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.

THE SECOND PART OF PHARMACEƲTICE RATIONALIS, OR OF THE OPERATIONS OF MEDICINES IN HUMANE BODIES. (Book 2)

SECT. I. Of the Medicines of the Thorax.

CHAP. I. Of the Organs of Breathing and their Ʋse.

IN the former Treatise having essayed to explain the reasons of every Medi∣cine, for the most part we have toucht only upon general Medicines, namely which excite some Evacuation, or recreate and restore the fainting Spirits, or calm those which are too much raging and unquiet:* 1.1 But moreover there are many other Remedies, and those of several sorts, which are supposed to have respect to some peculiar part of the Body, or some particular Disease, and to be appropriated to those ends by a certain kind of specific virtue or operation. Now as concerning both the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 of these, at least the chief of them, viz. whether it be really so, and for what reason it comes to pass to be so, it seems now worthy to be inquired into: And first of all we will treat of the Medicines of the Thorax, viz. those that are wont to be prescribed against the Cough, Phthisic, Catarrh, Asthma, Dyspnoea, and other Diseases of the Breast.

But since the reasons as well of these Diseases as of medicinal Operations in heal∣ing them seem very abstruse and most difficult to declare:* 1.2 therefore before I enter upon this task, something ought to be premised about the parts themselves, as well touching their uses and ordinary actions, as their sicknesses or preternatural affects. As to the first, the parts of the Thorax are either principal, as the Heart and Lungs,

with the Vessels appendent unto them; or subservient, as the Membranes and Mus∣cles, with the Diaphragma; as likewise the Ribs, with the Vertebra's; the Pneu∣monic Vessels, with the nervous Fibres and Glandules. The consideration of the Heart and its Vessels doth not properly belong to this place, because not so much the sicknesses of the Breast alone as the general sicknesses of the whole body are usually reckoned amongst its passions. Whereas therefore the remedies appointed to cure the diseases of that region, have special respect to the Lungs, and to the other Organs of breathing serving them; therefore first we will describe the fabrick and use of these parts, then their diseases afterwards, together with the method of cure, and remedies; and lastly endeavour to add the reasons of all these.

The substance of the Lungs was always accounted by the Ancients, and mostly hi∣therto by modern Authors for flesh and a Parenchyma, like the frame of the other bowels; which notwithstanding was accounted lighter and spongeous (for as much as it was apt to be distended much by air pufft in,* 1.3 and to float upon waters.) More∣over, whereas the Lungs taken out of an Embryo look red, and sink in water; and the Lungs of some grown persons being boiled, appear compact enough and more so∣lid; almost no man doubted but they consisted really of flesh: until lately the re∣nowned Malpighius, a most diligent Searcher of Nature, found those parts to be alto∣gether excarneous, and meerly membranous;

and therefore he judges the bulk of the Lungs, if the Nerves and certain Vessels be separated with the branches of the Trachea, to be a certain heap of little Bladders, and those small Bladders every where stretched out and sinuous, to obtain such position and knitting together, that an entrance lies open into them from the Aspera Arteria, and so from one into another, until at length they all end in the Membrane inclosing the Lungs. And truly that it is so, he makes clear to sense by an Experiment. For let a Lung be taken out hot, and let water be so often cast by a Syringe into the Pneumatic Ar∣tery, as till the whole frame appear somewhat white, and almost transparent, the blood being clean washed out; afterward this water being squeezed out by pres∣sing, and the air let in by the Wind-pipe, and pen'd in, let the Lung so filled be dryed: and it does not only, whilst exposed to the light, outwardly shew transpa∣rent little Bladders; but being inwardly cut, it presents a white heap of little Bladders to the eyes.

Besides, having viewed it with a Microscope, he discovered a certain wonderful Net, binding and knitting together every one of those little Bladders; which Net consists of the minute productions and branchings of the Arte∣ry and Vein; which Vessels circulate the blood by the small and crooked passages, and by the many turnings of the Pipes.

The most renowned man hath found out beside these little Bladders for the most part constituting the frame of the Lungs, a new and more admirable furniture of this Bowel,* 1.4 viz. he shews plainly the bulk of the Lungs to be blown up by almost in∣finite lobes girt about with their proper Membrane, which being endued with com∣mon Vessels, grow to the small twigs of the Aspera Arteria: the insertion and situa∣tion of which kind of little Lobes are manifold, as being sometimes affixt to the Ba∣sis of the Trachea, sometimes to the Ribs, or to its Cone; also according as they end in the outward and plain superficies, or in the corners of the Lungs; and accor∣ding as they ought to have a due position, knitting and inter-spaces among them∣selves, rightly to fill up the frame of the Lungs. The little lobes out of which each lobe of the Lungs is made up, in the third Table are accurately and to the life ex∣pressed.

Certain inter-spaces distinguish these little lobes (which manifestly appear in a lar∣ger Lung or in any other half boiled) which (as the renowned Person hath observed) are not bare cavities or empty spaces,* 1.5 but they have many Membranes spreading from the little lobes, some parallel, some angular, and are also covered with many Vessels, so as these inter-spaces are certain membranous little bladders, yet trans∣parent and most thin. If you lightly open in one single lobe of the Lung one of these inter-spaces with the point of a knife, and shall blow into it by a small hole through a Pipe, presently that whole lobe will be very much extended, every inter∣space being pufft up; and then if you bring this frame to the light, the inter-spa∣ces being made transparent, do sever by great intervals every lobe very conspicuous; and so every rank of the lobes will appear like a Polypody-leaf, and under the same figures, as Malpighius hath described, and are represented in Fig. 2. of our third Ta∣ble. But when the little lobes are filled and extended by liquor easily congealing cast

into the passages of the Trachea, the appearance thereof is somewhat diverse, and seems in the form of Grapes, as is expressed in Fig. 1. of the same Table. The Veins and Arteries every where accompany this production of the Aspera Arteria, and ex∣tend themselves through the whole substance of the Lungs by a certain knitting and alike branching. This is plainly perceived by a pleasant sight, in a lobe of the Lungs being emptied and turgid, Quick-silver being cast into some of the Vessels, and others filled with a coloured liquor. But in dissecting the living, another sort of Vessels, viz. Lymphaeducts are manifest to the eye to be spread through the whole Lungs:* 1.6 and we have in another place clearly enough shewn, both very many Nerves and ner∣vous slips every where to be distributed through them. Besides these parts, and the primary or chief vessels of a Lung, some others, and those as it were secondary, are to be observed. For the Pneumonic Veins and Arteries are endued with other sanguiferous Vessels springing from the Aorta, moreover with Glandules, and like∣wise with Fibres as well nervous as moving; and the Wind-pipe is endowed with every one of these, and cartilaginous ones besides.

Whence we may infer, that the entire frame of a Lung is meerly fistulous,* 1.7 and compacted of Pipes of several kinds and magnitude, and variously and most intri∣cately disposed: which although they may appear wonderfully complicated, and many ways twisted and wreathed, are yet every where continuous, and being stretch∣ed out with a mutual respect to one another, do hither and thither in good order and regularly convey and dispose the air, the blood, the Lympha, and animal Spirits for some accessary uses. To describe as it were with a Pencil this bulk of a Lung, together with the branchings, separatings, and mutual complications of all its Ves∣sels, would be no less difficult a task than to trace the several threads of a harl of silk, and their respect one to another. Nevertheless, that both the Pathology of the Thorax, and the cure, may be duly known according to our design, it seems to be material to recite here all the Vessels of the Lungs one after another, and to deli∣ver as well their descriptions, as their preternatural uses and diseases, to which at length the Therapeutic Method shall be subjoyned. And these are the Vessels of which the entire fabrick of the Lungs consists, the Wind-pipe, with the Bronchia and little Bladders, Arteries, Veins, Lymphaeducts, and Nerves, to which may the parts and appendices of those Vessels be added, viz. the Coats of the greater Vessels, which are endued with other sanguiferous Vessels and Glandules, and also with ner∣vous Muscles and Fibres.

Therefore as to the chief Vessels of the Lungs, although all these, by reason of their mutual offices, communicate among themselves with a wonderful affinity; yet the Arteries and Pneumonic Veins attend on the Trachea and its partitions the most exactly;* 1.8 for the branches and sprigs of every one of these springing alike from their respective stocks, and stretcht out to and fro, go on every where with like pace; so that the Trachea and its branches are always in the middle, above that the Vein, and beneath the Pneumonic Artery are carried, and all are distributed with an equal and sociable branching: and the sprigs and branches, sent from each of them, are presently applied to their like, and are interwoven like wonder∣ful Nets, of which the texture of the Lungs is almost totally constituted. It will be impossible to describe the spreadings out and various complications among themselves of all these going on together, as to the lesser sprigs and slips; yet if you will cast into every vessel apart Quick-silver, hot and flowing Gypsum, Wax min∣gled and made liquid with Oyl of Turpentine, or some such matter, which will extend all or the chief passages, and continue them stufft, then you may exactly enough represent the figure: and after that manner the frame or texture of the whole Lung may be conceived, each being described by it self and apart. Where∣fore upon these and all other Vessels and parts of the Lungs we will treat in order; and first of the Trachea or Wind-pipe.

The Wind-pipe or Aspera Arteria is a Pipe somewhat long,* 1.9 consisting of Grisles and Membranes, which beginning from the Throat or lowest part of the Jaws, and leaning on the Gullet, and descending into the Lungs, is dispersed by manifold little branchings through their whole frame. It is divided into two parts by the Anci∣ents, viz. the upper, which is called the Larynx, and the nether commonly called Bronchus; to which a third or lowest is added, by Malpighius called Vesicularis, or the bladdery one.

The former of these, which is the beginning of the Aspera Arteria,* 1.10 doth chiefly

serve for vociferation or loud noise, formed of many and various Grisles, to which also are adjoyned proper Muscles; the description and use of all which are so exactly delivered by Anatomists, that there is no need of dwelling longer on the description: we only advertise for methods sake and by way of abridgment, that the Larynx con∣tains some greater Cartilages of divers forms, and some uniform; the former, by reason of resemblance, bear the denomination of Epiglottis, the Buckler-like Carti∣lage, the Ring Grisle, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. To this last doth succeed a continual rank or row of Cartilages, fashioned altogether after the same figure and manner; every one of which, whereas they resemble a circle, but not compleat, are disposed after such a sort, as if one so compose many wooden Rings, that there should grow up from the sides of them, by laying a good many one upon another, a certain Pipe as it were with Ribs. These circular Cartilages are equally distant one from another in their whole passage, and are knit together by the benefit of an inner Membrane (which fills up the spaces between like the Periostium) as with a ligament. But the hinder part of every Ring-like Grisle where it lies upon the Gullet, that it may serve better to the swallowing of meats, turns into a Membrance, which altogether is the same, and binding together those cartilaginous rings, and covering the whole hollowness of the Larynx, is always moist with an unctuous homour, by which it may as well be defended against the sucking in of sharper air, as breathing out more acrimonious vapours.

Besides this inner Membrane,* 1.11 also another outward, though thinner, encompasses the whole Wind-pipe, by the aid whereof both the Cartilages are more firmly knit among themselves, and the whole Pipe bound to its neighbouring parts, and descends more safely and strongly into the Breast. Besides, we judge there are some other uses and offices of either Membrane, than that it only serve to fashion or defend the sides of the Wind-pipe: for as much as we do here manisestly observe many Nerves and nervous strings every where inserted, and also the more inward Coat of the Aspera Arteria to be endued with Fibres, as well nervous as fleshy or musculous: from whence we may conclude the Wind-pipe to injoy both a certain sense and mo∣tion either in the whole, or at least in some parts. And truly it is manifest even to common observation, that its more inward passage doth excel with a most acute sense; for as much as it is so much provoked by the smallest prejudice, that present∣ly it is wonderfully forced into a convulsive motion, viz. a Cough: but as a sense of annoyance, and from thence very often an instinct of motion arises from this Vessel; so we think that its Fibres do after a sort move of themselves both in breath∣ing and coughing. Surely in respect of this it is not to be doubted, because in this inner Membrance we find two orders of muscular Fibres in that fashion disposed as in the Aorta and Intestines: to wit, there is one upper order of straight Fibres, which while they are contracted, make all the circular Cartilages to be drawn together nearer to one another, and for that cause to abbreviate the Trunk of this Vessel ac∣cording to all its parts successively. Under this lies another order of circular Fi∣bres, which (while they are pufft up) being contracted, the hollowness of the Wind-pipe is much narrowed. Therefore when the moving Fibres of either kind make the passage to be straitned according to all its dimensions, it is obvious enough that they conduce to the discharge of the function of breathing, and more or less to be active, as there is endeavour to breathe quicker or slower, more intensly or more remiss. These Fibres being more vehemently contracted in a Cough, in hawking, in blow∣ing out, and certain other more strong exercises of expiration, do force the breath and other contents of the Aspera Arteria to be violently expelled. Moreover from this action sometimes either depraved or hindred, it shall be declared hereafter how an Asthma, a Dyspnoea, and some other diseases about breathing do arise.

This inner musculous Coat hath also two others,* 1.12 as if growing thereunto, to wit, one glandulous, and that full of vessels. For as in another place we have remarked a∣bout the Anatomy of the sanguiferous Artery, one may also here take notice, that the inward Pipe of the Wezand is covered with a most thick weaving of Vessels of every kind, and especially of those carrying blood, in fashion of a Net. The Arteries not springing from the Pneumonic Vessels, but from the Bronchial branch (which the most renowned Mr. Ruisch discovered to have its rise from the Aorta) are inserted into this same; which the veiny slips do accompany, owing their origine to the Vena cava. The nervous sprigs meeting these two, are variously folded; and so of all weaved together, is framed as it were a little Net, covering the whole back of the

Weazand, under which folding of Vessels very small and whitish Glandules are every where strewed, or rather cleave to them; just in the like manner, as we have in another place shewn to be in most other greater Vessels, and in all membranous Bowels: on all which the Lymphaeducts adjoyned do wait. As to the use of these, without doubt the Arteries and Veins wash through the Pipe of the Weazand with bloody stream for its nourishment; and the Nerves carry plenty of Spirits, and the faculty of performing motions to the muscular Fibres. Afterwards whatsoever of superfluous moisture be left by the Arteries, that the Veins cannot bring back, the Glandules do receive and retain, until it may be sent back to the mass of blood through the Lymphaeducts. When they are too much filled, by reason of the Lym∣pha more plentifully left, a humour distilling from the Glandules as well as from the Arteries into the hollowness of the Wind-pipe brings a Catarrh. All the Coats of the Aspera Arteria distinct and separated from each other are expressed in the seventh Table.

The second part of the Wind-pipe, commonly called Bronchos,* 1.13 begins from the entrance of the Lungs: for near the fourth Vertebra of the Chest that great Pipe descending, is divided into two Trunks, one whereof goes towards the right side of the Lungs, the other the left: afterwards both haveing entred the Lungs, and being subdivided for the greater Lobes, distribute very many sprigs (as for the most part in the gills of fishes) to the Lobes or lesser Lobes through the whole frame of the Lungs. The passages of all these are furnished, even as in the Larynx, with Car∣tilages, but framed something in a differing manner: for in the Bronchia these are not Ring-like, but resembling a Coat of Male, so that when there is need to contract those passages, the inferiour Cartilage goes under the hollowness of the upper, al∣most in the same manner as it is in the joynts of the shelly Coat of a Lobster. Provi∣sion is so made by the work of God, that when the Lungs are dilated, the Bronchia are stretcht out into the greatest length; and when they are contracted, the Bron∣chia are abbreviated, one part being drawn into another.

The Coats of the Bronchia, as also of the Larynx,* 1.14 have muscular Fibres of both kinds, together with the Glandules and the Net-like twisting of Vessels: from whence we may also conclude, that all the lesser Pipes of the Aspera Arteria have their constant turns of Systole and Diastole, viz. all the Pipes are contracted while we breathe out, and relaxed while we suck in air: moreover from the same Glan∣dules and little Net of Vessels every where continued almost within every inward recess of the Lungs, doth distil the Catarrh humour. A certain Bronchial branch of the Trachea belonging to each Lobe of the Lungs is described in the second Table H. H.

And the branched Bronchia of both sides not only constitute two or more greater Lobes; but, as Malpighius hath observed,* 1.15 many lesser or little lobes distinct among themselves; for each Bronchial branch sends forth to and fro many little branches or twigs, every of which twigs being joyned with alike twigs of the Pneumonic Arte∣ry and Vein, from thence are parted into innumerable lesser sprigs; all which being every where fellowed and complicated among themselves, and having got Nerves and peculiar Lymphaeducts, and ending in the outward superficies of the Lungs, re∣present as it were a certain private Grove; and so the whole structure of the Lungs consists of many little branches of the aforesaid Vessels complicated, as it were of so many several Groves. The branches whereof and outmost sides of which,* 1.16 al∣though they may seem mutually to touch themselves and cleave together, yet they are disjoyned one from the other, and are every one bounded within their proper limits; far otherwise than the productions and communications of Vessels are in the Brain, where the Arteries and Veins rising up in its several corners, extend on every side, and creeping through its whole space, and mutually inosculating, do all com∣municate among themselves.

That former fashioning of the Vessels hath been very necessary to the uses of the Lungs; for seeing the air ought only to enter the Lungs for that end,* 1.17 that it might pour out to the blood nitrous particles for its flame and vitality or life, and pre∣sently return back; and seeing the blood doth pass through the Lungs for that cause, that it might meet the air suckt in according to all its parts; therefore it behoves that both these, viz. the air and the blood be divided into small portions, and with these make every where distinct and short meetings. The manner of this is most elegantly perceived in the gills of fishes; for seeing the Bronchia are as

so many greater Lobes, every one of these is divided into many rundles, furnished with a complication of every kind of Vessels, as if it were into so many Lobes; in every one of which the blood is drawn out by minute portions, as it were little rivu∣lets, that it might throughly meet with the nitrous particles, and afterwards return into its chanel.

The Bronchial Pipes lead into the utter cavities,* 1.18 viz. into the numerous little Blad∣ders discovered by Malpighius; which truly are certain continued parts of the Aspera Arteria, but distinct from the former, because the Grisles are wholly wanting to them, and, which supply the turn of these, are distant one from another in larger spa∣ces: for all the Bronchial branches send forth lesser slips from themselves every way; whose passages, although void of Grisles, notwithstanding are straitned as it were with certain ligaments at certain intervals; and the spaces between these being filled with air suckt in do make partly those small bladdery little Cells. In truth those passages may not unaptly be compared to the Gut Colon of a Mouse, whose continued hollowness in as much as it is girt about in divers places, seems to be di∣vided as it were into many little purses. Moreover those bladdery passages being shorter on either side the Sinus or hollowness, have as it were particular little Blad∣ders growing thick to them, and therefore the heap of all the Cells seems not much unlike to a bunch of Grapes. The Figures of these as much as may be are exactly represented in the third Table. Those little bladdery Cells, that they may put forth their contracting endeavours for breathing, have muscular Fibres, as is plainly seen by the Microscope. For as much as great plenty of air ought to be drawn within the Lungs, and reserved in part, lest it fail at any time; therefore besides those up∣per passages which are as it were the threshold and dens, moreover more inner chambers and capacious are required, in which the air may be treasured up, and from thence be dispensed upon occasion. For it sometimes happens the external is too sharp, or otherwise disagreeable to the Lungs; so that as it was greatly ne∣cessary that it should be suckt in more sparingly, and its vehemence presently be at∣tempered and rebated by the air treasured within. Moreover it cannot be drawn in or inspired otherwhile in quantity great enough, as in running, singing, or much speaking, also in some crazy dispositions; and in that case the inward air being rari∣fied, supplies in a manner the defect of the outward.

Therefore seeing those bladdery little Cells receive a greater stock of air than that they can be bound presently to return it all by every turn of expiration;* 1.19 there∣fore the grisly twigs are wanting to them, and their hollownesses are more large of themselves, that they may be more largely distended: but that they may puff out a greater quantity of air upon occasion, or throw out matter to be coughed out, being endued with muscular Fibres, they contract themselves more narrowly, and throw out what is contained within them thoroughly. For the ordinary Systole's of the Breast, which the relaxation of the Muscles do partly effect, cast out perhaps at eve∣ry turn the whole air from the Trachea and Bronchus, but not from the little Blad∣ders: for the emptying of these as often as need shall be, both the cavity of the whole Breast is very much straitned, and the small bladdery Cells themselves are straitned from their proper Fibres being drawn together.

2.* 1.20 The next Vessel is the Pneumonic Artery, of whose most thick branches ex∣tended every where to and fro, and with other branches twisted and complicated together, the frame of the Lungs consists. This Artery issuing from the right Sinus of the Heart, and inclining towards the Trachea, is parted into a right and left branch; which applying themselves to the like parallel branches of the Trachea, do accompany them every where, or rather are set under them; for they are planted beneath, and are first carried into the greater lobes of the Lungs, and afterwards into all the lesser lobes: in every of which the little branch of the Artery stretched out, sends out on either side more slips from it self, which presently are associated by other bronchial and venal slips, and are several ways complicated; and where the outmost sprigs of the Aspera Arteria depart into circular little Cells, the Arte∣ries being complicated with the Veins (as is discovered by the Microscope) do girt about those little Bladders with their thick branching, and enwrap them like Ivy: from whence we may conjecture, that it is not for nothing that the Blood-vessels that are any where in the Lungs, do curiously wait upon those of the air, and every where insinuate and intimately mingle themselves. Surely whatsoever hath been supposed by others, I shall not easily believe that this is done for the more exact

mingling of the Blood and its parts, be they never so unlike. For to do that, what need would there be of so full an access of air, which in rightly making other mix∣tures (the more perfect whereof are called Digestions) we seek as much as we can to keep out? For if the air might freely come and go, the Particles that should be mixed, would most of them flye away. And as to that which is affirmed, That the Blood in the Lungs is carried through those small, winding and extreme narrow passages only that it may be the better mixed; I say, that its being so carried is quite contrary to such an intention: for the best mixture of any liquor (as also of the Blood it self) is made by fermentation; and the liquour to be so mixed or fer∣mented, like Wine in a Hogshead, requires a free and spacious room: but its going through these small and narrow passages like so many strainers, serves rather for the separation than the mixture of its parts; wherefore unless the Blood be exactly mix∣ed in the greater Vessels, and be there rightly fermented, it does, while it passes through the Lungs, leave there the dregs and whatsoever parts are not rightly mixt, and so does stuff up and very much obstruct their passages; as we may see in persons affected with the Green-sickness, Cachexy, and that sort of Dropsie called Leuco∣phlegmatia, who all have a difficulty of breathing, by reason of dregs of the ill-mixt Blood that are left there. Wherefore the use of the Lungs seems to be this, That the Blood through the lesser Vessels, as so many rivulets, may as to all its parts lie open to and meet with the nitrous Particles of the Air, and be by them enlivened and accended. The Pneumonic Artery, as also the Aorta and Wind-pipe, hath a muscular Coat furnished with two ranks of Fibres, namely straight and circular; which doubtless, when they are contracted, do make the Pneumonic Arteries to beat, and the Blood to be urged and driven still more and more forward. A great many Glandules with a Net of Vessels lie on this musculous Coat. The frame and branching of the Pnenmonic Artery in some one Lobe of the Lungs are expressed in the second Table. All the Coats of this Vessel are drawn distinct and apart from one another in the sixth Table and first Figure, and also in the fourth Table and se∣cond Figure.

The Pneumonic Vein, having its rise in the left Ventricle of the Heart,* 1.21 and being divided and variously subdivided first into greater branches, and then, according to the greater and lesser Lobes of the Lungs, into lesser, and lastly into the least of all, is carried above the Weazand, and as it goes on does exactly answer to the branch∣ing both of the Pneumonic Artery and the Weazand, and goes every where with them as it were cheek by joll; and where the Weazand ends into the little Blad∣ders, the Veins being twisted with the Arteries (as was said before) do make as it were a little Net wherein those little Bladders are encompassed. The Anatome of the Pneumonic Vein differs little or nothing from that of the Vena cava and its branches. All the Vessels of this kind have four Coats distinct from one another.

1. The outmost of these Coats consists of Fibres that seem to be nervous, which perhaps are after a sort muscular and are extended straight long-wise, (though in no very regular order.) This Coat of the pulmonary Vein is very laxe, and loose from the rest of the Vessel, insomuch that it may all of it be blown up and very much extended, as if it were a distinct Vessel: Whence one might suspect that this were a peculiar passage to carry back Lympha or Serum separated from the Blood: but it seems to be more probable, that this outmost Coat is therefore made so loose, that the passages might be much distended and widened for the return of the Blood now hot and boiling.

2. 3. Two other Coats (common both to a Vein and Artery) viz. the vasculous,* 1.22 and the glandulous lie under this: the office of the vasculous is to bring nourishment to the part, and of the glandulous to receive and send away the superfluous sero∣sities.

4. The fourth and inmost Coat is plainly muscular, having Ring sibres,* 1.23 as the like Coat of an Artery hath, which certainly being successively contracted after the stream of Blood, do cause its return to be hastened, and on occasion to be shortned. But here arises a doubt, wherefore,* 1.24 seeing the Veins as well as Arteries have con∣tracting muscular Fibres (which in the latter are pulfifick) and seeing both are alike joined to the Heart that beats continually, the Veins as well as the Arteries should not statedly beat according to the constant turns of the Systole's and Diastole's in the Heart? It may easily be answered to this, first, that the Arteries have a great deal more of the moving Fibres than the Veins have; and therefore whereas those

being strongly contracted successively, do force the Blood along as if driven with a wedge, for these it sufficeth that whilst they are gently contracted behind the stream of Blood, they calmly and equally drive it forward, flowing back again of its own accord, and as it were down-hill. But besides, the reason hereof seems to depend some∣what on the unlike or rather inverted conformation of the Vessels; for the Blood conveighed by the Arteries is driven still from wider to narrower spaces, and there∣fore going along it every where violently distends them, and lifting up the sides of the Vessels raises the Pulfe; because whiles that part of the Artery that is behind the Blood is contracted by its muscular Fibres, that part which is before it, must needs beat being filled with the stream of blood gushing in: but on the contrary, the blood in the Veins returning to the Heart, runs out of less into greater spaces, or out of rivu∣lets into a more capacious and deep chanel, and therefore glides along silently and without the fluctuating of a Pulse.

The blood in the pulmonary Veins seems as much,* 1.25 or more than that within the Arteries to be animated or inflamed anew by the air insinuating it self every where from the Pipes or little Bladders of the Trachea, because in those Veins 'tis first changed from a black-purple to a scarlet: the reason whereof is, because the blood at the extremities of the Vessels, namely as it passes out of the Arteries into the Veins, does every where and most of all meet with the particles of the air. And for that reason it is, that if any liquour be squirted into the Pneumonic Artery, it will not so readily and quickly pass through the Lungs and return by the Vein, as it will do if you make the same experiment in any member, or part of the body be∣sides; yea part of the liquor so injected will sweat through into the Pipes of the Trachea, or the spaces between the little Lobes, and another part, being turned into a froth, will return very slowly by the Veins: which is a certain proof, that while it passes through the Lungs it makes a stay in the mouths of the Vessels, and is mingled with the airy particles. The Circulation of the blood through the Lungs hath something diverse from, or rather contrary to that which is made through the rest of the body; seeing the Pneumonic Arteries contain a black-purple blood, and the Veins a scarlet, whereas in all the body besides the branches of the Aorta carry a scarlet blood, and those of the Vena cava a black-purple. Besides we may ob∣serve of the pulmonary Vein, that it does every where in its whole length want valves, except where 'tis fastned to the Heart. Which appears by this, that when any liquor is injected into its trunk (just as it is in the Artery) it presently passes through all its branches without lett. Which ought to be so, to this end, that the blood may always, because of the violence of the passions, freely every way fluctuate and regurgitate in and about the Heart. Besides, that the left Ventricle of the Heart might never be overcharged with the blood impetuously rushing into it, by the instinct of Nature the Fibres at the root of the Vein being contracted, its course might be inverted and flow back. The description of the Pneumonic Vein as to its utmost branching is in the fourth Table and third Figure.

To these three sorts of Vessels,* 1.26 wherein the air and the blood are conveighed, the Lymphaeducts that carry forth a water are joined. A power of these dispersed through the Lungs, wait on the Arteries and Veins. All the branches tending from the surface of the Lung towards its original, unite into some greater trunks; which, being inserted into the Wind-pipe, discharge thereinto the Lympha that is super∣fluous from the blood and nervous humour. Indeed there is need of a great many of this sort of Vessels in the Lungs; because, seeing the blood is hottest of all here, is hastily circulated, and yet can exhale nothing to without by transpiration, the Veins can hardly receive all the whole mass of blood from the Arteries; and the Glan∣dules contain not long what is deposited in them: therefore there as need of Lym∣phaeducts as so many chanels, whereby the superfluous humour might continually be sent off. If these at any time happen to be obstructed or broken, there often fol∣lows a Dropsie of the Lungs or Breast, and sometimes Coughs and Phthisicks. These lymphatick Vessels of the Lungs may very well be seen, if in dissecting a live Dog you press the top of the Thoracick duct, that nothing may be poured into the subcla∣vian Vein: for then the Lymphaeducts of the Lungs, because they cannot discharge themselves into the common Receptacle now stopt and filled, swell much and are very apparent. If such a stoppage be made for some time in a Dog that hath eat and drunk largely, a milky liquor will sweat into the Lungs out of the Thoracick duct, the Valves being unlocked: yea and the same liquor will pass through the Lymphae∣ducts

placed far beneath the Reins, and will render them strutted with that homour, as if abounding with milk. The rough delineation of the Lymphaeducts spreading them∣selves in the superficies of the lobe of a Lung, is represented in the first Table.

5. The last kind of Vessels belonging to the Lungs are the Nerves and their bran∣ches,* 1.27 whereof there are many (as we elsewhere intimated) dispersed every where through the Lungs. Heretofore doubting about the office of these, we were induced to think the first force, or at least instinct of breathing depended on these Nerves; be∣cause otherwise we can hardly conceive, after what manner the motion of the Lungs in breathing, coughing, laughing, and other their actions should be always so exactly pro∣portioned according to the several exigences of Nature. For even as the blood doth more intensly or remisly heat and boil up within the Praecordia, and as certain contents of the Trachea provoke the nervous Fibres, we breathe either quicker or slower, and oft∣times, though unwillingly, we cough. But besides there doth occur another and more necessary use of these Nerves: for since it is manifest, that the Coats of those Veins and of the Trachea are every where endued with muscular or moving Fibres by which they are contracted, it is plain, that the Pneumonic Nerves do convey as well plenty of spirits, as inclinations of contraction to those Fibres. And it is very probable from those Nerves convulsively distempered, that the Palpitation of the Heart is often exci∣ted, as also the Asthma and Chin cough. We have some time since delivered the Ana∣tomy or description of the Pneumonic Nerves in our Treatise of Nerves, viz. pag. 311. so that there is here no need to repeat or inlarge. The fivefold Vessels forementioned being mutual, and many ways accompanied in their distribution, as if divided into se∣cret Groves with small bladders as in Trenches every where interwoven, when they are complicated and variously woven together do constitute a fleshy web, which is the very structure of the Lungs: which moreover appears like a more solid Parenchyma, in as much the Arteries and Veins being filled with blood are stufft up, and the Vessels of the Trachea and Lymphaeducts being emptied of the air as well as water, do fall together and seem to close. We shall the less admire the fleshy fabrick of this Lung wove to∣gether out of meer Vessels and little Bladders, if we consider the frame of the seminal Testicles to be nothing else than a heap composed of hollow filaments or spermatic Pipes woven together. The description of the Nerves of the Lung, and what relates to the bundle of Fibres whereof it is compact, and to the spreading of its branches, are described in the fifth Table.

The web of the Lung, as above-said,* 1.28 being weaved together of Vessels and little Bladders, and divided according to their greater and lesser branchings into lobes and little lobes, a Membrane wraps them about as a common covering. Of this there are two Coats, viz. one outer and fine, which appears like a certain subtle texture or wea∣ving together of nervous filaments (as is apparent in most other Bowels;) the other more inward, which is both rough and somewhat thick, and consisting almost of meer ends of Vessels and little Bladders: and by reason of the hollownesses every where cau∣sed from these, its inward superficies resembles a Hive of Bees; the forms of these are aptly enough described in the eighth Table. This Membrane of two Coats blown up hath very many and large Pores, insomuch that if Quick-silver be poured into the Tra∣chial branch of one of the lesser lobes, almost filling within the whole Membrane, it will every where burst out from the Pores. Both the arterial blood and the air beat∣ing in this Membrane as against a bank, are reflected; the former is brought back by the Veins into the left Venter of the Heart, a certain watry part being sent away through the Lymphaeducts. In the mean while the air is returned back by the same passages of the Trachea by which it flowed in. For continually fresh air ought to be suckt in, that it might supply nitrous Particles to the Blood; to make room for which the other old air being now weak and useless, must be first breathed out. Because there∣fore both functions are to be performed within the same passages, it is to be done by alternate turns, first the one, then the other. While the air is drawn in, the Lungs are blown up, as if wind were forced into them; and whilst the same is breathed out they fall down, and are narrowly squeezed together for the benefit of excluding it; and so after the manner of Bellows discharge constant changes of the Systole and Diastole. Yet by what impulse and Organs it is accomplished, is worth our labour here to con∣sider.

Therefore upon the whole matter it is manifest by common observation,* 1.29 the Dia∣stole of the Lungs perpetually succeeds the opening the Breast, and its Systole in like manner its contraction; so that we may conclude, when the cavity of the Thorax be∣ing

dilated a greater space is yielded to the expansion of the lungs, the extern air of its own accord leaps into the Trachea, whether by reason of the Pulse, or by its own Elastic force (for it is all one) and presently enters into its Trunk, the bronchia and all the little bladders, and blows them up; namely for that end, that its nitrous particles may every where occur to the blood, washing all parts of the lungs: after∣terwards when the breast receding from that dilatation, is straitned as to its cavity, even the lung being compress'd, falls together by its Diastole, and excludes the air even now breath'd in. But truly, because the air doth not of its own accord leap out with that plenty as it skipt in, neither the hollowness of the breast so straitly con∣tracted, that it should mightily compress the lungs; therefore all the passages of the Trachea are endowed with muscular fibres, which being contracted orderly while we breathe out, they may promote the expulsion of air. Wherefore, that the cause of breathing, and the manner of doing it may more plainly be made known, inquisition ought to be made after what manner, and by what Organs, that interchangeable dila∣tation and contraction of the breast are performed.

We cannot enough admire,* 1.30 concerning these motions, the cunning artifice of the Divine Creator, evidently adapted unto Mathematical rules; for truly in no other matter doth He more plainly appear 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. For when both the enlarge∣ing and the straitening of the breast ought to be performed by some muscles (to whose function it only belongs to contract;) the matter is so ordain'd, that the ribs which shape out the sides of the Thorax even as of oblong parallel lines bowed to∣wards a Cylinder, are brought one while in a square figure with right angles for the enlargement of the breast, and afterwards into the form of a Diamond-figure with sides unequal, with acute angles for the contraction thereof. What follows from the scituation of parts so chang'd, that whenas the sides depart farthest from one another, the ends are brought nearer, and so è contra; and for that cause the largeness of the space is wont rather to be altered than either augmented or diminished; lest it may so happen about the cavity of the Thorax, it is so provided against by an admirable workmanship, that whilest the ribs ascend upward for enlarging the breast to a square figure, lest the ends should be shortned inward, the Diaphragma, which closes the bottom, swells downward toward the Abdomen; so that the Thorax may be enlarged as well towards its length as to its depth: on the contrary, while the ribs beneath are brought to straiten the breast towards the figure Rhomboides, lest they should depart farther than they ought, the Diaphragma ascends upwards for that cause that the largeness of the Thorax may be straitened, while we breathe out, according to both dimensions.

What belongs to the muscles of the breast,* 1.31 serving as well to the enlargement for sucking breath, as to the constriction for breathing out, the most wise Creator of Nature hath ordained more and sundry instruments of either function; Therefore truly that the work of breathing being especially necessary as to life might be perform∣ed incessantly and very strongly, some of the former order of Muscles, viz. those by which the hollowness of the Thorax is opened, do raise the ribs and afterwards draw them back, even as they are bow'd and more enlarg'd; in which number there are three muscles to the shoulder, one belonging to the loyns, and eleven intercostal out∣ward; and another inward muscle, viz. the Diaphragma, depresses the bottom of the breast, and enlarges its length and depth.

The aforesaid muscles,* 1.32 viz. the scapular, lumbar, and intercostals being also ap∣pointed with the Diaphragma for the function of breathing, are accurately enough describ'd by many Anatornists, but chiefly by Fallopius, that here seems little need to unweave this web; especially because a more full and permanent knowledge of these parts is not wont to be acquired unless by frequent dissections and anatomical inspe∣ction. The four former muscles being of divers forms, conduce chiefly to stronger and violent inspiration; but the exterior intercostals in regard of the ordinary actions of breathing employ their continual endeavours by turns during life, every one of these being uniform, with a fleshy and more thick basis, being rooted in the bottom of the upper rib are carried by oblique fibres, and broad towards the forepart unto the top of the rib that lyes under, and are implanted to it with a small and tendonous end; whence it follows, those fibres being swell'd, and shortened towards their root, do lead and draw back the nether rib towards the upper; and so while all these muscles are contracted together, all the ribs are raised upwards, and altered from oblique angles into direct ones, they render the trunk of the Thorax more large, but some∣thing

shorter; which defect that it may be helped, the Diaphragma (which being free before from the Systole, is hidden within the cavity of the breast) together with the ribs drawn upwards, is extended beneath; so that the breast, as it were a Drum bra∣ced, does become most capacious; and in the mean time the lungs, having a more ample space yielded to them, are blown up by the air rushing in wheresoever there is passage, and sill the whole hollowness of the Thorax enlarged.

Thus far touching the muscles serving to inspiration,* 1.33 which ever and anon ceasing from contraction, the ribs presently fall down from a direct position into an oblique; and the Diaphragma also being freed from its extension, ascends into the cavity of the breast, or is rather thrust thither by the bowels of the Abdomen; and so by reason of the position of parts so changed, viz. the breast straitened, and the lungs com∣pressed, the act of exspiration doth succeed. Some have determin'd this to be a meer intermission of the other, and onely to proceed from the rest, or ceasing of the muscu∣lar motion (by which breathing is performed.) But the declination of the ribs from right angles into oblique, and the ascension of the Diaphragma, is related to be the natural position of these parts, because they are found in such a scituation in dead bo∣dies. I think my assent not easily owing to this opinion, because sometimes the fun∣ction of exspiration is performed much stronger and more violently than that of in∣spiration, as in coughing, singing, laughing, hollowing, and in other affects whose exercises are the more difficult labour and more earnest endeavours of the breast. Wherefore there is no reason that we should think that such vigorous exercises of ex∣piration, should be excited by the meer rest and ceasing of the aforesaid muscles, but from the motion of others opposed to them. Moreover the Muscles now cited and opposite, and straitning the breast, seem to be required not only by reason of their violent exspiration, but for their ordinary and constant service, at least for the poising the function of respiration: for otherwise those other whose office it is to enlarge the cavity of the Thorax, being sometimes unmindfull of their task, do it either stronger or longer than is convenient; wherefore it is necessary they be forthwith admonished by others, viz. their Antagonists subservient to Expiration, and to be restrained in their duty. But the muscles appointed for the straitning the breast, are the Sacrolum∣bus, the Triangular, and inward Intercostals, and some muscles of the Abdomen; the use and descriptions of all which are delivered by many Anatomists, and most ac∣curtely by Fallopius. The inner intercostal muscles as they obtain a contrary scitua∣tion, so a contrary function to the outer intercostals, which namely is to depress the ribs, and to straiten the cavity of the breast, by forcing it into the Rhomboidal Fi∣gure. For we are to observe, that the carneous and thicker basis of each of these is implanted in the lowest part of the nether ribs, and the moving fibres, ascending from thence obliquely and forward, and dividing cross-wise the rest of the outward inter∣costals, with their smaller and Tendony end are engrafted in the bottom of the upper∣rib; hence none need doubt, but that these inner muscles do depress all the ribs, or bring them downward: but whilst these ribs are so depress'd, that the trunk of the breast is rendred more strait, these inward muscles (otherwise than the outer) do not only incline the ribs downward, but also their gristly or cartilaginous processes. For Fallopius hath acutely described this: That the outward intercostal muscles do onely fill up the inter-spaces of the ribs and not of the gristles, but the inward fill up both spaces. The reason where∣of seems to be after this manner, affording a most delightfull speculation of the Di∣vine Architect, viz. while the ribs are brought upwards to the exercise of fetching in breath, and are withall drawn back towards the Spine, that motion commencing back∣ward, is performed by the ribs themselves; which being first moved together, the cartilages easily discharge their function as cords fitted to that purpose: wherefore there seems little need of the muscular aid to place these in their order; but to put the ribs in action, not onely the intercostal muscles afore mentioned, but the four other greater ones do continually endeavour it; but on the contrary, that the ribs may be depress'd and brought forwards together, the force taking its rise before, is performed by the cartilages as so many leading cords, most easily bending the ribs downwards as far as need requires.

Moreover to this end, that the cartilaginous appendices of the ribs may be drawn down and nearer one the other for the exercise of expiration, not onely the inward intercostal muscles fill as well the intervals of the cartilages as of the ribs, but more∣over an entire triangular muscle is allotted for this function; for this springing be∣neath from the bone of the Sternon, and ascending upwards obliquely, is inserted in∣to

to the lower Cartilages, which it constrains towards its head, and bends the Thorax nearer on the other side. That is worthy of consideration, which Fallopius hath remarked touching this muscle, viz. whereas it is so little and minute in a man, that it may hardly be allowed for a Muscle, it is stretched out in a Dog along the whole bone of the Breast, and reaches to all the Cartilages, even those inosculated into the Sternon of the true Ribs.* 1.34 The reason of which difference clearly points at the Divine Providence touching the Fabrick of Animals. For whereas this Animal is born to most swift and long running, that the blood, while it is more vehemently agitated, may duly be kind∣led and fan'd, as it ought swiftly and strongly to draw in the air, even so to expire it; (for that fresh air may be more freely suckt in, it behoves that all the old be strongly cast out and exploded) therefore for the stronger discharge of this exercise (of the which little use in a man) this Muscle of a Dog is allotted a great bulk, propor∣tionable to such a work.

Hitherto of the Muscles that straiten the Trunk of the Breast: by whose provision it is manifest enough, that the relaxation of the opposite muscles are not sufficient to this function. But that while the breast is constrained, the Diaphragma ascend∣ing upwards may shorten its hollowness, it is not enough that it is released from its contraction, but it is also necessary, that as soon as this ceases, the muscles of the Abdomen being contracted squeez together the Bowels, and press them upwards, by which the Diaphragma being relaxed, is lifted up and driven higher into the Trunk of the Thorax.

From the supposed reasons of these things we may infer,* 1.35 no less endeavours of the muscles are imployed in the exercise of expiration, than in inspiration: nay rather we may affirm them greater, after this is added, that the Pipes of the Trachea and Bronchii are endowed with muscular Fibres (as we have shewed) which being only contra∣cted while we expire, do cause the air contained within to be cast out with the greater force. And truly so it ought to come to pass, because the air prevailing with an elastic force, doth of its own accord readily enter the pulmonary passages, as often as they are suffered to be open; but from thence that again it may presently and thorowly be exclu∣ded, there needs a certain force and compression of the parts to thrust out. For although the inspiration precede in course, yet it is necessary that expiration follow immediate∣ly after, and be proportioned according to the fashion thereof; for that it may be great, the turns or changes of this being greater are requisite. Wherefore in vehe∣ment exercise of the whole body or of the Lungs alone, that the fresh air may more plentifully be drawn in, all the old air must be moved, not only out of the Trachea and Bronchii, but also out of the farthest little Bladders every turn or change of breath∣ing out, and expulsed most of it: whereas while we draw in the breath only the mus∣cles of the Breast are imployed, the Lungs having respite, in strong breathing out both the opposite Muscles and the Lungs themselves labour.

Having thus explained the Organs of Breathing,* 1.36 it remains yet to be inquired into, by what instinct, being stirred up to motion, they so repeat perpetual changes of Sy∣stole and Diastole, that one while these muscles are contracted for inspiration, and another while for expiration, in the mean while the opposite muscles have a pause, and are moved by turns, that they mutually give place to themselves successively. From all this in the first place it is clear (which likewise in another place we have abundantly declared) that the animal Spirits, for the exercising the contractive motion of the mus∣cles, leap from the Tendons into the fleshy Fibres, and afterwards for their relaxation they recede out of these into those. Moreover, whereas the mutual function is twofold, viz. spontaneous and meerly natural,* 1.37 we have before shewed in the former, that the Spirits are brought from the Tendons into the fleshy Fibres by approaches according to the command of appetite, and to remain within during the action, till they are dismissed by its will; and afterwards return into the Tendons, till they are again commanded forth; insomuch that the times of their motion and rest are unequal and uncertain, and variously determined at our pleasure.

But it is far otherwise in the natural function:* 1.38 because the animal Spirits are carried out from the Tendons into the flesh by perpetual turns, or constant reciprocation, and a short contraction being made, presently leap back from the flesh into the Tendons, and so alternately: after which manner the Heart it self, the Organs of the Trachea and breathing, also the fleshy Fibres of the Stomach and Guts, unless they are other∣wise limited by reason of their objects, are drove on by their constant Systole and Dia∣stole.

It will be needless to repeat here what we have already observed in another place touching these two kinds of motions,* 1.39 viz. that the animal spirits of the spontaneous moving function are altogether or chiefly dispensed from the brain, and the others cau∣sers of the meerly natural function are dispensed from the Cerebellum; moreover also as the plenty of both sorts of spirits, so the very instincts of beginning those actions have their conveyance through the Nerves.

Notwithstanding here ariseth a doubt, to what kind of moving function,* 1.40 viz. whe∣ther spontaneous, or meerly natural, the actions of breathing ought to be referred; also of what original, viz. whether of the Brain or Cerebellum, the animal spirits appointed to that employment, are. It is manifest enough that this function is in a sort partaker of a spontaneous motion, because it is in our power one while to shorten its exercises, at other times to prolong, and otherwise diversly to alter them, yea sometimes a little to restrain them. Moreover the nerves belonging to its chief moving Organs, viz. the Diaphragma and Muscles of the breast, springing from the nerves of the Arms and Loyns, do owe their descent to the Brain, and do plainly ac∣knowledge the spirits they contain are chiefly ordained for voluntary motions: but moreover on the contrary, this function is so far natural, that its organs do reciprocate the constant changes of Systole and Diastole in sleep, without our notice, and while we wake, we not perceiving it: Moreover although we can for some little time stop its exercise, or at our pleasure vary it, yet we deny it to be altogether or long suspen∣ded: besides, although the nerves appointed to the muscles of the breast and Dia∣phragma proceed from the spinal nerves, yet these latter coming from the branches belonging to the arm communicate in their progress with the slips of the intercostal nerves; moreover, all the other nerves (which belong to the Cerebellum) arise from these, which are spread about through the Trachea and Lungs.

From these it plainly follows,* 1.41 that the power of breathing is as it were a mixt action, and doth participate of either moving function, viz. as well of the spontane∣ous as natural; and that the spirits and nerves of either Province are imployed in this duty, which proceed as well from the brain as from the Cerebellum; and truely so it ought to come to pass according to the animal government: for although some acti∣ons of breathing necessary for the preserving life, ought to be constant and perpetual, there are yet many other motions of the breast and lungs onely occasional, and to be perform'd at our pleasure, as may be discerned in laughing, crying, singing, hollowing, whistling, and other singular offices of the lungs and wind-pipe; in which works that they may be done strongly, the muscles conspire together, and endeavour joyntly. As in violent labours and exercises of the whole body, by which the blood being stirred up doth want the greater ventilution, the arms being vehemently moved also do force the muscles of the breast, and other pneumonic organs, into more speedy motions for a more frequent breathing. And truly for joint labour of this sort of the Arms and Diaphragma, the nerves serving this motion proceed from the nervous branches of them. Moreover, it is provided for this purpose, lest the exercises of the body might enfeeble at any time the strength of the lungs, or exceed the order of breath∣ing; for when its organs labour more difficultly, or begin to be weary, the nerves of the Diaphragma do warn the other nerves of the arms, plucking them and as it were admonishing of their duty to desist from an over intense motion.

For whereas the function of breathing is ordained for many uses,* 1.42 whereof some are merely natural, and others spontaneous or violent; therefore the spirits and the nerves which proceed and have their government as well from the brain as from the Cerebellum, ought to be joyned together, and to afford their social endeavours; yet on that con∣dition, and as it were by mutual agreement, that one give place to the other by turns for the discharging all works chiefly necessary, or convenient, and do mutually obey. From the pneumonic nerves, the instinct of ordinary breathing or meerly vital beginneth, and is presently communicated to the nerves of the Diaphragma, and from thence to all of the Thorax;* 1.43 so that presently all the moving parts agree to∣gether in the action, and cause the Systole and Diastole of the breast in such sort as are required to the present state of the blood; notwithstanding on the contrary, as to other actions of breathing, whether spontaneous or violent, it seems to have them also, viz. the instinct or first force of these, beginning one while from these muscles, another while from them is presently communicated to all the other Organs; so that it is called upon by a working consort of all together sooner than the twinkling of the eye, for the performing the designed acts of breathing.

What we have hitherto declared about the Organs of Breathing and their functions and uses, that they may more clearly be manifest, it seems to be material to expose to your view the forms of some of their chiefest parts described to the life, together with the explication of their Figures: yet it seems proper first to insert a few things concerning the Lymphaeducts and interspaces of the Lobes omitted in the former Discourse.

The most renowned Malpighius first discovered these little Lobes of the Lungs and their interspaces; but to what uses they serve he hath not clearly enough shewed. Hap∣ly it may seem that these little places and empty spaces within the Lungs, are certain receptacles of the air (that there may be a larger store of it.) Notwithstanding it is evidently manifest upon experiment frequently made, that the air pufft into the Pipe of the Trachea (which is the only entrance into the Lung) doth not enter or blow up these interspaces of the little Lobes:* 1.44 notwithstanding if you blow into the hole of any of these interspaces, immediately all these spaces pufft up do swell in the whole lobe of the Lungs, so that all the little lobes distinct by great interspaces, will appear with a pleasant prospect; as is expressed in the second Figure of the third Table. Moreover the Lymphaeducts creeping through the superficies of the Lungs, seem to be every where included in little Membranes covering those interspaces, and to end in them. But as the lymphatic Vessels are all furnished with little valves, so those which appertain to the Lungs are furnished with almost infinite; as is to be seen in the warm large lobe of an Ox, and expressed to the life in Tab. 1. d, d, d, d.

That I may dare to conjecture concerning the use of these things,* 1.45 it is probable, that those cavities intercepting each little lobe, do receive the vapors flowing copi∣ously every where from the blood being kindled, (when they cannot any where else be better thrust down or separated) which sweat through their slender Coats into these cavities out of the ends of those Vessels, and thence being forced further, they are con∣densed into water to be carried out of the Lungs through those appropriate Vessels: moreover lest the Lympha's caused from vapors within those passages, and so being made thick, should whirle again back into the Lungs (which would bring great preju∣dice to them) the thickest obstacles of the valves do hinder. For I have frequently admired what becomes of the vaporous steams which incessantly flow in great plenty, and sometimes most impetuously out of the blood burning ardently in the Praecordia. For although very many of them flye away through the passages of the Trachea together with the air while we breathe, notwithstanding one only way of passage or particular sluice doth not suffice to them, from every place breaking forth: wherefore these little places or empty spaces are every where placed, that they may receive those vapors shut up in the Lungs, and may drop out the same immediately condensed through the Lym∣phaeducts, as if through so many noses of an Alembick.

The lymphic Vessels having their passage out of the Lungs incline towards the passa∣ges of the Thorax with their numerous branches,* 1.46 and are for the most part mingled with them; but they climb upon the Oesophagus in their way, as also the trunks of the Tra∣chea and the Aorta, and do lose many slips in them by a various insertion; likely for this cause, that some of the lymphatic humor may be bestowed for making slippery the sides of those Vessels.

The Explication of the Figures.

THE first Table shews one entire lobe of the Lungs, upon whose superficies the Lymphaeducts are seen spread through every where.

• A. The Orifice of the Trachea being cut lying in the midst of the Vessels.
• B. The Orifice of the Pneumonic Artery lying under.
• C. The Orifice of the Pneumonic Vein placed above it.
• d, d, d, d. The outer Lymphaeducts spread abroad through the superficies of the Lobe.
• e, e, e, e. More Lymphaeducts meeting on the back of this Lobe, from whence they pass into the Thoracick ducts.

The second Table shews one lobe of a Sheeps Lung cut in the midst, that the upper part (wherein is the trunk of the Vein) being removed, and the trunk of the Aspera

Arteria laid by it self, the branching of the Pneumonic Artery is shewn throughout its whole frame, viz. through the small and least little Lobes. All the passages of this, viz. the slips and twigs how small soever, being filled and coloured by any liquid thing cast into them, are drawn to the life.

• A, A, A, A. The nether half of the Lobe divided, containing the branching of the Pneu∣monic Artery.
• B, B, B. The Trunk of the Pneumonic Artery belonging to this Lobe.
• C. A hole from whence its other branch was cut off and removed.
• D, D, D, D. The Trunks from which its other branches (because they could not be ex∣pressed in this Table) were cut off.
• E, E, E, E. The arterious stems thereof stretcht forward into length, the side-branches on both parts stretcht out into the right and left side.
• F, F, F, F. The twigs and lesser slips, which are every where intermingled with the like from the Veins and Bronchials; and at last woven together with the Veins every where encompass the orbicular little Bladders, and bind them as it were in clusters.
• G, G, G, G. The Bronchial branches, which being cut from the stem of the Trachea laid aside, and entring secretly into this lobe of the Lungs, are accompanied with bran∣ches that bear blood.
• H, H. The stem of the Trachea appertaining to this Lobe, which lay upon the Pneumonic Artery, cut and laid aside.
• f, f, f, f. The stems of the Bronchial branches, which are immersed partly in this portion of Lobe described G, G, G, G, and are partly distributed in the other half cut off.

The first Figure of the third Table expresses one lobe of the Lungs, according to the branchings of the Aspera Arteria divided into lesser and less lobes, the twigs and slips of which Vessel being filled by a liquid first injected, and afterwards separated from among themselves towards the little lobes, are also drawn to the life.

• A. The Trunk of the Aspera Arteria being cut from the rest of his body.
• B, B, B. The inner part being cut open, that as well the holes leading into all its branches, as its straight muscular Fibres, are viewed together.
• a, a, a. The abve-mentioned holes leading into the every where stretched out branches.
• b, b, b. The straight muscular Fibres, upon which the other circular do lye.
• C, C. The upper part of this Tracheal stem being whole or shut, that the Ring-like Grisles might appear.
• D, D, D, D. The branches of the Trachea constituting the lesser lobes are whole and shut, that the Ring-like Griste may also appear in them.
• E, E, E, E. The like branches being cut open, that the holes and straight muscular Fibres may be seen together.
• F, F, F, F. The trunks from which the Tracheal branches being cut off are removed, that there may be space afforded to the rest, when cut open.
• G, G, G, G. The secondary little lobes hung upon the trunks of the Bronchii as grapes, which also may be divided into lesser lobes, the more inward passages of all which pass out of the Bronchii into the little bladdery Cells.
• h, h, h, h. The Vessels bringing blood crawling over the superficies of those little lobes.

The second Figure of the third Table expresses a part of the pulmonary lobe, where∣in the membranous interspaces being blown up, all the little lobes appear in their pro∣per figure, and do somewhat represent the leaf of Polypody.

• A, A. A part of the Arteria complicated with the other Vessels, to which trunk made up of all those, the little lobes grow like leaves of a tree.
• b, b, b, b. The little Lobes themselves.
• c, c, c, c. The Vessels bringing blood creeping through them.
• d, d, d, d. The membranous interspaces of the little lobes, which also are covered with
• e, e, e, e, the Vessels bringing blood.

The fourth Table expresses as well the Vessels belonging to the Trachea as those bringing blood, separate and distinct one from another, constituting one little Lobe, as also the peculiar framing of every one of them.

The first Figure represents the separating into divers parts the Tracheal branch di∣stributed into one little lobe, and the branching into Pipes and orbicular little blad∣ders.

• A, A, The trunk of the Aspera arteria, in the superficies whereof the ring-like gristles do appear.
• b, b, b, b, The lesser branches going from that trunk, wherein also little Rings appear.
• c, c, c, c, The passages of those branches into orbicular little bladders, which seem like the clusters of Grapes.
• d, d, The Vessels bringing blood, distinct from the Pneumonic which cover the Trachea, and serve to nourish it.

The second and third Figure shews distinctly the equal branchings of the Artery and Pneumonic Veins within the same little Lobe; both which being complicated with Tracheal Vessels, do for the most part make up the texture of the pulmonary frame.

The fifth Table sets forth the pulmonary Nerve more accurately described by the aid of a Microscope; so that it plainly appears that the Trunk is as it were a bundle of innumerable little Fibres bound together; moreover its Trunk, while it creeps into the lungs in the likeness of Mother of Time, doth spread the various little sprigs every way.

Fig. 1. resembles a part of the nervous trunk cut away, one end whereof being opened and lookt on by a Microscope, seems to unfold it self almost into innumerable little fibres.

• A, The trunk of the Nerve.
• a, a, a, a, The little Fibres divided from one the other about the end cut off, and spread abroad.

The second and third figure do shew some fibres as well of the trunk as of every branch, and moreover the slips of the little twigs from divers stemmes often repeated.

• B. The chief trunk.
• b. b. b. b. The little fibres about the extremity cut off explicated.
• c. c. c. c. The little twigs springing from the bundles of the little fibres.

The sixth Table first sets forth the anatomy of the Artery bringing blood drawn in apt figures, which we have described in a late treatise.

The first and upper figures hereof, represent the four distinct Coats of that Vessel, viz. the nervous, muscular, glandulous, and the vasculous.

1. The first inward nervous coat, which perhaps is somewhat musculous, consisting of streight or long fibres, which being contracted shorten the Pipe of the Artery.

2. The coat properly muscular, consisting of a heap of small circular fibres, which when they are contracted successively under the stream of blood, do make its circuit to be shortened. It is from the motion of these that the arteries beat.

3. The glandulous coat, which (like that in the guts) being placed over the muscu∣lous coat, is weaved together of very small and most numerous glandules.

4. The outward vasculous coat, which variously folded together and wreathed, of Vessels bringing blood, and with slips and nervous fibres, seems like a certain little net.

The second and lower figures of the sixth Table, do shew the anatomy of the Vein, or its four coats expressed in fit places; which Coats do appear entire as successively taken one part from the other (beginning outmost.)

I. The outward coat consisting of nervous fibres (which perhaps are somewhat mus∣cular) and as it were streight or stretch'd out in length, although not orderly.

II. & III. The vasculous and glandulous coat, which are the same as in an artery.

IV. The most inward muscular coat, consisting also of circular fibres, as in an artery, which being contracted behind the stream of blood, hastens its returning course.

The seventh Table expresses the distinct Coats of the aspera arteria, and separated one from the other.

The first figure shews the most inward Coat, endowed with streight or long muscular fibres.

The second figure descrbes the glandulous coat, and the third figure the vasculous coat

(which are almost the same as in the vessels bringing blood, and also in the Guts.)

4. The fourth figure expresses the outward coat (which is partly cartilaginous, and part∣ly muscular.) The transverse or annular fibres hereof do fill up and weave together the interspaces of the Cartilages.

The eighth Table shews a part of the outmost pulmonary Coat covering over its whole frame, most finely and curiously described by the help of a Microscope.

The first Figure shews a portion of the above-mentioned coat, which partly by rea∣son of the extremities of Vessels of every sort ending in it, seems pricked full of holes as it were, and partly from the complications of the vessels bringing blood, which like the twining sprigs of Vines gird about the orbicular bladders, is distinguished into ma∣ny irregular Area's.

The second Figure represents a part of the outermost membrane separated from the clusters of vessels pull'd off, and without any Area, onely markt with little holes as it were with small pricks.

The third Figure expresses one singular area of the Coat above mentioned, augmen∣ted in largeness by the help of a Microscope.

SECT. I. CHAP. II. Of the sundry kinds of Breathing hurt, and their causes, with the accounts of their Symptoms.

HItherto we have strictly viewed the Lungs, and the parts any way serving their motions, and consequently the vital function; which being many and different, and the provision of the Organs as many very accommodate to Breathing; so the same are many wayes in hazard to be perverted or vitiated, upon sundry occasions. Truly a Watch framed with the greatest artifice with a Spring, with wheels plain and toothed, with chain and ballance, is not more prone or easie to be obnoxious to depravation than this Pneumonic machine of the breast,* 1.47 through which by sucking in air we preserve the vital flame of the blood with its motion and heat. For whereas the vessels of the lungs belong to the function of breathing, viz. the Trachea, with the Bronchii and little bladders; also the heart with arteries and veins, besides which there are nerves with fibres as well musculous as nervous, Lym∣pheducts and Glandules; also the contents of these Vessels, viz. Air, the old and fresh blood, with its Serum, the Lympha, and the animal Spirits; any fault happening in any of these doth oftentimes discompose the whole Pneumonic function. Nor less also the moving Organs of the breast, viz. the muscles with the Diaphragma, and the nerves appointed to their use. And likewise sometimes the animal spirits be∣fore they enter into those nerves, being ill disposed, often cause great disorders in breathing.

When the chief function and uses of the Lungs have been to convey the blood and air through the whole frames of the parts and their inmost recesses,* 1.48 and every their smallest passages, and every where to mingle them; namely for that purpose, that the venal blood returning from its circuit, and diluted with fresh juice, and thereby crude and as it were half extinct, may as well be more perfectly mix'd and wrought together, as more effectually kindled afresh in all its parts by the nitrous air; from hence the chief faults about this business or function of the Lungs do most of all consist in these two things. First, that the blood hath not due passage through the Sinus of the heart, and the pneumonic vessels: And secondly, because the Air is not drawn in and breathed out in a due manner into the Trachea and its passages.* 1.49 There are two parts of either of these: For first as to the passage of the blood, some∣times the fault is caus'd within the right Sinus of the heart, or the pneumonic Arte∣ries; and also sometimes caused within the pulmonary veins, or the left Ventricle of the heart: Secondly, as to the Air, the failure is chiefly in inspiring and exspiring; al∣though each function offends sometimes equally. There are divers accidents of each, and many causes and ways of its being done, whereof we will here briefly touch upon the chief.

Therefore first,* 1.50 when the blood doth not duly pass through the right Ventricle of the Heart and the Pneumonic Arteries, either it happens by its own fault, or by the fault of those passages, and sometimes by the fault of further passages. For sometimes the stream of blood stops in the nether region of the Pracordia, by reason of obstru∣ction in the other; moreover, sometimes the defect or fault of the air breathed in stops the free passage of the blood.

What relates to that fault of the blood,* 1.51 when it passes not quick enough through the right Sinus of the Heart and Pneumonic Arteries, the opinion of the Renowned Sylvius should here be discoursed, but that it would be too tedious, and from our purpose. For he supposes, The descending branch of the venal blood, moistned with chyme together with the lymphatic humour returning from the whole body, hath the nature of an acid-sweet spirit; and in the mean time its branch ascending impregnated with choler from the bladder of the gaul mixt into the mass of blood, does participate of an oily volatile salt; and so by the meeting toge∣ther of these something contrary to themselves, a gentle and friendly contention or boiling is stirred up in the right ventricle of the heart, in which and for which the fiery parts lurking and being shut up in each, being freed and set at liberty, do rarifie the chyle and blood, and so change and alter them, that they exercise the function of life and heat as well as motion and nou∣rishment through the whole body.* 1.52 There are many reasons why I assent not to this inge∣nious and neatly-framed Hypothesis. For besides that many do far otherwise deter∣mine about the origine and dispensation of Choler, and so not without strong reasons and experiments are thorowly perswaded, (by eye-sight) that there is not any such boil∣ing up of the blood of a different quality, and striving or contending in the right ven∣tricle of the Heart:* 1.53 Our judgment continues still, as it hath been, that both streams of blood, washed thorowly with the fresh chyme, do consist altogether of one kind; and for that cause the milky Vessels of the Chest carry about part of the Chyle so long a journey, which they pour into the descending trunk of the Vena cava, just as the mese∣raick Veins pour the other part into its ascending trunk: also that the lymphatic hu∣mor together with the Chyle is poured into the subclavian Vessels, so that it may very commodiously be reduced into blood; neither truly doth there seem need of other or more passages. Moreover we determine that that humor rightly constituted doth agree with, and is easily assimilated to the mass of blood, as well as the Chyle it self made sweet, without any contention raised in the heart. But if the lymphatic humor re∣turning from the Brain and nervous kind as well as from the Glandules, degenerate from its due temperature, and contract a sowreness (as it often comes to pass) then being re-infused into the venal blood it overcomes it, and it precipitates it into sero∣sities, and from thence great streamings of urine do ensue. Moreover we have shew∣ed elsewhere, that the Diabetes is provoked from such a cause. But such a flux of the lymphatic humor is so far from exciting a greater boiling up of the blood in the right ventricle of the Heart, that rather on the contrary from thence often chilness of the whole or stiffness, with a weak Pulse, and sometimes swoonings or convulsive fits are provoked, accompanied with a plentiful and pale urine. The reason whereof without doubt is, that then the clear humor flowing from the brain and nervous parts, turns the blood into serosities, and cools it by too much diluting; and for that cause the animal spirits being destitute of their vehicle, either faint or run into irregular motions.

But truly as we altogether deny an Elastic effervescence of the blood in the right Ventricle of the Heart from contention of dissimilar parts;* 1.54 so as often as from thence the blood is not cast out into the Lungs after a due manner, we determine it to happen not so much from the proper fault and defect of the blood it self as from the animal faculty. For if the spirits actuating the moving Fibres of the Heart, either grow weary, or are forced into convulsive disorders; for that cause the Heart beating in disorder, drives out before it the blood either infirmly or irregularly.

But that the blood issuing out of the Heart doth not always with expedition pass through the Pneumonic Arteries,* 1.55 that sometimes happens from its own proper fault, and also sometimes from the passages obstructed, and also by reason of other causes. The blood it self in a double respect hinders its own passage through the Lungs, viz. either offending as to its kindling, or as to its temperature. There are sundry acci∣dents of either of these. For first, even as the blood is more or less kindled than is con∣venient, it is hindred or obstructed in the pulmonary circuit: if at any time the watry, earthy, or fixt saline parts are predominant in the blood, the spirit and sulphur being consumed or brought low; by reason hereof its liquor being not well or less kindled by the nitrous air, is not easily rarified in the pulmonary passage, and scarce passes through

them like a flame of its own accord, but it sticks still in its passages, heavy and muddy, and creates much trouble and labour to the Heart wheresoever it is circulated. Hence as often as the blood is a little more plentifully forced into the Pracordia by the quick∣er motion of the whole body, or of its parts, the Heart and Lungs labour hard for its driving about, and that with the utmost endeavours. And in this case it is probable,* 1.56 that the blood carried more rapidly into the right Ventricle of the Heart, doth some∣what stagnate; because it cannot presently be carried into the passages obstructed before it. Moreover from this cause those grumous or fleshy concretions called the Polypi of the Heart sometimes seem to arise. Hence both in the Pica, Leucophlegma∣tie, Dropsie, and inveterate Scurvy from the quicker motion of the body arises difficult and painful breathing.

2. Sometimes the blood is too much kindled, and breaking out almost into a flame,* 1.57 and being above measure expanded, it can scarce be contained in the pulmonary passa∣ges (which it very much blows up and extends) but endangers them to be inflamed or kindled; wherefore lest it should tarry longer in them, the Pracordia beat with most frequent and strong endeavours, that the blood so over-much kindled might be ventila∣ted and circulated: for otherwise it being carried within the Lungs, and inflaming them all over, would quickly destroy the vital function.

Besides these things which concern the kindling of the blood,* 1.58 there are other faults as to its temperament or mixture, by reason of which it less freely or expeditely is conveyed through the pneumonic passages. For when its consistence is either too laxe or too close, it will not easily pass through the small passages of the Lungs; but often∣times is in hazard to stick and stagnate in them, and also run out and be extravasated.

The blood being in a diverse manner made loose in its consistence, either deposites its Serum, or its dregs, or its putrefaction in the Lungs; which being lodged in the re∣cesses of the Vessels, or affixed unto their sides, do variously stop or pervert the course of the blood.

1. The dissolution of blood, which is most commonly injurious to the Lungs,* 1.59 (al∣though not very dangerously) is wont to happen, for as much as the serosities being un∣apt to be contained within the mass thereof, and when they are not presently sent away by sweating or urine, they separate from the blood within the Lungs; and so boiling up, and breaking out from their proper vessels, do as well disturb and stop the passage of air, as that of blood; so that for the sake of expelling those serosities and continua∣tion of the circulation of blood, the Lungs are provoked into a frequent and very trou∣blesom Cough. What the formal reason of this Cough is, and the manner of its being brought about, we shall declare hereafter.

Though there are many causes and occasions, by which the serous liquor,* 1.60 departing from the loosned consistence of the blood, flows out abundantly into the Lungs; yet for the most part it happens from one of these three, viz. first and most frequently, because the Pores outwardly bound up by cold, cast back the serosities which were wont to be sent away by perspiration, into the mass of blood; which compel it presently to boil up, and cast off the serous superfluities in the Lungs.* 1.61 From this kind of cause Ca∣tarrhs and Coughs frequently arise, insomuch that the beginning of every cough by the vulgar is always imputed to such an occasion, to wit, catching cold. 2. The drinking of sharp and thin liquors, as Cider, Rhenish Wine, white Wine, Paris Claret common∣ly causes to some a Cough, or catarrhal distemper: the reason whereof is, for that the blood, weak in temperament, is presently dissolved and precipitated into serosities like milk by sowre things cast into it, which flow plentifully from the mouths of the in∣ward Arteries. I have experimented this upon my self yearly, when in the Summer season (when the blood abounds with sulphur) I have drank Cider and tartish Wines safely, yea frequently to advantage, the same in winter (when the blood is prone to sowreness) but moderately tasted of, do presently provoke a Cough. 3. There is ano∣ther cause of this serous inundation flowing out upon the Lungs, viz. when the Lympha watering the nervous and solid parts, doth suddenly suffer a flux; and for that cause it streams back into the blood out of the Fibres and Glandules, and other passages and receptacles; whose liquor it presently dissolves, and precipitates into serosities, which often infests the Lungs.

For this reason a sudden and troublesom Cough frequently accompanies convulsive distempers, which being commonly called a vaporous Cough is ascribed unto vapours. Moreover in great alterations of air, especially when the season varies from dry into moist, and the volatile and fixed salts do thereby melt, the Cough and Catarrhs increase very much.

Neither doth the serous liquor only, but also many other humors or recrements of the blood lodged in the Lungs frequently stuff up their passages; so that by obstructing both the passages of air and of blood, they cause difficult breathing or a cough. This is every where perceived in ill-habited bodies, also in Gluttons and Drunkards, and others leading an inordinate and slothful life. Wherefore Foot-men use a thin and spare diet, that they may have their Lungs free from the filth and recrements of the blood. I have observed some melancholy persons, the adust faces abounding in the pulmonary passages, to have voided blackih spittle like ink; also others cholerick, and inclining to the Jaundice to void yellow, and sometimes very bitter, as if it had been meet choler.

3.* 1.62 Moreover many instances manifestly declare, that sometimes the Lungs are taint∣ed by the corruption and putrefaction of the blood. For the blood, toucht with an infe∣ction or a pestilent or venemous contagion, begins to be corrupted, and withdraw into clotted and corrupted portions; from thence the Lungs undergo the chief taint, from whence the greatest danger of life is threatned. This is too well known in the Mea∣sles, small Pox, Plague, and malignant Feavers, for me now to undertake to explicate it: by which maladies as often as the sick die, it seems to come to pass, either be∣cause the blood clodding in the vessels of the Heart or Lungs, obstructs the way of its proper course, so that presently its influx into the Brain is hindred, or because the cor∣ruption of the blood, affixt to the sides of the pulmonary passages, causes a Phlegmon as it were; and therefore provokes a most troublesom cough or difficult breathing, and frequently bloody spittle. So much for the impediments of the circulation of the blood, which happen in the Lungs by reason of the mass of blood too much dissolved,* 1.63 and apt to depart into parts and portions, (which being there left obstruct their passages.) There remain other no less prejudices to the Pracordia, which proceed from the con∣sistence of the blood too much bound up together, and sending nothing from it self: by which a burning Feaver, Pleurisie, or Peripneumony arise.

In the former distemper the blood being more sulphureous than it ought, and there∣withal being thick,* 1.64 is not diluted enough with its Serum; and those particles of it con∣tained within it self, it puts away with great difficulty: wherefore it is more plentifully kindled in the Lungs; and when it passes through the passages hereof with more diffi∣culty, by reason of its greater boiling, and of its thickness, the Heart beating quick and most vehemently, endeavours its circumpulsion with all its might; notwithstanding from its greater flame growing hot within the Pracordia, heat and a most troublesom thirst, with roughness, and as it were a certain parching of the tongue arises.

In the other kind of distemper,* 1.65 viz. a Pleurifie and Peripneumony, the blood is alike thick, but less sulphureous, and inflammable; wherefore it doth not participate of such a burning: yet by reason of its thickness it doth not so easily and quickly pass through the Chest or Lungs, is frequently extravasated, and sticking to the inter∣spaces or sides of the passages, causes obstructions, and soon after an inflammation, to which pain often succeeds with bloody or discoloured spittle. We may observe in blood-letting in these kinds of distempers, that after it hath setled, its superficies is co∣vered with a little whitish skin, or otherwise discoloured, but always with a thick and viscous: the reason whereof is, that the blood, when it doth not send away in the circu∣lation its old particles, nor doth admit enough of new, it is thickned with a conti∣nual boiling, and like boiled flesh changed from a bloody colour into a whitish; in which state, passing with difficulty through the small passages of the vessels, it is in danger to be extravasated, and easily provokes a Pleurisie or Peripneumony.

Besides these stoppages of the blood,* 1.66 caused by its own fault, while it passes through the Praecordium, there are also other impediments, which happen either by the defect of the Heart, or its passages, or by the fault of the air inspired. By what means and for what cause the Heart offending in its motion, forces the blood from its right ventricle through the Lungs into the left irregularly, we have clearly shewn in our late Tract of Cardiac Distempers: to wit, that muscle sometimes labouring for want of spirits doth not vigorously and strongly enough perform its beatings.* 1.67 For when in corporal exercise the blood more plentifully than usual, is forced from the Vena cava into the ventricle of the Heart; if this cannot firmly contract it self, labouring according to its strength, it causes frequent and weak Pulses: moreover to help this, as well the Pneumonic Arteries, as others in fundry parts of the body, which drive about the blood every way, do cause frequent and inordinate contraction. Thus I have observed in Virgins af∣flicted with the Green-sickness, and in other cachectical bodies, from a quick motion of

the body, not only a palpitation of the Heart, but in the neck, temples, and other pla∣ces the Arteries to have beaten irregularly. Neither is it the want of spirits only,* 1.68 but their disorder is sometimes the cause that the Praecordium doth with less strength con∣vey the blood; for sometimes the spirits, the inmates of the Cardiacal nerves, being stirred up by an incongruous conjunction, and affected convulsively, do impress their irregular contractions upon the Heart or Arteries, whereby the progress of the blood is several ways perverted or hindred, as it often happens in Palpitation of the Heart, Trembling, intermitting Pulse, and other the like passions.

3. The pneumonic process of blood is variously stopt,* 1.69 because the passages are not open enough: which impediments happen as often as the Pores or those passages are ei∣ther stopt or broken. Of the former there are two reasons, viz. sometimes the ways are shut, for as much as the passages of the vessels, contracted by the carneous fibres, are brought nearer one another; as we have elsewhere shewed, doth sometimes happen in Palpitation of the Heart, and a convulsive Asthma. The affects of which sort, by rea∣son of the stream of blood shut within the Praecordia, difficult or hard breathing, a small Pulse, and chilness of the whole body are wont to accompany. Moreover sometimes the course of the blood is shut up, because the passages of the vessels are pressed together by a body, or by some humor from without: wherefore when the little Cells or bronchial Pipes (as is usual) are filled with a viscous flegm, purulent matter, or blood extravasa∣ted, as the free passage of the air is hindred in them, so also the passage of blood is stopt in the vessels adjoining. On the same account come tumors, little swellings, worms, also stony, sandy, and curdly concretions, and others of another kind are in diverse manners excited; the chief whereof we shall touch on hereafter.* 1.70 Moreover we some∣times see the canals as well of an Artery as of the pneumonic Vein, made very bony in some part, and their sides so compressed, that a very small chink remains for the blood to pass. Not long since we dissected a young man who died by reason of an ill forma∣tion of the pneumonic Vein,* 1.71 in whom the trunk of this vessel growing stony near the juncture to the heart, did stick so close, that the blood did drop into the heart only by drops, or by a very little stream. 2. That the passages bringing blood are often filled and stopt, insomuch that the stream of blood is obstructed or straitned, many anatomi∣cal instances and observations manifestly declare. From thence it appears,* 1.72 that gru∣mous, or as it were carnous concretions of the blood do frequently so stop the ven∣tricles of the heart, and the roots of its larger vessels, that the course of the stream of blood is almost entirely stopt. Moreover reason perswades, and experience concludes this more frequently to happen in the lesser vessels: for seeing (as we have even now inti∣mated) the blood emitted by Phlebotomy in Rheumatisms, Peripneumonies, and Pleuri∣sies, when it is cold is covered all over with a thin skin altogether of the like substance with those concreted Polypus's; it plainly appears, that it passes with difficulty through the passages of the lesser vessels by reason of those viscous excrements: wherefore that it may pass by some means, it distends them very much, and sometimes breaks quite through them, also it frequently unlocks their mouths, and opens gaps into the Tra∣chea, insomuch that portions of the extravasated blood are by coughing frequently eje∣cted. We have known some to have died Asthmatic or short-winded, whose Lungs being free from an Ulcer, or any more grievous wound, have swelled so much, that they wanted room for their motion within the cavity of the Chest: the reason whereof doubtless was, that the thicker and more feculent blood, for that cause not easily passing through those vessels, every where extended the Arteries and Veins, and caused it to stagnate in the lesser Pipes. Moreover the feculencies of blood one while salt of different kinds, another while sulphureous or earthly being combined with them, and thrust into the small passages of the vessels, and fixed there, do altogether obstruct them; insomuch that the pneumonic circulation of the blood is contracted into a shorter space, and consequently the function of breathing is straitned in the compressed Pipes or little Cells. There are many kinds and sundry ways of such an obstruction, which if all or the chief should be enumerated, such a Pathology would swell into a too great bulk. 3. The pneumonic passage of blood is not only hindred by reason of the passages shut and obstructed, but sometimes also being burst asunder. For those vessels being small,* 1.73 or tender, or very loose in some persons, are frequently opened by the force or acrimo∣ny of blood; so that the blood either bursting into the Trachea, is ejected by spitting, or heaped up in the interspaces of the passages, causes a Peripneumony, or falling down into the cavity of the Chest, produces an Empyema. Of all these we shall treat singly in the Chapter of spitting of blood.

3.* 1.74 There remains as yet a third impediment of blood in the pneumonic passages, which happens for the want or fault of Air. If at any time the Blood is not kindled after a due manner within the passages of the Lungs, from air breathed in by the Trachea; for that cause as presently its flame is irregular, so likewise its motion is variously stopt or perverted: for although the blood is forced through the lungs by the meer impulse of the heart, notwithstanding the pulse hereof is proportioned according to the tenour of its being kindled by the air; wherefore when the flame of blood is diminished, or sup∣prest, for want or through the fault of the air, presently the pulse proves languid or unequal, and by reason of the bloods course being troubled, or stopt, presently a paleness and coldness succeeds wholly intercepted or frustrated (because the nitrous particules are wanting) presently the pulse ceases, and anon life is lost. The reason of all which is, both because the blood being much impeded in its accension, or extinct, like Must given over working presently subsides, and is unapt for any motion; and chiefly because the flame of the blood failing, and being substracted from the brain, presently the Hypostasis of the animal spirits, as it were light streaming from thence, immediately fails, and together with it the exercise or actions of all faculties do cease. But if the blood is too much kindled, the Sulphur of the Blood, and the Nitre of the Air running together more than it ought; for that cause presently, that this too much burning may be eventilated enough, the pulse of the heart is increased to its utmost. We might adde many instances of this kind; but truely this consideration of the blood leads us to the second thing proposed of Respiration hurt; namely that we may duely weigh, what sort of failings or defects do happen about the inspira∣tion as well as expiration of the Nitrous air, requisite for the preserving the nitral flame of blood; that is to say, from what causes they proceed, and also what effects they are wont to produce; in which search we will first treat of Inspiration hurt.

SECT. I. CHAP. III. Of Inspiration hurt.

BReathing is accounted hurt,* 1.75 when its use is frustrated, or any ways hindred; which most frequently happens, by reason of the fault or defect of the Air drawn in. As to the former, if the Air chance to be depraved, it neither duely kindles nor eventilates the blood, yea it sometimes overthrows the temperament there∣of, or infects it, as is every where seen in a Constitution of Air very malignant. That we may touch on the chief reasons of these distempers,* 1.76 we are to observe, That as the Nitrous particles of Air are chiefly necessary, (as is manifest by manifold experi∣ment) for the preservation of life; so frequently it happens that Nitre of the Air either to sail or be wholly wanting, or by particles of another kind to be so much muffled, or bound up, that they cannot enough exercise their vital power; or lastly, malignant or fatal Corupscles to be adjoyned thereunto. First, the nitrous particles of Air are deficient, if when it stagnating or growing hot the Nitre is chased thence, or not stirr'd into action. Wherefore, in a low-roost Chamber, or too close, and in other places crouded with assemblies of men, or made hot with the ardor of the Sun, we difficultly or weakly breathe. The same comes to pass in places of great height, on the tops of those mountains exceeding the top of the Atmosphere; wherein breath is faintly drawn for want of Nitre, neither can we live long there. Secondly, the Nitrous particles of Air are wont to be obscured or blunted by other accessories, also sometimes they are too much sharpened. For as often as the South-wind blows, the Air is too moist and thick, inasmuch as the Nitrous particles are seiz'd upon by the watry and sulphureous, and are much blunted, so that while it is drawn in, the blood is not vigorously kindled, but like green wood put into fire it rather smokes than burns bright; wherefore during such a state of Air we become stupid and dull, and unapt for motion; but on the contrary, the North-wind blowing, the cooling, sharp and most nipping particles are adjoined to the Nitrous, and the blood is enough kin∣dled, and we breathe freely; yet the Vital flame is every where restrain'd by intense frost disproportion'd thereunto, and unless refresh'd by motion and heat, it is fre∣quently entirely extinguished.

2. Besides these faults of the Air, whereby breathing is wont to be hurt,* 1.77 more∣over this evill sometimes proceeds from its defect; inasmuch as it cannot be drawn in in plenty enough. Of which effects though there are many and divers causes, yet for the most part it happens in respect of the organs of breathing, either hindred as to their motion, or their passages obstructed.

1. The Organs of breathing are either meerly passive, viz. which are moved, as the Lungs; or are Active, and move themselves, and those together, as the muscles of the Chest and Diaphragma. In every of these the impediments of the motion by which breathing is hurt, happen variously. And first what respects the Lungs, we mentioned before, that they sometimes very much swell, by reason of the vessels being much distended, and fill'd with blood, insomuch as being stiffe and inflexible, they obey not the turns of the Systple and Diastole of the Chest. Moreover it happens sometimes through a phlegmon, little swellings, and other concretions of divers forms, that a like stiffeness is caused in them. Secondly, the active organs of breathing, or the moving parts, viz. the muscles of the Chest and Diaphragma are wont to be per∣verted or stopt from their moving function by divers causes. A solution of continuity made in any part of these, either by clotting of blood, or by falling down of the Serum, and other homors, as in the Pleurisie and Scurvy, or in those that are wounded or bruised, doth every where cause pain in the place affected, with impotency of moti∣on and difficult breathing. Moreover, sometimes without pain, or any evident cause, those parts being hindned from their motion do produce a most heavy pursiness; As is frequently seen in an Asthma, Suffocation of the womb, and in certain other convul∣sive or hypochondriac distempers. The reason of which passion without doubt consists in this, for that the animal spirits appointed to the moving function of those parts, are disturbed about their Origine, or hindered in the passages of the Nerves, and are turned aside from their due influx into the moving fibres: Insomuch as many who are sound enough as to their Lungs, and only obnoxious to affects of the Brain and Nerves, are frequently surprized with horrid fits of an Asthma, as we have at large declared in another place.

2. The stopping of air, hindering breathing, whereby it less freely enters the Lungs, frequently happens, by reason of the Conveyances, viz. the passages of the Trachea being shut, or not enough open. For indeed those passages are wont to be stopt (as we have formerly observed touching the Vessels bringing Blood) and pro∣hibit the full entrance of air, when they are either obstructed or compressed, or more narrowly contracted.* 1.78 Though there are many causes and wayes whereby the pas∣sages of the Trachea are wont to be obstructed, yet chiefly and most often a Catarrhal distillation of the Serum, while it departs from the blood, and flows out of the ves∣sels bringing blood into these parts; which being first thin and sharp, produces a troublesome Cough; afterwards thickening by digestion, and cleaving to the sides of the Trachea, exceedinly straitens the ways of inspiration,* 1.79 and shortens them by quite stuffing up their extremities. In like manner the sweating out of extrava∣sated blood, as also of Pus or ichorous matter out of the Lympheducts or Veins into the tracheal little bladders, doth frequently produce an Asthma, and often a Consumption; the reason of which sort of distempers shall be more largely explain∣ed hereafter. Secondly, it is manifest enough by common observation, that the Tra∣cheal passages as well the last as the intermedial, often-times are straitened, or shut,* 1.80 by compression. For after a plentiful meal, or abundant drinking of Wine or strong Ale (inasmuch as the pneumonic vessels are very much distended by reason of the tur∣gency of blood, and the sides of the Trachea being press'd together, do not admit of a free and usual entrance of air) men otherwise healthful enough, do breathe diffi∣cultly and painfully: Which truely we esteem to happen from the lungs being filled and extended rather, than from a cram'd stomach hindering the Systole of the Diaphragma. Moreover, for this reason, even in the very paroxysmes of feavers a frequent and pain∣full breathing is manifest. Neither onely from the turgency of blood, but also from the same stagnating, or extravasated, and also from stony concretions, and divers other man∣ners, the vessels of the Trachea being pressed together, cannotdischarge a free breathing.

3. The passages of the Trachea being sometimes more nearly contracted and closed from their fibres convulsively disposed, deny a passage to the Air for due breathing.* 1.81 From hence, when there is no obstruction, or ill conformation in the lungs, as also no consumptive disposition, yet from those fibres preternaturally convulsed and drawa together, dreadful fits of an Asthma frequently arise. Whereas we have in another

place discoursed of these passions, it will not be requisite here again to repeat that discoure. Resides these accidents of breathing hurt, there are certain others which are stirr'd up by reason of the Air prohibited in its frist entrance, viz. in the Nostrils, the throat, the Larynx, from a tumour or ill conformation: For the Polypus in the Nose, the Quinzy in the Throat, or inflammation of the Tonsils, do render a difficult breathing; in the same manner as a heap of sand about a Haven, obstructs the ingress and regress of Ships. But truly since the reasons of those passions, and their manner of being made, are exposed to sense, it seems superfluous here to deliver their causes.

SECT. I. CHAP. IV. Of Expiration hurt.

AS Expiration is much easier,* 1.82 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.* 1.83 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.* 1.84 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.* 1.85 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.* 1.86 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,* 1.87 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,* 1.88 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,* 1.89 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,* 1.90 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;* 1.91 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,* 1.92 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,* 1.93 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.

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,* 1.94 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,* 1.95 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.* 1.96 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,* 1.97 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,* 1.98 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,* 1.99 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,* 1.100 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,* 1.101 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,* 1.102 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,* 1.103 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,* 1.104 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,* 1.105 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,* 1.106 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.* 1.107 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,* 1.108 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,* 1.109 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,* 1.110 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.

SECT. I. CHAP. VI. Of a Phthisis properly so called, or of a Consumption arising by fault of the Lungs.

A Consumption doth so frequently and usually proceed from the Lungs being de∣praved, that some have termed it the peculiar Disease of this Bowel: and that it very often so comes to pass, the reason is; because (as we have shewed before) the pining of the body doth for the most part more immediately proceed from the blood depraved and unapt for nourishment, it is manifest, that as its perfection is acquired in the Lungs, so from these being ill-affected the same is most of all vitiated, and degenerates into a languishing and corruptible state. For in the Lungs rather than in the Heart or Brain, the threads of life are spun, and there they are oftnest defiled or broken.

A Phthisis is usually defined to be A pining away of the whole body,* 1.111 taking its rise from an Ulcer in the Lungs. But less true: because I have opened the dead bodies of many that have died of this disease, in whom the Lungs were free from any Ulcer, yet they were set about with little swellings, or stones, or sandy matter throughout the whole: for from thence the blood, because it could neither be freely circulated in the Praecordium, nor animated enough by the nitrous air, and when in the mean time it is

perpetually polluted by its proper dregs deposited in the Lungs, is frequently vi∣tiated and made incapable of nourishing thereby: wherefore a Phthisis is better defined, that it is a withering away of the whole body arising from an ill fromation of the Lungs.

The Ancients following Hippocrates,* 1.112 for the most part have assigned only two causes of this disease, viz. a Catarrh, and the breaking of a Vein, to which some have added an Empyema: and others exclude a Catarrh from this number: for what is vulgarly affirm∣ed, that flegm falling from the Head into the Lungs, and abiding there putrifies, is most commonly the cause of a Phthisis, or is often brought by it, we have formerly intima∣ted to be altogether erroneous, and shall presently shew it more clearly. In the mean time to shew what the matter is that generates a Consumption as often as it arises with∣out an Empyema or Haemoptoe going before,* 1.113 it must be considered after how may manners and by what ways any thing disagreeable or heterogene can enter into the Lungs; which diligent search being made, it will easily appear, that any thing that is an enemy to the Lungs creeps in and is admitted chiefly either by the Trachea or by the pneumonic Arteries,* 1.114 yea and sometimes haply by the Nerves, but nothing by the Veins or Lymphaeducts, whose function is only to carry back or away the blood or Lympha, and to leave there nothing at all.

As to the Trachea, it is manifest it is ordained for this end, that by its passages or pipes the air might be conveyed in or presently carried back by a constant recourse from whence it comes;* 1.115 moreover, whether any matter being hurtful or mortal to the Praecordia may be admitted the same way, shall be now our present disquisition. And that the Lungs frequently incur a pernicious pollution by this entrance is clear from hence, because the moist air of some regions, repleat with fumes, or abounding with malignant vapours, doth frequently induce the consumptive inclination; nevertheless the affection thereof is wont to be communicated only by aerial minute particles (whereby either the temperament of the blood or the conformation of the Lungs or both are prejudiced.) But whether besides this a serous matter or some humor corrupt∣ing the Lungs doth enter them through this passage, is not without reason doubted: al∣though many do determine a Catarrh or a destillation of the Serum from the Brain in∣to the Lungs by the passages of the Trachea, the principal cause of a Phthisis. Which opinion being erroneously delivered by the Ancients, I admire any either of our mo∣dern Physicians or Philosophers have admitted thereof; for it is manifest by anato∣mical observations, that nothing from the Brain by the Glandula pituitaria which seems the only passage from thence) falls down into the Palate or Breast, but that the Serum there deposited is conveyed by appropriate passages to the jugular Veins, and is re∣manded to the blood. Moreover it is manifest to sight, that whatsoever relique of Se∣rum is laid aside in the Glandules of the Ears, Mouth, Nose, or Face, is conveyed from them all by peculiar passages, insomuch that no humor whatsoever destils from the Brain or the Palate into the Lungs.

But although matter exciting a Congh doth not destil from the Head by the Trachea into the Lungs, yet sometimes falling down from the sides of the Trachea into their cavities,* 1.116 it produces that disease commonly called a Catarrh. For the Aspera Arteria, like the Arteries beinging blood, are endued with a nervous and musculous Coat, and so do occasionally enjoy sense and motion, having also a glandulous Coat and full of lit∣tle vessels to sustain the vital heat and nourishment. These last Coats make those in∣terspaces, and as it were cover the Cartilages. Moreover the superfluous serosities proceeding from the blood watering the Trachea are deposited into this glandulous Coat, which for the most part presently sweating into the cavities of the Trachea, serves chiefly to make them slippery and most: but if the mass of blood be poured out too much, and precipitated into serosities (as it frequently happens, a cold being taken, or the swallowing down of acid things, and on many other occasions) for this cause a great plenty of watry matter sweats out of the Glandules of the Trachea and mouths of the little Arteries into its cavities, which soon doth cause a most troublesom Cough, and often much spittle (which afterwards comes to be consumptive.)

But surely this cause of Spittle and as it were a Catarrhal Cough very rarely comes alone,* 1.117 because while the blood watering the Trachea having suffered solution, throws in its serosities into the Glandules (whence presently they sweat into its cavities) and also the remaining blood being in like sort dissolved, it insinuates its Serum set apart within the pneumonic arteries, partly into the tracheal hollownesses, and partly into the Lympheducts, by the overflowing whereof the Lungs are as it

were overwhelmed and much incited, for the most part provok'd to Cough and conti∣nual spitting. A Cough and spitting of this kind as long as moderate,* 1.118 only throwing off the serosities of the blood, rather are beneficial than prejudicial; because the mass of blood, and the very lungs being throughly purged after this sort, those symptoms for the most part spontaneously abate, and from thence ensues a more perfect health. But if they be protracted a long time, the serous humour being on both sides laid aside into the tracheal passages, and from thence more plentifully daily heapt up, at length it will change into corruption; because as well the free enjoyment of air is impeded, as also the motion of the blood, and its temperature wholly perverted; from hence a Cough becomes more fierce, and breathing more difficult; nay rather the whole mass of blood in as much as it is defiled by the foul blood (which the Veins receive from the Lungs) degenerating by degrees from its benign properties, and being depraved, it not only continually pours forth the super fluous Serum, but also the nutritive Juice (which it cannot assimilate) out of the pneumonic Arteries into the tracheal passages;* 1.119 and so this mass of consumptive matter is daily increased, till the Lungs being more and more obstructed and filled, and the blood being defiled, and rendred unfit to perform any of its functions, the Cough and Spittle become worse and worse, and presently be∣come dangerous; Moreover breathing being hurt, the faintness and pining away of the whole body, the debility of all the functionx, and at length a hectick feaver, and a hasty declination to death follows.

When by the long continuance of a Cough and Spitting, leasurely encreasing,* 1.120 the humour is more plentifully deposited out of the mass of blood into the lungs, it first of all enters into the tracheal little bladders, and at length fills them, and somewhat distends them, from which while every morning by expectoration then more copi∣ously performed, it is almost entirely cast out from them, thence the Thorax is ex∣empt for a short space from the burden, and respiration seems more free: yet a little afterwards the blood being stuff'd again with Serum or nutritive juice, it pours down new matter into the lungs; and from thence again after meat or sleep the little bladders are fill'd, and the humours by the afflux daily encreased, are more distended and enlarg∣ed, and at length the sides of two or more of the little bladders, being burst, many little bladders are here and there framed as it were into one lake, within which the con∣sumptive matter being more abundantly collected, there it putrifies (for it is not en∣tirely prefently cast out) and from thence it corrupts the substance of the lungs, to which it is joined, and imparts a putrid defilement to the blood passing through it. This breach thus made in the lungs is daily encreased, and frequently more are at the same time formed in divers places, and by reason of the great plenty of humours heaped up and putrified in them, a heaviness of the breast is felt, like a weighty bur∣den upon them, the breathing is more hindrd; moreover from the tabid blood being more plentifully intermix'd with the mass of blood, frequent effervescences of it, destruction of the nutritive juice, also thirst, heat, loss of appetite, nightly sweats, and a pining of the whole body do arise.* 1.121 But the blood being polluted from the lungs, causes them to be punished with a reciprocal affection, that is to say from its peculiar pollution; because the blood in the veins receiving this purulent matter in every circuit, it immediately delivers it into the arterial; from whence, whereas it cannot be sent enough away by sweat, or by Urine, it is brought back by the pneu∣monic arteries to the lungs, where again being separated from the blood, it is every where conveyed as well into the little bladders of the Trachea as into the lesser passages; insomuch, that at length the whole frame of the lungs being filled, clefts or ulcers are formed consequently in many places, and all the other hollownesses are stufft with frothy quitter.

But sometimes it happens that there is one Ulcer or hole, or happily two formed in the Lungs, and the sides grow callous round about, so that the matter being there gathered together is not conveyed into the mass of blood, but is daily expectorated though in a vast plenty. They that are so affected, as if they had but an issue in the lungs,* 1.122 although they cast up much Spittle, and thick and yellow matter every morning, and a little sometimes all day, yet otherwise they live well enough in health, they breathe, eat and sleep well, are well in flesh, or at least remain in an indifferent habit of body, and frequently arrive to old age: insomuch that some are said to have been consumptive thirty or forty years, and to have prolonged the disease even unto the term of their life (for that cause not being shortened). And in the mean time others who cough or spit less, within a few months fall into a hectick feaver, and in a short while are hurried into their grave.

Hitherto touching the conjunct cause and formal reason of a Phthisis or pulmonary Consumption;* 1.123 what belongs to the other causes (that is to say, procatarctic and evident ones) they truly are various and manifold, inasmuch namely as they are more near or more remote, inward or outward, and lastly connatural or adventitious: That I may un∣dertake to design the powers, operations, and modes of effecting of all these in producing a Phthisis; primarily it is requisite that I shew, by how many modes, and by reason of what occasions the serous humour of (as folks commonly say) the Catarrhal, is laid a∣part out of the mass of blood into the little bladders of the lungs, and into other passages of the Trachea.* 1.124 Upon diligent search of this it is obvious to any one to percieve the morbific cause consists of two parts, and that the fault is in the ill temper of the blood sending an offending matter to the Thorax, and also the weakness or ill tone of the lungs easily receiving it.

As to the former, it is manifest enough by common observation, that the mass of blood being stuft with incongruous particles, viz. its proper ones degenerated, or with others from other places intermingled,* 1.125 doth boyl up for the expurging of them, and what is to be separated, when it is not easily sent away by any other ways, it is spread abroad into the lungs, (if they are of a weaker constitution) and cleaves to them.

There are many dyscracies of the blood, and those of divers kinds and affections, by by which its liquor being dissolv'd in its consistence, and as it were curdled, doth not rightly contain the serous and nutritive juice within it self; moreover sending away these and other excrementitions humours uncessantly from, it self, as sometimes it de∣posits them among other parts, so more often into the lungs.

1. The blood sometimes like Milk grown sour of it self, is depraved by little and little, and at length departing from its genuine faculty into a sourness, and being dissolv'd in its existence, doth cast abroad its serosities (too easily prone to separate themselves) out of the Pneumonic and also Tracheal Arteries into the tracheal passages. Thus to some it is ordinary once or twice in a year, without any mani∣fest cause to be afflicted with a grievous and troublesome Cough, with copious spitting, which in a certain process of time (after the blood purged from its dregs and excre∣ments recovers its temperature) doth spontaneously abate, and after doth succeed a more firm and durable health. By reason of such a Cough serving for a purge to the blood, I have known some often in a day, and especially every morning, who were wont to spit out spittle like black Ink, with a small endeavour of the Trachea; which distemper when for many months they had constantly labour'd under, after a greater Cough occasionally contracted, with much and yellow spittle, they have afterwards escaped altogether free from that former black spittle; the reason whereof it, that a heavier Cough abiding with plentiful spitting for several days, altogether purges a∣way those melancholy foeculencies from the blood, and moreover it alters the tem∣perament of the blood, or rather takes away the ill temperament thereof.

2.* 1.126 The nervous juice being frequently degenerated, and with an abundant lympha returning back out of the fibres and nervous parts into the blood, as it produces ill affects of the bowels, and of the reins (whereof in another place we have hinted) so sometimes it causes a fierce and very troublesome Cough. This kind of Cough one while is Catarrhal, inasmuch as the Lympha having pass'd through the mass of blood, is deposited in the Lungs by the arteries; another while it is convulsive, inasmuch as the Nerves and fibres, constituted to move the breast, are possest by that liquor, and are provok'd into convulsive motions: from either cause either conjunct or sepa∣rately it comes to pass, that more grievous passions of the brain and nervous kind frequently call on a troublesom Cough, or are wholly changed into it.

3.* 1.127 Besides the faults of the blood and nervous juice, frequently exciting a Cough, it is probable that it sometimes arises from the Lympheducts being obstructed, which be∣long unto the Lungs: for whereas very many Vessels of this kind are spread abroad through the Lungs, whose function it is to receive whatsoever is superfluous of the Lympha that is carryed through the Arteries into the Praecordia, and not immediately brought back by the veins, and to convey it to the trunk of the passage of the Thorax; if by chance it happens that these passages are stopt or obstructed by viscous matter, or compress'd or thickned by cold should not well discharge their duty, it must needs be that those watery excrements shut out from their wonted sluces, or whirling back into the blood, do incite its fierce boyling up, or being poured into the passages of the Trachea, do stir up a Cough.

4. Neither do the humors above-mentioned only,* 1.128 in as much as they either pervert or hinder the crasis or motion of the blood, induce a Cough (which frequently is the be∣ginning of a Phthisis;) but moreover any usual or wonted Evacuations suppressed, or let, do usually impress a fault upon the Lungs. The menstruous flux or the Haemorrhoids obstructed, often bleeding at the Nose it by chance it ceases, Issues closed up, Pustles, Scabs and Wheals driven back, do frequently affix a taint in the Thorax. If a plentiful spitting from the Glandules of the Mouth stops of its own accord, or be cu∣red by Medicine, afterwards sometimes a consumptive Cough succeeds; wherefore the same is vulgarly called a Rheum, which had lately fallen from the Head into the Jaws and Throat, and thence destilled deeper into the Lungs; when indeed it is no∣thing else but a certain superfluous serosity of blood, that being used to be put aside by the cephalic Arteries into the Glandules of the Mouth, now being excluded thence, is hurried through the preumonic Arteries into the Lungs.

Besides these private and periodical, or extraordinary Evacuations,* 1.129 whose suppressi∣ons incline to a Cough and Phthisis, there occurs another general and constant Evacua∣tion, viz. insensible transpiration; which being either stopt or suppressed, is oftner the occasion or parent of that evil than all the rest. For the steams that usually evaporate by the Pores of the skin being restrained within, ferment the blood, and soon pervert it, and cause it to be precipated into serosities; which with other excrements of the mass of blood being immediately laid aside in the Lungs, do stir up a troublesom Cough and often a consumptive one. Hence it is a common observatioin, that the catching of a cold, by which the Pores are stopt, whether it be by the blowing of cold air, or being wet by rain, or leaving off cloaths, or by what other means it may come to pass, disposes very many to distempers of the Thorax. Wherefore in our Idiom the cause being put for the effect, a Cough is called Catching of cold.

These are the chief causes and occasions which occur from the blood any ways de∣praved,* 1.130 and therefore depositing a peccant matter into the Lungs. There follow other causes in regard of the Lung it self, viz. those which dispose this Bowel more readily to a Cough or a Phthisis, of which there are three sorts. 1. An ill frame of the Breast.* 1.131 2. An innate weakness of the Lungs, or hereditary disposition to a Consumption. 3. Preceding diseases of the Thorax, as a Wound, a Blow, a Pleurisie, a Peripneumony, Empyema, Spitting of blood, the small Pox and Measles, &c. 4. The incongruity of air which is inspired (as deserving a place among the procatarctic causes.) By reason of any one of these causes, and sometimes of many together, the matter provoking a Cough, proving often after consumptive, doth easily assault the Lungs, and enters them, and frequently imprints a deadly hurt. On each of these we shall insist a little.

First therefore as to the frame of the Breast the case stands thus: viz. that the Lungs being still whole and sound, and free from any phthisical impression, may be kept for a long time in their office, it will behove that they sitll be exercised with a motion that is vigorous, and with stretched our sails as it were to discharge the strong interchanges of the Systole and Diastole; to that end, that the air being plentifully suckt in,* 1.132 may be admitted to their inmost apartments, and from thence immediately be cast back for the most part together with all the effluvia and sooty vapours at every change of breath. Wherefore since the action of the Lungs doth depend much on the frame of the Thorax, as being the moving Engine, it must needs be, that by reason of its ill fashioning, the function of breathing becomes defective in many things. There are two special kinds of a Breast ill framed, (viz. crookedness, and shoulders like wings) for which reason many are found prone to a Phthisis: the reason of which is, that in any such figure of the breast, being either depressed or made long, the Lungs do neither injoy a space so free and ample, nor can the moving Muscles be so strongly contracted as in a square breast.

2.* 1.133 The innate debility or hereditary disposition of the Lungs to a Consumption is so frequent and vulgarly known, that when any is found inclining to a Consumption, he is presently questioned, whether his parents were not obnoxious to this distemper? Very many of these being endued with a narrow breast and a neck somewhat long, and of a constitution very tender, contract a Cough from the least occasion; neither can they endure a cold or moist air. To some of these a mansion in a City is very preju∣dicial, where the air is breathed in thick and smoaky; on the contrary, to others prone unto the same disposition it is very friendly (the reason whereof we shall diligently in∣quire hereafter) To all of them a North-wind is for the most part an enemy, consider∣ing that it usually irritates a Cough, also a Spitting of blood, a Pleuisie, or Peripneu∣mony,

viz. the pneumonic or the thoracical Vessels being thereby stufft, and in the mean time the blood being rendred more rurgid and sharp, by reason of transpiration hindred, and the effluvia's restrained within the mass thereof.

For an hereditary disposition to a Phthisis doth chiefly consist in these two things:* 1.134 viz. 1. In regard the Patients being endued with a more sharp and elastic blood, do require a more plentiful transpiration; which perhaps if it be less granted, the matter that was wont to evaporate redounds upon the infirm Lungs. 2. If the pneumonic Vessels be too loose and tender, they do not duly contain the Serum and other recrements of blood within the dissolved mass thereof, but they sometimes suffer both them and a certain portion of the blood it self to break out into the Tracheal passages: whose moving Fi∣bres, when they are infirm, do not presently turn forth what is poured out into the ca∣vities; but they suffer it to abide and putrifie in the same place, and at length to degenerate into black filthy gore corruptive both of the Lungs and blood.

3.* 1.135 A Phthisis is sometimes the product or consequent of some other previous distem∣pers of the Breast. Those consumptive passions chiefly are Empyema's, Pleurisies, a Peripneumony, and Imposthume of the Lungs; and sometimes the small Pox, Measles: also irregular Feavers ill or slightly judged, do cause the same effect. The chief of these distempers, or at least those which are proper to the Thorax, together with the ren∣dring the reason of the causes, and how they dispose to a Consumption, shall be de∣clared hereafter, with the reasons and manner of procedure; in the mean time we are to take notice, that this kind of fault is common to them all, that is to say, they dissolve the unity and weaken the tone of the Lungs, and pervert the temperature of the blood; whence whatsoever incongruous or distempered thing is poured out upon them from its depraved mass, they do easily admit thereof, and difficultly or not at all drive it back.

4.* 1.136 The procatarctic causes of a Phthisis being now explained, viz. those which con∣sist as well from the blood as the Lungs, there is another common to them both, which may be justly added, and (although altogether extrinsec) hath great affinity with them both, viz. the condition or temper or the air breathed in. For such is the influence hereof to some consumptive persons, that the cause of the disease is sometimes wholly ascribed to the incongruity of the air wherein they dwell, and for a cure the alteration of air or soil is preferred to all other remedies whatsover. Hence many of our Country troubled with a Cough, or being in a Consumption, flock to the Southern parts of France; and others in the mean time who cannot go beyond Sea, or will not, presently hasten to remove out of the City-smoke into the Country as to a most undoubted re∣fuge: wherefore all our Villages near London, which injoy a clear and open air, are esteemed as so many Spittles for consumptive persons. Notwithstanding all do not alike receive help from such a change of places; for many either passing to France or to Coun∣try Villages, do in those places rather find their graves than health. And therefore London is not presently to be forsaken by all phthisical persons: for I have known may obnoxious to a Cough or Consumption to have enjoyed their health much better in this smoaky air than in the Country. So that for cure of the same disease, while some avoid this City as Hell, others flye to it as to an Asylum.

The reason of these things do clearly appear out of the Doctrine of Breathing before handled;* 1.137 for we do demonstrate the blood passing through the Lungs, both as to its kindling or vitality, and as to its motion doth chiefly depend on nitrous air suckt in; whence it is a consequence, that the tenor of this ought to be so proportioned to the temperament of that, that the blood being moderately kindled within the Pracor∣dia, may burn out clearly and vigorously,* 1.138 as well without smoak and sootiness as with∣out too intense a flame, and that it may pass the pneumonic Vessels freely, and without any hindrance or leaving of recrements. Wherefore a moist, and close air, as it is healthful to none, so to them that cough it is especially hurtful; on the contrary, a serene and mild air, moderately injoying the Sun and wind, as it is healthful to all per∣sons, so it is friendly to all consumptive persons. As to other conditions of the air, some escape a Cough, or lose it living in mountainous places exposed to the Sun, where the impendent Atmosphere being free from all thick, smoaky, and feculent va∣pous whatsoever, abounds with nitrous particles: for those whose thick and feculent blood abounds with an impure Sulphur, to kindle this duly and to waste the dreggi∣ness, there is need of a very thin and nitrous air. If the Lungs be not too tender, but firm and strong, they endure the more fierce assaults of its particles; on the other side, they who have a thin and subtil blood, easily dissolvable and endued with a more

pure but very little Sulphur, and having tender and soft lungs, very sensible, and of a finer texture; these persons being impatient of a nitrous and sharper air, are most at ease and best in a thick and more sulphureous one. Wherefore it conduces to these persons, that they breathe the gross and more fat air of a smoaky City; which to an impoverished and more thin blood, doth afford Sulphur (which fails sometimes) and also Nitre, and doth something thicken and fix its subtile consistence; moreover it dulls the substance or texture of a Lung too much sensible and more thin, and is a defence against the invasions of a more sharp and improportionate Air.* 1.139 It is manifest by frequent experience, that a thicker Air, provided it be sulphureous, proves very benign to some phthisical persons (that I do not say to all.) It is a common observation, that a Consumption seldom infests those Regions either in England or Holland, where fires are nourished by turffe, and do breathe a very sulphureous odour, yea rather those places are chiefly wholesom and frequently sanative to persons obnoxious to a Phthisis, or labour∣ing under it. To which we may add, that a suffumigation of Sulphur and Arsenic (which is filled with much Sulphur) is reputed for the curing of almost incurable Ulcers of the Lungs, although the last, yet the most efficacious remedy.* 1.140 Moreover add to this, that pectoral Medicines prepared of Sulphur are far to be preferred to any other; so that Sulphur is justly reported by Chymists to be the Balsam of the Lungs. By what order and by what means these Medicines do work; and so nota∣bly help in diseases of the Thorax, we shall hereafter make diligent search into: in the mean time that sulphureous Air is found helpful to certain phthisical persons, the rea∣son consists in these two things; viz. in the first place, as we now intimated, from such an Air suckt in there is help brought to the jejune and depauperated blood and to the tender Lungs. Secondly, that the sulphureous Particles being suckt in with the nitrous, do provide against,* 1.141 or take away the acidities of any of the humours (by which their flowings and extravasations into the Lungs do chiefly arife.) And for this reason it is that sulphureous Medicines, being also taken inwardly, do confer so excel∣lent a help to them that cough or are phthisical: therefore Sulphur, as I now hint∣ed, hath the report of being the Balsam of the Lungs. For as balsamic things applied to an Ulcer or Wound extinguish the acidity of the Ichor there sweating out and cor∣rupting and paining the little Fibres, soon ease the pain, and afterwards heal the wound; so also the sulphureous Particles, passed into the Lungs either with the air or with the blood, in as much as they provide against or abolish the acidities of all humors, i.e. the blood, the Serum, the Lympha, the nervous or nutritive Juice, they conduce to the prevention or cure of a Consumption. We shall in what follows more at large declare the cause, when sulphureous Medicines shall be particularly treated of. The conjunct and procatarctic causes of a Phthisis being thus handled, it will not be necessary to discourse much touching the evident causes. For in what manner a closing of the Pores by cold, a surfeit or tipling, and other errours of several sorts, in the six non-naturals, dispose to those distempers, and sometimes presently do bring them,* 1.142 is so clear, that it needs no explaining. Neither is there any reason we should be long delayed about the Semiotical part of this disease; nevertheless it is fit we observe the divers states or distinctive signs which certainly belong unto it. 1. When it is meer∣ly a Cough. 2. When it begins to degenerate into a Phthisis. 3. When it is a per∣fect and almost desperate Phthisis. From which things duly designed, the Prognostic of the above-mentioned affections will be very apparent.

1. And in the first place what belongs to a new Cough, and as yet alone,* 1.143 this taking its rise from any cause whatsoever in bodies predisposed to a Phthisis, will scarce ever be free from the suspicion of danger; but in a strong man, and one who hath often before endured a Cough Scot-free, it will not be immediately to be feared: for when being stirred up from a more forcible evident cause, without Feaver or indisosi∣tion of the whole body, it shall not be very troublesom, then it meerly passes for a cold being taken, and is altogether neglected, or in a short time is wont to be finished without many or very considerable Remedies. Moreover if a small Feaver with thirst and want of appetite accompany this, there is hope that the blood being restored to its due temperament, the Cough then will cease of its own accord: but if it be protracted longer, and not easily yield to vulgar Remedies, and produces much spitting, and that discoloured, it must not be any longer neglected, but be pro∣vided against by a method of healing, and by fit remedies and an exact course of diet. For then it may well be suspected, that the Lungs being prejudiced in their structure, do not circulate the blood entirely, but let fall the Serum and Lympha, and fre∣quently

the nutritive Juice; and moreover those humors so laid aside do putrifie; and from thence the blood is defiled, which by a reciprocal hurt prejudices again the Lungs.

2.* 1.144 But if to a Cough growing daily worse and worse with plentiful and thick spittle, a languishing and pining of the whole body, loss of appetite, difficult breathing, thirst, and fervent heat of the blood be added, there is great cause of suspicion that it is come at least to the first limits of a Phthisis (if not further.) Wherefore it will behove us to use all means, whereby the Lungs may be freed from the great quantity of matter heaped up together, and be defended from its continual assault or invasion; and also that the mass of blood may be cleansed from all dregs, and restored to its due tempe∣rament whereby it may rightly contain its serosities and other humors within it self, or transfer them to some other place than to the Lungs.

3.* 1.145 But if, beyond the state of this distemper now described, plenty of spittle, and that discoloured, shall be daily increased, and all other things growing worse and worse, a dejection of the whole strength, and a hectic Feaver with a continual thirst, night Sweats, an Hippocratical face, an utter decay of the flesh almost to the driness of a Skeleton, happen upon all these, then for the most part no place is left for Medicine, but only a dreadful prognostic; at least all hope of Cure being waved, we must insist upon Anodynes, whereby an easie death may be procured.

What therefore belongs to the cure of a Cough in general,* 1.146 according to the three above-mentioned states of this disease, a threefold method of healing ought to be ap∣pointed, viz. that bounds as it were being set, we may more distinctly prescribe what is to be done for the cure of a Cough, whilst being on this side the limits of a Phthisis, it passes only for a cold catched. 2. What manner of healing to a beginning Phthisis. 3. What to a Phthisis consummated, or desperate.

1. Although against a new Cough for the most part there are used only Remedies Empirical, and scarce any of the common people but are furnished with many and di∣vers of this sort, which every where without the advice of a Physician very many con∣fidently take, and without method, and give them to others: yet men of a delicate constitution, or inclining to a Consumption hereditarily, or sometimes formerly in ha∣zard from a Cough, ought immediately to provide against the first assaults thereof, and readily betake themselves to the Precepts of Physick; according to which, that the method of healing may be duly instituted, the curatory indications shall be chiefly these three;* 1.147 viz. 1. To appease or take off the disorder of the blood, from whence the fluxes of the Serum do proceed. 2. To derive the excrements of the blood and all exuviae, apt to separate from it, from the Lungs to the Pores of the skin, or to the urinary passages, and into the other Emunctories. 3. To strengthen the Lungs them∣selves against the reception of the Serum and other humors, and also to defend them against the invasion of outward cold, whereby they are wont to receive further hurt. Upon each of these we shall treat a little more plainly.

1.* 1.148 The first indication respects as well the boiling up of the blood, wherein by rea∣son of the effluvia's restrained, it grows too fervently hot, and boils in the vessels; as its dissolution, whereby being solved in its consistence, it lets go too much Serum and other humors from its embraces. For the taking away of both, a thin diet must be ap∣pointed, and, the injury from outward cold carefully declined, a little more sweating ought to be procured, or at least the accustomed restored. To this end let the Pati∣ent put on thick garments, and let him keep his bed or chamber, at least let him hardly go out of his house, evening and morning let a small breathing Sweat be pro∣voked by Posset-drink boiled with Rosemary or Sage. If notwithstanding all this the Cough increases, Phlebotomy, if the strength and constitution will bear it, is often used with success: after which Hypnoticks for the most part help, in as much as they retard the motion of the heart and consequently the too precipitate course of blood: moreover they cause it to circulate in the pneumonic Vessels gently and mildly without any great throwing out its serosities, and to send away what is superfluous either by Sweat or Urine. To this purpose pectoral Decoctions are also to be administred, in as much as they destroy the acidity of humors, and hinder the dissolution of the blood, and its melting into serosities. By the like reason and manner, Medicines prepared of Sulphur do so signally help against a Cough.* 1.149

The second indication, viz. that the Serum and other recrements of the blood, de∣rived from the Lungs, may be evacuated by other ways, is performed by Diaphore∣tics, Diuretics, and mild Purgers; which ought to be mixed with other Remedies,

or now and then used alone. Wherefore after Phlebotomy we use to prescribe a gentle Purge, and sometimes to repeat it. Among the Ingredients of the pectoral Decoction let the Root of Chervile, Butchers-broom, Elicampane, and other things that provoke Sweat and Urine be put. Hog-lice, volatile Salt of Amber, and other fixed Salts and Powders of Shells made into Pills with Turpentine are often given with success.

The third indication,* 1.150 that the Lungs and their passages might be desended against the flowing of humors, the encountring of cold, and the suppression of the Catarrh, as they commonly call it, is performed by Linctus's, Lohochs, and other private Reme∣dies, and chiefly respects two things; viz. that the mouths of the Vessels and Glan∣dules opening into the Trachea be shut with moderate Astringents, lest they should too much east out the serosities into it: and secondly, that the sides of the Tracheal passages may be made smooth and glib, that neither from the pouring out of the sharp Serum, nor invasion of any outward cold they may be offended, and continally provoked into a troublesome Cough; and moreover when those passages are made slippery enough, the spittle sometimes obstinately cleaving to their sides, might be the more easily coughed out. For the first intention it is, that Conserve of red Roses, Olibanum, Mastich, Lohoch of Pine-tree, Syrup of Jujubes, of dried Roses, of Cup-moss, and other Astringents are often put into the forms of Pectoral Prescriptions. For the second intention Liquorish, with the divers preparations thereof, is reputed a famous Remedy against any Cough: for this purpose Syrups and Lohochs, and all other sweet Pectorals seem to be ordained. To which is added Oyl of sweet Almonds, either administred by it self, or brought with pectoral Syrups after a long stirring of them together into a milk form liquor.

These are the chief Therapeutic indications, together with the apt intentions of healing, which seem chiefly to be of use for a new Cough, while as yet we have no suspi∣cion of a Phthisis, or at least that it subsists without the manifest limits thereof; it now remains, after this general method briefly shadowed out, that we subjoin certain choice forms of Medicines appropriated to every intention. These, though they are manifold and of divers preparations, yet those which are of chiefest note and most in use,* 1.151 are Mixtures, Linctus's, Lohochs, Tinctures, Balsams, Troches, Lozenges, Powders, Pills, Decoctions, and distilled Waters. Of each of these we shall set down some choice Receipts.

1. Mixtures.

Take of Syrup de Maconio, of Jujubes, of each an ounce and half; of powder of Oliba∣num a dram, the water of Earth-worms, or of aq. Hysterica, or Peony compound a dram, mingle them. The Dose is one spoonful at bed time and after midnight.

Take of the water of Snails, of Earth-worms, of each an ounce and half; of the liquid Laudanum Tartarizated two drams, Syrup of Violets an ounce. The Dose is one spoonful at bed-time.

Take of Snail-water ℥vj. Syrup of the juice of ground-Ivy, ℥iij. Flower of Brimstone ʒss. mix them. The dose is one spoonfull at bed-time, and soon in the morning.

Take of our syrup of Sulphur 4 ounces, Water of Earth-worms 1 ounce. Dose 1 spoon∣full after the same manner.

2. Linctus's.

Take of syrup of Jujubes, Maiden-hair of each one ℥ and half, syrup of red Poppys 1 ounce, mix them; to be lick'd with a Liquorish Stick.

Take Oyl of Sweet-Almonds fresh drawn, Syrup of Maidenhair, of each 1 ounce and half, white Sugar-candy 2 drachms, mix them by beating in a Glass-morter, or shaking them in a Glass Vial till it wax white.

3. Lohochs.

Take Conserve of red Roses 2 ounces and half, Lohoch Sanum 1 ounce and half, Spec. Diatragacanth. frig. 1 dram and half, flowers of Brimstone half a dram, Syrup of Vio∣lets or red Poppyes as much as sufficeth, let it be made a sost Lohoch. Dose 1 dram and half at night and early in the morning; at other times to be licked with a Liquorish stick.

Take of the powder of the leaves of Hedge-mustard, or Rockets, 1 ounce and half, clarified Honey 4 ounces, mix them for a Lohoch, let it be administred after the same manner. It agrees with cold Constitutions.

4. Tinctures.

Take of Tincture of Sulphur, without empyreuma 3 drams, Dose from 6 drops to ten in the evening, and early in the morning in 1 spoonfull of Syr. of Violets, or of the juice of ground-Ivy; I scarce know a more excellent remedy for any Cough, provided there be no feaver.

Take of Tincture of the Sulphur of Antimony 2 drams, Dose 20 drops evening and morning in one spoonful of the pectoral Syrup.

Take of the Tincture of Gum Ammoniack (prepar'd with the Tincture of Salt of Tartar) 1 ounce, Dose from 15 drops to 20. After the same manner the Tinctures of Galbanum, Assa foetida, Gum of Ivie (prepar'd after the same manner) are proper for a Cough in any cold constitution.

5. Balsams.

Take of Opobalsamum 2 drams, Dose from 6 drops to ten in a spoonfull or two of Hyssop, or Penny-royal, or any other Pectoral water.

Take of the Balsam artificially distill'd, commonly call'd the Mater Balsami, two drams, Dose from 6 drops to ten in one spoonfull of Syrup of Violets or Canary Wine eve∣ning and morning.

Take Balsam of Sulphur two drams, the dose from five drops to ten after the same manner.

Take of Balsam of Peru one dram, Dose from two drops to 4 or 6 in Conserve of Violets.

6. Troches.

Take of the Species of Diatragacanth. frigid. ℥ss. Liquorish ʒj. flower of Sulphur ℈ij. flower of Benzoin ℈j. Sugar Penids ℥iij. make a Paste with the dissolution of Gum Tra∣gacanth in Hyssop-water, form it into troches of the weight of ʒss. Take one often in the day or in the night.

Take of the seeds of white Poppies ʒ vj. of the powder of the flowers of red Poppies ʒj. extract of Liquorish ʒij. milk of Sulphur ʒss. Sugar Penids ℥ij. with mucilage of Quince∣seeds make a Paste, and form it into troches.

Take of the Species Diaireos, of the lung of a Fox, of each ʒss. Sugar Penids ℥ij. with the dissolution of Gum Tragacanth, make them into Troches.

Take of powder of Elicampane, Anniseeds, Liquorish, of each ʒij. flower of Brim∣stone ʒj. of Tablet Sugar ℥iss. juice of Liquorish dissolv'd, as much as will suffice, make Troches.

7. Lozenges.

Take of the Species Diatragacanth. frigid. ʒiij. powder of the flowers of red Poppies, milk of Sulphur, of each ʒss. of Sugar dissolv'd in Poppy-water, and boyl'd to make Ta∣blets, ℥iiij. form lozenges of ʒss. weight.

Take of Species Diaireos, of the lung of a Fox, of each ʒiij. flower of Brimstone, powder of Elicampane of each ʒss. of the whitest Benzoin ʒj. make them in a fine pow∣der, adding of Oyl of Anniseeds ℈j. Sugar dissolved, and boyled to a height to make lo∣zenges ℥viij. for lozenges of ʒss. weight.

8. Powders.

These though more seldom, yet are sometimes given with success in a Cough, and pneumonic distempers.

Take of the tops of Ground-Ivy somewhat reddish, a sufficient quantity, bruised let them be form'd into a Cake, which dryed presently in the hot Sun, reduce into fine powder, and keep it in a glass. This Plant keeps its virtue with smell and taste longer than any either Conserves or Syrups, and greatly profits in a grievous and pertinacious cough. Take from ʒss. to a dram, in distill'd water, or pectoral decoction twice in a day.

After the same manner Powders of other pectoral Plants are prepared, and taken with benefit.

Take of Cup-moss or chin-cups ʒiij. milk of Sulphur ʒj. Sugar-candy ʒss. make a pow∣der; the dose from ℈j. to ʒss. twice in a day. This powder is given with great benefit to those labouring with a chin-cough.

Take of the flour of Brimstone, Olibanum, Ceruse of Antimony, of each ʒij. divide it into xii. parts, take one part in the morning, and another in the evening in a spoonfull of a convenient vchicle.

9. Pills.

Take of Aloes rosata, or rather of Ruffus's his Pill, flower of Brimstone of each one dram and half, flowers of Benzoin ℈ j. Juice of Liquorish dissolv'd in as much Snail-water as will suffice to make a mass, form it into small pills to be taken 4 at night, to be repeated every or every other night.

Take of powder of Elecampane, Liquorish, flower of Brimstone, of each one dram, flowers of Benzoin half a dram, Tarr as much as is sufficient, form it into small pills, the Dose 3 or 4, evening or soon in the morning.

Take of Millepedes or Hogs-lice prepared ʒ ij. the powder of the seeds of Nettles, Bur∣dock of each half a dram, Oyl of Nutmegs distilled ℈ j. Salt of Amber half a dram; Juice of Liquorish what will suffice, form it into small Pills, take three in the morning and in the evening.

10. Decoctions.

These are taken either by themselves, or with the addition of Milk. Among those which are of the first kind, 1. The Pectoral Decoction according to the London Dispen∣satory, offers it self. Which is taken twice a day from ℥ iiij. to vj. or ℥ viij.

Take of the leaves of Ground-Ivy, white Maiden-hair, Harts-tongue, Coltsfoot, Agri∣mony, of each one handfull, Roots of Chervil, Knee-holm, of each one ounce, Carthamus and sweet Fennel seeds, of each half an ounce, boyl them in 6 pints of Spring-water to the con∣sumption of half, adding towards the end Liquorish three drams, Raisins stoned two ounces, Jujubes, n^o vi. or clarified Honey three ounces, make an Apozeme, clarifying it with the white of an Egge; Dose 6 ounces warm, 2 or 3 times in a day.

Decoctions taken with Milk, are used morning and evening instead of Breakfast and Supper, according to the manner following.

Take the flowers of greater Daisies one handfull, three cleansed Snails, half an ounce of candied Eringo roots, Barly 3 drams, boyl them in a pint and half of water to a pint. Take 6 or 8 ounces warm, adding a little milk; and afterwards the quantity encreased by little and little.

After the same manner, Cup-moss, Ground-Ivy, St. John's-wort, and other pecto∣ral herbs are boyl'd and taken with Milk.

The Decoction of Woods often does conduce much to the cure of a stubborn Cough, especially if appointed in the place of Beer, for ordinary drink, and taken for some time.

Take of the roots of Sarsaparilla 4 ounces, China two ounces, white and red Sanders of each half an ounce, shavings of Ivory and Harts-horn of each 3 drams, let them be infused, and boyled from 8 pints of Conduit-water to 4, adding Liquorish 6 drams, Raisins stoned an ounce and half; in a phlegmatick or colder constitution, adde of sha∣vings of Lignum vitae.

11. Distilled Waters.

Every one may compound manifold and divers forms of these as occasion requires, and appoint according to the constitution of the patient, sometimes simple Milk, sometimes Milk with some part of Wine, sometimes Ale, or Brunswick Mum. For a Sample we will prescribe the form of these.

Take of the leaves of ground-Ivy, Hyssop, Penny-royal, of each four handfulls, of Snails half-boyl'd in their shells two pounds, Nutmegs sliced no. vj. Ʋpon all being cut small pour eight pints of fresh milk, let it be distilled in the common Organs, i.e. a Pewter-Still.

The dose 3 ounces twice or thrice in a day by it self or with some other Medicine.

Every dose let it be sweetned when it is taken with Sugar-candy, or with the syrup of the juice of Ground-Ivy.

In a constitution less hot, especially if there be no fervent heat of the blood or Praecordium, to six or seven pints of Milk, adde one pint or two of Canary wine; and in a phlegmatick or old body, instead of Milk let the Menstruum be Ale or Bruns∣wick Beer, i. e. Mum.

Moreover, in Winter-season when Snails cannot easily or scarcely be procured at all, there may be substituted in their stead Lambs or Sheeps Lungs, also sometimes Calves, being half-boyl'd and cut small, with the forementioned ingredients, and a fit Menstruum being added, let them be distilled in common Organs, or Rose∣stills.

To this form,* 1.152 treating of a Cough not yet arrived to a Phthisis, ought to be re∣ferred the convulsive or suffocating Cough of children, and in our Idiome called the Chin-cough. This assaults chiefly Children and Infants; and at certain seasons, viz. Spring and Autumn especially, is wont to be epidemical. The diseased are taken with fre∣quent and very fierce fits of Coughing, wherein namely the Organs of breathing do not only labour in pain, but also being affected convulsively, they do variously suspend or interrupt their actions; but for the most part the Diaphragma convulsed by it self, or by the impulse of other parts, doth so very long obstinately continue the Systole, or Diastole, that Inspiration, or Expiration being suppress'd for a space, the vital breath can scarcely be drawn; insomuch that coughing as being almost strangled they hoop, and by reason of the blood stagnating, they contract a black∣ness in their countenance; if perhaps, those organs not in such a measure convulsed, they are able to breathe any thing freer, notwithstanding they are forced always to cough more vehemently and longer, untill they wax faint.

The formal reason or conjunct cause of this disease,* 1.153 consists in these two things, viz. that there is present a quick and vehement irritation of the lungs, whereby they are almost continually incited to throw off something troublesom by Cough; and al∣so that the motive parts of the Thorax, viz. the Nerves and nervous fibres being pre∣disposed to convulsions, as often as they are irritated, do excite a Cough not regular but convulsive, and such as is opposite or injurious to the usual function of breathing.

The matter provoking the lungs so frequently into a Cough seems to be the Serum,* 1.154 uncessantly soaking out of the mass of blood, by reason of its frame being too much loosened, and troubling the parts belonging to the breast, inasmuch as it destills as well through the tracheal arteries into the hollowness of aspera arteria, as that it is poured in plentifully through the pneumonic arteries into all the open passages.

The convulsive disposition of the moving parts,* 1.155 as in other convulsive distempers, seems to proceed from a heterogene and elastic matter falling from the brain through the nervous passages, together with the nervous liquor, into the small moving fibres of the breast; wherefore, when the spirits that are contained in those little fibres, are stirr'd to perform violent motions of breathing out, they pass into convulsive motions.

What relates to the Prognostick of this distemper,* 1.156 this Cough although it be sel∣dom very dangerous or mortal, yet it remains very difficult of cure; and frequently it rather ceases by change of the season than is extinguished by remedies. The cause whereof is, that here not, as in an usual Cough, the blood onely ought to be altered, and its recrements to be derived out of the Lungs, to be conveyed to the habit of the body by sweating, but moreover an amendment of the nervous juice ought to be procured.

About the curing of this disease,* 1.157 the way of healing used in other kinds of Coughs doth rarely profit here; wherefore old women and Empiricks are oftener con∣sulted than Physitians, and the rational curatory method being postponed and neglected, remedies for the most part onely Empirical are brought into use.

Among the many remedies of this kind, these two following are preferr'd to all others, and chiefly wont to be used; viz. Cup-moss or Chin-moss or Chin-cups, and the various preparations thereof and compositions are taken inwardly, and if there

shall be need of any further medicine, that some Bugbear being presented, the Child la∣bouring with it may be cast into a sudden fright. But if the wished success be wanting to administrations of this sort, Ptisans, Syrups, Julips, or Decoctions, and other pecto∣ral helps are rejected, and frequently they desist from all other Medicines, expect∣ing untill the disease either at length of its own accord determine, or be cured by reason of the succeeding change of the year.

1.* 1.158 Chin-cups or Moss is in most common use in our Countrey against the Coughs of Children, and is vulgarly enough known as to its form and manner of growing. It is of an astringent nature (as far as we gather by its taste) and contains in it self par∣ticles somewhat sharp and biting, and smelling of plenty of volatile Salt: from whence we may safely conjecture that its use is to fix the blood, and to appease the fluxes of Se∣rum,* 1.159 and moreover by volatilising the nervous juice, to take away the convulsive disposi∣tion. It is usually administred in form of Powder, Decoction, and Syrup; according to the following Receipts.

Take of Chin-cups in powder one dram, Sugar-Candy one scruple, mix them; divide it into three or four parts, take a dose morning and evening with a fit vehicle.

Take of the same Cup-moss two drams, milk of Brimstone two scruples, powder of Anni∣seeds one scruple, divide it into six parts to be taken as the former.

Take of the same Chin-moss or cup-moss one dram boyled in milk for one dose; take it morning and evening. To those with whom milk doth not agree, or to whom it little profits, let it be boyled in Spring-water or Hyssop-water, or in any other pectoral water, and let it be given from two ounces to four, twice in a day, sweetning it with Sugar or some fit Syrup.

Take of this Muscus Pyxidatus or chin-moss one ounce, boyl it in two pints of some pectoral water to the consumption of half: To it strained adde of Sugar-Candy one pound, and evaporate it in a gentle bath, to the consistence of a syrup.

2. The other remedy for the convulsive Cough is wont to be,* 1.160 that they be cast in∣to some sudden fright; from hence, whenas medicines effect less, with the vulgar it is a familiar practice, that, to fright them, while a great Mill is driven about with a screeking noise, and a dreadful aspect of the wheels, the distempered be put into the Trough or Receiver of the Grain or Corn, and from thence the sudden cure of this disease sometimes happens. The reason whereof without doubt consists in this, that the Animal spirits being put to flight and forced into fresh distractions, they relin∣quish their former disorders; moreover, the convulsive matter is either dissipated by that disturbance, or is forced into other nerves where it is less troublesome.

The Empirical cure of this disease being described after this manner,* 1.161 together with the remedies vulgarly used, and the rendring a reason of the cause at least probably unfolded, from hence it will be lawfull to design a rational method of curing, and per∣haps more efficacious against childrens Coughs of this kind. Wherefore, in such a case sometimes successefully enough I have prescribed according to the following forms. And seeing we ought to begin with purging,

Take of the syrup of Peach flowers one spoonfull, of Aqua Hysterica one scruple, mix it,* 1.162 and let it be taken with government.

Or, take of Mercurius dulcis 6 grains, Scammony prepared with Sulphur, Resine of Jalap, of each three grains; make a powder, give it in a little Pulp of a preserv'd Cher∣ry to a lad six years old, and let the dose be encreased or lessened according to the age, let the Purge be repeated in 6 or 7 days.

If the Patient (as it often happens) be prone to vomit, Take of Oxymel of Squils 6 drams, Salt of Vitriol 4 grains, mix it for a child of six years old, and according to this proportion let the dose be accommodated to others. I have known a Vomit of this kind taken every morning for four or five dayes together with good success.

Vesicatories or Medicines drawing blisters are in daily use,* 1.163 and are applyed some∣times to the Nucha or nape of the neck, another while behind the ears, then to the inside of the arms near the arm pits, and as soon as these sores begin to heal in these places, let others be raised in other places.

Instead of Beer let the following Decoction be used for ordinary drink.

Take China-roots an ounce and half, of all the Sanders of each half an ounce, the sha∣vings of Ivory, and Harts-horn of each three drams, let them be infused and boiled in six pints of spring water to the consumption of half, adding Raisins stoned an ounce and half, Liquorish three drams.

Take of Spirit of Gum Ammoniac with Salt Armoniac a dram,* 1.164 Syrup of Chin-moss three ounces, Aq. hysterica an ounce: the dose is a small spoonful in the evening and morning fasting.

Or, Take of tincture of Sulphur two drams, dose three drops in the evening and first in the morning in a spoonful of the Syrup of Cup-moss.

To some endued with a hot constitution, and while they cough their countenance is spread with redness, or rather blackness, I have prescribed Phlebotomy or drawing of blood with Leeches to two or three ounces with good success.

Take Hog-lice living and cleansed two ounces, powder of Aniseed a dram, Nutmeg half a dram, fine Sugar an ounce, bruise them together, and pour upon them six ounces of Hysop-water, of Magistral Snail-water two ounces, stir them together a little, and press them out hard: the dose two or three spoonfuls twice a day.

Hitherto of a Cough and its Remedy, while it is only an entrance to a Consumpti∣on; now it remains to treat throughly of the distemper it self, having passed the li∣mits of this dangerous disease, and to design a method of curing, and the forms of rome∣dies, which are proper to heal an inveterate Cough, when either being neglected, or not easily giving place to remedies, it begins to degenerate into a Phthisis; namely when it arrives to that state, that the blood being dissolved in its consistence, doth not only pour out the superfluous Sorum, but also the nutritive Juice, and perhaps the ner∣vous, the Lympha, and other its superfluities on the Lungs, and lodges them within its passages;* 1.165 and in the mean time the corruption of the Lungs is so much increased, that the little Bladders being distended, or many of them broke into one, so that a solution of continuity or an Ulcer being caused, a greater plenty of corruption is daily heaped in; and moreover the matter in that place gathered together, because it is suffered to abide there long, putrifies, and for that reason doth still more corrupt the Lungs themselves, and defile the blood flowing through. In this case the Therapeutical indications shall be chiefly these three:* 1.166 viz. in the first place to stop the dissolution of the blood, which is the root of all this evil, and to make provision that it pour not out the matter any longer in such abundance upon the Lungs. Secondly, by expectorating the purulent mat∣ter heaped up within the Lungs, and to evacuate it quickly and sufficiently. Thirdly, to strengthen and dry the Lungs loosned from their unity, or being too loose or moist or otherwise infirm, lest they be daily more and more corrupted, and give more reception to the morbific matter. Every of these indications suggests various intentions of heal∣ing, and requires remedies of divers kinds and many ways of administrations. The chief of which we shall here briefly treat of.

1.* 1.167 Therefore what the first indication suggests, that the dissolution of blood may be prohibited, these three things (as much as may be) ought to be procured: viz. First that the mass of blood may contain and assimilate whatsoever of nutritive juice it may be furnished with; and that it be so proportioned, that it neither offend in quality nor in quantity. Secondly, that the acidities either generated in the blood, or poured into it from some other place, may be so destroyed, that the blood retaining as yet its mix∣ture or temperament, may not be prone to flowings and pourings out. Thirdly and lastly, that all the excrements produced in the blood may be derived from the Lungs to other Emunctories and places of Evacuations.

1.* 1.168 As to the first intention of healing, viz. that the nutritive Juice may be pro∣portioned to the blood, let it be advised before all things, that they who cough and are phthisical abstain chiefly from drink, and that they take liquid things in a very small quantity; for that the blood being infirm in its temperament, so long as it is not too much imbued with fresh juice, may be able to digest small portions, and retain it within its own consistence. Moreover, let that fresh juice consist of such kind of particles, which being mild and thin, may be tamed by the blood, and assimilated without any effervescence or heat. Wherefore Asses milk, also sometimes Cows or Goats milk; also Water-gruel, Cream of Barley, Ptisan, Almond-milks, and other simple nourishments will better agree and nourish more than Flesh, Eggs, and Gelly-broaths,

strong Ale, Wine, or any other kind of richer fare. Secondly,* 1.169 that the blood retaining its own temperament, be not easily dissolved into serosities injurious to the Lungs, it behoves that as well the acidities of it self as of other humors mixt there∣with, and chiefly the nervous and limpid ones be destroyed: which intention Medi∣cines prepared with Brimstone will best accomplish; which for that cause in this case (provided a hectic Feaver be not present) may be more frequently and in abundance taken. Wherefore the Tincture, the Balsam, the Syrup, the Flowers, and Milk of Sul∣phur in somewhat a large Dose may be exhibited twice or thrice a day. For the same reason traumatic or vulnerary Decoctions, also Decoctions of the pectoral Herbs com∣monly so called, also of the Woods, are to be taken instead of ordinary drink. Moreover the Powder of Crabs eyes, Hog-lice, and other things endued with an Alcali or volatile Salt are often administred with great success.* 1.170 The third intention of healing respect∣ing the first indication, viz. that the superfluous dregs of the depraved blood, (if they shall be very much predominant) being commanded out from the Lungs, may be dis∣charged by other Emunctories, suggests very many ways to be used for their dispatch. For besides Phlebotomy, Diuresie, and sometimes a gentle Purgation (which take place in all Coughs, yea in the beginning of a consumptive Cough, or Phthisis) hither also ought to be referred Baths, taking in a more warm air whereby they may more freely transpire, also Frictions of the extreme parts, Dropaces, Issues, Blisterings, or Depilato∣ries, Errhines, Gargles, and other private or public sluices either of humors or vapors.

The second indication in the beginning of a Phthisis, viz. that the consumptive matter laid aside within the Lungs may be easily and daily evacuated,* 1.171 is performed by expectorating Medicines. These are said to operate after a twofold matter, ac∣cording to which their virtue is conveyed two ways to the Lungs. For of those be∣ing taken by the mouth, some immediately dismiss their active particles into the Tra∣chea, which partly by making the way slippery, and loosning the matter impacted, and partly by provoking the excretory Fibres into Convulsions, do procure expectoration: in which number are chiefly accounted Linctus's and Fumigations. The expectorating Remedies of another kind, which deservedly are accounted more available, do exer∣cise their energie by the passage of the blood. For whereas they consist of such kind of particles which cannot be digested and assimilated by the mass of blood, being spread through the blood, because they cannot be mixt with it, they are presently again exterminated, and so penetrate from the pneumonic Arteries into the tracheal passages; where lighting on the matter they divide, and attenuate, and so disturb it, that the little fibres being irritated from thence, and successively contracted while they cough, the contents of the Trachea and of its little bladders are ejected upwards into the mouth. Medicines proper for this use besides Sulphur and the pre∣parations of it, are artificial Balsams distilled with Oil of Turpentine, Tinctures and Syrups of Gum Ammoniac, Galbanum, Asa foetida, Garlick, Leeks, and such like yielding a strong scent; from which also Lohochs and Eclegma's are prepared. And these work both ways, partly by slipping into the Trachea, and partly by entring the Lungs by the circulation of the blood, and assault the morbific matter both before and behind, and so exclude it with the greater force.

3. What belongs to the third indication, viz. that the frame of the Lungs being hurt, or their constitution vitiated, may be either restored or amended;* 1.172 such things are of use as resisting putrefaction do cleanse, heal, dry, and strengthen; to which intent also Remedies prepared of Sulphur, Balsamics and Vulneraries do agree. Hence some Empirics do not only successfully prescribe the smoak of Sulphur vivum, but also of Auripigmentum, to be suckt through a Pipe or Funnel into the Lungs. Moreover it is for this reason, that change of air and soil, viz. from Cities to the Country or sulphureous air, or the passage from one Region into another that is hot∣ter, is of such a signal advantage.

Hitherto of the Method of Healing, which seems to be of use against the more pain∣ful Cough, or Phthisis beginning; now it remains according to all those curatory indi∣cations to subjoin certain select forms of Medicines, which also, according to the way of healing described above in a slight Cough which is short of a Phthisis,* 1.173 we shall distin∣guish into certain ranks, viz. which are Mixtures, Linctus's, Lohochs, Tinctures, Bal∣sams, Troches, Lozenges, Powders, Pills, Decoctions, and distilled Waters. We shall set down some Examples of each of these: whereto also may be referred some of the forms of Medicines before described for a beginning Cough, and not as yet consum∣ptive.

1. Magisterial Medicines and Syrups.

Take of our Syrup of Sulphur three ounces,* 1.174 water of Earth-worms an ounce, tincture of Saffron two drams, mingle them. Take one spoonful at night, and first in the morning.

Take of Syrup of the juyce of Ground-Ivy three ounces, Snail-water an ounce, flour of Brimstone a dram, mix them by shaking. The Dose one spoonful at night and morning.

Take of tincture of Sulphur two drams, Laudanum tartarizated a dram, Syrup of the juice of Ground-ivy two ounces, Cinamon-water two drams: the dose one spoonful at bed∣time, and if sleep be wanting, towards morning.

Syrupus Diasulphuris. Take of Sulphur prepared after our manner half an ounce,* 1.175 best Canary wine two pints, let them be digested 28 hours in a water or sand Bath; which being done, take of the finest Sugar two pounds dissolved in Elder-flower-water, and boil to a height to make tablets: af∣terwards pour to it by little and little Wine coloured with Sulphur and warm, let it boil a little on the fire, strain it through woolen. You will have a most delicate Syrup of a gold colour, and for coughs and other distempers of the lungs (where a hectic Feaver and heat of the Prae∣cordium is absent) most profitable: the dose a spoonful morning and evening by it self or with other Pectorals.

Syrup of Garlick. Take ten or twelve cloves of Garlick stript from the little skins, and cut into slices, Ani∣seeds bruised half an ounce, Elicampane sliced three drams, Liquorish two drams, let them digest for two or three days in a pint and half of spirit of Wine close and warm; strain it clear and hot into a silver dish, and add a pound and half of fine Sugar, the dish standing upon hot coals, let the liquor be fired, and while it burns stir it; and strain it through wool∣len, and keep it for use.

Syrup of Turneps. Take Turneps sliced and fine Sugar of each half a pound, put them in a glased pot a lay of Turneps and a lay of Sugar, the pot being covered with paper, put it into an oven to bake with the bread; when it is taken out, press the liquor, and keep it for use: the dose one spoon∣ful morning and evening.

Syrup of Snails. Take fresh Snails with their shells n. xl. cleanse them with a linen cloth, afterwards each being run through with a bodkin, let the open shell be filled with powder of Sugar-candy, and being put in a linen bag, let them be hung in a cellar, it will dissolve into a Syrup and drop into a glass vessel set under it: the dose one spoonful twice or thrice a day in a convenient vehicle, viz. Milk-water or pectoral Decoction.

2. & 3. Linctus's and Lohochs.

Take of conserve of red Roses three ounces,* 1.176 of our tincture of Sulphur two drams, mix them in a glass mortar: the dose the quantity of a Nutmeg evening and morning. To this sometimes to appease a troublesom cough add from half to a dram of powder of Olibanum.

Take conserve of red Roses four ounces,* 1.177 flour of Brimstone four scruples, fine oyl of Tur∣pentine a dram, powder of Fox-lungs three drams, syrup of the juice of Ground-Ivy as much as will suffice to make a soft Lohoch, to be taken after the same manner, viz. morning and evening; also to be licked at other times with a Liquorish-stick.

Take powder of Sugar-candy four drams, tincture of Sulphur two drams, mix it in a glass mortar: take it after the same manner.

In the place of Tincture of Sulphur may be administred other balsamic Tinctures, viz. Balsam of Peru, Opobalsamum, Gum of Ivy, Guajacum, Amber, with many others, which either may be mixt with Conserve of red Roses, or with the Conserve of the flowers of Colts-foot, or with Sugar-candy.

4, 5. Tinctures and Balsams of the same nature and composition, but in a larger Dose are convenient in a Phthisis, which we have above prescribed for a beginning Cough.

Take of Tar an ounce, Lime-water thrice cohobated two pints, distil it in a Bath to half;* 1.178 afterwards being filtrated, let it be drawn off to the consistence of Honey in Balneo; to which pour half a pound of tincture of salt of Tartar, let it digest in a close glass to extract the tin∣cture: the dose from 20 drops to 30 in a fit vehicle. After the same manner is prepared the tincture of the black oyl of Soot, liquid Amber, liquid Storax, and many others.

Take of our prepared Sulphur an ounce, adding Mirrh, Aloes, and Olibanum in treble quan∣tity, draw off a tincture with oyl of Turpentine, also with rectified spirit of Wine: dose from 15 drops to 20.

6, 7, 8. Troches, Lozenges, and Powders, because they chiefly respect a Cough, are almost of the same nature and composition with those before-described for a new Cough; unless that for the drying and healing of the Lungs things sulphureous and Vulneraries are required in a greater proportion.

Take powder of the leaves of Ground-Ivy a dram, flour of Brimstone two drams,* 1.179 of Su∣gar penids a dram and half, with juyce of Liquorish dissolved in Hysop-water make troches of the weight of half a dram.

Take of Yarrow bruised and dried in the Sun half a dram, flour of Brimstone, Olibanum,* 1.180 of each a dram; powder of dried red Roses half a dram, Sugar dissolved and boiled to a height six drams, oyl of Aniseeds a scruple and half, make Lozenges of half a dram weight: take one three times or oftner in a day, and especially evening and morning.

9. Pills.

Take a pint of the juyce of Ground Ivy clarified in the Sun, flowers of Colts-soot dried,* 1.181 the tops of Hysop, Sage, Pennyroyal, each a handful; Aniseed, Caraway-seeds, sweet Fennel-seeds bruised, each half an ounce; distil them in Balneo Mariae to half; strain it and distil it to the consistence of Pills, by adding half a dram of juyce of Liquorish, powder of Elicampane, flour of Brimstone, each three drams; flowers of Benzoin a dram, Balsam of Peru half a dram, tincture of Sulphur three drams, tartarizated Laudanum two drams: make it into a mass, and form it into small Pills to be taken three or four evening, and first in the mor∣ning.

10. Decoctions, as I have above prescribed for a stubborn Cough,* 1.182 are used with suc∣cess against a beginning Phthisis. In a case almost desperate I have prescribed the fol∣lowing Decoction to be taken twice a day, and also instead of ordinary drink with very good success.

Take Lignum vitae four ounces, China, Sassaphras, each two ounces; of all the Sanders each an ounce, shavings of Ivory, Harts-horn, each three drams: infuse them, and boil them in twelve pints of Spring-water to half, adding Liquorish an ounce, Raisins stoned four ounces: strain it.

11. Distilled Waters, such as we have before prescribed, are specific here,* 1.183 whereto may be added Solenander-water of Hogs blood and Turpentine; also Balsamic Waters distilled from Turpentine with Pectoral Ingredients.

Take leaves of Ground-Ivy, white Horehound, Hysop, Pennyroyal, each three handfuls; root of Elicampane, Orris of Florence, each two ounces; Turpentine dissolved in Oyl of Tartar four ounces, Hysop-water four pints, Malaga-wine two pints; distil them in a sand Bath: let all the liquor be mixed, the Oyl separated: the dose two or three spoonfuls twice a day, with a spoonful of Syrup of Ground-Ivy.

12. In the last place we must describe the forms of Vapors and Fumes;* 1.184 the admini∣stration whereof doth use to profit more than any other remedies in a Phthisis not yet desperate, for that they arrive at the very Lungs, and so purge them by an immediate affect, dry them, and keep them from putrefaction, strengthen and open all their passa∣ges. 1. Therefore a moist steam may be made after this following manner.

Take leaves of Hysop, Ground-Ivy, white Horehound, each two handfuls;* 1.185 Elicampane two ounces, Calamus aromaticus half an ounce, Aniseeds and Caraway-seeds, each an ounce: boil them in a sufficient quantity of Spring-water: let the vapor of the hot strained liquor be drawn by the lungs through a paper rolled up like a cone or funnel: and used morning and evening for a quarter of an hour.

2. A fumigation or dry vapour, is made one while more mild out of meer Balsamics, another while more strong out of Sulphurs, and sometimes out of Arse∣nicals.

Take of Olibanum,* 1.186 white Amber, Benzoin, of each two drams, Gum Guaici, Balsam of Tolu of each one dram and half, powder of red Roses, and red Sanders, of each one dram to be strewed upon burning coals.

Take Gum of Ivie,* 1.187 Frankincense, of each two drams, Flower of Brimstone one dram and half, Mastich one dram, with a dissolution of gum Tragacanth, form Troches.

Take of white Amber,* 1.188 Olibanum, of each two drams, prepared Orpiment half an Ounce, Styrax, Labdanum, of each one dram and half, with solution of Gum tragacanth, make Troches for fumigation.

Mountebanks do ordinarily prescribe the smoak of Arsnick to be suckt into the mouth,* 1.189 like Tobacco kindled in a Pipe, and sometimes with good success: Moreover, it is in practice with the Vulgar, to burn like Tobacco in a Pipe little bits of cloth stained with Arsenick (such as wherewith the walls of Taverns are hung) and so suck the smoak into the consumptive Lungs for cure.

3.* 1.190 These things being thus unfolded concerning a Cough, and a Phthisis begin∣ning, both as to what belongs to the Pathologie, and cure; it remains now lastly to discourse of a more painfull Phthisis confirm'd, and almost desperate; and to con∣sult what is to be perform'd, when the lungs being very much vitiated, and affected with one or more filthy ulcers, neither the air nor the blood do rightly pass through them, but choak or corrupt the mass thereof, by continually suggesting filthy cor∣ruption; insomuch that a hectick feaver and an Atrophie, by reason of nourishment being frustrated, infest the diseased, with the loss of all their faculties, and by daily weakening their strength precipitate them to the grave. The most certain sign of this disease growing desperate, uses to be accounted a pain very troublesome with an inflammation of the throat; for this symptom argues a great putrefaction of the lungs, from whence the putrid effluvia's exhaling are thrown about in the narrow passage of the throat,* 1.191 which wound and grievously irritate those tender fibres there. In this case the cleansing of the lungs, as also the drying up of the Ulcer are in vain designed: for all hotter Medicines ordain'd for those purposes, and fit enough in the beginning of a Phthisis, are not to be endured in a confirmed one; inasmuch as augmenting the inflam∣mation of the lungs, they procure a hectick feaver, thirst, wathings, and other more painfull symptomes, or call them back afresh. For truly in such a state of this disease where onely the prolongation of life is proposed with a light toleration and an easie death; those remedies help chiefly, which bridle the fervour of the blood, allay the heat in the Praecordia, and restore the sprits, and gently cherish them. Hence for food, Asses Milk, also Water-gruel, Barly-broths, Cream of Barly, and for drink, Ptisan, Emulsions, water of milk distilled with Snails and temperate pectoral herbs, are usually of greatest success.* 1.192 Syrups and Linctus's, which appease the inflammation of the throat and Lungs, and facilitate expectoration, but chiefly the more mild Hyp∣noticks, whereby moderate rest may be procured, may be frequently or daily taken. The forms of these are common enough; but however according to our method, we will annex some of the more select of each kind.

Take of Barly half an ounce,* 1.193 candied Eringo roots 6 drams, parings of Apples one handfull, Raisins stoned two ounces, Liquorish three drams, boyl them in three pints of spring-water to two, make a Ptisan to restrain thirst: take it 3 or 4 times a day, also in the room of ordinary drink if it agree.

Take the tayls of twenty Crevises, candied Eringo roots one ounce, a crust of white-bread, Raisins stoned two ounces, Liquorish 3 drams, boyl them in 3 pints of Spring-water to two, strain it, and take 3 or 4 ounces three times a day. After the same manner is prepared the Decoction of Snails.

Take of Snails half-boyled and cut three pound,* 1.194 ground-Ivy 6 handfulls, Nutmegs sliced numb. 6. crum of white-bread two pound, fresh milk 8 pounds, distill it in a Pew∣ter Still. The same way is distilled the water of Crevise-tayls. The dose 3 or 4 ounces three times a day,* 1.195 sweetned with pearl'd Sugar or Sugar of Roses.

Take ears of greeen Wheat as many as convenient, distill them in a common still; drink three or four ounces three times a day, sweeten'd with pearl'd Sugar.

Take syrup de Meconio three ounces, water of green Wheat 6 ounces, mix them,* 1.196 drink two or three spoonfulls at bed-time, every or every other night.

Take Conserve of Mallow-flowers wild or garden three ounces, Lohoch de pino two oun∣ces,* 1.197 Syrup of Jujubes two ounces, make a Lohoch, of which take often a dram and half or two drams.

What hitherto we have discoursed of concerning a Cough of every kind (whether it be solitary and simple, or the forerunner and companion of a Phthisis) also what is to be prescrib'd in every case touching the method of healing, it would be easily illustrated by the history of Cures, or by the Anatomical observations on those that have dyed by that disease. For instances of this sort, and very many examples are every where had, and happen daily; it pleases us here to annex a few of the more select, out of the large choice of these, accommodated to the chief kinds of a Cough, and Phthisis. And first I will endeavour to illustrate the type of a simple Cough by one history or two, and which takes its rise of it self, and is altogether void of the suspicion of a Phthisis.

It is now many years since I took care of the health of a certain Student,* 1.198 ob∣noxious to a Cough from his tender years, and who was wont frequently to undergo the more painfull affections of it, and those of long continuance. This person seem∣ed of a melancholick temper, of a sharp wit, of an indefatigable spirit, of a consti∣tution indifferently strong, but that his Lungs originally being infirm, did suffer when the blood dissolv'd into serosities. In Summer as long as he transpired freely, he lived healthily enough; but in the Spring and Autumn, when the blood changing its tem∣perament, those serous fluxes came upon him either of their own accord, or from any sleight occasion, he fell easily into a Cough with abundant and thick spittle; not∣withstanding this distemper frequently within six or seven dayes, as soon as the mass of blood was purged throughly by the Lungs, vanished leisurely without any great use of remedies. But if to the aforesaid occasions of this disease were added some stronger causes, as chiefly the obstruction of the pores, and errors touching his diet, sometimes a more prodigious and stubborn cough, neither presently nor easily yielding to remedies, and threatning nothing less than a Phthisis, did come upon him, then manifestly the patient for the first days suffered light shiverings in his whole body, and the sense of a Catarrh in his Larynx; afterwards by frequent cough∣ing with thin spittle, together with a giddiness, he was afflicted with numness of his senses, and a dropping at his nostrils.

In this state his best remedy was wont to be, and frequently tryed with success, to drink a little more freely generous Wine, and any other liquor very sparingly: for so the acidity and fluor of the blood being suppressed, and transpiration procured more freely, he was much eased, and sometimes recovered health in a short time. More∣over at night and early in the morning he was used to take seven or eight drops of the tincture of Sulphur in a spoonfull of Syrup of Violets, or of the Juice of Ground Ivy, or

Take Conserve of red Roses three ounces, spirit of Turpentine two drams mingled, the dose the quantity of a chesnut evening and morning.

If that these remedies together with the Canary Antidote and thin diet effected little, the disease not being so cured, spinning out into a long period, and pressing him sharply for many weeks, yea sometimes months, it reduced the sick to a remarkable leanness, and to the very brink of the Grave. For then the Cough daily encreasing and being very troublesome, did very much impede and break his sleep, his strength languished, his appetite was dejected, heat and thirst molested him; in the mean time spittle every day encreased, and was cast forth in great plenty; so that not onely the Serum of the blood, and the recrements, but also the nutritive Juice, and the drain∣ings of the solid parts being continually poured out upon the lungs, turn'd into cor∣ruption, which was abundantly cough'd out; moreover his breath was difficult, his joints very infirm, and his flesh very much consumed.

When of late our patient laboured after this manner, we prescribed the following method, and remedies, by the continued use whereof at length he recovered his health. First of all, a thinner diet being appointed him, and for the most part Ale being forbidden altogether, he took twice in the day of the following Apozeme about six ounces warm, and a little at other times cold to restrain his thirst.

Take of the roots of China two ounces, Sarsaparilla three ounces, white and yellow San∣ders of each one ounce, Ivory and Harts-horn of each three drams; infuse and boyl them in 8 pints of water to half, adding Raisins of the Sun 3 ounces, Liquorish 3 drams, strein it, and keep it for ordinary drink.

Take tincture of Sulphur three drams, take from seven drops to ten, at night and in the morning, in a spoonfull of syrup of Violets, or of syrup of the juice of Ground-Ivy.

When he began by continual use to nauseate this Medicine, in its place the fol∣lowing Eclegma was appointed.

Take conserve of red Roses three ounces, spirit of Turpentine two drams, mix them; the dose is one dram, at the same hours.

Afterwards instead hereof the following Powder was sometimes taken.

Take of the powder of the leaves of ground-Ivy dryed in the Summer Sun three ounces, Sugar-candy half an ounce, mix them, the dose half a spoonfull twice in a day, with three ounces of the following water.

Take Ground-Ivy 6 handfulls, Hyssop, white Hore-hound, of each 4 handfulls, Lambs∣lungs half-boyl'd and cut small, pour upon them eight pound of Posset-drink made with small ale, distill it in common Organs, the liquor being mixed, let it be sweetned to the taste as it is used with Sugar-candy or syrup of Violets.

To appease his almost continually troublesome Cough,* 1.199 he swallowed the following Troches, and sometimes a little of the extract of Liquorish.

Take of the species of Diatragacanth. frig. 3 drams, Annise, Carue, sweet Fennel∣seeds, of each half a dram, flower of Brimstone two scruples, flowers of Benzoin one scruple, extract of Liquorish dissolv'd in Hyssop-water; make a paste which form into Troches. Or,

Take of Species Diaireos, è pulm. Vulpis, of each two drams, flower of Sulphur, of Elecam∣pane, of each half a dram, Oyl of Anniseeds ℈ss. Sugar dissolv'd in a sufficient quan∣tity of Penniroyal-water and boyl'd to a body ℥ vj. form Lozenges of half a dram weight, let him eat one, swallowing it by degrees, as oft as he will.

In the midst of this course, although he was endowed with a weak pulse and more cold temperature, we breath'd a vein in his arm: moreover, with these remedies, the chiefest help accrued to him from the open air, which for the most part he daily enjoyed, either by riding on Horse-back, or in a Coach; for from hence he first be∣gan to recover his appetite, his digestion, and sleep; whereto afterwards a relaxati∣on of the other symptoms did sensibly follow, till at length he recovered his entire health. As often as he was afflicted since then with a stubborn and tedious Cough, he used a method like this, and with the like success; and now although he lives alto∣gether exempt from that distemper, notwithstanding he is constrained to decline care∣fully all occasions or causes whereby either the pores might be shut, or the flux of blood or its precipitation into serosities might be provok'd; which were chiefly his going by water on the Thames at London, and drinking of acid liquors, as Cider, French or Rhenish wine.

From the above-mentined history, you may easily conceive both the means and the reason of healing of the Cough, (which caused by the fault of the blood, is without the limits of a Phthisis): The other follows, which illustrates the nature of the same distemper, when it chiefly proceeds from the nervous juice.

A Boy about ten years of age,* 1.200 of a hot temper and fresh countenance, from his infancy obnoxious to a frequent Cough, in his succeeding years sustained more grie∣vous and lasting fits and assaults of this distemper, and by turns was used to labour with a strong and shrill Cough,* 1.201 without spitting, which almost continually afflicted him day and night, and so infesting him many days, yea weeks, brought the sick to utter weakness. Afterwards the period of his disease being come (which happened not but by consuming the store of th morbific matter) he again in a short time became healthy enough, and very free from any sickness of the Thorax: till the morbific matter (as it seems) being heaped again to great abundance, without any evident cause, the same di∣stemper

returned and performed its Tragedy with its wonted fierceness. About its first beginning the Cough was troublesom only morning and evening: after wards the evilby little and little increasing, he almost continually coughed whole days and nights, and if at any time sleep happening of it self, or by the use of Anodynes, afforded any truce, a more outragious fit of couhing succeeded his wakening. After this manner most frequently and fiercely coughing without any spittle, he laboured for three or four weeks, till he was brought to an extreme leanness and weakness; and then the sickness leisurely remitted, so that he coughed somewhat seldomer, and enjoyed moderate sleeps; afterwards in few days growing very hungry, being quickly made full of flesh and vigorous, he recovered his former health in a short time. Fits of this kind more sel∣dom infested him in Summer-season, but in the restof the year, repeated three or four turns, and brought the sick even into great hazard of life.

If disquisition be made of the nature, causes, and formal reason of this unwonted and as it were irregular kind of Coung, it is manifest it proceeds like all other, from the provocation of the Lungs; nevertheless as to the matter exciting, its seat, and manner of affecting it is doubted: because neither thick spittle, nor plentiful thin (as is usual in other distempers) is here cast out; neither doth the Patient complain of feeling a Catarrh, nor of any weight of the Lungs. Wherefore, not as in a common Cough, does the serous humour either slowly or plentifully sweating out of the Trachea or pneumonic vessels into the little bladders or pipes of the Trachea, induce the afore mentioned symptoms: But it is plain from thence that the passages of the aspe∣ra Arteria are wholly empty of the serous or thick humour, because the deep and sounding Cough throws off nothing. Moreover, neither from the blood impacted in the Membranes of the Lungs, doth this Cough take its origine, because neither fea∣ver, nor thirst, nor pain are present here as in a Peripneumonie. Besides, neither doth the morbific matter seem to adhere to the nerves or muscles appointed to the function of breathing; because then besides a Cough, Asthmatical or otherwise con∣vulsive fits would sometimes urge with a sense of strangling; which notwithstanding did not happen to our patient.

Having frequently and seriously meditated about the aetiologies of this very diffi∣cult case, I am at length induced to think, that a certain serous and sharp matter, as being loaded with a scorbutical taint, falling from the head by the passage of the nerves, doth enter into the nervous fibres and Membranes of the lungs or Trachea; which cleaving throughly to them, is by degrees encreased to a fulness,* 1.202 and at length be∣ing chaf'd, and grown turgid with a perpetual provocation, creates so troublesom a Cough. We have in another place declared the matter of this kind impacted in the Coats of the guts, and the neighbouring parts about them, not rarely to excite a scorbutical Colick, for many days, yea sometimes weeks, infesting them with vo miting and a most sharp torment; and what else is this Coungh, but a certain convulsive distemper of the lungs, whose taint notwithstanding, according to the capacity of the part labouring, is imprest rather and more on the motive, than on the sensitive Power. For the lungs however twicht adn hurt, do suffer small pain, or scarce any at all; not∣withstanding from any light occasion, they are invaded by storms and fits of coughing. Indeed we compare this distemper of coughing so much the rather to the Colick, because the subjects of either of them, that is to say, the Trachea, and the guts, as to their coats, vessels, little fibres and glandules, are after the same manner fashioned.

The chief cause of the Cough now deseribed, depends upon the morbific matter heaped together within the little fibres of the rough arteries, to a provoking fulness; wherewith when they are loaded, first a quick and painfull breathing infests onely, with amornings Cough; because from the beginning onely some small portion of that matter being disquieted provoke the part: afterwards when the whole mass thereof growing turgid, almost perpetually twitches the fibres, there follows a most troublesom cough; which also being often repeated, endures a long season; because the morbifick mass impacted in the parts affected, is neither presently cast off by the strength of na∣ture, nor easily gives place to any remedies.

For in all the fits of this disease, I have made tryal of various methods of curing, and of medicines of divers kinds, though with little success. That distemper begin∣ning at any time, is wont to make a long period, maugre all remedies. The medicines commonly called pectoral, as Syrups, Lohochs, Eclegma's, or Lambitives, have con∣ferred little benefit to its cure; not withstanding sometimes it hath seemed good to

admit of them into use for this purpose, that they might make slippery and moisten the Lungs, lest they run the hazard of being rent by a violent Cough, and their vessels burst asunder: for sometimes a more fierce fit troubling our sick Patient, he hath been wont to cough out a little blood, though no thick spittle.

A gentle Purge both in the beginning and declination of this distemper hath succeed∣ed well. Opening and diuretical Apozemes are ever administred with success, both which he used enough through his whole course instead of ordinary drink. Evening and morning he took some drops of the Tincture of Sulphut with the Milk-water of Snails; late at night I was sometimes constrained to administer a Dose of Diacodion or of liquid Laudanum: his belly for the most part loose enough, that it seldom required Clysters: in two of his fits he breathed a vein, whereby nothing of success ensued.

In the last fit,* 1.203 beinning about the Autumnal Equinoctial, which passed away a little more lightly and gently, this following method of healing was observed.

First of all this Purge was given,* 1.204 and after four days repeated. Take of Mercurius dulcis ten grains, Resine of Jallop four grains, mix and make a powder to be taken in a spoonful of Syrup of Violets.

Take China-roots sliced a dram,* 1.205 Grass-roots three ounces, Chervil an ounce, candid Erin∣goes six drams, shavings of Ivory, Harts-horn, each three drams; Raisins of the Sun stoned three ounces: boil these in three pints of Spring-water to two pints, strain it, and use it for ofdinary drink.

Take syrup of Jujubes two ounces,* 1.206 Diacodion an ounce, spirit of Salt Armoniac with Gum Ammoniac a dram, mix them: the dose a spoonful at night and early in the morning. He was mauch relieved with this medicine, notwithstanding he took it only every other or third day, and for change sometimes a dose of the tincture of Sulphur with syrup of Violets.

The disease declining a Purge was twice repeated, and afterwards, recovering his health by degrees, within two weeks he became healthy enough. But when I beheld him not only obnoxious to frequent relapses of coughing, but every fit to be irresisti∣ble when it assaulted him, and its stay very long notwithstanding the use of remedies, and all this threatning no less than a Phthisis at length; I advised that as well for his preservation, as for the more easie cure of the distemper, if it should return, he should travel into a hotter Region. Hereupon he did not much delay, but sails into France about the beginning of November, and from thence by a straight journey to Montpelier, where abiding half a year he was sick only twice and both tiems lightly: afterwards returning into England quite free from a Cough, praise be to God he enjoys his perfect health.

SECT. I. CHAP. VII. Of Spitting Blood.

HItherto of a Cough and Phthisis, as well in its beginning as confirmation; which are the most common affects of the Lungs, and most especially dangerous. Besides which there are many other diseases of those parts that do occur, which when they are not at all, or not seasonably enough cured, for the most part de∣generate into a Phthisis. These passions, or at least the chief of them, (as we have be∣fore hinted) are spitting of blood, an Imposthume, or Ulcer of the Lungs, a Peripneu∣mony, Empyema, a Pleurisie, a Tumor of the Lungs, and obstructions by reason of things divers ways concreted, viz. sometimes little Pustles and Scirrhus's, another while gravel and little stones, and sometimes other preternatural matter; and lastly hitherto belong an Asthma and convulsive distempers of the Breast. Of these we shall treat in order, and first of Spitting blood.

The spitting of blood out of the Lungs and the ejection thereof by Cough sometimes less and almost none,* 1.207 another while more violent, is a distemper frequent enough, and truly an admiration it is, that it happens not more frequently. For whereas the vessels bringing blood are divided into twigs and innumerable slips, and those very small; and whereas the blood even siercely boiling, is violently conveyed through them all, complicated after divers manners and variously intorted; we can hardly conceive how

the circulation thereof being so perplexed and intricate, and also so impetuous, should be performed without some impediment and interruption. And truly we conclude it to be very difficult in living bodies, because it hardly succeeds by injection in the dead: for as much as liquor sent therough the entrance of the pneumonic Artery, will not rea∣dily and easily return by the Veins; but sticking longer in the passage, and skipping over the usual passages, variously runs out into the little bladders and other canals of the Trachea, and into the interspaces and other various gaps of the little Lobes.

Concerning an Haemoptosis or spitting blood we are to consider,* 1.208 first out of what vessells, and by what distemper the blood bursts out; secondly in what places most fre∣quently laid up; thirdly by what means it is wont either to be ejected or brought up∣ward, that it may be discharged by the mouth.

As to the first, we are to suppose by the Law of Circulation, that the blood of it self bursting out, doth altogether proceed from the Arteries: for the Veins, as long as they remain whole, do reduce it towards the Heart, and not at all pour it out; although we deny not that sometimes they being hurt by a wound, fall, bruise, or some violent acci∣dent, so as to be loosned from their unity, do let go the blood out of their cavities.* 1.209 Nevertheless the blood most commonly causing an Haemoptoe or blood-spitting, pro∣ceeds from the little mouths of the Arteries being open or torn; and then the fault is wont to be either in the ill temperament of the blood, or ill framing of the vessels.

Of either of these there are variousw kinds and differences,* 1.210 which also concur after a diverse manner to provoke the spitting of blood. For the blood being sometimes more thin and also sharp, it unlocks or corrodes the mouths of the little Arteries; and sometimes again being more thick and prone to coagulate, when it cannot readily enough be received by the Veins, it is extravasated. By reason of these faults in the blood, they who labour with the Scurvy or with a pestilent Feaver, as also those who have drunk some sort of poison, do srequently fall into a spitting of blood. Neither is this distemper less wont to arise from the fault of the vessels, in as much as those being too tender or too thin, many times are burst by a violent motion, as by coughing, hol∣lowing, leaping, or other vehement exercises; or for that being too loose and moist, their mouths open, and suffer the blood to break out of its circulation: moreover some∣times for that the Veins being contracted and wrinkled by cold, do not readily pass away the blood, but the same restagnating distends the little Arteries, and bursts out of their mouths.

As to the Arteries, out of which the blood breadks, causing a spitting of blood,* 1.211 it concerns much of what sort they are, and where they are placed; for besides that there arise notable differences of bloody spittle, according as the blood breaks out from a smaller or a greater vessel; and if either of them be placed in the top of the Lungs near the Larynx, or in the middle region thereof among the greater branches of the vessels, or lastly in the lower region among the orbicular little bladders: moreover we observe, that the Arteries which use to void blood, are either of the number of them,* 1.212 which arising out of the pulmonary Trunk, do every where accompany the branches of the Trachea; or of those which owning their origine to the Aorts, do cover the coat of the Trachea with a thick branching.

For it is apparent (as we have declared before) from the mouths of these, as also of the Glandules, and unctuous humor sweats out to make the inner superficies of the Tra∣chea slippery;* 1.213 moreover in as much as a serous houmor distils abundantly ont of the same into the cavity of the rough Artery, a Catarrh arises. Wherefore we doubt not at all to affirm, that even fro the mouths of these being open, meer blood sometimes soaking into the Tracheal passages, does propagate a bloody spittle, though in quantity very small. I have observed many, who without a Cough or any indisposition of the Lungs, have once or twice a day voided one or two bloody spittles: which as often as it came upon them, the Patients perceived, either in the bottom of the throat, or on the top of the breast a kind of distillation; whence immediately by the meer contraction of the Tracheal Fibres, with a Snail-like motion, a little of the fluid blood being mixed throughly with flegm, and not at all frothy, is voided: and when some∣times that distemper had lasted for many months, no prejudice ensued from thence, which might bring or threaten a Phthisis: which would not have come to pass, if any of the pneumonic Vessels had been opened.

2. So much concerning Vessels voiding blood, and of their divers affections.* 1.214 What belongs to the places wherein the extravasated blood is deposited, these chiefly and al∣most only arew the rough Artery, and the inward cavity of the parts thereof. For into

this, as into a Jakes, all the filth or superfluities of all the rest of the passages are deri∣ved by the utmost endeavours of Nature, as far as is possible, to be presently sent out of doors. But if the extravasated blood be thrown into the interspaces of the little Lobes, or soaking out of the outer Membrane, fall into the cavity of the Thorax, it doth propagate an Empyema, and frequently an Imposthume in that place. But for the most part the blood subject to fall from the pulmonary course, produces various kinds of bloody spittle;* 1.215 according as it makes its nest, either upwards within the cavity of the Larynx, or a little beneath about the intermedial passages of the Trachea, or lastly further within the orbicular little bladders. The first distemper proceeds alone from the mouths of some Artery being opened, which covers the trunk of the Trachea; the next sometimes perhaps from this cause, yet more often from the pneumonic Ar∣teries themselves being open or burst asunder, which vessels as they are greater, pour out often a dreadful quantity of blood; the spitting out whereof proves plentiful and violent, in regard that the muscles of the whole breast, together with the fibres of the Trachea are much provoked and greatly contracted. But if the spring of bloody spit∣tle consists in the lowermost little bladders, the blood is thrown out more sparingly, but with a profound, frequent, and very troublesom Cough.

3. And from hence (which was in the third place purposed) the differences of bloo∣dy excretion out of the Lungs, and the manifold modes and courses of bloody spittle are made known. For the blood soaking into the Larynx, after a small tickling in the throat without coughing or hawking, doth easily and almost insensibly ascend into the mouth: and if an extravasation of this kind of blood happens in sleep, it presently flows out of the mouth upon wakening, they being scarce sensible of it; in as much as the moving fibres of the Trachea being contracted while one sleeps, have then emptied the blood fresh distilled into the mouth. But if from a greater vessel gaping or burst about the middle of the Lungs, the blood (which is ever frothy) does break out abundantly into the Tracheal passages, this by an outragious Cough raised there∣by is forthwith cast upwards with violence and in great plenty; insomuch that the sick seem rather to vomit than cough out blood. And finally, if the blood breaking out of the foldings of the vessels wherewith the orbicular little bladders are incompassed, falls down into those little cells, from thence it is discharged by turns in lesser quantity, and not unless by a strong and very frequent Cough.

So much concerning the formal reason,* 1.216 the conjunct causes and differences of an Hae∣moptoe: as to what belongs to the primary and evident causes, either of them are ma∣nifold and various. In the former number are reckoned, first an hereditary indispo∣sition of the Lungs, whenas they have originally been weak and soft with a straitness of the breast. Moreover their ill temper from a Cough, Empyema, or Pleurisie going before, and especially an obstruction or ill conformation do very much dispose to spit∣ting blood, and so much the rather, if in such a habit an acrimony or Dyscrasie of the blood shall accrue from an ill course of Diet, unwholesom Air, or by any other means. The suppression of the Menstrua, the Haemorrhoids, or blood flowing from the No∣strils incline most to a spitting blood. Secondly, among the evident causes ought to be reckoned primarily the excess either of heat or cold; for when the blood grows above measure hot, or the transpiration thereof through the Pores of the skin is hindred; there∣upon swelling after a huge manner, it frequently bursts out of the pneumonic Vessels. From hence Hippocrates long ago observed, and as yet it is a vulgar observation, That spitting blood most frequently happens in the winter when the North-wind blows. Nei∣ther less seldom hath the use of bathing brought this evil upon many, before the use whereof they were healthful enough. Moreover many contract this from drinking of wine and strong waters, from a blow, a fall, hollowing, vomiting, coughing, or any other violent stirring of the whole body or of the Lungs. Also certain poisons, and according to Hournius the Lunar beams (the reason whereof doth not easily appear, neither doth there remain any credit thereto) are reported to provoke this distemper.

The Prognostics of this disease are enough known to the vulgar,* 1.217 whereas there is not any one of them, who doth not suspect the spitting of blood as very dangerous. Nevertheless whereas the kinds hereof are various, one is found more or less dangerous than another. The blood soaking out of the vessels of the Trachea is often free from any evil: moreover when breaking out from the lowest and lesser pulmonar Vessels, it often admits of Cure; at least it is much safer than a plentiful spitting of blood hap∣pening from the great branches of the Artery being opened into the Trachea. But the predisposition of the Patient makes a great difference in the Prognosticks of this dis∣ease:

for if blood-spitting be provoked by reason of a solitary evident cause, and shall happen to a body formerly sound and well set, there appears far greater hope of help, than if the distemper arising of its own accord shall happen to a cachectical, phthisical, scorbutic, or otherwise sickly body. However 'tis a common observation, that this disease is dangerous and always difficult to cure: the reason whereof is also clearly ma∣nifest, for as much as the function of the Lungs consisting in a perpetual motion, is al∣together contrary to the method of healing a wound, whereto primarily ease and rest are required. In like manner this happens to be a greater hindrance to its Cure, in as much as the frame of the Lungs is not a Parenchyma (as was thought) but a texture or very subtile web of innumerable vessels; the unity whereof if once dissolved, it will be altogether impossible for the ends of the disjoined vessels to meet again together, or the space to be filled up with flesh or callous, as in other parts. But there is this only to be hoped, that while the ends of the vessels grow together incongruously and always imperforated, the circulation of the blood ceasing in the part distempered, may be sup∣plied by another neighbouring part: which indeed rarely succeeds without hurt or prejudice of the whole Lungs.

As to what appertains to the Method of healing the Haemoptoe or spitting blood,* 1.218 the curative indications shall be chiefly these two, viz. to stay presently and restrain the flux of blood; then secondly, to heal the dissolution of unity without any relicts of a Consumption in the Lungs.

I. As to the former, these two things are chiefly to be procured,* 1.219 viz. first that blood flow not to the part distempered; and secondly, that in the mean time the opening of the vessel may be some-how shut.

1. That the blood may not flow to the part distempered,* 1.220 there are many intentions of healing in use, viz. it will be requisite to diminish the abundance of blood, to restrain the boiling thereof, to alter the intemperament, and depress its motion or divert it another way: for which purposes Phlebotomy, Ligatures, and Frictions are often con∣venient: also Juleps, Decoctions, Emulsious, and succulent Expressions of Herbs ought to be drunk. Likewise moderate Hypnotics, and in the first place Diacodiates are ex∣hibited with success: for these, by restraining the motion of the Heart, do force the blood to cool.

2. That the opening of the vessel may be shut,* 1.221 astringent and agglutinating reme∣dies are in the first place convenient. The chief of these are used to be exhibited in the form of a Linctus, so that while one swallows, certain particles gliding into the rough Artery, may more immediately communicate their power to the part disea∣sed. But the reason of this operation seems not to be of any great moment; because the efficacy of the Medicines themselves, chiefly and almost only by the conduct of blood reaches to the seat of the disease. Wherefore not only Lohochs, but also De∣coctions, Powders, and Pills of vulnerary and balsamic Ingredients are prescribed with success. The forms hereof we shall annex beneath.

II. The second indication, which is also preservatory,* 1.222 respecting the healing of the dissolution of unity without any remaining hurt of the Lungs, ought to provide against two sorts of evils, viz. lest the spitting blood (whereunto the distempered are afterwards always prone) begin again; and lest a Phthisis succeed, which threatens every body subject to the Haemoptosis. For these ends for the prevention of this disease daily care and constant course of healing ought to be ministred to the blood and Lungs.

1. As to the blood, the mass thereof ought to be contained ever in a due quantity,* 1.223 and a right temperament, with a mild and equal motion. Hence lest it superabound, or distempered with a Dycrasie enter into turgescencies, or lodge its impure feculencies in the breast: it is requisite sometimes to use Phlebotomy and a gentle Purgation. An exact course of Diet is always necessary. Moreover for the depurating and sweet∣ning the blood, drinking of Asses milk, or of Medicinal waters sometimes does greatly help. But Decoctions, distilled Waters, Juices of Herbs, which carry away the ill temperaments of blood, and derive the Serum and other impurities from the Lungs, and bring them forth either by Sweat or Urine, are to be carefully drunk. Besides for this purpose Issues do chiefly conduce.

2. Neither ought there to be less care of the Lungs themselves,* 1.224 namely that the whole frame thereof, and chiefly the place affected, be preserved in due frame and right tone. Hence every violent motion, whereby its unity is more dissolved, or the restitution thereof hindred, should be industriously declined. Let the party live

in a clear and open air, but not too fierce, or sharp; let him abstain from grosser foods, from Noon-sleeps, from plentiful Suppers, and other errors in diet, which in∣duce either repletion or obstruction upon the Praecordia. But let remedies be admit∣ted in daily use, which by a peculiar property, or certain specifick vertue are reported to heal the Lungs.

The method of healing requisite for spitting of blood, being shadowed after this manner, there yet remains as to all the therapeutic indications, and according to the various intentions of healing which belong to them, for us to subjoyn some more choice forms of Remedies, whose Van those deservedly lead which meeting with the symptom most urging, do suddenly restrain the flux of blood cast out by coughing or otherwise out of the Lungs. In the first rank of these Medicines those are reckon'd which hinder the blood from flowing to the part affected, and together are impregnate with a certain astrictive and agglutinative power whereby the opening of the vessel may be shut;* 1.225 and after the Belly being cleared with a Clyster, and Phlebotomie (unless a weak pulse and defect of heat withstand it) made use of, there is wont to be given somewhat in form of a Julep, Decoction, Emulsion, juicy Expression, Powder, Pills or Lohochs. We will annex certain more elegant and more efficacious Receipts of all of these, as likewise of Narcoticks, which notwithstanding ought not every where and indifferently to be used, but methodically and seasonably, according to advice of a discreet Physician, according to the various constitution of the patient and con∣dition of the disease.

1. Juleps and Distilled Waters.

Take of Purslain and Poppy-water of each 6 ounces,* 1.226 Dragons-blood in most fine powder half a dram, syrup of red Poppies two ounces, spirit of Vitriol of Mars ℈ss. mix them; the dose ℥ iij. repeated once in 5 or 6 hours.

Take of Plantane-water lb j. Gum Tragacanth and Arabick powder'd, of each ʒss. mingle and dissolve them; after adding syrup of dryed Roses ℥ j ss. make a Julep; the Dose ℥ iij. or ℥ iiij. every third or fourth hour.

Take of the water of Oak-buds, red Roses, Water-lillies, of each ℥ iiij. of Blood-stone finely ground, Bole-Armenick powder'd, of each ʒss. syrup of Water-lillies ℥ ij. mix them; the dose ℥ iij. or ℥ iiij. three or four times a day.

Take of the Dew or almost insipid Phlegm of Vitriol lb j. Syr. of Myrtles ℥ ij. mix them,* 1.227 the dose ℥ ij. or ℥ iij. often in the day or in the night.

Take of Cypress-tops M. viij. of the leaves or flowers of Willow M. vj. the greater Comfry-roots, Water-lillies, of each lbss. Pomegranate flowers M. ij. All being cut small together, pour on them lb viij. of new Milk; let it be distill'd in common Organs, the dose ℥ iij. or iiij, often in a day.

Take of this distill'd Water, and of Plantane-water, of each lbss. Gumm Tragacanth and Arabick of each ʒ ij. dissolve them; the dose is ℥ iij. every third hour.

The following Mixture is prescribed by Dr. Frederick Decker, to be taken a spoon∣full at a time in spitting blood, and seems a very beneficial one.

Take of Plantane-water ℥ ij. Cinnamon-water ʒ ij. conf. of Hyacinth ʒ iss. distill'd Vinegar ℥ss. of red Coral prepar'd ʒss. Balaustins, Dragons-blood, of each ℈ ss. Lauda∣num Opiate gr. iij. Syr. of Myrtles ℥ j. mingle them.

Take of Plantane, red Rose, and Purslain-water, of each ℥ iiij. of Blood-stone and Dragons blood reduced into fine-powder,* 1.228 of each half a dram, Sugar-Candy ʒ vj. make a Julep.

A Solution of common Vitriol, or of Vitriol of Mars made in Spring-water, and ap∣plyed with a rag to a wound, wonderfully stops bleeding, but is scarcely convenient to be given inwardly.

2. Decoctions, Tinctures, and Emulsions.

Take the leaves of Blood-wort,* 1.229 Periwincle, Mouse-ear, Plantane, Wood-sorrel, both sorts of Daisies, of each one handfull, red Rose leaves half a handfull, Barly half an ounce, Raisins two ounces, boyl them in three pints of Smith-forge water filtred, (or water wherein hot Iron hath been often quencht) to two pints. To the strain'd liquor

add two ounces of the syrup of the Juice of St. John's-wort, or of Mouse-ear, make an Apozeme, dose from four ounces to six, three times in a day.

Take the leaves of St. John's Wort, roots and leaves of Tormentil, of the greater Burnet, Meadow-sweet, of each one handfull, of the seeds of Purslain, Plantane, Sorrel, of each one dram, Conserve of red Roses half a pound, Spring-water eight pound, boyl them for 12 hours in Balneo Mariae, to it being strained adde half a scruple of the spirit of Vi∣triol of Mars, to be taken as the former.

Take of Barly-water with Madder-roots boyled in it a pound and half,* 1.230 infuse in it be∣ing warm a handfull of red Rose-leaves, adding one scruple of spirit of Vitriol, after three hours strain it, adding Syrup of the Juice of St. John's wort one ounce and half, take three or four ounces, three or four times a day.

Take of the decoction of the roots of fresh Nettles a pound and a half,* 1.231 white Poppy and Henbane-seeds of each two drams, Melon-seeds 6 drams, make an Emulsion, sweeten it with Sugar penids; the dose is three ounces, three or four times in a day.

3. Juices of Herbs and juicy Expressions.

Take of the Juice of Plantane half a pound,* 1.232 take two or three drams three times a day, in 3 ounces of the distilled water prescribed before; sweeten it to please.

Take of fresh Nettles, Plantane, the smaller Daisies, of each 3 handfulls, bruise them, and pour upon them of Purslain-water 6 drams, make an expression, take it as the former.

4. Powders and Pills.

Take of the powder of Blood-stone, Dragons-blood, ground with Rose-water on a Mar∣ble,* 1.233 Pearles, of each one dram, Bole Armenick, and Earth of Lemnos, of each half a dram, Troches of Winter-cherries two drams, make a powder, divide it into twelve parts, one part to be taken three times a day in the former distill'd water.

Take of Henbane, white Poppy-seeds, of each 10 drams, sealed Earth, red Coral, of each 5 drams, Sugar of Roses three ounces, make a powder, the dose one dram morning and evening; this composition made up with a fit Syrup into a soft consistence, was anci∣ently call'd and renowned in Germany, by the name of Helidaeus Electuary.

The aforesaid Powders with the addition of Gum Tragacanth dissolv'd, or some fit syrup,* 1.234 may be reduced into Pills or Lozenges.

The spongious excrescence usually growing to the fruit of Hipps or Dog-bryar, reduced into powder, half a dram taken twice a day, is a very profitable remedy in spitting blood.

Take of Yarrow bruised and dryed in the Summer-Sun as much as you please, reduce it into powder to be kept in a Glass; the dose from half a dram, to a dram twice a day in any convenient liquor.

Julius Caesar Scaliger's Powder, or rather that of Serapion is mightily commended. Dose four drams, twice or thrice a day.

5. Lohochs and Electuaries.

Take conserve of red Roses, of Dog-rose, of each two ounces,* 1.235 powder of white Poppy and Henbane seeds, of each two drams, species Diatragacanth. frig. one dram and half, of Blood-stone, Dragons-blood prepared, of each half a dram, Syrup of red Poppyes what will suffice to make an Electuary. Take the quantity of a Chesnut evening and morning, at other times let him lick with a liquorish stick.

Take conserve of the greater Comfry flowers, of Water-lillies,* 1.236 of each an ounce and half, Troches of Winter-cherries, of Diatragacanth. frig. of each a dram and a half, syrup of Jujubes what will suffice to make a soft Electuary, of which lick often.

Take of the white of an Egge well beaten two drams, Sugar of Roses one dram, of white Starch three drams, make a Lohoch to be taken often with a spoon.

Take of Conserve of red Roses 3 ounces, Leucatella's Balsam half an ounce, Troches of Winter-cherries two drams, Syrup of red Poppies what suffices to make a soft Lohoch: the dose is the quantity of a Chesnut night and morning.

II.* 1.237 The second preservatory Indication exhibits such remedies, which by contain∣ing the blood in its right temper, and the Lungs in their due frame, do provide a∣gainst a relapse of spitting blood, and the following of a Phthisis. Such things which respect the blood,* 1.238 either are mild evacuators by Stool, Urine or Sweat; or are meerly Alteratives. Every of these are usually prescrib'd either in form of Potion, Powder, Electuary, or Pills: We will here shew you the most select patterns of the chief of them.

1.* 1.239 As to Evacuators, a gentle Purgative is sometimes appointed after this man∣ner.

Take of the best Senna three drams, Cassia fistula bruised one ounce, Tamarinds three drams, Coriander-seeds a dram and a half, boyl them in Spring-water to 6 ounces, to it strain'd add syrup of Chichory with Rhubarb one ounce, clarifie it with the white of an Egge. Or,

Take 4 ounces of Gereons decoction of Senna, Syrup of Apples purging one ounce, mingle them and make a potion.

2.* 1.240 That the good temper of the blood may be preserved, and the superfluities drained from the Lungs may be continually discharged by Sweat and Urine, these following Alteratives, or some of them are for the most part receiv'd in constant use; which also being endued with a healing power, do succour the weak Lungs, or those whose Unity is dissolv'd.

For ordinary drink, let simple water, especially in a hot constituion, or being colour'd with a little Claret-wine, be drunk. Those with whom this doth not agree, a Bochet of China, Sarsa, with shavings of Ivory, Harts-horn, with white Sanders, or small Beer, or small Ale, with the leaves of Harts-tongue, Oak of Jerusalem, and the like infused, are frequently used with good success.

Pectoral Decoctions or Hydromels with temperate Vulneraries are taken twice or thrice a day to 6 or 7 ounces.

Take of fresh Nettles,* 1.241 Chervil, of each one ounce, Harts-tongue, Speedwell, Mouse-ear, Ground-Ivy, St. Johns wort, of each a hand-full, boyl them in three pints of Spring∣water, to two points, adding Raisins stoned an ounce and half, Liquorish two drams, to it strain'd add Syrup Byzantine two ounces, clarifie it with the white of an Egge, make an Apozeme to be taken from 4. ounces to 6, twice or thrice in a day for a month. In a more cold or phlegmatick constitution, let the Liquorish and Raisins with the Syrup be omitted, adde at last of Hony well? clarified two ounces, strain it and keep it for use. The Dose is the same.

The use of these is sometimes intermingled with a distilled water appropriate for that use, which likewise is more frequently taken by such who nauseate and loathe Apozemes.

Take the tops of Cypresse,* 1.242 leaves of Ground-Ivy, of each 6 handfulls, of Snails half boyled one pound and half, of all the Sanders bruised of each one ounce, being cut and bruised infuse them in 8 pound of fresh Milk, distill it in common Organs, the Dose 3 or 4 ounces with a spoonfull of Syrup of Ground-Ivy, to be taken twice in a day.

2.* 1.243 In respect of the Lungs, viz. that without obstruction or opening of the vessels, the Union of parts, and due conformation of the whole may be preserved, temperate balsamicks chiefly conduce. To this intent Leucatello's Balsam is commonly prescri∣bed to be taken daily and for a long season. Chymists and certain Noble women do cry up with great praise a balsamick Oyl drawn by distillation, called by them the Mother of Balsam.

It would be easie here to reckon up very many other remedies against spitting blood, very much celebrated by the ancient as well as by modern Writers; notwithstand∣ing the harvest of these already gathered together doth at present seem rich enough. But it remains, that I illustrate as well the Theory of this disease, as the curatory method above delivered, by a History or two of sick Patients.

A noble young man,* 1.244 when after a scorbutical Cachexia he was affected with a Pal∣sie, and for curing this disease, remedies not only great but improportionate to the blood and spirits were experimented by him, viz. Salivation and the use of Baths,

he contracted a spitting of blood, whose fits (of all I ever knew not presently mor∣tal) were most fierce. Presently on the first appearance of this disease, spitting blood followed the Operation of Hues's powder (from which having for some time suffered a flowing of the Mouth, without his Palsie being cured he was reduced to great weak∣ness:) Then being afflicted with a Catarrh, and a Cough very troublesome, he began to discharge a discolour'd Spittle, sometimes stained, and sometimes sprinkled with blood; but this disease being mild from the beginning, did suddenly vanish away by the use of remedies, and after going into the Countrey, and sucking in a more pure air, he became better, and after a while feeming healthful enough in his breast, he went to the Bath, for the benefit of his Palsie; where daily bathing for a fortnight in those hot waters, he again contracted a Cough, and a little after an horrid Haemoptoe or a spitting of blood, so that in the space of 24 hours, coughing often and plenti∣fully, he poured out blood in a vast quantity.

I first visiting him in this condition, provision being made for the whole, I pre∣scribed presently Phlebotomy for revulsions sake: notwithstanding after this admini∣stration (both then and ever after) he either repeated the bloody spittle, or grew worse. Moreover, I exhibited Juleps, Lohochs, Decoctions, and also Hypnoticks, which helping little or nothing, ligatures made about his arms and thighs, did first of all restrain the tyranny of this disease: And when afterwards the Evil broke out again, I perswaded him at length, (his drink of Beer being left) that he should con∣stantly drink the decoction of China and Sarsa with the Pectorals. By the continual use hereof, observing moreover an exact course of diet, and altogether abstaining from wine, more hot aliments, and Salt, and Sugar, for above two years he was well in health.

But afterwards when by being crouded in a Court of Judicature, he grew mighty hot, he relapsed back again into a terrible spitting of blood. A Physitian being sent for, he was presently let blood in the arm, whence his spitting of blood became more sharp; and when afterwards letting blood was repeated the second and third day, and the evil grew worse every time, at length Ligatures (as at first) being administred, and the pe∣ctoral drink and a Linctus being often taken, the disease presently remitted, and in a short space wholly ceased; notwithstanding he continued the use of his pectoral de∣coction and slender diet, viz. no flesh-meat, for a fortnight; and from thence he obtain∣ed truce from his enemy for three years; and when afterwards at any time the blood sweeling by drinking of wine, or taking more dainty food, began to break out from the Lungs, presently by ligatures, and the use of the Decoction and Lohoch, and a thin diet, its assault was wont to be repulsed. But he did not so safely escape, but that it was necessary for him for the most part to keep perpetual watch against that enemy always lurking: for not long since by reason of the intemperature of the year, he contracted a troublesom Catarrh, with a Cough, a plentifull spittle, and some∣times bloody, and then the former medicines effected less; wherefore, he betook himself by his own advice to new things, and in the first place took evening and morning a spoonfull of Syrup of Ground-Ivy, and thereby ensued a notable help: but when that Syrup became quickly loathsome by reason of the Sugar, he took the pow∣der of that herb well prepared to half a dram, or one dram twice a day in a spoonfull of some liquor; by the long use of which Medicine he was much better as to his Catarrh and Cough. But when the spitting of blood now and then broke out, though in little quantity, he chang'd again his Medicine, and took twice in a day the powder of the tops, and chiefly of the hairy excrescences of Cynorrhodon or Dog-bryer: which only medicine a certain Physician renowned for merly for the cure of spitting blood, used with great success. Neither did our Patient receive a less happy effect from that medicine, for presently after he escaped altogether free from a Cough, a Ca∣tarrh and bloody Spittle, and so remained for a long while: untill at length believing this disease of the Breast to be wholly subdued, and therefore slighting it, he assu∣med weapons against the other more ancient enemy the Palsie. Wherefore, while his Haemoptosis or Spitting of Blood was neglected, he daily took a large dose of hot Me∣dicines to conquer that other distemper, viz. magistral waters distilled with Wine, spirit of Harts-horn, of Sa't Armoniack, and Aromatick Powders and Confections; Besides, whilst he indulg'd himself in a more plentiful diet, with a moderate drinking of Ale and Wine, the roaring Lion that at first seem'd to sleep, was again stirr'd up, viz. he had not long continued in that antiparalytical Method, but the Spitting of blood returned with its greatest fierceness, so that in the space of a day and a night he

coughed out above three pints of spumous blood. But afterwards a Physician being sent for who presently prescribed Phlebotomy, the spitting of blood began to cease up∣on bleeding (as formerly it was always wont to do) but then fell into sharp fits again: which however by the use of Ligatures, and a Lonoch and pectoral Decoction daily taken, was presently asswaged, and a while after wholly ceased. And when afterwards he used the pectoral Decoction three months, and a very slender Diet, viz. without any flesh, only of Herbs, Barley, &c. and Milk-meats, in a short time he recovered his former health, and now lives in that state, so triumphing over that cruel disease, that many Haemoptotic persons consult him as their Oracle, and for a Cure do propound a method of this kind of living to be followed before the Physicians advice.

What is most wonderful in this case is,* 1.245 that after so many breaches so often hap∣pening in the Lungs, this famous Person was not in the intervals affected with a Cough, neither fell afterwards into a Consumption; whereas most after any of the smallest vessels being open in the Pracordia, for some time after labour with a Cough with plen∣tiful and thick spittle, and at length frequently become consumptive. And that it hap∣pened otherwise to our Patient, I chiefly attribute to the balsamic constitution of his blood, viz. in the mass whereof the serous recrements are either less collected, or so strictly mingled, that they cannot be easily separated thence; wherefore after the ves∣sels were broken, or their unity dissolved, a plentiful I chor or sharp humor (being wont to generate a Cough and Spittle) did not sweat out as in many others. Moreover what he himself observed, contrary to many others, that his spitting blood happened never in winter, but in Summer, came also so to pass by the same reason: because when the blood did less abound with vaporous recrements, the opening or obstruction of the Pores were neither an advantage nor prejudice to it; nevertheless the blood growing hotter than it ought to be, seeing it exhaled not, there was a necessity it should break out of the vessels; and when again diminished in quantity, sending away little or no serous Ichor out of the orifices of the Vessels, the spitting of blood ceased without a remaining Cough. The same reason holds of many that spit blood, wherefore some are found much inclinable, others not prone to a Consumption. This Gentleman ever found the use of the pectoral Decoction advantageous to him: wherefore when he often varied other Medicines he always retained the same Decoction: moreover he hath commended it to many others spitting blood with success. The form of the Prescription was this.

Take of all the Sanders of each six drams,* 1.246 infuse them for twelve hours in seven pints of Spring-water, then hoil them to a confumjption of a third part, after add leaves of Colis-foot, Maidenhair, Mouse-ear, Speedwel, flowers of St. Johns-wort, each two handfuls; sweet Fennel-seeds six drams, Liquorish half an ounce, Raisins stoned half a pound: boil them to four pints, afterward strain it, and keep it for ordinary drink.

Moreover the spitting blood threatning and pressing upon him he took thrice or oftener a day the quantity of a Nutmeg of the following Electuary, drinking after it seven spoonfuls of a Julep.

Take conserve of red Roses three ounces,* 1.247 conserve of Hips, Comfry, each an ounce and half; Dragons blood a dram, species of Hyacinth two scruples, red Coral a dram, with a sufficient quantity of syrup of red Poppies, mix them and make a soft Electuary: let him take hereof evening and morning a dram and half, drinking after a draught of the following Julep. At other times let him lick it with a Liquorish-stick.

Take Plantane and Spawn-Frog water, each six drams;* 1.248 syrup of Coral, dried Roses, each an ounce; Dragons blood two scruples: mix them, and make a Julep.

Among the examples of them that spit blood the case of that Reverend person Dr. Berwick S.T.P. and lately Dean of St. Pauls Church ought not to be omitted, which some while since I learned partly from the Patient himself, and partly was communicated to me from his Brother that most skilful Physician Dr. Berwick my most dear Friend.

That most renowned Divine fifteen years before he died laboured with a most ob∣stinate Cough,* 1.249 and sometimes with a bloody and falt spittle, with a grievous breath stinking like Heel; by which being made lean by a pining away of the body, he want∣ed but little of being almost extinguished by a Consumption. As often as his spitting blood intermitted, the rankness of breath and spittle ceased also; afterwards the re∣turn hereof declared constantly that other affect to be presently attendant. In this

languishing condition, when this Renowned man was discovered to favour the Kings Party at that time oppressed with a grievous Tyranny, and being cast into a strait Prison, did drink meer water instead of ordinary drink, he recovered his health beyond the hope and expectation of all persons, and so remained indifferently healthful for above ten years space. Nevertheless afterwards, I know not by what occasion, unless by the hardship of a cold winter, not only the aforesaid evils, viz. a Cough with bloody and salt stinking spittle did become fierce upon him, but also over and above, a debility of stomach, want of appetite, and a nightly Feaver did accrue. But not long after these Symptoms a little remitting, fair weather again seemed to shine out; until on a certain day, the air being suddenly changed into an intense cold, towards night he was assaulted with great straitness of breast and difficult breathing, with a quick and weak pulse, and fainting of all his spirits, as if he had been expiring. Nevertheless from his danger he suddenly escaped by the interposition of a Crisis, viz. by a plentiful spit∣ting of blood, and after by a breathing Sweat: but from that time his spittle remitted much of the usual stench, and something of its saltness; and when in a short time af∣terwards the last and most painful invasion of spitting blood threatned him, that usual presage from stench of breath was wanting; but the subsequent spitting of blood being very plentiful, did so dcebilitate his strength, that from that time declining sensibly, he expired within a month: and when a little before his decease, by reason of a sharp pain in his side, a Vein was breathed, his blood seemed to fail so, that almost none streamed out. Moreover in his body dissected after death very little quantity of blood was found: nor could they find any footsteps of the other most notable Symptoms, viz. spitting of blood and of the stinking breath and spittle; for there was no colle∣ction of any filth or stinking and putrid matter, nor any cavity in the Lungs made by an Ulcer or Wound; but only one lobe of this bowel, or rather the whole left side was so hardned from a scirrhous Tumor, that the blood could not easily or but very little pass through the frame being so obstructed, and as it were stony: wherefore it is no marvel, if the blood that should have passed most swiftly through the Lungs, did now and then burst out in some place from the vessels, which were joined together, or suffered not a circulation by reason of the Schirrosity.

Notwithstanding here a greater difficulty ariseth,* 1.250 viz. whereas his Lungs were found altogether free from any Ulcer or notable wound, whence that most dire stench of spit∣tle and breath, always a forerunner and companion of the bloody spittle (the last inva∣sion of this disease only excepted) proceeded. We have in another place given re∣marks upon all these things, as that Ulcers of the Lungs and the purulent spittle of con∣sumptive persons seldom or never stink, but the matter cast out of an Imposthume of the Lungs doth frequently stink: but that in the sick Doctor the Lungs being free from either affect, breathed out so horrible a breath, the reason will best of all appear, if we inquire of the manner and cause of a stench in general. For we observe this to be excited when the impure Sulphur is dissolved either by a lixivial, or an acid Salt, and is precipitated by the other. Let common Sulphur, or Sulphur of Antimony be dissol∣ved by Oil of Tartar or Stygian water; afterwards if you pour on this solution a disso∣lution of fixed Salt, and upon that, Vinegar, a most hideous stench will arise. In like manner we may conceive in the case proposed, that the sulphureous particles of the blood being very impure, were corroded by the fixt Salt, with which its juice abounded very much; afterwards when the acid humor, having endured a flux, re∣flows from the nervous parts into the mass of blood, it precipitates the dissolved Sul∣phur, and so causes that stench to be exhaled from the Lungs, and whilst it forces the blood into a turgency, a little after it compels to a spitting of blood. I have known some endued with a breast firm enough, and free from all Coughs and consumptive dis∣position, who have for the most part breathed out a most hideous stench: which could proceed from no other cause, besides what even now we have observed. The impure blood abounding with Sulphur dissolved with Salts, if perhaps while it is rarified with∣in the Lungs, and loosned in its frame, it meets with an acid humor, it will exhale in breathing putrid and horrid effluvia's. It happens by the like reason of the blood otherwise disposed, that as the breath of some persons is very stinking, so of others ve∣ry sweet. And indeed the breath or air reciprocated through Respiration, for that it carries out with it the effluvia's of blood highly rarified within the Pracordia, one while disperses a grateful vapor, another while a most unpleasant.

SECT. I. CHAP. VIII. Of a Peripneumony, or Inflammation of the Lungs.

APeripneumony is usually defined to be,* 1.251 an inflammation of the Lungs with an acute Feaver, a Cough, and difficult breathing. They who labour with this distemper are greatly sensible of a notable inflammation in their breast with a swelling of the Lungs, and sometiems a pricking pain, they draw a painful and short breath, or, as Hippocrates affirms, a deep breath; the Feaver presses with great thirst, watching, and painful Cough; whereto also bloody spittle, or streakt with blood, suc∣ceeds. By which Symptoms it clearly appears, that this disease arises, in as much as the blood boiling feaverishly, doth not easily pass through the lesser pneumonic Vessels; but sticking in their passages, begets first an obstruction, afterwards being more heaped and extravasated, propagates a Phlegmon or inflammation with heat, a Cough, and dis∣coloured spittle. Moreover in as much as the blood so accumulated and stagnating, puffs up these passages of the Lungs, and compresses them, a difficulty of breathing is caused; and in as much as it pulls or distends the nervous Fibres, a pain frequently arises.

But if it be asked,* 1.252 how a Phlegmon should grow together in the frame of a Lung meerly bladdery and excarnous; and after what manner it is distinguished from that distemper which is wont to be stirred up in musculous flesh, or the substance of a bowel? We must answer, although the above-mentioned parts vary as to the texture, notwithstanding the reason of the affect is altogether the same in each of them. For the small sanguiferous vessels do every where alike embrace, bind, and variously gird about both all the Tracheal passages in the Lungs, and also the fleshy fibres in the Muscles, and lastly the little fibres and nervous threds, with the thickest foldings like clusters, of the Parenchyma. But that which produces a Phlegmon is the blood it self, which, while it grows very hot, and is hindred in its passage, every where, and espe∣cially in the Lungs, whose vessels branch into very small foldings, doth first beget an obstruction, and then an inflammation.

Wherefore the formal reason and conjunct cause of a Peripneumony consists in these two things,* 1.253 viz. that the blood boils feaverishly, and sticking also within the more nar∣row passages of the Lungs, engenders there an obstruction causing inflammation. Un∣less these two things concur, there is an exemption from this disease; for in many other Feavers, especially in a burning Ague, though the blood, most intensly heated and inflaming all the Praecordia, as also in the longing of women, the Green-sickness and the Dropsie of the breast, is very clammy, yet though sticking very much in the pas∣sages of the Lungs, it does not stir up a Peripneumony: to produce which both distem∣pers must concur and join their strength. Nevertheless when there is an indisposition of both these, one while this, another while that, is first in act, and after a sort one is the cause, or at least the occasion of the other. For sometimes the blood irritated into a Feaver causes an obstruction of the Lungs; and the blood also sometimes finding a re∣mora in the Lungs, receives a feaverish boiling from its proper obstruction. Notwith∣standing, for the constituting the procatarctic cause of this disease, the blood ought to be fitted as well for the boiling, as for the obstructing the vessels of the Lungs.

Though it will not be easie to shew what this disposition of the bloody liquor is in∣clining to a Peripneumony,* 1.254 yet the reason thereof doth something appear by Phlebo∣tomy, always made use of in this disease with the best success. For the blood being drawn from any labouring with this disease, as also from those in a Pleurisie, after it grows cold, in its superficies instead of a Scarlet cream, it hath a little film somewhat white or otherwise discoloured growing on it, which also is very tough and viscous: whence we may conjecture, that the mass of blood being too strait in its frame, whilst that in the circulation it doth not discharge its recrements, grows too thick, and as it were clammy, and for that cause becomes too prone as well to boil as to stick within the narrow passages, and especially of the Lungs.

But if farther inquisition be made,* 1.255 from whence this disposition of blood proceeds, by which it becomes clammy and viscous like ropy wine; the general reason hereof is this, viz. that the more thick parts of blood are not made thin enough by the more sub∣tile; so that all of them being equally mixed and mutually incorporated, at length the

good humors separate themselves into their appropriate functions, and the superfluous are perpetually discharged by their proper Emunctories. But on the other side in as much as the sulphureous particles of the blood being combined together with the saline and earthy too much exalted, ensnare and entangle all the rest; for that cause its li∣quor containing within it self all its recrements and impurities, grows clammy as glue, and in that regard contracts an inflammable disposition.

For it is obvious to every person, that the blood that grows clammy in this manner, is rendred prone to obstruct the narrow passages of the vessels (which surely are very small in the Lungs); moreover for the same reason they are disposed to become fea∣rish: viz. because retaining obstinately within its own bosom all the feculencies and ecrements, from the same presently gathered into a heap, it is constrained into a great turgescence or swelling, whereby of necessity an inflaming obstruction of the Lungs takes either its origine or augmentation.

Moreover as to the procatarctic cause of this disease,* 1.256 very frequently the faultiness of the Lungs is joined herewith, and determines that general intemperament of blood to affect this part in such a sort. For as the clammy blood grows hot, the more strong and sound Praecordia do frequently discharge the designed mischief from themselves, and the taint being fixed to the Pleura, or about the habit of the body, a Pleurisie or Rheu∣matism is rather caused than a Peripneumony. Nevertheless the tender Lungs being bnoxious to a Cough, or formerly prejudiced in their frame either by spitting blood, or other distempers of the breast, from the blood boiling up (while it is too much bound nd clammy in its own consistence) they easily engender an obstructing Phlegmon.

Hitherto of the conjunct and procatarctic causes of a Peripneumony:* 1.257 as for what regards the evident causes, whatsoever suddenly perverts the temperament of the blood, or restrains its free transpiration ought to be referred hither, as chiefly are ex∣cesses of heat and cold, or the inordinate drinking of Wine or strong Waters, any ve∣ement exercise, and the drinking of some waters, and those especially icy. Besides, sometimes a malignant distemperature of Air doth engender this disease in many, and akes it Epidemical.

Authors in Physick do every where observe (and it is also a vulgar observation) a Peripneumony frequently succeeds or comes upon a Pleurisie;* 1.258 but nothing is more usual than in a Pleurisie a bloody and thick spittle, and as it were purulent to be void∣ed. Hence a regat disquisition arises, by what passage or ways the matter by spittle cast out, can be conveyed from the Pleura to the Tracheal passages. Some think, that this being fallen into the cavity of Thorax, is sucked into the Lungs as with a Sponge; and others suppose, that it is transferred thither by the Membranes adhering thereto, by which the Lungs often stick unto the Pleura. But truly either way seems impro∣bable, if not impossible. For first, that the Lungs do not suck in the contents of the hollowness of the Chest is manifest from hence, because in a Dropsie or wound of the breast, when they happen, the Lungs being unhurt, neither water nor blood is at all dis∣charged by coughing; though frequently great plenty of this or that humor be there, which presently flows out of its own accord from the Thorax, incision being made. But that Sometimes the Membranes growing from the Lungs, knit themselves tot he Pleura, is clearly manifest by Anatomical observation; yea and by this way of return I have sometimes known the purulent matter translated into the side, and there by an Issue, made by Art or Nature, to have been evacuated with a heathful Crisis: nevertheless such Membranes of the Lungs joined to the Pleura do seldom pre-exist, and in a Pleurisie, which is a very acute disease, they cannot, like a Mushroom, be the issue of one or two days: moreover, though sometimes those obscure passages may be ready at hand, which perhaps by some admirable instinct of Nature discharge something out of the Lungs towards the precincts of the Thorax; yet it seems against the Oeconomy of Nature, that they can derive any corruption outwardly engendered to this most noble part within, which surely is the fountain both of life and heat.

As to this, if it may be lawful to propound our Judgment,* 1.259 I am induced to think that a Peripneumony and Pleurisie are one while singular and separate affects, and ano∣ther while bred together and coexisting from the first, and another while are by course one after another or succedaneous. For the procuring cause being stirred up into act, so that the blood growing clammy, and boiling together, obstructs in some places the lesser vessels: the nest of the disease sometimes is fastned on the Pleura, or separately in the Lungs, sometimes in each of them together, and sometimes first in one, and then in t'other: but for the most part, the Pleura being first healed, presently the

same morbific cause invades also the pneumonic Vessels. Moreover we have known a various shifting of this affect; viz. that it has first troubled the right or left side, pre∣sently that being deserted, to have occupied the Lungs, and afterwards both being de∣serted, to affect the Brain, and frequently to transfer its seat from thence into the above-mentioned places. But for the reason aforesaid a Peripneumony not only suc∣ceeds a Pleurisie, but frequently a Squinancy, and sometimes other distempers: for while the blood growing clammy, and boiling together, continues a Feaver in the whole, it transfers the obstruction causing a Phlegmon variously hither and thither. And from hence the solution of that observation is clearly manifest, which has so much puzled Interpreters, viz. that a Palsie or dead Palsie of one side doth sometimes suc∣ceed a Peripneumony, because the blood that being clammy, had lately obstructed the pneumonic Vessels, afterwards stuffing certain foldings of the vessels of the Carotides, prohibits the engendring of animal spirits in this or that part of the head, and so re∣strains their influence into the respective nervous parts.* 1.260 From what hath been said, the chief differences of a Peripneumony are made plain, namely that it is either a simple distemper, or joined together with a Pleurisie, Squinancy, or some other, and then it is either primary or secondary. Moreover it is usually distinguished as to the Feaver and state of breathing: to wit, according as this is more or less prejudiced, and as it shall be more intense or remiss, this disease also is denominated either more or less acute.

As to the Prognostics of this disease,* 1.261 common experience doth attest, that it is a very dangerous disease, because many Patients either die of it, or very difficultly reco∣ver health. No less may we conclude this from the reason or Etiology of it; for a wound with much extravasation of blood, or a stagnation caused in the Lungs, is most difficultly cured, and the affected place is never restored unto its former conformation. The prognostic signs, which are of greatest note, are taken from the appearance of Symptoms and nature of things thrown out, and the state of strength.

1.* 1.262 A Peripneumony coming upon a Pleurisie or Quinzy, for the most part is worse than arising of it self, or succeeding either of them: but if upon this disease, after what manner soever begun, an acute Feaver follows with great thirst, watchings, and not breathing unless set upright, it is ill; and yet much worse, if upon it a Deli∣rium, a Fenzy, convulsive motions, or a Palsie on one side ensue. Moreover the Pa∣tient is not in less danger, if he be very pursie, if troubled with vomiting, or frequent swounding away, a weak Pulse, and a cold Sweat. For while these Symptoms are in∣stant upon him, the obstruction of the blood in the Lungs is not removed, nothing is digested or ejected by spittle; but the circulation of the blood being more and more hindred, and its kindling by breathing stopt, the animal spirits are throughly disorde∣red, and at length faint, until together with a prostration of the whole strength the vital flame is extinguished.

2.* 1.263 As to Prognostics from things excerned, we observe a Peripneumony to be dan∣gerous, wherein nothing is thrown out by spittle; next to this, then the spittle is thin and crude, mixed with blood; it is far better when the spitting is yellow and thick, streaked with a little blood. The Urine being yellow from the beginning, and of a good consistency, with a cloud in the midst, shews that almost all the recrements of the blood are lodged in the place affected; when from that state it is changed into a thick and turbid Urine, it shews the morbific matter to be swallowed up again from that part into the blood; but if such kind of Urine be suddenly changed into a thin one, then a Delirium or death it self is impendent. Much Sweat and plenty of Urine, a Diarrhoea, bleeding at Nose, flowing of the Menstrua's, or the Haemorrhoids do fre∣quently promise good in this distemper, yea any of these Evacuations happening sea∣sonably doth frequently discharge the disease.

3.* 1.264 The condition of strength is ever of great moment in forming a due Prognostic in this disease: for oftentimes when horrid Symptoms, as an intense Feaver, a Breathing very painful, with a Cough, watchings, and other ominous signs, shall be pressing, if the Pulse be as yet strong, and the animal spirits persist in their vigor, there is better hope of the Patient, than if these things being more quiet, there were a weak Pulse, and the Spirits should become drowsie and oppressed.

The first indication about the curatory Method in a Peripneumony is,* 1.265 that the blood being impacted in the pneumonic Vessels, and causing a phlegmonous obstruction, may be from thence discussed and restored to its pristine circulation. Which if not to be procured, the second indication will be, that that matter be duly digested or brought

to suppuration, and with all expedition voided by spittle.

While the former indication prevails, the intentions of healing will be these ensuing.* 1.266 First, that the more plentiful afflux of blood to the part affected be prevented, or pro hibited by some means. Secondly, we must endeavour, that the matter stagnated or extravasated in the Lungs, be swallowed again by the Veins into the rest of the mass, and caused to circulate. Which that it may be the better procured, thirdly, the hoold ought to be freed from its clammy viscousness, whereby its fluidity is impeded. Fourthly, that we apply to the Symptoms most urgent, viz. a Feaver, cough, Watch∣ings, and difficult Breathing, fit Remedies. But if notwithstanding all these another indication shall come into use, it will be requisite to prescribe maturating and expecto∣rating Medicines vulgarly so called, together with these.

1. That we may satisfie the first and second intention together,* 1.267 Phlebotomy is for the most part requisite in every Peripneumony, yea sometimes it ought to be more fre∣quontly repeated; for the vessels being emptied of blood do not only withdraw the nou∣rishment of the disease, but do also sup up the matter impacted in the place affected. Wherefore if strength remain, and the Pulse be strong enough, a more free breathing of a Vein is convenient at the very beginning; but otherwise let it be used in a little quantity, which however may be repeated as occasion offers it self. We intimated above, that blood drawn in a Peripneumony and also in a Pleurisie, after it is cold, con∣tains in its superficies a small viscous and discoloured film: moreover we may observe one while the blood entirely, another while only a portion thereof is subject to this change. For when the blood is received into three or four dishes, sometimes in all, but oftener in the second and third dish it is apparently bad, and in the first and last laudable enough: wherefore they commonly give it in precept, that blood is always so long to be emitted, till that which is so depraved begins to come forth; and if strength remain, the bleeding should continue till the good blood flows out again. Truly as common experience doth approve of this practice, even so doth reason it self; for in this disease,* 1.268 because the whole mass of blood doth not presently acquire that clamminess, the depraved portions are chiefly accumulated about the place of ob∣struction, and adhere on every side in the lesser vessels. Wherefore the blood first issuing by Phlebotomy is often void of any fault; afterwards the vessels being emptied receive the other morbific matter at first stagnated, and restore it to its circulation; and when the portions thereof being placed near, are carried as it were in a joint troop, they flow out together at the orifice of the opened Vein, and after that entire mass of bad blood hath flowed out, the residue being more pure doth succeed. Wherefore in this case ever let incision be made with a large orifice, and let the blood be drawn out not only with a more plentiful spouting, but also with a continued: for otherwise if in the midst of Phlebotomy, the bad blood issuing out, the orifice (as the manner of some is, lest the spirits should saint) be closed with the finger, when again it is opened, the blood pure enough will issue next, but the bad sliding by, if there be any remaining, will not return presently to that orifice. Besides Phlebotomy many other remedies, viz. whatsoever do repress the trugency of blood, and empty the passages thereof, whereby the morbific matter may be suckt up, are here to be used. Wherefore a very thin diet is prescribed for the most part meerly of Barley and Oats: and if Cathartics are alto∣gether prohibited, because they disquiet the blood, and hurry it more impetuously into the part affected; notwithstanding Clysters which gently loosen the Belly, and draw the recrements of the blood towards the Belly, ought to be daily used. Moreover Ju∣leps and temperating Apozemes which bridle the fervor of the blood, and draw out the superfluous serositles thereof, and which also do gently open the passages of the Breast, are taken with success.

3. The third intention of healing,* 1.269 which respects the withdrawing of the clamminess or obstructing viscosity of the blood, is altogether to be performed by remedies which unloose the frame thereof being too much bound, and dissolve the coupling together of its salts. And truly the remedies of this kind, which in this respect reason and analogy would dictate, are now received into use by long experience. For Powders of Shell-fish, the Tooth of a Boar, and the Jaws of a Pike, and other things endued with an Alkali Salt, also Sal Prunellae, for the most part are prescribed by all Practitioners, as well modern as ancient. I have more frequently known the Spirit of Salt Armoniac and of Harts-horn to have yielded notable relief in this disease: and for the same rea∣son it is, (viz. because the volatile Salt is useful) that the infusion of Horse-dung, though a common remedy, affords oftentimes singular help.

4. As to the Symptoms and their Cure,* 1.270 very many remedies appropriated to these fall in together with the former; for against the Feaver the same Juleps and Apozems which appease the heat of blood, and withal recreate the animal spirits are of most common use: to which besides in respect of the Cough and difficult breathing, temperate pectoral Remedies are added. The great difficulty is what ought to be exhibited against want of sleep, when it shall grievously oppress; for Opiates, because they do fur∣ther prejudice the breathing, which in this disease is already hindred, are scarce safely administred, nay sometimes become mortal. Wherefore Laudanum and the strong Pre∣parations of Opium are to be shun'd in a Peripneumony worse than a Dog or a Snake; nevertheless Anodynes sometimes, and mild Hypnotics, as water and Syrup of red Pop∣pies, are not only allowed, but accounted specific remedies in this disease and in a Pleu∣risie: but sometimes it will be expedient to use Diacodiates as long as strength en∣dures, and as long as the Pulse is strong and good enough. For the pain of the breast, if at any time it be troublesom, it is expedient sometimes to apply Liniments, Fo∣mentations, and Cataplasms.

The second curative inoication,* 1.271 whose intentions are to digest the matter impacted in the Lungs (if it cannot be discussed or suckt up) and to throw it out by spittle, re∣quires ordinary maturating and expectorating Medicines, both which notwithstanding ought to be temperate, that is to say, such as asswage thirst, and appease the feaverish heat rather than exasperate it. We have above recited in the Chapter of a Cough, the kinds of these sorts of Remedies properly called Pectorals; the more select Receipts, and chiefly accommodated to this affect, shall be annexed here beneath.

The Forms of Remedies.

1, 2. The Medicines conducing to the first and second intention are prescribed ac∣cording to the following Forms.

Take the water of Carduus Mariae ten ounces,* 1.272 red Poppies three ounces, Syrup of the same an ounce, Pearls prepared a dram, make a Julep: the dose six spoonfuls every fourth hour.

Take water of black Cherries, Carduus benedictus, Balm, each four ounces; powder of a Boars tooth a dram, Syrup of Violets ten drams: make it into a Julep to be taken after the same manner.

Take Grass roots three ounces,* 1.273 shavings of Ivory and Harts-horn each three drams, Rai∣sins stoned an ounce and half, Liquorish two drams, boil them in Spring water from three pints to two, to the strained iquor add Syrup of Violets an ounce, Sal prunella a dram: make an Apozem to be taken thrice a day about three or four ounces.

For the same intention,* 1.274 viz. that the Vessels being emptied may withdraw the nou∣rishment from the disease, or sup up the morbific matter, a Purge is prescribed by many. In the Practice of the Ancients against this disease, even as against many others, after Phlebotomy, Preparatives and Purgatives were usually appointed in a constant course, and of late the Chymists with greater boldness do recommend Vomits, and in a Peri∣pneumony prefer it to all other remedies. Yea Phlebotomy being omitted or counter∣manded, they place the chief Cure in stibiate Vomits: than which rash advice of theirs I know not any thing may be thought of more pernicious. Indeed in rustic and robust bodies sometimes this Cure has been effected without danger, notwithstanding for the most part no less unsuccessful; but in tender constitutions it ought to be reckoned little inferior to poyson. But for what respects Purgation, although it may not be presently convenient from the beginning, because it is then for the most part prejudicial, never∣theless the flowing of the morbific matter being finished, and the effervescency of blood being appeased, we may safely and gently evacuate the body with a loosning Purge.

Take of the decoction of Senna of Gereon four ounces,* 1.275 syrup of Roses solutive an ounce: mix them for a Potion. Or,

Take the best Senna three drams, Cassia and Tamarinds each half an ounce, Coriander-seed two drams: boil them in a sufficient quantity of Spring-water to six ounces, to which strain∣ed add syrup of Violets an ounce, clarified with the white of an Egg, and let it be given.

Purgatives are not always to be exhibited, nor ever unadvisedly in this disease: but frequent Clysters, and almost daily are in use; but let them be gentle and emollient

only, which easily loosen the belly, without any great agitation of humours or blood. For this purpose Milk or the Whey thereof is often convenient, with red Sugar, or syrup of Violets: Or, Take the leaves of either sort of Mallowes, of Melilote, of Mercury, of each one handfull, Linseed and sweet Fennel-seeds, of each half an ounce, sweet Prunes,* 1.276 numb. vi. boyl them in a sufficient quantity of Spring-water to a pinte, to which adde syrup of Violets one ounce, Sugar ten drams, sal Prunella one dram, make a Clyster.

3. Medicines for the third intention,* 1.277 viz. for the dissolving the Clamminess of the Blood, are wont to be administred in form of a Powder, of a Spirit, a Potion, or of a Bolus, according to the manner following.

1. Powders.

Take of Crabs eyes two drams, sal Prunella one dram and half, pearl'd Sugar one dram,* 1.278 make a powder for 6 doses, one to be taken every sixth hour, with a proper Julep or Apo∣zeme. Or,

Take of the Tusk of a Boar, (or the Jaw of a Pike) of Crabs-eyes, of each one dram and half, flowers of Salt Armoniack, Powder of red Poppy Flowers, of each half a dram, mix them for 4 doses.

2. Spirits and Chymical Liquors.

Take of spirit of salt Armoniack distill'd with Olibanum, 3 drams;* 1.279 the dose from 12 drops to 15 or 20, three times in a day. Or,

Take Spirit of Ʋrine or Soote, after the same manner, three drams.

Take of the sweet Spirit of Nitre, (viz. often cohobated with Spirit of Wine,) 3 drams, the dose from 6 drops to ten after the same manner.

Take half an ounce of Spirit of Tartar, dose 15 drops to 20 or 25, in a fit vehicle.

Take of the simple mixture one ounce: the dose is one scruple to half a dram, after the same manner.

3. Potions.

Take of Carduus-water one pound, fresh Horse-dung 3 ounces, dissolve it warm,* 1.280 and filtre it; the dose is 3 or 4 ounces, twice or thrice in a day, with half an ounce of Syrup of Vio∣lets or red Poppyes.

Take of the Leaves of Dandelyon two handfuls, bruised and infused in half a pound of Cardnus Mariae water, Treacle-water half an ounce, press it out, and adde powder of Crabs-eyes one dram: take 4 or 6 spoon-fuls three times a day.

The fourth intention of Healing in respect of the symptomes greatly urging,* 1.281 doth suggest divers sorts of preparations of Medicines. 1. In respect of the Feaver, the Ju∣leps and Apozemes above recited are convenient. Moreover, the use of Mineral Crystal ought to be frequent. 2. For the Cough and difficult Breathings, Linctus's, Eclegma's, and Decoctions, or pectoral Juleps are administred with success.

Take of Syrup of Jujubes, of Maiden-hair, of each one ounce and half,* 1.282 of Violets one ounce, flowre of Nitre one scruple; make a Linctus to be lickt now and then.

Take of syrup of Marsh-mallowes one ounce, Diacodium, red Poppyes, each half an ounce, powder of Crabs-eyes two scruples; make a Lohoch, to be taken the same way.

Take Syrup of Hyssop, of Liquorish, of each one ounce and half, red Poppy-flowers powder'd,* 1.283 one scruple, Crabs-eyes one dram, Lohoch de Pino 6 drams, make a Lohoch, take the quantity of a Nutmeg four times or oftner in a day.

Take the roots of Grass, Chervil, Marsh-mallows, of each one ounce,* 1.284 Figgs numb 4. Jujubes and Sebestens, of each numb. 6, Raisins one ounce, Liquorish three drams, Barly half an ounce, boyl them in three pints of Spring-water to two, strayn it; the Dose three or four ounces.

Take Raisins stoned one ounce and half, Filberds numb. 4. cut, Liquorish sliced 3 drams, of Hyssop-water a pound and half, infuse them warm in a closed Vessel 6 hours, strain, and adde Syrup of Marsh-mallows an ounce and half, make a Julep, the dose is 3 or 4 spoon∣fuls often in a day, swallowing it by degrees.

3^ly,* 1.285 Against Watchings, Take Poppy-water 3 ounces, Syr. of red Poppies 6 drams, Aq. Epidemica 2 drams, for a draught, to be taken at night.

If the Pulse be strong, and the strength agreeable, Take Cowslip-water 3 ounces, sy∣rup de Meconio half an ounce, for a draught at night.

4. If the pain be troublesome about the place affected,* 1.286 Take Oyntment of Marsh-mallows two ounces, Oyl of sweet Almonds an ounce and half, mingle them for a Liniment to be applyed with thin Lawn-paper.

Take of Oyntment of Marsh-mallows and pectoral Oyntment, of each an ounce and half, Linseed Oyle fresh drawn one dram, to which adde the Plaister call'd Emp. de Mucilaginibus, make a Plaister for the Region of the breast, to be applyed on the place affected.

Fifthly, For the last intention of curing which answers to the secondary Indication, and prescribes Medicines ripening and expectorating, the following forms are con∣venient.

Take Linseed Oyl fresh drawn three ounces,* 1.287 Syrup of Violets two ounces, Hyssop-water half a pound, mixe them in a Glass, take two or three ounces three times in a day, sha∣king the Glass first.

Take powder of Olibanum one dram, put it into an Apple made hollow, and roast it in hot Embers, let him eat it at night, repeating it three or four times.

Take Oyl of Almonds fresh drawn,* 1.288 Syrup of Maiden-hair, of each an ounce and half, Sugar-Candy two drams, stirre them well in a Glass-mortar untill they are perfectly mixt, make a Linctus to be taken often in a day with a Liquorish stick; also let a spoonfull be taken three times a day in a draught of Posset-drink.

As to the rest, Remedies prescribed against a beginning Consumption do also profit in this case.

It would be easie to heap up here many Histories and Instances of Patients affected with a Peripneumonie; but whereas the same order and figure of the disease, and the same reasons of the Symptoms are almost in all, it suffices here to note one or two Exam∣ples only.* 1.289 And while I was writing these things I am sent for to a Patient grievously sick with a Peripneumonie. He was aged about Fifty years, lean in body, and of a cholerick temper, by taking cold he fell into a Feaver, with a Cough, with pain of the Breast, and difficult breathing: when he had laboured thus four dayes without any remedy or physical administration, I found him in a notable Feaver, with thirst, and a huge inflammation of the Precordia, breathing very difficultly, with labour of the Thorax, and painfully, with a noise of the Bronchia, insomuch that he seemed evidently in the very Agony of death. His Pulse being strong enough (although quick and disturbed) I immediately prescribed Phlebotomy, to eight or ten ounces, by which when he received a little relief, after three hours intermission, a Clyster being first ad∣ministred, I ordered him to repeat his bleeding to twelve ounces: Moreover, I or∣dered Spirit of Harts-horn to be given twelve drops every sixth-hour, with an appro∣priate Julep, and in the distance between I ordered a dose of the following Powder to be administred:

Take powder of Crabs-eyes, sal Prunella, of each one dram and half, Pearles a dram, Sugar-Candy two scruples; make a powder to be divided into 8 doses.

Moreover, he took as often as he pleased a draught of a pectoral Apozeme. By the use of these within three hours all the symptoms began to abate, and the night following he sweat, and slept a little; the day after I repeated Phlebotomy, and after continuing the same Remedies in four or five dayes he intirely recovered his health. The blood we took from him was alwayes in the Superficies viscous and discoloured.

A certain Gentleman of a sanguine Complexion and a strong habit of body,* 1.290 after an immoderate drinking of Wine contracted a Feaver, with a most painful Peripneu∣monie, insomuch that thirst and heat mightily pressing him, sitting always upright in his bed or Chair, and breathing short and very frequent, he could scarcely, yea al∣most not at all suck in air enough to sustain the vital flame. Because he could not undergoe a large Phlebotomy, I drew blood twice or thrice day after day; frequent Clysters were administred: Moreover, Apozemes, Juleps, also Spirit of Armoniack, and

powders of Fish-shells were administred by turns. Within four or five dayes the Fea∣ver somewhat abated, also he began to breathe better, and sometimes to take short sleeps, yet he did always complain of a notable heaviness of his breast, and intolerable oppression of the Lungs; wherefore, when Phlebotomy was no longer safe, I applyed very large Vesicatories to his Arms and Thighs, the blisters in his arms dry'd up in a short space, but those on his legs did not only remain open, but after five or six days did run hugely, and afterwards almost for a month daily discharged great plenty of a most sharp ichor; in the mean time his lungs sensibly amended, and at length were delivered from all their burden; lastly, the little sores raised by the Vesicato∣ries very painfully and not without frequent Medicines could be cured.

SECT. I. CHAP. IX. Of a Pleurisie.

HOw great affinity there is between a Pleurisie and Peripneumonie,* 1.291 we have hinted before; viz. although either distemper is sometimes solitary, and exists separately from the other, yet they often happen together, or one while this, another while that, come one upon the other, or succeeds it. The foregoing cause is the same of both, viz. a disposition of the blood to be clammy and boyl up withall; also, the conjunct cause is the same, viz. an obstructing Phlegmon in some part of the lesser Vessels, by reason of such a disposition of blood. Moreover, the same method of Cure is prescribed by most modern Physicians for either disease: The chief reason of the difference whereby they are distinguished one from the other, is taken from the places affected, which their Names denote.* 1.292 For the blood predispo∣sed to the enkindling in some place an enflaming obstruction, therefore often plants the nest of the disease in the breast, because here it burns out more hideously, by rea∣son of the Hearth of vital fire; and also is not freed from the vaporous Effluviums and other Recrements which hinder Circulation. To all which there ensues, that in this Region, the mass of blood being shut up, and not able to pass through the more strait Conveyances; is not as in the bowels of the lower Belly, opened with any ferment, or new washt with any watery juice: wherefore, if perhaps the blood, car∣ried through the vertebral Arteries into the membrane encompassing the ribs, shall stick in its passage, about the narrowness of the Vessels or inter-spaces, the Distemper of which we now treat succeeds: In like manner, if an obstruction happen within the passages of the Lungs, a Peripneumonie will ensue, as we have declared before. Where∣fore, according to the Pathologie of this disease before delivered, those things which belong to the Theory of a Pleurisie, as well as the Curatory method, may with small labour be designed.

Both the sense of pain,* 1.293 as well as Anatomical Observations taken from the Pa∣tients dead of a Pleurisie do plainly attest, the feat of this Disease (as often as it exists primarily and solitarily) consists in the Pleura or Membrane environing the inside of the ribs. And a true and singular Pleurisie is an inflammation of the Pleura it self, from the abundant flowing in of inflamed blood, growing clammy withall, taking its mo∣tion through the vertebral Arteries, with a continual and acute Feaver, a pricking pain of the side, a Cough and difficulty of breathing.

The next Cause is the blood obstructed by reason of its clamminess in the lesser vessels and interspaces of that membrane (in like manner as it is in a Peripneumonie) or being extravasated, being heaped in the same place more plentifully,* 1.294 by reason of the swelling up, for that cause exciting an inflammation. An acute pain ariseth upon this, by a wound in a part highly sensible; also there ariseth a Cough by reason of a provocation giving impression to the intercostal muscles; moreover a difficult breathing by reason of the muscular fibres being hurt as to their action; which because they can∣not perform long and strong contractions, they are constrained to undergoe weak although more frequent Contractions: otherwise than in a Peripneumonie, in which that symptome ariseth from a Lung too much fill'd and stuffed. The Feaver is caus'd from effervescence of blood, and is for the most part rather the associate than the ef∣fect

of a Pleurisie. For the blood from what cause soever driven into a feaverish tur∣gescency, if it be bound up together in its mass, will be apt to grow clammy, which together with the Feaver most often induces a Pleurisie or a Peripneumonie, or both of them. From hence we may observe this disease doth frequently vary its kind, and change its place, viz. from a Pleurisie into a Peripneumonie, and on the contrary; afterwards it passes from both or either into a Frenzy or a Squinancy: for that the blood while it is boyling throws off its viscous recrements one while in this part, ano∣ther while in that, another while in more together, and lastly it reassumes them again, and variously transferrs them.

The more remote causes of a Pleurisie are the same as of a Peripneumonie, viz. what∣soever stirs up the blood,* 1.295 predisposed to grow clammy and also to boyl up, and pro∣vokes a feaverish turgescency. Hither appertains excess of heat and cold, a sudden constipation of the pores, surfeit, drinking of Wines or Strong-waters, immoderate exercise; sometimes the malignant constitution of the Air brings this disease almost on every body, and renders it Epidemical: whereto may be added, that this disease is very familiar to some from their constitution or custome; so that a distempe∣rature of blood, induced almost by any occasion, immediately passes into a Pleu∣risie.

From what we have already said, the signs of this disease do appear manifest enough, by which it is well known as to its Essence, and is distinguished from other diseases, and especially from a Bastard Pleurisie and a Peripneumonie. But it is to be observed that a pain in the side arises sometimes very troublesome, which while it counterfeits a Pleurisie, is sometimes taken for it, although falsly. For in some persons obnoxi∣ous to the Scurvy, and the affects of the nervous kinde, sometimes it happens that a sharp humour, and very painful descends into the Pleura or intercostal Muscles, and being fixt there produces most fierce tortures; which distemper is yet discriminated from the Pleurisie, inasmuch as it is void both of Feaver and Thirst, the Pulse always abides moderate and laudable, frequently the appetite and strength endure; more∣over, the pain is not long fixed or limited to one place, but sensibly creeps hither and thither into the neighbouring parts, as the matter slides down through the passages of the fibres, out of one place into another.

We meet not with many differences of this disease;* 1.296 notwithstanding it is used to be distinguished, viz. to be either true and exquisite even as we have now described, or spurious, which having its seat in the intercostal muscles, or their interspaces, pro∣ceeds from winde, or a serous and sharp humour heaped up in the same place, and raises a pain less sharp, without so much as an inflammation or feaver: And whereas the grief is planted externally, the Patient for the most part lyes better on the oppo∣site side, otherwise than in a true Pleurisie. Secondly, a Pleurisie is either single, or complicated with a Peripneumonie or some other distemper, and so it is either prima∣ry, or secondary, or join'd with some other affection.

As to the Prognosticks of this disease,* 1.297 Hippocrates hath observed many certain to∣kens whereby a good or evil event is signified to patients sick of the Pleurisie. To run through each of these, and to unfold them with Commentaries added to them, we have neither leisure, nor doth it seem worth our endeavours. The chief thing of all in a Pleurisie, is, that the disease be presently dispatch'd, partly with a free and frequent bleeding, and partly by a Critical Sweat, arising about the fourth day, or before the eighth; or these things not duely succeeding, it will be prolonged, and then most fre∣quently a Peripneumonie or Empyema, or a collection of corrupt matter between the Breast and Lungs, or both distempers do arise upon this disease; from which there follows a solution of the disease but slow and incertain, and most frequently full of dangerous chances.

A Peripneumonie coming upon a Pleurisie not presently cured (as it is often wont to be) all our hope is placed in digesting maturely the Spittle and quick Ex∣pectoration thereof: for if this be laudable and plentiful, and easily and hastily thrown off, it doth often finish both diseases intirely. Notwithstanding, it is not there∣fore a consequent that the matter of a Pleurisie is derived from the side into the Lungs by I know not what blinde passages, or that the same being sweat out of the Pleura into the cavity of the breast is imbibed by the Lungs, and at length drawn upwards through the passages, and excern'd forth. But when a Peripneumonie arises on a Pleurisie, and the matter impacted in the Lungs begins to be evacuated by Spittle, so that the affected places of the Lungs are continually emptyed; the blood resumes

the other matter fixed in the Pleura, and carryes it to the Lungs where the places of conveyance are open, to be ejected by Spitting. But if the Pleurisie be cured neither by it self, nor associating with a Peripneumonie, then at length either by an Im∣posthume made in the Pleura or in the Lungs, an Empyema or corruption between the Breast and Lungs succeeds; or all the matter being brought into the Lungs and there putrified, loosning the unity of the Viscera, it propagates a mortal or scarce curable Consumption.

As to the cure of a Pleurisie, forasmuch as the state of this Disease,* 1.298 the Crisis and tendencies are manifold, divers curatory Indications offer themselves according to their various regards; and as occasion serves, according to the advice of a prudent Physician, they ought to be appointed in the beginning, and sometimes altered or continued. For surely one Method is convenient for a solitary and simple Pleurisie, and another if it be complicated with a Peripneumonie: Besides it behoveth to ordain another and another if perhaps a Crisis be expected by Spitting, or matters growing worse, the disease is either passing into an Empyema, or tends to a Consumption. As to the three later cases, that is to say, when a Pleurisie commencing, passes into a Peri∣pneumonie or Empyema, or lastly into a consumptive disposition, there is designed an appropriate way of curing in the pathologies of each of these diseases particular∣ly delivered. But as to what appertains to our present purpose, three Indications offer themselves for a primary and simple Pleurisie, and they are curatory, preservatory and vital.

I. The first Indication takes care that the Inflammation or obstruction of blood in the Lungs by all manner of means with all expedition be removed;* 1.299 for which intent phle∣botomie in every Age by all physicians (excepting some Fanatick or false Chymists) is wont to be prescribed, as a principal remedie:* 1.300 The reason of which is altogether the same as in a Peripneumonie and many other distempers, caused by reason of a stop of blood in some place, and so an accumulation: Because that the vessels bring∣ing blood being much emptyed, do not only rescind the nourishment of the disease, but drink up the matter which is the conjunct cause thereof, and convey it to another place. Wherefore blood is to be freely drawn away in a Pleurisie, if the strength en∣dure it, and the Pulse be strong. And surely it is far better that the first time and every time after (as often as there is need to repeat it) blood be more largely emitted, than to do it more often and more sparingly. For very many portions of the blood growing clammy and degenerating into viscousness, are heaped up about the place af∣fected; which, unless they are call'd away from thence by emptying the Vessels through large phlebotomie, and in a great part let forth, the letting of blood will be frustrated of its desired effect. Wherefore, that Physicians prescribe blood in a Pleu∣risie to be drawn out even to swooning, seems not incongruous to reason, although that practice is not rashly to be attempted, for that every evacuation ought to be pro∣portioned to the tenour and tolerance of the strength, which rule such a phlebotomy doth exceed.

But though there is almost a general consent of all Physicians to breath a vein in a Pleurisie, notwithstanding there was ever an earnest contention about the place,* 1.301 what Vein ought to be opened. Hippocrates and Galen opened a Vein on the same side of the patient; afterwards the Arabians and their followers the Italians, and French, did either open the Saphene or the Basilica of the opposite side, damning the phlebo∣tomy of the same side by Bell, Book and Candle. Yet in the later generation, the practice of the Ancient Greeks by little and little revived,* 1.302 so that some did dare to make incision on the same side; yet always one side judged the others of the oppo∣site perswasion as it were guilty of murder, as often as any unlucky event did happen. So that while among Physicians about phlebotomy there was no less a contention than among the Jews and Samaritans about the Sacred place of Worship, at length the Doctrine of the Circulation of the Blood held out like a new Light by the most re∣nowned Harvey, discuss'd all the clouds of this Controversie; so that immediately it clearly appeared to be almost the same thing, whether incision be made in the Vein on the affected or opposite side of a patient sick of a pleurisie; although in our Age Custom hath prevailed first and rather to open the Vein of the affected side. Notwithstanding a Vein being opened in either Arm draws nothing at all immedi∣ately from the vertebral Arterie or from the pleura; they are only the branches of the Azygos, or of the vertebral vein that receive the blood out of the place affected: but that they may accomplish this, they are not unloaded in any other manner, but

that the quantity of the whole blood be abated by phlebotomie wheresoever made. Onely this may be affirmed for opening rather the vein of the affected side, that the Basilick vein being unloaded, the Arteries of the Arm receive the more ample pro∣vision of blood; from hence the bloody stream of the vein Aorta runs down more swistly from that side towards the branches of the Arm, and perhaps in the interim of its quick passage it infuses less blood into the vertebral Arteries, for the nourish∣ment of the disease. As to that opinion, that the blood is sometimes more plenti∣fully carryed from place to place, that from hence the right Lung or Liver being be∣set with an inflammation or obstruction, the right part of the head is in pain, and of the face grows more red; I say this sometimes is brought to pass, because the patients do constantly lie in their bed on the side affected; wherefore, the Vessels being com∣press'd, the blood stays longer in other parts of the same side while it is circulating. But of these things we will make a more diligent search when we shall render the Hi∣story and Aetiologie of phlebotomy.

But if phlebotomy by reason of a weak pulse,* 1.303 and fainting of the animal function, neither ought to be at first administred, nor repeated, though the pain be most urging; Cupping-glasses with Scarification do well supply the turn hereof, being applyed to the place pained. Riverius, and Zacutus Lusitanus have cited notable Examples of cures effected by this remedy. And surely this practice seems to lean upon a reason strong enough; for the blood being drawn away from the side affected, that which is lodged in the neighbouring vessels, being the conjunct cause of this disease, is moved with it, and partly drawn away, and partly turned to its Circulation. Moreover, to re∣move an inflammation of the Pleura, besides withdrawing blood by a free Phlebotomy or Scarification, also the serous and other excrementitious humours ought to be gently solicited and excerned as well out of the mass thereof, as out of the bowels, by Stool, Urine and Sweat. The more strong purgatives are deservedly prohibited, because they disquiet the blood, and constrain it to be impacted more deep into the places affected. And that certain renowned Chymists, viz. Angelus Sala, Hartman, M. Rulandus, with many others, do audaciously exhibit Vomits of Stybium to any af∣flicted with a Pleurisie, and magnifie it for the best remedy, seems to me neither safe nor congruous to reason;* 1.304 the only reason of helping, as I think, and that very un∣certain, and full of danger, may be, viz. that the medicine operating more vehemently while the patients suffer exolution of spirits or swoonings, all the vigour and tur∣gescence of the blood abates, and for that cause the nervous Fibres remit their wrink∣lings or painfull contractions, and the Vessels carrying blood being much emptyed, do suck up the morbifick matter: In the mean time, there is danger lest the humours being violently disturbed, rush more impetuously to the part affected; at least, lest the Spirits being too much dejected, and the work of Nature disquieted about the digest∣ing or separation of the morbific mater, strength should utterly fail, before the disease be cured. Yet in the mean time, Clysters are of frequent or daily use: yea some∣times more benigne solutive purgatives are allowed, provided that the Feaver be not very intense. Julips and temperating Decoctions and things gently moving Sweat and Urine,* 1.305 as we have prescribed before for a Peripneumonie, are also here conve∣nient; but let all hot and sharp things, whether aromatick, or endowed with a vinous spirit be carefully declined.

II.* 1.306 The second Indication preservatory, designed against the clamminess and boyl∣ing up of the blood, prescribes Medicines of that sort which consisting of a volatile or alcalizated Salt, do destroy the combinations entered into, of the acid and fixed or otherwise distempered Salts, with the other more thick particles. For which in∣tent the eyes or claws of Crabs, the tooth of a Boar, the Stone of Carps, the jaw of a Pike Fish, the Bone in the heart of a Stag, the Priapus of a Hart, Sal Prunella, Salt of Coral, Salt of Urine, or volatile salt of Harts-horn, powder of Goats-blood, in∣fusion of Horse-dung, Spirit of Harts-horn, of salt Armoniack, Spirit of Tartar, the simple mixture, mineral Bezoar, Diaphoretick Antimony, flowers of salt Armoniack, are very famous Remedies in a Pleurisie.

III.* 1.307 The third Indication vital which provides that the strength and vital heat be preserved during the course of the Disease in due tune and state, gives in precept first an apt kind of food, and moreover Cardiac and Anodyne remedies, and those which seasonably occur to other symptomes, if perhaps they arise. First, in a true Pleurisie, a most thin Diet ought to be appointed, viz. of meer Oatmeal and Barley; and for ordinary drink, a Ptisan or Posset-drink rather than Beer

alone is convenient: although in an outragious thirst this also is to be allowed of in a moderate quantity. Moreover, for quenching thirst, Juleps, Apozemes, and Emulsions are taken by turns; to all which adde Sal Prunella. Secondly,* 1.308 let only the tempe∣rate Cordials be administred which mildly do recreate the animal spirits, and not at all intend the kindling of the blood, burning out of its due proportion. For these intentions, the water of Carduus Mariae, Carduus Benedictus, of Balm, Borage, Cowslips, Black-cherries, are usually given with success: whereto let the powder of Pearls and Coral be added. Thirdly, It behoveth to administer Anodynes, both inwardly, to provoke sleep in case it be very much wanting, and also externally, to alleviate the pain of the side. Of the former kinde the more usual are the distill'd water, syrup and powder of red Poppies, which are esteemed Specificks in a Pleurisie and in a Peri∣pneumonie: Moreover, when the pain is very acute,* 1.309 and watchings instant upon the patient, they may lawfully drink Diacodiates. Against pains, Liniments, Fomenta∣tions, Cataplasmes, and sometimes the hot bowels of Animals newly slain are con∣venient to be applyed. These are the principal Intentions of healing which seem re∣quisite to cure an exquisite and simple Pleurisie, before it contracts a Peripneumonie to it self, or passes into it, or into an Empyema. It only remains to adapt to each of these the more select forms of Medicaments.

First therefore in the beginning of the Disease, for taking away the Phlegmon,* 1.310 Ju∣leps, Apozemes, Powders, and gentle loosening Clysters are wont to be prescribed.

Take water of Carduus Mariae eight ounces, red Poppies 4 ounces,* 1.311 Syrup of red Poppies one ounce, sal Prunella one drachm, make a Julep, the dose two or three ounces every third hour.

Take of Grass-roots 4 ounces, Barly half an ounce, Apple-parings one handfull,* 1.312 Rai∣sins one ounce, Liquorish two drams, boyl them in three pints of Spring-water to two; clarifie the strained liquor, adding Syrup of Violets one ounce and half, Sal Prunella one dram and half, make an Apozeme, the dose 3 or 4 ounces often in a day.

Take of Sal Prunella two drams, flowers of Nitre one dram,* 1.313 powder of red Poppy flow∣ers two scruples, Sugar-candy 4 scruples, make a powder, the dose half a dram three or four times in a day.

Take of the Decoction of Mallows, leaves and roots, with Prunes,* 1.314 one pound, syrup of Violets three ounces, Sal Prunella one dram, make a Clyster.

Take Cassia bruised two ounces, Tamarinds one ounce, Damask-Rose leaves one handful, Coriander-seeds two drams, boyl'd in Spring-water to a pint, strain it, and adde Syrup of Chi∣cory with Rhubarb two drams, clarifie it with the White of an Egge, the dose is 5 or 6 ounces in the morning, continued for two or three dayes.

Secondly, The following are of use to dissolve the clamminess or coagulating vis∣cosity of the blood, in form of a Drink, of a Powder, and of Spirit.* 1.315

Take fresh Horse-dung 4 ounces, Carduus-water one pound and half, infuse it warm for two hours, after filtre it, to which adde syrup of the juice of Dandelyon, or of Chicory,* 1.316 two ounces, Spirit of salt Armoniack one dram, let five or six spoonfuls be given three or four times in a day.

To this end Water of Horse-dung wonderfully profits.

Take of Horse-dung 4 pounds, leaves of Carduus Benedictus, Carduus Mariae, Scabious,* 1.317 Pimpornel, of each three handfuls, upon them cut and mixt together pour six pints of new Milk, distill them in common Organs. The Dose is from two Ounces to three, either with it self, or with other distill'd Waters, in form of a Julep.

For the same use, the Tinctures, or the solutions of other Dungs are administred by some Physitians, and highly magnified by them. Helmont commends the dung of an Oxe, Panarolus commends Pidgeons-dung, others the white dung of a Cock, for the Pleurisie. Epiphanius Ferdinandus was wont to give with success the Decoction of Tobacco with new Wine; Valeriola by experiment as a familiar remedy made use of the Decoction of the Flowers of red Poppies:* 1.318 The renowned Sylvius prescrib'd the following mixture to be taken by Spoonfuls, within short spaces of time.

Take Parsly and Hyssop water, of each two ounces, Fennel-water one ounce, Treacle-water simple half an ounce, Laudanum Opiate 4 grains, Salt Armoniack half a scruple, Syrup of red Poppies one ounce. Mingle them.

Frederick Deckers adds to this the Powder of Crabs-eyes, and Mineral Bezoar, of each one scruple.

Medicines chiefly efficacious for this use are wont to be administred in the form of a powder: for examples sake,

Take Powder of Crabs-eyes two drams,* 1.319 Sal Prunella one dram and half, of the flowers of red Poppies half a dram, mix them and make a Powder, the dose half a dram, three or four times a day, in a convenient Vehicle.

Instead of Crabs-eyes, the powder of the Jaw of a Pike, or the Tusk of a Boar, or the Pizzle of a Stag, or Bull, are used, and if they prove ineffective, try the following.

Take of Antimony Diaphoretick, or the Ceruss thereof, or Bezoar Mineral, two drams, the volatile Salt of Harts-horn half a dram, the powder of red Poppies two scruples, make a Powder; The dose from one Scruple to half a dram, three times or oftner in a day.

For the same intention of curing it was, that Riverius gave of the Powder of Soot from half a dram to a dram; others the powder of Pidgeons dung, or of a Cock. And indeed by reason of this analogie, whereby the dungs of Animals stored with vo∣latile Salt, do succour in this disease; it is probable, the dung of a Dog doth no less conduce to cure a Pleurisie than a Squinancy, and so much the rather, because these diseases frequently change their forms among themselves, and one assumes the species of the other. Chymical liquors endued with a volatile Salt do also notably help sometimes in a Pleurisie.

Take of Spirit of Blood two drams,* 1.320 Water of red Poppies three Ounces, the Syrup of the same one ounce. Let it be given by spoonfuls often.

Take spirit of Sal Armoniack, distill'd with Olibanum, three drams, the dose from 12 drops to 15 or 20, twice or thrice a day, in any convenient liquor. After the same manner the Spirit of Ʋrine, Soot, or Harts-horn may be given.

Take the Spirit of Tartar 3 drams, the dose one scruple in a convenient vehicle.

Take of the simple mixture 3 drams; Dose from one Scruple to half a dram.

As for the third Intention,* 1.321 besides a thin diet, Cardiac remedies and Anodynes are prescribed. Examples of the former kinde for the first Indication may be supplyed by Juleps and Apozemes; for the second Indication they may be supplyed by Spirits and Powders. Anodynes are prescribed to be exhibited inwardly upon watching, and very intense pain, according to the following method.

Take of Poppy-water two ounces,* 1.322 the syrup of the same 6 drams, Spirit of Harts-horn 12 drops, make a draught to be taken at Bed-time.

If we must proceed higher, Take Carduus-water two ounces, Diacodium from three drams to half an ounce or 6 drams, Spirit of Sal Armoniac with Frankincense half a scruple, make a draught: and sometimes although rarely Laudanum is expedient, which timely given, inasmuch as it excites sleep, and moves sweat and Ʋrine, does greatly profit.

Take Cowslip-water two ounces, Tartariz'd Laudanum from 16 drops to 20. the Spirit of Blood half a Scruple, Syrup of Violets two drams, mingle them for a draught.

Outward Anodynes in form of a Liniment,* 1.323 Fomentation, and Cataplasm, are usually prescribed.

Take Oyntment of Marshmallows two ounces, Oyl of Almonds one ounce, Dogs-turd two drams, mix them by grinding together.

Take the Plaister of Mucilages two ounces and a half, moistened with Linseed-Oyl, and applyed upon Lawn-paper.

Take the tops of both Mallows, the leaves of Mercury and Beetes, of each 4 handfuls,

boyl them in Spring-water, and strain'd, let it be used for Fomentation.

Take the Dregs of the herbs after the liquor expressed, to which adde the bran of Oats 6 ounces, Linseed and Foenugreek-seeds, of each two Ounces, Oyntment of Marsh-mallows two ounces, make a Cataplasme.

There is no occasion to go far for Histories and Instances of patients sick of a Pleu∣risie,* 1.324 for a notable Example of this disease is now under our hands: to wit, A very lovely Maid, frequently and as it were habitually obnoxious to that distemper, is com∣mitted to our care. This Virgin being very amiable, of a sanguine complexion, but of a weakly constitution, upon any the smallest occasion, viz. by taking cold, or by er∣rors in any of the six Non-naturals, yea sometimes from the meer alteration of the year, or the air, has for many years been wont to fall into a feaver; whereupon imme∣diately pleuritick pains, with a Cough and difficult breathing come upon her, and af∣terwards for the most part hideous Convulsions; under which passion in time past she did so grievously labour, that frequently every year for or above six months she was constrain'd to keep within her Chamber. But of late, although she is not acquitted from this hurt, yet she is seldomer punish'd with it. The last year all the Sum∣mer, and almost the Autumn, she enjoyed her health indifferently; in the beginning of Winter she took her bed with this sickness, and now about the end is again sick. A pain from the Pleurisie constantly afflicts her right side, where the blood sticking in its passage, and being extravasated about the intercostal muscles, the Fibres being provoked, fall into a most troublesom condition, together with a convulsive motion of Coughing, and almost perpetually repeat it: In the mean while her Lungs be∣ing sound enough, and open as to the passages, do readily convey the blood without any stop by its clamminess, (which frequently is the author of a Peripneumonie.) No remedies that are used will do her good without phlebotomie, which continually is so very necessary, that upon every return of the sickness, in spite of all things, we are compelled three or four times to repeat it, and sometimes oftener: the blood let out in the Superficies hath constantly a viscous and whitish silme. This disease was ever a simple Pleurisie void of a Peripneumonie, and for cure she with constant success used the following method.

Take Spirit of Sal Armoniack distilled with Gum Ammoniacum three drams; take from 15 drops to 20, three times a day, with the following Julep.

Take Carduus and Black-Cherry water, of each six ounces, Hysterical Water one dram Sugar 6 drams. Between whiles she took a dose of this Powder with three ounces of Apozeme.

Take Powder of Crabs-eyes, of a Boars tooth, Sal Prunella of each one dram, make a powder for 6 doses.

Take Grass-roots 3 ounces, candied Eringo one ounce, Shavings of Ivory and Harts-horn of each two drams, the Parings of Apples one handful, Raisins one ounce, boyl them in three pound of Spring-water to two pound, to it strain'd, adde Syrup of Violets one ounce, sal Prunella one dram, mix them, and make an Apozeme.

Clysters of Milk with Syrup of Violets were injected, sometimetimes every, sometimes eve∣ry other day. If Opiates, however mild, were given to allay pain, upon it a pain and drousi∣ness of the head, and Convulsions did infest her most grievously.

SECT. I. CHAP. X. Of an Empyema.

IT is clearly manifest from what hath been said before,* 1.325 that a Pleurisie, and Pe∣ripneumonie, ripneumonie, are diseases not only akin but commutable among themselves, and successive to one another; Moreover, as well this as that, and frequently both together, not being well cured, doe pass into an Empyema. For when a Phlegmon rais'd about the Pleura is brought to suppuration, at length the Impo∣sthume being broke, the matter falling into the cavity of the Thorax, produces this disease. In like manner sometimes it follows from the Lungs being inflamed: inas∣much as the ichor accumulated about the place affected, turns into a thick and yellow homour by a long digestion, which unless it be ejected by a Cough, either sensibly corrupting the inner substance of the Lungs, it causeth a consumptive disposi∣tion, or dissolving the unity of the intire Lungs, and at length corroding the outmost membrane, it slides down into the breast, and so engenders an Empyema. And one labouring with an Imposthume or ulcer of the Lungs, although he do spit out abun∣dant and foetid matter (at it frequently happens in an Imposthume of the Lungs,) is not therefore accounted obnoxious to an Empyema. For in truth, by the common acceptation of this Term is signified a Collection of rotten matter within the cavity of the Thorax, by which the Organs of breathing are oppressed: but that rotten matter is wont to have a conflux thither either by a Pleurisie or Peripneumonie, (and sometimes perhaps from a Squinancy) brought first to suppuration and after∣wards broke.

Forasumch as an Empyema never begins primarily and of it self,* 1.326 but for the most part is the effect or product of other diseases, not duely cured, it will not be re∣quisite to make much inquisition about the causes thereof. The formal reason or conjunct cause thereof is known well enough, (to wit) it is a purulent matter, poured out from the Pleura, or the Lungs, or the Larinx, into the cavity of the Thorax. But the other proper causes of the previous effects, appertain to the Etiologies of every of them.

There is a certain dispute about the morbific matter;* 1.327 for some contend that it is meer corruption, others not that, but that it is a purulent matter, of which opinion is Johannes Heurnius, who averring a purulent matter for the conjunct cause of an Em∣pyema, distinguishes between this and mere and pure Pus, affirming this to come to pass from a bloody nutritious homour, i.e. from the blood it self somewhat corrupted, but ca∣pable of digestion, but that a purulent matter is an excrementitious homour, viz. a Serum or Ichor, which proceeds from the blood obstructed and hindered somewhere in its Circu∣lation. From hence we may observe concerning an Imposthume which affords true and laudable Pus or matter, that it is for the most part compact, every way shut up and wrapt up together either in a bladder, or (as it were) within private Apartments, and then after it is maturated and broken, pours out the contained homour, and is soon and easily healed.* 1.328 But an Imposthume affording a purulent matter forms its nest not so bound up and encompass'd with walls, but for the most part unequal and crook∣ed, and being broken rather pours out filthy blood or gore than matter or Pus, and then by reason of the successive source of excrementitious homour, it is very difficult∣ly healed.

Moreover, we are to consider, that each humour as well Pus as purulent matter doth sometimes stink notably, and is also sometimes very free from any bad savour. Some maturated and broken Imposthumes pour out fetid matter, others matters with∣out any smell. I have often observ'd Imposthumes of the Lungs, as well as Phleg∣mons of other parts to have this several distinction. Purulent matter from any Ul∣cers stinks ill;* 1.329 the Spittle of consumptive persons which is esteemed to be very dan∣gerous, for the most part is without any scent. It is usual where the side is opened by reason of an Empyema, that at first the matter flows out not unsweet, but after two or three days the air having more frequently enter'd into the orifice, it stinks most horribly: which stench notwithstanding after an injection of some aromatical or vinous Spirit vanishes again in a short space. But it would be a thing of much te∣diousness

to denote the particular reasons of each of these accidents and alterations, for that never so little alteration of the Pus or purulent matter, both causes and re∣moves the stench from them. When the sulphureous particles are equally digested, and being subjugated to the salts are contained in a mixture, there is no stench; but as soon as they being loosed begin to fly away, and carry the salt particles with them (whereby they are sharpened) they disperse a very bad stench round about. But whereas an Injection or Lotion with vinous and aromatical liquors, being sometimes administred to a putrid Ulcer or nest of an Empyema, frequently removes all stench; the reason is, becase the sides of an Ulcer, no otherwise than as a stinking pot, in∣fect the contained liquor as with a certain ferment, and so impresse a stink; but when that ferment of the vessel or bowel is washed or overcome by a well-tempered and strong liquor, then that propagation of a stench ceaseth. From hence follows not always an ill sign, nor is it so very good, if the Spittle of consumptive persons, and the Imposthumes of such as are Empyematical are excerned either with, or without stench; for that I have known it to have been to some healthful, and to others deadly in either case. Moreover a more certain Judgment is not to be taken from thence, that the spittle of some consumptive persons floats upon the water, and that of others sincks.

But although we do not much disapprove of that distinction of Pus and purulent mat∣ter,* 1.330 notwithstanding we adjudge neither only this, nor always that, to be a conjunct cause of an Empyema. Whenas this disease succeeding a simple Pleurisie, arises from an Imposthume being suppurated and broken in the side, it is most commonly pure and meer Pus, which falling into the cavity of the breast, engenders that disease. But if an Empyema be an Offspring of a Peripneumonie (unless an Imposthume of the Lungs intervene) the ichorous matter being accumulated about the place of the phleg∣mon, and after thickening by meer concoction, it wounds the Lungs, and at length making a hole through the membrane encompassing it, and flowing out into the Thorax, produces an Empyema. That matter is rather to be accounted purulent than meer Pus.

The signs of an Empyema either prognosticate it while it is in fieri,* 1.331 or indicate it plainly done. Some foregoing diseases are esteemed of the former sort, whose issue this uses to be, of which sort are the Pleurisie, Peripneumonie, and Squinancy, also sometimes a stroke or wound of the breast, and sometimes other distempers thereof, not well cured, nor discharged; out of which the suspicion will be greater of an Empyema to ensue, if after one or two weeks without abundant Spittle, the shiver∣ing of an Ague and fainting of the Spirits overtakes one. Then after fourteen or twenty days, there will be signs of an Empyema fully made, as difficult breathing,* 1.332 a heaviness of the breast, a swimming to and fro of the matter, and a sense of pain from the position of the body chang'd, thirst and a small feaver almost continual, red∣ness of the cheeks, disquietness of the whole body, and watching.

An Empyema is distinguished many ways, viz. First according to the distemper going before, whose Offspring it is; also according to its seat, one while in the right side of the breast, another while in the left, and another while in the whole capacity thereof; and lastly, as to the morbific matter, which is either meer and laudable pus, or purulent matter, and this one while gentle, and benigne, and another while sharp and stinking.

Prognosticks of this disease begin as well before as after incision;* 1.333 the former deter∣mins whether the side ought to be opened or not, also it presages of what sort the event will be, either with or without opening. If an Empyema succeeds more slow, after the first distemper, to wit not before the thirtieth or fortieth day, whenas the strength is very much worn, and the Lungs are vitiated, and their structure hurt; and also if a feaver remain as it were hectick, the breathing short and painful, the Pulse weak and quick, with cold sweat, and with a Diarrhea or wasting loosness, and fre∣quent faintings of the Spirits, then the state of such a person being evidently despe∣rate, doth not admit of any opening; let a Physician suffer him to dye without bleed∣ing, lest he seem to murder him. But if on the contrary, after manifest signs of an Empyema more maturely perfected, the painfulness of the Lungs or side, as also the feaver and other symptomes abate, and the Pulse, and strength of the Spirits are in vigour, it will be lawfull safely to advance to cutting, and thereby to hope a happy success. Incision being made, if white Pus duly concocted or otherwise laudable skip out with ease, and thence the heaviness of the breast and difficult breathing

abate, and the patient is better as to the other passions, there will not the least doubt remain of his cure: but if no Pus, or that which is bad, if thin, something bloody, or stinking, flow from the side being opened, we can conceive thereby but small hope of recovery.

Hippocrates among the presaging signs of a mortal Empyema,* 1.334 recounts that of the Probes being coloured by the Pus, as by fire; or what we often observe, and some∣times without any evil event, if the silver Probe being put into the orifice of the open'd side, be presently ting'd with a colour as it were of Gold or Copper; which surely signifies no other thing but that the sulphureous particles of the pus, or purulent mat∣ter are so exalted, and loosen'd from the bond of mixture, that easily departing they may be affix'd to any other body, and especially silver, whereunto they are akin. Some∣times I have seen Venison kill'd by long and wearisome hunting, presently bak'd in an Oven for Entertainment, become not only most tender, insomuch that it might be taken out with Spoons, but even to have guilded a bright silver Spoon at the first touch. The reason whereof is the same with the former; viz. that the flesh was so disposed to putrefaction by too much exercise while the animal lived, that the par∣ticles of the Sulphur being exempt from Concretion, and apt to fly away, presently ad∣here to any other fit subject: But this by the by.

As to what belongs to the curatory part of an Empyema,* 1.335 we ought chiefly to con∣sider whether the signs of this disease, as being now perfected, be certain, or doubt∣full. In the former case there will not be much need of Medicine, but the body only being prepar'd before-hand, we may immediately proceed to the opening of the side. Wherefore, if from a Pleurisie or Peripneumonie not rightly cur'd, or from blood poured out after a stroke, fall, or inward wound, a fluctuation of Pus or puru∣lent matter, or bloody within the cavity of the Thorax, be perceived, with no Spit∣tle, or with little, there will not be need that we dwell longer on maturing or expecto∣rating Medicines, but the belly being loosened, and the blood and humours rightly temperated by Juleps, Apozemes and Anodynes, either that a bare Section be or∣dained; or that in tender and fearful persons a Cautery be applyed between the 6^th and 7^th Vertebra,* 1.336 and after the Eschar is rais'd, the Incision-knife be obliquely fore'd by little and little, towards the hinder and upper part, untill it penetrate into the very Cavity of the Thorax; afterwards, a little silver Pipe being put in, let the contained matter be sent out by degrees; notwithstanding in such manner that, if his strength will bear, an evacuation of the whole humour be accelerated; for a portion thereof being left within,* 1.337 often contracts a hideous stench, within a few days (by reason of the Air, as is abovesaid, being admitted) which evil, that it may be provided against, or soon removed, a vulnerary and abstersive liquor is to be cast in twice or thrice a day by a Syphon or Syringe. It will not be requisite to prescribe particularly the other things belonging to this operation, and the process thereof; for that each of these things are evidently known to any of the more expert Chi∣rurgeons, and are used in familiar practice. After incision and the appertaining admi∣nistrations rightly performed, there will not be much besides left for a Physician to doe. It is convenient there be a right course of Diet, a frequent loosening the belly (as often as need shall be) by Clysters; and moreover it behoveth us to prescribe remedies vul∣garly called Vulnerary, which hinder the dissolution of blood, and the profusion there∣of into ferosities injurious to the breast.

But if the Signs of this Disease be less certain,* 1.338 and (as for the most part it is wont to be, from a Peripneumonie and Imposthume of the Lungs going before) altogether doubtfull, Incision must not too soon or rashly be made. For I have known some spit∣ting forth a purulent matter, yea a fetid Pus, with painfull breathing, and heaviness of the breast, to have undergone a Paracentesis in vain, and not altogether exempt from hurt. Wherefore, until it is apparent by pathognomic signs that it is an Em∣pyema confirm'd, expectorating medicines (as are before prescribed for the cure of a Peripneumonie) as also things gently moving evacuation by Urine and Sweat, may be used for some time: But these availing nothing, and the Empyema still remaining or increasing, (because whilest there is strength it is better to try doubtful Medicines than none) proceed to a Paracentesis.

As to the Forms of Medicines requisite to the curing an Empyema,* 1.339 before Incision, the same remedies that are prescribed in a Peripneumonie are convenient; but the Pa∣racentesis being made, these following will be chiefly in use.

Against fainting of the Spirits, and swoonings which happen in that operation, or

afterwards, let the following Julep be at hand to be taken now and then about four or five spoonfuls.

Take Balm and Black-cherry water, of each six ounces, Aq. Mirabilis one ounce,* 1.340 powder of Pearle one dram, syrup of Gilliflowers one ounce. Mingle for a Julep.

The following Decoction to be drunk three or four times a day.

Take of Harts-tongue, Speed-well, Agrimony, Colts-foot, Mousear, Sanicle,* 1.341 of each one handful, Madder and Chervil-roots of each one ounce, Barly half and ounce, red Cicers half an ounce, Raisins an ounce and half, boyl them in four pound of Spring water to half, sweeten it with clarified Honey, or with Syrup of Mouse-ear as you take it, to your pleasure. If a Feaver be wanting, the following Pills may be taken from one scruple to half a dram, Evening and Morning.

Take powder of Crabs-eyes two drams, Flower of Sulphur one dram, Sal Prunella half a dram, Spec. Diarrhodon Abbatis one scruple, Venice Turpentine washed, make a mass formed into small Pills, or omitting the Turpentine take the powder from half an ounce to two scruples, twice in a day.

Examples of persons sick of an Empyema are not so frequent,* 1.342 and those cured of that Distemper more seldom. I have known two, unwilling to admit of an Incision prescribed by all means by the Physicians, to have fatally expired, and their dead bodyes I have dissected. Also I saw that operation administred to two others, where∣of one recovered health, the other dyed consumptive; but the reason thereof was, his Lungs being notably corrupted, and his strength utterly lost, the too late opening his side conferr'd no help to him; but did much depress his spirits, weak enough before, and wasted his strength. He whose side was opened, had Lungs found enough; but from the Imposthume of the side being broke inwardly, the matter falling into the cavity of the Thorax did so compress the Diaphragma that he could scarcely breathe. The Chirurgeon without a Caustick thrust in his Incision-knife between the 6^th and 7^th Vertebra, and having made a hole quite through his flesh,* 1.343 he put in his Pipe. A bloody ichor first flowed out, afterwards being drawn away by a moderate quantity at times for three dayes, it flowed out without any stench; but afterwards as often as the Orifice was opened, a most horrid smell came forth, exceeding the stench of any Jakes, though ne're so stinking, and infected the whole Chamber with the ill scent: Moreover it remain'd so for many days, untill by injections made of Myrrh and bitter herbs, boyl'd in Water and Wine, and very often administred every day, at length it was extinguished; by the daily use of which, the morbific matter and at length all the fordidness being washed away, all flowing out ceased; and last of all the Orifice being closed, the patient recovered his entire health. I dissected the dead bodies of those who dyed, when by no perswasion of Physician or Friends they would admit of the opening of their side. One I have spoke of otherwhere,* 1.344 the result whereof was, the Pus streaming from the Imposthume raised in the Pleura, and in the intercostal Muscles, and broken internally, had wasted part of the affected place, and of the contiguous Lung, with a Sphacelus or Gangrene, and so corroding the Dia∣phragma, and a hole being made on the right side thereof, it had descended into the Viscera or bowels of the lower belly: and there in the whole passage of the Ventricle and Intestines, the outer Coats on which the purulent matter had fallen, appeared eaten and discoloured; and at length the purulent matter corroding and boring through the intestinum rectum, it came forth through the fundament together with his excre∣ment. The sick man being strong and impatient of any medicine, endured the ty∣ranny hereof for about two months, but in the mean while he lived miserably, af∣flicted with a light Feaver, thirst, inquietude, pain of the stomack, and frequent tumbling up and down, and almost with continual watchings. His body being opened after his decease, a most horrid stench, exceeding any Jakes, diffused it self throughout the whole Chamber. The Anatomy of another who dyed by an Empyema,* 1.345 afforded not so vast an effusion of purulent matter. This indeed had its nest in his side, from whence fall∣ing into the cavity of the Thorax, and there accumulated in a vast heap, and conti∣nually defiling his Lungs drenched therein, it caused a slow and as it were a hectick Feaver, whereby the patient, being very old, dyed.

SECT. I. CHAP. XI. Of an Imposthume of the Lungs.

A Vomica of the Lungs is something a-kin to Empyema or Peripneumonie,* 1.346 considering that the morbific matter is always meer Pus, which notwithstand∣ing is generated in the Lungs without a Feaver and Phlegmon, yea without any great Cough or Spittle, as it were silently, and without noise; and frequently this evil doth not discover it self before it kills the patient. Galen makes mention of this in lib. 1. de locis affectis; but among Authors who have written Systemes and the Practi∣cal parts of Physick, mention thereof is seldom of scarce to be met with. Tulpius in lib. 2. chap. 10. describes this distemper after this sort. This evil (meaning an Im∣posthume of the Lungs) lurks in the beginning so secretly that it scarce discovers any signs of it self, besides, in the first place, a little dry Cough, and presently moist; which continuing for some time, the breath is drawn with difficulty, the spirit fails, and the body withers by degrees, although in the mean time the Spittle makes no shew either of pus or blood; and if the Imposthume break by way of surprisal, the man is kill'd immediately. It is wont some∣times so to happen, but I have known many who in an Imposthume rising insensibly, being maturated, and at length breaking, have spit up g••••t plenty of fetid corruption; and though with voiding daily such a Spittle, for many weeks, nay months, they be∣came very weak, and as it were consumptive, yet at length by the help of Medicines, after the Ulcer hath been mundified, and dryed, they have recovered their health entirely.

This disease,* 1.347 if we search into the formal reason and conjunct cause thereof, is in truth a concourse of ill humours gathered in some part of the Lungs; whose matter although it be heterogene and an enemy to nature, notwithstanding from the beginning ap∣pears not sharp, or irritative. For when at first being separated from the blood, it is deposited in some hollow place of the Lungs, perhaps in some bladdery cell, it doth neither raise a Cough nor produce a Feaver; but after wards when sensibly encreased it compresses the neighbouring Vessels bringing blood, and moreover insinuates into the very blood passing by, incongruous Effluviums; from thence a small Feaver suc∣ceeds, with a certain disquietude, and feebleness; and at length being accumulated to its fulness, and maturated by a long digestion into mere pus; breaking its nest very much distended before, it flows out every where all about. But if the ways are not open for the issuing of the pus, it incontinently mingles it self with the blood, and either empoysons it, or impedes it from Circulation; or rushing by heaps into the Tracheal passages, it doth fill most of them at once, and so stuffs them, that a suffici∣ent entrance is denyed to air to kindle the blood, and presently the viatl flame expires: but if this matter find passage, and flow by degrees into the Trachea, from whence again it may be presently carryed away, and spit out, there will be then some truce of life, with hope and opportunity of cure. And indeed I have known may cur'd of this disease.

The usual matter of an Imposthume of the Lungs is meer Pus,* 1.348 which often stinks notably, and by that differs from the Spittle which is ejected in a Peripneumonie or a Consumption of the Lungs. But whence that matter proceeds in the beginning there∣of, and of what disposition it was before it was ripened into pus, I cannot so easily determine: because the seeds of this disease being privily sow'd, and growing up se∣cretly, spring wholly from an occult original; wherefore its procatarctick or more remote causes lye conceal'd, yea while it begins and increases, can neither be disco∣vered by any pathognomical Signs, nor can any prognostick be devised, before it discovers it self with a mortal stroak, but the whole procedure thereof is treache∣rous.

Now if after the Imposthume is broke, and the spitting up of pus with an easie dis∣charge being begun, with a constancy of strength, there be means offer'd for some method of cure, the chief Indications according to the common custom in most diseases will be these, viz. Curatory, preservatory, and vital. The first com∣mands the matter of the Imposthume speedily to be discharg'd by Spittle, and that the sides thereof should be cleansed and healed as much as is possible. The second In∣dication

provides against the conflux of new matter to that nest, or other adjoyning places of the Lungs (whence a Consumption may be engendred). The third restores the languishing of the Spirits, the lost strength, and the frustrated Nourishment.

1. As to the first Indication, remedies commonly called expectorating,* 1.349 and of them those that are more hot and sharp, and do very much cleanse and drye, but especially (for that for the most part here a Feaver is wanting) sulphureous remedies are expedi∣ent; which also may be prescribed according to the following forms.

Take of Tincture of Sulphur three drams, take from seven drops to twenty,* 1.350 at bed∣time, and early in the morning in a spoonfull of Syrup of the Juice of Ground-Ivie. Or,

Take our syrup of Sulphur, as before set down, 6 ounces, let a spoonfull be taken at the same hours.

Take the dried leaves of Ground-Ivy, Germander, white Maiden-hair, Coltsfoot, Hyssop, white Hore-hound, Savory, of each one handful, Enula-campane, Orris, and Chervil-roots, of each one ounce, Anniseeds half an ounce, boyl them in 6 pound of Spring-water to three pound and a half, adding towards the end White-wine 6 ounces, clarified Honey three ounces. Let the strained Liquor be clarified, and kept for use: the dose 6 ounces warm, three times a day. Or,

Take of Lime-water 6 pound, put it in a Glass with a large mouth, hanging in it the following bag:

Take the dried leaves of Germander, Ground-Ivy, white Horehound, of each one handful, Orris and Enula-campane sliced one ounce and a half, Anniseeds bruised two ounces, Li∣quorish an ounce and half, Raisins stoned three ounces, let them be stopt and stand cold. Pour out for use, the bag remaining.

Take Lohoch Sanum three ounces, Species Diaireos two drams and a half, flower of Sulphur one dram and a half, of simple Oxymel two ounces, make a Linctus to be lick with a Liquorish stick.

Take the powder of Hedge-mustard, Ground-Ivy, of each half an ounce, flower of Sulphur a dram and a half, syrup of Sulphur (or of the juice of Ground-Ivy) what will suffice to make a Lohoch.

Take of fine Mirrh, of white Amber, of each half an ounce, Sulphur Vivum, Auri∣pigment, of each two drams, the rinds of Pistaches one dram and a half, make a powder for Fumigation, to be used in a Paper-funnel, morning and evening.

2. The preservatory Indication, abolishing the morbific matter,* 1.351 and so providing against a Phthisis prone to succeed; endeavors the purifying of the blood, and strength∣ning the Lungs, to which ends, Purgers, Vulnerarie Decoctions, distill'd waters and physical Drinks, are convenient.

Take of the Decoction of Senna of Gereon (with one dram and half of Agarick) three ounces and a half, purging syrup of Apples one ounce, Aq. Mirabilis two drams, make a potion to be taken with government once in a week.

The form of the Wound-drink let be the same as was prescribed for an Empyema after opening, or 4 or 6 ounces of the Decoction common in Shops, three times a day, (because here is no feaver.)

Take of Firre-tops 6 M. fresh Ground-Ivy, Hyssop, Sage, Rockets, Hedge Mustard, St. Bar∣baries herb or Winter-cresses, of each four handfuls, the seeds of the Sun-flower 6 ounces, sweet Fennel-seeds two ounces, Enula campane, Orris-roots, of each 3 ounces, being cut and bruised, pour upon them 8 pound of Brunswick Mum or Spruce-Beer, distill it in a cold Still, let the liquor be all mixt, and when used, sweetned at pleasure with syrup of the juice of Ground-Ivy; the dose three or four ounces, three times a day.

Take of the roots of Sarsaparilla six ounces, China two ounces, of each of the Sanders six drams, Shavings of Ivory and Hartshorn, of each half an ounce, Mastick-wood one ounce, being cut and bruised infuse them in 12 pound of Spring-water, boyl them to half, adding one ounce of Liquorish, Raisins 4 ounces, let the strained liquor be kept for ordi∣nary drink.

3. The vital Indication prescribes Cordials, Anodynes,* 1.352 and a convenient course of diet. The same forms of Medicines for the most part are expedient here, which were

prescrib'd for an Empyema after incision, and also the same diet as was ordain'd in a beginning consumption; besides, in this case Asses-milk often-times doth much good. As to the curing this disease, I have observed, that an Issue made in the side, for the most part doth signally profit. I remember two suffering under this distemper, by coughing up plentifully mere stinking Pus or corruption after the Imposthume broke, to have been heal'd by this Remedy in a short space of time. The Histories of the Cures shall be afterwards annexed.* 1.353 In both these by a shallow orifice made in the side by incision, meer Pus began within three or four days to flow out, and then the Spittle began to be abated; and after that flowing, encreased from day to day, for some time continued, the Spittle altogether ceased, and the Patent recovered his entire health.

The reason of this admirable Effect seems to be, that the part affected of the Lungs, or that which is bordering upon it, while the disease was arising, or before, grew to the very side, and therefore Nature had endeavoured by this way the thrusting forth of the Pus or matter contained in the Imposthume; and for that cause perhaps had made secret passages even to the superficies of the side; wherefore, afterwarts an issue being laid open by a knife, the excretion of the morbific matter was conduct∣ed thither. It is also probable, that a certain part of the Lobe of the Lungs at first grew to the side in the diseased, and by reason of the cleaving thereto, afterwards the Imposthume had its rise; for whereas that part being almost immoveable, could not be stirred like to the other parts of the Lungs, the morbific matter was deposited there, and was the better able to reside or form its nest there.

Although the Imposthume of the Lungs be thought a very rare distemper with some Physicians, and by Tulpius judg'd so mortal, that when it breaks it kills out right; yet I have known many to have labour'd under this disease, and by the help of Medicines to have recovered their pristine health. We may here describe two or three of the more remarkable Histories of them.

A Gentleman of a middle age, and before strong and continually healthful, find∣ing himself not well, without any apparent cause, contracted as it were a crazie dis∣position; for being without pain, without Vomit, Cough or notable Feaver, in a short time grown weak, he became without any appetite, unapt to sleep, full of thirst and hot about the precordia; this person was handled a long while by some Physicians as Scorbutical, and by others as hectical; and after various methods of healing were as∣say'd in vain, at length the disease fallying out as from an ambush, appeared manifeltly. For whilst on a certain night being more unquiet than usual, he tossed himself very much in his bed, all on a sudden the Imposthume breaking in his Lungs, a large quantity of stinking pus was thrown out by Cough, so that in four or five hours he threw off about two pints. Moreover, after his Cough continuing about two months, he daily spit out purulent matter, thick and very stinking, untill his flesh being consumed, and he wholly spent, was reduced to languishing, and a notable Consumption. From the stench of his Spittle and breath the whole Chamber was so filled, that his Servants or those attending him, could not endure the ill scent thereof.

After the Imposthume was thus broken, I and two other well-known Physicians being advised with, with all circumspection we prescribed Medicines to absterge and heal the Imposthume, and to cleanse the Blood and Lungs, and to redeem him from an imminent Consumption. A Tincture, and syrup of Sulphur, together with Pectoral and Vulnerary Decoctions and Distillations were taken; also Lohochs and balsamick Pills, day after day in a constant course, with Clysters, gentle Purgatives and Diureticks, were taken be∣tween whiles: then these, Vaporations and Fumigations, as well sulphureous as arsenical, were used morning and evening. After these things being long and carefully used did help nothing, I often propounded the opening of the Thorax; but the sick man ob∣stinately rejecting this operation, said he would rather dye than be murdered; yet at length, when I assured him that this remedy, or none, was further to be attempted, he began to deliberate with himself, and immediately baring his breast, he suffered me to search a place where I might apply a Cauterie; the business was presently put out of doubt, for a Tumour appeared on the left side of the Sternon, between the 5^th and 6^th Vertebra. Instead of a Cautery, I applyed thereto a suppurating Plaister, and within three dayes the top of that swelling became red and soft: out of which, being the next day opened, first a thin ichor, and a little after a yellow and concocted pus flowed out, and afterwards it continued daily to stream out more plentifully: from

that time his stinking Spittle began to abate, and within fourteen days it ceased quite; the morbific matter obtaining through that orifice both an easie and more convenient issue. Although by the effect it was manifest, that the passage of that orifice lay open into the breast, and perhaps into the middle of the Lungs, yet no liquor cast in by a Syringe, could either penetrate or be forced in thither: so secret and intricate are the conveyances which Nature forms for her last aids; that by the same paslage by which the morbific matter is exterminated, nothing more hurtful can enter. This opening of the side was at length chang'd into an Issue, and a Pease or a wooden pill being put in, there came forth daily for half a year together plentifull ichor; and in the mean time this well-known person, all corruption of the breast being shook off, and the fleshy habit of his body being recovered, became healthful in all respects, and lastly, that issue being removed to his arm, he bears no sign of that nor any other disease in his breast.

After this Cure so by chance accomplished, it hapned I performed another like it, on purpose, not less successefully; for shortly I was sent for to a noble Lady which had been for many years obnoxious to the heat of the precordia with a Cough. One day, when she coughed she was throughly sensible of something broke in her Lungs, and presently she voided abundance of meer pus, and that stinking; after that, this kind of Spittle continuing with a Cough, for a week, notwithstanding the use of remedies, seemed rather augmented than diminished, I advised to have an Issue cut in her side, near the very place whence she perceived the pus to ascend, which she readily granted: Within three days, from the orifice being opened meer pus began to flow out, like that she discharged by Cough. Then after the morbific matter had issued out by that Fontinel, both the Cough and the spitting of pus wholly ceased, and with∣in a Fortnight the patient recovered her firm health.

After this I was sent for to another, viz. strong man, and as strong a drinker; who being affected with an Imposthume of the Lungs, also spit up an abundance of pus and very stinking matter. This Patient by a certain rude contumacy abhorr'd any issue, wherefore he would not suffer any to be made in his side; notwithstanding he took any Medicines offered to him, by a long use of which Remedies he escaped free from that disease: the Medicines whereby he chiefly received help were prepared of Sulphur, as our Syrup and Tincture, taken daily and very frequently. To these for Vehicles were added one while a Decoction, another while a pectoral Hydromel, ano∣ther while Lime-water, with an infusion of pectoral, as well as vulnerary Ingredients. Moreover Fumigations and Smokes, especially of sulphureous and arsenical Ingre∣dients, did contribute very notable help.

SECT. I. CHAP. XII. Of an Asthma.

AMong the Diseases whereby the Region of the breast is wont to be infested,* 1.354 if you regard their tyranny and cruelty, an Asthma (which sometimes by reason of a peculiar symptome is denominated likewise an Orthopnoea) doth not deserve the last place; for there is scarce any thing more sharp and terrible than the fits hereof; the organs of breathing, and the precordia themselves, which are the foundations and Pillars of Life, are shaken by this disease, as by an Earthquake, and so totter, that nothing less than the ruine of the whole animal Fabrick seems to be threatned; for breathing, whereby we chiefly live, is very much hindred by the assault of this disease, and is in danger, or runs the risque of being quite taken away.

An Asthma is denominated from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, (which is to breath pursie, or difficultly) and may have this description, that it is a difficult, frequent, and pursie breathing, with a great shaking of the breast, and for the most part without any Feaver.

The act of breathing depends as well on moving the Lungs,* 1.355 the Structure whereof ought to be of that fort that its passages, and all the pores may perpetually be open, for the free sucking in and letting out air; as from the parts or organs moving them, which by alternate turns of Systole and Diastole, do cause the hollowness of the breast, and consequently the Lungs themselves to be dilated, and contracted: whereas there∣fore there are many and divers reasons of disturbance, whereby respiration is preju∣diced, for the most part they may all be reduced to these two heads; viz. that there is a fault either in moving the Lungs, or in the parts or instruments that ought to move them, and from hence the differences and kinds of this disease are best of all design'd; for according to the various nature and position of the morbific cause, it is called an Asthma, either meerly pneumonick, proceeding altogether from the passages bring∣ing in aire being obstructed, or not enough open; or it is meerly convulsive, which only arises by reason of a defect of fault in the motive organs; or mixt, when either parts conspire in the fault, which origine every great and inveterate Asthma is wont to have; of each of these we will treat in order.

1. The ancient Physicians,* 1.356 and for the most part hitherto the Moderns have only acknowledged the first kind of Asthma, judging the next cause, and almost the only cause of this Disease, to be the straitness of the Bronchis, viz. inasmuch as the spa∣ces of those passages, being either straitned together by obstruction, or com∣pression, as often as the use of breathing is required, do not admit of plenty enough of Aire, wherefore, for the more free inspiration of aire, as shall be needfull, the organs of breathing do most difficultly labour, with throes most frequently repeated. But that some are found obnoxious to fits of an Asthma,* 1.357 without manifest taint of the Lungs, it was wont to be ascribed to vapours from the Spleen, Womb, Mesentery, or some other bowel, undeservedly enough; but surely that passion, without the strait∣ness of the Bronchia, or fault of those bowels we have in another place sufficiently evidenced to arise from Cramps of the moving parts, and shall be presently clearly made out. But in the mean time by what means it may arise also from the passages of the Trachea obstructed, or compressed, it lyes upon me to declare.

The straitness of the Bronchia,* 1.358 inducing the first kind of an Asthma, is suppo∣sed to come to pass by an obstruction, as often as either thick humours and viscous, or purulent matter or blood extravasated, are forced in upon them; or that little swellings, or Schirrus's, or little Stones, stop up their passages; or finally that a Ca∣tarrh of a serous humour suddenly distills upon them. Moreover the same distemper is thought to be raised by compression, as often as matter of that kind (and of every kind of them) shall cleave to the passages of the pneumonic Arterie or vein. Sure∣ly, an asthmatical disposition depends upon these various causes and manners of di∣sturbance: but all invasions of the disease, or at least the greater fits are usually pro∣voked by reason of some accidents or occasions. For while the stream of blood sliding and running down gently can be content with a small breathing, it passes through the precordia without great labour either of Lungs or Breast. But being boyling and

passing through the Lungs more impetuously, it requires a more full inspiration of aire; for the freer admittance of this through strait passages presently all the breathing organs are alarmed into most frequent throes.* 1.359 Whatsoever therefore makes the blood to boyl, or raises it into an effervescence, as violent motion of the body or minde, excess of extern cold or heat, the drinking of Wine, Venery, yea sometimes mere heat of the Bed doth cause asthmatical assaults to such as are predisposed. It is usual that those who are obnoxious to this disease oftentimes dare not enter into a Bed, only sleep in a Chair, or on a bed, being covered with garments. The reason whereof is,* 1.360 that the body covered and heated with bed-cloaths, the blood being a little raised into a more quick motion. and grown hot, requires a more plentifull sucking in of air than may be supplyed from the passages of the Trachea being straitned: for the more blood passes the Lungs each Systole and Diastole, by so much, for the enkindling and eventilation thereof, the air ought to be more plentifully and quickly brought in, and sent forth: to which task (when by reason of impediments it is not easily dispatched) yet in some manner to be performed, the ultimate endeavors of all the parts appointed for breathing are made use of with a great contention of the whole breast. More∣over the blood being stirr'd, is not only an occasion, but also in some part a cause in those that are asthmatically predisposed; for the vessels bringing blood being thereby more fill'd and distended within the lungs, compress the Tracheal passages being already very strait, and render them much more close.

II. A convulsive Asthma (which we judged to be the second kind of this disease,* 1.361 and to be raised without any great obstruction or compression of the Bronchia, from the mere Cramps of the moving fibres) is not limited to one place, or to any peculiar organ, but being of a diffused energy, it is extended to almost all the parts employed in breathing (whereof one while this, another while that, or some other is in fault.* 1.362) For a convulsive affection inciting an Asthmatical invasion, hath regard to the moving fibres of the vessels of the Lungs, to the Diaphragma, to the muscles of the breast, to the Nerves, which belong unto the Breast, or Lungs, nay to the origine of those Nerves planted within the Brain; and whilest the morbisic matter dwells in every of these places, hindering or perverting the work or breathing, it brings on the fits of this Disease, as in another Tract we have somewhile since plainly demonstrated. For the animal Spirits destin'd to the function of breathing, if at any time they are very much molested and constrained into irregular motions, enter inordinately into the fibres as well nervous as moving of the organs of breathing, and make them for that cause one while to be contracted, another while to be distended irregularly, as also their solemn and equal turns of Systole and Diastole to be variously disturbed or hin∣dered.

The morbific cause or matter provlking the Spirits prepared for the pneumonic work, as in divers places, so chiefly in these three,* 1.363 is wont to advance its force or power, viz. 1. Either in the muscular fibres themselves, or 2. In the branches or nervous slips, or lastly within the Brain by the origine of the Nerves.

1. As to the former,* 1.364 the heterogene matter being inimical to the Spirits is some∣times shaken off from the Brain into the trunks of the Nerves, and from thence by their passages and slips, if perhaps it shall be in very little quantity, without very great or sensible hurt slides down to their lower ends. And when it falls in the ner∣vous fibres, and being heaped up daily, shall at length sensibly increase unto a great quantity, it begins to trouble the inmate Spirits, and to provoke them into asthmati∣cal Convulsions; which forthwith infest, and are encreased by reason of evident causes, neither do they utterly cease, untill the stock of matter so accumulated, be wholly dispers'd, and consumed; afterwards when it being renewed arises to a fulness, the fits of that disease return, and are for that cause most frequently periodieal, as is ma∣nifest to common observation. According to this account we do deservedly suspect the cause of a convulsive asthma sometimes to lurk in the muscular coats of the pneu∣monick vessels, also sometimes in the fibres of the Diaphragma, or the Processes thereof towards the loyns. It is not very probable that the nest of this disease con∣sists within the fibres of this or that pectoral muscle, although in Scorbutical persons from these also possessed with a convulsive matter, we have known pains to have risen with breathing being hurt.

2. But truly (even as in another place we have not only demonstrated by reason,* 1.365 but by the observations and Histories of the sick) a convulsive asthma is often incurred, as often as the morbific matter sliding down into the pneumonic Nerves, sticks in

some place within their passages, and especially about their foldings: whence as of∣ten as it is accumulated to a plenitude it begins to be mov'd and shaken; where∣fore the spirits lying lurking, and flowing into the ongans of breathing disturbed, are forced into irregularity, and those spirits presently affect other inmates of the fibres of the Lungs and breast, and provoke them into unequal and asthmatical convulsions. For this cause and the reason of the disturbance, we have declared that not only invasi∣ons of this disease, but also the precordia being disturb'd thereby the Cardiack passions do arise.

3.* 1.366 We have clearly unfolded by anatomical observations that the cause of a con∣vulsive Asthma sometimes consists in the hinder part of the head near the origines of the nerves. Surely I have observ'd some patients, who when, lying sick of other desperate diseases, they were also asthmatick, found it necessary to be whether in bed or chair with their head always erect, or looking down, but lying on their back or leaning backwards incontinently they gaped for breath as if they were dying, and hardly breathed; the cause whereof (as appear'd by dissection after they were dead) was only a huge collection of sharp Serum which was gather'd within the cavities of the brain; which, if by reason of the head inclining back wards, it fell into the origine of the Nerves of the eighth pair, presently the precordia, and chiefly the breathing organs were affected with horrid cramps. Moreover sometimes for this very reason it seems that Orthopnoick persons cannot lie down in their bed without danger of choaking, but are constrain'd to sit up with an erect body.

III.* 1.367 Although an Asthma is sometimes simple from the beginning, viz. either merely pneumonical, or convulsive, notwithstanding after either disease hath for some time encreafed, for the most part it gains the other to it self: hence it may be concluded every inveterate Asthma to be a mixt affection, stirr'd up by the default partly of the Lungs ill fram'd, and partly by default of the Nerves and nervous fibres appertaining to the breathing parts. For when the pneumonic passages being straitned or ob∣structed from some cause, do not admit of a free sucking in, and breathing out of the air, for that cause also the blood, yea and nervous humour, being hindred in their courses, and compell'd to proceed slowly and to stagnate, do fasten their feculency and dregs upon the nervous parts; whence the passages of the spirits are obstructed, or perverted, and at length a convulsive taint accrues to them. Moreover the blood, being not duly inspir'd and eventilated within the precordia, at length being viti∣ated in its temperament supplies the brain and nervous stock but with a depraved juice, whose faults do chiefly punish the organs of respiration before hurt and debi∣litated. In like manner also the evil is reciprocrated on the contrary part, as oft as this disease begins by fault of the nervous stock; for as much as the motion of the Lungs is often stopt or hindered, by reason of Convulsions in the muscular fibres, both the blood and the nervous juice being restrain'd from their usual motions, do heap up dregs and filths, fastening them to the parts containing them, by which not on∣ly viscous humours and obstructing of the passages, but even Tumours and other more solid concretes vitiating the structure of the Lungs, are produced.

Therefore if when an Asthma being for some time confirmed and become habitual,* 1.368 shall attain to frequent fits, and those emergent upon every occasion; the conjunct cause thereof, and also the procuring cause is placed as well inwardly in the lung it self, as outwardly in the Fibres and Nerves, and in the spirits imploy'd for the function of breathing. Neither will it be difficult, by seeking diligently each of these things, to find in any case of the patient, as well the chief nests, as nourish∣ment of this morbifick matter. But as to the evident causes they are very many, and also of diverse sorts. For hitherto ought to be referred whatsoever move, either the blood and the other humours, or trouble the animal spirits and force them into irre∣gularities. Asthmatical persons can indure nothing violent, or unaccustomed: from excess of cold, or heat, from any vehement motion of body or mind, by any great change of air, or of the year, or from the slightest errors about the things not natural, yea from a thousand other occasions they fall into fits of difficult breathing.

As to the prognostick part,* 1.369 an inveterate Asthma is difficulty or scarce ever cu∣red; notwithstanding the medicines and method of healing being rightly ordered, of∣tentimes great succour is afforded, viz. the fierceness of the fits is diminish'd, longer respites are procured, yea, even the dangers of life it self, seeming frequently to be imminent are removed.

This disease growing worse, either threatens a Consumption, or a Dropsie, or some

drowzy, or convulsive affect; accordingly as the Serum by reason of perspiration being hindred, being more abundantly accumulated (because the sick cannot sleep enough in their beds) it is either fixed in the lungs, or transfer'd into the habit of the body, or into the brain it self. For this very reason the diseased do find themselves better in Summer, when they breath more freely, than in Winter; likewise better in hot countries than in cold, the South or West wind blowing, than the North or East.

Of the curatory method of an Asthma there will be two chief indications,* 1.370 or ra∣ther so many distinct methods of healing, viz. Curatory and preservatory. The first instructs what is to be perform'd in the fit it self, that the Patient may be deli∣vered from present danger; the other, by what out of the fit, we ought to endeavour the taking away the morbifick cause, lest that distemper be repeated more often, or more heavily.

1. Therefore a fit urging, there will be two chief intentions of curing, viz. first,* 1.371 that a more free breathing be procured, as well upon the account of air, as of the Lungs, at least so far, as may suffice to support life; and secondly, that the organs of breath∣ing may be withdrawn, and restrain'd, as soon as may be, from the Convulsions begun, and usually obstinately continuing.

1. As to what respects the former,* 1.372 let the Patient be placed in an upright position of body, in a more open place, and pretty airy, free from Smoak and breath of by-stan∣ders; then let it be indeavoured that the Lungs, being made free from all obstructi∣on, and inward oppression, and also external compression, may be able to draw and change the breath more easily. For these purposes lest the bulk of the nether bowels compress or straiten the precordia, the belly is to be loosen'd by a Clyster, the apparel and what ever binds about the Breast to be loosened; also when in this case either from the blood swelling up inordinately within the Pneumonic vessels, or from the Serum distilling out of the Arteries and Glandules into the tracheal passages, they are wont to be oppressed, the impetuosity and instigations of either humour ought to be restraind and appeased; insomuch that if strength endure, and the pulse be strong enough, Phlebotomy is oftentimes convenient. Moreover those things are carefully to be administred which dispatch away the Serum and superfluities of the boiling blood by urine, as well as sweatings: to which intention, Juleps, Apo∣zemes, commonly call'd Pectorals, do notably conduce; yea, powders of shells, mille∣pedes prepared, Spirits and volatile salts, are successfully used. In the mean time besides let there be administred whatsoever opens and makes slippery the passages of the Trachea, and moves expectoration, and whatsoever, if need be, gives stop to a Catarrh distilling upon the fame; for which purposes, Lambitives, Lohochs, pectoral Decoctions and suffumigations are good.

2. As to the other intention of curing in these Convulsive fits,* 1.373 viz. that the organs of breathing may be restrained from the Convulsions begun, and may quietly return to their ordinary task, (unless this succeeds of its own accord, after the boiling of the blood and Serum in the Lungs be appeased) we must use Antispasmaticks or remedies against Convulsions, and Anodynes: for medicines which are used to be admi∣nistred in hysterical passions, do conduce in a convulsive Asthma.

Spirit of Harts-horn, of soot, and especially of fal Armoniac distill'd with gum Ammoniacum; also the tinctures of gum Ammoniacum, of Sulphur, of Castor, of Asa fetida, Syrups of Ammoniacum, Sulphur; Oxymel of squils and such like, which because they are of an ingrateful tast or smell, as it were dissipate the spirits and with∣draw them from tumults, do sometimes help notably. But if the spirits being outra∣gious cannot by this means be appeased, we must assay Narcotics,* 1.374 that some of them being subdued the others may be reduced to order: for surely unless a stuffing up of the Lungs, with a great oppression of the Precordia do hinder, Opiates do sometimes greatly profit. In the dreadful fits of this disease, when other medicines had effe∣cted less, I have often administred successfully Diacodium, as also Laudanum Tarta∣riz'd. But these may not be exhibited without great circumspection, because whereas more or less they hinder breathing (which already is difficult and too much hindred) they frequently bring the Patient into danger of life. Besides this, that the Pneumo∣nic spirits may be diverted from their Convulsions, it is many times expedient to mo∣lest the spirits in other places; for some of the spirits being in other places afflicted most commonly the residue as well as those that are smitten do dismiss their irregula∣rities: Wherefore Vesicatories, Cupping-glasses, ligatures, and painful frictions bring

help; also for this reason vomits are successfully taken in the midst of a fit. The scope of healing being now design'd, after what manner the patients in an urging fit of an Asthma ought to be handled, it yet remains for us to propound some more select forms of Remedies appropriated to the same ends.

In the first place therefore to give a stop to the flux of blood and serum,* 1.375 and to dis∣miss their superfluities deriv'd from the Lungs by sweat and urine, these ensuing are prescrib'd.

Take the water of ground-Ivy eight ounces, of Rue, Pennyroyal, Dragons, of each two ounces, of sal prunella one dram and a half, Syrup Byzantinus, red Poppies of each one ounce; make a Julep, take it three or more times in a day, the dose three or four ounces.

Take grass roots three ounces,* 1.376 roots of Kneeholm two ounces, candi'd Enula campane one ounce and a half, barly half an ounce, Raisons of the Sun, one ounce, boyle them in three pound of water to two pound, adding to your strain'd liquor sal prunella one dram and a half; sweeten it, if there be occasion, with Syrup Byzantinus or of Violets.

Take tincture of Sulphur three drams,* 1.377 the Dose six drops to ten, evening and morning in a spoonful of Syrup of the juice of ground-Ivy, or Violets.

Take of faecula of Aron and Briony, of each one dram and a half, flower of Sulphur one dram, flowers of Benzoin half a dram, Suger-candy half an ounce, Liquorish two drams; make a powder to be taken to half a dram or two scruples twice in a day with the former Julep or Apozeme: or,

Take of the powder prescribed two ounces,* 1.378 hony or Oxymel what will suffice, make a Lin∣ctus, take about half a spoonful evening, and morning, and at other times lick it with a stick of Liquorish.

Take Syrup of Horehound, of Garlick of each one ounce and a half, tincture of Saffron, Castor, of each two drams mix them, take a small spoonful in the fits.

Take of spirit of sal Armoniack with gum Ammoniacum three drams,* 1.379 of snail water, and of Earth-worms of each three ounces, Syrup of Horehound two ounces, mingle them, take by a spoonful once in four or five hours.

Take of the powder of Hedge mustard, or of ground Ivy gather'd in the heat of the Sun one ounce, of Oxymel simple enough to make a Linctus.

2.* 1.380 So much concerning the method, and medicines requisite in the fit of an Asthma. The other indication preservatory designing the taking away of the whole procuring causes and the morbific matter, contains two parts or distinct scopes of cure: both which for the most part are wont in the practice to be complicated and administred together. One of these endeavours to amend the conformation of the Lungs, if it be any way hurt or faulty,* 1.381 and the other to take off the irregularities of the moving parts and spirits, appointed for them. We shall best answer both these intentions if the remedies vulgarly call'd pectorals, are mixt with anticonvulsives, and the use of these with other medicines respecting the preparation of the whole body and emer∣gent symptomes be apply'd between whiles. For which purposes the method and en∣suing forms of remedies may be administred.

Take of Aloes rosata a dram and half,* 1.382 flower of Sulphur a dram, salt of Amber half a dram, Tar what will suffice, make 24 pills, take 4 every, or every other, or every third night. or,

Take of gum Ammoniacum,* 1.383 Bdellium dissolv'd in vinegar of squils of each half an ounce, flower of Brimstone three drams, powder of hedge mustard and savory of each half a dram, make a mass with Syrup of Sulphur or Oxymel of squils; make small pills, take 3 every e∣vening. or,

Take Hog-lice prepar'd two drams, flower of Benzoin half a dram, salt of Amber two scru∣ples, extract of Enula campane half a dram, Castor half a dram, Saffron a scruple, Venice Turpentine enough to make a mass, form small pills, take 4 every evening and morning ex∣cept the times of purging.

But if this form of Pills will not please, or the above mentioned Medicines pro∣fit little, afterwards the ensuing shall be essay'd to free the Lungs from obstruction.

Take spirit of gum Ammoniacum distilled with sal Armoniac three drams,* 1.384 the syrup of Ground-Ivy three ounces, magistral Snail and Earth-worm water of each an ounce, tin∣cture of Saffron two drams, mingle them and take a spoonful evening and morning. Or,

Take Tincture of Ammoniacum three drams, the dose from 15 to 20 drops in a spoonful of Oxymel, or of syrup of Ground-Ivy. Or,

Take Tincture of Sulphur three drams, dose from 7 drops to 12 or 20 in a convenient ve∣hicle at the same hours.

In like manner other spirits endued with a volatile salt, and mixt with pecto∣ral Syrups and Cephalick waters, may be prescribed successfully evening and morn∣ing.

In place of a mixture or an Asthmathical Julep from distill'd-waters in the shops, let this following magistral be prepared for frequent and several uses.

Take roots of Enula campane, Orris of Florence, Angelica, Masterwort,* 1.385 of each four ounces, of Bryony a pound, the leaves of white Hore-hound, Hysop, of Savory, Penny∣royal, Ground-Ivy of each four handfuls, Juniper and Ivy-berries of each a pound, Bay-ber∣ries half a pound, sweet Fennel, Carue, Annis, Louvage, Dill seeds of each an ounce, Cu∣bebs two ounces, Long-pepper, Cloves, and Mace of each an ounce, all being sliced and bruised pour on them eight pound of Brunswick beer, distil it in common organs, mix the whole, and as you use it sweeten it with Sugar, or Syrup of Ground-Ivy, or with Oxymel.

Moreover in lieu of Oxymel, or any common pectoral Syrups, the ensuing forms of medicines appropriated to an Asthma are prescribed; and in the first place the Syrup of Enula-campane invented by Horatius Augenius and called by his name, and afterwards commended by Platerus, Sennertus, Riverius and other renowned Pra∣ctitioners, ought to be observed in this place, and used frequently.

Take of Enula-campane, Polypodie of the Oak prepared of each two ounces,* 1.386 Cur∣rance two ounces, Sebestens 15, Coltsfoot, Lungwort, Savory, Calaminth, of each a handful, a large leaf of Tabaco, Liquorish two drams, Nettle and Silk-worm seeds of each a dram and a half, boyl them in Wine mingled with Hony and diluted to a pound and half, and with a little Sugar make a Syrup: take it by it self in form of a Linctus, or a spoon∣ful evening and morning, or add a spoonfull to the distilled water or Apozeme.

Take Florence Orris-roots, Enula campane of each half an ounce, Garlick peel'd four drams, Cloves two drams, white Benzoin a dram and half, Saffron a scruple, slice and bruise them and digest them warm in a pound of rectified spirit of Wine for 48 hours; to it strained add fine Sugar a pound, put it in a Silver Bason upon live coals, stirring it till it flame, and let it burn as long as it will, then the flame being out make a Syrup of it to be taken as the former.

Moreover hither may be referred the decoction of an old Cock so much magnified by renouned Physicians as well antient as modern, for the cure of an Asthma;* 1.387 which although Septalius damn'd for gross and of no efficacy, notwithstanding Riverius after him vindicates; and to attest the efficacy of this remedy opposes his own experience to the others. These broths are of two kinds, viz. either with or without purgers; and various Recipes of each do remain in practical Authors, all which would be te∣dious to recount here, we shall propose one or two forms.

This is the common example without purgers.

Take of Orris and Enula-campane roots of each half an ounce,* 1.388 Hysop and Hore-hound dryed of each six drams, Carthamus seeds an ounce, Annis and Dill seeds of each two drams, Liquorish scraped and Raisins stoned of each three drams; let them be prepared and sewed into the belly of an old Cock, which boyl in fifteen pound of water until the flesh depart from the bones, strain it and let it settle: of the clear liquor the dose six ounces, with an ounce of Oxymel simple. Or if the remedy be desired to be solutive, dissolve of fresh Cassia and Manna of each half an ounce in each draught, taken for many days together, and sometimes for a whole month.

Riverius prescribes a convenient form of such a kind of purging broth.

Take Enula-campane and Orris-roots of each a dram and a half, Hysop and Coltsfoot of each a handful, Liquorish and Raisins of each two drams, Figgs 4, Senna cleansed three drams, polypodie of the Oak, and Carthamus seeds of each half an ounce, Anniseeds a dram and a half, boyl them with the third or fourth part of an old cock, make broth for one dose to be taken in the morning, let them continue it for twelve or fifteen days.

Of many examples of Asthmaticks I shall propound only two singular ones,* 1.389 viz. I will describe the History of one who hath been obnoxious to fits of this disease meerly convulsive, and of another partly convulsive and partly Pneumonic. A No∣ble person, proper and well set, and formerly healthful enough, after that by chance he had struck his side against some solid body, from that time contracted a hurt, and afterwards an Asthmatical taint. For we may suspect, a certain folding of the Nerves belonging to the precordia placed near was prejudiced by that accident, and from such a cause afterwards this distemper derived its origine, viz. at some incertain times the pain at first troubled him about that place, and presently a most painful Dyspnoea ensued with a laborious and lasting contention of all the breathing parts; insomuch that while the fit lasted the patient was thought to be in the agonie of death. I was first sent for to him after labouring for two days with such an invasion of the Asthma that he was accounted in a desperate condition; Notwithstanding finding his Lungs without hurt, our prognostic willed as yet to hope well, and immediate∣ly by a consultation of other Physicians it was prescribed as followeth.

Take of spirit of gum Ammoniacum distill'd with salt of Tartar three drams,* 1.390 take from 15 to 20 drops in a spoonful of the following Julep, drinking after it five spoonfuls, re∣peat it every sixth hour.

Take elder flower, camomile, and Penyroyal water of each four ounces, Snail-water two ounces, Sugar one ounce, mingle them, between whiles he took a dose of the following powder with the same Julep or pectoral decoction.

Take powder of Crabs eyes two drams, sal prunella a dram and a half, salt of Amber half a dram, mix them, divide it into eight doses.

Large vesicatories were applied on the inside of his arms near the arm-pits, Cly∣sters daily administred, and frequent frictions. By the use of these he received sud∣den and unexpected help, and within a few days became wholly free from that fit. Afterwards as often as he had any perception o the first motions of this disease, pre∣sently he took a large dose of that spirit with the same Julep 3 or 4 times a day, by which remedy often used, one while for preservation, another while for the cure sake, he was void of any outragious invasion from his habitual Asthma for above two years, in the mean while suffering some more light assaults but easily blown off.

A very Honourable old Gentleman dignified by many great Titles,* 1.391 himself being greater than all them, after that for some years he had liv'd every winter obnoxi∣ous to a cough and a moderate spitting, and gentle enough, at the end of the last An∣tumn returning from a long journey he was less healthful: (as it was thought by cold he had taken) for he complained of a pain in the middle of his breast next the sternon, which growing worse in an evening, as soon as warm in his bed, wholly disturbed his sleep, and most part of the night was very troublesome: notwithstanding without a∣ny Dyspnea or evident sign of an Asthma. To take away this pain both Purging and Bleeding were used, pectorals and antiscorbuticks were daily used, liniments and fo∣mentations were applied to the place pained, yet without any great success or ease: for the alteration which happened afterwards declined rather to worse; for a difficult and obstructed breath came upon the pain's growing a litlle more remiss, so that from his first sleep, or inclination thereto he became asthmatical and gaping for breath, and suffering about the precordia he was constrained to sit upright in his bed. Moreover a dyspnoea of this kind and a convulsive agitation of the breathing parts did not only return every evening, but from day to day were rendred more outragious and lasted a longer time; insomuch that one night waking from his sleep, for many hours he was assaulted with a most painful fit of an Asthma which had almost kill'd him. The Physicians being at a great distance from him, although desired about midnight came not while the morning following, mean while by reason of bleeding used by a Barber this worthy Gentleman revived, being redeemed from the jaws

of death; but afterwards by the consultations of Physitians that day a slender diet and loosening the belly by a Clyster were prescribed: In the evening and early in the morning he took of Spirit of gum Ammoniac distilled with sal Armoniac 12 drops in a proper vehicle, and continued the use for many days after; Vesicatories were applyed on the inside of his arms near the armpits; moreover Juleps and pectoral Decoctions, Lohochs, Clysters, and also mild Purges were taken by turns; also Phlebotomie was repeated after two days. Whereas formerly he was used to drink for his mornings draught a pint of Alf with Wormwood and Scurvy-grass, in the room of that about eight a clock he took 15 drops of Elixir Proprietatis tartariz'd in a draught of Coffee made with Sage. By these remedies his asthmatical fits presently abated of their fierceness, insomuch that the beginning and end of every night were quiet enough, but in the middle light troubles about the precordia kept him from sleep, sitting upright an hour or two. Certain other medicines were propounded by the Physitians, and others of diverse sorts privately offered by his friends, which notwith∣standing the Honourable Person utterly rejected, or soon loath'd; and that the rather, because, winter then being almost spent, his restauration was hoped for by the coming on of the Spring and enjoyment of the Country air without the help of much Physick. Wherefore of the medicines above mentioned he used one while this and another while that a little by turns, and sometimes kept holy-day from them all; but in the interim although his asthmatical invasions little or nothing troubled him as formerly in the night, yet by reason his Lungs were very much obstructed, and a serous hu∣mour fallen down into his feet, he was not able to walk fast or ascend steep places, without a painful dyspnoea, being in danger of choaking; and now (while I am writing this) not so much an Asthma or Consumption, as a Dropsie is feared.

The Aetiologie of this case is clearly enough manifest from the above-men∣tioned things,* 1.392 viz. one procuring cause of this Asthma was a lung greatly obstru∣cted, insomuch, that whereas the blood boiling, passed through the precordia more impetuously, the air requisite for its ventilation could not be admitted in plenty e∣nough; wherefore to supply this defect there was necessity that the Lungs and their motive organs should be provoked into more frequent, and more vehement throes. Afterwards from thence ensued a convulsive disposition of the fibres mo∣ving the breast: for the heterogeneous matter descending into those parts together with the nervous juice, and being gathered to a plenitude, first excited pain and afterwards fierce and periodical convulsions in the pneumonic organs: and now al∣though this latter disposition cease (because the Elastick and spasmodical matter is blunted or extinguished by the serous illuvies) yet the other procuring cause still remains, and hath got another associate, viz. a worse Devil that it self, to wit a Dropsie.

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

IT is clearly manifest by certain and manifold discoveries,* 1.393 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,* 1.394 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;* 1.395 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.* 1.396 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.* 1.397 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;* 1.398 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,* 1.399 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.* 1.400 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,* 1.401 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.* 1.402 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,* 1.403 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:* 1.404 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,* 1.405 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,* 1.406 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;* 1.407 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,* 1.408 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,* 1.409 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,* 1.410 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,* 1.411 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,* 1.412 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,* 1.413 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,* 1.414 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,* 1.415 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.

SECT. II. Of Splanchnick remedies, or those which respect the bowels of the lower Belly.

CHAP. I. Of the Jaundies and the remedies thereof, and the manner and reason of their operations.

HItherto we have largely enough unfolded the Pathologie and curatory me∣thod of the Thorax; now it follows next to finish our task in like manner a∣bout the lower Belly. But we have in our former tract for the most part described already the medicines belonging to this region, and the manner and rea∣sons of their working, together with the Anatomy of the Stomach and Intestines: we have treated of remedies stomachical, dysenterical, and others belonging to the in∣testines, as also diureticks together with the reasons of them: Moreover we have sus∣sicently elsewhere handled the aetioligie of Hypochondriack, and Hysterical reme∣dies. What therefore remains, of Hepatical distempers as well proper, as of those vulgarly ascrib'd thereunto, and of their remedies we will discourse in this Section; notwithstanding in each of these, we will bestow more labour, about the curatory, than pathological part.

The chief diseases by which the Liver and the appendix thereof,* 1.416 are wont to be incumbred, are the Jaundies, and a Tumour, and under this latter many other affects, viz. obstruction, inflammation, induration, and schirrus are numbred; to all which are vulgarly appointed remedies commonly called Hepaticks, and which make up a great part of the Dispensatory.

The Jaundies is either a disease by it self, primarily beginning, which is here pro∣perly treated of: or it is an effect or product of another disease; as when it arises upon an intermitting Feaver, which oftentimes it puts an end to, of which also we will presently treat by the by.

An Icterical distemper by the common consent of most is judged to arise in as much as the yellow choler, not at all, or not enough received,* 1.417 from the ends of vena porta, into the passages of the cholerick pore, overflows into the mass of blood and pollutes it with its greenness, whereby also the very skin is discolour'd.

That obstruction is wont to happen after many manners and in various places.* 1.418 For sometimes it happens near the extream ends of either kind of vessels, viz. the end of the vena porta, and the porus bilarius; the interspaces whereof happen frequently to be compressed, and stopt by reason of the Parenchyma of the Liver being tume∣fied, or otherwise vitiated; wherefore the humour of the gall not being transferred out of the separating vessels of the porta into the other receiving vessels, turns back upon the blood. Secondly, the passage of the humour of the gall is sometimes intercept∣ed in the middle passages of the cholerick pore; for that the cavities of these are filled either with a viscous, or sandy, and sometimes with a stony matter; as is plainly discerned in the Livers of beasts in the winter senson, while they are fed with hay and straw. Thirdly, it is also manifest by Anatomical observation, some∣times an obstruction in the very bladder or the gall, or in the cystic passage is the cause of the Jaundies; for if at any time, it being filled with stones, receive not the choler, or being here shut up, or grown together, it restrains the descent of the choler towards the guts, that humour although well separated from the blood, is constrained to flow black into the mass thereof, and so propagates the Jundies.

Against this most received opinion, by which it is judged,* 1.419 that the cause of the Jaundies for the most part consists on this side the vesica fellis or about it towards the Liver: the most Renowned Sylvius altogether places it without this, viz. in the

Cystic or common passage. For supposing the choler not to be separated from the blood, within the passages of the Liver, but in the very bladder of the Gall to be pro∣pagated of a humour brought thither by the Arteries; He judged the greatest part, being carried upwards by the passage of the pori bilarii, to be poured into the blood for some notable uses, and also another part to descend beneath to the Intestines, also for necessary uses: wherefore if this latter sluce be shut, all the choler is carried upwards into the blood, and filling it too much with this humour, perverts it from its genuine temper, into an Icterical.

But truly lest the stopping of the passage of the bladder, or of the common passage, (neither of which easily happens, or from any light occasion) may seem less effica∣cious to excite any Jaundies; therefore, whether such an obstruction hath place, or no, the most Renowned man ingeniously supposes besides, The choler while it is generated in the bladder does undergo sometimes a notable change, by which it is moved, and is born about more plentifully and impetuously, towards the blood, with which yet it is less mingled than is was wont to be, but only confounded together with it, and so more easily departs from it and infects and tinges the solid parts with its colour.

But that the choler in the Jaundies may be rendred unfit a mix with the other humours, or to be nearly united; he determines it to be done, by a spirit too valatile, mixed plentifully with it, and so making it more spirituous and immiscible with others. He confirms this assertion by two instances, viz. in as much as the most spirituous poison from the biting of a Viper, and the too much use of the more generous drinks, viz. Wine and Strong-waters, causes sometimes the Jaundies. Moreover he endeavours to procure credit to this Hypothesis, for that this disease is wont to be cured, not only by medicines opening obstructioins, but by them which blunt the force of a ra∣ging volatile salt (of which sort are the decoction of Hemp-seeds, also Venice soape with many other things of the same sort.)

It belongs not to this place, neither is it to our purpose to descend to end this con∣tention, nor dare I now rashly determine it (since it hath tired so many Renowned Wits of the Moderns) whether really the choler be made in the bladder of the Gall, or whether it be only separated from the blood in the Liver, the great organ of separation; I confess this latter opinion best pleases me.* 1.420 And weighing these things seriously I am induced to think the cause of the Jaundies to consist chiefly in this, that the choler be∣ing sever'd in the Liver, is not, by reason of the ways being obstructed, at all, or not enough conveyed to the bladder of the Gall, but that it must of necessity regurgi∣tate into the mass of blood; notwithstanding in the mean while we deny not, but this affect may sometime arise (although more rarely) from the Cystic passage or common pipe being obstructed. But also we think the fault of the blood to preceed in part and perhaps sometimes wholly for the morbific cause; when to wit from its sulphurous and fixt Saline Particles above measure exalted, the choler is more plenti∣fully, or quicklier generated in the mass of blood, than can be separated or discharged forth by the ordinary ways; wherefore this, separating every where from the blood with the Serum,* 1.421 is affixed to the solid parts, and impresses its tincture upon them. And without doubt it is for this reason that some poisons, and chiefly the biting of Vipers, and the dayly use of more generous drinks, induces the Jaundies in bodies be∣fore sound, for whose cure sometime Phlebotomie, and medicines reducing the blood to a right temper, are wont to profit more than those opening obstructions. More∣over it seems for this reason, that a tertian intermiting Feaver so frequently termi∣nates in the Jaundies; for we may not suspect the passages of the Liver can be by any means obstucted, since in all fits, so great an agitation of the blood and humours, by cold, and heat, and such an-evacuation of them happens either by vomit or sweat: and truly even as feaverish fits are caused, inasmuch as the sulphurous part of the blood being too much advanced, in the first place perverts the nutritious juice into a morbific matter, and afterwards being inflam'd consumes and exterminates it; so when the fixt salt is at last exalted together with the sulphur in the blood, and for that cause meer choler is abundantly engendered, the feaversh enkindling of the blood ceases, by reason of the restrictive force of the fixt salt, and in place thereof the distemper of the Jaundies doth succeed. But as the blood being too much advanced to a sulphureo∣saline distemperature causes the Jaundies in any, though least predispos'd to it; so in others very much disposed thereto, having the ways of choler obstructed & the sulphur of the blood being too much depressed, it produces a freedome from that disease; for I have known many cachectick and phlegmatick persons, to have been free from the Jaun∣dies

though they have suffered under obstructions and indurations of the Liver, as to most of its passages.

It is not worth our labour to make more ample disquisition about the aetiologie of this disease; as to what respects the cure, there will be three primary indications,* 1.422 all which (for what may be the chiefest of them, and first to be exhibited, for the most part is concealed) we shall prosecute together; wherefore the intentions of healing shall be, 1. That the obstructions of the passages or choler-bearing vessels be opened, if perhaps any shall be either in the porus bilarius, in the Cystic passage, or in any place about the Liver. 2. That the blood be reduced to its due temperament and mixture, lest it ingender choler above measure, or render it unapt to be voided. 3. That the strength may be sustain'd, and the symptomes chiefly hurting them may be with∣stood.

1. That we may satisfie the first indication, cathartic evacuations notably con∣duce,* 1.423 as well by vomit, as siege, whereby the choler's descending towards the inte∣stines may be furthered, and vessels obstructed, by the great snaking of them, freed from their obstruction. 2. Sharp, bitter, salt medicines and others indued with a cer∣tain briskness ought also to be given, which provoke the motion of choler gathered in the Liver, and stagnating; hither also ought to be referred, what by similitude of substance, and as it were signature, in as much as they are indued with a yellow juice, have the report to help against the Jaundies; notwithstanding many of these may fitly be numbred under the same classis of evacuators, as the former, because they move urine or sweats.

The second indication altogether requires alteratives,* 1.424 viz. medicines which may depress the exaltations, or ragings of the Sulphur and fixt salt, and in the mean time provoke the restitution of the volatile salt depressed; for these ends remedies endued with an acid or volatile salt, besides chalybeats do principally bring help; from hence spirit of salt, of vitriol, juice of Lemons, also spirit of Harts-horn, also dung of Sheep, and Geese, crocus Martis and diverse other preparations thereof, are fre∣quently used with success in the Jaundies.

The third indication vital suggests more and sundry intentions of cure,* 1.425 procuring the strength to be restored, and the removing the symptomes whereby it is prejudiced, all or the chief particularly to enumerate, and prescribe would be a vast and tedi∣ous work; wherefore we will annex only certain general rules about diet, and some cordials and anodynes appropriate in this condition.

The curatory indications being appointed after this manner,* 1.426 it next lies upon us to acommodate the most select medicines, viz. as well the simple as the compound, to these now proposed intentions of curing, and to unfold the manner and reason of the operating of remedies which are accounted of special note in this disease. There∣fore first we propound the forms of evacuating medicines appropriate in the Jaun∣dies.

1. Vomits.

Vomiting medicines are frequently wont to help in the recent Jaundies,* 1.427 while the tone and strength of the bowels are firm; in as much as they alleviate the stomach always oppressed in this disease with an unprofitable burden of viscous phlegm; and moreover do free their infarctions by irritating the vasa choledocha, and by much shaking all the passages of the Liver, and make easie the passage of the cholet by the former accustomed ways.

Take of the infusion of Crocus Metallorum half an ounce to six drams, Wine of Squils an ounce, Oxymel simple half an ounce, make a vomit to be taken with government.

Sometimes it is convenient to exhibite, the evening before, the following preparatory medicine for the easier vomiting.

Take of the powder of Asarum roots, faeculae Aronis of each a scruple, of Tartar vitrio∣lated half a scruple, of Oxymel of Squils an ounce, mix them.

Take of Sulphur of Antimony seven grains, Scammony sulphurated eight grains, cream of Tartar half a scruple, make a powder, give it in a spoonful of panada.

Take nine Asarabacca leaves, cut and bruised put them into three ounces of white wine, press out the liquor, let it be taken in the morning with regiment.

Take of Gambugia prepared eight grains, Tartar vitriolated seven grains, make a powder.

2. Catharticks.

Purgers take place in this disease,* 1.428 be it recent or inveterate, viz. that as well a more plentifull store of Excrements may be now and then withdrawn from the first passages, as that the vasa choledocha may be excited to Excretions.

Take of Electuary of juice of Roses three drams,* 1.429 Rhubarb a dram, Salt of Wormwood, Cream of Tartar, of each half a Scruple, Syrup of Rhubarb, make a Bolus.

Take of the roots of sharp-pointed Dock prepared one ounce,* 1.430 the tops of Roman Worm∣wood, of Centaury the less, of each P. ij. Gentian and Turmerick roots an. two drams, yellow Saunders one dram, boyl them in a pinte and a half of Spring-water to a pinte, ad∣ding towards the end Senna six drams, the best Rhubarb three drams, Agarick a dram and half, Coriander-seeds two drams, White-wine two ounces, let them boyl close two hours, after strain it and clarifie it by settling; the Dose from four ounces to six, with one ounce of Syrup of Rhubarb, the water of Earth-worms three drams; make a potion to be repeated every or every other day, for three or four dayes.

In a weaker Constitution.

Take choice Rhubarb two drams,* 1.431 Agarick trochiscated, half a dram, Cinnamon half a scruple, Ginger half a scruple, make an infusion in White-wine and Cichory-water, of each three ounces, for three hours, in it strained dissolve one ounce of Syrup of Rhubarb, water of Earthworms two drams. Or Rhubarb from half a dram to a whole one, Salt of Worm∣wood a scruple, make a powder.

Take pil. Ruffi a scruple,* 1.432 Extr. Rudii half a scruple, make 4 Pills, take them in a morn∣ing with government, after 4 or 5 dayes repeat them.

In the third place follow Deoppilatives,* 1.433 which are also Diureticks, or Diaphoreticks, some whereof are accounted specifick, by reason of similitude of substance; Medicines of this sort, both promote the separation of choler from the blood, and urge the passage of it, being separated, through the passages and pores in the Liver open but little. Moreover, in the mean time, by dissolving the blood, they carry off the serosities and cholerick recrements thereof, sometimes by sweats and urine.

Take of Elixir Proprietatis one ounce,* 1.434 take 20 drops in the morning, and at Five in the afternoon, with a convenient vehicle: after the same manner are taken, Tincture of Antimony, or of Salt of Tartar, and the simple mixture in a greater Dose: for vehicles, Apo∣zemes, distilled Waters, and Juleps for this Intention of curing are convenient.

Take of the roots of Celandine the greater,* 1.435 stinging Nettles, Madder, of each one ounce, tops of Roman Wormwood, white Horehound, Agrimony, Germander, of each one hand∣full, Worm-seeds two drams, Shavings of Ivory and Harts-horn, of each two drams, yellow Sanders a dram and a half, Coriander-seeds two drams, boyl them in three pound of Spring∣water to two pound, adding of White-wine four ounces, strain it, and adde Syrup of Chi∣chory with Rhubarb two ounces, water of Earth-worms, an ounce and a half, make an Apozeme, the Dose four or six ounces twice in a day.

Take of white Horehound dryed, Centaury, of each one handful, Gentian and Turme∣rick-roots, of each three drams, Cinamon one dram, Saffron half a dram, being sliced put them into a Glass with two pound of White-wine or Rhenish-wine; make an infusion, the dose three ounces.

To this we will adde Gesners famous Antictericum.

Take of the roots of stinging Nettles a pound, Saffron one scruple, bruise them well, and draw off the tincture with White-wine, the dose three ounces 4 or 5 dayes.

Like to the former is that of Fr. Joel. Take the Roots of Celandine the greater,* 1.436 two handfuls, Juniper-berries a handfull, bruise them and pour on them a pound of Rhenish∣wine, and draw out the juice, the dose sour ounces twice a day.

The juice of white Horehound is mightily commended by Dioscorides, and the Syrup of the same by Forestus, for curing the yellow Jaundice.

In lieu of an Elixir, and other chymical liquors, which to avoid nauseousness are to be taken in very small quantity; to others endued with a stronger Constitution, Electua∣ries, Powder and Pills may be administred with better success.

Take of Conserve of Roman Wormwood, of the yellow Rinds of Oranges and Limons,* 1.437 of each two ounces, Species Diacurcumae one dram and half, powder of Ivory, yellow Saun∣ders, of Lignum-Aloes, of each half a dram, Troches of Capers one dram, of Rhubarb half a dram, Salt of Wormwood two drams, with Syrup of Cichory with Rhubarb, make an Electuary, the dose the quantity of a Chesnut twice a day, drinking after it three ounces of the following Julep.

Take of the greater Celandine-water, Fumitory, Wormwood,* 1.438 Elder-flowers of each five ounces, Snail-water, water of Earth worms, compound, of each two ounces, Sugar half an ounce, mingle them and make a Julep. Or,

Take of the roots of stinging Nettles, Angelica, Gentian, of each four ounces, the greater Celandine leaves and roots, six handfuls, Wormwood, Tansie, Southern-wood of each four handfuls, the outer rinds of twelve Oranges and four Limons, prepared Worms and Snails of each one pound, Cloves bruised two ounces, being all cut and bruised pour upon them eight pound of White-wine, let them be distill'd in a cold still, and the whole water mixt. Or,

Take of filings of Steel one pound, fresh Strawberries six pound, put them into a gla∣zed pot, stirring them together, and let them stand a day, afterwards adde of English Rhubarb sliced one pound, the rinds of four Oranges sliced, pour upon them of White wine six pound, and distill them according to Art; let all the liquor be mixt together. The dose of this and of the former is three ounces twice in a day after the Electuary or any other medicine.

Take of Turmerick-roots, Rhubarb, of each one dram and a half, the Bark of Caper-roots, of Asarum-roots, of each half a dram, Extract of Gentian, and Centaury, of each one dram and a half, Salt of Wormwood four scruples, Water-cress-seeds half a dram, of Rocket half a scruple, Elixir Proprietatis one dram, gum Ammoniacum dissolved in the water of Earth-worms what will suffice to make a mass, form it into small Pills, the dose is half a dram evening and morning, drinking after it three ounces of the distilled water.

Sylvius doth much magnifie for cure of the Jaundies,* 1.439 the Decoction of Hemp-seed in milk, and the solution of Sope, and from thence endeavours to establish his own Hypothesis (as we have above intimated) whereby he endeavours to deduce the Aetiolo∣gie of the Jaundies, rather from an alienation of the choler, than from the obstructi∣on of its passages.

2. The Second Indication respecting the altering or tempering of the blood,* 1.440 by which it may breed but moderately, and duly separate the choler, requires Medicines of that sort, which depress the Sulphur and fixt salt too much advanced. For these ends, I know not by what chance or conduct Medicines endowed with a volatile salt, as Worms, Snails, Millepedes, yea Lice, Dungs of fourfooted Beasts, and Fowl, are brought into practice for curing the Jaundies, and not only prescribed by Empiricks, but the more famous Physicians: These sometimes by themselves, but oftener joyn'd with Purgers and Deoppilatives, become the chief Ingredients in Compositions against the Jaun∣dies.

Fonseca prescribes Goose-dung gathered in the Spring-time and dryed, as also the white excrement of Pullets, of both which let the Powder be given in a convenient vehicle from half a dram to a whole one.

Take powder of Earth-worms prepared, of Goose-dung, of each three drams, Ivory,* 1.441 yellow Sanders, of each half a dram, Saffron one scruple, make a powder, divide it into six parts. One to be taken every morning with some appropriate liquor. To the Apozeme, or Anticterical Tincture prescribed above, Earth-worms, Goose-dung, and also Sheeps∣dung are profitably added.

Take Millepedes fresh and alive from 50 to 100. Saffron half a Scruple, Nutmeg a scruple, bruise them together, and infuse them in Water of Celandine four ounces, of Earth worms two ounces, express them strongly, and drink it: after this manner take it first once, then twice in a day for a week.

The vulgar and Empirical remedy with us is, that Nine quick Lice be taken in a morning for five or six dayes, by which remedy they report to me many to be cu∣red (whenas other remedies effected little) which truly can help by no other means than by restoring the volatile Salt depressed in the blood.

Upon the same account of succour even in this disease the flowers of Sal Armoniac,* 1.442 the volatile Salts of Amber, Harts-horn, Soot, in like manner their Spirits are fre∣quently administred with great success.

Take powder of Earth-worms prepared two drams, Species Diacurcumae one dram, flower of Sal Armoniac half a dram, Salt of Amber a scruple, Extract of Gentian one dram, Saffron one scruple, Gum Ammoniacum dissolved in water of Earth-worms what suffices, make a mass, and form it into small Pills; the Dose is three or four, morning and evening, drinking after it three ounces of the Julep before prescribed.

Take Spirit of Harts-horn tinctured with Saffron three drams; Dose from 15 drops to 20. with the distilled water prescribed above.

In this Class of Medicines by which the icterical distempers of the blood are to be corrected,* 1.443 steel'd remedies do also challenge their place by right; for these afford notable help, not so much by unlocking the obstructions of the bowels, as by de∣pressing the rage of the Sulphur, and fixt Salt, and by volatilizing the blood, in the Jaun∣dies, no less than in other cachectical distempers.

Wherefore, to the Decoction, or Tincture, or Infusion above prescribed, is pro∣perly added the filings of Iron, or the prepared powder thereof (its mineral con∣sistence being some wayes opened) or the vitriolic Salt extracted; from hence it is, that Medicinal waters heal even to a miracle those sick of the Jaundies, that had been de∣spaired of; although these drunk in a very large quantity, inasmuch as they pass through all the vessels, do also open the passages of the Liver, however shut up.

Therefore also even Preparations of Steel are added to the Electuary, Pills and Powders above recited, one while this, another while that, in due proportion. More∣over the Syrup thereof given twice a day to one spoonfull, in three ounces of Apozeme or water against the Jaundies; also tincture of Steel to twelve or fifteen drops may be administred in the same manner.

In the last place we may annex to this classis of altering Medicines those things which not taken inwardly,* 1.444 but outwardly applyed, and by contact, used to the very urine of the Patient are held to cure this disease.

As to the former, a remedy often tryed by the vulgar, is a living Tench-fish, whose Scales and outer superficies do resemble a yellow colour, applyed to the right Hypochondria, or Stomach according to some, (to the soles of the feet, according to others) whence a sudden flight of this disease is expected; hence although many pro∣mise themselves a sure cure, it hath often deceived me.

Another cure of the Jaundies at a distance is said to be done by I know not what sympathy or secret manner of working.

Take the fresh Ʋrine of the Patient made at one time, of the ashes of the Ash-tree searced, as much as suffices to reduce it into Paste, which may be formed into three equal balls, to be placed in a place shut, near the hearth or Stove; as these dry and harden, the Jaundies will vanish; after this course, I have known this inveter ate disease happily cured, although resisting many other remedies; the practice thereof is very familiar with the Vulgar.

If of a certain it could be made manifest that this effect doth for the most part happen,* 1.445 and the reason of it be inquired into; in the first place we ought to sup∣pose a consent or sympathy of the spirits and other particles in the animated blood, with other symbols inmates of the fresh urine; and that they immediately are af∣fected in the like manner with these. Notwithstanding it is evident enough that a lixivial Salt mingled with urine, doth presently set free the volatile salt formerly sub∣dued or enwrapt in other particles; as is plainly seen in distillation of Urine, which if you urge by it self with a sand-heat, nothing but phlegm will arise; but adde the calx of Tartar, or Ashes, immediately the Spirit and volatile Salt will come forth: wherefore, that Empirical administration being administred, at the same time, both in the Icterical urine, and also in the blood of the Patient, the volatile Salt escapes out of the power of the fixt Salt and the Sulphur, and for that cause the icte∣rical

distemper of the Blood is put to flight. Also upon the same reason is built ano∣ther sympathetical cure of the Jaundies, whereof Phil. Grulingius and Felix Platerus do make mention, viz. the sick party pissing upon Horse-dung while it is hot, hath cured many of the Jaundies; inasmuch as the fixt Salt of the Urine, and thereby the fixt Salt of the icterical blood of the patient, is altered by the volatile Salt of the fresh dung, and reduced into its due temperature.

3. The third Curatory indication vital institutes a convenient course of Diet,* 1.446 and moreover Cordials and Anodynes, of both which there is frequent need.

As to what relates to the former, Food in this disease, more than in any other ought to be medicinal. For Vegetables and their parts, styled commonly Hepatick remedies, are boyled in the broths of these Patients. And these also are wont to be made instead of other flesh, of Worms, or Snails, (which are accounted Antidotes against the Jaundies.) Moreover Ale, and other ordinary drinks are impregnated with infusion of Medicaments.

Take of the roots of stinging Nettles, of Strawberries, of each an ounce and half, Eriygo-roots candied one ounce, Ivory and Harts-horn, of each two drams, Earthworms cleansed twenty, a Crust of White-bread, Mace two drams, boyled in two pound of water to one pound, strain it through Hippocrates sleeve, to which adde Diasantalon half a dram, make broath, whereof take from four ounces to six, twice in a day: for ordinary drink, fill a Tub of four Gallons with Beer, after it hath wrought, put in the follow∣ing Bag.

Take the tops of Roman Wormwood, white Horehound dryed, of each two handfuls, the roots of sharp pointed Docks six ounces, of the Bark of Ash, of Barberries, of each 3 ounces, the outer Rinds of eight Oranges, and of four Limons, being sliced and bruised, let them be prepared according to Art.

Since many sick of the Jaundies are usually affected with a great languishing,* 1.447 and frequent faintings of the Spirits, they have also need of cordial Remedies.

Take of small Aqua Mirabilis eight ounces, water of Earth-worms four ounces, Syrup of Orange-peels two ounces, mingle them, the dose two or three ounces.

Moreover, they who are troubled with this disease, do very much suffer with pain sometimes very troublesome in the night, and are often obnoxious to waking; where∣fore also Anodynes come into use for administration.

Take of Aqua Mirabilis, water of Earth-worms, of each one ounce, Diacodium six drams, Tincture of Saffron half an ounce, the dose one or two spoonfuls late at night, if sleep be wanting.

Take of Laudanum tartarizated two drams, Aqua Mirabilis two ounces, Syrup of Clove-gilly-flowers one ounce, mix them, the dose is one spoonfull after the same man∣ner.

SECT. II. CHAP. II. Of other Hepatick Remedies.

THe Liver is seldom or never found obnoxious to an Atrophie or extenuation, since truly it performs the office of a strainer, and according to some, of a mingling bowel; but on the contrary by reason of many causes and occasions, it runs the hazard of being encreased as to its bulk, and to be stufft and swell'd with divers things gathered therein, and with concretions. Hence no small account of health consists in this, that the Liver having right conformation may freely convey the blood every where, without keeping back too much Custome or provision for it self.

Truly many faults,* 1.448 and indeed not altogether undeservedly, are imputed to this Bowel, as also unto the Spleen; the chief Kinds of which we shall touch upon. The Liver frequently and chiefly is wont to be faulty in one of these two, viz. Frist that in∣tercepting the nutritious juice appointed for other parts, it bestows it to its own pro∣per use; this is plainly discerned in Children affected with the Rickets, and more∣over in many others that lead a sloathful and idle life. Anciently there was an art with the Romans so to feed a Goose that the Liver prodigiously encreased might weigh more than the whole body. Secondly, the other fault of the Liver is, that it too easi∣ly receives all the excrements and feculencies whatsoever of the depraved Blood, brought into its inward recess, and by retaining them there, doth not only grow large, but is obstructed in its passages, whence frequently comes the Jaundies, or a Dropsie; it contracts also tumours and preternatural Concretions of divers kinds of matter.

Many and divers distempers of the Liver ought to be referred to these two heads:* 1.449 of each of which it is not our purpose to institute particular pathologies. As to what appertains to the general pharmacie of this bowel, there will be one principal scope of curing, that its income be diminished as much as may be, or altogether cut off. Wherefore it will behove us to procure these two things, viz. That the Liver augment not above measure, by taking the nutritious juice too much unto it self; and that it retain not the feculencies of the Blood, whereby it may be affected with obstructions and preternatural Tumours.

It will be much easier to prevent than cure either of these faults of this bow∣el. For truly the former may be done, respect being had only that the blood be well vonstituted in its Temperament, and enjoying a free Circulation, it may both dispense its nutritious juice to the parts, and especially its outward parts, and driving forth all its excrements to the particular Emissaries, it may put them away there. And surely, the Medicines vulgarly called Hepaticks, do first and more immediately exert their power by purging the blood, rather than by correcting of the Liver: those namely consist of particles of such a kind, which entering into the blood, and not mixing with it, do so stirre up the mass thereof, and break it into pieces, that all the Coagulations and Concretions being taken away, all its dregs and impurities may easily depart, and being carryed to their proper Emunctories may be cast out of doors.

For truly all remedies which are called Splanchnick,* 1.450 first work upon the blood, and incite its constitutive parts into a kind of effervescency, and so toss, divide, and move them rapidly to and fro, that the vaporous effluviums being sent into the habit of the body, the serous excrements into the Kidneys, the cholerick into the Liver, the melancholy into the Spleen, and others to other Emissaries for which they are fitted, may be shut out, without impediment or adhesion.

Wherefore the same Remedies which help the Liver,* 1.451 help also the Spleen, the Reins, the Lungs, and other the Bowels in their separations; and for the most part move sweating and urine. If any be found to respect one part before the rest by any specifick power, it is therefore because their particles being more ally'd unto the excrements to be separated within that bowel, and from thence associated to them are conveyed thither together with them. For this reason Rhubarb, Turmerick, the greater Ce∣landine, with many others adjoyned to the bilious humour, do the more easily reach the passages of the Gall, and are wont to succour in the Jaundies. We have observed

before, the energies and manners of operating of Medicines of this kind. As to what appertains to the other, vulgarly called Hepaticks, first we will annex briefly certain forms of those which are reported either to prevent or remove the unnatural aug∣mentation of the Liver, and then those which are held to provide against or take away the obstruction and preternatural Tumours thereof.

1. Against the too much encrease, or improportionate nutriment of the Liver, first a more sparing and thin diet, short sleeps, and moderate and frequent exercises are convenient: wherefore we prescribe for Infants, and Children, when they are disco∣vered obnoxious to this distemper, as in the Rickets, that they suck thin and serous milk, that they be shaken or tossed in their Nurses arms, and tumbled quickly to and fro, or be carried swiftly in a Chair or Coach, and as soon as may be, learned to go and to use their feet.

Take of the water of Snails, of Earth worms, of each three ounces,* 1.452 Syrup of Chicory with Rhubarb two ounces, spirit of Sal Armoniac with Gum Ammoniacum one scruple, mix them, and take a spoonfull evening and first in the morning.

Take of the roots of Maleferne, Chervil, candied Eringoes, of each one ounce, the leaves of Agrimony, Harts-tongue, male Speed-wel, of each one handful, Shavings of Ivory, Harts-horn, of each two drams, white and yellow Sanders, of each one dram, Raisins stoned one ounce and a half, Barly three drams, boyl them in three pounds of Spring∣water to two, to it strained adde of Snail and Earth-worm water, of each one ounce and half, Syrup of Chicory two ounces, make an Apozeme, take two or three ounces in a day.

Take Powder of white and yellow Sanders, Crabs-eyes, Lignum-Aloes, of each half a dram, Salt of Wormwood one Scruple, make a powder, the dose half a Scruple to a whole one twice a day.

Take Empl. Diasaponis, Cerate of Sanders, of each what will suffice, make a Plaister to be applyed to the Hypochondrion.

Take Ʋnguentum Splanchnicum two ounces, Oyl of Wormwood one ounce, mixe them, and make a Liniment for the region of the Liver.

Hither many other methodical as well as Empirical Medicines being used for the Rickets may be referred, but we hasten to other things.

2.* 1.453 Remedies ordained for most other distempers of the Liver are either simple or compound. Very many of the former sort are reckoned by Authors, as if they were procreated for this particular use. Heurnius says, That God Almighty hath offered to the World the greater plenty of Remedies of this kind, by reason of their notable necessity. And to this Rank may be referred in the first place all kinds of Chichories, the Sor∣rels,* 1.454 the sharp pointed-Docks, and almost all Vegetables endowed with bitterness and something of sharpness, (wherein the deoppilative vertue is reported to consist) as Wormwood, Germander, Ground-pine, Fumitory, Tanzy, Agrimony, Liverwort, Lignum Aloes, all the Sanders, Tamarisk-bark, and Ash-bark, the roots of Capers, with many others, which commonly make up the greatest part of Herbals; so that whilst the Liver like a certain Goddess ruled sanguification, very many Medicines were used to be ascribed fot its safeguard and succour.

The fixt Salts of herbs, the acid Spirits of Minerals drawn by distillation, belong by right to this number, as they do chiefly exagitate the masse of blood, dissolve the Con∣cretions thereof, dispatch their obstructions, and cause it every where to be passable, as to all the parts thereof.

If I here omit Chalybeates, most Chymists will censure me very unjust to the Liver;* 1.455 for truly as the Prerogative of Venus is vulgarly attributed to this bowel, so as to con∣strain to Love, we may hence expect that Mars will be perpetually kinde unto it. And really it is manifest by Reason, as well as Experience, that Preparations of Steel are convenient in hepatical affects, as chiefly in the Jaundies, and oftner in the Drop∣sie; wherefore these are put into the Receipts of the Ancients and modern, and a∣mong curatory Compositions. For what reason the Preparations of Steel as in like manner the medicinal waters from Iron, as well natural as artificial, do purifie the masse of blood, and by consequence do relieve many distempers commonly call'd He∣patical, is shewn by us largely enough in another place, so that here is no need for repetition.

Medicines that are appointed by Physicians for the Liver are divided into vari∣ous

forms, but first into hot and cold, and also into moist and dry; accordingly as the temper of this bowel is supposed to consist after divers manners: when in truth it is only a dyscrasie of the blood, which being so diversly faulty, desires so various an energy of medicines. Neither is it a less vulgar error, that in the estimating of mens constitu∣tions, the various temperament of every one due to the blood, is ascribed chiefly to the Liver, as hot or cold, or otherwise disposed.

In the Antidotaries of the Ancients there are many Shop-compositions extant,* 1.456 which seem to be besigned for the Livers sake only, of which sort are Rhasis his Electuarie of the dross of Iron, Crocus ferri of Balchusis, which being mixt with Treacle is commend∣ed for hepatical affects; the species Diatrion santalon, Diarrhodon Abbatis, Trochiscs of Rhubarb, of Agrimony, of Capers, Diacurcuma, Dialacca, Syrup of Wormwood, Chico∣rie, of the five roots, Byzantinus, with many others, unto all whose forms, a vast Catalogue is annext for curing all the diseases of the Liver. But these passed over, it pleases me now to propound some Kinds and Examples of Medicines which are count∣ed deoppilative according to the practice of the Moderns.

Therefore for an opening Decoction, Take of the roots of Ferne,* 1.457 Chervil, stinging Nettles, Dandelyon, of each one ounce, the leaves of Agrimony, Harts-tongue, Speed-well, Oak of Jerusalem, Liver-wort, of each a handfull, white and yellow Sanders, of each three drams, Ivory half an ounce, red Cicers an ounce, Coriander-seeds three drams, Raisins two ounces, boyl themin four pound of water to two pound, adding towards the end White-wine four ounces, stram it through Hippocrates Sleeve, to which adde Species Diarrhodon Abbatis one dram, of our prepared Steel two drams, Syrup of Chicory with Rhubarb two ounces, the Water of Snails and Earth-worms, of each one ounce, the dose six ounces twice in a day after ae dose of the following Electuary.

Take of Conserve of the yellow of Oranges and Limons,* 1.458 of each two ounces, of Worm∣wood and Fumitory, of each one ounce, simple Powder of Aron-roots, yellow Sanders, Lignum Aloes, of Caper-roots of each one dram and a half, Crabs-eyes one dram, Salt of Wormwood two drams, syrup of Fumitory what suffices, make an Electuary, the dose the quantity of a Walunt twice in a day, drink after it a draught of the Apozeme now prescribed, or of the following distilled water.

Take the leaves of Wormwood,* 1.459 Centaury, Tansie, both sorts of Southern-wood, Tama∣riske, of each four handfuls, of green Walnuts four pound, of Ashen keyes green two pound, the Rinds of ten Oranges and four Limons, Snails and Earth-worms prepared, of each one pound, all being sliced, pour on them of White-wine eight pound, distill it in a cold Still, let all the liquor be mixt together, the dose three ounces, sweetning it with Sugar or a fit Syrup.

If a form of Pills will please better, the ensuing Extract called in the Shops Ex∣tractum Ecphracticum, seems profitable.

Take of white and clear Tartar,* 1.460 and of fresh Filings of Iron, of each 4 ounces, let them be ground together into powder, after boyl them in Fountain-water from four pound to two (some use White-wine) to the strained liquor adde the tops of Centaury, of Roman Wormwood, or Carduus, of each one handfull, Gentian-root half an ounce, Species Dia∣curcumae an ounce and half, let them boyl shut close for three or four hours, strain it, and evaporate by the heat of a Bath to the consistence of Pills, adding roots of Rhubarb or Species of Hiera Picra two drams; the dose is from one scruple to half a dram made into Pills, in the evening, with an appropriate vehicle.

For the same intention, viz. to prevent or to remove the obstructions of the Liver, a medicated purging Ale, to be taken many dayes in Spring and Autumn, is by some very much magnified, and exactly observed every year during their lives.

Take of the roots of sharp pointed Docks prepared, Polypodie of the Oak, of each 3 ounces, Madder-roots two ounces, English Rhubarb two ounces, of leaves of Senna four ounces, Epithymum two ounces, yellow Sanders one ounce, Carthamus and Coriander-seeds, of each one ounce and a half, slice them and bruise them according to Art, make a bag for 4 gallons of Ale, after six dayes let him take to 12 ounces more or less in the morning, expect∣ing four or five Stools without regiment.

SECT. II. CHAP. III. Of Remedies for the Dropsie called Ascites.

AFter the Jaundies and the Remedies thereof, our method leads us to treat of a Dropsie; not because of the Vulgar opinion, that it always arises from the fault of the same bowel; but because that former disease having long continued, for the most part concludes in this: which happens so, not so much from the fault of the Liver, as from the whole Blood, for this and not that perform san∣guification. Wherefore, when the masse hereof hath for a long time been filled with cholerick excrements, and at length degenerating from its temper, accumulates also watery humours, then doth a Dropsical Disposition come upon the Jaundies.

But whereas three sorts of Dropsies are vulgarly supposed, viz Ascites, Tympanites,* 1.461 and Anasarca, we will at present handle only the two former, appertaining to the Splanchnick or Pathologie of the nether Belly. And first what relates to an Ascites, this disease as to its matter and formal reason is manifestly known by the sign of even many senses together, viz. it is a Tumour of the Abdomen,* 1.462 from a waterish tu∣mour contained within the cavity thereof. The water making this tumour, some∣times encreases to a huge inundation, and scarce credible quantity. I have once seen a Tub would hold 15 gallons filled with water taken out of the Abdomen of a wo∣man dead of a Dropsie. But whence that humour proceeds, also by what manner, and from what causes it gathers together in the belly first, and afterwards is sensibly augmented; and lastly by what passages, and by what vertue and operations of Hy∣dragogue Remedies, it may again be taken from thence, and evacuated, seems most difficult to be unfolded.

As to the former, viz. the encrease of water,* 1.463 some have thought it to descend from the Liver, and others from the Spleen distempered, into the cavity of the Ab∣domen; and so this bowel or that being vitiated, always to be the cause of an Ascites. But that this is otherwise, Anatomies of many dead of this disease, do manifestly declare: when after the inundation of the belly, the Liver and Spleen and found often without fault. And truly these bowels do not seem the Springs of any such illu∣vies, being endowed with no cavityes, wherein waters might be accumulated toge∣ther: wherefore the origine of an Ascites, as of a standing Pool or Lake, is to be de∣rived from a River, or at least a glutt or inundation of some Humour.

The humours that flow within the passages, or Vessels as Brooks,* 1.464 are chiefly these three, viz. the Blood, the milkie Humour, and the Lympha. The showering or distilling of water may come to pass from the nervous Liquor which sometimes slowly and insensiby sweats out of the fibres and membranes, and from vapours condensed within the hollowness, or some Cavity of the Body. Whether by these wayes an Ascites doth rather, and oftener proceed, we will now search.

And in the first place as to what relates to the blood, it is without doubt,* 1.465 the Se∣rum falling from the masse thereof, too much dissolved, as it doth excite Fluxions and Catarrhs of various kindes, so it sometimes stirs up the greater illuvies of waters, viz. Dropsical: wherefore when an Anasarca proceeds altogether from this cause, and when oftentimes an Ascites comes upon that disease not immediately heald, we may well enough inferr that either distemper is induced from a watery humour, every where poured out from the little mouths of the Arteries. Moreover, it is not much improbable, that the Serum of the dissolved Blood is first and solitarily poured out of some end of the Coeliac and Mesenteric Arterie being open into the Cavity of the Abdomen, and so brings on an Ascites without an Anasarca going before; and so especially if perhaps it happen, that scirrhous Tumours, Ganglion's, little swell∣ings, or preternatural Concretions of another manner, are first raised about the Me∣sentery, the Spleen, the Liver, the Womb, or any of the other bowels of the nether belly: for, because the Circulation of the blood is hindred in those places, that the blood being carryed through the arteries, may be some way brought back, the serous part being thrust out from its company, falls into the cavity. For truly it is most evi∣dently manifested, that it so comes to pass, by this Experiment mentioned by us in another place, viz. If in a living animal, the jugular veins being taken up and bound

with a thred, the reduction of the blood be stopt, the whole Region of the head swells in a short space, with a water between the skin, and clearly hydropical. And truly I have more frequently observed that an Ascites hath followed upon secret tumours gathered and raised in some place in the lower belly: which certainly happens for the reason above recited. When the course of blood being obstructed, the watery part is extravasated in a short space, that humour is not meerly serous, but besides, the nutritious Liquor, ordained to nourish all the solid parts, is emptyed into the belly: wherefore, while this Region swells up, the members are extenuated, and the Lym∣pha taken out from an Ascites, with heat thickens and grows white, like the white of an Egge.

It is also very probable,* 1.466 that the milkie Vessels being burst asunder, pour out their humour into the cavity of the abdomen. Truly the most renowned Sylvius thought this disease most frequently engendred from such a cause. And truly as out of the milkie or watery Vessels, viz. one of them or both together, being divided, or opened, we may well suspect the illuvies of water or chyle sometimes to overflow the bowels of the nether belly; so the following observation seems to confirm the same thing. Of late one that had been long sick of the Jaundies, and in the mean time temperate and abstemious of drink (to which he was not prompted by thirst) contracted an Ascites, increased in a short time hugely. After that medicines were administred in vain, a Paracantesis is attempted according to the manner of Sylvius, with a hollow Needle; out of the orifice, not icterical water, but limpid and thin flowed out abun∣dantly; from whence we may inferre, that hydropic humour flowed not out of the mass of blood, for then it had been coloured, but distill'd out of the lymphic or milkie vessels into the cavity of the abdomen. We have joyn'd together as akin the ways of the milkie and lymphic Vessels in propagating an Ascites, because both ves∣sels do convey the chyle, or what is analogous to it, to the common Receptacle; and many branches or leading Pipes of either kind, are distributed about the bowels of the nether belly; in the mean time, it is not improbable but that a solitary fault of either vessel may sometimes produce an Ascites.

As to the other wamys of generating an Ascites, proposed in the beginning, I am scarce induced to think, such an inundation of the belly can easily arise from the distilling of a nervous humour, or by reason of vapours there condensed: although perhaps in a Tym∣pany where the cavity of the abdomen is enlarged, and transpiration hindred, the efflu∣via that were wont to exhale, being forced inwards, are changed into Lympha or wa∣ter, wherefore for the most part an Ascites is ever conjoyn'd with that disease.

The immediate or conjunct causes of an Ascites being design'd after this manner,* 1.467 which indeed seem to be, either a watery humour poured out of the Vessels bringing Blood, or Lympha or Chyle poured out of the proper passages of them both; not we must in the next place inquire about the more remote causes of this disease, viz. for what occasions, and after what manner, the vessels affected of either sort deposite their burdens into the cavity of the belly.

First therefore,* 1.468 that the watery part of the blood sweats out into the Aqualiculum or belly, either the very Blood, or Vessels containing it, or both together, are in fault. The Blood is in fault, when being depraved in its Crasis it doth not rightly contain within its consistence the constitutive parts, but being apt to be dissoved, it every where rejects its serosities from the mixture; which either it drives out by Urine or Sweat, or permitting them to reside within, pours them out into the pores of the flesh,* 1.469 or the cavity of the bowels. The vessels bringing blood grow faulty for a second reason, for that their extremities or little mouths either are too much loose, or altogether shut up. In the former state the clew of Circu∣lation of blood is not entirely and firmly continued; but the thinner and more crude part of the blood being apt to depart, is suffered to flow out near to the inter∣spaces or inosculations of the Arteries and Veins; likewise on the other side, when the course of blood is hindred, by reason of a tumour or obstruction of some vessels, their little mouths being throughly closed; to this being so straitned that a passage may be made open by some means, that which is thin and watery is extravasated, and sent away into the neighbouring places, as we have shewed above.

2,* 1.470 & 3. But an Ascites beginning alone, doth often arise, by reason of the milkie or lymphatic vessels being depraved; wherefore seeing we suppose the cause of this kind of disease to be oftentimes conjunct, we must enquire, by what means, and for what occasions, these vessels are wont to be so opened or burst asunder, that they pour out thei liquor into the cavity of the belly.

First therefore as to what belongs to the Lymphaducts, these vessels may be in fault after a diverse manner, but chiefly, either that being obstructed or compressed near their origine, they do not receive the humour, or being burst about the middle or extream parts, do pour it out into the belly. There are many causes and rea∣sons of effecting of either of these, for it may be a viscous matter obstructs their be∣ginnings, or glandulous, scirrhous, and other preternatural Tumours compress them, as also a vast inundation of Lympha flowing out, moreover vehement motions of the Body, or passions of the mind, may burst them asunder.

2. The milkie Vessels, no less than Lymphatick, are in danger to be broke,* 1.471 and so by pouring out their liquor into the cavity of the Belly, do excite the Dropsie called Ascites; and truly they are wont to be hurt for the like reason, in regard their middle passages, or their ends, either are obstructed by a more viscous chyle brought into them, or by Phlegme from the intestines, or they are compressed by Tumours bred in the Mesenterie: for forthwith the chyle entering into the beginnings of the vessels, and not finding a passage, first very much distends them, and afterwards breaks them. There are many causes and occasions, for which the thicker and obstructing humours are driven forwards into the milkie Vessels; for besides an irregular Diet, and for the most part from meats hard to be digested, this evil is frequently caused by too much drink, or immoderate exercise immediately after Food, also from cold drink while the Bowels are very hot; for so the passages of the Vessels before gaping are suddenly shut, and afterwards more narrowly closed, wherefore the chyle sticking within their straitned chanels, doth throughly fill and obstruct them in a short space.

As to what belongs to the differences of this Disease, besides them already cited,* 1.472 viz. that it comes after an Anasarca, or comes solitary; that this also is manifold and after a diverse manner, according as the Vessels bringing blood, or water, or milk, are found in the fault; Moreover we observe, that the Dropsie called Ascites sometimes proceeds from a meer watery humour filling and distending the parts of the nether belly; but sometimes there happens to this deluge an extension of the mem∣branes, or inflations made by the irregularities of the inmate spirits, and so they do encrease the swelling of the Abdomen; and in this case a certain Tympanites comes upon an Ascites, even as more frequently on the contrary, this is the offspring of that.

Moreover, in an Ascites meerly watery, sometimes the Lympha only fluctuates within the Cavity of the Abdomen, so that in the mean time the bowels being soakt in it, continue still entire, and little or nothing encreased in their bulk; but sometimes besides the inundation of the Lympha in the hollow of the belly, the blood being slowly circulated there, and almost stagnating it is much diluted with water; Moreover the Parenchyma of the bowels, and the sides of the Vessels and of the membranes, and chiefly the Glandules every where numerous, being moisten'd, do swell with the flowing water, and so the tumour of the belly consisting as it were of many pools of water and moorish Contents, rises into a vast bulk.

The Prognostick of this Disease, is always suspected and accounted of an ill omen:* 1.473 for none of the vulgar but will pronounce the obstinate tumour of the belly to be very dangerous and difficult to cure: If any seem to be affected with a Dropsie, or a Consum∣ption, with them presently the next question is, Who shall be his heir.

An Ascites beginning after an Anasarca (which proceeds commonly from the whole mass of blood being pour'd forth into serosities, and sweating them out of the little mouths of the Arteries into the cavity of the Abdomen) is accounted of easier cure, or at least of more promising hope, than that solitary disease coming from tumours about the bowels, or from the Lymphatick or lacteal Vessels being burst asunder; for as well the conjunct as procatarctick cause of the former Disease, oftentimes is used to be removed wholly, or in part; but in the other case, both for the most part exist incurable. A reddish Urine, lixivial, and little, in an Ascites is of ill signification, for 'tis a sign that the mass of blood, being repleated with a scorbutick Salt and Sulphur boyled together, is too much bound up in its substance; insomuch that it doth not well separate the feculencies, nor discharge them by fit and convenient Sinks, which notwithstanding it doth evilly dispose by constraint into the Cavity of the Belly, for∣asmuch as it is hindred in its Circulation in the very same place. For in an Ascites the blood is not always dissolved as in an Anasarca, but sometimes appears too much com∣pacted in its temper, yet so, that the salt Serum being denyed to the pores of the skin,

and to the Urnary passages, by reason of the Obstructions of the bowels is forced to break out within the abdomen.

If in an Ascites, by a Purge taken, the waters are evacuated with ease plente∣fully by stool, and from thence the swelling of the belly is somewhat diminished, we are not to despair of the Cure; but if Purgers bring out little or nothing of the Serum, or Lympha, and thence by reason of the Nervous fibres being irritated, and driven into extensions or inflations of the bowels and membranes (as it uses frequent∣ly to be) the belly swells the more, and grows like a Drum, we may expect only a fatal event of the Disease.

About the curing of the Dropsie called Ascites it behoves us chiefly to consider by what ways the waters heaped within the abdomen,* 1.474 may be thence brought out, and evacuated, for such an evacuation ought to be attempted only by possible ways. And here presently is to be observ'd, that the remedies used for Hydragogues according to the ordinary practice of Medicine, intend to accomplish that end by purging, by Urine,* 1.475 by Sweating, and by insensible transpiration: In some cases of the Sick you ought to proceed by this way, and in other cases rather by that way, or another, and if none of these seem feasible, or succeed well, let mature consultation be had for a Paracentesis. It will be worth our labour to weigh every of these kinds of Medicines, and the reasons of every one, and the manner of their operations, and with how much vertue Hydragogues are endowed.

First,* 1.476 therefore as to what relates to purging, we have in another place shewed that, from the irritation of the Physick made in the belly and guts, as well the Contents and winde of these bowels, as moreover the humours driven into their Coats and Glandules, and which are heaped up in the Vessels and Pipes of the neighbouring parts, are disquieted, and partly streined into the passages of the guts, and partly returned in∣to the mass of blood; insomuch that the tumour of the abdomen arising from the stoppage, and as it were a waterish affection of those kind of Parts, is often abated by Purgatives seasonably administred, and sometimes wholly removed; but it doth not so succeed when it proceeds from a Lympha fluctuating within the cavity of the abdomen, or from an inflammation of the membranes, or from a tympanitic exten∣sion: because Hydragogues do little or nothing bring out those waters, and if they be of the stronger sot, they encrease this passion and exasperate it by inflaming the part.

Catharticks used for Hydragogues,* 1.477 are either Vomits, or Purges; they exert their power in the stomace, and these rather in the Intestines; insomuch that they power∣fully provoke and twitch the Nervous fibres; and together pour forth the blood and nervous liquor by a certain septick force, and do cause the serous humours wherever impacted to be stirr'd, and do cause them plentifully to be sent away by the passage granted. Either are reckon'd of a various kinde, viz. either simple or compound, gen∣tle or strong, by the Ancients as well as by the Moderns; some of which that are most chielfy noted, we will here briefly observe.

1. Emetick Hydragogues, chiefly famous, are Gambugia, Esula, Spurge, and their se∣veral Preparations, as also the Hercules of Bovim, and the Pilulae Lunares.

2.* 1.478 Purgers are Elder, and Dwarf-Elder, Soldanella, Gratiola or Hedge-hyssop, the Juice of Orris, and Elaterium. We will briefly prescribe some methods either of prepa∣ring or compounding or administring each of these.

1.* 1.479 Gambugia, first an Indian Medicine, being from thence brought by our Coun∣trey-men, from the Painters Shops coming to the Apothecaryes, began to be in use, and is much magnified for purging out serous humours. But sorasmuch as taken by it slef it vehemently disturbs the Stomach, and often weakens it, therefore, that its outragious and violent vomiting force may be somewhat abated, there are divers ways of its Preparation invented; but truly it is best corrected with an acid Spi∣rit, or with an alcalizate Salt, or by throughly mixing and correcting it with aro∣maticks.

Adrian à Mynsicht,* 1.480 extolls the magistery thereof, which is made by a dissolution in Spirit of Wine, and after drawing it off, and precipitating it with Spring-water; also dissolving it with Spirit of Wine vitriolated, and with Tincture of Roses, and red Sanders, and after by evaporating it: others prepare it with the fume of Sulphur after the manner of Scammonie sulphurated; others grinde it on a Marble, moistening it with Oyl of Cinnamon, or Cloves, or other chymical Aromaticks. I use most the Solution thereof made with a tincture of Salt of Tartar, the dose from 15 drops to 20 or 30.

Take of Gum-gutta, gr. 6. Mercurius dulcis gr. xv. Conserve of Violets,* 1.481 a dram and a half, make a Bolus.

Take of Gambugia twelve grains, Salt of Wormwood fifteen grains, Oyl of Mace one drop, Conserve of Damask Roses one dram, make a Bolus: and it is wont to be given with Tartar vitriolate, or Cream of Tartar, and powder of Rhubarb.

Take of Gum-gutta sulphurated, or vitriolated, fifteen grains, Cream of Tartar half a scruple, Extract of Rhubarb one scruple, Oyl of Cinnamon, gut. 2. make 4 Pills.

Lately, a woman afflicted with a most painfull Ascites, and most desperate, as it seemed to me, the ensuing Medicine being taken for 6 days successively, she began to be much better, and in a short time afterwards recovered her health entirely.

Take of powder of Gum-gutta twelve grains, Oyl of Cinnamon one drop, with syrup of Buck-thorn, make a Bolus, the dose daily to be augmented, ascending from twelve grains to twenty.

Take of our Tincture of Gum-gutta one scruple, water of Earth worms one ounce, Sy∣rup of Rhubarb half an ounce, mix them, and let it be taken with government.

2. Whereas there are several species of Spurge, or Tithymalus,* 1.482 and all of them work more violently either by Vomit or Stool, by reason of the notable provocation they make in the bowels; and for that cause do abundantly bring out serous humours; yet by reason of the too outragious force of many of them, the lesser Spurge for the most part only is now in use, and the preparations thereof most of all magnified are, the powder of the bark of the Roots, and the Extract, and we think fit to adde the tincture inferiour to none of the rest.

Take of Spurge with the Roots cleansed four handfuls, Lignum-Aloes, and Cloves, of each one dram, bruise them and boyl them in four pound of Spring-water, to half, the strained Liquor clarifie by separation or settling in a long glass afterwards evaporate the clear liquor in a Bath heat, to the consistence of an Extract, the dose one scruple.

Take of this Extract half an ounce,* 1.483 pour upon it into a matrass of the Tincture of Salt of Tartar 6 ounces, digest them in a Sand-hath to the Extraction of a Tincture, the dose from 20 drops to 30 in a convenient vehicle.

Take of the Powder of Spurge from seven grains to ten, Cinamon half a scruple, Salt of Tartar eight grains, mix them together in a glass mortar, give it by it self or mixed with a fit Conserve, or Syrup, make a Bolus or Pills.

2. Precipitate of Mercury with Gold,* 1.484 or the Hercules of Bovius which is much extolled by the Author for curing Dropsies; it is described in a former Treatise in the Chapter of Vomits, and the manner of preparing, and the working thereof, and the Reasons are there delivered. This Medicine, inasmuch as it twitches the sto∣machical fibres by its acrimony, and pours out the blood by reason of the mercurial and salt particles, causes or stirs up a fierce Vomit, and thereby causes the serous hu∣mours, violently strained into the Cavities of the bowels, to be ejected.

3. The Pills called Lunares produce the same effect in like manner,* 1.485 by reason of the vitriolate particles of Silver sharpened with other saline menstruums, viz. by wrink∣ling of the fibres of the Bowels very much, they force the serous humours to be strongly strained into their passages, and so to be evacuated.

A Solation of Silver made in Stygian water, and well cleansed, and by a little evaporation is reduced into pleasant Crystals, which by themselves (or with an addition of Salt Nitre to abate the fierceness of the Lunar Vitriol) are made into Pills with crums of bread: the dose is one Pill, sometimes two or three, respecting the ability of strength and working. Medicines of this kinde are exhibited sometimes with success in a strong constitution, and bow∣els strong, and a good habit; but they are scarce ever conveniently or rarely without prejudice taken by tender and cachectical persons.

Hydragogues meerly or chiefly purging, are either of a more mild sort, as Elder,* 1.486 Dwarf-Elder, Soldanella, and juice of English Orris, which seldom being administred by themselves, do want the stirring up of sharper Medicines, and on the other side they blunt their too much fierceness; or they are of a stronger sort, as Gratiola or Hedge hyssop, Jallap, and Elaterium.

The seeds or grains of Elder and Dwarf-Elder being dryed,* 1.487 are reduced into a powder, which being taken to the weight of one dram, doth gently bring forth se∣rous humours by siege; Water and Spirits are distill'd of the juice of either sorts of Berries fermented, also Robs and Syrups are made of them; which with many other Preparations of those Vegetables, are much magnified for all hydropical Distem∣pers.

Soldanella and Gratiola,* 1.488 are rarely used by themselves in our age, neither are any neat and very efficacious Medicines prepared out of those Simples, they are frequent∣ly mixt with certain other Hydragogues, and chiefly are ingredients in compounding Apozems.

The Juice of English Orris is a very profitable Medicine,* 1.489 and because to be easily provured for the poor, is the more to be esteemed: It is given grom six drams to an ounce and a half, or two ounces, either by it self in a fit vehicle, or with other things appropriated thereunto. Jalap is a most known Medicine against every Dropsie, and common enough. Any one of the common people suffering under that disease, pre∣sently takes of the powder of the root of Jalap a Pennyworth, mixt with Ginger and White-wine, and the desired effect doth frequently follow this remedy used with in∣termission.

Elaterium, is rightly esteemed the most powerful Hydragogue,* 1.490 for that it most pain∣fully provoking the splanchnick fibres and together melting the blood and humours by a certain corrosive force, compells whatsoever serosities the Coats of the Bowels, Membranes, Vessels, also the Glandules, and flesh do contain in themselves, to be poured out into the cavities of the Stomach and guts: by which Medicine happily working, the asswaging of the Abdomen doth sometimes succeed. Truly this is the chief weapon of the Empirical Magazine against any Ascites; which they notwith∣standing using in all cases, do oftener administer to the hurt than benefit of the Pa∣tient: the dose is from three grains to ten or fifteen, taken either by it self, only with correcting spices added, or it is given with other hydragogues in form of a Powder, Pills, or Electuary. The tincture and essence of it are extracted with Spirit of Wine, or with tincture of Salt of Tartar.

These are the chief simple Hydragogues,* 1.491 from which being prepared with the ad∣dition of others, many compounded ones as well Magistral as common in Shops are made, adn are every where in use; moreover, very many more might be prescribed extemporarily, as occasion serves. Of these we will here annex a few more select forms, and chiefly those that are taken in the form of Potions, Powders, Electuary and Pills.

Take of Dwarf-Elder,* 1.492 English Orris, of each an ounce and half, leaves of Soldanella and Gratiola, i.e. Hedge-hyssop of each one handful, Asarum, and Asse Cucumber-roots of each two ounces, roots of lesser Galangal six drams, choice Jalap half an ounce, Ela∣terium three drams, Cubebs two drams, shred and bruise them, and pour upon them three pound of small Spirit of Wine tartarizated, digest it stopt close in Sand for two days, strain it clear and depurate it by settling. The dose from two spoon-fuls to three, in a convenient vehicle.

Take of Elaterium,* 1.493 Soldanella, Ginger, of each one scruple, Galangal, Cloves, Cina∣mon, of each half a scruple, Salt of Tartar fifteen grains, make a powder for two doses.

Take powder of Jalap one dram, Ginger one scruple, Cream of Tarar 15 gr. make a powder to be given in a draught of White-wine.

Take of Rhubarb one scruple,* 1.494 Elaterium 5 grains, Tartar vitriolated half a scruple, Spick∣nard three grains, with Syrup of Buckthorn make four Pills.

Take of pill Aloephanginae half a dram, Elaterium half a scruple, Oyl of Cloves gut. 3. make four Pills.

Bontius hydropick Pills are given from half a scruple to half a dram, prepared thus:

Take of Aloes two drams and a half, the preparation of Gum-gutta one dram and a half, Diagridium corrected one dram, Gum Ammoniacum dissolved, one dram and a half, Tartar vitriolated half a dram, make a mass, and form it into Pills.

Certain hydragogue Electuaries re now every where in use and celebrated by practi∣sers.* 1.495 Of which sort are, 1. One described by the renowned Sylvius, and the other by Zwelfer. This following pleases us.

Take of Resine of Jalap two drams, Tartar Vitriolate one dram, Extract of Rhubarb two drams, of Spurge a dram and a half, lesser Galangal one dram, beat them in a mor∣tar, and lastly adde of Conserve of the flower of English Orris, four ounces, and with Syrup of Peach-flowers make an Electuary, the dose from half a dram to a dram and a half, or two drams.

I might here set down or describe many other purging Hydragogues,* 1.496 but Cathar∣ticks do not always cure an Ascites, yea often-times exasperate it, and (if they be long continued) render it incurable; hence it is necessary to have recourse to other Reme∣dyes for the Cure of this disease. Wherefore, let us next enquire whether Diureticks do here profit or not?

And truly any one may easily think that Remedies moving Urine conduce very much for draining waters out of every place or cavity of the body. In truth it is ma∣nifest by frequent experience, these do often cure an Anasarca before any other Re∣medy; let us see what they may effect for the emptying the Cavity of the Abdo∣men.

As to this it first appears,* 1.497 that there is no passage immediately open from an Ascitick pool to the Reins, although contiguous; but that whatsoever waters are transferred from hence thither, must of necessity first be drunk up into the mass of blood, and from thence be poured out of its bosom into the sink of Urine; and truly it is but a little which the gaping little mouths of the veins about the superficies of the bowels can receive (if perhaps they are open at all) and Diureticks can but effect this one thing, that by pouring forth the blood, and forcing its serosities more plen∣tifully to the Kidnies, they cause the waters fluctuating in the belly to be allured to it being so emptyed; in the mean time there is no less danger, lest Diureticks be∣ing unseasonably administred, while they dissolve the blood too much, they constrain the serum to depart into the seat of the Ascites, more than into the Reins, and so rather augment than remove the inundation of the belly. For that it sometimes so happens, I have often found by experience; wherefore when Diureticks are prescur∣bed to cure an Ascites, we must chielfy provide against such a contrary effect. For this reason indeed Astringents and Corroboratives are always mixt in Remedies for the Dropsie (founded on experience, and the Authority and Practice of the An∣cients) not that such (as is commonly said) do confirm the Tone of the Liver, but conserve the temperature, and mixture of the blood, lest it be wholly dissolved by too great a fusion. Wherefore in an Ascites which chiefly or in part happens by rea∣son of the frame of the bowels and vessels, and chiefly the Coats, Glandules, and their little strings, and their interspaces being stuffed by a serous humour, and there∣fore very much swell'd up, as Catharticks so also Diureticks profit, and are fre∣quently taken with success; forasmuch as by the use of these the masse of blood be∣ing emptyed (the serum being more plentifully derived to the kidneys) doth easily reveive unto it self those waters every where stagnating about their little mouths, and conveys it towards the urinary sink: but on the contrary, in a meer Ascites where the heap of waters do overflow the Cavity of the Belly, the Textures of the bowels being free from the serous stuffing; Diureticks are given in vain, or incommodiously; inasmuch as they express nothing from this Lake of the belly, and most frequently by dissolving the blood more impetuously drive together the waters apt to be instill'd there.

Not all Diureticks of every kinde are equally convenient in an Ascites,* 1.498 neither ought they indifferently to be administred; for we must observe, the affected in this disease for the most part make a little, reddish Urine, and as it were lixivial; which truly is an indication that the temperature of he blood is too much bound in them, by reason of the fixt and sulphureous Salt exalted and combined together: and therefore that the Serum is not duely separated within the reins; which notwithstand∣ing is shook off about the windings of the obstructed bowels, and so is depisited in the Cavity of the Belly. Wherefore in this Case it will be convenient to drink only those things to excite Urine, which so restore and amend the Constitution of the blood, that the enormities of the fixed Salt and Sulphur being taken away, the serous part might be separated within the reins, and more plentifully discharged; for which purpose, not acid or lixivial things, but those endowed with a volatile Salt are appointed. For I have often observed in Patients of that kind, when the Spirit

of Salt, and other acid drops of Minerals, and when the dissolutions and Deliqui∣ums of Salt of Tartar, Broom and other things, have done more hurt than good, that the Juice of Plantane, Brooklime, and other Herbs abounding with a volatile Salt, have much helped, as also the expressions of Millepedes: for the same reason Salt of Nitre throughly purified or Crystal Mineral doth often profit. Forms of Medicines more accommodate for this use are extant in our former Treatise, where, viz. ex∣amples of Diureticks are described, in which both volatile and nitrous Salts are the Basis. Moreover, hither ought to be referred the notable experiment, by which Joannes Anglus affirms himself often to have cured the Ascites from a hot cause,* 1.499 which Medicine also that expert Physitian Dr. Theodore Mayern was wont to magnifie and prescribe in the like case.

Take of the juice of Plantane and Liverwort, and fill an Earthen pot to the top, which being stopt close, put in a hot Oven after the Bread is drawn, and make a little fire on the sides of the pot to continue the heat of the Oven; after it is so boyl'd strain it, and being sweetened with Sugar, drink of it Morning and Evening, and it cures. In imita∣tion of this I have often with success prescribed as followeth.

Take of green Plantane-leaves four handfuls, Liverwort, Brooklime, of each two hand∣fuls, bruise them together, and pour upon them half a pound of small compound Radish∣water, or other appropriate Aagistral, express it strongly, the dose three ounces three times in a day.

Although Diaphoreticks are most efficacious in an Anasarca,* 1.500 yet in an Ascites they are rarely or not at all used: for being unseasonably offered, they impress oft-times great hurt on the Patient without any avail; forasmuch indeed as by heating the blood, they cause the fluctuating waters to grow hot, and as it were to boyl in the hollowness of the belly; so that the spirits and humours are disturbed by vapours raised from thence; and so a disorder of all the functions follows, and the very bow∣els being as it were boyled, are much prejuciced. Moreover from sweating unadvi∣sedly instituted, the blood being forced into a fusion and precipitation of the Serum, throws it off the more into the nest of the Ascites. Wherefore when some prescribe fomentations, and liniments, adn bathing, to be applyed to the swelling Paunch of the Belly, for the most part it turns to the worse in such Patients; for besides a little Feaver, a Vertigoe, fainting of the spirits, and other ill symptomes of the brain and heart, being most frequently so raised, even the belly also doth from thenc swell the more: forasmuch as the Blood being agitated and poured out, deposits in that place more largely the Serum; and for that cause the mouths of the Vessels are more loose∣ned and opened, so that they may more readily let fall water prone to depart from the mass of blood. But the Remedies which are chiefly wont to be administred with success near the places affected (when a Cure is intended without a Paracentesis) are Clysters and Plaisters.

The former draw the Serum out of the Vessels and Glandules of the Guts and Me∣sentery without fusion of the whole mass of blood,* 1.501 (which the stronger purging Me∣dicines do excite,) which being so emptyed do imbibe a little the extravasated Lym∣pha. For this purpose the ensuing Clyster, wont to be prescribed by us in this case, is most fit, in regard it contracts the intestinal fibres together, and draws the Serum imbibed by the blood, or contained formerly therein, towards the Reins.

Take a pint of Ʋrine of a sound man that drinks Wine,* 1.502 Venice Turpentine dissolved with the Yolk of an Egge, an ounce and a half, Sal Prunella one dram and a half, make a Clyster, which repeat daily. Sometimes Plaisters yield help in an Ascites, yet let them be such, as by a certain restringent and comfortable virtue strengthen the bowels and bind together the moughs of the Vessels, lest they too much spue out their serosi∣ties: for this purpose, I use to apply the Plaister Diasaponis with successe. Or,

Take of the Plaister of Minium, Paracelsus Plaister, of each what suffices, make a Plaister to be applyed to the Abdomen. If this disease is accompanyed with a Tympanie, Epi∣themes of another manner are fit, as we shall hereafter declare.

The great and most present remedy of an Ascites, is, that the waters may be drawn out by a Paracentesis being made; which administration however doth not oftner cure the disease, than kill the Patient; wherefore there is need of exact caution

to whom, and at what time of the disease it ought to be administred: to persons of an ill habit, who have been long ill, in whom the conformation and temper of the bowels is wholly depraved, it will be in vain to have the Lympha drawn out by the Paunch being pierced; for thereupon immediately the Spirits faint and the strength is dissoved, and after a while a new illuvies of the morbific humour succeeds.* 1.503 But those who being formerly of sound bowels, and healthful enough, as to other parts, when they fell into an Ascites from some great and evident cause, as we are not at first presently to make a Paracentesis, so neither if it be needfull ought we to deferre it too long: for an incorrigible depravity of the Bowels is contracted by a longer delay, while they remain a long while drowned, and as it were boyled in water.

It is beside our purpose to describe here the administration of a Paracentesis, whe∣ther it be done after the ordinary manner, or by a hollow Needle according to Sylvius; this part of Chirurgery, as dangerous, when Physitians seldom prescribe, yet Quacks and Empiricks rashly and unluckily essay it, Artists not being consulted: we will re∣late here for conclusion the History of a true and huge Ascites, lately cured without and Paracentesis.

A young Woman wise to a Merchant, being slender and proper,* 1.504 while she gave suck to her Child, to encrease her milk day and night did immoderately guzzle one while plain Ale, another while Posset-drink. After having used this kind of dyet for a fortnight, she contracted a vast Ascites in a short time, the beginning whereof she was not in the least sensible of; for her Abdomen being great with water fluctuating within, did much swell up, and its bulk when she turned from one side to the other, fell without the Ileon and borders of the rest of the body: when in the mean while the flesh of all her Members was very much consumed, that she seemed no less in a consumption than a Dropsie.

The Child being weaned, and a better course of Diet being appointed, she be∣took her self to Medicines, and took in the first place the more mild Hydragogues, as well purgative as diuretical, but without any advantage; also she was worse after every purge; but being committed to our care, and almost desperate, I handled her after the ensuing method.

I prescribed these Medicines, for the most part forbidding Ale, and any potulent liquor (medicined excepted.)

Take of the leaves of Plantane, Brooklime, Clivers, of each 4 handfuls bruised, and pour upon them of water of Earth-worms and Rhadish compound of each three ounces, press them, take it twice a day, viz. at Eight in the Morning, and at Five in the After∣noon. She continued long in the use of this Medicine, but did sometimes vary the Compo∣sition, sometimes changing the herbs, sometimes the Liquor poured on them.

Take of the reddest Tincture of Salt of Tartar an ounce and a half, she took 20 drops at night, and early in the morning, in two spoonfuls of the following Julep, drinking seven spoonfuls after it.

Take water of Elder-flowers, Saxifrage, of each six ounces, water of Snails, Earth∣worms, and Rhadish-compound, of each two ounces.

She wore a Plaister of Minium and Oxycroceum upon her Belly.

The following Clyster was given first daily, afterwards every two or three days.

Take Ʋrine of a healthy man one pound, Turpentine dissolved with the Yolk of an Egg an ounce and a half, Sugar an ounce, Sal Prunella one dram, make a Clyster.

By the constant use of these things her Belly asswaged within a fortnight, but her flesh daily wasting, a Consumption was threatned. Wherefore, going into the Coun∣trey to avoid this, she drank Asses milk; by the benefit of which Nutriment and of purer Air, continually taking the above-mentioned Medicines, she recovered her en∣tire health within three or four weeks, and lives yet in health.

SECT. II. CHAP. IV. Of a Tympanie.

ATypany vulgarly,* 1.505 although not properly, is esteemed a kind of Dropsie, from which rank, Prosper Martianus alleading the testimony of Hippocra∣tes, rejects as well this Disease, as an Anasarca. But the former infessting the region of the Abdomen, and raising it up into a bulk, now comes under conside∣ration next after an Ascites, (to which it is something a-kin): where first of all it is obvious, that this Disease as it is most difficult to cure, so also to be known; for although its outward form, viz. a somewhat hard swelling of the belly, very stiffe and yielding a sound like a Drum, upon touching it, is evidently perceived by many senses together; notwithstanding what may be the morbifick matter inducing that Tumour, or after what manner it is generated in the belly, or from what place it comes thither, is altogether unknown: therefore those who have a Tympanie, as though they were big with winde, are ignorant both of the manner and time of its conception.* 1.506 Truly I therefore judge the nature and causes of this disease to lye concealed, because whereas its first beginnings are not observed, it suddenly aug∣ments prodigiously; so that they who are affected, do scarce sooner perceive them∣selves to be sick, than that they are become almost incurable. Moreover, a Tympa∣nie, its station being accomplished, degenerating into an Ascites, or rather procuring it to its self, seems to lose its own nature; and truly after death Anatomical inspecti∣on scarce discovers any thing more in bodies dying with a Tympany, than with an Ascites.* 1.507 But that many Physical Authors do readily declare this Distemper to be raised by wind enclosed within the cavity of the abdomen, doth not at all satisfie a mind desirous of the truth; because it seems altogether improbable that winds should be produced so suddenly, and in so great plenty in that place; or admit they were, that so hard, unmovable and constant a tumour should be raised.

Moreover they do not easily agree concerning the seat of the disease,* 1.508 where the wind is supposed to be included; for some affirm that this place is determinate in the concave of the Peritonaeum, and by the convex superficies of the Intestines, and other bowels of the lower part of the belly; but affer what manner such a heap of winds can be therein collected, in my opinion it cannot be manifested by any reason, exam∣ple, or parallel instance. Besides, if the case were such, it might be more easily cured by pricking, than an Ascites by a Paracentesis; which yet I never heard accomplisni∣ed. Helmont reports a stinking wind was vented by a Paracentesis,* 1.509 in one esteemed Hydropick; that suddenly his abdomen sunk, and the man dyed immediately. But Platerius and Smetius, no less worthy of credit, do affirm, They discovered in some who wore thought to have the Tympaine, and dissected after death, that no wind broke forth out of the hollow of the belly, neither that it fell, but that especially the smaller guts being distended, and strutting with winde, burst out so, that they could not be put up again into the same belly.

But truly neither is this observation an argument to me,* 1.510 that the cause of the disease (of which we treat) remains within the Cavities of the guts, and that the winds ac∣cumulated in that place, do often or most of all raise a Tympanitick swelling of the belly. For besides that, a disease taking rese from such an occasion, would not be of im∣movable, and frequently incurable; moreover, I am induced to think, that the In∣testines are not so greatly dilated by winds shut up in them, but that they often of their own accord swelling out, give occasion to those winds consequently and secon∣darily to be produced, by which the spaces enlarged might be filled, as we shall by and by more clearly demonstrate.

But what is asserted by others,* 1.511 that the windes which are the cause of a Tympany, are engendered among the Coats of the Mesentery, and Guts, seems yet much more improbable; because when there is no cavity in that place preexistent, after what manner can the winds so tear those parts and separate them froom one and another so that from such formed Denns, the whole region of the Belly should grow into so vast a bulk by accumulated windes there laid up? Certainly so many and so great divulsions could not be made without continual torment and most sharp pains.

Wherefore, omitting these opinions already spoken of about a Tympanie,* 1.512 let us proceed another way to the more assured searching out its Pathologie; viz. by tho∣rowly weighing by what means, and by what evident causes, the Abdomen is wont to swell up. Wherefore, we advertise there are four kinds of things contained, from which proceeds a tumour in the nether Belly of the living, (why the Abdomen swells in dead personns, the reasons follow hereaster) which kinds are, solid, humid, wind and Spirits.

First, It is obvious enough, that the inward tumours of the bowels,* 1.513 viz. scirrhous, strumous, cancrous and glandulous, and some perhaps of another kinds, when they rise to any notable bulk, do swell the whole belly; yet in the mean time as long as they are simple, and new, they may be perceived and circumscribed by the touch; yet afterwards growing inveterate, they cause other evils to the neighbouring parts, yea over the whole Region of the Abdomen. Truly these as they are sometimes the procuring cause of an Ascites, so of a Tympany from the beginning, to which after∣wards for a complement of either disease, another conjunct cause gains access, viz. an illuvies of waters, or an irregularity of the Spirits.

Secondly, a watery humour gathered within the Cavity of the abdomen,* 1.514 or being impacted in the membranous or glandulous parts thereof, frequently produces an Asci∣tes, the reasons whereof, and the manner of its coming to pass, are at large set domn before.

Thirdly, Winds within the bowels of Concoction being reised from crudities,* 1.515 ill concoction, or fermentation of heter ogeneous humours, do frequently puff up the Cavity of the guts, and for the most part produce a short and transitory tumour of the belly. For the fermentation of the Juices ceasing, and eruption of wind being pro∣cured, immediately succeeds an asswaging of the Belly. To this cause, both the Colick and Tympanie, not only by the vulgar but by Physicians of great note are imputed; but in our judement, when it is solitary it produces neither of these distempers.

Fourthly, There yet remains another sudden, and vast swelling of the belly,* 1.516 which the animal Spirits, (not for nothing styl'd by Hippocrates violent) seem to procure. For when these in heaps, and inordinately, rush into the nervous fibres belonging to the bowels of the lower belly, presently the parts that these weave together are caused to be puffed up, and extended every where round about. For truly, from this cause (as we have often shewed in another place) a swelling, and as it were a tympanitical puffing up of the whole abdomen, as well in the Colick as in Hysterical fits vulgarly so called, doth often happen. And truly these distempers are so allyed to a Tympany, that they sre∣quently end in it; for I have oft observed, that those who have been obnoxious to the Colick and hysterical passion long and grievously, unless they receive cure, do become Tympanitical. And then the greatest of the difference will be, that the swelling of the belly, which before was a wandring Symptom, and soon passing over, at length grows to be a fixt and permanent disease.

Wherefore, it seems material in this Case, to accommodate th Aetiologie of those passions delivered by us in another place, to unfold the Nature and Causes of this present maladie.

Which truly will not be of any great business or difficulty.* 1.517 For supposing (what we have in another place more largely set down) the extensions and inflations of the membranes and hollow bowels, take their origine from the impetuous invasions of the Spirits into the nervous fibres (of which they are interwoven) it will be obvious enough to conceive cven a Tympaine to be produeed from such a cause, but being more sixt, and longer, or uncessantly in the act; into the reason of which difference, we will by and by inquire.

In the mean time I am induced to believe a Tympanie not the be stirred up from winds shut up within, or without the Cavity of the guts,* 1.518 (for such an accumulation of winds in those places, is an effect, but not a cause of this disease) but that it does arise, inasmuch as the animal Spirits, in the bottom of the belly, belonging to the membranous bowels, being forced into disorder by something incongruous, do tu∣multuously rush every where into the nervous fibres, and puffe them up, neither do they immediately recede back from them: from hence the Peritonaeum swells, and the guts being blown up and enlarged, they are as it were inflated, the Mesentery, and other membranous bowels, being turgid with an impetuous Spirit, are as it were raised up into a bulk; moreover, while these come thus to pass, that the va∣cuities caused from the swelling of hollow bowels might be filled, a portion presently

of every humour within contained, being rarified into vapours, forthwith turns into wind, wandring about those empty spaces.

Truly,* 1.519 we have clearly enough shewn, by reasons and instances in our Pathologie of Convulsions, that the animal spirits puff up the membranous parts by their irre∣gularity, and so produce as it were this windie Distemper. Moreover the fame is demonstrated by Anatomical observation made in dissecting a living Creature; viz. inasmuch as the Trunk of the eighth pair of Nerves, descending on each side by the Neck, if it be taken out and bound with a thred, forthwith all the stomach swells up, as if it were puffed with winde;* 1.520 which certainly can proceed from no other cause than that the animal Spirits of the fibres of that bowel, and others flowing through the nervous passages, (inasmuch as they being cut off from their origine, are driven into confusion) do tumultuously enter those part, and puss them up. Besides these, for the further illustrating of this Hypothesis, I will relate a History cited by the most re∣nowned Smetius, of an universal Tympany (as he calls it) in a certain young man of Liege: Who when he had received, in a conflict, under his right arm-pit, a wound, made by a prick, penetrating into the Cavity of his breast, next day and night being past, he ap∣peared in the morning after swell'd throughout his whole body, not only in his breast, but also in his back, belly, loins, and in the cods, besides both in his arms, shoulders, neck and face, that he could not open his eye-lids, also on the crown of his head, the skin being every where swolne and tumefied, the tumour was every where extended with great pain. The Author calls this wonderful affection, an Universal Tympanie. The most renowned Sennertus relates a Case like this from his own knowledge: Moreover, I remember I have heard or read of the like from a wound of the breast being reveived near the arm-pit.

Notwithstanding,* 1.521 the reason of this Symptom, deliver'd by Smetius, and approved by Sennertus, doth not at all please me: for they ascribe the cause of the general Tympanie to the puffing up of the breast, by the axillary wound, made all that night under the skin, as we see a new and moist bladder to be blown up by boyes with a quill: which truly doth not only seem improbable, but also we think scarce possible, that the wind to be blown out of a wound of the Thorax, by reason of the hole one might stopt, can enter the skin, and from thence passing through the whole body, should make it become every where Tympanitical: For besides that the wind cannot so suddenly pass from thence into all parts, although it should be blown with a quill from the mouth, under the skin; besides, while the orifice of the wound is stopt, no wind can altogether be blown out from the Cavith of the breast, because none in the mean time enters. But assuredly the cause of that wonderful affection is this; (whence also the formal reason of a Tympanie is illustrated) In the Breast near the Arm-pits,* 1.522 are many and eminent fold∣ing of Nerves, (as we have described in our Treatise of Nerves,) by which the nerves of the whole body communicate among themselves: viz. the Trunk of the eighth pair unites with the intercostal Nerve, and both with the nerves of the Spina Dorsi, by branches and sprigs sent here and there. Wherefore, this nervous, folding, perchance being pierced by the point of the Sword, first of all the spirits resi∣ding in that place being provok'd, run into disorders, afterwards a consent being im∣mediately made thorow so many notable Nerves, and transmitted to and fro every where, other Spirits, and then again others, are sensible of the like irregularities, and puffing up the membranous and nervous Fibres (which every where they en∣ter tumultuously) they induce as it were a tympanitical affection throug the whole body. By reason of the like fury or virulent madness imposed upon the Spirits, in any place, and from thence immediately diffused far and wide, certain Poysons be∣ing fdrunk, the strokes of weapons, or of wild Beasts, or a venemous bite, do fre∣quently induce a swelling together of many parts, or of the whole body; which swelling distemper of the Spirits, is styl'd by Helmont to be Indignatio Archaas. There are many other Cases and Instances, by which it is most clearly evinced, that the Animal Spirits being provok'd, and driven into angry inclinations, inasmuch as they do more impetuously enter into the nervous Fibres, are wont first to swell the membranous parts, and to excite many passions out of those, which are vulgarly but falsely ascribed to windes: so that in truth no other cause of a Tympanie can be assigned more like truth.

If it objected,* 1.523 that the Paunches of the defunct after some time are raised by winde into a bulk, and swell like as in a Tympany: I pronounce this to proceed from the putrefaction of humours, and the extream dissolution of the mixture, wherein

all the active particles depart, being freed one from the other, and flying about seek vent in every place, and distend greatly all obstacles, and chiefly the sides of the Ca∣vities, (which doth not at all happen in living bodies;) wherefore, as all Carkases do not putrifie alike, so their bellies swell sooner or later, more or less: But while life endures, no rottenness or dissolution of particles is made in an animated body, that can bring about a splanchnick fermentation or swelling. In the mean while we deny not, that winds are generated within the offices of concoction, fanguification, and separation, yea within all the particular cells and recesses of our whole body; notwithstanding from them all, unto the winds wheresoever engendred (whilest the Spirits have their due influence, and actuate the nervous as well as moving fibres, that the sides of the howels be not kept distended and rigid) and easie vent does every where lye open. And the truth is, in a Tympany, we allow the wind to fill up the empty spaces, but the spirits, inasmuch as they extend the bowels by their irregu∣larity, do first cause those vacuities, (wherein the winds secondarily and consequently are engendreed) and they (inasmuch as the same bowels are still kept strutted and di∣stended) do hinder those winds from being removed.

And now I judge it is plain enough by what we have said,* 1.524 that the animal spirits ra∣ther than the wind do raise swellings of the belly in that fort; at least such short and transitory ones, as happen in Hysterical and Colick fits. Notwithstanding there yet remains a great difficulty, after what manner the Tympanitical swelling of the Abdo∣men, which is fixt and permanent, yea for the most part immpovable, can proceed from any such cause; especially, because the Animal Spirits being of their own nature active and very apt to motion, do for the most part so affect removal, that unless they be wearyed or become defunct, they scarce ever lie still.

That I may loosen this knot by reasoning, it becomes us to consider the Nervous Juice together with the substance of the Animal Spirits, which is every where a vehicle to them, and also a bridle: for the Spirits enjoying the most subtile stream thereof, do freely expatiate, and lest being dissipated from one another, they might fly away, they are contained in and entire series. When therefore theat Juice is faulty as to its temper or motion, immediately the animal spirits become diversly delinquent, or are perverted in the exercises of their functions, as we have at large expounded in our Treatise of Paslions. And lest by repeating them now I should make long Preambles, I will contract into a few words what belongs to the present pur∣pose.

Wherefore in the first place, it is to be observed,* 1.525 that the contents of the nether belly (excepting only the Liver, Spleen, and Kidneys) are furnished with many mem∣branous bowels, (which the nervous fibres for the most part weave together) whence it follows that the nervous Juice (whose journey is longer, and the passages straiter in these parts) doth find here many remora's which also may be proved from the effect, forasmuch as the convulsive invasions, every where stirr'd up in the Hypochondriack, Colick, Nephritical and Hysterical Passions, do so grievously infest the Abdomen. When therefore that Juice watering the nervous fibres of these parts, shall be either viscid or tenacious of it self, or fill them with very many feculencies, for that cause it will come to pass, that all the animal spirits will not easily return from thence as oft as they are hurl'd into these fibres, in some part obstructed: and when in this manner there is a full incursion, and a small return of them, at length it will happen that great abundance of the spirits remain in these fibres every day more and more impacted, and hold them always distended and very much pufft up; and at length by reason of the ways of their ingress and regress in those fibres being obstructed, they become immovable in that place, and keep the affected parts always extended and stiffe: in the mean time because these Spirits there impacted within the nervous passages,* 1.526 and cramm'd thick, have commerce whit others that flow to them in their dens, therefore the affected part although it be stiffe and almost immovable, yet how∣ever enjoys sense. This Pathologie although it may seem to some a Paradox, and un∣couth, I doubt not but it will deserve assent from many, if it be throughly weighed, that those who have been a long time obnoxious to Hypochondriack, Colick, and other convulsive distempers of the nether Belly, do at length become sick of a Tym∣pany.

The formal reason and conjunct cause of a Tympanie being delineated after this manner, before we proceed to trace out diligently the more remote causes thereof, it may be lawfull for us from what we have said to deliver a definition, of at least a

certain description of this disease, viz. That it is a fixt and constant Tumour of the Ab∣domen, equal,* 1.527 hard, stiff, and yielding a noise upon striking, taking its origine from a con∣vulsive inflation of the parts and membranous bowels, by reason of the Animal Spirits be∣ing driven into those fibres in too great abundance, and through the fault of the nervous juice obstructing, being hindred from their return back; to which disease consequently an ac∣cumulation of winds in the empty places, accrues as a complement.

As to what appertains to the procuring and evident causes of this disease, it very seldom happeneth that they are altogether observed,* 1.528 but that insinuating it self by silent beginnings, it frequently is finished, or becomes deplorable before it is per∣ceived; insomuch that against this disease scarce any antidote can be appointed; for while the ordinary functions are not much prejudiced, the swelling of the belly is presumed only to have its origine from winde, and while it is expected to vanish spontaneously, it often grows into a Tympanie. Wherefore that we may have time∣ly notice of its beginning, we may take notice, that some previous affects dispose to it;* 1.529 of this sort is first an Hypochondriack, Colical and Hysterical disposition, yea and sometimes an Asthmatical; whose fits when they are used to be frequently raised, if at length a tumour of the Abdomen follow it, though it be small in the beginning, a Tympany forthwith may be feared. Of the former of these affects cases every where are to be met with, and stand fair to common observation: of the later Scheri∣chius reports,* 1.530 That a man of Sixty years of age was infested with this symptome some months before his Belly was swell'd into any manifest tumour, that as often as he sate at meat, beginning to eat, also when composing himself for sleep, he began to sleep soundly, he was surprized with such a difficulty of breathing, that the frequency of it threatned the dan∣ger of choaking; at which time also he perceived a certain palpitation about the Hypochon∣dria, as if some living Animal were underneath the midriff; this distemper afterwards ended in a Tumour of the Abdomen, by which he dyed. In this and other cases now cited the same reason holds, viz. that the animal spirits being used to make irregular ex∣cursions into the nervous Fibres of the lower belly, at length do not only more often and abundantly enter into them, but being impacted and hindered they abide in them, and so at length induce tympanitic inflations of the bowels. Truly this mor∣bific beginning happens sooner of later,* 1.531 if thereupon do come the evident causes, which disturb the Spirits in the bottom of the belly, and compel them to frequent disorders, and also do either stop the motion or pervert the temperature of the ner∣vous Juice flowing within those Fibres; in which rank are accounted irregularities in the six Non-naturals, immoderate Passions, and chiefly of grief, and usual evacuations suppress'd, drinking of cold water after some great heat, or any sudden cold induced on the belly, either from air or water.

As to the Prognosticks,* 1.532 this disease is always accounted of so bad an omen that commonly the name is abhorr'd, insomuch that frequently when there is no suspi∣cion of ill from the tumour of the belly, if perhaps that swelling be call'd by the Physitian, a Tympanie, forthwith it is concluded desperate. Notwithstanding this Disease rarely kills of it self, but being protracted a long space of time, that it may at length more certainly kill, it gains to it self an Ascites, as a Harbinger of Death. That we may search into the reason thereof, it will be obvious enough to conceive, while all the bowels are distended in the lower belly, and are held as it were stiffe, the passages of the blood, and nervous and lymphatic humours, being too much ex∣tended, or compressed are much straitened, and for that cause cannot freely and readily transmit its Juice; from whence it follows that every humour being strait∣ned in the passage, that at length it may pass by some means, it shakes off a certain serosity from its masse wherever way is given; and those droppings of the humours falling into the hollow of the Abdomen, excite an Ascitick Dropsie.

What relates to the Curatory part of this Disease,* 1.533 the whole scope of healing is com∣monly bent against wind, viz. Indications inculcated by practical Authors suggest the matter to be evacuated, from whence the winds are raised, and to remove the cause that lifts them up, and the winds to be discuss'd and dissipated, which do already distend the belly.

For these ends Purgers appointed against the humour chiefly suspected are wont to be prescribed with great confidence, although with small or ill success; that is to say, Phlegmagogues so called, another while those that purge Melancholy, another while those that purge Choler, whereto also are joyn'd purgers of water (as weapons intended against every enemy.) For this disease (as is manifest by our observation) is

wont for the most part to be exasperated with strong Purgers, and seldom alleviated; the reason whereof is evident enough, because the nervous fibres being provok't by a sharp Medicine, the animal Spirits renew their irregular excursions,* 1.534 and do every where more and more stretch them out, rather than give any remission to them; where∣fore, although frequent and abundant watery and flatulent stools are procured, not∣withstanding the Belly swells the more. Moreover, to dispell, discusse, and bridle the winde, there is a more than Aeolian power prescribed; Medicines commonly call'd Carminatives, almost of every kind or form are sedulously administred, within and without, above and beneath, and upon the part affected; notwithstanding this dis∣ease for the most part is untamed by all these; whence we may suspect, that the true cause of the disease lyes as yet conceal'd, because Medicines profit not that are administred, indicated or suggested according to the ordinary Aetiologie or reason of it.

Although I cannot challenge a better successe in curing this disease, or a more cer∣tain method of healing, attested from experience, notwithstanding in the mean while we will here proffer another way of curing, accommodated to our Hypothesis, and established by reasons strong enough.

Wherefore in a Tympany, as in most other affections,* 1.535 there will be three chief indications: Whereof the first, and chiefly insisted on, is the Curatory, that by recall∣ing the animal Spirits from their convulsive affection, and reducing them into order, endeavours the removal of the swelling of the Belly. The second Preservatory, which restrains those or other Spirits from their irregular excursions into the lower Belly, and together corrects the faults of the nervous liquor, watering it, both as to its tem∣per, or motion. The third Vital, by removing the Symptoms urging, doth succour and sustain all the functions oppressed or weakened, as much as possible may be.

I. The first Indication is of greatest moment,* 1.536 on which the hinge of the whole Cure turns, but it is most difficultly performed, for it doth not easily appear by what re∣medies or wayes of administration it ought to be attempted, when most weapons or medicines do little or nothing prevail against this inviolable enemy.* 1.537 Phlebotomie assumes no place here, but is declined for the most part as prejudicial; also Cathar∣ticks, insomuch as they provoke the affected fibres, and disturb the Spirits, and hurry them more impetuously, do increase rather than diminish or cure the Tumour of the Belly; in like manner Diaphoreticks impell the Spirits and the morbific particles deeper into them, whereas they ought to be allured, and call'd out of the Fibres. The chief order of healing seems to be placed in Diureticks and the use of Clysters; and also great things are expected from topical Applications, because they are more immediately exhibited to the disease, and as it were by contact, and because they do best discusse Tumours in other places. Yet not all Dissolvents are here fitting, nor those which profit most in other Tumours; for the more hot being given for discus∣sing, whether they are applyed by fomentation, Liniments, or in the form of a Ca∣taplasm or Plaister, oftner afford hurt than succour in a Tympanie; for the both open and dilate the passages of the fibres, that from thence they may lye more open to the incursion of the Spirits; and also rarifie the particles impacted, so that while they occupy a larger space, an inflation and intumescency of the Belly is augmented. Lastly, what appertains to Alteratives which succour against other affections of the nervous kinde, only a certain few are fit in a Tympanie; for where the morbific matter sticking within the straiter passages cannot be impell'd straight, or throughly, Elastick medicines render the stoppage greater and more fixt, by enfixing the matter deeper; wherefore Spirit of Harts horn, of Soot, of Sal Armoniack, yea also Tinctures, Elixirs, and other Medicines endowed with a volatile Salt, or active particles of another kind, do not only acquire heat, and a troublesome thirst in the sick person troubled with a Tympanie, but also cause the Abdomen to swell the more, inasmuch as they melt the blood and nervous Juice, and stirre the Spirits, insomuch that the particles de∣posited by each of these, are compell'd into the parts affected.

But truly although Medicine doth so little avail against this disease,* 1.538 it is not alto∣gether to be neglected, (as if either it effected nothing, or what is ill,) but it behooves us to turn every stone, that by some means we may succour the Patient, and at length may obtain a cure for him, or at least an alleviation. Wherefore in the first place (because it is the custom to begin with Purgatives) although the stronger do ever hurt, and the gentler scarce ever prevail to discharge the conjunct cause, notwithstanding these latter, inasmuch as they do something substract the nourishment of the disease,

also make a way by which other Medicines do exert their powers, they ought to have their turns in physical practice once in six or seven dayes; and at other times let Clysters (whose use is much better) be frequently administred. Hydroticks being prohibited, we must rest upon moderate Diureticks, whereto are adjoyned things respecting the alteration and reduction of the Spirits and Humours, which truly make up the Tympanitical pharmacy. Moreover in the mean time the use of Topicks is not to be neglected. We will annex certain select forms of Medicines appropriated for every of these purposes. For a Medicine mildly solutive, let the laxative Wine be used, prescribed by the renowned Greg. Horstius for a Tympanie, in his book of Observations, lib. iiij. Chap. xxx. or in its place let the following be pre∣scribed with greater ease.

Take the leaves of Peach-flowers,* 1.539 of Damask-roses, of each two Pugils, Broom, Elder, Centaury the lesser, of each Pugil 1. the leaves of Agrimony, Roman Wormwood, of each one handful, Senna one ounce, Rhubarb six drams, Carthamus-seeds half an ounce, Dwarf-Elder two drams,* 1.540 yellow Sanders three drams, Galangal two drams, slice them and bruise them, put them into a silk Bag in a Glass, with 2 pound of White-wine, Saxifrage-water one pound, Salt of Tartar one dram and a half, let them stand 48 hours, let the patient drink from four ounces to six, every third or fourth day.

In a hotter Constitution let the following form be taken, which I have proved with success in this disease.

Take of purging Mineral-waters eight pound, Salt of Wormwood two drams, let it eva∣porate in a gentle Bath to two pound. To this I use to adde four ounces of water distill'd from Purgers with Wine; the dose from four ounces to six.

Or to the two pound of evaporated water adde of Mechoacan, Turbith, of each half an ounce, Rhubarb six drams, yellow Sanders two drams, Cloves one dram, digest them close and warm for two hours: filtre it through Paper, the dose 3 or 4 ounces.

Clysters are of frequent use in this Disease, inasmuch as they loosen the Belly with∣out any great irritation of the fibres.

Take of the Infusion of Stone-horse dung with Cammomile-flowers a pound,* 1.541 Mellis Mercurialis two ounces. After the same manner Decoctions and Infusions are prepa∣red, with Carminatives, from Dogs-dung.

Take of the Emollient Decoction one pound, Sal Prunella, or Sal Armoniack from one dram to a dram and a half; make a Clyster.

Take of sound Ʋrine one pound, Sal Prunella one dram, Venice Turpentine dissolved with the yolk of an Egge, an ounce and a half: make a Clyster.

2.* 1.542 Diureticks if any other Remedies promise help in this Disease.

Take of Millepedes living and cleansed three ounces, one Nutmeg sliced, bruise them together, and pour upon them one pound of the Diuretick-water prescribed below: Press them strongly, the dose from three ounces to four twice a day.

Take of green Juniper-berries,* 1.543 and Elder-berries, of each six pound, of Firre-tops four pound, green Walnuts two pound, Cortex Winterani four ounces, the outer Rinds of six Oranges and four Limons, Seeds of Ameos, Rockets, Cresses, of each an ounce and half, Dill∣seeds two ounces, slice them and bruise them, and adde of Posset-drink made with White∣wine 8 pound, distill it in common Organs, let the whole liquor be mixed.

Take of Crystal Mineral half an ounce,* 1.544 Volatile Salt of Amber, two drams, the pow∣der of Carrot-seeds one dram, Turpentine of Venice what suffices to make small Pills, the dose Numb. 3. in the evening and morning, drinking after it three ounces of the distilled water.

Take of the sweet Spirit of Salt half an ounce,* 1.545 take six drops to twelve, twice in a day, in a draught of the same water, with a spoonful of Syrup of Violets.

Take of spirit of Salt of Tartar one ounce, take one scruple to half a dram, twice a day, after the same manner; So also spirit of Nitre, and Tincture of Salt of Tartar may be taken.

Take of Plantane,* 1.546 Chervil and Clivers-leaves, of each four handfuls, bruise them, and

pour on them a pint of the former distilled water. Press them strongly, the dose three oun∣ces, twice or thrice in a day with other Medicines.

Take of Grass roots three ounces, of Butchers-broom two ounces,* 1.547 Chervil and Eringo candied, of each one ounce, shavings of Hartshorn, Ivory, of each two drams, of burnt Hartshorn two drams and a half, Burdock Seeds three drams, boyl them in three pound of Spring-water to two pound, in it strained hot, infuse the leaves of Clivers, Water-cresses, bruised, of each one handful, adding of Rhenish wine six ounces, make an infusion close and warm for two hours, after strain it again, and adde of Magistral-water of Earth-worms two ounces, Syrup of the five opening Roots an ounce and a half. Make an Apozeme, the dose four ounces twice a day, with some other medicine.

While these are taken inwardly,* 1.548 also Topicks and outward Applications may be carefully administred; not those which are hot and discussing, but those which are endowed with particles of a volatile Salt, and Nitrous, to wit, those which destroy the Combinations of other Salts, and dissolve the impactions of the Spirits, for which we propound the ensuing things. If Fomentations ought at all to be admitted into use, let them not be applyed too hot, also let them be prepared not of those that are usually call'd Carminative, but chiefly of Salts and Minerals. Cabrotius (cited by Helmont) says, That he cured one of 80 years of age, whose Belly he somented twice a day with a Lye, in which he boyled Salt, Alum and Sulphur, and after applyed Cow-dung for a Cataplasm. I use to prescribe these ensuing.

Take of flowers of Sal Armoniack one ounce, Crystal mineral two ounces,* 1.549 Spirit Wine small and imbued with much Phlegme two pound, mixe and dissolve them in a glass.

Let a woollen Cloth dipt into this warm be applyed upon the whole Abdomen, and then let it be changed, wetting it again; let it be done for the space of half an hour twice a day, afterwards let there be applyed a Cataplasm of Cow-dung, with the powder of Dogs turd, or the following Plaister.

Take Empl. Diasaponis, that is, de Minio, with Venice Soap,* 1.550 let it be spread thin upon limber Leather, and applyed to the whole Belly, to be renewed once in ten or twelve dayes.

II. The second Indication requires mostly alterative Remedies, to wit,* 1.551 those which stop the fermentations of the humours in the bowels of the nether Belly, and the Or∣gasms and irregular excursions of the Spirits, also those which procure equal mixtions and due motions of the Chyle and nervous Juice:* 1.552 for which end Chalybeates are chiefly in use. And truly it is wont not only in this, but in many other splanchnical Diseases, to have resort to the Medicines of Iron, as if from thence to fetch the sharpest weapons; whenas many Empiricks and Quacks, who prescribe these things confidently and dog∣matically, observe not by what way such a Medicine doth operate, or what alterations for the better may be lawfully expected from thence: wherefore, while Iron, changed into Medicine, although the Sword of Goliah, is snatcht and brandisht by a blind man, it is no marvel if it prove in vain, or if in the stead of the disease, which is an Enemy, Nature it self is sometimes hurt; and truly frequently it happens so, when Chalybeats, of which there is great variety, and diversity of operations, are administred without any choice or difference either of the temperament or constitution in the Patient, and respect to the state of the Disease.

Of Medicines prepared of Iron or Steel, and of their vertues and manner of work∣ing,* 1.553 we have in another place treated, and there is no need here to repeat the same things. For this disease, if any of them, not all of them are fit; for those in which the frame of the mixture being opened, the Sulphur remains still, and being loosened predominates over the rest, they are altogether to be excluded from this number; for they do much ferment the Juices of the bowels with their notable fermentation, and do so exagitate the Blood and Spirits, that the whole Region of the nether Belly is lifted up into a greater bulk, as if by a certain Spirit thronging violently into it.

Neither here are they fit, from which the sulphureous particles together with the saline are chased away, as in Crocus Martis prepared by long and strong Calcination. For this Medicine as it is conducing to stop all fluxes, rather fixes any impaction of Humours and Spirits, and renders them more obstinate.

But there remains a Martial Remedy of a middle kind,* 1.554 wherein the Sulphur being wholly or for the most part expell'd, a vitriolic Salt remains and predominates: as indeed it is in the solution of the filings of Iron, or in a simple Infusion, or in Mineral wa∣ter, in the Salt or Vitriol of Mars, in our preparation of Steel, with many others; out of which medicines, being prepared or compounded, we find by often Experience that in some cases, they contribute notable help. For these destroy the exotick ferments of the bowels, and restore the native ferments; they open their obstructions, they fix the blood, and restrain its consistence from too much dissolution; wherefore Cha∣lybeate remedies, after the same manner as certain other alteratives, do perhaps some∣thing profit against the procatarctick, and more remote causes of a Tympany; but as to the conjunct cause, they contribute little or no succour.

Take of our Steel finely prepared two drams,* 1.555 the distilled water above prescribed two pound, Syrup of the five Roots two ounces, mix it in a glass, let it clarifie by settling, the dose three or four ounces, in the morning, and at five afternoon.

Take of the Powder of Aron-roots, Crabs-eyes, of each three drams, Crystal Mineral two drams, Vitriol of Mars a dram and a half, Sugar of Rosemary-flowers two drams, mix them, the dose half a dram twice in a day with a convenient vehicle.

Hartman doth wonderfully magnifie the liquor of the flowers of Tapsus Barbatus or Mullein,* 1.556 as a specifick remedy in this disease, by putting the fresh flowers into a Vessel, being strongly press'd, and put into an Oven with bread being close stopt, after∣wards the Liquor being strained, let it be distill'd in Balneo, the dose one Scruple in the Decoction of Fennel-seeds and Roots. Surely this Medicine, if it doth effect any thing, ought to be given in a larger dose.

Johannes Anglus commends an Electuary of Rosata Novella with Diatrion Santalon, and Egges of Ants, which remedy seems to promise something probable enough. In imitation of this I here propound this ensuing.

Take Conserve of Chichory flowers,* 1.557 of Indian Cresses, of each three drams, powder of Aron-roots, Lignum Aloes, yellow Sanders, of each one dram, Crabs-eyes one dram and a half, Salt of Wormwood one ounce, Ants Egges one ounce, the liquor of Tapsus Barba∣tus half a dram, with a sufficient quantity of Syrup of Citron-rinds make an Electuary, the dose two drams twice in a day, drinking after it of the former distilled water, or of the following Julep three ounces.

Take the water of the leaves of Aron,* 1.558 of the Juice of Elder-berries, of the water of Juniper and Elder-flowers, of each six ounces, the magistral water of Snails, and of Earth worms, of each two ounces, Syrup of the Juice of Elder-berries two ounces, mix and make a Julep.

III.* 1.559 The third Indication Vital prescribes Remedies against fainting of Spirits, and difficult breathing, and against Watching and Thirst. We will briefly annex certain forms of either kind.

1. Cardiacks.

Take of the water of Napha,* 1.560 Marygolds, Camomile, of each three ounces, of Dr. Stephan's water two ounces, Tincture of Saffron two drams, Sugar one ounce, Pearls one dram, make a Julep, the dose four or five spoonfuls three times a day or oftner in faintings.

Take Conserve of Marygolds two ounces, Confection of Alchermes, and de Hyacin∣tho, of each two drams, prepared Pearl one ounce, Syrup of the juice of Citrons, enough to make a Confection, take the quantity of a Nutmeg evening and morning, drinking after it a draught of the Julep.

2. Hypnoticks.

Take of Aqua Hysterica six drams,* 1.561 Syrup de Meconio half an ounce, mix them, and take late at night. Or,

Take of small Cinnamon-water one ounce, Diacodium three ounces, Tincture of Saf∣fron two drams. Mix them, and take one spoonfull at night, if sleep be wanting. Or,

Take Syrup of Cowslip-flowers three spoonfuls, compound Poeony-water one spoonful, Lauda∣num tartarized one dram, take one spoonful, if Watchings require it.

3. Extinguishers of Thirst, in this Disease being very thirsty,* 1.562 ought frequently and in small quantities to be administred, that that troublesom symptom may be restrained without much drink, which is perpetually pernicious. For which pur∣pose,

Take of Conserve of Wood-sorrel passed through a Sieve three ounces, Pulp of Tamarinds two ounces, Sal Prunella one dram, with a sufficient quantity of Syrup of the juice of Wood sorrel, make a Lohoch, of which let him lick often.

SECT. II. CHAP. V. Of an Anasarca.

NOw two kinds of Dropsies, viz. Ascites and Tympanie (according to common reckoning) being finisht, although the third, to wit an Anasarca (for that it is an affection rather of the whole body, than of the nether Belly) ap∣pertains not properly to this place, notwithstanding the Pathologie thereof having some affiance with the former, we think sit to deliver here also its Cure in short.* 1.563 An Anasarca is described after this manner, That it is a white soft Tumour of the whole out∣ward Body, or of some of its parts, yielding to the touch, and leaving a dent upon compression, proceeding from a watery humour extravasated, and accumulated as well within the interspaces of the Muscles, as within the pores of the flesh and skin, yea of the Glan∣dules and Membranes.

It differs from an Ascites as to its outward form and appearance,* 1.564 yet not as to its morbific matter, which being the same in both distempers, as it is heaped within the greater or lesser hollownesses, it gains divers Appellations of the Dis∣ease.

The watery humour procuring an Anasarca,* 1.565 doth proceed altogether or for the most part from the blood; for it being continually produced within the mass of blood by the fault and defect of sanguification, it is poured out in greater abundance from the extremities of the Arteries, than can be received, or brought back by the Veins, or the Lymphaducts, or can be discharged by the Reins or pores of the skin, and other vents of the serous Juice.

From these it follows, that the material cause of this Disease is a watery humour,* 1.566 and the efficient is blood, which engenders waters and deposits them in the places affected. We will exactly weigh the reasons of either of them, and the manner of becoming and effecting it, and first we will treat of the efficient Cause of an Ana∣sarca.

1. The affection of the Blood, or rather the Hydropical brood,* 1.567 consists in these two things, to wit, First by reason of a failure or fault of sanguification, it doth not rightly assimilate the nutritious Juice perpetually infused into its mass, but suffers it to degenerate into a watery humour: Then secondly by reason of the too loose mix∣ture thereof, it doth not retain that humour, so degenerated, so long within its consistence, untill it might be discharg'd through fit Emunctories or Emissaries, but lets it out every where near to the ends of the Arteries, into the inter-spaces of the Vessels, and there leaves it. Either of these vices of the Blood we will consider a little more.

In the first place as to the former, for the most part it is confessed by all,* 1.568 that the Blood it self and not the Heart or Liver sanguifies, by what of late is plainly understood concerning the functions of these parts; yet by what means the Blood assimilates Chyle infused to it self, and converts it into fresh blood, to be bestowed to so many and diverse sorts of uses, doth not easily lie manifest to us. But what some affirm, that it is made only by the exact comminution and commixtion of particles, and for that cause the particles of either kinde being confused together, they think, that within the

straiter passages of the Liver and Lungs they are kneaded and wrought together as it were with little pestils, seems little probable to me; but on the contrary, I think these bowels (as I have shewed already) are constituted the Organs rather of separation than of mixture;* 1.569 but the reason of sanguification altogether consists in this, that the active particles of the old blood, to wit, the saline and sulphureous, being placed in vigour with the spirituous, immediately act upon the like particles of the infused Chyle as yet existing in an inferiour state, and do so stir them up and ferment them, that thereupon being extricated from the coverings of the thicker parts, they are carryed into a like degree of exaltation or perfection with the former, and being at length associated with them, and made also homogeneous, they put on the same nature of Blood; the more thick and heterogeneous particles being removed thence to another place, from those which they had deserted and gone away from. For tru∣ly Sanguification is altogether finisht by Fermentation, even as the maturation of the Must into Wine or Ale; but the reason of the difference is, that Wine being shut up in the Tub, still remaining entirely in the same Mass, is flowly fermented, as to its whole consistence, and is not accomplished but in a long space of time; but the Blood constituted in a perpetual flux by the loss of some parts and the reparation of others, is fermented by the parts still received fresh, and is generated anew.

The old Blood for the most part affords the same thing towards the fresh Chyle,* 1.570 as Ferment from the flower or faeces of old Ale, being put into new Ale; notwith∣standing as it were by a contrary manner; because the huge mass of blood being for∣merly fermented, doth suddenly ferment and alter the small portions of the Chyle continually brought in; but the fermenting liquor in Ale in a very little quantity is put to the great mass of the other liquor to be fermented; which it brings not to maturi∣ty under a long space of time. After the rudiments of blood are so cast by fermen∣tation, the conclusion and perfect assimilation into blood, is acquired by accension; (for surely that it is so enkindled (as I think) I have formerly shewed by demonstration, which arguments chiefly taken from its proper passion, although many have cavil'd at, none have been yet able to overthrow.) Wherefore, while the whole mass of blood consists of Blood and Chyle confusedly mixt together, it is fermented while it is circulating; andbeing divided into most minute portions, is spread through the whole Lungs, that it might be kindled successively according to all its parts, by the nitrous air suckt in: for by that means both the vital flame is continued, and all the particles of Blood having as it were passed the fire, become more purified, and more agreeable among themselves; moreover, they are so disposed of whilest they are kindling, that while some go into Nourishment of the Spirits, of the Nervous Juice and the folid parts, and others less useful depart into the ferments or recrements of the bowels; mean while others being more fixt, abide longer in the mass of blood, and sustain its consistence, and by fermenting the Nutritious Juice, still engender new Blood, untill themselves being impoverished, are at length discarded, and give place to others that are fresh and Iustie.

Having shewed after this manner by what course Sanguification ought to be finish∣ed,* 1.571 as well by fermentation as accension of the Blood; it will be easie to conceive wherein the fault confists producing an Hydropick dispdsition: To wit, this usually assumes its rise whensoever either or both those Conditions requisite to Sanguification, ether fail, or are perverted.

First therefore this bappens more frequently and rather,* 1.572 for that the blood being depraved in its temperature, doth not rightly ferment the Nutritious Juice poured into it, that so it might be changed into laudable blood. For when the watery par∣ticles predominate with the earthy in the mass of Blood, the Salt and Sulphur being depressed with the Spirit, as all the functions, both Vital and Animal, from thence languish and waver; so especially Sanguification it self fails and is perver∣ted. For the Juice of the Chyle commixt with the Blood, when it cannot be dissol∣ved and fermented, with the particles thereof, (after the fashion of other liquors, as often as being mixt they want ferment,) it degenerates perhaps into a watery, acid, or ropy, or otherwise faulty humour, which being afterwards daily encreased, and at length rising to its fulness, lyes heavy on the blood, and oft-times almost stifles its heat; from whence there is a necessity that it be forthwith discharged by some means, and wheresoever it can get vent; but afterwards for that the offices of sepa∣ration fail in their sunctions (the stock of the animal Spirits Languishng by reason of the diminished provision from the influxe of Blood,) the abounding Serum is deposited

every where into the pores, and next vacuities whether greater or lesser, out of the little moughts of the Arteries; from whose daily and great encrease, after all the pores are filled, arises that as it were fenny habit call'd Anasarca of the whole body out∣wardly, or of some of its members.

Secondly, not only the defect or fault of Fermentation,* 1.573 but also of the accension of the Blood, induces sometimes an Hydropical disposition on the mass thereof: which is clearly discern'd, inasmuch as some persons inhabiting Maritime or moorish places, fall into the Dropsie without any other cause or occasion, than that they draw a thicker air endowed with heterogeneous vapours, by which the Nitre is either driven away or obscured. Therefore the blood becoming degenerate, and vitiated as to its temperature, because it is not duely kindled, nor perfected by efflagration within the precordia, doth not rightly dissolve and assimilate the Juice of the Chyle, but suffers it to be perverted into a watery liquor. But although in the first place, the blood being depraved for this reason, sometimes loses its fermenting vertue, and there∣fore the rather and more immediately procures a Dropsie; notwithstanding it is ma∣nifest, the first fault thereof assumes its origine from unwholsom air suckt in, and not duely enkindling the Blood; because such Hydropicks removing their resi∣dence into Sunny and Mountainous places, recover their health without any other Medicines.

Hitherto of the nearest Causes of an Anasarca and which are conjoyned to the Dis∣ease it self, which namely are the depravation or defect of the mass of blood, chiefly as to its fermentation, and in some measure as to the enkindling thereof; which latter is scarce wont to be effective but when if follows the former: But what remains as to the more remote and procuring causes of this Disease, to wit, from which the defer∣mentative affection arises (that I may say no more of the defect or depravation of its enkindling;) I say that these appear so diverse and many, that I judge it hardly pos∣sible to recite them all particularly; notwithstanding, very many or at least the chief may be reduced to these three heads: to wit,* 1.574 For that the watery distemperament of the blood doth arise, inasmuch as its active Principles, viz. Spirit, Salt and Sulphur, are not invested with their fermenting and sanguifying force or vertue, I account this to come to pass, either First because those particles are too much wasted by their great expences; or Secondly because they are not repaired by convenient and propor∣tionate Refections; or Thirdly, for that they are overwhelmed or obscured by some other duller or heterogeneous Particles being too much accumulated in the mass of Blood: We will a little weigh the Reasons and ways of each of these their coming to passe.

In the first place, the former of these is evidently discerned in frequent and inor∣dinate Haemorrhages, whereby many men, although strong and formerly healthy,* 1.575 are immediately enclined to a Dropsie, more than from any other accident or occasion; the reason whereof is, that the blood is so impoverished, through its more noble Par∣ticles issuing out in great abundance, that afterwards it can neither duely ferment nor enkindle the Juice of the Chyle brought into it. Moreover, sometimes the same effect fucceeds (although in a more slow degree) from Feavers and other long mala∣dies and languishings; to wit, inasmuch as the blood suffering under a long depressi∣on, is so extenuated and robb'd, that at length it becomes watery and defermenta∣tive.

Secondly, the Blood sometimes deferting its genuine disposition,* 1.576 declines into an Hydropical one, for that the nourishment being more slender than it was wont, or ought to be bestowed upon it, its active and sanguifying Particles are not enough re∣paired within its masse; for so we have observed, that some who have used themselves to Wine and stronger Drink, after they have been reduced to homely Diet, and smal∣ler drink, of water of small beer, suddenly have become Hydropick. It is a com∣mon observation, and frequently true, although of ill omen, that Drunkards, and darly drinkers, if that wild Custom be left, at length becoming sober and abstemious, are much in hazard, lest by reason of the usual fermentation of the blood being denressed, they become obnoxious unto that Disease. I knew a notable Drunkard, who declared that a Priest very learned and Pious was guilty of his death, because he gave him admonition to Temperance, and to leave his Drunkenness,* 1.577 and he complying therewith, incontinently fell into a mortal Dropsie.

But the third cause or occasion disposing to that Disease, the most common and no∣table, consists in this, that the active Particles of the Blood, being involved with

other more dull or heterogeneous ones, or being dissipated from one the other, lose their fermentative power, or cannot enough exercise it. But such an affection of them, as it is wont to be raised from various causes and accidents, so chiefly from these, three,* 1.578 one while solitary, another while united together; to wit, First from the Non-naturals immoderately received: Secondly from the Naturals unduely retain'd; or Thirdly, from the Preternaturals corruptly generated in the body.

The errors of Diet deservedly may be referred to the first rank of these (whereby the stock of that Disease is always most abundant) For it is a common Prognostick and in every bodies mouth,* 1.579 that Gluttons and great Drunkards dye at length of a Dropsie: to which moreover, not only Surfeits and immoderate and daily Tiplings incline, but also frequent and unseasonable Treats; and moreover the continual pour∣ing in of absurd and hard to be digested Nourishment. For from the evil course of Diet of each kind used any while, whenas the Juice of the Chyle, oftentimes crude, in∣congruous, and above measure plentiful, is poured into the masse of blood, it of necessity follows, that it is first burdened, and afterwards its Consistence being loosened, the more noble Particles being forced asunder, it is so involved, or abated by the other heterogeneous ones, that being hindred, it desists from its fermentative or sangui∣sying virtue; insomuch that the bowels being in a short time hurt by its assaults, a Cachexia, and then a Dropsie sollowes, whereof that is alwayes a forerunner.

Secondly,* 1.580 in this place are put all ordinary, accustomed and solemn Evacuations suppressed. It is observable enough, that a Cachexie, and often a Dropsie, doth arise from a menstruous or Hemorrhoidal flux dimmished or stopt, no less than from a too immoderate one, (by reason of the fermentation of blood impeded by the heterogeneity of Particles.) Moreover, the same is often wont to be effected from Issues suddenly stopt, or eruptions of the Skin suddenly repercuss'd. Lastly, suppressi∣on of Urine, and sweating much hindred, do render the blood more watery, by an immediate and necessary affection, and incline to the Dropsie. Also it is an observa∣tion frequent enough fo healthful Persons, who being compelled for some time to ab∣stain from going to Bed, that their feet have swoln.

Thirdly,* 1.581 Preternatural things generated within the Body, but especially Tumours and Humours do hinder the motion of the blood, or pervert its temper, and so in∣duce an Hydropical disposition. Tumours stirred up in some place about the Bowels, inasmuch as they hinder or straiten the circuit of the Blood, do cause its Serum to be there extravasated, and poured out; by the accumulation whereof within some cavi∣ty, in the first place an Ascites (as we have shewn above) and at length an Anasarca a consequent of that doth frequently ensue.* 1.582 Moreover, Humours of divers sorts be∣ing engendred in divers places within, and transferred into the blood, do first pollute the masse thereof, and defile it with heterogeneous Particles, whereby at length it is so depraved in its temperament, that it perverts the Juice of the Chyle brought in (when it cannot further ferment and assimilate it) into an hydropical liquor. For this reason, nothing is more usual than that Consumptive persons, and those that are affected with strumous and cancrous Ulcers, nay of any sort within the Reins, Mesen∣tery, Guts, or other Bowels of the lower Belly, after they have been long consuming, dye at length hydropical.

Hitherto concerning the next efficient cause of this Disease,* 1.583 also of the chief re∣mote ones, as well procuring, as evident. But as to what appertains to the material cause, it is obvious unto the Sense, that it is a meer Lympha accumulated within the pores of the Skin, and of the other outward parts; which being deposited there by the blood (the liquor thereof being partly serous, and partly chylous Juice) but fail∣ing in Sanguification and Nourishment of the body, to which it was destinated, it is cast off like recrements into the vacuous spaces of every vessel. And though the matter of the Dropsie proceed from the Blood and Chyle, yet it is no wonder if it appear nei∣ther like blood, nor milkie, but only limpid; because the Urine even of healthful people, after more plentiful drinking, is rendred crude as well as watery; and there∣fore it is manifest, it is nothing changed by the blood, but leaves in that place, what∣soever of colour or thicker consistence it brings to its masse. And although a reason may be given in either case, that the Urine, inasmuch as it is streined through the Kidneys, and the hydropic matter thorough the pores of the solid parts, even so become limpid and watery; notwithstanding it is evident by observation, that the watery part of the Chyle, even while it is confounded with the blood, is not inti∣mately mixt with it, but being deprived of its colour and consistency, it remains under

the form of Lympha, within the pores of the blood; the sure sign of which is, that the blood taken from any Animal by Phlebotomy, after being cold it is divided into parts,* 1.584 exhibits a watery liquor (which consists of Serum and Nutritious Juice) plainly limpid, and separate from the other blood. It will be from our present purpose to enquire any further into the reasons hereof, and manner of being so, and where∣fore blood, which being poured into water doth presently tinge the same, and bloodies all solid bodies whensoever it is sprinkled thereon, yet dyes the Serum of no colour with which it is intimately confounded and a long time circulated.

From the AEtiologie of this disease now delivered,* 1.585 the differences of it may easily be collected; to wit, first it is either universal, when the whole habit of the body and all the members swell up; or it is particular, wherein for the most part the in∣feriour members only suffer, in the mean time the rest of the body pining away for want of Nourishment, which kind of distemper, and not a Tympanie, Prosper Martianus will have Hippocrates style the dry Dropsie, in which what is reported of the Syren, the dry is joyned to the watery.

Secondly, an Anasarca whether universal or particular,is either simple of con∣plicated with an Ascites; and then either an Anasarca ensnes an Ascites, or this dis∣ease follows that. Moreover an Anasarca may be distinguished many ways in respect as well of the procatarctick as evident causes, as we have before intimated; and such differences thereof are found to be frequently fo great moment about duely institu∣ting the Prognostick and Cure.

Wherefore, what relates to the prognostick part, this disease while it is simple,* 1.586 proves least dangerous among all the kinds of Diopsies; and a particular one seising only the inferiour members, so that the belly doth not together swell with them, in much safer than an universal one.

An Anasarca bringing on an Ascites, wherein for the most part the Urine is plenti∣ful enough, and the thirst not very intense, is far more safe than an Anasarca brought in by an Ascites, wherein the diseased do very much thirst, and make little, red, and thick, and for the most part a lixivial Urine. In like manner it is, or worse, when an Anasarca comes upon a Tympanie or a Phthisis (as sometimes 'tis wont.) Lastly, no slight Prognostick of this disease is taken from the complyance, or the ob∣stinateness of the Patient, about Diet and Medicine. For whatsoever the condition of the disease may be, if the hydropick person refusing medicine will indulge his fancy, we may not hope any good from thence.

About the Curatory part to be designed in order,* 1.587 two chief Scopes of Healing do occurre, viz. First, that the water between the skin be consumed by some means; Secondly, then provision must be made, lest it be continually generated and accumu∣lated afresh; for which purpose a Physitian is to employ his labour, both that the bowels of Concoction being emptyed of their Superfluities, and free from obstructi∣ons, may always procure laudable Chyle, and supply the masse of blood in due plenty; as also that the blood (the principles thereof being restored to its sermenta∣tive power) may orderly ferment the Juice of the Chyle continually poured into it, and assimilate it into Blood. The vital Indication seems not at all necessary in this disease as in many others, for that very rarely in this appear swoonings of the Spi∣rits, or Watchings, for which Cordials and Hypnoticks are required; and there is little need of restoring Diets, because Fasting and Abstinence rather help, and oft∣times make up the greatest part of the Cure: the reason whereof is, that the Vessels being emptyed through want, do swallow up the waters between the skin, or stag∣nating in other places, and do discharge them forth partly by the Kidnies, by the pores of the skin and other Emunctories, and partly do adyantageously employ them being yet turgid with alimentary Juice, to the nourishing of the body.

First, That the first Indication being Curatory,* 1.588 intending an Evacuation of th morbific matter, may be performed, there ought to be exhibited all Hydragogue medicins, as well simple as compound; and also the froms of medicines recounted and prescribed in the former Chapter of an Ascites. Moreover, hereto belong not only Catharticks and Diureticks, but also Diaphoreticks, which though in other sorts of Dropsies they are very much forbidden, often take place in curing of an Anasarca.

In a simple Anasarca we may lawfully administer strong Purgers,* 1.589 and frequently they much profit. And truly this Disease being cured sometimes by means of a Ca∣thartick, Empiricks do much glory of their Cures, and certain of their medicines be∣come much cryed up for curing hydropical persons; for if at any time it happens

that they have healed one or two labouring with an Anasarca, by their specifick Hy∣dragogues and Elateriums, it is enough wherewith they may always magnifie them∣selves and their Art, although by the same medicine they have murdered a hundred Ascitical persons.* 1.590 Wherefore, although Preparations of Spurge, or Elaterium, Pilu∣lae Lunares, Hercules Bovii, and other Hydragogues, have sometimes profited in some cases; notwithstanding if they be indifferently exhibited to all Hydropicks, or at all to any endowed with a weak Constitution, and Bowels of a brittle tone, or of evil conformation, they oftener cause death than remedy: wherefore let it always be committed to the judgment of a prudent Physitian, the time when, how long, and what sort of Catharticks are to be used.

We have before described froms of Hydragogue Purgers of every sort, to wit, those that exercise their power upwards and downwards, and as well mild as strong∣er workers, so that they may be referred hither, and accommodated to the method of healing now proposed.

But if the reason be enquired,* 1.591 after what manner Purgers do operate in this dis∣ease, and why they more happily, and much more efficaciously bring out waters than in any other sorts of Dropsie; I say, in an Anasarca the morbific matter (which is the Lympha) subsists partly in the mass of blood, partly in the habit of the body, within the pores and vacuities between the ends of the vessels; wherefore, a strong Cathartick being administred, presently troubles and dissolves the mass of blood, and stirres it up to the excretion of any superfluous or heterogeneous thing; and irritates also the little mouths of the Arteries gaping towards the Cavities of the Intestines, that the humour ejected from the blood may easier find vent through these Emunctories. From hence in the first place, the waters fluctuating within the blood are abundantly drained out, afterwards the vessels being emptyed, do pre∣sently swallow up again the waters between the skin, and presently discharge them forth partly by siege, and partly by Urine, or Sweat; in the mean time there is no fear lest, as in an Ascites, the morbific matter being driven and poured from the blood, by the Medicine, should be further forced into the places affected, whence not easily flowing back again, it should be more largely encreased; nor lest, as in a Tym∣pany, by reason of the Fibres of the Stomach and Guts being too much irritated by the Physick, those bowels might be provok'd into convulsive swellings. For as long as the bowels are firm and well constituted, the particles fo the Medicine inflict them with no hurt; but presently being brought into the blood, they do not only allure waters out of it, but by exagitating the mass thereof, they raise the active particles formerly overwhelmed, and dispose them towards their fermentative power.

Secondly,* 1.592 Hydragogues working by Urine, as well simple as the compound, as also forms of Medicines prepared from either of them, and the manner of their ad∣ministration, we have also described above, which also may be transferr'd hither to save repetition.* 1.593 But because not all Remedies of this kind do help alike in all the Distempers, it is here observable, that for curing an Anasarca Lixivials (as has been frequently manifest by our observation) do far excell other Diureticks. For indeed now it is a common and thredbare Remedy, for any one having swell'd members, after a previous Purge, to take twice or thrice in the day, from six to eight ounces of a Lye made of the Ashes of Wormwood or Broom, made in White-wine, and to con∣tinue the use of it for some dayes. This Medicine moves potently the Urine as I have observed in many, yea sometimes in such abundance, that pissing the quantity of half a gallon in a day and a night, the Patients have recovered their healths in a short time even to a miracle.

We have unfolded in a former Treatise,* 1.594 by what manner and fashion Diurticks of several kinds do operate, and after what manner they affect the bowels, blood and other humours: But that in those that labour under an Anasarca, Medicines endow∣ed with a fixt and lixivial Salt, expell Urine more than those of an acid, alcali, or volatile Salt, the reason as I judge is this, viz. in those affected with this disease, after the fermentation and sanguisying vertue of the blood failing, the watery and crude humours heaped up as well in its mass as in the habit of the body, do there remain almost immovable for a long time, till at last they (as the manner is of watery Juices long stagnating) do wax soure; wherefore the lixivial particles of the Medicine spread abroad in the blood presently boyl up with the acids of the waters, which while they serment and move, they stirre up in the whole mass of Blood, a notable and excretive fermentation; insomuch that all the particles being put into motion,

not only the watery and superfluous being thrust from the rest, are discharged by the Reins; but also the innate and active particles of the blood it self, unfold themselves from the more gross with which they were involved, and lastly rising up, they begin to resume their fetmenting power, and to sanguifie.

Take of the Ashes of Broom or Wormwood,* 1.595 or of the twigs of a Vine calcined to white∣ness and sifted, sour ounces, put them into a glass bottle with a quart of White-wine, let them digest close stopt and warm for three or four hours, after strain it j the dose froms six to eight ounces twice a day.

Take of white Tartar calclned with Nitre, and after melted in a Crucible to blueness three ounces, small Spirit of Wine a pound and a half, water of Snails and Earth worms, of each four ounces, digest them in a Sand furnace for two days: the dose of the clear liquor from two to three ounces, with sour ounces of the decoction of Kneeholm and Burdock-roots in Ale.

For ordinary Drink:

Take of the white Ashes of Broom cleansed two pound, put them into a little Bag, with three ounces of Sassafras, one ounce of lesser Galangal, an ounce and a half of Juniper∣berries, and as much of Carrot-seeds, make a bag for four gallons of Ale, after seven or eight dayes begin to draw it.

3.* 1.596 Diaphoreticks od often very hotably help in a Leucophlegmatia (which is the commencing or declination of an Anasarca) but in this disease confirmed, they are wont to be more convenient than in other kinds of Dropsies. And although from the beginning they cannot cause Sweats, by reason of the habit of body surround∣ed as it were with a more thick marsh, however while they exagitate the blood, they cause the innate active particles thereof, being before dormant, and half overwhelm∣ed, to be raised up and disposed towards fermentation, and also they cause all the excrementitious, and chiefly the watery, to be raised into motion, so that presently flowing out of their Receptacles, they may the more readily and easily find way by siege or Urine, and oftentimes in some part by transpiration. But truly after the waters being poured out by purgation, the morbific matter is diminished so much, that the bulk of the body and the swelling of the members begin to abate, the reliques of the humour are best consumed by a moderate transpiration and constant sweat∣ing.

We have described before the number and forms of Hydroticks;* 1.597 as to the present purpose for curing an Anasarca, those chiefly are fit which are given in a larger dose; for they whose quantity is very small, their active particles being overwhelmed in the waters, are lost before being infused into the blood they can exert their strength. Wherefore, Spirits, whether armoniack or vinous, as also Tinctures and Elixirs, yea and powders, are more rarely used in this disease, because they effect little in a lesser dose, and if they be exhibited in a very large one, they often hurt the bowels by their outrage; But those things are rather chosen, which being taken hot, and in a full draught, are able to pass into the whole blood not weakned; of which sort, in the first place are Decoctions of Woods, and Roots, whose particles being agreeable enough to the Blood, and not to be tamed thereby, do pass through the whole mass thereof, and do exert their Elastic power by moving together all the humours.

Take of the Shavings of Lignum Vitae six ounces,* 1.598 of each of the Sanders six drams, shavings of Ivory, Harts-horn, of each three drams, let them be infused and boyled in eight pound of Spring-water to half; adding of Calamus Aromati∣cus, lesser Galangal, Burdock and Butter-Bur-roots, of each one ounce, the leaves of Sage, Germander, dryed, of each two handfuls, let the strained liquor be kept for use; the dose from eight to ten ounces twice in a day warm; to every dose may be added 20 or 25 drops of Spirit of Sal Armoniack drawn with Amber, or of Spirit of Soot, or half a dram, or a dram, of Tincture of Salt of Tartar.

Hitherto of inward Hydragogue Medicines,* 1.599 which cause the Lympha to be drawn forth, either by alluring it inwards towards the guts, or by driving it forth to the Reins or pores of the skin. Besides, there are certain outward administrations in use, by which the water accumulated within the habit of the body are moved toge∣ther,

and so are either generally disposed to go forth by sweating, or Urine, or par∣ticularly are sent out forthwith, a vent being made in some private places.

In the first rank are placed Frictions,* 1.600 Liniments, Fomentations and Baths as well dry as moist: Then those particular things that bring out waters are, Vesicatories, and things that bring the Skin to an Eschar, and pickings by a Needle. We will treat brief∣ly on each of these, or at least of the principal of them, as far as they have reference to this disease.

1.* 1.601 Frictions do frequently afford advantagious success in a Leucophlegmatia and an Anasarca: for when the habit of the body is not only filled with a watery il∣luvies gathered there together, so that nothing can evaporate, but that the extern parts grow cold by reason of the approach of blood towards them being stopt, often and stong frictions do move together the stagnating waters, and dissipate them from thence in some measure, and also recall again the blood by opening the passages into those parts from whence it was banished; wherefore, not only the swoln members, but also the whole body once or twice in a day, is expedient to be rubbed with a course Cloth, or with a little Brush now ordinarily prepared for that purpose.

2.3.* 1.602 With or after Frictions, Liniments and Fomentations are sometimes con∣venient. They are prepared either of Salts, and other Minerals dissolv'd, or from hot and discussing Vegetables, with the faeces of Wine boyl'd in water, the hot ap∣plication whereof opens the pores, moves together more amply the accumulated wa∣ters, and discusses them, and also enlarges the compass of the bloody Circuit, the watery heap being somewhat dissipated. Let the Liniments consist of Sulphur, and Salts of a diverse kind, or of Quick-lime, and other Minerals, which being powdered and mixed with the mucilaginous Extracts of sharp Herbs, are reduced into the form of an Unguent; to which let a fit quantity of Oyl of Scorpions be added, for the better consistency. Moreover this Oyl (so it be genuine) applyed by it self, doth frequently afford notable help. I knew a Boy much swell'd with an universal Ana∣sarca, who was cured by this Remedy alone: for his mother (I know not by whose advice) anointed his whole body morning and evening with Oyl of Scorpions, strong∣ly rubbing all the parts with her hot hand; by which act within three dayes he be∣gan to pour forth abundance of Urine, and when he had continued pissing so for some dayes, the swelling vanishing by little and little, he became sound.

4.* 1.603 Baths are not convenient in any Dropsie but an Anasarca, and not for this un∣less in a Diathesis or Declination. For seeing the Blood from the heat thereof, en∣compassing the whole Body, being made boyling and stirr'd up, every where puts in motion the waters formerly stagnating, and swallowing them up into it self, con∣veys them variously away; the danger is, lest (as frequently it falls out) receiving them out of the habit of the body into its own mass, it should depose them presently into the Praecordia or the Brain: for there in noting more usural than an affection of those parts, viz. an Asthma or Apoplexie to come upon Hydropicks by unseason∣able bathing. But when the conjunct cause of the disease (viz. a Swelling) becomes moderate, or not much, a Bath of water impregnated with Salts and Sulphur, or a Hot-house, by which a gentle Sweat is promoted, is frequently administred with suc∣cess: As for the Stew it is more expedient, and oft-times notably helps, that the Patients be placed in fitting Seats in Salt-houses, near the Furnaces wherein Mineral Waters are boyled into Salt.

5.* 1.604 Vesicatories send out abundantly the waters between the skin, and often too profusely. Touching the manner how they operate we will treat more specially here∣after; in the mean time we advise, that they are very cautiously to be exhibited to Hydropicks, for that Epispasticks of this kind, applyed to the swell'd places, do make the Emissarie too open, by which apertion the water in the first place burst∣ing out, draws oftentimes a great illuvies after it from the neighbouring parts, whence immediately ensues a great prostration of the Spirits. Moreover, some∣times the place is so suddenly emptyed, that being destitute of heat and spirits, it is in a short time sphacelated or mortified; wherefore this Medicine is seldom ap∣plyed to the Legs, or the Feet of Hydropical persons, where the heat is weak, and the humour greatest, but sometimes to the Things and Arms with security (as often as there shall be need.)

6.* 1.605 Escharoticks are administred a little safer than Vesicatories, to the swell'd pla∣ces, because from this Emissary the flux of waters happens not so headlong and abun∣dant at first: but commencing moderately grows up by little and little to a great

stream, which Nature (after that by degrees it is accustomed thereunt) endures the better. Moreover, there is less fear of a Gangrene from an Escharotick than from a Vesicatory, because in that application the part, whose union is dissolved, is defend∣ed by the Eschar against the loss of heat. I have known sometimes an illiterate and rude Empirick, who frequently by an Escharotick did evacuate with success the mem∣bers of hydropick persons, however swell'd, by the ensuing manner: to wit, he fo∣mented the legs evening and morning with the Decoction of Dwarf-Elder, Worm∣wood,* 1.606 Cammomile and other hot herbs put into the Lees of Ale of Wine; and between the times of the Fomentations he applyed a Cataplasm prepared of the masse of that Decoction with Bran; after he had used these for three dayes, he co∣vered both legs and seet with a Plaister of Burgundy Pitch, leaving only a small hole on each Calf, about the bigness of a Nut, in which places he put an Escharo∣tick, on the bare skin, of the Ashes of Ashen-bark: which after twelve hours being removed, a small Eschar was left, from whose pores water was wont at first slowly to sweat out, afterwards day by day a little more plentifully to drop out, and after∣ward (the Eschar falling off) it used to flow out more abundantly as from an open Spring untill it had drein'd the whole leg both beneath and above.

7.* 1.607 There remains another manner (not inferiour though less used than the former) of draining out the waters between the skin, viz. by the pricking of a Needle; which likewise ought cautiously, and minutely to be used, lest a headlong and too great efflux of waters be provok'd thereby. Take an ordinary Needle (such as Taylors use) and let it be thrust into the skin, pricking over the place chiefly swelled, only so far that blood follow not: and so at one time let six or seven little holes be made, a thumbs breadth distant from each other; from every little hole the water will issue forth by drops, and so it will contiually drop out untill all the swelling vanish about the place so pricked; afterwards, the next time after twelve hours, another while after 18 or 24 hours, let the same pricking be exercised in another part of the same thigh, or of the other; and afterwards once or twice a day in this or that member, or in both together, or in more places, let such Emissaries of the water between the skin be excited. For in truth after this manner the hydropick illuvies may be ex∣hausted more plentifully and safely than from any other outward Chirurgery; In the mean time if the new provision thereof be provided against by inward Physick, the disease will be the easier cured. Moreover in a desperate Dropsie life is best pro∣longed by such an administration, for that the waters being exhausted continually by those outward Emissaries, the inner inundation of life is longer protracted. Not long since an old man aged seventy years, overwhelmed with a Dropsie over his whole body, by the help of this Remedy only, remained living for many moneths beyond expectation, and raised his head above the waters.

Hitherto of the Kinds and Forms of Remedies suggested by the first Indication,* 1.608 viz. the Curative; what belongs to the other, to wit the Preservatory, which respects the temperature and sanguisying power of the Blood to be restored, it offers Medicines of that sort which being endowed with more hot and Elastick particles, revive the active or depressed Principles of the mass of blood, or cause those consumed to be repaired, for which end Remedies commonly called Altering are wont to be prescri∣bed under the form of an Electuary, Powder, Pills, distilled Water, Julep,* 1.609 Apozeme and Diet, to which also Spirits, Tinctures, Elixirs, are sometimes added, for the bet∣ter essicacy. We will propound one or two Examples of each of these.

1. Take of Conserve of Roman Wormwood, Scurvy-grass, the yellow Rindes of Oranges,* 1.610 of each two ounces, Winters-bark two drams, Species Diacurcumae a dram and a half, of Steel prepared with Sulphur three drams, Syrup of Citron-peels what suffices to make an Electuary, the dose two drams morning and evening, drinking after a draught of the Julep, or three or four ounces of the distilled water.

Chalybeate Medicines notably help in this Disease, as in the green sickness of Virgins,* 1.611 insomuch that frequently the whole or chief scope of curing depends upon this kind of Remedy; yet we are to observe, that not all Medicines of this kind are equally convenient in these cases: for those which are chiefly in use, viz. Salt of Steel,* 1.612 or Vi∣triol of Mars, and others prepared with acids, and deprived totally of Sulphur, do not help, inasmuch as they do not promote the fermentation of the blood, but ra∣ther on the contrary fix it, being too wild or elastick. But for an Anasarca or any

watery tumours, in a cachectick habit of the body, Chalybeates of that sort are given, wherein the sulphureous particles are left, and are predominant; as in the first place the Filings of Iron, and the Scales, reduced into a fine Powder, also Steel dissolved with Sulphur, and powdered. The powders of this being taken, are pre∣sently dissolved by the acid Salts within our body, whence the sulphureous metallick particles being set free, and brought into the blood, they ferment the whole mass thereof, and revive the like particles in the same, which before lay dormant, and being conjoyned therewith, they give vigour to the blood, and renew its sanguifying power being formerly depressed. Wherefore we may observe by using but a little Chalybeates of this sort, the green and yellow colour of the face is converted into a florid.

2.* 1.613 Take of the compound Powder of Aron-roots, of Winters bark, of each three drams, lesser Galangals, Cubebs, of each a draw and a half, of Steel prepared with Sulphur half an ounce, Sugar of Rosomary flowers six drams, make a Powder, divide it into twenty parts. One part is the dose, morning and evening, with a draught of the sudoriferous De∣coction before prescribed.

3.* 1.614 Take half an ounce of the gummous Extract residing after the distillation of the Elixir Vita of Quercetane, powder of Earth worms two drams, lesser Galangal, Winters∣bark, of each one dram and a half, Salt of Wormwood two drams, of Rust of Iron two drams and a half, Balsam of Peru one dram, Tincture of Salt of Tartar two drams, Balsamum Capivii what suffices to make a mass to be formed into small Pills, the dose half a dram evening and morning, drinking after it three ounces of the Julep or the distilled water following.

4.* 1.615 Take of the water of Elder-flowers, of the juice of their Berryes fermented, of each one pound, water of Earth-worms magistral, of Rhadish compound, of Aqua Mirabilis, of each two ounces, Syrup o fthe juice of Elder-berries two ounces, mix them and make a Julep.

5.* 1.616 Take the leaves of Carden Scurvy-grass, of Hedge-Mustard, of Pepper-wort, of each six handfuls, of the Roots of Calamus Aromaticus, Galangal, of Zedoaria, Orris of Florence, of Elder, Aron, of each six ounces, Winters-bark, Jamaica Pepper, of each three ounces, Juniper-berries four ounces, Cloves, Ginger and Nutmegs, of each one ounce, slice and bruise them, and pour upon them eight pound of old Rhenish-Wine; distill it in common Organs, let the whole Liquor be mixt.

6, 7.* 1.617 An Anti-hydropick Decoction is described above, among the Diaphoreticks. A Diet-drink is to be taken instead of Ale, and is to be made according to the en∣suing form.

Take of Shavings of Guaiacum,* 1.618 Sassafras, of each four ounces, Florence Orris-roots, Calamus Aromaticus, Galangal, Enula-campane, of each one ounce and a half, of Juni∣per and Bay-berries, of each two ounces, Anniseeds, Carue, Sweet-fennel, Coriander and Dill-seeds, of each one ounce, long Pepper and Cubebs, of each an ounce and a half, cloves, Nutmegs and Ginger, of each half an ounce, Jamaica Pepper two ounces, the dryed leaves of Sage, Wood-sage, Calamint, Agrimonie, of each one handful, Liquorish four ounces sliced and bruised, boyl it in four gallons of Spring-water to half, the strained liquor being cold, let it be kept in glass Bottles for use; with the constant use of this drink, I have known many laborring with a deplor able Anasarca to be made well. Among many Examples of Dropsies cured, I shall propound but one.

A certain strong man of a middle age,* 1.619 after he had contracted an Epidemical Qnartan Feavour, and being evilly handled from its beginning, had laboured with it above a year, and in the mean while had used an ill course of Diet, fell into an Anasarca, which afterwards in a short space augmented hugely, by reason he in∣dulged himself more freely to drink for quenching his thirst (which was outragious) so that all his members being swollen from head to foot, and over the very Abdo∣men it self, he could not turn in his bed from side to side without help.

When I first visited this man,* 1.620 and despairing of a Cure (as the Physitian in Celsus lib. 3. Chap. 21. who denyed that any intemper are Hydropick could possibly be cured) I immediately affirmed this Prognostick, That he would dye in a short time unless he abstained from drink. Whereunto he replying, profest he would not drink in a

weeks space, provided he might be helped; and indeed did as he said, although be∣ing very thirsty, for six or seven dayes he scarce took any liquid thing in his mouth, but what was Medicine; and during that time, when in the mean while he took Hydragogues, Catharticks and Diureticks, and any other things prescribed care∣fully, he became much better, and afterwards the method (before described) some∣while being administred, he was restored to his entire health, and even now though five years since lives and continues sound.

There remain certain other splanchnical Affections,* 1.621 touching the Remedies where∣of, according to the ensuing method, we should here have treated, notwithstanding I have performed this task already for the most part under other titles; for as is above intimated, Remedies which concern the Kidnies we have for the most part unfolded under the rank of Diureticks, and those which concern the Stomach and Guts, un∣der that of Vomits and Purges; what relates to the Spleen we have finished in the Hypochondriac Pathologie; and what to the Womb in the Hysterical. As to what ap∣pertains to the Genital parts and their Diseases, and help, I reserve for another time and place; it behoves me now next of all, after treating hitherto of the in∣ward Pharmacie, to discourse something of the outward, and of the Reason or Aetio∣logie of the administrations thereof, which shall be done inthe next Section, begin∣ning with Phlebotomie, that great Remedy.

SECT. III.

CHAP. I. Of Phlebotomie.

AMong the universal Documents of Philosophie,* 1.622 or aids of Physick, none either in Theory or Practice hath been more ancient or general than the speculation of the Blood and letting it out by opening a Vein. As to the former we have in other places often explicated the nature and constitutive parts of the Blood, we have unfolded the Virtures and Energy of the same, and have demonstrated that it is in truth enkindled, and that from the burning there of the flame of animal life, as of a Lamp, doth begin and receives continuation: But as to what relates to Phlebotomie, all Authors of every age have made mention thereof: Moreover the same was ever in Medicinal use with all Nations howsoever barbarous or rude. Neither is it a won∣der, for truely Nature it self in the first place hath taught the necessity, and way of that part of Chirurgery; Even the Divine Law commanding the Rite of Circum∣cision, as a Symbol thereof, seems to intimate that the innate impurities of Humane Nature ought to be purged in some manner by letting out the blood.

That we may methodically discourse of this great Remedie,* 1.623 we ought first to con∣sider, by what means, also for what causes and ends, the letting of blood either hap∣pens spontaneously to Nature, or is indicated by the Physitian; then secondly we will annex the chief effects of this Evacuation, as well good as bad, whether advan∣tageous or disadvantageous, and together propound certain Rules and Cautions to be observed, about due administration of Phlebotomie.

As to the former, spontaneous Haemorrhagies (which suggest the use of Phlebo∣tomy) whereas they are manifold and of diverse kinds, they are usually reduced to these two heads or ranks: to wit, they are denominated either critical, Nature en∣deavouring something good and wholsome; or symptomatical, which for the most part happen, she being dejected from her government, and being altogether out of order.* 1.624 The bloody eruptions of the former kind are again distinguished; that they are either raised without a Feaver, and are either perodical, which happen often at set seasons, as the Flowers in Women, and the Hemorrhoids in some, and in others the solemn or otherwise accustomed opening of the Nostrils; which very often succeed according to the great changes of the Year, or alterations of the Air: or they are fleeting and uncertain, as when blood doth advantageously break out of those places, and of many others, one while in this part, another while in that part of the body. Moreover, bloody Crises do sometimes happen in a Feaver, and do often put an end to it, as Hippocrates long ago observed, and is now manifest by very common ob∣servation. The blood breaks out in all these cases, inasmuch as being turgid, and above measure rarified within the vessels, it desires a larger space, wherefore, unless some portion thereof give way, the whole mass rund the hazard of being constipated, and as well the motion thereof to be hindered, as the enkindling to be suffocated, and the temperature to be perverted.

For there are two chief Reasons or Causes,* 1.625 wherefore such turgescencies of the Blood do arise: inasmuch as its liquor is as well inflammable, as fermentative.

1. As to the former of these, that the Blood may be duely enkindled for the sup∣poriting Life,* 1.626 and the due exercise of the functions thereof, it behoves that the innate sulphureous particles of it be proportion'd unto the Nitrous adventitious ones from the Air. Therefore as often as the Blood being very boyling and rarified, is much opened and loosened in its own consistence, so that the Sulphur being dissolved, is kindled in greater plenty, there is a most frequent and painfull breathing instituted for the drawing in of a more plentifull Nitre. Now if the Sulphur abounding in this manner, cannot be wasted by burning, nor the vital flame regulated, the next course immediately to diminish the sulphureous suel, is, that a certain portion of the rari∣fied Blood have vent. From hence, not only in Feavers, but after drinking Wine, Bathings, being in the Sun, and other accidents by which the Blood grows very tur∣gent, either an Haemorrhagia of its own accord succeeds, or there is often need to supply the defect of such a spontaneous evacuation by Phlebotomie. But that such

kind of effusions of Blood, whether made by Nature or Chirurgery, are commonly reported to bridle its heat or raging; really they do this only inasmuch as they diminish the kindling of the blood, by withdrawing part of the sulphureous fuel, as Oyl from a Lamp.

2. But moreover in the second place, the Blood,* 1.627 inasmuch as it is a fermentative liquor, it is apt also to be extravasated. Namely, if at any time any heterogeneous thing, and not miscible, be confounded with its liquor, it grows hot very much, like Wine in a Vessel, and boyls up in the Vessels to exclude that disagreeable thing, which if it can neither subdue, nor turn off by Sweat, Urine, or otherwise, the Blood it self excludes part of it self as a Vehicle for carrying that matter forth, whereso∣ever a vent is to be found. For this reason (viz. that any disagreeable or indomita∣ble thing may be turn'd out of the mass of blood) divers sorts of Hemorrhagies hap∣pen, as well in Feavers as without them; all which are excited by Nature for an intention of good, as also those by which the too much enkindling of the Blood is depressed: But that frequently it happens otherwise, ought to be imputed to divers accidents and circumstances. But for the most part the sailure about the spontane∣ous Hemorrhagies critically instituted,* 1.628 is either in the first place because the blood while it is boyling knows no measure of flowing out, and therefore being stirr'd into violence, it flows out too much; or secondly, because the mouths of the vessels once opened do not presently close again, nor are able to be shut; or Thirdly, because Nature endeavouring an excretion of blood, doth it by places more open,but often inconvenient; as when an Hemorrhage happens through the Lungs, the Kidneys, Guts, or other Bowels, which therefore pass from a Critical into a Symptomical and often into a malignant Haemorrhage.

Neither only by these means, but by many other failings of Nature, or impedi∣ments,* 1.629 do Symptomatical Haemorrhagies happen, in all which either the Blood it self, or the Vessels containing it, or both of them together, are wont to be chiefly in fault.

1. In the first place, the Blood, besides the reasons above mentioned,* 1.630 (to wit, for∣asmuch as it becomes inflammable or fermentable above measure) is apt also to be ex∣travasated, because either its liquor being empoisoned, or otherwise corrupted, can∣not retain its due mixture, but being apt to coagulate or putrifie, divides it self into parts; and whilst some of them being here and there planted, sending forth spots, wheals, and other brands of Malignity, do discolour the Flesh and the Skin, and ob∣struct the proper passages; others otherwise running out an breaking forth where∣soever there is a vent found, do produce bloody Excretions in divers places, as is commonly discerned in the Plague, Small-pox, Measles, and malignant Feavers; yea perhaps this in some measure is the reason why in scorbutick Distempers, as spots and marks, so also Haemorrhagies are so familiar.

2. Secondly, The vessels bringing Blood being faulty many and divers ways,* 1.631 but chiefly in these three, do appear the cause of a symptomatical Haemorrhage, viz. In the first place, if perhaps any where some of them are obstructed, as often as the blood assumes a more rapid motion, either in the same place, or in the contiguous parts, and also sometimes in remote parts it is constrained to burst out. Frequently from such a cause an Haemoptoe proceeds; moreover Spitting of blood, and the Hae∣morrhage of the Nostrils do often follow the suppression of the Terms and Hemor∣rhoids. Secondly, the little mouths of the vessels (by reason of the fleshy Fibres be∣ing loosened or resolved by which they are clos'd) sometimes are ill formed, so that when the ends of the Arteries do gape too much, the little mouths of the veips do close. By reason of this affection, Scorbutical and Cachectical persons, are found ob∣noxious to Haemorrhagies, as we have remarkt in another place. But Thirdly,* 1.632 it fre∣quently comes to pass that the Vessels, being so evilly formed, are also convulsively affected, and so the morbific cause being as it were doubled, this evil is much encreased, insomuch that the muscular fibres of the Vessels being inordinately contracted, cause sudden and violent fluxes of the blood, one while towards the upper parts, anotehr while to wards the lower; and so their little mouths being open in the mean time, they provoke prodigious Haemorrhagies. For I have observed in some persons, when the current of blood was small enough, with a small and weak pulse, the Convul∣sions of the Vessels generated in some place, and propagated under the likeness of wind running to and fro in the body, to drive more impetuously the blood, how∣ever slow of it self, and to constrain it into violent eruptions; and in cases of this

sort, when Phlebotomies and Medicines refrigerating and tempering the blood have not at all profited, the greatest relief hath been found from Narcoticks, Antispasmodicks and Ligatures.

3.* 1.633 Thirdly, If perhaps it shall happen that these faults of the Blood and Vessels are complicated, and put forth their mischiefs joyntly at once, from thence it will be of necessity that this evil will be more intense, and more frequent and prodigious Hae∣morrhagies will be raised; the reasons of which as they appear plain enough by what goes before, it will be neither necessary nor seasonable here longer to dwell upon ex∣plicating of them; but rather, whereas we have designed hitherto the acts of Nature about spontaneous effusion of Blood, and its courses both rightly instituted, and also wrongfully and evilly constrained; now it behoves us next to declare, how far Art (for the most part the Ape of Nature, and sometimes Mistris or Moderatrix thereof,) can act likewise well, or better about letting of blood, and how sometimes it is wont to succeed worse.

We advertise of these things in general,* 1.634 that a Physitian imitates Nature in some cases of letting blood, exceeds her in other cases, and frequently regulates and reduces her when acting amiss. Moreover, ther are some cases wherein Nature excells far the efficacy or Art concerning bloody excretions; briefly of each of these.

Therefore in the first place,* 1.635 in whatever affects, spontaneous Haemorrhagies are wont to bring help, when these are wanting, Physick the Handmaid of Nature rightly substitutes Phlebotomie. Therefore, if perchance the Blood be immoderately kindled by reason of its Sulphur being too much loosened and advanc'd, by breathing a vein, what is superfluous of that inflammable fuel will flow out, as also the immoderate turgescency of Blood, by reason of somewhat untamable being mixed with it, will be allay'd by this course. Wherefore letting of blood is advantageously administred, as well against continual Feavers, which proceed from the former cause, as inter∣mittent Feavers, whose fits proceed from the latter cause. Also in like manner, as often as an accustomed evacuation being suppressed, or a humour driven back from the ourward parts, or a sudden stoppage of the pores, or if a Surfeit, drinking of Wine, or other accidents of this nature, cause a turgescency of blood (inasmuch as they dash heterogeneous particles against it) Phlebotomie is usually the most ready Re∣medy.

Secondly,* 1.636 Physick in Blood-letting, not only imitates Nature, but often excells it; and also succours her being weakened, and reduces her often erring. For if at any time the blood struck with violence, rushes in a heap against any part, and either presently breaks out in the same place, or abundantly gathered together engenders an Inflammation, a vein being pierced in a remote place, stops that preternatural ten∣dency of the blood, and frequently carryes away the bleeding, or inflammation. Wherefore, in a Pleurise, a Squinancy, a Peripneumonia, in spitting or vomiting of blood, when Nature is vanquished, or being outragious, seems to cast violent hands upon her self, Chirurgery recalling the blood to another part, and sending it out, re∣stores the matter that was almost desperate.

Moreover Physick frequently restrains or reduces Nature, when too prodigal or prevaricating in pouring out of the blood: for in truth all immoderate Haemorrhagies do want Bridles, not Spurs. But in the Plague, Small-pox and Measles broke out, and in malignant Feavers, sometimes the blood spontaneously flowing out, portends for the most part evil; therefore in those affects styptic Remedies, or things stopping the eruption of blood, are more convenient than breathing of a Vein.

Thirdly,* 1.637 Notwithstanding on the contrary there are cases of shedding blood by Na∣ture, which Physick can no way imitate, neither if they chance to fail, can be sup∣plyed by Phlebotomy. In Feavers about the Crisis of the Disease, to wit, after the digestion of the matter, that is to say, the preparation for Excretion, spontaneous Haemorrhagies if coming in time, do far excell any Phlebotomie which none knows the best season of; Moreover, the Fluxes of the Terms and Haemorrhoids happening by Natures instinct, are more advantageous than the mission of blood provok'd by Art in any of those places.

Between Phlebotomie and spontaneous Haemorrhagies,* 1.638 there is yet a notable diffe∣rence. (although not of great moment in Physical practice) viz. both as to the Subject and Matter of either of them; for in this the blood being florid, and throughly Scarlet, doth for the most part only flow out of the Arteries, but in the other Evacuation the Blood being of a black purple with a Scarlet Cream, is only drawn out of the

vein. Whence the stream of Blood, which is one within all the vessels and throughout continuous, acquires such a diverse kind of appearance, seeing we have shewed in ano∣ther place, it is not our present purpose to make any surther search into this Aetiolo∣gie; because it concerns not much to the curing any distemper, out of what vessel the blood be let, provided it flow out largely: But that the ancients do in some cases commend Arteriotomie, and prefer it to an incision of a vein, the Circulation of Blood not being then known, we have elsewhere discoursed how well it may be done.

Hitherto of Phlebotomie compared with a spontaneous Haemorrhage;* 1.639 now our next business is, to describe the use and effects thereof, as well good as bad, in Phy∣sical practice. Wherefore we will first shew in general what alteration of the mass of Blood this Evacuation bring; then what diseases it more immediately respects, either of the whole body, or its particular parts.

About the former,* 1.640 it is obvious enough that the blood is altered by breathing a vein, both as to its quantity and temperament, and as to its disposition and mo∣tion.

The first and most common Indication of Phlebotomie, is,* 1.641 that the plenty of blood be diminished by this Administration. And truly this is a vulgar Remedy, to re∣move or provide against a Plethora. Any one, though of the vulgar sort, growing to a full habit of body, lets blood without the advice of a Physitian; Moreover Rusticks and Countrey-men for healths sake,* 1.642 once or twice in a year cause blood to be drawn from themselves and their Beasts But although this custom is grown so much in use with some prodigal of their blood, that they breathe a Vein on the smallest occasion, and sometimes without any manifest cause; notwithstanding we may find many others no less obstinate against this custome, insomuch that for no cause will they lose any blood, unless the greatest necessities be urgent.

Upon this matter (whereas Arguments are alleadged on either part,)* 1.643 that I may in few words determine what seems fit to be ordained, in the first place it is requisite we grant, that letting blood is convenient against a Plethora either made, or begin∣ning: for by no other Remedy are the evils of that Affection wont to be better re∣moved or provided against. Notwithstanding, the necessity of this evacuation ought to be declined as much as may be; because from thence (as we have intimated else∣where) the blood becomes more sulphureous, and less salt, and for that reason it most commonly disposes all men to be feaverish and to be fat. Moreover the Great Remedy Blood-letting, if it be prostituted to every little occasion, becomes less efficacious to any grand affections when need requires: To which we may adde, that according to the vulgar observation, by how much the more familiarly any one uses Phlebotomy, he will the more frequently stand in need of it: for blood being emitted to avoid a Plethora, the rest of the mass will the sooner rise to a Plethora: far other∣wise than is the opinion of some, who dread lest the store of blood be consumed by frequent Phlebotomie; for that on the contrary by this means the quantity is more encreased, although the Crasis be the worser: for so the blood having lost much of its balsamick Salt, and preservative against putrefaction, instead thereof, is filled with a pinguifying and more fiery Sulphur.

Secondly,* 1.644 Phlebotomie doth frequently correct the mixture and temperament of the blood in a manifold respect. For in the first place, if any thing heterogeneous be confounded with its mass, which cannot be rightly digested, nor easily excerned and sent away: a Vein being opened, the blood flowing out conveyes frequently much of the portion of that matter forth with it, insomuch that the rest may be either subdued or expell'd. For the orifice of a vessel being opened, presently the blood fermenting gathers together the extraneous particles as much as possible, and excludes that portion of it self wherein many of them are heaped up: From hence we may observe the blood flowing out first and last to be well enough,* 1.645 when that emitted between appears corrupt. Also secondly, the blood declining from its tem∣perament, is frequently restored by Phlebotomie. For when the mass thereof by the Sulphur or fixt Salt, or both together being exalted, shall degenerate into sharp, salt, or saline-sulphureousness, a portion of the blood being withdrawn, immediately a new fermentation thereof arises, and very often there is a transposition made of all the particles of that sort, that afterwards the Spirits may a little emerge with the volatile Salt, and recover their dominion, the Sulphur, and fixt Salt (as is fitting) being subdued. For this reason it is that letting Blood doth not only confer great

help in Feavers, but also in the Scurvy, Jaundies, and beginning Consumption; for the blood after the vessels are emptyed, like the Stomach disburden'd, doth better digest and assimilate any humoursingested, and the more easily throws off and separates what∣ever is heterogeneous.

But if the mixture of Blood begins to be much loosned and become very bad,* 1.646 as in the Plague and malignat Feavers, we must altogether abstain from Phlebotomie; for the blood being withdrawn, the store of Spirits (whose only part it is to vindicate the mass of blood from putrefaction and corruption) is diminished, so that immedi∣ately all things tend to a deadly dissolution. Moreover, if the Dyscrasie of the blood shall be of that manner, that the more noble Principles, to wit, the Spirit, the vola∣tile Salt and Sulphur, being depressed or cnsumed, the watery and earthy particles predominate, the blood ought not to be sent out, but preserved even as the treasure of life; for when the abundance of Spirits are so small, any loss of them doth cause all the functions to stagger, and gives way to the disease; wherefore in a Dropsie, Cachexia, Consumption, and other Distempers, where the active Principles are greatly depressed, the opening a vein is almost the same thing as cutting the mans throat.

In the before mentioned cases,* 1.647 where the temperament of blood is respected, it is easie to determine, whether Phlebotomie be convenient or not; but in some others, as in a putrid continual feaver, when upon this hinge Life and Death are turned, there is need of the greatest deliberation: and so much the rather because the event of the Disease, and the success of all the accidents in its whole course, whether good or bad, is usually imputed to Blood-letting, or its omission: and from hence it is, that Physitians being solicitous to preserve their own repute, do chiesly raise doubts in their consultations of this matter.* 1.648 But truly in this difficult knot that we may not be led by the rumour of the vulgar (as it chances to happen) one while approving, another whise condemning Phlebotomie, but with more certain advice: we must consider the state of the Blood, the tendency of the morbific matter, and the strength of Nature. First as to the former, if in a putrid Feaver, the blood very much growing hot shall raise a great heat, with thirst, watchings, and burning of the Jaws, and no eruption of abundant sweat, nor pushes appear, or is suddenly expected, opening of a vein is so clearly demonstrated,* 1.649 that it is a wickedness to omit it; but on the contrary if in a languid body, a slow and remiss Feaver, but continual, arises, with a weak Pulse, let Blood-letting be spared, and the cleansing thereof be procured by breath∣ing Sweats, Urine, and blistering. Notwithstanding, in a middle state of Blood, and of a Feaver, Phlebotomy almost indifferent in it self, is determined by other things. Therefore secondly we must weigh the tendency or flux of the morbific matter, which if it remain dull in the mass of blood, and unfit to be separated, and so (as it is fre∣quently wont to be) instead of a Crisis, a translation towards the head be made, and threaten the brain and nervous stock, the cutting of a vein ought seasonably to be administred, whereby these evils may be provided against. Notwithstanding, if that this matter being soon raised into a rage, and either rushing inwardly to the bowels of the nether Belly, provokes a huge Vomiting, or Dysenterical affections, or being driven outwardly, seems to be about to bring the Small-pox, Measles, and other pushes, every such force of Nature, if good, ought not to be disturbed, if evil, not to be made worse by Phlebotomie; for in these cases it is not only dangerous to let blood, but also very scandalous, Thirdly, about Phlebotomy to be administred in a doubtful case, we are to take heed to the strength of the Patient; for in a health∣ful Constitution, a vigorous Age, the commencing of a Disease, and the functions both vital and animal being yet in a florid or indifferent estate, we may confidently prescribe letting of blood, unless something indicates the contrary. Notwithstanding, when it is otherwise, as to those conditions, we may not rashly proceed to that Eva∣cuation.

Thirdly,* 1.650 the inordinate motions of the Blood, when being very much moved, as it were with fury, it either rushes impetuously one while into these parts, another while into those, or transferres the noxious matter, are best restrained or reduced by Phle∣botomy; wherefore in great Cephalalgies, in all soporiferous or convulsive invasi∣ons, for Catarrhs, Ophthalmia's, and a Cough, Asthma, fits of the Gout, and Stone, or Phlegmons, Erysipelas's, also for many other Distempers, raised by the flowings of the Blood or Serum, an incision of the vein is commonly prescribed, and indeed for the most part as with good success, so also upon right Reason; for the Vessels being

emptyed, the blood having obtained a more free space, is circulated pleasantly and undisturbedly, besides, whatever is extravasated of the Blood or Serum, is wont to be suckt up again and reduced into its course.

The Effects as well good as bad being thus shewn,* 1.651 which happen to the blood in the manifold state thereof, by Phlebotomie, we will next make strict examination what Diseases chiefly, either of the whole body, or of any private Region that kind of Remedy doth more immediately regard. And first as to what relates to general Distempers, it is commonly enough known, that letting blood is indicated bu a hot and dry temperament, and interdicted by a moist and cold. It is usually propound∣ed in every Feaver, but never in a Dropsie, Moreover, if we consider particular Diseases, there is no region or part of the Body, but as they rejoyce in the influence of vital as well as nutritious blood (as long as it is well) so as often as it is disturbed in any place, or reaches out any disagreeable or provocative thing, in place of be∣nign Juice, it requires avocation and a letting out thereof. If I should take notice of every single case of this Indication, we should here rehearse almost the whole Patho∣logie of the humane body. An aking Head, a Brain oppress'd with blood, or over∣flowed with Serum (whence spring a world of evils) burning of the eyes, inflamma∣tion of the face, mouth and throat, all the diseases of the Breast and Praecordia (inas∣much as the disorder of Blood affords a rise or fuel to each of these) likewise ob∣structions or inflammatory affections of the Liver, Spleen, and other Bowels; more∣over, as a Plethora, and Athletick habit of the whole body, so also the tumours of each member, painful and convulsive passions, seem to accuse the blood as Author of all the evil, and require its sending out, as a certain kind of revenge.

In these and very many other distempers, if at any time Bleeding be clearly indi∣cated,* 1.652 before it be performed four things ought to be considered, viz. In what place, by what manner and instrument, at what season, and in what quantity the Blood ought to be taken away.

First, as to the former, although according to the Laws of the Circulation of the Blood, as oft as the mass should be diminished,* 1.653 it differs little from what vessel a part thereof be taken, provided it be large enough; notwithstanding, for that besides a general evacuation of the blood, sometimes a particular one properly called Deri∣vation (as when the blood is to be brought out of a private place where it is accumu∣lated) and moreover a Revulsion, when it is to be called into this or that part, are intended; for that reason, in a humane Body there are appointed as it were various Boundaries, out of which, now by this, now by that, or by another vein, the blood may be emitted as occasion is given, and for the uses chiefly requisite.

If therefore at any time an univeral Evacuation of the blood be indicated, the medi∣an vein of the Arm is best to be opened, for this is easily opened being large enough, and whereas it equally flows from the whole body to the orifice thereof being open enough, by whose more free efflux nt only a Plethora is taken away, but the greater vessels being every where emptyed after this manner, the blood stagnating in any place, is brought into motion, and being extravasated is again swallowed up into the veins; wherefore, in great distempers when the blood being heaped in the Brain,* 1.654 or Praecordia, does threaten sudden destruction, the best way not only of general Eva∣cuation, but of a Revulsion, is to send the blood by a full current out of the vein of the Arm, being largely open'd.

But if without any great Plethora the blood ought to be evacuated from the whole, and pulled back from the upper part of the body towards the inferiour, as in the suppression of the menstrual flux or Hemorrhoids, it will be rather fit to bleed in the Foot or sedentary vessels by Leeches.* 1.655 But if after the blood being evacuated from the whole, it be also to be derived from any private part where it is accumula∣ted, let its drawing off be near the place affected. Hence in Cephalick Diseases, we open the vein of the Forehead, of the Temples, or of the Throat. To cure Tumours, or pains raised in the Joynts, we cut a vessel either beneath or near them, or draw out the blood by Cupping-glasses or Leeches. In like manner in distempers of the Thorax and nether Belly, either Cupping-glasses are applyed to the region suffering,* 1.656 or Leeches to the sedentary vessels.

But that some Vessels are reported to bear a peculiar respect to certain Bowels, and that they ought to be lanced in their distempers; viz. such are the outward brachial vein, which is said to respect the head, and the inward the Liver, also the outer vein of the Hand tending to the Ring-finger, which is said to respect th Spleen, and for

that cause this is called the Salvatella, and the former of them the Cephalick, and the other the Jecorary; all this is meerly a vulgar error, which being propt by no reason or Anatomical observation, I am ignorant whence it took its origine: Therefore as soon as it is agreed on to cut a vein and its place, let a large Vessel be chosen, and very con∣spicuous, that it may the more easily be opened; and being remote from an Arterie, Nerve, and Tendon, may be the more securely lanced; wherefore in the Arm the median vein is commonly chosen, although the Cephalick being less environed with other Vessels, is the more safely opened.

The Jugular Vein is almost always opened as often as blood is let in Beasts,* 1.657 it is a wonder it hath not obtained the same Custom in Man, when the large and eminent Pipe hereof may most easily and safely here be cut, because it neither hath an Arterie for its companion, and lies a great way from any Nerve. Moreover, from this vessel as from any other whatsoever opened, an universal evacuation of blood is made from the whole body, and together the best derivation thereof from the head, so that all the stagnations or aggestions of the Blood and Serum are discharged thence.

Concerning Vessels in the soot or the hand there is no great reason of choice,* 1.658 but take the vein which chiefly swells: it matters little concerning the Place, unless that if inci∣sion be made above, or near the Ankle, there is great care to be taken lest a Tendon be hurt, which sometimes by unskilful or rash Chirurgeons happens to the damage of the Patient. Moreover, let care be taken lest a vein be cut near its Anastomosis with an Artery, for if this be committed, the blood being entirely Scarlet, will impetuously skip out, and the flux thereof is not easily stayed, nor the orifice of the vessel soon stopt.

The chief places being thus designed of letting forth the blood,* 1.659 and the choice of the vessels being shewed, we ought next to treat of the Manner or Instruments by which blood is drawn out; which is used to be done either by a Lancet, in cutting the vein, or by suction by Leeches, or by Cupping-glasses after Scarification. But there is no need of discoursing these, because each of these parts of Chirurgerie are every where in familiar use by Quacks, Barbers and Women, and all things relating to them so commonly known, as a man his own house; wherefore we will speak but one word.

Helmont of late, and still certain followers of him,* 1.660 Pseudochymists and Fanaticks, have ejected Bleeding out of all Physick, because they think this evacuation to be a great injury to Nature, (which being aided either by her own strength, or by their Panacea's, they will have to overcome every offensive thing of her self;) Surely, this is no less ridiculous a thing than that long since Chrysippus, Apaemantes, Strato, and some others, (as Galen reports) damn'd this remedy, because a vein is diffi∣cultly known from an Artery. Truly it is manifest enough by sad experience, that in cutting a vein sometimes an Artery hath been pierced; whence either death or loss of the member sometimes ensues: the reason whereof is, not as is commonly alleadged, that the coats of an Artery being more nervous or membranous than the coats of a Vein, can scarcely or not at all be healed; when in truth that Vessel is en∣dowed with more and thicker fleshy fibres;* 1.661 but the cause is, that an Artery like the Heart it self, ought incessantly to shake and beat, the fibres thereof repeating perpetual turns of Systole and Diastole; wherefore, a little hole being made in its Pipe for the most part remains uncurable by reason of the continual motion of the Vessel, and the efflux of blood. It is otherwise in a Vein whose opening is immedi∣ately stopt of its own accord; for but little of contractive work lies in its Coats, yea this only, that its fibres being lightly opened as occasion serves, the blood flowing back of its own accord, is gently moved forwards; and after Phlebotomy, the ves∣sel being empty, they are permitted to be quiet, so that in the mean time the little hole made by incision is easily glewed together. Whenever Physitian or Patient do dread the opening of a vein to be administred, drawing of blood by Leeches or Cupping-glasses, will aptly enough and with like advantage supply the defect hereof. Moreover these administractions to remove the conjunct cause of a disease, where there is need rather of partial than general Evacuation or Derivation, are frequent∣ly preferr'd to Blood-letting it self. There is no need to dwell longer on explicating the manner and reafon of the effects of either of these operations, commonly enough known, but proceeding to other things, we will next throughly weigh the Time and Quantity of letting Blood.

The opportunity of letting blood is often of so great moment,* 1.662 that whereas this Eva∣cuation succeeds well at one time, at another it highly prejudices: But there are diverse respects of time to be considered about the due performance of Blood∣letting, but chiefly these four: The Time of the Disease, the Age, the Year, and Day: The first concerns chiefly the Cure of the Patient, the others the Preservation of him.

First therefore if blood ought to be let in any Disease,* 1.663 it will be chiefly sesonably about the beginning or encrease thereof, but not at all or very cautiously in the state or declination. For at that time whilst Nature is busied, endeavouring a Crisis, so that the Spirits are in great labour, and the blood ferments very much, that great endeavour of it ought not to be disturbed; and in the height of the disease, either Nature being Conqueress doth not want such a relief, or being subdued will not en∣dure such an Evacuation.

Secondly, If at any time for preservation it be deliberated touching letting blood,* 1.664 Infants, Boys, and Old men, by the Custon of all Nations obtain an exemption; also this evacuation was wont to be interdicted to pregnant Women, but now most commonly prescribed. Men of a vigorous Constitution and middle Age, do well enough endure Phlebotomy, and often times want it. Notwithstanding the first and second time it ought not to be done without great occasion, for that being once be∣gun and afterwards repeated, it will soon proceed into an inevitable Custom.

Thirdly, Hence they who used to let blood Spring and Autumn,* 1.665 afterwards cannot omit this evacuation without hazard. But to whom it will be either profltable or necessary to breath a Vein once or twice a year, the chief seasonable times will be in the beginning of Spring and Autumn, viz. when the Blood being prone to ferment anew, is in danger to change its Crasis. Phlebotomy seasonably administred, pro∣vides lest the Sulphur and Salts being exalted, it should contract a feaverish, scorbuti∣cal or other peccant distemper; likewise, lest suffering a flux, it should pour forth the serous Recrements, and other Feculencies upon the Brain, the Lungs or Bowels of the nether belly. About the Solstices, when our bodies are very cold, or hot, the blood, as the juice of all Vegetables, consisting in a more fixt state, and unapt to sweel up, ought not to be let out, unless upon some urgent cause.

But whereas some precisely, or rather ridiculously, observe about Phlebotomy,* 1.666 (even as the Countrey-men about Gelding Cattle,) the position of the Heavens, and the Aspects of Moon and Stars, it appears altogether frivolous; and for that chiefly is this Custom condemned, inasmuch as counterfeit Astrologers have a Figure in their Almanacks wherein every sign of the Zodiack, is allotted to every particular member of our bodies; and for that cause, under what sign the Moon is conversant, they for∣bid blood to be drawn from the respective part of man. They who observe without reason the Heavens, do erre (as the saying is) the whole compass of the Heavens. Moreover, this vulgar error is not only absurd, but frequently malevolent, inasmuch as many of the common people will abstain from Phlebotomy whatever indication makes for the same, if (as they say) the Sign be in the place of letting blood.

Fourthly, As to what relates to the time of the Day, in acute Disease,* 1.667 when a Phy∣sitian is sent for, and there be indication for Phlebotomy immediately to be performed, after the body is prepared, he may prescribe that operation any hour in day or night; but otherwise, if any interval may be allowed, then breathing a Vein rather is to be celebrated in a morning when the Stomach is fasting, the vessels emptyed by sweat in the night, the stream of blood being quietest, and appearing free from any ••••ous filth. Yea although necessity urge, it may be deferr'd a little untill the new Juice of things eaten be pass'd into the blood; for the vessels being emptryed-will not only snatch the crude Chyle into themselves, but frequently what is disagreeable or unproportionate unto the blood, whence not only its motion is difordered, but also the vital flame runs the hazard of being extinct. I have known some by Phlebotomy administred presently after plentiful Drinking, or pouring in of vinous liquors, to have fallen into dreadfull swoundings away, which have lasted very long, untill the vi∣tal spirit being almost overwhelmed recovered it self again.

Moreover, in the fifth place, the opening the vein being indicated,* 1.668 and its time appointed, there remains still no little consideration to be had, what Quantity of blood is to be let out, in which point there is most commonly a fault committed, while some being too audacious, and others no less timerous, they affix those bounds on this or that side of which for the most part consists the Right. For that I may

omit those who scarcely or not at all admit of Phlebotomy (as I have before hinted) so I cannot easily assent to their practice who fear not to draw blood to swounings:* 1.669 Be∣sides, an error of no light moment is committed within the moderate bounds, while in some cases blood is drawn by too sparing a hand, and in others with too free. In a burning Feaver,* 1.670 Pleurisie, Peripneumonia, Squinancy, Frenzie, Apoplexie, and other great diseases, that have their origine from a turgescency or phlegmonic incursion of the blood, a sparing Phlebotomy doth always more prejudice than advantage. For besides that it doth not remove the antecedent cause of the disease, to wit, the Plethora, it further causes the conjunct cause, viz. the inflammation and bursting out of the blood to be angmented. For truly it is a constant observation, that upon blood too sparingly drawn, the whole mass doth boyl up more notably, and doth acquire a new flux into the part affected; the reason of which is, that in a great Plethora many portions both of the Blood and Serum being thrust forward into recesses and strait places, are there constrained to abide; which, after the Vessels being a very little emptyed,* 1.671 do impetuously regurgitate into the mass of blood, and do much di∣sturb it, and force it more impetuously to and fro. Wherefore also in this respect the vessels ought to be very much empted, viz. that besides freeing the former Juice from straitness, also space may be given to the Juice reduced from exile, which other∣wise being not congruous, coming upon the blood, troubles it, and provokes it into effervescencies and eruptions. From hence we may observe, that almost all men grow more hot presently after Phlebotomy, and yet the blood being sufficiently evacu∣ated, a little after they enjoy a more temperate condition.

But as a slender withdrawing of blood in some cases is only vain, but is per∣formed with prejudice, so in other cases too much effusion is rarely committed scot∣free, and sometimes brings notable detriment of health. For when either strength languishes, or the body labours under a notorious Cachexia, we must spare Blood∣letting and its taking away is either prohibited, or being indicated by some accident, is allowed but in a small quantity. Wherefore in men endowed with a weak, tender and cold Constitution, and in consumptive persons, those affected with a long or malignant Feaver,* 1.672 also in Hydropicks or Cacochymicks a vein is not rashly to be breathed, at least if it be, much blood is not suffered to be taken away. It will be an impossible thing to prescribe general Rules, according to the particular cases of every individual person, whereby the quentity of letting Blood may be exactly proportion'd according to the strength of the Disease and the ability of the Patient; but let this be left to the judgment of the prudent Physitian present, and let his Commands be ever exacutly observed; And let not (as it every where is) such leave be given to Quacks, Empiricks and Barbers to play with humane life, who every where rashly and wic∣kedly use Phlebotomy; and if the blood spring more sreely and appear discolour'd, therefore bragging of the vessel being well pierc'd, they say it must be let out more plentifully, because it appears bad, when oftentimes on the contrary it ought to be spared.

As soon as the Quantity of Blood to be taken away is determined,* 1.673 our next care ought to be, that a more large orifice being made, the blood equally mixt may flow out as soon as may be; for otherwise, if it go out from a small hole, or drop by drop, or with a little stream, the mass of blood fermenting will separate into parts, and what is more subtile and spirituous will burst out, the thicker and feculent remaining behind. Hence it is to be observed, that the blood being let out of a large orifice with a more full stream, if it be a little stopt with the finger clapt on it, and a little after suffered to flow out, the blood going out the second time becomes much purer and brighter than the former, because in the interval of flowing, the more subtile par∣ticles being unfolded from the thicker, and accumulated together, have prepared themselves to fly away. Wherefore, if Hippocrates's Precept shall be observed, 'viz. to let it run to the change of its Colour, it behoves us to procure that it spring out quickly, with a full a not interrupted stream. Besides all this, as to what apper∣tains to the alteration of the blood let out, and cold, and to the inspection and the judgment thereof, for that we have often discoursed it in other places, we now pass it by, hastening to other things; and now the thread of Method leads us to entreat of Re∣medies opposite to Blood-letting, to wit Ischaemones, that is, those which are convenient to stop immoderate Haemorrhagies, whether engenderd by Nature or by accident.

SECT. III. CHAP. II. Of Remedies restraining or stopping of Blood.

EVen as Art imitates Nature in letting forth the blood by Phlebotomy offend∣ing in plenty, or temperament, or in its motion,* 1.674 so it succours her being dis∣eased or working wrong, by stopping the flux of blood whensoever it is im∣moderate or hurtfull. Whereas there are various and many species of an Hemorrhage, there is no need of Physick for them all. If perhaps a great effusion of blood happens by a solution of unity, excited by an outward accident, as a wound, or stroke, Chirurgery suggests the manner of Administrations whereby it should be restrained. Moreover, an Hemorrhage as long as it shall be Critical, ought to be disturbed by no Medicine, but left to the meer government of Nature (as long as she does aright use her power;) and as to the Symptomatic, whilest it is little or not much troublesome, there is required no Physick: notwithstanding there is great need of it, if at any time the Flux of blood be either immoderate, or flow out by unapt places.

Eruptions of blood of this last kind chiefly challenge a Cure,* 1.675 if perhaps the blood be cast upward by Coughing or Vomit, or downwards by seige, or thrown off through the Ureters. For in these cases, though the quantity of the Blood excreted, be not much to be dreaded, notwithstanding because often a dangerous or mortal Ulcer en∣sues the solution of the Unity so made in the Lungs, or in the Stomach, Guts, or in a Vein; therefore we must industriously rancounter those Hemorrhagies from their first appearance. Therefore among the Diseases of those parts,* 1.676 such bloody excreti∣ons are accounted; but we have already in another place delivered the Theories of Spitting Blood, and of the affection Dysenterical, and the reasons of healing them, so that there is no need to repeat them here; neither also to propound here a reme∣dy for bloody Urine, for that it belongs to the Nephritic Pathology; wherefore we will pass to those Passions, for which by reason of an immoderate efflux of blood, there is great need of restraining Medicines.

The kinds of these Affections are chiefly three, viz. Haemorrhage of the Nostrils,* 1.677 of the Flowers, and the immoderate Flux of the Hemorrhoids: The Cure of which last doth belong more to Chirurgery than Physick, and I think it best to referre the other to the hysterical Pathologie. Here properly belongs to this place the blood flowing out of the Nostrile, being the most general kind of passions of the sort,* 1.678 and common to every Age, Sex and Temperament, so that from the Diagnostick and Therapeutick of it duely assign'd, the uses and efficacies of Medicines stopping blood will best appear: for what we proffer for the unfolding the Causes and Cure of this bloody eruption, may be accommodated unto all other dreadful Hemorrhagies.

It is observable enough, that the Flux of blood from the Nostrils doth happen to most men from extraordinary occasions; for as oft as the blood, about to break out through its own turgescency, or through laxity of the vessels, is apt in some place to make or find its way, it is, by a certain instinct of Nature, very often directed to the Nostrils, as to the part most easily opened.* 1.679 The vessels from whence it flows in that place, are slips of the arterial Branch going from the Carotides, after having pass'd the Cranium, it comes to the basis of the Cerebrum; for this proceeding near to the mammillary Processes, sends very many twigs from it self every where about, of which some eminent ones passing the hole of the Sieve-like Bone with the smelling Nerves, are distributed through the glandulous membrane, investing the windings of the top of the Nose. These nasal Arteries departing first from the Trunk of the Carotides within the skull, anticipate part of the blood chiefly serous from the brain, and lay aside the Serum it self and other watery recrements into the glandules of the Nostrils, as into the proper Emunctories of that Region, whence they distill into the cavity thereof. Wherefore, if the mouths of those little Arteries do alwayes gape somewhat by reason of the sweating out of the Serum, it is no marvel if the blood it self being made more turgid, opening them a little more (which often are too loose of themselves) bursts forth of dores. Indeed this Emissary both of the Serum and of the Blood, being apt ordinarily to open, or on any occasion,

prevents or cures great incommodities of the brain, or of the Praecordia, yea and sometimes of the whole body.

For in the first place,* 1.680 this way the Serum (as I said) is derived from the head, and when the mouths of those Vessels are vellicated or provoked by any sneezing Medi∣cine put into the Nostrils, the Serum is from thence more abundantly drawn out; which yet doth not descend from the Brain (as is commonly thought) but is antici∣pated by these nasal arteries, lest it should go to it; from which when it is more plen∣tifully drained and brought forth by the use of Errhines, for that cause the Brain be∣comes more serene and exempt from vapours. Then secondly, lest the Brain should be overwhelmed at any time by blood more impetuously overflowing, a portion here∣of passing through these vessels and breaking out, easily prevents it.

But sometimes it happens that an Haemorrhage of this kind,* 1.681 rather becomes a Disease than a Remedy; for whensoever the blood flows out more often and more abundantly than is fit from the Nostril, if life be not immediately hazarded by reason of too great loss, yet the remaining mass of the blood being impoverished thereby, and losing its temper, acquires a cachectick and frequently an hydropick disposition; even as we have clearly intimated before, where we also have shewn the Aetiologie of this distem∣per in common with other too great Hemorrhagies, either to consist in the fault of the blood, or of the vessels, or of both together.

First,* 1.682 the blood bringing an Hemorrhage of it self, offends either in Quantity or Quality; and therefore while occasionally it boyls up, it cannot be contained within the vessels, but either opening their mouths by distending them, or unlocking them by its acrimony,* 1.683 it skips out: To which happens that the blood being sometimes dissolved in its consistence, and as it were infected, becomes unfit to continue the course of Circulation, inasmuch as portions thereof separating from one another, are partly fixed in the flesh or skin, having suffer'd death; and partly breaking out, stirre up frequently dreadful, and sometimes mortal Haemorrhagies, as every where is discovered in malignant Feavers, and sometimes in the Scurvy. Notwithstanding the blood offending by meer Quantity or Acrimony, unless the fault of the Vessels happening thereon provoke the flux thereof, or too easily permit it, seldom breaks out into a great Hemorrhage.

Therefore secondly,* 1.684 the vessels bringing blood, as often as they conspire to produce that affection, are usually in the fault, either first inasmuch as their small mouths gaping, by reason of the fibres being too loose and weak, do not readily enough transvasate the blood out of the Arteries into the Veins; which fault happens to scorbutick and cachectical persons; or secondly inasmuch as by reason of the same moving fibres being affected with the Cramp and Convulsion, the blood being snatcht impetuously to and fro, and chiefly towards the Head, is constrained to break out to continue the thread of circulation, even as it will plainly appear in the case of a Pa∣tient which shall be shewn below.

1.* 1.685 As to the Prognosticks, although an immoderate flux of Blood, in the Small-Pox, Measles, malignant Feavers, and in the Plague, doth ever presage evil, and is expedient to be stopt; notwithstanding it ought to be restrained not by meer cool∣ing or revulsory things, but to be chang'd by temperate Hydroticks into sweat∣ing.

2. An Haemorrhage of the Nostrils, though not great, is more dangerous in Ca∣checticks with a weak Pulse, and a cold sweat, than a plentifull Hemorrhage in men endued with a Pulse strong enough, and blood very fervent.

3. They who are obnoxious to this Disease, by reason of a Dyscrasie of blood and loosness of the vessels, if there come upon both these a convulsive disposition of the fibres of the little Arteries, they receive a far more difficult Cure, and frequently are reduced to extream languishings by reason of the great losses of blood.

4. From those who are feaverish, when much blood shall flow out of the Nostrils, and does not terminate the disease, often-times in the place of a Crisis a delirous or a so∣poriferous affection succeeds. There are many other prognosticks about a Hemor∣rhage accurately remarkt by Hippocrates, which notwithstanding properly belonging to the discourse of a Feaver, we omit in this place; for truly, the Cure in general of this Distemper is here almost only intended.

About which there will be three primary Indications,* 1.686 to wit, Curatory, Vital, and Preservatory; the two former respect immediately the symptom to be stopt, as often as it shall be urgent; and the last is busie about removing the Cause of the Disease,

that so the assaults of the Hemorrnage may be small, or not at all. Besides, an He∣morrhage ought to be handled one way without a Feaver, and after a different man∣ner if pressed with a Feaver.

Therefore whensoever without a feaver much blood shall flow out of the Nose,* 1.687 pre∣sently as there shall be need of stopping Remedies, there will be three chief intentions of Curing, all being together assumed into practice, viz. Let the turgescency of blood be bridled, that it may be less disposed into inordinate tendencies. Moreover in like manner let it be endeavoured, that as well its fluxion being withdrawn from the Nostrils may be diverted to another place, as that the mouths of the Vessels gaping within the Nostrils be shut: for which purpose Remedies as well external as internal very many and of diverse kinds are wont to be exhibited; of the former we will en∣treat in order briefly.

First therefore let the Patient be quiet, plac'd with his head upright,* 1.688 then let many of the Joints of his Arms and Thighs, but not all, be bound with strait Ligatures, which ought now and then to be loosened and removed to other parts; for all being bound together and long, by reason of the blood being held in the outward parts,* 1.689 and too much detained from the heart, hath caused most dreadful swoundings; but otherwise this Remedy being prudently administred, frequently helps. For when the blood by this means running into the members by the Arteries, is stopt, that it pre∣sently returns not by the veins, its more impetuous spreading it self into the head is impeded. Moreover, by the painfull Ligatures of the Joints, the muscular Fibres of the Carotides Arteries are preserved from Cramps which oftentimes come upon them.

Secondly, For diverting the tendency of blood from the Nostrils,* 1.690 it is sometimes expedient to breath a Vein in the Arm or in the Foot. For by how much more blood is carryed by the Arteries to the vein cut, by so much less will the afflux be towards the Nostrils. Yet this administration does not always so help, but sometimes a con∣trary effect thereof happens, as we have already observed in spitting blood. The reason whereof is, that the vessels being suddenly and not sufficiently emptyed, suck up again the disagreeable humours formerly ejected, and stagnating within the pores, whereby the blood incontinently is stirred up into a greater eruptive tur∣gescency.

Thirdly, Cold things applyed to the Forehead and Temples,* 1.691 also to the Nape of the Neck, where the vertebral Arteries ascend, cause the vessels to be bound toge∣ther, and the flux of blood to be somewhat stopt or repelled. Notwithstanding it is ill which some advise, that cooling Topicks be applyed to the Jugular Veins; for so the blood being retarded in its recourse, flows the more plentifully out of the No∣strils. Moreover, what is usual, to apply linty Cloaths, or a Spunge moistened with Vinegar, to the Pubes and Testicles, helps by no other means than the ligature of the members, to wit, inasmuch as the flowing back of the venous Blood is impe∣ded. A sudden and unexpected sprinkling of cold water on the face, frequently stops an Haemorrhage, inasmuch as it gives an impression of terror.

Fourthly, Cupping-glasses applyed upon the Hypochondres, Flanches,* 1.692 inner part of the Thighs, and the soles of the feet, are accounted a famous remedy as well with the ancient, as with modern Physitians, for diverting a tendency of the blood from the Nostrils. And the reason is plain, viz. because a Cupping-glass being put on, the impulse of air being prohibited by the space of the orifice, and encreased every where about, presently the blood and humours, yea and vapours, and solid parts, being call'd from any other tendency, are driven towards the empty space of the Glass.

Fifthly,* 1.693 Rubbing of the extream parts are commended in this distemper by some Practitioners, which we judge not always useful, nay scarce safe; because, although they solicit a greater appulse of the blood to the feet or hands, yet they so hasten the re∣turn thereof, that the whole mass of blood being raised into an effervescence, it ha∣zards a more violent tendency towards the Nostrils.

Sixthly, Zacutus Lusitanus among his revulsory Remedies,* 1.694 propounds an actual Cau∣tery to be applyed to the sole of either foot; and Crato the bending the little finger of the same side, which because done with no trouble we may try; but we advise not so of the former, unless the way of helping were more certain, which might com∣pensate the pain and lameness that would ensue thereon. Seventhly, Swounding raised by any means, presently stops an Haemorrhage,* 1.695 how∣ever

contumacious it be; wherefore when such bleeding persons are taken out of their beds, or when they do timorously admit of Phlebotomie, though but sparingly, or have their members bound for a longer time, or are suddenly affrighted with some feigned rumour, or by some other occasion fall into a swouning or fainting of the spirits, the flux of blood ceases thereon presently. The reason whereof is evident enough, for that as soon as the motion of the heart fails, presently the blood and spi∣rits rush thither, and so every outward flux is stopt on a sudden, and what was im∣moderate before, doth not again return.

Eighthly,* 1.696 In the last place, for repressing the flux of blood from the Nostrils, Reme∣dies ought to be recited, which are said to operate after an occult manner, by Sym∣pathy or Antipathy,* 1.697 of which sort first is the sympathetick powder, made of Roman Vitriol calcin'd to a whiteness by the Summer Sun; also a piece of wood cut from a young Ash first sprouting about the time the Sun enters Taurus; the efficacy of which remedy in the late Civil Wars many worthy of credit attest to have been ap∣proved for stopping the Hemorrhages of wounded Souldiers: Yea some still with much confidence prescribe it in all eruptions of blood. I confess the reasons of ef∣fects of this kind are concealed from me, if so be they happen often. Besides, it seems not a less Empirical and irrational Remedy, that a silk Bag with a dry Toad in it,* 1.698 worn on the pit of the Stomach, stops any kind of Hemorrhage, and prevents its return: unless (according to the Aetiology of Helmontius) that the application terrifying the Archaus, compells the blood being astonish'd, either to go back, or desist from its inordinate excursion.

There remain very many famous Medicines whose Operations are wont to be re∣ferred to hidden Causes and secret vertue;* 1.699 as are Necklaces of Blood-stone hung about the Neck, also the moss of a humane Skull carryed in the hand; Epithemes of the leaves of Nettles bruised and applyed to the soles of the feet, and the Palms of the hands; the Empirical administrations of which kind, when they may be admi∣nistred without trouble or cost, we make no refusal of; since in a dangerous case every thing is to be attempted; and applications of that sort do help sometimes in re∣spect that they fortifie the imagination of the patient.

While such like outward Administrations are used,* 1.700 for repressing or calling aside the flux of blood out of the Nostrils, also other Topicks are put up into the Nostrils, which may shut the gaping mouths of the vessels, for which use the injections of liquid things, Pledgets, Powders to be blown in, and Fumes are wont to be prescribed, which not helping, in the last place we descend to Escharoticks.

Ninthly,* 1.701 Among Liquids, not only first, but as good as all others is esteemed the solution of Vitriol in Fountain-water. Some boast this for a great secret, and a most certain Remedy. Indeed the same being applyed to a fresh wound, forasmuch as it shuts the ends of the cut vessels, by wrinkling them up, it restrains and presently stops the flux of blood. But that application in Hemorrhages of the Nostrils, where the blood being brought to the gaping mouths of the little Arteries, ought to be received by the Veins, in regard it shuts them as well or rather than those, it succeeds little, and sometimes not at all, as I have known it frequently experi∣mented. This Medicine is prepared of Green Vitriol, viz. of Hungary, or of our Countrey, also of the fictitious Vitriol of Mars dissolved in a sufficient quantity of Spring-water. I know some commend the solution of Roman Vitriol, which they not only apply by injection, but also to a linnen cloath dipt in the blood are wont to administer it sympathetically. Moreover the water of the infusion of white Vi∣triol prepared with Bole and Camphire, I have known to be used successefully as well in wounds, as often in other Hemorrhagies.

Tenthly,* 1.702 Since water cast into the Nostrils, doth not adhere enough to the mouths of the Vessels, but is washed away by the breaking out of the blood, before it can exert its Virtue, it is therefore more expedient either that a Styptick powder be blown in, or that a Pledget dipt in the water of Vitriol, either by it self, or strewed with an astringent powder, be thrust into the upper part of the Nostril. For this purpose many and several kinds of styptick powders have been prescribed, I have fre∣quently used either Crocus Martis calcin'd to the highest redness, or the powder of Camphorated Vitriol, or the vitriolic Soot scrap't from the bottom of an old Brass Pot, the powder whereof I have often used with success in this case. In obstinate He∣morrhagies not yielding to other remedies, let Pledgets, whose tops are dipt in Cau∣stick Colcothar, be put up deep into the Nostrils, that the mouths of the Vessels

being burnt, and covered with an Eschar, all flux of blood may be presently stopt. Many other Errhines to stop bleeding are accounted famous with Practitioners,* 1.703 as Hogs-dung, thrust into the Nostrils, which by the meer ill savour is thought to re∣pell the blood; also the smoak of Blood dropping on hot Iron,* 1.704 repercuss'd into the Nose, the Powder being burnt is also taken inwardly. The moss of a humane Skull unburied, put into the Nostrils, is commended by many for this effect: but these latter applications ought to be referred to the sympathetick Aetiologie, if they avail any thing.

These things concerning outward Remedies stopping blood, the vertue and effi∣cacy of which ought at the same time to be promoted by intern Remedies, seasonably exhibited and cooperating.

Therefore a slender Diet being instituted,* 1.705 and the Patient ordered to keep himself in an upright posture, or not much supine, while the aforesaid Administrations are orderly administred, medicines appropriated to the same end are also prescribed to be taken inwardly. There will be two scopes of Remedies of this sort, viz. 1. That the effer∣vescency of Blood whether incentive or fermentative being suppressed, the liquor there∣of being restrained within the vessels, may pleasingly circulate. 2. That the more impetuous motion of the heart driving about the blood too rapidly, may be dedpressed by apt Sufflamina's.

1.* 1.706 The first Intention requires Medicines that suppress the too much kindling of the blood, and appease the undue fermentation thereof, for which intents I usually prescribe the ensuing Remedies.

Take of the water of Plantane, red Poppy, Purslain, and frog-Spawn,* 1.707 of each four ounces, Syrup of water-Lillies two ounces, Sal Prunella one dram, mix them for a Ju∣lep, the dose three ounces three or four times a day.

Take Barly-water two pound, Red-rose leaves one handfull,* 1.708 Spirit of Vitriol what suffices to make it gratefull, or about half a dram, make an Infusion warm for extract∣ing the Tincture, adde Syrup of St. John's-wort two ounces: the dose three or four ounces, as oft as they please day or night.

Take leaves of stinging Nettles, of Plantane, of each three handfuls, pour upon them being bruised Plantane-water 6 ounces, press them strongly, let the strained liquor be taken.

2. For the second Intention, to wit,* 1.709 for the cooling of the heart too vehemently beating, Hypnoticks and Opiates are convenient.

Take water of red Poppies three ounces,* 1.710 Syrup of Diacodium half an ounce, make a draught to take at night. Or,

Take Conserve of red Roses an ounce and a half, Powder of Henbane, and white Poppy-seeds of each two drams, Syrup of Poppyes, enough to make an Opiate. The dose the quan∣tity of a Nutmeg every six or eight hours.

Take of Laudanum Cydoniatum one dram, the dose fifteen drops twice a day in a convenient Vehicle.

These things touching an immoderate Hemorrhage, and the Remedies thereof,* 1.711 when it happens without a Feaver: but that which coming in a feaver ought to be stopt in regard of the too great loss of Blood, is either Critical making an immoderate excursion, by reason of some accident, for which the Method and Medicines even now prescribed with caution and respect had to the Feaver may be accommodated; or meerly Symptomatical, which being excited in a malignant and Spotted Feaver, Small-pox, Measles, or the Plague, neither scarcely can, nor ought to be stopt with the Remedies above recited. For letting of blood is not convenient, repelling Topicks, also cooling Juleps, or Decoctions, and Narcoticks, have no place here: The chief intention of Healing will be to change the Hemorrhage into Sweating, for a gentle Sweat being raised, the flux of Blood often ceases, if it be not very dangerous.

Take water of Meadow sweet, Tormentil, of each four ounces,* 1.712 Saxons cool Cordial two ounces, Treacle water an ounce and a half, Acetum Bozoardicum three drams, Sy∣rup of Croal an ounce and a half, Confection of Hyacinths two drams, make a Julep, the dose six spoonfuls, every third hour.

Take of the Powder of Toads prepared half a dram, Camphire two grains, take it every sixth hour, with the forementioned Julep. Or,

Take Powder of Scarlet-cloth from half a dram to two Scruples, as before.

Take Consection of Hyacinths three drams, Powder of Scarlet-cloth on edram, Syrup of Corals enough to make a Confection; the dose the quantity of a Nutmeg every other hour.

Take of Bistort and Tormentil-roots, of each one ounce, the leaves of Meadowsweet, Pimpernel, Wood-sorrel, of each one handful, burnt Harts-horn two drams, Shavings of Ivory and Hart horn, of each two drams, boyl them in Spring-water from three pound to two, adding about the end Conserve of red Roses three ounces; the dose three ounces being strained, often in a day.

2.* 1.713 Hitherto of the first Indication Curatory, together with the scopes of healing, and forms of Remedies, appointed for a Haemorrhage of the Nose happening with or without a feaver. The second Indication Vital only prescribes a slender Diet, tem∣perate Cordial,* 1.714 and a fit handling of the Patient. The Provision of the first is so small and easie, that there seems no need to appoint a Measure and Rules for it par∣ticularly. About the latter the chief question is, whether we ought to retain them within or out of their beds. Without doubt the languishing, and those obnoxious to often swounings, are not to be roused up, unless (as we have already hinted) it be for a Curatory attempt: as to others less weak, it seems so to be determijned. Those whose Blood does not easily transpire by reason of the constipation of the pores,* 1.715 and is incited into a greater turgescence from the heat of the bed, and proner to break out, it will be expedient they not only remain out of bed while bleeding, but also sometimes through extern applications to be cooled in the whole habit of their body, or at least in most of their members. Wherefore, Fabritius Hildanus relates he suddenly cured one of a great Hemorrhage of the Nostrils, after many things tryed in vain, by putting him into a vessel of cold water. Also with like success Riverius cured another affected in like manner, being taken out of his bed, and laid on a woollen Matte on the Pavement, he bathed his whole body with Linnen dipt in Oxycrate. Yet this method is not alike convenient for all persons, or at all seasons; but on the contrary, those whose blood is halituous, and enjoying more open pores, doth evaporate easily, mnad being wont to be dissolved by a more moderate heat encompassing them, into sweat, and from thence find themselves more quiet, it is more convenient that they remain within the bed, not only while the blood breaks out, but as long as there is danger of its return. For this reason it is, that many obnoxious to dreadful Hemorrhagies, during the Summer, when they tran∣spire more freely, live exempt from that disease, but the Winter cold pressing them, by reason of their pores being bound up, they suffer under more frequent and dread∣ful Invasions.

3.* 1.716 The third Indication Preservatory, which regarding the removing the Cause of that disease, either stops the eruptions of blood, or renders the same more rare, or less, and suggests these two Intentions of healing, viz. 1. That the blood being restored to its due temperament and mixture, may quietly circulate within the ves∣sels, without turgescency and breaking out. 2. That the Vessels carrying Blood, as to the structure of their little mouths, and the tenours of the muscular fibres, may be contained in their due state; so that they neither cause those inordinate tenden∣cies of blood towards the Head, nor suffer effluxes out of the nose: For both these ends too great plenty and impurity of the Blood are carefully to be provided against by Phlebotomy and Purgation seasonably used; afterwards for procuring and con∣serving its good temperature, the following Alteratives may be given at fit seasons of healing.

Take of Conserve of red Roses,* 1.717 of Hipps, an. three ounce, powder of all the Sanders an. half a dram, Coral prepared one dram, of the reddest Crocus Martis two drams, Sal Pru∣nella four Scruples, with Syrup of Coral, make an Electuary, take the quantity of a Chesnut early in the morning and at night, by it self, or drinking after it three ounces of the following water.

Take the tops of Cypresse, Tamaris, an. eight handfuls, St. Johns-wort, Tamarisk, Horsetail an. four handfuls, of all the Sanders bruised an. one ounce, of the Crum of White∣bread two pound, slice them small, and pour on them of new milk eight pound, distill

in a cold Still, sweeten each dose when taken with Syrup of the juice of Plantane.

Take leaves of Plantane, Brooklime, stinging Nettles, of each four handfuls, to them bruised pour half a pound of the foregoing water, of small Cinnamon-water two ounces, press them strong, the dose three ounces to four, at Nine in the Morning, and at Five in the Afternoon.

Madicines of this sort are taken in Spring and Autumn for twenty or thirty dayes, with sometimes a gently Purge coming between. In Summer let them drink Mineral Steel-waters for a Month, than which in this case there is not a better Remedy. Out of many Examples of persons labouring with an Hemorrhage, we only propose this one singular case.

I was lately consulted at a distance for a certain Gentleman that had suffered fre∣quent and great eruptions of blood, one while at the Nostrils,* 1.718 anotehr while at the Hemorrhoid Vessels. He had frequently used Phlebotomy by perswasion of his friends, without benefit; yea frequently falling into cold Sweats and Swounings after breathing a vein, and notwithstanding obnoxious to eruptions of blood, he was wont to be much worse. I prescribed Juleps (having not yet seen him) and cooling Decoctions, and Anodyhnes, also the juicy expressions of herbs, and other things cooling the blood, but even from these, (as if all still far enough from the scope) he was nothing the better. At length being sent for into the Countrey to visit him, I found the affection under which he suffered to be meerly or chiefly convulsive; for whereas he daily bled, his Pulse was weak, the extreme parts cold, and all his Vessels as being too much emptyed fell flat;* 1.719 also the patient was affected with a continual Vertigo and trembling of heart, and by and by with a swouning or fear of it. Really the blood was so far from breaking out by reason of turgescentce, that rather the stream thereof being de∣pressed and small, it seemed scarce enough to sustain the current of Circulation. Not∣withstanding the truth of the matter was, he was often sensible of something in his body creeping one while upward, another while downward like wind, and for the most part the flux of blood out of his Nostrils or Hemorrhoids, followed the tendency of that motion: henced it was easie to conclude, that the moving fibres of the Vessels carrying blood, by which they are contracted, being affected with a Convulsion, did disorderly convey the stream of blood however small and low, to and from, and so compell it into Eruptions: which also happen'd the easier, inasmuch as the mouths of the vessels being laxe and gaping, suffered the blood forc'd into them to flow out without any due resistance.* 1.720 The instituted method of Curing did plainly approve of this Aetiology, inasmuch as it happily succeeded, leaning on this supposition; for Blood∣letting, and the use of Medicines stopping blood being at last omitted, I prescribed the use of the ensuing Powder, a dose whereof he took every sixth hour with a fit∣ting Julep.

Take the powder of male Poeonie, red Coral, Pearles, of each one dram, Ivory, Crabs∣eyes, Blood stone of each half a dram, Lapis Prunellae one dram, make a Powder, the dose half a dram.

Take of Black-cherrie water eight ounces, Balm, Barly Cinnamon-water, of each two ounces, Treacle-water one ounce, Syrup of Coral an ounce and a half.

But I commanded that Ligatures should be applyed to certain places by a constant course, and by and by to other places as occasion should be given, as well to stop as to intercept the Convulsions of the Vessels; and by remedies of this kind, and means of administration, he recovered his health in a short space, without any return of the disease.

SECT. III. CHAP. III. Of Vesicatories.

OF losing Blood by Phlebotomy, whensoever it is troublesome and injurious, and swells too much, and tumultuates within the vessels; also of retaining it by Medicine s stopping Blood, as often as being outragious it rages too much of its own accord and flows out, we have hitherto largely discoursed. There remain other certain humours, viz. Nervous and Nutritious, as also Serous, and other recrementitious ones which are wont to flow within the Brain and Nerves, and as well in the nervous fibres, as the fleshy, yea and within the Pores of the skin and of the solid parts, which being often depraved or hindered in motion, require emission, being otherwise about to raise great troubles or pains, and frequently dangerous Diseases. Wherefore, that we may seasonably rencounter distempers that are about to rise or take their origin from thence, Physick hath found out certain other Emissa∣ries, mediately or immediately deriving the forecited humours out of the parts and places where they shall offend. And those are either continual, viz. Fontinels of di∣verse kinds, which are as it were perpetual Drains, and pour out continually the Ichor; or they are temporary, when as occasion requires, the Scarf-skin being taken away in some part of the body, the extremities of the vessels in the skin are made naked, and withall so provok'd, that they spue out in great abundance the serous humours of a various descent and disposition, and so continue to evacuate the same for some time, one while longer, another while shorter. But such a manner of draw∣ing out the serous humours from the outward superficies of the body or any part thereof, is wont to be procured gby Medicines called by the Ancients Phaenigms, or Sinapismus,* 1.721 by Moderns Vesicatories; of which in the first place we will treat here, (because the knowledge of these leads the way to the Doctrine of Fontinels) and we will chiefly insist on unfolding these three things; viz. First, It shall be shewn, from what Bodyes, and after what manner disposed, Vesicatories are wont to be prepared. Secondly, Whereas they are of diverse kinds, it shall be decalred what is the manner and reason of their operation in every one, or at least in the chief of them: Third∣ly and lastly, we will make search for the curing of what sort of Distempers they ought to be appointed, and in what places applyed.

1.* 1.722 As to the first, the most simple Blisterers are either Fire, or soled Bodies, or Liquors endued with fiery particles; (which are seldome administred for this use by reason of the terror which they impress, and the imminent danger, lest being more strongly apply'd, they do not only blister the Scarf-skin, but burn the skin and other parts.)* 1.723 Let therefore what is safer and less dreadfull, Epithemes out of Concretes having more sharp and (as as is affirmed) potentially fiery particles, be applyed to the places to be blistered, which are either milder, and by the Ancients were call'd Phaenigms, because they made the part red, the scarf-skin taken away; or were call'd Sinapisms in respect of the matter, and were wont to be prepared of Mustard, Pidgeons-dung,* 1.724 Squills masht, Garlick, Milk of Figs, and the like; or they were stronger, and consisted of Euphorbium, Cantharides, Flammula Jovis, Crows foot, great∣er Plantane, with many others, which being endued with a certain burning and cau∣stick quality, are used outwardly for the use above recited, but taken internally, they prove venemous and frequently mortal.

The Composition and forms of things drawing blisters are reported to be mani∣fold and of sundry kinds, although one or two may here suffice, and by how much the more simple, the better; and in most cases for the most part 'tis all one which you use: notwithstanding we shall after our manner annex some select Prescriptions of these kinds of Remedies. And that we may say little of Dropaces, Sinapisms, and Phaenigms, whose use is almost exploded; almost all Vesicatories now in use have Can∣tharides for their Basis.

Take powder of Cantharides half a dram,* 1.725 to a dram, powder pf Ameos seeds one scruple, of old Leaven kneaded with Vinegar, enough to make a Plaister, spread some of it on

Leather, apply it twelve houns to the place to be blistered. This works certainly and strong enough: but because it is lessx compact and sticking, and may fall from the place to which it is put, or is apt to crumble, therefore for the more commodious application, this following is very convenient, and now in use with most.

Take of Cantharides three drams, Euphorbium half a dram, powder of Ameos seeds one dram, let be incorporated with Melilote-Plaister by a warm hand, as much of this powder as it is capagble to receive, then spread it on Leather, and apply it for twelve or six∣teen hours.

Some do use to incorporate the foregoing powder with Burgundy Pitch,* 1.726 and spread it upon Leather, afterwards to cover the sides with red Sanders incorporated with Burgundy pitch, and so administer both a Dropace and Vesicatory. Also by applying still the same Plaister, the Scarf-skin being blister'd and taken off, and the place being red, and ulcerated, and only wiping it once or twice in a day, and put∣ting it on again, they cause the little Ulcer raised by the Vesicatory, to flow at plea∣sure, yea sometimes above a month, and to throw off a plentiful Ichor.

Others inclose Cantharides bruised, and sprinkled with Vinegar in Silk, and apply to the place.

Some Empiricks use in the room of Cantharides a mass of the leaves of Crow-foot, or flamula Jovis bruised on the place, by which the Scarf-skin being blistered, or ra∣ther eaten, the skin it self, as if toucht with an actual fire, is much inflam'd and deep∣ly ulcerated; whence not only a profusion of Ichor but an inflammation of the whole member, and a feaverish disposition sometimes follow: wherefore these things are not to be used rashly.

2.* 1.727 If it be enquired of the manner and reason how these and other Vesicatories operate: in the first place we ought to shew by what manner actual Fires, and things endued with particles proceeding from Fire, do raise a blister; then by an easie Analogy the force and manner of working of those sorts of remedies will be known, which are reported to be endowed with a potential fire. Wherefore we observe of the former, that the fiery particles not being too vehemently applyed, penetrating the Scarf-skin without dissolution of unity, enter under the skin it self,* 1.728 where the extremities of the vessels bringing blood, of the Nerves, and of the nervons Fibres are terminated; and there do variously twist together these, altering them from their position, and pervert the structure of the whole texture of the skin: insomuch that from all the vessels being made angry in a high degree, the watery humour being imbued with igneous particles, and therefore rejected, as well by the blood as by the nervous Juice, is spued out in great abundance: This Lympha, because it cannot pass through the Scarf-skin, separates it from the skin, and raises it into a bladdery bulk, from which at length being broke of its own accord, or occasionally, it flows out. Moreover as long as the igneous particles adhere to the skin, and the mouths of the Vessels, being covered with an Eschar, are not closed up, these being continually twitched by them, do continue to spue out the Ichor. This kind of ichorous flux will the sooner cease, if immediately upon the hurt inflicted, the fiery particles be drawn out, by the application of some proper Antipyretick, as Fire it self, Nitre, Soap, Onions, and the like. Moreover it runs the longer, if omitting an Antipyretick, me∣dicines hindering the generation of a Cicatrice, or of the outer-skin, and unlocking the mouths of the vessels, be worn upon the place affected.

By these it is easie to understand by what manner Vesicatories perform their ope∣ration,* 1.729 viz. Cantharides (as likewise any other of the same vertue) being outwardly applyed, and being heated by Effluvia's of the parts subjected, and so being provok'd to exert their power, do plentifully dispatch sharp and as it were fiery particles from themselves, which penetrating the Scarf-skin without any tearing it, they are dashed against the Cutis or other skin, where first they act upon the Spirits, and then by the affecting these, upon the Humours and solid parts. They very much provoke the Spirits, and drive them into painful Convulsions of the fibres, dissolve the Hu∣mours, and constrain them to separate into parts, so that the watery part being very much embued with those sharp, and as it were venemous particles, is rejected every where by the other Juice; and when in the mean time the ends of the Vessels and Fibres are either eaten by the burning, or opened by twitching, and as it were drain∣ed, that Ichor conveying the hurtful particles is plentifully spued out of their little mouths; which then separateds the impervious Cuticula or the Scarf-skin, from the

other skin or Cutis is self, and raises it into a little bladder, and after this being beoken and taken away, it is for some time poured out by the ulcerated shin (as we shewed it to come to pass by reason of the particles of fire.)

But this is not only done, because the serous Juice imbibing the sharp parts of the Medicine, and conveying them out, doth not always bear them all back the same way by which they entred, but sometimes this being endued with these stings, regurgi∣tates into the mass of Bloodl; and afterwards being circulated with it, and ejected with its infestous burden through other Emunctories,* 1.730 offends some weak or tenderer Channels in its passage or going forth; from whence very many contract a Strangu∣ry, from great or many Vesicatories, by reason of the urinary passages being affected for that cause with Acrimony or Erosion, which in some becomes most sharp and in∣tolerable. Also that application sometimes brings bloody Urines to others afflicted with the Stone; hence a suspicion also arises, that those who have tender Lungs, or who are subject to a Consumption, are much endagered by this Medicine outwardly applyed; which notwithstanding I have not known happen to any; but can reather attest by frequent experience on the other side, that it redounds to advantage ra∣ther than hurt. For the more sharp particles of Cantharides, if they be long ap∣plyed, being sometimes imbibed more plentifully by the blood, infect its whole Serum: which Juice so sharpened, as long as it is confounded with the Balsamick blood, hurts no part; but being separated from it by the Kidneys, it sometimes brings hurt to them, and frequently not only twitches the neck of the Bladder by its Acrimony, but sometimes corroding it, causes filth, and little skins, nay and blood to come away: but in the mass of blood, the same more sharp, saline-volatile par∣ticles do often most notably help; inasmuch as they destroy the fixt or acid Salts in it, and unlock the consistence of the blood too much bound up, and so do cause the serous and other morbific recrements before wrapt up with it, to be separated from it, and to be more easily dispatched by Urine and Sweat;* 1.731 hence Vesicatories being ap∣plyed long in Feavers do call forth plentifull Urine and a more easie Sweat. Also they open the obstructed wayes, and move together the portions of Blood or Se∣rum, stagnating or being extravasated in any place, and restore them to their Circu∣lation. Wherefore they are not used only to help in serous maladies, but also in those of the blood, yea in a Pleurisie, Peripneumonia, and in any other Fea∣vers.

Having hitherto shewed after what manner Vesicatories operate first on the Spirits, and then on the Humours and solid parts, it is now our business in the next place to shew both the good and evil effectgs of them, as also the manners of using them. But that they in the first place operate on the Spirits is manifest from hence, that they exert no power on the deceased, and it is an ill Omen in those that are lan∣guishing, when Vesicatories have no operation, because it is an Indication that the Animal Spirits are much dejected, or abundantly diminished.

Thereofre,* 1.732 it behoves to consider about the due unfolding the energy, force or virtue of this remedy, what humours it either immediately or mediately evacuates or alters; and afterwards in what Diseases, and bodies how disposed it either pro∣fits or hurts.

First,* 1.733 As to the former, the humours that are immediately sent out by a Vesicatory, drop forth partly from the pores and glandules of the Skin, and partly out of the mouths of the little Arteries, and partly out of the extremities of the Nervous fibres; perhaps some little of the Juice newly received, out of the mouths of the veins, though not much, seems to be carryed back. The humours mediately drawn out by a Vesica∣tory are those which the aforesaid parts being emptyed receive elsewhere, and derive them forth.

1. The Skin is a thick Memgbrane consisting of a double Coat, very porous, also thick set about with most numerous galndules, with fat, as also the ends of the Ves∣sels and fibres being terminated therein, and thickly woven one within another. Wherefore, while a portion of it is made bare, the Scars-skin being taken off with a Vesicatory, and the nervous sibres being twitched, do bind together, and wreath the glandules and pores, the serous humour contained in both, is most plentifully squeezed out. And whereas some pores are pervious into others, the Serum doth not only flow out of the place blister'd, but sometimes into the little holes first so empty∣ed, a portion of the Serum coming from the neighbouring pores succeeds, and thence by and by sweats out: wherefore in Patients affected with an Anasarca, the little

ulcers raised by a Vesicatory, exhaust the waters every where in great plenty; and draw them out of the neighbourhood, yea and sometimes at a great distance.

2.* 1.734 The little mouths of the Arteries being uncovered and twitched about the blistered place, do not only vomit out a portion of the Serum brought to them, by ordinary custom, but the serous liquor being imbued with the Stimula of the me∣dicine in the whole mass of blood, immediately is separated more plentifully from the blood; and at every turn of Circulation a greater plenty thereof is thrown out by the same mouths of the Arteries continually irritated:* 1.735 Moreover together with the Serum as it were so stagnating, and therefore removed from the whole blood in∣to the little ulcers of the skin, other recrements and sometimes the morbific mat∣ter it self depart in plenty, and are dispatched forth by the same Emissaries; and for this reason in malignant feavers, yea in some putrid, that are difficult to be judged of, when the recrements and corruptions of the blood, unapt to be thrown off, do threaten the Praecordia or Brain, Vesicatories continually and leisurely draining it, do frequently yield notable relief; whereunto we may adde, that they do also alter and restore (as we before mentined) the blood degenerate or depraved as to its Salts, and also by opening or subtiliing its consistence, dispose it towards an Eucrasie; wherefore, not only in a seaverish state of Blood, but also in a state otherwise pec∣cant, or of ill Juice, this kind of remedy is often extreamly convenient.

3.* 1.736 Both reason and experience have enough proved, that Vesicatories evacuate a certain humour from the Nerves and nervous Fibres, and for that cause profit very much in convulsive distempers: For surely we have in another place clearly enouth demonstrated, that the watery liquor of the Brain and Nervous sytem, doth sometimes abound with heterogeneous Particles. Also it is manifest by frequent and familiar observation, that the impurities and recrements of that liquor, together with the watery Juice, do spontaneously sweat out from the Nerves and nervous Fibres, when the fluor is raised, and either restagnating within the mass of blood, are car∣ryed off by Urine or by Sweats, or being deposited within the Cavities of the bowels, are dispatched by Vomit or Stool. Wherefore, when a Vesicatory is applyed, the extremities of the Nerves and nervous Fibres being made bare, and very much angred, immediately a humour abounding near their ends is voided; and also the whole Juice planted within their passages by a long succession, is chafed, and deli∣vered from stagnation; and the heterogeneous particles mixt with that nervous Juice, being every where agitated and derived from the Brain, slide towards their newly opened Emissary, by degrees, and at length are removed wholly forth.

From these things we may collect,* 1.737 for the Cure of what Diseases this kind of re∣medy doth chiefly conduce; for by reason of its evacuation out of the pores and glan∣dules of the skin, as often as any serous, salt, sharp, or otherwise hurtful humour is collected in those parts, or their neighbourhood, and being excluded from the Circu∣lation of blood, shall obstinately stick in that place, surely there is no more ready or easie way afforded for drawintg it forth, than by applying a Vesicatory,* 1.738 upon or below the place affected. Wherefore, it is not only indicated by an Anasarca, or by any foulness or eruptions of the Skin, but moreover a Vesicatory is required for pains either arthritical or scorbutical, fixt any where in the extern habit of the body, or in any certain member.

Secondly, In respect of the Blood, Vesictatories are always used in malignant Fea∣vers,* 1.739 as well to purge out leisurely any heterogeneous or morbific matter, as to change it from a disposition either too acid, or salt, or otherwise peccant, into a right tempe∣rament; yea they are of most excellent use in all putrid feavers of ill habit and hard to be judged of. Also for that cause in the Scurvy, Leucophlegmatia,* 1.740 Pica Virginum or Green Sickness, also in any other ill habit of body, this kind of remedy affords frequently notable help. Moreover not only for the sake of correcting the blood it self, but besides as often as it being depraved spreads its corruption on other parts, and so doth first beget diseases in the Head, the Chest, the nether Belly, or Members, and then excites their Fits, Vesicatories are usually exhibited with success. Wherefore it is a common remedy in Head-aches, a Vertigo, and soporiferous affections, no less than in a Catarrh or any defluxion either into the Eyes, Nose, Palate, or Lungs, in which every one without consulting a Physician, will prescribe to themselves Cantharides for Re∣vulsion. I confess, when I have often been surprized with a great Cough, with abun∣dant and thick Spittle (whereot I am originally obnoxious) I have received relief from no other Remedies more than from Vesicatories; wherefore I am wont, while

that distemper doth urge, to apply Medicines drawing blisters first upon the Ver∣tebra's of the Neck, then those little Ulcers being hcaled, beneath the Ears, and afterwards if need require it upon the Scapula's; for so the serous filth loosened from the consistence of the blood sweating forth, is derived from the Lungs, and also the mixture of the blood sonner recovers its temper, inasinuch as after this manner its enormous salts are destroyed.

Thirdly,* 1.741 In respect of the Humour, Epispasticks, as they are of most common use, so they are wont to confer great help, in soporiferous, convulsive and painful distem∣pers, for deriving and evacuating it out of the nervous stock and the brain it self. Was ever any surprized with a Lethargy, Apoplexie, or Epilepsie, but that imme∣diately Friends and Attendants however unexpert, have tormented his Hide with the application of Cantharides? In stupendious convulsie motions, ascribed usually to nothing less than Witchcraft, I have applyed Vesicatories with great benefit in many parts of the body at once, and I have continued them above a Month, pre∣sently renewing them in fresh places. And also pains that are fixt and most fiercely tormenting in the membranous parts, are seldom cured without this administration. For sometimes morbific humours and Particles which being deeply radicated, yield nothing at all to Purgers or sweating Medicines or Diureticks, yet have seemed to have been pulled up by the roots by Vesicatories, as it were remedies laying violent hands on the disease.

But this Remedy although most general is not used to operate so easily and happi∣ly in some Diseases and Constitutions;* 1.742 wherefore we may not rashly or indifferently use it towards all persons. For those who are Nephritick and obnoxious to a frequent and painfull Strangury, scarce ever endure the application scot-free; wherefore, on those that are so affected we must not use Vesicatories, unless in malignant Feavers, or acute Cephalick Disea2es, for avoiding the greater Evil.

As to what relates to the various Temperaments and Constitutions of men in re∣spect of which Vesicatories are used to be more or less convenient or advantageous:* 1.743 Concerning these, this threefold notable difference occurs. In the first place, some persons for the most part endure well the use of this Medicine, and the little Ul∣cers raised thereby in the skin, sweat out an Ichor sufficiently plentfull witout any Dysurie, or great Inflammation of the place blistered; and then heal of their own ac∣cord; which effect succeeds only in blood of a good temperament, where, to wit, the Salt and Sulphur being moderately and rightly constituted, there is present an abun∣dant plenty of Serum; whose Juice easily and more largely separating from the rest of the blood, carryes away the sharper particles of the Medicine imbibed with it self, and partly sweats them out through the placd blister'd, and partly conveys them out without prejudice by the Urinary passages; therefore also the advantagious effects now recited are produced in the mass of blood.

2.* 1.744 But secondly this remedy with some doth nither well agree, nor operate pro∣fitably; because it rubifies the place very much to which it is applyed, or rather ex∣coriates it with most fierce pain and great inflammation; notwithstanding the little ulcers made in the ssme place, although they do for some time torment the patient, yet pour out very small or scarce any Ichor: Also to these always blister'd with tor∣ment, for the most part a violent Strangury happens. The use of these Vesicatories being troublesome and unsuccessefull, doth frequently to men of a cholerick and hotter temperament;* 1.745 whose blood is endowed with a plentiful Salt and Sulphur, and a small quantity of Serum, being more throughly concocted with the rest. Where∣fore, when the Juice that ought to carry away the more sharp particles of the Me∣dicine, doth neither easily nor plentifully pass from the rest of the blood, (that it may speedily wash them out) those particles sticking still in the skin, do as it were infect and impoyson the blood it self, passing through, and for that cause beingimpeded from its circuit, they cause it to stagnate, and to be gathered together about the ex∣tremities of the Vessels, whence they are inflamed. Moreover the serous Juice being separated by the Kidneys when of it self it is little and sharp, and besides becomes sting∣ing from the particles of the Medicine, it irritated the Neck of the Bladder, and fre∣quently corrodes it by its acrimony.* 1.746

3. There remains a third Case although more rare, relating to blistering, to wit, in whom little Ulcers beling raised in the skin, presently pour out the serous humour in so great abundance, that in a little time it will be necessary to give repelling Medicines, and that shut the mouths of the Vessels; otherwise, from too much flowing out of

waters, a dissolution of strength, and a fainting of the Spirits are in danger to ensu. This I have known so constantly happen to some Patients, that afterwards I was fain to restrain their use of Cantharides although there was need of them; the reason whereof seems to be, that the blood being endowed with a salt Serum, and more sharp than it ought to be, hath a consistence too easily dissolved: wherefore, that se∣rous juice being sharp, and fretting of it self, as soon as it is provok'd by the par∣ticles of the Medicine loosening the consistence of the Blood too easily dissolved, im∣mediately breaking out with violence from the mass of blood, wheresoever there is a passage afforded, it flows out with a full torrent through the mouths of the vessels gaping in the blistered place. Besides this too much flowing out of the Serum,* 1.747 raised from the first application of the Vesicatory, sometimes happening late in malignant Feavers, and in others ill, or not at all judged, and remaining a good while, wholly consumes the morbific matter, and delivers the Patient from the jaws of Death. In such a Case after the little Ulcers for the first days have poured out little or a very small quantity of Ichor, at length Nature attempting a Crisis by this way, a vast Illuvies of Serum flows out from the same; and so sometimes for many dayes, nay weeks, continues to flow out, untill the Patient before accounted desperate, recovers his entire Health. Little Ulcers so abundantly flowing, as it is not easie,* 1.748 so it is not safe to stop them before the whole Mine of theDisease be consumed. Not long since, a famous Doctor of Physick in London,* 1.749 searcely recovering from a malignant Feaver, did copioufly sweat out lchor daily from places blistered in several parts of his body; after some time (they being troublesome and tedious) he did apply stronger Repercussives to them all, and immediately restanined their flux. Those sluces were scarce two days stopt, but his disease revived, and on the sudden he was affected with sainting of Spirits, and often swooning, a cold Sweat, and a low weak Pulfe: and whereas he could not be relieved by any Remedies, however cordial they were, hd dyed within three days; the cause of which seems to be, that the malignant matter being suddenly repercussed, fell into the Cardiac Nerves, whose action being hindred, the vital function quickly failed.

SECT. III. CHAP. IV. Of Fontinels, or Issues.

BEsides Vesicatories, which being as it were the extemporary Emissaries of the Serum, and other humours externally to be brought forth, are only raised upon some occasions, and then after their efficacy a little shewed, are per∣mitted to be dryed up; there are others esteemed as it were continual Foutains,* 1.750 therefore named Fonticuli or Issues, out of which the Ichor or ferous houmour flows with a constant Sping. Those former, as they are requisite for the most part for Cure-sake in acute or other Diseases, whose morbifick matter requires a quick dis∣patch, in the first place respect the conjunct cause of the Disease to be removed; and therefore being more broad, are made only superficial, that such little Ulcers being large, may evacuate much, and then easily be healed: but on the other side, Issues being chiefly indicated for preservation, are ordained to remove or vanquish the procatarctick cause of the Disease: wherefore they consist of a more narrow orifice, but made more deep through the thickness of the whole skin, to the end, that while they send out the morbifick matter in lesser quantity, they may derive it further, and continue longer to purge it out.

There are three chiefheads of disquisitions concerning Issues, viz. First,* 1.751 what humours these Emissaries chiefly evacuate, and whence they bring them: Secondly, in what Diseases or Constitutins, they better or worse agree: Afterwards Thirdly in what places, in what from, and with what instruments they ought to bre made.

1. As to the former, Issues, like Blisters,* 1.752 purge out all humours fixt within the skin, (although in a less compass,) or brought through it as well by the sanguife∣rous, as nervous Vessels, not only as they provoke, or as it were suck the outer su∣perficies of the skin, but by piercing through the whole hide or skin, they convey

out whatsoever flows from the sides of the orifice through the broken Vessels, also whatsoever slides down elsewhere beneath the orifice. Wherefore not only humours accumulated within the pores of the skin, or glandules, or brought thither by the Arteries, or Nerves, have conflux to Issues; but moreover the serous recrements un∣der the skin, that are wont to be tranferr'd, or creep between the interspaces of the muscles and membranes from place to place, tend every where unto them and find passage. Moreover an Issue appointed in the way anticipates morbifick humours, which were formerly wont to be conveyed to other weak and long afflicted parts, and by such means exempts one while this part, another while that, from their inva∣sion. Hence either a Gouty, or Nephritick, or Colick matter, and sometimes a Pa∣ralytical, or otherways scorbutical, are frequently intercepted by Fontinels, in their passage from their Source to their nests or places of residence, and so are conveyed forth, and the usual assaults of a disease declined: Neither doth this Emissary less purge from thence by degrees the humours impacted in any part or region of the body, and there causing prejudice, than water-furrows made for derivation of moisture, and so prevent or cure a sickly disposition.

2.* 1.753 From these several accounts of assistance, whereby Issues in general are wont to help, it is easily collected, for what distempers they are chiefly required; for although there is scarce any disease happens, wherein this remedy is either hurtfull or unprofitable, notwithstanding it seems rather more necessary in some cases than in others. It is commonly prescribed for almost every disease of the head, whether outward or in ward: Every one of the ordinary people procures an Issue as equal to all other Remedies, for the Convulsions of Infants, or Youths, for Sore-Eyes, Kings∣Evil, as also for Head-ache in persons adult or ancient, for drousie, vertiginous or Cramp like distempers. Neither is it less celebrated against diseases of the Breast; As who is obnoxious to a Cough, bloody or consumptive Spitting, or an Asthma that long enjoys his skin whole? In like manner Issues are commended in affects of the lower Belly; scarce any Hypochondriacal person or Hysterical woman, in like manner no Gouty or Cachectical person, but hath his skin pierc'd in many places like a Lamprey. It would be a vast work to recount here particularly all the Distempers for which Fontinels are helpfull.

3.* 1.754 But really this remedy, nt however advantagious and benign of it self, doth not agree with all persons, nor is it indifferently to be prescribed to every one. For there are two sorts of men, which though sick, are to be excused from Issues, inasmuch as this Emissary evacuates too much in some, and too little in others, or less than is convenient; and in the mean while remains very painful and intolerable.

Sometimes a Fontinel is not convenient,* 1.755 because it too much evacuates or consumes the humour or Spirits. For I have observed in some, that an Issue made in any part of the body, pours out an immoderate quantity of Ichor, and peccant in quality: for out of it by often turns, if not continually, a watery, thin and fetid Juice, often∣times discolouring the Pea and Coverings with blackness, flows out in great a∣bundance, and so the strength and flesh is impaired by too great an Efflux there∣of.

The reason whereof seems to be this,* 1.756 that in some persons end ued with an ill dispo∣siton of blood and humours, a wound being made and hindred from healing up, de∣generates straightways into a silthy and malignant Ulcer; the sides whereof put on the nature of an acid corruptive ferment, whereby the portions of blood continually forced thither, are so tainted and dissolved, that the Serum thereof imbued with the dissolved Sulphur, and other Corruptions, being refused by the Veins, flows out there copiously. Moreover, this putrifying pollution of an Issue being communicated to the blood, depraves in some part the whole mass thereof, and so at least (as also by too much loss of the serous Juice) it is rendered less nutritious: Besides, from the Sulphur of the blood dissolved near the sides of the Issue and flowing out with the Serum, the streaming Ichor doth so stink, and black the Covering. Sometimes an Issue pouring out the ichor not immoderately, consumes the spirits and strength more than it ought, which really we take cognisance of from the effect, and sometimes not till afterwards;* 1.757 inasmuch as some, while they bear about them one or more Issues, remain feeble and lean; but they being stopt presently become vigorous and more plump. Moreover, it is a common observation, that many from an Issue raised near the head, have been presently surprized with a certain defect, and weakness of sight, insomuch that they have been constrained immediately to heal it up: which seems to

happen for this cause, for that where the provision of spirits is small, and their con∣sistence very thin, the small losses of them, or of the Juice from whence they are pro∣created, if so be they are constant, are difficultly endured.

But in another and different respect, Issues like Vesicatories are forbid to some,* 1.758 or very cautiously prescribed, for when they evacuate little or nothing at all, they very much vex the place, where they are made. For in persons endued with a cholerick, or hotter constitution, the masse of blood being thicker than it ought to be, and less diluted with Serum, becomes more bound in its consistence; in these the solution of Con∣tinuity being made and kept by reason of the Issue, the blood it self (for that it doth not sufficiently discharge its Serum, whereby it many go away) sticks in the passage, and so being extravasated, causes a very painfull inflammation; and in the mean while, as it pours out little ichor, it remains as well unusefull as troublesome. The opera∣tion and uses of Fontinels and their indications being designed, we shall shew in what place, in what form, and with what instruments they ought to be made, and after what fort to be managed.

The places are appointed according to the ends or intentions of Curing by them,* 1.759 which chiefly are these three, viz. 1. A general Evacuation of humours from the whole body. 2. An Evacuation and also a revulsion from some particular member. 3. An Evacuation and also a derivation from some particular member. In respect of the first it is expedient that an Issue be made in the lest arm; The fecond Intention requires it far from the part affected, and the Third near the part.

For these ends, viz. one while for this, another while that or the other Fontinels are made in all parts of the Body, viz. in the Head, Breast, Abdomen, in the Arms and Thighs, and in most parts of each of these, either by Incision, or Cautery, or piercing throngh, and in their holes or orisices Pease, or wooden Pease, Pellets or Pledgets, are put to keep them open. We will observe the principal places and kinds of Issues by running through the members of our body.

1. A Fontinel is prescribed by some to be burnt by a Cautery in the Coronal Su∣ture,* 1.760 and is commended for exhausting and evacuating humours out of the brain and its outer Coverings. Although some use this in familiar practice, yet I have found by experience in some it doth less happily succeed, insomuch that I have or∣dered many Issues to be stopt that have been made on the top of the head, being in∣structed herein from Reason and Experience; for that the blood transferres more fe∣culency towards the place where it was wont to lay aside its recrements, and depo∣sites them in the whole vicinage, and chiefly in the part affected, (as being the weaker and more susceptible part) whence a Disease is oftner augmented than cured. For the same reason, viz. for the derivation of the humours from the inner head out∣wards, some form Issues in the fore-part of the Head over the sagittal Suture, others in the hinder part of the Head about the beginning of the Lamboides, but the same excepti∣on remaings against both as the former.* 1.761 And doubtless more rightly doth an Issue in the Arm anticipate the morbifick matter that is wont to be deposited about the head, or makes revulsion in the Thigh, and raised a little beneath the head, derives from thence. For this reason in painfull distempers of the brain, and Meninges, we cut a deep hole in the Nape of the Neck in Children and Youths; but for those grown up, and Old men, we apply Cauteries on either side the Spine between the Shoulders or the Homoplatas, and in the same places we make incision for two Fontinels capable of many Pease,* 1.762 often with very great success. As to holes cut or burnt behind the Ears, or a Seton with a skane of Silk drawn through the Lobes thereof, I have seen them rarely with any success, but osten very troublesome; Inasmuch as a solution of Unity made in these places, neither discharges much Ichor, nor for any long space; for though the hole or orisice be fill'd with a Pease, or Pill, it will be covered in spite of all endeavours to the contrary by the Cuticula, or skin growing under.

Issues in the back do notably help diseases not only of the Head by Evacuation,* 1.763 and derivation of the morbific matter, but also in all Gouts, Stone and Colicks, by anticipating the fuel of the Disease, and by intercepting it while it tends to its feats: which really is plainly proved by experiments and obser vations taken from the help of the Patients.

Fontinels between the Shoulders, also in the Arm or Thigh, conduce to the eva∣cuating or anticipating, in pectoral Diseases, the humours flowing to the Lungs, and to the drawing back those deposited there. How an Issue cut in the Chest between the Ribs doth sometimes more immediately derive the consumptive matter from the Lungs, we have elsewhere shewed.

The Region of the Abdomen seems unapt for bearing an Issue in any part thereof; notwithstanding the practice of some,* 1.764 although it be more rare, is much fam'd for a large Issue capable of many Pease to be burnt with a Cautery upon the Region of the Spleen for any hypochondriac affection. I have known it of sinall benefit to some, at least not recompensing the trouble and pain of such a remedy.

Some time since I successefully cured a weakness in the Loyns obstinate to all other remedies,* 1.765 by a Fontinel in the Groin, and in another patient an inveterate Sciatica. For surely the glandulous Emunctories settled in that place, do imbibe very many recrements of the blood and nervous Juice; which if they be throughly and conti∣nually discharg'd from them by a fit vent, it will much conduce to exempt the con∣tiguous parts from any morbifick Mine.

The Thigh being a member soft and large in bulk,* 1.766 seems apt enough for enduring many and great Issues, to wit, those which may purge away plentiful humours from the whole body. Yet it doth not succeed so with many patients, partly because of its figure too much declining, like a Cone invers'd, the Ligature containing the Pease in the orifice is not easily kept on, and partly because a solution of the Unity being made among the concourse of so many Tendons, it frequently becomes inflamed and pain∣full; insomuch that fometimes it hath been necessary that it should immediately be stopt up, to withdraw the trouble of pain and of lameness. Notwithstanding it suc∣ceeds better in some Patients, for that an inflammation doth not always ensue upon the place where the incision was made, and that the Ligature has remained immov∣able to those that tye their hose above the knee.

Moreover,* 1.767 as concerning Issues, it is requisite to choose a convenient place not only in the body, but also in the very member where incision is made, which chiefly calls for the judgement of an expert Physician or Chirurgeon; for carefull provision must be made, lest a Cautery or incision be made upon, or too near the Tendons or greater Vessels; but let the Fontinel be made not in the very body of the muscle, but in the interspace or distance between the muscles; where the orifice, as John Heurnius learnedly observes, ought to pass through the whole skin so far, untill the little mem∣brane of the muscle underneath be penetrated. Wherefore, this part of Chirur∣gery is not rashly to be allowed to Quacks and others ignorant of Anatomy, for that from this being ill done, not only a frustration of the benefit, but from thence fre∣quently great mischief happens, and sometimes to the hazard of life.

It is not needfull to describe the figure and use of the cutting Instrument,* 1.768 toge∣ther with the manner of preparing and compounding Causticks for making Issues, inasmuch as it is notorious to the common people; yet it behoves us to handle in what manner the symptomes which happen to these Emissaries after they are made, may be cured, and it will not be besides the matter to discourse, what do either impede or pervert their powers.

Whereas many and several distempers happen to Issues, help is not required for them all, but only for such as are of greatest moment: Wherefore there will be need of help, 1. Wheresoever an inflammation ensues upon the part or place where it is.* 1.769 2. If the Orifice vent more or less Ichor than it ought. 3. If the Ulcer shall be apt spontaneously to be dryed up, and cover'd over with a skin: or if it be prone to abound with spongious flesh growing about the sides. As to lesser faults, as when the Ulcer shall break forth into frequent Haemorrhagies, or change its place creeping into another less convenient, with many other ways by which it prevari∣cates, it will not be worth our labour to discourse here.

1.* 1.770 An inflammation frequently happens to an issue, and that so painfull sometimes, that it threatens a Sphacela, yea and sometimes causes one. But such an affection ensues either upon the orifice new made, or happens after wards by reason of the blood and humours, occasionally agitated and rushing frequently and in heaps to that part.

When a Fontinel is made,* 1.771 immediately by reason of solution of the Unity, and consequently by reason of the circuit of blood somewhat hindred in that place, a certain inflammation and ulcerous pain happens to some patients; but in some en∣dued with a fervent blood, and whose Serum is less diluted, this ensues much fiercer. For the blood being brought thither by the Arteries, the ends of the Vessels being cut off and obstructed, it can neither go out nor be returned immediately by the Veins, but sticking there in the passage it is accumulated more and more, and being at length extravasated, and filling and stopping all the pores of the contiguous skin and

flesh, it raises a tumour with redness, and heat most intense, which coming to pass, either the blood so heaped up, and extravasated,* 1.772 in a snort space of time becomes immovable by reason of constipation, and for that cause being as it were divided from the rest of the mass, it is extinguished, and suffering death produces a Sphacela upon the part: or secondly, the blood so stagnating, is after a sort agitated as to its particles, and enjoying alwayes a vital flame, and made more intense by the same, it is as it were boyled throughly, and so is changed into a Pus, to be evacuated by an ab∣scesse: Or thirdly, which happens more frequently, and ought always to be procured in our case, the blood provoking an inflammation is reduced into the Vessels and restored to Circulation by other passages whereinto it is constrained.

But that it may be reduced, these two things will be necessarily requisite: First,* 1.773 That it be much diluted with the Serum flowing thither abundantly, or rather thrust forward into the part: Then secondly, that the Vessels behind the Tumour being emptyed, may swallow up the blood diluted, and driven back by the Serum; for the blood being forced towards the Tumour, whenas it cannot advance forward, yet its bulk being diminished, that it may be able to return back, it dischages the Se∣rum plentifully from it self, and drives it for wards into the places obstructed; which entring under the stagnating blood, dilutes it, and succeeding into its places, forces it back into the passages of the Vessels, and in the mean while that Serum tending for ward ex∣hales by the pores; insomuch that the blood which was extravasated being diluted and forced back by the Serum, and the Serum it self evaporated,* 1.774 the swelling with the Inflammation vanishes leisurely away. But if (as in more hot tempe∣raments it comes often to pass) the blood being extravasated and impacted in the pores, be not diluted by the Serum brought to it in great plenty, it will not only stick there pertinaciously, but it will irritate a fiercer Phlogosie with a Feaver, and some∣times other dreadful symptomes. So not long agoe, when a renowned Divine, en∣dowed with a thicker and hot blood, had an Issue cut in the inside of his Leg, although the skin only was cut, an inflammation followed presently, which within a few days so cruelly encreased, that it could hardly be impeded by any Remedies from dege∣nerating into a Gangrene. Wherefore, when the blood being extravasated through the solution of the Union, and wanting the afflux of the Serum whereby it may be diluted and brought back, proceeds into an Inflammation,* 1.775 Fomentations and Cataplasms of Emollients being outwardly administred, do often-times bring help; inasmuch as the moist and sost particles falling from these, go under the blood stagnating, and dllute it, and so pleasingly moving it together, cause it to return the more easily into the Vessels; hence it is, that the moist applications of this king being administred out∣wardly, do supply the defect of the intern Serum requisite to dilute the blood;* 1.776 not∣withstanding that the blood being so diluted and irritated into motion, might be rendered fit for its Circulation, there is also need that the Vessels which should receive it should be enough emptyed, for which purpose Phlebotomy and Purgation are fre∣quently of necessary use, besides a slender Diet. And indeed according to usual custom, we purge Cacochymicks or Plethoricks a little before, or after the Issue is made, and frequently breathe a vein in those Patients. Neither are these Remedies ony fit in an Issue new made, to provide against or discharge an Inflammation, but also they are advantageous as often as that distemper ensues upon an old Orifice of the skin. For as often as the blood being very impure, and together growing feaverishly hot,* 1.777 doth enter into a separating turgescence, it frequently hppens that it discharges its recrements and feculencles, otherwise unapt to be purged out, about the Fontinel, and there being impeded in its Circuit by them accumulated together, it is extrava∣sated, and for that cause brings on a fierce Phlogosis. Such an affection not long since happening in a renowned ancient person, and being neglected from its com∣mencing, within a short space of time degenerated into a Gangrene; notwithstanding from which by the help of appropriated remedies carefully exhibited, as well inward as outward, he escaped not without great danger of life. At some other time here∣after perhaps, when treating of Cutaneous diseases, we will speak more largely of the Aetiologies and Remedies of an Inflammation, and of an Abscesse or Impostuma∣tion and Spachela. At the present we will consider the other Symptomes of Fonti∣nels.* 1.778

2. Whenever an Issue throws out too much Ichor, which for the most part is thin and very stinking, and sometimes discoloured, so that the so vast loss of humour, and that stinking, not to be endured, do require a Remedy; in such a case there will be

two chief Therapeutick Intentions, viz. First, that the mixture of blood be strengthened, lest its consistence should be too prone to dissolution and serous efflux:* 1.779 Secondly, That the tone of the place ulcerated by the Fontinel be preserved, and rendred exempt from any putredinal ferment, so that no taint being there lodged in secret, do impart any pollution on the blood passing through in Circulation, whereby it being infected, might presently goe into parts, and the Serum be constrained there to discharge it self more abundantly.

This former scope of Curing enjoyns scarce any thing but moderate purging by in∣termission,* 1.780 and a regular Course of Diet, viz. that the Patient be restrained from all surfeit and excess, as to the plenty of Nourishment, the quality, and seasons of re∣ceiving it; likewise more especially from small Wines, Cider and other acid liquors, whereby the blood is wont to be dissolved into effluxes. For indeed those that are so affected, do smartly pay for any error or irregularity in Diet, pain being immediately irritated about the Issue.

For due preservation of the tone of the place where the Issue is made,* 1.781 and exempt∣ing it from putrefaction, let sedulous care be endeavoured, that all nastiness be de∣clined, that both the solid things put into the orifice, as also the Coverings, whe∣ther Plaisters or Leaves of Ivy, or Oyl cloaths, be changed twice every day; for in some persons any of these will quickly contract a stench, and presently cause the Ul∣cer of the Issue to putrifie. But if this tends to putrefaction, immediately in place of a Pease or wooden Pill, let a Pill of Virgins Wax be put in, incorporated with red Sanders and Verdigrease: Moreover, let a Fomentation withall, Morning and Eve∣ning, with the Decoction of St. John's Wort, Yarrow, Centaury, &c. be made use of.

3.* 1.782 Sometimes a Fontinel like a dry Fountain pours out little or no humour; the reason whereof is usually, either for that orisice being not deep enough, doth not penetrate the whole skin, which is cured by piercing it deeper; or the Ulcer though hollow and large enough, yet remains always dry, because the Serum doth not easily nor in plenty separate from the mass of blood, by reason of its consistence being too much bound up; and then the only remedy is, to wear solid things with∣in the Orifice, which may more proyoke or twitch the mouths of the Vessels, for which purpose Pease made of Ivy-wood, or Box, or of the roots of Gentian or Hermodactyls, are often used with success.

4.* 1.783 It often happens, that the Orifice of an Issue being too mallow, and sparingly sweating out lchor, is grown over with a thin skin with the Pease included therein, and the deep hole is healed up quite; for which fault there is scarce an apt remedy to be administred. Wherefore it is better to close that Issue (rather than alsays in vain to fret the skin) or transfer it to some other place.

5.* 1.784 The sore of an Issue tending to healing, and being forbidden, often procures a spongious flesh about the edges, and sometimes in the hollowness it self; the reason whereof is, because the nutritious liquor being conveyed to the ends of the Arteries and nervous fibres, and being not immediately washt away by the serous Ichor, fixes there, and beginning to be assimilated stretches out both these vessels to fill the ca∣vity with flesh, and into these rudiments of flesh both the blood and Animal spirits flow most copiously; and the blood int he mean time being conveyed thither, forms sprigs of veins within that bulk for its return: Not with standing this flesh as yet rude and without shape, being excluded for the most part from the hole, grows up over the edge; and when in this manner it rises higher than that it may possibly be co∣vered and cloathed with skin and Cuticula, it remains always naked and spongious, This excrescency is easily enough cured by sprinkling thereon Escharotick powders, of burnt Alum, Colcothar, or Mercury precipitate; for remedies of this kind do eat away the flesh so luxuriating by their acrimony as well as stiptickness, repel the nutritious humour,* 1.785 and lock up the mouths of the Vessels. As often as that super∣fluous flesh encreases about the sides of the Issue, it is a sign that the nutritious hu∣mour flows thither more plentifully than the excrementitious; and for that cause in Pa∣tients so affected that vent proves not always so benign. Wherefore, under pretext of this reason many are averse to that remedy (though surely it is harmless to most, although not alike usefull and advantageous to all.) We have before considered the chief disadvantages thereof, as likewise the scandals objected thereunto; yet there remains another thing according to the opinion or rather error of the Vulgar, a notable objection against Issues, which we will here discuss for a Conclusion.

With many in England a contumacious opinion is grown up (I know not whether it be so in other Countreys) That one or more Fontinels dispose to barrenness.* 1.786 Where∣fore this kind of remedy, however otherwise conducible to health, is scrupulously forbidden to all marryed Women that desire Children; of which Prohibition there is no reason as yet made out, but only Stories related of certain Women that have been barren having Issues; when it were as easie to enumerate more barren women without Issues, and many others that have been fruitfull with them; and truly I use to retort (whenas there is no need of any other refuting) this as a chief Argument against that opinion.

SECT. III. CHAP. V. Of the Diseases of the Skin, and of their Remedies.

AFter Attractive Remedies of the Cuticula and Skin, namely Issues and blister∣ing Medicines delivered before, by a certain Law of Method we are in∣duced to handle Diseases of those parts, and other kinds of Remedies of divers sorts; the true Aetiology of which will afford matter of most pleasant as well as profitable speculation.

As for the fabrick and uses of those parts,* 1.787 it needs not that I should here repeat all things already accurately described, and well known in Books of Anatomy. It may suffice us to note concerning the Cuticula, that this outward skin is thin and dense, without blood and without sense, as destitute of Vessels and Fibres, which cleaving to the inward skin, coners and defends it from outward injuries. This is every where full of pores, into whose orifices the Vessels discharging sweat do open, which Mal∣pighius viewing more accurately with a Microscope, a little before their gaping or opening, affirms to be endued with little Valves, for the retaining or free breating forth of sweat: but I consess they lye hid to me.

The Cuticula being taken away by Fire, or Phaenigmons, the skin appears naked,* 1.788 and looks red, by reason of the sanguiferous vessels. But this is a thicker membrane, as to its greatest parts, formed of filaments of Vessels bringing blood, of Nerves, and of nervous Fibres, variously interwoven and complicated among themselves, among which numerous Glandules and Lymphaducts, or Vessels discharging Sweat and Va∣pours, are thickly interposed. The substance hereof is related to be double by most Anatomists, the outer is nervous, the inner fleshy, or rather glandulous; for an ex∣ample of which, the Rind of an Orange is brought. If the skin be viewed naked by a Microscope, by the renowned Malpighius's observations,* 1.789 First there presents it self a body in form of a Net, in whose thick holes are contained not only passages of Sweat, but also very many Teats in form of a Pyramid, rising out of the skin in pa∣rallel ranks, and passing into the Cuticula, where being stretcht out in length, they are divided as it were into many little Fibres; which the same Author hath determin'd to be the sense of touching. Besides these, the substance of the skin contains very many Glandules, by which means the Lympha or watery matter is carryed by the Lym∣phaducts or excretory Vessels, out of the Arteries to the Pores.* 1.790 For indeed the most accurate Stenon hath observed, that its Glandules lye under every pore; which become either greater or lesser, according to the use of sweating: the sweat or vapours con∣tinually streaming out of these by the excretory vessels, avoiding the excrements, do moisten the nervous Teats in their passages, lest perchance they should grow dry.

As to the pores or passages of Sweat,* 1.791 they are discovered by a Microscope to be of two kinds, viz. The greater, in most of which the roots of the hairs are im∣planted, and by interspaces, on both sides of each wrinkle of the skin, are dispo∣sed in a parallel rank: Or secondly, they are the lesser Pores, which being num∣berless, do fill up all the spaces between the former in most thick Punctums or pricks. For indeed the whole skin with its wrinkles, appears like a Field furrowed by a Plow, and after wards harrowed with the ranks turned, or rather oblique; so that its ground

being eminent above the surrows of either kind, there remain in its plain, Figures very much of a Rhomboidal or a Diamond-fashion;* 1.792 and accordingly as those fur∣rows, with their banks or flattes, are either shorter and less, or deeper and greater, the texture of the skin appears either delicate and thin, or thick and course. This kind of Constitution although it be most owing to ones birth, and to the primogenial growing together of the humours, is however manifoldly altered by reason of the various accidents of the ensuing life. A more gross Diet, difficult labour, injury of Air,* 1.793 and chiefly excess either of heat or cold, render a skin more rough: also contra∣riwise a nice and delicate education renders its tone more fine and soft.

That the skin may become more neat, smoothe and equal, it avails much that all its pores be filled with a benign, mild and unctuous humour; for so, whilest all its pores become full,* 1.794 and extended, the level of the whole skin appears more smooth: Notwithstanding, if a vicious humour furnish those pores, or the benign humour that was in them be too much exhausted, for that cause the skin will become rough and full of wrinkles. Wherefore if any endowed with a most soft and even skin, shall wet their hands in a Soap Lather, Lie, or Lime-water, or also for some time in warm Blood, presently the furrows and wrinkles will grow greater and deeper, the saline humour being drawn out by the other Salts out of the pores; wherefore more delicate wo∣men scrupulously decline washing with Soap or any other things that furrow the skin.

Neither only the humour being too much exhausted out of the pores, but also re∣tained in the same either unduely or above measure,* 1.795 doth render the skin rough and unequal. The hairy pores (which though they are not the only, yet are much the passages of Sweat) do constantly send out more plentiful Effluvia's for the sake of transpiration, wherefore they ever seem greater and more open; but if it shall hap∣pen that these are suddenly obstructed by any outward cold, the Vapours being re∣strained within,* 1.796 they do every where swell up the skin about the places where they break out, and lift it up into little heaps: from hence of at any time our bodies are exposed naked to the Northern wind, or are plunged in a River, the exterior Superficies before smooth and soft, will become rough and rugge, like the skin of a a Goose new pull'd. Without doubt those greater pores, being, according to the fur∣rows of the skin, planted parallel and as it were in a rank after the manner of a Quincunx or exact Square, are made as so many pitts for the planting of hairs as it were trees; for so they appear in four-footed Beasts, and in some hairy parts of men.

These things being thus briefly declared concerning the Cuticula and Skin, as touch∣ing their frame and uses, there is way enough made to search and unfold the Diseases of the same parts, and the reasons of healing them.

Wherefore first scarce any Diseases properly belong to the Cuticula,* 1.797 it being devoid of life and sense. This sometimes being too thick hinders Transpiration, and also sometimes by reason of accidents in some places it grows too thick and callous: but it self being clearly unsensible it is never sick, notwithstanding this is a cause that some distempers which might be blown off by Transpiration, do cleave to the super∣ficies of the skin, inasmuch as the dregs of the blood, and humours, and recrements being thrust forward outwards,* 1.798 having passed through the whole skin, when they cannot evaporate wholly by reason of the thickness of the Scarf-skin, being fastened in the outed skin, produce various discolourations, and stains thereof; of which fort are those spots called Heat spots, Freckles, or Ephelides, as also scorbutical and ma∣lignant spots, also Pimples and whatsoever other stains without any swellings or roughness do seem to besprinkle the skin or outward Scarf-skin, with marks, or some little disfigurings.* 1.799

But truly as to what belongs to the distempers of the Skin it self in general, since they are various and manifold, they are wont to be distinguished under a various respect, and chiefly that they are either with or without a Tumour; we have but now taken notice of these latter ones.

Distempers of the Skin with a Tumour,* 1.800 are either universal, dispersed throughout the whole body; or are particular, being raised in these or those members, disper∣sed or as it were by chance.

The former either happen upon a Feaver, as chiefly the Small-pox, Measles, or other malignant wheals, whereto also may be added the fleeting pushes of In∣fants; or happening without a feaver, as the Itch, Tetters, and leprous distem∣pers.

The outward particular Tumours, or dispersed ones, for the most part do not seize upon the skin only, but also upon the parts subjected, viz. now the carne∣ous, another while the tendinous, or membranous or glandulous, and for that cause do exist of a sundry disposition, and of a diverse form. To discourse particularly concerning all these, and to assign the reasons of their Causes, and Cure of every one, would be a matter not only of an entire Tract, but of a great Volume: Wherefore, for the present we will only briefly speak of the Distempers merely or for the most part Cutaneous (of which sort are all spots and Pimples, as also the Scab, or Itch, Tetters, or leprous Maladies): perhaps, an opportunity may happen, when I may treat more specially of Tumours of every kind.

First then (that we may begin with Spots as Affections of lesser moment) those offer themselves called Ephelides, because they are chiefly caused from the Suns heat;* 1.801 for that cause frequent in the Spring, and increase most in Summer, again in Winter they soon vanish. Moreover, whereas they happen in the more beautifull persons,* 1.802 and of a thinner skin, they break out chiefly in those places where the Cuticula is most thick, and is exposed to the Sun and Air, viz. the face and hands, of a colour yellowish or brown, in magnitude of a Flea-bite, but they exist unequal and irregular as to their Figure. These differ little or nothing from those brownish or yellowish spots which some call Lentigines or Freckles, which consisting of the bigness of a Lentil, mark the parts of the face as it were with many drops.

The matter of these seems to be a more thin portion of the cholerick humour,* 1.803 allured outwards by the force of the Sun attenuating it, and opening the pores of the skin; which beginning to be evaporated, is fixt to the inside of the outmost skin or Cuticula, which it cannot pass through. Surely it is a sign these spots proceed from Choler, or other yellow scums of the blood, because they are chiefly familiar to them whose hair is yellow. Moreover, the reason is manifest enough, because they arise more often in a fair Complexion, and in those parts exposed to the Sun and Air; for their more thin skin transmits the humour rarified by the solar heat so far untill it is retained by the thicker Scarf-skin, near the places of issuing out. This affection presages or indicates no evil, as to the state of health; and although in appearance it represents something of deformity, notwithstanding that is made good again, in∣somuch that it signisies them so spotted, to be endued with a more pure Consti∣tution.

Besides these small freckly spots there are others much larger,* 1.804 above a hands breadth in magnitude, which deform the skin in divers places, especially about the breast and back, one while with brown, another while with pale or blackish spots. These at certain times, as I have observed in many, being wont to arise in certain parts and vanish again, are commonly called Liver-spots,* 1.805 and those most markt with them are thought to have a Liver less sound, or at least not well sanguifying; which not withstanding is not true on this account, but only inasmuch as the cholerick humours, when they are not enough separated from the mass of blood within the Liver, being thrust for ward to the skin do so discolour it: which fault also is imputed to the Spleen; for truly this deformity arises, because that the feculencies and excrements of the blood, when not enough received by the Vessels of separation, are together dl∣luted with the Serum, with which they are conveyed to the skin, and in the same place being cast off by the blood, and deserted by the serous Juice while it is evapora∣ting, they are fastened about the outer little holes or pores, even as a mossie down cleaving to the strait places of a River.

These spots chiefly appear in Summer, and most upon the Breast and Back,* 1.806 viz. at which time and in those places men are most apt to sweat: for that serous Juice which brought out those dregs from the mass of blood, into the strait places of the skin, leaves them there, altogether unable to evaporate. This indisposition hath no∣thing of evil joyned to it, nor is it a symptom of any present disease, nor doth it pre∣fage any suddenly approaching; Moreover, when for the most part it happens to places that are covered, and brings no deformity or trouble, there seems little or no need of Cure: but because an opinion is frequent with the Vulgar, that the Liver is eminently endangered by these spots, and necessarily requires Medicine, for this cause to satisfie the importunate, craving Medicines, we are wont to prescribe, besides extern Cosmeticks, even inward hepatical Remedies; whose use although not very necessary, yet because from thence the depuration of blood, and opening obstructi∣ons of the bowels are dispatcht, they are not altogether in vain. The inward Medi∣cines

profitable to this design, are described before among the hepatical Remedies: The Topical or outward are altogether the same in these as in any other kind of spots; some select forms of which we will annex.

Concerning Pestilential,* 1.807 as also Scorbutical spots, of which we have purposely in another place spoken, there is no need here to repeat the same; especially because for these another method is required, than for those but now described; inasmuch that in one kind of spots, Medicines for the most part outward are wont to be admi∣nistred, without Splanchnic or Cordial medicines, but in the other kinds only in∣ward medicines, without any that have reference to the Skin.

Wherefore,* 1.808 as to the spots called Freckles, Lentigines, and those commonly called Hepatical, they properly belong to the Art of Beautifying; and for the taking away these Deformities of the Skin, only Cosmetick Remedies are prescribed, with∣out any method of healing. There is every where a plentiful harvest of these with curious Ladies, and others, that are solicitous of cleansing their skins; yet all these, forasmuch as they only respect two Intentions of healing, may be reduced to these two heads; viz. either by opening the pores of the skin and Scarf-skin, and sometimes by excoriating this, they do endeavour to have the humour drawn outward, and also to be evaporated; or on the other side, and not with less success, those things are administred that may drive back the spotty matter, and force it inwards. We will annex here in order some usual Forms of the Topicks of either sort, being rationally found out, and frequently made use of happily enough; because it is not lawful with∣out offence of the Great Ones to detect the more secret mysteries of the Cosmetick Art,* 1.809 and to profane it among the Vulgar.

First therefore for cleansing the skin,* 1.810 and drawing forth the matter of Spots:

Take of a small ly of Salt of Tartar four ounces, Oyl of bitter Almonds made by expression, as much as suffices, in such a proportion let it be mingled, that the liquor turn presently white, and so remain; with this mixture let the parts be anointed morning and evening, and gently chased.

Take of Aron-roots, Bryony, Solomons-Seal, of each one ounce, Powder of Fenugreek: seeds one dram, of Camphir half a dram, these being beat together, pour on them three ounces of Oyl of Tartar per deliquium, let it be pressed and applyed with a rag twice a day.

Take of quick Brimstone in powder one ounce, black Soap two ounces, tye them in a rag, and hang them in a pinte of Vinegar for nine dayes; after let it be used by washing the part twice a day, and chafing it.

Secondly,* 1.811 For the other intention of discussing the spots from the skin, and re∣pelling their matter inwards, Lac Virginis was a renowned Remedy among the An∣cients, and is as yet commended and made use of by many: The Preparations are well enough known, Viz. A Solution of Litharge made in distilled Vinegar, by pouring of Oyl of Tartar per deliquium,* 1.812 it is precipitated into a white liquor like milk, with which let the face and hands be washed twice a day, and gently chaf'd. A remedy like this or of the same vertue is prepared out of the solution of red Lead or Ceruse made in the same Menstruum, and precipitated with Alum Water, or a Solution of Sal Gem. Or,

Take of Camphir sliced two drams bruised in a glass Mortar, pour thereon leisurely the juice of one Lemmon, then adde one pint of White-wine, strain it, and let the remain∣ing Camphir tyed in a rag be hung in the Glass.

Take Verdigriese four Ounces, pour thereon two pints of White-wine Vinegar, being put into a Cucurbite-glass, let them be distilled in Sand, let the Phlegme be kept for use, with which let the face be anointed twice a day.

For this purpose also the Phlegme of Vitriol doth notably conduce. It suffices some to use the distilled simple water of Bean-flowers, or of Fumitory, or the liquor of a Vine distilling from the Boughs cut in the Spring-time. Notwithstanding the more nice, and those who chiefly boast to understand this Art, are scarce content with any Remedies but Mercurial, wherefore the following water is commended and sold by Empiricks at a great rate against all foulness of the face whatsoever.

Take of Mercury sublimate one ounce powdered,* 1.813 put it in a Tin Vessel with three pints of Spring-water, let them stand twenty four hours space, ever and anon stirring it with a wooden Spatula untill the whole liquor grows black, which notwithstanding being phil∣ter'd through brown Paper, becomes clear; with a rag or a feather dipt in this, let the face be gently done over once or twice in a day.

This Remedy doth most notably help against all cutaneous Deformities,* 1.814 viz. inas∣much as it drives away the humours within the little pores, and those impacted with∣in the little holes howsoever small, dissolves the inveterate and stubborn combinati∣on of Salts or Sulphurs, and restores the whole skin, (where it is applyed) though evilly framed as to its pores, and makes it well coloured. Wherefore it is usefull not only to cleanse the spots of the face, but also to take away wheals and its redness, as also the Disease of the Erisypelas. Moreover, sometimes it happens that many parts of the face, especially the Nose and Forehead, are markt with most thick Specks looking black, as if burnt by Gunpowder, which proceeds from hence, because the sudatory pores are sometimes fill'd with a more thick black humour, another while with little worms with black heads (which little Insects being squeezed out of the pores, and exposed to the Sun, are easily seen to live, and to move themselves) and in such a malady of the skin, no Lotion or Oyntments are wont to profit, but what are Mercurial; notwithstanding to this Hony there is a Thorn at hand more than enough malignant.* 1.815 For the particles of the Mercury together with its Salts (by which they are divided and sharpened into small bits) being applyed to the face, do shake off the peccant and uncleanly matter out of the Pores, and expell it thence, but having driven it back, they pursue it in, and readily insinuate with the Blood and nervous Liquor, whose temperaments they prejudice. Yea by meeting with these they imprint very often on the Brain and sometimes on the Praecordia and other parts, their virulency that can never be wiped out. From hence it is frequently ob∣served, that women or men that have long used Mercurial Cosmeticks, are troubled with a Vertigo, and convulsive Distempers, or are obnoxious to paralytical, and their Teeth grow black, and sometimes fall out.

SECT. III. CHAP. VI. Of the Mange or Scab with the Itch.

AFter the more simple maladies of the skin, viz. those which happen without any Tumour and Ulceration, and only deform it with spotted appearances,* 1.816 we will now in order treat of the more grievous Affections, and those which dissolve the Unity, and especially of the Psora or Scab, which in sundry and srequent places of the whole Body doth much infest the skin with a painful Itch, and with small Pustles and breakings out, being sometimes dry and often scaly, and another while moist and disposed to ulceration; and a malady of this sort is most properly the Disease of that part, considering it frequently begins in the very skin by reason of some outward Contagion, and often receives Cure by certain Remedies applyed to the skin only, at least the reason of both holds so far, that it is seldom otherwise un∣dertook or perfectly cured.

The Psora or Scab is vulgarly described to be a breaking out of Pustules and wheals throughout the whole body, here and there,* 1.817 procured from a sharp and salt humour heaped up in the Pores of the skin, and that it may be discussed from thence, indu∣ces a notable Itch, and a necessity of scratching.

That we may search duly into the causes of this Disease, and the reason of the symptoms, we will more deeply enquire concerning the matter effecting and the con∣junct cause thereof, that it may certainly be known of what sort that humour is which is heaped up within the skin, by what means it is either generated there, or comes from some other parts, afterwards in what pores or little places it is contained, and how endeavouring to break out, it doth create so troublesom an Itch.

Wherefore about the origine of this Disease,* 1.818 that we may not impute the fault with the Ancients to the Liver or Spleen, the matter thereof is not any particular humour of the four commonly supposed ones, not Phlegme, nor yellow Choler, nor black,* 1.819 neither also the blood apt of it self to be extravasated; moreover neither doth it seem to consist of two or more of these humours mixt together. For though such humours be granted, notwithstanding if this Disease always consist of them, it would not so easily be catch'd by a meer and light contagion,* 1.820 or receive Cure by an Oynt∣ment alone. Wherefore it is rather to be supposed, that the morbific matter is the humour of the Lympha constantly resting in the glandules of the skin; notwithstand∣ing degenerating from its genuine disposition, that is to say, its volatile-salt, into an acid or otherwise offending disposition. For when the continual Supplements from the blood come to this so depraved, and uncessantly evaporating, these Juices new and old do not easily agree, or are united, but boyling together after the mu∣tual custom of dissimilar Salts, they are coagulated into a recrementitious matter, which filling and distending the pores of the skin, every where raises it into Tu∣mours; Moreover it something hinders the Blood in its passage, and constrains it to be extravasated. From hence thick Pustules are raised, and because that matter passing into an Ichor is compelled by the Serum and Blood pursuing it still forward, they rise up into little heaps; afterwards the Animal Spirits entring inordinately into the nervous Fibres, that they may promote the throwing off that ichor, do cause the sense of that troublesome itch.

Indeed an inspection with a Microscope doth most clearly discover that there is a lymphous humour in the glandules of the skin which lye under all the sweating pores, treasured up for some uses,* 1.821 so that according to the plenty and diverse stay thereof, these Glandules exist more or less turgid. This Juice is laid aside by the Blood, through the Arteries, in these Glandules, that this little burthen being cast off, it might return more easily through the veins; in the mean time being reposed there, it hath its uses, viz. In the first place continually moistening the miliarie Teats, which lying under the nervous little Fibres, are the proper Sensory of Touching, it preserves them from dryness, which would hinder the Sense; also it imbues the adust effluvia's passing uncessantly from the blood being kindled, in their passage near the skin, with a certain moisture, and renders them fit to be voided by the pores; and whilest part of this humour doth so continually evaporate with the Effluviums of the blood, those expenses are repaired by the Lympha continually fresh, being deposited by the Arterial blood as is abovesaid.

Notwithstanding this occonomy of the Region of the skin is not always so regu∣larly kept,* 1.822 but that the glandulous humour falling from its own disposition and functi∣on, not only will provoke in the skin, but sometimes in the whole body, preterna∣tural affections of divers sorts. This growing clammy, and cleaving more obstinately in the little Cells obstructs transpiration; and immoderate sweating proceeds from its too plentifully flowing out, and from the same restagnating inwards, a more than usual Diuresis.* 1.823 Moreover, as to what belongs to the Scab and pustulous eruptions, that humour as it is wont to be depraved many ways, so chiefly these three, and is wont to enter into a coagulative disposition with the Serum, being fresh poured out from the blood.* 1.824 viz. First the Blood it self being very impure, and also dissolved, it leaves its corruptions and superfluous dross in the cutaneous Glandules, which in the same place putting on the nature of more corrupted ferment, they boyl up with other ad∣ventitious Juices, or passing by these, and are diversly thickened, and so they be∣get not only pustulous affections, but also leprous of divers kinds. From hence the daily and often eating of Shell-fish, and also of others; and of salted meats that have been hung in the Sun or Smoak; also the taking disagreeing Drinks, and venemous Medicines, do cause cutaneous and frequently dreadful eruptions.

Secondly,* 1.825 The humour being heaped within the cutaneous Glandules, sometimes doth not only become pustulous by a mere stagnation, but also frequently Lousie. Wherefore, not only they that have been long in prison, but also those who being of a sedentary life, are used to nastiness and sluttishness, do live obnoxious to the above∣mentioned maladies; inasmuch as the cutaneous humour being not at all eventilated, is corrupted by mere standing, after the manner of putrefying water, and so it puts on the disposition of a corrupting ferment;* 1.826 to which moreover Supplements of putre∣fraction come from the blood in the like manner depraved.

Thirdly, If perhaps these Canses are wanting, that the glandulous humour of the

skin, neither contracts any stain from fault of the blood, nor its own proper stag∣nation, notwithstanding virulent steams communicated from without, render it no less prolific as to those diseases. This is manifest by common observation especially, forasmuch as they that have health most, and are endowed with the best Constitutions, scarce ever escape free from the same, if they lye in the same Bed either with a scabby person, or where he hath lately lain: and not only so, but moreover the Linnen of the Scabby, oftentimes washed with other Linnen have bestowed the contagion upon others. Surely, the taint of no disease (the Plague only excepted) is more easily or certainly propagated than this of the Mange.

If the reason of this be enquired into,* 1.827 we presently say that the liquour susceptive of the scabby taint is mightily exposed, and most easily disposed unto it; and indeed much more ready to either, than the Blood or Nervous Juice. For the glandulous humour of the skin abounding in the outer superficies of the body, first imbibes every atome let in by holes and pores every where open, and anticipates them from the blood. Moreover, that this is so soon infected with a scabby Contagion, both the activity of the ferment communicated causes it, and also the proneness of the glan∣dulous liquor to degenerate. For indeed the effluvia's falling from the breaking out of the scabby skin, are aptly enough compared to the Yest of Ale, remaining on the top as it were its outmost Coat; of which if the least portion be taken from thence, and mixed with other new Ale unfermented, presently it ferments the whole mass how great soever, and changes it into the disposition of the liquor from whence it was taken. Certainly there is a very considerable energy, which the particles however so small and little, carryed to the highest activity, are able to perform; but especially if they fall into a liquor (of which sort is the cutaneous) made up together of subtile particles of several sorts, as well partaking of the blood, as of the nervous Juice, and for that cause most readily apt to be fermented.* 1.828 Wheresoever therefore these effluvia's of the Contagion abovesaid hit against any outward part of a healthful bo∣dy, first they will infect the cutaneous humour only planted in that place, but then the particles of this so corrupted, being received by the venous blood, and presently delivered to the Arteries, are diffused through the entire habit of the body, and in a short time defile the whole mass of this Humour, and make it scabby.

From these Causes of a Psora as well adjunct as procuring being unfolded,* 1.829 the rea∣son of the first symptoms, or breaking out in Pustules, is manifest enough; but as to the other, viz. the Itch, as it is troublesome to Sense, that the formal reason thereof may be known, we ought to consider to what Sensory or organ of sense it properly belongs, and of what sort its passion or affection should be.

Concerning these things, first it is sure it belongs to the sense of touching,* 1.830 and that the first Instruments hereof are Teats fashioned like a Millet, and their little Fibres dispersed through the whole skin, as we have before declared. Moreover with this sense all the nervous fibres are endowed, being diffused throughout the whole body. Notwithstanding, whereas there are two supream passions of Touching,* 1.831 and as it were generical, viz. Pain and Pleasure, it is deservedly doubted to which of these Itching ought to be related. For the solution of which, we ought to shew by what means the Animal Spirits, being inmates to the organ of Touch, are affected in Pain, and also after what manner in Pleasure; then their demeanour also as to the Itching being design'd, it will easily be manifest of what Province this Passion is,* 1.832 and in what things the nature of it, and the manner of its acting do consist. Let the Reader pardon me, if I should by way of digression expound this more at large, and even to tediousness, because this Aetiology seems very necessary both to the under∣standing and curing of most outward distempers. Pain being distinct from Sadness, and belonging to the Touch, is used to be defined, Atroublesome feeling proceeding from the dissolution of Ʋnity. And indeed it takes its origine as often,* 1.833 and in as much as any sensible thing, disagreeable or improportionate, being applyed to that organ of fense, divides and separates the fibres one from the other; and for that cause repel∣ling the animal spirits inhabiting in them, from their wonted and quiet emanation, distracts them from one another, and as it were puts them to flight; then presently forasmuch as that outward repulse of the spirits, is communicated by a continued order of other spirits, to the first organ of Sense, it stirres up the Spirits dwelling there into the like confusions, so a perception is caused of grief or pain inflicted outwardly. In truth the whole series of animal spirits which are affected with pain, as it were some singular member of the sensitive Soul, conceiving trouble, as it were,

from the impression of the object, is forced to be wrinkled with pain, and to contract in self into a lesser dimension.

When a dissolution of Unity is said to be the cause of pain, we must not un∣derstand it so as if this affection only were caused from a wound or blow inflicted upon the body,* 1.834 for the same thing is used to be induced from cold, heat, wind, from the extravasating of the blood and of other humours, or their being heaped up together in several places, oftentimes the fashioning of the member remain∣ing as yet entire; in which cases, although the continued parts, and chiefly the fibres and filaments, are not at all cut off, notwithstanding they are in every Affection of grief pulled from their usual position, either by the oppression of the object, or by strange particles forced like wedges, and are compelled into too much tension or distor∣sion, or divulsion; and for that cause the inmate spirits being pulled from their mutual embraces, and dissipated, are ill at case, and incur the passion of pain or grief.

Pleasure is opposed to Pain,* 1.835 and is a manner of Feeling clearly contrary there∣unto; which takes its origine, inasmuch as a pleasant stroaking being made upon the organ of Sense, the spirits flock thither, and presently being thickly gathered together, and overspread with a certain delight, they do as it were exult and re∣joyce together in the organ: afterwards, inasmuch as the spirits enter into the like triumph or rejoycing within the Corpus striatum, a perception of pleasure is stirred up.

The greatest pleasure which is offered to the Touch,* 1.836 consists in this, that the cause of Pain being removed, the parts formerly affected by it, may recover their wonted temper and frame; for so the animal spirits being before put to flight, and dispersed from one another,* 1.837 they recollect themselves, and rushing into the places from which they were banished with reinforced strength, they prepare themselves to re∣joyce. From hence the Peripateticks placed the formal reason of Pleasure only in the removal of something that was troublesome, as when the excesse of cold or heat is received by an opposite and more agreeable state. Indeed the tangible object (because it is alwayes thick and dull) doth scarce any way else (excepting Venery) allure the animal spirits into heaps to the organ of Sense, unless for that it removes their former confusion.

From these things so described concerning those passions,* 1.838 it is easily manifest, that the Itch according to the formal account thereof, is neither perfectly nor fully either Pain or Pleasure, but imperfectly and as beginning, partakes of both. For really the scabby matter being heaped up within the pores of the skin, and making the solu∣tin of Unity in many places, enclines towards pain: yet as it is volatile, moving, and hastens towards vent,* 1.839 for that cause the Animal spirits are not put to flight from the Fibres although pulled asunder, neither are they driven back with sense of pain; but the contrary, as if being stronger than the humour infesting, they were able to cast it forth, they being wrapp'd up more thick, but irregularly within the cutaneous fibres, do twitch them together variously, and draw them on, that they may the sooner discharge the morbific matter, and expell it forth. Wherefore inasmuch as the Ani∣mal spirits being neither put to flight, nor repulsed, but flowing together in crouds into the organs of Touching, they manage themselves there tumultuously, and dis∣orderly, and as it were by tickling the sensible fibres do provoke them into small Convulsions, no pleasure, but a troublesom feeling, nor also is it Pain, but a Passi∣on clearly diverse arises from it. But as soon as by rubbing or scratching, the plenty of Spirits assembled about the organ of Sense, begin to be better disposed, and as it were reduced into order, from thence a thorough feeling of Pleasure is introduced. Wherefore the Itching seems to be a middle-state between the betginning of Pain and Pleasure,* 1.840 or a passage of the Spirits from the rudiments of that, towards the full compleating of this. But from this Physical discourse by the by, let us return to our Pathologie or discourse of the distemper. From what is above said it is easie to collect the differences of this disease.

In the first place therefore the Psora as to its origine either is got by Conta∣gion,* 1.841 or by reason of an ill Course of Diet, the fierceness and supply thereof is communicated by the Chyle and Blood being vitiated, or it is generated in the skin it self, by reason of filth, and the defect of Transpiration: Whereto we may adde, that sometimes Infants acquire this taint hereditarit contracted from their Parents.

Secondly, These cutaneous Eruptions as to their form,* 1.842 vary according to the di∣verse Constitutions of the persons affected: for in some persons of a cholerick dryer Temperament, or Melancholy, only a dry Scab is stirred up, and inasmuch as it eva∣porates lessby reason of the defect of the Serum, with an stching not altogether so troublesome; but in others of a moister Temperament, and of more unclean blood, very many wheals and pustules imbued with schor, and most of all itching, do very much provoke to scratching, and by reason of the Ulcers stirred up therewith, the Itch is immediately altered into pain.

As to the Prognosticks, although this Disease is never of it self mortal or very dangerous, and always easie of Cure: yet frequently it contains an evil event;* 1.843 in∣asmuch as being long continued, it utterly depraves the blood and nervous Juice, and from it hastily cured, by reason of the matter received within, while it is discuss'd from the Pores, a pernicious taint is brought upon the Praecordia, and Brain, and other noble parts.

The greatest hazard from a Scab, threatens Children and Cachectick persons;* 1.844 as in both of which the taint is more easily impressed from this Cutaneous humour upon the nobler parts, which afterwards when the outward malady is removed, remain∣ing within cannot be vanquished entirely, but by a very long Course of Physick, of which neither is capable nor patient; wherefore, such persons,* 1.845 all care and dili∣gence being administred, ought to be preserved from the infection of the Scab as from the Plague.

Coucerning the Cure of a Scab or Psora, two chief Indications present themselves,* 1.846 and each of them two-fold, viz. The first intention Curatory respects these two things, First, that the glandulous Humour (its corruptive ferment being wholly extinct) may be reduced to a due temper. Secondly, afterwards that the Pores and passages of the skin being freed from those schorous congealings, may recover their pristine frame or good temper.

The Second Indication Freservatory takes care to prevent these two things,* 1.847 viz. First, lest the impurity of the Psora, or corrupting Miasma's of the skin, being dis∣cuss'd from the skin (while the ferment is expugned) turn back again into the blood and nervous liquor, and bring upon them not only ill temperaments, but also (as frequently it uses to doe) a more considerable prejudice upon the Brain or Praecor∣dia. Secondly, also let it be endeeavoured that the taint of the Humours, and of the noble parts contracted from the Itchy matter, may be eradicated while the faults of the skin are repaired.

All these intentions of Curing, by remedies internal as well as external together,* 1.848 being much and often used, ought to be joyn'd together, or at least-wise to be inter∣us'd, viz. that the morbific matter being discussed from its recesses, may not depart into and lye hid in any lurking-places any where else, but from every part, inwardly and outwardly, by remedies taken, may be wholly removed away; wherefore Purgatories ought alwayes to begin and end this method of Curing.* 1.849 Although Hel∣mont with great pomp overthrows this Cathartick method of Physick, and as it were leads it in Triumph, because it doth not cure the Scab by it self, yet we may affirm this Disease without that remedy can scarce ever easily be cured, but never safely. Moreover Phlebotomy, unless something contradict it, is presently to be celebrated in the beginning; upon these, Alteratives that cleanse the blood and strengthen the bowels, and defend against the assaults of the morbific matter, challenge their turns; and in the mean time Liniments, or Baths, or topical remedies of another kind, and pro∣perly Cutaneous, are administred: As without which not only Purging and Bleeding, but also Diaphoreticks, Diureticks, yea whatsoever remedyes evacuating blood or humours, or altering them, become useless. We will annex some more select short forms of Medicaments, of every one of these Kinds but now recited. And first for the due undertaking of the Purging part, let there be administred in the beginning a purging Medicine or a Vomit; also after Phlebotomy being used (if need require) an Apozeme or purging Ale may be administred for seven or eight dayes.

Take of Electuary Diacarthamus three drams,* 1.850 Spec. Diaturbith with Rhubarb one dram, Cream of Tartar, Salt of Wormwood an. half a scruple, syrup of purging Apples what suffices, make a Bolus to be taken with Government. Or,

Take Sulphur of Antimony seven grains, Scammony sulphurated eight grains, Cream of Tartar half a scruple, make a powder.

Take roots of Polypody of the Oak, sharp pointed Docks prepared, an. one ounce, leaves of Senna ten drams, Turbith, Agarick, Epithymum, an, one ounce, Carthamus-seeds half an ounce, Curine Sanders two drams, Annise, Carus seeds, of each two drams, being sliced, bruised, &c. digest them warm in four pound of White wine twenty four hours, pour it clear off without straining: the Dose six ounces by it self, or with a spoonful of syrup of Epithymum.

Or take the foresaid Ingredients and boyl them in six pound of Spring-water to half,* 1.851 then adde one pound of White-wine, and presently strain it for an Apozeme to be taken as the former.

Take roots of Polypody of the Oak,* 1.852 sharp-pointed Docks an. three ounces, Senna four ounces, Epithymum, Turbith, Mechoacan, of each two ounces, of yellow Sanders one ounce, Coriander-seeds six drams, prepare them according to art, make a bag for four gallons of Ale; draw it after five or six dayes, take twelve ounces more or less every morning, for eight or ten dayes.

For ordinary Drink let a little four-gallon Vessel be filled with small Ale, wherein may be put the following Bag.

Take the tops of Tamaris, dryed Fumitory an. four handfuls, roots of sharp-pointed Docks dryed six ounces, the rinde of woody Night-shade two ounces, slice and bruise them and mingle them. Or let them take a Bochet of the Decoction of Sarsaperilla, Saunders, with shavings of Ivory, Harts-horn, and Liquorish.

II.* 1.853 As to what belongs to altering Remedies, beside the Physick-Ale for ordina∣ry Drink, there seems not need of many others, but only, that a due government of Diet be observed, by declining Salt and spiced Food, Shell fish, and others seasoned with pickle; also abstinence from Wine, Strong waters, stronger Ale, and from all Liquors apt too much to stir and ferment the blood. In a contumacious Psora, and seizing upon a Cachectick body, it will be expedient to administer the following Electuary with a distilled water twice a day.

Take of Conserve of Fumitory,* 1.854 roots of sharp-pointed Docks, of each three ounces, Troches of Rhubarb, Species of Diatrion Santalon, of each one dram and a half, Salt of Wormwood one dram, Vitriolum Martis four scruples, with a sufficient quantity of sy∣rup of Cichory with Rhubarb, make an Electuary, the dose from one dram to two, twice in a day, drinking upon it three ounces of the following water.

Take of the tops of Fir-tree,* 1.855 six handfuls, of leaves of Fumitory, Agrimony, Fluellin, Liverwort, Brooklime, of each four handfuls, roots of sharp pointed Docks two pound, Bark of Elder two handfuls, the outward Rinds of six Oranges, cut them and bruise them, and then pour upon them eight pints of Posset-drink turn'd with middle beer, distill them in a Rose-Still; let the whole Liquor be mingled together.

III.* 1.856 Oyntments for to anoynt the Skin, are wont commonly and efficaciously to be prescribed for the curing of the Scab; notwithstanding those which are admini∣stred to many other Tumours or Ulcers, do not help here at all; but Brimstone and Preparations thereof seem to have a specific vertue in this Disease, so that for the most part they are put into all Liniments for the Itch, and are the basis of the whole Composition. The Receipt chiefly used by the Vulgar is this.

Take Powder or flower of Brimstone half an ounce,* 1.857 unsalted Butter four ounces, powder of Ginger half a dram, make an Oyntment.

A little more neat, though not much more efficacious is prescribed thus.

Take Oyntment of Roses four ounces, powder of Quick Brimstone half an ounce, Oyl of Tartar per deliquium what suffices, make an Oyntment: for scent sake adde one scruple of Oyl of Rhodium.

When the force of the Brimstone is to be drawn forth or strengthened by other things added,* 1.858

Take Oyntment of Enula-campane without Mercury four ounces, powder of Sulphur half an ounce, Oyl of Tartar per deliquium what suffices. For the same purpose the Oynt∣ment

of the roots of sharp pointed Docks boyled in Butter, or Oyl, with White-wine, to the consumption of the Wine, and made up with Sulphur and Oyl of Tartar. Also those Oyntments are used with success by themselves, the more curious abhorring the smell of Sulphur.

3. The third kind of Liniment against the Itch, is made of Mercury,* 1.859 wanting no guards of Sulphur, or any other Vegetables. But of it self it is too powerfull to be applyed all over the body, but only to the Joynts of the Arms and Thighs, or worn about the Loyns, made up in a Girdle, for so it seldom fails in curing the Itch.* 1.860 Not∣withstanding there is danger lest this practice (as it often happens) produce evil and pernicious symptomes; for from the Mercurial Oyntment, frequently a salivation, also sometimes dimness of the eyes, or drowsie or convulsive Affections do proceed: Also sometimes the Poyson of the medicine within the Praecordia or Bowels produces the dreadful Affections of short breathing, Swouning, or bloody Fluxes.

The vulgar form of a Mercurial Oyntment, and chiefly in use for the itch, is this.* 1.861

Take of Quick-silver reduced into small particles with an acid, or (as they say) kill'd, an ounce and a half, fresh Hogs Lard six ounces, incorporate them well, stirring them long in a Stone or Glass mortar.

Neither only under the form of an Oyntment,* 1.862 but also after many other wayes the aforesaid Medicines are wont to be often used. For the fume of Cinabar (which is prepared of Mercury with Sulphur) cast upon Coals and taken in at the mouth, or striking the superficies of the Body, cures the Psora. The Mercurial Cosmetick before described, being weaker by two degrees, if it be applyed upon the Skin, chiefly on the ulcerated places, it kills the Scab. Notwithstanding the use of these is not al∣ways so secure as to be administred every where to all persons.

Baths are prepared of Sulphur and Vegetables, either apart or together,* 1.863 being boyled in water, which heal this Disease not as a common Bath, by only washing off the filthiness of the Skin, but also by destroying the ferment thereof. Moreover, beside these there is another more easie and neater manner of healing the Itch, viz. Let a Shirt boyled with Powder of Brimstone in Spring-water,* 1.864 and dryed by the Sun or Fire, be worn next the body for four or five dayes; for so that disease is wont to be cured without bathing, or nastiness of anoynting, or evil smell.

It the Aetiologie of these be enquired into,* 1.865 and first why Brimstone is such a specifick Antidote against the Itch, that poor and ordinary men (who have not wherewithall to use any other Medicine) do take against this Distemper inwardly only powder of Brimstone with Milk, and administer it outwardly with Butter, I have already in part given an account, where we have unfolded the balsamick vertue of Brimstone towards the Lungs. Namely, it is a good expedient in either case, inasmuch as it destroyes the acidities of the Blood and Humours, and all the exotick and corrupting roughnesses, and restores a benign disposition to every Juice, viz. a mild and an unctuous:* 1.866 and so the Particles of Brimstone any way outwardly applyed, do easily enter into the pores of the skin, and being admitted inward, do forthwith work upon the ulcerous Ichor there abounding, kill the Salts there predominating, and procure a balsamick na∣ture to the cutaneous Juice, that it may aftewards agree with the Blood and Serum continually flowing to it.

As to Mercury, it is no wonder if Medicines prepared hereof do throughly heal the places of the skin affected with the Psora wherever applyed,* 1.867 for by the appli∣cation hereof, wheals and pushes, and all malignant ulcers, viz. Venereal and Scor∣butick, are wont to be tamed. Neither is it a thing to be admired, that these Re∣medies administred in any private places, as long as they provoke salivation, are a Cure of an Universal Itch; but really that without spitting they can produce such an effect, as that a Girdle wherein Quick-silver is sowed and worn about the Loyns, should abolish the Scab of the whole body, and that sometimes without any sensible eva∣cuation or harm caused thereby, I say the reason hereof is not so easily apparent.

Yet for the solution hereof,* 1.868 we must say that the Particles of Mercury being able to extinguish the scabbiness of every Itchy ferment, when they are applyed to any private part, do presently take away the Scab of that place; and besides being caught by the venous blood, and diffused through the whole masse thereof, and a little after they are not only carryed back by the arterious blood to the same

place where taken in, but being brought outward every where, they are deposited in the skin of the whole body, and in the same place destroy every Miasma of the Scab: If it then shall happen that these Mercurial particles, after they have finish∣ed the Cure, should be all evaporated again out of the skin, no salivation after∣wards, or other prejudice will follow.

SECT. III. CHAP. VII. Of the Impetigo or Lepra of the Greeks.

AFter the Scab with the Itch,* 1.869 it follows that we treat of another Distemper, a little a-kin to this by reason of the breakings out of little pustules, which is commonly call'd Impetigo, by some a Tetter and Morphew, and by others the Leprosie of the Greeks. And as it gains several names, so they are variously applyed by Authors, and by these they design one kind of Disease, and by those another kind. Wherefore, as the names of this Distemper are variously confounded, and perhaps that as to its nature and formal appearance it has been various in divers Regions, neither may it be altogether the same in our generation as in former times, for this cause my business here shall not be to describe this disease according to Boods, but from the proper observation of the Patients themselves.

The Impetigo is wont to arise and affect after this manner;* 1.870 to wit, little wheals or red pustules, sometimes single, and sometimes many together, are raised in di∣vers parts of the body, but chiefly in the Arms or Thighs; to each of which, new ones every where are adjoyned, (the Disease augmenting) and in a short space of time there become many heaps of risings of that kind, like clusters. For the little pimples breaking out daily near to their stemme, and spreading still larger, diffuse themselves into a Circle, and so cause every heap of Eruptions to be enlarged. The rough super∣ficies of each appears something white and scaly, so that upon scratching the scales fall off, and often a thin Ichor sweats out, which being presently dryed up again, hardens into a shelly scale.

These Clusters of little Pimples being first small and fewer, appear perhaps three or four in the Arm or Thigh, or other particular member, about the bigness of a Penny or half a dram: but afterwards, if the disease be suffered to augment, they break out every where more frequent, which being leisurely encreased in their ground, after wards appear to equal or exceed the bitgness of a Silver Crown, but not always round or of a regular Figure, but diversly formed. Moreover there is no stop in this condition, but the distemper, unless it be restrained with Medicine, breaking out still in more places, and creeping on every where in broadness, at length not only covers over the whole member but also the whole body with a leprous dry scurf; and this kind of Impetigo the Ancients call'd by reason of its outrage 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and for the most part accounted it incurable.

From hence the chief differences of this disease are made known;* 1.871 and in the first place as it is less or more malignant according to the fashion thereof, it is distingushed, as it comes nearer the nature of the Scab, or Leprosie, or as it is in a middle condition between both. We are also to note, this distemper sometimes infests some particular members, as the Arms or Thighs, the rest of the body being untoucht; but some∣times it begins together in all parts, and every where excites scatrteringly little Pim∣ples or Clusters thereof. Also eruptions of this kind are in some for a season, or pe∣riodical, and for the most part infest these persons during Winter only, vanishing away about Summer; likewise on the contrary, in others they abhorre Winter, and are wont to observe the season of the Swallow going and coming: but in most others the Disease being continual grants no truce, yea it hat neither remission nor me∣diocrity.

Moreover,* 1.872 we must distinguish an Impetigo from other Diseases a-kin to it, and first from the Scab, and the Leprosie. It differs from the former as to the form of the Pustules; for every where in the Psora they are single and remote from one another, although by small spaces; here most of them break out in Clusters, con∣currently,

and as it were disjoyned by branches with great interspaces. But be∣tween these distempers a notable difference yet arises, in that the Scab is wont easily or scarce otherwise to be propagated or arise, but by Contagion; but the infection of an Impetigo is so seldom or never, that the Miasma from the Husband doth not pass to the wise, or from her to him, though they lye together.

Also this Disease differs from the Leprosie, as well in respect of the form of its eruption, as of its contagion, which is likewise active in this, as in the Psora; and the breaking out is much larger and more horrid, viz. it is every where shelly and scaly, without intermission, and diffused through the whole body.

From hence it is manifest, that the material cause of an Impetigo,* 1.873 is not merely a cutaneous humour, by reason of effluvia's or a taint received from without, or de∣praved by reason of other accidents, and degenerated from its temperament; be∣cause it is not easily communicated to others by Contagion, as in the Psora, neither is it immediately dispersed throughout the whole body.* 1.874 But indeed little Pustules breaking out first about the initiations of the Disease seem therefore to proceed, for that certain acid salt Concretions happen to be in the mass of Blood (like Tar∣tar in Wine) which when they can neither be concocted or again dissolved, are here thrust out into the skin, as there into the sides of the Vessel. As long as these Con∣cretions are small and few, they are conveyed into the skin in this or that member, and by one or two branches of an Artery; then as Nature is wont to continue the same manner of excretion as it began, the matter being carryed every where by the same vessels, to the same nests, near the first wheals it causes heaps of others round about therm; but afterwards when the dyscrasie of the blood is daily augmented, and that Tar∣tarous matter is generated more plentifully in the mass thereof, more portions are con∣veyed by other Arteries, and still by more to the outward places: and for that cause also more pimples break out both in the same, and in other members, which a new matter coming continually by the same Arteries, and being placed close to the former, enlarges them every day, and every where dilates them by the addition of other pustules; and at length if this sort of Tartar of the blood augment hugely, being car∣ryed out by more or all the Arteries together, it is fastened in the skin, and in pro∣cess of time covers over all the superficies thereof with a scaly or downright leprous shell: And then that cutaneous humour being wholly corrupted, promotes the disease it self; for it causes the stock of the morbific matter to be encreased, by pollu∣ting more, or rather poysoning the blood and humours, whilest they pass in Circu∣lation; moreover dismissing the corruptive steams from it self, it renders the Con∣tagion of the same disease unto others.

Wherefore, both the procuring and conjunct causes of this Disease consist in this,* 1.875 for that without any fault of the skin, it happens that the blood is filled with salt Particles of a various disposition and condition; (into the preceding cause of which disposition we will anon inquire) and where those fixt and acid Salts are especially predominant (as the manner is) they mutually embrace one another, and so grow together into Tartarous Concretions; which being thrust forth into the blood, cause eruptions of wheals, as it were nests of the Disease; then they being daily and leisurely encreased both in number and largeness, according to the supply of matter, they produce the beginning, augmentation, and state of this disease.

As to what relates to the antecedent and evident causes,* 1.876 there are two chief kinds of occasions from which this distemper for the most part derives its origine; to wit, an evil manner of Diet, or a taint of the Scurvy, or Pox, or other Diseases left in the body, being ill, or not at all cured. We will weigh a little the reasons of each of these.

As to the former, besides the common irregularities in Diet,* 1.877 wherein some being too much addicted to eating of flesh salted and afterwards dryed in the Sun or Smoak, and the drinking of acid Wines, do easily contract this malady; Also it is a vulgar observation,* 1.878 that very many are disposed thereunto by the too frequent or daily feeding on Pork, and Fish, and especially Shell-fish. There is a notable instance of the former, which is, that that food was chiefly forbidden the Jews for prevention of this disease. Also there is an example of the other, that in time past the Inha∣bitants of Cornwal for the most part dwelling on the Sea-coast, inasmuch as the poorer sort were fed with Fish, became very obnoxious to Leprous Distempers;* 1.879 insomuch that for their relief many Hospitals were erected in that Countrey. That I may hint in a few words the reason hereof, I am apt to think whether that food is rancid,

or otherwise improportionate, that it conveys particles not rightly mixed, nor easily to be subdued to our blood, which being so heterogeneous and largely heapt up by a long use of such Diet, the saline particles of which kinde do easily associate them∣selves, and so do constitute Tartarous Coagulations to be exterminated in the skin, and the seeds of the Leprosie or of the Impetiginous Evil.

But yet a plentiful Crop is begot from the taint of the Scurvy and Pox left in the body,* 1.880 and afterwards by the combination of Salts and Sulphur exalted to ex∣tremity. We have elsewhere discovered the reasons of the former disease, and espe∣cially of the foresaid symptome coming after it, which being accommodated to our present Hypothesis do make it more clear. And it so often happens, that pustulous eruptions of this sort do follow an inveterate Pox, although it seem to be cured, that none distempered almost with these, wants the suspicion of that shamefull Disease; so that the first Question of a Physician in such a case being consulted, is, Whether the Patient have not at some time formerly contracted that Distemper? For surely the Corruptions of the blood, after they are by a long stay become altogether heteroge∣neous and indomitable, at length acquire to themselves salt Particles, wherewith growing into such like Tartarous Concretes, and being thrust forth into the skin, pro∣duce those Impetiginous Pustules.

As to the Prognostick part of this Disease,* 1.881 although it seldom threatens death or imminent danger, yet after it hath taken deep root, the Cure is very difficult, if at all: The Impetigo first beginning, and exciting a few Pustules, and knots of them, perhaps in one or two members, sometimes admits of Cure, but hardly without a most efficacious remedy. But if the Disease proceed so far, that the frequent and broad clusters of wheals appear dispers'd throughout the body, then small remedies effect nothing, and the great ones howsoever diligently observed, will not easily per∣form a Cure. But if the Disease, maugre all remedies advance daily, and encrease at length into a Leprosie, Celsius judges it impossible to be cured, and therefore we must wholly abstain form it.

There are two chief Indications concerning the Cure of an Impetigo,* 1.882 viz. Preser∣vatory, which respects the cause of the Disease, and the Curatory, which relates to the symptomes,* 1.883 viz. the pustulous Eruptions. The vital Indication hath seldom place here, unless in a desperate condition, where sleep and strength fail. The Method of Curing ought to begin with the Preservatory Indication, which takes away the Causes of the Disease by inward remedies, for otherwise external (as in the Psora) are never administred with success; but the roots of the disease in the blood being cut off, the cutaneous sproutings quickly consume away: for the taking them away, we must proceed in one manner when the Impetigo begins by it self, and in somewhat a different manner when it follows an inveterate Scurvy or Pox, being ill or not at all cured. We will consider each case throughly by it self, and distinctly.

Therefore whensoever this Disease is simple,* 1.884 and primarie, and being yet New, let the evident and extern Causes be removed; let the manner of Diet, and unwhol∣somness of Air be corrected; therefore those that have been lately too much accustom∣ed to salt Diet, and the flesh of Pork and Fish, let them change to Diet of good Juice and easie of digestion.* 1.885 They that inhabit the Sea-coast, or Fenny places, let them remove to a dry and clear Air; in the mean while let no less care be had to their Drink, by declining thick and foggy Ale, and small and acid Wines too much abound∣ing with Tartar: at length let care be taken lest their Drink or Food be dressed with any mineral waters that are apt to petrisie.

Secondly,* 1.886 In respect of the conjunct and procuring Cause, there are two chief Intentions of Cure, viz. that the impurities of the bowels and humours be quickly purged out; also that the acid faline distemperatures of the blood and nervous Juice be altered (whereby the Tartarous matter may be the less engendred in them;) for these purposes Medicines both evacuating and altering are prescribed of several kinds. Notwithstanding, because not all, but the greatest remedies are here convenient, those which are most chiefly of use and available, are Catharticks, Phlebotomy, Whey, Chalybeate Waters,* 1.887 Juicy expressions of Herbs, Decoctions of Woods, steel'd Me∣dicines and Salivation. Some certain Models of each of these, and the manner of using them, we will annex.

Wherefore in the first place,* 1.888 universal purging and bleeding being celebrated (as in the Cure of the Psora) we appoint the following Tincture or purging Infusion, whose dose is from six to eight ounces, to be repeated in six or seven days.

Take of the roots of sharp-pointed Docks dryed, Polyodie of the Oak,* 1.889 of each half an ounce, Senna ten drams, Epithymum six drams, Rhubarb, Mechoacan of each half an ounce, yellow Sanders two drams, Celtick Nard half a dram, Salt of Tartar one dram and a half, put them in a glass with three pints of White-wine, water of Elder-flowers one pound, let them stand stopt in a cold place three dayes, pour off daily as much of the clear liquor as is sufficient.

Secondly, For sweetning of the Blood, and washing of the Salts thereof,* 1.890 let simple Whey, two or three pints, or with the infusion of Fumitory, Chicory, and sharp-pointed Docks, be drunk every morning, for twenty or thirty dayes, if the Stomach will bear it, and likewise evening and early in the morning, let a dose of the ensu∣ing Electuary be swallowed.

Take Conserve of the roots of sharp-pointed Docks six ounces, Crabs-eyes, Coral pre∣pared,* 1.891 of each two drams, Ivory one dram, Powder of Lignum Aloes, yellow Sanders, of each a dram and a half, Sal Prunella two drams, Vitriol of Mars a dram and a half, Syrup of juice of Wood-sorrel what suffices to make an Electuary, the dose two drams.

Thirdly, For the same reason that Whey,* 1.892 your Iron Mineral waters are prescri∣bed bed for this Disease, and do oft notably help: for when all the other remedies have been in vain, I have with those alone cured a painfull and almost leprous Impetigo. Moreover, for more efficacy sake, let the use of Sal Prunella or Vitriol of Mars, or of the Electuary but now mentioned, be dexterously adjoyned.

Fourthly, In some endued with too much Serum, and a watery Constitution,* 1.893 where the drinking Whey or Mineral waters are less requisite, it is sometimes expedient that a Decoction of the Woods be assumed at physical hours, and also constantly instead of ordinary drink.

Take the Shavings of Willow half a pound, of Sarsaperilla eight ounces, whits Sanders, Lignum Lentiscinum, of each two ounces, Shavings of Ivory and Harts-horn, of each six drams, Filings of Tin, crude Antimony, of each four ounces tyed in a rag, of Liquo∣rish one ounce, infuse them in sixteen pound of Spring-water, and boyl them to half, keep it strained for use.

Fifthly, Medicines of Steel,* 1.894 in that they are every where accounted among the more excellent Remedies, are wont seldom to be omitted in this Disease, although not frequently given with success: for most Preparations of Steel, wherein the Sul∣phureous Particles predominate, inasmuch as they ferment the blood, and irritate it into Critical Effervescences, do cause these impetiginous eruptions to augment ra∣ther than diminish; notwithstanding the Salt, Syrup, Tinctures, and infusions of Vi∣triol, inasmuch as they fix the Blood, and something restrain the raging of the Salts, do fitly enough agree with the intention of Cure now proposed; but being weak in efficacy, they do not prevail against so Herculean a Disease.

Wherefore Sixthly, these and many other Remedies nothing availing,* 1.895 many commend Salivation, as the stoutest Wrestler and only match for such an Enemy. Yet the event doth not always answer this great expectation; for I have experi∣mented this remedy without success in four Patients labouring under a painful Im∣petigo, which had resisted other Medicines. Some of these were provok'd to abun∣dant Spitting by Unction with Quick-silver, others by doses of Solar Precipitate; which they have endured for the space of twenty dayes; which time being elapsed, all the scaly eruptions and clusters of wheals have vanished; notwithstanding, to confirm the Cure, a Diet-drink of the Decoction of Sarsa was appointed, and fre∣quent sweating under a Cradle, and due purgation between, was continued for a month: Notwithstanding, this Course being finished,* 1.896 when no footsteps of the distem∣per seemed to be left, within another month a new stock of the same Disease begin∣ning to break out, it encreased quickly to its usual maturity. Moreover, when one of them would repeat this course, and another after two relapses would experiment it the third time, both of them at length after great sufferings of Pain despaired of Cure: Whence it is manifest that the Venereal Distemper, although highly malignant, and raising most filthy Ulcers consuming the flesh and bones, is more easily and cer∣tainly cured than the Impetigo.

The reason whereof if we enquire,* 1.897 may plainly be conceived, for that the cause of the latter Disease consists in a malignant and altogether heterogeneous pollution, infecting and poysoning the blood and nervous Liquor for a certain time, but not altogether overthrowing, or for ever depraving its temperament; wherefore the Cure is performed by Salivation, or a sudorifick Diet, eradicating all that venom, and then the natural disposition of the blood and humours remains entire: But in a more difficult Impetigo, the Elemental particles and first Constitutives of the blood are corrupted, insomuch that unless the natural disposition and constitution of these are restored, all Evacuations and Expurgations of any venemous, malignant and heterogeneous matter, however plentiful and eradicative, do little or nothing prevail. Wherefore, many famous Physicians not undeservedly judg'd this Disease being confirmed and raised to the borders of a Leprosie, to be hardly or never cu∣red.

Secondly,* 1.898 No better event attends this malady ensuing upon an inveterate Scur∣vy; perhaps hence the intentions of healing are a little more certain when this Di∣stemper is placed as the Basis or root of that; to wit, that the chief curing Indica∣tion being taken from thence, we must chiefly insist upon Antiscorbutical remedies; but the more sharp and hot of this kind, as the Garden Scurvy-grass, Water-cresses, the Horse-rhadish,* 1.899 Pepperwort, and others too much irritating the blood, inasmuch as they dissolve the temperament thereof more, and drive out more plentifully the Tar∣tarous Coagulum to the skin, are always discovered to be more prejudicial than ad∣vantagious; and for this reason the use of Baths,* 1.900 or bathing in hot waters, which namely evacuate the humours of the whole body by an abundant Evaporation, and cleanse the pores of the skin, and seem very available in this malady, often-times are so far from helping, that those Eruptions are wont to be exasperated from thence and very much encreased: for I have known many not extreamly Impetiginous, to have gone to our Baths, to bathe in the hot waters, that have returned altogether Leprous.* 1.901 Wherefore, when the Symptoms of this distemper arise from a scorbu∣tick evil, all elastick things are to be avoided, and only the more temperate, en∣dued with a Nitrous, Vitriolic or volatile Salt, are to be administred. We will lay down some Models of each sort; As first Crystal Mineral, Juices of some Herbs and Decoctions, Salt and Mineral purging Waters, are most predominant with a Nitrous Salt.

Take of Crystal Mineral,* 1.902 or Nitre purified one ounce, Flowers of Sal Armoniack one dram, bruise them in a glass Mortar, give one dram three or four times in twen∣ty four hours.

Take of the leaves of Housleek the greater two handfuls, bruise it and boyl it in two pound and a half of new Milk till it turn to Curds and Whey, strain it, and take a pint of the clear liquor twice in a day.

Take of the leaves of Dandelyon six handfuls,* 1.903 bruise them, and put them into a glazed earthen pot with a cover, which put in an Oven after the bread is drawn out, let it stand six or seven hours, then pour it through a Strainer, the dose is four ounces to six of the clear liquor, thrice or oftner in a day.

Cucumbers being endowed with a Nitrous quality are advantagious by experience against this disease,* 1.904 wherefore in lieu of a Sallad let them be plentifully and often eaten; moreover three of four of them cut into slices, let them be infused, and stopt close, in three pints of Spring-water all night; to the clear liquor poured out, adde Sal Prunella two or three drams, the dose is half a pint thrice or oftener in a day. For the same purpose Decoctions of the leaves in running water together with the fruit do profit.

1.* 1.905 Certain mineral purging waters, of which sort are chiefly those of North-hall, an Analysis being made by Evaporation, manifestly shew a Nitrous Salt with which they are imbued, and I have sometimes found the daily drinking about four pintes for many dayes, to help against a gentle Impetigo.

2.* 1.906 But as I have before hinted, those Mineral waters endued with a vitriolic Salt, of which kind are the SPAW, and Tunbridge, and Astrope Wells, do far excell those Nitrous, and all other Remedies, and do more prevail in the Cure of an Impetigo. To those Patients that have not the opportunity of using these waters, I used to give with good success against this disease common water impregnated with our Steel,

and so rendring most exactly the gust of those Mineral waters. By reason of the Mi∣neral Salts, or at least the Mercurial Particles in them, Tin and Antimony are oft in use in the Cure of the Impetigo, and are usually prescribed with other reme∣dies. Let the Filings of Tin, and Powder of crude Antimony,* 1.907 be infused in Ale for ordinary Drink: also Dectoctions of Sarsa made with the woods, are found beneficial against this Distemper.

3. The use of a Viper,* 1.908 and the Preparations thereof, doth enough commend the wonderful vertue of volatile Salts in a grievous Impetigo, and also in curing the Leprosie it self. This Antidote of that Disease is reported to be found out first by a casual experiment, inasmuch (as Galen reports) that drink being pour'd out of a Bottle wherein a Viper was put to poyson one labouring with an Elephantiasis,* 1.909 and so given him to free him from his misery, prov'd his remedy, and what was destined for his murder, dispatched an incurable Disease. Hither relates the Analogy, taken from the nature of this Animal, whence they collect that it helps in this Dis∣ease: because the Viper yearly shakes off his scaly Coat, therefore some think its particles prevalent to throw off the leprous skin of a diseased man; but though we do not attribute much to these things, yet it is manifest by frequent observation, that remedies of a Viper do profit in the Impetigo and Leprosie; the true reason where∣of ought to be ascribed much to the volatile Salt wherewith this Animal is endued. For the particles hereof destroy the sixt and acid Salts predominating in the blood of the diseased, and dissolve their combinations; notwithstanding, the Salt, Spirit,* 1.910 and Oyl chymically extracted out of Vipers, by reason of their elastick particles, contracting an Empyreuma from the fire, profit not in this disease; as also neither Spirit nor volatile Salt of Harts-horn, Soot, Blood, and other the like Armoniacks; be∣cause by violently stirring the Blood and Humours they rather dissolve their tempe∣rament, and thrust forth the Corruptions more plentifully into the skin. Where∣fore the more simple Preparations of Vipers,* 1.911 as broths from their flesh boil'd in wa∣ter, and Drinks impregnated by Infusions, and Decoctions, and powders being made of them dryed and beaten, are prescribed more successefully against this Dis∣ease. Moreover not only the boyl'd flesh of Vipers, but of any other kinde of Ovi∣parous Snakes being taken in lien of ordinary food do ost afford notable relief.

4. The Impetigo or scaly eruption of Pimples, and formed as it were into clusters,* 1.912 is so frequent and familiar a symptome of an inveterate Venereal distemper, that we first ask the Patient whether something of that malignity be not concealed of which they are conscious; and if we perceive the matter such, all Specificks against this Disease, and Antiscorbuticks being omitted, we must come to the Decoctions of Woods, and those little or nothing helping, we must descend to the use of Quick∣silver. And truly by this method I have cured many that were accounted Impeti∣ginous and Leprous, (who have been handled long in vain, and wretchedly vexed with other Remedies appropriate to these diseases:) But we referred this sort of Impetigo to the Pathology of the Venereal distemper, whereto it is an Appen∣dix.

II. The second Indication curatory relating to the Disease it self,* 1.913 and the primary symptom, to wit, the scaly eruptions and clusters of Pustules, prescribes Topical Remedies to be applyed to the outer skin for the removing these effects; for which purpose in the first place Baths and Liniments are convenient: which yet rarely or never help of themselves, unless the procuring cause, that is, the Tartarous dispo∣sition of Blood be first purged out.

There is a vast medley of Topicks of this sort vulgarly vented,* 1.914 as well by Physi∣cians as by Empiricks and Quacks; among all which notwithstanding, Baths or Lini∣ments compounded of Tarre do far excell all other Remedies of either kind, insomuch that we should only use these but for their ill savour; wherefore we will annex some models of Compositions both with and without Tarre.

Wherefore, for Baths it is common to take water out of Tubs wherein Tarre hath long stood, and impregnated with the infusion thereof: Or,

Take of Tarre two pound, and with white Ashes sifted incorporate it into a gross mass, which boyl in a sufficient quantity of Spring-water, adding leaves of Ground-Ivy, Fumito∣ry, white Horehound, the roots of sharp-pointed Dock, Enula-campane, of each four hand∣fuls, make a Bath to be used with government; Or let such a Decoction be prepared without Tarre for Patients abhorring the smell.

Sulphureous Baths as well Natural as Artificial are found by experience less appro∣priate,* 1.915 yea for the most part the former do prejudice; Moreover, every bathing ought cautiously to be administred: for because this administration exagitates the blood, and puts it into an Effervesence, its Temperament is endangered (as has been said) rather to be dissolved, and the corruption to be spread more plentifully over the skin.

2.* 1.916 Liniments whose use is more safe, and convenient, are of a Triple kind or degree, viz. Gentle, Indifferent, and most Strong; of each of these we will pro∣pound one or two patterns.

1.* 1.917 First therefore in a slighter Impetigo, when the Eruptions and Clusters are small, Fasting Spittle is commended; likewise the weeping of green Wood in the Fire, also mere rubbing them with roots of sharp-pointed Docks bruised and ma∣cerated in Vinegar: Or,

Take Oyl of Tartar per deliquium, Oyl of Nuts or Almonds by expression of each equal parts, make a Liniment to be used to the parts affected twice in a day.

2.* 1.918 Liniments of the Second kinde have Tarre for an Ingredient, which is esteem∣ed above all.

Take of Oyntment of Roses six ounces, of Tarre two ounces, melt them together: Or,

Take a fat piece of Weather-mutton, which stick with the roots of sharp-pointed Docks, spit it and roast it, and in the mean while baste it with Tarre dropt leisurely upon it; the Dripping being received in a Vessel under it, keep it for an Oyntment most excellent for an Impetigo.

3.* 1.919 The most prevalent Liniments are Mercurial, viz. those made with Quick∣silver or Praecipitate. Let the model of the former be that prescribed already against the Scab; for the other,

Take of white Praecipitate three drams, Oyntment of Roses three ounces, mix them, for to anoynt the parts chiefly affected.

The use of these ought chiefly to be suspected in this Malady; for if spitting be raised, that great glutt of matter impacted in the pores of the skin will be moved, which if the whole together rushing too much towards the Ductus Salivales, gather about the parts of the Throat, will endanger suffocation.

Some years since a Virgin of a Noble Family,* 1.920 being of a hot Temperament, and endowed naturally with a sharp and salt blood, after being a long time obnoxious to an Impetigo, almost from her Cradle, about her riper years began to be afflicted more grievously; for the clusters of scaly Pustules covered not only her Arms and Thighs every where, and the other covered parts of her body, but also her Hands and Face were so defiled, that she was ashamed to appear abroad or converse with others of her rank. Lesser remedies almost innumerable were exhibited without suc∣cess; by using Baths she at first appeared relieved, but at length grew worse thereby. Astrope Wells which have cured some, afforded her little or no relief. Wherefore, when all ordinary means would not effect any thing, I propounded Salivation, as a remedy more prevalent than all the rest and (as it is accounted) the last. When the Parents and Patient readily consented to this advice, preparing her body duely by Purgation and Phlebotomy,* 1.921 I gave her (after our manner) Pills of Solar Praecipitate two dayes, and after the interval of one day, the remedy being repeated the next, an abundant and laudable spitting began, and continued for a month without any ill symptome; to keep which in its due tenour, I applyed a Mercurial Oyntment to the bending of the Joynts and the places most affected one while to one, another while to another. Before the finishing of this course, all the Eruptions vanished; notwithstanding to confirm the Cure, as also for the extirpation of the Mercury, she remained another month in Purging, Sweating, and Diet of the Decoction of Sarsa, China, &c. in which time seeming perfectly cured, she so remained for about forty dayes. But afterwards though she observed an exact course of Diet, the same disease began to bud forth again, and leisurely encreasing, at length it advanced into its former state. I being confounded with this event, perswaded her to hope an alte∣ration for the better after her Menstrual Flux, which was suddenly expected. Not∣withstanding,

after long delay that Crisis at length happening, and managing her self regularly after it, brought no Cure or ease of that Disease, but rather a fresh assault. Whereupon recourse was had again to Physick, and divers Remedies assay'd, all which when they became frustrate,* 1.922 her friends importuned that she might sali∣vate again, to wit, allured by this hope, that that method which cured her for a short space, being administer'd again, would cure her either for a longer space or altogether. Wherefore according to their wishes, the same course of spitting and sweating re∣peated for two months space, and thereupon the Pustules every where going off, the Noble Virgin seem'd again wholly to recover her health. But within a fortnight after the course finished, the Pustules and their Clusters again appeared, and leisure∣ly encreasing daily in number and bulk at length grew fouler than before, insomuch that like an Hydra, after the loss of one head this disease received sevenfold.

I knew another strong man endowed with a lusty habit of Body, who after he had laboured with an Impetigo many years, the malady still encreasing, and being ad∣vanc'd to the highest, he was covered all over with a white Scurf, as it were leprous, that every night the Scales fell off like Bran in great plenty in his bed, and might be gathered up in heaps. This man for Cures sake first tryed the ordinary Reme∣dies of every kinde, notwithstanding without success; and afterwards trying a lighter Salivation, found himself nothing better: but afterwards the same method being re∣peated, by a long and painful Spitting, he seemed to be restored to health; but within three months the same disease budding out, in a short space arrived to its former outragiousness; Moreover, when he had undergone the third time that most painful Remedy, that affect, which seemed expulsed for a certain time, returned again; and afterwards maugre this and all methods, it exercis'd its Tyranny during the Patients life. It will not be requisite here to discourse any thing of the Lepra, which being only a more intense degree of the former Malady, for the most part admits of no Cure. As to what relates to other Tumours, and their manifold kinds, and the Aetiologies or Reasons of each, I confess I am scarce able to contain my self, but that I should enter upon that pleasant Field of Speculation. But this seems as irrational and unusual, as for one wearyed with a long Course, and breathless at the end, running beyond his Post, presently to begin a new Race.

FINIS.

Notes

• * 1.1

  The Authors pur∣pose in the pre∣sent work.
• * 1.2

  The parts of the Thorax.
• * 1.3

  The substance of the Lungs alto∣gether membra∣nous.
• * 1.4

  Consisting of al∣most infinite Lobes.
• * 1.5

  Their little branchings.
• * 1.6

  The Lymphae∣ducts and ner∣vous slips.
• * 1.7

  The Vessels of a Lung.
• * 1.8

  Wait on the Trachea.
• * 1.9

  The description of the Trachea.
• * 1.10

  The description of the Larynx.
• * 1.11

  Membranes en∣compassing the wind-pipe.
• * 1.12

  The glandulous and vasculous Coats.
• * 1.13

  Of the Bronchia:
• * 1.14

  Their Systole and Diastole.
• * 1.15

  The Lobes of the Bronchia.
• * 1.16

  Their little bran∣chings disjoyn∣ed from one the other.
• * 1.17

  The use of the a∣foresaid frame.
• * 1.18

  The uses of the little bladdery Cells.
• * 1.19

  Endued only with Muscular Fibres.
• * 1.20

  The description and use of the Pneumonic Ar∣tery.
• * 1.21

  The description and use of the Pneumonic Vein.
• * 1.22

  The use of the venous and vas∣culous Coat.
• * 1.23

  The muscular Coat.
• * 1.24

  Why there is no Pulse in the Veins.
• * 1.25

  The disposition of the blood in the Pneumonic Veins.
• * 1.26

  The Lymphae∣ducts added to the aforesaid Vessels.
• * 1.27

  The nervous slips dispersed throughout the Lungs.
• * 1.28

  The Coats of the lungs, whereof one is smooth, and the other rough.
• * 1.29

  The Systole and Diastole of a Lung.
• * 1.30

  Its motion me∣chanically un∣folded.
• * 1.31

  The Muscles serving respira∣tion.
• * 1.32

  Their function as well in in∣spiration;
• * 1.33

  As in expira∣tion.
• * 1.34

  Wherefore the triangular Mus∣cle being small in a man, is stretched out through the whole bone of the breast in a Dog. The Diaphrag∣ma follows the motion of the Abdomen.
• * 1.35

  The labour of Muscles the same in exspiration as in inspira∣tion.
• * 1.36

  The causes of the above-mentio∣ned motions.
• * 1.37

  In the animal function.
• * 1.38

  And natural.
• * 1.39

  The motion of the former sort ariseth from the brain, the other from the Cere∣bellum.
• * 1.40

  It is a quaere of what kind the actions of breathing are.
• * 1.41

  It is concluded to be a mixt act.
• * 1.42

  The nerves of the lungs some rulers of the natural motion, and others of the voluntary.
• * 1.43

  Both do alter∣nately obey one the other, and agree in their office.
• * 1.44

  The interspaces of the little Lobes have pas∣sage one into the other, and from thence into the Lymphaeducts.
• * 1.45

  Which therefore is done, that the vaporous stea∣ming of the blood being re∣ceived by the in∣terspaces, and condensed into water in the Lymphaeducts, may be conveyed out.
• * 1.46

  The progress and distribution of the pulmonary Lymphaeducts.
• * 1.47

  The organs of breathing being hurt, the breath∣ing is hurt also.
• * 1.48

  The uses and ends of breath∣ing which use to be hurt.
• * 1.49

  The defects and failings of the Lung in its of∣fice.
• * 1.50

  First in respect of the blood.
• * 1.51

  The opinion of the famous Syl∣vius concerning the blood fer∣menting in the Lungs.
• * 1.52

  Which seems not likely to be true.
• * 1.53

  Our opinion hereof.
• * 1.54

  The pneumonic circulation of the blood is stopt sometimes by the fault of the heart it self.
• * 1.55

  2. Sometimes by the fault of the blood. 3. Sometimes by reason of passa∣ges obstructed.
• * 1.56

  The blood hin∣dred in the Lungs sometimes because not kin∣dled enough;
• * 1.57

  Sometimes too much.
• * 1.58

  It is also stopt through its tem∣perament being vitiated.
• * 1.59

  When the blood is too much loo∣sened in its con∣sistence.
• * 1.60

  Why it lodges the Serum in the Lungs.
• * 1.61

  The various cau∣ses and ways of doing it.
• * 1.62

  The blood dissol∣ved also lodges in the Lungs infections that cause corruption.
• * 1.63

  The blood is hin∣dred in the Lungs by reason of the too thick consistence of the blood;
• * 1.64

  As is perceived in a Feaver.
• * 1.65

  In a Pleurisie and Peripneu∣mony.
• * 1.66

  The blood is hin∣dred in the Lungs by the fault of the heart.
• * 1.67

  1. When the spi∣rits thereof are wanting.
• * 1.68

  2. Because mo∣ved inordinate∣ly.
• * 1.69

  3. The blood is hindred from obstruction of the passages. Which are shut up divers ways. For divers cau∣ses here rehear∣sed.
• * 1.70

  The bronchial Pipes are filled.
• * 1.71

  Sometimes wax hard.
• * 1.72

  The vessels are stuffed with con∣cretions resem∣bling the Poly∣pus.
• * 1.73

  The blood is al∣so hindred be∣cause the passa∣ges are burst a∣sunder, as in spitting blood.
• * 1.74

  One impediment of the blood is want or default of air.
• * 1.75

  Breathing hurt by the vicious qualities or de∣fect of air.
• * 1.76

  The faults of the air.
• * 1.77

  The defect of air hurting breathing, pro∣ceeds from the pneumonic Or∣gans.
• * 1.78

  The various ways of Ob∣structions.
• * 1.79

  A Catarrb.
• * 1.80

  The swelling of blood by which the passages are press'd together.
• * 1.81

  The Cramps of the tracheal passages.
• * 1.82

  The act of expi∣ration is easier than of inspira∣tion.
• * 1.83

  Expiration hurt sometimes proceeds from the fault of inspira∣tion.
• * 1.84

  Sometimes being alone depends on various cau∣ses.
• * 1.85

  1. On the wound of a part mo∣ving.
• * 1.86

  2. In a Cough.
• * 1.87

  The description of a Cough.
• * 1.88

  Its formal rea∣son and the man∣ner of its being done.
• * 1.89

  Its primary cause.
• * 1.90

  The evident causes thereof.
• * 1.91

  The kinds thereof.
• * 1.92

  A moist Cough.
• * 1.93

  A dry Cough.
• * 1.94

  A Phthisis ac∣counted chief a∣mong the disea∣ses of the breast.
• * 1.95

  The various ac∣ceptation of Phthisis.
• * 1.96

  It denotes any Atrophy.
• * 1.97

  An Atrophy first depends on the blood made unfit to nourish.
• * 1.98

  The consumptive Dyscrasit of the blood either from it self or com∣municated from other parts.
• * 1.99

  1. The kinds of the former are reckoned up.
• * 1.100

  This proceeds sometimes from a fault of the bowels or solid parts;
• * 1.101

  Or from the ner∣vous juice.
• * 1.102

  The nervous juice sometimes of it self is chief∣ly the cause of an Atrophy.
• * 1.103

  Two chief kinds of Atrophies.
• * 1.104

  Tabes Dorsalis.
• * 1.105

  Two kinds.
• * 1.106

  From the nervous juice stopt or de∣praved in the loyns.
• * 1.107

  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.
• * 1.108

  The losses where∣of are volun∣tary or involun∣tary.
• * 1.109

  2. Or Ichor flowing into those parts from solution of continuity.
• * 1.110

  The formal rea∣son of a virulent Gonorrhea.
• * 1.111

  The definition of a Phthisis.
• * 1.112

  The cause assign∣ed by the Anci∣ents.
• * 1.113

  What the con∣sumptive matter is.
• * 1.114

  By what ways it enters the Lungs.
• * 1.115

  Sometimes by the Trachea, yet not destilling from the head.
• * 1.116

  But sweating out of the sides of the Trachea.
• * 1.117

  The consumptive matter brought into the Lungs rather by the pneumonic Arte∣ries.
• * 1.118

  A Cough and spitting some∣times healthful.
• * 1.119

  Yet often being too much is dangerous.
• * 1.120

  Why the Con∣sumptive matter affects, and by degrees hurts the lungs.
• * 1.121

  How an Ʋlcer of the Lungs is made.
• * 1.122

  An ulcer of the lungs covered with a callus less prejudicial.
• * 1.123

  The evident causes of a con∣sumption.
• * 1.124

  The primary causes of a Con∣sumption some from the blood, others in part from the lungs.
• * 1.125

  The ill temper of the blood disposes to it.
• * 1.126

  And sometimes it receives a consumptive taint from the nervous juice.
• * 1.127

  And sometimes by reason of a fault communi∣cated from the Lympheducts.
• * 1.128

  The fourth reason is usual evacua∣tions suppressed.
• * 1.129

  By reason of transpiration hindred.
• * 1.130

  Partly from the Lungs.
• * 1.131

  From the breast ill formed. From the here∣ditary disposi∣tion. From foregoing distempers of the breast. From incongrui∣ty of the air.
• * 1.132

  The reason of the former exposed.
• * 1.133

  What an heredi∣tary disposition is.
• * 1.134

  In what it con∣sists.
• * 1.135

  What the con∣sumptive disea∣ses of the breast are.
• * 1.136

  The influence of the air for exci∣ting a Consum∣ption.
• * 1.137

  The grosser and City-air to some consumptive per∣sons healthful, to others hurtful.
• * 1.138

  The reason whereof is in∣quired.
• * 1.139

  A sulphureous air healthful to some consum∣ptives.
• * 1.140

  Sulphureous Me∣dicines chiefly agreeing.
• * 1.141

  The reason there∣of discoursed.
• * 1.142

  The three times or distinct states of a Cough.
• * 1.143

  When new, there is no suspicion of a Consumption.
• * 1.144

  When it begins to induce a Con∣sumption.
• * 1.145

  When it becomes a confirmed Con∣sumption.
• * 1.146

  The curing me∣thod, and first against a begin∣ning Cough.
• * 1.147

  Three indica∣tions.
• * 1.148

  The first respects the effervescence of the blood.
• * 1.149

  The second re∣spects the deri∣vation of the Serum and other excrements from the Lungs.
• * 1.150

  The third in∣tends the sup∣pressing the Ca∣tarrh and strengthing the Lungs.
• * 1.151

  Forms of Medi∣cines which are most in use.
• * 1.152

  The convulsive Cough of chil∣dren call'd the Chin-cough.
• * 1.153

  The reason thereof.
• * 1.154

  The cause partly a Catarrh.
• * 1.155

  A convulsive disposition of the parts of the breast.
• * 1.156

  The prognostick of this disease.
• * 1.157

  Cures first Em∣pirical.
• * 1.158

  Chin-cups a great remedy.
• * 1.159

  The reason wherof is in∣quired.
• * 1.160

  Frights profit in this Cough.
• * 1.161

  The rational cure.
• * 1.162

  Purging.
• * 1.163

  Vesicatories.
• * 1.164

  Mixtures.
• * 1.165

  Of what sort the beginning of a consumptive Cough it.
• * 1.166

  Three indicati∣ons concerning its cure.

  • 1. To stop the dissolution of the blood.
  • 2. To draw out the filth from the Lungs.
  • 3. To heal the Lungs hurt.
• * 1.167

  The first indica∣tion suggests three intentions of healing.
• * 1.168

  The first intenti∣on, that the nu∣tritive juice may be propor∣tioned to the blood and assi∣milated by it.
• * 1.169

  2. That the a∣cidities of the blood and other humours be ta∣ken away.
• * 1.170

  3. That the ex∣crements of the blood be drawn off from the Lungs.
• * 1.171

  Second indica∣tion requires expectorating Medicines.
• * 1.172

  Third indica∣tion is perform∣ed by Balsa∣micks and vul∣neraries.
• * 1.173

  Forms of reme∣dies for a con∣sumption.
• * 1.174

  Mixtures.
• * 1.175

  Syrups.
• * 1.176

  Linctus's.
• * 1.177

  Lohoch.
• * 1.178

  Tinctures.
• * 1.179

  Troches.
• * 1.180

  Powder.
• * 1.181

  Pills.
• * 1.182

  Decoctions.
• * 1.183

  Distilled Waters.
• * 1.184

  Fumes and Va∣pours.
• * 1.185

  Formules of the former.
• * 1.186

  Forms of the more gentle Fume.
• * 1.187

  Of the more strong.
• * 1.188

  Arsenicals.
• * 1.189

  Smoak of Auri∣pigment.
• * 1.190

  Of a confirm'd Consumption.
• * 1.191

  The formal rea∣son thereof.
• * 1.192

  Forms of reme∣dies in a despe∣rate Consumpti∣on.
• * 1.193

  Decoctions.
• * 1.194

  Distilled wa∣ters.
• * 1.195

  Hypnoticks.
• * 1.196

  Hypnoticks.
• * 1.197

  Eclegma's.
• * 1.198

  The History of a Cough threaten∣ing a Consum∣ption.
• * 1.199

  Troches.
• * 1.200

  The second re∣markable Histo∣ry.
• * 1.201

  A hooping Cough.
• * 1.202

  The conjuct cause of the disease.
• * 1.203

  The usual method of curing.
• * 1.204

  A Purge.
• * 1.205

  A Drink.
• * 1.206

  A Mixture.
• * 1.207

  Spitting blood a distemper ve∣ry frequent.
• * 1.208

  Three things to be considered concerning it.
• * 1.209

  Out of what vessels the blood bursts out.
• * 1.210

  By what sault both of the ves∣sels and of the blood it happens.
• * 1.211

  What Arteries chiefly and where placed do void blood.
• * 1.212

  Both the pneu∣monic and tra∣cheal are in fault.
• * 1.213

  Spitting blood from the tra∣cheal Arteries.
• * 1.214

  2. In what pla∣ces the blood is deposited.
• * 1.215

  Either in the Larynx, or in the middle of the Bronchii, or in the orbicular little bladders.
• * 1.216

  The procatarctic and evident causes thereof.
• * 1.217

  The Prognistics of this disease.
• * 1.218

  The Cure thereof.
• * 1.219

  1. Indication.
• * 1.220

  1. It stops the flux of blood.
• * 1.221

  2. It shuts the opening of the Vessels.
• * 1.222

  II. The second preservatory in∣dication.
• * 1.223

  1. It respects the blood which is to be kept in a right Crasia.
• * 1.224

  2. A 〈◊〉〈◊〉 frame of the Lungs to be procured.
• * 1.225

  The forms of Me∣dicines.
• * 1.226

  Juleps.
• * 1.227

  Distilled Wa∣ters.
• * 1.228

  A Julep.
• * 1.229

  Apozems.
• * 1.230

  Tinctures.
• * 1.231

  Emulsions.
• * 1.232

  Juyces of Herbs.
• * 1.233

  Powders.
• * 1.234

  Pills.
• * 1.235

  Electuaries.
• * 1.236

  Lohochs.
• * 1.237

  The second Indi∣cation.
• * 1.238

  The first inten∣tion in respect of the blood.
• * 1.239

  A Purge.
• * 1.240

  Alteratives.
• * 1.241

  Decoctions.
• * 1.242

  A distilled water.
• * 1.243

  The second in∣tention respects the Lungs.
• * 1.244

  The first Hi∣story.
• * 1.245

  The reason of the case.
• * 1.246

  A Drink.
• * 1.247

  The Electuary.
• * 1.248

  The Julep.
• * 1.249

  The second Hi∣story.
• * 1.250

  The reasons of the case.
• * 1.251

  The description of a Peripneu∣mony.
• * 1.252

  After what manner a Phleg∣mor is bred in the Lungs.
• * 1.253

  The conjunct cause of a Peri∣pneumony con∣sists in two things. 1. That the blood boils. 2. That it sticks in the passages. Sometimes this disposition, sometimes that is first.
• * 1.254

  What that is Phlebotomy dis∣covers.
• * 1.255

  What affection of the blood pro∣duces it.
• * 1.256

  The fault of the Lungs produces it.
• * 1.257

  The evident cau∣ses of a Peri∣pneumony.
• * 1.258

  It often succeeds or follows after a Pleurisie.
• * 1.259

  The reason of this is inquired into.
• * 1.260

  The differences of this disease.
• * 1.261

  Prognostics.
• * 1.262

  1. From the ap∣pearance of Sym∣ptoms.
• * 1.263

  2. From what is excreted.
• * 1.264

  3. From the state of strength.
• * 1.265

  The Cure hath two chief indi∣cations.
• * 1.266

  The first indica∣tion suggests four intentions of cu∣ring.
• * 1.267

  1. The first in∣tention that the afflux of blood may be cut off. 2. That the ex∣travasated be reduced to oir∣culation.
• * 1.268

  Rules concerning Phlebotomy.
• * 1.269

  The third inten∣tion of healing is that the clam∣miness or visco∣sity of the blood may be taken a∣way.
• * 1.270

  4. That the most urging Sym∣ptoms may be helpt.
• * 1.271

  The second indi∣cation respects the maturation and expectora∣tion of the mor∣bific matter.
• * 1.272

  Juleps.
• * 1.273

  Apozemes.
• * 1.274

  Purgation.
• * 1.275

  Purges.
• * 1.276

  Clysters.
• * 1.277

  Things dissolv∣ing the clam∣miness of the blood.
• * 1.278

  Powders.
• * 1.279

  Spirits.
• * 1.280

  Potions.
• * 1.281

  The cure of the Symptomes.
• * 1.282

  Linctus's.
• * 1.283

  Lohochs.
• * 1.284

  An Apozeme.
• * 1.285

  Against Watch∣ings.
• * 1.286

  For Pain.
• * 1.287

  Maturating medicines.
• * 1.288

  Expectorating Medicines.
• * 1.289

  The first History.
• * 1.290

  The second Hi∣story.
• * 1.291

  The diseases of a Pleurisie and Peripneumonie are akin.
• * 1.292

  How they differ betwixt them∣selves.
• * 1.293

  The seat of a Pleurisie.
• * 1.294

  The next cause of it.
• * 1.295

  The more re∣mote causes of this Disease.
• * 1.296

  The differences of it.
• * 1.297

  The Progno∣sticks.
• * 1.298

  The Cure there∣of.
• * 1.299

  The first Indi∣cation.
• * 1.300

  Phlebotomie ne∣cessary almost in all Pleurisies.
• * 1.301

  What Vein is to be opened in a Pleurisie.
• * 1.302

  Various opini∣ons are recited.
• * 1.303

  Cupping-glasses with Scarifica∣tion supply the place of blood∣letting.
• * 1.304

  Whether Purges and Vomits are to be taken in a Pleurisie.
• * 1.305

  What other kind of Reme∣dies are conve∣nient in this disease.
• * 1.306

  The second Indi∣cation preserva∣tory.
• * 1.307

  The third Indi∣cation vital.
• * 1.308

  Cardiacks.
• * 1.309

  Anodynes:
• * 1.310

  Forms of Reme∣dies.
• * 1.311

  First for the re∣moving the In∣flammation. Juleps, &
• * 1.312

  Apozemes.
• * 1.313

  Powders.
• * 1.314

  A Purge.
• * 1.315

  Secondly for the taking away the Clamminess of the Blood.
• * 1.316

  An Infusion of Horse-dung,
• * 1.317

  And distilled water.
• * 1.318

  Sylvius's Anti-Pleuritick.
• * 1.319

  Powders.
• * 1.320

  Chymical Li∣quors.
• * 1.321

  What remedies the third inten∣tion requires.
• * 1.322

  Hypnotick Ano∣dynes.
• * 1.323

  External Ano∣dynes.
• * 1.324

  An History.
• * 1.325

  An Empyema is the product of other diseases of the breast.
• * 1.326

  It rarely or ne∣ver begins of it self.
• * 1.327

  What the mor∣bific matter is.
• * 1.328

  The difference of Pus and a puru∣lent matter.
• * 1.329

  Why both some∣times with, and sometimes with∣out stench.
• * 1.330

  Neither the cause of an Empyema.
• * 1.331

  The Signs of an Empyema whilst begin∣ning.
• * 1.332

  When perfect.
• * 1.333

  Prognosticks of this disease.
• * 1.334

  What it signi∣fies when the Probe is guilded by the Empye∣matical matter.
• * 1.335

  The cure of the disease.
• * 1.336

  The cutting or opening the side.
• * 1.337

  The Empyemati∣cal matter is went to stink by the often ad∣mission of the Aire.
• * 1.338

  Those things which perswade of forbid a Pa∣racentesis.
• * 1.339

  Forms of Re∣medies.
• * 1.340

  Cardiacs.
• * 1.341

  A Vulnerary Decoction.
• * 1.342

  An History of one troubled with an Em∣pyema, the cut∣ting of whom was mortal.
• * 1.343

  Of another who recovered by that remedy.
• * 1.344

  The History of one who dyed because he was not cut.
• * 1.345

  A fourth Histo∣ry like the for∣mer.
• * 1.346

  Vomica Pulmo∣nis a disease seldom observ'd,
• * 1.347

  The formal rea∣son and conjunct cause thereof.
• * 1.348

  The morbifick matter.
• * 1.349

  First Indicati∣on.
• * 1.350

  Forms of Reme∣dies.
• * 1.351

  Second Indica∣tion.
• * 1.352

  Third Indicati∣ons.
• * 1.353

  Fontinels in the side very often greatly help in this disease.
• * 1.354

  An Asthma a most terrible disease.
• * 1.355

  The causes of re∣spiration hurt.
• * 1.356

  The Ancients allowed the cause of it only from the Bron∣chia obstructed:
• * 1.357

  Or vapours from the Spleen or Womb, but er∣roneously.
• * 1.358

  After what manner the straitness of the Bronchis arises.
• * 1.359

  Whatever causes an effervescence of the blood is the evident cause of an Asthma.
• * 1.360

  Why Asthmati∣cal Persons are worse in bed.
• * 1.361

  A convulsive Asthma.
• * 1.362

  Its Seat mani∣fold and diffused.
• * 1.363

  The morbific matter consists in several pla∣ces.
• * 1.364

  1. In the mus∣cular fibres.
• * 1.365

  2. Within the Nerves and their ensold∣ings.
• * 1.366

  3. Near the O∣rigines of the Nerves.
• * 1.367

  3. A mixt Asthma or part∣ly Pneumonic and partly Con∣vulsive.
• * 1.368

  The causes of an Asthma recited.
• * 1.369

  The Progno∣sticks of the Dis∣ease.
• * 1.370

  Two chief In∣dications.
• * 1.371

  What is to be done in the fit.
• * 1.372

  1 Intention to facilitate breathing.
• * 1.373

  2 Intention to free from Con∣vulsions the moving parts. Remedies which dissipate the spirits profit for this end.
• * 1.374

  Or do bring them asleep.
• * 1.375

  Forms of Re∣medies.
• * 1.376

  An Apozeme.
• * 1.377

  A Tincture.
• * 1.378

  A Powder.
• * 1.379

  Mixtures.
• * 1.380

  2. The Indica∣tion preservato∣ry proposes what is to be done out of the fit.
• * 1.381

  Suggests two Intentions of healing.
• * 1.382

  Forms of Re∣medies.
• * 1.383

  Pills.
• * 1.384

  Mixtures.
• * 1.385

  A distill'd wa∣ter.
• * 1.386

  Magistral Sy∣rups.
• * 1.387

  The decoction of an old Cock.
• * 1.388

  Without purg∣ers.
• * 1.389

  The first History of a Convulsive Asthma.
• * 1.390

  The Cure.
• * 1.391

  The second Hi∣story of a mixt disease.
• * 1.392

  The reason of this case.
• * 1.393

  A Dropsie of the Breast is easily known.
• * 1.394

  Its cause is hid∣den.
• * 1.395

  How many wayes it may be produced.
• * 1.396

  1. By Vapours condensed there.
• * 1.397

  2. By Serum deposited there.
• * 1.398

  Which some∣times breaks out from the Ar∣teries.
• * 1.399

  3. And some∣times from the Lymphaducts.
• * 1.400

  A remarkable history of the like case.
• * 1.401

  The reason thereof.
• * 1.402

  The Cure by a Paracentesis of the breast.
• * 1.403

  The differences of this disease.
• * 1.404

  The Diagnostick signs.
• * 1.405

  The Cure.
• * 1.406

  What Intentions of healing the first Indication suggests.
• * 1.407

  The first Inten∣tion.
• * 1.408

  A Purging Hy∣dromel.
• * 1.409

  Tinctures.
• * 1.410

  Julep.
• * 1.411

  Pills.
• * 1.412

  A Lime-water.
• * 1.413

  A Bochet.
• * 1.414

  A History of a Patient.
• * 1.415

  The Cure of him.
• * 1.416

  Diseases of the Liver.
• * 1.417

  The Jaundies.
• * 1.418

  The cause of it.
• * 1.419

  The opinion of Sylvius of the cause of the Jaundies.
• * 1.420

  The Authors opinion.
• * 1.421

  The cause of this disease some∣times in the blood.
• * 1.422

  The cure of the Jaundies.
• * 1.423

  The 1. Indica∣tion.
• * 1.424

  The 2. Indica∣tion.
• * 1.425

  The 3. Indica∣tion.
• * 1.426

  Forms of Reme∣dies.
• * 1.427

  Vomits.
• * 1.428

  Purgers.
• * 1.429

  A Bolus.
• * 1.430

  Apozems.
• * 1.431

  A Potion.
• * 1.432

  Pills.
• * 1.433

  Deoppilative Medicines.
• * 1.434

  Elixir.
• * 1.435

  Apozems.
• * 1.436

  Empirick Re∣medies.
• * 1.437

  An Electuary.
• * 1.438

  Distilled Wa∣ters.
• * 1.439

  Sylvius his Em∣pirical Reme∣dies.
• * 1.440

  The second Indi∣cation. Remedies a∣gainst the Jaundies en∣dowed with an animal vo∣latile Salt.
• * 1.441

  Varlous forms of them.
• * 1.442

  Also such as are endued with a mineral vola∣tile Salt.
• * 1.443

  Steel remedies of several kinds.
• * 1.444

  Outward and Sympathetick remedies a∣gainst the Jaundies.
• * 1.445

  The reasons of some of them.
• * 1.446

  The Third Indi∣cation vital.
• * 1.447

  Forms of Cor∣dials.
• * 1.448

  The Kinds of Remedies as∣signed to the Liver.
• * 1.449

  Two general in∣tentions of cu∣ring this bowel.
• * 1.450

  Medicines vul∣garly called Splanchnick, first and chiefly operate upon the blood.
• * 1.451

  What such they are which more especially respect the Liver.
• * 1.452

  Some forms of Hepaticks.
• * 1.453

  Their numbers enumerated.
• * 1.454

  First Simples.
• * 1.455

  Chalybrater.
• * 1.456

  The Shop-com∣positions of He∣paticks.
• * 1.457

  Magistral Compositions.
• * 1.458

  Electuary.
• * 1.459

  A distilled Wa∣ter.
• * 1.460

  Pills.
• * 1.461

  The more remote causes of an Ascites.
• * 1.462

  First in respect of blood.
• * 1.463

  It doth not al∣ways proceed from the Liver & Spleen.
• * 1.464

  The humours by which it is pro∣duced are,
• * 1.465

  First the Blood.
• * 1.466

  2, & 3. The milkie and wa∣tery humour.
• * 1.467

  An Ascites often the product of the Jaundies.
• * 1.468

  The kinds of a Dropsie.
• * 1.469

  The Description of an Ascites.
• * 1.470

  2. In respect of the Lympha∣ducts.
• * 1.471

  3. In respect of the milkie ves∣sels.
• * 1.472

  The differences of this disease.
• * 1.473

  The Prognostick.
• * 1.474

  The Cure of an Ascites.
• * 1.475

  By what and how many re∣medies the e∣duction of the water is to be endeavoured.
• * 1.476

  First by purg∣ing.
• * 1.477

  Catharticks are either Vomits or Purges.
• * 1.478

  The chief medi∣cines of either kinde.
• * 1.479

  1. Gummi gut∣tae.
• * 1.480

  Its various Pre∣parations.
• * 1.481

  The forms of Hy∣dragogues pre∣pared thereof.
• * 1.482

  2. Spurge. The Preparati∣ons thereof.
• * 1.483

  Forms.
• * 1.484

  The Hercules of Bovius.
• * 1.485

  Pilulae Lunares.
• * 1.486

  Purging Hydra∣gogues.
• * 1.487

  Elder and Dwars-Elder.
• * 1.488

  Soldanella.
• * 1.489

  The juice of Orris.
• * 1.490

  Elaterium.
• * 1.491

  The forms of Hydragogues.
• * 1.492

  A Tincture.
• * 1.493

  Powders.
• * 1.494

  Pills.
• * 1.495

  Electuaries.
• * 1.496

  2. Diuretick Hydragogues.
• * 1.497

  What Profit they bring in an Ascites.
• * 1.498

  With what choice and dif∣ference they ought to be ad∣ministred.
• * 1.499

  John English his Empyrical remedy.
• * 1.500

  How beneficial Diaphoreticks are in an Asci∣tes.
• * 1.501

  Glysters and Plaisters.
• * 1.502

  Forms thereof.
• * 1.503

  When and to whom a Para∣centesis is con∣venient in an Ascites.
• * 1.504

  A history of a cure.
• * 1.505

  A Tympany not properly a kind of Dropsie.
• * 1.506

  Wherefore its cause is occult.
• * 1.507

  Commonly ascri∣bed to Winde.
• * 1.508

  Authors do not agree about the seat of the Windes.
• * 1.509

  Not without the guts in the ca∣vity of the Ab∣domen.
• * 1.510

  Nor within their passages.
• * 1.511

  Not between the coats of the bowels.
• * 1.512

  By what and how wany cau∣ses the Belly swells.
• * 1.513

  1. From tu∣mours of the Bowels in that place.
• * 1.514

  2. From wa∣ters gathered as in an Ascites.
• * 1.515

  3. From winds.
• * 1.516

  4. From the in∣flation of the Fibres, by rea∣son of the Spi∣rits being di∣sturbed.
• * 1.517

  An Affection of what sort a Tympany is.
• * 1.518

  Its cause and formal reason explicated.
• * 1.519

  And proved by arguments and instances.
• * 1.520

  An universal Tympanie.
• * 1.521

  The Cause of an universal Tym∣panie enquired into.
• * 1.522

  The true cause assigned.
• * 1.523

  Why the belly swells in the dead.
• * 1.524

  The Animal Spirits and not winde the cause of the Tympanie.
• * 1.525

  This happens by the fault of the Nervous juice.
• * 1.526

  By the obstructi∣on whereof the Spirits whthin the fibres are detained and made immo∣vable.
• * 1.527

  A description of the disease.
• * 1.528

  Its procuring causes.
• * 1.529

  Other previous convulsive af∣fections.
• * 1.530

  The case of an Asthma ending in a Tympanie.
• * 1.531

  The evident causes of this disease.
• * 1.532

  The Prognosticks thereof.
• * 1.533

  The Cure.
• * 1.534

  Remedies de∣signed against Wind profit not.
• * 1.535

  3. Curatory In∣dications.
• * 1.536

  The first Indi∣cation hardest.
• * 1.537

  What, and what sort of Medi∣cines are good or hurtful in this Disease.
• * 1.538

  Only mild Pur∣gers and Cly∣sters are conve∣nient.
• * 1.539

  Forms of Medi∣cines.
• * 1.540

  A solutive li∣quor.
• * 1.541

  Clysters.
• * 1.542

  Diureticks.
• * 1.543

  Distilled Wa∣ters.
• * 1.544

  Pills.
• * 1.545

  Spirits.
• * 1.546

  An Expression.
• * 1.547

  Apozems.
• * 1.548

  Topicks.
• * 1.549

  A somentation.
• * 1.550

  A Plaister.
• * 1.551

  The second In∣dication.
• * 1.552

  Of Chalybeate Medicines.
• * 1.553

  What preparati∣ons of Iron are not convenient.
• * 1.554

  What sort may be admitted.
• * 1.555

  Forms of Cha∣lybeates.
• * 1.556

  A liquor of the flowers of Tap∣sus Barbatus.
• * 1.557

  An Electuary.
• * 1.558

  A Julep.
• * 1.559

  Third Indica∣tion.
• * 1.560

  Cordials.
• * 1.561

  Hypnoticks.
• * 1.562

  Things mitiga∣ting Thirst.
• * 1.563

  The description of an Anasarca.
• * 1.564

  How it differs from an Ascites.
• * 1.565

  The Original from the blood.
• * 1.566

  The material and efficient cause.
• * 1.567

  The Blood its efficient cause in a double respect.
• * 1.568

  First that it doth not right∣ly sanguifie.
• * 1.569

  The reason whereof enqui∣red into.
• * 1.570

  The reason and manner of san∣guification ex∣plained.
• * 1.571

  An Hydropick temper of the blood springs from a double respect.
• * 1.572

  Viz. First from the desect or fault of its Fer∣mentation;
• * 1.573

  Secondly, from defect of Ac∣cension.
• * 1.574

  Reduced to three heads.
• * 1.575

  First, because the active par∣ticles of the blood, are too much consumed.
• * 1.576

  Secondly, be∣cause they are not enough re∣paired.
• * 1.577

  Thirdly, because they are buryed in duller par∣ticles.
• * 1.578

  Whereof there are three causes.
• * 1.579

  First from Non∣naturals immo∣derately ingest∣ed.
• * 1.580

  Secondly, From Naturals un∣duely retained.
• * 1.581

  Thirdly, From Preternaturals generated in the Body.
• * 1.582

  Different man∣ners hereof are reckoned.
• * 1.583

  The material cause of an Ana∣sarca is partly the Serum of the Blood, and partly the nu∣tritious Juice.
• * 1.584

  Why the hydro∣pick humour is limpid and not milkis nor bloody.
• * 1.585

  The Differences of the Disease.
• * 1.586

  The Progno∣sticks of it.
• * 1.587

  The Cure of it. Two Indicati∣ons.
• * 1.588

  The first intends the evacuation fo the morbific matter.
• * 1.589

  By Purgers.
• * 1.590

  Strong Purgers are couvenient but not to all.
• * 1.591

  The manner of their working.
• * 1.592

  Secondly, By Diureticks.
• * 1.593

  And chiefly Lixivials.
• * 1.594

  The reason and manner of their operation en∣quired into.
• * 1.595

  Forms of lixi∣vial Diureticks.
• * 1.596

  Diaphoreticks.
• * 1.597

  Diaphoreticks profit which are taken in a targer dose.
• * 1.598

  Forms thereof.
• * 1.599

  External Hy∣dragogues.
• * 1.600

  The chief Kinds of them, and the manner of their Administrati∣on.
• * 1.601

  1. Frictions.
• * 1.602

  2. Liniments, and, 3. Fomentati∣ons.
• * 1.603

  4. Baths.
• * 1.604

  5. Vesicatories.
• * 1.605

  6. Escharoticks.
• * 1.606

  The empirical manner of Es∣charoticks.
• * 1.607

  7. Pricking with a Needle.
• * 1.608

  The second In∣dication pre∣servatory what kind of Reme∣dies it suggests.
• * 1.609

  Forms of them.
• * 1.610

  1. Electuary.
• * 1.611

  Chalybeates profit much in this Disease.
• * 1.612

  But only those endued with Sulphur.
• * 1.613

  2. Powders.
• * 1.614

  3. Pills.
• * 1.615

  4. Julep.
• * 1.616

  5. Distilled water.
• * 1.617

  6, 7. Decoction.
• * 1.618

  Dirt-drink.
• * 1.619

  An Example of the Cure of an Anasarca Drop∣sie.
• * 1.620

  The Prognostick and Cure of the Disease.
• * 1.621

  The 〈◊〉〈◊〉 of 〈◊◊〉〈◊◊〉.
• * 1.622

  Phlebotomie a very general and ancient medicine.
• * 1.623

  Nature shews it by Haemorrha∣gies.
• * 1.624

  Critical either with or with∣out a feaver.
• * 1.625

  The causes there∣of proceed ei∣ther,
• * 1.626

  1. From the kindling of the blood.
• * 1.627

  2. From its Fermentation.
• * 1.628

  1. Criticall Hemorrhagies sometimes turn into symptor∣matical.
• * 1.629

  2. Symptoma∣tical Hemor∣rhagies arise either,
• * 1.630

  First by the fault of the blood.
• * 1.631

  Secondly, The fault of the Vessels, for that they are ill formed.
• * 1.632

  Thirdly, Foras∣much as they are convulsive∣ly affected.
• * 1.633

  3. From the blood and ves∣sels being both in sault.
• * 1.634

  Emission of the Blood procured by art.
• * 1.635

  1. It either imi∣tates Nature.
• * 1.636

  2. Or excells and regulates it.
• * 1.637

  3. Or Art out∣done by Nature.
• * 1.638

  Phlebotomy and spontaneous He∣morrhagies dif∣fer as to the subject and matter.
• * 1.639

  The use and effects of Phle∣botomy.
• * 1.640

  How it affects and alters the Blood.
• * 1.641

  1. Diminishes its quantity.
• * 1.642

  Emission of the Blood is not to be either too prodigally, or too slenderly made.
• * 1.643

  The reasons of the former hint∣ed at.
• * 1.644

  2. Phlebotomie amends the mixture of the Blood.
• * 1.645

  It restores its temper.
• * 1.646

  Some distempers of the blood ad∣mit not Phle∣botomy.
• * 1.647

  In some eases about Phleboto∣my it is very doubtfull.
• * 1.648

  And chiefly in a continual pu∣trid Feaver.
• * 1.649

  How the doubt is to be deter∣mined.
• * 1.650

  Thirdly, Phle∣botomy corrects or stays the inordinate mo∣tions of the Blood.
• * 1.651

  What Diseases, and of what parts Blood-letting chiefly respects.
• * 1.652

  After Phleboto∣my being indi∣cated these four things follow∣ing ought to be considered.
• * 1.653

  First the place from whence Blood is to be taken.
• * 1.654

  In some cases from the Arm.
• * 1.655

  In others from the vein of the Forehead, Tem∣ples or Throat.
• * 1.656

  The Cophalic Vein of the Arm, the Liver Vein, or the Salvatella er∣roneoufly so called.
• * 1.657

  The jugular Veln is most safely opened.
• * 1.658

  Of Veins in the band or feet.
• * 1.659

  we ought to con∣sider by what menns or by what instru∣ment the Blood ought to be drawn forth.
• * 1.660

  Some of the Ancients as well as Modern have ridicu∣lously exclaim∣ed against let∣ting of Blood.
• * 1.661

  Wherefore in opening a Vein the pricking of an Artery is so dangerous.
• * 1.662

  Thirdly, The Time of letting Blood comes in∣to considera∣tion.
• * 1.663

  1. In respect of the disease.
• * 1.664

  2. In respect of age.
• * 1.665

  3. In respect of the Tear and its parts.
• * 1.666

  The Aspect of the Moon and Stars are here of no moment.
• * 1.667

  4. The time of the day about letting of Blood.
• * 1.668

  5. The Quanti∣ty of the Blood to be taken a∣way ought to be considered.
• * 1.669

  Too much Phle∣botomy to be avoided.
• * 1.670

  But a more spare Bleeding often hurts, and fixes a feavour.
• * 1.671

  The Reason of which is de∣clared.
• * 1.672

  In some eases the mission of Blood must be altogether avoi∣ded.
• * 1.673

  Phlebotomy ought ever to be done with a large orifice.
• * 1.674

  Every Hemor∣rhage is not to be stopt.
• * 1.675

  But only the im∣moderate and inconvenient.
• * 1.676

  The chief Cases of the latter are reckoned.
• * 1.677

  And also of the former.
• * 1.678

  For the present the Cure of the Hemorrhage of the Nostrils is only propounded.
• * 1.679

  A description of the Vessels from which Blood flowes.
• * 1.680

  They are the same by which the Serum di∣stills to the Nostrils.
• * 1.681

  The Blood flow∣ing forth in too great plenty from these Ves∣sels, is very hurtfull.
• * 1.682

  The causes of such an immoderate flux.
• * 1.683

  1. From the fault of the Blood.
• * 1.684

  2. From the fault of the Vessels.
• * 1.685

  Prognosticks.
• * 1.686

  Three primary Indications of Cure.
• * 1.687

  The Curatory In∣dication sug∣gests three in∣tentions of heal∣ing.
• * 1.688

  Outward reme∣dies to stop the flux of blood.
• * 1.689

  1. Ligatures.
• * 1.690

  2. Bleeding.
• * 1.691

  3. Application of cold things.
• * 1.692

  4. Cupping-glasses.
• * 1.693

  5. Frictions.
• * 1.694

  6. Cauteries.
• * 1.695

  7. Faintings.
• * 1.696

  Remedies by Sympathy and Antipathy.
• * 1.697

  1. Sympathe∣tick powder. 2. Young Ash¦wood.
• * 1.698

  3. A dry Toad.
• * 1.699

  4. A Blood∣stone. 5. Mosse.
• * 1.700

  Topicks closing the mouths of the Vessels.
• * 1.701

  6. Escharoticks. The injection of Vitriol water.
• * 1.702

  10. Pledgets.
• * 1.703

  Hogs-dung.
• * 1.704

  Burnt Blood.
• * 1.705

  Inward Reme∣dyes, whereof are two inten∣tions.
• * 1.706

  1. Things ap∣peasing the ef∣fervescency of the blood.
• * 1.707

  Juleps.
• * 1.708

  Tinctures.
• * 1.709

  2. Intention, to cool the motion of the Heart,
• * 1.710

  Is done by Hyp∣noticks.
• * 1.711

  Of a Hemor∣rhage in a ma∣lignant Feaver.
• * 1.712

  Remedies.
• * 1.713

  Second Indica∣tion vital.
• * 1.714

  The Position of the Sick.
• * 1.715

  Sometimes in bed, and some∣times out.
• * 1.716

  Third Indica∣tion Preserva∣tory hath two intentions of healing.
• * 1.717

  Forms of Re∣medies.
• * 1.718

  An Example of a rare Hemor∣rhage.
• * 1.719

  Its Aetiologie.
• * 1.720

  His Cure.
• * 1.721

  Vesicatories an∣tiently called Phenigms and Sina∣pisms.
• * 1.722

  1. Of what prepared.
• * 1.723

  1. From actual Fire, or things imbued with it.
• * 1.724

  2. From things potentially burning.
• * 1.725

  Forms of Vesi∣sicatories.
• * 1.726

  A more delicate Vesicatory with a Dropace.
• * 1.727

  2. How they operate.
• * 1.728

  Shewed by the example of Fire.
• * 1.729

  How Cantha∣rides excite Blisters and draw forth water.
• * 1.730

  Why they bring a fervent Dysu∣rie.
• * 1.731

  Vesicatories move Sweat and Ʋrine.
• * 1.732

  The effects of Vesicatories.
• * 1.733

  1. As to hu∣mours of the Skin.
• * 1.734

  2. In respect of the blood.
• * 1.735

  Which they purge and alter.
• * 1.736

  3. In respect of the Nerves and of the humours abounding in them and in the nervous parts.
• * 1.737

  For the curing of what Disea∣ses Vesicatories are convenient.
• * 1.738

  1. In all cu∣taneous Di∣stempers.
• * 1.739

  2. They take away the im∣purities and ill temperament of the blood.
• * 1.740

  This Remedy is profitable in those Diseases which the blood produces in other parts.
• * 1.741

  3. Also in all Distempers of the Brain and of the nervous Stock.
• * 1.742

  For what Dis∣tases Vesicato∣ries are in∣tended.
• * 1.743

  In what Con∣stitutions they agree best.
• * 1.744

  Also in whom not.
• * 1.745

  In men of a more hot tempera∣ment they tor∣ment the part and do not draw forth the water.
• * 1.746

  In others, inas∣much as they draw forth too much Ichor, they are not profi∣table.
• * 1.747

  The Ʋlcers of Vesicatories do sometimes plen∣tifully flow in Feavers, and give Judgment of the Disease.
• * 1.748

  They are not to be cured.
• * 1.749

  An Example is shewn.
• * 1.750

  Issues rather a preservatory than curatory Remedy.
• * 1.751

  About these, three things are to be enquired into.
• * 1.752

  1. What hu∣mours they eva∣cuate.
• * 1.753

  2. In what diseases they chlefly prevail.
• * 1.754

  3. In what Bodyes they agree not.
• * 1.755

  Viz. First where they eva∣cuate too much.
• * 1.756

  Why they often pour out the humour too much.
• * 1.757

  Why they ex∣pend the Spi∣rits too much.
• * 1.758

  Issues are like∣wise inconve∣nient when they evacuate less than they should doe.
• * 1.759

  The places of Issues are de∣signed, accord∣ing as the ends are Evacuation Gineral, or Se∣condly, Evacu∣ation and Re∣vulsion, or both that and deri∣vation.
• * 1.760

  1. In the Co∣ronal Suture.
• * 1.761

  Issues in the fore and hinder part of the head.
• * 1.762

  Between the Shoulders.
• * 1.763

  Which are pro∣fitable in many diseases.
• * 1.764

  An Issue in the lest Hypochon∣drion.
• * 1.765

  In the Groin.
• * 1.766

  In the Thigh.
• * 1.767

  A fit place in the member to be chosen that it may be made far from Vessels and Tendons.
• * 1.768

  Symptoms acci∣dental to Issues how to be cured.
• * 1.769

  What chiefly re∣quire help.
• * 1.770

  1. Inflamma∣tion.
• * 1.771

  Which happens to a new Issue, the Reason of it and Cure pro∣posed.
• * 1.772

  An Inflamma∣tion hath three manner of Cri∣sis's.
• * 1.773

  The ordinary and best these is, that the extravasated blood may be reduced.
• * 1.774

  How it is done.
• * 1.775

  What Remedies there is need of.
• * 1.776

  For this end oftentimes pure∣ing and bleed∣ing are requi∣red.
• * 1.777

  An Inflamma∣tion sometimes happens to old Issues.
• * 1.778

  2. An Issue pouring out too much and stinking Ichor requires reme∣dy.
• * 1.779

  Of which there are two Inten∣tions.
• * 1.780

  First, that the Temperament of the blood be restored.
• * 1.781

  Secondly, to pre∣serve the tone of the part ulce∣rated.
• * 1.782

  Thirdly, a dry and troublesome Issue requires help.
• * 1.783

  An Issue some∣times will heal up notwith∣standing all en∣deavours to the contrary.
• * 1.784

  Sometimes it hath spongy flesh growing about the lips.
• * 1.785

  The reason there∣of delivered.
• * 1.786

  The common er∣ror is that Issues dispose to bar∣renness.
• * 1.787

  A Description of the Cuticula.
• * 1.788

  Of the Skin.
• * 1.789

  The pyramidal Papillae the Or∣gan of feeling.
• * 1.790

  The Pores and Glandules of the Skin.
• * 1.791

  The Pores two∣fold, greater and lesser.
• * 1.792

  The wrinkles and furrows of the Skin.
• * 1.793

  From whence the Roughness or Fineness of the skin.
• * 1.794

  Depends much on the Humours filling the pores.
• * 1.795

  From the sudden shutting up of the pores.
• * 1.796

  In the larger pores are the roots of the hairs.
• * 1.797

  No Diseases of the Scars-skin.
• * 1.798

  The cause of some.
• * 1.799

  The Cutaneous distempers rec∣koned up.
• * 1.800

  Distempers in the skin with or without a tumour.
• * 1.801

  1. Spots call'd Ephelides.
• * 1.802

  The description of the Ephelides.
• * 1.803

  The matter and cause thereof.
• * 1.804

  Lenticular Spots.
• * 1.805

  Liver Spots falsly so called.
• * 1.806

  The Description and Cause of them.
• * 1.807

  Pestilential and scorbutick spots.
• * 1.808

  The Cure of the Spots.
• * 1.809

  Forms of Cos∣meticks.
• * 1.810

  1. Which cleanse the skin.
• * 1.811

  2. Which repell the spotty mat∣ter.
• * 1.812

  Lac Virginis.
• * 1.813

  A Mercurial Cosmetick wa∣ter.
• * 1.814

  Its Vertue.
• * 1.815

  Its familiar use is not safe.
• * 1.816

  Psora a disease properly cuta∣neous.
• * 1.817

  Its description.
• * 1.818

  What humour its matter is of.
• * 1.819

  Not any of the four common humours.
• * 1.820

  But a humour plac'd in the Glandules of the skin.
• * 1.821

  The description of that Juice or Humour.
• * 1.822

  How it dege∣nerates.
• * 1.823

  This is done three ways.
• * 1.824

  1. By reason of impure Blood.
• * 1.825

  2. By mere stagnation.
• * 1.826

  3. By Conta∣gion received from without.
• * 1.827

  The reason of its most sudden con∣tagion is un∣folded.
• * 1.828

  The Contagion when any where received, pre∣sently spreads over the whole skin.
• * 1.829

  Of the Itch.
• * 1.830

  It belongs to the Sense of Feel∣ing.
• * 1.831

  Of what sort its Affection is.
• * 1.832

  The chies Af∣fections of feel∣ing are Pain and Pleasure.
• * 1.833

  The formal rea∣son of Pain.
• * 1.834

  The Solution of the Ʋnity al∣ways the cause of it.
• * 1.835

  What Pleasure is.
• * 1.836

  Its formal Rea∣son.
• * 1.837

  It chiefly con∣sists in remo∣ving of Pain.
• * 1.838

  What the Itch is.
• * 1.839

  How the Spirits are moved in it.
• * 1.840

  A certain me∣dium between Pain and Plea∣sure.
• * 1.841

  The difference of the Psora as to its origine.
• * 1.842

  2. As to its form.
• * 1.843

  The Progno∣sticks of it.
• * 1.844

  Most dangerous to Children and ill juiced or cachictick per∣sons.
• * 1.845

  Its Cure.
• * 1.846

  The first Indi∣cation curatory.
• * 1.847

  The second In∣dication pre∣servatory.
• * 1.848

  Both inward and outward Medicines are to be taken to∣gether.
• * 1.849

  Purges, Bleed∣ing and Alte∣ratives, and af∣terwards To∣picks are re∣quired.
• * 1.850

  Forms of Pur∣gers.
• * 1.851

  Apozems.
• * 1.852

  Medicated Ale.
• * 1.853

  Altering Re∣medies.
• * 1.854

  Electuary.
• * 1.855

  A distilled wa∣ter.
• * 1.856

  Oyntments whereof the Basis is chiefly Sulphur.
• * 1.857

  Forms of them.
• * 1.858

  Other stronger Medicines.
• * 1.859

  The most power∣full made of Mercury.
• * 1.860

  But dangerous.
• * 1.861

  The Form of it.
• * 1.862

  A Mercurial Water for the Itch.
• * 1.863

  Baths.
• * 1.864

  A Sulphurous Shirt.
• * 1.865

  Why Sulphur is the Antidote of the Psora.
• * 1.866

  The Reason of it.
• * 1.867

  How Mercury cures this Dis∣ease.
• * 1.868

  The reason of its vertue.
• * 1.869

  Several names of the Impetigo.
• * 1.870

  It is described according to its appearances.
• * 1.871

  The differences of this disease.
• * 1.872

  How it differs from the Psora and Leprosit.
• * 1.873

  The material cause not a hu∣mour of the skin.
• * 1.874

  But tartarous Concretions be∣got in the blood.
• * 1.875

  The next cause of it.
• * 1.876

  The evident Causes.
• * 1.877

  Irregularities in Diet.
• * 1.878

  The daily eat∣ing of Pork or Fish.
• * 1.879

  The reason there∣of inquired in∣to.
• * 1.880

  It often follows the Pox and Scurvy.
• * 1.881

  Its Progno∣sticks.
• * 1.882

  The Cure.
• * 1.883

  Two chief Indi∣cations.
• * 1.884

  How to be cu∣red, the Disease beginning of it self.
• * 1.885

  The evident causes to be first removed.
• * 1.886

  The conjunct Causes how ta∣ken away.
• * 1.887

  The chief Re∣medies made known.
• * 1.888

  1. A Purge.
• * 1.889

  A purging In∣fusion.
• * 1.890

  2. Whey.
• * 1.891

  An Electuary.
• * 1.892

  3. Steel'd Wa∣ters.
• * 1.893

  4. Decoctions of Woods.
• * 1.894

  5. Medicines of Steel.
• * 1.895

  6. Sallvation.
• * 1.896

  Salivation does not alwayes cure this Dis∣ease.
• * 1.897

  Why the Impe∣tigo is more difficult of Cure than the Pox.
• * 1.898

  Impetigo suc∣ceeding a Scur∣vy, how to be cured.
• * 1.899

  Hot antiscorbu∣ticks do not agree.
• * 1.900

  Nor Baths.
• * 1.901

  But only the more temperate Remedies en∣dued with a nitrous, vitrio∣lick or vola∣tile Salt.
• * 1.902

  Forms of Ni∣trous Medi∣cines.
• * 1.903

  Water of Sow∣thistles.
• * 1.904

  Cucumbers.
• * 1.905

  Purging Mine∣ral Waters.
• * 1.906

  Vitriolick aci∣dule waters.
• * 1.907

  Medicines of Tin and Anti∣mony.
• * 1.908

  3. Medicines endued with a volatile Salt.
• * 1.909

  Chiefly prepared of Vipers.
• * 1.910

  But not chymi∣cally.
• * 1.911

  Broths and in∣fusions of Vi∣pers.
• * 1.912

  4. How the Im∣petigo follow∣ing the Pox is to be cured.
• * 1.913

  The second In∣dication Curd∣tory.
• * 1.914

  Topicks of Tarre are the best.
• * 1.915

  Baths.
• * 1.916

  Liniments.
• * 1.917

  1. Mild Lini∣ments.
• * 1.918

  2. Stronger, of Tarre.
• * 1.919

  3. The strongest of Mercury.
• * 1.920

  A notable Rela∣tion.
• * 1.921

  Salivation cures for a time the Impetigo, but with a relapse.
• * 1.922

  That remedy re∣peated, did not thoroughly cure the Disease.