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 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 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.

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 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, 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 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 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, 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.

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 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 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 the muſcular motions, and cauſeth pain. Sometimes from flatulency and wind, getting into the Interſtitia of the Muſcles, thereby cauſing intercurrent and fleeting pains.

And for remedy in ſuch caſes, Fomentations and hot Bags applied are advantageous; Evacuations being premitted, according to the condition of the Body requiring.

We come now to conſider of Pleuriſies or pains in the Pleura; that inward Membrane that does inveſt or line the Breaſt: a diſeaſe very eminent and frequently occurring, that both Hippoc. and Galen often mention it by way of example.

Theſe pains are acute and ſharp like punctures; and have no conſtant place, but in ſome perſons they ſeize the right ſide, in others the left; in ſome the pain is higher, in others lower towards the Hypochonders; ſometimes more backward, and ſometimes forward: and although chiefly and more manifeſtly the pain be here or there, to be pointed at; yet the whole Membrane by reaſon of continuity, is thereby affected, and the parts adjacent do ſuffer by conſent: from whence various Symptoms, as concomitants and attendants, do inſeparably accompany and conſort with this pleuritic pain.

Hence it is, that difficult and ſhort breathing is conſtantly annexed to it; and this becauſe the parts for reſpiration are hereby impeded, and have not their due motions and liberty of extenſion, but are reſtrained and curbed; which is done in favour, to avoid compreſſing the grieved part, otherwiſe would exaſperate and increaſe the pain: and therefore the ſick fetch their breath ſhort and quick, becauſe they cannot take it fully and largely, and do repeat it the oftner by way of recompence.

To this (and by conſent of parts) is adioyned a ſhort and dry Cough, which irritates and provokes the pain by moving and ſtraining thoſe parts, and therefore is very troubleſom and grievous to the Patient.

Here alſo a continual acute Feaver does neceſſarily follow as inſeparable: for the Archaeus or vital Principle being invaded in thoſe parts by ſomething hoſtile, does therefore inſurge, becomes inraged, grows hot and fiery, raiſing a burning diſtemper throughout the body.

To theſe we may add another conſtant Character; namely a hard, ſwift, but ſmall Pulſe.

And theſe are the pathognomonical ſignals that are always attending upon, and do diſtinguiſh Pleuriſies from other diſeaſes of adjacency or affinity and likeneſs with them: for, when pains fall in amongſt the intercoſtal Muſcles, although there may be ſome punctures or prickings becauſe of the Membranes there, yet not ſo great, the Feaver not ſo high, nor the breath ſo ſhort, nor the Cough ſo troubleſom, if any.

If the Lungs be inflamed only, the pain is but little; not punging, but obtuſe; not in the circumference or ſides, but in the cavity or middle of the Breaſt: yet the difficulty of breathing is greater here than in Pleuriſies, from anguſtneſs that ſeizeth the parts of reſpiration.

Pleuriſies differ from Inflammations of the Diaphragma; becauſe in this there is no pain in the ſides, but only at the end of the ſhort Ribs, and the upper part of the Belly is extended; and with it a Delirium.

Pleuriſies alſo are diſtinguiſhed from Inflammations of the Liver; in the ſeat or place of pain, which always is in the right ſide, under the ſhort Ribs; the pain not punging, but heavy and obtuſe; the Cough leſs, difficulty of breathing leſs; but the Urine higher-coloured, or tinged red.

And now I ſee the reaſon (though very weak) why ſome Authors have diſtinguiſhed Pleuriſies or differenced them into legitimate and ſpurious, which indeed is a diviſion of Pleuriſies into Pleuriſies and no Pleuriſies; for I account no diſeaſe to challenge that denomination, but ſuch as have their foundation in the Pleura: elſe by the ſame reaſon all diſeaſes may admit of the ſame diſtinction of legitimate and ſpurious; for as much as every diſeaſe hath ſome Symptom which is common to other diſeaſes that may give them ſome reſemblance or affinity with each other, or be affected by conſent from another: but I paſs it over and come to examine the cauſes from whence pleuritic pains do ariſe.

Theſe cauſes are external, and internal.

External cauſes are ſuch as remotely prepare and diſpoſe the body to a likely capacity of reception or aptneſs to this diſeaſe, laying the foundation for internal cauſes; and they do ariſe out of, or from the irregular, unfit or improper uſe of the Diaetetics, which leads to a morbific or unſound ſtate.

For example: violent exerciſe or otherwiſe, raiſing great heat in the Body and opening the Pores; by neglect upon it, as not to preſerve that warmth for ſome time, and ſuffering it gradually to abate and go off, by keeping on cloaths and forbearing cool drinks; this may introduce a Pleuriſie. So likewiſe in the heat of Summer to throw off cloaths, and be expoſed to the wind at a Caſement, or the cool Air in the evening. To over-heat the Body with ſtrong Liquors, and ſuddenly endeavor to cool it again with ſmall Beer, may effect the like. Cold 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 〈1 page duplicate〉 〈1 page duplicate〉 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 Veſſels, too great for the capacity and reception of theſe exiguous canals.

2. Acidity or an acrid ſeroſity does ſometimes fabricate and finiſh this diſeaſe by punging and lancinating the Pleura; (for omne acidum extra ſtomachum corpori eſt hoſtile, ſays Helmont) thereby irritating and exciting the vital ſpirit to eſtuate and be incenſed; and from this focus a febrile heat is kindled and communicated to the whole Body: and that oftentimes and for the moſt part, it is a ſharp ſerous humor predominant in the blood which cauſed this diſturbance in the Pleura, is confirmed by the manner of ſolution or termination of the diſeaſe, which moſt frequently is by a ſudorific evacuation, or inſenſible tranſpiration: and therefore Hippoc. in his Predictions ſays; Sudores & urinas in Pleuritide probè fieri bonum eſſe & ſalutare, Friendly Sweats and effuſion of Urine preſageth a good event.

2. Viſcidity, or grumoſity of the blood does ſometimes cauſe pleuritic pains; for by obſtructing thoſe ſmall ductures of the Pleura and ſtopping the Circulation, a Tumor thereby is raiſed within this double Membrane; for the Veins, Arteries and Nerves lye between theſe two Coats of the Pleura.

And that the blood is thus apt to be ſtagnant (eſpecially in the ſmaller Veſſels) by coagulation, groſſneſs, or congelation, is confirmed by Phlebotomy; for being let out of the body, it is ſometimes found deſtitute of its Serum or Latex, that keeps it fluxile, thin and tranſient: and alſo is manifeſt ſo to be when it is in the Veſſels; as in Gangrenes, where the blood is fixed and the part almoſt mortified: and when Pleuriſies do happen upon this cauſe of concretion, they commonly tend to ſuppuration, as not capable of being diſcuſſed, or put into motion for a diſcharge of the part.

Now the Blood becomes thus incraſſated, groſs and viſcous, from every cauſe that does too much exhauſt and expend the ſeroſity thereof; as too great tranſpiration or ſweating, or immoderate making of urine: and ſometimes from a malignant, or a venemous Miaſm that curdles or congelates the blood.

3. Fluxion or ebullient and preternatural Fermentation cauſeth pleuritic pains: and thus it happens when a Pleuriſie is the conſequent or appendent to a Feaver preceding: for ſometimes a Pleuriſie does precede and is the cauſe of a Feaver; as when the dart is felt to ſtrike the Pleura before any febrile diſtemper appears: ſometimes a Pleuriſie does ſupervene and follow a Feaver as an effect from that general ebullition, the hot ſpumous blood ruſhing into the Pleura.

Having eſtabliſhed theſe cauſes in their due Series, preſenting them in the method and order of their cauſation and action; we ſhall not trouble our ſelves with Choler, Flegm and Melancholy, the ſuppoſed materials of every diſeaſe; nor ſhall I controvert the inſufficiency of that doctrine here.

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.

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 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 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.

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.

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, 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 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.

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 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 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.

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 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 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 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 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.

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 ſo cauſe an Inflammation or ſcorching heat, no ſuch thing: but this morbific hoſtile matter ſtirs up the vital heat by way of irritation, provokes the vital principle to eſtuate and wax hot: for from hence does all heat emanare, ſtream, and iſſue forth; whether it be a temperate and natural warmth, or a preternatural and inflaming heat, both proceed from this fountain: So that hereby you muſt diſtinguiſh between the occaſional matter of Inflammations, and the internal efficient that does excandeſcere & inflammare. This inflaming heat ariſeth from a principle much different from the materia morbifica occaſionalis: this great heat does not riſe out of the morbific matter inflamed, but from the vital Principle incenſed.

A Stone in the Kidneys by raiſing great pain, may cauſe an Inflammation there; and this ſtone is the occaſional and material cauſe thereof; but none can think that this contains fire in it, or is capable to be inflamed, or to communicate any heat to the containing parts, ſave only what it hath received from the vital heat reſiding in the body. And thus it is in all other caſes of Inflammation, in any part of the body, from what cauſe ſoever.

This vital Principle is ſeated in every member of the body, and does preſide as Governor; and not only for defence thereof, but alſo to move and act in it ſo; as no vital office or function can be performed without the aſſiſtance and power of this internal inviſible Agent; nor is there any heat, but what ariſeth from hence: And this is that which Hippocrates calls the impetum faciens; Helmont the Archaeus, which I chuſe rather to call the vital Principle.

When any thing happens out of order in the body, a Veſſel obſtructed, or ſome liquor extravaſated, or what elſe that may diſturb and interrupt any member in its office; ſoon the vital Principle is affected and concerned therein; and if the matter be conſiderable and contumacious, pain ariſeth there: and this pain is the ſuffering and anguiſh of the vital Regent, ſtrugling to reſiſt the injury, and labouring to remove the impediment: hence the Inflammation and preternatural heat ariſing from this vital power.

Fifthly, and in the laſt place, from the doctrine preceding we are to make ſome obſervations that may be uſeful for guidance in Practice, and to remark ſome pernicious errors that paſs undiſcerned.

And firſt, here you muſt take notice of the affinity between Inflammations and Feavers: that moſt Feavers do ariſe from Inflammations of ſome particular part, and are the off-ſpring from thence, or ſpringing from that root. For the quòd ſit Practice does affirm it; for rarely you ſhall meet with any conſiderable Feaver, but ſome particular part is chiefly complained of; and as the grief or pain does abate there, the Feaver is remiſs and ſlackens alſo.

Secondly, you are to note, that Feavers are erroneouſly defined, à calore praeter naturam in corde accenſo: aſſigning the Heart to be the Focus where febrile heat is firſt kindled, and from whence it is maintained; when almoſt in any other part of the body, if an inflammation happen there, a Feaver will certainly follow, taking its riſe from thence, not from the Heart: ſo that the Heart then ſuffers ſympathically by conſent; not idiopathically and originally. And whereas I ſaid almoſt any part, intimating thereby, that a ſlight Inflammation may be in the ſmall and capillary Veins of ſhort continuance, which may not communicate a Feaver to the whole body: and ſuch inflammations we ſee externally planted ſometimes, the capillary Veins of the Cutis being affected calore & rubore, which either ſpontaneouſly vaniſh, or ſoon yield to ſome outward application only.

Thirdly, From the denominations of Feaver and Inflammation, you may obſerve the parity or near relation they have to each other; for from the Etymon of the words , they ſeem to import much what the ſame thing, denoting only an extraordinary heat, 〈 in non-Latin alphabet 〉 from 〈 in non-Latin alphabet 〉 ignis, and in the Latine Febris, à ferveo: 〈 in non-Latin alphabet 〉 inflammatio, from 〈 in non-Latin alphabet 〉 uro.

Fourthly, We ſhall not depend upon Etymologies, which are allegorical, and often ſtrained; but inquire into the nature and extent of each, and know what is meant by the one and the other, and then what difference between them. Feavers are known, and defined by preternatural heat and efferveſcency through the whole body. Inflammation is a preternatural heat of a particular part. Hence we remark, that Feavers are general Inflammations or inflammations dilated: Inflammations particular Feavers of a member, thus differing in extent and latitude: but withal obſerve the order of cauſation; Inflammation precedes and lays the foundation, in this or that part there is the fomes and miner a morbi: a Feaver follows upon the whole body, cauſed only by conſent from thence and condolency.

Now if all or moſt Inflammations cauſe Feavers, and Inflammations ſo frequent, as being the certain conſequents of great pain, then two things are to be noted: firſt, that upon the appearance or diſcovery of a Feaver, you may ſuſpect an Inflammation couched under it, from whence as the ſpring, this Feaver does ariſe. Secondly, that the Cure of moſt Feavers ought to be deſigned and managed ſo, as reſpecting and aiming chiefly at a particular Inflammation, upon which the Feaver does depend: ſublatâ causâ— and when a Feaver ariſeth upon this account (as. for the moſt part it doth) then little regard is to be had to the general Feaver, but die ſtreſs of Cure lyes upon removing the occaſional and material cauſes of Pain and Inflammation in the particular part, the foundation of all the reſt, which being removed, the depending Feaver falls of courſe.

Thus all our Diſcourſe tends to make a true diſcovery of cauſes; that when preternatural heat does ariſe in the body and beget a Feaver; we may know, not only what to call it, but alſo what to do, by levelling at the right mark.

But by the way I muſt tell you alſo, how a Feaver ſometimes does ariſe, and not from Inflammation of a pained part: and that is when ſome heterogeneous diſcordant matter, or ſome malign and venenate Miaſm is mingled or got into the blood; Nature, which is the vital Principle, raiſeth a preternatural fermentation and febrile efferveſcency in the maſs of blood, for a purification and ſeparation of this exotic mixture; and admits of no ſedation and reſt until that work be finiſhed.

Fifthly, and from hence you are to be warned of the dangerous and common Practice in Feavers, by Juleps, Barley-water and other ſuch like cooling Medicines uſed to allay the heat; from a great miſtake of the riſe of Feavers, and from whence this heat does aſſurge: for, whether the Feaver does depend upon a particular inflamed part; or a general fermentation of the blood for purification; in both caſes of Feavers, ſuch cooling Medicines are pernicious, and have killed thouſands: for by inſiſting ſo much upon them, and aiming to ſuppreſs the Feaver by Coolers, (which is not poſſible to be done) thus trifling the time away, the opportunity of curing is loſt, and the diſeaſe prevails.

The errour of theſe cooling Medicines is apparent from the inſucceſs thereof; for never was the thirſt of a ſick perſon ſatisfied by a Julep; but a draught of good drink, ſuch as the Patients ſtomach calls for, that is acceptable and refreſhing: ſo that I ſay, Juleps are but cold comfort to a feaveriſh ſick man; for theſe cold Medicines impoſed upon the ſick, are ſo far from aſſiſting Nature to perform the work ſhe is ſtrugling about, that they nauſeate and flat the ſtomach (which ſhould invigorate the other faculties) damp the power of Nature contending, and leave her languiſhing for refreſhment coveted in her natural common drink.

What advantage can there be in a Julep to take off, or any way contribute to the removal of any matter that is the cauſe of Inflammation in the Liver, Spleen, Kidneys, Meſentery, Pleura, &c. any part of the body? truly none; but that is not all; for beſides the doing no good, it does much miſchief, in ſuppreſſing the fortitude of Nature, and cheating the poor Patient of that deſired common aſſiſtance by drink that would be comfortable. But no more of this, becauſe I have enlarged upon this point pag. 27, 28, 29, 30. yet it falls in here, neceſſarily to be taken notice of; becauſe Inflammations always introduce Feavers, which Feaver being moſt obvious and apparent, ingroſſeth all endeavours for allaying that general and expanded heat; but they go the wrong way to work, even prepoſterouſly, beginning at the wrong end.

But now to inform what is neceſſary to be done, when a pained inflamed part requires help, take theſe directions in general, which will be advantageous in moſt, if not all particular caſes.

Firſt, Examine and conſider the nature of the part inflamed, being the part primarily affected, the foundation of this diſturbance; from whoſe peculiar ſtructure and fabrication, as alſo from its office, you will find what are the uſual impediments that moleſt and diſturb ſuch a part, and how it becomes liable thereto.

Secondly, You are to conſider what way this matter is to be carried off (if it be humoral) and by what means: adapting ſuch Remedies ſuitable to the condition of the part affected, and proper for the removal of ſuch a morbific cauſe.

Thirdly, The Feaver that ariſeth from, and depends upon this Inflammation, is not to biaſs you, or take you off from any thing neceſſary to be done, in order to reduce the part primarily affected, but proſecute directly there, and regard not the Feaver; for as you get advantage in relieving the part grieved, you will find the Feaver to decreaſe, and totally vaniſh when that is reſtored. And to tell you plainly, I know nothing you can do advantagious for the part inflamed, that may be injurious upon account of the Feaver, if the Feaver were independent, and had no relation to the other.

Fourthly, If blood be the primary cauſe, or otherwiſe aggravating through plenitude, make a depletion; thereby the Circulation will be more free, turgency abated, and fluxion prevented, at leaſt retracted; for if the cauſe be in the Veins or Arteries, moſt neceſſary it is to be done; for commonly then a plethory, groſſneſs, or coagulation gave the occaſion of this grief; but if it an acrid ſeroſity, that lanceth and irritates the tender part, Phlehotomy may draw off, and make a diverſion for a time, until other good means can be adminiſtred, to eradicate or blunt the ſharpneſs of its acidity.

Fifthly, Set open the vents and outlets which Nature hath framed, and make evacuation, to abate fulneſs, and remove foulneſs in the whole body, thereby you will prevent or allay the turgency of ill humors that are apt to ferment and move upon this diſorder; and cut off a ſupply of morbific matter that may reſort to the part pained, of raiſe a new diſturbance in other parts of the body.

Here you muſt procure , and proſecute this intention with Balſamic Abſterſives, the true Cathartics, (not venenous Laxatives the common reputed Purgatives) and cleanſe the lower region of the body; whereby alſo you will ſubduct and draw away from the parts affected. The groſſer matter being thus removed and carried off ſufficiently, the remainder diſcharge by Tranſpiration, making an apertion of the Pores, and ſetting open thoſe imperceptible vents, by the uſe of effectual and choice Diaphoretics, thereby to attenuate, rarifie, and ſcatter.

For outward Inflammations Topical Medicines are applied to the part, Fomentations, Cataplaſms, 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 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.

THE Latine word Ʋlcus is derived of 〈 in non-Latin alphabet 〉 , 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 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 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, 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.

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 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 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 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 thouſands dye by an internal Gangrene, not taken notice of: for if the major part, at leaſt a great part, do dye with a high Feaver or Phlogoſis, we may rationally then conclude, that a Gangrene is frequently conjoyned as the laſt Actor in the Tragedy and immediate cauſe of death: for Gangrenes do commonly ſupervene Inflammations where they are mortal: and thus alſo Inflammations from fractures and diſlocations, often bring on a Gangrene.

And in malignant high Feavers there are ſometimes ſuch vibices, marks of mortified blood, and black mouths, which do ſtrongly ſuggeſt a Gangrene within the body.

And for thoſe that periſh by the Plague in ſo ſhort a time, whoſe venemous matter ſhews it ſelf by Spots, Veſicles, Buboes, and Carbuncles; moſt of theſe dye gangrened.

And many of thoſe that expire by the ſmall Pox, have a Gangrene in ſome part; the putrid matter being lodged there, Nature not able to protrude and bring it forth: and it is very reaſonable to aſſert this; for, if a Gangrene will ariſe out of a very ſmall portion of matter extravaſated, defluxed, or congeſted in a part; then where the whole body abounds with malign putrefaction and overflows with it, any part thereof remaining within the body, may and does very often corrupt and gangrene that part.

That our Opinions are not ſo extravagant and excentric from the Judgment of all Learned men, as ſome perhaps inconſiderately may cenſure: take notice what Arniſaeus an eminent Phyſician in Germany, Profeſſor in the Univerſity of Julia, writing to Gregor. Horſtius about a Perſon of Quality that dyed of the ſmall Pox, queried or rather concluded, that the Liver was gangrened: and farther ſaith, Veriſimile est, multis idem accidere, qui ex variolis moriuntur.

To which Horstius anſwers by Letter, and conſents with his determination in theſe words: Cùm autem neceſſariò febris ſanguinea cum putredine majori concurrunt, in tali caſu facillimè fieri poterit, ut praevalente calore febrili 〈 in non-Latin alphabet 〉 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 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 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, 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 〈 in non-Latin alphabet 〉 mortification; then theſe means are to be laid aſide, and nothing remains to be done but amputation or diſmembring; and that only if the part will allow it, as Arm or Leg, Scrotum or Dug, —immedicabile vulnus Enſe recidendum eſt, ne pars ſincera trahatur.

And if a ſeparation of this dead part from the living cannot be performed, there is no hopes of recovery or reduction of that to life again: à privatione ad habitum non datur regreſſus. Nor is there any hopes of the Patients life, for this mortified part will corrupt and mortifie the whole.

Where amputation can be performed, this queſtion, as a difficulty, ariſeth amongſt men of Art: Whether Section ſhould be made in the ſound, or unſound part. Some are of opinion, that it ſhould be in the dying or dead part; thereby to avoid pain, to prevent the great Haemorrhage or flux of blood, and Convulſion: but I rather conſent with thoſe that determine of the other ſide, as the moſt ſecure way, and the arguments for it are more prevalent, rather to take away ſome of the ſound fleſh, than to leave any of the corrupt and mortified; for from that root the ſame miſchief may grow again, notwithſtanding cauterizing, or what elſe may be done.

For a good performance and happy ſucceſs in this operation being the ultimum refugium and extreme remedy in this deſperate caſe, there are many things to be cautioned; ſome before as previous; others in the doing, and alſo after diſmembring, to prevent the ill accidents that may attend or follow. But I muſt wave thoſe particulars now, until occaſion be offered to reviſe this Work, and enlarge upon the ſeveral Heads treated of.

And ſince that theſe diſeaſes now briefly diſcourſed, have ſuch tranſitions and gradations, from bad to worſe, and from thence to extremity; it behoves every one upon ſuſpicion of theſe latent and obſcure Maladies (intimated by pain) to begin early with them, when with a ſmaller matter they are capable to be reduced: but delays and neglects, or improper miſtaken courſes, do precipitate the Patient into languiſhing and difficult, or irremediable conditions.

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 theſe ſtages; for pain is ſo general in diſeaſes, and this ſo naturally leads on the reſt, or at leaſt does ſignally declare that the reſt are coming on; as in pag. 9, 10, 11, 12. is ſet forth.

And if you do but conſider, that in diſeaſes, both acute, and ſlow of motion, there is moſt commonly a peccant matter lodged here or there, and cauſeth particular pain in ſome part; or elſe this morbific matter is floating in the Veſſels, and produceth only ſome general indiſpoſition, or a febrile eſtuation and diſtemper: if it be lodged in any part by defluxion, or bred there by congeſtion, it neceſſarily diſeaſeth that part, gives ſome diſturbance by pain, and will form a Tumor, if not removed and diſlodged in due time: but if the morbific matter be roving and fluctuating, Nature either makes a ſecretion and ſends it forth by her own ſtrength, or aſſiſted by Medicine; or elſe it is tranſmitted into ſome ignoble part, where it will not lye dormant long, but accumulates there, becomes more depraved, and lays the foundation for this train of diſeaſes: ſo that either way there is a tendency to bring about this deſign, the ſubject of our Diſcourſe.

In the moſt malignant ſickneſſes you may diſcern ſome or more of theſe confederate diſeaſes as Actors therein, whether ſmall Pox, great Pox, Plague, &c. for eruptions and ſuperficial Tumors are but internal Tumors tranſplanted; at leaſt are the ſignals of Natures endeavors and ſtrength, with or without aſſiſtance to caſt out that morbous matter, which otherwiſe muſt neceſſarily inflame, tumifie, apoſtemate, ulcerate, corrupt and deſtroy the internal parts.

And Feavers that are not malign, they are adjudged ſalutary and hopeful, when Nature makes a good Criſis, by Fluxes or Sweats, by 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 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 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.

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

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 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 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 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; 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 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 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 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 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 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, 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.