to discharge and abate blood by the Nose by the Haemorrhoids or Menstrual purgations sometimes by plentiful feeding and too much ease so that evacuation and transpiration is not proportionable in abatement and to balance the imported food Conjunct causes are such as more immediately and nearly concur or conspire actually in forming of these pleuritic pains and they are either acidity or viscidity within the Vessels of the Pleura or a violent fluxion from the larger Vessels too great for the capacity and reception of these exiguous canals 2. Acidity or an acrid serosity does sometimes fabricate and finish this disease by punging and lancinating the Pleura for omne acidum extra stomachum corpori est hostile says Helmont thereby irritating and exciting the vital spirit to estuate and be incensed and from this focus a febrile heat is kindled and communicated to the whole Body and that oftentimes and for the most part it is a sharp serous humor predominant in the blood which caused this disturbance in the Pleura is confirmed by the manner of solution or termination of the disease which most frequently is by a sudorific evacuation or insensible transpiration and therefore Hippoc. in his Predictions says Sudores urinas in Pleuritide probè fieri bonum esse salutare Friendly Sweats and effusion of Urine presageth a good event 2. Viscidity or grumosity of the blood does sometimes cause pleuritic pains for by obstructing those small ductures of the Pleura and stopping the Circulation a Tumor thereby is raised within this double Membrane for the Veins Arteries and Nerves lye between these two Coats of the Pleura And that the blood is thus apt to be stagnant especially in the smaller Vessels by coagulation grossness or congelation is confirmed by Phlebotomy for being let out of the body it is sometimes found destitute of its Serum or Latex that keeps it fluxile thin and transient and also is manifest so to be when it is in the Vessels as in Gangrenes where the blood is fixed and the part almost mortified and when Pleurisies do happen upon this cause of concretion they commonly tend to suppuration as not capable of being discussed or put into motion for a discharge of the part Now the Blood becomes thus incrassated gross and viscous from every cause that does too much exhaust and expend the serosity thereof as too great transpiration or sweating or immoderate making of urine and sometimes from a malignant or a venemous Miasm that curdles or congelates the blood 3. Fluxion or ebullient and preternatural Fermentation causeth pleuritic pains and thus it happens when a Pleurisie is the consequent or appendent to a Feaver preceding for sometimes a Pleurisie does precede and is the cause of a Feaver as when the dart is felt to strike the Pleura before any febrile distemper appears sometimes a Pleurisie does supervene and follow a Feaver as an effect from that general ebullition the hot spumous blood rushing into the Pleura Having established these causes in their due Series presenting them in the method and order of their causation and action we shall not trouble our selves with Choler Flegm and Melancholy the supposed materials of every disease nor shall I controvert the insufficiency of that doctrine here For Indications of Cure prompting what is to be done which way and with what they are various as the case presents 1. Plethory indicates Phlebotomy and requires a depletion or abatement of the redundance of blood that there may be room for the peccant matter to retire and for a revulsion and derivation thereof as also to avert the current and flux tending towards the pained part 2. Purgation by sedate and amicable Cathartics if you can procure such else by Clysters the best substitutes in that defect is necessary to absterse and cleanse the whole Body thereby subducting fuel from the fire and for rendring the Patient not so liable to effervescency and turgid estuation and for a retraction from the part affected 3. Topical Discussives are available and contribute to the remove of the morbific cause both as defensatives giving robor to the grieved part for resistance of the humors flowing in and also for a transmission and discharge of the conjunct matter residing 4. Diaphoretics to rarifie dissipate and set open the Pores for a free transpiration and exsudation are not only safe but exceeding necessary thereby to avert the antecedent cause resorting to the pained place and to disperse and scatter the morbific conjunct cause from the part affected if possible to prevent suppuration which is very dangerous and commonly mortal 5. Anacathartics or proper and truly expectorating Medicines are auxiliary and profitable in promoting expectoration by digesting the peccant matter and rendring it more apt and easie to be brought up and of these some are attenuating others incrassating to be used pro re nata suitable to the offending cause which if it yields soon and freely and Nature throws it up by cough and spitting it portends good promising shortness of the disease and a prosperous event which Hippoc. 1. Aphor. 12. confirms 6. Anodynes elected by a discerning Judgment and cautiously used may be of good advantage in some cases and at some times else may prove very pernicious Having dispatched these pleuritic pains we are next to take notice what other pains are incident to the Thorax or Breast And here we find pain to arise from Inflammations of the Lungs of the Mediastinum and of the Diaphragma whereof an account will be given in their proper places hereafter when we treat of Inflammations But the Lungs do suffer pain also from other causes as from Tumors not inflamed sometimes from adhesion or sticking of the Lungs to the sides of the Breast sometimes from stones and worms that have bred there observed and found upon Dissections and sometimes by Erosions and Vlcers of which in their due place following Back-pains of the Thorax are either upon the Spine between the shoulders or upon the Scapulae the shoulder blades And these pains do arise from some impressions of cold lately taken or from defluxion of a serous humor from the Head or sometimes from a maligne Miasm Venereal or Scorbutic that infests those parts Pain sometimes is seated at the bottom of the Sternum between the short Ribs under the Cartilage mucronata vulgarly called the Pit of the Stomach but improperly This Cartilage hangs down being as it were a defensative to the subjacent parts namely the Stomach and Liver yet is flexible to give way to the extensions of the stomach without compression This place is very tender at all times insomuch that a blow here is ready to make a strong man faint the part being thus sensible pain therefore here must be very troublesom Now this place is of acute sense or feeling in regard the upper Orifice of the Stomach being very nervous and almost subjacent to this Cartilage and the Heart adjacent hence it is that a blow or
Dysentery sending forth blood and corrupt matter Sometimes a bloody Flux continues a while without Vlceration and afterwards ulcerates the guts and makes a Dysentery that is when this extravasated blood lodging in the guts degenerates and putrifies it does thereby erode and plant an Vlcer which compleats a Dysentery Now this kind of Dysentery ariseth from an impurity or corruption of the blood which causeth a preternatural fermentation or effervescence in the whole mass but Nature not being able to depurate and separate from this degenerate admixture either by Transpiration or Vrine is forced upon this emission by the Intestines without a secretion and throws out both the good and bad together In the prosecution of Cure as these causes are rightly adjudged and Medicines adapted thereto depends the success and therefore that course and Method which is advantageous and proper to one may be injurious and altogether disagreeing to another And here you must take notice that Dysenteries are sometimes malignant as commonly when Epidemical and then Alexipharmacal Medicines are not to be omitted Now concerning the degrees of Dysenteries as to a better and worse curable or deplorable state and the signals declaring them as also several Queries that might be raised and satisfaction given to each the conciseness of this Work will not admit to inlarge thereon In the next place and of great affinity with Dysenteries is a Tenesmus agreeing in the causes and Symptoms but differing in the part affected a Tenesmus being seated at the lower end of the right Gut or Fundament The Etymologie of the word imports something of the nature of the disease being a frequent desire and straining downwards to the stool but instead of excrements blood and mucous matter is brought forth and with great pain This ariseth from an Ulceration of the last Intestine procured from the same causes as Dysenteries which we need not repeat This disease is most dangerous to women with child for that it causeth abortion but to all persons it is very troublesom and painful and if it continues long the Vlcer becomes fistulous and difficult to be cured And now I remember the Cure of an old Vlcer in this part notwithstanding the contumacy and difficulty thereof In the year 1653. when I was but a young Practiser yet by the blessing of God upon my endeavors I cured a Gentlewoman afflicted with an Ulcer in ano for seven years who could not in all that time receive help though she had tryed many Physicians and Chirurgions having a plentiful Fortune to allow it She was aged between fifty and sixty an Aldermans Wife of Maxfilde in Cheshire where I happened to stay in that Town for some time whereby this Gentlewoman beyond her expectation received a perfect Cure To finish our Discourse of Pains belonging to the Intestines we shall conclude with the Haemorrhoids A disease frequent and sometimes of great complaint The word Haemorrhois signifies a Flux of Blood in general but custom hath restrained it and amongst Physicians it is used and understood only that effusion of blood by the Haemorrhoid Veins which Veins terminate at the lower end of the last Intestine and about the Fundament These Haemorrhoid Veins are internal and external although most of the Ancients and some modern Authors acknowledge only the internal but erroneously The internal and external Haemorrhoid Veins do differ much As first in their rise or descent for the external do proceed from the Hypogastric branch of the Vena cava and the internal from the Vena portae and commonly from the splenical branch thereof Secondly in number the internal being but one though orbicularly multiplied and divided about the Anus The external are threefold Thirdly in their insertions the internal being inserted into the membranous substance of the right Gut the external into the musculous substance of the Anus or Fundament Fourthly they differ in their contents the internal carrying a gross and blacker blood the external more thin and ruddy Fifthly in their office and use the internal evacuates the Vena porta and splenical Arteries thereby advantageous in some diseases of the Spleen and Cacochymies The external do empty the Vena cava and correct such diseases that depend upon Plethory or redundance Sixthly they differ in evacuation the internal not so copious the external commonly large in the profusion and sometimes very injurious and to some mortal Seventhly in pain the internal for the most part painful the external not in evacuation Lastly they differ in association the internal descending without Arteries the external are adjoyned with Arteries to the Anus The Haemorrhoid Veins are liable to contrary affects and the diseased do suffer in a different way sometimes these Veins abound with blood and swell for want of apertion and a discharge and this is called the blind Haemorrhoids è contrà sometimes the mouths of these Veins do open and pour out too plentifully either suddenly or by too long continuance and this is called the open Haemorrhoids Both these extremes are grievous to suffer The swelling of the Haemorrhoid Veins and pains from thence have the same causes as provoke and continue the Haemorrhoidal Flux viz. blood offending in quantity or quality which if it find not vent by the terminations or mouths of the Veins they are extended and swell big and sometimes inflame which if it continue is dangerous lest it become cancerous and gangrene On the other side an immoderate Flux is very pernicious and induceth Dropsies Consumptions Cachexies c. by exhausting the treasury of life These Haemorrhoidal Fluxes continuing unduly and injuriously argue the blood to be hot and sharp or too thin abounding with an acrid serosity which provokes the expulsive faculty and opens the mouths of the Veins But the blind swelling Haemorrhoids denote the blood to be gross and thick or the coats that cover the extreme ends or mouths of those Veins to be dense and impenetrable not permitting an exsudation Here it may be queried how it comes to pass that these Haemorrhoid Veins should be more troubled with blood and more frequently suffer an apertion since many other places of the body receive the extremities or terminations of the Veins and so equally capable of effusion In answer hereunto you must understand that although Nature hath formed the like and planted them in divers parts of the body which sometimes though more rarely do issue and send forth blood yet these Haemorrhoids are placed more commodiously for voiding of superfluous and feculent blood being near the common vent and outlet for excrements to pass away and their situation being downwards together with the straining upon occasions at the stool the extremities of these Veins are filled and sometimes forced to evacuate more frequently than others Now concerning the blind Haemorrhoids you may take notice and know that there is this difference sometimes the Tumor or extension is in the trunk or cavity of the Veins and then there is no apertion and sometimes the
heterogeneous discordant matter or some malign and venenate Miasm is mingled or got into the blood Nature which is the vital Principle raiseth a preternatural fermentation and febrile effervescency in the mass of blood for a purification and separation of this exotic mixture and admits of no sedation and rest until that work be finished Fifthly and from hence you are to be warned of the dangerous and common Practice in Feavers by Juleps Barley-water and other such like cooling Medicines used to allay the heat from a great mistake of the rise of Feavers and from whence this heat does assurge for whether the Feaver does depend upon a particular inflamed part or a general fermentation of the blood for purification in both cases of Feavers such cooling Medicines are pernicious and have killed thousands for by insisting so much upon them and aiming to suppress the Feaver by Coolers which is not possible to be done thus trifling the time away the opportunity of curing is lost and the disease prevails The errour of these cooling Medicines is apparent from the insuccess thereof for never was the thirst of a sick person satisfied by a Julep but a draught of good drink such as the Patients stomach calls for that is acceptable and refreshing so that I say Juleps are but cold comfort to a feaverish sick man for these cold Medicines imposed upon the sick are so far from assisting Nature to perform the work she is strugling about that they nauseate and flat the stomach which should invigorate the other faculties damp the power of Nature contending and leave her languishing for refreshment coveted in her natural common drink What advantage can there be in a Julep to take off or any way contribute to the removal of any matter that is the cause of Inflammation in the Liver Spleen Kidneys Mesentery Pleura c. any part of the body truly none but that is not all for besides the doing no good it does much mischief in suppressing the fortitude of Nature and cheating the poor Patient of that desired common assistance by drink that would be comfortable But no more of this because I have enlarged upon this point pag. 27 28 29 30. yet it falls in here necessarily to be taken notice of because Inflammations always introduce Feavers which Feaver being most obvious and apparent ingrosseth all endeavours for allaying that general and expanded heat but they go the wrong way to work even preposterously beginning at the wrong end But now to inform what is necessary to be done when a pained inflamed part requires help take these directions in general which will be advantageous in most if not all particular cases First Examine and consider the nature of the part inflamed being the part primarily affected the foundation of this disturbance from whose peculiar structure and fabrication as also from its office you will find what are the usual impediments that molest and disturb such a part and how it becomes liable thereto Secondly You are to consider what way this matter is to be carried off if it be humoral and by what means adapting such Remedies suitable to the condition of the part affected and proper for the removal of such a morbific cause Thirdly The Feaver that ariseth from and depends upon this Inflammation is not to biass you or take you off from any thing necessary to be done in order to reduce the part primarily affected but prosecute directly there and regard not the Feaver for as you get advantage in relieving the part grieved you will find the Feaver to decrease and totally vanish when that is restored And to tell you plainly I know nothing you can do advantagious for the part inflamed that may be injurious upon account of the Feaver if the Feaver were independent and had no relation to the other Fourthly If blood be the primary cause or otherwise aggravating through plenitude make a depletion thereby the Circulation will be more free turgency abated and fluxion prevented at least retracted for if the cause be in the Veins or Arteries most necessary it is to be done for commonly then a plethory grossness or coagulation gave the occasion of this grief but if it an acrid serosity that lanceth and irritates the tender part Phlehotomy may draw off and make a diversion for a time until other good means can be administred to eradicate or blunt the sharpness of its acidity Fifthly Set open the vents and outlets which Nature hath framed and make evacuation to abate fulness and remove foulness in the whole body thereby you will prevent or allay the turgency of ill humors that are apt to ferment and move upon this disorder and cut off a supply of morbific matter that may resort to the part pained of raise a new disturbance in other parts of the body Here you must procure and prosecute this intention with Balsamic Abstersives the true Cathartics not venenous Laxatives the common reputed Purgatives and cleanse the lower region of the body whereby also you will subduct and draw away from the parts affected The grosser matter being thus removed and carried off sufficiently the remainder discharge by Transpiration making an apertion of the Pores and setting open those imperceptible vents by the use of effectual and choice Diaphoretics thereby to attenuate rarifie and scatter For outward Inflammations Topical Medicines are applied to the part Fomentations Cataplasms Vnguents c to appease and allay but our internal cases do not admit of such applications therefore we are to design otherwise and adapt such internal Medicines and by such operations as may reach the morbous matter to remove and transmit it yet when an Inflammation is seated near the superficies or extern parts of the body as the Pleura the gibbous part of the Liver and such like especially if a Tumor conjoyned do appear also or any visible extension then local Medicines may be of good use and contribute towards a Cure But here by way of caution take notice That no refrigerating or repercussing application be made to repel and drive back from the part pained for this may prove of dangerous consequence as the imprudent adventures of some in this manner have left sad memento's to forbid the like practice But some may say How shall we know when any internal part is inflamed because neither the eye nor the hand can reach there to discover the disease Yes very well for great pain and anguish continuing in any secret internal part and raising a febrile heat in the whole body does as certainly declare that part to be inflamed in the sense before expressed as any outward signs can manifest where seeing and handling does or can adjudge the case Sixthly and in the last place because Inflammations do arise from and depend much upon the continuance of pain therefore Anodynes or allayers of pain may be profitable at some times and in some cases but warily to be used and the times nicely to be distinguished and
is no passage or vent it corrupts the containing part and is mortal except a passage can be made by section Vlcers from their causes their aptness and inaptness for healing some are benign mild and tractable others are malign very difficult or incurable The benign and mild are such as arise in sanguine sound bodies and the younger people having no ill Symptoms or adjuncts of impediment the matter of such Vlcers is a laudable Pus or otherwise apt for digestion more yielding and readily commanded by Medicines Malign Ulcers and contumacious difficult or intractable are such as are sordid fetid ichorous unctious dolorous corroding and depascent of long continuance virulent cancerous fistulous cavernous the products or effect of malignant diseases as venereal Lues Leprosie Pestilence c. in cachectic habits of body hydropic hectic aged consumptive and decayed persons in principal and difficult parts of the body as the Brain Lungs Liver Spleen c. the Spondyls of the Back and great Junctures Since Vlcers are thus various in their nature from the several conditions of bodies and diseases that they arise from or depend on and the difference of parts wherein they are seated a general Method of healing and course of Medicines cannot be instituted and appointed but every case hath its peculiar complication of circumstances as directory indications to be remarked from whence a designment method and adaptation of Medicines is formed suitable to the particularity and different case of every individual Patient and therefore I have not proceeded to the Rules and Medicines for Curation Only thus much I shall note to you as a grand observable in the Cure of these Vlcers That such as arise from some remarkable disease as Dropsie Scorbute Venereal Lues or other malign and Cacochymical habits of body that these Vlcers are not to be cured until the disease and evil state of the body on which they do depend be reduced to a good condition or mediocrity of constitution for the antecedent cause which first produced the Vlcer must be removed before the Vlcer is capable of healing because of the continual supply of peccant matter brought to the ulcerated part and therefore application is first to be made there else all endeavours will be frustrate And further the designment of these Cures are not to be paralleled with nor levelled by the methods and intentions that the common Rules in Chirurgery have laid down for as much as many of them are erroneously grounded and deserve great correction and amendment which hereafter will be pointed out and discussed for we have not room here nor time now to ingage in that Cantroversie and must refer it to the next opportunity Gangrenes and Mortification THE last and worst transition of this dangerous train of Diseases and the ne plus ultrà in vitality is a Gangrene being a borderer upon or next adjoyning unto Mortification or the beginning thereof And although Gangrenes are thus ranked next to Vlcers and it falls out so sometimes in the preternatural course of Nature if I may so speak yet it is not always so but a part may and does gangrene sometimes before it be ulcerated for Inflammations and Tumors do gangrene as oft as Ulcers but Gangrenes are placed in this order after Vlcers as being the worst and last morbous state that can come and beyond this there is no disease for although Mortification be set down after Gangrene yet this is no disease vita extincta non est morbus for diseases are seated in the life corpus vivens est domicilium morborum and where no life is there is no disease but Mortification is posited here as the center to which diseases move and as bounds to stop all farther disquisition A Gangrene is a corruption and change of a part or member into such a degree or state as beginning to mortifie or is mortifying But Sphacelus with the Greeks Syderatio in the Latine which we call Mortification in English is when a part is perfectly mortified and dead and therefore a Gangrene is capable of Cure but a Sphacelus not because the part is dead A privatione ad habitum non datur regressus The external and primitive causes of Gangrenes are Contusion Vulneration Congelation Combustion Constriction Poyson Contusion sometimes introduceth a Gangrene by coagulating and fixing the blood so firmly in the part contused that thereby the life is supprest and overcome for communication and intercourse with other parts of the body which is requisite being thus denied the life extinguisheth besides the coagulated bruised blood remaining long undiscussed does putrifie and gangrene Vulneration or section sometimes procures a Gangrene when the vital Principle is so debilitated or enormous by the wound that instead of a good suppuration and vigorous transmutation a depraved matter is generated which corrupts and gangrenes the part and thus a small cut of a finger or Toe hath gangrened and killed the person but in greater Wounds the danger is greater as more frequently to happen Congelation by extremity of cold hindring Transpiration and condensing the blood rendring it stagnant in the Vessels suffocates the life and gangrenes the member thus in extreme cold Countries people by casualties exposed have their Limbs mortified sometimes and thus a Gangrene is brought upon an Inflammation or Erysipelas sometimes by incautelous and pernicious application of great refrigerating or cooling Medicines thereby incrassating the blood and prohibiting transpiration And this is very hazardous though advised and practised frequently by some Chirurgeons in these cases using cold astringent emplastic Cataplasms ex farin hord bolo armen album ovor aceto c when an Inflammation appears Combustion sometimes begets a Gangrene and destroys the life of the part when by neglect thereupon or improper means used relief is not duly afforded and thus by Cauteries and Caustics sometimes a member becomes mortified Now Vstion or great hurt by burning causeth Gangrenes by corrugating shrinking and searing up the Vessels that they cannot bring supply of vital Spirits and nutriment to the part Constriction or compression procures a Gangrene by intercepting of vital communication so that the member thereby is as it were separated and cut off from the body and fountain of life for the parts are maintained by influxed rays and streams of vital heat and moisture to the remotest parts of the body but being deprived thereof they dye thus a Ligature drawn strait about the Arm or Leg and continuing too long may gangrene and mortifie the part by excommunicating it from commerce with and participation of the general life And thus sometimes internal scirrhous Tumors do compress the Vessels and obstruct them of this Fabricius Hildanus gives an example of one that a Gangrene seized both his legs of which he dyed the cause was latent until by dissection he found a scirrhous Tumor about the Vena cava descending between the Reins where this great Vein divides into two parts to supply both legs Poysons some of them do gangrene by concreting and condensing the blood stopping
his right aims at the morbific cause Hence ariseth all the inventions of cooling and so frequently used in most cases repeated Phlebotomies Ptisans Juleps Emulsions cooling Apozems Embrocations Liniments c. which make the great clutter of Pots and Glasses about the sick and nothing more advantageous to the Apothecary than trifling away the time thus with a number of these hazardous but many times and too often pernicious Medicines This mode of Practice and these devices for cooling feaverish bodies I suppose are taken up in imitation of Galen a famous Master of this Art who appoints exhaustion of blood by Phlebotomy ad animi deliquium until the Patient faints and large draughts of cold water until the Patient turns pale shakes or quivers and the whole body cooled And an Author of our time in his Writings de Febribus appoints the casements to be set open to cool the sick upon what design I know not except to fan the house lest the heat of the Feaver should fire the chamber And a late Author of great Fame in his Works de Febribus supposing Feavers to arise à sulphure accenso exaltato from a sulphurous deflagration of the blood prosecutes upon the indication of refrigerating and quenching this fire by cooling Liquors and for incouragement herein gives an example I suppose his own Patient of a young man about twenty years old that by immoderate drinking of Wine fell into a Feaver with thirst and insignal burning about the Heart who after Phlebotomy and plentiful drinking of water aquae fontanae ingentem quantitatem ebibit the Authors words he recovered The success was good and I may say wonderful but whether from the means or Providence judge you but I shall not imitate the Practice lest ten dye for one that lives but this learned Doctor hath highly deserved in some other parts of his Writings and therefore I tread softly Now to consider all this in gross for brevity sake and apply it to our purpose in hand these ways truly are very probable not rational to cool a feaverish hot sick man and to make him in a short time stone-cold and the probability thereof upon good ground does appear thus First Upon the account of this latent Series and progress Inflammations Tumors c. ushered in by pain more frequently than discerned as already proved this refrigerating course the insisting upon or intermixing these cooling Medicines now and then to quench a preternatural heat is destructive at best a great delay and impediment in the Cure and this is the common way of Practice which needs no farther confirmation but a review Secondly In all other cases and from what cause soever a Feaver doth arise this juleping and cooling mode of Practice is dangerous more or less as the case is in it self but in no wise advantageous making acute diseases to commute and terminate in chronic and chronic or lingering diseases to hold on their course and become more contumacious To prove the first we shall compare that series and commutation of diseases with the designment and nature of these cooling Medicines and by that you shall see what probability and season there is to expect from thence any good effect but rather the contrary promoting of mischief begun and setting forward those diseases Whatever causeth pain whether it be obstruction in the part or oppression by indigested or degenerate incongruous matter by wind and flatulency by any exotic generation as worms stones c. any Tumor or Apostem breeding Inflammation or Vlcer planted c. these cooling and cold inventions touch not the disease except to do mischief and exasperate and remove no morbific cause for the nature of these causes and diseases requires Aperitives Abstersives Catharticks Discussives Diaphoreticks Dissolvents Sarcoticks c. pro re nata each case requiring some or more Medicaments of these Operations But these Coolers è contrà stand in opposition and act repugnant to these properties and consequently to the Cures of those infirmities by obstructing of Ductures and Pores incrassating what should be attenuated coagulating what should be kept fluid condensing what ought to be rarified and discussed fixing and retaining what should be moved and sent off impeding transpiration but promoting putrefaction generally they check and damp the power of Nature endeavouring to extricate and quit her self from those incumbrances and growing evils that assault and beset her To make good the second part that in what other case soever a Feaver or vehement heat shall arise with ebullition of the blood and preternatural fermentation cooling Medicines are very prejudicial in many cases mortal for whether it be a pestilential or other maligne Miasm seminary or taint or other impurity and feculency of the blood that Nature intends by this febrile disturbance and irritation to throw off and separate which Nature sometimes without help does perform and makes a good Crisis but these Coolers act counter to and prevent Natures good work checking the fermentation and thereby hindering the separation of any degenerated or noxious admixture And the reason of these ill consequents from Coolers does mainly lye here for as the stomach doth preside over and hath great influence upon the other faculties and subsequent digestions whose briskness and vigorous performance depend much thereon so likewise whatever subverts the tone of the Stomach and flats the acuteness of this principal part and prime office of digestion injures allays and abates the energy of the rest impedes the fermentation of the blood for depuration in such cases as also for conservation and. supply in the constant daily work And although the Patient escapes this Feaver and comes off with life yet by this male Practice they fall into Dropsies Scurvies Jaundies and cachectic foul habits of body an obstructed or tumified Spleen Liver Mesentery c. Or it breaks out upon the Skin and some eruption or cutany defedation will appear in time or it settles in some Limb and disables the part And it is but reasonable to expect that Patients thus cured should soon be Patients again upon the old account the relicts of the former sickness for that morbific matter and cause of Feaver being retained by checking and cooling the febrile fermentation and not observing Hippoc. advice Quò natura vergit this morbous impurity and foulness must precipitate and settle somewhere and then you may well imagine it will make some appearance or alteration in time upon some part or other and then an after-game is to be played for not having its due fermentation secretion and pass-port formerly when it did turgere and was upon the flight only wanted the Physician 's direction and guidance hinted by Hippoc. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Aphor. 21. Sect. 1. Now a hole in the skin perhaps is thought on an Issue for a tedious and troublesom vent to discharge the matter which a good laudable course in due time might have prevented And thus or by this means the Patient comes into the Physicians
pervious Caruncles or glandulous substances through which the Serum is strained and thus the water is transmitted by percolation The Vessels bringing into the Reins are the emulgent Arteries and these draw a Serum from the great Trunk of the Aorta Arteria and import it into the Kidneys the emulgent Veins from the Vena cava were thought by the Ancients to be for the same purpose but latter discoveries contradict it They also receive from the lacteal Veins the thinner and more watry part of the Chyle being an expedite and shorter way hence it is the Urine is pale or whitish when the Kidneys are not strong enough to give this milkie humor the urinary digestion or when drink is too plentifully poured in and forcing through before its due time therefore great Drinkers commonly piss a pale water There are also Nerves inserted into the Kidneys from a branch of the sixth pair which also serves the Ventricle hence it is that the Stomach is drawn into consent by loss of appetite nauseating and vomiting when the Kidneys are pained as in a fit of the Stone it is manifest By these Nerves the Kidneys do suffer not only a heaviness but sometimes very acute pains Vessels carrying the Vrine out of the Kidneys are the Vreters one belonging to each Kidney and they pass from hence down by the Loyns between the two Membranes of the Peritonaeum and are inserted into the Bladder to convey the Urine thither The length of these urinary ductures are about a span the cavity or hollow like a straw but capable of enlargement to the bigness of a finger as by a stone coming down though with extreme pain by reason they are membranous and nervous exquisitely sensible and therefore upon any obstruction are highly urged to expulsion especially by a solid sharp or rugged body as stone or gravel Hereby you may understand the office and use of these parts that is to drain the body from a superfluous saline and tartarous serosity and this ought daily and dully to be performed but this serosity is not all discharged this way by the Reins but some passeth off by insensible Transpiration and some by manifest Sweats but the greatest part by the Kidneys And from hence it appears that the Vrine is partly an excrement of the first digestion in respect of the aquosity drawn from the lacteal Juyce and partly of the second in respect of the Serum sanguinis exhausted from the blood by the emulgent Arteries And here you may observe that by a certain digestion or elaboration in the Kidneys these serosities are transmuted into Vrine and then carries an Odor or scent with it much different from what it was before and the like we may observe in other creatures that their urines have peculiar smells which argues a digestive transmutation But although Nature intends and endeavors this work constantly yet there are many casualties and impediments to disturb these parts and frustrate in some measure the designment of Nature the errors and failings herein we shall recite but those chiefly that are accompanied with or produce pain we shall discourse of with brevity The general and most frequent Symptoms that manifestly afflict or incommode the Reins are Pain and Weakness or Tenderness about those parts Diseases planted there from whence those pains or weakness do arise and depend are Intemperate Heat Imbecillity and a declining state Consumptive diminution and wasting Inflammations Scirrhous Tumors Angustness and Obstructions of the Cavities and Ductures Apertion of the Vessels Apostems Vlcers Some there are whose Pains are hot and molesting not by a natural constitution but acquired by time and evil customs or accidents happening to those parts and this begets a tenderness there and it is painful to lye on the Back The Vrine most frequently is hot or high-coloured sometimes sharp and then apt to make water often prone to Venery at least the constitution of those parts does dispose that way Causes introducing this distemper are too frequent use of Wine strong Drinks and hot Spices much Riding lying on the Back and soft Beds or too frequent Venery and for a correction of this distemper all these procurers and aggravators are sparingly to be used and some of them to be avoided and forborn But if this intemperate Heat depend upon any other disease seated there disturbing the office of the Kidneys and raising a preternatural heat then Remedies must be applied to that as the nature thereof does require which being removed this heat will allay and cease Imbecillity and weakness does sometimes affect the Reins and a decay in the performance of their office may be perceived and if this be not the consequent of some manifest disease debilitating and rendring them incapable then you must know that There is a natural Robor and fortitude implanted in every part by Nature whereby they execute their functions with integrity and constancy there is also an inequal distribution of this vigor and strength that some parts naturally are strong and durable in their stations others are not so firmly radicated in their principles but by time spontaneously fall off from their duties and decay much sooner than other parts of the body Hence it is that some though regularly living complain of this part others of that There are also occasions accidents and different manners of living which we call Diaetetic customs which as they are various do variously injure and decay this or that part of the body and cause it to decline sooner than the rest Imbecillity therefore of the Reins comes under some of these notions and hath its original from thence which when such a case present examination is to be made to which of these the case belongs and is to be ascribed Now that which I call Imbecillity or a decayed state is when the Reins do not make a due secretion or separation of the Serum from the blood and give it the urinary transmutation so that from hence the Vrine is but little and that not well digested the injurious consequents whereof are many for the blood remaining too much diluted and over-charged with the Serum or watry part which being distributed throughout the body and falling upon this or that part cause many Hydropic diseases and some of them mortal as examples hereof might be given The next considerable is Consumptive wasting diminution or lessening of the Kidneys not by ulceration but exsiccation proceeding from a hot and dry distemper of the Kidneys arriving to a colliquating Hectic or Tabes which by time begets a Consumption of the whole Body procured sometimes from a falacious temperament There is felt a heaviness and weakness about the Loins and the Kidneys do not perform their office aright Inflammation sometimes possesseth the Reins caused by pain of the stone gravel or otherwise by obstructions sometimes by a blow or fall also by an influx of blood or any foul corrupt matter transmuted thither and lodged there obstructing the passages and causing a suppression
of Urine This disease is always accompanied with an acute Feaver great Thirst astriction of the Belly heat of Vrine and great pain about the Loins and if the Arteries be affected the pain will be with pulsation Sometimes a Delirium attends with long watching and if the Inflammation be in the Membrane the Patient is scarce able to sit upright because the pain thereby is exasperated If the right Kidney be affected pain extends upwards to the Liver and short Ribs and downwards to the Genitals also a stupor seizeth the right Thigh by consent the Nerve being compressed that passeth thence down to the Thigh But if the left Kidney be the part affected that side is most grieved and in like manner but if both the Kidneys be attacked then the Symptoms on both sides are equal The termination of these Inflammations are either by an Apostem or Abscess by induration and a scirrhous hardness or by Transpiration and resolution which last is the only safe and secure way and this the Physician ought to design for and aim at in his administrations But if contrary to his endeavors the Inflammation apostemates suppurates and breaks evacuating the purulent matter by the Vreters into the Bladder there is good hopes of safety but if it be discharged inwards by the emulgent Veins the case is desperate Scirrhous Tumors in the next place come to be viewed and these are hard Tumors very difficult to be removed being the relict of an Inflammation or other Tumor preceding and not well cured or formed by gross matter congested and accumulated there causing contumacious obstructions for humoral matter flowing thither and being obstructed in the transition the heat of the part does exsiccate and harden it by time more and more and then by accumulation and addition forms a Tumor This causeth heaviness about the Loins but little pain the Urine is but little also and that pale and watry in regard the office of the Kidneys is debilitated and by reason of the angustness of the passages letting pass the thinner but retaining the thicker part of the Urine The longer this Tumor continues the more difficult and incurable it becomes and withal it brings on hydropic Cachexies for the superfluous serosity not being drained away regurgitates back into the body The Cure is to be set upon with internal and external Medicines Aperitives Resolvents Discussives and Emollients Apertion of the Vessels contrary to Nature somtimes does threaten danger by the appearance of blood staining the Vrine and this proceeds from a weakness of the Vessels being relaxed in their retentive faculty or by a plenitude and fulness of blood or because the blood is thin and sharp which causeth the mouths of the Vessels to open On the contrary Angustness or straitness sometimes does incommode the Vessels appertaining to the Reins which hinders the free ransmission of the Vrine Now this angustness of the Vessels does arise either by compression from some Tumor or distended part that presseth upon the Vessels and straitens them from without Or by contraction or constriction of the Vessels that are shrunk as by great heat in long Feavers or a Tabes that seizeth the Kidneys Or lastly by obstruction within from some viscous matter grumous or clotted blood sand gravel stone c. The Sign declaring these obstructions is a suppression of Vrine with pain or an abatement of the usual quantity not answerable to the drink received The place or part affected whether in the Kidneys or Vreters is known by the seat of pain The causes that obstruct are known by their proper signals and by examining into the preceding state of the Patient The place or part grieved with these obstructions whether in the Kidneys or Vreters pain discovers and the dislodging or shifting thereof Of all the obstructions that infest the Kidneys the most frequent and saddest complaint is from the Stone this being the most contumacious obstruction the most painful being a hard solid body and the most uncertain Remedies for relief Concerning the generation of these Stones there have been various Opinions amongst Learned men in short the difference and contest hereupon may be reduced to these two Heads what the material cause of the Stone is and what the efficient For the material cause or matter whereof the Stone is bred Galen and most of his Disciples will have it to be a phlegmatic gross or viscous humor apt for condensation and induration and the efficient to be heat exsiccating this matter and bringing it to a stony hardness but others of them will have this to proceed from cold by way of congelation But this Doctrine cannot hold as rational nor does it answer experience as for the matter we cannot allow it to be such for as much as many that abound with a viscous tough Phlegm and slimy matter as most ancient people do yet many of them are never trouble with stone or gravel And for a concurrence of both the causes material and efficient we have examples of the Aged who are most cold and phlegmatic and for abounding heat with the like matter we may produce Feavers yet no stony concretion or signs thereof to be found from such sicknesses So that we are now to seek for other causes both material and efficient whereon to ground our endeavors for the relief of such as are afflicted with this disease The matter therefore and substance of the Stone is from a tartarous and saline succus with the addition of a terrestrial feculency concreted or petrified by a lapidifactory Spirit or disposition of the Reins which is the efficient and seminal being of that production The concurrence of both these causes does much produce the Stone and afflict the Patient in a high degree but one of them is sufficient viz. this petrifying power of the Reins to coagulate any laudable good matter imported there into a stony substance To confirm this Fernelius relates upon his own knowledge of one that for three or four months together above a dozen small stones came from him every day all which time notwithstanding he eat nothing but Broths and Panadoes being confined to his Bed by weakness and pain But allowing this to be true from the credit of the Author yet we must owne and acknowledge that besides this principal cause of a petrifying Spirit in the Reins there are also antecedent and procatarctic causes adjuvant and promoting as some sorts of meats and drinks and other errours in the Diaetetics that increase and set forward this disease which otherwise might be much slower in generation nor yet arrive to so high a degree of torture also the Stomach Spleen or Liver not performing their functions rightly may contribute matter to the promotion hereof For relief of the diseased in this case there are two grand intentions to be prosecuted and aimed at a dissolution of the body of the stone already generated and secondly the taking away of the petrifying disposition of the Reins and abolition of
very weakly others use their arms but with little strength and some the use of their Limbs almost taken away The material and continent cause of these fugitive and vagrant pains is the same or of the same nature with the former Arthritis or Joynt-Gout viz. a tartarous or sharp penetrating serosity that molests these several parts and to confirm that this is a serous or watry humor it makes no Tumor nor suppurates which were it of another kind it would besides the mobility and fluctuating nature thereof argues it to be of that kind and farther à juvantibus we may most rationally conclude so Transpiration and copious emission of Urine and also Purgation that evacuates serous humors gives allay and sedation to these fleeting pains But why this should be so moveable and changing its place the other fixed or constant to a part since one and the same humoral matter is the cause of both the reason hereof may be this from abundance of the humor and for want of vent one way not being sufficient to receive and spend it Nature is necessitated to find out and break through several ways that is by forcing the Anastomoses and opening the terminations of the Veins spewing forth this punging irritating humor into several parts and being an unwelcome guest hostile and troublesom the Archaeus or vital principle defending its Territories quoad posse and unwilling to give it harbour transmits it from place to place This Rheumatism and erratic pains depending upon the same humoral cause with the Gout will require much what the same method and Medicines for Cure as also such Prophylactics that are proper and fit by way of prevention for the other may here be used with the like advantage and therefore it is not needful to point out a particular methodus medendi or peculiar Medicines only the Topical Medicines are not of such use here as in the Joynt Gout And now I have gone through and briefly inquired into the most and most considerable pains incident to several and principal parts of mans Body it remains now as is proposed and promised in the front of this Work that I proceed on to the next Stage viz. Inflammations and there observe what is most remarkable and most profitable to be taken notice of Inflammations internal BY the common order of causation Pain precedes Inflammation follows To illustrate and set forth the nature of Inflammations more evidently and to avoid confusion and intanglement in our Discourse we shall distribute our matter and place it distinctly under these following Heads First What the word imports and congruous signification with the nature thereof Secondly What Parts of the Body Inflammations do usually possess Thirdly The occasional Matter that provokes and sets forward these Inflammations Fourthly How they arise and from what Principle or Efficient they are caused Fifthly The Vse and Practice that ariseth naturally from the preceding Doctrine The word Inflammatio used in the Latine in the Greek is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro to burn or inflame in both Languages signifying some extraordinary and preternatural heat kindled and begun in some part of the Body and in the common acceptation of a Phlegmon or Inflammation is understood thereby a hot Tumor arising from blood But although Inflammations are reckoned among the Tumors and so accounted by most Practisers yet I must take leave to divide Inflammations from Tumors and distinguish them apart as properly so for commonly they are separate although oftentimes conjunct and the denomination was given à calore not à tumore By Inflammation therefore I understand here only a preternatural or extraordinary heat begun in any part as the Etymon of the word imports before a Tumor be raised but by time and continuance Inflammation or great heat does attract matter and forms a Tumor and then Inflammation and Tumor are coupled or complicated together for as we plainly find external parts to burn or feel very hot and to look red you say then the part is inflamed although no Tumor or swelling appear so is it internally the part is fiery hot or inflamed before a fluxion of blood arrive thither to throng the part and raise a Tumor so that there are Inflammations without Tumors and Inflammations conjoyned with Tumors and here I make Inflammation a distinct Classis and to be a gradation or step towards a Tumor which probably may follow if not prevented as sometimes it doth And here it is worth our inquiry to know the reasons why some Inflammations produce Tumors and some go off without forming a Tumor and this is caused from the difference of the parts affected and the copious influx and contumacy of the material cause to be removed from the efficacy of means timely used or the strength of Nature to relieve her self Secondly We are to take notice what parts of the Body are subject to Inflammations and they are the muscular flesh the Membranes the Parenchyma of the Viscera and the Glandula's hence it is that Inflammations as they are seated in divers parts of the Body so are they called by distinguishing names from the part affected as Phrenitis an inflammation of the Meninges or Membranes of the Brain Ophthalmia of the Eye Parotis of the Glandule near the Ear. Peripneumonia of the Lungs Pleuritis of the Pleura Nephritis of the Kidneys Angina of the Muscles of the Throat Now from the part affected you are to observe that any member the more nervous it is by so much the pain is greater and by how much the part is more fleshy by so much the sooner the Inflammation comes to a resolution or collection of matter In the third place we come to remark the conjunct and material causes of Inflammations and they are generated either by obstruction or extravasation Obstruction begets Inflammation when the fluid liquors in the Vessels are denied their free motion and transition and this happens when these Juyces are coagulated gross or thick and thereby become stagnant in the smaller Vessels Or by compression when the Vessels are stopt by some adjacent part tumified or extended beyond its common bounds Or by an influx of blood rushing into some smaller Vessels from whence there is not a ready transmission and passage for the venal and arterial Pipes entring into a member are commonly large but grow smaller as they go deeper in and their ramifications very minute that they may soon be overcharged by a turgid blood more than ordinarily fermenting and flowing in Thus great pain from what cause soever may introduce Inflammation by drawing a flux of humors to a part or member from whence they cannot readily retire or move forwards And here you may see how Contusions Luxations Fractures c. do occasion Inflammations if not prevented by care and skill with exquisite good means By extravasation sometimes Inflammations do arise that is when either by plenitude and fulness or heat and
malignity and venenate matter hath proceeded too forward and draws near to a 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 mortification then these means are to be laid aside and nothing remains to be done but amputation or dismembring and that only if the part will allow it as Arm or Leg Scrotum or Dug immedicabile vulnus Ense recidendum est ne pars sincera trahatur And if a separation of this dead part from the living cannot be performed there is no hopes of recovery or reduction of that to life again à privatione ad habitum non datur regressus Nor is there any hopes of the Patients life for this mortified part will corrupt and mortifie the whole Where amputation can be performed this question as a difficulty ariseth amongst men of Art Whether Section should be made in the sound or unsound part Some are of opinion that it should be in the dying or dead part thereby to avoid pain to prevent the great Haemorrhage or flux of blood and Convulsion but I rather consent with those that determine of the other side as the most secure way and the arguments for it are more prevalent rather to take away some of the sound flesh than to leave any of the corrupt and mortified for from that root the same mischief may grow again notwithstanding cauterizing or what else may be done For a good performance and happy success in this operation being the ultimum refugium and extreme remedy in this desperate case there are many things to be cautioned some before as previous others in the doing and also after dismembring to prevent the ill accidents that may attend or follow But I must wave those particulars now until occasion be offered to revise this Work and enlarge upon the several Heads treated of And since that these diseases now briefly discoursed have such transitions and gradations from bad to worse and from thence to extremity it behoves every one upon suspicion of these latent and obscure Maladies intimated by pain to begin early with them when with a smaller matter they are capable to be reduced but delays and neglects or improper mistaken courses do precipitate the Patient into languishing and difficult or irremediable conditions Multae aegritudines suâ naturâ sanabiles aegri negligentiâ aut Medici errore fiunt incurabiles The Result of the whole matter by way of Recapitulation I Have thus briefly delivered to you the most considerable matter relating to the Subject proposed in the Front of this Work Pains Inflammations Tumors Apostems c. this frequent and latent progress of Diseases which might admit of great inlargements and long discourses upon the several parts and points touched upon but I have only drawn out the chief Heads as a Compendium easie to review and retain in memory whereto many cases and the most principal in Practice do refer and belong and may serve as a guide and caution to Practisers that jog on in the common beaten road who little suspect this train of Diseases and discern not their disguises in the sicknesses they undertake Indeed it seems something strange that these capital diseases which most other are dependent upon or move towards should not be obvious and more frequently the subject of Practice these being primitive diseases and a ground-work from whence many others are derived and bottomed upon or else they are such as most diseases do fall into and are the terminations of them And it is very reasonable to expect that both most acute and also chronic diseases should go in this road and make their transitions by these stages for pain is so general in diseases and this so naturally leads on the rest or at least does signally declare that the rest are coming on as in pag. 9 10 11 12. is set forth And if you do but consider that in diseases both acute and slow of motion there is most commonly a peccant matter lodged here or there and causeth particular pain in some part or else this morbific matter is floating in the Vessels and produceth only some general indisposition or a febrile estuation and distemper if it be lodged in any part by defluxion or bred there by congestion it necessarily diseaseth that part gives some disturbance by pain and will form a Tumor if not removed and dislodged in due time but if the morbific matter be roving and fluctuating Nature either makes a secretion and sends it forth by her own strength or assisted by Medicine or else it is transmitted into some ignoble part where it will not lye dormant long but accumulates there becomes more depraved and lays the foundation for this train of diseases so that either way there is a tendency to bring about this design the subject of our Discourse In the most malignant sicknesses you may discern some or more of these confederate diseases as Actors therein whether small Pox great Pox Plague c. for eruptions and superficial Tumors are but internal Tumors transplanted at least are the signals of Natures endeavors and strength with or without assistance to cast out that morbous matter which otherwise must necessarily inflame tumifie apostemate ulcerate corrupt and destroy the internal parts And Feavers that are not malign they are adjudged salutary and hopeful when Nature makes a good Crisis by Fluxes or Sweats by Vrine or a Haemorrhage and if the morbific matter be not discharged some of these ways it lodgeth here or there after long floating about is sequestred and cast into some recess Glandule or other ignoble part where it forms a Tumor and is the secret foundation of some chronic disease or another acute sickness if not anticipated or prevented by due course of Medicine and therefore in the designment of most Cures acute or chronic these are the dangerous rocks you are to avoid lest the Patient miscarry here for want of discerning and foresight thereof The method and drift of our Discourse is to let you understand that this grand Series of diseases is the usual progress in sickness and by these stages most diseases do pass on and have their gradual advance by these commutations and thus make their approaches towards death Some go but part of this way such as Providence with good means does shorten the course prevents the mischief threatned and reduceth them back into their former state of health Some are only pained for a while it goes off and ends there but some are pained in a higher degree and Inflammation follows thereupon but it goes no farther this febrile inflaming heat is allayed and all is quiet again Sometimes it proceeds farther and to Inflammation a Tumor is added which notwithstanding by due administration of Medicine this is dispersed and the sick reduced to a sound state again but yet sometimes it advanceth farther and into greater danger as by some neglect improper means or other casualties that this Tumor apostemates and then it cannot stop there for this must break and then an Vlcer will follow of
commonly called Stitches Pains are incident to these Muscles from external injuries as contusions and impressions of cold or else internal causes and these are either by defluxion of humors that may flow in as most frequently from an abounding serosity being thin sharp and extravasated falls in amongst these Muscles or else by congestion matter is accumulated which Nature not being able to discharge lyes there as a burden impeding the muscular motions and causeth pain Sometimes from flatulency and wind getting into the Interstitia of the Muscles thereby causing intercurrent and fleeting pains And for remedy in such cases Fomentations and hot Bags applied are advantageous Evacuations being premitted according to the condition of the Body requiring We come now to consider of Pleurisies or pains in the Pleura that inward Membrane that does invest or line the Breast a disease very eminent and frequently occurring that both Hippoc. and Galen often mention it by way of example These pains are acute and sharp like punctures and have no constant place but in some persons they seize the right side in others the left in some the pain is higher in others lower towards the Hypochonders sometimes more backward and sometimes forward and although chiefly and more manifestly the pain be here or there to be pointed at yet the whole Membrane by reason of continuity is thereby affected and the parts adjacent do suffer by consent from whence various Symptoms as concomitants and attendants do inseparably accompany and consort with this pleuritic pain Hence it is that difficult and short breathing is constantly annexed to it and this because the parts for respiration are hereby impeded and have not their due motions and liberty of extension but are restrained and curbed which is done in favour to avoid compressing the grieved part otherwise would exasperate and increase the pain and therefore the sick fetch their breath short and quick because they cannot take it fully and largely and do repeat it the oftner by way of recompence To this and by consent of parts is adioyned a short and dry Cough which irritates and provokes the pain by moving and straining those parts and therefore is very troublesom and grievous to the Patient Here also a continual acute Feaver does necessarily follow as inseparable for the Archaeus or vital Principle being invaded in those parts by something hostile does therefore insurge becomes inraged grows hot and fiery raising a burning distemper throughout the body To these we may add another constant Character namely a hard swift but small Pulse And these are the pathognomonical signals that are always attending upon and do distinguish Pleurisies from other diseases of adjacency or affinity and likeness with them for when pains fall in amongst the intercostal Muscles although there may be some punctures or prickings because of the Membranes there yet not so great the Feaver not so high nor the breath so short nor the Cough so troublesom if any If the Lungs be inflamed only the pain is but little not punging but obtuse not in the circumference or sides but in the cavity or middle of the Breast yet the difficulty of breathing is greater here than in Pleurisies from angustness that seizeth the parts of respiration Pleurisies differ from Inflammations of the Diaphragma because in this there is no pain in the sides but only at the end of the short Ribs and the upper part of the Belly is extended and with it a Delirium Pleurisies also are distinguished from Inflammations of the Liver in the seat or place of pain which always is in the right side under the short Ribs the pain not punging but heavy and obtuse the Cough less difficulty of breathing less but the Urine higher-coloured or tinged red And now I see the reason though very weak why some Authors have distinguished Pleurisies or differenced them into legitimate and spurious which indeed is a division of Pleurisies into Pleurisies and no Pleurisies for I account no disease to challenge that denomination but such as have their foundation in the Pleura else by the same reason all diseases may admit of the same distinction of legitimate and spurious for as much as every disease hath some Symptom which is common to other diseases that may give them some resemblance or affinity with each other or be affected by consent from another but I pass it over and come to examine the causes from whence pleuritic pains do arise These causes are external and internal External causes are such as remotely prepare and dispose the body to a likely capacity of reception or aptness to this disease laying the foundation for internal causes and they do arise out of or from the irregular unfit or improper use of the Diaetetics which leads to a morbific or unsound state For example violent exercise or otherwise raising great heat in the Body and opening the Pores by neglect upon it as not to preserve that warmth for some time and suffering it gradually to abate and go off by keeping on cloaths and forbearing cool drinks this may introduce a Pleurisie So likewise in the heat of Summer to throw off cloaths and be exposed to the wind at a Casement or the cool Air in the evening To over-heat the Body with strong Liquors and suddenly endeavor to cool it again with small Beer may effect the like Cold North-winds after Southerly and hot weather does alter the texture of the blood and is previous to pleuritic or similar pains But here you must take notice and know that quicquid recipitur recipitur per modum recipientis all Bodies are not alike nor equally disposed for reception for in some these causes produce Pleurisies in others Angina's in some Dysenteries in others Arthritic pains c. According to the aptitude and disposition of Bodies in fabrication or organization and peculiar properties have the same general external causes various and divers effects being determined and specificated by different states of Body more liable and apt to this or that disease rather than another Hence it is that external causes as Diaetetic errors have heterogeneous effects and procure dissimilar diseases according to various constitutions purity and impurity stability or debility concurring with or resisting their influence which consideration brings me directly to the next stage being the latter part of the preceding division Internal causes are antecedent or conjunct Antecedent as plethory being fulness of blood or Cacochymy a depraved or degenerate blood both which are previous states or conditions of Body disposing or rendring more liable to this disease for the great Vessels being full and distended upon any Effervescence and Superfermentation of the blood this impetuously like a torrent is impelled into the smaller Pipes as those of the Pleura where not having a free passage it does cause pain by distension and Inflammation Now this plenitude is brought on or aggravated and increased sometimes by a suppression of some accustomed Evacuation as those that are wont
extuberance is out of the Veins that is when the extravasated blood is lodged between the mouths or terminations of the Veins and the covering coats In the former case and when the external Haemorrhoid Veins be so affected Phlebotomy may alleviate make a revulsion and draw away the plenitude but in the latter it gives no relief for the extravasated blood will not return into its canal or pipe again and besides it soon coagulates and putrifies out of the Vessels the proper place and then suppuration is to be promoted the Apostem to be broken after that abstersion and healing to be designed and endeavoured And here you may discern the difference between these two Haemorrhoid painful swellings that the first kind does abate and retire of its own accord sometimes Nature retracting and turning the current of blood to some other part at least it sooner yields to means and is more easily remedied but the latter will not revert nor is easily cured but proceeds to Apostemation and after breaking sends forth corrupt and bloody matter From hence you may perceive that as there are many sorts of Haemorrhoids so many questions might here be started and much more to be said concerning them to compleat the Discourse thereof as why the Hemorrhoids should swell and not bleed sometimes Why they are painful and sometimes not Why they appear and pass away without injury sometimes What difference between an Inflation and Inflammation of the Haemorrhoids c. But to inlarge hereon and give full satisfaction would swell this Work beyond intention and our limits set at this time Pains of the Spleen THE Spleen being a principal part and of great use in the Body is also subject to disturbance and great pain This member is seated in the left Hypochonder over against the Liver below the Diaphragma and under the short Ribs hanging downwards in figure like an Ox-tongue inclining rather to the back-parts and near the left Kidney To pass over the different Opinions amongst the ancient and modern Authors concerning the office of this Organ we shall concur with those that assign the use of this member for a depuration of the blood transmitted from the Heart to receive a farther elaboration there that the whole mass of blood may be purified and kept in a due state From whence it comes to pass that when the Spleen is injured out of order or decayed and performs not this office aright the blood becomes foul and many diseases arise from thence which causeth much alteration in the body for with the Spleen do many parts consent and well or ill as that is in a good or bad condition The Brain though remotely seated is much affected from hence causing sometimes Epileptic fits Vertigoes Head-aches mad Melancholy and many other Symptoms which Hippocrates hath observed 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 The Heart also from a tumified or obstructed Spleen is drawn into consent causing palpitations and oppressions Hence also difficulty of breathing from a swelled big Spleen hindering the free motion of the Diaphragma The Liver also seldom stands firm if the Spleen be diseased And the Pancreas for the most part incurs prejudice being obstructed or scirrhous from an ill affected Spleen Hence it is that the Spleen challengeth a great share in the production of divers Cachexies or ill habits of body Dropsies Scorbute black Jaundice Haemorrhoids Cancers c. of which I might give you many examples but I shall recite one only and that very eminent plainly shewing that the rise thereof and dependence is sometimes from the Spleen In the year 1658. a Cheshire Woman named Elizabeth Swaine a Farmers Wife aged 39 years came to me at Chester where I then practised she living about a dozen miles off her complaint was of pain hardness and Tumor of the Spleen before which happened she had a tertian Ague for some time but after that had left her the left side began to swell and pain upon the region of the Spleen this increasing and when she came to me the Tumor was raised very high and the compass of a penny-loaf being very hard and scirrhous not yielding when it was pressed with a finger Her desire was to be under my care and I was willing to undertake the Cure but she not having brought conveniencies with her to stay would go home and return speedily with such necessaries as she should want but came not again until three months after and then not only the left Hypochonder but the Abdomen her whole belly was tumified and extended as big as if she were ready to be delivered of a child so that the Tumor of the Spleen was then hid the whole belly being equally raised up to it by a Dropsie Ascites This neglect of hers and thereby rendering the Cure much more difficult and uncertain made me to refuse medling with her since by her folly she had lost the opportunity for I was doubtful and feared that the Spleen by that time was become scirrhous and the Tumor not to be discussed or otherwise decayed and putrified as not be restored but she having a Sister living in that City who had been my Patient before upon both their importunate intreaties though I would give little incouragement I unwillingly did put her into a course of Physick but after I began I endeavoured the best I could for her which was as followeth First I appointed a Preparative to be given which was this R. Radie. utriusque bugloss gram cichor apii ana ℥ j. polypod quercin ʒ vi cort cappar median fraxin liquirit ana ℥ ss herb scolopend ling. cervin chamaed ana M.j. Tamarisc Mss sem foenic. dulc ʒ iii. passular maj exacinat M.j. Coq in aq vin alb ad lib. ii colat ℥ iv adde syr de pomis magistral ℥ j. rosar solut ℥ ss tart vitriolat ℈ ss Misce pro dos After that I ordered Leeches to be applied to the Haemorrhoids and much watry blood came away and she found her self something better Then I appointed a purging Apozem for four doses and it was this R. Rad. filicis mar cort cappar polypod ireos nostr liquirit ana ℥ j. herb scolopend M.j. cuscut tamarisc ana M. ss sem alkekeng foenic. dulc anaʒ iii. stor bugloss p. j. Coq in aq vin alb ad lib. jss colat infund sennae opt mund ℥ jss epithymi ℥ j. agar troch ℥ ss rhabarb opt ʒ iii. macis caryophyll ana ℈ ii calam aromat schoenanth ana ℈ j. Fiat colat pro 4 dos addendo unicuique dosi syr rosar solut ℥ j. aq cinnam ʒ ss tart vitriolat ℈ ss Which being taken the distension of her belly began to abate After the Apozem I gave her a Chalybeate Wine for four days mornings and at four a clock after noon with exercise and at nights three aperitive Pills not purging The Chalybeat Wine was this R. Cort. rad cappar polypod ireos nostr liquirit ana ℥ ii herb scolopend cuscut tamarisc ana M.j. chalyb.
Liver BEfore I inquire into the nature and causes of these pains it will be necessary to let you know the office and use of this member its situation figure and vessels for hereby the disease upon which pains depend will be more manifest and apparent as also such parts as suffer by vicinity connexion and consent from hence To enumerate the various Opinions that have been held by Learned men in all Ages concerning the office of this member would be too tedious therefore I shall only mention what latter discoveries have proved most rational from the motion of the Chyle and Blood which is this That the Liver primarily is appointed to receive the blood coming from the Heart to give it a farther digestion and depuration by separating the bilious matter and secondarily by embracing the Ventricle to cherish and promote the stomachs digestion or chylification for which purposes this member is fitly seated formed and furnished with vessels to import and export The Liver is placed in the right Hypochonder under the Diaphragma covered in part by the short Ribs and covering the upper and forepart of the Ventricle and for firmness of situation it is fastned by three Ligaments to the Abdomen to the Cartilage ensiformis and to the Diaphragma The figure of this member upon the superior part is convex or round the better to give way to the motion of the Diaphragma but the under side is concave or hollow fitly to apply to the extension of the Ventricle As for magnitude it is various in divers persons greater and less and also different in the same persons in health and sickness this member sometimes being wasted and shrunk and sometimes swelled or increased wonderfully big This Organ hath vessels appertaining to it as Veins Arteries and Nerves the two eminent great Veins of mans Body Vena cava and Vena portae having their roots variously dispersed here through the Parenchyma or body of the Liver the trunk of the former rising out of the superior gibbous part the latter from the concave and under-side The Liver being designed for the use aforesaid seated and accommodated after this manner we shall inquire into the impediments and preternatural conditions from whence pain and trouble ariseth for many complain of pain and heaviness in their right side about the short Ribs sometimes more forward sometimes backward sometimes inward and sometimes more outward To what parts these pains belong and the causes from whence they arise is worth our labour to be resolved for sometimes pains of the Liver have erroneously been taken for Pleurisies because the pain hath extended upwards and affected the Thorax by reason of vicinity and sometimes the muscular pains of the Abdomen in the right Hypochonder have been adjudged to be hepatic not rightly discerning the diagnostic signs Diseases which the Liver is most subject to and procuring pain are these Obstruction Adhesion Inflammation Inflation scirrhous Tumors Apostems Vlcers From hence we may understand that as these pains are various in their causes so are they dissimilar and unlike in the sense of feeling and differently seated Obstructions that impede and injure the office of the Liver and producing pain are frequent and these are either in the outmost gibbous part and do belong to the trunk of the Vena cava or else in the hollow inferior part and the Vena portae is concerned herein or else the obstructions are fixed in the body of the Liver and then the small ramifications of either or both Veins are affected Hence it is that this member is most frequently infested with obstructions because it is stored with so many vessels as none more But besides these obstructions of the Vessels there are also obstructions in the Parenchyma or substance of this Organ that is when the small Meatus or Pores are shut up that ventilation and transpiration is denied hence it is that this member sometimes is preternaturally extended and increased in magnitude through all its dimensions for having a continual supply of additional matter and not duly expended the part of necessity must be augmented and inlarged And it is observed by some that those have the greatest Livers that are of a colder temperature and such as are great eaters of this Cornelius Gemma gives an example of an Old woman that could not forbear eating and drinking scarce a moment but with great trouble and anguish and being opened after her death her Liver was found to be wonderfully big Signals declaring the Liver to be obstructed are a heaviness fulness or an obtuse pain in the right Hypochonder and chiefly after meat or exercise and upon more than ordinary motion the face is apt to be high-coloured the hands to look red and the breath to be short and they are apt to be feaverish upon small occasions but upon rest and ease commonly they are inclined to be pale Causes from whence these obstructions arise and do depend are first such as remotely dispose as a plentiful and bad Diet or a gross feeding upon such meats as are difficult to be digested and distributed what those are you will find in the Preservation of Health c. also a thick unwholesom Air to be without exercise and to indulge sleep too much which over-clogs the body makes a Plethory and fulness whereby the circulation is retarded laying the foundation and an aptness for obstructions in general Secondly and more immediately from a viscidity and grossness of the blood rendring it influid slow of motion and apt to stop in the vessels and this is generated in the Liver from its distemper debility and decay of the faculty or is transmitted from other parts and brought in from the antecedent causes aforesaid to which we may add angustness of the vessels in some persons disposing to this inconvenience Obstructions of the Liver are carefully to be lookt after and removed because they introduce many other diseases as Jaundice Dropsies Feavers Inflammations scirrhous Tumors c. Adhesion or Coalescence sometimes is the cause of pain in the right Hypochonder as when the Liver sticketh to or groweth together with the Peritonaeum And this may happen from too much and constant lying on the right side or by the magnitude of the Liver extending to the Peritonaeum whether tumified preternaturally or increased by a natural nutrition and growth Now pain ariseth hence the Membrane that invests and covers the Liver being very sensible as all Membranes are that cleaving to the Peritonaeum is disturbed and strained by motion or shaking of the body or by lying on the contrary side the weight of the Liver endeavouring a separation Inflammation sometimes seizeth the Liver and causeth great pain and this commonly proceeds from or is the consequent of obstructions for the blood being stopt in its current and overflowing especially being more hot and fiery is then apt to inflame the part and this is manifest to sense by heat and tension of the right Hypochonder Inflammation is known from
time I have a Patient repenting that ever he committed himself into the hands of a practising Apothecary for he by stopping his Gonorrhoea before the virulency was eradicated which I judge was done by astringent Medicines the Patient was forced to leave his Undertaker and came to me in a painful and dangerous condition one of the Testicles being inflamed hard and swell'd as big as a Turkyegg By such miscarriages some have been quite lost others have been perplexed and almost ruined afterwards with difficult and very chargeable Cures as not long ago a Gentleman came to me who had spent above five hundred pounds having been under several Physicians and Chirurgeons of good repute for some years being reduced to such a difficult state from the imprudence of his first Undertaker Vlcers in the Bladder are known by pain about the Os pubis and bottom of the Belly a strong or stinking Urine if the Vlcer be fordid a purulent or furfuraceous matter floating a hot or sharp Urine which causeth a painful discharge thereof and sometimes with difficulty if any excrescence or viscous matter obstruct the passage These Vlcers have been accounted incurable by our Predecessors but this Age hath given testimony of their curability and my self have had good success in these undertakings to the relief of some thus affected and great satisfaction to my self Verruca's Caruncles or fleshy Excrescences do infest the neck of the Bladder and sometimes the Vrethra or urinary ducture and these commonly are the products of a preceding Vlcer or Gonorrhoea and sometimes conjoyned therewith And now we have briefly declared and run through the several pains that belong to the Kidneys and Bladder remarking the diseases whereto they belong and from whence they do arise it remains in the last place that we set down the principal morbous affects discovered or intimated by the Vrine Capital Symptoms that attend the Vrine denoting some diseases or infirmity considerable in the parts that belong to this urinary office are chiefly these a bloody Urine sand or gravelly oily or greasie purulent or furfuraceous too much Urine or too little a painful suppression or emission a white water red or black stinking or strong-scented hot or sharp And thus having traced through the Head Breast and Belly examining the most frequent and remarkable pains thereof it remains that we inquire into those pains that possess the Limbs as Legs and Arms of which in the following Paragraph Gout-pains and Rheumatism IN this our Catalogue of Pains We must not forget to insert Arthritic or Gout-pain being so eminent a Tormentor so contumacious and resisting that oftentimes it hath bid defiance to the potent means of the most reputed Physicians hereby gaining the name with many and accounted amongst the number of incurable Diseases from hence the endeavors of the most are rather to palliate than to cure as having no hope to effect so great a work I must confess that mitigation and allay of pain is very acceptable to the tortured Patient and not without a deserved praise to the Physician but to acquiesce and rest here as the ne plus ultrà is too inferior a station and below the dignity of his function we will therefore make a farther inquiry into the nature and difficulty of this contumacious Malady thus posted possibly thereby to meet with some incouragement and to find out a way conducting us to such advantageous approaches as may dispossess and subdue this grand enemy Arthritis the Gout is so denominated from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Articulus the Joynt and is the generical word comprising several particular species thereof having their distinguishing names from the part affected as Podagra the Foot-gout Gonagra the Knee-gout and Chiragra the Hand-gout but Rheumatism takes denomination from motion or fluxion Rheumatismus fluxio from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fluo this kind of Gout not fixing here or there but moving from part to part is therefore called the running Gout I shall treat of these several Gouts together because of their affinity with each other in their continent cause and differing only as to the sedes morbi which may cause some variation in practice but not much Concerning the continent cause of the Gout there are various Opinions some determine it a sanguine humor others phlegmatic some a choleric others melancholy and some a mixture of these humors Hippoc. lib. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 will have the Gout to arise from Choler and Phlegm Galen de comp medic says the humor is sometimes sanguine but for the most part phlegmatic or Phlegm and Choler mixt Trallianus also an ancient Greek Author lib. 11. derives the Gout from Blood Choler Phlegm and Melancholy farther affirming that if the several kinds of the Gout arising from the different mixture of these humors were rightly known this disease were easie to be cured Thus from the difference of opinions and mistakes concerning the Gout the designment of Cure and means adapted thereto have been various and also frastraneous other improbable opinions there are but I wave the recital of them and come to set down what is most consonant with reason established upon latter and clearer discoveries And here I must premise a few things as introductory but necessarily serving to our present purpose Food which sustains and repairs the body is meat and drink of meats some are liquid others solid but the solid and dryer meats coming into the stomach are macerated liquefied and transmuted by the digestive power thereof and assistance of ingested liquors is changed into a liquid juyce called Chyle this Chyle being exported out of the stomach receives several alterations afterwards in the various parts through which it passeth and is become a milky juyce in the Venae lacteae blood in the Veins and Arteries water in the Lymphae-ductus and a spirituous exalted Succus in the Nerves and all these for various uses and purposes but still keeping in a liquid form and flowing in the Vessels containing And to prevent stagnation or stoppage of their motion in the several small Pipes of conveyance through the body hence it is that all the humors or juyces of the body do participate much of water or a thin watry and fluctuating substance called Serum by some Lympha by Helmont Latex which being thus appointed for a distribution of the Chyle and Blood hence it is that Hippocrates fitly calls it 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Vehiculum nutrimenti This Serosity or watry part abounding is not easily contained in the Vessels or Conduit-pipes especially being depraved become sharp and penetrating with a Tartarous saltness but either by apertion or exsudation is let put and where it takes its course discharging it self upon some tender part there pain and trouble ariseth Thus the Gout takes its beginning from an acrid or sharp saline serosity invading the Ligaments Membranes and nervous parts about the Joynts lancinating those tender and very sensible parts But how this Serum comes to abound and how to
thinness of blood the terminations or mouths of the Veins are opened and some effusion made which then being out of its proper place does degenerate and corrupt and affords matter for Inflammation Thus by Ruptures Punctures and Wounds extravasated blood is the material cause of Inflammations Fourthly but matter alone cannot produce an Inflammation nor any other disease being inactive and a dead thing of it self except some vital Agent works upon it forms and moves it who or what this Agent is we are to inquire farther Since then Inflammation is not procured by matter alone nor can it exist only by matter there must then be an internal efficient and movent Principle joyned with this matter that fabricates and generates of this matter an Inflammation But understand me rightly I do not mean that this matter takes fire and is kindled as if it were a sulphurous and combustible matter and so cause an Inflammation or scorching heat no such thing but this morbific hostile matter stirs up the vital heat by way of irritation provokes the vital principle to estuate and wax hot for from hence does all heat emanare stream and issue forth whether it be a temperate and natural warmth or a preternatural and inflaming heat both proceed from this fountain So that hereby you must distinguish between the occasional matter of Inflammations and the internal efficient that does excandescere inflammare This inflaming heat ariseth from a principle much different from the materia morbifica occasionalis this great heat does not rise out of the morbific matter inflamed but from the vital Principle incensed A Stone in the Kidneys by raising great pain may cause an Inflammation there and this stone is the occasional and material cause thereof but none can think that this contains fire in it or is capable to be inflamed or to communicate any heat to the containing parts save only what it hath received from the vital heat residing in the body And thus it is in all other cases of Inflammation in any part of the body from what cause soever This vital Principle is seated in every member of the body and does preside as Governor and not only for defence thereof but also to move and act in it so as no vital office or function can be performed without the assistance and power of this internal invisible Agent nor is there any heat but what ariseth from hence And this is that which Hippocrates calls the impetum faciens Helmont the Archaeus which I chuse rather to call the vital Principle When any thing happens out of order in the body a Vessel obstructed or some liquor extravasated or what else that may disturb and interrupt any member in its office soon the vital Principle is affected and concerned therein and if the matter be considerable and contumacious pain ariseth there and this pain is the suffering and anguish of the vital Regent strugling to resist the injury and labouring to remove the impediment hence the Inflammation and preternatural heat arising from this vital power Fifthly and in the last place from the doctrine preceding we are to make some observations that may be useful for guidance in Practice and to remark some pernicious errors that pass undiscerned And first here you must take notice of the affinity between Inflammations and Feavers that most Feavers do arise from Inflammations of some particular part and are the off-spring from thence or springing from that root For the quòd sit Practice does affirm it for rarely you shall meet with any considerable Feaver but some particular part is chiefly complained of and as the grief or pain does abate there the Feaver is remiss and slackens also Secondly you are to note that Feavers are erroneously defined à calore praeter naturam in corde accenso assigning the Heart to be the Focus where febrile heat is first kindled and from whence it is maintained when almost in any other part of the body if an inflammation happen there a Feaver will certainly follow taking its rise from thence not from the Heart so that the Heart then suffers sympathically by consent not idiopathically and originally And whereas I said almost any part intimating thereby that a slight Inflammation may be in the small and capillary Veins of short continuance which may not communicate a Feaver to the whole body and such inflammations we see externally planted sometimes the capillary Veins of the Cutis being affected calore rubore which either spontaneously vanish or soon yield to some outward application only Thirdly From the denominations of Feaver and Inflammation you may observe the parity or near relation they have to each other for from the Etymon of the words they seem to import much what the same thing denoting only an extraordinary heat 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ignis and in the Latine Febris à ferveo 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 inflammatio from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro Fourthly We shall not depend upon Etymologies which are allegorical and often strained but inquire into the nature and extent of each and know what is meant by the one and the other and then what difference between them Feavers are known and defined by preternatural heat and effervescency through the whole body Inflammation is a preternatural heat of a particular part Hence we remark that Feavers are general Inflammations or inflammations dilated Inflammations particular Feavers of a member thus differing in extent and latitude but withal observe the order of causation Inflammation precedes and lays the foundation in this or that part there is the fomes and miner a morbi a Feaver follows upon the whole body caused only by consent from thence and condolency Now if all or most Inflammations cause Feavers and Inflammations so frequent as being the certain consequents of great pain then two things are to be noted first that upon the appearance or discovery of a Feaver you may suspect an Inflammation couched under it from whence as the spring this Feaver does arise Secondly that the Cure of most Feavers ought to be designed and managed so as respecting and aiming chiefly at a particular Inflammation upon which the Feaver does depend sublatâ causâ and when a Feaver ariseth upon this account as for the most part it doth then little regard is to be had to the general Feaver but die stress of Cure lyes upon removing the occasional and material causes of Pain and Inflammation in the particular part the foundation of all the rest which being removed the depending Feaver falls of course Thus all our Discourse tends to make a true discovery of causes that when preternatural heat does arise in the body and beget a Feaver we may know not only what to call it but also what to do by levelling at the right mark But by the way I must tell you also how a Feaver sometimes does arise and not from Inflammation of a pained part and that is when some
such a product for as much as pains are very frequent in most diseases as before proved Then also remember upon a cessation of pain there ought to be care taken by proper means for the recession and dissipation of confluxed matter and not imagine upon a presumption that when the pain is gone all is gone and the Patient secure Secondly Transmission procures a Tumor when the expulsive faculty of some parts is vigorous and strong to send off any excrementitious matter and deposite it upon a weaker which being not able to expel it lodgeth there and generates a Tumor Thus the principal and more noble parts have a natural robor and fortitude to send off their superfluous and noxious matter and transmit it to the inferior and ignoble Now there are some parts that are weak by Nature and some by Accident By Nature those are weak that are designed ministerial and subservient and therefore liable to transmited matter from their superiors thus the Glandules are all weak parts lax and spongious apt to receive and imbibe hence it is that the Heart transimts to the Glandules in the Arm-pits the Brain behind the Ears the Liver to the Groins and the Glandules of the Mesentery are very apt to tumifie and are the latent causes of some difficult abstruse diseases The Skin also is a weak part and general Emunctory for the whole body and therefore many Eruptions and Tumors are there visible By Accident some parts are weak as when by a disease inordinate living or casual injury some particular part though strong by nature and original formation may be vitiated debilitated and made feeble Thirdly By Congestion Tumors are sometimes bred as when a part or member does not transmute the alimentary supply into its own substance but suffers it to degenerate there and accumulate into a Tumor or else the expulsive faculty may be weak and not able to send off the excrementitious part which remaining there may produce the like or sometimes the fault may be in the nutritious supply not being capable of a good transmutation as in cacochymical and foul bodies Sometimes the relicts of an acute sickness not well cured by congestion in this of that part does afford matter to beget internal Tumors and therefore after the small Pox Agues Feavers c. purgation and cleansing ought well to be performed else chronic diseases commonly do succeed them from peccant matter lodged here or there and therefore upon such neglects or insufficient performance thereof we find commonly big and hard Bellies or swell'd Legs some part or other pained tumified or hard And these are the effects of imperfect Cures when the morbific matter is only abated and the storm laid but the remainder accumulates by collection and congestion to produce a dissease of another nature Fourthly By Obstruction Tumors or extensions are begotten for when the current is stopt in any Vessel and by the Law of Circulation the continent Succus or humor is still moving forwards to this place obstructed the Vessel or containing part must needs tumifie and swell as not able to receive and contain the additional flowing matter in its former dimensions And this is apparent to the eye in external parts which must needs prove the internal for a strait Ligature upon the Arm or Leg does cause the part below the binding to swell and for this reason because the Vessels are obstructed by compression that the blood cannot circulate and move on And the case is the like in effect when obstruction of a Vessel is made from coagulation incrassation or grossness or any concreted matter within the ducture or cavity to obstruct and stop the stream Now obstructions are generally acknowledged to be the frequent causes of many or most-diseases and few cases do present in Practice but obstruction bears a part and sometimes the solitary cause or else obstruction is very much wronged for nothing more frequent in Physicians mouths than obstructions and yet nothing more seldom mentioned than an internal Tumor from whence we may well conclude it is rarely thought on or not at all suspected But obstructions are so familiar and frequent in discourse that they are little accounted of at least not thought to be of any dangerous consequence not considering that this obstruction may and does often being contumacious beget a Tumor and this Tumor may cause a long and difficult or dangerous acute sickness if not mortal for the progress may go on still from Tumor to Apostem or suppuration and then plant an Vlcer there or this Tumor may become scirrhous and hard then perhaps cancerous gangrened and then you know what follows next mortification From hence it is very reasonable to judge of the series and course of many chronic or long lingering diseases as also or the acute mortal sicknesses most of which do make their progress by these stages have these commutations and transition at last their fatal termination because this latent train of diseases was not suspected But all this while the Feaver was the disease feared and vainly endeavoured against and the Patient is said to dye of a Feaver because a Feaver did attend the life did estuate and was disquieted in the whole course and every transition of the sickness even to death Fifthly By Extravasation a Tumor is sometimes generated as when the Vessels are replete and full causing tension by thinness heat and sharpness of blood or a preternatural and turgid fermentation distending the Vessels the mouths of the Veins are hereby opened sometimes and a stillicidium or effusion of the contained liquor procured which being lodged out of its proper place does corrupt inflame and produce a Tumor Now concerning the signs of an internal Tumor they are not only extension and increase of magnitude which is apparent when it makes a protuberance upon the superficies but also a fixed heaviness or hardness or pain upon pressure with the hand does give great suspicion and probable conjecture of a latent internal Tumor lying deep and obscure especially and by way of confirmation when the preceding causes apt to generate Tumors do concur to strengthen the probability But before we conclude this Discourse of Tumors something more is to be said and that touching a Scirrhus and Apostem which are comprehended under Tumors and do signifie only the distict and special condition thereof and here we have occasion to take notice of the different state of Tumors and their way of resolution fixation or translation Tumors do either wear away and spend by discussion and transpiration or they recede by a translation of matter into another part or they apostemate and come to suppuration or they indurate and become scirrhous or they tabefie and corrupt the part where they are seated Discussion of a Tumor is the best that can be expected and this ought chiefly to be aimed at in Practice the next to be hoped for and endeavoured is dislodging of it and removal from a noble to an
the canals and suffocating the life as the Venom of a Scorpion and Asp others by putrifying and corrupting the blood or some other part where they chiefly discharge their venom Internal and conjunct causes of Gangrenes are Inflammation corrupt venenous or malignant matter that preys upon and destroys the vital Principle stagnation of the blood or what else may intercept commerce and supply from the fountain of life The Characters or signs declaring a Gangrene are these the sense of feeling decays the colour changeth and inclines to be livid or blackish the flesh grows flaccid and frigid but when the Gangrene proceeds on to a Sphacelus or perfect mortification these Symptoms then are aggravated and appear more eminent sense is quite abolished and the part becomes fetid and cadaverous Gangrenes are very seldom mentioned in Practice and you shall rarely hear of any person to dye of a Gangrene yet I must believe and not without good grounds that many thousands dye by an internal Gangrene not taken notice of for if the major part at least a great part do dye with a high Feaver or Phlogosis we may rationally then conclude that a Gangrene is frequently conjoyned as the last Actor in the Tragedy and immediate cause of death for Gangrenes do commonly supervene Inflammations where they are mortal and thus also Inflammations from fractures and dislocations often bring on a Gangrene And in malignant high Feavers there are sometimes such vibices marks of mortified blood and black mouths which do strongly suggest a Gangrene within the body And for those that perish by the Plague in so short a time whose venemous matter shews it self by Spots Vesicles Buboes and Carbuncles most of these dye gangrened And many of those that expire by the small Pox have a Gangrene in some part the putrid matter being lodged there Nature not able to protrude and bring it forth and it is very reasonable to assert this for if a Gangrene will arise out of a very small portion of matter extravasated defluxed or congested in a part then where the whole body abounds with malign putrefaction and overflows with it any part thereof remaining within the body may and does very often corrupt and gangrene that part That our Opinions are not so extravagant and excentric from the Judgment of all Learned men as some perhaps inconsiderately may censure take notice what Arnisaeus an eminent Physician in Germany Professor in the University of Julia writing to Gregor Horstius about a Person of Quality that dyed of the small Pox queried or rather concluded that the Liver was gangrened and farther saith Verisimile est multis idem accidere qui ex variolis moriuntur To which Horstius answers by Letter and consents with his determination in these words Cùm autem necessariò febris sanguinea cum putredine majori concurrunt in tali casu facillimè fieri poterit ut praevalente calore febrili 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in viscere sanguificationis prae caeteris corrumpatur inprimis cùm propter cutem undique pustulis exulceratam incrustatam transpiratio eventilatio difficilior fit Si enim inflammationes internae ipsiusque jecoris juxta communem nostrum amicum Guil Fabr. non rarò desinunt in gangraenam non video cur non idipsum saepiùs etiam fieri possit tunc temporis ubi variolis undique satìs quidem expulsis gravissima symptomata partium internarum inflammatarum nihilominus perdurant eo usque donec aegrum penitùs jugulent Horst Institut Med. Disp 3. coron 1. additament And in many other acute malign Diseases either the morbific matter is not discussed and discharged from the seat of the disease or else is expulsed thence into some other perhaps a remote part where it corrupts the member and extinguisheth the vital Principle called by some the innate Spirit Now concerning the curability and incurability of Gangrenes take these instructions before the disease be undertaken or left for desperate and hopeless First Consider the duration or time of the disease the age and strength of the Patient for a Gangrene in the beginning is more easie and hopeful than after continuance because it proceeds on commonly and draws nearer to a Sphacelus which is incurable also young persons vegete and vigorous in spirit are more hopeful than others aged or worn out by long or enervated by acute sickness Secondly Examine into the essence nature and rise of the disease which will lay open much of the difficulty thereof for Gangrenes from a primitive cause as Contusion Fracture Section Vstion Caustic or other erosion c. are more curable and less dangerous than those that arise and depend upon antecedent internal causes for Gangrenes of this sort do declare a cachectic depraved habit of body and that some of the internal Viscera are damnified and vitiated from whence a supply of ill matter and therefore in Hydropic Scorbatic and Hectic febrile bodies also in malign and contagious diseases small Pox Venereal Lues Plague c. Gangrenes are more desperate Thirdly The part affected or seat of the disease is to be noted for if a principal part be gangrened recovery is very rare also in the Guts a Gangrene is mortal by reason of continual moisture there and imbecillity of these also in the Vagina Vteri and Glandules of the body a Cure is seldom performed Now as touching the Cure of Gangrenes there is not any one Method or particular Medicine for Gangrenes but they require such variation of Cure according to the difference of their causes from whence they do arise with respect to the part affected And therefore we cannot point out any general course that may be applicable to this great disease but indications of particular and special cases must vary and will make exceptions against it So that the rational Physician perpending and duly considering the nature of the disease and variations thereof as aforesaid with the Symptoms and circumstances attending must design such a Method and adapt such Medicines pro re nata as may best suit with the urgency of this dangerous and threatning Malady The means required and useful in these emergencies are taken some from Pharmacy and some from Chirurgery Pharmaceutic Remedies are both internal and external Internal are select and choice Purgatives Diaphoretics and Cardiacs elaborated and prepared according to latter inventions and the best Rules of Art Topical and external are Fomentations Liniments and Cataplasms specificated and appropriated to these purposes Chirurgical helps are Phlebotomy Cupping Scarification Canteries c. and therefore an expert Chirurgeon must here be assisting to perform these operations Now all these various means are not to be used to every person gangrened but each case will require some of these more or less as the Judgment of a skilful Physician in this disease shall determine and appoint But if the Gangrene by continuance and neglect or from acuteness by great