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. V. Of a Phthisis or Consumption in general.

WHereas we have hitherto viewed the fabrick of the Lungs accurately de∣lineated, and the motion thereof together with that of the whole Breast, and the ways and passages of the air, and of the blood, and of other hu∣mors through them; and have also observed their various impediments, their remora's, or diversions, according to which it happens the act of the pneumonic function is after a diverse manner hurt or perverted in inspiration and expiration: now in the next place we are to descend to the Pathology of this region so travelled over, and, which was our design from the beginning, to treat of Medicines belonging to the Thorax, or Remedies appropriated to heal the distempers of the Breast, and the manner of their operation.

Of all the diseases of the Breast a Phthisis, or Consumption, by right claims the first place: for there is none more frequent or difficult to cure. Moreover all the other affects of the Thorax being ill, or not at all cured, do lead into this, as lesser streams in∣to a greater Lake, and so ending in Phthisis, lose both their natures and ancient names.

But truly these terms of Phthisis and Tabes in their proper signification denote an Atrophy, or a withering away of the solid parts with debility of strength: the distem∣pers of which sort frequently proceed from a wound or Ulcer of the Lungs; notwith∣standing sometimes without any fault of these, the extenuation or pining away of the whole body takes its rise from the meer fault of the blood, or chiefly from the nervous juice. Therefore before we handle a private pulmonary Phthisis, seems to our purpose to explain the general reasons of this sickness, and to declare how many ways, and from when causes the ill temperaments of the humors are wont to induce a privation of nourishment of the whole body, as it were consumptive. For truly the Consumption of the Lungs it self doth not next and immediately proceed from an Ulcer or corru∣ption of that bowel; but it arises for as much as the blood from them contracting a corruption, and highly defiled, for that very cause loses altogether its nutritive virtue. Moreover as well this as the nervous liquor acquires such an indisposition. Of which in general we will now inquire.

And first what relates to the Blood, we may often take notice, that some pine away without a Cough, or without any apparent fault either in the Lungs or Breast; in the mean time as to appetite, digestion, sleep, and almost the oeconomy of the whole natu∣ral and animal function do carry themselves indifferent; notwithstanding, as if nou∣rishment should be poured into a Receptable bored through, they are not nourished, but pine away sensibly maugre all Dietetical Rules. The formal or conjunct reason of which kind of affect frequently consists only in this, that the blood being notably de∣praved, cannot assimilate the nourshing juice continually mixt with it; wherefore it doth not only forthwith send it away, but also takes away some particles of the solid parts; which snatching to it self, it presently throws out, or casts it into some place or other, or consumes it by evaporation.

The depravations or degenerate states of the blood, that are wont to induce an Atro∣phy, either consist in its proper distemper, or themselves are communicated from some other place, and indeed chiefly from the bowels, or from the nervous liquor being also degenerate.

The proper Dyscrasie of the blood it self is twofold, according to which it happens, that the saline-acid particles or the sulphureous and most sharp are exalted above mea∣sure, and predominate over the rest. For sometimes the blood withdraws it self from its genuine disposition, viz. a sweet and volatile into an acid, as is always found in scor∣butical, melancholy, or cachectical persons. Wherefore the nutritious juice being ever mingled with the bloody mass, seeing it cannot for that reason be assimilated, and affix∣ed to the solid parts, is released again in a short time; and is either forthwith sent away by urine, sweat, or a Diarrhoea; or being pen'd up within the flesh or cavities of the bowels, brings a Dropsie: of which sort of distempers, being led forth into an evil state, the ordinary effect is wont to be, that when some parts do swell very much, other parts are very much extenuated. Here it would be far from our purpose to deliver the true cause of the above-mentioned affects, and to put our sickle not only into another mans harvest, but also one far remote. 2. Moreover there is another state of blood unfit for nourishment quite contrary to this, to wit, when being above measure hot and sul∣phureous, and from thence always violently burning out, it consumes the nutritious juice by its effervescence and raging, and causes it too much to evaporate; so that the solid parts being defrauded of their provision pine away. The persons obnoxious to this distemper have large vessels, and much distended with blood, but their flesh withe∣red and hardned by heat. Though persons so affected seldom pine away to death, yet they grow old sooner, and end their life in a shorter space.

2. The blood not only from its proper indoles, but also by reason of a Consumption elsewhere, and chiefly communicated from the bowels and nervous juice, is often unfit to nourish. And first this frequently happens by fault of the bowels; for these being ill-affected, sometimes do not duly digest the Chyme to be conveyed over to the blood; also oftentimes they pervert and defile it with their extraneous and heterogene fer∣ments, insomuch that the functions are frustrated in the faculties of breeding good blood and nourishment. Moreover sometimes by reason of the Vessels bringing the Chyle obstructed within them, though much be eaten, yet little or less than due, is con∣veyed into the bloody mass. Also in the bowels of concoction sometimes Tumors, Im∣posthumes, and Ulcers happen; from whose corruption the blood being infected in its passage, contaminates the rest of the mass, and renders it unapt to the work of nou∣rishing. How often do we see from a Schirrus happening in the Spleen, Liver, Pancreas, or Mesentery, or by an Ulcer or cancrous Tumour of some Gut, as also of a Kidney, Womb, or Bladder, or otherwise malignant Sore, a deadly Atrophy to have succeeded without any notable fault of the Breast or Lungs? Yea Tumors, Imposthumes, or cancrous and strumous Ulcers happening in the outward parts, and especially in the Back, do frequently end in a pernicious Consumption. The reason whereof is plain, viz. in as much as in such distempers both great plenty of the nutritious juice brought to the affected part through the Arteries, is either entirely bestowed in the same place, or from thence is poured forth abroad, insomuch that all the other parts of the whole body are defrauded of their due provision; as also that the virulent or very incongru∣ous matter there engendered and lodged is swallowed up by again the Veins, which defiles the blood by an impure black gore, and from thence renders it altogether unapt to discharge the faculty of nourishing.

Neither only from the bowels and solid parts, but also from the nervous juice the stain (by which it becomes unfit to nourish) is frequently communicated to the blood. For when this liquor degenerates from its genuine temper, to wit, sweet and volatile into an acid, presently flowing out of the fibres and nervous parts, and flowing back into the blood, it doth precipitate the liquor thereof, and compels it into fluxes, whereby all the nutritive matter is cast forth, and one while poured forth by Urine or Sweat, another while by Vomit or Loosness. The reasons of all these, and how they come to pass we have explicated in a late Treatise.

But the nervous liquor, sometimes by it self, departing from its good temper, and being vitiated in its temperament, is a cause of want of nourishment, which also hap∣pens to be made in a twofold respect, or two manner of ways. For sometimes that Juice being very much vitiated and degenerate, proves as it were vappid and decay∣ed; so that it doth not actuate enough the fibres as well nervous as carnous, and inlighten them with an animal spirit: wherefore as the motive virtue, so also the nutri∣trive fails in the solid parts. From hence either the entire body, or certain members and parts thereof being for some while affected with a Palsie, at length they wither away: as we have at large declared the reason thereof in another place. 2. We have

also observed, that many labouring with a slow Feaver (or as called by us a nervous) do presently languish, and in a short time become much emaciated. In either case the same reason ought to be assigned; for, as is shewed in another place, seeing the animal spirits, together with the nervous liquor, their vehicle (which is as it were the mascu∣line seed) do actuate the nutritive humour every where collected by the solid parts even as the feminine seed, and render it as it were pregnant with a nutritive faculty; for that cause if that nervous liquor becomes either depraved or vappid, the bulk of the solid parts pines away as if it were made barren.

So much of these things touching an Atrophy, or waxing lean, and the formal rea∣sons thereof, the causes and various manners of its coming to pass in general. Of this disease as there are many kinds and differences, so two chiefly and more observably occurr, whereof either will deserve a particular consideration; viz. Tabes or Phthisis Dorsalis commonly so called, and a Consumption of the Lungs. This latter, which pro∣perly belongs to this place, shall be discussed in the following Chapter; in the mean time concerning that (because the knowledge thereof doth illustrate the Pathology of this) we shall speak in a word.

Tabes Dorsalis, although it hath almost lost its name in this our Age, or perhaps changed it into a Gonorrhoea, yet Hippocrates makes mention of it, and handling it avowedly, he assigned a twofold kind thereof, viz. one from immoderate Venery, and the other from a destillation into the Spine of the Back. What relates to the latter, I have often observed some to be most grievously vexed with a pain about their Loyns, yea sometimes in the whole Back, which when for some time some have so laboured under, they afterwards come to be lame or crooked, and at last fall away in the whole body, all but the head. The cause of which disease doubtless consists in this, viz. first a humour or a certain incongruous morbific matter, descending with the nervous juice through the spinal marrow, did run into the branches of the vertebral Nerves, and therefore from the beginning, by reason of the Fibres being twitched, a continual pain almost did arise; afterwards by reason of some Fibres being resolved, the opposite ones more vehemently contracted distort certain Vertebra's of the Spine; and lastly seeing the animal Spirits cannot actuate enough the Nerves and Fibres belonging to the trunk and members, by reason of the nourishment frustrated, the withering of the entire body succeeds. Surely when the nervous liquor and animal spirits pass not fully and freely out of the Dorsal Spine into the whole body, from thence oftentimes a pining doth arise: hence Imposchumes and Ulcers arise about the Loins or the Os sacrum, which in as much as they consume or pour forth the nervous liquor too much, cause an Atrophy in the whole, or at least in the lower parts.

2. Another kind of Tabes Dorsalis far more frequent, is also twofold: viz. it either ariseth from the great or too-often loss of the genital humor, or from a continual cor∣rupt flux from the genital parts.

1. As to the first, it is manifest by vulgar observation, that the immoderate use of Venery, yea involuntary efflux of the seed, if it be either great or continual, produce a faintness in the whole body, and at length a pining away. The reason of this (as we have intimated in another place) is not, that the seed, according to the opinion of some, de∣scends from the Brain through the Nerves into the spermatic bodies, and from thence, by reason of a great loss thereof first the Brain, and then the parts, all depending on the influence of the Spirits springing from thence, become infirm and pine away. But seeing we have sufficiently evinced, that the seminal matter is immediately supplied out of the mass of blood into the genital parts, and that it is altogether the same with that out of which the animal Spirits instilled into the Brain are proceated, it will necessarily follow, by now much the greater portion is got to the Testicles for repairing the loss of seed, by so much is the Brain defrauded of its due share, and therefore at length the sunction in the whole body, as well motive as nutritive, doth waver and diminish. Our furious Whoremongers are sensible of a great debility about their Loins, and the parts placed below them, to wit, the Thighs and Legs, do chiefly wither away; the rea∣son is, because as well the provision of the animal Spirits in its first spring, viz. in the Brain failing, the outmost chanels, viz. the ends of the spinal marrow, and the Nerves springing from it, do suffer first and chiefly for this defect; and moreover because near the Loins the arterious blood gives out to the Testicles more excellent particles and chiefly restaurative, being destined to nourish the Back, and in the mean time the ve∣nous blood being for that cause decayed or consumed, is enfeebled, and steals from the Loins as much as possibly may be.

The loss of the seed causing a Consumption is sometimes voluntary, of which sort the salacious and prone to Venery do suffer: sometimes involuntary; of which affects there are divers kinds. For in some it only happens by dreams or obscene phantasms; but in others, besides those occasions, every endeavour of the Back, whether through bearing a weight, or excretion of Urine, or the faeces of the Belly, causes the genital humor to be thrust out: the cause whereof is, both because the seed is watry and thin and at once sharp and provocative, also because the parts are weak, and not able duly to digest or retain it.

In the other Tabes Dorsalis above-mentioned, not the seed it self, but an ichor or a certain putrilage is cast out abundantly from the genital parts; the efflux whereof, if it the great and continual, doth frequently impair the strength of the whole body, and by withdrawing and prodigally removing the nutritive matter, it induces an Atrophy or consumption. For near the spermatic Vessels, or in passage from them, as well in men as women, there are certain Emunctories placed, whose faculty is to receive the superfluous humour from the seed formed, and when it abounds to send it abroad through the genital parts. For this cause that those passages in either Sex may be made slippery and moist (lest they grow dry, and become less sensible) the Prostates in men and the Glandules about the horns of the womb in women are constituted; out of both which always in the act of coition, and sometimes without, when the spermatic bodies abound with too much moisture, a certain serous liquor sweats out: and in wo∣men (whose bodies are more moist, and in whom nature hath made these ways for their menstrual excretion) this doth oftner and more plentifully happen than to men. But if these Emunctories be affected with a great debility, or a certain virulency, so that they corrupt this liquor sent, or do not retain it enough, it is not only sent away in∣cessantly, and flows out plentifully through the Pudendum, but also other superfluous hu∣mours or recrements of the whole body flowing together to those weak parts are thrown forth together. Also the nutritious Juice destined to the neighbouring parts flows thither, and presently goes out together; so that at length by reason of the loss of the nutritious Juice (which flowing to the same place is corrupted and continually sent away) not only pains of the neighbouring parts, but of the whole body, and a pining doth succeed. These things are commonly known in a Gonorrhoea, also in fluore mu∣liebri, or those affects from an impure bed, or immoderate Venery, or are caused by a blow, a bruise, violent exercise, or any other hurt inflicted upon the Loins. It is not proper to this place to deliver particularly the true rendring of the cause and cu∣ratory method of healing of this sort of passions: we shall proceed to treat of a Phthi∣sis or Tabes properly so called, viz. which arises from the only or chief fault of the Lungs, which was the business of our design.

Notes

• A Phthisis ac∣counted chief a∣mong the disea∣ses of the breast.
• The various ac∣ceptation of Phthisis.
• It denotes any Atrophy.
• An Atrophy first depends on the blood made unfit to nourish.
• The consumptive Dyscrasit of the blood either from it self or com∣municated from other parts.
• 1. The kinds of the former are reckoned up.
• This proceeds sometimes from a fault of the bowels or solid parts;
• Or from the ner∣vous juice.
• The nervous juice sometimes of it self is chief∣ly the cause of an Atrophy.
• Two chief kinds of Atrophies.
• Tabes Dorsalis.
• Two kinds.
• From the nervous juice stopt or de∣praved in the loyns.
• From the ex∣pense of the hu∣mour through the genital parts. That humour is first either seed, a too great expence where∣of induces an Atrophy.
• The losses where∣of are volun∣tary or involun∣tary.
• 2. Or Ichor flowing into those parts from solution of continuity.
• The formal rea∣son of a virulent Gonorrhea.