Lungs through the passage of the Trachea. For air being violently excluded, and dash'd in the way on the sides of the Tracheal passages, whatsoever is in any place impacted in them, if it be easily moved, it dis∣cusses and wipes it away, and frequently sends it out of doors.

For the exciting of a Cough,* 1.7 both the muscles contracting the Thorax, and also the moving fibres of the Bronchii, do concur in motion with a joynt force together. For while the muscles straiten the cavity of the breast, and every where squeeze the whole lungs; these fibres one while contracting these tracheal passages, another while them, closing behind the air while it is driven forwards, do endeavour its expulsion more quick and vehement.

A more intense sudden inspiration precedes every act of a Cough, to wit that the air being admitted in greater plenty, may presently be more violently driven out with noise; in which endeavour not onely the new that is fresh breathed in, but also the old, being heaped up before in the tracheal little bladders, is driven forth together with a noise, for the encrease of breath blown out; and when what is troublesome is not settled nor removed at the first assault, the vehement exspiration of this kind is repeated by a frequent course, even to the great wearying of Nature.

The first cause of every Cough is an irritation of the nerves or sibres belonging to the lungs; concerning the nerves we are to observe,* 1.8 that not onely the branches and their slips inserted into the Lungs, but others from which they do arise, or with which they do intimately communicate, being provok'd in places far distant from the breast, immediately cause a cough: for which cause oftentimes a sharp humour being lodged within the Brain, and from thence falling down into the little head of the pectoral nerves, is wont to produce a most troublesome Cough or Asthmatick distempers, as not long since we have declared by notable instances. For the same reason a pain in∣flicted on the nostrils, palate, or Gula, provokes a Cough, or rather a vain attempt of coughing. Moreover a little Serum distilling from the Arteries into the upper parts of the Gula or Larynx produces a frequent and very troublesome Cough, without any notable prejudice of the Lungs. But truly this provocation, inflicted on the nerves and fibres distributed in the Lung it self, more frequently, and truly more violently pro∣vokes an endeavour of Coughing, which is repeated by courses, till what is trouble∣some be turned forth, or the provocation restrained. Of this kind of Cough from the nerves, a notable Example shall be after set before you.

The provoking causes producing a Cough are manifold,* 1.9 and make their stay in se∣veral places: for besides that the nerves, as we but now intimated, and also the membranes, with which there is an intimate communication with the Lungs, being provoked in the open Nostril, give an impression of that passion at a distance to the Lungs; most frequently that irregular exspiration is stirr'd up, by reason some in∣congruous or in some measure unproportion'd thing is cast into the Lungs. For in the first place, that this troublesome thing may be removed, the nerves and the nervous fibres dispersed about the Lungs are irritated; afterwards by the con∣sent of these, the muscles of the breast that draw it together, and the moving fibres of the Trachea at once are forced into vehement and often repeated con∣tractions.

Every Cough is either moist or dry;* 1.10 in the former a certain humour being depo∣sited in some place within the tracheal passages is shaked by coughing, and being to be thrown out upwards is cast into the mouth. That humour, whereas it is ma∣nifold and after divers sorts, for the most part it is either call'd serous, or nutritious, or purulent, or bloody.

Of the former there are many kinds and differences; namely, as to its consistence it is either thin, or thick, or crude, or digested; as to its colour, it is either white or yellow, or somewhat greenish; also sometimes it is blewish, or black. Moreover,* 1.11 a moist Cough is variously distinguished, as to the places from whence the humour to be coughed out proceeds. For sometimes cleaving to the sides of the Larynx, or sweating from them, the moving fibres being shaken by a gentle little Cough, it is easily and by a short passage cast forth into the mouth; sometimes the matter to be excerned, being impacted a little deeper in the pipes of the Bronchii, is not shook out but by large expirations, and often repeated; and lastly it sometimes happens, that the excrements to be cast out, are deposited within the farthest little bladdeers of the Trachea, out of which it is not brought forth without a vehement labour of coughing, and that frequently repeated, and at last driven forth by a long journey through the whole lungs. Concerning the Cough of a nutritious humour, as also of a bloody and purulent, hereafter it shall be discoursed when we treat of a Consumpti∣on and its remedy.

A dry Cough, as often as it is the proper passion of the Lungs,* 1.12 is excited after many manners and by sundry causes; for an obstruction of any of the pneumonic pas∣sages, whether it be by compression, or oppletion, or contraction, doth necessarily in∣duce this. Wherefore an inflammation, a tumour, a little swelling, a stagnation of the blood either through plenty or scarcity, also gravelly, stony, or polypose Concretions, worms and many other preternatural things, inasmuch as they almost perpetually provoke the nervous fibres, do induce a dry, vain Cough, but troublesome. But

a dry Cough sometimes is stirr'd up by the instinct of Nature, as in place of a Pump; to wit, that the blood either by reason of its proper ill temperament, or by reason of the pneumonic Vessels not being open enough, not passing well through the lungs, may be promoted by the shaking of these parts, and forced into a more rapid mo∣tion.

What belongs unto the other acts of expiration hurt, as when in sneezing, hiccough, laughing, crying, and in other affects its natural and even function is troubled or per∣verted; seeing the rendrings of the causes of these (which also in another place we have in part designed) do not properly appertain to our purpose, omitting them here we will pass to the thing chiefly designed, viz. to the diseases of the breast and their remedies, and to the reasons of curing them.

Notes

• * 1.1

  The act of expi∣ration is easier than of inspira∣tion.
• * 1.2

  Expiration hurt sometimes proceeds from the fault of inspira∣tion.
• * 1.3

  Sometimes being alone depends on various cau∣ses.
• * 1.4

  1. On the wound of a part mo∣ving.
• * 1.5

  2. In a Cough.
• * 1.6

  The description of a Cough.
• * 1.7

  Its formal rea∣son and the man∣ner of its being done.
• * 1.8

  Its primary cause.
• * 1.9

  The evident causes thereof.
• * 1.10

  The kinds thereof.
• * 1.11

  A moist Cough.
• * 1.12

  A dry Cough.