CHAP. I.

A Nervous Atrophy, or Consumption is a wasting of the Body without any re­markable Fever, Cough, or shortness of Breath; but it is attended with a want of Appetite, and a bad Digestion, upon which there fol­lows a Languishing Weakness of Nature, and a falling away of the Flesh every day more and more.A Nervous Consumption that which Virginians are most in­cident to. Which kind of Consumption I have sometimes observed in England, but most frequently amongst those that have lived in Virginia, after they have come over hither.

In the beginning of this Disease the state of the Body appears oedematous and blouted, and as it were stufft with dispirited Chyle; the Face is pale and squalid, the Stomack loaths every thing but Liquids, the strength of the Patient declines at that rate, that before the fleshy Parts of the Body are evidently con­sum'd, he is render'd plainly feeble, and al­most always confin'd to his Bed. The Urine also keeps not constant to any colour, though for the most part it be high-colour'd, and but little in quantity. Yet it is sometimes, (as it happens commonly to be in Nervous Distem­pers) though seldom, pale and plentiful. But there is no considerable Fever to be discovered, either by the Pulse, or a Thirst, or Heat, how high-colour'd soever the Urine appears. So that the Pathognomonick Signs, or those which [Page 5] do evidently manifest the beginning of this Consumption, are a decrease of the Patient's Strength, and a loss of Appetite, without any remarkable Fever, Cough, or shortness of Breath, though in the Progress of the Distemper, when a Consumption of the Flesh has gradually af­fected the whole Habit of the Body, there is some difficulty and trouble in breathing to be observed, as it uses to happen to all those who are under a great Weakness.

The immediate cause of this Distemper I apprehend to be in the System of the Nerves proceeding from a Preternatural state of the Animal Spirits,The Causes. and the destruction of the Tone of the Nerves; whereupon I have used to call this a Consumption in the Habit of the Body. For as the Appetite and Concoction are overthrown by the weak and infirm Tone of the Stomack, so also the Assimilation, the Fermentation, and Volatilization of the Nu­tritious Juice are hindred in the whole Habit of the Body from the distemper'd state of the Brain and Nerves.

The Causes which dispose the Patient to this Disease, I have for the most part observed to be violent Passions of the Mind, the intempe­rate drinking of Spirituous Liquors, and an unwholsom Air, by which it is no wonder if the Tone of the Nerves, and the Temper of the Spirits are destroy'd.

This Distemper as most other Nervous Dis­eases is Chronical, but very hard to be cured,The Progno­sticks. unless a Physician be called at the beginning of it. At first it flatters and deceives the Pa­tient, for which reason it happens for the most part that the Physician is consulted too late. And at last it terminates in an Hydropical and [Page 6] Oedematous swelling of the Body, especially of the lower and depending Parts, in which case there remain no hopes of the Patient's Life, neither is there any thing more to be done for his Cure, than giving him some ease, whereby his Miserable Life may be lengthened for some days.

The Cure.The business of Cure, if it be so that the help of our Art is called in in due time, con­sists in the convenient use of Stomack-Medi­cines, and such as comfort and strengthen the Nerves; such are Chalybeates, Antiscorbutick, Cephalick, and bitter Medicines of all sorts. As for Example, let the Patient, if his Body be costive, take every third or fourth Morn­ing four Ounces of the bitter Decoction with Senna, or every fourth Night two Ounces of the Sacred Tincture, or of our Sacred Cepha­lick Tincture made with Hiera Picra infused in Rue-water, Black Cherry-water, and strong Piony-water.

For his common Drink, let him use Ale, in which a Bag of Cephalick and Antiscorbu­tick Ingredients has been hung. An hour be­fore Dinner let him take xxx drops of Elixir Proprietatis in a draught of Wormwood-White-wine. To the Region of the Stomack let there be applyed the Magisterial Stomack-Plaister, with some Drops of the Chymical Oyl of Cin­namon and Oyl of Wormwood. Or let the Stomack be fomented every day with some Aromatick Bags made of the Leaves of Mint, Wormwood, Cinnamon, Mace, Ze­doary, Galingale, Cyprus-roots, Calamus Aro­maticus boyl'd in Claret. If it be in the Sum­mer, let him use the Chalybeate Waters: But if it be the Winter time, let him make use of [Page 7] a Chalybeate Syrup, or our Chalybeate and Aromatick Wine made with the Filings of Steel quenched three or four times in strong White-Wine, and with Zedoary-roots, Galin­gale, Nutmegs, the best Cinnamon, Mace, Cubebs, Cloves bruised, and steeped in the same Wine. But for Chalybeates, I do pre­fer Mynsicht's Extract before any other, which I order to be given for xx. or xxx. days in the form of a Bolus, or Pills. As for Example.

Take of Mynsicht's Extract half a Scruple, Balm of Gilead (which in this case is very pro­per and beneficial, because it is not a little grateful to the Stomack and Nerves) seven Drops, Old Conserve of red Roses a Dram, mix them, and make them up into a Bolus to be repeated every day. Or if the Patient chooses to take Pills, let the Extract be made up into that form in the manner following. Take of Mynsicht's Extract half a Scruple, of Balm of Gielead seven Drops, of Haly's Pouder six Grains, of the compound Pouder of the Roots of Wake-Robin four Grains, of Pouder of Liquorice so much as will make them into the due con­sistence of Pills, and make the Mass into Pills of a middle size, let them be gilded, and re­peated once every day.

Also Natural Balsam by it self, as likewise Spirit of Hartshorn, and Spirit of Sal Armoni­ack are of use in this case, because they are good for the Nerves. As for Example: Let the Patient take viij. or x. drops of Natural Balsam, or Spirit of Hartshorn in a conveni­ent quantity of Sugar-candy twice a day.

[Page 8] Rules for Ex­ercise, Diet, &c.Let the Patient endeavour to divert and make his Mind chearful by Exercise, and the Con­versation of his Friends. For this Disease does almost always proceed from Sadness, and anxious Cares. Let him also enjoy the bene­fit of an open, clear, and very good Air, which does very much relieve the Nerves and Spirits. And because the Stomack in this Di­stemper is principally affected, a delicious Diet will be convenient, and the Stomack ought not to be too long accustomed to one sort of Food.

CHAP. II.

TO this sort of Original Consumption from the whole Habit of the Body belongs al­so another kind of Consumption (which I have often met with in my Practice) arising from the empoverishment of the Blood,The loss and want of Nu­tritious Juice empoverishes the Blood, and causes a Consumption. occa­sioned by the Preternatural substraction and loss of the Nutritious Juice. Whereupon the whole Mass of Blood being deprived of the Nutritious and Oily Juice, grows sour and too hot, affording none or very little Nourishment to the Muscular Parts; and thereupon there follows a Consumption of the whole Body, and a Hectical heat fixed in the whole Habit of it, without any considerable Cough, or difficulty of Breathing, or any other remark­able affection of the Lungs, at least in the beginning of the Distemper. But it must be confest that in the Progress of it the Lungs seem to be in some measure affected,At length the Lungs seem affected in some mea­sure. especi­ally where the Preternatural Evacuations, which are the cause of the Distemper, are stopt by Art without any correction or sweet­ning of the Mass of Blood, by which means it might recover its Natural, Oily, Benign Na­ture, and such as renders it fit for Nourishment. In which case there is no reason to wonder if the hot and sharp Serum of the Blood conti­nually [Page 12] passing, after the other Sluices of Na­ture are stopt, through the soft and glandulous substance of the Lungs, does at length stuff, inflame, yea, and at last exulcerate them too; whereby it comes to pass, that this Consump­tion, which was Originally in the Habit of the Body, does a little before Death end in a Consumption of the Lungs, with a Cough, difficulty of Breathing, and other Pathogno­monick Signs of that Distemper. And there­fore I have often observed, that if the Appe­tite and Digestion are not restored by such Medicines as have a peculiar quality of alter­ing the Blood, and strengthening the Stomack, so that the Mass of Blood may thereupon be supplyed and filled with a sweet and Oily Juice, the Consumption is not cured,This Distem­per sometimes turns to a Consumption of the Lungs. but at length is changed from a Consumption in the Habit of the Body, to a Fatal Consumption of the Lungs.

This Con­sumption is akin to that which is Ner­vous.And this Consumption is in truth a-kin to the Nervous Consumption, which I have be­fore mentioned. For as in that, which pro­ceeds from a Preternatural state of the Nervous Juice and Spirits, the Nutritious Chyle, which is continually carryed into the Blood, is ren­dred less fit for the Nourishment of the Parts, and thereupon as the Mass of Blood is filled with stale and dispirited Chyle, such as is un­fit for Nourishment, and not craving any new, there follows a loss of Appetite, and a sickness in the Stomack, and consequently a Consum­ption of the whole Body, and at length a fixed Hectical and Colliquative heat in the solid Parts from the heat of the Blood and Spirits: So in this kind of Consumption the Nutritious Juice running off from the Mass of Blood with a [Page 13] full stream, the Muscular Parts of the Body being thus deprived of their due Nourishment, fall into an Atrophy; whereupon likewise the Mass of Blood which remains, for want of new Oily Chyle is not only dispirited, and rendred unfit for Nourishment, but a preter­natural, fixed, and hectical heat is kindled not only in the Blood, but also in the Spirits, and all the solid Parts; whereupon there follows a Drought and want of Appetite. Which kind of Consumption is that, which we are now in the first place professedly to treat of.The Cure of this Consum­ption is to be altered ac­cording as the Evacua­tion varies. But because the Cure of this kind of Consump­tion is to be altered according to the variety of the Evacuations, which are the cause of it, I shall add nothing concerning the general Cure of it, but refer that to the several kinds of Evacuations, which are the cause of this Distemper, to be spoken of under their pro­per Heads. Of which (so far as I have had an Opportunity to make Observations) I come now particularly to treat.

CHAP. III.

THat which here first offers it self, is a Consumption from Bleeding, whether it be at the Nose, or from the Lungs by cough­ing, from the Throat by hawking, from the Stomack by vomiting, from the Kidneys by the passages of Urine, from the Haemorrhoids, or Vessels of the Womb in the ordinary Monthly Purgations, or difficult Labour, or lastly, from Wounds, where there happens a plentiful and long flux of Blood from the open­ing of the large Blood-Vessels.Moderate and frequent bleeding makes People grow fat. For although frequent and moderate Blood-letting (as every ignorant Fellow and Barber knows) will make one grow fat; forasmuch as the emptying the Vessels with a moderate hand does make room for a greater quantity of new Chyle, where­upon the Mass of Blood growing richer, is rendred more fit for Nourishment, and conse­quently the Appetite is excited:But an im­moderate bleeding im­poverishes the blood, and causes a Consumption. Yet every immoderate and long Bleeding impoverishes the Blood, and creates a Hectical heat in the Spirits and solid Parts, thereupon destroying the Appetite, and bringing the whole Body into a Consumption and Leanness.

Here the bleeding must be stopt.In this case the bleeding must be stopt as soon as may be, and the return of it is to be pre­vented by Incrassating, Opiate, and Glutinous Medicines, of which we are to speak more fully in the Chapter of Spitting of Blood. As [Page 15] for Example:The manner how this is to be done. Let strong Ligatures be made upon the Arms and Thighs, yea, if it be ne­cessary, and the strength of the Patient will bear it, let a Vein be opened with a Lancet, and Blood taken away frequently, but in a small quantity, to divert the present Flux of Blood, and to prevent the return of it. If the Part where the Blood breaks out will ad­mit of it, let Galen's Styptick Plaister, the Roy­al Styptick, cold Oxycrate, Ink, the ashes of Humane Hair lightly burnt in a Retort, and made into the form of a Pultise with Vinegar; true Bole, Dragon's Blood, and other things of that Nature, be in a convenient manner presently applyed, and often renewed.

Inwardly let the Patient take three or four times a day xx. or xxx. drops or more of the Royal Styptick in a draught of Milk-water. Also v. or vj. spoonfuls of the clarified Juices of Plantain and Nettles; or let him frequently take the following Linctus out of a Spoon.

Take of Syrup of Purslane three Ounces, true Bole, Dragons-Blood, Troches of burnt Ivory, sealed Earth, of each two Scruples, Japan Earth a Dram, of Gum Tragacanth dis­solved in Plantain-water, a sufficient quantity, mix them up into a Linctus. Or let him take the quantity of a Nutmeg of the following Electuary.

Take of the Conserve of red Roses an Ounce, Troches of Amber three Drams, true Bole, Dragons-blood, of each half a Dram, Syrup of Myrtles a sufficient quantity; mix them up into an Electuary.

Let him likewise take every Night v. or vj. Spoonfuls of the following Julep, shaking the Bottle.

[Page 16]Take of Plantain-water six Ounces, small Cinnamon-water three Ounces, distill'd Vine­gar half an Ounce, true Bole, Dragons-blood, of each half a Dram, London Laudanum three Grains, Syrup of Myrtles an Ounce and half, mingle them, and make a Julep.

After the bleeding is stopt the blood must be supplyed with new Chyle.The Flux of Blood being thus sufficiently stopt and cur'd, we are to use our most dili­gent Endeavours that the Blood may be quick­ly replenished with such new Chyle as abounds with sweet and Nutritious Juice, and that the Feverish heat (if there be any) may be ex­tinguisht, to prevent a Consumption. And therefore the Patient is to be nourished with the frequent taking of Jelly-Broaths, poached Eggs, and variety of Food that affords good Juices, and is both easie to be digested, and most grateful to the Stomack. Nevertheless he is to abstain from Wine, and from things that are salt, or have Spice in them, lest they in­crease the heat of the Blood, which was be­fore too hot from the defect of its Nutritious Juice. And because this sort of Patients, as all that are upon the Confines of a Consumption, are subject to Anger, to Sadness, Hypochon­driacal Oppressions, Hysterick Fits, and to a want of Appetite, whereupon they can neither take, nor digest much Food, and consequent­ly uncapable of making up the loss of that Blood which has been spent; therefore the sick Person ought to be diverted and humour'd by his Friends, and to be sent as soon as may be into an open and wholesome Air,The Patient must be di­ver [...]ed, and sent into the Country Air. which in truth I have, being taught from a great deal of Experience, observed to conduce more than any thing of Medicines to the comfor­ting and fortifying of the Nerves and Spirits, [Page 17] to the recovery of an Appetite, and a chear­ful Mind, and consequently to the preventing of an approaching Consumption.

But if the Patient seems either through his own neglect,When there is a Hectical heat, it must be taken off with the Bark. or the sudden advances of the Distemper, to be affected with a Hectical Heat, and some degree of a Consumption from his bleeding, then let the Physician make it his whole business perfectly to put out this flame as soon as ever he can with the help of the Peruvian Bark given in a large quantity, the efficacy of which I have often found to be wonderful in this case. Afterwards,What is af­terwards to be done. if it be necessary, let the Patient be put into a Milk Diet, or upon the use of the Chalybeat Wa­ters. But he must forbear the use of all Pur­ging Medicines. And some benefit may be reasonably expected from the giving of Crabs-Eyes, Coral, Pearl, and other such kind of altering and sweetning Medicines.

CHAP. IV.

THIS Consumption seems to have been known even to the Ancients,This Con­sumption was not unknown to the An­cients. under the name of a Consumption of the Back, when it proceeds from a Gonorrhoea. Galen also notes the Story of the Wife of Boethius, a certain Noble­man of Rome, who fell into a Consumptive Drop­sie from the Empirical suppression of the Whites, that had flow'd in too great a quantity, and a long time.

'Tis very true indeed that a Gonorrhoea, A Venereal Gonorrhoea and Whites often end in a Consump­tion of the Lungs. and the Whites, that are of an ill Nature, and Vene­real, (when the Impurity proceeding from that Venom has once infected the Humors) do often terminate in a Consumption of the Lungs, un­less they are timely and perfectly cur'd. But of this kind of Consumption, and of the Causes, Degrees, and Cure of it, I shall Discourse more fully in its proper place, to wit, in the latter part of this Treatise, when I shall professedly speak of a Symptomatical Consumption of the Lungs. But for the present I do from a long Experience and Observation affirm, that a Con­sumption does often arise from a simple or be­nign Gonorrhoea and Whites,A Consump­tion some­times proceed from a sim­ple Gonor­rhoea, &c. and therefore this sort arising from the continual substraction of the Nutritious Juice by the Seminal Glands, must be reckoned under the Head of an Originary [Page 20] Consumption. For in a Gonorrhoea and the Whites, sometimes the Flux is so extraordinary, and continues so long, that the Mass is thereby plainly dispirited, and rendred unfit for Nourish­ment, whereupon the Blood being loaded with Heterogeneous and disagreeable Particles, grows hot, and at length a Hectick Disposition is by degrees brought upon the solid Parts and the Ha­bit of the Body, which is the same sort of Con­sumption that we are now treating of.

The presaging signs of this Consumption.The Symptoms which presage this Consump­tion, I have for the most part observed to be these, to wit, an Hypochondriacal Oppression, Me­lancholy, and too much Thoughtfulness, with a decay of Strength, and loss of Appetite in Men that are affected with a plentiful Running of the Reins; but in Women that have been long afflicted with the Whites flowing in a great quantity, a soft and blouted Habit of the Body, a squalid and pale Countenance, together with Hysterical Fits, a remarkable Weariness, and de­cay of Strength; all which Symptoms proceed from the same cause, to wit, from the poor dis­pirited Nature of the Blood, caused by a want of new Chyle, whereby not only the Spirits are weakned and opprest, but also the Habit of the Body is rendred Oedematous from the waterish disposition of the Blood, as it is full of old and dispirited Chyle. And therefore the Signs which presage this Consumption are, as I said before, Hypochondriacal Oppressions, Hysterical Affections, a decay and want of Strength, a blouted habit of the Body, and a want of Appetite. Which Symptoms in progress of time, that is, when the Distemper comes to be confirm'd, are followed also by some others, as a Thirst, a Hectical dis­position, Atrophy, and wasting of the Flesh, till [Page 21] at length the Body is plainly brought to the highest degree of a Consumption, and that ve­ry often without any Cough, or any other re­markable sign of a Consumption of the Lungs.

This Distemper is easily cured, if the antece­dent cause of it can be removed, that is, if the Gonorrhoea and Whites can be cured.When confi [...] ­med, it is in­curable. But when it comes once to be confirmed, it is plainly in­curable. And therefore a Prudent and Honest Physician, that is carefully concern'd for his own Reputation, will not do well to undertake the Cure of it, but ought rather to take his leave, and walk off from such a Patient, after he has made a Prognostick of his Death; and so he will be just to his Art, and may satisfie his Con­science, though he loses some Fees, and defrauds his own Pocket.

But if the Physician be sent for in time,What a Phy­sician is to do in the Cure of it, when he is sent for in time. he ought to do all he can by all proper means, and a convenient Method to stop the Gonorrhoea, or Whites, which are the cause of this Consumption. Which thing we shall speak of at some other time, and shew how it is to be done in the Chap­ters of a Gonorrhoea, and of the Whites. This efflux of the Nutritious Juice being once stopt by Art, we must endeavour with all our Power to replenish the dispirited and impoverisht Blood as soon as may be, with new, oily, and benign Chyle. And therefore, as we hinted in the former Chapter, such Food as is delicious, and affords a good Juice, and is most grateful to the Patient's Palate and Stomack, must be given of­ten in a day, though in a little quantity at a time. And that his Appetite may be the more excited, let him be advised to be chearful: For there is nothing that destroys the Appetite, and confirms a Consumption more than Grief and [Page 22] Sadness. Let him also enjoy the advantage of an open and benign Air, which is very benefi­cial to the Nerves, and consequently to the Ap­petite and Stomack. Let him likewise use Exer­cise every day, and rubbing of his Body even to the procuring of moderate Sweats (if his strength will bear it) that the load of old di­spirited, and unprofitable Chyle, with which the Blood-Vessels and Habit of the Body are stufft, may be sweated out, to make more room for new and useful Chyle, and consequently for the improvement of the Appetite in the Stomack. But he must Religiously abstain from the libe­ral use of Wine,Spirituous Liquors are to be avoided and Spirituous Liquors, which are wont to put the Blood, which is before be­come too hot,No conside­rable Eva­cuations are to be made. into a greater flame. Let the Physician also take heed he does not prescribe any Purges, or any Medicines whatsoever, to procure any other considerable Evacuation, which may create farther Expences to Nature, when she is already weak. But if a Hectical heat, even in the least degree be kindled in the solid Parts, he must presently endeavour with all his Industry to quench this flame by the use of Asses Milk, a Milk Diet, and of such Mineral Waters as are Chalybeate.

CHAP. V.

I Have always observed that Apostemes, Large Ʋlcers in any part may cause a Consumption. and large Ulcers, let them happen to any part whatsoever of the Body (whether external or internal) if they continue long, and throw out much Serum, or waterish Matter, have at length rendred the Body of the Patient Consumptive, and that even to the degree of a Fatal Con­sumption; and I can say, I have taken notice that these kind of Ulcers do bring on a Con­sumption as well when they are in the Muscles of the Back, and in the Testicles, yea, in the Knee and the Foot, as when they are in the Kid­neys, or Liver, or in the Lungs themselves. Be­sides that, I have often observed that a Con­sumption of the Lungs has come upon these large and old Ulcers.

The cause of this Consumption without all question is the long and plentiful substraction of the Nutritious Juice continually flowing out of the Mass of Blood by the Ulcers;The reason of this Con­sumption. whereby the Blood, which remains in the Vessels being de­prived of its Oily, Nutritious Juice, does grow sour, and contracts a Preternatural heat, and is thereupon rendred unfit for the Nourishment of the Body; whereupon a Feverish and Hectical heat not only is kindled in the Blood and Spirits, but also remains fixed in the Habit of the Body, and the solid Parts, together with a Thirst, a [Page 24] decay of Strength, want of Appetite, sickness of the Stomack, an Atrophy of the Parts, and at length a want of Sleep, Light-headedness, and the other signs of a Fever, until the sick Person, being brought into the state of a Marasmus, or consummate Consumption, does miserably end his days, though for the most part without a difficulty of Breathing, Cough, or any other Pathognomonick sign of a Consumption of the Lungs.

This Con­sumption may be costly cur'd, if the Ʋlcers are heal'd in time.This Consumption (as we have observed of that in the foregoing Chapter) does easily ad­mit of a Cure, if it be so that the Ulcers, which are the cause of it, can be timely cured by the internal help of Physick, and the external Ap­plications of Surgery, that is, before the Patient is fallen into any degree of a Marasmus. But (alas!) the Patient too often in this case being deceived by the fair Promises and Encourage­ment of some ill Surgeons, does not send for the Physician, till such time as it is more proper to have the good Counsel of some Divine about the future state of his Soul, or the Advice of a Lawyer about making his Will.

Where the Patient is too far gone, the Physician should not undertake the Cure.In which case it is convenient for a Prudent Physician, after he has foretold the Fatal Event of it, rather to take his leave of the Sick Per­son, than to deceive him, when he despairs of his Recovery, with the hopes of an impossible Cure.

What is to be done, when the Physician is sent for in time.But if the Physician be sent for in time, before the Patient be too far gone in a Consumption, and Hectical, the Cure of the Ulcers is to be endeavoured as soon as may be, and to be pusht on with all speed by the internal help of the Physical Art. To which end a plentiful use of the Decoction of Sarsa, &c. is of great use, not [Page 25] only to give a softness to the Blood, that the Blood being freed from its sharpness and preter­natural Heat, may be able more easily to assi­milate to it self the fresh Chyle, and to change it into its own Nature, and that the efflux and loss of the Chyle by the Ulcers may be mode­rated, which does much promote the Cure of the Ulcers; for which reason without doubt these Decoctions are commonly called drying; but also to carry off that load of dispirited, and unprofitable Juices, which lurk in the Habit of the Body, and in the Vessels, by the pores of the Skin in sweats, and insensible Breathings. It has been my Practice to use the following De­coction.

Take of the best Sarsaparilla sliced six Ounces, A Diet-drink to be used in this cose. China-roots two Ounces, Sassafras Chips, red Saun­ders, shavings of Hartshorn, of Ivory, of each half an Ounce, Raisins of the Sun stoned a quarter of a Pound, Liquorice slic'd an Ounce, one Nutmeg slic'd. After they have been steep'd a convenient time in six quarts of Spring-water, boyl it with the Ingredients to three quarts, adding at the end of the Decoction (if there be the least suspicion of any Mischief in the Lungs from a Cough, or difficulty of Breathing) the Leaves of Coltsfoot, Maidenhair, spotted Lungwort, Tunhoof, Fluellin, Flowers of great Daisies, of each a handful; then strain it, and let the Patient drink plentifully of this De­coction for his ordinary Drink.

Yea, if the Ulcers are old,If the Ʋlcers are stubborn, Lime-water must be us'd. and hard to be cured, let the Sick Person also drink at Physical Hours six or eight Ounces of Lime-water, by the excellent Salt of which the sharp and acid Par­ticles of the Blood being precipitated, the whole Mass becomes more mild, and thereupon does more easily embrace the new Chyle, and change [Page 26] it into its own Nature, whereby the Flux of the Chyle to the ulcerated parts is rendred less, and consequently the Cure of the Ulcers by the Sur­geon's Art is more quickly perform'd. For which reason this Drink is also thought to be drying. And here I shall add the Prescription for that Lime-water which I commonly use.

A Prescrip­tion for the making of a Lime-water.Take of the best Sarsaparilla slic'd six Ounces, Currans half a pound, after they have been steep'd for a convenient time in six quarts of Spring-water, boyl them till the Liquor comes to three quarts; then strain it. Then in this Decoction quench half a pound of Quick-Lime, and after it is clear'd by setling, and impregnated with the salt of the Lime, let it be poured off clear, and kept in Glass Bottles for use.

Such Purges as are pretty strong must be given eve­ry fourth or fifth Night, unless there be a mani­fest Hectick heat.Yea, if there be not a manifest Hectical Dis­position, let the Patient during the use of these Decoctions be Purged every fourth or fifth day, and that not only with gentle Medicines, as a Decoction of Senna with Manna, &c. but also with such as are stronger, as with half a Dram of Ex­tractum Rudii, or a Dram of the lesser Pil. Cochiae. Yea, if the Patient bears Purging well, and it be necessary, he may ascend to the use of Scam­mony, and of Rosin of Jalapp it self, to which it is always convenient to add a Dose of Calome­lanos. Which Medicine, by correcting and altering the disposition of the Blood, is in an extraordi­nary manner serviceable to the Cure of Ulcers. I have in my Practice used the following Pre­scription.

In the form of a Bolus.Take of Diagrydium, or Rosin of Jalapp six­teen Grains, Calomelanos five and twenty Grains, or half a Dram, Conserve of Damask-Roses, or Syrup of Buckthorn-berries a sufficient quantity: Mix them up into a Bolus.

[Page 27]Or let the Patient take a Mercurial Purge in the form of a Pouder in a Spoonful of Milk,Or of a Pou­der. observing the Rules which are common in a Purge. By which Medicine the load of dispi­rited, and unprofitable Chyle, which was re­tain'd in the Blood, and Habit of the Body, is in an extraordinary manner discharg'd by Stool, and thereupon the Cure of the Ulcers is ha­stened.

Yea, if the strength of the Patient be firm,If the strength and temper of the Patient allows it, Sa­livation. and no degree of a Hectical disposition has yet seized him, a Mercurial Salivation must be raised by the help not only of Calomelanos, but also (if it be necessary) of Turbith Mineral it self. Which in truth is the last Refuge,Which is the last, and most power­ful Remedy. and a Power­ful Remedy, and is also safe enough (if it be cautiously given) in the Cure of old and ob­stinate Ulcers.

Here also internal Balsamick Medicines may be prescrib'd with advantage,Balsamick Medicines. such as the Bal­samick Syrup, Leucatella's Balsam, &c. As for Example: Let the Patient take every Night, Leucatella's Balsam, Conserve of red Roses, of each half a Dram, or two Scruples with three or four drops of Balsam of Peru. Or a spoonful of the Bal­samick Syrup truly made, twice or thrice a day, either by it self, or dissolv'd in a draught of Sarsa Drink: Or half a Dram of Balsam of Tolu made up into Pills at Physical Hours, drinking a draught of the Sarsa Drink after it. Or if there be no Feverish Heat, let him take twice a day eight or ten drops of Natural Balsam mixt with a little Su­gar-candy.

But when the Ulcer comes to heal,Care must be taken, that a Consumption of the Lungs does not fol­low upon healing of the Ʋlcers. there must be a great deal of care taken, lest a true Con­sumption of the Lungs follows in the room of a common Consumption from the substraction and [Page 28] loss of the Chyle, which indeed does very often happen. For this passage, by which the Nu­tritious Juice uses to run off, being now stopt by the Surgeons and Physicians Art, if the Blood still remains dispirited, and does not recover its former Balsamick and Oily Nature, it is wont to grow more hot and sharp, and thereupon that sharp and hot Nutritious Juice (which was used before to be thrown out by the Ulcer) it usually comes now to cast off upon the substance of the Lungs, as being spungy, and apt to receive the Humours. Whereupon follows not only a stuffing of the Lungs, and upon that a difficulty of Breathing; but also a considerable swelling of the Glands, which do often enough happen in these parts, and upon that a dry and trouble­some Cough, yea, a Heat and Inflammation, and thereupon a Fever, not only a Hectical one, but also a Putrid, or rather Inflammatory Fever, and at length an Apostem, and Ulcers, with a Thirst, and want of Appetite; all which do at last end in a fatal and confirm'd Consumption of the Lungs.The Signs which threa­ten it must be attended to. And therefore as soon as ever these external and remote Ulcers begin to heal, the Physician ought to make what Observation he can, to find whether the least degree of a diffi­culty of Breathing, or any other sign of an Af­fection of the Lungs comes upon it. Yea, if the Appetite continues weak, or if but the least de­gree of a Preternatural Heat in the Habit of the Body does appear,If they ap­pear, what is to be done. which may give us the least occasion to suspect a Consumption of the Lungs, the first Attack and Progress of it ought to be prevented with all the Physician's Power, in the manner following. Let several Issues be made, the Head shaved, the use of the Balsamick Re­medies before mentioned, and the Sarsa Drink, [Page 29] with the aforesaid Vulnerary Herbs be continued; or for the farther temperating and altering of the Blood, let the Patient be put into a Milk Diet, and kept strictly to it. For the same rea­son the Chalybeate Mineral Waters are here also of great use. Also the Physician must make all the hast he can, and disburden the Lungs that are stufft, by Pectoral and Pulmonary Apozems, expectorating Linctuses, and other Medicines of that Nature, which we shall afterwards describe in the Book of a Consumption of the Lungs, be­fore the Tone of the Parts is injured, and a Fe­verish heat is brought on by the continual stag­nation of hot and sharp Juices.

Let the Patient also have a very great care to preserve himself from Passions of his Mind,Passions of the Mind, Cold, and violent Excer­cise are to be avoided. and Cold, and use no violent Exercises; let him also abstain from the use of Wine, and Spiri­tuous Liquors, which may make the motion of the Blood to and through the Lungs quicker than it ought to be, and kindle a Preternatural heat in the Blood.

But if there be no suspicion of the Lungs,What is to be done after the Ʋlcers are healed, when there is no suspicion of the Lungs. when the Ulcer comes to be healed, let the Pa­tient be enjoyn'd to be chearful, let him be plac'd in a benign and open Air, and eat plen­tifully of such Food as affords a good Juice, but yet is mild, and free from a sharpness; and lastly, let him use moderate Exercise, by the use of all which the Blood may as soon as is possible recover its former Balsamick, Tempe­rate, and Oily Nature, and the Appetite of the Stomack may be increased.

By which Method we may not only prevent a Consumption that is coming, but also cure one that is begun, when it proceeds from external Ulcers, as I have before discours'd more largely [Page 30] in the former Chapters of other Original Con­sumptions caused by the loss and want of the Nutritious Juice.

CHAP. VI.

What the Milk is.MILK is nothing but the Nutritious Juice continually separated from the Mass of Blood by the Glandules of the Breasts. And therefore if by reason of the want of an Ap­petite there be more Nutritious Juice suckt out of the Blood through the Breasts for a long time, than is supplyed to the Mass of Blood by the new Chyle from the Lacteal Vessels,When, and how the gi­ving of Suck does cause a Consumption. it is in, possible but an impoverishment of the Blood should follow, and thereupon an Atrophy of the Body (seeing it is depriv'd of due Nourishment) and consequently an Hectical heat in the Blood, Spirits, and Habit of the Body, which is ano­ther kind of Original Consumption proceeding from the substraction of the Nutritious Juice; of which we shall now treat.

Yet a Con­sumptive dis­position is sometimes cured by gi­ving of Suck.Yet I must ingeniously declare, that I have sometimes observed a Consumptive Disposition cured by giving of Suck, and that not only in my most dear Wife, but also in very many other Women. As for Example: My Neigh­bour Mrs. Wilson, who at other times is Con­sumptive, and goes up and down like a Ghost, does always grow fat all the time she gives Suck. Yea, Mrs. Thompson upon Snow-Hill did mani­festly fall into a fatal Consumption in the Habit [Page 33] of her Body, and upon that into a Consumption of her Lungs from the sudden weaning of her Child. But at the same time it is as obvious to our Observation, that all such Nurses as grow fat in this manner from giving of Suck,But such Nurses have always a good Stomack. have a good Stomack, yea, that during the time of their giving of Suck their Appetite is very much increased, and from thence it is very easie to give an Account for this appearance; to wit, that the Appetite being increased by the conti­nual drawing off of the Nutritious Juice by the Child's Sucking, there is room made for a greater quantity of new and oily Chyle, by which the Blood is every day enrich'd, which does con­duce more to the Cure of a Consumptive Dis­position than all the Medicines in the World. But if the Appetite during the time of giving Suck grows languid, and thereupon by reason of the little Food that is taken in, a less quan­tity of new Juice is supplyed to the Blood, than is carried off by the Breasts, a Hectical Dispo­sition in the Blood and Spirits must inevitably follow; and an Atrophy, or Consumption in the Habit of the Body, and that for the Reasons which we have just now given.

The first thing that presages the coming of this Consumption, is a want of Appetite;The presa­ging signs of this Consum­ption. and therefore I give this Caution to all Nurses, that when they find their Appetite to abate for some time, they forthwith wean their Children. The second sign is a weakness and faintness of the Spirits, proceeding from a dispirited and impo­verisht state of the Blood. A third sign is an Hypochondriacal Oppression, and frequent Fits of the Mother, and Choakings. Which appear­ance does not proceed from the sucking of the Child, drawing the Vapours upward (as is com­monly [Page 34] thought) but a too plentiful substraction, and too great an expence of the Nutritious Juice. By which means the Spirits themselves become in the same manner as the Blood, poor and windy, by reason they have lost their Na­tural and Original Vigour, whereupon there follows an Obstruction, and this inordinate and ungovernable motion of the Spirits in the Nerves and Fibres of the Muscles, and upon that Op­pressions, and Suffocative, and Convulsive Con­tractions of some Parts, commonly called Hy­pochendriacal and Hysterical.

This Con­sumption of­ten termi­nates in a Consumptions of the Lungs.These presaging Symptoms in the Progress of the Distemper have an Atrophy, and a Hectical heat following them, (which is not strange) and do often terminate in a Consumption of the Lungs, together with a Cough, shortness of Breath, &c. Nevertheless this Consumption is Originally in the Habit of the Body, and that from too great an expence of the Nutritious Juice.And is then fatal. This Consumption, when it once comes to the degree of a Marasmus, and to terminate in a Consumption of the Lungs, proves plainly fatal and incurable.The Method of Cure. But in the beginning it is easily cured; first, by the speedy weaning of the Child, whereby the cause, which dispos'd the Person to it, is removed. Secondly, by gi­ving the Patient plentiful Nourishment of such Food as affords a good Juice. Thirdly, by ex­citing and restoring the Appetite by chearfulness of Mind, the enjoyment of a benign and open Air, by moderate Exercise, &c. Yea, and lastly, if her Hectical Disposition requires it, the Sick Woman must be put upon the use of a Milk Diet,A Caution. or of the Chalybeate Waters. But let her abstain from Wine, and all Evacuations, but what are necessary, as we have already hinted [Page 35] in the Cure of a Consumption proceeding from other Evacuations.

CHAP. VII.

MANY times in a Scorbutical Disposition of the Body,A sharpness of the Blood often arises from the Scurvy. the Blood grows sharp to that degree, that being disturbed upon every little occasion, it cannot assimilate the new Chyle to it self; whereby it comes to pass that it is thrown out by the Glands of the Intestines in a continual flux like a stream. Which Chyle, if it is benign, and more mild,Which in a lower degree causes a Looseness: In a higher a Bloody-flux. forms a Distem­per in the manner of a Looseness; but if it be sharp, and of a Malignant Nature, produces one in the form of a Bloody-flux. By this con­tinual efflux of the Chyle, the Blood is much impoverisht, and grows hot, so that although the Bloody-flux, or Looseness be overcome by the use of Opiates and binding Medicines, (such as are particularly to be described in a Chapter of a Bloody-flux,Which cause a Hectick heat, &c. and Looseness) yet a Hectical heat still remains in the Blood, together with an Atrophy, and dryness of the Skin, arising from the impoverisht and dispirited state of the Blood: As it happened to mine only, and most beloved Son, and to very many others.And this Consumption often termi­nates in a Consumption of the Lungs. Which Con­sumption does very often terminate in a Con­sumption of the Lungs. But the way to prevent it is (after the Looseness and Bloody-flux are cured by proper Medicines) by a long use of a Milk Diet, the Peruvian Bark, the Mineral [Page 38] Waters, which are Chalybeate, and of the white Decoction for ordinary Drink.It often hap­pens to Chil­dr [...]n [...] of their Tee [...]. This Consump­tion often happens to Children that breed their Teeth. But by the long use of the white Drink, of Pearl Juleps, and binding Medicines mixt with some little Opiate, it is easily cured.

CHAP. VIII.

A Diabetes is commonly called a Dropsie of the Chamber-pot,What a Dia­betes is. and it is a continual Flux of the Nutritious Juice running down through the Kidneys,The Causes of it. which for the most part happens to those that are very thoughtful, and to such as are drinkers of French Wines, and Diuretick Liquors. Whereupon the Urine (by reason of the great quantity of new Chyle which flows to it, and mixes it self with it) being deprived of its Saltness, becomes sweet, even like Honey.A Diabetes causing a poorness of the Blood, and a Hectical heat, produ­ces a Con­sumption. By this continual efflux of the Chyle the Blood is impoverisht, and there­upon the Strength of the Patient grows extream­ly languid. By the burning Flame of the Blood a Preternatural Heat is kindled in the solid Parts, by which the Nerves are weakned, and upon that Convulsions, a Giddiness, and other Affe­ctions of the Nerves do follow, and at length the Muscular Parts being deprived of their Nu­tritious Juice, do fall into an Atrophy, or Con­sumption: As it happened to Mr. Pettit's Son, and to Mrs. Wells, and very many others.The Method of Cure. The way of Curing this Consumption is by a long use of a Milk Diet, Conserve of red Roses, Bole Armenack, Gum Arabick, Gum Tragacanth, &c. by drinking the Bath or Islington Waters, or any other Mineral Water, that is Chalybeate, for a [Page 42] long time. But the Patient must abstain from Wine, especially French Wine, he must not Bleed, nor use any Purging Medicines, except Rhubarb, Myrobalanes, and other such like gentle things, which have also some styptick and binding Par­ticles, of the Vertue of which in Curing this Distemper, I shall presently give a very Re­markable History.

tory ducts to no purpose, is restored to Nature to make up the loss which the Mass of Blood sustains.

When a Con­sumptive di­sposition is to be expected from an Ar­tificial Sa­livation. How the Pa­tient is to be managed in this case.It is also as certainly true, that every Saliva­tion procured by Art, that is, raised with Mer­curial Medicines, (if it continues long) does bring a Hectical and Consumptive Disposition.

In which case (the Salivation being ended) the Patient must be put into a Milk Diet for a long time, by which the sharpness of the Blood may be corrected, and a Consumptive Dispo­sition may be prevented. After that he must be sent into an open and benign Air, and be nou­risht with the plentiful use of such Food as af­fords good Juice; and besides all this (if it be necessary) he must drink the Chalybeate Waters.

An Observa­tion of a Consumption from an Ar­tificial Sali­vation.I met with a very Remarkable Instance of this kind of Consumption in Mr. Daulton an Apothe­cary's Daughter, who from a Salivation, that was raised with Mercury to Cure the Kings-Evil, fell as soon as ever the Salivation was ended, into a fatal Consumption, and by reason of the great expence of the Humours caused by her spitting, she could never be restored, either by the help of the Air, or by a Milk Diet, or any other Art, but being gradually wasted away with a Consumption, after a Month or two from the end of the Salivation, she dyed without any sign of a Consumption of the Lungs.

CHAP. X.

A Dropsie is caused by a Rupture of the Lym­pheducts, or of the Chyliferous Vessels,The cause of a Dropsie the breaking of the Lympha­tick, or Chy­liferous Ves­sels. whereby the Nutritious Juice (which is Natu­rally conveyed by these Vessels as it were in cer­tain continual Streams into the Mass of Blood in the form either of a Lympha, or of Chyle, in order to recruit it) does now continually flow out of those Vessels, and distills into the cavity of the Belly and Breast, or into the Limbs themselves, and Habit of the Body.How it cau­ses a Con­sumption. By which means the Blood being deprived of its usual re­cruits of Chyle, or Lympha, or of both, is very much impoverisht, and thereupon grows sharp and hot; upon which consideration no one has reason to think it strange that a Fever does arise with a Drought, and other Symptoms of that kind, as also a Consumption, or Atrophy of the Parts, with a great Weakness following upon it by reason of the want of fresh Nutritious Juice; and finally, a difficulty of Breathing, by reason of the distention and fulness of the Muscles, that serve for Respiration, from the Dropsical Humour which is contained within them.

The most usual cause of the breaking of these Vessels,The usual cause of their rupture. is the swelling of the Glands of the Belly, or of the Breast, or Limbs, through which, or just by which these Vessels have their [Page 48] course, and by which they are propt. By which swellings those tender Vessels being streightned and comprest, they cannot give a free passage either to the Lympha, or the Chyle, and there­upon these Vessels being distended beyond their Natural Tone by the continual flowing in of fresh Liquor, that has its tendency to the parts of the Vessels, that are comprest, and does press on behind the Liquor, which goes before it, and stops at the compressure, are at length broken. This Distemper is very hard to be cured, neither indeed is there any possibility of doing it with­out healing and closing the Breaches in the Lym­pheducts, or Lacteal Vessels, and consequently ta­king down the swelling of the Glands, which causes the rupture of the small Vessels by com­pressing them.The Indica­tions of Cure. Therefore in this case the Indi­cations of Cure are these which follow.

1. To evacu­ate the extra­vasated Hu­mours.First, to bring down and evacuate that load of the Nutritious Juice that is extravasated, with Cathartick Medicines, that purge off Water, as Rosin of Jalap, Gum Gottae, and others of that sort, which are more particularly to be specified in the Chapter of a Dropsie; as also by Diureticks, as Salt of Amber, Wood-Lice, &c.

2. To open the Obstru­ctions.Secondly, to open the Obstructions of the swell'd Glands, and to dissolve their swellings, which cause the Obstruction of the Chyle, and upon that to restore and strengthen the Tone of the Parts that were swell'd, by a long continued use of Chalybeates. Which being done, the Sick Person must be plentifully Nourisht with Food that affords good Juice, and at length be sent in­to a free and benign Air, and drink the Chaly­beate Waters, not only for the farther tempera­ting of the heat and sharpness of the Blood, but also in order to the perfect opening of the [Page 49] Obstructions of the Glands. But in this case we must carefully abstain from a Milk Diet, because it does stuff the Glands, that are already obstructed, more, and consequently promote the cause which disposes the Patient to this Di­stemper.

CHAP. XI.

Profuse and long sweats often turn Colliquative.SUch Sweats as are profuse, and last long, do very often become colliquative, that is, they carry off a great quantity of the Nutritious Par­ticles, as if they were melted, and more fluid than ordinary: For by these Sweats not only the load of old, dispirited, and unprofitable Chyle, but also a great quantity of that Chyle, which is fresh and Oily, is readily cast out by the pores of the Skin, by reason the Blood cannot assimi­late it from its own too great and Scorbutical sharpness, which it had contracted by degrees. From whence it comes to pass by reason of the continual impoverishment of the Blood,And from hence a Con­sumption a­rises. that not only the Mass of that becomes sharp, and grows hot with a Feverish and Hectick flame; but also the solid Parts of the Body being at the same time deprived by this means of their requi­site Nourishment, do by degrees fall into an Atrophy, and perfectly wast.

Colliquative Sweats at­tend every Consumption when deplo­rable.This Colliquative Sweat, as it accompanies every Consumption of the Lungs in the deplora­ble state, and highest degrees of it, that is, when it is now hastening to a fatal period; so it is found in the lamentable state of every Distem­per, and the sudden ruin of Nature always fol­lows it: And therefore these Dews, or Colli­quative and Oily Sweats are commonly called clammy Death-sweats.

[Page 53]Sometimes also, though seldom,I [...] the Scurvy Coll [...]qu [...]tive Sweats the Original of an Atrophy. I have obser­ved in a Scorbutical Disposition that this kind of Colliquative Sweat has the place of an Original Distemper, by the excess of which I have seen the whole Body brought into a Hectick and Consumptive state in a few Weeks: Which comes to pass, because the Mass of Blood is by these profuse Sweats continuing long, reduced to an impoverisht state, and rendred unfit for Nourish­ment: Upon which there necessarily follows a Hectick heat, and an Atrophy of the Parts, with a great Weakness, and other usual Symptoms of a Consumption in the Habit of the Body.

I have a mind to add here to the end of this Chapter an Instance or two of this Nature, by the relating of which, the cure of this Consump­tion will be shewn so far as I have observed, and am able to give an Account of it.

CHAP. I.

The general cause of a Consumption.THE cause of a Consumption of the Lungs in general is a vitiated disposition of the Mass of Blood, and of the Spirits in the Nerves, contracted gradually from several Procatartick or predisposing causes, in which the sharp or Malignant Serum or Water of the Blood being separated by the soft and Glandulous substance of the Lungs, does stuff, inflame, and at length also exulcerate the Lungs themselves, which is the immediate cause of this Distemper.

The Proca­tarctick cau­ses of a Con­sumption. First, the stopping of Evacuations.The Procatartick causes, or those which give the first occasion to this Disease, are, First, the stopping of some usual and necessary Evacua­tions, as the Monthly Courses, Child-bed Purga­tions, Old Sores, and especially Fistula's, Issues, Sweating in the soles of the Feet, or any other parts of the Body, a Gonorrhoea, the Whites, and other Evacuations of that kind, when they are stopt without correcting or removing the causes upon which they depend: From whence it comes to pass that even the Blood it self is pol­luted and distemper'd by those Humours, which are condemned by Nature to be thrown off, or banisht, but by some Bars and Impediments lying in their way are stopt, and retain'd in the Mass of Blood longer than is convenient.2. Passions of the Mind. Secondly, troublesome Passions of the Mind, but especially [Page 65] Fear, Grief, Anger, too much Thinking, and Sollicitude, as also unseasonable and too long Studies, with other things of this Nature; which contribute very much to this Distemper, not on­ly by vitiating the Animal Spirits, and there­upon hindring the Natural Fermentation of the Blood, but also by fixing almost a continual Spas­modick Contraction, or Convulsion upon the soft substance of the Lungs. Thirdly,3. Intempe­rance in eat­ing and drinking. a too plentiful, and an unseasonable gorging of Meat and Drink, and also an imprudent choice of such Meats and Liquors, as abound with Excre­mentitious parts, and are not very easie to be digested; but especially the drinking too much Wine, and Liquors that are very Spirituous. Which when it is joyn'd with Cares and Grief, and other such-like Passions of the Mind (so far as I have been able to observe) is commonly the cause of a Consumption of the Lungs. For the Habit of the Body being from hence filled with a load of dispirited and unprofitable Humours, as it is, when it is Oedematous, the whole Mass of Blood is polluted, and rendred waterish and sharp, and at length is disposed to a Hectical heat. Fourthly, the neglect of due Exercise,4. Want of due Exercise. for want of which the Excrements, which ought by the usual Law of Nature to be thrown out by the Skin, being detained in the Blood, are wont by degrees to destroy the Crosis or mixture of it. For want of this the Humours also are wont to stagnate in the Habit of the Body, and various Obstructions to arise here and there in the small Fibres themselves; which contribute very much to the corrupting of the Blood, and the weak­ning of the Spirits. Fifthly, Night-studies,5. Night Stu­dies, and long Watchings. and long Watchings, which not only weaken the Animal Spirits, which are necessary for the [Page 66] Fermentation of the Blood, but also keep with­in the Body those Excrementitious parts, which are wont to be thrown out in the Bed by Sweat, or Perspiration; and who will think it strange, that the whole Mass is by degrees vitiated by this means?Sleeping in the day. To this we may also add sleeping in the Day, and sleeping much, but especially pre­sently after eating, which as it dispirits the Mass of Blood, and fills it with useless Chyle by hin­dring the Digestion of the Food (from which cause frequent and troublesome Coughs are wont to proceed:) So by putting the Animal Spirits to sleep at an unseasonable time, and thereupon hindring the Fermentation and Volatilization of the new Chyle, it makes the whole Mass of Blood too waterish and sharp.6. An ill Air. Sixthly, also a foggy and thick Air, and that which is filled with the smoak of Coals, does extreamly pro­mote a Consumption by vitiating the Animal Spirits, which are so necessary to the Natural Fermentation of the Blood; and also by stuffing and weakning the Lungs, that serve for Respira­tion, which are the Seat and Theatre of this Distemper.7. An Here­ditary Dispo­sition. Seventhly, An Hereditary Dispo­sition from the Parents does very often bring a Consumption of the Lungs, when every Body knows very well, that those who come of Con­sumptive Parents, are apt to fall into the same Distemper.8. An ill formation of the Breast. Eighthly, an ill formation of the Breast, whether it be Natural or Accidental, is another cause of this Disease. I call that Na­tural, where the Breast is narrow, the Neck long, and the Shoulder-blades stand out like Wings: And that I call Accidental, where there is a crookedness, or distortion of the Breast, whereby not only the parts of the Breast, and especially the Lungs being once weakned in their [Page 67] Tone, are rendred subject to the Flux of Rheumes; but also the Lungs wanting their ne­cessary expansion, and being streightned, do heap up in themselves, and retain the vitiated Serum of the Blood, from whence it comes to pass, that at length they come to have Obstru­ctions. Ninthly,9. Infection. This Disease is also propaga­ted by Infection. For this Distemper (as I have observed by frequent Experience) like a Con­tagious Fever does infect those that lye with the Sick Person with a certain taint. Tenthly,10. Chalky stones, and such like in the Lungs, also Chalky Stones, that are Preternaturally bred in the Lungs; or Nails, and other hard Bodies slip­ping down into the Lungs, when Persons laugh, are to be reckoned among the Causes of a Con­sumption of the Lungs. By which not only a troublesome Cough, provoking a Flux of the Humours is caused, but also Apostemes and Ul­cers, where also for the most part a spitting of Blood preceding does dispose the Lungs to those Apostemes and Ulcers. Of which I shall after­wards give some Histories. Eleventhly,11. Some pre­ceding Di­stemper. Also some particular Diseases, which corrupt and over­throw the Nature of the Blood and Spirits, do occasion this Distemper. From whence there follow a Symptomatical Consumption (of which I shall make it my business to discourse in the end of this Treatise,) as the Scurvy, Kings-Evil, Convulsive, and especially Hysterical Af­fections, if they have been of a long continu­ance; also Fevers, and especially Intermitting, and Scarlet Fevers, and such as proceed from a Surfeit; so the Small-Pox, Measles, Stone in the Kidneys, the French Pox, an Asthma, spitting of Blood, Inflammation of the Lungs, Pleurisie, and other Distempers of the Breast ill cured; [Page 68] likewise the Green-sickness, a sixt Melancholy, Gout, and Rheumatism.

The more im­mediate cause is taking of cold.The Body being thus predispos'd to a Con­sumption by these and other such-like Proca­tarctick Causes, the more immediate cause of this Distemper is for the most part the taking of Cold, from whence it comes to pass, that in the Body disposed in such a manner by a load of Humours, or Water continually deriv'd from the distemper'd Habit of the Body into the Lungs, a Cough is caused, that is not easily sha­ken off, as that is wont to be, which happens from a meer accidental Cold, where the Matter is concocted within a few days into a putrid Flegm, and upon that is all perfectly thrown out by a Cough (as I shall shew more largely in the Chapter of a Catarrh.) Moreover from a stock of very sharp and Malignant Humours, which were gathered before in the Habit of the Body, (as there is a continual supply of new Matter from the Circulation of the Blood) there is a continual and troublesome Cough produced, and sticks upon the Patient to his dying day: The Serum, or Water of the Blood being sepa­rated, as it were in a perpetual stream by the Glandulous parts of the Lungs, and not admit­ting of any Concoction until the Lungs, espe­cially the Glandulous parts of them, swell from their being stufft, and grow hard, and at length the Tone of the parts is quite destroyed, and they are ulcerated by the sharpness of the Hu­mour, that is separated by these tender and soft ways: Which indeed is the immediate Cause of a Consumption of the Lungs.

CHAP. II.

THE degrees of this Distemper are these which follow, to wit, first,The first de­gree is a stuf­fing of the Lungs. 2. A Swel­ling. a stuffing of the Lungs from the Serum, or Water of the Blood, that is plentifully separated in them. Secondly, a hard Swelling, but more especially in the Glandulous parts of the Lungs arising from the same Serum distending those parts too much, and not having a free passage out of them. Which Tu­mour I take to be the crude Tubercle mentioned by Galen; which Tubercles, or crude and glan­dulous Swellings I have often found in the dead Bodies of Consumptive Persons, when the other parts of the Lungs have been full of Apostemes and Ulcers. Thirdly,3. An In­flammation. an Inflammation of the Lungs arising from the heat and sharpness of this Serum. And lastly,4. An Impo­stumation, and Exulce­ration. an Impostumation and Ex­ulceration of these inflamed Parts, when the Distemper comes once to its height and extre­mity.

[Page 70]The signs which respect a Consumption of the Lungs, are either the Prognostick, or Dia­gnostick, and Pathognomonick signs: Those of the first sort are these which follow.First Prog­nostick Sign being born of Consumptive Parents. First, the being born of Consumptive Parents; for this Di­stemper (so far as I have been able to observe) is more Hereditary, and oftner propagated from the Parents than any other.2. An ill fi­gure of the Breast. 3. A shrill squeaking Voice. Secondly, an ill conformation and figure of the Breast, whether it be Natural, or Accidental. Thirdly, a Voice that is naturally small, and squeaking, or at least so by use, and a habit; as being that which pro­ceeds either from a Natural weakness of the Lungs, or from an Obstruction of the Glandu­lous Coat of the Wind-pipe, and the branches of it, caused by a glutinous and tough Phlegm. But from which soever of these Causes that ap­pearance arises, still it threatens a Consumption of the Lungs, which is afterwards like to fol­low.4. A white soft Skin. 5. A blouted habit of the fleshy parts. Fourthly, a white and soft Skin, toge­ther with a thin Habit of Body. Fifthly, a soft and blouted habit of the Muscular Parts, pro­ceeding from their being much stufft with old and dispirited Nutritious Juice.6. Melancho­lick Oppres­sions about the Breast. Sixthly, long Hypochondriacal Oppressions about the Region of the Breast, that feel heavy like some trouble­some weight, as also Hysterical Choakings, that are frequent, of long continuance, and unusual, being in the same places.7. Thought­fulness, and some Passions of the Mind. 8. The stop­ping of Cu­stomary Eva­cuations. 9. Spitting of Blood. 10. The hawking of black and tough Phlegm Seventhly, Thought­fulness, Anxiety, Sadness, and an unusual prone­ness to Anger, especially if they be without any evident cause. Eighthly, the stopping of customary Evacuations by Issues, or old Sores, so likewise of Child-bed Purgations, the Whites, and all others of this Nature. Ninthly, spitting of Blood, though it be accidental. Tenthly, the hawking of black and tough Phlegm con­stantly [Page 71] in a Morning, for a long time: For that it proceeds from those Glands being filled with a black Humour, which are placed in the Lungs near the Wind-pipe. Which Symptom, as it is a common thing with those that have the Scurvy or Kings-Evil, so it does in progress of time af­ford us a Prospect of an Asthmatical Consump­tion that is like to follow. Eleventhly,11. A sharp and salt tast of the Phlegm. a salt tast of the Phlegm that is hawk'd up; which discovers a saltness and sharpness to be in all the Serum, or Water of the Blood. Which, when a great deal of it passes through the soft substance of the Lungs, and is separated there upon the getting of a great Cold, is apt to in­flame and ulcerate them in a strange manner. Twelfthly,12. A prone­ness to spit much. A proneness to have a great flux of Spittle by the glandulous Coat of the Tongue, and by the Salivatory Ducts and Tonsils, and that whether it be with, or without any evident cause. Which Symptom is a thing that is very common with those that have the Scurvy, and such as are Hypochondriacal, and shews a Col­liquative disposition of the Blood: That is, that it cannot by reason of its too great and preter­natural sharpness, perfectly assimilate to it self the new Nutritious Juice, nor make it duly mix with it self, and therefore throws it off upon these Glandulous Parts, and consequently does in progress of time oblige the soft substance of the Lungs to receive it; from whence a Con­sumption commonly has its Original. 13ly,13. A want of Appetite, that lasts long. A want of Appetite, that continues long, and still grows worse without any other Distemper ac­companying of it; so that the sick Person, un­less he uses much Exercise, and abstains from eat­ing a great while, and pleases his own Fancy in the choice of such Food, as is very grateful, [Page 72] cannot make a full Meal as he used to do with­out the turning of his Stomack, and making him sick: Neither indeed can he digest, or distribute the Food, which he takes, be sure if he eats much, without an Oppression at his Stomack, and a gravative weariness in his Limbs. Which is the very Symptom that opens the way to a Consumption: For it proceeds from too great a fulness of the Vessels, and the whole Habit of the Body, caused by stale and dispirited Nutri­tious Juice, by which means there is not room to receive new Chyle, and therefore Nature does not desire it. Which want of Appetite does yet grow worse, if it happens so that a flame is kindled in the whole Mass of Blood by the pre­sent Catarrh from the continual and violent mo­tion of the Lungs, and by reason of the serous and colliquative state of the Blood. In which case, as the Thirst increases, so the desire of Food grows less: Or else there follows an universal want of Appetite from too great a fulness of the Vessels, so that the sick Person plainly refuses Drink as well as Food.14. A Chro­nical heat. 14ly, A troublesome and Chronical heat, at least in the soles of the Feet, and the palms of the Hands, especially af­ter eating, together with a Pulse somewhat quicker than it ought to be. For this Symptom shews an Inflammatory and Hectical state of the Spirits, and consequently a sharp, serous, and colliquative disposition of the Blood, from which causes a Consumption of the Lungs does com­monly proceed.15. A streight­ness of the Breast, and shortness of breath. 15ly, A straightness and op­pression of the Breast, with some difficulty and shortness of Breath almost always joyn'd there­with. Which Symptome is very common, not only with such as have the Kings-Evil, by rea­son of the swelling of the Glands of the Lungs; [Page 73] but also with those that are Scorbutical and Hy­pochondriacal, by reason of the constriction of the Lungs, the Diaphragm, and other Muscles that serve for Breathing, which is from a light degree of a Convulsive Affection of the Nerves that are assign'd for their motion. 16ly,16. A dispo­sition to Ca­tarrhs. A dis­position to Catarrhs, that is, when the sick Per­son is frequently subject to a Cough, even upon every little occasion, yea, and sometimes with­out any evident cause. For this Symptom shews a sharpness and colliquative state of the Blood. From whence it comes to pass that the sharp Serum, or Water of the Blood, supply'd from the load of Humours lurking in the Habit of the Body, uses to be almost continually separa­ted, and thrown out by the glandulous Coat of the Wind-pipe, and by the soft substance of the Lungs. Which is a very evident sign that a Consumption of the Lungs is then just at hand, which will most certainly seize the Patient, whenever the serous part of the Blood has con­tracted so great a sharpness as is sufficient to in­flame or exulcerate the Lungs, either from the liberal drinking of Spirituous Liquors, or from taking of great Cold, or any other cause. 17ly,17. Any of those Distem­pers preced­ing, which are apt to di­spose to it. All those Distempers before mentioned, as the Scurvy, Kings-Evil, a Chronical Green-sickness, an Inflammation of the Lungs, spitting of Blood, Pleurisy, Rheumatism, Asthma, &c. which are wont to occasion a Consumption of the Lungs. For the Body being in this manner as it were habitually predisposed, a Consumption of the Lungs, and that many times an incurable one, does very frequently seize upon the Patient upon the next great Cold he gets. And indeed almost every Catarrh, when it afflicts the Patient, does at the same time threaten a Consumption that is like to follow.

[Page 74] To prevent a Consump­tion, the great business to be careful in the six non-na­tural things.Therefore in the preventing of a Consump­tion (which is much easier than the Cure of it) the great business whilst the Patients remain in this sickly condition, is to take all possible care that no Error be committed in those six things, which we call not Natural. For in this so slip­pery a state of Health they are wont upon every little occasion of this Nature to fall headlong into a Fatal Consumption. As for Example: First,1. In eating and drink­ing. they ought to be Prudent in the choosing of their Meat and Drink, that the Chylous Li­quor may be made to abound with good Juice, and that the Nourishment may create very little trouble to Nature in digesting and dispensing of it. Let them also take heed they do not eat too much Food, though it be such as affords a good Juice, as also that they do not drink too much Wine and strong Liquors.2. Sleep. Secondly, let them sleep the fore-part of the Night: But let them avoid sleeping in the day-time, yea, and sleeping too long in the Morning; because such sleep is wont to retain and heap up a great load of Hu­mours in the Habit of the Body.3. Exercise. Thirdly, let them every day use moderate Exercise, and rub­bing for a good while together, to fetch out the dispirited Humours from the Habit of the Body by the pores of the Skin.4. Evacua­tions. Fourthly, let them strictly avoid all strong Purges; forasmuch as they not only weaken Nature, but also by put­ting the Blood into too great a motion with their sharp Particles, they make it grow acrious and hot, and bring it into a more Serous and Col­liquative state; upon which a Catarrh, and a Consumption of the Lungs are wont to follow. Fifthly,5. Passions of the Mind. let the Patient by all Lawful ways in­dustriously lay aside Care, Melancholy, and all poring of his Thoughts as much as ever he can, [Page 75] and endeavour to be chearful. For I have very often observed, that a Consumption of the Lungs has had its Origine from long and grievous Pas­sions of the Mind. Sixthly,6. The Air. let the Patient en­joy an open, fresh, kindly Air, and such as is free from the smoak of Coals, which may not only cherish the Animal Spirits, and comfort the Nervous Parts, and consequently restore the weak Appetite, but likewise procure quiet (at least in some measure) to the Lungs. But there must be great care taken, that he does not get new cold. For the Body being in such a man­ner filled with a load of Humours, every new Catarrh or Cold tends to a Consumption, and from hence come all our Sorrows.

And here I shall earnestly beg Pardon for be­ing too quick with my Pen (if any one can re­sent it as preposterous) whilst I offer something more in this Chapter (though briefly) concern­ing the Indications for preventing this Distem­per, and that before the Methodical Thread of my Discourse brings me to the more copious sub­ject of the Indications of Cure.

The general Indications for preventing a Con­sumption in this sickly state, are chiefly three.The Indica­tions of Cure The carrying off by some way of Evacuation the dispirited Chyle, that lurks in the Habit of the Body. The tempering of the Preternatural and Hectical heat in the Blood and Spirits newly caused by the stagnation of the Humours. And lastly, the strengthening of the Tone of the Parts, and consequently freeing them from their Ob­structions; which being neglected, there is all the reason to fear an ill Habit of Body, and a return of the Preternatural Heat.

[Page 76] Gentle Purges to evacuate the Humors.For this end, though strong Purges (as I have before hinted) are in this case to be condemned, yet it is very convenient to carry off the load of Humours by Stool gently, and by degrees, with kindly and Stomatick Purges, until the Bo­dy is freed from its bloutiness and Obstructions, and reduc'd to its first and Natural state.

The Purges of this Nature are, the Stomack Pills with Gums, Aloephangin Pills, Aloes prepared with juice of Roses, Mastick Pills, Pill Ruffi, the bit­ter Draught with Senna, &c. But I prefer the Tinctura Sacra, and the Purging Mineral Waters before any other sort of Purge, which as they carry off the vappid Humours by little and little with ease, and without putting them into too great a motion, so they also rather temper the Heat, than kindle a new flame in the Spirits and Blood (which is often the effect of other Purges) and strengthen the Tone of the Sto­mack, which in this case is weak and relaxt, and withal increase the Appetite.Diureticks and Diapho­reticks for the same end. For the same purpose likewise such Medicines as provoke Urine and Sweat, are of great use in order to the more effectual carrying off of the nasty Se­rum of the Blood.But a Physi­cian must be very prudent in the choice of these Me­dicines. But in choosing of these Me­dicines a Physician ought always to be very cau­tious and prudent, preferring those which com­municate the least heat and sharpness to the Blood before others. For Diureticks, I prefer before any others, Wood-Lice, raw, or prepar'd, Turpentine, Leucatellus Balsam, Balsam of Sulphur, and other Preparations made of Turpentine; but especially the Chalybeate Mineral Waters, Amongst the Diureticks the Chaly­beate Waters are the best. and amongst them Sadler's Waters at Islington; the Vertue of which I have had the Experience of now for five Years, not only in many others, but also in my self, with very good Success, [Page 77] because that they are impregnated with more of a Mineral Spirit than any others (that I have ever yet try'd in several Parts of England) by which they penetrating like Lightning the far­thest corners of the Body, open Obstructions, and provoke Urine very plentifully; and yet they do not affect those that drink them, so as to make them giddy, and as it were fuddled, to oppress the Stomack, or to cause a great heat in the Hands and Feet at the end of their pas­sing off, so much as other Chalybeate Waters use to do.

Among those Medicines that are Diaphore­tick, a Decoction of Sarsa deserves the preference,Amongst the Diaphore­ticks, a De­coction of Sarsa. which not only causes a gentle breathing by the pores of the Skin, but also tempers and softens the Mass of Blood: As also Ceruss of Antimony, Diaphoretick Antimony, &c. which Antimonial Medicines provoke Urine as well as sweat.

If the Blood seems but in the least degree to grow preternaturally hot,If the Blood be at all pre­ternaturally hot, some must be ta­ken away. it is convenient in the very beginning to take away a moderate quan­tity of it, in order to cool it, and to abate the fulness of the Vessels. For although Bleeding is condemn'd in a Consumption, when it is once confirm'd, because the use of it at that time not only affords no benefit, but also procures the sudden destruction of Nature: Yet nothing does conduce more to the preventing, or extinguish­ing of that Hectical Flame which is in the Blood, if it be administred time enough. By which means (other necessary Medicines being also given in a due Method) the Inflammation and Swelling, and consequently the Exulceration of the Lungs themselves; yea, and the Consumption it self, together with a Cough, difficulty of Breathing, and the rest of the train of direful [Page 78] Symptoms may be happily prevented. And in­deed from what I have learnt by a great deal of Experience, I do not doubt but many fall into fatal Consumptions from an Inflammation of the Lungs,Many fall into Consum­ptions for want of due Bleeding. a Pleurisie, ordinary Catarrhs, and other Distempers of that kind, because through the carelessness of the Physician, or the Patient's fear, and the timorousness of his Friends that are about him, there was not Blood taken away in due time, or so often as there should be, or in a sufficient quantity by opening a Vein. From whence it comes to pass, that the Blood retaining a Hectical heat, the Lungs for a long time remain hotter than they ought to be, and upon that there is a conflux of the Humours flowing into the Part affected, or rather a plen­tiful separation of the new Chyle by the Glands of the Lungs: From which there follow violent and dry Coughs, Inflammations, and at length (when the Consumption comes to its height) Exulcerations. And therefore I never do take away so great a quantity of Blood from other Persons, that have a Fever, as from these sickly Consumptive People, whenever they happen to be Feverish, and this I have done with very good Success, so that I do not remember that I ever yet repented of doing it.

If there be any Hectick heat with a Catarrh, an Opiate must be given.If the Catarrh has but the least degree of a Hectical heat joyn'd with it, and the other Cir­cumstances of the Patient allow it, the frequent use of an Opiate is also very necessary in this case, and that not only to quiet the Lungs, which at this time are heated by the continual and violent motion of the Cough, but also to temper and calm the whole Mass of Blood. So that it is plainly convenient every Night, or every other Night to give a Grain and half of [Page 79] London Laudanum in a little Conserve of Red Roses, or an Ounce of the Syrup of Meconium with three Ounces of Milk-water, and three Drams of old Epi­domick Water, or twenty Drops of Helmont's Liquid Laudanum in a spoonful of the Balsamick Syrup, which I shall afterwards describe; or half a Scru­ple of Hounds-tongue Pill, or the Pill of Styrax.

Yea,And in this case every Purge, ex­cepting the Mineral Wa­ters, should have an Opi­ate mixt with it. and in this case no Purge except the Purging Mineral Waters ought to be prescrib'd without mixing an Opiate with it, lest the Cough and Heat should happen to be increased by too great a Commotion of the Humours. As for Example: Take a Scruple or half a Dram of Aloes rosate, half a Scruple, or twelve Grains of Hounds-tongue Pill, mix them, and make them up into four Pills to be gilded, and taken when the Patient is to go to sleep. Or, Take two Ounces and a half, or three Ounces of the Sacred Tincture, fifteen or twenty Drops of Helmont's Liquid Laudanum.

This kind of Purges may be ordered every third or fourth Night, and two Quarts of the Purging Waters the following Mornings, either cold or boyl'd, according to the Season of the Year.

Those days the Patient does not Purge,When the Pa­tient does not Purge, Diu­reticks and Diaphore­ticks are to be taken. the Physician must go another way to work, and endeavour to carry off the Humours gently by the Pores of the Skin, and by the Kidneys, and do it with the use of such Diuretick and Dia­phoretick Medicines, as may rather abate than increase the Preternatural heat of the Blood. For Example:

Let the Patient take three times a day Fifty Wood-lice bruised in small draught of Milk-water, Parsley, or Fennel-water, sweetned to the Palate with the Syrup of the five opening Roots. Or, Take two Drams of Wood-lice prepar'd, a Dram of Ceruss of [Page 80] Antimony, so much Turpentine washt in Plantain-water as will make them into Pills, mix them, and make them into Pills of a middle size, to be put up in Pouder of Liquorice, of which let him take three three times a day at Medicinal hours, and drink after them half a pint of the Decoction of Sarsa and China, keeping himself from the open Air.The Chaly­beate Waters are excellent in this case. But for this purpose I generally prefer the Chalybeate Mineral Waters before all others, it being what I have learnt from long Experience; for that they are found by precipitating the se­rous Liquor out of the whole Habit of the Body by the Kidneys in a great quantity, and tem­pering the Hectical heat of the Blood and Spi­rits, likewise by opening Obstructions, and re­storing the due Tone of the Parts to perform every thing that is requisite to a preventive Cure, even Reason it self being Judge. Which I have also found by much Experience ever since this kind of Waters here near us (that is, at Isling­ton) have first come into Publick use with the Approbation of our Famous Colledge.Many pre­serv'd and cured by them. And by the help of these I have seen a great many pre­served, and indeed others miraclulously recover'd from a Consumption, such as I had plainly thought could never be cured, no, not with all that vast stock of Medicines, which are Sold either in the Apothecary's or Chymists Shops, and the most approved Method of giving them, at least that I knew, unless I had had those Wa­ters, or at least some others like them ready for my purpose: I shall afterwards at the end of this Treatise, give a short Account of some few Hi­stories, out of many, that are pertinent to this business.

[Page 81]Here also Issues made in the Arms,Issues. or between [...]he Shoulders, are serviceable for abating the [...]uantity of the Serous Liquor of the Blood, and [...]onsequently for comforting the Brain and Nerves, and tempering the Animal Spirits; which doubtless contribute very much to the ex­ [...]inguishing of the Hectical Flame, and to the [...]revention of a Consumption.Shaving of the Head. And perhaps [...]ut little less benefit may be expected from the [...]equent shaving of the Head: When by this the [...]assage of the Humours through that very thick [...]kin of the Head is rendred more free, the use [...]f which thing in relieving obstinate Catarrhs, [...] approved almost by universal Experience.

But alas!Physicians seldom con­sulted for the preventing of a Consump­tion. Physicians have very seldom an oc­ [...]asion to give their Advice about preventing this Distemper (when in the beginning perhaps it [...]ay be cured as well as other Diseases, although [...]or the most part by neglect it proves fatal) [...]e sick Persons seldom imploring Aesculapius [...]elp before the Distemper has run on so far as [...] be a fatal case, and then they in vain expect Miracles from the Art of Physick, when it is [...]ore convenient for them to have the good Counsel of a Minister about the future Salva­ [...]on of their Souls, and the Advice of a Lawyer [...]bout making their last Will. Wherefore I [...]all spare that labour, which will be to so little [...]urpose, and without any farther delay proceed [...] the Diagnostick and Pathognomonick Signs [...]f this Distemper.

CHAP. III.

THE Diagnostick and Pathognomonick signs of a present Consumption,The signs ei­ther shew the beginning or confirmation of a Consum­ption. are ei­ther such as discover it when it is but begun, or when it is once confirm'd, and deplorable. The Pathognomonick signs of the beginning of a Consumption of the Lungs are, First, a Cough, which one may, and that by very certain signs distinguish from a simple Catarrh, how violent soever, and Chronical it may be, because, strict­ly speaking, the Part affected, or seat and source of both Distempers are not the same.The begin­ning is known by a Cough diffe­rent from an ordinary Cough. For a Consumptive Cough proceeds from a Glandulous Swelling, or Tubercle of the Lungs themselves, and that with the sense as it were of some heavy weight in the Breast, as also a difficulty of Breathing, and other Symptoms of the same Nature, which I shall by and by particularly, though briefly, run thorough. But on the con­trary, a simple Catarrh owes its Original from a distillation of Rheum cast out as it were in continual drops by the Uvula and Almonds, and the other Glands seated in the upper part of the Wind-pipe, yea, and by all the glandulous Coat of the Wind-pipe it self. For the Wind-pipe by a certain Providence of Nature is covered on the inside with a Nervous Membrane that has a [Page 83] very exquisite sense, which will by no means ad­mit of any thing but the Air it self, no, not a drop of the clearest Water without grievous trouble and opposition, and therefore when it is tickled by the going down but of the least dis­agreeable Particle, it presently endeavours with all its might to throw it up again by Coughing: And indeed Nature has made this Provision for very great Reasons. For if a free and quiet passage were every day allowed but to the smal­lest Body, or Particles, that are heterogeneous, how soon would there be an end of Man's Life by the stuffing of the small branches of the Wind-pipe, which by reason of the straightness of the passages use sometimes to be stufft, and Asthmatically stopt even by the Air it self when it is thicker than ordinary. But how fierce so­ever and continual this Catarrhous Cough is, as being provok'd by a tickling from a continual Excretion and Distillation of Rheum from the Glands in the Wind-pipe, yet as it is always at the beginning moist, and joyned with a great flux of Humours; so likewise it is accompanied with no weight, or oppression of the Lungs, or shortness of Breath, which for the most part are obvious to our Observation in a Consumptive Cough, and that in the very beginning.

Therefore this I make to be the first distin­guishing sign of a Consumptive Cough; to wit,This dry Cough from Tuber [...]l [...]s of the Lungs. that it is dry, at least in the beginning, because it proceeds from a swelling of the Lungs rather than from any thin Rheum owzing out of the Internal Membrane of the Wind-pipe, and the Glandules seated in the upper part of it.

Yet it cannot be denyed but these Patients in the beginning of this Distemper,Yet these Pa­tients spit a great deal of thin Rheum. whenever the Lungs happen to be violently moved by an ex­tream [Page 84] and deep Cough, so as to make them Vo­mit (either after eating, or from any other Ac­cident.) I say, these Patients do throw out a great plenty of thin, clear Spittle from the Sa­livatory Ducts, and likewise hawk up from the Tonsils some Glutinous Phlegm, that is some­times salt, sometimes insipid, which may happen also to those that are well sometimes from the same cause, to wit, by reason the Salivatory Ducts, and Glandulous Parts seated in the Throat are squeez'd, and as it were milkt by this violent motion.But yet it is a dry Cough. But nevertheless this Cough is to be reckoned a dry one, because there is no Rheum or Phlegm thrown out of the Wind-pipe, or the branches of it. And it is as true that this dry Cough uses sometimes to turn to a Catarrhous Cough, and such as is attended with a flux of Rheum, as the Wind-pipe and the branches of it supply a continual flux of Humour, which is sometimes crude, sometimes in the form of con­cocted Phlegm (as it uses to be in a true and genuine Catarrh.) Which comes to pass from hence, because the Glandulous Coat of the Wind-pipe it self, and the branches of it being irrita­ted by this long and violent motion of the Lungs (in the Nature of a dry Cough) caused by the Swellings dispersed here and there through their whole substance, is continually emptied of its Liquor as if it were milkt, and thereupon does throw out daily an abundance of Serum, or Wa­ter almost in the same manner as Milk is fetcht out of the Breasts, and Spittle from the Saliva­tory Ducts, by drawing them in a manner con­tinually; or as an involuntary flux of the Seed in a simple Gonorrhoea proceeds from the Glandu­lous seminal Parts by frequent fribling.How it may be distin­guisht from a true Ca­tarrh. But yet this Consumptive Cough, when it is attended [Page 85] with a Catarrh, may be distinguisht from a ge­nuine Catarrh especially two ways: First, in that a Consumptive Cough is from the very be­ginning dry for some Months (and sometimes it may be for some Years;) whereas a simple Catarrh is at first humorose, as I said before. Secondly, in that a simple Catarrh goes off in a few Days, at most in a few Weeks; to wit, so soon as ever that accidental Feverish Ferment occasioned by taking of cold does by degrees once cease to put the Mass of Blood any longer into an extraordinary motion. Which being once done, the Glandulous Coat of the Wind-pipe does no more separate or spew out any Hu­mour, but what it does Naturally. From whence it comes to pass, that what remains of that Rheum, which is separated by these Glands, being no longer attenuated with a new flux of the Hu­mours, is by degrees concocted by the Natural heat of the parts into a Phlegm that resembles purulent Matter, and is cough'd up in that form, and thereupon the Serum or Humour being thrown out when it is first separated, the Glan­dules quickly recover their Natural Tone with­out any hard Swelling, or Tubercle remaining. By which means it also comes to pass, that the Cough, together with the tickling, wheesing, shortness of Breath, &c. cease of their own ac­cord. But on the contrary, in a Consumptive Cough, as the lasting and inexhausted Fountain does supply a distempered Humour to the Glan­dulous Parts from the Mass of Blood, predispos'd by a long abuse of those six things, which we call not Natural, and put continually into an inordinate motion by a Feverish Ferment ha­bitually fixed in it: So from the Swellings di­spersed here and there through the substance of [Page 86] the Lungs, and compressing the branches of the Wind-pipe, not without some trouble, the Wind-pipe it self is provok'd to cough by a certain continual tickling: And this causes as continual a spewing out of a sharp and distemper'd Hu­mour all along the inside of the Wind-pipe, un­til at length those Tubercles growing very large begin to be inflam'd, and to turn to Apostemes. Whereupon as soon as any one of the Bags, or Cavities, which contain the Matter breaks, there is plainly in coughing (if there be a passage for it) a true and stinking Corruption thrown out from these ulcerated Swellings, mixt with some thin Humour, or Phlegm, that is plentifully sup­plyed from the Glandulous Coat of the Wind-pipe. Neither indeed can the Patient (when the Distemper comes to be a Fatal Case) be ever freed from this Cough by any Art, till Death effectually stops it.

But let no one admire how those Tubercles, or Swellings that are placed in the Lobes of the Lungs far from the top of the Wind-pipe, can provoke this dry Cough, together with a tickling in the upper part thereof; when he may every day observe the same kind of Chronical dry Cough caused and continued a long time by chalky stones generated in the substance of the Lungs. Yea, and once I observed the same Symptom to happen from three Nails, that slipt by chance (as the Person was laughing) through the Wind-pipe down into the Lungs, and to continue for a whole Year, the sick Person all that while being in other respects very well.How the Tu­bercles, which are remove from the top of the Wind-pipe, do af­fect that part. And indeed the thing it self shews it, for the Wind-pipe is every where divided through all the Lobes of the Lungs into many branches, which are a great way distant from one another, [Page 87] so that the very fine and small Pipes of those branches are propagated to the very extremities of the Lungs by the continuity of those Mem­branes, which had their Original from the be­ginning or upper part of the very Wind-pipe. From whence it necessarily follows, that as those Tubercles, in what part soever of the substance of the Lungs they happen to be bred, cannot but make a troublesome compression upon some of these small Pipes, and straighten them: So that troublesome sense, by reason of the conti­nuity of the Membranes, does affect the upper extremity or beginning of the very Wind-pipe, by a consent of parts, as we commonly say; whereby it provokes the Wind-pipe to cast out its Enemy by a vain and dry Cough: Just as we see every day in a Strangury, or difficulty in making Water from a stone pressing uneasily up­on the Ureter; yea, if it be the very Kidney, a great pain felt in the extremity of the Yard it self, from the continuity of the Membrane: For in Nature's endeavouring to expel the Stone, there arises a Spasmodick Contraction of the whole Urinary passage from the very Kidneys, which yet does very much affect the extremity of the Yard with a kind of heat of Urine.The Nature of this Cough shews it to be from the Tu­bercles. And even the Nature of this Consumptive Cough does likewise favour much this Opinion, whilst it yet continues to be dry (as being caused on­ly by Tubercles) and before a disposition to a Catarrh does in progress of time come upon it. For as it is dry, and without any expectoration, so it is not great, nor the Fits long, and is rather made of its own accord to relieve the Oppression of the Lungs, then excited by a violent tickling, or accompanied with that great straining, which usually accompanies a Catarrhous and fierce [Page 88] Cough, that is caused by the continual excretion of a Waterish Humour by the Wind-pipe, and the branches of it.

But if any one should be inquisitive about the Original of the Tubercles in the Lungs,A general Account of the Original of the Tu­bercles in the Lungs. which are the first occasion of this dry and truly Consumptive Cough, I shall give this general Answer: That the substance of the Lungs not only seems more obnoxious to a flux of Hu­mours (as the Ancients love to Phrase it) than any other parts of the Body, from the continual motion of these parts caused in respiration; but also by reason of its spungy softness (because it consists wholly of small Bladders and Vessels) is wont to suck in, and retain the Humours. And therefore, when all the internal and exter­nal Parts, as well those that are Muscular, as those that are Glandulous, are very often affected with several sorts of such Swellings, why should it be strange, if they are frequently found here also, as they are in other parts of the Body? Yea, when I consider with my self, how often in one Year there is cause enough ministred for producing these Swellings, even to those that are wont to observe the strictest Rules of Living, I cannot sufficiently admire that any one, at least after he comes to the Flower of his Youth, can dye without a touch of a Consumption. And without doubt the breeding of these Swellings is so frequent and common,The breeding of these swel­lings is very common. that a Consumption of the Lungs would necessarily be the common Plague of Mankind, if those Swellings did not vanish, or were not removed by Art as easily as they are bred at first: And indeed I have been used to think, not without Reason, that as the more Benign Tubercles are wont to go off of their own accord, and that quickly, so none of [Page 89] them lay the Foundation of this great Disease,And when they are Ma­lignant, they occasion a Consumption. of which I am now treating, but only those, which are in some degree Malignant, and ill-natur'd, and that are wont to putrefie sooner or later from some peculiar quality in their Nature, from what part soever of the Body they have their Original.

But that I may more particularly say some­thing of the beginning and rise of these Tuber­cles:A particular Account of the beginning of them. As far as I have been able hitherto to learn, either from the inspection of the dead Bodies of such as have had a Consumption, or by Reason­ing; a crude Tubercle or Swelling is bred from the Obstruction of some Glandulous part of the Lungs; to wit, when a greater quantity of Se­rum, or Water is separated from the Blood, than is thrown out by the Duct of the Glandule: From whence it comes to pass, that as the Part affected being too much distended by the Hu­mour that is imprisoned in it, is deprived of its Natural Tone, and thereupon is no longer able to spew or throw out the Serum, or Water that flows into it, or is separated; so likewise the Humour, that is so shut up, not being any more renewed by an influx of fresh Humor, does by degrees grow dry and hard from the Natural heat of the Part: From whence arises a hardness, that resists a pressure, or a Tubercle (of which we are now speaking) which in progress of time, after the Natural Tone of the Part is in this manner destroyed, is wont to be inflam'd, and to turn to an Apostem sooner or later, according to the Nature of the Lympha, or included Humor, and of the Blood, from which it is separated, which indeed is the whole immediate cause of a Consumption of the Lungs, and of the dry Cough which attends it.

[Page 90] The causes of that Obstru­ction, which produces the Tubercles.There remains yet some Enquiry to be made from what cause this Obstruction, or Stagnation of the Humour in the Glandulous parts of the Lungs does proceed. And this is sometimes from the thickness, and glutinous quality of the Lym­phatick Juice, that is separated in the Glandules; from whence it comes to pass, that it is not ea­sily driven on, nor thrown out by the very small and straight pore or passage of the Glandule: And this is wont to happen to those that have the Kings-Evil swellings, and such as have the Scurvy, by reason of the great quantity of fixt Salt, which their Blood has too much of. From whence it comes to pass, that Persons so distem­per'd are more subject than other People to fixt and cold Swellings, and those in the Lungs as well as in other parts of the Body, and some­times they dye of a very Chronical, or lingring Consumption. Sometimes also there is so great a quantity of Humour separated in the Glandules from a violent and great Catarrh, that the ex­cerning Faculty or Power by which the Part empties it self, is plainly unable to throw it out. From whence it comes to pass, that the way by which new Serum should flow into it being stopt, the Water which is then retain'd within the Glandules, and stagnates there, does by the Na­tural heat of the Part gradually turn to a dryer Matter, and so into a substance that looks like Honey, or is of the Nature of a Suet, until the Tone of the Part being at length perfectly over­thrown by being too much distended, there fol­lows an Inflammation, and an Apostem upon it. And for this reason a Consumption of the Lungs does often succeed to a Catarrh it self, when a dry and hesky Cough comes in the room of that which was Catarrhous. Which dry Cough is [Page 91] caused by a Tubercle, or Glandulous Swelling, occasioned by a Catarrh upon taking of Cold.

Moreover it is easie to observe that a dry Cough,The ill Cure of a Pleu­risy, &c. sometimes occasions them. and a very Acute Consumption do often come from an Inflammation of the Lungs, a Pleurisy, or some other Disease of the Lungs; to wit, because either through the neglect of the Physician, or the timorousness of the Patient's Friends, such timely, or frequent, or such plen­tiful Bleeding as is necessary to answer to the greatness of the Inflammation, is omitted. From whence it comes to pass, that the Tone of the Parts, especially those that are Glandulous, being destroyed, are never able to recover their Na­tural state again; but here and there, in those places where the Inflammation has before for some time prevailed, there are hard Tubercles to be found dispersed up and down, together with a dry Cough, and a continual Hectick Fever; from whence such Patients, being once seized with a very Acute Consumption, dye with­in a few Weeks; for the Lungs having been be­fore inflamed, do very quickly Apostemate, which brings on the last Scene of this Distemper, with all the usual and fatal Symptoms accompanying it.

There is another Error in the Cure of this kind of Distemper no less fatal, and that is,Sometimes from the want of Pe­ctoral Medi­cines. when the necessary clearing of the Lungs from the Phlegm, with which the Glandulous Parts especially are stufft, is plainly omitted for want of using Pulmonary and Expectorating Medi­cines; or when these Remedies are administred with too sparing a hand. And much more,Or from the unseasonable use of Opi­ates. when that plenty of Lymphatick Juice, which is sepa­rated in the Glandules, is kept lockt up there by the unseasonable, and indeed fatal use of Opium, [Page 92] given in order to ease the pain. From whence it comes to pass, that although the Patient be delivered from the danger of the present Di­stemper, (which yet is very seldom the effect of it) yet by those Tubercles, or Glandulous Swellings, which are left by this Method, a ready way is made to a Fatal and Acute Con­sumption: Which shews it self first by a Cough, shortness of Breath, and a Hectick Fever, but afterwards does quickly bring on all the direful and fatal Symptoms of this Disease.

The most usual couse is some Spas­modick con­traction of the Lungs.But the most usual cause of these Tubercles is some little Spasmodick, or Convulsive Contra­ction of the Lungs, that is long and continual, with the sense of a weight and oppression, caused by Grief, Fear, Cares, too much Thinking, and other such-like Passions of the Mind. For as the soft substance of the Lungs, when they are contracted so long, and continually comprest or squeez'd together, is wont to grow hard of its own accord; so likewise the Glandulous Parts of them being once deprived of their usual ex­pansion, are not able to throw, or spew out, be sure in a sufficient quantity, that Lymphatick Liquor, which was separated in them. Where­fore no body has any reason to wonder, that as a stuffing of their whole substance, so likewise a hardness in the Glands themselves, that resists a pressure, follows upon it. And thereupon it is easie to observe, that as Hypochondriacal and Hysterical Persons are more subject than other People to a Consumption, though it be a Chro­nical and lingring one; so likewise that Distem­per seizes them for the most part from the oc­casion of some Misfortune, which thing does first cause Fear, Grief, Thoughtfulness, or some [Page 93] other grievous Passions of the Mind, and that long and fixt.

Secondly, A Consumptive Cough,2. A Con­sumptive Cough is mo­derate in the day time in the very be­ginning. as it is for the most part dry, so in the beginning of the Distemper, at least in the day-time, it is mild, and without any very great and vehement irri­tation, and often returns by long and uncertain intervals. But a Catarrh is in the very begin­ning fierce, and almost continual. It must in­deed be confest that both Coughs are violent and troublesome enough in the night-time; to wit, a Catarrhous Cough, because all separation of the soul Serum by the glandulous Coat of the Wind-pipe and its branches is more plentiful at the time of lying down in our Beds; but a Con­sumptive Cough, because the Lungs are more constring'd and straightned in this posture of the Body. Whereupon as the branches of the Wind-pipe being more comprest by the glandulous Swel­lings, have upon this occasion more trouble from their compression: So likewise there is a greater quantity of glandulous Liquor at such a time prest out of the Glands into the branches of the Wind-pipe, by which the Lungs are more stufft, and thereupon are likewise more provoked to cough: And from this continual motion of the Lungs caused by the Cough, proceed those per­tinacious Watchings, which contribute more than a little to the increase of the Fever, which at first depended upon the Colliquative and Tu­multuos state of the Blood. Though I have sometimes observed, especially in Consumptive Persons, that have been Hypochondriacal, long and troublesome Watchings without any Cough, especially after their first sleep.

[Page 94] 3. A Vomi­ting after eating, dis­covers a Con­sumptive Cough.Thirdly, as there is almost always a want of Appetite, and a Thirstiness accompanying a Consumptive Cough, so likewise a Vomiting af­ter eating uses commonly to follow upon it; so that usually the sick Person, when he has eaten, coughs, and never ceases, till he has vomited up the Food he has taken.The Causes of it. Which Symptom pro­ceeds not only from a weakness of the Stomack, by reason that the Concocting Faculty is im­paired by the distempered state of that Liquor, which is continually thrown into the cavity of the Stomack by its glandulous Coat for the sake of Fermentation, and is at this time supplyed from the Mass of a Feverish Blood; but like­wise from too great an agitation of the Stomack, caused by the violent motion of the Lungs coughing just by it: For as soon as ever the Lungs begin to be swell'd with a new influx of fresh Nutritious Juice conveyed into them, there begins to be a plentiful separation and excretion of the Lymphatick Liquor by the small Pipes of the Lungs, and the glandulous Coat of the Wind-pipe, and upon that a continual tickling, and a troublesome and violent Cough; by which com­motion the Stomack being by reason of its Vi­cinity brought into a consent is also shaken, till at length the Natural motion of it being per­fectly inverted, it throws up by Vomiting what­ever was contained in it. From whence it comes to pass, that the stock of new Chyle being in this manner thrown out, there is no more of it for that time carryed into the Lungs, and so the Lungs being quiet upon it, as not being irritated any more by an influx of new Chyle, the Sto­mack is at quiet too, and so the Cough and the Vomiting come to cease together, until the Lungs begin to be irritated again from the taking in [Page 95] of new Food.This is one of the most cer­tain signs of a Consump­tive Cough. And verily this disposition to Vomit being joyned with a Cough, I reckon one of the most certain Pathognomonick signs of a Consumptive Cough. For although I have known some that have been in a Consumption, who have had for the most part a good Stomack, (that is, when the Fever, that has gone along with it, has been very mild) yet I scarce ever met with any, but had this disposition to Vomit after eating joyned together with a Cough.Though a vo­miting does attend the Chin-Cough; It must indeed be confest that this Diagnostick sign is not proper to a Consumptive Cough in the fourth Mood (as the Logicians use to speak) that is, so that where-ever this is found joyned with a Cough, that Cough is a Consumptive one. For although all Persons, who are in a Consumption, are wont in that manner after eating, to vomit up what they have taken, with their coughing, yet the same thing happens like­wise every day to Infants, and Children that have a Chin-Cough.Yet it is easie to distinguish them. However it is very easie by the Age of the Patient, the continuance of the Symptom, the fierceness of the Cough, and other Circumstances to distinguish this Catarrhous Cough from that which is truly Consumptive.

Fourthly, Likewise a hoarse,4. A hoarse, or squeaking Voice, joyn'd with a Cough is a sign that it is Consum­ptive. or shrill and squeaking Voice, joyned with a Cough, if it be frequent, much more if it be continual, and Chronical, shews it to be plainly a Pulmonary and Consumptive Cough: For as the hoarseness proceeds from a roughness of the Coat which covers the inside of the Wind-pipe, which being continually moistned with a salt Rheum, puts the whole Pipe or Instrument out of Tune; so likewise the smalness of the Voice depends upon the stuffing of the small Pipes, that are clogg'd with glutinous Phlegm.

[Page 96] 5. A weight in the breast, and difficulty of breathing shews a Con­sumptive Cough.Fifthly, as this Cough is accompanyed with an Oppression of the Breast like a weight from the beginning, so likewise with some trouble, and difficulty in breathing, and a shortness of Breath, especially upon walking faster than or­dinary. Which as it proceeds from crude and harden'd Tubercles scatter'd up and down through the Lungs, so likewise from the small Pipes be­ing stufft with tough and glutinous Phlegm. But in Scrophulous,Which short­ness of breath is more re­markable in some particu­lar Persons. Scorbutical, and Asthmati­cal Persons, that are in a Consumption, this Symptom by reason of the Convulsive contra­ction of the Nerves of the Breast, is more re­markable, and more troublesome than it uses to be in others; and therefore a fresh and open Air, and such as is free from the smoak of Coals, is more beneficial to these Patients, than to other Consumptive Persons, as we shall shew more in its proper place.

6. Fretfulness and Sadness, with a Cough discover it to be Consump­tive.Sixthly, when some of the Glandulous parts of the Lungs happen to be very much distended by the long gathering of the Humour, which could not find a way out by the small Pipes, and to become hard, there grow crude Tuber­cles scattered here and there in the soft substance of the Lungs. Whereupon there follows not only some difficulty of Breathing, and a short­ness of Breath, but also an Oppression of the Breast, and a weight under the short Ribs, ac­companyed with an unusual Fretfulness, Sadness, and Thoughtfulness. Which Symptoms, when they are joyned with a Cough, I always reckon among the Pathognomonick signs of a Con­sumptive Cough.

[Page 97]Seventhly,7. When the Patient coughs more as he lyes on one side, then as he lyes on the other. when at length those Glandulous Parts from a long infarction or stuffing of the Lungs, that are loaded with a filthy Serum separated in the Glandules, are very much swel­led, and grow hard in one or other of the Lobes, (this Serous Matter being then contained in large bags) that Lobe of the Lungs which is affected, is heavier than the rest, and there is a greater weight evidently perceived in that part of the Breast; from whence it comes to pass,The cause of this. that the Patient likewise coughs more when he lies on one side, than on the other, because the Glands that are affected, are comprest more in one po­sture than in the other; from the compression of which there follows a continual spewing out of Serum, or Whey-like Liquor into the small Pipes of the Lungs, together with an incessant tickling, and a troublesome Cough. And this likewise is always to be reckoned one of the most certain signs of a Consumptive Cough. For although I have known some, that have been affected in this manner, to have lived several Years, yet they always remain in a sickly and Consumptive state.

Eighthly,8. When the Tubercles Apostemate, there arises new Symp­toms. when at last those swell'd Glands of the Lungs begin to be inflam'd, and to turn to Apostemes, with a Collection of purulent Matter contained in their proper Bags, whether they are of the Nature of a Steatoma, where the Matter is like Fat, or of a Meliceris, where the Matter is of the colour and consistence of Ho­ney, or of any other kind of Swelling what­soever, (which variety proceeds from the dif­ferent Nature of the Serum, or Water of the Blood, as we shall shew afterwards) then the Consumption begins to be confirmed, and to be­come Fatal, upon which there follows a new [Page 98] company of deadly Symptoms; which are the Diagnostick signs of a confirm'd Consumption, of which I shall hasten to discourse more large­ly by and by, as soon as I have given some short Account of the two other signs of the be­ginning of a Consumption, viz. a Fever, and the wasting of the Solid Parts.

The Second Pathognomo­nick sign of a Consump­tion is a Fever.The Second Pathognomonick sign of the be­ginning of a Consumption, is a Fever, which does, at least in some degree, accompany this Distemper, when it first seizes the Patient, to­gether with the loss of Appetite, some Thirst, a Urine somewhat high colour'd, a quick Pulse, want of Sleep, a heat of the Parts, especially the extream Parts, and other such-like Symp­tomes.By which we may know a Consumptive Cough. This Fever at first is some­times mode­rate. And by this means a Consumptive Cough may almost at any time be distinguisht from an ordinary Catarrh.

Indeed this Fever in the beginning of the Distemper is very moderate in Scorbutical and Phlegmatick Persons; however, some Preterna­tural heat (if they make a diligent Observation) may be discerned, especially in the palms of the Hands, and the soles of the Feet, together with a quickness of Pulse, and sometimes also a fixt redness in the Cheeks, more especially after eat­ing. But this Fever is purely Hectical, and con­tinues almost always alike, because it proceeds from the Solid Parts, and the disposition of the Blood, by reason the Mass of Blood has lost its due mixture, and runs a great deal of it into a Serous Matter, which is occasioned by an Acid, or sharp Ferment that is in it, and is continually disturbing,Afterwards it increases. and putting it upon the fret. It is very true, this Fever is in progress of time very much increased by the continual motion of the Lungs, and they being heated with the Cough, [Page 99] and the want of Sleep occasioned by it; as like­wise by the addition of an Inflammatory and Putrid Fever, proceeding from the Inflammation of the Tubercles of the Lungs, and the Apo­stemes that follow upon it: Of which we shall presently Discourse more largely when we come to speak of the Diagnostick signs of a confirm'd Consumption.

The Third Diagnostick sign of the beginning of a Consumption, is a wasting,The Third Diagnostick sign of an in­cipient Con­sumption is a wasting of the Flesh. or extenuation of the Muscular Parts, which in the beginning of the Distemper is very slow, and almost in­sensible (the Parts at this time rather growing loose and flabby, than wasting) until from an Inflammation of the Tubercles, or from Apo­stemes, or some other Accident an Inflamma­tory or Putrid Fever comes to be joyn'd to the Hectick; and then as the new Fever not only spoils the Appetite and Digestion, but also melts down the Nutritious Juice, and throws it out of the Blood, the Consumption increases apace, so that within a few Weeks the Patient has a Hip­pocratick Face. From which time the Diagno­stick signs of a confirm'd Consumption appear, of which we come now to speak.

CHAP IV.

The signs of a confirm'd Consumption are, 1. A new Fever.THE Pathognomonick signs of a confirm'd Consumption, are, a new Fever added to the Hectick, and that first, Peripneumonical from an Inflammation of the Lungs, and Conti­nual, afterwards Putrid and Intermitting; and a greater colliquation of the Blood,2. A greater Colliquation. which is mightily increased by the new Fever, and dis­covers it self by Prodigious Sweats, a Catarrhous Cough, a Looseness, Dropsie, Thrush, and a particular soreness of the Throat in swallowing. By which the Patient being at length brought to the last degree of a Consumption, is reckoned to be in a deplorable Condition, even by those that understand nothing of Physick. Of all which signs I intend particularly, though briefly, to subjoyn my Observations.

The causes of the second, or Inflammatory Fever.And first, of the Inflammatory Fever, or the Fever from an Inflammation of the Lungs. This Fever has its beginning from an Inflammation of the Tubercles of the Lungs, to wit, when-ever one or more of those Tubercles happen to be inflamed by the taking of Cold, the liberal drinking of Spirituous Liquors, too much Exer­cise, or from any other such-like Accident, which by putting the Blood into too great a motion, may make it too hot, or else by too great a di­stention of the Tone of the Glands, or from the [Page 101] peculiar Nature of the Humour contained in the Bags, and its disposition to ripen, this Fever (which I use properly to call a Peripneumonick, or Inflammatory Fever) cannot but arise, and that with the conjunction of a difficulty of Breathing, (the expectoration or raising being then stopt, though the Cough continues violent) and oftentimes also of a pain of the Side, a Drought, Restlessness, want of Sleep, a great and continual Heat, and other Symptoms of a Fever from an Inflammation of the Lungs. By which the Patient, so long as the height and vio­lence of it continues, is almost always confin'd to his Bed, and many times never comes out of it again.

And indeed this Fever is to be treated wholly in the same manner as other Fevers that are at­tended with an Inflammation of the Lungs,This Fever is to be treated like other Fevers with an Inflam­mation of the Lungs. that is, with a very thin Diet, the plentiful use of Pectoral and Expectorating Medicines, the out­ward application of Anodyne Fomentations and Liniments, Pearl Cordials, and Temperate Ju­leps, but above all, with Bleeding, and that such as is administred in due time, frequently, and plentifully, let the Patient be never so lean and Consumptive. For by this means only is it pos­sible to prevent the fatal Event of the Distem­per at this time. For the Blood being once cooled by bleeding in time, and in a sufficient quantity, the Fuel, which would maintain the Inflammation, is taken away, and the Flame, which is kindled in the Tubercles, is with the same ease extinguisht in a day or two. But if this be neglected, the Patient dies within seven days with an Inflammation upon his Lungs, and all the Fatal Symptoms of this very Acute Di­stemper, which many times happens from the [Page 102] negligence of the Physician, of the Patient, or his Friends; or at least, though if he does not dye so quickly, yet he dyes as certainly, having an Aposteme succeeding to the Inflammation of the Tubercle about the seventh day, and from thence this Acute and Inflammatory Fever turns to a Putrid Intermitting Fever, which though it be Chronical, yet is altogether as Fatal and In­curable.

This Fever sometimes re­turns often in a Year.Sometimes I have found (as in Mr. Tibs in Pater-Noster-Row, and in a certain Merchant in Philpot-Lane) that this Peripneumonick Fever has return'd several times in a Year, to wit, as often as any new Tubercle happened to be in­flam'd, whether it were from some evident cause, or from the Natural disposition of the Tubercle it self to ripen,Some Apo­stemes ripen sooner than others. and become an Aposteme. For all the swell'd Glands are not disposed to an In­flammation at the same instant of time, as it was evidently apparent to me in the Body of Mr. Davison, who dyed of a Fatal, though a Chronical Consumption, when we came to open it. For in the Lungs of the dead Body we found at the same time some Tubercles that were turned to Apostemes, and others that were in­flam'd; and lastly, some that were crude and unripe. But for the most part such Consumptive Persons dye of a Peripneumonick Fever proceed­ing from a new Inflammation of some Tubercle, which the Patient has not strength enough to overcome, having been weaken'd by grapling with his Distemper before.

The degree and da [...]ger of the Fever answers to the degree of the Inflamma­tion.As the duration of this Fever, so the degree and danger of it is to be calculated from the Inflammation of the Tubercle, upon which it depends. For as soon as the Inflammation goes off, whether it be of its own accord, or by the [Page 103] help of Physick, this Fever likewise ceases, tho' as often as the Part that is inflam'd happens to be turned to an Apostem, there forthwith comes in the room of it a Putrid Intermitting Fever, arising from the collection of Matter. And ge­nerally speaking, according to the Nature of the Swelling, and its disposition sooner or later to ripen into purulent Matter, the Peripneu­monick Fever it self, which proceeds from it, is sooner or later cured; and according to the Malignity of the Humour, and the bigness and number of the Swellings that are inflamed, it is more or less Acute and Fatal. Whereupon tho' this Fever does for the most part come to a pe­riod within the compass of seven days (for in that space of time inflamed Swellings begin to turn to Apostemes) yet Scrophulous Tubercles,This Fever generally ter­minates in seven days. as they ripen very slowly,Where the Consumption is Scropho­lous, the time is uncertain. so they bring an In­flammatory Fever, which, though it be almost insensible, and less dangerous, yet is Chronical, and ends in no certain number of days. But by how much the Fever is more Acute, so much the shorter it is; and by how much the more moderate, so much the longer it lasts.

I come, Secondly, to speak of the Putrid In­termitting Fever of Persons in a Consump­tion.

As soon as these inflamed Swellings of the Lungs begin to be Apostems (whether it be for want of Bleeding in time,A Descrip­tion of the Putrid Fever in a Con­sumption. or a sufficient quan­tity, or from the Natural disposition of the Swellings to putrifie) this Inflammatory Fever is changed into a Putrid Intermitting Fever: Whose Fits for the most part observe no certain Order at first, but the cold and shivering Fits return often the same day, as it uses to be when puru­lent Matter is breeding. But when the Matter [Page 104] is once perfectly made, this Fever imitates the Type of a Quotidian, and sometimes (though seldom) of a Tertian, and that at a certain time of the day, beginning with a chilness and cold­ness, proceeding with a great heat, and so at last ending in profuse and colliquative Night-sweats. During the time of the chilness and hot Fit, the Cough and shortness of Breath, with the other troublesom Symptoms are increased: But during the time of the Sweat, and the a­batement of the Fever (the Cough and other Symptoms being mitigated) the Patient sleeps quietly, recruits his Strength, and flatters him­self with the hopes, he is then ready to have, of his Recovery. And this Putrid Intermitting Fever I always reckon one of the most certain Pathognomonick signs of a confirm'd Consump­tion; because as it proceeds from purulent Mat­ter bred in the Lungs, so it is an Infallible Evi­dence of corrupted Lungs. And from thence it comes to pass, that this Putrid Intermitting Fever uses to accompany a Consumption (when­ever this Distemper happens to be Fatal) to the Patient's dying day. Whose Fits, and the Col­liquations proceeding from them, are greater or lesser, longer or shorter, according to the great­ness and number of the Tubercles that are ri­pened into Apostemes.This Fever not to be cu­red without the Cure of the Ʋlcer. Neither indeed can this Fever be perfectly cured with the Peruvian Bark, Poterius's Antihectick, or any other Specifick Medicine (having often tryed what they could do in this case) nor by any other Method that I know of, unless the Ulcer be so benign, that that can be healed by the help of Balsamick Medicines given inwardly, and the Mass of Blood it self (where the fuel of the Distemper lyes) can be brought to a good state by the [Page 105] plentiful use of temperating and altering Medi­cines;Or of the Distemper upon which the Consum­ption depends when it is Symptoma­tical. The colliqua­tion of the Nutritious Juice is ano­ther sign of a Consump­tion. or at least unless the Consumption be Symptomatical, and depends upon some other Distemper, which may admit of a perfect Cure with the use of Specificks.

The Second Pathognomonick sign of a con­firm'd Consumption, or that plainly discovers it to be such, is a great and continual colliquation or melting of the Nutritious Juice, and a conti­nual and plentiful separation and running off of it from the Mass of Blood by all the ways of Evacuation that Nature affords; from whence it comes to pass, that a sudden sinking of strength, and a Marasmus with a Hippocratick Face follows in a short time, though it comes gradually.This Colli­quation is proportionate to the degree of the He­ctick Fever. In­deed I must confess a Consumption has from the beginning always something of a Colliquation joyned with it proportionable to the degrees of the Hectick Fever, from which it proceeds, which discovers it self by Night-sweats, a Loose­ness, or some other way. Which Colliquation, though it be very hard to be cured, because it depends upon a Hectick Fever, that is incurable, yet is always moderate, and brings but a very slow, and less sensible Consumption, till first a Peripneumonick Fever from the Inflammation of the Swellings of the Lungs, and then a Pu­trid Intermitting Fever from the Exulceration of them, comes upon, and is joyned to the He­ctick. And then indeed as the Fever, so the Colliquation which proceeds from it, is increa­sed. For the Blood being then continually foul'd by purulent Particles communicated to it, as it circulates through the Lungs, by the Swellings that are ripened, Nature when she is so much loaded, and opprest with such Heterogeneous Particles, that she cannot bear them any longer, [Page 106] rises up against them, and begins a Fight (or Feverish Fit) in order to thrust them out, and this Combate she renews every day. In the be­ginning of this Conflict she is too much opprest, and therefore is affected with a chilness and cold­ness; but as soon as she rallies her Force, and begins to get the better, there is so great an ebul­lition and commotion made in the whole Mass of Blood, that the fresh Nutritious Juice, which is then carried into the Blood-Vessels, can no longer unite it self to the Blood, but is thrust forth, and thrown out in a large quantity toge­ther with the purulent Particles by any of the parts of the Body that are open and passable, as if they were melted, not without a great loss of Strength, nor without a wasting of the Body, that is by this means continually deprived of its Food, which should restore and nourish it. And the greater the Ulcers are in magnitude, and the more they are in number, the greater quantity of Heterogeneous Particles are mixed with the Blood as a Preternatural Ferment, and the more severe is the Feverish Fit, the Colliquation like­wise is so much the greater, and the Consump­tion makes so much the quicker dispatch.

This colli­quated mat­ter runs off first by the Glands of the Wind-pipe and the Bronchia.1. This separation of the colliquated Matter is first made by the Wind-pipe and the branches of it, by which the Cough, that at first was dry, is now turned to such a one as is attended with a great Catarrh, especially when the Feverish Fit is going off: At which time a great quantity not only of a crude thin Matter, but likewise of concocted Phlegm, either purulent, or like Pus or Matter, and of several colours is thrown out of the Lungs by Coughing, until the Mass of Blood, having thrown out that heterogeneous and purulent Ferment, or Leaven, does by de­grees [Page 107] cool, and come to be quiet. And this Calm lasts no longer than till this deceitful and uncertain Truce happens to be broke by a new Fit.

Secondly,Then by the Pores of the Skin. this separation of the colliquated Humours is made likewise by the pores of the Skin in large and colliquative Sweats.

For these Sweats differ in their degree, to wit, according to the different degree of the Colli­quation of the Blood, and of the Fever Fit, which precedes, and is the cause of it. For the Sweats always come on, when the Putrid Fever is going off, to wit, after Midnight. For this Fever (whether it be a Tertian or Quotidian) comes like other Intermitting Fevers at a certain hour (which is about Noon, or a little after) with a manifest chilness, but then proceeding for some hours with a burning Heat, Drought, Restlesness, Vomiting, shortness of Breath, a continual, fierce, and violent Cough, want of Sleep, yea, sometimes also Light-headedness, and a very red colour in the Cheeks, proceeding from the Oppression of the Lungs, and those parts that are seated under the short Ribs: But at length, to wit, about Midnight, it ends in vast and colliquative Sweats. At which time the Patient sleeps quietly, breaths not so short as be­fore, and plentifully coughs up concocted Phlegm without any difficulty or pains, having the Symp­toms of the Fever all gone off altogether of their own accord. For at this time the stream of the colliquated Humour is turned from the Lungs, and carried to the Pores of the Skin. And by that means the Patient seems all the Morning to be free from a Fever, his Heat is moderate, and his Pulse low, until at length another new Fit seizes him, and breaks the Treacherous Peace. [Page 108] And from these remissions of their Fits it often happens that these kind of Consumptive People, even when they are lookt upon as deplorable by others, flatter themselves extreamly with the hopes of their Recovery; so that the same Per­sons that at Night use to think themselves irre­coverable, and tell those about them they should certainly dye, yet the next Morning they al­ways pluck up their Courage, and in vain en­tertain the hopes of living long.

The stopping of these Sweats does no ways re­lieve the Pa­tient, but thereupon the Matter runs off from the Blood some other way.'Tis true indeed, these Colliquative Sweats causing a great expence of the Nutritious Juice, do commonly spur on the Patient's Consump­tion, and quickly make him a Skeleton. And yet he must not expect any relief or benefit from the violent stopping of them, either by the change of Air, or rising out of Bed in the Night; which I have often seen prov'd true by Expe­rience. For the Blood thereupon growing hot, does not melt or dissolve ere the less, but when this passage of the colliquated Humour is once stopt by Art, Nature presently opens some new Sluces to carry that troublesome Load another way, (though it may be more inconvenient) as either into the cavity of the Breast,As into the cavity of the Breast or Belly, &c. from whence there follows a Dropsie of the Breast, with an increase of their Cough, and an intolerable dif­ficulty of Breathing; or into the cavity of the Belly, and into the Legs and Thighs, in the Na­ture of a Dropsie in those parts; or else by the Glandules of the Guts, whereupon there arises a violent Looseness, that is no less Colliquative than the Sweats themselves: Yea, and some­times even a Bloody-flux (if the colliquated Humour be very sharp) attended with dreadful Convulsions and Torments of the Bowels, which bids defiance to all the Medicines that are used [Page 109] to cure a Dysentery; as I found in the deplo­rable case of Mr. Lechmere, and likewise some other Persons that have been in a Consumption, who being by that Symptom thrown into the last degree of a Consumption, with a Hippocratick Face, dyed as quickly as they did miserably. But this Thread of my Discourse has unexpect­edly brought me to the other Diagnostick signs of a confirm'd Consumption, of which I must likewise say something briefly.

Thirdly,The colliqua­ted Matter when the Consumption is confirm'd is exern'd by the Guts. This Colliquation (as soon as the Consumption comes once to be confirmed) is often made by the Glands of the Guts, in the Nature of a thin and waterish Looseness, or else of a Bloody-Flux. For the Blood when it can­not in this colliquative state assimilate the fresh Nutritious Juice to it self, nor unite it to the so­lid Parts, by reason of its own Preternatural Heat and Sharpness, does frequently endeavour to drive it down, and throw it out as an unpro­fitable Burden by these Glandules likewise. But Nature does not use to endeavour the expul­sion of her Enemy this way, unless it be either for want of Care, or designedly that the High-way by the Pores of the Skin is stopt, or at least, when this way alone is not sufficient to serve her purpose, by reason of the greatness of the Col­liquation. And therefore a Looseness is justly to be reckoned, for the most part, one of the last and fatal Diagnostick signs of a confirm'd Con­sumption. For excepting only the case of such Persons as have the Scurvy with their Consump­tion, who are always subject to Colliquations of the Serum by the Glands of the Guts, and Sali­vatory Glands, a Looseness is wont to arise, and joyn it self to a Consumption not long before the Patient dyes. For as it shews Nature to be [Page 110] in a very great flame, so it strangely hastens and promotes its farther Destruction.

This Loose­ness is pro­portionate to the present state of the colliquated Blood.This Looseness is sometimes moderate, in as much as it is always proportionate to the present state of the colliquated Blood, but in others it is violent, and accompanied with racking pains, which usually defies the power of Opiates, and all manner of Astringent Medicines; or at least returns upon taking of the least Cold, or drink­ing a draught of Beer, or omitting the use of Opiate Medicines. And so long as the Loose­ness is stopt by the Narcotick Power of Medi­cines, we usually have a difficulty of Breathing, in which the Patient is almost choak'd, or a Dropsie, or some other Symptoms no less trou­blesome, nor less dangerous arise. For the Blood being once brought by degrees to an irrepara­ble and incurable state of Colliquation, the crude Nutritious Juice, that is continually carried a­bout in the Mass of Blood, does, when one Door is shut, find some other, and it may be one that is more prejudicial and troublesome to the Pa­tient.

The colli­quated Hu­mours pro­ducing a Dropsie, is another sign of a con­firm'd Con­sumption.Fourthly, But when in this colliquative, or melting state of the Blood, the Nutritious Chyle that is quite dispirited, does not find a conveni­ent passage through the Glands of the Skin, by reason they are stopt by the cold of the ambient Air, or by the Glands of the Guts being shut up by the use of too many Opiates, either a Dropsie of the Breast, or else of the Belly, and the lower Limbs does usually follow. Yea, a blouted swel­ling in the whole Habit of the Body, if the passages into the aforesaid Cavities of the Body, and the lower Limbs, are either by Art or Ac­cident stopt. And in plain terms, a Dropsie coming upon a Consumption, of what kind [Page 111] soever it be,And not on­ly of a con­firm'd but of a deplorable Consumption. is to be reckoned amongst the signs not only of a confirm'd, but likewise of a de­plorable and incurable Consumption. And that not only because it shews a very great flame in the Blood, and that the state of it is extreamly colliquative; but likewise because the Patient by reason of his too great weakness is not able to bear such an Evacuation of the extravasated Se­rous-water, as is necessary, by such Medicines as purge forth Water. And for Diureticks, they are plainly of no use in this case, because even the strongest of them cannot promote a Flux of Urine, but rather cause a greater Colliquation in the Blood, by attenuating, and heating of it more. Whereupon there is caused a greater and quicker flux of the Water into the cavities of the Body, and into the lower Limbs, where it has a free passage, so as to increase the Dropsie.

Fifthly, and lastly,At last the colliquated Humours are thrown out by the glands of the Throat. In this universal Colli­quation Nature sinking a little before the Person dyes, makes it her business to throw out the Serum, or Juice that is full of distempered and purulent Particles, by the Tonsils, and other Glands, that are seated in the Throat, as also by the Salivatory Ducts of the Mouth.From whence arises, 1. A heat in the Throat. From whence there are wont to arise two new Symp­toms, and they very troublesome ones; to wit, a great heat about the Tonsils, and the Parts that serve for swallowing. Whereby it comes to pass, that the Patient can scarce swallow any thing but with grievous pain. Which Symptom is wont to proceed from a light Inflammation of these parts, caused not only by the perpetual agitation of them by the Cough and external Cold; but likewise by the separation and spew­ing out of the Feverish Serum and sharp Matter. Secondly,2. A Thrush. long and troublesome Thrushes disperst [Page 112] through the whole Mouth, which arise from the distemper'd state of the Spittle: But espe­cially if the Looseness that they have been fol­lowed with, has been violently stopt with Opi­ates, and Astringent Medicines. For hereupon Nature (when the Door by which the Serum uses to pass, is once stopt) endeavours, though in vain, to force out her Enemy by the passages of the Spittle. By which means it comes to pass, that the parts of the Mouth being tinged with that sharp Humour, happen to be inflam'd and ulcerated with the Acrimony of that distem­per'd and feverish Serum, which is separated and thrown out by the Glandulous Membrane of the Mouth. Which indeed is the immediate cause of this Symptom, which how troublesome soe­ver it is, does nevertheless plainly defie what­ever either Art or Nature can do, because the stock and fuel of it, that is heaped up in the Mass of Blood,This univer­sal Colliqua­tion quickly brings a Ma­rasmus. cannot be spent. Thirdly, this universal Colliquation, through what Sluces soever of the Body it happens to be made, uses very quickly to bring a Marasmus, with a Hip­pocratick Face, which is a total Consumption of the Muscular Flesh, from the defect of the new Nutritious Juice, which by adhering to the Solid Parts might repair the continual loss that they sustain. And when the thing is at length come to this pass, there are no hopes of the Patient's Life. And therefore this Symptom has ever been reckoned by all Persons one of the most certain signs, not only of a confirm'd, but likewise of a deplorable Consumption.

ObservationsBesides these Diagnostick signs, which I have already mentioned, it may perhaps be beneficial to add likewise my Observations concerning the Pulse, the Urine, and the Matter which they [Page 113] bring up in their coughing, in the several de­grees of this grand and stubborn Distemper.

And first, of the Pulse:1. Of the Pulse. When there is only a He­ctick Fever. In the beginning of a Consumption, whilst there is no other Fever but a Hectick, as the preternatural heat is continual and moderate, so likewise the Pulse is somewhat quicker than it ought to be, according to the degree of the Fever; yet for the most part it always observes the same strokes, and is always alike, but only that after eating, as a feverish Heat, so likewise a quickness of the Pulse may more easily be discerned. And indeed some Per­sons in a Consumption, that are more cold and Phlegmatick, do use to perceive nothing amiss, either in their Pulse or Temper at any time but only then.When there is an Inflam­matory Fe­ver. But as soon as ever the Peripneu­monick Fever, with an Inflammation of the Lungs seizes them, the Pulse, as it uses to hap­pen in other Peripneumonies, is not only quick, but also hard and strong, yea, likewise rises up more in one place than in another, so as to feel somewhat like a Saw, when one feels it with se­veral Fingers together. Though sometimes, by reason of the violence of the Spasmodick pain caused by the Inflammation of the Tubercles, it is no rare thing to observe a weak Pulse, to­gether with a coldness of the Extream Parts for a time, which may employ the Sagacity of the most Skilful Physician, to know whether he ought to prescribe Bleeding, or no. For as the taking away of Blood does suddenly destroy Nature, and ruin the Patient whenever the weak­ness of the Pulse, and the coldness of the Ex­tream Parts proceed from an habitual Weakness: So Bleeding by abating the Inflammation, makes the Pulse stronger, and restores heat to the Ex­tream Parts, whenever this Weakness proceeds [Page 114] accidentally from a painful Spasm of the Lungs caused only by an Inflammation, which is often immediately relieved by Bleeding.

When there is a Putrid Intermitting Fever.But when in the progress of the Distemper a Putrid Intermitting Fever comes on from the gathering of Matter in the Lungs, the Pulse is very uncertain, to wit, in the Morning before the Fit it is somewhat quick, and weak; quick from the Hectick Feverish disposition of the Blood; but weak from the exhausted and impo­verisht Habit of the Body at this time for want of the reparation, which should be made by due and sufficient Nourishment: But in the Fit it is quick and strong; quick from the Hectick Fe­ver, strong from the present Orgasm, or preter­natural Commotion of the Blood. But when the Sweat begins to come on, both the preter­natural quickness and the strength of the Pulse are by little and little abated, until the strength of it is renewed by the next Fit.

2. Observa­tions of the Ʋrine.Secondly, the Urine, when the Distemper first seizes the Patient, is in some degree less than usual, and somewhat high-coloured, according to the degree of the Hectick Fever, and being exposed to the Air, turns thick with some settling at the bottom, as abounding with more Chylous Particles than it should do. But when the Tu­bercles begin once to be inflam'd, it is very red, and high-colour'd: But as soon as the Putrid Fever from the Apostemes of those Tubercles succeeding the Inflammation of them comes to be one of the Symptoms, it is high-colour'd, as it uses to be in Intermitting Fevers, and thick, and at length being exposed to the external cold, has a white settling like Meal, and sometimes a little red; for the Blood in this Colliquative state separates the Nutritious Juice by the Glands [Page 115] of the Kidneys as well as by other Glands. Though it must be confest, that Persons in a Consumption, that are Scorbutical, and Hypo­chondriacal, but especially where the Nerves are affected, or upon drinking of French Wine, or other Diuretick Liquors, do make a good quan­tity of Urine that is like Water, thin, and pale at some times, after which there presently fol­lows a high-colour'd and thick Urine.

Thirdly,3. Observa­tions of the Matter that Consumptive Persons spit. that which Persons in a Consump­tion spit at first (that is, when the stuffing of the Lungs gives the first occasion of it) is plentiful, sometimes crude, sometimes concocted, as it uses to be in a common Catarrh. Or else it is thin and waterish, because for the most part (to wit, whilst the Cough is dry) it is thrown out of the Salivatory Glands from the extraordinary shaking of them by Coughing, excepting some little quantity of viscid Phlegm, which is wont to be hawk'd out of the Tonsils. But in the progress of the Distemper, especially when it is concocted by sleep, or the use of Opiates, it is of an ash-colour, or yellow, or greenish; the like Concoction to which the Serum admits in the Glands of the Nose, or Wind-pipe, in the latter end of a Catarrh. But after the Lungs are ulcerated, if the purulent Matter not being contained in a proper Cystis, be thrown into the branches of the Wind-pipe, that which they spit is purulent, and stinks, and is sometimes al­so mixt with streaks of Blood, like that which uses to run out of old and foul Ulcers.

But we must not make a Judgment of the spitting of purulent Matter,We must not judge of pu­rulent Mat­ter by the yellow or greenish co­lour of it. from the yellow or greenish colour of it: For this kind of colour not only the Serum, that comes from the Glands of the Lungs has, but likewise that which is [Page 116] separated by the Glands of the Nose in the end of a Catarrh, to wit, as soon as it comes to be concocted. Neither is that that Persons spit to be presently taken for purulent because it sinks, or dissolves in warm water.Nor by its sinking and dissolving in warm water. For the spitting of Scorbutical Persons, because it is much impreg­nated with Salt, and thereupon glutinous, and heavy, is wont to dissolve, and to subside in hot Water,How true Pus may be known. though the Lungs are sound. But true Pus or Matter may be known by these three signs. First, it affects the Nose with a stinking smell. Secondly, though it be something thick, yet it is not at all glutinous, but fluid, having no strings or ropiness. Thirdly, it is of several colours, to wit, yellow, greenish, &c. but for the most part of an ash-colour, and something black.

CHAP. V.

HEre I could easily make several Divisions of a Consumption of the Lungs, and those such as are confirm'd by daily Experience; but, because they neither afford any light to the forming of a true Notion of this Distem­per in general, nor help us to a clearer, or more distinct Understanding of the general Progno­stick Signs and Indications of Cure, I shall not so much as mention them, at least in this place. But yet there is one Division of a Consumption of the Lungs, which is into an Acute,The Division of a Con­sumption in­to Acute and Chronical. and a Chronical Consumption, without the knowledge of which, a Physician must needs be very often mistaken, as well in the making of his Progno­sticks, as in the discovery of the Indications of Cure. And therefore no one ought to think it improper, if I here add with what Brevity I can, my Observations for a fuller explication of it. For as I have seen some taken away by this Distemper within the space of one, or at most of a few Months, so I have observed a great many others, that were far gone in a Consump­tion, by due care, and by making use of proper means, who have lived, though in a sickly and crazy state, for many Years; as for Example, Mr. Haither, who after the Cure of a spitting of Blood, which he had been seized [Page 118] withal when he was a Youth, is yet living in the fiftieth Year of his Age, though in the whole course of this time he has been lean, troubled with a Cough, and often had touches of a Fe­ver, and been freed from several Putrid Fevers by our Art. And thus my dear Father, who himself was a very skilful Physician, though he was troubled with a continual Cough, a diffi­culty of Breathing, frequent Putrid Fevers, a light degree of a Hectical Heat, though conti­nual, did nevertheless by this means spin out his Life, though he continued sickly, from the thir­tieth to the sixtieth Year of his Age; and at last did not dye of a Consumption of his Lungs, (from which he seemed for the last three Years of his Life to be more free than he had been before) but of that Epidemical, that continued Putrid Fever, which reigned publickly all over England in the Year 1658. The same thing I observed in Mrs. Davison, a Merchant's Wife in London, for the space of fifteen Years, and in a certain Merchant that lived in Philpot-Lane, who after several Inflammatory Fevers, that returned often in a Year from every little occasion, at length happened to have such an extraordinary exulceration of his Lungs, that he dyed of it, together with a Dropsie, and the other usual Symptoms of a Fatal Consumption of the Lungs, when he was about Sixty Years old. I could likewise give several Histories of this Nature, but at present I study brevity.The cause of this diffe­rence. As for the cause of this difference, to me it seems to proceed from the different disposition of the Blood, and of that Humour, which is supplyed to the Tuber­cles of the Lungs, and differs according to the various dyscrasy of the Blood. For if the stuf­fing of the Lungs, and the Tubercles, which [Page 119] arise from it, by reason of some peculiar dys­crasy of the Blood, have their Original from some malignant or cancrous Humour, or a Hu­mour that is apt to cause a Gangreen, (as I remember it has sometimes happened) the Di­stemper is not only certainly Mortal, but also quick, and very Acute, and such as carries off the Patient in a few Months, and it may be Weeks. But if they arise from some benign, mild, and cold Humour, such as is less apt for Inflammation and Putrefaction, the Patient gains a longer, though a miserable Truce for his Life. But if the Mass, that is contained in the hard­ned Glands, be (as it is often seen in some Scor­butical Persons, and much more in those that are Scrophulous) either not at all, or at least but more slowly disposed to an Inflammation and Putrefaction, the Distemper is very Chro­nical, and the Patient living in a Consumptive and Sickly state for many Years, is at length sometimes seized, and carryed off by some other Disease, as appears plainly from the instances I have before mentioned. For so long as the Lungs are only stufft, or the Tubercles, that arise from that stuffing, remain in a crude state, the Per­son's Life, though it be miserable, yet is not brought into any sudden danger, though he is troubled with an Oppression of his Breast, some difficulty of Breathing, and a frequent Cough; all which Symptoms are wont to be increased even from the taking of the least Cold, or the committing of any Error in his Diet, and that with the addition of an uncertain Fever for a time. Likewise some degree of a continual He­ctical Heat may be perceived in the Solid Parts, but especially in the palms of the Hands, and the soles of the Feet; as also a redness in the [Page 120] Cheeks, especially after eating, and the drink­ing of Wine. The Pulse also is something quick, and sometimes intermitting; the Appetite un­constant, and for the most part weak, at least upon the taking of cold. There is likewise ra­ther a lankness of the Muscular Flesh, than a plain Consumption. That which they spit is sometimes viscid, and black, or of an ash-co­lour, according to the colour of the Matter con­tained in the swelled Glands. Many times too a spitting of Blood uses to return pretty often upon the least occasion. Which are the Symp­toms, or Diagnostick signs of a lingring Con­sumption of the Lungs, which notwithstanding a Person, though he must expect to be always crazy and sickly, may many times live a long time; but 'twill not be safe for him to indulge himself in the free use of Wine and Meats with­out any distinction, and the choice of such as are most convenient, nor of several other things, that conduce to the pleasure of Humane Life, as others do. But as soon as a new Inflamma­tory, or Putrid, and Colliquative Fever is pro­duced by the Inflammation and Apostemation of these Tubercles, all the Symptoms of a confir­med and deplorable Consumption are wont to follow; which are more or less certainly and suddenly, according to the Nature of the Swel­lings, as they are more or less disposed to an In­flammation, and a quick Exulceration. And here perhaps it may be worth the while to add farther some particular Observations. As for Example.

Observa­tion 1. T [...] Nature of the S [...]l­ling makes the Fever more or less [...].First, As the Inflammatory Fever, or the Pu­trid which arises from it, is more or less acute and dangerous, according to the Nature of the Swellings, as they are more or less Malignant, and [Page 121] disposed to an Inflammation, and an Exulcera­tion; so likewise the Consumption from thence grows more or less quick, and incurable.

Secondly, The frequent taking of Cold,Observ. 2. Taking of Cold, &c. make a Con­sumption more Acute. and often committing of Errors in their Diet, Exer­cise, and Passions of the Mind, &c. do by bring­ing Inflammatory and Putrid Fevers, that return in the same manner, upon the Hectick Heat they had before, bring this Distemper sooner to a fa­tal end, making that Acute, yea, very Acute, which otherwise would have been in its own Nature Chronical.

Thirdly, The Consumption of Young Men,Observ. 3. A Consump­tion more A­cute in young than in old Persons. that are in the Flower of their Age, when the heat of the Blood is yet brisk, and therefore more disposed to a Feverish Fermentation, is for the most part Acute. But in Old Men, where the Natural Heat is decayed, it is more Chronical.

Fourthly,Observ. 4. When is from Acute Distempers, it is Acute. A Consumption that proceeds from Fevers, especially such as are from an Inflamma­tion of the Lungs, or from the Suppression of Malignant Ulcers, is almost always Acute: But when it depends upon a Scrophulous and Scor­butical disposition, so in a cold and phlegmatick Temper, it is Chronical.

Fifthly, The omission of Bleeding,Observ. 5. For want of B [...]eeding in the [...] Fe­ver makes a Consumption to be Acute. or taking away too little Blood, or bleeding too late in the Inflammatory Fever of such as have a lingring Consumption, makes that Consumption, which otherwise was in its own Nature slow and lin­gring, very Acute, and presently Mortal; be­cause the parts of the Lungs, that are stufft and harden'd, having been heated for some time, do from that grow more apt to he inflamed, to pu­trefie, and to be exulcerated.

CHAP. VI.

WHat will be the Event of this Distemper, does plainly appear in the several Stages or Degrees of it, as well to our very Reason, as to Experience, from what I have already said; and therefore I shall not propose my Prognosticks, though found out by much Practice and Expe­rience, after the usual manner, that is, like a Dictator, and Magisteriously, any further than as they are confirmed by Reason, and proved the Nature of the thing it self. As for instance,

Every Con­sumption of the Lungs is Chronical.First, Every Original Consumption of the Lungs, strictly speaking, is Chronical, though when we compare them, one Consumption may be more quick than another, and in that respect may be said to be Acute. But let it be whither it will, it is always very hard to Cure, because it depends upon a load of Humours, and a stock of them heaped together in the Habit of the Bo­dy, which cannot be emptied, or drawn out by any sudden Crisis, like a Fever and other Distem­pers, that are properly called Acute.

A Consump­tion in the beginning is curable.Secondly, But yet in the beginning, when the Lungs are only stufft, yea, in the Second de­gree of this Distemper, when the Tubercles are already bred from a long stuffing, and whilst they remain crude, and not so subject to be in­flam'd and ulcerated, a Consumption does admit [Page 123] of a Cure as well as other Distempers, but espe­cially in the Spring-time, which is wont mighti­ly to conduce to this Cure, whilst the Sun is ad­vancing towards us. It admits of a Cure, I say, either true, or at least palliative, according to the Nature of the Swelling, and the present state of the Blood, from which there arises a Swelling more or less Malignant, and apt to be inflam'd and ulcerated: To wit, a true Cure, as often as these Swellings (being but few and benign) happen to be dissolved by the Art of Physick: And a palliative Cure so long as those Swellings can but be kept from an Inflammation and Ex­ulceration,Though the Cure is some­times only palliative. by the help of Balsamick and other such-like Medicines. By which means it comes to pass, that the Patient, though he is sickly, and subject to Fevers, even upon every little occasion, yet is able to do his ordinary business, and ma­ny times lives to grow Old.The Reasons why it is thought in­curable. And this Distem­per comes to be reckoned such a stubborn and incurable Disease, either because the Patient be­ing deceived by the flattering Nature of the Di­stemper, or through carelesness, and the fear of Charges (who commonly sets a lower Price upon himself than any thing else) comes to de­sire the Physician's Advice too late (which very often happens;) or else lastly, through the Ig­norance of the Physician, who not having a true Understanding of this Distemper in the several degrees of it, knows not therefore how to treat it in a due Method.

Thirdly, but a confirm'd Consumption,A confirm'd Consumption rarely cured. toge­ther with the Putrid Fever that is added to it, caused by an Inflammation, or Exulceration of the Lungs, does very rarely admit of a perfect Cure. But yet if it be but a small part of the Lungs that is ulcerated, and the Matter be benign, [Page 124] and contained in a proper Bag, the Life of the Patient may be preserved many Years by the careful management of himself, and the use of proper Medicines; but he will be always sickly, and subject to a Putrid Fever even upon the least occasion.

The more A­cute, the har­der to Cure.Fourthly, A confirm'd Consumption, by how much the more Acute it is, by so much the more difficult it is to cure, because it depends upon more Malignant Tubercles, and is accompanyed with a greater Colliquation, and likewise a quicker decay, and loss of strength.

An heredi­tary, &c. Consumption generally Mortal.Fifthly, If a Consumption be Hereditary, or proceeds from an ill conformation or make of the Breast, for the most part it is Mortal, be­cause the cause which produces it, lyes beyond the reach and power of our Art.

Very hard to Cure, when 'tis got by In­fection.Sixthly, A Consumption that is got by Infe­ction, but especially whenever that Infection is derived from one that has an Acute and Ma­lignant Consumption, is, when all other Circum­stances are alike, more difficult to cure, and for the most part more Acute and Fatal than other Consumptions.

A Consump­tion in young Persons is very hard to Cure.Seventhly, A Consumption in Young Persons (by reason it is more Acute, and apt to bring a Putrid Fever sooner) is harder to cure, than when it falls upon one that is of a greater Age, where the Blood as it is less disposed to be hot, so it threatens a slower Fever, and not so sud­den a destruction as in the flower of their Age, where all the Essays of Nature are made with strength and violence.

It cannot be owed in the Autumn, or Winter.Eigthly, A Consumption in the Autumn, or Winter, though it may be relieved by a careful management, and the convenient use of Medi­cines, yet it can never be perfectly cured with­out [Page 125] the benefit of the Spring, and of the ap­proaching Sun. For as the vesiculous substance of the Lungs is almost continually penetrated by the Air, and by the Decree of Nature is blown up in the farthest corners of it by the continual succession of new Air, that is driven in and out by Respiration, so the present state of the Air must necessarily be of very great moment, seeing it may either hinder or promote the Cure of this Distemper, as it is found to be wholsomly dry and warm, or unwholsom by being cold and cloudy. So that the due constitution of the Air contributes not only to the Preservation of the Lungs, when they are out of Order, but al­so to their Cure more than the most pompous heap of Medicines, which cannot be conveyed into the Blood, and the Part affected so conti­nually, or in the same quantity as the Air is. And therefore 'tis usually in vain to expect the Cure of a Consumption in the Winter-time, and in Autumn, to wit, whilst the state of the Air being cold, thick, and moist, and consequently unwholsom, does continually promote the Di­stemper more than a store even of the most pro­per Medicines can stop and check it, when the edge of the most Powerful Remedies is taken off, and their Efficacy weakned in this manner by the extreamly incommodious state of the Air.

Ninthly, Every Putrid Fever,Every Putrid Fever pro­motes a Con­sumption. though it pro­ceeds meerly from an accidental Catarrh, or ta­king of Cold, does by heating the Lungs, migh­tily promote a Consumption; but especially if Bleeding be omitted in the beginning.

Tenthly,An Original Consumption is harder to cure than one that is Symp­tomatical. An Original Consumption of the Lungs is for the most part harder to cure than a Symptomatical Consumption, because this last seems to arise not so much from the Habit of [Page 126] the Body, as by Accident; and many times the Original Distemper, from which it takes its be­ginning, is easily cured. Though I must con­fess, that whenever a Consumption happens to arise from a Peripneumony, or any other Di­stemper of the Breast ill cured, from the dry­ing up of old external [...]ores, or the running of internal Ulcers, it is a very hard thing to cure it.

Every Con­sumption when 'tis cured is opt to return.Eleventhly, Every Consumption though it be cured, is apt to return, and he that has once been in a Consumption, unless he governs him­self very regularly, falls back into the same con­dition, even upon the least occasion. For not only the Lungs, being already impaired by a former Attack from the Distemper, are the more apt to receive a new impression, but there is like­wise found a greater inclination and disposition to this Distemper from the Habit of the Body it self in these, than in other Persons. Yea, more­over, even after the most perfect Cure of a Con­sumption, there is reason to suspect that there are some crude Tubercles yet remaining, which at length may by often meeting with an occa­sion be inflamed, and ripen into Apostemes, and so at last become Ulcers.

The sooner the Cure of a Consumption is begun, the easier it is.Twelfthly, The sooner the cure of a Con­sumption is begun, the better it usually succeeds; and from hence this Distemper especially proves fatal, because the Physician is consulted when 'tis too late; it being a common thing for Patients to neglect our Advice so long, till they are not capable of any of those Evacuations, and seve­ral other Medicines that are very necessary to this Cure.

CHAP. VII.

IN the beginning of this Distemper, to wit, whilst the Lungs are only stufft, and being filled with dispirited Chyle, and obstructed (with the Habit of the whole Body at the same pass) they have a Hectical Heat, and spew out a great quantity of Serum (which does often happen in a Consumption proceeding from a Catarrh, and taking of Cold, that is, where the Body has been so predisposed, and indeed continues a long time before the Tubercles, and the dry Cough, that proceeds from them, are produced.) I say, at this time the Indications are plainly these.

First,The first In­dication is to temper the heat of the Spirits, &c. This is to be done by al­terative Me­dicines. To temper the heated disposition of the Spirits, by procuring a quiet and chearful Mind, and to mend the Mass of Blood, that has been by degrees reduced to a sharp and hectical state, by the plentiful use of alterative Medicines. And such we must reckon not only a Milk Diet, the Chalybeate Mineral Waters, and those Medi­cines that are commonly called Pectoral, as be­ing soft and mucilaginous, and so obtunding the sharpness of the Humours, but also Balsamicks, and Specificks, which have a respect to the pro­per Constitution of the Patient. But the Re­medies of this Nature must be taken plentifully, and so must be given (as much as can be) in the manner of a Diet, and they must persist in [Page 128] the use of them for a long time: For the sharp and distempered state of the Humours, which has been contracted by little and little, is not corrected without a long and plentiful use of proper Medicines.

The second Indication is to carry off the ill Hu­mours by E­vacuations.Secondly, Gently to carry off the load of the dispirited and diseased Humours lodged in the Habit of the Body, with convenient Medicines, as Vomits, Purges, Diuretick, and Sweating Me­dicines.Which must be always gentle. But all manner of care must be taken in the choice of these kind of Remedies; to wit, that they be very gentle and benign, left that by heating the Blood, and putting it into too great a commotion, and by that means bringing it farther into a colliquative and waterish state, they should by Accident increase the Distemper.

The third In­dication is to open Ob­structions, &c.Thirdly, To remove Obstructions, and to strengthen the Tone of the Parts, especially of the Lungs, that are weakned by the Humours they have imbibed, and disposed to a Convul­sive Contraction, by the use of Steel prepared either by Art or Nature, of Balsamick Medi­cines, of good and agreeable Air, of Volatile Salts, and other things of this kind.

The fourth is to correct the Colliquative state of the blood.Fourthly, To prevent the Hectick and Col­liquative Heat, or Catarrhous state of the Blood, or at least to lessen it by timely and plentiful Bleeding; which, although it may do mischief sometimes in a confirm'd Consumption, yet in the beginning of one it is very beneficial: And I do not at all doubt but the Tubercles for the most part are occasioned by the neglect of it, or for want of Bleeding to a sufficient quantity in the beginning of the Distemper, whereby the Consumption uses to run presently into the se­cond, and more fatal degree.

[Page 129] The fifth is to concoct and thicken the Rheume in the Lungs.Fifthly, To take all the care that we possibly can of the Part affected, to wit, the Lungs, by hastening (as much as may be) the concoction of the thin Rheum, that flows continually into them, whereby the troublesome Cough it self, together with the cause of it, may be wholly re­moved.What Medi­cines are con­venient for this purpose. Which is done not only by alterative and mucilaginous Medicines, commonly called Pectorals (which being taken plentifully, do by taking off the sharp disposition of the Blood and Humours, hinder any farther colliquation and heat in them; by which means the new influx of them being once rendred less, the Humours, that are already sticking in the Lungs, may be more easily and sooner concocted by the Natu­ral heat of the Part:) But likewise by gentle evacuating Medicines, which by diverting the Humours from the Lungs, do for the Reason already mentioned, conduce very much to the more speedy concoction of those, which had been before collected. But above all by the pru­dent and alternate use of cleansing and inciding Medicines, as there shall be occasion. For as Incrassating and Opiate Medicines prudently gi­ven, do much promote the concoction of the Humour, that is already fixt in the Lungs, by stopping the influx of fresh Humours into them, at least for a time; so likewise by that respite, which they procure to the Lungs from coughing, the Lungs themselves, not being for that time so much distended beyond their Tone, and reco­vering their Natural strength, are very much comforted. But by the use of Oily and Lubri­cating Medicines, the Humours that are lodged in the Lungs, and concocted, are more easily brought up by Expectoration. And if in their concoction they happen to grow more hard and [Page 130] tough than they should be, they may with the help of cutting, and cleansing Medicines be brought up without violent straining, or force of their Cough, which, if it happens, may raise a new Flux (and that a very troublesome one) of thin Rheum, from the Glandules of the Wind­pipe and Lungs, like the sucking of a Pump.

In the second degree of a Consumption the Indica­tions are al­most the some as those above mentioned.In the Second degree of this Distemper, that is, when the Tubercles are first bred in the Lungs, with a dry and troublesome Cough, and so long as they remain crude, without any great Inflammation and Exulceration, the Indications are almost the same as before, excepting that they must insist more diligently upon a very plen­tiful use of altering Medicines, according as the degree of the Hectick heat is increased; but ac­cording as their Weakness, and the Colliquation of the Humours are greater, all manner of E­vacuations must be made more cautiously and sparingly; but especially we must endeavour all we can to dissolve those Swellings with the use of Balsamicks, Chalybeates, Antiscorbutick Medi­cines, of Wood-lice, and other things of that kind.

But in the last degree of a Consump­tion there are new Indica­tions.But as soon as the Distemper comes by the In­flammation, and ripening of the Tubercles, at length to the last, and for the most part fatal degree of a confirm'd Consumption, (which commonly shews it self not only by the vast in­crease of the Colliquation, and the accession of a new Fever, not only an Inflammatory, or Pe­ripneumonick, but likewise a Putrid Intermit­ting Fever) there presently arise new Indica­tions of Cure.

1. For when the Lungs are affected with an Inflammation of the Tubercles in the manner of a Peripneumony, as there is an Indication of [Page 131] timely Bleeding, and of Temperate and Cor­dial Juleps to soften the Blood, and to keep up their Strength, so also of a very thin Diet, and a plentiful use of Pectoral Medicines (but espe­cially such as are Oily and Mucilaginous) to take off the Convulsive contraction of the Lungs, by their Anodyne Power, and to facilitate and pro­mote the bringing up, or expectoration of the Phlegm out of the stufft Pipes.

But as soon as the Peripneumonick Fever hap­pens to be succeeded by a Putrid Intermitting,In the Putrid Intermitting Fever all E­vacuations are to be a­voided. and extream Colliquative Fever, together with a sudden decay of Strength after the Inflamma­tion of the Tubercles turns once to an Exulcera­tion; as all Evacuations are contradicted by that Weakness, so there is an Indication for the use of Temperate Pectoral Cordials, Pectorals, Opi­ates, Slippery, and Cleansing Medicines. We must likewise endeavour to root out the Putrid Fever, which, although some deceitful Truce may be gained with the use of the Peruvian Bark,The Peruvian Bark must be given. yet does never admit of a perfect Cure without the Ulcers are healed, which, when they are small and benign, is not altogether impossible with the help of a convenient Diet, and good Air, and the use of Balsamick Medicines. But however that may be, we may endeavour to give some check to the Colliquation, by mitiga­ting the Fever Fit, and to alleviate the fatal Sym­ptoms, which arise on every hand from the Col­liquation. Of which I shall speak more largely by and by in the Method of Cure.

The Medicines that are proper in this Disease,What Pur­ging Medi­cines are convenient in a Consum­ption. are, First, Purging Medicines, which ought al­ways to be mild and benign, as Manna, Lenitive Electuary, the greater Compound Pouder of Senna, Aloes prepared with the Juice of Roses, Mastick [Page 132] Pills, Pills of Amber, Alaephangine Pills, Stomack-Pills with Gums, my Magisterial Stomack-Pills (by the Prudent use of which at due distances my most dear Father, who was himself a very Skil­ful Physician, for the space of Thirty Years, li­ved till he was an Old Man, though in a Con­sumptive and Sickly state) the description of which I am willing to publish out of his own Manuscript, for the Publick Good.

Take of the finest Aloes an Ounce, the best Myrrh, Mastick, of each half an Ounce, Cinnamon, Saffron, of each two Drams, Cloves, Roman Wormwood, Red Roses, Nutmeg, Mace, Calamus Aromaticus, of each a Dram, of the best Rhubarb two Drams, Galingale, Schaenanthus, Yellow Saunders, Wood of Aloes, the lesser Cardamoms, of each half a Dram, of Oriental Musk four Grains, with a sufficient quanty of Syrup of Wormwood. Make them up into a Mass for Pills, according to Art.

Likewise the Purging Mineral Waters, and in general all gentle Purgers, that are grateful to the Stomack and Nerves, and which cause as little heat as may be in the Blood and Spirits, are of use here.

What Vomits may be given.To this Head we must also refer Vomits, as Honey of Squills, and in the beginning of a Con­sumption especially, when it is from a Surfeit, the Infusion of Crocus Metallorum.

What Diure­tick Medi­cines are pro­per. Secondly, Diureticks, as the Mineral Waters, both Chalybeate, and Purging, Wood-lice both crude and prepared, the four greater cold Seeds, common Tur­pentine, Natural Balsam, Balsam of Tolu, of Peru; and Compound Medicines made of these, as Bal­sam of Sulphur made with Oyl of Turpentine, and with Oyl of Aniseeds, Dr. Goddard's Balsamick Sy­rup, both the Simple and the Anodyne; the Roots of Fennel, Parsley, Eringo, and those either raw or can­died, [Page 133] of Elecampane, the Seeds of Mallows, of Marsh­mallows, Plantain-leaves, Juniper-berries, Elder-berries, simple Honey, Honey of Violets, Craw-fish, Syrup of Marsh-mallows, Sweet Almonds, &c.

Thirdly, Diaphoreticks, The Diaphe­retick Medi­cines that proper. As Sarsaparilla-roots and China, in decoctions, Venice-Treacle, Laudanum, both liquid and solid, Mithridate, Confection of Alkermes, Saffron, Sassafras-wood, Lignum Vitae, Saunders, yellow or red.

Fourthly, Pectorals,The several sorts of Pe­ctoral Medi­cines, As those that are soft. to which Head I use to refer, First, all Simple and Compound Medi­cines, which by taking off the Acrimony of the Humours, do abate the Colliquative state of the Blood, whereby it comes to pass, that the Rheum is not separated so plentifully by the Wind-pipe and Glands of the Lungs. As for Example, Coltsfoot, Maiden-hair, Alehoof, Brook-lime, Water-Cresses, Pine-tops, Scabious, spotted Lungwort, the Flowers of the great Daisie, of Rosemary, Betony, Sage, Violets, of Borrage, Bugloss, Lilly of the Val­lies, the Roots of Polypody, the Leaves of Yarrow, Mouse-ear, Burnet, Dandelion, Plantain, Self-heal, Sanicle, Fluellin; and such mild Plants abounding with a Volatile Salt; with Syrups, and other Com­pound Medicines made of those Simples; the Leaves of the Oak of Jerusalem, of Sun-dew, Golden Maiden-hair, and other Herbs commonly called Vulnerary, which by altering the Mass of Blood, do very much help the Concoction of the Hu­mours, that are lodged in the Lungs. Likewise the Balsam of Tolu, of Peru, Natural Balsam, Storax, Ben­jamin, Gum Elemi, Balsam Capivi, with other Gums and Balsams; Brimstone, and the several Prepara­tions of it; Crabs-eys, Egg-shells, Chalk, Coral, Pearl, Wood-lice; the four greater cold Seeds, the Seeds of Mallows, Marsh-mallows, and Lettuce: the Roots of [Page 134] China, Sarsaparilla, the shavings of Hartshorn and Ivory, with the Compound Medicines made of them, such as Haly's Pouder, the Analeptick, or Re­storative Antidote, the Pectoral Decoction, the Deco­ction of Sarsa, and China; Pectoral and Antiscorbu­tick Ingredients in their ordinary Drink, Emulsions of the four cold Seeds made with Barley-water, a Milk Diet, but especially Asses Milk, things made with Bar­ley, the Chalybeate Waters, Oysters, Snails, and Me­dicines made of these.

These that are lubrica­ting and in­ciding.Secondly, Lubricating and cutting Medicines, which promote the Expectoration of the Hu­mours, that stick in the Lungs; as Liquorice, Ho­ney, Mead, common Oyl, Oyl of Sweet Almonds, but especially Linseed-Oyl fresh drawn without fire, Tur­pentine, Natural Balsam, fresh and sweet Butter, Al­monds, Figs, Raisins of the Sun, Dates, Sebestens, Jujubes, Juice of Liquorice, Gum Ammoniack, Ben­jamin, Balsam of Tolu, Lohoch Sanum, & expertum, Lohoch of Foxes Lungs, of Coltsfoot; Sugar-candy, or Loaf-Sugar, with several Linctuses, and other Medicines in which that is an Ingredient, such as the Syrups of Hedg-Mustard, Maiden-hair, Colts-foot, simple Syrup of Horehound, Syrup of the Flowers of St. John's wort, of the five opening Roots, the Bal­samick Syrup, Syrup of Jerusalem Oak, of Liquorice, Hyssop, Horehound, Marsh-mallows, Jujubes, Violets, as also Honey of Violets, the Compound Pouder of Or­rice, Haly's Pouder, Trochisci Bechici, or Cough-Lo­zenges, both white and black.

Those that are Carmi­native.Thirdly, Carminatives, which by comforting the Nerves, and freeing them from Obstructions, do remove the Convulsie Constriction of the Lungs, upon which there follows a freer Respi­ration, and consequently a more easie Expecto­ration; as Aqua Mirabilis, Spirit of Hartshorn, of [Page 135] Salt Armoniack, the Compound Waters of Briony and Piony, Aniseeds, Fennel-seeds, Elecampane and Orrice-Roots, Orange-flowers, Rosemary-flowers; the Leaves of Hyssop, Sun-dew, with the Waters and Syrups made of them; Orange and Citron Pills candied, Bay-berries, Juniper-berries, Honey, Civet, Gum Ammo­niack, Benjamin, Cinnamon, Nutmeg, Mace, Balsam of Peru, Natural Balsam, Syrup of Hedg-Mustard, of Hyssop, the Compound Pouders of Orrice, of Cala­mint, Treacle, Mithridate, Laudanum, and others of that kind, which yet must be used very cau­tiously, and sparingly, and not without urgent Necessity, if there be any considerable Fever.

Fourthly,Those that are Incrassa­ting and ag­glutinating. Incrassating and Agglutinating Me­dicines, which conduce very much to the speedy Concoction, and consequently the Expectora­tion of the Serum that flows into the Lungs; as Comfrey, Alehoof, Yarrow, Dandelyon, Mouse-ear, Plantain, Self-heal, Sanicle, Scabious, and in gene­ral all Vulnerary Herbs; the Flowers of Red Roses, of Red Poppies, English Saffron, Liquorice, Saunders, yellow and red; Pectoral Fruits, as Raisins of the Sun, Figs, Dates, Jujubes, Sebestens, Sweet Prunes, Pine-Kernels, Fistick-Nuts, white Poppy-seeds, the four greater cold Seeds, Seed of Henbane, with the Emul­sions and Syrups made of them; Sugar penidate, Su­gar of Roses, old Conserve of Red Roses, Juice of Liquorice, Starch, Honey, Olibanum, Gum Arabick, Tragacanth, Syrups of Comfrey, Marsh mallows, dryed Roses, and of Liquorice, Lohoch of Fleawort-seed, of Coleworts, Poppies, Purslane, of Pines, Sanum, & expertum, and of Raisins, Jelly Broths made of Calves-feet, &c. Jellies of Hartshorn and Ivory, the species Diatragacanthi frigidae, Haly's Pouder, the black Lo­zenges for a Cough, Mithridate, Diascordium, Ve­nice-Treacle, Syrup of white Poppy-heads, and in ge­neral [Page 136] all Opiates, as Laudanum, both solid and li­quid, Hounds-tongue-pill, Styrax Pill, Philonium Persicum, and Romanum, &c. Which by stopping the present influx of the Humours into the Lungs (as the Ancients love to speak) do likewise con­tribute very much to the Concoction of the Hu­mours, which had been lodg'd in the Lungs be­fore. And therefore without the cautious and prudent use of them there is no great matter to be done in the Cure of a Consumption.

And lastly, Deobstruents.Fifthly, Such Medicines as open Obstructions, which by freeing the stufft Glands from their stoppages, do lessen them. As the Roots of Orice, Sarsa, China, Sassafras-wood, Saunders, Bay-berries, Juniper-berries, Gum Ammoniack, Benjamin, Bal­sam of Tolu, of Sulphur, of Peru, Opobalsam, Steel, either of Nature's Preparation in the Mi­neral Waters, or prepared by Art in the form of a Syrup, or Electuary, or of Pills, &c. Wood-lice; with many other Antiscorbutick and Antiscrophu­lous Medicines.

From this Treasure of Simple and Compound Medicines, a Prudent Physician ought with the Direction of his Judgment and Experience, to compose and prescribe divers Medicines in the several degrees of the Distemper, and accord­ing to the Exigence of the Symptoms, as there shall be occasion, in that form which shall be most grateful to the Patient, that he may be always able to answer the present Indications in the whole course of the Distemper, and not insist, like a Quack, upon one single Me­dicine, as a Charm for the Disease. The Me­thod of which Rational Cure in the various state and Symptoms of this Distemper as it pro­ceeds, I shall immediately propose.

[Page 137]The Chirurgical Remedies in this Distemper are Issues, Blisters, Shaving of the Head, What are the Chirurgical Remedies. the appli­cation of the Head-Plaister, Betony-Plaister, or any other of the like Nature as also Bleeding; of the Use, and Reason of which I shall Discourse more largely in the following Method of Cure.

CHAP. VIII.

In the Cure of a Con­sumption in the beginning the influx of Rheum into the Lungs must be stopt.IN the beginning of this Distemper (to wit, when the Lungs, the Wind-pipe, and Glan­dules that are dispersed through all that Pipe, and the branches of it, are at first only stufft by the constant spewing out of the Serum, that is separated from the Mass of Blood, and they are troubled with a continual Cough, especially in the Night, proceeding from thence) the new influx of Catarrhous Rheum into these parts is to be stopt by all proper means, and the Hu­mours that are already lodg'd there, must be con­cocted as soon as may be. And therefore,

First, Some Blood must be taken away.First, There must be some Blood taken from the Arm, (especially if the Patient has a fulness of Blood, and has before been accustomed to Bleed) to the quantity of Six, Seven, Eight, or Ten Ounces; not only to abate the Efferves­cence, and consequently the Colliquation of the Blood; but likewise to prevent the Swelling and Inflammation of the Lungs themselves, and to take away the Feverish Heat, which is usually caused by the continual agitation of the parts of the Breast by the Cough, and by the want of Rest,This must sometimes be done more than once. which follows upon it. This opening of a Vein (where the Indications require it) is to be done once, twice, or thrice, at due inter­vals; especially where there is a flux of colliqua­ted Serum, in the form of a suffocative Catarrh, [Page 139] together with a plentiful Expectoration of crude Phlegm, that comes near to the Nature of a Rheum; or where there is a very Asthmatical difficulty of Breathing, a pain of the Side, or any signs of a Rheumatick, Pleuritick, or Pe­ripneumonick disposition; or lastly, where a Sur­feit, or a too plentiful drinking of Wine, or other Spirituous Liquors have preceded. And indeed I do not at all doubt but Catarrhs,For want of this, ordinary Coughs some­times turn to a Consump­tion. and ordinary Coughs do very often turn to a Con­sumption of the Lungs for want of due Bleed­ing and fanning of the Blood in the beginning of this Distemper: And moreover we have rea­son to suspect that the Concretion, or hard knots in the Glandulous parts of the Lungs, and the Hectick Heat proceed from thence.

Secondly, After Bleeding it is very necessary,After bleed­ing a Vomit is necessary. especially if the Distemper had its beginning from a Surfeit; or if there be a nauseating and disposition to Vomit joyned with it, to prescribe a gentle Vomit of Honey of Squills, or Oxymel of Squills; yea, and sometimes of the Infusion of Crocus Metallorum, to be taken in a moderate quantity. By which Vomiting not only the Sto­mack, that was opprest with a load of Humours, may be eased, and the sickness of the Stomack arising from thence, may be removed, and the Digestion restored (all which are to be highly valued;) but likewise the heap of Humours which were before lodged in the Lungs, uses by the exagitation or shaking of these parts in Vo­miting, to be expectorated very considerably, not without a remarkable easing of that heavy weight, which was caused by that load. And I have not only seen several Empericks boast, and that not without good Success, that they could cure any incipient Consumption this way, [Page 140] but likewise I my self, by the Direction of Rea­son, and the Encouragement of Experience, have many times in the same manner stopt the Progress of a Consumption in the beginning of it, in a very short time.

And is some­times to be repeated.This Vomiting (especially if the Patient bears it well, and finds Relief by it, and if it be ne­cessary) may be repeated every third or fourth day, for three or four times.

The most convenient time to give a Vomit.The most convenient time to give a Vomit in this case, is a little before the Evening, but they ought to bleed first the day before, for fear the Blood should be heated by the violent agitation of the Parts, and by that means a Fever should be brought on, or increased if there was one be­fore: And likewise to prevent a spitting of Blood, which is wont to arise from the more vehement straining of the parts of the Breast caused at this time by Vomiting before the Blood-Vessels have been emptied. It is also very convenient when the Vomit has done working,When the Vomit has done working we must give an Opiate. to Order some Opiate, not only to temper the heat of the Blood excited by the straining and agitation, but like­wise to hinder a new influx of Rheum into the Lungs, which uses to arise from this violent agi­tation of the parts.

The forms of the Vomits and Opiates, which I commonly use in this case, are these which follow.

Take of Honey of Squills half an Ounce; let it be given in a Draught of Posset-drink, and re­peated twice or thrice in an hour, if the Patient does not Vomit sufficiently. Which is a Vomit mighty proper for Children and Young People, being gentle, and very grateful. Or,

Take Oxymel of Squills, Oyl of sweet Almonds, of each an Ounce. Mix them. Let the Patient [Page 141] take it dissolved in a large draught of Posset-drink, and repeat it twice or thrice in an hour (if it be necessary) to promote his Vomiting. Or,

Take of the Infusion of Crocus Metallorum seven Drams, Syrup of Violets two Drams: mix them for a Vomit. And in the time of its working (if it be needful) give Oyl of sweet Almonds, and Oxy­mel of Squills, of each half an Ounce, in a draught of Posset-drink once or twice.

Salt of Vitriol is not so convenient, because it continually twitches, and irritates with its styp­ticity the Glandulous parts about the Throat, and so uses to cause a greater flux of Rheum, and so a troublesom and long Cough after the Vomi­ting is over.

The forms of the Opiates to be given after Vo­miting, are these which follow.

Take Cordial Milk-water, Carduus-water, of each an Ounce; of Barley Cinnamon-water half an Ounce, Syrup of white Poppies six Drams. Mix them for a Draught. Or,

Take of the clear Pectoral Decoction four Ounces, of Tincture of Saffron two Drams, of Helmont's Li­quid Laudanum fifteen drops, of Syrup of Violets two Drams. Mix them for a Draught. Or,

Take of Coltsfoot-water two Ounces, Oyl of sweet Almonds fresh drawn, Syrup of white Poppies, of each an Ounce. Mix them. Or if the Patient likes the form of a Bolus better,

Take old Conserve of Red Roses, Mithridate, or Venice-Treacle, Conserve of Wood-Sorrel, of each half a Dram, of London Laudanum half a Grain. Mix them into the form of a Bolus. Or, let him take in the form of Pills, half a Scruple of the Cyncgloss Pill, or as much of the Storax Pill.

[Page 142] Gentle Pur­ges are con­venient.Thirdly, it is convenient also gently to carry down the load of Humours by Stool and Sto­mack-Purges, and others of that Nature, such as may cause but a very little Effervescence, and Colliquation of the Blood. As for Example.

Take the best Manna, Oyl of sweet Almonds, of each an Ounce and half, or two Ounces, dissolve them in a Pint of hot Ptisane. Let the Patient drink half of it in his Bed, the other half, half an hour after rising out of his Bed. Or,

Take of the best Senna two Drams, Cassia broken with the Canes, Tamarinds, of each half an Ounce, of Coriander-seed prepared, half a Dram; boyl them in a sufficient quantity of Spring-water, or Barnet, or any other Purging Water, to half a pint. Dissolve in the Liquor strained an Ounce of the best Manna, half a Dram of Salt of Prunella. Mix them. Let the Patient take half of this Potion in the Morn­ing, and the rest half an hour after, with due care.

After the working of a Purge, we must give an Opiate that Night.But whenever he takes a Purge, that Night after it has done working there must be an Opiate given, as after the Vomits, to calm the Commotions in the Blood, and to give the Lungs some quiet, for fear there should arise a new in­flux of Humours into the Lungs from the agi­tation of the Blood by the Purges.

And for the same Reason it is convenient to mix some Opiate with Stomachick Purges, to be taken just before they go to sleep. As for Ex­ample.

Take of Rose-Aloes a Scruple, or five and twenty Grains, of Hounds-Tongue Pill half a Scruple. Mix them, and make them into four Pills to be gilt; which must be repeated every other Night, after the Patient has been duly blooded. This Pill commonly goes by the Name of the Catarrh Pill [Page 143] amongst Apothecaries, because it not only car­ries the Humours down by stool, but also hin­ders a new influx of them into the Lungs. Or,

Take of the Stomack-Pill with Gums, Aloephan­gine, Mastick Pill, or Pills of Amber, half a dram, or two Scruples, of London Laudanum one Grain; mix, and make them up into four Pills, to be gilt, which must be repeated every third Night, for three times.

Yea, if the flux of Rheum be violent,An Opiate must be gi­ven every Night con­ditionally, and a shortness of Breath, or weight, or straightness of the Breast does not follow upon the use of them, some Opiate must be given every Night; because it may not only procure sleep, and so hinder the Effervescence of the Humours and Blood; but also by stopping a new influx of the Humours into the Lungs, may promote the In­crassation, Concoction, and Expectoration of those Humours, which are already lodged there. So that I can from Experience confidently af­firm, that although Opiates are for the most part of some use in the whole course of the Cure of a Consumption, yet they are more safe, bene­ficial, and necessary in the beginning, and with­out the use of them no great matter can be done in preventing the progress of this Distemper.

Fourthly,Diaphore­ticks are very useful. in this state of the Disease Diapho­retick Medicines are likewise very profitable, be­cause they plentifully carry off the Serum, which is continually colliquated from the Blood, by the Pores of the Skin, whereby it comes to pass that the flux of it into the Lungs being lessened, that which was fixed there before, is more easily con­cocted.

But yet in the use of Sudorifick Medicines, we must diligently observe these following Rules.

[Page 144] But in the use of them, 1. An Opiate must be al­ways mixt with them.1. That Diaphoretick Medicines have always something of an Opiate in them, lest by a new Colliquation caused in the Mass of Blood by them a fresh stream of colliquated Serum (by the Lungs as well as the Pores of the Skin) should be produced, and the Cough too thereupon should be increased. Which I have always observed to happen from the imprudent use of Diaphoreticks, that have been given by Women, and Quacks in this case without mixing an Opiate with them. But now with a convenient quantity of Laudanum mixt with a Diaphore­tick, the Lungs are quiet so long as the Sweat lasts. Whereby it comes to pass, that the stream of the Lympha of the Blood is turned from the Lungs by the Pores of the Skin with great bene­fit, the Cough is then easie, and the Serum that is lodged in the Lungs is concocted.

2. We choose such as are least hot.2. We must choose such Diaphoreticks as have the least heat, such as may cause the least Effer­vescence, or new Commotion in the Blood, that the old load of Humours that had been collected before, may be evacuated by the Pores of the Skin without breeding more of them by a new Effervescence.

3. We must not give them before convenient Evacuations by bleeding, &c.3. We must never give Diaphoretick Medi­cines before the use of Bleeding, Vomits, and Purges, whenever these are necessary. For I have always observed a new Colliquation to a­rise from a Commotion of the Blood, that has been made before the Vessels have been emptied, together with an increase of the Cough, and other Symptoms, that depend upon it; yea, and sometimes with new Accidents of a spitting of Blood, of Rheumatick and Pleuritick Pains, and other dreadful Symptoms. The Diaphore­tick Medicines that I commonly use, are these which follow.

[Page 145] Take of Venice-Treacle half a Dram, or two Scru­ples, of Old Conserve of Red Roses half a Dram; mix them for a Bolus. Or,

Take Diascordium, Conserve of Wood-Sorrel, of each a Dram. Mix them together. Or,

Take of Matthew's Pills fifteen Grains, make them into two Pills, to be gilt, and taken when the Patient should go to sleep. Or,

Take of the Cynogloss Pill twelve Grains, of An­timonium Diaphoreticum a Scruple, of the Tincture of Saffron a sufficient quantity. Make them into four Pills, to be gilt.

The most seasonable time to give these Dia­phoreticks is at Night,What is the best time to give Diapho­reticks. and that presently after an Evacuation by Bleeding, Purging, or Vomi­ting, because they procure sleep. The Patient also must be freed from his Sweats with a great deal of care, lest by the Pores being suddenly stopt in this colliquated state of the Blood, he should take new Cold, and thereupon the Cough and other Symptoms should be increased.

During the use of these kind of Evacuations,Whilst these Evacuations are making, there are o­ther things to be done. the Application of Vesicatories to the Arms, and between the Shoulders is very beneficial for di­verting the violent flux of the Humours from the Lungs. But when we are making these Eva­cuations (which are very useful for lessening the colliquated Serum of the Blood, and so for the Concoction of the Humours, that are already lodged in the Lungs) we must not by any means neglect the frequent use of those Medicines which are commonly called Pectoral, or Pulmonary,Pectoral Me­dicines must be given plentifully. which in the time between Evacuations must be given very plentifully, as it were in the manner of a Diet, but always in such a form, as is most grateful to the Patient. For there must always be a peculiar respect had to the Stomack, (which [Page 146] in this Distemper is commonly affected with a Sickness, want of Appetite, and Vomiting) lest being offended with the form, and tired with the great quantity of them, it should be used to a Habit of nauseating, and throw up not only the Medicines, but also the most grateful Food. The best Medicines in the beginning of this Di­stemper are such as are Incrassating and Lubri­cating,What of this fort are best in the begin­ning. which by softning the Serum of the Blood, conduce very much not only to the allaying of the Cough, but likewise to the Concoction and Expectoration of the Humours, that cause the Cough.

But these Incrassating and Expectorating Me­dicines may be given sometimes separately, but for the most part mixt together in a compound form, that we may answer both Indications at once. So for Incrassating Medicines, let the Pa­tient be enjoyn'd the frequent use of Sugar-candy, Saccharum Penidiatum, and Sugar of Roses, as also Old Conserve of Red Roses, Juice of Liquorice, the black Lozenges for a Cough, which must be often and gently swallowed down, that they may re­tund the Acrimony of the Humours, that ouze out by the Wind-pipe, by their soft, mucilagi­nous, and incrassating quality, and so mitigate the troublesome Cough.

For Lubricating Medicines, let the Patient plentifully use New Butter, that has not been sal­ted, in all his Spoon-meat, Butter'd-Ale, and (if he bears it well) common Sweet Oyl, or rather Oyl of Sweet Almonds, but especially Linseed-Oyl fresh drawn without Fire, of which let him take a Spoonful every hour, unless there be a Loose­ness, or some other Symptom that forbids it. Let him also chew Raisins of the Sun, Figgs, &c.

[Page 147]But the Medicines compounded of Lubrica­ting and Incrassating Ingredients, and which sa­tisfie both Indications now mentioned, are those which are commonly called Pectorals, and Ex­pectorating, the more neat forms of which I shall very willingly subjoyn.

Take Oyl of Sweet Almonds, Syrup of Maiden-hair, Jujubes, Violets, or of Marsh-mallows, of each an Ounce and half, of white Sugar-candy a Dram and half; mix them very well for a Linctus, of which let the Patient take a Spoonful every four hours, and drink four Ounces of the following Apozeme warm after it.

Take of the Pectoral Decoction when 'tis clear, a pint and half, Tincture of Saffron extracted with Treacle-water, Syrup of Maiden-hair, Scabious, or Jujubes, of each an Ounce; mix them, and make an Apozeme.

If you have a mind to incrassate more, Take Oyl of sweet Almonds fresh drawn, Syrup of Com­frey, red Poppies, or of dryed Roses, of each an Ounce and half, of Syrup of Meconium half an Ounce, of Sugar of Roses a Dram and half; mix them, and make a Linctus.

But if you have a mind to lubricate more, Take Linseed-Oyl fresh drawn without fire, Syrup of Liquorice, or Honey of Violets, of each an Ounce and half, of white Sugar-candy a Dram and half; mix them exactly for a Linctus, to be taken either by it self, or dissolved in a Draught of the Apozeme above-mentioned.

If a Feverish Heat should forbid the use of Hyssop, or of the Tincture of Saffron, If there is a feverish heat, hot things must be omitted. let them be omitted in the Apozeme.

[Page 148] If there be a Looseness, such things as will make them laxa­tive must be omitted.If a Looseness, or any other Symptom for­bid their use, let the Pectoral Fruits be left out of the Apozeme, and the Oyl out of the Linctus's; or else instead of the Medicines just now men­tioned, let these be substituted, which follow.

Take the Lohoch of Poppies, Sanans, of each an Ounce and half, Syrup of Purslane, of dryed Roses, of each an Ounce, the cold species of Gum Tragacanth, Haly's Pouder, of each a Dram, Saccharum Penidi­atum, or Sugar of Roses, three Drams. Mix them, and make a Linctus, to be taken in a Spoon, or with a Liquorice-stick every four hours, or oft­ner if the Cough requires it, swallowing it gently, and drinking after it a quarter of a pint of the following Emulsion warm.

Take the four greater cold Seeds, of each a Dram, white Poppy-seeds, Lettuce-seeds, of each two Drams, Pine-Kernels, Fistick-Nuts, of each three Drams, with a pint of the Water of Red Poppies, Red Rose-water, Barley Cinnamon-water, of each three Ounces. Make an Emulsion according to Art, to be sweet­ned with Saccharum Penidiatum. Or,

Take the Lohochs of Foxes Lungs, of Colts-foot, of Purslane, of each an Ounce, the Syrups of Jujubes, Maiden-hair, of each an Ounce and half, of Flower of Brimstone two Drams, of the Tincture of Saffron half an Ounce, the cold species of Tragacanth, the could species of Pearl, Haly's Pouder, of each a Dram, Saccharum Penidiatum half an Ounce. Mix them, and make a Linctus, to be taken as before.

Take Tacamabac, Balsam of Tolu, of each a Dram, a sufficient quantity of the Ingredients of the Pectoral Drink; boyl them in a sufficient quantity of Spring-water to a pint and half, with the Liquor strained, and a Dram of each of the four greater cold Seeds, two Drams of white Poppy seeds, and as much Hen­bane seed, seven sweet Almonds blanch'd, Make an [Page 149] Emulsion according to Art, to be sweetned to the Palate with Saccharum Penidiatum.

But if there be a greater difficulty of Breath­ing than ordinary from the toughness of the Phlegm, let the following Linctus be prescribed.

Take the Lohochs of Raisins, of Squills, of each an Ounce and half, the Syrups of Hedg-Mustard, of Hyssop, of Hore-hound, of each an Ounce and half, the species of Orrice, of Calamint, Flower of Brim­stone, of each a Dram and half, of the Tincture of Saffron half an Ounce, of white Sugar-candy six Drams: Mix them, and make a Linctus, to be taken as before. Yea, if this Symptom be very urgent, there may be added a Dram of Gum Ammoniack depurated, and a Dram and a half of Flowers of Benjamin, to the Linctus.

These Intentions (to wit, the speedy Con­coction of that Mass which is lodg'd in the Lungs, and the preventing of a new influx of it) are likewise satisfied by Compositions made of Bal­samick and Agglutinating Medicines. As for Example.

Take the Pulp of Conserve of Red Roses, of Wood-Sorrel, of each an Ounce and half, of Olibanum three Drams, of Natural Balsam two Scruples; mix them, and make an Electuary, of which let the Pa­tient take the quantity of a Wallnut three times a day at Physical hours, and drink after it a quarter of a Pint of the following Apozeme warm.

Take the Leaves of Yarrow, Mouse-ear, Burnet, Dandelion, spotted Lung-wort, Jerusalem Oak, Sca­bious, of each a handful, Flowers of St. John's wort, Violets, great Daisies, red Poppies, of each half a handful, Jujubes, Dates, of each six pair, of Saf­fron tyed up in a Cloath half a dram, Anise-seeds, Juniper-berries, of each three drams; steep them in [Page 150] a due manner, and boyl them in a sufficient quantity of Spring-water to three pints. In the Liquor when it is strained, dissolve a quarter of a pound of the Conserve of Red Roses (which being in this man­ner added to the Apozeme, gives it a Balsamick, and very grateful taste,) strain it again, and then add Syrup of Corals, of Jerusalem Oak, of Maiden-hair, of each an Ounce; mix them, and make an Apozeme for use.

Or instead of the former Electuary, let this be prescribed which follows.

Take of the Pulp of the Conserve of Red Roses strained through a sieve, two Ounces, of the Conserve of the Fruit of the Dog-Rose an Ounce, of Haly's Pouder a Dram, of Leucatellus Balsam half an Ounce, a sufficient quantity of the Balsamick Syrup; mix them, and make an Electuary, to be taken as before.

Let the Patient likewise take often in a day a Spoonful or two of the Balsamick Syrup, (which is very grateful to the Stomack) and a Scruple of Balsam of Tolu, made up into little Pills, with every Dose of the Syrup.

Every Night an Opiate must be given.Also every Night, when there are not some other Medicines to be taken (if nothing forbids it) it is convenient to give xv. or xx. Drops of Helmont's Liquid Laudanum in a Spoonful of the Balsamick Syrup. For this end likewise 'twill be well to prescribe a Dram of the Flower of Brim­stone in a potch'd Egg, or a sufficient quantity of Honey of Rosemary-flowers.

If a tickling Cough, by reason of the Acri­mony, and thinness of the Humour separated by the Wind-pipe, and the branches of it, be very troublesome to the Patient, so that 'tis to be feared the Catarrhous Cough being irritated af­ter the manner of Suction, or drawing the Hu­mour [Page 151] more into those parts, will be increased, let the following Lozenges be always at hand, to be taken at pleasure, and swallowed gently to quiet the Cough.

Take of the Pulp of Marsh-mallow-Roots prest through a sieve, an Ounce, Sugar of Pearl, Gum Arabick, Tragacanth, white Starch, all dissolved in red Poppy-water, of each two Drams, of Saccha­rum Penidiatum dissolved in Rose-water a sufficient quantity; mix them, and make them into Lo­zenges of a Dram weight.

Likewise when the Cough is very troublesome, let the Patient take often, or at pleasure, a piece of Sugar of Pearl, of Roses, Penidiate, or Loaf-Sugar, letting it dissolve, and go down gently. The Juice and Root of Liquorice are likewise ser­viceable to this end.

But if the Cough be long and violent,If the Cough continues ob­stinate, we must use Balsamicks. and does not yield to the former Remedies, so that from the Lungs being long stufft there is reason to suspect that Tubercles will at length breed; then there must be a recourse had to the use of Balsamicks. As for Example: Let the Patient take three times a day at Physical hours three of the following Pills (the good success of which in Consumptive Coughs I have now experienced for many Years) in a Spoonful or two of some convenient Linctus, drinking after them a draught of the Pectoral Apozeme already described, warm.

Take of the Pouder of Wood-lice prepared three Drams, of the finest Gum Ammoniack a Dram and half, of the Flowers of Benjamin two Scruples, or a Dram, Extract of Saffron, Balsam of Peru, of each half a Scruple, of Balsam of Sulphur Terebinthinate or Anisate, a sufficient quantity. Mix them, and [Page 152] make them up into Pills of a middle size, to be gilt, or put up in Pouder of Liquorice.

These Pills do mightily promote the Cure of this Disease, not only in the beginning, but also in the progress of it, in the lingring Consump­tion of such as are Scorbutical, or have the Kings-Evil (which are Consumptions that are very frequent) where the Fever (if there be any) is very moderate, and the Phlegm, that is spit up, is somewhat tough, like that in Asthmatical people, as I shall shew more at large, under the Heads of a Scorbutical Consumption, and a Con­sumption from the Kings-Evil.

A Physician must give Directions about the Air, Eating, and Drink­ing, &c.But a Skilful Physician ought in this Distem­per to give Directions about the Air, Eating, and Drinking, the Passions of the Mind, and the other things that belong to the Government of the Patient, with as much care as about the Me­dicines. For without a careful Ordering, and a cautious Use of them, the most Noble Reme­dies signifie nothing in the Cure of a Consum­ption.

What Air is proper.And therefore let him choose an Air that is moderately hot and dry, and likewise somewhat thin. For that which is foggy, moist, or pol­luted with the smoak of Coals, by continually filling the Blood with unwholsom Particles, and causing a Commotion in it, does keep it in its Colliquative state, whereby it comes to pass, that a Catarrhous Flux of Rheum does perpetually fall upon the Lungs, and upon the Glandulous Coat of the Wind-pipe; and thereupon these parts being continually shaken by the trouble­some Cough, the Distemper is always increased, notwithstanding the use of the most Efficacious Medicines. For no Medicines can work a Cure by the way of a Charm.

[Page 153]Let the Food be such as affords a good Juice,What kind of Food is to be ordered. by which as few Excrementitious Particles as can be, may be heaped up in the Blood; such as Mutton, Veal, Mountain-Birds, Fish, that are fryable, and easily broke into pieces, Craw-fish, &c. Let the Patient likewise eat Flesh only at Dinner, and content himself with Panadoe, Wa­ter-gruel, Broths, potch'd Eggs, &c. at Night. Let the quantity of his Food also be moderate, and let him avoid Gorging till he can eat no more. Let him drink sparingly, and let that be not too strong, but such as may cause the least ef­fervescence and heat of the Blood, as small Beer, &c. Let him forbear Wine, and Spirituous Li­quors, but especially a Debauch, and Surfeit pro­ceeding from over-charging the Stomack with them. It also helps to promote the Cure of this Distemper, to alter and impregnate ordinary Beer with Pectoral Herbs, and other Ingredients, which have a respect to the Distemper, from whence this Consumption had its Original (if there has been any such one.) For this way a great quantity of Medicines are conveyed into the Blood in the manner of a Diet, without ma­king the Stomack loath them, or spoyling the Appetite; to which a prudent Physician ought always to have a special regard. For Example.

Take of the best Sarsa sliced eight Ounces, of China cut into slices four Ounces, Polypody of the Oak, Maiden-hair, Tunhoof, spotted Lungwort, Coltsfoot, Scabious, Jerusalem Oak, of each two Handfuls, Flowers of Scabious, of Water-Lillies, Rosemary, great Daisies, St. John's wort, of each a handful, of Juniper-berries four Ounces, of Raisins of the Sun stoned six Ounces, of Liquorice sliced an Ounce, of Aniseeds two Drams. Make a Bag for four Gallons of midling Ale, and let the Patient use it for ordi­nary [Page 154] Drink. In a Scorbutical and Scrophulous disposition, the mild, and more gentle sort of Simples, that are proper for the Kings-Evil and Scurvy, must also be added, of which I shall af­terwards speak.

The Patient must use mo­derate Exer­cise every day.Let the Patient use moderate Exercise, and Rubbing every day, but especially before Meat; yet he must by all means have a care he does not get any new cold, which is the greatest of mischiefs in this case.

He must a­void all trou­blesome Pas­sions.Let the Patient be diverted as much as may be from Anger, Grief, much Thinking, and all o­ther troublesome Passions of the Mind, and that not only by Admonitions and Advice, but also by Society, and the Conversation of pleasant Friends. Let him also carefully avoid unseaso­nable Studies, and Watching, always sleeping (as much as is possible) the first part of the Night.

CHAP. IX.

IT often so happens to Consumptive Persons,Consumptive Persons sel­dom ask a Physician's Advice in the begin­ning of the Distemper. that either from Want, Covetousness, or else an averseness to Physick, taking the beginning of a Consumption for an ordinary Cold, that will go away of its own accord, they very seldom ask the Advice of Physicians in the first degree of the Distemper, when it may be easily cured by Evacuations, and the rest of that Method, which we have already described. But content­ing themselves with I know not what Receipts of Old Women and Empiricks, they squander away their precious Time, scarce desiring the Assistance of a Physician, until by reason of the increase of the Hectick Fever, and the loss of their strength, they are plainly uncapable of the Evacuations, which we have before prescribed, which yet are very necessary to the just and regular Cure of this Distemper.

[Page 156] Through their neglect, their Lungs come to be knotted.From which neglect it often comes to pass, that the Matter having stuck a long time in the Lungs; Tubercles or Glandulous Swellings are by degrees bred in them, whereby the Cure in this second degree of the Distemper is rendred not only more difficult, but likewise more uncertain; the Disease admitting no Cure, or at least but a pal­liative one. And from hence it comes to pass, that a Consumption has so ill a Name,At first a Consumption is easily cured. as if it were a Distemper altogether incurable in its own Nature, when (as far as I apprehend from what I have been taught by Experience) it does ad­mit of as certain a Cure as other Diseases, so it be timely treated in a due Method. Though it must be confest that as other evil Affections of the Body,Ʋnless in some parti­cular cases. so likewise a Consumption where it seizes the Patient by Inheritance, if it arises from an ill conformation of the Breast, or depends upon an inexhaustible stock of Humours, con­tracted by a long and habitual use of the six things, which we call not Natural: Or lastly, where it proceeds from a peculiar Malignity, a Cancrous, or Gangrenous disposition of the Blood, or something in the Nature of it, that makes it apt to be quickly inflam'd, it does not use to yield to any Regular Method of Cure, though it be observed never so early: But every day it runs on with speed to the third degree of a Con­sumption, notwithstanding the use even of the most Generous Medicines.The time from whence the second degree of a Consumption is to be reckoned. But this second de­gree of the Distemper is to be reckoned from the first beginning of the Tubercles, until those Swellings in the Lungs happen to be very much inflamed, and to putrifie; that is, so long as they remain in a crude state.The Tubercles are not all of the same Nature. For these Tubercles are not all of the same Nature, but they assume a various, and very different disposition; for some­times [Page 157] they are Malignant, of a Cancrous Nature, apt to Gangreen, and threaten a sudden De­struction: But sometimes though they are more benign, yet they are of the Nature of Inflam­mations, Boyls, or a St. Anthony's Fire, accom­panied with a pain, and Inflammatory heat, and subject to a sudden putrefaction, and thereupon from their first breeding they cause a Peripneu­monick Fever, and have a very quick tendency to Apostemes.Some quickly Apostemate, and these make a quick transition to the third de­gree. So that as in this quick kind of Consumption arising from Tubercles of this Na­ture, there is no room for this second degree of the Disease; so I shall not here say any thing more of it. For whatever relates to the Cure of it, is to be spoken of in the third degree of this Distemper, to wit, when I shall particularly make it my business to treat of the Peripneumo­nick and putrid Colliquative Fevers of Consump­tive persons.

But for the most part these Tubercles are Glan­dulous Tumours of a Chronical and cold Nature,For the most part they are Chronical, and of a cold Nature. and somewhat like Kings-Evil Swellings, having their Original from the glutinousness of the Hu­mour, or from an Obstruction of the pore or duct of the Glandules; from whence it comes to pass that the Humour stagnating within them, is gradually concocted by the Natural heat of the part into the form of Chalk, or into a substance like Suet, or like Honey, and yet is always con­tained in its proper Bag; and thereupon arises immediately that hard Swelling, which I call a crude Tubercle; which although in progress of time it may grow to a considerable bigness, yet is not presently inflam'd, and turn'd to Corrup­tion, until from the Acrimony contracted by the Humour in its Bag, or from the Tone of the part being too much distended, there comes on [Page 158] from some Accident an Inflammation, and upon that an Aposteme.

So long as this crude state of the Tubercles of the Lungs lasts, the Consumption remains in its second degree.The Diagno­stick signs of Tubercles in the Lungs, are, 1. An increase of the Hectick Fever. The Diagnostick signs whereof are especially to be taken, First, from the re­markable increase of the Hectick Fever, which at this time does often begin in some measure to imitate a Putrid Intermitting Fever, by reason of the Acrimony that is at length procured to the Matter contained in the Bags.2. A remark­able wasting of the Mus­cular parts. 3. A dry Cough. Secondly, from the notable increase of the wasting, or Con­sumption of the Muscular Flesh, which now at least begins to grow lank. Thirdly, from the dryness of the Cough, which how frequent and troublesome soever it is, yet is not accompanied with a Catarrh, and such a frequent spitting, as before. Fourthly, from the heavy weight and oppression which are always felt in the Breast. To which also for the most part there use to be joyned a difficulty, shortness, and trouble in Breathing.Purges, Vo­mits, and Diaphore­ticks are hurtful at this time. In this degree of the Distemper all Evacuations by Stool, by Vomit, or by Sweat are mischievous, because they promote the Fe­ver, and quicken the pace of the Consump­tion.

Neither is Bleeding convenient, unless for some particu­lar Reasons.Neither indeed is it convenient at this time to bleed, unless it be to prevent an Inflammation of the Lungs; that is, as often as a Pleuritick pain, the liberal drinking of Spirituous Liquors, the taking of new Cold, and other such-like Occasions give a Sagacious Physician ground to suspect that such an Inflammation is at hand. And then too by reason of the present Consum­ption and Weakness, the Blood must rather be cooled by drawing it off with a sparing Hand, than taken away in a large quantity. But yet [Page 159] he must diligently persist in the use of those Al­tering and Pectoral Medicines, which have been already described (so far as the Stomack can bear them.) But the chiefest benefit is to be ex­pected from the long use of Balsamick Medi­cines, as of my Balsamick Pills before prescribed,But Balsa­micks are especially proper. and of other things of the like kind (so there be no considerable Fever:) And by this means I have (with the Blessing of God) recovered a great many Consumptive Persons (whose Tu­bercles seemed to be of a cold Nature, and crude, and so the Consumption slow, and Chronical) to a former state of Health, and the Lives of some I have preserved several Years, though they have continued sickly. In a Scorbutical and Hypochondriacal disposition it is proper also to mix Mynsycht's Extract, or some other Chalybeates, and mild Antiscorbuticks with these Balsamick Medicines; as likewise Remedies against the Kings-Evil in a Scrophulous disposition: Of which I shall speak more afterwards under their proper Heads.

But now besides the altering Medicines (al­ready described) which are given in a little quantity, and at certain hours,The altering Medicines. we must do all we can to temper the Feverish Heat of the Blood, and to eradicate the inexhausted stock of Hu­mours lurking in the Habit of the Body, toge­ther with the Colliquation arising from it, by making the Patient take them plentifully, and continually in the manner of a Diet. And there­fore we must not only diligently make choice of such Food as affords good Juice, and corrects the sharpness of the Humours, as Partridges, and Mountain-Birds, potch'd Eggs, Oysters, the Feet of Animals, together with Gelly-Broths, and Gellies made of them; also Craw-fish, and other [Page 160] Testaceous Fishes, with Broths artificially made of them; some forms of which I shall after­wards subjoyn; but also the Chalybeate Mineral Waters, a Pectoral Mead, a Milk Diet, Asses Milk, Milk-water, Pig-water, Snail-water, and other Liquors, that soften and take off the sharp­ness of the Blood, must be ordered to be taken plentifully in the manner of Drink: Likewise Issues, shaving of the Head, and the application of proper Plaisters are of great advantage. Of the use of which, and the Cautions that are to be taken in the use of them, I shall briefly and particularly propose my own Observations.

If the Hectick heat is small, we must use the Chaly­beate WatersAnd first, if the Hectical Heat be moderate, and almost insensible, from whence we may con­jecture that those fixt Swellings of the Lungs are crude, or at least scrophulous, and of a cold Na­ture, that they are stufft with a chalky, fatty, or any other such kind of Matter; the Patient must by all means be put upon the use of the Chalybeate Mineral Waters in the Summer time. And by this means I have relieved a great many of this kind of Consumptive Persons for many Years, restoring their Appetite, their Flesh, and Strength, abating their Hectick Heat, and Cough, and giving then a greater freedom of Breathing; and that not only during the time of their drink­ing the Waters, but also all the next Winter. From whence we have reason to conclude, that those Swellings, if they are not perfectly eradi­cated by the use of the Waters, at least are les­sened, and the Mass of Blood mightily temper'd by them. And this palliative Cure (if we can­not obtain a perfect one) is of some moment. For although the Patient prolongs his Life in a state somewhat sickly, yet still he lives, and by taking due care is able to do his usual Business, [Page 161] and to have a moderate Enjoyment of the com­mon Delights of Humane Life. But I have seen some perfectly recovered from an evident Con­sumption by the use of these Waters, and made sound again without a Relapse; a History or two of whom I shall faithfully and briefly relate in the Chapter of a Hypochondriacal Consum­ption. But for the use of the Chalybeate Waters, I would recommend the following Rules strictly to be observed by all Consumptive Persons.

First, in an Acute Consumption, to wit,Rules to be observed in the use of the Chalybeate Waters. where the Lungs are evidently putrefied, and where the Fever is advanced beyond the degree of a He­ctick; as also in an extream Chronical Consum­ption, where the Patient is come to some degree of a Marasmus, together with Colliquative Sweats, a Looseness, or Dropsie, the Waters must be a­voided, which most certainly in this case are not only mischievous, but also deadly. Secondly, those that are sick of a Consumption, though they ought to spend a long time, to wit, the greatest part of the Summer, in the use of the Waters, that the Crasis of the Blood, which is almost quite destroyed, may by degrees be re­stored by the long use of them, yet they must drink them sparingly every day, and in a less quantity than others are wont to do, that is, four, five, or six Pints at a time, lest by too great a distention of the tender Vessels of the Lungs, there comes at length a spitting of Blood. Third­ly, during the use of the Waters, they ought to take more care, lest they get cold, and commit any Errors in their Diet, than many Persons, that are sick of other Distempers, commonly do. Fourthly, it is convenient for Consumptive Peo­ple to repeat the use of the Waters for several Years in the Summer-time, though after they [Page 162] have been used to them it is not necessary to drink them so long every Year, as at first. Fifth­ly, neither are Consumptive Persons to be purged during the use of them, as other Water-drinkers use to be. But if they are subject to be more costive than they should be, it is convenient be­fore they fall upon the use of the Chalybeate Wa­ters, and after they have made an end of drink­ing them, to give them the Purging Mineral Waters in a moderate quantity, and to repeat them every three or four days, till they have taken them three or four times. Sixthly, if the Waters do not pass off in a sufficient quantity by Urine, much more if they cause a Looseness, they must not persist any long time in the use of them, unless we can by Art provide suffici­ently against these Inconveniences. To take off, and prevent a Looseness, I use to order the quan­tity of a Wallnut of the following Electuary every Night, when they go to Bed.

Take the pulp of Old Conserve of Red Roses, Mar­malade of Quinces, of each half an Ounce, of Tro­ches of Amber three Drams, Bole, Dragons-blood, of each half a Dram, of London Laudanum three Grains, of Syrup of Myrtils enough to make an E­lectuary.

To promote the passing of the Waters by Urine, they must dissolve a Scruple of the finest Salt of Amber very well cleared from the Oyl in the first draught of the Waters. Seventhly, it likewise does very well, during the use of the Chalybeate Waters, to order their ordinary Drink to be impregnated with a Bag of Pectoral Ingre­dients; to which may also be added such as are proper for the Scurvy and the Kings-Evil, that are mild, if the Original Distemper requires it.

[Page 163]Secondly,If the Hectick heat is great, and the Con­sumption quick, we must rather make use of a Milk Diet. The Rules that are to be observed in a Milk Diet. but if the Hectick Heat be consi­derable, and thereupon the Consumption quick in its Progress, it is better to temper the heat with a Milk Diet, than with the Waters. But about a Milk Diet we must observe these follow­ing Rules. First, In the use of this Diet no­thing must be either allowed, or taken for Meat and Drink, but Milk, and things made of Milk (except Bread.) But they must take this Food in a good quantity, and frequently, for fear the parts should be deprived of their due Nourish­ment, by reason of the thinness of it. Secondly, a Course of the Milk Diet ought to be conti­nued a Month or two. Thirdly, the Spring is the most convenient time of all for this Diet, that is, when the Flowers and Herbs, with which the Beasts are fed, are fresh.

Thirdly,If common Milk will not agree, we must use only Asse's Milk. But if there be too Acid a Ferment in the Stomack that turns common Milk into a hard Curd, and makes it uncapable of being concocted, (as it sometimes happens) from whence their commonly follow Vomitings, Gripes, and a Looseness, it is better to abstain from the use of common Milk, and to endea­vour to temper the Blood with Asse's Milk; con­cerning the use of which these following things are also to be observed. First,The Rules to be observed in the use of Asse's Milk. That the most convenient time to give the Asse's Milk is early [...]n the Morning, so that the Patient may sleep in his Bed afterwards, and then again at five a Clock [...]n the Afternoon. Secondly, That nothing else of a different Nature is to be taken into the Stomack either in the form of Food, or of Me­dicine before the Milk is concocted. Thirdly, The Quantity, or Dose of Milk for one time is from half a Pint to a Pint, or there-abouts. For [...]he Stomack can neither receive nor digest a [Page 164] great quantity of this, as neither of common Milk, but uses presently to cast it out, either by Vomiting, or Stool, and that to the great Pre­judice of the Patient. And therefore it is Pru­dently advised by Physicians, that the Stomack be by little and little accustomed to this kind of Nourishment, beginning at half a Pint, and in­creasing the quantity every day, till they rise to a Pint. Fourthly, If the Patient, by reason of the Acid Ferment of his Stomack, be subject to a Looseness from the use of Asse's Milk, (which often happens) the Milk must be sweetned with Sugar of Roses, and milkt upon a sprig or two of Mint. Yea, if it be necessary, and nothing contraindicates, let the Patient every Night take a Grain of London Laudanum, or a Dose of the Astringent Electuary, which I have already men­tioned. Fifthly, This Milk ought always to be given in its own Natural Heat as it comes from the Ass. For if it has been once cold, and is warmed again, it is not only made less grateful to the taste, and to the Stomack, but also by lo­sing its Spirituous part, it loses some of its Ver­tue. Sixthly, During the use of the Asse's Milk, they must abstain from all other Medicines, (which is a Rule ought to be prescrib'd as well in every Milk Diet) excepting Opiates and A­stringents, if they should be necessary to prevent a Looseness, or to quiet the violent Cough in the Night-time. Seventhly, But if a Looseness that is caused by the Milk should not be stopt with the use of Laudanum, and Astringent Medi­cines; or if a Vomiting, or at least a continual Sickness, and gravative Oppression of the Sto­mack succeed to the stopping of the Looseness (which are certain signs that the milk curdles in the Stomack.) Or lastly, if there are signs of [Page 165] a Schirrous, and very obstructed Liver, (which is no rare thing in Scorbutical and Hypochon­driacal Persons in a Chronical Consumption) then they must carefully abstain from all sorts of milk: For the use of milk is wont by increa­sing the Obstructions of the Liver, to bring the Jaundice and a Dropsie upon the Consumption, whereby the Original Distemper becomes plain­ly deplorable.

Fourthly,If Asse's Milk dis­agrees with them too, then we must use Shell-fish, Testaceous Medicines, &c. Therefore in these cases it is better to alter the Blood, and to correct the Acrimony of it with the plentiful use of Shell-fish, and of Testaceous Medicines; as also with Jelly Broths made of the Feet of Animals, and drinking a good quantity of Compound Waters made with Milk, of a Capon, a Pig, Snails, and other things of that Nature.The Phlegma­tick Waters of Snails &c. must not be used, where there is an Obstruction of the Liver. Although what I have already hinted concerning the use of milk, is also true of these Phlegmatick Waters, to wit, that as often as the Liver happens to be before obstructed, a Jaundies and Dropsie are wont to follow upon the plentiful drinking of them. There­fore in this kind of Icterical, and Hydropical Persons it is more convenient to endeavour to sweeten the Blood in the manner following: Let them feed plentifully upon River, and Sea Craw-fish, Lobsters, and in general all sorts of Shell-fish. Which sort of Food being taken plen­tifully, does very much temper the four state of the Blood, and correct the Acid Ferment of the Stomack. And of these Shell-fish may be made by Art very pleasant Broths, which must be gi­ven in good quantities.

Take of Craw-fish an Hundred, Prescripts for making of Broths. beat them to pieces alive, and then boyl them in two Quarts of Spring-water, adding when they are almost boyled enough, two or three blades of Mace, one Nutmeg [Page 166] sliced, and half a pint of Malaga Wine. Let the Broth be strained for use. Amongst these may be reckoned Jellies, and High Broths. As for Ex­ample:

Take shavings of Harts-horn, of Ivory, of each four Ounces, two blades of Mace, the candied peel of an Orange sliced; boyl them in two Quarts of Spring-water to a Quart, or a Pint and half. Strain it, and let the Patient, when he pleases, take three or four spoonfuls by it self, or with warm'd Broths. These kind of Jellies may be made grateful to the Patient's Palate, by adding at the time when they take it, a little Syrup of Baum, of Cloves, of Rasberries, Acids do not well agree with Jellies. Oranges, or Lemons. Though it must be confest that Acid Syrups do not so well agree with Jellies, because they do in some measure spoil their Vertue.

For an Example of a Jelly Broth, take this which follows.

Take one Capon drawn, and cut to pieces, two pair of Sheeps-feet, two pair of Calves-feet, shavings of Ivory, of Harts-horn, of each half an Ounce, two blades of Mace, one Nutmeg sliced, of yellow Saun­ders three Drams, or half an Ounce. Boyl them all gently in a Gallon of Spring-water to two Quarts, adding when they are almost boyled enough, of right Malaga Wine a pint, the Flowers of great Daisies, Colts-foot, Maiden-hair, spotted Lungwort, of each a handful, of fat Dates eight pair, of Jujubes twelve pair, of Sebestens ten pair, of Raisins of the Sun stoned three Ounces. Strain it, and let the Patient take a large Draught of this Broth two or three times a day. For the farther tempering of the sharp­ness of the Blood, it is also very good for this sort of Consumptive Persons, that are troubled with Obstructions, to use prepared Coral, Wood-lice, Pearl, Crabs-eyes prepared, the simple Pouder [Page 167] of Crabs-claws, and other such-like Testaceous Medicines, which must be taken in a good quan­tity, and often in a day. As for Example:

Take of the Cordial Milk-water, Carduus-water, or Black-Cherry-water a pint, of small Cinnamon-wa­ter half a pint, of prepared Pearl half an Ounce, of Loaf-Sugar two Ounces; mix them, and make a Julep, of which let the Patient take a quarter of a Pint (shaking the Bottle first) three or four times a day, adding (if his Stomack should re­quire it) an Ounce or two of Epidemick-water, Aqua Mirabilis, Dr. Stephens's, or some other Spi­rituous Water. Or,

Take Wood-lice prepared, Crabs-eyes prepared, the simple Pouder of Crabs-claws, red Coral, of each a Dram, of the Pouder of white Amber half a Dram. Mix them, and divide them into nine Papers, of which let him take one three times a day in a Spoonful of the Pearl Julep just now descri­bed, or of some other such-like Julep, drinking a Draught after it. Fifthly, If the Patient should seem to be plainly free from Obstructions of his Liver, and so be neither in an Hydropical, nor an Icterical state; but yet the Milk Diet before described should not be very convenient, by rea­son of a Looseness, and the Acid Ferment of the Stomack, besides the altering Medicines be­fore described, for the farther tempering of the sharpness of the Humours, the plentiful use of a Compound distilled Milk-water, Capon-water, Snail-water, Pig-water, &c. may be enjoyned with Advantage, of which I shall in the next place give some Prescriptions.

CHAP. X.

WHEN he comes once to this Third Degree of a Consumption,A Consump­tion in the third degree is very sel­dom cured. the Patient (unless the Ulcers are very small, and benign) very seldom is cured, or lives long. And there­fore though a Prudent and Honest Physician, when he is called to Consumptive Patients in this degree of the Distemper, ought as much as it is in his Power to mitigate and relieve the Symptoms that afflict such poor Wretches, and [Page 172] should make it his business likewise to prescribe such Antiphthisical Medicines, as may best an­swer the present Indications, and be most agree­able to the present state of the Patient; yet he ought by no means,Therefore a Physician must be very careful how he promises a Cure. though there should be some hopes from the abatement of the Symp­toms to flatter him, to injure the Reputation of Physick, and his own too, by promising a Re­covery of his Health to the Patient, or to his Friends too confidently: But what good soever he should with the greatest Commiseration and Diligence do the Patient, yet he must always pronounce a Fatal Prognostick of his Life, and not suffer himself to be deceived with the vain hopes of his Friends, and those that are about him: And by this means he will secure as well the Art of Physick as himself from Reflexions.The Intenti­ons of Cure. The Intentions of Cure in this degree of the Distemper are these four. First, we must take care of the Lungs by the use of Pectoral and Antiphthisical Medicines; and promote the Cure of the Ulcers (if they are small, benign, and curable) to wit, so far as the present weak and low condition of the Patient can bear. Second­ly, the Peripneumonick, or Inflammatory Fe­ver must be taken off as often as it happens, to­gether with the direful Symptoms of it. Third­ly, the Putrid Fever arising from the Purulent Matter in the Lungs, must be relieved. Fourthly, and lastly, we must help those troublesome Symptoms arising from the Putrid Fever by the Colliquation; that the Patient, if he does dye, may at least obtain an easie passage out of this World.

What we must give with respect to the Lungs.As for what concerns the first, the Medicines proper in this degree of the Consumption, are such as are Altering, Expectorating, and Bal­samick [Page 173] or Healing; not too hot (because of the intense degree of the Fever) but always Cor­dial, because of the Patient's Weakness. Such also must be made choice of as are most grateful, and may be given in the least quantity, because of the weakness of their Stomack, and their ap­titude to Vomit. As for Example:

Take the old Conserve of Red Roses press'd through a Sieve, of Wood-sorrel, Leucatellus's Balsam, of each an Ounce. Mix them, and make an Electuary, of which let him take the quantity of a Nutmeg in Wafers Morning and Evening. Or, let him take three of the Balsamick Pills already descri­bed, twice a day.

Take of the Cordial Milk-water, or the Pectoral Milk-water already described, eight Ounces, Magi­sterial Water of Snails, Barley Cinnamon-water, of each three Ounces, of Aqua Mirabilis an Ounce, of prepared Pearl two Drams, of the finest Chalk a Dram, of white Sugar-candy an Ounce, or ten Drams. Mingle them, and make a Julep, of which let the Patient take four or five Spoonfuls after every Dose of the Electuary, and of the Pills, and likewise at any time when he pleases, if he be faint.

Take of the Balsamick Syrup (which is very grateful to the Stomack) three Ounces, of the Tin­cture of Saffron made with Treacle-water two Drams. Mix them, and let him take a Spoonful of it often. In a Spoonful or two of this Mixture may likewise be given six or seven Drops of Opobalsam twice a day.

If the Cough,Sometimes we must give Opiates; and want of Rest be very ur­ging, let him also take sometimes, when he should go to Rest, Twelve Drops of Helmont's Liquid Laudanum. But very cautiously. But yet when the Patient is in this weak condition, Opiam must be given very cau­tiously, [Page 174] sparingly, and at due intervals; and in­deed not at all, unless there be a great Neces­sity, lest a sudden and unexpected Death should follow, and so bring a Scandal upon Physick. Or,

Take of Syrup of Maiden-hair four Ounces, of Aqua Mirabilis half an Ounce, or six Drams. Mix them, and let him take some out of a Spoon, or with a Liquorice-stick often, but especially when his Cough is troublesome. Here likewise Jellies, and Jelly-Broths are to be prescribed; and indeed in this deplorable state we must fetch our Remedies rather out of the Kitchen, than out of the Apothecary's Shop.

An Account of the Perip­neumonick Fever.As for the Peripneumonick Fever, that al­ways proceeds from a great Inflammation of the Tubercles of the Lungs; and therefore it is wont to return often, and to be renewed; to wit, as often as any new Tubercle happens to be inflamed, either of its own accord, and from its own Nature, or from taking of Cold, or any other Error committed in their management. So long as the Inflammation lasts this Fever con­stantly remains, and many times puts a sudden and unexpected end to the Patient's Life, being attended with the successions of a Chilness, that comes at uncertain times, and a great Burn­ing, with Watchings, Restlessness, Light-headed­ness, Shortness of Breath, a difficult Expecto­ration, and with violent and wandring Pains of the Side, Breast, and Shoulders. But as soon as the Inflammation begins to be changed into an Aposteme which (if the Patient lives so long) commonly happens about the seventh day of the Fever, that continual Inflammatory Fever is succeeded by a Putrid Intermitting Fe­ver, a Quotidian, or Tertian, which is a certain sign [Page 175] that the Tubercles are turned into purulent Mat­ter, and without the healing of them, it is im­possible perfectly to eradicate that.

This Inflammatory Fever,What is re­quisite in this Fever. as all others of the same Nature requires a very thin Diet, together with a due Government in their Beds, that the Body be kept open, Cordial and Temperate Ju­leps, Pectoral Apozemes, with Lubricating and Inciding Lambitives must be given plentifully to facilitate the Expectoration, or raising of the Phlegm too much thickned by the Feverish heat, to take off the painful compression of the Lungs, and thereupon to quiet the insignificant and troublesome Cough: Likewise Diaphoreticks, that are a little Opiate, must be exhibited at due intervals, to promote the extrusion of the Feverish Matter by the Pores of the Skin: Also Blistering-Plaisters must be laid on, and external Applications made for the relief of the Brain, and System of the Nerves, which otherwise are wont in a short time to suffer much from this kind of Fevers. Also Liniments, and outward Fomentations, that are Anodyne, to relieve the painful and Spasmodick contraction of the Muscles, and Membranes of the Breast:Bleeding especially is necessary. But above all Bleeding, and that in due time, to a good quantity, and (if there be occasion) re­peated, according to the strength of the Patient, and the present Effervescence of the Blood; which it may be a Consumptive state requires more than that which is Robust. And by this means I have seen Mr. Tibs, Dr. Owen, and our Famous Colleague Dr. Staines, and several others, even in their very Old Age recovered from se­veral of this kind of Fevers, returning some­times twice or thrice a Year (though it has been only to their former sickly state;) and [Page 176] that as easily, and as quickly, as if they had not been at all Consumptive. When on the con­trary, it is as well known how dangerous this kind of Peripneumonick Fevers very often are to the strongest Men, let them have never so good a Habit, where due Bleeding, and any other part of a right management has been o­mitted.

The Perip­neumonick Fever may be as easily cured as an ordinary Pe­ripneumony.Therefore though a Physician must make a Fatal Prognostick of the Consumption it self, (which without doubt is much promoted by every Fever of this Nature) yet he may set him­self about the Cure of the Peripneumony with as much hopes (if he be but sent for in time) as if the Patient were not at all Consumptive, and that in the manner following. Let him be ordered a Diet of Water-gruel, Ptisans, roasted Ap­ples, Posset-Ale, with Raisins of the Sun stoned, and Liquorice boyled in it, midling Beer warm'd with a Toast, and such-like. But in the first declension of the Fever, let it be of Chicken-Broth, potch'd Eggs, &c.

He must likewise (if there is occasion) pre­sently have a Stool procured with a Clyster made of Milk, in which Camomile-flowers have been boyled, sweetned with brown Sugar, which (as often as it shall be necessary) must be repeated. Then let Eight or Ten Ounces of Blood be ta­ken from the Arm of that side where the pain is; which Bleeding must be boldly repeated every day, or every other day, according to the Ef­fervescence of the Blood, and the violence of the pain in the Side, and the difficulty of Breath­ing, so far as the strength of the Patient will bear it, that the progress of the Inflammation to a ripening and an Aposteme (if it be possible) may be prevented.

[Page 177]In the mean time all along the course of the Disease let a Spoonful of the following Linctus be given dissolved in four Ounces of the Pecto­ral Decoction warm'd, every third,All the time of this Fe­ver we must use Pectoral Medicines. or at least every fourth hour.

Take Oyl of sweet Almonds new drawn, Syrup of Maiden-hair, of each an Ounce and half, of white Sugar-candy a Dram and half. Mix them very well, and make a Linctus.

Yea, if the toughness of the Phlegm, the dif­ficulty of Breathing, and the increase of the Pain arising thereupon require it, and there be no Looseness to forbid it, let new Linseed-Oyl fresh drawn without any Fire, be put in the stead of the Oyl of sweet Almonds, and Syrup of Hedg-Mustard, or of the five opening Roots, in the room of the Syrup of Maiden-hair. More­over let two or three Ounces of Linseed-Oyl be likewise ordered to be taken by itself every four hours, because it is wonderfully endowed not only with a Lubricating, but likewise an Ano­dyne Quality.

Take of the clear Pectoral Drink a Pint and half, Tincture of Saffron made with Treacle-water, and Syrup of Maiden-hair, of each an Ounce: Mix them, and make an Apozeme for the Use before mentioned.

For refreshing their Spirits,Something must be done to comfort them. and tempering the heat of the Blood, let four or five Spoonfuls of the following Julep be ordered to be taken.

Take of the Cordial Milk-water eight Ounces, Barley Cinnamon-water, Epidemick Water, of each two Ounces, of Pearl prepared a Dram and half, of Loaf-Sugar six Drams; mix them for a Julep. At the time they should go to Rest let the following Anodyne and Diaphoretick Bolus be ordered to be taken with a draught of the Pearl Julep, but [Page 178] especially if their Body be too loose, which of­ten happens in this state of the Distemper.

Take of Venice-Treacle half a Dram, of Gascoin Pouder a Scruple, of Syrup of Clove-gilly-flowers a sufficient quantity; mix them, and make a Bolus.

Something to preserve the Brain.For the security of the Brain, and the System of the Nerves, presently after Bleeding let Bli­stering-Plaisters be applyed to the hinder part of the Neck, to the inside of the Arms and Legs; and the Cephalick Plaister with Euphorbium to the soles of the Feet.

What is to be done when there is a pain in the Side.For the relieving of the pain in the side, caused by the Spasms of the Muscles, and Membranes of the Breast, let the following Fomentation and Liniment be alternately applyed to the Parts affected.

Take the Roots of Parsley, of Fennel, Linseed, Foe­nugreek-seed, of each two Ounces, Camomile flowers, Melilot-flowers, of each two handfuls; mix them together, and boyl them in a sufficient quantity of Spring-water, let the Liquor, being strained, be put into a new Ox's Bladder, till it is half full, and let it be applyed hot to the Parts affected, when the pain is violent. When the Bladder is removed, lay on a warm Flannel with some of the following Liniment. Take of the Oyntment of Marsh-mallows half an Ounce, Oyl of white Lillies, Oyl of Bricks, of each three Drams; mix them, and make a Li­niment for use.

For the farther tempering of the Effervescence of the Blood, and the heat of the Lungs, the following Pouder may be ordered with Advan­tage.

Take of the finest Salt-Petre two Drams, of white Sugar-candy half an Ounce; mix them, and then divide them into Eight Papers, and let one of them be dissolved in every draught of Beer the [Page 179] Patient drinks. As for the other things, they must be left to the Judgment of the Physician that is with him, to be prescribed as there shall be occasion.

As for what concerns the Putrid Fever of Con­sumptive Patients, we must take notice,A Descrip­tion of the Putrid Fever that al­though they being treated in the foregoing Me­thod, do not dye of a Peripneumony, yet the Inflammation of the Tubercles of the Lungs at this time turning to an Ulcer (which very often happens) at the end of the Inflammatory Fe­ver, there presently arises a Putrid Intermitting Fever, which returns at certain periods every day, or every other day, with a Chilness, a hot Fit, and then Sweats succeeding one another; for the Blood in its Circulation passing now through these purulent Parts, is filled and op­prest with Heterogeneous and disagreeable Par­ticles, by which Nature being irritated, is rouzed, and forms a Feverish Fit every day, or every other day, to expel her Enemy.Ʋnless we can heal the Ʋlcers, Pe­ctoral Medi­cines will not Cure this Fever. The Peruvi­an Bark will many times do great Ser­vice. Which Fever (so far as I understand) it is impossible perfectly to eradicate with the help of Pectoral and Bal­samick Medicines, without healing (as often as they are small and benign) the Ulcers, from which that Fever proceeds. Yet I have very often found with very good Success the efficacy of the Peruvian Bark, in taking off these Fever Fits, at least for a time, being frequently re­peated, and at due intervals: So that I have seen the Lives of some Consumptive Persons, that have been lookt upon as deplorable, by the fre­quent use of it prolonged not only some months, but likewise some years; who, though they were never perfectly recovered from a sickly state, yet being once freed from their Fever by the use of the Bark, could do their ordinary business [Page 180] well enough. Wherefore I look upon this as the only Febrifuge in this case, that has hither­to been found out. For although by this means there is only a Treacherous and uncertain Truce obtained, because the Fever is wont to return of its own accord, or upon the least occasion, yet by this temporary suppression of the Fever, the Patient is not only immediately freed from ma­ny troublesome and grievous Symptoms for a time, but likewise recovers his lost Strength in some measure, and moreover gains some Oppor­tunity for the use of Balsamick and Pectoral Medicines, which by healing the ulcerated Tu­bercles, may work a perfect and eradicative Cure of the Fever.We must mix Balsa­mi ke with the Bark. And therefore it is very conve­nient not only to insist diligently upon the use of this kind of Balsamick Medicines at those times the Patient is free from his Fever; but likewise to mix them with the Bark it self, when­ever you have a mind to repeat it, in the man­ner following.

Take of the Peruvian Bark beat into a very fine Pouder half a Dram, of the Balsamick Syrup a suf­ficient quantity; mix them up into a Bolus, and let the Patient take it in the Morning, and re­peat it every six hours for three days one after another, drinking three or four Ounces of the following Apozeme after it.

Take of the Peruvian Bark grosly pouder'd three Ounces, of Balsam of Tolu two Drams, English Saf­fron, Cochinel, of each a Scruple; boyl them in a pint of the clear Pectoral Decoction to six Ounces. Then strain it, and pour on another pint of the same Decoction, so repeating the Operation thus for three times: And then mix all the strained Liquors toge­ther, and add Malaga Wine, the Balsamick Syrup, of each four Ounces. Mix them, and make an Apozeme.

[Page 181]Let the use of this Febrifuge be repeated in the manner just now prescribed twice a month,The Bark must be re­peated. Balsamick and Pectoral Medicines must be gi­ven in the intervals. or oftner, if it shall seem necessary. But in the in­tervals the diligent use of Balsamick and Pectoral Medicines ought to be enjoyn'd, which must be varied according to the Temperament of the Pa­tient, and the Nature of the Disease under the care of a Judicious Physician. If the Belly should be too loose, a Grain of Laudanum may be added to every Night-Bolus, or instead of the Boluses, a Physician may make use of Pills made of Diascor­dium, and the Pouder of the Peruvian Bark, so that every Dose may contain half a Dram of the Pouder. And in this manner I saw Mr. Houghton an Apothecary's Wife, that was emaciated with a deplorable Consumption, preserved a Year or two, and very often recovered from a Putrid Fe­ver caused by her Consumption, by the care of my Famous Colleague Dr. Tyson; as also the Wife of Mr. Walker, a Merchant of London, and Mr. Bla­key the Minister's Son restored from a Putrid Consumptive Fever almost to a perfect Health by my care, recovering their Strength and Appetite; and so several others, whose Histories it would be too tedious to give an Account of in this place.

Yet I will ingenuously confess,The Bark does not an­swer so well here, as in Agues. that I have not observed the Bark to answer its end so cer­tainly and constantly in a Consumptive Inter­mitting Fever, as in a plain Ague proceeding meerly from a morbid disposition of the Blood: But where I have found it to do little or no good, I have always suspected that the Brain, and System of the Nerves have been injured, and that the Patient has been more apt to be light-headed, and more subject to Spasms than he had been before.

CHAP. XI.

AS Nature is wont to be irritated by the mixture of purulent and heterogeneous Particles with the Blood (to wit, as soon as the Tubercles of the Lungs happen once to ripen, and to become Apostemes) and to endeavour the extrusion of them in the Periodick Fits of an Intermitting Fever, by the Bowels, the Cu­taneous Glands, Salivatory Ducts, Stomack, Wind­pipe, &c. by what passage soever there is a vent opened, according to the Nature of the Humours, and the tendency of Nature, together with an extraordinary Colliquation, and a sudden sinking of their Strength:Nature to her violent efforts makes [...] Symp­toms. So it often happens, that Na­ture being then spurr'd on too far by that irri­tation, does in expelling the colliquated and sharp Serum in a greater quantity, than is con­venient, form some new Distempers, or at least some new Symptoms, that are more sharp, and more dreadful than the Original Disease it self; such as a Looseness and Bloody-flux, with vio­lent Torture in the Bowels, a Cough, and per­tinacious Watchings, profuse and colliquative Sweats, almost perpetual Vomitings, Hiccough, Thrush, &c. For the Relief of which Symptoms the Art of Physick may do something, though it should be unable to gratifie the Patient with a perfect Cure.

[Page 183]But by what means, and by what Rules a Physician ought to help these kind of Symptoms, I shall endeavour particularly to shew in what follows. And first,

CHAP. I.

This Con­sumption is very fr quentI Shall speak of this kind of Consumption in the first place, because it occurs most fre­quently in our Practice: For I remember more of this kind of Consumptive Patients that I have cured, or at least have seen cured by others, than of any other sort.

For in a Scrophulous Consumption the Blood, by reason of its preternatural Acrimony, being as it were coagulated, and so unable perfectly to unite the new Chyle to it self, and the solid parts, is wont to throw it in a greater quantity than is convenient upon the Glandulous Parts, where the small Vessels do not run in a right Line as in the Muscles, but spirally; from whence it comes to pass, that the Blood is wont to make a longer stay, and to stagnate longer in these, than in other parts, and so to make a more plentiful separation of the Nutritious Juice in them; whereby it comes to pass, that these parts are apt to swell more, and to grow larger, and harder than others. And what happens in other Glandulous parts, happens also in the Lungs themselves, which are every where full of in­numerable Glandules, but of some more con­spicuous ones upon the Wind-pipe, and the branches of it, though in their Natural state they are not so easily discerned: So that 'tis no won­der if those that have the Kings-Evil, who are frequenlty subject to Glandulous Swellings in [Page 195] other parts, are likewise many times affected with such kind of Tubercles, even in the Lungs themselves, the substance of which is Naturally spongy, and apt to receive the Serous Particles of the Blood, that are here plentifully separated by their continual agitation. And indeed from these sixt Swellings in the Lungs this Scrophulous Consumption is wont to proceed: The most certain Diagnostick Sign of which is to be ta­ken from Glandulous Swellings in the External Habit of the Body accompanying of it,The Diagno­stick sign of it. or at least preceding it; as also from an Ophthalmy and Scab, that often return, and from other such-like Scrophulous Affections. Though I think I must freely confess, that sometimes it happens so that the Glandules of the Lungs only, and no others are affected with this Humour. In which case there is need of an Experienced and Judicious Physician to find out the peculiar Nature of this Consumption from what yet re­mains to be spoken under this Head

Therefore here we must particularly observe,The Tubercles here are ei­ther Phleg­matick; That these Tubercles of the Lungs (as Scrophu­lous Swellings in other parts) are either crude and phlegmatick, and so no ways disposed to an Inflammation and Maturation:Or more hot. Or else more hot, which will be seized with an Inflammation sooner or later, according to the present dispo­sition of the Blood, and the different Nature of the Matter that is contained in the Cystis. For sometimes, to wit, when the Matter is concocted, and hardned into a Chalky, or Steatomatous Sub­stance, or into the substance of a Meliceris, (which it most commonly is) the Inflammation, and the Exulceration, that proceeds from thence, are not only some considerable time before they happen, but likewise when they do, they [Page 196] are very slow, Chronical, and almost insensible. But whenever the Blood,When the Matter is of a hot Nature, the Swellings are apt to in­flame. and the Matter con­tained in the Cystis are of a Nature different from this (which also sometimes, though sel­dom, happens) the Swellings are very apt to be inflam'd, so to suppurate, and to turn to an Ulcer. And from hence arises the difference in Scrophulous Consumptions: For some (to wit, whenever the Swellings are crude, and not apt to be inflam'd) in a Consumptive state live, though they are crazy and sickly, from their Childhood till they are old, with a Cough that is almost continual, and troubles them both Night and Day, Summer and Winter, with a weight in their Breast, with a difficult, and some­what Asthmatical Respiration, but yet without any sensible Fever; but upon the taking of the least Cold (to which also they are more subject than other People) they are wont to spit a great deal of Phlegmatick and Serous Matter. These People may be preserved from any dangerous, or fatal Effects of their Distemper, even with­out Physick, only by ordering themselves regu­larly in those Six Things, which we call Non-natural. And hence it comes to pass, that they seldom desire the Help of a Physician in this sickly crazy state, being better contented to live Miserably,A Scrophu­lous Con­sumption is curable, when the Tubercles are crude. than Physically. But for my part I do not question, but by the frequent changing of Air, and making choice of such as is thin and clear, and by the long use of Balsamick, and Mercurial Medicines, of Wood-lice, Chalybeates, but especially the Mineral Waters, and of other Antiscrophulous Remedies, these Swellings may be wasted in the Lungs as well as in other parts, and so the Patient may be freed from a Scrophu­lous and Consumptive state, as I have often ex­perienced.

[Page 197]In the Cure of this kind of Consumption,A Milk Diet is not to be used in the Cure of it. we must by no means put them upon the use of a Milk Diet; because it is wont to promote and increase the Obstructions and Swellings, that proceed from a Viscous Humour. Likewise those Pectoral Medicines, that are commonly called Expectoratives and Opiates, do no great good in this case, unless it be upon the taking of new Cold, to mitigate the Symptoms that arise from it, as a Cough, Fever, difficulty of Breathing, want of Sleep; and that only whilst all, or some of these do yet remain in a great degree, and violent.

But whenever these Tubercles are of a hotter Nature,When the Tubercles are hot, the Con­sumption is Acute. and thereupon more subject to a quick Inflammation and Exulceration, this Scrophulous, Consumption is very Acute, and terminates in a few Months; and as to the manner of Cure, differs but little from a common Consumption. Neither are we to make any other Prognostick in this than in another Consumption; to wit, that it differs in the event according to the de­gree and progress of the Disease, as I have said before.

I have many times observed this kind of Acute Consumption to proceed from the stopping and drying up of a Scrophulous Scab;The Occasion of this Con­sumption. as the other more Chronical Consumption is wont to seize upon those that have been subject to cold Swel­lings of the Glands.What is to be done in the hot Swel­lings. In the beginning of these more hot Swellings, liberal and frequent Bleed­ing is for the most part more necessary than in other Consumptions; by which means the In­flammation and Suppuration of the Tubercle may perhaps be prevented, though the incipient Tumour, that is begun to arise, may neither be lessened, nor perfectly wasted. Here also it is [Page 198] convenient to add your Figwort, Dropwort, Wood-lice, and other Antiscrophulous Ingredi­ents to the Pulmonary Medicines. Here like­wise the Gums and Balsams are very serviceable: As also my Balsamick Pills before mentioned, by a long use of which I have done more towards the perfect Cure of very many of this kind of Consumptive Patients than by any other Pulmo­nary Medicines.When they Apostemate, Specificks do no good. But if these hot Swellings be­gin once to turn to an Aposteme, Specificks then do no good at all; but such kind of Consump­tive Patients must be treated in the same manner as other Consumptive Persons, to wit, accord­ing to the degree and progress of the Disease.

If the Swel­lings are of a middle Na­ture, the Con­sumption is so too.But if these Swellings be of a middle Nature, so that though they are apt to be inflam'd, yet 'tis but slowly as they concoct the Matter con­tained in them into the form of Chalk, into the Nature of a Suet, or a substance like Honey; there follows thereupon a Consumption parta­king likewise of a middle Nature; to wit, a Chronical one, that runs on for many Years, and is attended with a gentle and moderate de­gree of Symptoms, to wit, with a continual Cough at all Seasons of the Year, which yet is moderate, and not very dry: But in the Win­ter, and when the Air is thick it is more trouble­some; a very mild, and almost insensible Fever, plainly of a Hectick Nature, accompanied rather with a lankness than an evident Consumption of the Flesh, as also with a delicate Stomack, ra­ther than a want of Appetite: Which indeed is the most common Consumption of Old Persons, and often occurs in Practice.These Con­sumptive Pa­tients with due care rub on a great while.

I have observed that this sort of Consumptive People have not only lived a great many Years, though they have been crazy, but also with due [Page 199] government and care in those six things we call non-natural, have followed their ordinary Bu­siness. But upon committing of the least Error either in the quantity or quality of their Food, or in the time of Eating and Drinking, much more upon a Debauch, and the liberal drinking of Spirituous Liquors, or upon the getting of Cold, they are very subject to Putrid Fevers, and so long as they last the Patient's Life is in danger; and the Lungs being heated suffer more Injury from thence in a Week, than otherwise they would do in a Year. For the Fever that seizes this kind of Consumptive Persons, con­trary to the proper Nature of the Tubercles, is Acute. But though in the beginning that, or even the Cough, and other Symptoms of the Lungs seem to be mild, and though the Habit of the Body be never so much emaciated, we must bleed them moderately, and (if there be occa­sion) we must repeat it at the first Invasion of the Fever; and with all the Medicines we use for the Fever, we must mix such Pectoral and Antiscrophulous Ingredients as are proper; by which means I have with the Blessing of God recovered one and the same Consumptive Per­son (as Mr. Andrews, and a certain Merchant in Philpot-Lane, with many others) from several Putrid Fevers, that have returned the same Year; and that without any great mischief occasioned to the Lungs by them. But the oftner these Fe­vers return, so much the sooner does the Con­sumption quicken its pace towards a fatal end; and the nearer the Consumptive Person is to this Fatal Day, the oftner are these Putrid Fevers apt to return, arising from the least occasion: The Inflammation of any new Tubercle (as it seems to me) always giving the occasion of this kind [Page 200] of Putrid Fever.The Cure of this Consum­ption where there is no Putrid In­flammatory Fever. But when there is nothing of this Fever, the Cure of this Consumption may be very well performed by observing those ne­cessary Rules, which concern the six non-natu­ral things, and that perpetually: By a long use of the Mineral Waters in the Summer-time, un­less there be some great Obstruction of the Li­ver, and a Dropsie proceeding from it. In the Winter-time by a frequent and long use of my Balsamick Pills, as also of the Gums, and other Balsamick Medicines; but in the Spring, and the Autumn, with a Diet-drink made with Wood­lice, Antiscrophulous, and Pulmonary Ingredi­ents steeped in Beer, which must be prescribed for their ordinary Drink. And by these means I have recovered even some, that have been old; but a great many others, as Mr. Tibbs, Mr. Her­bert, &c. I have brought to a better state of Health, than they could enjoy for a great many Years before. Expectorating, and other Pul­monary Medicines are useful to this kind of Con­sumptive Patients, as well as to others; except Opium, which must very seldom be given in this case, and that not without urgent Necessity, be­cause of its fixing and stopping Nature. But these Pectoral Medicines, though they do some good, and give some present relief, yet they do not much promote the Cure of the Original Di­stemper without Antiscrophulous Medicines, and the other things I have now mentioned.

CHAP. II.

There is a Colliquative Ferment in all Scurvies.IN all Scurvies, but especially that which is Saline, the Blood always has in it a Ferment, which causes a great Colliquation, and likewise Secretion of the Chylous Lympha in the Glands; but especially in those that are seated about the Mouth, Jaws, and Lungs; and from hence it comes to pass that this kind of Patients, as they are subject to great Sweating, and to make much Urine, so likewise to a continual spitting by the Salivatory Ducts, to a hawking up of tough Phlegm from the Tonsils, and to a frequent Cough, proceeding from a continual spewing out of a Serous Liquor by the Glandulous Coat of the Wind-pipe. But this Scorbutical Lympha, that is excern'd by the Tonsils and the other Glands, though it admits of some Concoction, yet (as it abounds with a fixt Salt, and is in its own proper Nature glutinous) it has always some toughness;The Cough in a Scorbutical Consumption is not vio­lent. and hereupon the Cough of this kind of Consumptive Persons, though it be continual, yet is not so violent and dry as it uses to be in others, where the Serum, that is thrown out by the Glandules is thinner; whereupon there arises a fierce and troublesome Cough from the conti­nual spewing out of that Serum by the Wind­pipe; or at least a perpetual tickling molests them from the swelling of its Glandulous Coat, whenever the Lympha does not find a convenient passage out of the Glandules; and from hence [Page 203] for the most part there arises a violent and dry Cough. From whence it comes to pass that in a Scorbutical Consumption, by reason of the viscousness of the Matter that is separated, by which the Coat of the Wind-pipe, and of the branches of it, is rather troublesomly besmeared, than irritated, the Patient is not so much pro­voked to Cough, as he makes a Cough of his own accord to bring up the Phlegm that sticks, and is troublesome to him;But Asthma­tical. and hereupon this kind of Cough comes near to the Nature of an Asthmatical Cough, and is attended with a greater Wheesing, difficulty of Breathing, Con­striction, and weight of the Lungs, than we use to observe in other Consumptions.This Con­sumption is very Chro­nical. And from hence also a Scorbutical Consumption proves very Chronical, and never threatens a sudden Fatality without a spitting of Blood, or some other great Symptom coming upon it.

This kind of Consumptive Patients,Every little Error makes these Patients Feverish. though they spin out their Life to some length without any Medicines, only by a due government and care in those six things, called non-natural, yet they live sickly, and upon committing the least Error in their Diet, or taking of Cold, they are wont to be Feverish, and to lose their Sto­mack.

The Signs, that presage this Consumption,The signs of this Consum­ption. are especially two; to wit, a frequent eruption of Spots scattered up and down upon the whole Skin like the Miliary Shingles, and a perpetual hawking up, but especially in a Morning, of Phlegm, that is salt, and troublesome, thrown out by the Tonsils, which is many times accompa­nied with an Exulceration, and wasting of the Gums.

[Page 204] The manner how it is to be cured.But in what manner the Cure of this Con­sumption is to be altered from the General Me­thod I have already described, I shall here briefly observe, to wit,

Opium is hurtful.First, Opium is always mischievous, unless it be upon the taking of new cold, and then only it must be given to mitigate the Symptoms that arise from it; because it makes the Phlegm more tough, and hard to be expectorated.

Inciding Me­dicines are bes [...] of Pecto­ra [...]s in this case.Secondly, Amongst the Pectoral Medicines, those that are cutting and cleansing, are alway, to be preferred, for helping, and making the Expectoration easie, or at least they must be mixt with others; as Honey, Mead, Oxymel, Gums, and Balsams, Wood-lice, Syrup of Hedg-Mustard, of the five Opening Roots, the Balsamick Syrup. But above all, I commend my Balsamick Pills, which I have already described, the Use and Efficacy of which in a Scorbutical Consumption I have often had Experience of.

Antiscorbu­ticks must be mixt with the Pectoral Medicines.Thirdly, Antiscorbuticks must always be mixt with the Pectoral Medicines, that at the same time, when the flux of colliquated Matter is ex­pectorated with the help of the Pectoral Medi­cines, the Ferment, that causes this Colliqua­tion, may be destroyed, or at least abated by the Vertue of Antiscorbuticks. Otherwise so long as the Cause is not taken away, the Di­stemper it self cannot admit of a perfect Cure: But we must make choice of the milder sort of Antiscorbuticks, such as may cause the least heat and disorder in the Blood; as Water-cresses, Brook-lime, Pine-tops, the Leaves of Tun-hoof, red Dock-roots, Male Piony-roots, &c. of which a Bag may be made to be hung in Ale for ordinary Drink: By which means the Volatile Salt of the Simples (in which the Energy of the Medicine consists) is better [Page 205] preserved, than in Apozemes, and so the Ver­tue of the Medicine is more freely communica­ted to the Blood, and the Appetite is less inju­red by them.

Fourthly,Steel is use­ful. Also Steel is very useful in the Cure of this Consumption, unless it runs hastily on to its Fatal Period. If it be an Acid Scurvy, then Salt of Steel will be proper, a Grain or two of which may be mixt with every Dose of the Bal­samick Pills. If it be a Salt Scurvy, Mynsicht's Extract, which we have already taught how to give in the form of Pills.Especially the Chaly­beate Mine­ral Waters. But in all Scorbutical Consumptions the Chalybeate Mineral Waters are to be preferred before any Artificial Preparation of Steel in the Summer-time (if it be so the Consumption has not reached to the third de­gree) because they are endued with an extraor­dinary power, not only to open the Obstructions of the Nerves, and to penetrate and dissolve the Tubercles▪ but likewise to temper the Hectical Heat in the Blood and Spirits, to quench the Drought, restore the Appetite, and to procure a Briskness and Chearfulness of Mind; the Effi­cacy of which in curing this kind of Consump­tions above any other Method of using Pectoral Medicines, I have very often experienced with great Success. And therefore I shall add at the end of this Chapter a History or two of their extraordinary Vertue in the curing of a Scorbu­tical Consumption. But the use of them ought to be repeated every Year, because this Chro­nical Distemper does not use to be overcome with one blow.

Fifthly, If the Patient is costive,What is to be done if the Patient is Costive. the Purging Mineral Waters are here also very useful, as also any Stomack-Pills before described; by the help of which, being repeated once or twice a Month, [Page 206] my dear Father did happily prolong his Life in a Scorbutical Consumption for many Years.

Diversion and Chear­fulness ne­cessary for these Pati­ents.Sixthly, The Patient must recreate his Mind, and all Lawful means must be used to make him chearful: For as this Distemper for the most part takes its Original, so likewise its fatal In­crease from Grief, and disturbance of the Mind.

A Milk Diet seldom agrees with them.Seventhly, A Milk Diet seldom [...]ees with this kind of Consumptive Persons, by [...]eason of the Acid, or Salt Ferment of their Stomacks; and generally speaking, is wont to disagree as well with Scorbutical, as Hypochondriacal Per­sons.

The use of Tobacco is to be much su­spected.Eighthly, The taking of much Tobacco is likewise to be much suspected in this Consump­tion; because not only it increases the Ill and Salt Ferment of the Stomack, by reason of the abundance of Salt that is contained in it (where­by the Colliquation, that is caused by a Saltness, is increased;) but also because that Saline Smoak by irritating the Salivatory Ducts, does promote a more plentiful excretion of the Spittle, and that not only by the Glandulous Coat of the Mouth, but also by the Tonsils, and the whole Trunk of the Wind-pipe, even to the very Lungs; from whence it comes to pass, that as the trou­blesome hawking up of Phlegm from the Ton­sils, so also the Cough of the Lungs is wont to be promoted. Finally, the shaving of the Head and many Issues are here very advantageous, be­cause they conduce very much to the lessening of the quantity of the Serous Liquor, that a­bounds in this Distemper, the one by promo­ting a Perspiration, the other by deriving that Liquor to themselves.

CHAP. III.

THough every Scorbutical Consumption is of an Asthmatical Nature, yet by this I espe­cially understand that, which proceeds from a true Asthma as the preceding Cause, and de­pends wholly upon it.Every Asth­ma has a ten­dency to a Consumption. For every Asthma, but especially that which is Humerose, has a tendency to a Consumption; because in this Distemper not only the Lungs are very often straitned, and drawn together in the Nature of Spasms (where­by the Tone of them is wont to be injured and destroyed, and a thick viscid Humour is wont to be prest out of their substance into the branches of the Wind-pipe by that frequent compression, which sticking fast there, causes a Cough, Whee­sing, and difficulty of Breathing) but likewise from the previous disposition of the Blood to be viscid and tenacious, the Lungs are almost always knotted from the very beginning of this Distem­per; which Knots or Tubercles in progress of time are wont to be inflam'd and exulcerated; from whence there follows a true and fatal Asth­matical Consumption.How this Consumption is distinguisht from others. But this Consumption is to be distinguished from others especially by this, that it is accompanied through the whole course of the Disease with a Wheesing, and extream difficulty of Breathing, because the Humour, that is continually prest out of the Tubercles and substance of the Lungs into the Wind-pipe, and branches of it (as I hinted before) is always [Page 213] thick and viscid, sticking tenaciously and trou­blesomly to the sides of the Wind-pipe and its branches like Glew, and so hindring the free passage of the Air.

But this Consumption,This Con­sumption is very Chro­nical. though it is usually Fa­tal and Incurable, yet in its own Nature it is very Chronical; so that I have seen some, who, though they have been in an Asthmatical Con­sumption, yet have lived several Years with the help of a due Government, and of a thin Air. The cause of which thing seems to me to be the toughness and viscidity of the Humour thrown out by the Lungs in this Consumption. For this Humour, by reason of the great quantity of Salt contained in it, easily and quickly admitting some concoction, though into a viscid Matter, loses a great deal of its corrosive Acrimony; and thereupon becomes more benign, leaving a less impression behind it upon the Lungs, than where it is sharp, thin, and perfectly crude, and ad­mits of no Concoction at all.Old Age is such a Con­sumption. And indeed Old Age seems to me to be this kind of Chronical and Incurable Consumption; because all Old Peo­ple, that are not seized with some Acute Dis­ease, languishing in this manner with a Con­sumption, do at length come to the period of their Lives, but not without such fore-runners, as a Chronical Cough, a difficulty of Breathing, a wasted lean Habit of Body, and something of a Hectick Disposition. And we need not won­der at it, when the small Fibres of the Substance of the Lungs, by reason of a great Age losing their tensness, are wont to fall together; from whence it comes to pass, that the whole Sub­stance of the Lungs grows slabby like a Quag­mire, from the Nutritious Juice being seperated, and stagnating there; and upon that there is [Page 214] that plenty of viscid Phlegm, a Wheesing, Asth­matical stuffing of the Lungs, difficulty of Brea­thing, an emaciation of the whole Body, and a Hectical Disposition. And why should I use many words, wh n there follows plainly a Con­sumption of Old Age?

Neither is a Milk Diet nor Opiates convenient in this Con­sumption.1. A Milk Diet is seldom convenient in this Consumption, much less Opium, because by in­creasing the thickness of the Humours, it pro­motes the difficulty of Breathing, and all the o­ther Symptoms of this Consumption; so that I have sometimes in this case seen the Life of a Pa­tient brought into sudden danger with but one Grain of Opium.

A thin Air is necessary in the Cure of it.2. A thin and open Air is more necessary in the Cure of this Consumption, than in any o­thers. Neither indeed can this kind of Con­sumptive Persons live long with the use even of the most Generous Medicines in a foggy or smoaky Air.

Inciding Me­dicines are the best sort of Pectorals.3. Amongst the Expectorating Medicines the best are such as are Cleansing and Inciding, as Honey, Mead, Syrup of Hedg-Mustard, of the five Opening Roots, of Vinegar: We must avoid, at least we must be very cautious in giving Incrassating things. Balsams, Gums, Wood-lice, but especially my Balsamick Pills, are here of great use: As also Spirit of Harts-horn, of Salt Armoniack, &c. whenever the Consumption depends upon a Con­vulsive Asthma.

What is to be done in vio­lent Asthma­tick Fits.4. This kind of Consumptive Patients are many times taken with Fits of an Asthma to a great Extremity. In which case it is necessary to open a Vein, though the Patient be never so much emaciated; and it is as convenient to give Riverius's Emetick Mixture of equal parts, of Oxymel of Squills, and strong Cinnamon-water, [Page 215] or something of that Nature; and to repeat it often, because it takes off the Spasmodick con­traction of the Lungs by its Carminative Power, and by its Abstersive Faculty it cuts and brings up the Phlegm. But yet we must bleed them sparingly, according to the Patient's strength; and we must not give that Mixture of Riverius, unless there is an absolute Necessity.

CHAP. IV.

ANY one, that has been but a little con­cerned in the Practice of Physick,Hypochon­driacal and Hysterical Persons are often Con­sumptive for a long time, and at last dye of it. The Reason why it is so may easily observe, that those that are Hypochon­driacal and Hysterical, do often live a long time in a Consumptive state, and at length being seized with those Symptoms of a Consumption of the Lungs, that accompany the last and fatal degree of it, they dye. The reason of which thing may be easily gathered from the Principles which I have already mentioned. For in an Hy­pochondriacal and Hysterical Affection, the Brain, and the whole System of the Nerves are always distempered; and thereupon not only the Animal Spirits do degenerate into a Windy and unquiet Nature, but also the whole Mass of Blood, which ought to be duly actuated and in­vigorated by those Spirits, is turned into a crude and cachectical load. And indeed we have rea­son to wonder that a Consumption does not al­ways follow, where there is such a destruction of the Tone of the Nerves, and from such a disposition of the Spirits and Blood. Moreover every one knows that some troublesome Passions of the Mind do for the most part precede, or at least accompany an Hysterical, and an Hypo­chondriacal Affection. From which (as I have [Page 218] already observed in the beginning of this Dis­course) a Consumption is wont oftner to take its Original, than from Cold, or any other Oc­casion. Besides those that are Hysterical and Hypochondriacal from Fear and Anxious Thoughts, are very often subject to continual Suffocations, and Oppressions of their Breast (which are nothing but Spasmodick contractions of the Muscles of the Breast and Larynx, and of the tender Substance of the Lungs) whereupon their Tone being once weakned and destroyed, no Body can think it strange if there often fol­lows a Consumption.

This Con­sumption is for the most part Chroni­cal, yet fatal.But this Consumption for the most part is Chronical, because it depends upon a morbid disposition of the Spirits, and Humours contra­cted by degrees: But yet for the most part it is Mortal, not only because they are seldom frighted at it by reason of the insensible Progress of it, until the Patient, that had been a long time sickly, falls at last into a deep Consumption; but also because the stock of Humours, upon which this kind of Consumption depends, is plainly not to be exhausted.How it is distinguisht from other Consump­tions. This Consumption may be distinguisht from other Consumptions especially by an Oppression of the Breast, and an unusual Sadness of the Mind; as also by fre­quent Hysterical Choakings, Faintings, and other Nervous Symptoms.

The Cure is almost the same as the general Me­thod. But the Vo­latile Spirits and Cepha­licks must be given more plentifully in this Consum­ption.The Cure is not to be altered much from the General Method. Yet I will subjoyn some Ob­servations concerning it. First, In this Con­sumption, because the great Weakness, and Ob­struction of the Nerves require it, we must al­low, if not even enjoyn, a more liberal use of Spirit of Harts-horn, Spirit of Salt Armoniack, Tin­cture of Castor, Hysterical Water, and Compound [Page 219] Piony-water, and other things of that Nature, than we use to do in other Consumptions; the extraordinary Efficacy of which in relieving the Symptoms of this kind of Consumptive Persons, I have very often found by Experience; and in­deed without these neither their Faintness, nor Choakings (which are Symptoms that are wont very frequently to affect these Patients) nor in­deed the Cough it self (which in this Consump­tion does for the most part proceed from the Genus Nervosum) can be mitigated. Secondly,The Chaly­beate Waters are very use­ful. Likewise the Mineral Waters are very useful in this case, and indeed without Chalybeate Medi­cines, those which are commonly called Pecto­ral and Antiphthisical, do no good. But they must be put upon the use of this kind of Me­dicines in time, before there appear any signs of an Ulcer of the Lungs, for fear the Patient should find more hurt than good from them, when Na­ture is once by degrees reduced to such a colli­quative state. Thirdly,Neither a Milk Diet nor Purges are conve­nient. As a Milk Diet seldom is convenient for this kind of Consumptive Pa­tients, so neither for the same Reasons (to wit, the weakness of their Nerves, and the preterna­tural sourness of their Stomacks) do Purges do any good, especially to Hysterical Women, un­less they be very gentle, and given in due time. Fourthly, But gentle Vomits,Gentle Vo­mits are very beneficial. and such as are fitted to the strength of the Patient in the be­ginning of the Distemper, are wont to help this kind of Consumptive Persons to a wonder, by relieving the Brain and Nerves. Fifthly,Opiates are many times necessary. The use of Opium may not only be allowed by a Physician, but many times it appears plainly necessary, perhaps more in this, than in any other Consumption of the Lungs, by reason of the grievous Spasms of the Stomack, Intestines, [Page 220] and other parts, which are wont to happen to this kind of Consumptive Persons more than to any others from their pertinacious Watchings, and other Symptoms, by reason of the windy and explosive state of the Animal Spirits, and the delirous activity and working of their Fan­cies.

CHAP. V.

THAT common saying amongst Physici­ans, That Purulent Matter follows Blood, seems to have had its Original from hence, be­cause an Aposteme of the Lungs, or a Pulmo­nary Consumption is wont to follow a spitting of Blood sooner and oftner than any other Di­stemper. Which whether it happens from the Crasis of the Blood being spoyled by too great a loss of it, or from a plentiful Flux of the Hu­mours from the whole Habit of the Body into the tender Lungs, where they have a free pas­sage; or from the Putrefaction of the clotted Blood, that remains in the Lungs after the spit­ting of Blood; or lastly, from some Ulcer fol­lowing upon the erosion of the Vessels, I do not well know.A Consump­tion usually follows a spitting of Blood. A Physician must endea­vour to pre­vent the one, as well as to cure the other. But this we may almost always ob­serve, that where a spitting of Blood has pre­ceded, a Consumption of the Lungs is wont to follow. And therefore a Prudent and Honest Physician, when he is called to one that spits Blood, ought not only to take care of his own Reputation, and the Honour of Physick, by ma­king a Prognostick at first of the Consumption that is like to follow, but also as far as he is able by necessary Cautions, and proper Medicines, to prevent this fatal event of the spitting of Blood, as well as to Cure the present Distemper, at least not to do or attempt any thing in the [Page 226] Cure of it, that may make the Patient more sub­ject to a Consumption.

We must di­stinguish be­tween an Ac­cidental and an Habitual Haemoptoë.And here it is necessary to distinguish between an Accidental and Habitual Spitting of Blood. I call that Accidental, which proceeds meerly from some Accident; as from Hollowing, or speaking too loud, Exercise, or a violent Cough, from the suppression of some usual Haemorrhage, from Chalky Stones, that are bred in the Lungs them­selves, or from Pins, and any other things that slip down into them from without. That I call Habitual, which depends upon a vitiated, sharp, and fermenting Disposition of the Blood; so that the stock and fuel of the Disease always lurks within.An acciden­tal Haemoptoë seldom ends in a Con­sumption. That Accidental spitting of Blood, as it seldom returns when it is cured after letting of Blood, a due ordering of their Diet, and the use of proper Medicines; so though the Bleeding has been profuse and plentiful, yet it seldom ter­minates in a Consumption; but the Patient be­ing once by degrees freed, with a due manage­ment recovers his fresh Colour, and gets his Flesh, as if he had never been troubled with such a Flux, as it usually happens after an immoderate Flux of the Menses, and other Fluxes of that kind. But an Habitual spitting of Blood, as it depends upon an intestine motion of the Blood, that is in a Ferment, and upon the Acrimony of it,An Habitual Haemoptol [...] hot always a Fever joyned with it. by which it opens the Vessels; so it has always a Fever joyned with it, together with a quick Pulse, and an Urine that is something high­colour'd, and is likewise wont to return after un­certain intervals; to wit, whenever the incon­stant Feverish Fit returns, from the force of the Blood, that is in a violent Ferment, the tender Vessels of the Lungs being not able to endure this quick motion of the Blood, are wont one [Page 227] time after another to be opened, and then there follows a great expense of that red Liquor, which for the most part does not stop till the Feverish Orgasm, and the Intestine motion of the Blood depending thereupon, perfectly ceases, either with the help of Art, or of its own accord, at least with the lessening the quantity of the Li­quor. And then too there is but a treacherous Truce, until the next time that the Vessels hap­pen to be too much distended by the preternatu­ral motion of the Blood in the next Fit.And often ends in a Consumption. And indeed this is that fatal spitting of Blood, which as it is hard to Cure, and often comes unexpe­ctedly upon the Patient, so it has at first a Putrid, then a Hectick Fever joyned with it, which is wont very often to terminate in an Incurable and Fatal Consumption.

The Grand Antidote for this spitting of Blood is the Peruvian Bark,The Peruvian Bark is the great Remedy in this Hae­moptoë. the extraordinary Vertue of which both to extinguish the present Feverish Effervescence of the Blood, and to prevent the return of it, I have always experienced with very great Success, whenever I have made use of it for this purpose. And as it quickly and safely stops the present spitting of Blood,An Hae­moptoë cured this way does not end in a Consumption. and likewise prevents it for the future; so I never see a spitting of Blood that was cured this way, end in a Consumption. For the Flame being in this manner perfectly put out, and the Fever once overcome, the Blood uses presently to reco­ver its Natural state, so that there cannot re­main the least suspicion of a Consumption fol­lowing upon it. For a Consumption, that uses to follow a spitting of Blood, does not seem to have its Original so much from the breaking or gaping of a small Vessel, as from the inordinate and Hectical state of the Blood. And therefore [Page 228] though a Consumption usually follows a spitting of Blood, when 'tis cured the common way, that is, by frequent Bleedings, Emplastick Me­dicines, Opiates, &c. which rather hinder the Eruption of Blood by force, than alter the in­ternal state of the Blood: Yet no one will won­der if the Hectick Flame remaining within does at length throw the Patient into a Consumption; yet whenever the present Orgasm of the Blood is so overcome by repeated bleeding, the use of the Temperate Juices, of Astringent and Opiate Juleps and Electuaries, and other things of that Nature (which are to be found in another place in the Chapter of a Haemoptoë, or spitting of Blood) that we have an Opportunity to give the Bark totally to extinguish the Feverish flame, and to open the Obstructions, which otherwise might occasion a new Effervescence, we com­monly make not only for the present a palliative but a truly, eradicative, and perfect Cure, with­out the least danger of the return of the spitting of Blood, or of a Consumption following upon it. For the flame being in this manner perfectly extinguisht, the Blood is reduced to its Natural Motion and Crasis, whereupon the Appetite pre­sently returns, the Lungs recover their Natural Motion and Temperament, and the loss of the Blood is by degrees repaired; until at length the Patient obtains, though by little and little, his former strong and lusty state, and it may be a better than he had before, without the least de­gree of a Hectick Heat, or the danger of a Con­sumption following upon his Bleeding.

In this Con­sumption there are Tu­bercles in the Lungs.But if either through the Physicians neglect, or from the peculiar Constitution of the Patient, or from any other cause, it so happens, that a Consumption of the Lungs succeeds to a spitting [Page 229] of Blood, the whole Lungs, or at least one of the Lobes, being stufft with hard Glandules scat­tered every where up and down in the form of Tubercles, is much swelled. And these Tuber­cles are wont sooner or later to turn to Apo­stems, and to be ulcerated, and from thence this Consumption has its Original, and Progress too. But according to the Magnitude and Number of these Tubercles,The Nature of which makes the Consumption various. and their disposition to a more quick or slower putrefaction, this Con­sumption is very various; sometimes slow, and Chronical; sometimes quick and Acute, yea, very Acute. For as I have seen some Persons that have been in a Consumption (who have been subject to a frequent spitting of Blood from the least occasion) live several Years with due care and management; doing likewise their busi­ness, though they have been sickly, with a Cough, and some degree of a difficulty of Breathing; to wit, whenever the Tubercles of the Lungs happen to be few, small, and not apt to putrefie; or whenever the spitting of Blood proceeds ra­ther from Stones that are bred in the Lungs, or from some external Accident, than from an In­testine Hectical motion of a hot Fermenting Blood: So I have observed others that have been carried off with a quick Death within the space of a few Weeks; and that has been when great Haemorrhages have often returned upon the Pa­tient from the Commotion of the Blood boyling vehemently, or when the Tubercles have par­taked of some malignant Nature, and so have been quickly putrified.

But whatever this Haemoptoïcal Consumption has been, whether Acute or Chronical,This Con­sumption is one of the most fatal. it has from the common Observation of Physicians been always reckoned amongst the number of [Page 230] the most Fatal and Incurable Consumptions. But the more Acute it is, the more dangerous it is wont to be. For as the spitting of Blood is the first occasion of this Consumption, so like­wise it is very apt in the Progress of the Distem­per to return often, either from the taking of the least Cold, or the committing any Error in their Diet, from Passions of the Mind, &c. And every new spitting of Blood pushes on the Con­sumption to a Fatal end. So that I have often seen this kind of Consumptive Persons in the very Haemoptoë, when it has returned upon them, spit out their very Lives in that stream of Blood which has come from them. And therefore in the Cure of this Consumption,Inciding and Lubricating Medicines are not good in the Cure. Cleansing, In­ciding, and Lubricating Remedies must be a­voided, or at least used very cautiously; as also hot and penetrating Liniments and Plaisters, that are outwardly applyed to the Breast, to promote Expectoration.But Incrassa­tin, &c. But we must (at least in the beginning of this Disease, and after every new spitting of Blood) rather insist upon the use of Alterative, Incrassating, Agglutinating, and Opiate Medicines; as also a Milk Diet, Solid or Liquid Laudanum, Syrup of Meconium, Syrup of Purslane, of Marsh-Mallows, of Ground-Ivy (the plentiful use of which in a Consumption from spitting of Blood I would recommend above all other things) Bole-Armenack, Coral, Dragons-Blood, Lapis Hae­matites, Gordonius Troches, Troches of Amber: Of which Electuaries may be made, and Compound Medicines in other forms for the Patient to take. Of which it will be proper to speak more largely in the Chapter of an Haemoptoë.

But in the Progress of the Disease, when once there is not so much fear that the spitting of Blood will return, we may more safely answer [Page 231] the Indications of the Disease, with the cautious use of Lubricating and Expectorating Medicines. Likewise Balsamick Medicines are here of great use; as the Balsamick Syrup, Balsam of Tolu, Ca­pivi, of Peru, Leucatellus Balsam, or Opobalsam, Bal­sam of Sulphur Terebinthinate, and Anisate, my Bal­samick Pills, and other forms compounded of these Medicines, the manner of giving of which is to be learnt from what has been already said in the General Method of Cure. Also Issues, and shaving of the Head are very Advantageous in this Consumption.

But above all, I must,The best thing in the Cure of this Consumption is the Peru­vian Bark. from the long Expe­rience I have had of it, commend in this Acute and Dangerous Consumption from a spitting of Blood, the use of the Peruvian Bark, to be given in that form, which is most grateful to the Pa­tient. By the frequent and sufficient repetition of which we may expect to temper the Feverish Heat, and to suppress the Intestine motion of the Blood, and so consequently to prevent the return of the Haemoptoë, and the Progress of the Consumption, more than with a Milk Diet, with Asse's Milk, or a Magazine of Pectoral Medi­cines.

But in a Chronical and slow Consumption,In this Con­sumption when 'tis slow the Cha­lybeate Wa­ters are pro­per. or rather a Consumptive state from a spitting of Blood, (where the heat of the Blood from the Intestine motion of it does not use to be so great) the Chalybeate Mineral Waters are of great use, if they are drank every day for a long time, but yet in a small quantity. They must be order'd to be taken thus in a little quantity, and to be drank lei­surely every day, lest a too great and sudden disten­tion of the tender Vessels of the Lungs, caused by drinking a great quantity of Water at a time, should bring a fresh spitting of Blood. But the small [Page 232] quantity of Water that is drank at a time must be made up by the length of the time that is every Year designed for the drinking of those Waters. By which means likewise the Blood perhaps is more tempered and altered, than by drinking a great quantity in a shorter space of time.

CHAP. VI.

Chalky stones are often bred in the Lungs.I Have often observed Chalky Stones bred in the Lungs, which when they have been Angular, and disturbed with the shaking of the Lungs, are wont to tear the tender substance of those parts; from whence have arisen a violent and dry Cough, and a horrible pain in the Breast, like that in a Pleurisy and Peripneumony; some­times also an Haemoptoë with a considerable Flux of Blood, and from thence Ulcers, with the usual Signs of a Consumption of the Lungs. Therefore when these horrid Pains happen with an Haemoptoë about the beginning of a Consump­tion,When we may judge a Consumption to be from them. we may justly suspect it to be a Consump­tion from Stones in the Lungs. Although we cannot pronounce any thing certain of this thing, till a Stone or two have been cough'd up. For it often happens that these Stones passing by de­grees through the Lungs, do at length get into the branches of the Wind-pipe, by which they are cough'd up, and that seldom without a great flux of Blood. But if these Stones are smooth, and not such as may break or tear the substance of the Lungs, they do not dispose the Patient much to a Consumption (at least an Acute one;) [Page 239] nor indeed do they occasion any great mischief more than a dry Cough, that is somewhat trou­blesome, and something of an oppressing weight in the Breast, as I have observed in several long ago, in whose Lungs, after they have been dead, I have found many of these smooth Chalky Stones, and some of them pretty large, with­out the least Tubercle, or Ulcer occasioned by them:Where these Stones are sharp they cause a Con­sumption. But where these Stones have been Angu­lar, and sharp, and apt to break and tear the Lungs, they have caused a Pain, a spitting of Blood, Ulcers, and a Consumption it self, as I have already hinted. In which case, as a pain does precede to, and accompany the spitting of Blood, so a spitting of Blood goes before, and accompanies the Ulcers and Consumption.

What I have now said of Stones,The same is true of Nails, &c. is likewise true of Nails, Pins, and other things, that slip down into the Lungs as People laugh. For un­less they are quickly cough'd up again, they prick the Lungs, and cause a lancinating pain, from whence a spitting of Blood, Ulcers, and a Con­sumption are wont to proceed. Of which I shall add a remarkable History presently at the end of this Chapter.

These Ulcers, as also the Consumption,The Ʋlcers they cause, cannot be cured before they are brought a­way. which is the effect of them (which we may likewise observe of Ulcers in the Kidneys and Bladder) can never be cured without fetching away the Stone, or Nail, or Pin, or whatever else it is of that Nature, that breeds the Ulcers. But these things, which causing a continual pricking in the ulcerated part, did by that means render the Cure of it impossible before, being once come away, though it be, as it usually is with a great Haemorrhage, yet the Ulcer, and Consumption of the Lungs, that proceed from them, do often­times [Page 240] admit of an easie and perfect Cure, because they have not their Original so much from a pre­disposed Habit of the Body, as from a meer ac­cidental Distemper of one single part. Of which I shall relate one or two remarkable Histories at the end of this Chapter.

The Cure of this Con­sumption.In the Cure of this kind of Ulcers, Opiate and Balsamick Medicines, with a Milk Diet, are of very great use; Opiates to obtund the sense of the torn and stimulated parts, and to keep them as quiet as is possible, whilst the Balsamicks exert their Healing Power. And with the con­tinual use of Milk the Hectick heat of the Blood, contracted in this Consumptive state, is to be allayed. But although these sharp Stones can neither be made to lye quiet in that part of the Lungs which they occupy, with the plentiful use of Laudanum, nor brought away with the use of Lubricating Medicines, but cause an Incura­ble Consumption, and spitting of Blood, and that such a one as returns by uncertain Intervals with a lancinating pain: Yet this Consumption is in its own Nature slow, and very Chronical, as a Consumption from the Stone in the Kidneys and Bladder uses to be, and, generally speaking, every Consumption that depends meerly upon an indisposition or Ulcer of some particular part, without an habitual disposition of the Blood con­tracted either by propagation from the Parents, or a long abuse of the six things called non-na­tural. But whenever a heap, or stock of pre­disposed Humours does conspire with some such fatal Cause, the Consumption which proceeds from thence, is not only fatal from the very be­ginning, but also quick and very Acute, so that it carries off the Patient within a few Months, and it may be Weeks. I shall add these few [Page 241] things concerning the variation of Cure in this kind of Consumption.

First, Lubricating Medicines must be taken plentifully in the beginning of this Distemper; yea, and gentle Vomits; by which means we may endeavour to bring away the Stone, or any other things that have slipt down into the Lungs, before they are quite fixt there by their lodging long in the part, and before the Tone of the Lungs is much injured by them.

Secondly, But if great and spasmodick pains are excited by the tearing of the Lungs, caused from the motion of these sharp bodies, we must expect a great spitting of Blood; and therefore instead of Lubricating Medicines we must give Laudanum, and that in good quantities, and of­ten, whereby we may hinder the motion of the Stone for the present, abate the pain, and pre­vent the spitting of Blood. For in this case let­ting of Blood, outward Fomentations, and Li­niments do no good (as they use to do in Pleu­ritick and Peripneumonick pains,) and this I found by Experience in one Mr. Foster, and in many others. 'Tis true indeed that a lingring and slow Consumption, attended with a difficulty of Breathing, and other such-like Symptoms will follow from a Stone lying in this manner in the Lungs, which I have often observed in my Practice. But yet a lingring and uncertain Consumption is better than an Acute one, ac­companied with horrid pains, that certainly and quickly terminates in Death. For if this kind of Consumptive People take such care of their Health as to live always in an open and Country Air, to keep from taking of Cold, from Drink­ing, and too much Exercise, and any other thing, that may disturb the Stones again, that [Page 242] are fixt, and lye quiet, they may live to a great Age, and do their Business well enough.

Sometimes the Bleeding must be per­mitted a while.Thirdly, But if there follows a spitting of Blood from the tearing of the Lungs, it ought to be let alone for a while. For in this Flux, the Stones, or any other things that have slipt down into the Lungs, may be voided. But if the Haemoptoë is great and dangerous, we must open a Vein, and if it be necessary, repeat it; and we must give not only Opiate Medicines, but also Astringents in the form of Linctuses, Ju­leps, &c. the Lapis Haematites, the Royal Styptick Water; we must use a Milk Diet, and other things briefly mentioned before in the former Chapter, which I shall hereafter give a larger Account of in another Book, if I have an Op­portunity to treat of an Haemoptoë.

Balsamicks must be plen­tifully used.Fourthly, But if the Lungs happen to be torn, and to be ulcerated from the motion of the Stone (whether it be voided or not) we must make choice of Balsamick Medicines, and give them plentifully; of which I have given several forms in the General Method of Cure.

A Milk Diet is not conve­nient, where there are Stones in the Lungs.Fifthly, we must not Order a Milk Diet in a Consumption proceeding from Stones in the Lungs, unless there is a great necessity; because it is apt to breed some new Chalky Stones: Whereby it comes to pass, that the Cure of one Consumption is wont to lay the Foundation of another.

The Chaly­beate Waters must be drank in lit­tle quantities.Sixthly, Likewise the Chalybeate Waters, though they may be good in this Consumption, must be drank in a little quantity at a time, for fear the Stone should be stir'd again by the too great di­stention of the Vessels of the Lungs. Whereby it comes to pass, that the return of the pain, and of the spitting of Blood does often follow upon it.

[Page 243]Seventhly,Sometimes there are se­veral Stones. Sometimes there are several of these Stones in the Lungs; so that after one or two, or it may be a third has been voided, yet the Lungs are ulcerated by those which remain be­hind, and from thence there follows a Consump­tion. As I remember it happened to Mr. Pluck­net, and some others.

But a Consumption of the Lungs is wont to proceed not only from a Stone in the Lungs,The Stone, and Ʋlcers of the Kid­neys and Bladder do often cause a Consumption. and an Ulcer there following upon it, but like­wise very often from Ulcers, and a Calculous disposition of the Kidneys and Bladder; so that I have very often observed those that have had the Stone, to dye of a Consumption. But this Consumption is alwas lingring, and Chronical; and is to be cured in the same manner as an or­dinary Consumption,How this Consumption is to be cured. only we must avoid those Medicines that irritate the pains of the Stone, as my Balsamick Pills, &c. But the Chalybeate Waters, which ease those pains, must be often used. For I am apt to think that those who have the Stone, do not fall into a Consumption so often from the long and tormenting pain, as from a want of the due secretion of the Serum, and an alteration of the Ferment, which sepa­rates it in the Kidneys, following upon it. And therefore in the Cure of this kind of Consump­tion, we must have a regard not only to the Consumption, by using the Pectoral Medicines I have before mentioned, but also to the Disease, which is the cause of this Consumption; to wit, the Stone of the Kidneys and Bladder, by using such Medicines as may lubricate the Urinary Passages, and expel the Stone, or at least miti­gate the pain.

CHAP. VII.

The French Disease often brings on Atrophy.'TIS certain every French Pox if it be Chro­nical, accompanyed with a virulent Go­norrhoea, or many and large Ulcers, is always apt to bring the Patient by degrees into a Consump­tive state by the continual substraction of the Nutritious Juice from the Habit of the Body, of which sort of Consumption I have before dis­coursed in the First Book.

And likewise a Consump­tion of the Lungs.It is also as true, and I have often observed in my Practice, that a true Consumption of the Lungs has had its Original meerly from the al­teration of the Blood and Humours caused by the French Pox.

And it is no wonder, when the whole Mass of Humours is so manifestly altered, and brought into a colliquative state by the Ferment of this Distemper (which is evident enough from the Malignant Swellings, Gonorrhoea's, and Ulcers, that commonly accompany this Disease) if these kind of Venereal Swellings and Ulcers happen sometimes also in the spongy and soft Substance of the Lungs; whereupon a true Pulmonary Consumption must necessarily follow. Indeed I have rather wondred that we ever meet with the French Disease, especially if it has been of a long standing, or ill cured, without an Ulcer in the Lungs, and a Consumption proceeding from it. But to speak the truth, I very seldom, if ever, [Page 251] observed a Consumption of the Lungs from the French Pox,Which is rare, unless the Lungs were obstru­cted before, or from ill man­agement. unless it has been where the Lungs were obstructed, and disposed to a Consumption before; or at least where there has been a bad management, and ill-natur'd Medicines have been given by some Quacks; and the often ta­king of Cold in a Sweating Course, or in a Salivation, has been joyn'd with the French Pox. This Consumption (if it be treated in due time, and in a due manner) is as easily cured as any other.This Con­sumption is of an Asth­matick Na­ture. For (as far as I have observed) it is of an Asthmatick Nature, and is wont to be at­tended with tough Phlegm, and a difficulty of Breathing rather than a violent Cough; and therefore it is Chronical, and ascends slowly and by degrees to its highest degree; from whence it comes to pass, that I have sometimes observed some of these kind of Patients to live several Years in a Sickly and Consumptive state. Which perhaps may be partly from the continual use of the Decoction of Sarsa, and other things of that Nature; by which the Malignant Venom of the Humour, though it is not perfectly era­dicated, is in some measure obtunded. For I do not doubt but the peculiar Nature of the French Pox is so Venomous, that unless the Ma­lignity of the Humour happened to be corrected by the use of Calomelanos, a Decoction of the Woods, and other Medicines prepared by Art or Nature, every Consumption from a French Pox in its own proper Nature would be Acute.

From a frequent Experience I do affirm,This Con­sumption is not to be cu­red without Antivenereal Medicines mixt with the Pectoral. that all Pectoral and Pulmonary Medicines, that are meerly such, without mixing Antivenereal Me­dicines with them, will do nothing towards the perfect Cure of this Consumption. And there­fore there is no better Method can be thought [Page 252] of, than to endeavour the healing of the Ulcers of the Lungs, and the restoring of the Crasis of the Blood,The best thing is a Salivation. which has been destroyed by the Ve­nereal Ferment, by a Mercurial Salivation, be­fore the Patient has been weakned by a long protraction of the Distemper, and so is unable to bear such a continual and profuse Evacua­tion.

What is to be done if the Patient can­not bear that.But if the Patient, by reason of the extenua­ted Habit of his Body, does not seem to have strength enough for this Method of Cure, all the hope that remains must be from the use of a Restorative Milk Diet; and then from a strict and long use of a Decoction of Sarsa, and of my Balsamick Pills, giving likewise Purges with a moderate Dose of Calomelanos mixt with them. Of a Cure of this Nature I shall not think much here to give an extraordinary Instance.

CHAP. VIII.

How this Consump ion is caused.I Have also observed in my Practice these kind of Consumptions; which are not caused (as it is commonly thought) by the translation of the Purulent Matter into the Lungs (which to me seems impossible;) but by the Pollution of the whole Mass of Blood by the violent keep­ing in of the Excrementitious Juice, which used to be continually thrown out by these Ulcers. From whence it comes to pass, that the Blood being in this manner foul'd, does make it its bu­siness to cast off this extraneous and excremen­titious Ferment, and to lodge it in the soft sub­stance of the Lungs as it circulates through them, which many times according the Nature of the Matter is disposed to a speedy Putrefaction. And hereupon that Consumption of the Lungs, which I make it my business to treat of in this Chapter, though it be sometimes of a middle Nature,This Consum­ption is A­cute. yet for the most part it is Acute; yea, many times according to the Nature and Disposition of the Ulcer of the Lungs,And most commonly Mortal. which causes it, very Acute, and almost always Incurable and Mortal, because [Page 255] it depends upon an inexhaustible stock of Mat­ter lurking in the Habit of the Body.

In the Cure of this kind of Consumption,The Cure. besides the General Method before prescribed, I shall add these few things particularly to be observed.

First, The former, and accustomed Ulcers must as far as it is possible be revived; whereby the Humour may be diverted from the Lungs, and be evacuated by the usual and less dangerous vents, though it may seem troublesome.

Secondly, But if this cannot be obtained (which indeed is very seldom done) then frequent Issues, yea, and Vesicatories, but especially applyed near the place which Nature first assign'd for the separation of this Humour, ought to supply this defect, by which we may make some compen­sation to oppressed Nature, and particularly de­rive the Matter from the Lungs.

Thirdly, In the beginning of this Consump­tion, to wit, when the Glands of the Lungs be­gin to swell (which we may guess at by the Cough, difficulty of Breathing, and Feverish Heat) we must use Bleeding, and also repeat it if it be necessary. By which the stagnation of the Blood, which arises from the first reception of the Matter into the Lungs, and so the swel­ling of the part may be prevented, or at least abated.

Fourthly, Amongst the more general Pectoral Medicines already described, I would commend the use of a Milk Diet, of Asse's Milk, the Cha­lybeate Mineral Waters (if they are drank in time) of a Pulmonary Decoction of Sarsa, for ordinary Drink, of the Gums, Balsams, and Wood-lice, but especially my Balsamick Pills.

[Page 256]Fifthly, But we must always add to the Pecto­ral Medicines also those things which have a respect to the peculiar Nature of the Ulcer, or Original Distemper.

CHAP. IX.

THIS is most commonly the Original of Women's Consumptions,Ab Obstru­ction of the Menses is commonly the Original of Consump­tions in Wo­men. and I have very seldom seen any Woman that was capable of the Monthly Purgations, either Virgin, married Wo­man, or Widdow, who ever fell into a Con­sumption without an Obstruction of these Pur­gations coming upon it, either in the beginning, or at least in the progress of the Distemper.

Sometimes 'tis the effect of a Con­sumption.'Tis true indeed this Obstruction may arise in the progress of a Consumption from the impo­verisht state of the Blood, by reason of the want of new Nutritious Juice; and therefore is to be accounted an Effect rather than the Cause of this Disease.But many times the oc­casion of it. But many times it is the occasion of a Consumption, and that not only in Virgins and Widdows, but even in married Women. For when there is an Obstruction of these Pur­gations caused by Passions of the Mind, taking of Cold, or using such Food as breeds a bad Juice, the Mass of Blood is apt to be foul'd, and to be rendred cachectick by those Excrements, which used to be thrown out, but are now de­tained in it: By which Mass of Humours now gathered in the Blood the Lungs are wont to be stufft, and thereupon a Cough, difficulty of [Page 259] Breathing, and the other ordinary Symptoms of a Consumption are wont to arise: From which being a long time neglected, a Consumption of a peculiar Nature, attended with prickings, and dreadful pains in the Sides does many times arise.

In the beginning of this Distemper, Bleeding,What is to be done in the beginning of this Consum­ption. and moderate Purging with the Sacred Tincture, and other things of that Nature; and the use of Chalybeate Medicines, but especially my Chalybeate Electuary, which I may afterwards mention in the Chapter of a Chlorosis, &c. are convenient to provoke the Menses, and to correct the Cache­ctical state of the Blood: But if through the neglect of the timely use of these things, the Patient is already brought into a Consumptive state, it is not only in vain to try any of these things (because we cannot expect those Purga­tions in this impoverisht state of the Blood) but also very prejudicial to the Patient to give them. For it is to no purpose to diminish the stock of Blood by opening a Vein; and with the use of Chalybeates it is more exagitated and grows hot. Therefore in this case the Patient must be put in­to the General Method of Cure used in a Con­sumption of the Lungs, and already described; and the Pains of the Sides must be eased with warm Liniments and Fomentations, mentioned in another place. But the Consumption being once cured, and the Body grown lusty again, the Uterine Vessels being replenish'd with Blood and Nutritious Juice, are wont to be opened of their own accord in a thin Country Air. But we must relieve this defect of Nature (if she is still deficient after the Patient is recovered) with the help of Art? For if the Obstruction still con­tinues, the Patient will quickly grow Cachectical [Page 260] again, from whence we may justly expect a re­turn of the Consumption. Therefore in this case let the Patient be kept in a thin Air, and shake off all Sadness and troublesome Cares; let her use Exercise, and due Frictions; as also bit­ter, Antiscorbutick, and Chalybeate Medicines, but especially the Vitriolick Mineral Waters, if it be a proper time of the Year for them. This Consumption, because it proceeds from a Ca­chexy, is for the most part Chronical, and not presently Mortal. But if it is not cured in the beginning, it is very difficult, if ever, to be cured; and indeed the Green-Sickness of Virgins has very often this Fatal Event; because the Symp­toms of a Consumption and a Green-Sickness are so much alike, that the Common People seldom perceive when one comes to be joyned to the other, till the Consumption is come almost to its Third and Fatal Degree. And from hence it is that I am wont always to suspect a Chronical Cough that attends a Chlorosis.

CHAP. X.

IT is well enough known to all those that have but a little Skill in Physick,A Consump­tion often proceeds from a Peripneu­mony and Pleurisy. that a Consump­tion is wont to arise likewise from these Distem­pers very often. And this happens sometimes from the Ignorance or Neglect of the Physician, sometimes from the perverseness and peculiar Na­ture of the Original Distemper, or a previous disposition in the Patient to a Consumption: Many times too the Patient himself, and his Friends that are about him, are to be blamed, who not observing the proper Directions of the Physician, in Bleeding so often as is necessary, in the seasonable and plentiful administration and taking of Pectoral Medicines, and in the other parts of a due management, do many times lay the Foundation of a Consumption, that follows afterwards. For a Consumption follows after a Peripneumony and a Pleurisy, for the Reasons following.

First,The first Rea­son why it does so. When the Blood is left in a Colliqua­tive state by these Distempers, which is wont to happen likewise for two causes; to wit, First, when the Patient has been Habitually predispo­sed to a Consumption by a propagation from the Parents, or by a long abuse of the six non-na­turals; in which case the Blood and Lungs be­ing heated and inflamed, are very difficultly brought to a due temper; for the Peripneumony [Page 264] and Pleurisy being once conquered, the putrid heat of the Blood degenerates into a Hectical, or Habitual heat, so that afterwards the Chyle can neither be perfectly united, nor amicably mixt with the Mass of Blood: And from this Colliquative state of the Blood a Consumption of the Lungs must necessarily follow. Second­ly, and it may be this more frequently happens from the perverseness of the Patient, and the timorousness of his Friends, and those that are about him; and perhaps too from the Ignorance, or at least the Negligence of the Physician, when timely and plentiful Bleedings, which are not only necessary to relieve the Pain, but also ab­solutely requisite from the degree and exigence of the Fever, and the Inflammatory disposition of the Blood, are wholly omitted. For in this case there still remains a Hectick Heat in the Ha­bit of the Patient, which disposes him to a sud­den Consumption, after a due Concoction and Expectoration of the Matter, which was gathered in the Lungs.

The second Reason want of due Ex­pectoration.Secondly, When the Matter that is gathered in the Lungs is not at all concocted and expecto­rated, or not in a sufficient quantity, or at least not so soon as it ought to be. And this is wont to come to pass from several causes: As first, when the parts of the Lungs, that are inflamed, are the Vesicles, or Air-Glands, and thereupon the Matter, that is lodged in them, though it be concocted as it should be, yet being contained in its proper Cystises, does not find a passage out, notwithstanding the most diligent use of Expe­ctorating Medicines. For though there is a greater quantity of purulent Matter concocted and gathered in the Glandules with the use of those things, and thereupon there follows an [Page 265] Aposteme of a great bigness;Which occa­sions an A­posteme. yet because the Matter does not find an immediate Vent, no Expectoration succeeds, and so the Lungs are not able to clear themselves; whereby it comes to pass, that after the Aposteme is broke, there remains a foul Ulcer in the Lungs, proportionate to the largeness of the Aposteme. And upon this breaking of the Aposteme, the Matter that is contained in it,Which when it breakt, empties itself either out­wardly, is wont to empty it self ei­ther outwardly or inwardly, according to the Situation of the suppurated part. For if the af­fected Glandules are placed near the branches of the Wind-pipe, when the Cystis is broke, the Matter easily finds a vent into the Wind-pipe: And many times the Patient is suddenly strang­led, or ready to be choaked with the violent gushing out of the Matter,And some­times the Pa­tient is sud­denly choak­ed; flowing out all toge­ther this way: Which I sometime since found in Mr. White's Son, whose case I shall give an Ac­count of in the end of this Chapter. But if these Glandules are placed at that distance,Or inwardly. that the Matter cannot find a passage into the bran­ches of the Wind-pipe it self, those parts do in progress of time swell to a great bigness, where­upon at length, when the Cystis breaks, the Matter diffusing it self every where through the whole substance of the Lungs, does perfectly destroy their Tone. Yea, sometimes I have observed the Lungs to be so much distended with it, that part­ly from their distention, and partly from the Acrimony of the Matter, that has insinuated it self into them (the outward Membrane, which invests the Lungs being once broken, or eroded) the matter has fallen continually, and plentifully out of the Lungs into the Cavity of the Breast: And thereupon in the dead Body, when it has been opened, though we found an Ulcer only in [Page 266] the upper part of the Lungs, and the Tone of the Lungs every where corrupted with the Mat­ter passing through them, yet we met with se­veral Pints of purulent Matter, which was faln into the Cavity of the Breast through the bro­ken Membrane, after the manner of an Empyema. And from hence it came to pass, that when the Physician had done all he could in prescribing, and the Patient had been as diligent in the ta­king of Expectorating Medicines, yet we did no good with them.

The Expecto­ration is hin­dred by very profuse and unseasonable Bleedings.Secondly, When with unseasonable, and very profuse Bleedings the Blood is grown so cold, that the suppuration of the inflamed part is ei­ther hindred, or at least comes to be late. For every one, that understands any thing of Sur­gery or Physick, knows that Bleeding causes a suppuration to be slower than otherwise it would be. And that famous Aphorism of Hippocrates is no less true, That unless those that have a Pleurisy do expectorate in fourteen days, if they live so long, they will be Empyical upon the fortieth day; so great a quantity of true Matter being in that space of time collected in the Lungs, that by reason of the quantity, and Acrimony of it, it is apt to make its way through the broken and eroded Membrane of the Lungs into the very Cavity of the Breast.From the want of Pe­ctoral Medi­cines. Thirdly, this also sometimes happens through the carelesness of the Physician, or else the perverseness of the Patient, from the neglect of the use of Expectorating Medicines in the beginning of a Pleurisy and Peripneumony. Fourthly, in fine, this often happens to Infants for want of Understanding, because they have not wit enough to raise and spit out the Puru­lent Phlegm which is lodged in their Lungs.

[Page 267]This Consumption is always very Acute,This Con­sumption is always A­cute. be­cause it proceeds from an Acute Distemper pre­ceding, by which not only the Patient has been very much weakned, but likewise the Mass of Blood has been left in a Colliquative state; yea, and very often there has happened to be a Col­lection of Matter made in the Lungs. So that this Consumption has scarcely gone by the Name of a Consumption, before the Patient has arri­ved plainly to the state of a Marasmus. The Cure of this Consum­ption, when 'tis from a Colliquative state of the Blood. If this Consumption has had its beginning from a Col­liquative, and too hot a state of the Blood, cau­sed by the preceding Distempers, we must not only continue the use of Expectorating, and o­ther Antiphthisical Medicines, (which yet must be of those, that are more mild, and not very hot) but we ought also to prescribe Temperate Pearl Juleps to be taken plentifully to temper the heat of the Blood; as also Milk-water, Snail-water, yea, and the Chalybeate Waters, if it be a time of the Year proper for the use of them; but above all we must have recourse to Bleeding (however the Patient is weakned, and his Body brought into a Tabid state by his former Distem­per) and that not once only, but frequently; and we must repeat it too (if it be necessary) not with too sparing a Hand.

But if this Consumption proceeds from the breaking of the Glandulous Aposteme emptying it self by the Wind-pipe,The Cure, when 'tis from the breaking of an Aposteme. we must promote the Purgation of the Lungs by this High-way with the plentiful use of Expectorating Medicines. And if there is any fear that the Patient will be choak'd after the first breaking of the Abscess with the Matter rushing too fast, and in too great a quantity into the branches of the Wind-pipe, (which I remember happened to Mr. White's [Page 268] Son, and to some others) we must hasten the Expectoration by giving Oxymel of Squills, and other gentle Vomits; and then provoking them to Vomit by tickling the Tonsils and Uvula with a Feather dipt in Oyl. Whereby it comes to pass, that a violent motion of the Stomack being excited in Vomiting, the Lungs also being agi­tated by it, can more easily free themselves from that glutinous Matter which sticks in them. The greatest part of the collected Matter being in this manner once evacuated, that which remains must be also brought away with the diligent use of Expectorating Medicines. Which being done, the Cure in progress of time may by degrees be perfected with a Milk Diet, Temperate Juleps, the Balsamick Medicines before described, and with the Chalybeate Waters drank in the Coun­try in a wholsom Air.When a Pa­racentesis is to be made. But if by the continua­tion of the Hectick heat, a redness in the Cheeks coming every day, a difficulty of Breathing, without any considerable Cough attending them; but especially by a fulness and weight in one or both the Hypochondres, and a fluctuation of Matter in the Breast, perceived by its moving from one side to another, this Consumption seems to have been occasioned by some Matter, that has been gathered in the Glandulous Apostems of the Lungs, running through their outward Mem­brane, when it is eroded, or broken, into the Cavity of the Breast, after the manner of an Empyema; then I say the Matter that fluctuates in the Breast, and is continually dropping out of the Lungs, must be conveniently taken out at due intervals as the Patient can bear it, by a Paracentesis made in a convenient place near that Hypochondre where the greatest weight is felt. The rest of the Cure is to be performed with [Page 269] the plentiful use of Wood-lice, Balsamick Me­dicines, and of Temperate Juleps; as likewise with a Milk Diet, Decoctions of Sarsa, Chaly­beate Remedies, but especially the Chalybeate Wa­ters.

But if by reason of the weakness of the Pa­tient,When there is Matter in the Breast, and a Para­centesis will not be allow­ed, we must use Diure­ticks. or the timorousness of them that are about him, we may not be allowed to make a Para­centesis, we must endeavour to evacuate the Mat­ter by a long and plentiful use of Diuretick Me­dicines, as Wood-lice, Salt of Amber, my Diu­retick and Lubricating Apozeme, which I shall give an Account of presently in the next Histo­ry, &c. which is sometimes done with good, though more uncertain Success (as I found in Mr. White's Son, whose Case I shall think it worth my while presently to subjoyn.How the Cure must be compleated.) Afterwards the Cure must be compleated with a Milk Diet, the use of Balsamick and Chalybeate Remedies, and likewise with Decoctions of Sarsa impreg­nated with Pectoral and Vulnerary Herbs, that are very temperate.

But if this Consumption proceeds from the slowness of Expectoration,What is to be done when there is a slow Expecto­ration from the Blood be­ing too much cooled, &c. caused by the Blood being too much cooled with unseasonable, or too liberal Bleeding, or by the neglect of Expecto­rating Medicines, we must enjoyn the plentiful and frequent use of Lubricating and Balsamick Medicines, and especially such as are hot, and endow'd with penetrating Particles; as Opobalsam, Balsam of Sulphur Terebinthinate and Anisate, Lin­seed-Oyl fresh drawn without a fire, an Antiphthisical Mead, and other things of the same Nature.

CHAP. XI.

There is a Colliquation in a Gout and Rheu­matism.IN a Gout and Rheumatism, especially that which is true, and Humorose (which is caused by a sharp Ferment supplyed from the Nerves) there is such an evident Colliquation in the whole Mass of Blood, that no Body can reasonably think it strange, that a Consumption should arise from these Distempers (but especially when they are stubborn, and Chronical, and return often.) And hereupon it is an easie matter to observe, that a Rheumatick Pain,In Rheuma­tick Pains there is a Cough. coming from the taking of Cold, seldom if ever is wont to seize upon the Joynts without a Pulmonary Cough. And as I have seen that great Man, the Lord Bridgman, Mr. Philips, and Mr. Tibs, and many others, af­ter frequent and long Fits of the Gout and Rheumatism, dye at last of a Consumption or Asthma; so I have likewise observed, that some­times an Acute and Fatal Consumption has fol­lowed upon the first Fit of a Rheumatism.

This Con­sumption it sometimes Acute.This Consumption when it seizes them from the first Invasion of a Rheumatism, happens some­times to be Acute, for this Reason; because it proceeds from a Colliquation of the Humours in an Acute Fit of a Humorose Rheumatism. And therefore because it partakes of the Nature of an ordinary Consumption,And must be treated with the general Method. it ought to be treated wholly in the General Method; that is, with the use of Lubricating, Incrassating, Opiate, [Page 277] and other Pectoral Medicines. And indeed it has been my Practice, and that with very good Success, to prescribe in every Rheumatick Fit the plentiful use of Pectoral, Lubricating, and Incrassating Apozemes and Linctuses, though there be no urgent Cough, nor difficulty of Breathing, not only to temper and soften the Blood, but likewise to prevent a Consumption, which uses often to be the effect of a Rheumatism.

But whenever this Consumption proceeds from an old Gout, or a Rheumatism,When it comes from an old Gout, &c. 'tis Chro­nical. that has retur­ned frequently, it is plainly Chronical, and does gradually in several Years create trouble to the Lungs, and the Parts that serve for Respiration. And indeed it is of an Asthmatick kind,And of an Asthmatick kind. attend­ed rather with a difficulty of Breathing from the toughness of the Phlegm, than a pertinacious Cough. Because it seems to arise rather from a Stupor of the Nerves, than from a Colliquation of the Humours.

But yet this Asthmatical Consumption to me seems to be of a peculiar Nature,But of a pe­culiar Na­ture. because it is not at all relieved by the choice of a good Air. For I have observed, that this kind of Consump­tive Persons, though they be likewise Asthmati­cal, breath as well in a foggy and smoaky Air, as in that which is thin and open. And from thence also it comes to pass, that Lubricating, and Expectorating Medicines do no good in this case, though Incrassating, and Opiate Medicines are fatally Mischievous. But there is more Re­lief to be expected from the frequent and plen­tiful giving of Spirit of Hartshorn, of Salt Ar­moniack, and Chymical Oyl of Juniper, and other things of that Nature, that excite the Spi­rits, and comfort the Nerves, than from any Opiates, or Pectoral Medicines.

[Page 278] As the Con­sumption proceeds, the Pains abate.The more this Asthmatical Consumption grows upon the Patient, the more the Rheumatick Pains and Swellings are wont to abate. And a true and genuine Humorose Rheumatism, long before it becomes Mortal, degenerates into a Nervous Rheumatism, attended with pains running up and down, but with no evident Swelling.

When a Rheumatick Consumption is incurable.This Rheumatick Consumption, proceeding from a Chronical Rheumatism, and happening to those that are Old, (so far as I understand) is plainly incurable. For it is a sign that Nature absolutely sinks, and is now overcome in the last Scene of a Rheumatism.

Gentle Vo­mits are goodGentle Vomits repeated at due intervals (espe­cially if the Patient bears them well, and they are not given when 'tis too late) do much to­wards the promoting of the Cure of this Con­sumption; because they open the Obstructions of the Brain and Nerves, and abate the Rheuma­tick pains, by taking off the stiffness, and Stupor of the Nervous parts; from whence it comes to pass, that a great part of the Procatartick Cause, or that which feeds the Distemper, is taken away.

Bleeding does good in the beginning.Likewise Bleeding in the beginning of this Consumption (before the Habit of the Body is too much extenuated) does a great deal of good, not only by abating the Hectick heat, and the Rheumatick pains, but also by relieving the dif­ficulty of Breathing.

When the Distemper is improved, it is hurtful.But in the progress of the Distemper, when a great Emaciation has before seized the whole Habit of the Body, as I have often observed Nature to be more weakned, so their Respiration to be rendred more difficult with Bleeding. And indeed I do not at all doubt, but this Asthmatical Consumption does often proceed from Bleeding [Page 279] profusely, and the often repeating of it in the Fits of a Rheumatism; the Crasis of the Blood being thereby destroy'd, and the whole Mass of it impoverisht, as it uses to happen in all immode­rate Haemorrhages.

I have likewise very often by Experience found the extraordinary Vertue of the Peruvian Bark in extinguishing the Colliquative Hectick Flame, which has been kindled in the Blood,The Peruvian Bark does well. and is left there by its Rheumatick state, which Flame, unless it is taken away either by some Art, or by Nature, does most certainly prepare the way to this Pulmonary Consumption.

I have observed likewise that Chalybeate Me­dicines do for the same Reason conduce very much in the beginning of this Distemper,So Chalybe­ate Medi­cines. at least to the gaining of some respite, if not to a per­fect Cure; but especially the Chalybeate Waters, if it be not too late when they are drank, if they pass plentifully enough by Urine.

The use also of Natural and Artificial Baths,And Baths. if they are used before the Habit of the Body is too much extenuated, is wont to promote the Cure of this Consumption very much at the be­ginning, by opening the Obstructions of the Nervous parts every where.

A Milk Diet is likewise very beneficial at the first Invasion of this Distemper,And a Milk Diet at the beginning. by lessening the flame that is kindled in the Blood, and correct­ing the preternatural Acrimony of it. Though it must be confest it does not so well agree with these Patients in the progress of the Distemper, when once there comes to be a difficulty of Breathing; because it uses to cause a greater toughness of the Phlegm, that is lodged in the branches of the Wind-pipe. And it may be this Conjecture is grounded upon very good Reason, [Page 280] to wit, that the using of Milk too much in a Rheumatism, does very much dispose the Pati­ent to this Asthmatical Consumption.

CHAP. XII.

A Consump­tion often proceeds from these Acute Diseases.I Have very often seen a Consumption of the Lungs take its Original from these Acute Diseases. Neither indeed have we any reason to think it strange that a heat kindled in the Hu­mours by a Putrid Fever is wont to degenerate so easily into a Hectick, or Habitual heat seated in the Spirits, and solid Parts of the Body. For when the Spirits and Humours in the Habit of the Body have been a long time fed, or nourisht by the Blood too much inflamed and heated, they do not easily shake off that Preternatural Heat. And what wonder is it if from this Hectical and fixt Flame a Colliquation and Consumption are apt to follow?Especially from the Small-Pox, &c. And this is wont to happen espe­cially in the Small-Pox, Measles, and in Scarlate, and Crapulous Fevers. Because in these Diseases there is so great a Colliquation of the Humours follows, caused by that sharp heat that attends them, that it can hardly be stopt afterwards; whereupon the new Chyle afterwards cannot be united, or assimilated to the Solid Parts. And from hence it comes to pass, that the Preterna­tural Heat of the Parts is not always quite ex­tinguisht by the critical eruption made in the [Page 295] former Diseases, but there still remains a Hectick heat in the Solid Parts, together with a dry Cough, with other signs of the Serous, and Col­liquative state of the Blood (after the other Di­stempers are cured) which even presages a Con­sumption that is to follow.

The most usual fore-runner of this Consump­tion is a light Peripneumonick Affection,What is the usual fore-runner of this Consum­ption. or Scro­phulous Tubercles bred in the Lungs themselves; which are always wont to arise first in the de­clension of the former Diseases. From whence it comes to pass, that not only a Feverish Heat is kindled again, but it likewise returns attended with a Cough, difficulty of Breathing, want of Rest, a Thirst, want of Appetite; yea, and sometimes with a pain in the Breast, and other signs of an incipient Consumption.This Con­sumption for the most part is Acute. For this Consumption for the most part is quick, and Acute, because it comes upon Nature when she is already weakned by the former Distemper; neither can it be prevented,Bleeding is necessary as well to pre­vent as to Cure it. or cured any way without timely and repeated Bleedings, though the state of the Patient seems never so weak. And indeed the neglect of Bleeding, or doing of it too late, or too sparingly in the declension of the preceding or Original Disease, uses for the most part to be the occasion of this Con­sumption.

But when we have bled the Patient as often,After which Expectora­ting and Bal­samick Me­dicines must be used. and as much as we ought to do, the rest of the Cure is to be performed with the diligent use of Expectorating, and Balsamick Medicines, already described in the General Method; as also of a Milk Diet, and Temperate Juleps. What I have said of a Consumption coming after the Measles, Small-Pox, as also Scarlate, and Crapulous Fe­vers, (all which Diseases are of one and the [Page 296] same kind, to wit, of a Serose, and Colliquative Nature) the same may likewise be affirmed with the same Reason of all Scorbutical and Chroni­cal Fevers; as also, generally speaking, of any kind of Fevers, that have terminated without a fair and due Crisis. For the Feverish Ferment being in this manner rather deprest by force, than overcome, there succeeds a mild Hectical Heat to the former Putrid Flame, which will afterwards introduce a Consumption after it. And therefore even in the declension of these Fevers,In the de­clension of some Fevers we must bleed. what sort soever they are of, we ought to bleed, and then finish the rest of the Cure in the manner as I have hinted in this Para­graph.

Malignant Fevers may bring a Con­sumption.And I do not doubt but that even Malignant and Pestilential Fevers, which are wont to have a Critical termination by Apostemes and Ulcers, may likewise bring a Consumption by throwing the Feverish Matter by the way of a Crisis upon the tender Substance of the Lungs, from whence Swellings, and ill-natur'd Ulcers arising, are apt to bring a very Acute Consumption. But the Cure of it must be performed with the timely and diligent use of Expectorating, Absterging, and Balsamick Medicines before described; by which means we may as soon as is possible clear the Lungs.Observations concerning a Consumption from Inter­mitting Fe­vers. But here I have a mind to add some few things particularly of the Original of a Con­sumption proceeding from Intermitting Fevers. Scil.

Observ. 1 First, That I have observed a Consumption to have its Original from no other Fever more frequently than from an Intermitting one. Which to me seems to happen for two Reasons. First, because this Fever either from its own peculiar Nature (because it has an inexhausted Source in [Page 297] the Habit of the Body) or from the neglect of giving Efficacious Medicines in time, and in a good quantity, is very Chronical, and many times though it is driven away, returns again; and from thence it comes to pass that at length a Hectical, and continual heat is brought upon the Spirits and Solid Parts by this Putrid Heat prevailing for a long time; and thereupon there must necessarily follow a Serous Colliquation of the Humours, together with a Cough, and the other Symptoms that accompany a Consump­tion.

Secondly, because this sort of Patients, ha­ving no suspicion that this kind of Distemper will be Mortal, as they commonly make slight of it, so they are wont to neglect themselves, not only endeavouring to Cure themselves with I know not what Receipts of Old Women, (from whence it comes to pass, that under the pretence of Curing the Fever, they many times procure an Inflammatory and Venomous disposition to the Blood and Humours) but likewise very often exposing themselves carelesly to the cold Air, even in the time of the Fit, and getting one Cold after another, they at length suffer for their carelesness and ignorance, by a Consump­tion caused by the often taking of Cold, and the neglecting of it too in this distemper'd state of the Humours. Which Consumption is wont to go by the less infamous Name of a Catarrh with these poor Patients; till at length through their Negligence it becomes incurable. And therefore I would give this Advice to all Persons, that they do not from a false Opinion of the Innocent Nature of this Disease, trust to the Re­ceipts of Quacks, and Old Women; but that they would immediately make it their business [Page 298] to Cure it perfectly, and in due time, with the plentiful use of the Peruvian Bark (the only mighty Antidote of this Distemper) and to prevent the return of the Fever by repeating the use of it. For a frequent relapse into this kind of Fever does threaten a Consumption as well as if it were plainly continual. I likewise ad­vise these Patients out of the same good will to have a great care of taking of Cold so long as the Distemper continues, but especially in the time of the Fit.

Observ. 2 Secondly, This Consumption is for the most part Chronical, and continues for the space of a Year, or more, before it comes to its helght, partaking in this respect of the Nature of the Original Disease, upon which it depends.

Observ. 3 Thirdly, The Pathognomonick Sign of this Consumption is, that from the first beginning of the Disease there is a Feverish Paroxysm every day, or each day, or every third day, accord­ing to the peculiar Nature of the Original Di­stemper, always joyned with the Hectick Fever, together with a Cough, difficulty of Breathing, and the other ordinary signs of a Pulmonary Consumption.

Observ. 4 Fourthly, In the Cure of this Consumption the Peruvian Bark ought always to be mixt in good quantities with the Pectoral Medicines. For though I have freed several from a deplo­rable Consumption of this kind in three Weeks or a Month in the Spring-time with an Ounce or two of the Peruvian Bark without any Pul­monary Medicine, and without a relapse (of a Cure of which kind I shall not think much to add an Instance or two by and by:) Yet I ne­ver my self cured any one of this sort of Con­sumptive Patients, nor do I remember one cured [Page 299] by any other even with the most diligent use of Antiphthisical Medicines without mixing the Bark with them.

CHAP. XIII.

THE Blood, as soon as it has here and there in its Circulation distributed the new Chylous Parts, and those that are fit for Nourish­ment, becomes plainly sharp, as if it were im­bued with a Ferment, from the Saline and Acrious Particles, which by the Law of Nature it still contains in it self (to the end that from thence the Bile, and other necessary Ferments of the Body may be supplyed, and every day renewed.) And therefore by the same Sagacity of Nature there is Provision made that after she has in this manner done what is sufficient for the necessary Ferments, the Acrious and superfluous remain­ders should as Excrements be forthwith thrust and thrown out by the pores of the Skin, by the Kidneys, the Glandules of the great Guts, and the other Avenues, or Emunctories of the Body; lest the Mass of Blood it self being burdened, and opprest with this kind of Particles, and thereupon brought into a distemper'd state, should not be able to perform its Natural Of­fice.

From what I have now said it is evident to Reason how many ways a Jaundies is wont to occasion a Consumption.How a Jaun­dies causes a Consumption. For whether it be Accidental, as when it proceeds from an Ob­struction of the Natural course of the Bile from the Gall-Bladder into the Cavity of the Duodenum, [Page 308] caused by a Stone, or the glutinousness of the parts of the Bile; or whether it be more Habi­tual, coming from a defective separation of the Bilious parts in the Liver, caused by a Schirrous hardness or an Exulceration of that part, there are two things, which must necessarily be the Effects of it; to wit, a want of Bile in the In­testines, and too great a congestion of it in the Blood. By the first of these, Nature for want of a due Menstruum in the Volatilization of the Chyle is hindred from the convenient separation of the Excrementious from the Chylous parts: From whence it comes to pass, that the Excre­ments of the Guts containing in them both parts, are voided of a white colour, together with a manifest faintness and weakness of the Patient, even from the very beginning of the Distemper. Because by this continual Substraction of the new Chyle there is caused by degrees an Univer­sal Atrophy; which I have already hinted in the Appendix to the First Book. But by the latter the Mass of Blood itself is altered and distem­pered, as being too much saturated with Bilious Particles, that are sharp and pungent. Which discovers itself not only by an Universal Itch­ing excited in the Habit of the Body, but also by a yellow Tincture coming upon all the Skin, and by the very red and yellowish colour of the Urine. From this Collection of sharp and bi­lious Particles in the blood (at least when it hap­pens to be long, and Habitual) no Body must think it strange if even the very Mass of Blood is vitiated, and contracts a Hectical Heat; and any one may as easily observe how soon the Lungs, being from thence affected with a Hecti­cal Heat, are apt to be stufft, to swell, to be in­flamed, and putrefie. So that the Jaundies, when­ever [Page 309] it is Chronical and Habitual, by gradually spoyling the Crasis of the Blood, is wont like­wise to bring a Chronical Consumption of the Lungs. Which also is not a little promoted by the Oppression of the Hypochondres,This Consum­ption is pro­moted by an Oppression of the H [...]po­chondres. which con­tinually creates a weight in them, caused by the preternatural thickness and compactness of the Liver; to wit, whenever the Jaundies is Chro­nical; and likewise from the Colick of the Sto­mack, or those dreadful Spasmodick Pains, which are wont to return often, from the Obstruction of the Gall-duct by a Stone, or the Glutinous­ness Viscidity of the Bile; or else from an In­flammation and Exulceration of the Liver itself, to wit, whenever this Distemper is Accidental, and more Acute. For as it is impossible but the Lungs must be much injured by the consent they have with the Liver that lyes so near to them, and must likewise necessarily partake with it of the Spasmodick Contraction in the manner of Hysterical Suffocations; whereupon their tender Substance must needs be very much inju­red, and changed from their Natural Tone by that frequent Constriction; to wit, in an Acci­dental Jaundies: So likewise whenever it is Ha­bitual, the Hypochondriacal Melancholy, which is wont always to accompany the Gravative Op­pression caused by the Obstruction of the Liver, does dispose Persons to a Consumption of the Lungs it may be more than any other Passions of the Mind.A Consump­tion is sel­dom caused by an Acci­dental Jaun­dies. 'Tis true indeed that I have very seldom met with a Consumption of the Lungs proceeding from an Accidental Jaundies, whe­ther this Disease has had its Original from the Obstruction of the Bile-duct, or from an Inflam­mation and Exulceration of the Liver it self: For by reason of the violent Colick, or Spasmo­dick [Page 310] Pain, and the Acute Inflammatory Fever, which are wont for the most part to accompany this Jaundice, the Patient very seldom happens to live so long, that the Blood can undergo so great an alteration from the Bilious Particles pre­ternaturally heaped up in it, as to be disposed to form a Consumption of so Chronical a Nature. But before it is possible for the Blood to undergo such an alteration as is able to produce so great an Effect, either the Distemper is taken off from the Patient by Art, or the Patient is killed by the Distemper.But no Dis­ease comes more fre­quently upon a Chronical Jaundies. But there is no Disease does come more frequently than a Consumption upon a Chronical and Habitual Jaundies, proceeding from a Schirrousness, or too great a Compact­ness and hardness of the Substance of the Liver; which Consumption for the most part is wont to terminate in a Fatal Dropsie. For as this is a Disease of several Years, because it is attended with no very great Symptom; so the Bile which is thereupon preternaturally heaped up in the Blood, though it is not in so great a quantity as in an Accidental Jaundies, yet by its long stay in, and frequent cohobations with it (if I may speak) it does more effectually alter the whole Mass, and disorder it; and it is no wonder if the tender Substance of the Lungs does at length get some fatal Mischief from it. The Evident or Procatarctick Causes of this Consumption,The Proca­tarctick cau­ses of this Consumption. are, commonly frequent and long Debauches, and the more grievous Passions of the Mind suc­ceeding alternately one another. By the first, the Substance of the Liver, and perhaps the Lungs too happens almost always to be too much heated and stuff [...] with superfluous Juice; and by the latter it happens to be spasmodically girt, or com­prest. By both together the Liver (and it may [Page 311] be the Lungs too) is rendred too close or com­pact in its substance, if it does not also become Schirrous, or inflam'd and ulcerated. And from hence there must necessarily follow too great a Collection of Bile in the Blood, and thereupon a Morbid alteration of it, an Oppression of the Hypochondres, a Melancholy, with the other signs just now mentioned, which tend to a Con­sumption of the Lungs. And hereupon I use to call this a Crapulous Consumption. For it is well known even to any one that has had but a little Experience in the Practice of Physick, how from anxious Care, and other troublesom Passions of the Mind, and much and accustomed drink­ing alternately succeeding one another, some happen often to pay dear for their ill-spent Life, by an untimely and miserable loss of it caused by this kind of Consumption; to which an Ascites, and sometimes an Anasarca is wont to be joyned not long before they dye.

The Diagnostick Signs of this Consumption are to be taken from three Heads; to wit,The Diagno­stick Signs of this Con­sumption are taken, 1. From the Ʋrine. from the Urine, the Skin, and the Hypochondres. First, for the Urine, that is very little in quan­tity, very full of contents, and of a very red and yellowish colour like Mum. 'Tis true in­deed the Urine of all Persons in a Consumption, by reason of the Fever, is high colour'd, and but little in quantity, and likewise by reason of the present Colliquation full of Contents; and in this manner it is wont to appear in Putrid In­termitting Fevers. But in an Hepatick, or Icte­ritious Consumption all those appearances are always found in a much greater degree; and by how much the more the Substance of the Liver is obstructed, and the greater the Collection of the Bile in the Blood thereupon is, by so much [Page 312] the more intense they always are. For by the mixture of the Bile the Serous or Urinary part of the Blood, as it uses to be imbued with a very deep red and yellowish Tincture, so it is apt to be coagulated, and to pre [...]ipitate its heteroge­neous parts; from whence we may deduce the reason why the Urine of this sort of Consump­tive Persons uses to be so little in quantity, and so full of Contents, as well as red and yellowish; also the colour of the Skin is yellowish. I do confess indeed that the Skin of all Persons that are in a Consumption, growing thick from the contraction of the Parts, so far as the Emacia­tion has prevailed, loses its wonted lustre; but in this Consumption, besides the paleness, and that squalidness of the Countenance, there is a different and uncertain yellowness more manifest one day than another;2. From the Skin. but especially about the Neck, Back, and some other parts of the Body, that are covered with a thicker Skin; though it is not so deep as it uses to be in an Accidental Jaundies, where there is a much greater quan­tity of Bile heaped up in the Blood by the total Obstruction of the Bile-duct, than where it is only imperfectly separated from the Blood by reason of the Obstruction of the Glands of the Liver.3. From the Hypochondres Thirdly, there is always the sense of a gravative Oppression in the Hypochondres joyn'd with a Melancholy proceeding from the Ob­struction of the Liver, and the bulk of it being enlarged thereupon; which very often grows so hard, and is so much increased in its Magnitude, that from thence not only the right Hypochon­dre happens to be much distended and elevated, but likewise a Swelling, as it were hard and re­nitent, may be perceived in it, even by the ex­ternal touch.

[Page 313]This Consumption is always Chronical,This Consum­ption is al­ways Chro­nical. and of several Years, because it proceeds from a slow and lingring cause. That which the Persons in this Consumption spit is likewise more viscid and plentiful, as it uses to be in every slow Con­sumption.

As this Consumption begins with a want of Appetite, and a loathing of Food,It ends in an Ascites. so it almost always ends in a slow and painful Ascites; to wit, as soon as the Liver is grown so hard from the progress of the Disease, that the Lympha­tick Vessels, which creep upon it, happen from their Constriction to be broken; to which also a frequent Bleeding at the Nose, proceeding from the circulation being hindred in other parts by the same Obstructions, uses almost always to be joyned. And though this Consumption may be curable, when a Skil­ful Physician is sent for in time by a Patient, that will be Obedient to Rules, yet there is no Consumption more Fatal than this is, when once there comes a Dropsie upon it from the Rupture of the Lympheducts caused by the hardness of the Liver. Nor indeed can the miserable Patient have so much as an easie Death, by reason of the dreadful and continual Pains, his shortness of Breath, and the other Symptoms, that are wont to accompany this lingring Dropsie.

The General Indications of Cure are only two; to wit, the restitution of the Lungs,The Indica­tions of Cure. that are distempered, to a sound state; and the ta­king away of the cause, by which the Lungs happened to be ill affected. The first Indication we may satisfie with the use of Pulmonary Re­medies, already mentioned in the Second Book in the General Method. But we must answer the second Indication with the help of Hepaticks, [Page 314] Diureticks, Chalybeates, and other such-like Me­dicines, which by removing the Obstructions of the Liver, may restore the due and free secre­tion of the bilious Particles from the Mass of Blood, and promote the Excretion of the Bile into the Intestines by the Bile-duct; by which means the cause of the Atrophy, and likewise of this Symptomatical Consumption of the Lungs may be perfectly removed. But in what man­ner the General Method of the Cure of a Con­sumption is to be altered by the mixing of He­paticks with Pulmonary Medicines (that we may satifie both Indications) I had rather shew by some Examples, than by the description of a new Method, least I should seem to spin out this Discourse to too tedious a length. And there­fore I will presently give a History or two rela­ting particularly to this business, only premising first this general Observation,The Pectoral Medicines we use must be always Inciding, Abstersive, and Carmi­native. which it is con­venient to have in our Eye through the whole Method of Cure in this Consumption; and that is that for Pectoral Medicines we must always make choice of those that are Inciding, Abster­sive, and Carminative; plainly avoid Incrassating things, and use Mucilaginous Medicines, mixed with other altering Medicines moderately; be­ing directed thus to do, not only by the tough­ness of the Phlegm (which this kind of Con­sumptive Patients with all that they can do can hardly expectorate or hawk up;) but also by the obstructed state of the Liver it self; where indeed in this case the first Seeds of this Consum­ption are lurking: And from thence it comes to pass, that though this Consumption, when it is but beginning, may sometimes admit of a per­fect Cure only with the use of Inciding and Cha­lybeate Medicines, which by removing the Ob­structions [Page 315] of the Liver, and consequently by ta­king away the Procatartick cause of the Disease, do likewise sufficiently provide for the Lungs, which have not yet received so much Mischief, but it may go off, and vanish of its own ac­cord after there is no more Fuel supplyed from a distempered Liver.But this Con­sumption is never cured with Pectoral Medicines alone. We must ab­stain from Incrassating Medicines. Yet I never saw this kind of Consumption cured by Pulmonary Medicines alone; but I have always observed that it has been very much, and quickly confirmed even to a fatal degree with the plentiful use of Incrassa­ting Medicines, and of all those things, which increase the Obstructions of the Liver. And therefore as common Milk, and all things made of it, yea, and Asse's Milk it self, much more a strict Milk Diet, is not convenient in the Cure of this Consumption. So likewise for the same Reason it is best to abstain from all use of Lau­danum and any sort of Opiates, unless there is a great necessity to give them.How the Pa­tient is to go­vern himself. The Patient must carefully avoid Sadness, which does always pro­mote the constriction of the parts of the Liver. He must likewise live in a thin and open Air, and there use moderate Exercise every day, all which do very much help to remove the Ob­structions of the Liver. But above all things the long use of bitter, and Chalybeate Medicines does promote this Cure; and especially the Cha­lybeate Waters, if the Obstructions are not come to that height as to hinder the passing off of the Waters by Urine. But if it be so, we must Re­ligiously abstain from the use of them, lest the Distemper be quickly rendred incurable, by bringing a Dropsie sooner than it would other­wise have happened.

CHAP. XIV.

I Have, as well from Reason as Experience, proved in the First Book, that there is a Flame kindled in the solid Parts, from the long and plentiful substraction of the Nutritious Juice caused by old and large Ulcers, which are wont to discharge continually a great quantity of gleety Matter in what part soever of the Body they happen to be seated, whether inward or outward, and thereupon the Patient is rendred Tabid. I have likewise sufficiently shewn in the 8th. Chap­ter of this Book, that a Consumption of the Lungs is very often occasioned from the healing of this kind of Ulcers, but especially if they have been customary, and of a long continu­ance, or else Malignant, or Fistulous.

A true Con­sumption of the Lungs often pro­ceede from Internal Ʋl­cers.But because I have observed, not only that Patients being brought into the state of an Uni­versal Atrophy, have at length been rendred Ta­bid, but have likewise many times from thence been affected with a Consumption of the Lungs from the beginning by a long continuance of Ulcers bred in the Viscera, and Internal Mem­branous Parts, but especially in those, that are reckoned the more Noble, and of greater use; such as the Liver, Kidneys, Testicles, Ovaries, the Womb, and the Vagina Uteri, the Urinary [Page 341] Bladder, Stomack, Intestines, &c. from long substraction of the Nutritious Juice, as frequently as from the healing of them; I shall think fit in this place to add also, though briefly, the Ob­servations, which my Practice has offered to me, concerning the peculiar Nature of this kind of Consumption.

Neither has any one reason to think it strange;This is not strange upon several Con­siderations. that this kind of Ulcers, especially if they have been Chronical, can occasion a true Consump­tion of the Lungs: I say, no one has reason to think it strange, that seriously considers with himself how great and continual an expence there is of the Nutritious Juice, that is wont to be dis­charg'd by this kind of Ulcers; and how great an impoverishment of the whole Mass of Blood, together with an Acrimony following upon it, from this substraction of the Chyle that is de­signed for the reparation of it; and how great a wasting, or Atrophy of the Parts proceeding from thence; thereupon how great an excan­descence or intestine motion of the Blood and Spirits, and finally, how great a Flame there is, with a fixt heat in the whole Habit of the Body, together with an Universal Colliquation of the Nutritious Juice from the Mass of Blood (to which by reason of its preternatural Heat and Acrimony it could not be perfectly united) made by every Avenue, where it has the liberty of passing. But to be Ingenious, and to speak the whole truth, I have been ready to wonder rather that in this Universal Flame and Colliquation, the Lungs (whose Substance is Naturally so Tender, Vesiculous, and Spongy, and thereupon as it is apt to be very soon affected with a He­ctical Heat, so it is also ready to be as soon cor­rupted by the purulent Particles, which are tran­slated [Page 342] thither by the Circulation of the Blood, and in every considerable Colliquation more susceptive of the Humours, than any other part) can ever be long free from a touch of a Con­sumption.A Consump­tion from Ʋl­cers in parts remote from the heart ends in an Ʋlcer of the Lungs. And indeed to speak the truth of this case, whenever these Ulcers happen to be bred in the Bladder, Womb, Vagina Uteri, the Ovaries, or Kidneys, or other Entrails, or Mem­branous Parts, that are remote from the Heart, and so of less note, as I have always observed the Consumption that is caused by them, to be more Chronical; so I have observed that a little before Death it certainly terminates in a true Consumption of the Lungs, proceeding by de­grees from a stuffing of the Lungs to Tubercles, and those such as at length become ripe, and ulcerate, together with a troublesom Cough, a shortness of Breath, an universal Colliquation, and the other signs of this Fatal Disease.In a Consum­ption from Ʋlcers in the Liver, &c. Death pre­vents this. But yet in a more Acute and hasty Consumption, proceeding from an Exulceration of the Liver, Stomack, and other Entrails, or Membranous Parts seated nearer to the Heart it self, I have found in the Bodies of such Persons, that have been opened when they have been dead, the Lungs not so much exulcerated, as discolour'd, stufft, and sticking to the sides of the Cavity of the Breast; and at length (that is, when they have been very ill affected) full of crude Tu­bercles: Because by reason they dyed quickly, there was not time enough for the Lungs to re­ceive any deep impressions from this Phthisical Malignity; the Patient being taken off by a quick Death from the Original Consumption be­fore the Tubercles of the Lungs could be ripen'd, or the Consumption of the Lungs could be ad­vanced beyond its first or second degree. But [Page 343] in this very Acute Consumption I have found plainly the same, if not more violent Symptoms, than in a true Pulmonary Consumption that has been Mortal; the same fierce and troublesome Cough, the same difficulty of Breathing, though they proceeded meerly from a stuffing of the Lungs, and crude Tubercles bred in them; but first an Inflammatory Fever, and afterwards a Putrid and Intermitting Fever, attended with an Universal Colliquation, Light-headedness, and other more direful and fatal Symptoms than in an Original Consumption of the Lungs; I speak of those which arise from an Inflammation and Exulceration of the Viscera, or Membranous Parts, that are very Noble. So that it is a very hard matter to distinguish this Consumption from an Original Consumption of the Lungs, unless it be by the more intense degree of the Symptoms, and by some Pathognomonick signs, which dis­cover the Part that is primarily affected.

Every Pulmonary Consumption of this sort is very hard to Cure,These Con­sumptions are very hard to Cure. because it springs from a certain Fountain, that is for ever running. For the Internal Ulcers, which gave the first Occa­sion to this Consumption, can very seldom be perfectly cured, as lying beyond the Sphere of Surgery.And not to be cured without heal­ing the Ori­ginal Ʋlcer. And indeed to Cure this Consumption perfectly, without healing of the Ulcers, from from which it takes its Original, is the same thing as to take away an Effect whilst the Cause of that Effect remains. It is true indeed that so often as these Ulcers happen to be small and benign, and are likewise placed in the Kidneys, Bladder, Testicles, Ovaries, the Vagina Uteri, or in other Membranous Parts and Entrails, that are more remote from the Heart; as the Ulcers themselves (which here assume the Nature of a Cause) [Page 344] do sometimes admit of a perfect Cure, so likewise the Pulmonary Consumption it self, which depends upon them, may as well be cu­red. But this Consumption, whether it be ca­pable of a Cure or not, does nevertheless almost always assume the Nature of a Chronical Dis­ease in some measure. And from hence I have found some of this sort of Patients for several Months,When this Consumption is Chronical. yea, and sometim [...] several Years lan­guishing with a Consumption, pining away by degrees, and dissolv'd by Colliquations; but e­specially when the source of the Disease has been in one of the Kidneys, the Bladder, or Vagina Uteri, that have been ulcerated. A Consump­tion proceeding from an Ulcer of the Ovaries in Women, or the Testicles in Men, I have ob­served to have been of a middle Nature, but for the most part to carry off the Patient within the space of a Year: But that which arises from an Exulceration of the Womb it self,When Acute. the Sto­mack, Liver, or other Entrails, or Membranous Parts of the greatest note, I have observed to put an end to the Patient's Life in the space of a very few Months, or even Weeks, after the manner of a very Acute Consumption; because it has been immediately attended, first, with an extraordinary Inflammatory Fever, and after that with a Putrid Intermitting Fever, and an universal Colliquation, together with a want of Rest, Light-headedness, Spasms, and other dire­ful Symptoms of the Nerves. But yet by reason of the sudden Destruction brought on from the Nature of the Original Disease, I have found by inspecting into Bodies after they have been dead, that the Lungs have not been so much af­fected, as they used to be in other Consumpti­ons, that are more Chronical; to wit, where by [Page 345] reason that the Original Distemper has suffered the Patient to live long enough, the Lungs have happen'd not only to be stufft, but likewise to have Tubercles bred in them, and those Tuber­cles at length have happen'd to turn to Apostems. But, generally speaking,The more Acute it is, the harder to Cure. as every Consumption of this kind is very hard to Cure, so it is so much the harder as it is more Acute, because it has its Original from more considerable Ulcers. Neither indeed does it ever admit of a perfect Cure without the healing of the Ulcers what­ever they are, and in whatsoever Entrail or Membranous Part those Ulcers are bred, which gave the first occasion to this Disease.

From what I have now said, it is plain enough even to Reason what are the Indications of Cure in this kind of Consumptions, which likewise the happy Success of our Practice is wont daily to present to our very sight; that is, whenever the Distemper does in its own Nature admit of a Cure.The Indica­tions of Cure And they must respect the Original Disease as well as the Lungs themselves, first, by promoting as much as we can the healing of the Ulcers, in what part soever of the Body they have been bred, with the plentiful use of Bal­samick and Vulnerary Medicines; which indeed ought to be of the milder sort, lest by increasing the Feverish Flame, that is already kindled in the Blood, they should do more hurt than good.

Secondly, by taking timely care of the Lungs with the use of Pulmonary Remedies, to wit, Opiate and Expectorating Medicines given al­ternately; by which the mischief which they have got, may be taken off, or at least as little as may be promoted by the Original Distemper.

Thirdly, by mixing always with the Pectoral and Balsamick Medicines those things which [Page 346] may restore and confirm the Tone of the Part, which was first of all affected, and which have a particular respect to it; as Uterines, Hepaticks, Diureticks, and other such-like Medicines, as the case may require.

Fourthly, by tempering the Hectick heat, which is already kindled in the Blood and Spi­rits, with a strict Milk Diet, the Chalybeate Mi­neral Waters, Vulnerary Decoctions of Sarsa, Lime-water, and other things of the like Na­ture (so far as the present state of the Patient can bear them;) as also by taking off the Pu­trid Intermitting Fever with the plentiful use of the Peruvian Bark, and with repeating of it of­ten enough at due intervals: And lastly, by re­lieving with the most diligent application the most urgent Symptoms, and those which weaken the Patient most, whether they arise from the Original Ulcer, or from the Lungs. As for Example.

The Method of Cure.If the Original Ulcer is so benign and small, that there appear any hopes of a perfect Cure, and it has not continued so long, that the Pa­tient is brought very weak with it; and if it is not seated in so Noble a Part, as to make us fear the sudden destruction of the Person from an Acute Consumption, it is plainly convenient in the very beginning of the Cure to endeavour the healing of the Original Ulcer, by giving Ca­lomelanos plentifully, and that not only mixt with Purges, and therefore at due intervals, but like­wise by it self in Doses repeated quickly one af­ter the other, with a design to raise a Salivation; by which (if the Patient has strength enough to bear so great an Evacuation, and it be conve­nient in other respects) we shall take much bet­ter Measures, as for the healing of the Ulcer, so [Page 347] likewise for the preventing of the Consumption, which is like to follow, than by any other Ap­paratus of Medicines.

But if that be contraindicated by the Patient's Weakness, the intense degree of the Fever, and the very Acute Nature of the Consumption, at least as Antimonial, so Mercurial Medicines may be so disposed at due intervals in the Method of Cure, that they may successfully exert their ex­traordinary Healing Vertue without any expen­sive Evacuation excited thereby. As for Ex­ample: Let the Patient take every Night xv. or xx. Grains of Antimonium Diaphoreticum in a little bit of Old Conserve of Red Roses mixt with Leucatellus's Balsam. And every third or fourth Morning a Scruple, or half a Dram of Mercu­rius Dulcis in a spoonful of Milk.

Let him also drink a Vulnerary Decoction of Sarsa, described in another place, for his ordi­nary Drink, adding always at the time when he takes it, of the Balsamick Syrup so much as will serve to make a Draught of it grateful to the Patient's Palate.

My Balsamick Pills are likewise very good in this case, being ordered so that the Patient may take three of them every day at Physical hours; drinking after them four or six Ounces of the Traumatick Decoction, and the Pectoral Deco­ction mixt in equal quantities. Here likewise it is very convenient to temper the Hectical heat of the Blood with a Milk Diet ordered in the strictest manner, or else (if other things do not contradict, and it is a proper time of the Year for it) with a long use of the Chalybeate Mine­ral Waters, the Vertue of which, especially in curing a Consumption proceeding from an Ex­ulceration of the Kidneys and Bladder, I have [Page 348] often tryed with good Success. Neither is it of less use, as well to temper the Acrimony, and heat of the Blood, as to carry down the load of Purulent and Heterogeneous Particles heaped up in the Mass of Blood, to give at Physical hours an Emulsion made of fifty or sixty Wood-lice, and four Ounces of the Vulnerary Decoction of Sarsa sweetned with the Balsamick Syrup; or with two Ounces of the Pectoral Decoction, and as much of the Traumatick Decoction.

The Peruvian Bark is likewise of very great Efficacy in this case to relieve the Putrid Inter­mitting Fever, caused by the mixture of the Purulent and Heterogeneous Particles, that are sent into the Mass of Blood from the Original Ulcer. Which we must repeat often at due in­tervals for this end, thereby to obtain some re­spite, as well to support and relieve languishing Nature, as for the use of Balsamick Medicines, and other things of that Nature, which respect the Original Distemper.