Pains afflicting humane Bodies, the different Nature and Causes thereof.

OF all Symptoms that attend, or are the con­sequents of Diseases, Pain is the most troublesom and irksom to bear. Weakness and languishing are tolerable evils; but pain is rest­less, tormenting and full of complaints. And although this be the worst (in extremity) to a­bide, and the most mournful accident that befals mans Body; yet no part thereof hath a privi­ledge by Nature to be exempt, or protection from this calamity: the reason whereof we will inquire into.

All parts of the Body wherein is the sense of feeling, are liable to pain: and by virtue of this sense, pain is communicated to this or that part: and therefore dead Bodies, parts paraly­tic, benummed or mortified are not capable of pain, because in them there is not that sense of feeling: and although the Organs of the other senses are subject to pain, as the Eyes, Ears, &c. yet pain is not proper to them (quatenus) as [Page 37]they belong to those senses; but as the sense of feeling is seated there also, having a greater la­titude than the other; and is extended through the Organs of all those Senses. True it is; the other senses have their inconvenient and disturbing objects, as the Philosopher says, Ex­cellens sensibile laedit sen sum: as the light of the Sun, or flame is troublesom to the Eyes; and great noise, as of a Bell or Gun, if near, especial­ly sudden and unexpected, does offend the Ears: and a strong or stinking scent is offensive to the Nose: and an ungrateful taste, as too salt, too sowre, or bitter, is unpleasant to the Palate: but pain affects the sense of feeling.

Parts therefore that are capable of pain are endowed with the sense of feeling; and those parts are membranous; that is, they are invest­ed with, or lined with some Membrane, by which the sense of feeling is communicated; and hence the Bones are capable of pain, by the Pe­riosteum, that Membrane which covers them. And this sense as it is more general, extending through all parts, and more useful than the rest of the senses; so the disturbance arising thence is more insufferable and grievous to be endured: and better it is to want any other sense, than this, yea all; for where feeling is departed, the life is ceased in that part. This sense therefore be­ing supreme, the defections and disturbances thereof must be of greater importance and con­cernment than the rest.

The other Senses are confined to, and exer­cise [Page 38]their functions in one Organ or part of the Body, the Eye, the Ear, &c. but feeling is not restrained to so narrow a compass, but is seated in all parts of the Body, even in the Organs of those other senses. The great Prerogative of this sense above the rest, having no limits, but reaching through the whole Body , and exerci­sing its power among the other senses, and an in­separable consort with the life; were worth in­quiring into the reasons thereof, if time would give leave for that diversion.

What pain is, scarce any one but can tell; and some by woful Experience; whereby they will consent with the definition thereof, dolor est tristis sensatio in tactu: pain is a trouble arising in the sense of feeling: but that which is so plainly felt, is not very easie to be under­stood from whence it does arise.

The Causes of pain are as various as the Ob­jects of the sense of Feeling: for whatever ob­jects assault that sense violently or extremely, as too hot, cold, hard, sharp, heavy, &c. are of­fensive to the Organ of Feeling, and do raise pain.

Concerning the approximate cause of Pain, there are several opinions; I wave the more ex­travagant and improbable, and shall recite those in which the most Philosophers and eminent Physicians do consent and pitch upon as most agreeable to reason.

One Party asserts, That a sudden and violent mutation of the active qualities, or the tactil [Page 39]qualities suddenly and violently acting upon the sense of feeling, are the approximate cause of pain.

The other Party determines, That solutio continui, a solution or disjunction of continuity is the immediate cause of all pain.

The third Opinion joyns these two together, and will have pain to arise from them both; ac­cording to the definition of Plato: Est ita (que) do­lor tristis in sensu tactûs affectio, à membri in­temperie & continuitatis divortio subitò fa­cta. And Hippoc. before him taught the same doctrine: Quae naturam (inquit) mutant ac corrumpunt, dolores excitant. To which Ga­len does subscribe.

Now to comment a little upon these different Judgments I cannot but observe and do owne that there is something of probability and reason in these several sentiments; but not a full satis­faction to the matter queried; nor the whole truth rightly stated: and for this reason I am the more nice and strict in this inquiry, because from hence the nature of Anodynes or asswagers of pain are discovered; and this is the ground­work upon which they are formed and rightly adapted.

I allow that unity is the perfection of Bodies, and is necessary to perfect sanity; disjunction or separation dissolves the harmony, and leads or is the progress to destruction: for whatever tends to disjoyn or make a separation of parts, does threaten to ruine the whole. And true it [Page 40]is, that the active qualities or tactil objects, do cause pain as they do make their impulsions vio­lently upon the Organ of Feeling; which when they do it moderately, placidly and amicably, they cause pleasure or no pain. But whether the impetuous and vehement acts of those Agents raising pain, do always cause a solution of con­tinuity approximately and immediately, is much to be doubted.

I yield that the vehemency of these tactil ob­jects may procure a solution of continuity some­times, as we see from pain, that Imposthumes, Ʋlcers, Gangrenes and Mortifications do fol­low; but these are not inseparable and necessa­ry consequents, for they happen but sometimes: pain may continue for a time, cease again, and no breach of continuity remain a [...] an effect thereof.

To which our Adversaries have this evasion by way of Reply; That pain is caused à conti­nui solutione, non à soluta unitate: which, as I conceive the meaning, is as much as to say; solution of continuity in fieri is sufficient, though it be not in facto esse.

But to pass over this Sophistry, as not worth the expence of time to lay it open; and if we make appear that the whole matter or contro­versie is bottomed upon this error, mistaking the cause for the effect, and the effect for the cause. Cujus contrarium— then the pleadings of our Antagonists will be put to silence as absurd, the doctrine laid aside, and practice grounded upon better principles.

They affirm solution of continuity to be the approximate cause of pain; the contrary where­of we will set forth and prove, that pain is the cause of solution of continuity. And here we must first distinguish between violent external Agents, as sword, staff, bullet, fire, &c. causing wounds, contusions, fractures, combustions, &c. and internal causes gradually arising in the Bo­dy, as products of a degenerate state.

In the first cases, solution of continuity cau­seth pain: as when the wound is given, pain follows as an effect: so likewise upon a sudden fracture, or rupture in the latter, pain precedes as the approximate cause, solution of continuity comes after as the product or consequent. For example; some indigested or degenerate matter lodgeth or fixeth in this or that part of the Bo­dy, Nature not able to subdue or transmit it away, this like a thorn irritates and provokes the vital principle to a disquietness and disturbance, which is pain: this pain draws a confluence of humors to the part grieved, and increaseth the first offending matter, causing Inflammation and Tumors; this apostemates, and then breaks forth into an Ʋlcer.

Observe the Series, first here is peccant mat­ter as the occasional cause raising pain; this pain attracts humors from other parts, which be­ing transplanted out of their proper place, they degenerate, corrupt, and then produce an Im­posthume and Ʋlcer. Thus you see pain goes before, solution of continuity follows after, and [Page 42]therefore it is plain, as in this, so in all other ca­ses where separation of unity does happen from an internal cause arising in the body; that it is the consequent of pain, and not (as those learn­ed men would have it) the approximate cause of pain.

To illustrate this truth a little farther, and that you may the better understand and have a clearer satisfaction herein (practice depending upon it, I mean the allay or remove of pains) consider and know, that the sense of Feeling be­ing spread through the whole body, is as the last or inmost covering, that does inwrap or in­fold the life; and is as it were the watch or guard upon the confines thereof. Now any thing that does stir up Feeling, that thus nearly and inti­mately approaches the life; if it exceed the bounds of moderation and is violent, if it be any way unnatural or injurious, it raiseth a di­sturbance in the vital principle of that part, which is pain: so that the assault is first made upon the life, which governs and preserves unity and continuity of parts; but that vital princi­ple being fretted , distracted and put by its pla­cid, regular oeconomy and government, the Or­gan perisheth as the life of the part decays, or is out of course; being then unable to protect and preserve it.

From hence I am perswaded to believe and must assert, That the approximate cause of pain is every thing that does intimately and approxi­mately affect and disgust the vital principle in [Page 43]every part pained; which pain is the estuation, anguish and fury of the life or vital principle, which does dolere, being exasperated and pro­voked by those causes: and if solution of con­tinuity does happen upon this disturbance, it is wrought and caused by the exorbitance and enormity of the vital principle, deserting or be­ing put by the charge and due management of the part.

Moreover, pain sometimes continues long by intervals and remissions to molest a part, and no separation of unity to be caused thereby; al­though it is an interruption and breach of Har­mony: so that this ira sive dolor, this pain of the vital principle does not always arise to the height of producing discontinuity; and is so far from being the approximate cause of all pain, that many times it never happens either before or after pain, to be a cause or an effect.

Now what this vital principle is, residing in and governing every part in their several fun­ctions of vitality, whether it be Anima; or Ar­chaeus according to Helmonts doctrine; or spi­ritus impetum faciens, according to Hippocra­tes; I shall not enter into the controversie, be­cause it will require a large discourse, or rather a peculiar Tract to determine this Problem, and clear up the truth of our novel opinion, disin­tangling it from the objections and prejudice of ancient received doctrine; which will disjoyn and delay our matter chiefly intended, therefore I forbear the digression, and proceed.

Pains are various, or do affect the sense in a different manner; and this either from the na­ture of the part grieved, or from the variety of causes, or both.

Now the nature and condition of parts are different and various these ten several ways, or may be reduced to these heads: Ducture, Fi­gure, Situation, Composition, Beginning, Pro­gress, Substance, Temperature, Number and Of­fice. And as parts are varied by these differen­ces, so pains thereby are made various, and not only pains, but also all other Symptoms and dis­eases have a specification from hence.

Pain sometimes is obtuse or heavy, as if a weight were pressing upon the part pained; as when the Parenchyma of the Liver, spleen, Lungs or Kidneys is grieved; and this by rea­son they hang or depend on Ligaments and Membranes.

Pain sometimes is acute, sharp and punging; as if the part were perforated or pricked with a Needle; as in a Pleurisie, and this is caused from a thin, acrid or acrimonious humor penetrating the Pleura; for nothing but what is subtile and acute can procure this or the like punctures, and invade the dense substance of a Membrane.

Pain sometimes is with pulsation, that is, a beating pain like to the motion of the Pulse: and this pain happens commonly upon an In­flammation, and also where an Artery is seated in the part; for where there is no Artery, there is no pulsation, it being the office of this Vessel [Page 45]only to make a pulse. From hence Galen 2. de loc. affect. 3. took notice, that upon an Inflam­mation of the Lungs or the Pleura, there was no pulsation or beating pain, because there were no Arteries in the parts.

Pain sometimes is mordacious or biting, from sharp humors vellicating the sensible parts.

Pain sometimes is frangitive, as if grinding or bruising, and this is proper only to the bones, or rather the Periosteum that covers the bone, by which Membrane the bone is made sensible, and the pain lyes deep.

Pain sometimes is tensive or stretching, and this happens from a repletion or fulness of some humor, wind or vapor, filling and extending the part: if this stretching pain be cum gravitate & pondere, with heaviness or weight, then you may conclude it is humoral, or something of more solid substance; but if the extensive pain be without weight, then it signifies wind or vapor: as very often such are Colic pains, from a collection of wind between the tunicles of the guts.

Pain sometimes is convulsive; and this is pro­per to the Nerves and Tendons; because the nervous filaments are so united, that they can­not be torn, but are contracted to their origi­nal.

Pain sometimes is lacerating or tearing: and this is proper to the flesh; because the flesh hath Fibres and small Nerves not so united as the Membranes, and therefore à causa solvente con­tinuum [Page 46]are easily lacerated. And thus much for the various kinds or different sort of pain: next the situation or extension, and the duration is to be regarded.

Pain is either universal affecting the whole body, from some general cause; as in Feavers, Agues, &c. Or else pain is seated in some par­ticular region or part of the body; as the Head, Breast, Stomach, Belly, &c.

Pain sometimes is more outward ot external upon the superficies of the body, whose seat is more easily discovered and known, laying hand upon the place, by the Patients direction. Some­times pain is internal and deep, with difficulty to be certainly determined, which part is grie­ved, and requires good anatomical judgment to assign the part or member. From hence pains some may be said to be manifest, others ab­struse; as also from their causes, evident and la­tent.

Pains some are constant as to place, or fixed; others erratic or shifting from one place to ano­ther.

Pains some are constant as to time, or conti­nual; others intermitting and by intervals, ha­ving cessation for a time and returning again.

In all pains there ought to be considered these four things: the Greatness, the Kind, the Pro­perty, the Place.

Greatness and vehemency of pain does arise from the greatness of the offending cause, and the sensibility called tenderness of the part. All [Page 47] pain spends or wears and abates the strength of Nature; but violent and vehement pain re­quires sudden relief, lest the sick faint or expire. Upon the first assault Nature does insurge and raiseth all her strength to bear, resist and over­come the offending cause, and cooperates vigo­rously with the means for relief and ease; but help not coming, strength abates, grows weaker and weaker, as not able to hold it out long: and this is perceived and known by the Pulse, which at the first access of great pain, beats high, strong and quick; but afterwards falls off, grows weak, small, slow, or swift, labouring and languishing,

Secondly, The Kind and nature of the pain is to be observed and noted; whether tensive, heavy, acute, biting, &c. that accordingly fit Remedies may be adapted to such variations.

Thirdly, The Property is to be regarded; whether pain be moveable or fixed: continual or constant; or returning by intervals; whereby the fallacy or certainty of the Cause may be ad­judged.

Fourthly, The Place of pain is to be distin­guished: for that which will be a good reme­dy and proper to one part or member, may prove of little advantage or injurious to ano­ther; because some parts have Antipathy or disgust and dislike to some remedies, which ra­tione morbi, in respect of the Disease may be proper and requisite, but the part will not ad­mit it: as Oyl generally is anodyne and asswag­ing; [Page 48]but hot in pains of the Eyes, for there it is injurious to the part: and a puncture of the flesh and a puncture of a Nerve, will require different remedies. And upon this account Ga­len 4. Meth. 5. would not allow of Suppura­tives to every wound, and chiefly in the Ten­dons and Nerves, and condemns those Chirur­gions that make not that distinction.

And here you must diligently search and ex­amine, whether the pain be idiopathical or sympathical: that is, whether the part pained does suffer per se, from a cause residing in that part; or whether the cause lyes in another part, and the part pained does complain per sympa­thiam seu consensum, only by consent from some other diseased or distempered part.

And this distinction ought strictly to be ob­served, without which no Cure can succeed: for if the peccant matter or cause offending lye in one part, and the remedy be applied to ano­ther, you cannot in reason hope for a good ef­fect thereon. This therefore is to be received as a fundamental Truth, That all parts of the Body may fail in their office and true perfor­mance of their duties, vel vitio proprio, vel alie­no, either by a deficiency of their own, or de­pravation and injury from other parts: and this not being duly taken notice of by some Practi­sers, no wonder if Patients languish so long under their hands, waiting in vain for their relief and Cure: for, finding the Patient to complain of pain in this or that part, they think of no­thing [Page 49]but applying to the part pained; con­cluding with the common saying: Ʋbi est do­lor, ibi est morbus, which is oftentimes a great mistake. For example: the Head akes and complains many times, not from any defect of its own, being firm and sound; but either from the Stomach being foul or otherwise diseased, whose ill affects also are communicated to the Head by the Nerves of the sixth conjugation: sometimes from the Spleen; sometimes from the Womb; and sometimes from other parts, by reason of the Nerves propagated into all parts of the Body, having their original from the Brain and spinal Marrow, derived from thence and of the same nature; from whence the Head does consent with all those parts.

And the Arm may complain, wanting its power of due motion or strength, although the Arm be sound and well; yet if the Nerves that supply those Muscles of the Arm with Spirits be hurt, the Muscles are deprived of their use or act deficiently and depravedly. As by a blow upon the Back (or by other causes there not so manifest) the Arm may fail in its due motion, the Nerves being injured: in vain then it is to apply Topical Medicines to the Arm, but appli­cation must be made to the Vertebrae of the Back, from whence the Nerves are derived and implanted into those Muscles.

And since the several parts of the Body do complain, sometimes by their own fault or decay in themselves; and sometimes only by injury [Page 50]transferred or received from other parts; we will conside how many ways there are for parts of the Body to be ill-affeced and receive pre­judice one from the other.

The Sympathy or consent of parts, whereby one suffers from another, may arise upon a tre­ble account.

• 1. Per Sympathiam generis.
• 2. Ob Familiaritatem operis.
• 3. Propter Vicinitatem.

First, Per Sympathiam generis, by which we understand that consent and affect that is com­municated by continuity of parts of the same kind: as when the Neck being hurt, the Hand consents and complains; because the Nerve ser­ving and coming down to the Hand, is derived from the Neck: and this way of consent may also be effected, not only by the long Nerves, but also by the long Muscles, and the Veins in other parts: as sometimes it happens that the Leg is stiff and wants its flexibility and bending inwards by reason of some disease, not in the Leg, but in the Hip, where the original of the Muscle is, that serves for this motion; and there­fore erroneously some have applied Fomentati­ons, Ʋnguents and Plasters to the Leg upon this supposition, Quò ubi est symptoma, ibi sit morbus; not considering that the Tibia does suffer by consent, and the root of the disease lyes in Coxendice where the Muscle does arise. And thus it falls out very often, that the Dis­ease [Page 51]is far distant from the Symptoms; and therefore the original and progress of the Mus­cles ought diligently to be observed in such ca­ses as these, that the part primarily affected, and the part affected by consent may be distinguish­ed, else the designment of Cure will fail and be insuccessful.

Secondly, Consent of Parts is procured ob Familiaritatem seu per consortium operis: and this consent is common to all those parts that are ordained by Nature to concur together in some common office: and thus it is between the Womb and the Dugs.

Thirdly, Consent of Parts is frequent propter Vicinitatem, by reason of vicinity & adjacency: when parts are situate near to each other they are mutually affected, either by some sensible passages or insensible, for totum corpus est per­spirabile, the whole body is perspirable by Pores latent arid invisible, by which there is convey­ance to and reception from each other, and do thereby sympathize with the good or ill of one another, although the ways of communication are not manifest: and thus it is between the Stomach and the Lungs, and is easily perceived by fuch as are Asthmatical, Phthisical or have Coughs, that by eating or drinking this or that, those infirmities will be exasperated and made worse, almost presently: and è contrà, they will receive some ease and benefit by that which is good, soon after it is received into the Stomach; long before it can make a progress the common [Page 50] [...] [Page 51] [...] [Page 52]way out of the stomach. And this consent like­wise is between the Oesophagus, the mouth of the Stomach and the Heart: and thus it is bet­ween the Bladder and the Intestinum rectum the last Gut; and from hence pains of the Blad­der are mitigated and eased by Clysters, through insensible passages, and not by any manifest du­cture or Vessel of communication.

From hence we may learn by such Examples, that Sympathy and consent of parts is strictly to be marked, else it is not possible to know where the root of a Disease is, and from whence pain or other Symptoms do arise: for, one part may be pained, and the disease lye in another; and if this be not rightly distinguished, there cannot be a true adaptation of Medicines, nor due ap­plication made where it ought to be, which renders all endeavors frustraneous.

But to descend from generals, and to make our Discourse more profitable and satisfactory to the particular cases of the Reader, inquiring after his own peculiar concern and present com­plaint; we will take notice of some pains inci­dent to particular and principal parts of the Body remarkable and frequently occurring, ex­amining their causes.

Pains of the Head.

THat the Head akes, every one can tell that suffers under it; but the causes and the parts affected distinctly, are known only to the Physician: and he by questioning and ex­amining the Patient, draws his conclusions by collating the several answers, and makes Judg­ment thereupon. All which depends upon a due observance of these four Particulars, rightly to determine the case.

First, Inquiry is to be made of the Patient concerning his course of life for some time be­fore, whether regular or irregular; in labour, exercise, or ease; if thereby any thing hath been done to procure or introduce the present com­plaint, and of his former state of Health and Sickness.

Secondly, Of his state and condition of Body as it now is.

Thirdly, The place or seat of pain, the com­pass and extent of it.

Fourthly, The quality or condition of the pain; vehement or moderate, continual or in­termitting, acute or obtuse, &c.

Having made disquisition by these Topicks, and traced the Patient through these grand in­quiries; you will then understand something of the rise and progress of the pain sought after, giving you then occasion to take a farther pro­spect [Page 54]and consideration of the various differences of pains in the Head, wherein your present case will be found, and exhibited to your view, as followeth.

Head-aches are either more general and di­lated, affecting the whole; or else one side of the Head; or some particular part, as Forehead, Temples, &c.

2. Head-pains are either internal or exter­nal.

3. Idiopathical or Sympathical.

4. Recent and of late standing, or inveterate and of long continuance.

Pain of the whole Head or major part does denote the cause to be more general and of large extent; as in Feavers and plethoric persons, wherein the whole body is distempered, and from thence the whole Head or most part there­with affected.

Pain in particular places; as of the right or left side, fore-part or hind-part, the top or the crown, signifies the cause to be, or act there on­ly; and does arise from some defect or trouble in the part it self, by some peccant humor there bred, or by transmission of morbific matter from, or by consent with some other part disea­sed, adjacent or remote. As more particularly hereafter.

Now you must understand, that although every person seems to be equally disposed alike, and liable to these pains; yet it is much other­wise; for some are often complaining of Head-ach, [Page 55]some rarely or never: and this by reason of the different fabrication and formation of parts, as well within as without the man; and also by reason of the soundness and strength of parts that some have above another; by which they endure long, and free from pain or other infirmities.

Internal pain is seated within the Cranium or Skull, and signifies the Brain it self, or Mem­branes investing the Brain; or some Vessel, Vein, Artery or Nerve to be affected: if the Brain akes, the pain is obtuse and heavy, the Pa­tient is much inclining to sleep or drowsiness: so likewise when the Veins are molested, the pain is remiss: but if the Membranes or Nerves be the complaining parts, the pain is more acute and punging; and then it reacheth com­monly to the roots of the Eyes; because these Membranes do cover the Optick Nerves which lead to the Eyes: and it may be known what Nerve is affected, by the part consenting, which that Nerve does supply and serve; and thus sometimes the Ear, or Tongue; sometimes the Shoulders, or Breast complains, by that Nerve inserted into them for their use: but if an Ar­tery be the place, then the pain is beating, Pulse-like.

External pain is superficial and without the Skull, shewing that the Pericranium or Mem­brane covering the Skull is the part grieved: and sometimes the Cutis or outward skin only, and then the pain is more remiss; but both are [Page 56]known and aggravated by compressing the part or place: and if the pain be in the fore-part of the Head, and extend to the Eye-brow, the Pe­riosteum is affected.

Pains of the Head per essentiam or Idiopa­thical, are when the cause of pain is seated in the part pained, by reason of debility or dyscra­sie and infirm state thereof: from whence ill matter is congested and accumulated, causing a disturbance or distemper; and sometimes pains fixed from extraordinary productions there ingendred and bred; as worms, stones, &c. as hath been noted by Authors of repute and cre­dit: Hollerius, Schenkius, Kentman, and o­thers.

Pains of the Head sympathical are when the cause lyes remote, and the part pained suffers by Sympathy, transmission or consent from other members, and not by any proper defect or dis­ability of its own. And thus the Head is very apt compati to suffer and condole with most parts of the Body; by reason the Nerves are branched forth and dispersed in all parts of the Body from the Brain and spinal Marrow; which being of exquisite sense does affect their original and fountain by this communication and inter­course with other parts: and not only by the Nerves coming from the Head is this consent maintained, but also by the Veins and Arteries going from other parts up to the Head, convey­ing good or ill. Hence it is, that very frequent­ly the Head is pained from distempers of the [Page 57] Stomach; sometimes from the Spleen, Womb, Intestines, &c.

Having given you the various differences of Head-pains as to the quality or condition of them, and also pointed at the several parts affe­cted per se & per consensum: I come now to set forth the causes or rise of these pains from whence they spring; whether generated in the Head, or communicated to it from other parts.

Causes of. Head-achs or pains are, external and internal.

External Causes may be such as these; as when the Head is exposed to heat or cold, a strong scent sweet or stinking, Fumes or smoke, a blow or fall, &c. occasioning disturbance of the Spirits, Obstructions in the Pores and Ves­sels, Inflammations, Tumors or Imposthumes.

Internal Causes are, sometimes plenitude or fulness of blood, which then upon small occasi­ons is ready to estuate and ferment, causing ex­tension of the Vessels and Membranes: or else depravation and foulness of the blood which may offend the Brain, or other parts of the Head by its noxious properties.

Now the degeneration of the blood from its due and laudable state, to an evil and bad con­dition is various, and does manifest it self by divers Symptoms in several parts of the Body; and also when it is let out of the body, by co­lour, sapor, consistence, heat, &c.

Either the blood is impoverished and defici­ent in vital Spirits and heat, slow in motion, [Page 58]feculent, gross or grumous, and thereby apt to be stagnant or obstruct: or else too hot and fiery, causing inquietude of the Spirits and irre­gular motions of that vital stream, disturbing the Head with pain and watchfulness.

Secondly, The blood degenerates sometimes from its Balsamic qualities, into an acrid, sharp or acrimonious condition; and then most com­monly there is an abounding serosity, or a su­perfluous latex or water; which state of the blood, as very remarkable, causing many disea­ses, I shall set forth in another Work (Deo vo­lente) to be made publick.

Thirdly, The blood may be contaminated with a contagious, malignant or virulent Miasm and taint; as in the Plague, small Pox, highly graduate Scorbute, Venereal Lues, (as more fully appears in my Tracts of the Scurvy and that of the Venereal Lues.) In all which cases the Head frequently is offended and suffers pain.

And here: also we must account amongst the internal causes,

Impotency and weakness of some Organical parts of the Head, not performing their office.

Obstructions of some ducture or porosity, by constriction, compression or coagulation.

Congested matter infesting any part of the Head raiseth pain.

Wind or flatulent Spirits roving here and there may produce the like.

Watching unseasonably, which tires the Spi­rits, causeth disturbance in the Head.

Immoderate study or cogitation weakens the Brain, and renders it liable to pain.

Violent motion agitating the Spirits furious­ly, and driving the humoral currents out of their natural placid course, discomposeth the Head and may cause pain.

Immoderate Venus, or long forbearance: the first by too great exhaustion and draining the Nerves; the latter by plenitude, over-charging the Genital Vessels, reverberating back, or by consent affects the Head.

And now briefly I shall shew here, what parts chiefly and frequently the Head consents with, from whence internal causes of pain are com­municated; and as these parts are well or ill by intervals, so the Head is better or worse there­by.

The Stomach in the first place, as being the general and grand office of preparation to sup­ply the whole body with nutriment; so is it the part that most frequently afflicts the Head by communication, through Vessels of inter­course conveying to each other.

The Head complains from the Stomach either before meat, when supposed to be empty; or after meat, when replete and filled.

If the Head complains before eating, it argues the Stomach to have some remainders or relicts from former digestions not wrought off, that does disturb the Stomach, and from thence the Head: if after meat the Head akes, it does de­clare the Stomachs indisposition to digest, and [Page 60]imbecillity to overcome what is received, and labouring under the burden, the Head suffers also.

Now to know that the Stomach is not in good order or ability for the true performance of its office in digestion, is manifest by these signs: Vomiting or nauseating, pain, oppression or heaviness, eructation or belching, want of ap­petite, or thirstiness.

But here by way of caution in this consent between the Stomach and the Head, you must rightly distinguish, lest it happen, as sometimes it doth, that the Stomach suffers from the Head, and not the Head from the Stomach: and since the consent is reciprocal and mutual, you must nicely observe which is the part primarily affected, and which the part by consent; else endeavors of relief will be frustrate, if you be­gin not with the part primariò diseased, to free and set that right, for then the other spontane­ously and of course will be reduced.

The Spleen being ill-affected, draws the Head into consent sometimes, and participates of its evil: and this is to be known by examining the Spleen, whether any Symptom of disorder or distemper is manifest there or from thence. Now the signs of a diseased Spleen are these; pain, hardness, tumor or extension, flatulent motions in the left Hypochonder or side under the short Ribs: And most commonly the Head is affected or pained on the same side, or else the fore­part.

If the Liver occasions the disturbance or pain in the Head; for the most part the pain is seat­ted on the right side, and then some Symptoms of a distempered Liver will appear; as heavi­ness or fulness in the right side, hardness, pain or heat, affecting also the Stomach, and causing thirst; also driness or heat in the palms of the hands and soles of the feet: and as these signs have their intention or remission, so the Head is better or worse.

If the Womb be in fault, and cause pain of the Head (as frequently it doth by the great communication and consent between these parts) then either there is a suppression of the menstrual purgation; or irregular and out of due course, not keeping the due times; or in­sufficient in quantity, or abounding: or too long retension of semen; or too great a profu­sion and wasting. Some of these causes are suf­ficient, not only to disturb the Head, but also divers other parts of the body; and these pains of the Head arising by consent from the Womb, do most commonly affect the top or hind-part of the Head.

If from the Intestines pains of the Head do proceed, then either worms are bred there; or the Guts are troubled with sharp or corrupt humors; or else there is costiveness and siccity of the Bowels, whereby the Excrements are baked and hardned, causing too long retention▪ and from hence by Vessels of communication the Head complains also.

If from the Kidneys the Head is grieved; then inquire into the condition of the Kidneys, and you will find some signals of a Disease there: either stone or gravel, or a sharp Serum, an In­flammation or preternatural heat, an Ʋlcer or Excoriation.

Now as concerning the Cure of Head-achs, and likewise of all pains that arise by consent from other parts, take this general Rule; That in the first place application be made to the part primarily affected, to reduce that into a state of integrity; then consider the part that suffered by communication and participation, if by con­tinuance or length of time, any impressions re­main there, or debility, that may require help, although the foundation or first cause of com­plaint be removed; else you begin at the wrong end: for in vain it is to endeavor amendment in the part consenting, until the other be in its rectitude, sublatâ causâ tollitur effectus. For example; if the Head complain from the Sto­mach, let the Cure be designed upon the Sto­mach, and that being performed, the work is done.

Thus you see plainly, that the Cure of Head-pains by consent, is as various and different, as the parts of the Body are different in organiza­tion, situation and office; whereby they become liable, and are seized with various diseases, re­quiring a different manner or methods of curing, which are to be treated of in their proper places.

Touching the Cure of Head-pains that are the products or consequents of essential or idio­pathical Diseases seated in the Head; the remo­ving or taking away those pains depends upon the Cure of those Diseases, whereof they are the effects and concomitants; and do require their due and regular course of means, suitable to the nature of the disease: but in cases of extremity, and for mitigation of pain, and the inconvenien­cies arising thence, as long watching or want of rest, and prostration of strength; there are such good Remedies, as Anodynes, prudently to be used for allay and giving ease or respite, until the causes can be eradicated, and a perfect Cure wrought.

Pains in the Thorax or Breast.

AMongst the several divisions of mans Body into parts, we may observe three insignal Cavities, each containing principal Members of the Body: the first and supreme is the Head, and all contained therein: the middle cavity is the Breast, which contains the Lungs and Heart: the lower region called the Abdomen or Belly, comprehends the Stomach, Liver, Spleen, Guts, Kidneys, &c.

And having taken cognizance of those pains incident to the Head; we now come to remark what pains happen to the containing and con­tained [Page 64]parts of the Breast. Hence we may note, that these pains from their situation and place, may be distinguished into external and internal.

External pains we may call such as are out­ward amongst the musculous and fleshy parts, as the Paps, Dugs and intercostal Muscles.

Internal pains are such as seize the Heart, Lungs, Mediastinum, &c. parts contained.

The Breast is circumscribed thus; the upper part is from the two Canal-bones called Clavi­culae, about the bottom of the Neck; the low­er part is bounded by the Diaphragma or Mi­driff spread just above the Stomach and Liver from side to side: the fore-part is the Sternon or Breast-bone seated in the middle, which joins and fastens the Ribs: on the back-part is the Vertebrae or Spine, consisting of many bones knit together, where also the Ribs have their articulation: the sides are compassed with Ribs swelling outwards, and they reach from the Spine to the Sternon. And this is the extent or limits of the Breast.

Pain may fall into the Paps or Dugs of both Sexes, but most commonly it happens so to wo­men (except from external causes, blows or falls) and thus it is upon a sixfold account.

First, Because those parts are more capaci­ous and swelling outwards in Women, which being glandulous, spongy, soft and porous, are thereby apt to imbibe or receive any vagrant humor coming to this part.

Secondly, More liable to the impressions of cold, from its tender soft nature, and being by them more frequently exposed to the air; which may occasion and lay a foundation for pain and other Symptoms to follow.

Thirdly, In Women these parts being furnish­ed with more Vessels of use for lactation or suck­ling, are thereby more liable and obnoxious to disorder.

Fourthly, From the communication and in­tercourse between this part and the Womb, whose diseases and distempers may affect the other by consent.

Fifthly, From the attraction of suckling, ill humors may be drawn and gathered there, which otherwise would not resort to that part.

Sixthly, Pain seizeth this part in Women from the various conditions of their milk.

Now the variations of milk causing this effect arise upon a double account: redundance or plenitude, and Cacochymy or alienation. Some­times by plenitude; for milk abounding and di­stending the Vessels causeth pain and trouble in the part. Sometimes by alienation of milk from its natural good condition to a degenerate state: and this proceedeth from a cachectic or vicious habit of body; for as the blood is good or bad, so likewise the milk, which is sanguis dealbatus, blood changed white by another digestion.

This milky substance being balsamic, dulcid and pure in its integrity; yet is very subject to alterations and change from distempers and va­rious [Page 66]dispositions of the Body: as sometimes from thence, being not so sweet; but saltish, bitter, acrid and punging; sometimes curdling and coagulating, thereby not flowing freely in the Vessels, but causing obstructions in those small ductures: hence arise pains, inflammati­ons, hardness, tumors, &c. if not prevented by a due course with good means.

And such inconveniencies as these are fre­quent to Women after the birth of children, when milk flows plentifully into those parts; and this many times or for the most part does proceed from the imprudent custom of mana­ging Women in child-bed, especially some Nur­ses, who would be thought more careful, kind and diligent to their Mistresses; do feed them too plentifully, giving them Caudle at every [...] or after every short sleep night and day; telling them they are empty and must fill up a­gain and make up their loss: which after this manner being done too hastily, and the body changing from a large evacuation to a sudden [...]epletion; the Stomach thereby fails and is clog­ [...], the blood ferments into disorder, causing [...]e and dangerous Feavers, of which the milk [...]ticipates, and thereby degenerates, endanger­ [...]g both the Mother and the infant.

But indeed by experience I have found, and reason urgeth the same, that nothing is more safe than a spare diet, which preserves the Stomach quick and sharp, and keeps the whole body in a moderate temper and a regular condition, not [Page 67]occasioning such overflowings of milk, or other­wise flouding: and this I have cautioned and made some Nurses sensible of, who by obser­vance thereof afterwards, found their offices more successful and have given me thanks for my advice, as being the safest and best way to dis­charge the trust and care reposed in them.

In the next place we are to take notice of pains that are seated in the musculous parts, namely the intercostal Muscles, in number 44; so called from Costae the Ribs, which these Mus­c;les do cover, and also are inserted, filling up the spaces between each Rib. In these parts pains sometimes do fix and settle, and are most perceived upon drawing in of the breath, when the Muscles are upon extension and swelling outward. These pains are called by some Ba­stard Pleurisies, though improperly and by mi­stake; for pains of the Pleura are different. Sometimes these pains are not of continuance as to time; nor constant as to place, but move here and there; and these are 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 [Page 68]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 [Page 69]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 [Page 70]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 [Page 71]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 North­winds 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 [Page 70] [...] [Page 71] [...] [Page 72] 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 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 [Page 73]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, [Page 74]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.
• [Page 76]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 Ʋlcers, 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 pressure here, raiseth a fainting pain, the Carti­lage yielding and giving way to any force.

But sometimes a pain is planted here, not al­ways by any external manifest cause, but from internal, and preternatural state of the parts: and this pain is rarely taken notice of by Physi­cians, and mentioned but by a few practical Authors. Now to examine into the cause of pain, you must know that this Cartilage is flexible and [Page 78]yielding in its natural condition, being of a mid­dle nature between a Bone and a Ligament, and therefore may be curvated and bent inward up­on a threefold account.

By Laxation, Exsiccation, and external de­pression.

• 1. By Laxation, as when too much moisture resides here mollifying and loosning the part; from any small occasion the Cartilage may be in­flexed and turned inward, changing its due po­sition and rectitude: and from the like cause Ligaments are sometimes relaxed, which renders Junctures ready and apt for dislocation and dis­juncture; and upon this score the Vertebrae of the Spine have been displaced; also the Hip and Ancles.
• 2. By Exsiccation this Cartilage may be di­storted and wrested from its posture: as some­times that which was straight, green and pliable, by drying and shrinking becomes crooked, bent and drawn aside: So this Cartilage that was a Grisle, tender and pliable, sometimes becomes dry, hard and bony, and fixed upon distortion or writhing, as not returning to its rectitude or straightness, and distance from the subjacent parts, over which and for whose guard it is placed.
• 3. By external Depression, as from a blow or fall, any thing too much or too long pressing up­on that part, may pervert and alter the situation and due posture: and those whose business or imploy keeps them bending or pressing forward [Page 79]too much and constant, renders them liable to this inconvenience; and therefore Students and Clerks that write much pressing upon this part are injured thereby, and find it upon age, though youth bears it off for a time.

Now since this Cartilage is thus exposed to depression and bending inward, and thereby the tender parts subjacent to be pressed upon and molested; the cause of pain and manner how is made evident: and which most commonly is felt after eating and upon a full stomach, when the parts are dilated and swelling up to this Cartilage. And farther, as all parts of the Body in several persons do vary and differ much in figure, position , magnitude and distance; so thereby some are more liable and apt for this pain than others, although subject to the same external procuring, or internal antecedent cau­ses.

And so I dismiss this particular pain and pres­sure, and must take cognizance briefly of that which is more general upon the whole Breast.

The Thorax or Breast suffers by compression or constriction, whereby a general obtuse pain of angustness is perceived, and that chiefly upon inspiration and drawing in of the breath: and why now more than at another time, is because the inspired air fills and distends the Breast, which makes opposition to, or resists the com­pressing causes.

Now the cause of angustness or coarctation is from the Genus nervosum that gives motion [Page 80]to the Muscles and other parts of the Breast; which Nerves sometimes are impedited and con­tracted, that their functions are not freely exe­cuted: and therefore to this Symptom of com­pression is commonly adjoyned shortness or dif­ficulty of breathing, upon the same score; and sometimes spasms or convulsive motions. And this complaint of straitness or contraction of the Breast: does frequently happen to scorbutic per­sons, whose nervous juyce being degenerate and tainted, their Organ or Vessels perform not their office duly as they ought, in giving the full mo­tion and extension or every part: for, this ner­vous liquor being fed and supplied from the mass of blood which is scorbutic, feculent and depauperated in spirit, that also which is ex­tracted thence must be answerable, and of a de­generate nature: so then this nervous juyce which should be vegete, noble and spirituous, for putting the motive faculties into action with vigor and briskness, is become dispirited, flat and depraved, and the Organs acted thereby, move heavily and irregularly: so that upon inspira­tion or filling the Breast with Air, the parts do not readily give way by expansion to let in; hence the Patient feels himself girt or strait-laced.

It remains now in the last place, that we finish this second division, in examining and searching into the nature and causes of those pains that more peculiarly and eminently afflict the Heart.

The Heart being a noble (or the noblest and [Page 81]principal part, is as the Sun of the Microcosm, whose irradiating lustre and beams of vital heat, enlivens and refresheth all the regions and parts thereof: the Eclipses, storms and clouds then that happen as the consequents of its distempers and sufferings, must needs be eminent and re­markable. This supreme Organ that bears the government of vitality, is so generally concern­ed in all diseases and discomposures of the Bo­dy, that few there are but the Heart is made sensible thereby, and gives notice thereof by variation of the Pulse, as a sigrial from thence. And not only distempers of the Body, or the defect and decay of some particular member or faculty does affect the Heart; but also the dis­orders and passions of the Mind, have influence thereon, that from thence the Heart akes, beats, or suffers pain and restless disturbance: hence it is that grief, anger, fear, desire, &c. Changeth the regular motion of the Heart, and the Pulse alters as a token and manifest character of its sufferings.

Now the Heart is made thus sensible of the Bodies infirmities and preternatural mutations, from the vital government that is planted here; having commerce and communication with eve­ry member, from the circulating afflux and re­flux of the crimson vital stream, continually transmitted through this Organ, which thereby is affected well or ill, as the blood is better or worse, in the current and quality thereof. And the Heart is also affected from the mind; for as [Page 82]much as the Soul exerciseth her power more eminently here; and if a particular part may bee assigned, this may be said to be the seat or Throne of Regality.

The Heart being of a solid fibrous flesh, the pain thereof is obtuse, not so accurately per­ceptible, so acute and sharp, as those of the ner­vous parts: notwithstanding the effects and con­sequents thereof are impressed upon the whole Body, and each member is impaired in its viva­city and vigor: and although this Heart-pain by the nature and substance of the Organ, is not so great commonly and perceptible, as that of some other parts; yet when this pain does arise to some degree, a Syncope seizeth the, Pa­tient, a deprivation or cessation of life for a time; that what it wants as to sense is doubled in the consequents, as threatning and endanger­ing the life: so that extremity of pain is not per­ceived here, because sense decays, as the cause of pain increaseth.

The Heart is molested and suffers pain these several ways: by extension, constriction, ob­struction, inflammation or intemperate heat, Imposthumation, by erosion, by exotic genera­tion.

1. The Heart is pained by extension, from a sudden ebullition and turgid fermentation of the blood raised by passion, or otherwise; whereby the Vessels are suddenly forced upon distension to receive and transmit the inundation and swel­ling current of the blood; and from hence pain [Page 83]and trouble ariseth at the Heart.

2. By constriction the Heart is pained, and that from external and internal cause: exter­nally from the Pericardium compressing, where­by the Heart is denied the full liberty of its Diastole or expansion: and this may arise upon a double account; either from. the Pericardium being too replete and full; or too much exhau­sted and empty. You must understand there­fore that this Pericardium or Capsula cordis, is a Membrane designed by Nature to involve and inclose the Heart for its defence; as also being a moist Bath to irrigate and keep it souple, con­taining a Serum or water; and this Membrane should extend and be enlarged according to the motions of the Heart being greater or less: now when this water does abound filling the cavity of this inclosure, the Heart thereby is prohibi­ted its full expansion: and è contrà, when this water is too much wasted and dryed up, the Pericardium cleaves to the Heart, and impedes its pulsific motion: thus either plenitude or va­cuity begets anxiety and trouble at the Heart.

Internal cause of constriction is, when the Heart it self is seized with a Tabes or vehement exsiccation, and the fibres so contracted, that it hath no capacity, or less for dilatation, and per­mission of the transient blood.

3. Obstruction causeth pain and trouble at Heart, when the free current of the blood is im­peded from within due Vessels; and this is pro­cured sometimes from a perturbation of the mo­vent [Page 84]spirits, and sometimes from an indisposition of the impulsed blood.

First, from a sudden and violent recurrence of Spirits from other parts, and tumultuous confluence at the Heart, whereby the circulation is checkt, and the blood stopt in the Ventricles, causing a suffocation for a time; and this hap­pens upon vehement passions, and consternations of the mind.

Secondly, From an inhability and incapacity of the blood being gross, concreted or grumous, that it hardly or with difficulty passeth through this Organ, causing thereby an obtuse pain, op­pression or heaviness at the region of the Heart, and sometimes a Lipothymy or Syncope, faint­ing or swooning.

4. By Inflammation or intemperate heat, the Heart is pained; as in most Feavers where in­tensness of heat is accompanied: and this heat continuing does exsiccate, and contract the heart, and brings a Tabes or Consumption upon the whole Body.

5. By Imposthumation the Heart is pained sometimes, as also by other Tumors there bred, Which by dissection hath appeared after death.

6. By Erosion or Ʋlceration sometimes the Heart is pained, and suffers by continual palpi­tation.

7. By exotic Generations, and strange pro­ductions the Heart sometimes is pained; as when worms, stones or bony substance is bred in the Parenchyma of' the Heart; which hath been [Page 85]found there upon dissection after death: and to these diseases, and such as most of the fore­mentioned, the Symptom of Palpitation does necessarily belong; shewing the continual mole­station and trouble the Heart lyes under, who endeavors to acquit and extricate it self by la­borious, lofty and strong pulsations.

Pains in the Abdomen or lower Region of the Body.

NOW we have done with those pains inci­dent to the middle Cavity, namely the Thorax or Breast: I come in the next place, and by the order proposed to the lower Region, called the Abdomen or Belly, containing the Stomach, Liver, Spleen, Kidneys, &c.

And here first as the principal member we shall inquire into pains belonging to the Sto­mach or Ventricle; being the great Office and Laboratory to prepare Aliment to supply and maintain the whole Body; therefore if this part be pained and out of order, all the rest must needs fare the worse for it, every part having a concern from hence.

Pains of the Stomach are various both in re­spect of their causes; and also from the different parts of the Ventricle where they do infest, and those are three; the upper Orifice called Os [Page 86] Ventriculi; the lower Orifice called Pylorus; and the whole cavity of the Stomach.

The upper Orifice or mouth of the Stomach is subject to great pain, as being very tender and sensible, in regard it is very nervous, and this pain is the more eminent and remarkable, for that commonly two principal parts are hereby affected and drawn into consent, the Brain and the Heart: the former, by the Nerves of the sixth conjugation derived from the Brain, whose ramifications are wreathing or twining about this Orifice; and therefore from, hence Head­aches, Vertigoes and Epilepsies do often arise. The Heart also is affected, both in respect of vici­nity as near adjoyning to this Orifice; and also for that the same pair of Nerves doth serve both the Heart and Stomach, whereby of necessity there must be a communication of pain; and therefore it is that this pain in extremity causeth Fainting and Swooning: and hence it is that this pain by a peculiar distinguishing title is cal­led Cardialgia; and also for that the ancient Greeks called the mouth of the stomach [...].

As for the causes of this Cardialgia or sto­mach-pain; sometimes they are sharp, acrid and hot biting humors, fluctuating and rising up to the Orifice of the stomach, where they cause an eroding or gnawing pain, and sometimes a scald­ing or heat there; and this vulgarly is called the Heart burning.

Sometimes flatulency and wind causeth this pain by way of distension and a swelling fulness; [Page 87]and the Orifice is constringed and shut up so, as denying vent: in this case the Patient labours and strains to belch, but cannot unlock or loosen the Orifice of the stomach; but so soon as the Orifice does slacken and give way, the wind breaks forth, and ease followeth.

Sometimes Worms do cause this pain, having gotten up to the mouth of the Ventricle, where they gnaw and bite.

Sometimes churlish and deleterious or ill pre­pared Physick; or discordant food having such properties as may irritate and provoke this ten­der part: or food received in too great a quan­tity, above what the stomach is able to master and digest, then it riseth up to the mouth of the stomach, causing oppression and pain there, un­til it be discharged upwards or downwards, by the strength of Nature, or the assistance of Art.

Besides this Cardialgia, there is also another sort of pain that afflicts the mouth of the sto­mach, and that is Singultus a Hicket, or Hickop: and although the whole Ventricle be molested therewith, yet the chief pain or trouble is at the Orifice or mouth of the stomach. This Hickop is a convulsive motion of the stomach, thereby causing pain. The general causes assigned by Hippocrates are two, repletion and inanition: under repletion is comprehended whatever hu­mor or vapor is in the stomach and disgustful, to irritate and provoke the expulsive faculty: but a Singultus by inanition, is a vellication of [Page 88]of the retentive faculty, and is the effect of ex­haustion and large evacuations: and accounted more dangerous than the former. Therefore Hickops after great vomiting or purging, He­ctick Feavers, and long-wasting sicknesses, are very bad signs.

There is also a pain belonging to the mouth of the stomach, which although it be a real pain and properly so called (according to the defini­tion of dolor) yet Physicians have given it ano­ther denomination, and that is Nauseousness, or a nauseating sick pain at the Orifice of the sto­mach. The causes of this nauseating pain are various: as whatever is disgustful there, whether it be meat or drink offending in quantity or quality: or indigested depraved matter, the re­licts after former digestions, floating upon the stomach: or only imbecillity and weakness of the stomach, being not able to close with and digest, although good food be sent in: and thus it is when the Tone of the stomach is altered by intemperance and ill usage; by great or long sickness; or decayed and worn out by age. Sometimes the cause is organical, as when a Tu­mor or Apostem is forming there.

And not only thus idiopathically, but also sometimes the stomach complains and nauseates sympathically, by consent from other parts, by reason of vicinity or communication: and thus a Tumor of an adjacent part may molest and af­flict the stomach: and other remote parts dis­charging and emptying themselves into the sto­mach [Page 89]by Vessels of intercourse, Veins, Arteries, and Nerves.

In the cavity of the stomach, there is some­times a pain of oppression or heaviness, being over-charged or loaded and grieved with some­thing difficult to be digested and sent off: or a pain of distension and inflation, from wind and phlegmatic turgid humors: or a punging and pricking pain in this or that part of the Ventri­cle, from some acetous, sharp humor: or an eroding and gnawing pain, from worms, or a mordicant fretting bilious matter.

Pain of the stomach ariseth sometimes from Inflammation, accompanied with very severe Symptoms; but of this in its proper place here­after, where we treat of Inflammations.

Pain also afflicts the stomach from Apostems and Ʋlcers, of which in their due place also.

Pains of the Intestines or Guts.

HAving gone through those Pains belong­ing to the Stomach or Ventricle, in the next place and in order, we come to treat of pains incident to the Intestines or Guts; being derived from the Ventricle, and are one conti­nued body and passage from the Pylorus to the Anus: notwithstanding for distinction sake, and because this long cavity is different in several parts thereof, as to magnitude, substance, figure, [Page 90]place and office; therefore it is divided into parts, having several names, for a more distinct knowledge, both in relation to the different formation thereof, as also to point particularly where a disease is in any part thereof.

The division is made into small and great Guts; the small or thin are three; Duodenum, jejunum and Ileon; the great or thick are three also, caecum, Colon and rectum; and in this or­der they lye from the Ventricle to the Funda­ment. The three first are circumvolved about the Ʋmbilicus or Navel, and take up the centre of the Abdomen, the other are subjacent and circumferential.

Pains do frequently molest the small Guts, but chiefly the Ileon; which when they arise to extremity, the disease is called Iliaca passio, from that Gut most affected.

The seat of these pains are above the Navel chiefly, extending to the Hypochonders.

These pains differ in their causes, and there­fore some are weak and transient, arising from wind and acidities, which cause some pun­ctures, gripes, or distensions, and continue not: but sometimes these pains are more grievous, de­pending upon causes greater and more contu­macious; and therefore attended with other Symptoms in great rigor: as constipation of the Belly, violent heat, fainting, vomiting and cast­ing up whatever is received; nothing passing downwards, but moves upwards, that sometimes the excrements are voided by the mouth.

About the causes of these violent pains Phy­sicians do not concur. The general opinion (taken from Galen) will have these pains to arise from an Inflammation of the Guts: others (modern Authors) from a peristaltic motion, or the motion of the Guts inverted: for whereas in the course of Nature the expulsive faculty moves downward by a contraction of Fibres from the Ventricle to the Anus è contrà, in this case the Fibres contract below and drive upwards.

But this difference may be reconciled, and neither opinion to be faulted, being rightly un­derftood: for Inflammation may begin, and cause the motion of the Intestines which natu­rally tends or moves downwards, to be chan­ged upwards, by a different contraction of Fi­bres: So that Inflammation causeth mediate­ly, peristaltic motion immediately; and sets forth the order of causation; the one superior, the other subordinate. Quod est causa causae, est etiam causa causati.

All the Guts are capable of Inflammation; but the small Guts more usually, as being most liable, for having more Veins and Arteries than the rest.

These Iliac pains from Inflammation are ve­ry dangerous, if they arise to a great height; because the Inflammation is apt to make a mor­tal transition into a Gangrene: and indeed all Inflammations of the Guts are difficult and doubtful, because they easily gangrene and mor­tifie.

And not only Inflammation inverts the mo­tion of the Guts, but also other causes may be­get this Iliac passion, or joyn with it as partial causes: as an Apostem or other sort of Tumor; a Rupture, an Exulceration, indurated Excre­ments causing great obstruction: also whatever by compression or constriction of the Guts, con­stipation or coalescence, may cause contortion, and turn the natural course and motion there­of: and of these frequent examples in practice do manifest and confirm.

Pains of affinity and adjacency to the Ileon, and which are often complicated therewith, are Colic pains, so called from the Gut Colon, the part wholly or chiefly affected. This Intestine is last but one, and more capacious than any of the rest; furnished with many little cells or pri­vate receptacles, to receive the excrements and retain them, else they would pass away too fre­quently and inconveniently.

This Gut is seated almost round the Abdomen or Belly; so that Colic pains are not easily di­stinguished by the place, being sometimes here and sometimes there; left side, right side, or under the Ventricle; hence it is that Colic pains do counterfeit sometimes the stone or pain in the Kidneys, left and right, and sometimes they are supposed to be pains of the spleen: but most frequently these pains are towards the left side near the flank, where the Colon is more an­gust, tortuous and circumflected: and therefore when the excrements are hardned in the supe­rior [Page 93]and more capacious part of the Colon, and are then forced down by wind or otherwise, into the narrower, great pain must needs arise thereupon.

But concerning the causes of Colic-pains they are various, and may be ranked under these Heads.

• 1. Obstruction of the Meatus felleus.
• 2. Wind and flatulent Vapors.
• 3. Acrid, punging and sharp Humors.
• 4. Indurated Excrements.
• 5. Stones generated in the Colon.
• 6. Worms.
• 7. Compression.
• 8. Inflammation.
• 9. Venenous and malignant Matter.
• 10. Apostems and other Tumors.

By the first it appears, that Obstruction in the Guts (which produceth Colic pains) does some­times arise from an antecedent obstruction in a­nother part: as when the Meatus cysticus, the passage of the Gall into the jejunum is stopt, it causeth also a stoppage in the Guts: for the Gall being naturally discharged into the Guts does stimulate them to expulsion, and moves the ex­crements downwards; but for want of this ex­citing and provoking matter, the Guts fill up, are obstructed and distended, thereby raising pain.

Wind and flatulency begets Colic-pains some­times; and these are not fixed, but roving here [Page 94]and there; and commonly attended with a rumbling and noise in the belly: and this is an effect of crudities and weak digestion, rising from a natural debility, or occasioned by intem­perance and a bad diet. And this flatus is ei­ther in the cavity of the Colon involved in a viscous tough flegm inclosed as in a Bladder; or sometimes shut up within the Tunicles of the Intestine, where forcing its way out, does cause great pain in the part.

Sharpness of an humor indigested or degene­rate, does sometimes cause Colic pains; and this is either a mordant biting Choler, or an acid serosity.

Driness and hardness of Excrements do cause Colic-pains sometimes; for as much as they stop the passage and extend the Intestines, denying vent to any sudden fermenting humor, wind, &c. that should freely pase away. This costive­ness and constipation is acquired, by ill diet, in the use of hot, dry, astrictives: by watching or sleeping too much; immoderate Venus; by heat­ing the body, and sweating much, through ex­ercise, labour, intemperate Air, &c. These are great dryers, and take off the lubricity of the Guts, that they perform not their office as they ought: thus excrements not being transmitted and sent away duly, they accumulate, fill up, distend and obstruct the Intestines, and give great occasion to Colic-pains.

Stones sometimes are generated in the Colon, and do cause Colic-pains: also a clot of worms [Page 95]gathered and twisted together, obstructing the Guts, have raised Colic pains.

Compression and contraction, by Inflamma­tions and Tumors, in the Guts or parts adjacent, do sometimes cause Colic pains.

Also malignant and venenate matter hath procured the like; as Paulus Aegineta relates of a pestilential Colic that arose in Italy, and afflicted many of the Roman Provinces.

Fluxes of the Belly.

HAving spoken something concerning pains of the Guts, Iliac and Colic, attended with astriction of the Belly and costiveness: I shall briefly set forth those pains that are accom­panied with a Flux or loosness.

There are three sorts of Fluxes of the Belly distinguished by several names; Lientery, Di­arrhoea, and Dysentery.

The first is a Flux of indigested or semidige­sted food, passing away before its due time from an imbecillity of the digestive faculty. But this not being dolorous; or painful, we shall pass it by, as not our subjevt in hand.

The Diarrhoea is a flux of humors depraved and injurious, which stimulates Nature to expul­sion; and is for the most part painful and irk­som to bear.

• 1. This kind of Flux is various in the matter of
• [Page 96]2. Different in the efficient cause (as some are of opinion.)
• 3. Unlike in the manner and circumstances.
• 4. Various in respest of place; as issuing from several parts of the body.

Touching the diversity of matter in this flux, physicians have distinguished it into phlegma­tic, choleric, melancholic▪ and serous or watry: which distinction is not simply manifest, but a complication and mixture of many sorts, where­of one may abound and be predominant; yet the denomination and character of the whole is hard to be given.

The variety of depraved matter that happens in mans body, is not to be reduced to four Heads, nor three times so many: for this sti­mulating matter thus sent forth by a Flux, is the manifold different material cause of hun­dreds of diseases: which preternatural variation of humors or juyces are not to be comprised within so narrow a compass, nor reducible to four Cardinal points: for admit there were four natural constituent humors in mans body (as common doctrine teacheth) yet these in their sundry variations and complicate degenerati­ons, would be so variously changed, as not to retain any relict or smack of their original de­scent; that a denomination from thence, if pos­sible to be distinctly given, would no way an­swer in the similitude or nature thereof, and consequently of no use in practice.

In respect of the efficient cause, Authors have [Page 97]distinguished these Fluxes into critical and sym­ptomatical: by critical they understand, when Nature in due time, and with good success, throws off and expels any peccant matter, and finds relief by it in any case. A symptomatical Flux they mean, when Nature irritated untime­ly or immoderately, is not benefited thereby, but rather injured and endangered.

The [...] of this is true, and it often falls out thus; but the distinction of critical and sym­ptomatical, relating to the efficient cause, and the reason thereof, I do not assent to nor comply with, since every Flux is symptomatical, whe­ther it produce good or evil: for that which they call Critical, and is seasonable and duly performed with good effects attending, is but symptoma morbi, the Symptom of some disease, as well as the other: so that the difference is in the nature of the disease afflicting, the matter excreted or voided, the fortitude of Nature, the time where, the way by which it ought or ought not to pass, which does distinguish these Fluxes in their effects to be good or ill; but shews no diversity in efficient causes, which is one and the same: for Nature is efficient, whether irritated unseasonably and frustrated of her end; or per­forming these endeavors in due time and to good purpose.

But although the efficient cause of Diarrhoea's be simple and single, yet the occasional causes are many; for these Fluxes are occasioned sometimes by change of air or place, and varia­tion [Page 98]of the seasons; by some kind of meats or drinks, taking cold or other casualties and ac­cidents, which puts Nature upon some disorder­ly fermentation and excretion; and this com­motion occasions and stirs up any morbific mat­ter and noxious humors, which before perhaps lay dormant and still, now to grow turgid and active, contributing to advance and promote the Flux begun: but this managed by a discreet hand may not prove injurious, but some advan­tage gained; which if neglected, and Nature not governed and guided in this prodigal ex­pence, much detriment may come thereby, an exhaustion of nutritious Juyce, with great debi­lity and weakness.

As this Flux Diarrhoea is various in the mat­ter discharged; so likewise in the manner and circumstances: as greater and more violent, or moderate and gentle, making a profitable secre­tion: without gripes or pains, but for the most part with these more or less; which by conti­nuance and shaving the guts so thin, at last do come to the quick, and cause excoriations: and this difference ariseth from the nature and quality of the humors or stimulating cause, which sometimes is so extreme sharp, introdu­cing a Dysentery or bloody Flux.

These Fluxes sometimes produce good ef­fects, when the peccant matter of any disease, or an exuberant humor is timely and moderately discharged and sent off; but otherwise not: and therefore saith Hippoc. In turbationibus [Page 99]alvi & vomitibus sponte contingentibus, siqui­dem qualia purgari oportet, purgentur, confert & leniter serunt; sin minùs, vice versâ.

In respect of place, or parts mandant, from whence these Fluxes take their rise, and the terminus à quo; they proceed sometimes from morbific matter congregated and concentred, issuing from the whole body: and of this take the example of Hippoc. giving a Prognostic in this case, 7. Aphor. 29. Si Leucophlegmatiâ de­tento fortis Diarrhoea supervenerit, malum sol­vit. Which is to be understood, in the begin­ning of the disease, strength firm, and the Viscera sound, else it is commonly mortal.

But sometimes also these Diarrhoea's do e­merge from particular parts: as the Ventricle, Brain, Spleen, Liver, Mesentery, &c. and there­fore in the Cure of these Fluxes, regard must be had to the part principally affected, from whence as the original and fountain these Diar­rhoea's do assurge. And therefore examination is to be made by the Diagnostic signs of every principal part; discovering thereby which per­forms their offices in integrity, and which of them decline their functions, and are depraved, as being the Authors of this disturbance.

The third sort of Flux is a Dysentery or bloody Flux: which is a dolorous and frequent excretion of blood, from an Exulceration of the Guts.

There are several voidings of blood by stool, [Page 100]that are to be distinguished and know from Dy­senteries. Galen mentions four, others add two more.

• The first, is a profusion of blood arising from plenitude or fulness of good blood; Nature over-burdened dischargeth her self this way by the Guts.
• The second, is an evacuation of crude and watry blood, not having its full tincture.
• The third, is of a feculent and foul blood.
• The fourth, of an acrid and salt blood.
• The fifth, is of a tabefied blood in acute dis­eases.
• The sixth (which is Galens fourth) is a Dy­sentery, distinguished from the rest, by Ulcera­tion and great pain.

To examine this division in the several parts thereof, and to set forth what truth and errour it contains therein, is not our business at this time: I shall only discourse upon the last, viz. a Dy­sentery being painful and grievous to bear; which kind of bloody Flux ariseth from, and is ac­companied with an Exulceration, and common­ly is the consequent of long, or severe ;Diar­rhoea's; for those Fluxes not being checkt, do sometimes make their transition and terminate in Dysenteries.

This word Dysentery taking its name from the part affected, imports only a difficulty of the Intestines; but may as properly be used for other diseases and pains there: but Authors ha­ving fixed it to bloody Fluxes from Exul­ceration; [Page 101]its general signification is restrained, and custom amongst Physicians hath fastned it here, as the character of this disease only.

The parts affected are the Guts, either the small or the great, and sometimes both: but pains of the small are more grievous than those of the great: the small Guts being of more ex­quisite sense.

The external and procatarctic causes that pre­dispose and introduce a dysenterical disposition, or promote and set forwards an inclination al­ready begun, are

First, the constitution of the Air.

Secondly, a bad Diet conspiring therewith, or some unwonted kind of Meats or Drinks: and therefore it is that many people upon the change of Climate, and a new sort of Food, do fall into bloody Fluxes: hence it is also, that these Fluxes are sometimes epidemical and ma­lignant, infesting many together in a City or Country, as of late years in London, and some other parts of England, this disease was raging. These epidemical Dysenteries arise sometimes to to the height of pestiléntial, and are very con­tagious, that it is not safe to converse with, or be near the diseased, but especially such as at­tend upon the sick are in most danger, from the Excrements that send forth a pernicious and in­fectious vapor.

For the time of the year, Autumn is most ready, and does more frequently produce these Fluxes: partly from the change of the season, [Page 102]and partly from the effects of Summer-fruits, to which many are intemperately given: the con­sequents whereof are commonly Diarrhoea's and Dysenteries.

Now the reason why these Fluxes do break out more frequently at this time of the year is; because the external ambient Air and cool blasts condensing and incrassating the Juyces of the body, as also occluding and shutting up the Pores, denying and hindring the former Tran­spiration (which in the Summer and hot wea­ther did spend and evaporate that way much su­perfluous matter) which vents being stopt, hu­mors accumulate, ferment and grow turgid, and forceth a discharge inwards by the Guts.

And not only this change of Air from hot to cold, or Summer-fruits are procuring cau­ses; but also some astral and inimical influen­ces, drawn in with our breath, may deprave and alter the Crasis of the blood and nervous juyce, as to effect this disease, and make it popular in like manner as other Epidemical diseases are sometimes procured. Also some sorts of Meats in quantity or quality offending and disagree­ing, and for want of good digestion, may corruption and dispose to these Fluxes. To these we may add as procurers, some ill prepared Medicines, and medicinal Drugs not well corrected that have, and will produce a Dysentery.

But concerning the proximate cause and man­ner of generation of this disease, we must far­ther declare: And whereas before we mentio­ned [Page 103]several sorts of bloody excretions or fluxes not dolorous, nor depending upon or conjoyned with exulceration of the Intestines, and there­fore not denominated nor to be understood as Dysenteries in the strict and present sense; therefore I must wave the mentioning of their causes, and only give an account of Dysenteries in the usual acceptation of the word.

In the forming or generating of this Dysen­tery you must understand, that sometimes the Ʋlceration is planted first and hath the prio­rity, and a Flux of blood follows as the conse­quent: but sometimes the voiding of blood precedes, and an Ʋlcer or Ʋlcers is procured thereby as the effect: and this consideration is not of small moment in the designment and in­tentions of curing; for both the former and the latter happen in several persons.

Sometimes Ʋlceration is made by sharp cor­rosive humors, as in Diarrhoea's, which ulcerate the guts first, then a Dysentery of blood fol­lows. Or,

Sometimes from an Inflammation of the In­testines, or other Tumor coming to suppuration, which breaks and makes a Dysentery, sending forth blood and corrupt matter.

Sometimes a bloody Flux continues a while without Ʋlceration, 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 Ʋlcer, 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 Ʋrine, 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 [Page 105]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 Ʋlcer becomes fistulous, and difficult to be cured.

And now I remember the Cure of an old Ʋlcer 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 [Page 106]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 [Page 108]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 [Page 109]is no apertion; and sometimes the 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 [Page 110]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 [Page 111]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, [Page 112]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 [Page 113]the best I could for her, which was as followeth.

First, I appointed a Preparative to be given: which was this.

R. Radie. utrius (que) 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. ana ʒ 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 unicui (que) 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, [Page 114]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. praep. ℥ii. vin. alb. lib. iv. Diger. s [...]a. in balneo Mariae per dies iv. colat. duleoret. syr. byzantin. simp.

The aperitive Pills were these following.

R. Gum. ammonias. acet. scillit. solut. ʒ ii. myrrhae rub. tart. chalybeat. ana ʒ ss. croci ℈j. ol. foenic. dulc. chym. gut. viii. succi cochlear. q. s. Fiat massa.

During which time from the beginning, she was anointed with a Liniment all over her bel­ly, morning and evening. The Liniment was this.

R. Ol. cappar. unguent. è succis aperit. ana ℥j. Misce.

After this, a Cataplasm was applied to the re­gion of the Spleen, every day for a week. The Cataplasm was made thus.

R. Panis alb. farin. sem. lini. ana ℥iv. farin. hord. ℥jss. lactis vaccin. lib. jss. Coq. ad ex­siccationem, adde mucilag. rad. althaeae, foe­nugr. ana ℥j. ol. chamaem. cappar. ana ℥j. gum. ammoniac. acet. scillit. solut. ʒ iii. gal­ban. bdellii▪ styracis liquid. ana ʒ ii. croci ʒ ss. Misce, f. Cataplasma.

After this the pain was gone, and the Spleen began to be soft and yielding. Then I appoint­ed the former Apozem to be repeated; which [Page 115]being taken, the swelling of her belly was much gone down. After this I caused a Fomenta­tion to be applied, morning and evening, for some days; and then ordered the Chalybeat Wine to be repeated. The Fomentation was this.

R. Rad. bryon. ireos nostr. ana ℥iv. rad. cy­clamin. cucum. agrest. filicis mar. ana ℥ii. fol. lauri, abrotan. absinth. menthae, salviae, hyssop. ana M.ii. sem. cymin. foenugr. ana ℥j. flor. chamaemel. melilot. ana M.j. Coq. in aq. fabror. lib. x. acet. vin. alb. sub finem addit. lib. ii. ad tertiae partis consumpt. pro Fotu.

After which one purging Potion was given, and an Emplaster applied to the Spleen, and then both the Spleen and Abdomen, the whole belly as flat and soft as ever she was, and per­fectly cured, and returned home. All which was performed in the space of about seven weeks: and two months after she conceived with child, as I was informed by her relations; and she stood firm in health long after. Not­withstanding the success was very good, and the Medicines well designed, as such preparations will afford; yet in the like cases I do not use the same now.

This in short; and I could not rehearse the particulars so exactly (being twenty years since) but that I have the whole story, with the seve­ral Medicines, in writing now by me: and this I have related to confirm what I asserted here [Page 116]before, that a diseased Spleen may lay the foun­dation for, and introduce a Dropsie: and now I proceed on to set forth the causes of a pained Spleen; which being rightly stated, applications may more successfully be made in that com­plaint.

The most frequent and apparent Symptom that afflicts the Spleen is Pain; and this doth arise and depend upon some of these several dis­eases; Obstruction, Tumor, Inflammation, Aposte­mation, Compression, Ʋlceration.

Obstruction in some of the Vessels of the Spleen, is a frequent cause that produceth pain; and this obstruction is procured from a feculen­cy and grossness of blood, which ariseth either from a natural debility of the Spleen not able to perform its office duly; or occasioned by a melancholy disposition, a studious, sedentary, in­active, or a careful and afflicted life; to which, or singly, an evil bad diet and irregular diaete­tic customs may contribute, or effect: (as more fully you may be informed in a late Tract of mine, entituled, The Preservation of Health and Prolongation of Life.) All which impedes the due fermentation and volatization of the blood in the Spleen, from whence it becomes thick and foul, and begets a stoppage, or too slow a mo­tion and fulness in those Vessels.

And whereas the office of the Spleen (as be­fore determined) is to ferment anew, spiritalize, exalt and rarifie the thick, indigested and me­lancholy blood, sent thither for a farther ela­boration [Page 117]and depuration; it is most rational that this not being performed (from some of the impediments aforesaid) obstruction and stagna­tion there will be the consequent; and the Pa­tient from hence will feel a pain and heaviness about those parts.

But for a more promptness or aptness to these obstructions, angustness and straitness of the Vessels, so formed by Nature, does render some persons more prone than others to obstruction and these splenetic pains.

And farther, this obstruction does arise not al­ways from the causes aforesaid; but sometimes from a compression of other parts adjacent that may incommode and offend the Spleen, or by contusion from a blow or fall; or by an injuri­ous dress and too strait lacing or girding, as fre­quently amongst the female Sex.

These obstructions when continuing and con­tumacious, are so aggravated and increased with additional influx, that they form a Tumor: this distension being perceptible by sight sometimes, but always by seeling, is to be adjudged and di­stinguished; whether soft and flatuous, or hard and scirrhous; the former sooner yielding to means, but the latter more difficult of cure.

Inflammation, though rarely, yet sometimes does affect the Spleen; and this inflammation does arise from obstruction; for the blood being stopt in its current and passage, and upon some extraordinary causes being more hot and fiery, does make a sudden ebullition and inflame, cau­sing [Page 118]great pain, heat and extension; and this pain is distinguished by pulsation and beating of the part, having many Arteries. This Inflam­mation not rightly applied unto by diligent and good means, does make transition, and pas­seth into Apostemation; and sometimes termi­nates in a scirrhous Tumor: but these two dan­gerous commutations are to be prevented with great care and industry: therefore before the disease arrives to this height, and when only pain or heaviness gives warning, and tells you of a distempered Spleen, it is then most seasona­ble and opportune to apply the means; and then a little may prevent that, which after­wards perhaps a great deal cannot cure.

And first the procuring causes, if any there be apparent, are to be avoided; as a sedentary slothful life, intemperance and gross feeding, or unseasonable eating, as late suppers; immode­rate study, melancholy, grief or care; which in­troduce sometimes, but always contribute to aggravate splenetic distempers: and although a natural debility and infirm constitution of the Spleen, may procure the effects aforesaid with­out other provocations, yet most frequently they are so caused, at least much heightned thereby; and therefore for prevention, as also for cure, those injurious habits are to be aban­doned, and such a diaetetic course of life obser­ved, as may check this disposition of body, as at large you may be directed in the fore-mentio­ned Book, The preservation of Health and pro­longation of Life, &c.

For Pharmaceutic Remedies (that are made publick) I shall commend the aperitive Tin­cture of Mars; Pil. Antihypochondriac. Swelferi: chalybeated Tartar; Sal volatil. Succini; Spir. Veneris rightly prepared: which prudently used pro re nata, as the several cases require, may prove advantageous.

Pains of the 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: [Page 120]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 [Page 121]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, Ʋlcers. 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, [Page 122]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 [Page 123]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 [Page 124]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 other diseases of the Liver, by the vehemency of the Symptoms that attend this more than in other cases; for the pain is greater, the Feaver higher, and other Symptoms more fierce and sharp.

If the Inflammation be upon the superior gib­bous part of the Liver, it counterfeits a Pleurisie, and affects the breast much, by short breath and a dry Cough; the Tumor then extending to the Diaphragma, the Vitals are most affected, and pain reacheth up to the Jugulum sometimes: but if it be in the cavous inferior parts, then the Stomach is most sensible thereof, by great thirst, nauseating or vomiting.

But lest you be mistaken between an Inflam­mation of the gibbous part of the Liver, and that of the Muscles, you must observe the difference by sight and feeling: that the former hath its [Page 125]extension circular according to the figure of the Liver; but the latter not: besides the for­mer may be perceived to lye deeper; the other a more superficial distension.

If the Inflammation be in the body or flesh of the Liver, the pain is obtuse and heavy: but if the Membrane investing be the seat of the In­flammation, the pain is more sharp and pung­ing.

Inflammations are better or worse, as the blood is good or bad; for according to the degrees of pravity and goodness, the Inflamma­tion varies; and therefore a Phlegmon is not so vehement as an Erysipelas.

Inflammations are very cautiously to be dealt with, both in regard of the present danger, as also for future consequents: for if a right course be not observed in the Cure, although the Pa­tient may escape the acute sickness, and reco­ver; yet he may fall into a Dropsie or Consum­ption, and that perhaps incurable; the Liver being so decayed and tabefied, as not to be reduced to soundness: hence it is, that after Inflammation, Apostemation so frequently fol­lows, or a scirrhous Tumor.

If the Inflammation terminate in, or leave an Apostem behind it; if it be deep in the Paren­chyma of the Liver, it is more desperate: but if the Apostem or Abscess lyes between the flesh and the covering Coat of the Liver, their case is more hopeful: because the matter may be bet­ter discharged, and the Liver not in so much danger.

Concerning the termination of this Phlegmon or Inflammation; either it spends it self and goes off by resolution; or it arrives to matu­ration; or it ends in a scirrhous hard Tumor. The first is only desired, and that which all Practisers should aim at in the administration and application of Medicines: the two latter are doubtful and dangerous. In the beginning therefore, Discussives and Diaphoretic resolvers are the chief means to oppose this disease; not neglecting to abate Plethory, and to make eva­cuation, thereby to retract and withdraw fuel from the fire.

But if the Apostem cannot be discussed, then the best way is to bring it to suppuration as soon as may be, left the part gangrene: and if the faculty of the Liver be strong to digest and beget a laudable white Pus or matter, then there may be hopes of the Patients recovery; but if it be sordid and stinking, the case is de­sperate. This matter is evacuated sometimes by stool, and sometimes by Urine; but if it fall into the Abdomen, section must be made to let it out, if Nature cannot discharge it other ways. Natura in statu praeternaturali ab interitu se libe­ratura saepe mirabiles quaerit vias ac meatus. Moe­bius.

The Apostem being thus generated, and arri­ving to suppuration, it breaks, and then the Scene is changed; for now it becomes an Ʋl­cer, and challengeth that denomination. But an Ʋlcer is generated sometimes without In­flammation, [Page 127]by sharp eroding humors, which is not so dangerous as the other; because it comes on gradually, the Symptoms milder, and gives more time for the use of means.

An Apostem likewise is gathering in the Liver sometimes without Inflammation; is not then so painful, nor comes to its height so soon.

Apostems do not always come to suppuration, but sometimes they grow hard and scirrhous: and such Tumors the Liver, and also the Spleen are subject to.

These scirrhous Tumors do depend upon im­pacted matter that will not be discussed; and are the consequents of Inflammations or invete­rate obstrictions; procured sometimes by an ill management of their intended Cures, drawing away the thinner matter, and leaving the grosser behind; as by the use of too great dryers and heaters: or by refrigerating and constringing Medicines, do so incrassate the humors as not to be resolved.

This Scirrhus of the Liver is painful in the beginning before it come to be exquisite and confirmed; but afterwards not: and that which is with pain is more hopeful; the other despe­rate, because it is in the way to gangrene. Those that are thus affected, lye more easie on their right side than on the left; in regard the weight of the Liver presseth upon the Ventricle, when they are upon the left.

You are to take notice, that pains of this Scirrhus, and also from other Tumors of the Li­ver [Page 128]or obstructions, do not always possess the right side, but pain is felt sometimes forward up­on the region of the Stomach; for as much as one part of the Liver lyes forward upon the Ventricle: hence it is that many are mistaken sometimes, in judging all pains about the region of the Stomach to be pains of the Stomach, when indeed they are seated in the left part of the Liver.

There is also an Inflation of the Liver, which is a Tumor or extension thereof, from wind and flatulent humors, sometimes in the vessels, and sometimes lodged between the investing Mem­brane and the Parenchyma.

This Tumor is not hard, but yields to pres­sure; the pain from hence is mutable, shifting its place, greater and less, sometimes ceasing, but returning by intervals.

There are also other causes that have and may produce pains of the Liver; as stones and worms, which have been found upon dissection: but being more rare, and scarce to be discove­red but after death, I wave the prosecution thereof, and pass on to the next considerable part.

Pains of the Reins and Bladder.

FOR the better understanding of Pains in these parts, and their Causes, we shall first shew you the formation of the Kidneys, and their use; afterwards we shall discover the im­pediments and morbous affects that produce pain.

The Reins or Kidneys are two, placed one of either side the Spine or Back-bone, about the lower short Ribs, the one under some part of the Liver, the other under the Spleen.

In the structure of the Kidneys, the most ob­servable for our purpose, are the Cavities and Ductures in the Parenchyma or body of them, and the Vessels leading to and from. The sub­stance of the is much like to that of the Heart.

There are two Cavities in the Kidneys be­ing larger than the rest, into which the smaller Pipes do convey and empty themselves as con­taining Cisterns: and out of these again there are other small conveyances to transmit and send it forth: there are also certain 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 [Page 130]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 Ʋrine out of the Kid­neys, are the Ʋreters; 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 [Page 131]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 Ʋrine 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 Ʋrine, 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.
• Ʋlcers.

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 Ʋrine 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 [Page 133]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 [Page 134]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 Ʋrine 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 [Page 135] 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 Ʋrine, 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 Ʋreters into the Bladder, there is good hopes of safety; but if it be discharged inwards by the emulgent [Page 136]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 Ʋrine: 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 [Page 137]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 Ʋrine.

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 Ʋrine 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 Ʋreters, 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 Ʋreters, 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 [Page 138]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 [Page 140]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 that coagulating ferment: and for these purposes were Paracelsus his Ludus and Aroph; also the Alkahest cannot fail here­in.

But such as have not acquired the great Ar­cana's, and cannot procure a dissolvent for the Stone, that is, to make an Analysis or resolution of it into a liquid juyce, and reduce it back again to its humoral flowing state, capable of ab­stersion and cleansing out, must endeavor to fa­cilitate the exclusion of this hard body, by the best and most hopeful means for that purpose, by lubrifying, relaxing, and dilating the pas­sages, and asswaging the Spasm and contraction of the Ʋreters, that the stone may slide away much sooner, and with less pain: hence by way of caution observe, That Diuretics and provo­kers to expulsion are not to be given, before this preparation be made, else you precipitate the Patient into danger, and increase his tor­ment, dislodging and forcing the stone through angust and very tender cavities, not provided to give passage without detriment to this unwel­come stranger.

And thus much briefly concerning petrifacti­on, or the production of Stones in the Kid­neys; I proceed on to the next, a most difficu't and painful disease belonging to this Member, namely Ʋlcers.

Ʋlcers of the Kidneys are introduced seve­ral ways, or take their rise from several causes.

• 1. Acrimony and sharpness of humor passing this way, and continuing long, does excoriate; which not timely observed and remedied (be­cause pains at first are but small) does corrode farther, eat into the flesh, and plants an Ʋlcer.
• 2. The Kidneys are ulceratedsometimes from an Inflammation or other Apostem there, co­ming to suppuration and breaking, which dis­chargeth the matter by Urine, or otherwise, but leaves a putrid Ʋlcer behind.
• 3. Sometimes from a clot of blood extravasa­ted or out of its place putrifying, does infect the part, tabifie and ulcerate; and not to be neg­lected, lest this be the consequent.
• 4. Sometimes a Stone, being rough, angular or sharp, frets or grates upon the parts, and makes a solution of continuity, which at first sends forth a bloody Urine, afterwards purulent and begets an Ʋlcer: and this last is the most frequent cause that generates Ʋlcers in the Kidneys.

These Ʋlcers are discovered by pain about the Loins, a purulent Ʋrine, and sometimes Ca­runcles or small fleshy rags, or strings of concre­ted blood is brought forth with the Urine, ac­companied commonly with heat in the Back, and sometimes faint Sweats, which continuing, bring on a Consumption and Hectic Feaver.

Of these Ʋlcers some are more sordid, foul and stinking, as the Urine does declare: others not ill scented, the Pus white, not viscous, but clou­dy and light.

The difficulty of these Cures lyes here; for that the Urine which is acrid flowing always by the Ʋlcer, hinders the consolidation of the part: besides, the situation being remote, the virtue of a Medicine is much altered before it arrive to the part: but in the designment and managing of these Cures, the body must be well cleansed, not with the common deleterious Pur­gers, but balsamic Detersives; and so kept with a proper Diaetetic regimen, as no impurity or sharp humors disturb or abate the power or Me­dicines, which must be truly balsamic and heal­ing.

The experience of these Ulcers I have had se­veral times, both many years since and lately. I remember in the year 1652. I cured an Ulcer of the Kidneys in a man about thirty years of age, living near Sheffield in York-shire, who came to me four miles twice a week during his Cure; I being then for a while at Norton up­on the edge of Darby-shire. His Urine was hot, sharp, and stinking, with a great purulent sediment; a great pain in his Back, with scorching heat, and often flushing faint Sweats all over his Body. Indeed I have wondered since how I did perform such a difficult Cure then, having so little practical knowledge, I being but a Tyro in this Art, it being in the first year of my Practice, and newly graduated Batchellor in Physick: but Providence had ap­pointed me the instrument to free this poor man out of his pain and languishing condition. [Page 143]Since I have been acquainted with several of the like cases, and may with better assurance pro­mise a Cure, from tryed Medicines acquired by experience, beyond what Book-practice does communicate: and this last year here in Lon­don, I cured a Gentlewoman of an Ulcer in the Kidneys.

In the next place we are to take notice of Pains belonging to the Bladder.

The Bladder is the last receptacle for the Urine , and performs the office of a Cistern to the Body, for keeping and discharging the U­rine at convenient times; and therefore is capa­ble of distension and contraction, being a mem­branous bag, furnished with right, transverse, and oblique Fibres for that purpose: and hath two Muscles at the neck of it, to let go or re­tain the Urine.

This part is liable to great grievances and pain­ful infirmities: as Distension, Obstructions, In­flammation, Excrescences, Ʋlcers, scirrhous hardness. From hence come suppressions of U­rine, imminution or small quantity, ardor or heat of Urine, Strangury or dolorous emission and dropping, incontinency of Urine or diffi­culty of retaining it.

Distension of the Bladder happens from too long retaining of the Urine, whether it be vo­luntary or involuntary: so that afterwards the Fibres do not recover again the power of con­tracting the Bladder: and this may prove of dangerous consequence, and to some it hath pro­ved mortal.

Obstructions of the Bladder, causing a sup­pression of Urine, or diminution, dolorous or difficult excretion, does arise from many causes: as a stone in the Bladder or gravel, coagulated blood, worms, a viscous humor or purulent mat­ter, a Caruncle or Tumor in the neck of the Bladder: or by compression from a tumified part adjacent; as the Womb or right Intestine.

Inflammation sometimes happens from ex­tremity of pain by the Stone, Ʋlcer, or other torturing cause; and these Inflammations are commonly mortal.

Vlcers do possess the Bladder sometimes, and most commonly in the neck thereof, caused by a stone or gravel excoriating and wounding the part: or by an eroding purulent matter coming from other parts, and lodged there; or by a continued Acrimony and sharpness of Urine corroding: sometimes from an Inflammation or Abscess: more rarely, but it hath happen­ed sometimes, from a Gonorrhoea ill cured; and I may say very ill indeed; for the Ulcer thus pro­cured, is of far greater difficulty and danger than the Gonorrhoea.

Not long since an Ulcer of the Bladder was committed to my care, being the relict of a Go­norrhoea ill managed by a Chirurgeon, using Re­stringents unseasonably.

Ulcers in the meatus Penis, as also in the Prostates, are more frequently offered to our help: as lately another person applying to me having an Ulcer procured in the Prostates, from the [Page 145]like improper and pernicious course: and al­though Gonorrhoea's are frequently cured, and may with much certainty and safety in skilful hands; yet there are many that patch up a seem­ing Cure for the present, but future consequents are sad memento's of their Undertakers folly. And at this 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.

Ʋlcers in the Bladder are known by pain a­bout the Os pubis and bottom of the Belly; a strong or stinking Urine, if the Ʋlcer be for­did; a purulent or furfuraceous matter float­ing; a hot or sharp Urine, which causeth a painful discharge thereof, and sometimes with [Page 144] [...] [Page 145] [...] [Page 146]difficulty, if any excrescence or viscous matter obstruct the passage.

These Ʋlcers 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 Ʋrethra or urinary ducture; and these com­monly are the products of a preceding Ʋlcer 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 Ʋrine.

Capital Symptoms that attend the Ʋrine, 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 [Page 147]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 [Page 148]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, [Page 149]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 [Page 150] [...], 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 be depraved, is worth our inquiry; for from hence is the designment of Cure grounded, to prevent and take off both the one and the other. So long as it remains in its due state for quantity and quality, it is very necessary and useful to the body; but when it degenerates or is redundant, it raiseth disturbance variously, according to the parts it does infest: hence Ca­tarrhs or destillation of Rheums into the Eyes, causing them to be sore, hot and inflamed; sometimes upon the Lungs, causing vehement Coughs and shortness of breath: from hence pun­ctures, stitches or sharp pricking pains in divers parts of the body; Head-aches, Tooth-aches, spu­rious Pleurisies, Rheumatisms, Arthritic or Gout-pains.

Now this serosity does abound, either from a deficiency of the digestions, and transmutation [Page 151]of alimentary matter received: or from a defi­ciency of secretion or, discharge of it by those Emunctories appointed for that purpose; for as there is a continual supply by eating and drink­ing, so there ought; to be a proportionable dis­charge.

First, From a defect of digestion in the Chyle and blood, when they do not attain that com­pleat state as Nature hath required; but receive only a crude and imperfect transmutation: and this sometimes procured from an injurious sort of meats and drinks, or offending in quantity; as much Fruits, small Beer, Water, &c.

Secondly, From an insufficient discharge, and for want of due evacuation, this Serum does a­bound and become superfluous: that is, when the parts destined by Nature to separate, attract and transmit this serosity of the Chyle and blood, do not perform their office duly; as when the Lymphaeducts, Spleen or Reins are deficient in their functions; also when the Pores are occlu­ded, and Transpiration hindred, these occasion the overflowing and abounding of this serosity, having not its right conveyance, due vent, and discharge.

This Latex or Serum rarely continues in a so­litary state of redundance, but also is then soon vitiated and becomes depraved: for as our meats and drinks are endowed with a Tartarous and saline principle; so this Serum is impregnated therewith, and abounding variously as the food received contains variety of Salts; which disco­ver [Page 152]themselves and appear more or less, accor­ding to the strength or debility of the digestive power of fermentation, being able to subdue and subject them to the service of the body; or otherwise to suffer them to be exalted in their peculiar natures: and then as they are more sharp or milder, so is the pain and distur­bance from them greater or less.

But how this saline serosity does discharge it self upon the Joynts, and affect them with pain, is (by the consent of Authors) from a laxity or imbecillity of articulation, or promptness of the Joynts to receive: but this reason I cannot close with, since a more probable and rational may be given, which is from the formation and conformation of parts, as thus: That when the Serum sanguinis this serosity does effervescere and ebullire, estuate and grow turgid in the great Vessels of the Veins and Arteries, afterwards in the smaller Vessels; then it comes into their branches, and so to the extremities and termina­tions of them; which terminations (most of them) are placed in the Joynts, where they do effundere, discharge and let out this hostile inju­rious Serum, and therewith torment the Joynts, causing sharp lancinating Pains, Inflammation and Tumor of the part, &c. such Symptoms as attend the Gout.

As the Gout makes its progress from one state to another; so the Symptoms supervening do vary and appear gradually, as the disease ar­rives to its height and fierceness. First, the part [Page 153]affected is more tender and sensible than usual­ly, also less active and vigorous in motion: and before a fit of the Gout oftentimes a general in­disposition or febrile heat disturbs the Patient; the blood then fermenting for a purification, casts off this morbific tartarous serosity upon the Joynts. The part thus affected most common­ly is tumefied, and sometimes inflamed, pains in­crease and grow very sharp, and in some by time and continuance of this disease a tophous hardness or Nodes seize the part as the relicts and insignal characters thereof.

Some have the Symptoms of the Gout in a remiss degree, only at changes of the weather and seasons of the year, and are not confined to the house by a considerable seisure and great pain, but can walk abroad, although with some complaints and indisposition: others are attack­ed more violently, and so disabled, that they are laid up and deprived of their liberty.

To some the Gout is hereditary, derived from their parents in the principles of their Nature, and will shew it self, although they be of a strict and regular life: to others it is adventi­tious, arising from the procuring causes of this disease in the course of their life; by intempe­rate and inordinate, or incongruous way of li­ving in the Diaetetics, unsuitable and unfit for their condition of body.

For Cure of this Disease, these aims, are to be intended and prosecuted.

First, That this saline acid humor be preven­ted [Page 154]and stopt in the fountain or spring, the parts mandant from whence it does arise, that a future supply may not be generated.

Secondly, What is already produced, may be mortified, abstersed and evacuated out of the body.

Thirdly, That the parts recipient, invaded and debilitated, may be eased, restored and ro­borated.

The first intention is performed by such means as rectifie and fortifie the digestions, whereby their elaborations and transmutations of aliment received may be pure in their pro­per natures and free from any degenerate mix­ture: and here both good Aliment and good Medicament is required: for election of meats and drinks, and other Diaetetic rules necessary for gouty persons to observe, consult that Book called, The Preservation of Health, &c. where at large you are advised, and too much to in­sert here. For Medicament, gentle Vomits are profitable, both for cleansing and removing of the fundamental matter; as also for a revulsion from the part affected, and retarding the cur­rent thither: but where that operation is not convenient, then keep the stomach clean with a good Purgative downwards: the best Shop­medicines for this purpose is Pil. stomac. and Aloephangin. also Syr. de spina cervin. and Elixir propriet. in the intervals.

The second designment, is attained by Alca­lyes, whose properties are to correct and kill all [Page 155]acidities and corrosive sharpness: and these are the Salts of Vegetables made by Calcination: and next to these are Absorbents that imbibe and tame acids, being alkalisate or affine to Al­kalies: as Oculi cancror. Coral. Chelae canc. cran. human, corn. cer. ust. margarit. sacchar. Saturni. &c. But besides these, Cathartics, Diaphoretics, and Diuretics are to be used in due order; where­by the tartarous matter residing or fluctuating in any part of the body may be sent forth seve­ral ways.

To perform the work of Purgation you may use Arcanum corallinum and Pilulae Antimoniales prepared to work only downwards, which are of the better sort of Medicines made publick: in my own Practice I use Pil. Arthriticae nostr. which seldom fail my expectation; being seconded by some other Medicines in their due place.

After Purgation promote Transpiration, for this does much abate and scatter the superflu­ous serosity, driving it à centro ad circumferen­tiam, and transmitting it by the Pores; and may be done with ♁ diaphoret. or with decoct. rad. bardan. sassaphras, chinae, sarsaparillae, card. benedict.

Also Evacuation by Urine is of great advan­tage to spend and drain the acrid Serum that way: and to set forward this operation, use Sal succin. or the Mercurial liquor that separates from the Oil and Salt after distillation: also Sal volat. urinae & viper. are profitable.

To effect the third intention? Topical Medi­cines [Page 156]to asswage pain, to discuss and roborate, are useful and necessary to relieve the part af­fected.

For allaying pain in time of extremity, this Anodyne Cataplasm hath been used, and com­mended for successful: Rad. lilior. alb. althaeae a­na ℥ii. fol. parietar. hyoscyam. ana M. j. Coq. lact. vaccin. q. s. in mucilaginem, addend. micae panis alb. ℥ii. pulpae cassiae ℥j. croci pul. ʒ ss. ol. rosar. q. s. fiat Cataplasma, s. a. This Medicine is well designed and congruous in all its parts; and like unto this several others for the same purpose may be formed, and which will perform the intended effect: yet they cause a relaxness, and leave the part weak and tender: Unguents and Liniments upon the same account are cautiously to be used: but Lixiviums to foment the part affect­ed, are profitable to asswage, discuss, and robo­rate.

But they that will take a little pains to pro­cure a good Medicine, let them unite Sal volat. urinae cum spir. vin. rectificat. by digestion and circulation, in which if you dissolve a little Cam­phire, you have then an excellent Topic Reme­dy both curative and prophylactic, with which you are to foment the part every day.

Or if you will make a Cataplasm cum mica panis alb. macerated in spir. vin. addend. croci pa­rum, you have then a safe and good Medicine.

Some do adventure to use Restringents, Re­pellers and Coolers, to drive back the humor flowing; and they are made of Bol. armen. sang. [Page 157]dracon. malicor. album. ovor. acetum, and such like; but this is hazardous and dangerous to give the morbific humor a sudden check, which may re­turn upon some noble part; therefore I advise against such attempts, being not rational, and experience hath confirmed their fetal events.

For a Prophylactic-Remedy, or by way of prevention, to keep off the returns of the Gout, Spigelius commends this Medicine, and calls it his Podagrical Antidote.

R. Troch. de viper. fol. centaur. min. chamae­pith. beton. ana ℥j. chamaedr. ℥ii. rad. gen­tian. aristoloch. rotund, poeon. bardan. ana ℥j. baccar. lauri, myrrhae, rhabarb. elect. spic. nard. ana ℥ss. caryophyl. ʒ ii. in pulve­rem redacta, serventur in vitro, vel cum melle despumato misceantur.

Of the Powder he appoints a scruple for a Dose, of the Electuary a dram; and a draught of warm water to be drunk after it. The Me­dicine is good; but warm water to be taken after, I cannot so well comply with that. For my own Patients, I give an Extract designed for this purpose, and sometimes a Diet-drink, which strengthens the digestions, and prevents the sa­line serosity from generation, and are preserva­tives of value to those that have experienced them.

Now as concerning the curability and incura­bility of the Gout, we will make some inquiriy into this matter, because 'tis acknowledged by all to be of difficult Cure; and by many 'tis ac­counted [Page 158]an incurable disease: this opinion be­ing fixed in the minds of most people so afflict­ed, and despairing of help, at least of a Cure, they provide only to abide the pain, and resolve to be contented with their condition, as think­ing there is no other remedy but patience, be­cause they see few or none cured.

But I cannot consent with this opinion, that the Gout is an incurable disease, knowing the contrary by experience; although I must con­fess, such Cures are rarely performed: and the reason why; not so much from the impossibi­lity of the thing to be done, as from the intra­ctability of the persons to be governed and ru­led, and the circumstances under which some persons lye.

For the younger sort being the most curable, or in the best capacity for it; they will not be confined to such Methods, Rules, and abstinence for such a time as is requisite for this Cure; but indulge themselves in the liberty of their enjoy­ments, and pleasures of sense, doing those things which are very opposite and injurious to their condition of body; whereby they set on and procure the returns of this disease, notwithstan­ding some former good means used, hath taken good effect, and checkt the obstinacy of this Malady with hopes of prevailing.

For the old and feeble sort, they have not that assistance of Nature to cooperate with the means; besides, the continuance and long im­pressions of this disease, habitually indisposing, [Page 159]perverting, and enfeebling the parts affected, both mandant and recipient; which makes the perfect restauration of such, of much greater difficulty, and very rarely effected.

To these we may add, that for the most part, the Gout takes up its quarters with the rich and those that live plentifully, having all things for pleasure, ease and delight.

Dormit & in pluma purpureó (que) thoro: and the people thus stated cannot, at least they will not restrain their appetites or cross their inclinati­ons, and be observant of, and obedient to the Rules required; abstaining from the things they love and delight in; but on the contrary, do gratifie their senses, although they suffer for it afterwards: and finding the disease not to be mortal, they chuse rather to undergo pain for a time, than deny themselves the pleasures of their life as they account: and therefore it is, that the poor are seldom troubled with the Gout, be­cause they fare hardly, and labour much, both which are great enemies to and opposers of the Gout, giving no place for reception thereof, or long aboad at least, if it chance to lodge there: hence this disease was called by some [...].

Thus you see, and more at large might be amplified; how the Gout becomes so triumphant and invincible, having gained the character of Opprobrium Medicorum, as able to baffle all the designs of Physicians and their Remedies.

But amongst the vain Opinions that are raised [Page 160]concerning the Gout; this is not the least that alienates the minds of most people from their reason, and checks their endeavors for help: viz. that it is dangerous to tamper or provoke this Lion, because some have miscarried, and died by trying with uncertain means and ha­zardous Medicines; who otherwise probably might have lived a long time, the disease com­monly not being mortal, but a lingering and torturing sickness. And farther, it was related to me, that a great person in this Kingdom, a few years since (now dead) being often and much afflicted with the Gout, his Physicians told him, that the Gout kept him alive; and if he were cured thereof, he would dye soon after.

To obviate these objections I answer, and part hereof I grant, that some have dyed by their endeavours for Cure; and this not so strange, for the like may be said in all other dis­eases, that some have dyed by their Physicians, or such as they intrusted as Physicians, and not solely or chiefly by their disease: Examples we have had in the most, if not all diseases, the most curable and facile to be dealt with: so that by unskilful men, improper courses or de­signments, and by bad Medicines, or casualties happening by the Patients folly or their Ten­ders, many have dyed in the prime and strength of their age, by endeavoring for Cure in Disea­ses not mortal nor of sudden danger in their own Nature, and amongst those the Gout may be reckoned: So that if you will plead for no [Page 161]Physick, no tampering (as you call it) with the Gout, by the same argument you may abandon Physick in all other sicknesses; for the adven­ture is equal, and the security depends only up­on the judgment and ability of the Physician, and no more hazard in this disease than in ano­ther. I say therefore, in case of the Gout, as also in all other diseases, if you will securely pro­ceed; take a knowing man well grounded in the Theory, and through paced in the Practice of this Art; Having a frequent experience in the progress and Cure of Diseases, and a critical Observator of the Gout in particular; this man you may as freely trust, and safely yield obedi­ence to in managing a Cure for the Gout, as you can do to other Physicians, in all cases whatso­ever.

Now as for those Physicians (if there be any such so ignorant or fallacious) that alledge the Gout to be any way a Preservative of Life, and pretend not to cure it for that cause, I must tell them plainly; first, that this is only a pretence to palliate their inability, and a crafty evasion to shift off the censure that may fall upon them, for not curing what they ought, and would wil­lingly do if they could.

Secondly, To shew the pretence is errone­ous and void of truth; we will search the Gout and see if there be any thing in it, or appertain­ing to it, that is a Preservative of mans life, or conducing to his health and a sound state of being.

In the Gout there is no pleasure nor recrea­tion either of Mind or Body; both which are promoters of Health, and consequently prolon­gers of Life: but on the contrary, the Gout is attended with a sedentary inactive confinement, melancholy, pain, watching, and unseasonable sleep, (the consequents and effects of which are debility ot all the faculties and enervation of strength) which as these continue longer or more violent, and return more frequently and often, by so much more is the Patient damni­fied, both for the present and the future, and rendred more infirm and liable to the decays of Nature.

But perhaps you will say, this serosity and sharp punging humor, falling into an ignoble part, and far off from the Vitals, is much better and safer there than to wander up and down the body which (as it hath happened sometimes) may invade a principal part, and there threaten or cause death: therefore so long as this humor hath a recourse to the Joynts, and is not turned off from that current, the Patient is not in such great danger as otherwise.

To this I reply, That true it is, if there were a necessity that this Tartarous gouty humor must invade one part or other; better it is that it passeth a safer way, and lodgeth in an ignoble and remote part; and better it is that the Phy­sician does nothing than do hurt, or run a ha­zardous course. If he cannot eradicate this morbific matter, stop the spring and fountain [Page 163]from whence it does arise, and where it is gene­rated: or this being too hard and difficult a work, if he cannot derive the stream and issue thereof to the vents and outlets that Nature hath appointed and framed for a discharge of superfluous and degenerate humors, but lets them have their course (because not mortal) to the constant trouble and damage of this or that part in particular, and consequently makes the whole to suffer sympathically and by consent: such a Physician either hath not a true notion of this disease the Gout, or else he wants commanding Medicines elaborated by his own hands, exqui­site and effectual to answer the indications that this disease and causes thereof will put him upon for relief of the Patient: but to pretend that this disease must not be cured, because it spends or employs the humor in a safe way (so called) is much what alike (but very unlike a good Physician) as to suffer a man to continue lan­guishing in a Loosness or Vomiting, because it dischargeth some peccant stimulating matter: but in this case, as also in that of the Gout, the extravagancy and irritation of noxious humors are to be checkt, collected and sent forth by good Medicines, in a placid gentle way, through convenient ductures and outlets, and not let to continue in a detrimental extravagant course.

Now concerning the curability and incura­bility of the Gout, I do owne that some are much more capable of Cure than others, by the nature and condition of their bodies: and some [Page 164]are not curable, as age and other cirumstances have reduced them to an incurable state: yet I say, in the worst of cases there are mitigations and helps, that check and tame the fierceness of the disease, render it more tolerable and easie: and such Prophylactics or Preventives there are (with a due Regimen of life) that will keep off the frequency, and retard the returns of this painful Malady.

Thus much concerning the Gout fixed, or constant to a part: it remains that I deliver my thoughts and experience touching the Rheuma­tism or running Gout, so called; because it shifts from part to part, invading not only the Joynts, but also the membranosum Genus, the Membranes both of the Muscles, Viscera, and Bones.

Hence it is, that sometimes these pains are ex­ternal in the Muscles and habit of the Body: sometimes internal, when the Viscera are assault­ed; as the Lungs, Liver, Intestines, Spleen, &c. sometimes these pains affect the Bones, by pricking the Periosteum, that Membrane which covers and enwraps the bone.

Some complain of their Arms, others of their Shoulder-blades; some the Bach, others or at other times the Breast; sometimes the Thighs, and sometimes the Legs; the humor shifting and moving from one place to another: and this upon changes of the weather, turning of the wind, and seasons of the year; these pains do go and come, afflicting more or less: and yet [Page 165]no swelling, Inflammation, or outward appea­rance upon the part grieved.

These pains continuing, or frequently infest­ing, do debilitate and disable the parts affected; insomuch that some go 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 [Page 166]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 [Page 167]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 Ʋse 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 [Page 168]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 [Page 169] 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 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 [Page 171]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 [Page 172]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 [Page 173]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 [Page 174]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 [Page 175]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 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; [Page 176]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 [Page 177]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, [Page 178]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, [Page 179] Ʋnguents, &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 [Page 180]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 chosen, as not to displace or put by a curing Medicine; for no Opiate or Anodyne is curative, but palliative, and for allaying the ex­tremity of pain, and to give rest only: for pain keeping the sick from natural and wonted rest, does bring great weakness and lassitude of spi­rits. Since pain therefore and long watching enervates and debilitates Nature greatly; on the contrary, sleep refresheth and restores much, that the enfeebled Patient then may gain respite from pain, and refreshment by rest; when the sick is in danger, as being tyred out for want of ease and sleep, then the case calls for Ano­dynes, and ought to be made use of.

But because Opiates and Anodynes do not re­move the morbific cause, therefore they are not to be insisted upon, or relyed on as curing means; but they are to be used in cases of ex­tremity for mitigation and ease; and at such due times as not to hinder the operation of any curative Remedy.

Tumors Internal, Scirrhous, Apo­stemate, and Cancerous.

TƲmors may fitly be placed next to In­flammations, because Inflammations are the foundation or occasion of many Tumors; though Tumors sometimes arise not procured or cause by Inflammation preceding: but most frequent­ly Tumors grow up and take their rise from pain; and where pain is, Inflammation (in our sense) follows of course: and there is much reason for it, because pain and heat does arise from one and the same principle, as already set forth: and when this painful inflaming heat continues, you may rationally expect a Tumor (by fluxion) to follow; if not prevented by good means, to pluck out the spina morbifica the thorn in the flesh; or Nature so powerful and prevalent to free her felf.

Tumors have their denomination à tumeo to swell; and the Greek word [...] fignifies pro­tuberance or expansion; so that by Tumor you may understand a part enlarged, and increased in bigness preternaturally: for natural extensi­ons are not to he called Tumors: as the dugs or belly of a woman with child, though they be extended bigger than ordinary, yet it is natural, or by the course of Nature.

You are not to expect here a Chirurgical Trea­tise of Tumors, as if tire Cures hereof were to be [Page 182]performed by manual operation: but I shall shew you some differences of external Tumors that require such management, only that you may the better apprehend and judge of internal: for as external Tumors do arise from internal matter, and present outwards; so hidden inter­nal Tumors are formed of the like matter, and from such occasions much what as the external, save only some outward injuries that may affect the superficial, and hot the interior parts: as Contusion, Scalding, Cupping, Vesicatories, &c.

Galen in his Book de, Tumoribus, reckoning up all sorts of Tumors as he supposed, gives in the account to be sixty one: but Ingrassias in his Survey of Tumors afterwards, adds art hun­dred sixty five more to them, and gives particu­lar names: but examining the reason hereof we find the advance of number, not any way to promote their Cures, but makes confusion and perplexity in Practice: for this variety is not from any real difference in their nature, but from some accidental difference between them in appearance; as magnitude , figure, situation, &c. so that the same in kind is repeated by a­nother name: therefore this vast number will admit of a great abatement, and the designment of their Cures much easier and better managed, when all are reduced under a few general heads, respecting their continent matter, and many joyned together under one name by the union and similitude of their nature.

The difference therefore of Tumors arising [Page 183]from the variety their material causes, and the modus generandi, are chiefly to be lookt it; for from thence is the designment of Cures more especially bottomed; but with some respect to the seat or part affected.

The general division of Tumors from their material causes (in the common received Pra­ctice) is sixfold.

First, from Blood, which makes a Phlegmon.

Second, from Choler, which generates an Ery­sipelas.

Third, from Phlegm, which begets an Oedema. Fourth, from Melancholy, which makes a Scirrbus.

Fifth, from serous or watry humor, which generates watry Tumors, as Hydrocephalus.

Sixth, from Flatulency, and this Tumor is cal­led Emphysema, Inflatio, Tumor flatulentus.

Under these six general Heads are comprised alfo several other subdivisions: as first, such as arise from the degenerate and depraved condi­tion of these simple and single humors: second­ly, such as spring from the composition and mix­ture of the simple humors one with another.

How far I can comply with this specious Do­ctrine, whether it be not more notional than practical, and my exceptions against it, I shall not declare now, in regard time, and the intend­ed conciseness of this Work, will not give me leave to establish my own opinion, and judg­ment dissenting in this matter; nor is it necessa­ry to lay open the intricacy of out design in [Page 184]hand, by debating and controverting this Do­ctrine, which relates chiefly to external Tumors and Chirurgical Practice.

And although internal Tumors are generated of the same matter as external; yet all these differences (supposed to be true) cannot so nice­ly and certainly be adjudged and determined; but indications from thence must be more gene­ral and at large, for dislodging, cleansing, and carrying off any such material cause, that infests and tumifies a member or part.

Since therefore internal Tumors do not pre­sent themselves to the eye, for a more certain and exact: knowledge; we are to make judg­ment of them and determine, from the fabrica­tion and office of the part affected and com­plaining; which gives some intimation thereof, what Succus, or depraved and preternatural matter may reside there: as also from the gene­ral constitution and disposition of the body an­tecedently disposing thereto: for that Cacochy­my which is predominant in the body, is most likely to be the cause or matter of the hidden Tumor, except some other circumstances and probabilities do mainly suggest another morbous matter.

From the nature and condition of the part affected, you may sometimes conclude the Tu­mor there to be of such a kind: as when the left Hypochonder is preternaturally extended, you may rationally judge flatulency and melancholy feculency to be the matter and cause thereof.

From the signals of a serous Cacochymy, or abounding serosity in the body; you may con­clude, if swelled legs or feet do happen hereup­on, the Tumor is hydropic.

For the modus generandi, and the occasional causes of internal Tumors, they may be reduced to these five.

• 1. Attraction.
• 2. Transmission.
• 3. Congestion.
• 4. Obstruction.
• 5. Extravasation.

First, By Attraction humors are brought to any part, and there accumulated: and thus pain increasing heat preternaturally (like a Ventose or a Vesicatory) does attract from the adjacent parts, and procures a confluence of humors to the part pained, and thereby forms a Tumor.

Now if pain be so apt to beget a conflux, and consequently a Tumor; then you ought to be­ware, and often suspect 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, [Page 186]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 Arm­pits; 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 [Page 187]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 [Page 188]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 Ʋlcer 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 [Page 189]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 [Page 190] 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 ignoble part; or to such place where means can better be used, and more apt for recession, or egression of the continent material cause: but if the Tumor apostemates, the danger is greater or less according to the nature and condition of the member or part: if it indurates, the danger is delayed; but if it corrupts the part, the danger is greater, and more speedy in execution.

Apostem is that degree or state of a Tumor, when it is maturated or ripe, which is called Suppuration; the material or humoral cause be­ing then converted into a Pus or purulent mat­ter: and while this is in fieri doing, all Sym­ptoms [Page 191]are aggravated, pain, heat, pulsation, ten­sion are greater: but being perfected, they all decrease again, and the Patient finds ease; but not out of danger in these internal Apostems; for if it be so seated, where there is no conve­nient vent or Emunctory to discharge it, the case is desperate.

As the humoral matter that formed the Tu­mor was more benign and good, as pure blood; so the converted Pus or purulent matter from thence, does commonly answer it in goodness: for of good blood and in sound bodies, the maturation is more kindly, the Pus white, mild, and not endangering to corrupt the part: but in foul depraved bodies and malignant diseases, apostemated matter is more putrid, stinking, and venenous, and does threaten a Gangrene or mortification of the part: and therefore such in­ternal collections of matter, in pestilential and malignant Feavers, Venereal Pox, small Pox, and such like, are commonly mortal.

Scirrhous Tumors are such, as when the con­tinent matter does not maturate and become soft, fit to break and discharge; but grows hard and fined in the part, not apt to be dis­charged or removed by discussion or suppura­tion. And this the word Scirrhus imports, from [...] induro.

Tumors in some parts of the body are apt to suppurate, as in the carnous or fleshy: in other parts, as the Joynts, Tendons, and Ligaments, more inclined to indurate and become scirrhous: [Page 192]and the reason may be this; that those parts which take their origine from blood, are more prompt and ready to suppurate as the flesh; but those which take their rise from seminal matter, as the Tendons, Ligaments, Nerves, &c they are more inclinable to scirrhosity or hardness.

But besides this disposition of the parts affect­ed, there is also, and chiefly a propension in the congested or influxed matter of these Tumors: for by the different nature of humoral matter, some is more fluxible and thin, participating much of serosity, and apt to transpire or be dis­cussed: other more yielding to a preternatural digestion and suppuration, as the blood that is pure and good: other inclining to be viscous, coagulated, and consequently to indurate; as a feculent, grumous, or gross blood, deprived of its serosity.

And farther; besides the disposition of parts, and that of the material cause inclining to this scirrhosity, there may also come in and be joyn­ed with these a third promoter, which in some cases may be the chief cause, and that is, an ill method and injurious Medicines, so endeavour­ing to remove, may thereby fix and fasten the matter: for thus a Tumor which might probably be dispersed, may be changed from its own ca­pacity and tendency , and become scirrhous and indurate: as when constant or great Coolers are administred to abate the symptomatical or concomitant Feaver, the matter of the Tumor is thereby fixed and impacted;which otherwise [Page 193]might have surrendred unto proper and power­ful Medicines duly used. And e contrà, by too great Dryers and Heaters, the thinner part is evaporated, and the grosser remains; therefore medio tutissimus ibis; good resolutive transpi­ring Medicines, taking their turns with the use of proper Cathartics, is the safe and bed way.

These scirrhous Tumors, although they are not so dangerous for the present, except they be very great, or cancerous; yet they are the foundation of some chronic or lingering disea­ses, which proves very contumacious, and some­times incurable, especially if the Tumor be la­tent and concealed: and Hectic Feaver some­times takes its rise from hence, which if you think to cure by Emulsions, Restauratives, and cooling Drinks, you will be much mistaken in your purpose and endeavours.

These scirrhous Tumors, some are with pain, some without: those that have pain are more hopeful (except they be cancerous) but those which are insensible upon pressure, are more dif­ficult, or incurable. Now according to the na­ture and degree of depravedness in the continent matter, and from the part affected, so are these Tumors better or worse to be dealt with. And because these Tumors are internal and hid from the eye; therefore judgment is to be given of them from their situation, and from the constitu­tion, with other circumstances of the Patients body.

But although these scirrhous Tumors are thus [Page 194]difficult to be undertaken and managed; yet these are not the worst, and they may arrive far­ther, and to a more dangerous state: as when Tumors in their variation and degeneration do turn cancerous; and this is apt to be in such bo­dies as abound with a black feculent blood; or a thick blood adust by intemperate heat: and by how much the blood thus exceeds in this preternatural condition, by so much the Cancer is compleated, confirmed, and the worse: and this supervenes a Scirrhus commonly, as being an apt previous disposition; (but may happen also without a Scirrhus preceding, from other Tumors degenerating into Cancers) and there­fore in the Cure of scirrhous Tumors, great cir­cumspection and diligence is to be used, lest by their delay add continuance, or improper usage of Medicines, these Tumors do not become can­cerous and desperate, as sometimes it falls out so.

Now a Tumor is said to be cancerous, when it turns into a dark reddish, or livid and blackish colour, declaring this transmutation and dege­nerate state. The beginning of these Cancers are very small in compass (as those that present outwards do manifest their gradual inlargement) but by time they increase and grow big, with tumified Veins round about.

These cancerous Tumors may happen to any part of the body, but chiefly and molt frequent­ly, in the upper parts about the Face, as Nose, Lips, &c. or the Dugs, and other glandulous [Page 195]parts; also the Womb is thus affected sometimes from Tumor there bred, venereal or other, degenerating cancerous.

These Tumors sometimes are occasioned from the menstrual suppression in women; and Hea­morrhoidal in men: and when it happens so, those causes are to be removed with speed.

Great skill and circumspection is to be used in Tumors of this nature; lest provoking the continent matter, it grow more fierce, eating and ulcerating; and from a cancerous Tumor, it become a cancerous presiding Ʋlcer, which is worse: now the signs of this Tumor inclining to break and ulcerate are, great heat and pulsation in the part.

The difficulty or incurability of Cancers lye here; for that the cancerous matter will not yield to digestion or discussion: and this because the part affected is debilitated and overcome, by this depraved, malign matter, that it cannot exercise its transmutative and digestive power: nor will this cancerous matter obey Discussives, by reason of the viscidity and grossness thereof: wherefore Hippocrates gave sentence, That such are not cured but by section or ustion: and yet this is not to be done, except the Cancer be small, and in such a part as will admit of ampu­tation.

If Cancers external are thus difficult to be ma­naged although they appear to the eye, and are subject to manual operation and tractation; the internal must be greater and more hazar­dous, [Page 196]where they cannot be applied unto after this manner, with convenient Topical Medicines: therefore prevention in time is mainly to be en­deavoured when a Tumor is generated, lest it change into this dangerous condition: for I find by the design of Practisers in the Remedies appointed, that palliation is sought for, the Cure not hoped for.

The grand intention to be prosecuted for Cure, is to change the condition of the blood, which does feed and supply this Cancer; so that the antecedent cause being taken away, the continent will then more likely abate; and un­til that be done, this cannot be expected.

The means indicated for Cure of these cance­rous Tumors are branched into three parts: Diea­tetic, Pharmaceutic, and Chirurgical: but I shall not enlarge upon the Indications for Cure, for that these cases are so nice and difficult, as not to be handled with generals; but from a colla­tion of all the circumstances attending the Pa­tient, which varies every particular case.

And so I pass from Tumors, to remark their usual commutation and transition into Ʋlcers, the next considerable in order to be treated of.

Ulcers internal.

THE Latine word Ʋlcus is derived of [...], signifying a disjunction of parts or solution of continuity: but to distinguish this from other solutions of continuity; an Ulcer does yield a Sanies or purulent matter; so that a Wound coming to digestion and affording pus, may then be called an Ʋlcer: and any part that is gauled, raw, and tender, the covering Mem­brane being fretted and eaten away by some sharp humor, or other cause, it stiled Excoriation only, until it produce corrupt matter; and then it is properly called an Ʋlcer: thus internal parts are sometimes excoriated, raw, and painful, but cicatrized or skinned again before it arrive to the degree of an Ʋlcer. And thus it is most fre­quently in the urinary ductures or passages, and sometimes in the Guts; but such Excoriations are not to be slighted or neglected, lest they beget Ʋlceration, as sometimes it falls out so.

By external or outward Ʋlcers which are manifest to the eye, you may conceive of inter­nal Ʋlcers; for they arise from the same causes, and have the same accidents: but I shall not inlarge upon all the accidental differences that attend upon, and distinguish external Ulcers, as not so pertinent and necessary to our subject in hand.

The essential and most considerable diffe­rence [Page 198]of Ʋlcers does arise from their causes, and from the part affected; which bears the great sway in curing, and from whence the chief indi­cations are taken; for although in external Ʋl­cers other accidental differences may be obser­ved and noted; yet in internal Ʋlcers, such dif­ferences cannot be regarded, as being obscured or hid: so that whether they be broad or nar­row, deep or shallow, fistulous or otherwise, is hot positively to be said; and if it were known, institution or method of Cure could not be so varied as external are capable of, by reason these are subject to manual tractation.

The continent causes of Ʋlers, are such mat­ter as emane and flow from thence; and that is of three sorts: Ichor, Pus, and Sordes.

The first is an ichorous or sanious matter, be­ing thin, indigested and watry, or diluted bloody.

The second is a Pus or purulent matter, of a betted consistence and concocted thicker.

The third is a sordid foul matter, more thick and glutinous.

The ichorous thin matter usually issues in the beginning of Ʋlcers, and denotes indigestion; and also at any time afterwards does declare the same, that the Ʋlcer is not in a good healing condition.

The Pus or purulent matter signifies the Ʋl­cer to be in a better state of healing; and if it be white and sweet, these are good signs.

The sordid gross matter does intimate a pre­ternatural [Page 199]heat of the parts strongly exsiccating, but not healing; for as much as this matter is foul and stinking.

Ʋlcers for their manner of generation and rise, may be caused these four ways: by Erosion, by Frication, Apostemation, and Contagion.

1. By Erosion Ulcers are begotten in any part of the body, when a sharp corrosive humor does excoriate and eat into the substance of any part: and being thus injured, is thereby per­verted in its office, and self-preservation; con­verting that nutritious Succus which comes for its supply, into an ulcerous degenerate matter, no way useful but to be excreted and voided.

And thus a Phthisis an Ʋlcer of the Lungs is sometimes generated, from a sharp Serum inva­ding that tender part: and thus a Dysentery is sometimes begotten, being an ulceration of the Guts, from sharp excoriating humors: and thus an ulceration in the Meatus Penis is bred, from a sharp eroding Gonorrhaea: and an Ulcer in the neck of the Bladder may be planted there, by a sharp gauling Urine.

2. By Frication or attrition; as when any hard, bony, or stony substance, does fret, raze, and excoriate a part: and thus a stone begets an Ʋlcer in the Kidneys or Bladder, and some­times in other parts of the body.

3. By Apostemation; as when any Apostem breaketh and dischargeth its matter, an Ʋlcer is left behind, though the Apostem be gone: and thus are Ʋlcers generated sometimes in the Ear, [Page 200]from a preceding Apostem: in the aspera Arteria after an Angina or Squinance: in the Breast af­ter a Pleurisie; in the Lungs from a Tumor sup­purated there: also in the Liver, Spleen, Womb, or other parts apostemated.

4. By Contagion or infection: and thus wo­men whole Privities are infected, do communi­cate this virulency or venom, and seize the Ge­nitals of their Partner, from whence venereal Ʋlcers do arise: and thus men whole Seed is tainted, do infect sound women, and cause viru­lent Ʋlcers in their Privities; which malignity not being well managed and mastered by skill, and efficacious Medicines, it spreads, breaks forth, and begets Ʋlcers in many other parts of the body: as at large I have set forth in ano­ther Tract, entituled, The Mystery of the Vene­real Lues.

Internal Ʋlcers, though they disappear, yet are known to be by these signs.

First, Pain, which is more or less according to the nature and sensibility of the part.

Secondly, From preceding causes, as Inflam­mation or Tumor preceding, whose Symptoms being allayed and ceased, yet pain remains.

Thirdly and manifestly, From excretion of ulcerous matter, where there is any ducture or outlet for discharge: by the Intestines, by the Privities, the Nose, Ears, or Mouth: but where there is no passage or vent, it corrupts the con­taining part, and is mortal, except a passage can be made by section.

Ʋlcers 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 Ʋlcers 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 Ʋlcers 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 [Page 202]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 Ʋlcers: That such as arise from some remarkable dis­ease, as Dropsie, Scorbute, Venereal Lues, or other malign and Cacochymical habits of body; that these Ʋlcers 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 Ʋlcer, must be removed before the Ʋlcer 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 Ʋlcers, 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 Ʋlcers, 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 [Page 204]dead: and therefore a Gangrene is capable of Cure , but a Sphacelus not, because the part is dead.

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 [Page 205] 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 Ʋstion 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 [Page 206]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 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 [Page 207]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: [Page 208]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 undi (que) pustulis exulceratam & incrustatam, transpiratio & even­tilatio difficilior fit. Si enim inflammationes in­ternae ipsius (que) 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 undi (que) satìs quidem ex­pulsis, gravissima symptomata partium internarum inflammatarum nihilominus perdurant, eo us (que) 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 [Page 209]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, Ʋstion, 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 [Page 210]also in the Vagina Ʋteri, 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, [Page 211]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 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,

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: [Page 212]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.

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 ground­work, 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 [Page 214]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 [Page 215]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 Ʋrine, 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 [Page 216]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 Ʋlcer will follow of course: this Ʋlcer, if not of a very malign nature, or very ill seated, is yet cu­rable, and the Patient may do well and reco­ver, by care and skill of the Physician, and tra­ctability of the diseased: but else this does cor­rupt and mortifie the part; and then there must be dismembring (if capable) which is ha­zardous and doubtful; or mortification of the whole will soon follow, which is certain.

Thus you see some go half the way; some but a quarter; and come off well: others that are ingaged in a fatal sickness, must go through and finish the whole course by these gradations, or else per saltum; although they may step over, and miss some of them, yet they do arrive at the period of mortification.

I have now finished what I intended briefly upon this Subject, having given you a prospect of this secret and lurking train of Diseases; dis­covering them in their causes and disguises; un­der what distempers they commonly are vailed [Page 217]and obscured: their signal distinguishing Cha­racters: their dependence and complication: their manner of commutation and transition from one to another: the Indications belong­ing to each state and gradation, prompting a designment and method for redress, to obviate these dangerous and growing evils.

Of Fontanels or Issues, and Setons: Shewing the right Use, and true Effects thereof.

BY the course of Nature, humane Bodies are nourished and maintained, by a continual supply of necessary food daily to be received in; which before it be assimilated and incor­porated into the substance of the body, this Aliment must undergo several transmutations and digestions: in which previous disposition and gradual preparation for nutrition, there is a separation made, the nutritive and useful part, from the excrementitious and unnecessa­ry: the defecated utile part designed for ali­ment, is still conveyed from one digestion to another, for a farther elaboration, until it hath received the complement and full perfection intended by Nature; the excrementitious and [Page 218]inutile part separated in this course, is trans­mitted and received by sinks, chanels, and vent­holes peculiarly appointed and framed for such conveyance and discharge out of the body, as the Guts, urinary Ductures, Nose, Ears, Pores of the Skin: which passages, if at any time ob­structed and stopt, the detriment and sensible damage soon confirms the necessity of their use and office.

And as Nature hath thus appointed and fra­med in the body these Vents and Outlets for the daily discharging of excrementitious and super­fluous matter, which else would deprave and corrupt the body, suffocate and stifle the life, if not in some measure duly evacuated: in imi­tation therefore of Natures contrivance, Art hath invented Fontanels and Setons as Ports and Vents, to be placed here or there, (as the variety of occasions require) to supply Natures insufficiency and inability to help her self in the discharge and emission of superfluous or depraved matter, which produceth various dis­eases and Symptoms, according to the several proprieties of their nature and degeneration; or from organical difference, and peculiar offi­ces of the parts they invade and infest.

And having such artificial passages of egress set open, by which Nature finds her self allevia­ted and disburdened thereby; does daily trans­mit and send any exuberant morbific humors to this new Outlet as to other common convey­ances for excretion, by her own institution and fabrication.

But for a fuller information and satisfaction in the use of these Fontanels and Setons, we shall consider

• First, What these are, and the manner how they are made.
• Secondly, What matter is usually discharged and evacuated thereby.
• Thirdly, For whom and in what cases they are beneficial.
• Fourthly, The places and parts of the body where they are to be set.
• Fifthly, The due ordering and dressing of them; with observations upon their various conditions and accidents.
• Lastly, The Time convenient, and signs when to close them safely, with the circumstances thereto belonging.

Vesicatories, Cupping, Cauterizing, and Scari­fication are used upon emergent occasions for a more speedy and present help, and do shew their effects sooner: but Issues and Setons are planted upon a future expectation, and their effects are matter of time, and therefore they are continued longer; and because they are used sometimes by way of precaution, there­fore they are designed to be of continuance and constancy.

Fontanels are so called from Fontinella or Fonticulus; because, as a Spring, they send out their moisture continually: and they are also called Issues, from such issuing forth.

A Seton in Latine Setaceum, is so called, be­cause [Page 220]that which was drawn through the Se­ton, and remains to keep it open, was made of hair; but now we commonly use silk.

Issues and Setons are used for the same pur­poses; but Setons having two Orifices, and by drawing the silk to and again, do cause a greater discharge of humors, if the morbific matter be brought to the superficies, as in cutany affects: but these being more troublesom than Issues, they therefore are seldomer used. Fontanels are made by Section or Caustic; but Setons are always made by a perforating Instrument; which being well known to the Chirurgeon, I need not say more.

For the nature and quality of humors issuing forth, they are divers according to the various disposition of bodies diseased or sound: such as the body abounds with and is superfluous, such is transmitted thither for emission. And that the humor evacuated is not good and use­ful for the body, appears by the concomitant signs manifesting the nature of it; itching, pricking, sharp pain about the place, Inflam­mation and spongious proud flesh rising, in some more, in others less; which are not signs of a natural good humor, but a hot, fretting, sharp, preternatural humor flowing thither, degene­rate and corrupt. Also any extravasated hu­mor proceeding from the Veins and Nerves, does move and flow thither; sometimes icho­rous or serous, and sometimes bloody: And such humors as were wont to resort to, and infest [Page 221]any infirm part, an Issue well placed does in­tercept and evacuate: and although the mat­ter that issues forth is little to behold; yet be­cause this evacuation is constant, it amounts to something considerable.

From hence we may understand for whom, and in what cases these Fontanels are bene­ficial.

For corpulent and plethoric bodies; such as feed high, and live a sedentary inactive life, whereby a liberal and free Transpiration is re­strained, Issues may be good for them by way of precaution; for they are in danger of some sudden disease.

For several diseases of the Head, idiopathi­cally affected; Convulsions, Vertigoes, Pains, le­thargic and sleepy disposition, sore Eyes, &c. Fontanels or Setons may be used with bene­fit.

In cachectic depraved bodies, and diseases from putrid humors; Issues make an abatement of the morbous matter, and give some mitiga­tion of the effects.

For Revulsion, Derivation, or Interception of a humor injuriously resorting to an eminent or an infirm part; Issues are advantageous to alter the course and current thereof.

For erratic pains, cutany defedations or eru­ptions, and Tumors in any part; Fontanels are beneficial.

In most chronic diseases, that give time and liberty for the use of various means, a de­liberate [Page 222]way of Cure, and gradual spending of the morbific matter; Issues do contribute assistance herein: but in acute diseases that re­quire speedy help, they are not a proper Re­medy.

But although these Fontanels are of good use in the cases aforesaid; yet they are not to be relied on as curative Remedies; that is, they do not eradicate a disease, because they do not apply to the spring where it does arise; but they give vent, and turn the current of a hu­mor this way, or that way, that it shall not overflow to do hurt other ways. They mino­rate and lessen the morbific matter, and abate the extravagant productions and growth of a luxuriant humor, and are but remedia à poste­riori: So that these Issues do not hinder, must not justle out the use of good Medicines that must take away the antecedent cause, and ra­dically cure; by applying to the fountain and rise of a disease, the part primarily affected and deficient in office, that is the original cause of any producted noxious matter.

For the right placing of Issues, that they may prove advantageous for the purposes in­tended; you are to consider whether the case requires a general evacuation only, or revulsion and evacuation, or derivation and evacuation. If only a general evacuation answers your in­tention, then set your Fontanel in the left Arm: but if for revulsion of a humor, it must be remote from the part affected or complan­ing; [Page 223]but if derivation be most convenient, then the Issue must be near the part affected. Sometimes an Issue is placed in the part affect­ed, to empty and evacuate a morbific humor lodged there.

Secondly, Having thus determined the part or member; you are then to chuse a fit place for the Issue, observing diligently the position and motion of the Muscles, else your Issue will not be so beneficial nor lye easie: for if it be set upon, or too near a Tendon, or in the body of the Muscle, the motion and attrition of the Muscle will molest and disturb it with pain, and the evacuation will be but little; there­fore you must place them in interstitiis Mus­culorum, in the place or distances between the Muscles, where the extravasated humors are most frequent in their motions and perambu­lations: and therefore this operation is not rashly to be attempted, but considerately to be performed by good advice, and a skilful hand in Anatomy.

Fontanels being thus appointed for several purposes and cases, will require a different situa­tion, some in one part of the body, and some in another. For diseases that are seated in the Head, Fontanels or Setons may be placed in the hind-part of the Neck: but because they ap­pear more in sight there, and also are trouble­som, Issues may with the like benefit be set in­ter Scapulas, between the shoulders, one of each side the Spine: or else in the Arm between the [Page 224]two Muscles Deltoides and the Biceps, about four or five fingers breadth below the shoulder-joynt: and this is the most frequent place, be­cause the Patient may dress this Issue without help.

But Fontanels in the Back do not only con­tribute help to infirmities of the Head, but also they are beneficial for Arthritic or Gout-pains, by intercepting and evacuating the morbific hu­mor that tends towards the Joynts: also Fon­tanels thus placed, do divert and turn off a de­fluxion or current of humors that invade the Lungs; and therefore such as are troubled with Coughs from a destillation of Rheum into the Breast, and are inclining to be consumptive, will find benefit thereby.

In the Groin Issues may be set for diseases of the Liver or Spleen, observing the rectitude of parts; the right side for the Liver, the left side for the Spleen: this place also is convenient for derivation of the morbific humor that causeth Sciatica-pains, and pains of the Back towards the lower end of the Spine, and about the Loins. The Glandules in the Groin are ap­pointed to receive superfluous and excremen­titious humors, which being readily discharged again by Issues, the current of morbific matter will then more freely resort thither, and ex­onerate such parts adjacent as are infested and oppressed therewith.

The Thigh and Leg also are places for Fonta­nels, to make a revulsion of humors that molest [Page 225]and injure the superior parts; and also may serve for a general evacuation. In the Thigh an Issue is usually placed a little above the Knee, as being most fit there for a binding to keep on: as also in the Leg a little below the Knee, the inside of the gartering place.

The Issue being made, whether by Caustic or Section, the orifice must be kept open with some pellet; for which commonly the largest sort of Pease is made use of, and so continued, ex­cept some occasion by alteration or condition of the Fontanel causeth variation; and then sometimes little balls are made of Ivy-wood, Gentian-root, Orris, or Hermodactyls, &c. as the case may require.

The first dressings of the Issue for two or three days a digesting Plaster is to be laid on; afterwards an Ivy-leaf may be used, which at­tracts a serous humor, and provokes the Issue to run; and over this is laid a thin paper: but for a constant wearing and common use, a piece of varnish or oil'd cloth, such as the cover­ings or riding Hat-cases are made of, is very commodious and easie to provide; very ne­cessary for journies or voyages, where the other is not to be had; and this you need to change but once in a week or more, wiping and turn­ing it every dressing.

For the due ordering and keeping of Issues, you are to observe the times of dressing: such as run sparingly or but little, once in 24 hours is sufficient; but those that send forth matter [Page 226]more freely and plentifully, dress them morning and night: that is, to take out the Pease, wipe the place, and put in another.

If the Issue fills up at the bottom, and makes the Pease to start, then lay a Groat upon the place next under the binding, which will keep in the Pease, and continue the Fontanel deep.

If the brim or edge of the Issue rise high with proud flesh, sprinkle a little powder of burnt Alum upon it, for one or two dressings, which will bring it down even with the Cuticula.

When your Fontanel abounds, and runs much with a sharp, or stinking ichorous humor that excoriates round about the Orifice, and causeth pain; to abate and take off the antecedent cause, you must purge sometimes with a pro­per and good Medicine: avoid also intempe­rate, or often drinking between meals; be spa­ring in your diet, especially at nights, and keep seasonable hours for bed-time.

When you desire, and the case requires an Issue to evacuate more; inlarge the Orifice and Cavity thereof, by putting in pellets bigger than pease, as Horse-beans; and if that be not suffici­ent you may put in two.

An Issue sometimes at the first making will not run well; the morbific matter being ac­customed to frequent other places, and having not found this new vent-hole: you must then wait with patience for the desired effect, and use such means as hereafter is prescribed for a [Page 227]dry Issue: but if after six months you find not some reasonable discharge of matter here, let this Issue heal up, and set another in some place else, where the humors may more freely re­sort.

If an Issue runs but little, and begins to grow dry, as sometimes it happens so; then put in a pellet made of Ivy-wood, Orris-root, Gentian, or Hermodactyl.

When your Fontanel is inflamed round a­bout, by reason of Plethory or a febrile turgid blood causing extravasation and fluxion about the orifice; then apply Emplastr. è mucilagini­bus to the place; but if it continue pertinaci­ously, and threatens farther mischief (as some­times a Gangrene hath happened hereupon) then bleed and purge, which will empty the Ves­sels, retract and give room for retirement, and is the best way to prevent danger.

If a Fontanel by time shifts its place, and settles lower, as sometimes it doth in the Arm or Thigh, and comes too near the Juncture; then you must suffer this to close or heal up, and another must be made higher in the proper place convenient.

The closing or healing up of an Issue, not substituting another elsewhere, is warily to be done by advice, else you may run a hazard and be in danger thereby; for some upon this ac­count have lost their lives: for Nature having found such a conveniency and help, does expect and requires it to be continued, until the occa­sion [Page 228]be otherwise prevented, and cause removed by Medicine, or Nature better able to discharge and free her self by the Emunctories and outlets of her own appointment. Now if prematurely and unseasonably, this artificial passage be de­nied and stopt up, there being cause for the contrary; the confluence of humors then meet­ing and gathering at the place, regurgitates back again with united force and greater cur­rent; at which Nature being surprised unexpe­ctedly, and having made no provision to secure her self from such a Reflux, the same preterna­tural Symptoms and ill affects, against which the Issue was first appointed, or rather much worse, will ensue thereupon.

Before the closing up of an Issue, these things are to be considered: the cause for which it was appointed; what effects, alteration or abate­ment of the infirmities since; the age of the person, whether in youth, strength of Nature, or declining years, and what state of health the person hath for some time enjoyed, and is now in: which are to be adjudged and determined variously, as particular cases and their circum­stances collated do suggest: but generally the body is to be accounted in a better or worse condition, as the humor issuing does appear: ichorous, sharp, bloody, and sordid matter, smelling strong or stinking, much in quantity, declare the body to be cacochymical and foul, the Juyces depraved and degenerate, and require the Issue to be continued: but the matter issuing white, [Page 229]reasonable thick, sweet, little quantity, not sharp or painful, nor causing Inflammation about the place; these are good signs, and shew sound­ness of body, the nutritious Juyces to be in their natural condition, amicable and friendly to the body, and permit an Issue to be healed, caeteris paribus: but withal let due Purgation succeed by intervals, and a spare diet for some time.

London, from my House in Wine-Office Court in Fleet-street.