Abortus, or Miscarriage.

I. DAILY Observation shews, that Women with child are subject to many and great distempers, both Chronical and Acute, which are made more dangerous, and are harder to cure, from their being in that condition, especially Acute diseases, as Fe­vers,Aphor. 30. lib. 5. Pleurisies, &c. Hippocrates says, that it is dead­ly for a woman with child to be seiz'd upon by a­ny acute disease. And according to Galen there is a double danger; one from the Fever's killing the Child; another from the thin diet that is requisite for acute Diseases, but is injurious to Women with Child; as also from the necessity of the greater re­medies, such as bleeding and purging. But some rash men, if they see their Patient in great danger, advise the procuring of Abortion. Now Abortion is more painfull and dangerous than a natural birth, from the violent divulsion of the unripe Foetus, whence very many die, some escape, but not without grie­vous symptoms: And the danger is the greater, if the Foetus be pretty big, (as if the Woman be gone seven or eight months) or if the Woman her self be feeble and weak, or if she labour under dan­gerous acute Distempers. Even healthfull Women never miscarry without danger: some retain the Foetus so pertinaciously, that no medicines will make them miscarry. Wherefore their advice is per­nicious that counsel the procuring of Abortion in acute Diseases, 1. Because in many it is not easily done; 2. It cannot be done but by dangerous Re­medies, and those often repeated, which aggravate and heighten acute Diseases; 3. Nor is it safe, seeing Abortion it self is a dangerous and deadly affection, as experience shews: for by the apho­rism above cited, it is deadly to a Woman with Child to be taken with an acute Disease, from the Fever, the thin diet, and the danger of Abortion: now 'tis bad to add affliction to the afflicted: the Mo­ther often perishes by destroying the Foetus with such Remedies. 4. Even a natural Birth seldom gives any relief to several Diseases; much less will Abor­tion cure any Disease, especially such as is acute, no, it will rather make it worse, unless the Foetus be already dead, for then indeed 'tis necessary to exclude it. Yet we must not abstain from neces­sary helps, as bleeding and purging, which often prevent Miscarriage; and if it sometimes follow upon the use of them, 'tis not to be imputed to the Remedies being duly administred, but to the sharp­ness of the Distemper that is too hard for all Reme­dies, or to the weakness of the Mother, or lastly to the death or debility of the Foetus. Hippocrates in his oath promises,Prim [...]os de vulg. err. l. 4. c. 53. that he will give no Woman any Medicine to procure Abortion: 'Tis the part of a Physician not to destroy, but to preserve as much as he can.

[Page 2]II. Midwives ought to be very heedfull; for it sometimes happens, that a Woman with Child voids by her Womb much bloud, and imprudent Midwives think that she has miscarried, which yet is not so, but onely a Miscarriage is imminent: which whilst it is, it ought to be prevented by Adstringents; but if it be actually made, then we must help by Looseners. Wherefore Midwives ought to examine diligently the matter that comes forth, whether it be bloud, or flesh, or geniture, or the Foetus: for by washing what comes forth in water one may easily discern whether there have been truly an Abortion or not.C [...]ivace. [...]ract. l. 4. c. 8.

III. Serapio's opinion is to be noted: He thinks if a Miscarriage happen in the first or second month, that it is caused by wind, or a preposterous agi­tation of the Mother, breaking the slender fibres; if it happen in the middle months, that slimy hu­mours which loosen the acetabula (or saucers) of the Womb, are the cause of it; and lastly if it happen in the last months, that it is commonly cau­sed either from want of nourishment, or straitness of the Womb.

IV. The Wife of N. miscarrying, she first voided the Secondines with much bloud, which brought her very low and weak: the flux of bloud abating, the next day she excluded the Foetus that was four months old: after this she seem'd to grow better and cleans'd indifferently well: onely what came away was very stinking and cadaverous. On the seventh day she was taken with a high Fever, and voided the placenta (or womb liver) which stunk ex­tremely, and was full of black-bloud; whence she recovered by degrees. The Lady N. being four months gone with Child, miscarried, excluding the Foetus with the membranes; whence she was thought to be clear of all. But afterwards she fell into a high Fever, with frequent horrours and swoonings: then she voided most fetid matter with clods of bloud and pieces of flesh. On the seventh day she excluded the placenta which stunk very much; whereupon she grew to be better and re­covered.

These two Histories teach that the purgations of the Womb, when they have a cadaverous smell, for the most part signifie that some portion of the Secondines is staid behind in the Womb.River. obs. cent. 1. obs. 61.

V. When after Miscarriage part of the Placenta hath remain'd in the Womb, and a continual flux of Bloud for some months hath accompanied it; I have obser­ved it successfully expelled, and the Patient restored by three ounces of the following D [...]coction taken twice or thrice a day. Take of the Root of B [...]stort two Drachms; Franc. de le Boe Sylv. Prax. Med. l. [...]. c. 6. sect. 119. of the leaves of Marjoram, Penniroyal each one Hand­full; Boyl them in Water and White Wine of each alike as much as is sufficient. In twenty ounces of the Decoction clarified dis­solve of Syrup of Mugwort two ounces, of Cinamon Water half an ounce. For by virtue of this a piece of the Placenta as big as ones Fist was voided, and all further Flux of Bloud was stopt and cured.

VI. A Woman having suffered three Miscarria­ges one after another at different times of her gestation (or going with Child) being now gone but two months, had great pains about her Navel and Loins, which threatned an Abortion. Two plasters being applied, one to her Loins, and another to her Navel (made of the Plaster for fractures and dislocations) she was somewhat hel­ped for a while, but afterwards her pains returned. I being called, observing the Woman to be young and sanguine, order her to be let bloud; where­upon in a few hours she was freed from her pains and fear of Miscarriage. Her bloud was very se­rous. For prevention I give her a drachm of Rhu­barb in powder with Broth, to be repeated once a week for a month. These symptoms had happened just at the time when she us'd to have her Menstrues when she was not with Child. Again in her third month the same symptoms return'd, and were pre­sently removed by bleeding. In like manner in the fourth, fifth, sixth, seventh and eighth months the same symptoms returning, we opened a vein each time, whereby she was forthwith freed of them. The last time she was let bloud, was eight days before the beginning of the ninth month, with the same effect;Idem centur. 1. obs. 53. and at the end of the ninth month she brought forth a live Son in good plight but a little pa [...]e [...].

VII. That which Hippocrates writes is not every way true, That a Woman with Child miscarries if she be let bloud; unless perhaps he understand it of such as have but little bloud, or are weakly. Many plethorick Women that used often to miscarry, have come to retain the Foetus even to the ninth month by breathing a Vein. If the superfluous bloud be not taken from such Women, they either miscarry, the mouths of the Vessels being unlocked by the too great abundance of bloud; or else the Child grows so big that the Mother cannot be safely deliver'd of it. To such, repeated bloud-letting is very profitable after the second month, or rather from the fourth to the seventh.Idem. ¶ It is very necessary to examine those things that have happen'd former­ly. For when one Medicine sometime yields no relief, it will be the best way to try others. When I once saw a Woman very like to miscarry that was five months gone with Child, and had five times miscarried before; considering, first, that adstrin­gent Remedies, both internal and topical (that had been administred at other times by other Phy­sicians) had done her no good, and secondly, that she was very full of bloud, I order'd her to be let bloud in the Arm, and not in the Foot,D. Panarol, Pentec. 1. obs. 10. lest Abor­tion should have been caused; and in the ninth month she was safely brought to bed of a living and lively Son.

VIII. Concerning the Plasters that use to be ap­ply'd, this is to be noted, that they must not lie long on at a time, but must now and then be remo­ved: for otherwise by lying too long on the Loins they heat the Kidneys so that a Dysury or heat of Urine is caused,River. pract. l. 15. c. 17. or Stones and Gravel are bred therein, or sometimes piffing of bloud follows.

IX. In a Miscarriage it is chiefly to be observed, whether the Foetus be actually expell'd, or there is onely fear that it will be. For when it is actu­ally excluded we must, with Avicen, abstain from Adstringents and use Looseners, lest, which often happens, the Membranes or naughty excrements be left and staid in the Womb, whence the Wo­man will certainly perish. For this reason Avicen dislikes Adstringents, and propounds a fuffumigation of bdellium, hyssop, origanum and mustard, whereby both the exclusion of the foetus is help'd, and the ex­crements are happily purged. If the child be not dead nor as yet expell'd, but an abortion is immi­nent, and the foetus retreats,Capivacc. l. 4. c. 8. Heurn. dem. m. c. 7. then it is very conveni­ent to use adstringents, by the help whereof it comes to pass that abortion is prevented and the child pre­served.

X. A woman in the thirteenth week after concep­tion, helping to brew, and unwarily taking up a full pail, had almost miscarried, the membranes being broken and the embryo making its way forth. A Mountebank being by chance present, and casting a­bout how to help this disaster, advised to put the foetus up again forthwith into its place by the hand: Laying the woman therefore with her thighs high and her head low, the midwife very nimbly with her hand thrust in the Embryo that was coming forth, and presently after the operation laid the mother in her bed, that the foetus being put up again might fix in its former seat; yet her lochia flow'd for three days. The same Mountebank perswaded the woman to have her husband lie with her, that the broken mem­brane might be generated anew.Thom. Bar­thol. cer [...] 4. hist. 57. Hence the foetus being retain'd, was born at its full time, and is still alive.

[Page 3]XI. When there is not so very imminent danger of miscarriage, binding plasters ought not to be ap­ply'd to the belly, lest they intercept the passion of the womb;Heurn. l. 2. but let them be laid on the loins and Os sa­crum.

XII. Have a care to mix some hot things with ad­stringents and strengtheners,Idem. lest the womb be ener­vated; add mastick, mint, wormwood.

XIII. It is observable, that those remedies are sa­fer which are administred to the lower parts, than those that are taken in by the mouth,Idem. especially if a putrid fever be present, for this will be increased by the use of adstringents.

Hartman. Pr. Chymiat.XIV. Wine must not be drunk, for it expells the foetus.

Abscessus, or an Imposthume.

I. a. AN Ulcer left from an inward Abscess is clearly and fully cured by taking for some continu­ance Antimonium diaphoreticum, Bezoardicum minerale, or any other more effectual and fixed medicine made of Antimony; whose Elixir, Magistery, or quintes­sence (if any such be) will perform things wonder­full, although they seem incredible to most,Franc. Sylvi­us prax. med [...] c. 53. l. 1. not one­ly in curing this malady which is dangerous and hard to be cur'd, but also other like that are sometimes found in any bowel.

I. b. Avicen. says, 3. 4. tract. 1. cap. 29. Defer not to open an abscess that is suppurated, for many mischiefs f [...]ow from matter kept too long in the part. But Guido in his Trea­tise of Imposthumes, bids us tarry till Nature attempt to burst them; for he says, that opening which is made by Nature, is better than that made by Art: for this latter uses to breed an immoderate quantity of matter, and creates foulness in ulcers: [Page 4] But unless you understand Guido of Imposthumes sei­sing upon the inward parts, his doctrine will hardly agree with that of the best Physicians. Indeed that opening of Imposthumes which Nature makes, is without pain, and she chuses a better place for it than the Surgeon: Yet the proposition is not to be taken universally; for if the aperture be deferr'd so long in all cases, many and irreparable mischiefs fol­low, namely corruption of the bone, infecting the skin with a green colour,Severinus. and a slower return to health.

II. It is the opinion of the most skilfull, that Tu­mours ought not to be opened till they are thorough­ly suppurated, because otherwise the part is in dan­ger of mortification, that humour being crude which Nature endeavours to turn into the form of Pus: And also such hasty opening will encrease the pain especi­ally, which will cause a new conflux of humours. But this Rule admits of Exceptions: 1. where the native heat is weak, and there is fear lest the violence of the pain, or want of sleep bring a mortification on the part, before all the humour put on the form of mat­ter. Therefore Celsus lib. 7. cap. 2. says, If the matter be ripe, in the arm-pits and groins we must seldom cut: as nei­ther wheresoever there is but a small boyl; nor lastly, when the malady is but just under the skin or in the top of the flesh, un­less the weakness of the Patient compell us to make haste. Rha­ses confirms this 3 continent. cap. 2. 2. Section is to be made if there be that plenty of matter in the abscess that Nature cannot conquer. Avicen. 3. 4. tract. 1. cap. 27. 3. When the matter is thick, seated deep, and is wide at the bottom but narrow toward the surface. (See Avicen. in the forecited place.) 4. If the member begin to be mortified, Avicen. ibid. cap. 25. 5. When the Imposthume is malignant: for an evil quality oppresses Nature, unless you make timely incision. 6. When it is in the neighbourhood of a principal member: for the matter being pent in annoys it with a foul vapour, with fear of recurring. 7. If it be about the Joints; because the matter be­ing detained eats into the ligaments. 8. When it is upon the bones, nerves, tendons. So Hippocrates lib. 2. de morbis, Those which happen near the fingers, are to be open'd before they are perfectly ripe; lest they proceed to cor­ [...]ode and perforate the bone. For the fingers, that are bloudless, small, remote from the fountain of heat, are easily tainted with corruption, because they make but small resistance. Therefore Celsus is not to be heard, who says, lib. 7. cap. 2. When an abscess happens among the nerves, the utmost ripeness is to be tarried for, which may extenuate the skin and joyn the pus to it, to find it the nearer. So Hippocrates says of abscesses seated on the perinaeum (or between the genitals or funda­ment) in lib. de fistulis, When any such tubercle shall begin to rise, cut it forthwith while it is yet crude, before the suppu­ration reach to the streight gut. 9. If it be in glandulous parts, for these are subject to malignant putrefacti­ons, and it makes little matter if such ignoble parts be a little mangled.

III. Celsus cap. 2. lib. 7. bids open them with a knife: If the malady be deep, it is to be considered whether that place be nervous or no: for if it be without nerves, it ought to be opened with a red hot iron; but if nerves be near, fire is not proper: In these there is danger lest either the nerves be disten­ded, or the member be weakened; but it is necessary to use a penknife. But Albucasis lib. de cauteriis, orders the aper­ture to be made with a cautery; because by this means an imminent hemorrhagie is prevented, and also the part is secured from bad symptomes, which use to follow the puncture of a Nerve, if a pen­knife be used. Fire certainly (according to Hippo­crates) is an enemy to the nerves, namely if the im­pression of it be deep; otherwise it strengthens the parts that it reaches to.

IV. A Souldier being wounded in the breast bled nothing for seven days: by the advice of a Surgeon a Plaster being applied to the wound, brought forth a great quantity of matter. Another was very ill of a Tumour that was suppurated, which not being opened in time as it ought, the Patient was in dan­ger of his life, the pus being pent in and hid; but we drew it out by the help of the following Plaster. Take of new Rosin of the Pine, clear and fragrant, one pound, of the oil of Bay, and Turpentine, of each two ounces, gum Ele­mi four ounces. The rosin and gum must first be so long in the vessel you melt them in, as till they are mixed, and afterwards add the turpentine and oil: let them all boil again; and at length strain them through a thick linen cloth; spread a little of this upon leather, and make a plaster to be applied to the part;P. Pacheq. in observ. River. com­municat. obs. 54. change it once a day in winter and twice in summer, and you will admire the effect. Cut two or three long holes in the middle of it, that the matter which it draws may the better flow out.

V. They are in an errour, who cut an Impost­hume that is full of matter and hard, and let it all run out at once; they ought, for the asswaging of the pain, onely to let some part of it to go forth. For concocted pus when it is left in, deterges and cuts the ma [...]ter which makes the hardness, and dis­solves it. No topical Medicine is of that efficacy in taking away the hardness of an inflammation as pus is. Moreover when all the pus is evacuated, the humours often grow so hard and scirrhous, that they become incurable, and can be mastered neither by Rosolvents nor Emollients: not by the former, because they consume what's thin, whence the re­mainder waxes hard like a stone; nor by the latter, because an hard humour ought to be cut and atte­nuated to the smallest particles, which cannot be done by external Emollients,Sanctor. meth. l. 15. c. 9. but by the pus it self that touches the stubborn humour: for pus is the near­est efficient and of the same species, and alone can cut and attenuate it.

VI. Because for the most part in the opening of Abscesses I find one Surgeon to chuse and extoll the Lancet, another a potential Cautery, I will explain the matter in a few words. A potential Cautery has this convenience, that it does not affright faint­hearted Patients, nor is very painfull to those that are afraid of pain, especially if you make use of the famed remedies of this day: for Lime mixed with Holland Soap eats deep enough into the flesh, and much more gently than the holoserick Corrosive of Parae­us; but it has these inconveniences, 1. That as the skin and body is more or less firm, it corrodes sometimes far deeper than is needfull: for I have found by experience that in one it corroded the skin and muscles even to the cavity of the belly; and in another it hurt in an incurable manner the process of the peritonaeum, and the seminal vessels contained in it. 2. This corrosive extends it self also length­ways and breadthways farther than you desire, especially if it be to be laid on under the arm-pits, in the groins or joints; for assoon as it grows warm it begins to spread about, and will matter but lit­tle your defensive Plaster. 3. It needs some hours before it can perfectly finish its operation; yet more time is requisite in one body than in another: But the humour will not always permit of this lei­sure, especially if it be malignant. 4. The Eschar that it causes, does not presently fall off; so that if you would have the humours to issue forth out of hand you must use the Lancet for all it: Be as circum­spect as you will, you cannot avoid these inconve­niences. On the contrary the Lancet has these in­conveniences, That many Patients are afraid of it, as if it caused pain; but the fear is to be prevented by not speaking of it, and indeed the pain is of no great moment. In the mean time you have these benefits by the Lancet: 1. By it you may make the apertion as long and deep as the malady and your curiosity require. 2. You have the mat­ter quickly, and the Patient is relieved. 3. The matter that remains and which is not yet concocted, will be speedilier promoted towards concoction, by assisting Nature with fit Medicines as well internal as external. 4. And thus it will come to pass that [Page 5] you shall not have a long continued gleeting: for if a gleeting once begin, you may be sure that the fault is yours. If you desire a reason take this: Al­most all Tumours that shew themselves behind the ears, in the neck, arm-pits and groins, arise from hardened glands, and from preternatural and very penetrating humours; All these kernels are clad with a proper coat, which being hurt by a Lancet or Catheretick Medicines, a gleeting necessarily fol­lows: for no gland, when its coat is opened can preserve either it self or its humours: and this gleet­ing or dripping continues so long as till the hole in the coat be cured,P. Barber. chirurg. [...]ar [...]. 1. cap. 12. or the whole gland be vanished and consumed.

VII. Those are in an errour that though the Ab­scesses be large, rais'd up copped under the skin, and situated in places that are least subject to an af­flux of humours, do always content themselves with one simple section, forbearing from many and com­pound, as if every one should not be treated in a pe­culiar manner, and as if great ones should be treated like small ones, and mortified or unconcocted ones like those which have raised up the skin and are be­come copped. Let them consult Celsus, Paulus and Avicen, Severin. me­dic. effic. p. 93. who have appointed different manners of dis­section, and shewn which are necessary in such or such cases.

VIII. The ignorance therefore of some is to be noted here, who pretend that Nature rejoyces in the proper covering of the parts, which if it be taken off, the heat will not so well preserve its strength. The vanity of this superstitious providence is thus shewn: 'Tis true that Nature takes care for preser­ving the parts with a covering, but that is when they are sound and entire; for she intends to pre­serve such, and not corrupt parts. For the rind of a rotten Pomegranate covers and preserves all the rotten pulp and seeds: Now shall the rind be kept whole, to the end that the faultiness may be en­creased, and nothing be pared or opened? In like manner if we will not touch the skin with our knives for fear of uncovering the evil, we nourish and in­crease it. Thus while I have taken care of ulce­rous persons in the Hospitals, when I have laid open fresh ulcers that had burst of their own accord, I have often found the tendons rotting and corrupt­ing under them, though the ulcers seem'd not worth speaking of. Which ought to perswade us, assoon as the skin waxes soft with the malady,Severin. ibid. to cut it open, and apply such remedies as are fit for the purpose.

IX. Aquapendent advises, that in cutting an Im­posthume we make not the section so large, as that afterwards the skin can hardly be agglutinated to the muscles that lie under it, from whence a difficult motion of the Muscles may happen. But this cau­tion is either to no purpose, or it has this sense, That the incision should not reach the Muscles also: For though it might happen that as they heal, the skin and they might grow together, yet however the motion of the Muscles might by that means be prejudic'd and not be so certain: for the skin always yields; and therefore he seems somewhat fearfull in cutting. Just as he was also superstitious in curing of a venereal Bubo, when he admonishes not to thrust in the knife too deep, because if the glands were wounded, death would presently follow, &c. I speak not this that I would have a man butcher'd, but neither on the other hand would I be content with pricking him; for that does not please me at all. It has happened to many (when a slight incision has been made of large sinuous abscesses) what Hippocrates 1 Epid. 6. writes of one that died lan­guishing of a sinuous Ulcer,Idem ibid. If there had been a large incision made into it seasonably, he might have been saved.

X. Nor do I commend their advice, that with a cold moderation of mind doe the business by Causticks: For in these there are many things that may be con­demned. The first is an inconvenience that the vir­tue of the Caustick is not onely extended length­ways of the member, according to the desired form, but spreads it self also broadways; whence it is that it causes cruel pains and a great inflammation (which ought carefully to be avoided) in the parts, not onely in those to which the Caustick is applied, but in those next to them. Secondly, by reason the Eschar is long a falling off, and the parts that are laid bare are slowly restor'd, they doe not so much good as is expected from them. But cutting if it be skillfully performed, afflicts both less and a shorter while, and presently brings the desired help:Idem ibid. p. 94. and by cutting the skin in a line, it does no prejudice on ei­ther side.

XI. It is to be observed, that Tumours which sup­purate slowly grow not copped,Severinus eff. ch [...]r. p. 94. nor rise much out­ward: Therefore you must not wait for a head be­fore you lance them.

XII. A young man going down Mont Cenis and slipping on a sudden, fell upon his back, the hilt of his sword lighting under his short ribs and left kid­ney, and bruising his Loins very much. In which place a little after there began a great pain, with various symptomes, but without any sensible fever. The part affected was not black and blue, nor swel­led, but very smooth and plain. A great quantity of humours from the whole body had flowed to the left muscle called Psoas, and being there pent in made an Abscess. A certain Physician thinking him Nephritical, gave him many things against the Stone. But being brought to a Surgeon who not long be­fore had cured one in the same condition, he was told by him that there was matter shut up in the part which must have vent given to it; otherwise he would be in great danger if the Abscess should break inwards and the pus should be poured forth in­to the Abdomen. The young man committed himself to this Surgeon, whose first care was, that the mat­ter, which was all over the Loins, should be drawn to such a place (by applying powerfull drawers) as where there were few large vessels, and the in­struments of motion might be least hurt in the ope­ration. Which after he thought he had obtained, from the Patient's sense of pain upon pressing a fit place, he forthwith made a wound on the left side of the fourth Vertebra of the Loins with a red hot knife, as deep as the length of ones forefinger (from the palm) as one might guess by the tent that was afterward put in. Then notwithstanding its depth he put his two fingers into the same wound to make it the wider, that the matter might flow the more plentifully out of it. But a little moderating the evacuation, the Surgeon put in it a silver pipe, which being besmeared with purging and deterging oint­ments, he used for some months; and at length the wound was skinn'd over, without any fistula or sinus in it. Fab. Hildan. cent. 1 observ. 63. The same person advises, in such deep wounds and ulcers as are near some internal cavity, as the Chest, or lower belly, to abstain wholly from injections that are made with a Syringe, lest some part of the injection go into the cavity, where it might be the cause of grievous symp­tomes with the danger of the Patient.

XIII. I saw an unmarried Woman forty years old, labouring under an Imposthume behind her left ear. About the fourteenth day of the Disease, when it was grown to the bigness of ones Fist, and the Mat­ter was fully ripe, but retain'd too long through the toughness of the skin, it made its way downwards. When I was called, I found the Imposthume broke of it self some hours before, which run little or no­thing; but a few days after the Woman died, when she had a Fever, Fainting and other Symptomes: Hence it appears that in Imposthumes of this kind, whether they be in the Emunctories or near them, we must not stay till they break of themselves, which this History confirms; ¶ There was a Boy three years old, who had an Imposthume about his right shoulder, the matter whereof when it was more than [Page 6] enough digested, and the lancing of it denied, the swelling sunk by little and little,Fab. Hild. cent. hist. 39. & 81. and fell by degrees into the lower belly and Genitals, where having ex­tinguished the innate heat it produced a Gangrene. ¶ I saw almost the like case Anno 1660 in the Village Coussise in the Canton of Bern near Grandison. The Re­verend Mr. Bourgeois Pastor of the Church, a full bo­died man, who fared well, and omitted one Autumn his accustomed bloud-letting, whereby he used to abate his Plethory: In the Winter following a huge Boyl ariseth in the upper part of his back, for which he was not so much as let bloud. I and a Surgeon were called, and found the Abscess exceeding ripe, and pressing it with my fingers found it hollow: I bid the Surgeon use his Lancet, which he did; but the Patient felt it not. And he took great pieces of Flesh away. It cast out good and plentifull Matter; yet without Fever, Fainting, or any other grievous Symptome, his strength was perfect, and his sto­mach good: For I found him on his leggs, not dreaming in the least of his death, which I signified to his Wife, who took me for mad. I took leave of my Patient, intending to return to Newenburg in Swit­zerland, where I then practised Physick: But within three hours I was recalled to the assistance of the dying man, who a few hours after departed this life.

XIV. A Girl eight years old had a small Swelling sanguine and phlegmatick on the out side of the right under jaw. I fearing lest the scar should spoil her face, did before the Abscess came to break, resolve to try to disperse it; according to Guido, who saith that some­times suppurated Imposthumes are cured by discussi­on. After whose example Paraeus cured such another Abscess with crude Mercury mixt with Diapalma. I in imitation of him mixed one drachm of the said Mercury with an ounce of Diapalma, and applied it to the suppurated Tumour,Dionysius Io­meret apud Riverium obs. 1. Vid. Holleri­um de mat. ch. rurg. lib. 2. cap. 1. which within four days was wholly dispersed. The following qualifications are requisite to the dispersing of suppurated Matter. 1. That the quantity be but small. 2. That it be thin and serous. 3. That it be near the skin and sur­face of the Body. 4. That it be in a strong and young Body, and soft fleshed. 5. That it be Summer time.

XV. The Site of the Fibres is to be taken special heed of: for I observed, an ignorant Barber once opened an Imposthum [...] on the forehead cross-ways: The Imposthume indeed was successfully cured, but the Patient was ever after deprived the benefit of his Eyes, except when he pasted up his eye-brows with Plasters. It were more advisable to leave such Imposthumes to Nature,Rols [...]ceius disser [...]. Ana [...]. lib. 3. cap. 10. than to commit the Incision of them to unskilfull hands. See Galen. 4. de administr. Anatom. c. 1.

XVI. There lies a Nerve under the Buttocks, which if it be cut in Suppuration, or when it is laid bare, be hurt by cold, it leaves the Thigh under it benummed. A certain man had an Imposthume in the bending of his Buttock where it ends in the Thigh;Hollerius inst. ch [...]r. l 2. c. 1. & l. 3. c. 1. when the Matter was cleansed the Nerve was made bare, which being hurt by the cold, left the whole Thigh benummed.

XVII. If there be but little Matter, there is no harm if all run out, which is fit and ready for run­ning, without any violent or long pressing of it (a thing usual with many Surgeons) from which I could never yet observe any benefit to accrue to the Pa­tient; but oft times much hurt. Indeed when the Matter resides in some place remote from the Orifice or is conveyed onely by a sinuous pas­sage to the Orifice, then it is lawfull and re­quisite to squeeze it out by a gentle pressure of the Part.Sylvius de le B [...]ë.

XVIII. I saw a Woman whose belly was harder than any stone. I ordered Emplast. de Mucilag. to be applied, when the place was grown redder and seem'd to give way a little, I ordered it to be lan­ced, and a good deep incision to be made, great store of Matter gushed out, and she recovered. The Muscles of the Belly have a very thick Membrane, which except it be pierced, the Matter can scarce ever get out: Moreover I have observed these swellings, when they have not been cut,Heurnius. om. ad aph. 7. sect. 6. have turned into Stones, and the whole Mesentery for the same reason hath almost been as hard as a Stone.

XIX. A Boy having a swelling in his Belly was reckoned Hydropick, and when his navel stuck very much out, at last they opened the swelling, and there run out eight or ten pints of laudable Matter, and so he was well cured. Young Practitioners must observe, that such Imposthumes are often bred in Childrens Bellies, which resemble the Dropsie;P. Estinov. obs [...]rvat. 2. and if they be opened by the Artist in Time, the Patient escapes for the most part certain death.

XX. If Pain seize any part of the Body, and you have any suspicion that matter is gathered there; if the party sweat, especially about his Face, and the Pain continue, you may certainly conclude that Matter is gathered in that part: Therefore though the colour of the Part be not changed yet it must be opened to let out the Matter. For it is backed with Experience.

XXI. Among all things which move or promote the excretion of Matter, I prefer and commend An­timonial Medicines. For I have often observed they have moreover a Virtue to correct all harms brought on the body by Matter, and to hinder the producti­on of Matter anew. Because Antimony is not less serviceable to the Purification of man's body,Fr. Sylvius pract. lib. 1. c. 15. sect. 43. than to that of Gold, if it be aright prepared and admi­nistred. Antimonium Diaphoreticum stops the continual generation of Matter from corrupt bloud, and any other alterative Medicine made of Antimony; and especially the Balsam artificially prepared out of its Flowers,Idem sect. 44. and Balsamus Sulphuris anisatus is good for the same, &c.

XXII. In the Cure of Abscesses after Child-bed you are to inform your self how the Womb is disturb­ed, and appease that: and if any part of the After-birth be left behind, to endeavour the bringing that away, and by good Sudorificks, Cordials, &c. to expell the venome, and fortify the spirits against the malignity that is thereby contracted, and to con­temperate the heat and acrimony by Juleps and Emul­sions. The swellings arising from these require to be treated in their beginning with moderate Re­pellents and Discutients. Afterward, according­ly as the matter predominates,Wiseman obi­rurgical trea­tise, l. 1. c. 5. make way for its discharge; and cure them as in the treatise of Ulcers is shewed.

XXIII. A young Woman after Child-bed was seised with a great Pain and Swelling in her left Groin and T [...]igh with Fever. Sr. Charles Scarburgh and Dr. Weatherly were consulted. They prescribed Bleeding and lenient Purgatives, to evacuate the Humours: also cordial Juleps, &c. to contemperate the heat and fortify her spirits against malignity. I was also call'd in, and by moderate Repellents mixt with Discutients in Fomentations and Emplasters with Bandage disperst the humour in the Thigh, and restored the part to its former temper: but in the mean time the Tumour increased in that Groin. I sup­purated it after the manner of a Bubo, opened it, and endeavoured detersion: but the Sinus reaching down the Twist, the Matter could not be discharged with­out laying it more open as in Sinuous Ulcers;Idem ibid. by which Method I cured it.

Aegylops, Anchylops.

I. A Young Maid had a swelling at the inner corner of the left Eye, arisen from a Defluxion from her Head, which when it was prest, water ran out of her Eye (this was an Aegylops; but if it run not, it is an Anchylops) afterwards the Bone was eaten through to the Nostrils, and the Purulent Matter ran through them: We first purged the Head with Cephalick Pills; afterwards we laid on a Collyry to dryup the weeping moisture, resolving to try all things without the Instrument, lest the Face should be spoil'd: Then we applied a potential Cautery to that part of the Nose, where there is no danger of the Orbicular Muscle of the Eye: After the fall of the Eschar, the Flesh grew so proud in the bottom, that we were forced to keep it back sometime with Precipitate, and often as the flesh increased, the Cure was retarded with repeated Causticks: At length when no Matter or Water came by the No­strills, and we perceived the hole of the carious bone was filled with sound flesh,Tho. Bartho­linus cent. 5. histor. 85. we made use of driers and cleansers of the bone; but without Instrument or fire prescribed by Aegineta. Whereupon the wound was closed up with a small scar. ¶ If you find the bone carious, lay it as bare as you can, after strew plentifully upon it Euphorbium, finely powder­ed, than which nothing is better in carious bones. You need not fear the acrimony; for our Euphorbium does not inflame the adjacent flesh. But I would have a Seton first used, which is of such moment, that I have observed in several persons an inveterate la­chrymal Fistula could scarce be cured without the help of this.Fabricius Hil­danus cent. 6. observat. 3. Nor would I have any thing attempted, before the Seton have run for some time, and have drawn to it the Matter, which fell upon the Fistula.

II. There is another Aegylops often bred of a tough humour like gelly inclosed in a bladder which cannot be cured without opening the Tumour with a knife or a potential Cautery, and taking away of the skin;Enchiridii med. pract. p. 88. and then, lest the Ail return, a burning hot Cautery must be applied to cause an Eschar, which when it is fallen off, some beaten Allum mixt with Turpentine may be applied, till it be perfectly heal­ed. ¶ Because this Swelling cannot be cured with Medicines alone, it must be taken hold on with a pair of Nippers, and cut round the bottom with a knife;Scultetus tab. 31. arma­ment. yet so that the whole spungy Caruncle be not cut off, which is not unfitly called The Bridle of Tears: for upon taking it away a perpetual efflux of them or an incurable Rhyas doth follow.

III. A Matron about thirty years of age after fre­quent inflammation of the Eyes and Head-ach had a Lachrymal Fistula arose,Hildanus cent. 4. o [...]s. 19. and was cured by the help of a Seton.

IV. Sometimes there are cancrous Ulcers in this part, which cannot be cured, except the part be burnt, and the Veins and Arteries especially be burnt thoroughly and to the quick:Enchiridion med. pract: p. 89. For so the cure will be most safe without fear of relapse, because when these Vessels are burnt, there can be no more new Defluxion.

V. In the burning an Aegylops I should with the more approved Physicians, prefer an actual Cautery before that they call Potential: But why do they order it to be of Gold rather than of any other mat­ter? For one would think it might commodiously be made of Iron, nay perhaps more commodiously; seeing there is an astringent Virtue confest to be in Iron, a quality very requisite in this case: Again, Gold if it be violently heated, melts; if indiffere [...]t­ly, it is to no purpose: Yet Johannes Montanus a great Physician, chuseth Gold or Brass in his Counsels,Plempius Ophi [...] [...] mogr. l. 5. c. 3. by reason the burning is greater, and the Scar deep­r, than the tender particles here exposed can endure.

VI. All the difficulty in the Cure is about Re­pressers and Suppuraters, for either of them seem to incurr the hazard of a Fistula: that in­deed by repelling the humour to the Parts within; and this by putrifying: Nevertheless both must be done sometime of Necessity. When the Defluxi­on first begins, and the corner of the Eye ailed no­thing before, repressers are convenient, for if this place never ailed any thing before, the Parts under­neath are strong, therefore Repulsion should be made to the sides rather than directly under: But if in the process of the Disease an Inflammation arise, in this case Repulsion is no way convenient. Some­time we must use Suppuraters, when Nature hath al­ready begun the Suppuration, and the Humour is San­guine and in great plenty, & when Suppuration can­not be avoided,Saxonia prael. pract. part. 1. cap. 20. which when made though but imper­fectly, the Abscess must be opened.

Agonia, or Pangs of Death. How persons at the point of Death are to be Revived.

WHen Physicians perceive the Hippocratical Signs of Death, they bid adieu to their Pa­tients, lest they should expo [...]e themselves, their Art and their Medicines: But they should not be given [Page 8] up, but all means rather should be used, which have any possibility to prolong life. For I have known several at the point of death, who have been given over by the Physicians and yet have recovered by inconsiderable means, I will give you my opinion freely; In the Heart, which is the last that dies, the vital Spirits are extinguished divers ways. I. By the excessive heat of the Bloud: Cooling Potions and Epithemes to the Breast relieve such persons. II. O­thers die, when there is not a sufficient Affluence to the heart to continue the Circulation. 1. If new Chyle pass not to the Heart, either by reason of Ex­pulsion of the Food by Dysentery, Vomiting, or some fault in the vessels of the Mesentery, or if it pass not by the proper ways: Transfusion of man's or Calf's bloud would do good in this Case. 2. If the Bloud, which should be carried back by the Veins, do clot and congeal, and this it does variously in various Diseases, in the Phthisick, deep Consump­tion and Fevers, the Lympha or usefull Serum is want­ing in the bloud; A warm bath, which dissolves the Coagulation, relieves such for a time: In Tartarous Diseases, as the Scurvy, &c. the Bloud wanting Spi­rituous Parts is made tough and thick; such Patients begin to die at the extreme parts; warm baths also and spirituous Potions, which hinder Coagulation, do help such: In such, when they are dead the Arte­ries are flaccid, and the Veins do strut. III. The motion of the bloud is choaked by suffocating Ca­tarrhs, inasmuch as the Lungs (through which the Circulation of the Bloud is made out of one Ventri­cle of the Heart into the other) and the Vessels of Respiration are choaked by a cold Viscidity: Let the sick Persons be laid on their side, that the Phlegm may run out at the mouth, apply a hot Pultess to the Throat and hot sand to the Head and Neck. Because Apoplectick persons die of such Phlegm stopping up the Ventricles of the Brain, Cupping the head and blistering the neck signify little if Apophlegmatisms will not do: The viscia Matter must be drawn out of the nostrils, the Patient's Head must be raised, and shaked a little, to make the matter descend. In an Agony, when there was ratling, and scarce any Breathing, hot Pultesses, and Sand applied to the throat and breast, and a small draught of warm spirit of Wine with Oil of Almonds,Ex Miscel. cu­rios. an [...] 1671. obs. 159. recovered a man of Seventy. If the root of the Tongue and the Wind-pipe, have any glutinous stuff baked to them, Ni­trous liquours and cleaning with a Surgeon's hand are good.

Alopecia, or Falling of the Hair. We must proceed gradually in the application of Remedies.

THree kinds of Remedies ought to be provided, Weak ones which are of use in beginnings of Diseases, and in slight Ails, in hot Countries, and tender bodies, as of Children, Women and Persons of Quali­ty; Moderate ones in midling bodies; and Strong ones in strong and old Disaffections. We have laid down this distinction, that it may be carefully observed in the present case, that two errours, that are frequently committed, may be avoided, that is, Ulceration of the skin by sharp Medicines, and Consumption of the innate moi [...]ure of the Part by driers, which usually cause an incurable Baldness. For that reason the place affected should be often look'd on, that we may know whether the Medicine applied be too weak or too sharp: For a weak Medicine either hath no ef­fect at all, or a very slow one upon the body; and a strong one acts too violently and hastily upon it. Ron­deletius Pract. l. 1. c. 1. See Sennert. cap. 4. l. 5. Pract. part. 3. sect. 2.

Alvus Adstricta, or Costiveness. (See Leni­tives, Book XIX.)

I. IF the Belly be to be loosened, respect must be had to the Causes; if it be dried up, the Physician must neither give Aloes nor Scammony, nor any Pur­gatives, according to Hippocrates de m. m. If you would cause a stool, saith he, drink no Purge, but use other things; for, besides that it will do no good in this case, it will draw more to the Intestines. If heat be the cause of Costiveness, Mucilages of Linseed, Quince and Fleawort-seed may be put in the Clysters: by this means the thick and corrugated parts are made laxe, the hard are soft­ned, and the heat of the Intestines passeth away in Steam: If the Faculty of the Guts be slow, languid and dull, they must be involuntarily excited to mo­tion by sharp Clysters, in which you must leave out the oily things which are usually added, lest their Virtue be made dull: If one go not to stool because the Liver breeds no Choler, have a care of Rheu­barb: If from abundance of Wind, the effect of a weak Stomach, Hiera should rather be given than Cas­sia: If from want of sustenance, more plenty of it must be allowed: for Weight and Pinching are causes that move the Expulsive Faculty. ¶ Sennertus, in Epitome Instit. blames the Weakness of the Muscles of the Bel­ly (which also concur to the exclusion of the Ex­crements) Therefore Childbed Women go to stool with difficulty, not onely because of their long ly­ing in Bed, but because their Muscles are weakned by their labour: Laxatives and meats of the like na­ture are here used to no purpose; some Turpentine rolled in Tiphany is more convenient, or Aloes, or Rheubarb, wherein there is some small Astriction beside the stimulating Virtue; or a motion is to be procured by sharp Clysters. A certain Melancho­lick person had a very costive Body, so that some­time he went not to stool once in six or seven days. He was cured by taking about two hours before Sup­per some stewed Prunes with their liquor,Riverius centur. 3. ob­servat. 5. to which he added a small glass of Wine mixt with a great deal of water: half whereof he took before his Prunes, and the other half after: so he went well to stool, and this wrought better than Prunes alone are used to doe. A Matron about fifty complained that the strongest Purge would scarce work with her; I suspecting the heat and driness of her inwards (for she was Black, Hairy and Masculine) by giving her six drachms of Lenitive Electuary, and half a pint of Whey to be drunk upon it half an hour before Meal, obtain'd that which stronger means were not able to effect: For within a few hours she was very laxa­tive. So I perform'd that by gentle means which the former Physician could not doe by stronger.

In Costiveness accompanied with Wind and tor­menting Gripes, seeing then Acidity is joyned with the Viscidity of the Humours that turn to Wind, we must chiefly make use of some oily volatile Salt, mixt with Opiates, and all other Aromaticks, which are likewise good to break the Wind: But if mere Driness of the Excrements create this trouble in going to stool, the Excrements must be moistened and softened before they be voided, and this may be done over some Steam, or by application of a Flan­nel or Sponge impregnated with the emollient De­coction: for so the excrements will be softened and more easily voided. Besides, the Belly must be anointed with some emollient Unguent, that the Ex­crements may pass with more ease. A few days ago I was called by a person of Quality, I found a Child four years old very unhealthy, who went to stool but about once in three weeks, and in the mean time the Excrements were baked into Lumps, which you might distinctly touch through the Muscles of the Belly, and feel how big they were; nor were they voided without great pain, and sometimes loss of Bloud, and Sweat all over the Bo­dy. After the use of an emollient Ointment, with­in eight days he went to stool several times with much Ease:Sylvius de le Boë [...]ppen. Tract. 5. sect. 141, 142, 143. I have frequently observed a Clyster of Milk with a litle Honey of Roses hath done much good in such a case: for the Acidity, the usual companion of Wind, was tempered by reason of the Milk, and the Excrements were in some measure also loosened and softened.

II. It is not good to use looseners, as Apples, Prunes, or other fruit, frequently, and to cause plentifull evacuation; for they relax the Stomach, which when done, there can be no right concoction:Crato consi­lio tertio a­pud Schol­tzium. Seeing we are inform'd, that the Stomach concocts food aright, when it is corrugated and contracted in­to it self, and that it embraces and contains the whole Mass till it be concocted.

III. Prunes loosen, especially if they be eaten not immediately but some time before Dinner, and a­lone: for we must remember these common directi­ons for all Laxatives, out of Galen. 2. de Aliment. fac. The reason is, because they pass into the substance of the Body, for that they are not pure Medicines, but have something of Nourishment: Therefore they that give Manna and such things four or five hours distance from Meals,Augenius. are ever disappointed of their End.

IV. In great obstrustions of the Belly we have ob­served the Opening of it to be very difficult in seve­ral Patients. We must not pass in silence, what we have several times met with in our Practice, that when the Belly seem'd to be sufficiently emptied by purging Potions, and liquid Excrements were voi­ded; nevertheless a great deal of other dry Excre­ments stayed behind in the Gutts, and created a new Obstruction and repeated Pains. I was called to one sick of the Colick; when I had given him a pur­ging Potion, and he had purged much liquid Excre­ments, and yet neither the load in his Belly nor his pains did cease; I therefore ordered a Clyster, which brought away great store of dry and hard Excre­ments. From whence I conjecture, the Potion brought away some liquid Excrements; but that it was not able to discharge the Load of hardened Ex­crements. But it is usefull in such an Affection of the Intestines to loosen the Body with a Clyster or two, and after to give a purging Potion, which if either it work too slow, or Purge but a little,Oethius apud Schenckium. you may last of all give a Clyster to remove the Obstructi­on with more expedition. In curing a costive Body, it is better to admit of several Clysters seasonably repeated, than to take any one lenient Potion what­ever. One good Purge, administred with judg­ment in the Colick pain, does that at once which Clysters cannot well reach: especially in Colick pain from Obstruction of the Excrements above the Valve.Rolfinc.

V. Sometime Colick Pains and many Symptomes arise from the hardned Excrements. I knew a Pa­tient who was much troubled with a kind of hard swelling in his left side under the Spleen for two [Page 10] years. His Physicians continually ordered him Ointments and Fomentations, without any benefit; at length more Symptomes coming upon him, he died. We opened his Body and found the exceeding hard Excrement was the cause of that old Swelling: And then we found the cause why the poor wretch sometime voided by stool certain green and exceed­ing hard round lumps; for the Excrement, by reason of its weight tending downwards, some portion of it turn'd globular, which was daily brought away by Clysters; and afterwards, by reason of the parching Heat of the great Artery, which was near the place, new Excrement was again joyned to that Mass, and so hardened: From the foreknowledge of this case I cured several such with two ounces of Oil of sweet Almonds,Sanctorius art. par. c. 94. taken every day for a month together four hours before Meal.

VI. The Feet should be held in some mollifying Decoction: for as Astringents are applied to the Soles of the Feet, and the Legs are bathed in some Astrin­gent Bath,Enchir. med. pract. when we would bind a loose Body; So the same Parts may be bathed in some emollient Bath to make a Costive Body loose.

VII. A Costive Body had brought a man almost to Death's door; Solutives, whether taken in at the Mouth or by Clyster, were used to no purpose. The Obstruction continued immoveable for above a fort­night. The Belly rose in a hard swelling with pre­ternatural Heat and worse Symptomes. I therefore, judging that a desperate Disease must have a despe­rate cure, gave six grains of Tartarum Emeticum, to be taken in fat Broth without salt, and ordered a sup­pository to be given at the same time: [...]renfored. Ia [...]endornius [...]s. curi [...]s. anni 73. obs. 16. Upon this the long desired Discharge both upwards and down­wards did succeed. The Patient was for a while very weak; but a little after he recovered per­fectly.

VIII. A Maid laboured of irresoluble Obstructi­ons. A desperate Apothecary, when he had tried several things, gave this desperate Maid two ounces of crude Mercury.Sam. Ledeli­us mis. curios. anni 72. obs. 225. After which plentifull Evacuation succeeded, and after a few days she recovered her former Health.

IX. I knew a Man, who went to stool but once in a fortnight or three weeks, and ever with so hard straining, that bloud started out of his Nose. Many laugh at Ficinus, who, lib. de san. Studios. cautions men not to strain too hard in going to stool for fear of an Apoplexy or Epilepsy. What such hard straining can doe, this present Instance doth shew: Nor is it any wonder to me that the Veins and Ar­teries in the Plexus Choroides (part whereof reaches to the Ventricles of the Brain) should either be burst or so strained,Ph Salmuth. cen [...]. 3. obs. [...]. as to straiten the Brain; and so cause those Diseases.

X. The Excrements are often gathered in the up­per and larger part of the Colon near the Liver and Stomach: And because the Body is perspirable, if at any time one be slow in going to stool, the Sto­mach grows squeamish by reason of the filthy stink of the Excrements, the appetite is destroyed, the Heart faints,Riolan. an­ [...]ropograph. and the Brain is stuffed and oppress'd; then nothing is better than to wash the Guts with Clysters.

XI. Phlegm bred in the Stomach conduces to the better expulsion of the Excrements; for unless the Intestines be moist and slippery, Excretion will be difficult. We understand the necessity of this thing from some persons troubled with the Colick, whose Guts were so sodden with Clysters, Fomen­tations,Riolanus in Enchirid. and all sorts of Medicines, that they were like Leather; such never go to stool except forced.

XII. The Ancients used pickled Meats, and they are left off by us, to the great detriment of the Sick; For it is certain, that these Pickled things did not onely cut Phlegm and provoke to Stool; but they exceedingly strengthened the Stomach,Cr [...]to. helped Concoction, and stirred up an Appetite. But if the Body itch, we must abstain from them.

Aneurisma, or an Aneurism.

I. I Could never conceive how the inner coat of an Artery can be broke which is thick, and the outer Coat, which is as thin as a Cobweb, should en­dure whole (which is Sennertus his opinion) and so breed an Aneurism, when indeed there is no such distinction of Coats at all. But I acknowledge it may be bred two ways; One way from an External; Another from an Internal cause: The External is a Wound made in the Artery by an unskilfull Surgeon. For the Artery may be skinned over, and yet not so soundly healed, but that the Bloud, forcing vio­lently on the weak part of the Coat, may raise a Tumour upon it: The internal cause is the Opening or Anastomosis of a little Artery, by which the Bloud passing into the empty space or Interstice of the Muscles, is congealed into a Clod, which increasing by degrees, and by continuance being more con­cocted, turns into a fleshy Mass, not unlike the Muscles, which is found hollow, and contains in its middle plenty of black clotted Bloud. And in what I say, I am back'd with experience, acquired by Dissection of an Aneurism in Venice, Anno 1643. and with the Testimony of famous Bogdanus, Observat. Med. 8. But as the first case may be cured by binding and pressing the Tumour; so the second case scarce ad­mits of any cure at all, unless one will cut the Arte­ry, by dividing the skin take away the fleshy lump,I. Van H [...] microtech. sect. 26. and fill up the broken Artery with new flesh by Sar­coticks. I and a Surgeon were called to cure an A­neurism, occasioned by letting of Bloud, I presently [Page 11] threw away the things which were improperly ap­plyed to soften the T [...]our;Horstius, Tom. 2. Lib. 9. Obs. 1. because Gangrene, Mortification and Corruption of the Part do follow such Softning and Suppuration. The Part affected is very often the Neck, because of the Carotid Ar­teries. Yet I have observed it in the Arms and Legs. The Cause is a sharp, serous and bilious Hu­mour, eating either one or both the Coats of the Artery, and sometime the neighbouring Bones. Sur­geons, ignorant in their own Art, take it for an Ab­scess, and having opened it with an Instrument, the Patient dies immediately in their very presence. The Tumour must in the Beginning be comprest presently, and the sharp Humour repelled: Both these things may commodiously be done by a thin Plate of Lead. I cured a poor man palliatively by this means, so that he lived fifteen years after it: The Swelling was above his right Knee, as big as a Hen's Egg. Some advise to intercept the flux of Bloud, by tying the Artery above and below the Aneurism, and when you have cut it to heal it: But this is a painfull kind of Remedy; nor is it safe. I had rather, to save ones Life, cut off an Arm or a Leg. We dissected the Body of a poor Man, who died of an Aneurism, we found plenty of Bloud,P. Barbette, Practic. lib. 2. c. 3. both Serous and Gru­mous, and both Coats of the Arteries and the great­est part of the Collar Bone on the Left side ero­ded.

II. One was let Bloud in the Basilick Vein for an Itch caused by a Melancholick Humour, and the Ar­tery was also prickt, whereupon, by little and little, an Aneurism arose, to which, when for above a Months time they had applyed several things to no purpose, and they were past hopes of saving his Arm, he came to me. I found the Swelling as big as a Goose Egg, pale and also hard, in which you might not onely feel a Pulsation with your Finger, but you might perceive it by your Eye. I with much en­treaty undertook the Cure thus. When I had in the first place ordered his Diet, and applied my Plaster of Hemlock to the hard Swelling, he took a Clyster, and a Julep to digest Melancholick Humours. I then gave him a Purge, which when it had discharged the Noxious Humours both upwards and downwards with great Violence, it so recalled the Spirits and Bloud, which were in the Aneurism, to the inner parts, that the next day we could perceive no Pulsa­tion: The Swelling also was much fallen; then I applied the following Plaster. Take of Emplastrum Diachalciteos, Two Ounces; Powder of Mastick, Red Roses, Myr­tle, Comfrey Roots, each One Ounce, Oil of Roses what is sufficient. Afterwards I made a Bolster, or rather a Knot of Linen, often doubled, and laid it on the Tumour, and bound it fast with a Roller,Fabricius Hildanus, Cent. 3. Obs. 44. to repress the Tu­mour, and hinder the influx of the Bloud out of the Artery into the outer Membrane dilated. And by these Remedies the Arm was perfectly restored.

III. One prickt with the point of a very sharp knife an Artery in his Left Hand, between the Thumb and Fore-finger, the Bloud run out by leaps; with an Astringent Plaster applied in time, the out­er Coat of the Artery closed presently, but the in­ner remained open, and they were parted one from the other: Therefore the outer Membrane was so elevated by the vital Bloud, that it degenerated into a true Aneurism, with a continual Pulsation and Pain in the adjacent Nerves. You could no sooner press this Pulsatile Tumour with your Fin­gers, but the Bloud presently gushed back to the Veins, and the Aneurism seemed to be gone: But it immediately came in View again, if you removed your fingers never so little. Surgeons were not wanting who would gladly have seared the Artery across with a hot Iron; but the Remedy would have been more cruel than the nature of the Disease re­quired, and therefore we made tryal rather of an Astringent Plaster, and bound it so strait with a Plate of Lead, that when the Bloud was forced out of the Tumour, and the gaping of the wound con­veniently shut, the inner Coat of the torn Artery might close, and grow together: And it did close within five Months,Tulpius, c. 16. lib. 4. O [...]s [...]r. there remained onely a little Knot about the Scar, which at length also vanished, before the Aneurism was perfectly cured.

IV. A Woman beat her Son, about Seven years old, on the left side of the Head with a Stick, upon the place where the Carotid Arteries pass, where­upon a Pulsatile Tumour, like a Walnut at first, black, and yielding to the fingers, presently arose, and within eight days grew so big, that it spread over half the head, from the S [...]g [...]ttal Suture over the Temples and Forehead, to the very Eyes: The Phy­sicians, upon Consultation, judging a doubtfull Remedy should be preferred before most certain ha­zard of Life, open the Swelling with an Instru­ment, and taking away some part of the Bloud, which gusht violently out, and stopping what re­main'd with strait Ligature and Astringents; and do­ing thus frequently, they perfectly cured the Boy in a few days; Either because in young Persons all things are tender, and easily grow together; or because the hurt Artery had a bone under it, and so might be bound the harder to make it close. Hence Riolanus affirms,Riolan. fil. E [...]chir. p. 3 [...]. Jo [...]. Mi [...]ha­el Feti [...]. Th [...]t the Arteries of the Tem­ples and Forehead may be safely opened. ¶ Few find an Aneurism doe well, because the Arteries will not endure opening: Yet sometimes the strength of Na­ture conquers the Disease, a strait Ligature do [...]h now and then miraculously close a gaping Artery. But we experience the Effect of this Operation one­ly in the lesser Arteries: for in the greater, the Coats, because they are thick, are not easily bro­ken, unless of a violent Cause, and the Ruptures are healed up with more difficulty, and the Aneurism, because of the continual afflux of Spirituous Bloud, daily increases. The hoped Cure succeeds bet­ter where the Coat of the Artery is dilated, than where it is quite broken. And upon the Bloud's being hot, and so inclined to Violent Motion, or its being cold and thick, and so slow in Motion, the Cure or Death of the Patient doth in a great Mea­sure depend. We saw a Mortal Aneurism in a young Man, who had hurt his Thigh, nor did we wonder at it, for in opening it, we found the great Crural Artery broken, whereupon the Thigh swelled so much, that it seem'd quite Scirrhous; and after he was dead, and his Thigh opened, there run out not onely as much Bloud as would fill three of our Measures, but we took out of the Sinus's, which were made between these vast Muscles, Grumous Bloud, resembling, in shape and bigness,Bartholinus, Cent. 3. Epist. 54. the Paren­chyma of the greatest Liver: While he was alive neither Section was safe or possible, because of the huge breach of the great Artery, and of its Lying among the Muscles; nor was Ligature sufficient. I advise the young Surgeon not to open Ancurisms unadvisedly, unless they be small, and in an Ignoble Part, and have no Vessels remarkable. Let him rather take this Course of Cure: Lay the Skin over it open till you find the Artery, separate it on eve­ry side from the Parts about it; run under it a blunt crooked Needle with a Thread in it, bind it, and cut it off; you must tarry till t [...]e Threads tied about it fall off themselves, and till Nature have filled the Ends of the cut Artery with Flesh, and then the rest must be healed up as in the Cure of simple Wounds.Paraeus.

V. A Surgeon, when he was Letting a Man Bloud that was sick of a continual Fever, opened an Artery instead of a Vein. The famous Garcias à Lopès, a Jewish Physician of Burdeaux, standing by, suffered him to Bleed above Two Pounds, till he was ready to faint, on purpose, that the Vessels about the Part being drained, the Pulsation of the Artery, which would have hindred the healing of it, might be less: Then applying a piece of Silver with a Bolster, it was hard bound; it was loosed after Eight days, and the Patient escaped the danger of an Aneurism. [Page 12] He was rid of his Fever by the large Evacuation of Bloud; but he was faint a long time after.

VI. I have had many brought to me with swelled Necks, upon suspicion that they were troubled with a Species of King's Evil, called Bronchocele: but the Pullation of those Tumours shewed them to be Aneu­risms, and the most difficult to treat; they, by rea­son of their Situation, not being capable of Ban­dage.Wiseman's Chirurgical Treat. Book 1. Chap. 16. In which cases I commonly proposed the wearing of a Cap of beaten Lead, made of many Sheets laid upon one another, and covered with Silk or Sarsenet, which with Ribbons were made to fasten about the Neck with much ease: or, if they would have Emplasters, I applied some of a mixture of Ʋn­guent. sumach. with Emplast. Caesaris, or such like.

Angina, or Quinsey.

I. WHether a Vein should be opened in eve­ry Quinsey? The Negative seems pro­bable according to the Opinion of Mesue, who some­times orders a Purge before Bloud-letting, especi­ally when the matter peccant is also Cholerick or Phlegmatick; because the Cholerick matter boils and ferments higher, when the Bloud is taken away, and the Phlegmatick matter usually causeth greater crudity. Nay, if what Avicenna saith be true, That it is better the strength should remain in the Body, and that the peccant Matter should be taken away by Evacuation; it of neces­sity follows, that in a Quinsey, caused by a Cho­lerick or a Phlegmatick Inflammation, Bloud must not be let in the beginning, seeing by this means faintness follows, and Choler or Phlegm are not first purged, which certainly indicate Purging of the Mat­ter rather than Bloud-letting. But we defend the contrary with the greater number, scil. That in eve­ry Quinsey, whether the Bloud offend with Choler or Phlegm, or alone, we must begin with Bloud-let­ting, if nothing hinder; because in the beginning a Man must presently take care to stop the afflux of Humours to the part affected, which may conveni­ently be done by letting of Bloud, which draws back the affluent Matter from the part affected: For as in other Inflammations Bloud is let,Gr. Horstius, Problem. Dec. 4. Quaest. 4. not in respect of that Matter, which hath already actually caused an Imposthume in any part, but for Preservation's sake, in respect of the Matter yet affluent and in­creasing the Inflammation; so here we prescribe Bloud-letting in the beginning, lest the Inflammati­on should be increased by the affluent Humours, and there should be imminent danger of present Suffocation.

II. Seeing a Quinsey is a most acute Disease, and that sometime it takes a Man away in one day; the Great Remedies are to be used with huge Care and Diligence. Therefore, at what hour of the day soever a Physician is called, let him take away Bloud presently, from the same side the part grieved is on, to one pound, a pound and an half, or two pounds, as the Patient can bear it: For the principal hope of safety must rely on this Remedy. Yet so great a Quantity of Bloud must not be taken at once,Riverius Praxeos, lib. 6. c. 7. lest the Patient fall in a swoon, whereby his life would greatly be indangered; but at several times, that is, once in three or four hours.

III. If you meet with a Woman in a Quinsey, who has her Months stopt, or is in daily expectati­on of them, or actually has them, what must then be done? I would not have you follow them that breathe the upper Veins; for at this time you must breathe the lower. Trallianus teacheth this, lib. 4. c. 1. And Reason teacheth it: For in this kind of Bloud-letting there is not onely Revulsion,Saxonia Prae­lect. pract. c. de Angina. but also an Evacuation of the accustomed natural Purgation, which hugely helps the Inflammation. But if Strang­ling perplex you, when you have opened the lower Veins, you may with safety open a Vein under the Tongue: For this Bloud-letting draws not from the Womb, nor from the whole Body; but onely evacuates the Part affected.

IV. A Man of Fifty newly fallen sick, was taken about Midnight with so violent a Quinsey, that he was not able to speak one word.Rolfincci­us, Consil. v. lib. 3. A Surgeon was called, who let him Bloud under the Tongue, and in a short time he recovered. Saxonia Writes, that the opening of the Sublingual Veins should not be onely once, but repeated twice or thrice, as neces­sity requires, and Suffocation is urgent.

V. The Ancients in a desperate Quinsey opened the Jugular Veins, which Remedy, although it be ap­proved by most of the Moderns, is grown quite out of use in our times, because it is accounted dangerous, but erroneously. Trallianus, l. 4. c. 1. saith, He Cured several of the Quinsey by opening these Veins. ¶ I had under my Cure, Anno 1675. in the Month of May, Mr. Dennis Bordier of Geneva, a lusty Man, taken with a Quinsey and an acute Fever, although his Breathing and Swallowing were easie enough; I bled him in the Arm, the Bloud run very pure, but without any ease; I bled him under the Tongue also without any Benefit: But when I opened the Jugular on that side, where was most Pain, very Putrid Bloud ran out like a Rivulet, to his sudden and manifest Ease. Although this Ail ended in a [Page 13] Peripneumony, from which he shortly recovered by repeated Bloud-letting and Expectoration.

VI. A Matron of Fifty had a Phlegmatick Quin­sey all over her Throat, within and without; the Swelling appeared great outwardly, her Swallow­ing and Speech were hindered: When I touched the place, I found Matter lye deep; wherefore I knew that she would be choaked before the Impost­hume would break, either inwards or outwards; and feeling of it with my fingers,Lanfrancus Chirurgiae doct. 2. tr. 3. c. 5. I found ripe Mat­ter gathered more between her Chin and the Epiglot­tis, than any where else, and avoiding the Nerves and Vessels, I made a deep Wound in that place, out of which I took a good share of the Matter, leaving much behind. Then she took her Breath better, and the Fear of Death abated, &c.

VII. The Wife of N. being Plethorick, underwent most exquisite pains in her Jaws, her Tonsills were so swelled, that she could not swallow one drop, but threw whatever she took out at her Nostrils. I ordered Bloud-letting, I used Cataplasms and Gar­garisms, and the fourth day of the Disea [...]e, as I was searching the Sore with a Probe,P. Barbette, Prax. Med. l. 2. c. 1. I saw the Abscess suppurated: I was resolved to treat her somewhat Inhumanely, I broke the Abscess with the very same Probe; upon which, when she presently grew bet­ter, she Laught, and commended my honest Cheat.

VIII. Benivenius, when a Man was almost strangled by a latent Quinsey, and given up for Dead, cut the place with deep Gashes under the Jaws, and on the Throat also, out of which there run much Corrup­tion, and so rais'd the Man from Death to Life.

IX. Cutting the Windpipe is seldom put in pra­ctice, for fear of Disgrace, if when the Operation is perform'd, the Patient should Dy: Besides, in a ve­ry dangerous Quinsey, the Lungs are often afflicted and stuffed with Humours, which choak Men; in which Case this Operation is practised to no pur­pose. Yet Examples are not wanting of those that have had good success in it. Famous Renatus Moreau used it in a Gardiner and a Souldier, both which re­covered of their Disease and Wound, onely in the latter there remained a little hoarseness in his voice. The celebrated Tulpius, obs. 50. l. 1. shews, that Wounds of this nature heal quickly. Things that were never tried seem terrible, which, after they have been once practised, are used as confident­ly as they are perform'd easily. This is confirm'd by the Opening of the Jugular Veins, now very usual, and by Cutting for the Stone. The way of performing the Operation is thus; Let the Pa­tient be set in a Chair, with his Head leaning ba [...]k as much as he well can: let the Servant standing be­hind him, take up the skin on each side of the fore­part of the Neck, and the Surgeon must cut the Skin length-ways with the Muscles under it, just against the Aspera Arteria, not far from the pit of the Throat, and with a broad Lancet he must divide the Space between the Cartilages, and having made a hole, he must put in a Silver Pipe,J. Van. Horne Michrotechn. Sect. 17. a little crooked with Legs: By this way the Breath goes and comes to the Lungs, till the Inflammation be either dispers­ed, or brought to Suppuration, and a passage for breathing by the Mouth be restored.

X. In that sort of Quinsey, where the Muscles of the Larynx are inflamed, called, The Dog Quinsey, Breath may be restored to the Choaking Patient, by the help of Laryngotomy, an Operation less ha­zardous than the Disease. Nevertheless here great Circumspection must be used, lest, if other parts al­so, as the Pleura, Lungs, Gullet, &c. be inflamed, or full of Matter, the labour be in vain, and so give oc­casion for Reproach. All things therefore well con­sidered, the Operation may be gone about in this manner; Let the Head be bent back a little, that the Trachaea may come more in sight, and the Cartila­ginous Rings may part the wider one from another: Let the Skin of the Wind-pipe be cut length-ways to the Pit: Let it be drawn asunder by the Servant's fingers on each side, that the Surgeon may see the Sternothyreoides Muscles, which are to be parted one from another with a Wooden or Ivory Knife: After the Windpipe shews it self, Section must be made with a Lancet, in the middle space, between the third and fourth Cartilaginous Ring, taking diligent care that the Cartilages themselves be not hurt. When the Wind comes out, take away your Instru­ment, and fasten a Silver Pipe in the Wound: Care must be taken that it be not over long, nor touch the back-part of the Windpipe,Barbette, Pract. p. m. 130. for then it would cause continual Coughing. When the danger of Choaking is over, which usually comes to pass in three or four days, the Pipe must be taken away, and the Wound cured the ordinary way according to Art: for it differs not from other Wounds.

XI. When the Imposthume is opened,Chalmet [...]us E [...]ch [...]r. p. 113. care must be taken that the Corruption fall not on the Lungs, nor into the Stomach, for fear of another Disease; but it must carefully be cast up at the Mouth, and then a Gargarism of Hydromel used often is good for Detersion, &c.

XII. One had been sick of a Bastard Quinsey, and he often Relapsed: Because some thin Matter al­way flow'd to the foresaid par [...]s,Mercurialis Consul. Med. [...]. I therefore order­ed him an Issue in one of his Arms, which we tri­ed as the last Remedy; and by God's Assistence we restored the Patient to perfect Health.

XIII. There are some, who in that sort of Quin­sey, which is caused by a Vertebra of the Neck slipt in­wards, use Cupping-glasses, thinking by that means they may draw the dislocated Vertebra outwards again, which Hippocrates expresly forbids, lib. de Articulis. But it is great weakness to think to draw out the Verticles slipt in­ward, by applying Cupping Glasses: for they rather drive for­ward than backward, nor do those that set them on, take no­tice of this: for by how much faster they set them on, so much the more crooked are they made to whom they are applied; be­cause they shrink the outer skin together.

XIV. When the Patient has bled enough, he may be purged the day following,Riverius, l. 6. c. 7. never waiting for the Coction of the Humours, because the Disease gives no Truce: Nay, if that it be very violent, you may Bleed and Purge the same day, which Trallianus saith he did, l. 4. c. 1. But it must be done with gentle Medicines, because of the Inflammation. ¶ After the Patient has been let Bloud, the next morn­ing, if the Fever and Pain be any thing abated, I presently give him a gentle Purge, which, after Bloud-letting, is the best thing can be done, and by often experience I have found it highly neces­sary. If afterwards, which seldom happens,Sydenham, Observ. Sect. 5. c. 7. the Fe­ver and other Symptoms invade him, they must be en­counter'd with repeated Bloud-letting as before. Through the whole course of this Disease, I order every morning a Cooling emollient Clyster, except the day allotted for Purging.

XV. There are some that prescribe Gargarisms of some sower and bitter things, that are not very ingratefull to the Taste, for repelling the Humour: Yet I suspect the use of these things in this case, because the Parts Inflamed should be quiet; but the Throat and Jaws are moved by Gargling: Therefore I would either have them not used at all, or held in the Mouth without stirring,Enchir. Med. Pr. lying on ones back, that they may come to the Part af­fected. Then I prescribe the following Gargarism, not to be used the common way, but to be kept in the Mouth without Gargling, till it be hot,Sydenham, loc. supra cit. then to be spit out, and more taken. Take of Water of Plantain, Red Roses, and Frog Spawn, each four ounces, three Whites of Eggs beaten to water, of White Sugar-Candy three Drachms, make a Gargarism.

XVI. Galen and his followers, in all sorts of Quin­seys, from the Beginning, use cold and astringent Gargarisms, contrary to the Precept of Hippocrates 4. de rat. vict. in acut. vers. 72. who prescribes Gargarisms actually hot. They mistake, not considering how such Medicines cause certain and speedy Suffocation [Page 14] in the Quinsey, which depen [...] on Phlegmatick Mat­ter, seeing it gives not place to Repellents, but be­ing thickned and more-setled in the Part, it is ren­dred more unfit for Discussion, and readier for Suf­focation: and in that which comes of sharp and thin Matter, although they be not so pernicious, yet they may doe more hurt than good; for since they cannot repell upwards the Matter descending from the Head, when it is forced either to the i [...]ner parts of the Muscles of the Throat, or upon the Lungs; they may make the Disease more dangerous Hippocrates his Advice is better, whom all the Ancients follow'd (as you may see, 6. de comp. Med.) while he thinks good in all sorts of Quinseys, and at all times, to abstain from Repellents, and always to use Rarefiers and Dis­cutients, that the Matter may more easily be raised by Spittle, and be driven outward and discuss'd. Nor is there any fear the Flux should increase, seeing it may be prevented by Bleeding and Purging, and other Remedies respecting the Matter fluent.Mart [...]anus, C [...]m. in pr [...]e­ [...]ctum l [...]cuni p. 308. And if at any time he would have some Astringents mixt with the foresaid Medicines, when the Matter is thin, he does it not because he would repell, but that by their drying virtue, he might avoid too great laxity of the Part, and that he might lessen the Swelling: Therefore he approves the use of them rather in the Beginning, than at another Time, as appears from lib. 2. de morb. sect. 1. vers. 24.

XVII. Humours sticking in the Flesh, which are wholly extravasated, cannot run because of the thick­ness: Therefore the Physician must make them fluxile with hot Medicines: If one taken with a Quin­sey, do, in the beginning of the Disease, Gargle himself with Spirit of Wine,Walaeus m. p. 11 [...]. all Inflammation of the Throat will cease in three hours time.

XVIII. Whether a Swallow's Nest be of use? Some disapprove it, as Mercurialis, because the Vir­tue lies not in the Nest, but in the Bird: But grant the Bird be endowed with such a peculiar Virtue, yet it ought not be denied the Nest, because the Nest may have it from the Excrements of the young ones, which are full of Salt. Neither ought it to be rejected for the repellent virtue of the Earth, as Pereda doth, because all Earth hath not a Repulsive Virtue; nor is it desired alone, but for the sake of the Dung mixt with it, which is sharp and Discuti­ent, whose sharpness the Earth qualifies. There­fore it is a Remedy most proper to discuss Tumours, chiefly of the Jaws and Throat; especially if the Bird have a peculiar virtue against the Quinsey. If the Quinsey be Phlegmatick, Swallow's Dung used inwardly and outwardly is good: But a bilious one is exasperated by the use of sharp Medicines: It concocts and discusses Phlegmatick Humours, and dries up the superfluous Moisture.

XIX. J. Tiengius had a Nun under Cure, that had an Imposthume in her Throat, which was Twenty days before it broke, or she could swallow any Food: He ordered now and then a Clyster of sweet Milk boild with Yelks of Eggs.Forestus, Obs. [...]0. in scho­lio lib. 15. Amatus teaches the same, when the Quinsey is upon the Windpipe and Gullet, that Broths given by way of Clyster are able to nourish: Celsus and others affirm the same. We kept a Reli­gious Woman alive in a Quinsey for nine days one­ly with Clysters, and she recovered of her Sickness. Brassavolus comm. ad aphor. 15. Sect. 2.

XX. In a Quinsey Symptomatick of a Malignant Fever, we must doe nothing before the great Heat be laid, the Body evacuated and altered, and the Parts be preserved against the Poyson.

Hen. Petrae­us in N [...]sol. He [...]mon.XXI. Then Sleep, as in all inward Inflammations, so in this likewise, must be avoided, to our utmost power; for, according to the Prince of Physicians, in sleep the Bloud retires inwards; therefore the De­fluxion of the Humours to the part affected may be increased.

XXII. A Learned Man of a Sanguine Temper, in­clining to adust, was taken with a Bastard Quinsey without a Fever, he swallowed difficultly, and found some straitness about his Jaws: He tried many things to quiet his troublesome Disease, supposing it came of a Defluxion from the Brain, although there were more signs that that was dry: He Purged his Head often with Pills, he prescribed to himself (for he was a Physician) a Drying and Sweating Diet, he endeavoured to dry his Head with Bags, Plasters, &c. he used Apophlegmatisms, Sneezing, yea, and made an Issue behind in his Head; all in vain. At that time I was following my Studies at Paris, he sent me a Description of his Disease, to shew it to some famous Physicians. I consulted severally with Monsieur Carolus Buvardus, Chief Physician to Lewis XIII. with Monsieur Curaeus de la Chambre, Physician to the High Chancellour, and with Monsieur Hurduy­nus de S. Jaques, Physician to the Hospital of Charity: They well considering the Constitution of the Patient, declared, The Disease was Sympathick, arising from Fumes ascending from the Hypochondria, affecting the Top of the Chimney, i. e. the Gullet, and that the tempering and exclusion of Melancholick Humours must be lookt after; they prescribed him Spaw Waters, the use of Chalybeates, an Issue in each Leg, and stopt up that in his head; they order'd Leeches to the Haemorrhoids, and other things to conquer the Melancholick Humours. The Patient consented, who a little after was rid both of his Melancholy and his Quinsey.

XXIII. In this Controversie I think we must take great notice, whether the Body abound with Bloud, either naturally, or because of the manner of living, or of some accustomed Evacuation stopt; for then I think we should bleed in the Ham or the Ancle; and the same day, if the Disease be urgent, or the next, to Breathe the Jecorary, or Cephalick Vein; and if the Disease abate not, we must proceed to Bleed under the Tongue. But if there be no such great plenty of Bloud,Septalius Animad. vers. lib. 6. Sect. 113. I think it better not to meddle with the Veins of the lower parts; but presently to open a Vein in the Arm, and afterwards to bleed in the upper Veins.

XXIV. But Bloud-letting in the Arm must be re­peated, not onely because it makes better Revulsi­on, and causeth less weakness; but because it is of­ten observed, that there is new afflux to the Part affected, either from some other Part transfusing Matter,Idem. Ibid. Sect. 114. that it may ease it self of the burthen where­with it is oppressed; or by the Part affected draw­ing, by reason of its pain and heat.

XXV. And seeing some either in the Working of their Physick, or that they naturally abhor it, are apt to vomit it up again; it is better always to give Potions than Pills or Bolus's: for if they should happen to Vomit either a Bolus or Pills, when they are suddenly and with great Violence forced to the Passage straitned with the Inflammation,Idem, Ibid. Sect. 115. there is no small danger of Strangling.

XXVI. Bags that are made up with drying Pow­ders, to discuss in Inflammations of other parts, must never be made use of in the Quinsey, because by thickning the outer Skin,Idem, Ibid. Sect. 116. they rather hinder the Cure; Therefore we must rather work with Moist­ners.

Anorexia, or Want of Appetite.

I. WOmen about sick persons desire nothing more than to remove this fault; but they reckon that which is onely a sign of Health, to be the Cause; For this reason oftentimes the Physi­cian is forced to provoke an Appetite: It is lost, 1. Because the Powers are weakned, and the Bloud is not well concocted. 2. Because for the former reason the acid Humour cannot be separated, be­cause of the thin Humours that are admitted. (We see this in them, through whose Arteries noxious Humours, together with the acid Humour, are pour­ed into the Stomach, which often deceives Physici­ans, while they ascribe the cause to the Intempera­ture of the Stomach) or because it is corrupted and too thin. That the loss of Appetite is to be ascribed to the fault of the acid Humour, appears from this; If the Ail be alleviated by taking Acids. Melan­cholick persons, who have a good stomach after the use of Acids, seldom recover. We amend the loss of Appetite, that depends upon some fault in the acid Humour, with Acids, and we see that Acids are good almost for all Diseases, but those of the Breast: Spi­rit of Vitriol is qualified by a mixture of Sulphur; Vineger is good, and Oranges and Lemons; but people often take too much, and then they fall in­to gnawing of the Stomach, and much spitting; a little Sugar qualifies them. The season for giving them is in the state of Declination, before Dinner, not before Supper, lest when their Appetite is raised, they eat over-much, and so be not able to bear the Assault of the Disease, which is always more violent toward night, nor to digest your Food; the Seeds of Citrons and Oranges may both be eaten, because of their Cordial Virtue. The loss of Appetite, which arises from decay of strength, is seldom cured, unless that Decay come of a cold Cause; then hot and Aro­matick things are proper. In old Men, that through weakness have lost their Appetite,Valaeus, m. m. p. 145. hot things are not so good inwardly, as outwardly: For taken inward­ly, in dry Bodies they create greater dryness: Out­wardly Oil of Mace is good, and a Tost of Bread dipt in Malmsey Wine.

II.Rondeletius Pract. lib. 2. cap. 14. In all Loss of Appetite let the Food be given actually cold; and if possible, let it be set before the Patient when he is not aware of it. Let such use bread well baked, or a good while dried in the Air, or dry Cakes well fermented, and not too close.

III. When any one complains he never comes to his Meat with an Appetite, it is advisable to make him fast till he have a stomach,Vallesius, 6. Epid. s. 4. for starving breeds Appetite. So when a Man cannot get sleep, if he be forced to wake and nod standing, before he be suf­fered to ly down, he usually falls into a long and profound sleep.

IV. Want of Appetite in Women, not with Child, is cured better by Purging than Letting of Bloud, for it arises of bad humours abounding in the Stomach and the whole Body. In Women with Child bloud-letting is the better Cure;Riverius. for it is caused by re­tention of bloud, while they are first breeding.

V. Because Choler dejects the Appetite by its heat, to cleanse the stomach a Decoction of Tama­rinds, soure Prunes, and Sebesten, with syrup of Ro­ses and Rheubarb, should be given: The morrow following this Medicine, two hours before Meal let them drink a draught of cold water,Rondeletius l. c. unless weakness of the stomach, or something else do hinder: Let them use soure Sauces, and they may take a Tast of Salt things.

VI. But if Phlegm be the Cause, after Evacuation it is best to give Acids, but with detersive and salt things; for what sweet things are detersive, they satiate and are flatulent; wherefore they are not good in this case, unless a great deal of Vineger be added,Idem. so as they may scarce be perceived to be sweet.

VII. For raising the Appetite,Sylv. de le Boe, Prax. Med. Ap­pend. Tract. 3. Sect. 210. which is often de­jected in Consumptive Persons, I think there is no better Remedy known as yet, than Elixir Proprietatis, if 4 or 5 drops of it be taken in Wine, or some other convenient Liquor, about half an hour before Meal.

VIII. Sometimes I have known the Appetite recover of its own accord: But that falls out for the most part, either because of an exact Diet, which sometime is rightly observed even by chance, or of some notable Evacuations, or Alterations that are spontaneous: For when the noxious humours are conquered and amended, or evacuated,Idem. Prax Med. Ap­pen. Tract. 10. Sect. 739. the usefull and necessary ones, by degrees, recover their lost strength, and then exert it.

Diseases of the Anus.

I. I Will propose a Way of Cure, which, at first sight, will look ridiculous, but what is of great use in the falling out of the Arse-gut. Slap the Buttocks of your Patient with your flat hand five or six times, or oftner, that the Muscles Ani Le­vatores may immediately draw up the Intestinum rectum into its place:Barbette, Chirurgiae, cap. 9. But before you thus beat your Patient, it is requisite you anoint the Intestinum rectum with oil of Roses and Myrtle.

II. In curing the falling out of the Arse-gut, you must abstain from too much Astringents, lest by ma­king the Body Costive, and therefore causing greater straining,Platerus. you rather promote than hinder the fal­ling of it out.

III. Riolanus, Anthropogr. lib. 2. reprehends almost all modern Surgeons in curing Fistula's, which are ve­ry often bred in Ano, and pass the Sphincter-Muscle, and sometime go above it; for he affirms, the whole Sphincter Muscle may be cut, because, saith he, this Intestine cut is easily healed: for, seeing it is Flesh, it must be united. We also acknowledge it may be healed: We deny that the constrictive Faculty can be preserved; Whence it is, that the Excrements cannot be retained, as I have often observed, and especially in a Shoomaker, all whose Sphincter-Muscle was cut across, and then united: Yet the thin Ex­crements came away without his knowledge; it's true, he perceived the thick, but could not stop them; nor was there any other reason for this, but that the whole Muscle was cut. And, Aquapendent, l. 3. de ulc. c. 12. saith, We ought to cut the Sphincter-Muscle; yet, with caution, that we cut it not all, but that some portion of it at least always remain whole, lest the Excrements pass involuntarily:Domin. de Marchettis Anat. lib. 3. There­fore all the Muscle is not to be cut, as Riolanus would have it, but some small portion (though never so lit­tle) is to be saved whole, lest the constrictive Facul­ty be utterly lost.

IV. Condylomata (Swellings of the Anus, so called from their likeness to the knuckles of a Man's fin­gers) are irritated and grow painfull from the Af­flux of the Salt and Serous parts of the bloud com­ing from above: To take away these troubles I have experienced nothing better than to endeavour the vacuation of the Humour, by pricking them.Severinus, Med. Eff. p. 82. A Vig­neron Melancholick, of a thin body, but tall, was frequently troubled in this nature, and found pre­sent Remedy in pricking these Tubercles with a Pen­knife.

V. Many fleshy Excrescences grow about the Anus in Women and Boyes that live at Rome, which some call the Crested Haemorrhoids, and are accompanied with Chaps. For curing of which Fleshy Excrescences, whereas several have devised several things, we, after trial of various means, have hitherto found no safer Remedy, than to clip them off: for, when they are cut off, the Sores they leave are quick­ly cured. But the Chaps are healed with Oynt­ment of Lead, and other very drying things. Some cure these Crested Haemorrhoids with Waters made of Styptick things, as Allum, Tartar and Sublimate:Amatus, Cent. 2. cu­rat. 87. Some use Goldsmith's Aqua fortis: But the first way of Cure is safest, seeing it brings but little pain, and almost no symptomes with it, as we have tried by long Experience.

Aphonia, or Loss of Speech.

I Cured a Woman, that had been Speechless Se­ven years, with a Cautery made in the Coronal Su­ture. Lanfrancus, tr. 3. doct. 3. cap. 18. Neither were Evacuations, nor Unctions, nor any other Remedies able to doe any thing towards perfecting the Cure, till the foresaid Cautery did the work. And before I closed the Cautery, the Woman had a clear Voice: for she had lost her Voice by an old Catarrhe coming from her Head.

Aphthae, or a Thrush.

I. EVery Thrush hath its Rise from an offending Acid, and indeed usually rising from the lower Parts by the Stomach and Gullet; seldom brought into the Mouth with the Spittle. Therefore a Thrush always indicates some sharp Acid doth of­fend in the body, to which we must have a special regard, not onely because of the Thrush in the Mouth, but because of the Acid in the body, which doth or may produce other mischief in the body, from which there is greater danger of Life, than from the Thrush, which may indanger a Man's life by straitning the Jaws, and hindring breathing and swallowing. Its Cure therefore consists in the fol­lowing Particulars. 1. In correcting and amending the Acid Humours and Vapours that are brought to the Mouth, which not onely corrode its Superficies, but the inner Coat of the Gullet also, and produce infinite Ulcuscles. 2. In the Diminution, or Expul­sion of the foresaid Humours, when corrected. 3. In hindring a new production of them. 4. In clearing the Parts affected, in ripening and promoting the fall of the Thrush. 5. In cleansing and healing the Parts cleared. And although many have no regard to the Correction of the peccant Acid, because the know­ledge and doctrine of sharp things among Physicians hath hitherto been confused, one onely name of A­crimony being known to them; Yet now a two­fold, and indeed contrary sharp, being by me disco­vered, and now for some years confirmed by the Ex­perience of several, regard must be had to the force and Mischief of each Acid, and to the best correcti­on of it. And amongst many things which use to correct, or allay, either or both the Sharps, eve­ry thing deserves commendation in curing the Thrush, that concentrates the Spirits, and that does it gently; Amongst which are Crabs-Eyes, Pearl, Coral, White Earth, Bloud-stone, &c. which may be made choice of according to the Diversity of the Thrush, and the peccant Acids: For exam­ple; When the Mouth is not onely ulcerated, but the Tongue also chapt with extreme heat, and other parts in like manner affected, so that the very bloud runs out; Bloud-stone and Dragons-Bloud are pro­per. When a Thrush comes without such driness of Tongue, Crabs-Eyes and Pearl will be the best to temper and correct the Acidity, for they gently concentrate; and what I have mentioned hitherto doe good in asswaging and destroying the noxious Acidity. Bezoarticum minerale is also good. Medicines that purge Phlegm diminish, and carry off these hu­mours, when they are corrected as much as can be; for all pure Acid humours are found to be like Se­rum, and no wonder if they be joyned and confound­ed with other humours, as Phlegm and Choler; and so it is not absurd to carry them off by Spe­cificks. This is the reason why in curing the Thrush in Children we so frequently use Syrup of Cichory with Rhubarb; because Choler is also corrupted, and, by the very sharp Acid is made eruginous. To say nothing now, that all humours are purged by any Purgative, although I think that this or that hu­mour is more easily and plentifully purged by some certain Medicines, than by others. The producti­on of Acid humours, as it depends especially upon the use of Meats, Sawces and Medicines, that are Acid, as also of a cold Air, Grief, or Terrour of Mind; so this same production may be hindred, both by abstaining from such things, and by using those that are more oily, or more fat and spirituous, by the enjoyment of a more serene and warm Air, and by recreating the mind with gratefull and de­lightfull things. And, as the Original of Acid Vapours is owing to the effervescency, caused by a very sharp and powerfull Acid, so the vapours will be hindred, when the said vitious effervescency is corrected or hindred, both by things which con­centrate the potent and exceeding sharp Acid, and by things which otherwise take off its edge. Chalk, Dragons Bloud, and the like, do powerfully con­centrate a sharp Acid: Fat and oily things take off its edge, especially Opium, and all Narcoticks; but I prefer a Metallick, or Mineral Sulphur fixt, above all, in comparison of which, nothing I have hitherto tri­ed does so kindly, certainly, speedily and safely re­strain these vitious effervescencies. The parts af­fected may be cleared of the Thrush by maturation of it, and by its spontaneous Fall, promoted by Me­dicines, that kindly temper the Acid Acrimony, which accompanies it, and that draw the Acrimony to themselves, amongst which the juice of baked or boiled Turneps is deservedly commended with a little Sugar: Though less be needfull, when they are baked, for the juice that comes out of them then is in consistency and taste like a thin Syrup. The Patient must wash and gargle his Mouth and Throat often with this juice; or hold it a little in your Mouth and swallow it by degrees, which I prefer, because not onely the Mouth and the Parts therein contained have the benefit of it, but also the whole Gullet and the Stomach, which are not less troubled with the Thrush than the Mouth. And this should be done in Children especially, in whom we cannot expect Washing and Gargling. Besides, seeing this peccant Acid is kindly and effectually tempered by this juice, it is also corrected in the small Guts, and its ascent is hindred, and the Disease is sooner cured. Divers Syrups are also used, as solutive Syrup of Violets, Jujubes, Syrup of Li­quorice, &c. which I think doe good, in that they take off the edge from the noxious Accidity by the mucilaginous juice of the Plants of which they are made: I must needs commend the yelk of an Egg mixt with a little Rosewater and Sugar, for it draws to it the Acid humour that hurts the Stomach, and so by degrees clears the part affected, and promotes the fall of the Thrush: You may use it as the Tur­nep juice. Some commend Beer with slit Figs boil'd in it: Yet I have observed it ingratefull to some, because of its great Glutinousness. While the Thrush is ripening, that is, gradually falling [Page 18] from the Parts disaffected, a new Cuticle grows un­der them,Sylvius de le B [...]ë, Appen. Tract. 1. c. 5. Sect. 50. & 59. and covers the Parts: And although this follow of its own accord, and by the benefit of the Medicines now commended; yet it will be promo­ted by the Syrup of red Roses, Honey of Roses, and the like. Also Bole Armenick, Terra Lemnia, &c. ground fine with a little Plaintain Water and Sugar, may be held in ones Mouth, and the last part of the Cure, i. e. healing it, be hastened.

II. This is remarkable, that the cure of other Ulcers is promoted, when they are dried by de­grees, and little Humour comes from them: On the contrary, there is hopes in a Thrush, when it is moist,Idem. Ap­pen. Tract. 10. Sect. 2. 85. & 286. and when one spits as if he were in a Flux: For then the Thrush is cured with more speed and ease. Wherefore, as in curing other Ulcers, Medicines are commended, that temper the Acid Acrimony, and then dry; so Medicines on the con­trary, are good to cure the Thrush, which are gentle, and temper the Acid Acrimony; but they must also be moist.

Apoplexia, or the Apoplexy.

I. I Judge a Man may, nay must, according to Pru­dence and Art, let bloud in every Apoplexy, according to the Constitution of the Patient, and quantity of bloud in the Vessels, and that plentiful­ly. For so the Patient will endure the longer,Sylv. de le Boë, Pran. l. 2 c. 21. and the Apoplexy will be easilier cured, as experience te­stifies; without which I know not, whether upon consultation, one would not be afraid to let bloud in ancient people. When therefore the Physician dare not let bloud, experienced persons advise well, that Scarification should be used, or at least Cupping with Scarification, in stead of bloud-letting. And because so great a Man as Sylvius relies here altoge­ther on Experience, but remains dissatisfied in his Theory (as who pleases to consult the place cited, may see) I think it very pertinent to consider how exactly the excellent Wepfer hath laid down the The­ory: For, to discover so abstruse and latent Causes, he produces Anatomical Histories, or Observations, wherein the Phaenomena in Bodies of several, who di­ed of this Disease, are declared. In three that died Apoplectick, the extravasated bloud was either ga­thered here and there into great Clods, or had dis­coloured the substance of the Brain all over; in ano­ther a Floud of Serum had overflowed the Brain within and without. From these marks of this most occult disease thus discovered, the Authour con­cludes, the places principally affected are not the large Ventricles, but the medullous substance of the Cerebrum, and the Cerebellum, which is every way porous, and furnished with narrow passages, as well that Vital Spirits may flow thither from the bloud, as that the Animal may flow thence. And indeed he concludes, that the Cause of every Apoplexy wholly consists in these Two, i. e. in one alone, or both together, namely, either because the Afflux of bloud, through the Arteries to the Brain is denied, or the Efflux of Animal Spirits from the Cerebrum and Cerebellum, through the Nerves and Spinal Marrow, is stopt; or for both these causes. As to the First, he proposes how the bloud may be stopt three ways, i. e. First, Either by reason of the Obstruction of the in­ner Carotid and Vertebral Arteries, which happens in the bigger Vessels, and especially about the As­cent of the Cranium, from bloud concrete into gru­mous Lumps; or in the lesser Vessels, which cross the Brain, from their being stopt with viscous Mat­ter. Or Secondly, The influx of bloud is kept from the Brain, by reason of the Compression of those Vessels; which sometimes happens, when the Pa­risthmia, or Glands of the Neck are so swelled with Serous humours, that by pressing the Arteries that pass under them, they stop the passage of the bloud to the Head. Or Thirdly, The Afflux of Bloud may be hindred, when a Vessel being opened within the Cranium, the bloud is plentifully poured out, which should otherwise go to the benefit of the Brain. As [Page 19] to the other Cause of the Apoplexy, i. e. the hindring the spirits in the efflux, he reckons it is caused two ways, either by obstruction of the Origination of all the Nerves, caused by serous Matter; or by sudden Compression of the same, which either too great ga­thering of bloud in the Meninges, or in some certain parts of the Brain, or in its Ventricles, or some phleg­monous Disposition do produce. Seeing the Apo­plexy, according to the opinion of the Moderns, con­sonant to the doctrine of Hippocrates, arises from the stoppage of the Circulation of the bloud, or, as he speaks, from the standing of the bloud; and not, as Galen would have it, from the oppletion of the Ven­tricles of the Brain. All hope of safety consists in a speedy revulsion and retraction of the Matter from the Head; nor can there be found a Remedy, which can so speedily avert, derive, nay and evacuate the humours from the Brain, as Letting of bloud; there­fore we prefer it before all other means in curing the Apoplexy, and we think it proper for all Individuals, whether they be plethorick or no. The thing it self speaks, for several Apoplectick persons have been restored, and perfectly cured, onely by letting of bloud. When the bloud is taken from the Arm, that also in the Jugular Veins is drawn downwards, and then comes some portion of the Matter that is in the Sinus's, which although often it be phlegma­tick; yet it is found not without bloud, but may be removed and drawn back with it: And for that cause, unless some weighty reason hinder, we or­der large bloud-letting in Apoplectick persons, which may reach the humours above, and remove them, and sometimes we repeat it twice or thrice in each Arm, that the Veins being emptied on each side, may draw down the humours more powerfully from the Jugular Veins. Nor need want of strength be much feared, which is here oppressed, not wasted. As for cooling the body,Gr. Nyman­nus, Tract. de Apopl. p. 217. and thickning the humours, for which some reject bloud-letting, it is of no moment, for in the Apoplexy, nothing is more necessary than Revulsion and Turning the Matter away from the Head, and we must especially labour to doe it pre­sently, which Indication bloud-letting quickly an­swers; Wherefore, we may hope for more benefit from translation of the Morbifick Cause, than we need fear damage from cooling of the Body.

II. After the universal Plenitude is abated, by letting bloud in the Arm, the Parts especially affect­ed are to be relieved, for which purpose the best means is opening the Jugular Veins, out of which, by reason of their bigness, the bloud runs freely, which by stagnation oppressed the Brain; and by this discharge the Lungs are less oppressed, and when less bloud comes to them, they easilier deli­ver what they contain, to the Arteries and left Ven­tricle of the Heart, and the Current of the bloud being render'd more free, Coagulation is hindred, Obstructions are opened, and the Animal Functions are by degrees restored. Concerning opening of them, Experience seconds Reason; and these Veins may with more ease be opened,Fr. Bayle, Tract. de A­poplexia, c. 11. because in this Di­sease, they being swelled, there is no need of Li­gature, which in this case might doe harm, and therefore, after opening of them, must not be too strait, but Emplastrum Galeni must be applied to the Orifice.

III. When there is no Plethora, but great store of sharp humours, i. e. much sowre Melancholy, or its Exaltation hath caused the Apoplexy, which fore­going pains do shew, Hippocrates bids us use Fomen­tations before bloud-letting, nor without reason; for when the Veins are inflamed, dried and strait­ned, and the bloud by degrees coagulates, if we withstand these things by emollient, heating and attenuating fomentations, the bloud will run more freely, and with its rapid motion will wash what was beginning to coagulate from the Capillary Ves­sels dilated and softened, if presently after the Fo­mentation, or in the very use of it a Vein be open­ed: Otherwise, it is to be feared, the thinner part of the bloud may come away by bloud-letting, while the thicker, and what begins to coagulate, stays behind, which will hinder the effect of the Purge which should then be given. The Head espe­cially should be bathed, seeing in it there is the great­est danger from Coagulation; and next the Hypochon­dria. But both Fomentations and bloud-letting should be used in the beginning of the Disease, while the spirits are yet elevated.Ide [...].

IV. There is scarce a Practical Physician, but ad­vises bloud-letting in an Apoplexy caused by bloud. But I question whether it be proper in every Apo­plexy, as the excellent Nymannus thinks: For he, in favour of his Hypothesis, which takes every Apoplexy to be caused by Obstruction of the Sinus's, is very large in commendation of bloud-letting; which Hy­pothesis, since it does not hold true in every Apoplexy, as I have proved, the like and perpetual use of bloud-letting may be questioned. It's evident, when the Vertebral and Carotid Arteries are filled with fi­brous bodies, that bloud-letting avails little: And those Apoplectick persons are in the same Case, who have the Torcular stopt, seeing it cannot wholly be obstructed, except by some such like body. Nor likewise will bloud-letting be convenient, when Se­rum is gathered in the Ventricles, and Cavity of the Skull, since by it the immediate cause is not remo­ved; but the strength otherwise spent, is more weak­ned. In an Apoplexy, where a Vessel is broke, there is no hope; both because a quantity of bloud pour­ed into the Ventricles and Basis of the Brain, cannot be got back by Art, and because while it stays there it is coagulated. In that which is caused by Se­rum, gathered in the substance of the Brain, what good bloud-letting does, it is by accident, namely, as it abates the Turgescency of the bloud and Se­rum. Therefore this alone will not remove the A­poplexy, but we must also use things that spend and evacuate, the Serum, which moistens the medullous substance. But bloud-letting in an Apoplexy, cau­sed by a sudden Obstruction of the little Arteries, is good in many respects; for first the preternatu­ral violent motion of the bloud is stopt, which of­ten is the occasion of this Obstruction; and it runs in less quantity to the Brain; for instance, when the bloud is taken out of the Arm, no small porti­on makes to the Arm by the Axillary Veins, that so what was taken away may be supplied: Then the bloud hastens from the whole body, and from the brain, towards the Heart, to assist it, thus depau­perated and spoiled by bloud-letting:Wepferus, Exercitat. de Ap [...]plexia. p. 218. And the heart eased of the burthen wherewith it was loaded, both before and in the Paroxysm, disperses the bloud as it returns, more chearfully, in better order, and in quantity more usefull to the brain, which forceth and washeth out what caused the Obstruction and Trou­ble in the medullous substance, and drives it into the Capillary Veins adjoyning to the extremities of the Arteries.

V. Bloud abounding in the head cast a full-bodi­ed young man into an Apoplexy, with Trembling, loss of Speech and Ratling, three most dangerous concomitants of this Disease.Tulpi [...]. c. 7. lib. 1. Observ [...]. Wherefore speedily to abate these violent Symptoms, he was immediate­ly bled in the right Arm, but not bleeding so freely as his extremity required, the same Lancet was used to his left Arm, and when both had continued bleed­ing for some time, his Ratling evidently abated, he took his breath better, and quickly was cured.

VI. Cupping with Scarification should be appli­ed, not to the shoulders and back, as the Arabians ad­vise; because there is no remarkable Vein that reaches the Brain: But they should be stuck near the Jugulars, and under the chin, if possible.Rond [...]l [...] ­us. For these Topick Remedies should be applied, not one­ly upon the Veins that reach the part diseased, but upon the next and largest, if the constitution of the Part will permit it.

[Page 20]VII. A large Cupping-glass may well be applied to the top of the Head, seeing it draws the bloud out of the Sinus of the Dura Meninx, opens Obstructions, and raises the subsiding Brain. With which oppor­tune Remedy Fracastorius remembred how he had once cured a Nun, at that very time when he himself be­ing seised with a small Apoplexy,Horstius, in Probl. made signs by put­ting his hand to his Crown, that he would have the like remedy applied; but they that were by not un­derstanding him, and his Disease increasing, about night he died.

VIII. A Man of Threescore fell down drunk, and contused the hind part of his head, but his Skull was whole, and he was taken with a true and violent A­poplexy. While all despaired, I tried to cure him; I shake him violently, I give him a sharp Clyster, and make it work with a sharp Suppository, there was plentifull Evacuation. When his head was shaved all over, I applied a Cataplasm of Pigeon's Dung, Euphorbium Pyrethrum, and Mustard; hereupon many and great Blisters arise, out of which yellow matter ran. The next day I gave him of Species Hierae Dia­colocynthidos 2 drachms, of Castor half a drachm, of Rue one scruple,Heer; Obser­vat. 21. with Antapoplectick Water: I ap­plied Cupping with Scarification to his Shoulders; when the Blisters in his head ran no more, I raised new ones in his Neck, and thereabout, but onely with Cupping Glasses: And with some few more Remedies he recovered his health.

IX. Forestus lib. 10. Observat. 74. Condemns shaking of the body in Phlegmatick and Sanguine Apoplexies, and because the humours are thereby more stirred, he advises to use it with caution. Which not being observed in old Bokellus, l. c. the Imprudence of the Physician cost the Patient his life. Nymannus, in Chap. 39. of the Apoplexy, mentions a Patient, that had his end hastened by such unseasonable shaking. The shaking of the Womans body, mentioned by Forestus, as the Ail appeared, without using any thing before it, quickly cured her; which, in others, if it had not caused Death, it would at least have done hurt, and exasperated the Disease. But this shaking, and causing her to walk, seems therefore to have done good, because by shaking her body her bloud was stirred, which being provoked to more violent moti­on, forced that little, which caused the Obstruction already, and would have caused more, out of the lesser Arteries, and drove it farther into the small Veins; whereupon some portion of it, i. e. the more subtile, and the matter of the Animal spirits, was able to sweat through the Pores into the Substance of the Brain, and she at the first was able to walk again. Upon her walking more plenty of Vital Spirits suc­ceeded, while Nature used her utmost endeavour, being excited by stirring, to supply the Medullous Substances; and her bloud being not a little heated and made more subtile by walking, it could more rea­dily pass the Capillaries, and the Pores. But if the Paroxysm had had its original from the Serous Moi­sture poured into the substance of the Brain, it had not ceased so soon, and there had been other sym­ptomes, as Sleepiness, Vertigo, &c. Nay, by walking, being farther driven into the Medulla, Wepferus Exercitat. de Apoplexia. it would have bred a Palsie. In any Apoplexy likewise, bred of any other cause, it would hardly have done so much good. For either if it be caused by the Carotid and Vertebral Arteries being stopt, or by the Torcu­lar being stopt by pituitous Bodies, or by extravasa­ted bloud, in any of these cases more powerfull Remedies are necessary.

X. I cannot chuse but examine, as I have occasion, some sort of Remedies, commended by some, name­ly, whether they avail any thing in the Cure of the Apoplexy, or no. And in the first place pluck­ing the Hair, especially in the Legs, is commended, which, when the Patient wants sense, seems to me plainly ridiculous, for it conduces nothing to the re­moving any one cause of the Apoplexy; Bending the Fingers, and Twitching the Nose is of the same nature, nor do I see what good they can doe. And shaking the body, unless the head hang downwards, that so the humours offending may run out,Sylvius de le Boē. l. c. will con­tribute nothing but evident Damage to the Patient. So rubbing the extreme Parts with Vinegar and Salt, and Ligatures, will doe no good in any Apo­plexy. It is better therefore to abstain from such things, as have no use, nor doe the Patient any good.

XI. Some question Purging for two reasons. 1. Because Purges may not be given so long as there is crudity, according to Hippocrates and Galen's Max­ims. But without doubt, Crudity, properly so cal­led, which might hinder Purging, is wanting here; yet if there be any suspicion of a thick Humour, At­tenuatives may be mixt with Purgers, for the great­ness of the Disease, and the Imminence of the pre­sent Danger will not allow a Man wholly to intend the Preparation of Humours. 2. The way where­by Purgers should get into the Belly hinders Purg­ing, when one has not power to swallow without fear of choaking; Therefore a strong Medicine in a lit­tle Dose may be given, as Trochisci Alhandal, Diagri­dium, or Scammony with Castor, according to Trallia­nus; Rondeletius gives a drachm of Pilulae Cochiae dissolv­ed, according to Sennertus. Seeing the chief cause of the Apoplexy is Melancholy offending in quality, i. e. in excess of Acidity, or Acerbity, it is evident that the Humour, seeing it is preternatural, doth in­dicate its own Evacuation, and the rather, because of the present danger; nor can there be, even in a long time an alteration from Acidity to a more be­nign and spirituous, or Balsamick nature. And much more yet is Purgation indicated, if a Phlegmatick be joyn'd with the Melancholick Cacochymie. Nor doth Purgation allow any longer delay after bloud-letting, when the Plethory is taken from the whole, or from the head, than bloud-letting allows after the invasion of the Apoplexy, unless extreme faintness require time to recruit. Wherefore Purging is to be prescribed quickly without any respect to time: for unless while the bloud is made more fluid by Venaesection, and the obstructions of the Brain and Lungs are in some measure removed, or the Increase of them stopt, and while the spirits are yet eleva­ted, a Purge be given, when the Coagulation of the bloud is sensibly increased,Franc. Bay­le, Tract. de Apoplexia, c. 11. the Cohesion of the Parts of the bloud, and of the humours mixt with it, among themselves may be so pertinacious, as to bid defiance to all the virtue of Purgatives; Nay, the distribution of the Purgative, especially to the Parts affected, may be prohibited, if not wholly, at least in part, while the Passages are straitned by Coagulation of the Bloud.

XII. Nor may every Medicine be given, but a vio­lent one, such as the nature of the peccant humour, the disposition of the bloud, and the place it self do indicate. To the first Aphor. 9. Sect. 4. hath respect, You must purge Melancholick persons violently by Siege; for Melancholy will not stir, except it be forced from the other humours by a strong Drench. But the Co­agulated bloud, or next door to Coagulation, parts not easily with what it contains; but stands in need of a strong Ferment to make it boil, and endure a se­paration of parts. And seeing the humour to be re­moved is not in the Stomach, and first ways; but in the whole Mass of bloud, and in the Brain especial­ly, it is necessary that the virtue of the Purgative be diffused all the Body over, and reach the Head in its full force,Idem. to which a weak Purgative can never attain.

XIII. It often happens that the Faculties are so oppressed, that Purgatives cannot be brought in­to Act, and so operate nothing at all, which is an ill sign, and such persons usually die. But because, ac­cording to Celsus, Many things may well be done in a dan­gerous case, which should otherwise be omitted; therefore, when the foresaid Remedies avail not, we may come up to Antimonial Medicines, especially those that [Page 21] are less violent, such as Aqua Benedicta, made of Crocus Metallorum, which Purging both upwards and down­wards, brings away so great a quantity of Phlegm, not onely from the Stomach and lower parts, but from the Brain, that sometime the Patient is cured by this Evacuation: For I can truely testifie, that I saw a Nobleman cured of an Apoplexy thrice in two years by this onely Remedy. And although some condemn the use of Vomits in these cases; yet we must rather trust experience, which teaches us by daily experiments, how comatous Children are with more speed and safety cured by Vomitive Salt of Vitriol,Riverius. than by any other Remedy.

XIV. Here I must take notice of a frequent Errour in giving the Emetick Wine: For timorous Physi­cians prescribe it in too small a Dose, i. e. an ounce, or an ounce and half at most: and when they are fru­strated of the effect expected,Francisc. Bayle, Tract. de Apo­plexia, c. 11. they blame and dispa­rage the Medicine; whereas, to persons grown, and of any strength, it should be given to about three ounces in an Infusion of Senna.

XV. Walaeus saith, that in the Apoplexy Clysters may be so strong of Coloquintida, that they fetch the very bloud. Nothing hinders it, for Life must be saved, and this Damage may easily be repaired: And it may the better be done, if the Apoplexy were caused by too much bloud.

XVI. The Belly, for Revulsion sake, and to ex­cite the dull Faculties, may be provoked by admini­string sharp Clysters and Suppositories, whereas otherwise they would scarce go to stool. Suppo­sitories, because they provoke exceedingly, and are quickly made, and by reason Clysters cannot be kept for Senselessness, are very convenient, and should of­ten be repeated;Platerus. in which some burning hot things, since the Patient is without Sense, will doe no harm.

XVII. Some rub Hiera and Purging Electuaries on the Palate, to no purpose, in stead whereof it were better to use Confectio Anacardina, Idem. which inflames a little.

XVIII. We rub the Palate with things that bring away Phlegm; yet in that Quantity and Form, that if they should fall on the Aspera Arteria, they may not choak. Take of Mustard-seed, long-Pepper, Pellitory of Spain powdered a like quantity, mix them with as much Honey, juice of Rue, and Horseradish, as is sufficient to make them into the form of an Ointment. We leave out the Vinegar, which some put in, because it abates the strength of sharp things,Idem. as we see in Onions and Horseradish, if they be eaten with Vinegar.

XIX. Although the humour causing the Apoplexy cannot be cast out by Sneezing, because it is not con­tained in the Ventricles, yet in this most grievous and dangerous case, we must try every thing, that may remove the Matter. However, before Purg­ing, it is suspicious, because by the motion of the Head and Breast there is a greater afflux of humours. We may anoint the Nostrils with the same we a­noint the Palate withall.Platerus.

XX. Some provide Fumigations, but they are not at all to be commended, for they are dangerous to those that have difficulty of Breathing: It is better to hold a little Rue,Rondeletius. or Castor, or Galbanum to the Nostrils. Some highly approve a Fume of Amber made immediately; how destitute such are of Reason,Crato. learned Physicians can abundantly shew.

XXI. Things taken inwardly are not to be neg­lected in the very beginning, which encrease the Effervescency of the Bloud, refresh the Spirits, and raise the deficient Heat, in Plethorick persons espe­cially after bloud-letting, in others both before and after: The most spirituous, and which abound with volatile Salt, are best; Such as are several sorts of A­poplectick Waters, Spirit of Wine Tartarisate, distilled Oils of Anniseed, Rosemary, Sage, Cloves, and the like, with some Cephalick Water. Volatile Salts especially bring great and present benefit, that are separated and cleansed from all concretion of their Body, such as are the volatile Salts of Sal Am­moniack, Soot, Bloud, Hartshorn, and (which ex­ceeds them all) the volatile Salt of Vipers. These Salts quickly pass through the whole Mass of Bloud,Bay. Tract. de Apoplex. and render it more fluid, they infringe the force of Acids, and dissolve grumous bloud.

XXII. There are some who give Treacle or Mi­thridate to drink, but under a great mistake, be­cause all the virtue of the Opium will not be lost, though they be never so old. To say nothing of the many Astringents are in them, the strength where­of, although it be qualified, may be suspected; be­cause the humour, that is the cause of the Disease, and moistens the body of the brain, is more deeply impacted by these Medicines.R [...]nde [...]etius, It is better to give a Scruple or two of Castor, which, because of its un­pleasantness, less hurts the brain.

XXIII. When a continual Fever (for one Inter­mitting presages Death) accompanies the Apoplexy, as it should do, it needs no other help. If it be too low, it increases the Disease; if too high, it spends a Man. For a Fever cures no other Apoplexy,Crato in Consil. than that which comes of cooling the bloud, of crude humours, and a flatulent spirit. But here the Pru­dence of the Physician present is required.

XXIV.Holleriu [...] lib. cura [...]. Sect. 29. One taken with an Apoplexy was raised by rubbing and Motion; a Fever followed, gentle enough, but with a Delirium. Being negligently cu­red, and not raising what fell upon his Lungs, he died the ninth day after his Fever, and the tenth after his Apoplexy.

XXV. The question is, about the Posture of the Patient, namely, Whether he must presently be put to bed, or be kept up a-while: Some very carefully observe the latter, nor without rea­son, because certainly there will be a greater propensity to sleep in bed, and the bloud by the heat of the Clothes will be in a greater ferment, and the more it blazes, the more recementitious matter it discharges into the disaffected Brain: On the contrary, while the Patient is thin clad, and set in a Chair, the bloud runs slower, and while the Vessels subside, they seem fitter to receive the humours from the Head, than to send more thither. Wherefore, if the Patient have strength sufficient, perhaps it were better to sit up six or eight hours, till the flux of the morbifick matter be past, and the course of the bloud be made more sedate, by letting of bloud, and by other remedies carefully administred. But such as are weak, and of a tender Constitution, must, as soon as they are seized, be laid on a bed, either in it, or upon it. His posture must be not on his back, but with his head a little raised,Willis, c. de Apoplex [...]. and turned sometime on one side, sometime on the other.

XXVI. They that are stricken immediately with a deprivation of Pulse, and Respiration, and a lit­tle after, when they are cold, seem to have breath­ed their last, must not presently be laid out, and left destitute of the help of Physick. Moreover, were there no hope of life at all, they should not be buried for three or four days: Because such, sometime, either of themselves, or by the use of Remedies, come to life again: Which certainly comes to pass, not because the Vital Heat is kind­led afresh in the Heart (for it was never quite out) but inasmuch as the morbifick matter being discus­sed, or evaporated from the Cerebellum, the motion of the Heart, as that of a Clock,Idem. when the Weights are hung on, is set on foot again.

Appetentia nimia, depravata. Or, The Appetite too great and depraved.

I. FAt and clammy things stay too great hun­ger: yet they are more proper in the be­ginning, when we would provoke Vomit: but when the Vomit becomes violent, they must be omitted. We must also have a care lest we use them over much, and the Patient be brought into a contrary conditi­on; therefore, when the Patient begins to mend,Sennertus. Fat things, and which hinder concoction, must be omitted.

II. But Narcoticks are to be used with caution, and strong ones avoided, as the Infusion of Mad Nightshade made in Wine, which immediately de­stroys all appetite of Food in the most voracious per­son. Yet strong Wine and Brandy may be used, which, according to Platerus, take away hunger, not so much by heating, as stupifying: As Treacle and Mithridate by the same narcotick quality, he thinks, do take away the dog-like Appetite.Idem.

III. It is good in the depraved Appetite, some­times to cause a gentle Sweat. But we must have a care that the Patient be not stifled with Clothes; for it were better not to sweat at all,Fr. Syl [...] de le Boē, Tract. l. 1. c. 2. than too vio­lently; seeing that Sudorificks mend and correct the bad humours, though they expell them not. And I still prefer liquid and spirituous things before gross ones, though Antimonial, how dry soever, are ex­cellent in this case, to wit, Antimonium Diaphoreticum, Bezoarticum minerale, &c.

IV. Seeing a depraved Appetite differs, according to the diversity of the thing craved, I will here pro­pound its Cure onely in general, which consists in cleansing the Bloud, and other humours, by amend­ment whereof, the Pica ceases of it self.Idem. Prix. lib. 1. c. 2. I have by experience found, that Volatile Salts doe more good than all other Medicines I have yet tried, be­cause they provoke the Menses gently and kindly. The suppression whereof is often the cause of the Pica.

V. A Man troubled with the Itch, had also the longing Disease for three Months. He had the Haemorrhoids, and within two days the Disease left him:Rhodius. Centur. 2. Obs. 57. For the matter residing in the Veins affected the Nerves of the Stomach, which once removed, the party was eased of that trouble. Whence it is clear, that in this Disease the matter doth not al­ways stick in the Nerves.

Arthritis, Podagra. or, The running Gout, and Gout.

I. HIppocrates l. de Affect. Sect. 3. lays down the peculiar signs of the running Gout. 1. Pains of the Joints, with remarkable heat, not in them onely, but the whole Body over, insomuch, that men seem plainly to be in a Fever. 2. The nature of the Pains, which at the very first invasion are presently acute, although sometimes they are more moderate. 3. The running of the Pains from one Joint to ano­ther. The essence of the running Gout consists in these Three things, which distinguish it from the Gout: for in this the heat is not so evidently per­ceived at the first, as in the running Gout, nor till the corrupt Humour in the Veins be transmitted to the out-parts. And the reason of this difference ari­ses hence; because in the Gout the Disease is in the little Veins, and the inner parts; in the running Gout it lies outwardly, and nearer the skin. 2. In the Gout, the Pains at least in the beginning are not so sharp, and that by reason of the Matter, which, in the running Gout is thinner and sharper; which diversity of Matter indeed may be one cause, why the pain in the running Gout is accompanied with greater heat, than in the Gout it self. And there­fore the running Gout is reckoned among acute Di­seases: but the Gout among the Chronical, l. 1. de morbis, where there is no mention made of the Running Gout, it being an acute, not a chronical Disease. And then the running of the Pain from one Joint to another distinguishes them: For although the Gout pains pass from one Joint to another, they doe it gradually, and not so suddenly as in the Running Gout, in which, when the pain is at the height, it presently ceases, and takes another joint. Hippocra­tes saith, that Choler and Phlegm when they are mo­ved and settle upon the joints, are causes of the run­ning Gout. Where observe, that these Humours come not from any particular part of the Body, but from the whole: And in this lies the difference, the morbifick matter of the Gout comes not from the whole, but is cast off by some Principal Part to the Joints. And this is the chief reason why the Gout is a far more grievous Disease than the running Gout, and harder to Cure; and why the running Gout is sometime perfectly cured, and never comes again, which the Gout generally does.Hipp. l. de nat. hum. For whatever Diseases pass from a stronger part to a weaker are difficultly cured. Since therefore the Gout is of this nature, no wonder if its Cure be difficult; and the rather, because it is not easie to find what is the original of it, the Brain, or Liver, or what other noble Part; which being unknown, it is utterly impossible to cure the Gout, seeing the Part which sends the Humour should first be cured. Therefore, to the breeding of the Gout there concurs, 1. The fault of some Prin­cipal Part, which breeds, gathers and disposes of the morbifick matter. 2. The disposition of the joints to receive the Flux, i. e. a certain weakness, which when there is none, there is no Gout; but Diseases much of the same nature, and returning at certain times, as the Colick, Epilepsie, Asthma, Vertigo, Head-ach, especially the Stone in the Kidneys. Another difference of these two diseases, in respect of their material cause, is, that onely Choler and Phlegm con­cur to the breeding of the running Gout; but Hip­pocrates saith of the Gout, And indeed this is a disease of the Bloud in the small veins, corrupted by Phlegm and Choler. Whence we may gather, that Bile and Choler are carried from some part principally affected, by the Veins to the Joints; where, if they find the Bloud in the little Veins disposed to corruption, they cor­rupt it, and cause pain: If not, they use not to cause pain, because the Vessels do contain them; and unless there be distension, or the Humours be ex­travasated, [Page 25] there can be no solution of Continuity, which is the proximate cause of pain. Hippocrates treating of the Cure of them both, saith, And the same things are good for this, which are good for the running Gout. And the reason of their Convenience is, be­cause all of them have respect to the material Cause, i. e. Choler and Phlegm, which fall upon the Joints. But treating of the Gout he subjoyns; But if the Pain abide in the fingers, burn the Veins a little above the Knuckles, and you must burn them with raw fiax. He propounds not this Remedy in the running Gout, both because the remainder of its pains are not of any continuance,P. Martianus comm. in. cit. loc. p. 170. and because it lies not so deep as the Gout; as also because the continuance of the Pain argues great weakness of the Joint, which cannot be better help­ed than by burning, and it may alter the bad dispo­sition of the part, whereby the bloud therein con­tained is disposed to corruption, in which the Es­sence of the Gout seems to consist.

Sennertus, Epist, 1. cent. 1.II. We must rather take care of the Part that sends the Humour, lest it breed more, than think of outward Applications. All the stress of Precau­tion lies in this, in hindring the breeding of Serum, and the Ebullition of Humours. Crato in Epist. 52. hath these words; I think the whole of Precaution consists in a right course of Diet and Abstinence; also in washing the Head and Sweating.

III. That efficacious Remedies are required to cure the Gout, these following examples of persons cured do shew. A Turk at Constantinople (as an ocu­lar and credible witness, Mr. Arlaud a Watchmaker of Geneva told me) who had a confirmed Gout, re­ceived, according to the Custome of that People, five and twenty blows with a Cane upon the Soles of his Feet, as a Punishment for some Fault; he was deprived of the use of his Feet for some days, but he lived afterwards free from the Gout. Alterati­on of Diet is of great efficacy in this case. Mr. Franchet of Pontarlier in Burgundy, a Man well known to most, and to me formerly, who was banished his Countrey by an inrode of the Swedes, An. 1636. into Burgundy; having lost all, was forced to get his li­ving by carrying a Panier at his back to Markets and Fairs; and by this course of life he lived afterwards free from the Gout.

IV. The Patient was an Inn-keeper, the Physician was a certain Noble Knight, who bargained with his Host to Cure him of the Gout for 300 Florens, and having received a Bill under his hand, he un­dertook the Cure. The Patient was commanded to set his Feet upon a Block of Wood. The Knight had his Servants, who were stout Fellows, by, to hold him down, as he sate; The Knight himself with a Hammer, and six Nails, nailed his Feet to the Block; he left his Patient crying out most misera­bly, and took Horse. In the mean time he made In­quiry, whether the Gout came again, and after three years, when he understood it was not come, he re­turned to the Inn, and joking with his Landlord, Asked him, If he was Cured of the Gout? then he produced the Bill under his Hand, and demanded his Fee:Doringius, Cent. 2. E­pist. 46. His Landlord, though cruelly handled, a­greed to it. The Knight indeed tarried so long with him, till he and his Servants had spent the 300 Florens.

V. Lewis Noel a Surgeon of Geneva, Sworn Searcher of the Dead, who died almost Ninety years old, Anno 1678. had been long afflicted with the Gout. When he was laid up of a Fit, a Woman that was a Natural, called le Maistre, steals into the House, and catching him by his Feet, she hit one against the other violently, and would not leave off, till some came to his assistance, and turn'd his Tormentor out of doors. From that time he lived free from the Gout Twenty years and upwards, and made use of no Remedy.

VI. Bloud-letting, for prevention sake, must ne­ver be omitted in Plethorick Bodies, nor in those that fare well, and drink high. Spring and Fall breathe a Vein in the Arm; in Melancholick persons bleed the Haemorrhoids, in Women provoke the Menses if they be stopt. Galen confidently affirms, it is a present Remedy in sharp Pains, violent Defluxi­ons, and high Inflammations.Th. de May­erne de Ar [...]hr. p. 94. And if these three meet in the beginning of the Gout, Who will de­ny it in so urgent necessity? Since the Excellency of this Remedy is such, Can any other more certain, or of less dubious event be tried? Should not this, when pains are urgent, be preferred before Purg­ing?

VII. In a fresh Gout, or in one not very inveterate,Willis, cap. de Ar [...]hrit. in a hot constitution especially, to let Bloud in the beginning of the Disease, often gives relief. But in an habitual Disease, a cold Constitution, and old Age, it usually does more hurt than good; inas­much as it depresses the Vigour of the Bloud and Spirits that are not raised too high, without any diminution of the Morbifick Matter.

VIII. A Magistrate of Copenhagen, An. 1665. was ta­ken with a Second Fit of the Gout; his pain lay most in the Great Toe of his right Foot, and the Veins of that Toe strutting out very much; I order­ed him to be bled where his Pain lay most, the Bloud sprung out as violently, as if it had been out of the Median Vein.S. Paul Qua­drip. Botan. Class. 3. Bonus Hen­ricus. Afterwards I applied the following Cataplasm, and he was eased of his pain to the ad­miration of all men, so that within three days he was able to go abroad without any inconvenience. Take of fresh Allgood without the Flowers 4 hand­fulls, dry Flowers of Elder, Chamaemil, each 2 hand­fulls. Boil them to mash in a sufficient quantity of Elder-Water; add of Gum Caranna half an ounce, Camphire half a drachm. Mix them, make a Cata­plasm.

IX. A Vomit is an excellent Preservative against the Gout, which may be provoked by the help of Emeticks, where there is abundance of Humours; where the Joints are lax, and the Disease draws nigh, and when the Patient lives at large, and hearkens not to the Advice of Physicians, but indul­ges himself to the loss of his health. But there is another sort of Vomit, very usefull and less trouble­some. If you would understand the Reason of it, you must know, the Original of the Gout must not be derived from the Liver or Brain, but from the Stomach, the first source of the material cause, which is afterward diffused through the w [...]ole venous kind. According to the advice of the Arabians, it is conve­nient to be drunk once a month, which is not un­becoming, so that a Man turns not Swine, but re­tains his Reason. This Advice suits well wi [...] those Swill-guts, that swallow all things without scruple. Let such stuff their Guts once or twice a Month more than usual, with any sort of Food, but especi­ally Fat things,Th. de May­erne, Tra [...]. de Ar [...]hritide, p. 16 & 26. and then drink what Liquour they please in greater quantity than ordinary. Let them thus charged stand quiet for an hour, then walk gent­ly for half an hour, and then let them put their fin­gers in their Throats, to make themselves vomit, that, together with what they have gorged themselves, they may throw up that Ropy stuff which did stick to the sides of the Stomach; but is now washed off with drink, and mixt with the food.

X. A Purge should be given at the first, and in the very beginning of the Fit: for so the Humour that is flowing, and about to flow, will be diverted from the passages of the Joints to the Guts. And in this Pur­gation two very remarkable things should be obser­ved; first, not to Purge with a gentle lenient Medicine, that may rather stir than evacuate the Humours, and so throw them upon the Joints; upon which the Pain and Swelling use to increase; but with some smart Purge, that may evacuate the Humour, and avert it from the Joints. Secondly, to wrap some Defensative above the Knees and Elbows, that the flowing Humour, if any be on Motion, by taking of Physick may be intercepted, make an Ointment of Bole, Pomegranate Rind and Flowers, Root of [Page 26] Bistort,Riverius, c. 3. de Ar­thritide. Tormentil, Roses, with Whites of Eggs and Vinegar, which you may apply, and bind on with Swathing Bands and Roilers.

XI. As to Purging in the beginning of this Disease, it is a thing much controverted: while some Physi­cians do religiously abstain from all Purging before the Declension or end of the Fit; Others, on the contrary, give a strong Purge in the beginning of the Disease, and frequently with good success. The Reason of this Difference seems principally to con­sist in this, namely, that some Gouty persons have as yet a firm constitution and tone of Humours, and of the Vessels that contain them, and have Joints not yet weakned. Wherefore, as soon as the bloud or nervous juice are stirred by Physick, their Super­fluities and Recrements are not presently precipitated to the diseased Place; but by yielding to the irri­tation and motion of the Physick, they are discharg­ed into the Guts by the mouths of the Arteries, and the mean while the empty Vessels do draw and suck back some part of the morbifick matter.Willis, cap. de Arthriti­de. But otherwise, in tender and weak Constitutions, upon the least commotion of Physick, the Excrements of both these Humours fall upon the Gouty part. There­fore they, for whom a Purge is convenient, must be Purged with a strong and good working Medi­cine.

XII. Violent Purgers, although they seem to doe good, yet they strangely influence the Body, while they waste the Radical Moisture and Natural Heat, and much weaken the members of Concoction, so that within a little time there is as much Excremen­titious Humour bred, as was purged out; Where­fore men must have a care of frequent using such Me­dicines and unlearned Physicians.Crato.

XIII. Bayrus an Italian Physician extolls his Caryo­costinum to the Skies, the Simples whereof, since they are very hot, and that its operation is pret­ty violent, I scarce think it proper for dry bodies, but onely for those that are very moist and cold. And although he affirm, that when he was extremely af­flicted with the Gout, and the pain was very vio­lent, he hath taken this, and always recovered his Feet, so as to be able to walk to the Close-stool without leading; I do verily believe him, as be­ing a learned Physician, and a well-experienced old Man: Yet it is clear, that Gouty persons should not be purged with their Pains upon them,Th. de May­erne, in Tract. de Arthritide. p. 36 & 49. or if they be, it must be done to purpose; otherwise, you certainly exasperate the Disease. This danger will be prevented, if the same day you take your Purge, you take at night a dose of Laudanum: by which means the fury of the Humours will be laid, the Spirits fixt, and when the Cause is diminished, the Ail will abate, and Nature will be restored to her former Liberty.

XIV. But it is to be observed, that I never use any Purge, wherein there are Hermodactyls, when the Patient should be preserved from the Gout. For there is no need to fetch the Humours out of those parts into which nothing is fallen (except it be an old and knotty Gout, which, by frequent fits hath a return of its pains) and therefore let us be content with things that cleanse the Veins and Head,Spigelius de Arthritide, p. m. 80. if it be in fault, after gentle Purging.

Heurnius, meth. med. l. 2. c. 2 [...].XV. In the Gout we must not lightly give Cassia; for part of it turns into nourishment, and so renders the parts lax and liable to defluxions.

XVI. Diureticks are good in the Scorbutick run­ning Gout: for nothing more plentifully expells by Urine the Serous Humours, contaminated with a Scorbutick Ferment, which stirs up the Archaeus to that Affection: especially when these Specificks are An­tiscorbutick,Frid. Hofm. m. m. l. 1. c. 12. which their effect doth clearly shew; for after the use of them, the Urine which before was clear, is made thick.

XVII. Whether Salivation (which is an univer­sal Evacuation) be proper in the beginning of a Fit of the Gout? I Answer, I have never made trial of the thing, nor have I any reason, which might per­swade me to use it, but many not to use it. For Sa­livation cannot be raised presently, but after some days, which here would be to no purpose. And Sa­livation proceeds slowly, here is need of speedy Eva­cuation; And if one endeavour to promote over­much, you endanger your Patients life.Sylvius de le Boë, Tract. 8. Sect. 171. & se­quel. Yet I do not deny but it would be good sometime for Gouty persons, that are clogged with much viscid Phlegm: but then it must not be in the fit, but when they are free of it, and while they are strong, so that they neglect not other things, but have respect to other peccant Humours.

XVIII. Dr. Willis, cap. de Arthritide, relates a Case of a Gentleman, who, upon his being cured of the Stone in the Kidneys, was seized with the Gout. To cure which, he was advised to drink his own Urine. In a Month or two his Gout left him: but the Stone in his Kidneys returned again, and in a short time he died of a total Suppression of Urine. When he was opened, they found his right Kidney quite wasted, and in his left, between the Cavity and the Passage, a great heap of Gravel and small Stones. The Dr. imputes his last misfortune to his drinking his own Water.

XIX. Powders of Bones, Stones and Shells, as al­so of sharp Vegetables, which are called the Alexite­ria of this Disease, are good in a fit of the Gout: for they conquer the Morbifick Particles, and by fer­menting with them, as it were mortifie, and then they cast them out so conquered by Sweat and U­rine.Willis.

XX. Sweats after Vomiting and Purging are com­mended by some in the method of Cure. Indeed, when the Heat is cooled, and most part of the sym­ptomes gone, it were very proper to draw off the relicks of the matter in the Habit of the Body, by Sweat, or insensibly, that the Cure may be accom­plished, the Swelling disperst, the part asswaged, and made more nimble and fit for motion. But here you must take special care: for there is great hazard in Sweats given unseasonably, lest the Parts grow more inflamed, the Salt residing in them be made more fixt, and its passage thence more difficult, or its concretion into insuperable knots more easie. If therefore the Humour causing the Fit be thin enough and moveable,Th. de May­erne, Tract. de Arthriti­de. MS. so as it may be drawn off at one essay, and leave no dregs or tartarous matter behind, but that most part of it pass by sweat, you may give sudorificks; but they must be very gentle, of the Decoction of Groundpine or Burdock, and you must use such a Regiment as the Remedy may prove of use, which otherwise will be very ha­zardous.

XXI. A Milk Diet challenges not the lowest place among Alteratives, namely, that the Patient use no other food for three or four Months. Let him drink new milk Morning and Evening, about Noon, and at other times he may eat it boyl'd with White-bread, Barly, or Oat-meal. I have known some receive remarkable benefit from this sort of Diet; but others, who upon the use of Milk have grown worse, and their Gout not at all cu­red; but have contracted great Obstructions of their Bowels, and a Cacochymy.Willis, cap. de Arthriti­de. Therefore this Course should not be entered into without the Advice of a prudent Physician and diligent observation whether it agree or no.

XXII.Fortis, Cors. 66. Cent. 4. Preparatives should respect the Humours wholly, and not the Joints (the preservation where­of must be endeavoured, seeing they contain no matter at present) otherwise the preparatives would rather carry matter to them.

XXIII. When the Defluxion is violent, and the Pains intense, nothing is more gratefull and proper to cause sleep (which stops all Evacuation, except Sweat) nor is there any thing comparable to Lauda­num, 2, 3 or four grains of which may be given at the hour of sleep, for several nights successively. In [Page 27] time of Pest the Humours concoct,The. de Mayerne, Tract. de Ar­thritide, p. 41. and Nature re­covers strength, and makes head against the Adver­sary. There are other Narcoticks succedaneous to Laudanum, but it has the preheminence above all the rest.

XXIV. Alterative Medicines, by the Ancients called Gout Antidotes, are of excellent use, and taken for a long time, together with an exact ob­servation of the six nonnatural things, often give great Relief. Those Medicines are reckoned the chief of this nature, which are endued with a Vo­latile Salt, or Balsamick Sulphur, inasmuch as these do exalt the fixt Salt, and they reduce the Sowre: Moreover, bitter things, such as the leaves of Ger­mander, Groundpine, Centaury, the roots of Gentian, Aristolochia, &c. (for these things are approved by ex­perience in this Disease) seem to be proper for this reason;Willis, c. de Arthritide. because they help concoction, and Chy­lification, and restrain the Salino-fixt feculencies, that they be not carried to the Bloud.

XXV. Although there be danger in all sorts of outward Applications; in Repellers, for fear of a recourse of the Humours to the noble parts; of in­crease of pain, when they are return'd inwards, and of the concretion of them in the Joints; in Diapho­reticks, lest when the thinner parts are dispersed, the rest of the Humour settle deeper in the part; of Anodynes, for fear of Relaxation; and of Narco­ticks, for fear of weakning the Parts: Yet Anodynes seem most necessary; because Pain, that most grie­vous Symptome, weakens, draws the Humours to the Parts affected, causeth want of sleep, restlesness, a hot intemperature in the Bowels, and a Fever in the Bloud; it dejects the Appetite, spoils Concoc­tion, and breeds bad Bloud. Hence arises an in­crease of bad Humours, and of the Morbifick Cause, hence vapours arise to the Head, and obstructi­ons in the Bowels, which are succeeded by various Symptomes, especially by a decay of the innate Heat. Now by Anodynes the parts are mollified, and the Humour which lay deep in the Joints, is drawn outwards, whereupon the pains of the Gout, which before were most violent, abate, as the part swells. But the greatest caution imaginable, and the advice of a skilfull Physician is requisite, who must consider the time of the Disease, and its Matter: for what things are good in the beginning of the pain and defluxion, are not good in the state, nor are the same things proper in the declension, or con­clusion of the Gout; and so, either through unsea­sonable use of Remedies, or variety of Matter, fre­quently that which hath done one Man good, does another Man hurt.

XXVI. Most Physicians condemn Narcoticks and Stupefiers; because safer means are not wanting, whereby the violence of the pain may be asswaged: And in their opinion it were better not to stop mens roaring, rather than to weaken them with Medicines of that nature. A pretty plausible pre­tence! As if the patient and his parts were so weak­ned thereby. Narcoticks indeed taken inwardly, if they be not dextrously administred, are not void of hurt; for, given unseasonably, they cause a Conge­lation, if I may so say, and immobility of the spirits, not by cooling, but by fixing, which is the product of a luxuriant Sulphur in remedies of that nature, and upon the immobility of the Animal spirits their influx is stopt, and Death with suffocation doth fol­low. But if sharp pain do rage, you need fear no such thing from the outward Application of such Re­medies; since it is certain, that one dayes pain wea­kens and hurts the Nerves more, than six days such outward Application. But suppose a little deadness should remain, there are a thousand Remedies to take that off; as Baths, Fomentations, Plasters, Stoves, and other things, which quickly doe it. Besides a Narcotick mixt with its Antidote becomes harmless. All Authours almost in violent Pains of the Gout, make use of Henbane: Some go as high as Opium: If the Spleen be very hard, we apply Hem­lock without any danger; nay, it is applied to the eyes, so near the Brain, with great success. And I, being backt with good success, make no scruple to apply both the said plants, with Cassia, Camphire, Saf­fron, Sperma Ceti, and Man's Grease,De Mayerne de Art [...]iti­de, p. 41. which is a most excellent Anodyne in this Disease.

XXVII. Hippocrates bids men, before Universals, al­lay the pain by outward Application, which our Age so much dreads before general Evacuation: but this is no new thing with Hippocrates, who knew how dangerous a purge was, if given in the extremity of pain, as appears from 4. acutor. vers. 396. He orders the pain in the running Gout and Gout to be mitiga­ted with things actually cold. 1. Because they quench the actual heat of the running Gout, and asswage the Acrimony and Fluxibility of the Hu­mour in both Diseases, and they dull its activity and violence in acting, from which all sense of pain arises. 2. Coolers, by strengthning the innate heat of the part affected, do better qualifie it for Coction and Expulsion of the Humour. 3. They hinder the generation of a Callus in the Joints, which hot things often promote, by evaporating the thin part of the Humour, and baking the thick. I know the Vulgar believe the contrary, who are afraid to use actual coolers in the Gout, or any pain of the Limbs: But they are deceived;Prosp. Mar­tianus, Com. in v [...]rs. 37. Sect. 2. lib; de Affecti­bus. for although Cold do harden as well as heat, yet the hardness caused by Cold does not in our case harden into tophous knots, because it still retains its proper moisture, although congealed by Cold, which at length, by application of heat, dissolves, and recovers its for­mer softness. But whatever is hardened by heat, it is deprived of its proper moisture, the heat consu­ming and exhaling it, so that a hardness is introdu­ced, which is not easily removed, such as the hard­ness of those Tophi, which the Joints of Gouty per­sons contract.

XXVIII. When the Fit is over, it is usual to ap­ply Diapalma Plaster, which indeed is an innocent thing, but of small comfort. There are many better things extant, such as Emplastrum de Hermodactylis, de Mi­nio magistrale, they call it Emplastrum Sandicis: Gum Cu­ranna, and Tacamahaca dissolved in Spirit of Wine, are of singular efficacy, Emplastrum Betonicae, &c. For they that have undergone an Assault of the Gout, have occasion for the use of some remedy, that by its drying virtue may strengthen the nervous parts, whose tone and native temperament may be preser­ved by such things. Aegineta, a learned Physician, rubs the Joints of Gouty persons with an Oint­ment of Oil and Salt. It is good when the pains are over, but best of all to prevent them. There is an Oil made of Winter-Gilliflowers,De M [...]yerne Tract. de Arthr. p. 44. which is much bet­tered by addition of the Flowers of Mullein. By the use of it, a Physician belonging to the Duke of Bul­loin got such strength in his Joints, that after he had been 30 years troubled with the Gout, and he had lived as many more, 10 years before his death (he lived above an hundred) he walked as stoutly, as if he had never had a Fit of it.

XXIX. Such Discutients are requisite, as may not onely open the Pores, that the Serum may evaporate, and the Bloud be made to circulate, as in a Phlegmon and Oedema: But such, whose Saline parts designed to oppose those Saline ones of the Arthritick Mat­ter, may either, by mixing with them, bring them out, or by precipitating them, keep them from those painfull Effervescencies. Wherefore, in this Di­sease, when Fomentations, or Cataplasms of Cha­maemil, Mallows, Linseed and Faenugreek, doe little or no good, nay often a great deal of hurt, by re­laxing the Nervous parts; some Dissolutions, or stil­latitious Liquors of Sal Ammoniack, Sea Salt, Ni­tre, Vitriol, Quick-Lime, and the like, which, in other Swellings, or Pains, always doe hurt, are usu­ally of great benefit. Several such Liquors to be applied to the part grieved in a Fit of the Gout, [Page 28] and which have been tried by experience,Willis, cap. de Arthriti­de. are pre­scribed by Quercetan, Hartman, Crollius and others.

XXX. He does but expose himself, that engages to dissolve the Knots in the Gout; for if they are grown hard, it is onely labour lost, to try any such thing. But while the Matter is but in Gelly, I should not think it utterly impossible, if we could get a Remedy that would reach it, and that bore any proportion to it; Such is Sal Ammoniack both natural and artificial, yea, that which is made of Smoak and Urine. But volatile Salt of Urine depu­rated by many Sublimations, exceeds in virtue all other remedies. The Pores of the Part being sufficiently opened by a Bath or Stove, or over the steam of a Lixivium made of the yellow dross of Re­gulus of Antimony (whose Sulphur draws most pow­erfully, nor is it less potent in its dissolving virtue.) Take Salt of Urine, mix it with the best Spirit of Wine,Th. de May­erne, Tract. de Arthriti­de, [...]. 47. of this mixture make a Fomentation. Oil of Arsenick digests and draws outward, nor is there for this purpose a Remedy to be compared with it, if a little of it be mixt with May Butter, or some other Fat, anoint the Part gently. Sometime such swel­lings are dispersed by the sweating out of a cer­tain viscid matter, like Fat; and Blisters often arise weeping watry drops, not unlike Eggs when they are rosting. The main point in the use of this Re­medy, is not to make too much haste; for often the effect shows not it self, till the twelfth, or fifteenth day, or longer.

XXXI. There are great Physicians, who singularly commend Cabbage, and advise those that are sick of the Gout, while their Pain is upon them, onely to eat Cab­bage. This indeed is certain, that Food, the less nou­rishment it affords, the wholsomer it is: Therefore they that are troubled with the Gout, must abstain from Hens and Capons,Crato. which breed much nourish­ment and bloud.

XXXII. A Man should, without doubt, abstain from Wine, and all things that supply such a Tartar and sharp humours; For when I was once troubled with the Gout, and had read several Authours upon that subject,Sennertus, Epist. 1. Cent. 4. I observed they all agreed in this, that all hope depends more on a good Diet, than on Medicines.

XXXIII. Let the Gouty person take a turn at least in his Chamber, although stirring want not pain: for heat of the Part, and attenuation and resolution of the matter follows Motion. So exer­cise will be good for prevention, but it must be mo­derate.Forti [...]. Con­sul [...]. 73. Cent. 4. For, Paul, l. 3. c. 75. saith, that abating of ones Diet, and as much exercise as is sufficient, pre­vents the Gout.

XXXIV. First of all Bloud-letting, what great things soever it promise, either in evacuating the humours, that stand ready and upon the point to descend; or those that are already got into the Joints; yet it is manifestly repugnant to that Indi­cation, that the antecedent cause, which is Indige­stion, arising from depravation or defect of spirits (whom taking away of bloud farther diminishes and oppresses) doth challenge. Bloud-letting there­fore may not be used, either to prevent the Fit, that is feared, or to mitigate it, when come upon a man, that is, in the elderly sort. For though the bloud that is taken away, be like theirs that are sick of a Pleurisie, or Rheumatism, for the most part; yet it is observed, that Bloud-letting does harm as re­markably in this case, as it does good in those other two. For if bloud be taken away in the Intermis­sion, though never so long after the Fit, there is danger, lest a new one should come on by the agi­tation of the Bloud and Humours, that may prove longer than the former, and be attended with more enormous symptomes, the strength and vigour of the bloud, by help whereof it might stoutly cast off the matter of the Disease, being thereby abated: And this Inconvenience befalls a Man, if he let Bloud in the beginning of a Fit. If a Vein be opened present­ly after the Fit, there is great danger, lest nature, while the bloud is yet languid, and has not recover­ed its strength wasted by the Disease, be so weakened and sink by this wound unseasonably inflicted,Sydenham, de P [...]gra, p. 33. that way be made for a Dropsie. Nevertheless, if the Patient be young, and heated with hard drinking, Bloud may be taken away in the beginning of the Fit: but if he use constant Bloud-letting in the following Fit, the Gout will grow inveterate, even in a young Man, and will increase its Empire, or rather its Tyranny farther in a few years, than otherwise it could have done in a great many.

XXXV. Then as to Purging, whether upwards or downwards, we must take notice, that since it is the inviolable law of Nature, interwoven and joyned with the very essence of this Disease, that the mat­ter of the Disease should always be cast upon the Joints; all that Emetick or Cathartick Remedies can doe, will be onely to recall the Peccant Matter, Nature had thrust out to the extremities of the body, into the Mass of Bloud, whence it comes to pass, that what ought to have been thrown upon the Joints, falls perhaps on some of the Inwards, and so he who was in no danger, is like to lose his life. Which is frequently observed fatal to them, that accustom themselves to Purging Medicines, either to prevent the Gout, or (which is worse) to ease the Paroxysm. For when Nature is put out of her own way, where­by as the best and most secure, she sends the Morbi­fick Matter to the Limbs, while the Humours are invited inwards to the Intestines, Patients, instead of pains in the Joints, of which they have either none, or but a very little, are almost killed with sickness at the Stomach, Griping in the Guts, Fainting, and a long train of anomalous Symptomes. Indeed, I am fully perswaded, being so convinced by constant and often repeated experience, that all Purging, as well by Lenitives, as by stronger Medicines, such as are usually designed to purge the Joints, is exceed­ing hurtfull; whether we Purge in the Paroxysm, to diminish the peccant matter, or in the end to dis­sipate the relicks of the Disease; or in a perfect in­termission and good health to prevent the coming of a Fit. For I have experienced it both in my self and others, that a Purge given at any of these times, is so far from answering our ends, that it brings the very mischief upon us, which it should keep off. For first, a Purge given while the Fit rages, inter­rupting Nature as she is busie in separating the mor­bifick matter, and discharging it upon the Joints, hath sometimes raised a great disorder in the spirits, whereupon the Fit not onely grew stronger, but the Patient was brought into manifest hazard of his life. Again, Catharticks used in the end of a Paroxysm, when they should have carried off the relicks of the Disease, onely did this, they brought a new Fit, as severe as the former; and so the Patient flattering himself with vain hopes, brings upon himself those evils, which he had never suffered, had he not again put the humours on a fret. Which Inconvenience I my self have found, preposterously imploring Physick Art's aid, to throw off; as I thought, the relicks of my Disease. Last of all, as to Purging repeated at certain Intervals, and in perfect health, that we may obviate the Paroxysm, and stop its en­trance; although, it must be confessed, there is not so present danger of inviting a new Fit, as was in the former case, when the Patient was not quite out of Gunshot; yet at this time also it breeds a Paroxysm, and that for the causes above-mentioned; with which mischief, if it do not presently punish the Patient, yet it does not at all free him from his Disease, how constantly soever, and at due Intervals, he take this or that Cathartick. Nay, I have known some sub­ject to this Disease, who paid their devotions to Health by a Purge, not onely Spring and Fall, but once a Month, yea, and sometimes every week, yet not one of them escaped the Gout: which after­wards, for the most part, handled them more cruel­ly, than if they had abstained from all Physick. For [Page 29] though the said Purging may carry off some part of the Continent Cause; yet since it conduces not one jot to strengthen concoction (from which it is so far, that it weakens it, destroying nature by a fresh wound) it is onely opposed to one Cause, and has not virtue sufficient for the Cure of the Disease. Be­sides, we must note, that through the same defect of spirits, whereby coctions are vitiated in people sub­ject to the Gout, the consistence of their Animal spi­rits is rendred less firm and lively, whereupon it is presently scattered and disturbed by any cause which does a little more violently shake and disturb either mind or body, and therefore is very fleeting and dis­sipable, as it often happens to them that are either hypochondriack, or hysterick. From which propen­sity of spirits to disorder it is, that the Gout com­monly follows any the least evacuation. For when the tone of the body is destroyed, which the firmness of spirits, while they remain in their vigour, pre­serves well compact and lively, the peccant matter, as having broken all bounds, is at its liberty, and upon this wound's being inflicted on the body,Idem, p. 35. a Paroxysm presently arises.

XXXVI. But this method, as pernicious and hurt­full as it is, has got some Empiricks no small credit, who all of them craftily conceal the Purging Me­dicine which they make use of. For it must be ob­served, that the Patient, while he is in his Purging course, has little or no pain; and if the Course can be carried on for some days, and no fresh Paroxysm supervene, the Patient will be quickly well of that wherewith he is at present held: But then he must pay severely for it afterwards, by reason of the dis­order, into which the said disturbance of the Hu­mours hath precipitated nature.

XXXVII. Then, evacuation of the peccant matter by sweats, though it doe less hurt than the foresaid evacuations, yet it is clear that it does harm. For though it do not retract the matter of the Disease into the bowels, but on the contrary, force it into the habit of the body, yet however it does harm upon these accounts: First indeed, because out of the Fit it forcibly thrusts out the Humours that are yet crude, and not so ripe as that they ought by right to be separated into the limbs, and so soli­cite a Fit before the time, and even against Nature's mind. Then because in the Fit provoking of sweat doth force too violently the morbifick matter upon the part affected, and besides causes intolerable pain; and if the quantity of peccant matter be lar­ger than that the part affected can admit it, it pre­sently throws it on other Joints, whereupon there is a commotion and a great ebullition, or exestua­tion of Bloud and other Humours; But if the bo­dy abound with a serous floud that is apt to breed the Gout, there is fear of falling into an Apoplexy. Wherefore, in this Disease, like as in all other in which sweats are raised by Art to cast out the mor­bifick matter, and do not flow by the duct of Nature, it is exceeding dangerous to raise them so violent­ly, or beyond that degree of Coction, to which Hu­mours to be evacuated of themselves are arrived. And that most famous Aphorism of Hippocrates, Con­cocted, not crude things, must be Purged; has place as well in provoking Sweats, as in giving a Purge. Which is clearly evident from the Sweat that concludes the Fit of an Ague; which, if it be moderate, and an­swering exactly to the quantity of febrile matter, concocted by the preceding Fit, does remarkably relieve the Patient; But if Sweat be promoted be­yond Nature's measure, by keeping the Patient con­tinually in bed, then a continual Fever arises, and a fresh fire is kindled, whereas what was burning be­fore, ought to have been put out. By the same reason also in the Gout, that gentle dew, which, for the most part arises in the morning of its own accord, after every lesser Paroxysm (several of which make one great one) mitigates both the pain and restles­ness, wherewith the Patient contended all night; but on the contrary, if this gentle dew, that is fleet­ing of its own nature, be provoked longer, and more violently, than the proportion of peccant matter al­ready concocted by the last paroxysm, will bear,Idem, p 4 [...]. the Disease is thereby enraged. Therefore in this, as well as in all other Diseases, which I have had the hap ever yet to see, the Plague onely excepted, it is not so much the Physician's, as Nature's Province, to raise Sweats: because it is no way possible for us to know, how great a share of this same matter is already prepared to undergoe separation, nor by consequence, what measure we ought to observe in provoking Sweat.

XXXVIII. Whatever things therefore help Na­ture, in performing her Offices aright, where by strengthening the Stomach, that it may concoct food aright; or the Bloud, that it may duely assimilate the Chyle carried into it, or by corroborating the solid parts, that they may better convert the Juices designed for their nutrition and augmentation, into their proper substance; Finally, whatever things preserve the divers organs of Excretion and Emunc­tories of the body in that state, as they may be able to void the Recrements of each part in their due time and order; these, and all such things, are good to fulfill this intention, and are properly called Di­gestives, whether they be Medicines, or Diet, or Ex­ercise, or any of the sex res non naturales. Such Me­dicines are all in general as heat moderately, and are either bitter, or gently pierce the tongue, as being things that are gratefull to the Stomach, cure the Bloud, and cherish and comfort ot [...]er parts; such are for example Angelico and Elecampane Roots, Leaves of Wormwood, lesser Centaury, Germander, Groundpine, &c. Also common Antis [...]orbuticks may be added, as Horse-rhadish root, leaves of garden Scur­vigrass, Water-Cresses, &c. But since these sharp and pungent herbs, how gratefull soever to the Stomach, and conducing to it, in helping Digestion; do notwith­standing enrage the matter that hath been a long time bred, and encrease it, they must be used very sparingly, in comparison of those, that by their gen­tle heat and bitterness strengthen the Stomach, and render the mass of bloud more brisk and lively. Several sorts of these curiously mixt, do better concoct the Humours, than any simple taken out of any one Tribe of them. For although, when we have occasion for the virtue of any Specifick Medi­cine, the rule hold good, The more simple the bet­ter; yet when we propose to our selves, to cure our Patient by answering this or that Indication, every several Ingredient contributes its share to the cure of the Disease: And in this case, the greater the number of Simples is, so much the more powerfully the Medicine will operate. Therefore, out of the Medicines mentioned, and those of the same nature, several Recipe's tending to this end may be made. I prefer the form of an Electuary in the manner of Theriaca Andromachi, before all others, as excelling in virtue; because the mutual confermentation of all the Simples increases their virtue, producing as it were some third thing, which, in equal quantity, is of more virtue in them conjoyned, than in any one of them. And for the sake of young Physicians, I dis­cover the Remedy I my self make use of, which is compounded after this manner. Take of the roots of Angelico, Calamus Aromaticus, Masterwort, Elecampane, Leaves of common Wormwood, lesser Centaury, white Horehound, Germander, Groundpine, Scordium, common Calamint, Feaver­few, Meadow Saxifrage, St. John's Wort, Golden Rod, Mother of Time, Mint, Sage, Rue, Carduus Benedictus, Southern­wood, Flowers of Chamaemil, Tansie, Lily Conval, English Saffron, Seeds of Treacle-Mustard, Garden Scurvigrass, Caroway, Ber­ries of Juniper, of each a sufficient quantity. Let all the Herbs, Flowers and Roots be gathered at those seasons, when they have the most virtue. Let them be dried and kept in Paper Bags, till they be fit to Powder. Let 4 ounces of each be well mixt, and made up with a Syrup of Canary Wine and Sugar, into the form of an Electuary of a due consistence. Let him take 2 [Page 30] drachms morning and evening. Or in defect of this, let him use this following, Take of Conserve of Garden Scurvigrass 1 ounce and an half, of Roman Wormwood and y [...]llow rind of Oranges each 1 ounce; of Candied Angelico, pre­served Nutmeg, each half an ounce; Theriaca Androma­chi 3 drachms; Pulv. Ari. Comp. 2 drachms, with a suf­ficient quantity of Syrup of Oranges; make an Electuary. Let him take 2 drachms twice a day, drinking 5 or 6 spoonfulls of the following Scurvigrass Water up­on it. Take of Root of Horse-Rhadish sliced 3 ounces, Gar­den Scurvigrass 12 handfulls, Water Cresses, Brooklime, Sage, Mint, each 3 handfulls; Orange Pills, No. vj. Nutmegs bruis­ed No ij. Brunswick Mum 12 pounds, distill them in the com­mon Organs, till onely 8 pounds of Water be drawn off for use. Of all Medicines commonly known, which help con­coction, Theriaca Andromachi is the best; but because it is made up of very hot Simples, and besides abounds with Opium, the abovesaid Electuary may more con­veniently be made of the chief heaters and strength­ners, with Sugar dissolved in Wine, which will be more gratefull to the Stomach than Honey is. We must take care in the mean time, that those Sim­ples be made use of, that are more gratefull to the Patient's palate; for, seeing they must use it a long time, i. e. almost as long as they live, it is very con­venient,Idem, p. 49. that it be not ingratefull to the Palate.

XXXIX. This must be observed above all, namely, that all Digestive Remedies whatever, whether they consist in Medicine, or Diet, or Exercise, must not be used by the bye, but constantly and daily with all di­ligence. For since in this Disease, as also in most Chronical ones, its cause is passed into an habit, and as it were a new nature; no wise Man can think that any light and momentany alteration, brought upon the Bloud and Humours, by any kind of either Medicine or Diet, can attain the scope of Cure; but the whole habit of the body must be turned another way, and the whole Man must as it were be new forged again upon the Anvil. For neither is the case here, as in some acute distemper, when he that was as well as heart can wish but even now, is on a sudden taken with a Fever, and sinks down, as if a Bridge broke under him, from a very good state of health, into a most dangerous disease. The state of the Gout is far otherwise: When a Man, by leading an intemperate life for many years one af­ter another, omitting his accustomed exercise, con­suming in sloth and idleness, or by too much study and unremitted intention of mind, and other errors of life, hath endeavoured, as it were on purpose, that the various ferments of the Body should be pervert­ed, and the Animal spirits (which are the primary Instruments of Concoction) are oppressed, where­upon the preternatural Humours that are gathered, do at length break out, and give an overthrow, when they are exalted to the highest degree, and when the flesh is made soft, and the joints effeminate, they more readily receive the Humours falling up­on them: And so at length another Nature, as it were; is by degrees superinduced, the pristine and natural oeconomy of the body being utterly over­turned and destroyed: For these Paroxysms, which, in a manner, wholly take up the thoughts of the in­considerate and less knowing sort, are nothing else but a series and order of Symptomes dependent on that method which Nature commonly uses in expel­ling the matter, which is the cause of the disease, outwards. Wherefore, he loses his labour, whoe­ver goes about to stave off this disease, by using this or that Medicine, or Regiment likewise, onely now and then. But since this Habit is founded, and consists chiefly in the spoiling of all the Digestions, and in the loss of natural firmness in particular parts, we must obviate both evils, and as well the strength of Concoction, as the firmness of parts, must be re­duced and restored by degrees, that is, according to the Model of the pristine and accustomed oecono­my of the body. And however impossible this may seem to be done fully and perfectly, not onely be­cause every Habit is with great difficulty changed into its contrary, but because old Age, which com­monly is companion and partner to this disease, doth violently oppose, yet, as far as strength and years will allow, the Cure must be attempted, and as the Patient is younger or elder,Idem. p. 67. so he will more or less escape the Tyranny of the Gout.

XL. A Milk diet, either of raw Milk, or boiled, taking nothing else, unless a little Bread in it once a day, has been in vogue for 20 years last past. This did several good, beyond all other Medicines for this disease, so long as they exactly observed it; but as soon as ever he returned to the diet of the Healthy, were it never so mild and gentle, who had used him­self to this, the Gout presently returning, handled the Patient far worse than before: for the Principles of Nature being by this course weakned, the Patient is rendred more unable to keep off the disease, and therefore afflicts him more dangerously and tedious­ly. He therefore that thinks of taking this course, must first of all seriously consider with himself, whe­ther he be able to persist in it all his life; which yet perchance he will not be able to doe, be he ne­ver so resolved: For I know a Nobleman, who, after he had lived a whole year on Milk alone, not onely without offence, but with a great deal of pleasure; all which time he went to stool once a day or oftner; growing costive on a sudden, and the temper of his body being changed, but the resolution of his mind still continuing,Idem. p. 75. and his Stomach at length loathing Milk, was forced to give over.

Asthma, see Respiratio. Atrophia, or want of Nourishment, or Leanness.

I. AN Atrophy may be cured, 1. By repair­ing the general or particular defect of bloud, and by using good nourishment, and in due quantity.Sylv. de le Boë. p. 2-8. 2. By correcting any fault in the bloud by evacuations of all sorts, and by Alteratives. 3. By repairing the damage any particular part has sustained by mischance.

II. The Ancients had 3 sorts of Instruments to cup withall, of Glass, Brass and Horn; of which the 2 first draw by fire, the last without fire, onely by sucking with the Mouth: Which Horny Cupping-glass, although it be grown out of use among us; yet at this day, the Indians, that live under the Torrid Zone, have a value for it. A young Man that came from thence bestowed such a Cupping Instrument upon me, of which being resolved to make trial, I chose an Arme withered with an Atrophy, to which I applied my Cupping-glass, instead of Pitch and Rosin, which we reade, how the eldest Antiquity made use of in the like necessity. Now these Cupping-glasses draw powerfully, and drawing the Skin curiously, they elevate the Veins and Arteries, through lean­ness fallen flat together: which being opened again, the bloud and spirits pass to and fro: whose unces­sant Affluence, unless it daily supplied the place of those things that are continually spent by the Bo­dy, the Part so faulty would not onely not be nou­rished, but farther it would be emacerated of ne­cessity. For this withering nothing is better than this Horny Cupping-glass: especially if dextrously applied, according to the course of the Veins and Arteries, that carry life and nourishment thither. I made Experiment in the withered Arme of this young Man,Tulpius, lib. 3. Observ. 49. we saw so much Heat and Bloud drawn to the outer skin by its sucking, that the dry Arme was again nourished, and recovered its former strength. The way is this; when you have applied this Horny Cupping-glass to the Part, you must suck out the Air with your Mouth at the little hole, and then immediately close it with your fin­ger.

III. A Boy of 11 years old, had from his infancy been troubled oftentimes with a cruel Head-ach for several days together. He was lean, pale-fa­ced, and at length he fell into a perfect Atrophy, with Night-Sweats, and continual roaring, through violent pains of his left shoulder, tending towards his Heart, and the Hypochondrium, on the same side, sometimes pungent, by and by Contractive, or Spas­modick: He had also a desire to Cough, with strait­ness and difficulty of breathing, whereby the Con­tractions in his Shoulders and Breast seemed to in­crease; hereupon he was forced to sit upright in his bed, holding his Shoulder and left Hypochondri­um always with his hand, by reason of the continual spasmodick pain. One of his Physicians blamed his Lungs, another his Spleen, most suspected a hectick Fever: At length being brought extreme low,I. Jac. Wald­schmid. misc. cur. ann. 72. obs. 236. he was successfully cured, with a distilled Water drawn off Chicken Broth, with some leaves of Germander, and Flowers of lesser Centaury (in which there lies an Antispasmodick Virtue, observed by few) and other things. Truly it were not difficult to derive the Rise and Causes of the foresaid Symptomes, ac­cording to Willis his Principles, from the enormities of the Animal Spirits and Nervous Juice, without the distempers of the Bowels serving for concoction; which have been blamed by all Men hitherto.

IV. If to draw nourishment to the part,Hartmannus prax. Chymi. atr. c. 13. Sect. 4. Wedelius, de S. M. 1. p. 61. Sina­pisms be used, Emplasticks are good after them, lest what comes for the use and strength of the Part, do transpire, as also after rubbings and anointings Comfrey Roots boiled in Spring-water is success­fully applied to the Parts in form of a Cataplasm.

Aurium affectus, or, Diseases of the Ears. See Surditas.

I. WHether should we Vomit or Purge in pain of the Ears? A Vomit seems better according to Hippocrates, Aphor. 4.18. Those pains above the Midriff, which stand in need of Evacuation, require a Vomit. And accor­ding to that Precept, lib. de loc. in hom. n. 55. Diseases are to be discharged by the part next to them, and to be drawn out by that part, that hath a passage nearest each of them. In lib. de affect. he expresly commends Vomit. If pain arise in the Ears, it is good to wash in much hot water, and to apply a Fomentation to the Ears, and if by these means the atte­nuated Phlegm depart from the Head, and the pain cease, these things are sufficient; But if not, a Vomitory Potion is the best Medicine. Where you must observe, that the seat of Phlegm, the cause of the Pain, is above, and so ac­cording to Hippocrates said Rules, must be discharged that way. But in his Book de locis in Homine, n. 20. He commends Purging, and condemns Vomiting. If by this means the Pain asswage not, let cooling things, actually cold, be poured in, and let a Potion be given that purges downwards, and not upwards, because a Vomit will doe no good. But here you must note, that the Application of cooling things, in this case, argues, that some Hot Humour is in fault, the original seat whereof is be­low, and that Hippocrates, consonant to himself, pur­ges therefore downwards. And do but you consi­der the Cause; you have their directions before you.

II. Whether should we apply Repellents? We must listen here to the determination of Arculanus 9. ad Almansorem. Before Repercussion be made, let these things be observed, The Matter must not have been critically discharged; Not be venemous; Not furious; Not much; Not immediately discharged from the Brain; Not very tough and thick; Not gathered by little and little; Not run to the out-part of the Ear: Because all these things forbid the use of Repellents; besides, to repell to the Brain is very suspicious.

III. Whether must we always use gentle Medi­cines? The excellence of a most exquisitely sensible part, and its proximity to a principal part, seem to intimate so much: Wherefore Galen, 7. method. doth not cure sensible Parts at once with violent Medi­cines, but by mild ones by degrees. Yet he, in the violent pains of such parts uses strong Medicines, lib. 3. [...]. as Chalcitis, Nitre, juice of Onions, Goats Urine, &c. that is, when cold and gross hu­mours cause the Pain, which are attenuated and heated by the help of such Medicines, and the Va­pours raised by them are dissipated. But he ab­stains from such things, when the pain is the pro­duct of inflammation.

IV. Many Practitioners use Ben. Victorius Faventinus his Plaster of Onions, to asswage the Pain of the Ears, of whatever cause they come, indifferently, to the great damage sometime of the Patient, es­pecially when the Pain is but beginning, and de­pends on a hot Humour: But when the Pain is ow­ing to a cold cause, or the Inflammation tends to Suppuration, the remedy must be applied with good success. Take an Onion rosted in hot Embe [...]s, Zecchius. consult. 62. of fresh Butter 2 drachms, Oil of Chamaemil, Roses, each 1 drachm, Saffron 1 scruple, apply it warm.

V. N. was afflicted with an unspeakable Pain in his right Ear, he got no sleep, and was scarce him­self: the Humour indeed at first ran, but after the Surgeon applied a Plaster and Clothes to his Ear, the running stopt, but not the Pain. A Physician was called, and advised Opium, upon which he slept two hours, and when he waked, his Pain returned. At length, by my Advice, he took some Pills of Ex­tractum Rudii, & Extractum Rhei, morning and evening four days one after another; he bore the working well, when I had removed the Plasters and Clothes, the Matter began to run plentifully. Then I gave him a gentle Purge of Powder of Jalap 1 scruple, sharpened with 5 grains of its Resin, and so the Pati­ent recovered in three weeks. Another was troubled with a grievous pain in his Ears, his Head aked so, he could not sleep all night, scarce knowing what he did. I advised him to lay aside all externals (the former was my precedent) and present­ly to take these Pills; Take of Extract of Hellebor made with spirit of Wine, 1 scruple, Pill. Ruffi half a drachm, Resin of Jalap 6 grains, mix them, make Pills for 2 doses. The first Dose gave him four stools, with some alleviation of his Pain. The next day he took the second Dose: It gave him six stools: After Noon his Ear began to run, and when it had continued running four­teen days, the Patient was well. ¶ Another was tormented with so grievous a Pain in his right Ear for five or six days, that he was ready to make him­self away: Many Topicks were applied without be­nefit: Three grains of Laudanum were given him every night, upon which he slept with some ease, the Pain returning when the Virtue of the Medicine was expired: After some days a Swelling arose be­hind the Ear, which being scarified, the Pain chang­ed its proper seat, for it diverted from the Ear to the Loins, from thence to the Kidneys, and at length fixt in the left Knee: The Humour attenuated with Sudorificks, crept to the fleshy substance of the Ear, from the Ear it passed to the Throat; Then matter ran out of the Ear, attended with Swoonings and Death.Cnoffelius, m [...]sc. cur. anni, 1676. obs. 83. Therefore any one may gather from the Cases here related, that in this Ail outward Application does more harm than good, and that it is safer to follow Nature's duct, and to purge what way she inclines, than by Topicks to fix that, which seems made for Volatility: Experience also testifies, that in such cases a Physician may doe more in one day with inter­nal Specificks, that discuss the matter, than with all Topical Repellents, which hinder the peccant matter, that, when it is disposed to run out, it cannot obtain its end.

VI. Whether is Vinegar,L. 3. Acut. 39. and Oxyrrhodina to be a­voided? Vinegar seems hurtfull, because, if accor­ding to Hippocrates, it cause very much Pain, it must needs offend the Ears, those Nervous and Bloudless parts, which are drier by far than the Womb. But Galen, 3. [...]. disallows not Vinegar mixt with oil of Roses. Moderate Inflammations (he saith) and such as do not beat, may be cured by some such means, as Vinegar and oil of Roses warmed, and well mixt. For Vinegar cools, repells, penetrates and strengthens, by which [Page 40] means it defends the Part from vehement Inflam­mation. It is true, that by its acrimony it makes the Nervous parts smart, therefore it must not be poured into the Ears alone; but mixt with oil of Roses, and in a small quantity it becomes harmless; and so when its edge is taken off, and its piercing virtue made dull, it mitigates the Pain, and brings down the fierceness of the Cholerick Humour. Be­sides, Vinegar is not so cold as it is reckoned, when, as Galen confesseth, it consists of contrary faculties, for, by putrefaction it acquires some Heat; and there­fore it is not so astringent, nor so cold, as either to prick the Nerves, or thicken and repell the Humours in the Ears.

VII. Galen adviseth Opium to be poured into the Ears; and Paul and others dissolve it in Milk: but if (quoth Avicenna) any hurt follow the use of Nar­coticks, give Castor alone after it. Concerning this matter Faventinus speaketh thus; And beware of Nar­cotick Medicines, lest by their stupefying Coldness they destroy the Instrument of Hearing. Neverthe­less I would not neglect them, when I were cer­tain, that the Patient would die of the pain, if we gave him not a Narcotick: But because the benefit in delivering the Patient from Death, is greater than the hurt he will receive from Deafness; for this reason we are allowed sometime to give them. Some use Tosted Opium; but if this be never so finely powdered, it will signifie little to ease the Pain. Again, whatever is dropt into the Ear, cannot get beyond the Tympane, but if they penetrate not, they can never affect the inner Parts, that are so various, and at such distance:Schneiderus. Opium also is peculiarly an E­nemy to the Sense of Hearing.

Frid. Hoff­mannus, m. m. p. 298.VIII. Johnston commends the juice of Crow­foot for the breaking of an Imposthume in the Ear; but this should hardly be used, because it is strong and corrosive: But instead thereof we should use the juice of Houseleek with Woman's Milk.

IX. When any extraneous thing is got into the Ear, the business must not be wholly left to Nature; because many dangerous Symptomes use to arise from the Suppuration of these parts: For seeing the passage of the Ear is endued with a most exquisite sense, the Humours, by reason of the vehement pain, may easily flow thither, and so break the Drum, whereupon Deafness follows. Sometime the Bone also, that is covered but with a very thin Mem­brane, becomes carious after such Suppuration. And sometime after it a fleshy, or schirrous Fungus grows in the passage of the Ear. Therefore we must, with all diligence, get out whatever extraneous thing may come into the Ear.

X. When by chance a Leech had crept into the passage of a Man's Ear, Severinus poured some bloud on the out-part of the Ear, whereby the Leech was enticed,Fabric. Hil­danus. and left the Caverns of the Ear.

XI. 1. Whatever Medicines are to be put into the Ears, they must be warm, not very not, nor very cold;Heurnius. for, being void of bloud, they easily incline to their natural temperament. 2. New Me­dicines must not be put in, till the Ear be very well cleansed from the filth of the former. 3. Three or four drops at a time are sufficient. 4. After the Medicine is dropt into the Ear, the Patient must lye on the contrary side. 5. What is put in must not be unctuous, nor viscid, for such tnings, when they are got into the windings of the Ear, cannot well be got out again, and therefore Spirituous and Di­stilled Medicines,Sennertus. that are used by way of Evapora­tion and Fume, are the most proper. 6. Young Sur­geons should be admonished, that in curing Disea­ses of the Ears, they should rather gently drop in some convenient Liquors, than violently force them in by a Syringe, lest the Tympane be broke, and an incurable deafness do follow. 7. Topicks must not be applied till Universals have been used,Scultetus Armam. Tab. 36. Fabric. Hil­dan. Cent. 3. Obs. 1. Idem. especially if the Disease be grievous, and the body abound with bad juices. 8. We must have a care that the Medicine be not sharp; because the Passage of the Ear is very sensible.

XII. The Ancients abstained from moist things, and such as were cold especially. For Archigenes, when he was to use a Fomentation for the violent pain, uses live Sulphur mixt with Water.Rubaeus in Celsi, lib. 6. Sect. 3. Let the Spunges (saith he) be well wrung out, and applied to the Ears, for they are easily made loose and lax by moisture. Therefore in Galen Vinegar is often mixt with Me­dicines for the Ears, at least while they are boil­ing, not so much for the sake of penetration, but that they may dry the more. But Avicenna saith,Enchirid. Med. pract. 33. When we fear the pain will cause Convulsion, we cannot excuse our selves from the use of Mollifi­ers. But to cause Suppuration, we must not in the Ears use very moist things, as in Abscesses of other parts; because the cold and dry tempera­ment of the Ear must be preserved.

XIII. You may draw any Liquor, or Matter from the bottom of the Ear, if you dip a Sponge in Betony Water, and strain it out well again, and then put it in the passage of the Ear; and let the Patient lye on his sick side;Fabric. Hil­dan. for so the Sponge will soak up whatever is liquid; but the Sponge must be often changed and washed.

XIV. A Melancholick Person of about Fifty years of Age, was troubled for some weeks with a grievous tingling in his Ears, and was cured in a few days with a few drops of Spir. cephal. Anhalt. put into them with a little Cotton.Thonerus, lib. 2. Obs. ult. I have found the effect of it in strengthning the Brain, and dis­cussing a Vaporous and flatulent Matter, far be­yond distilled Oils, which, by their exceeding heat, doe more hurt.

Balbuties, or Stuttering.

I. SOME Stutterers have their Tongue weakned through the moist intempera­ture of the whole body, or of the Brain. And they that have a moist Tongue are for the most part loose, the same Mem­brane being a coat both to the Stomach and to the Tongue.Heurnius, c [...]mm. in a­phor. 32. Sect. 6. For this reason, when the Tongue trips, it portends a Diarrhoea: as if Hippocra­tes had said, Such bodies should be purged with caution, lest they be cast into a Loosness.

II. The disaffection of Lispers consists in Confor­mation, and not at all in Intemperature: for in the middle region of the Palate, i. e. in the fourth bone of the upper Jaw, in all persons that I have hither­to seen, who could not pronounce the Letter R, there are two holes, which are nothing so open and obvious, as in them that do not Lisp. Therefore those two passages are the immediate Cause, and the Disease will be in Conformation.

¶ In like manner we observe the holes near the Teeth (yet by all such so brought into the World with themselves) to be greater, through which the Phlegm trickling and moistning the tip of the Tongue causeth faultering, whereupon Men become Stam­merers, and half Tongued. Nor therefore must we say, that Men are Stammerers by reason of a Phleg­matick Head, or a moist Intemperature of Brain: For there is no Intemperature so dry, but so much Phlegm may be gathered,Sanctorius, Meth. lib. 3. cap. 9. as falling on that part may moisten the Tongue, and make Men Stam­mer.

Brachiorum affectus, or Diseases of the Arms.

I. A Goldsmith, who was Scorbutick, was troubled with a violent cutting Pain in his right Arm, so that he could neither eat nor sleep. I prescribed divers things to no purpose, at last the following Bag took the Pain quite away. Take of Grommel not excorticated 3 handfulls, of common Salt one handfull,Got. Christ. Winclerus, Misc. curios. an. 96. obs. 94. of Chamaemil Flowers and Wormwood each 1 handfull, of Bran 2 hand­fulls; heat them upon a Tile, put them in a Bag, and apply them hot.

[Page 43]II. A Man above Fifty years old, who was caco­chymick, and subject to great obstructions in his Bowels, had, without either Purging his Body, or advising with a Physician, and when he had no oc­casion to bleed, got himself let bloud in the Cepha­lick of the right Arm, the next day he had some small pain about the place of incision, which gra­dually encreasing, and growing more violent, a great afflux of serous Humours did follow. When I was called, I found his whole Arm incredibly swelled, from his shoulder to his fingers ends; there was an Inflammation with Pustules, as in a pustu­lous Ring-worm, out of which a serous and sharp Humour ran in abundance; he was restless, his sto­mach and strength were gone, he was in a Fever, and in much pain, and that not without fear of a Gangrene. Notwithstanding I undertook the Cure in this manner; When I had put him in a right course of Diet, I gave him a stool (for he was co­stive) with a Suppository: After Supper I gave him a little Laudanum, with Cinnamon Water, and Confectio Alkermes: The day following I gave him an Infusion of Rhubarb, Agarick and Senna, with a few drachms of Elect. Diacarth. But that Potion scarce wrought at all; the next day therefore I gave him a drachm of Pil. Coch. & de Hermodactyl. with a few grains of Tro­chischs of Alhandal & Diagrydium: I applied to his Arm things to asswage the Pain, maintain the native heat, consume excrementitious Humours, and to resist Pu­trefaction: Then I made use of an opening Apozeme for several days, and when at set times I had purg­ed him with our lenitive Phlegmagogue, and with Hydrogogues, he was perfectly restored. Hence it ap­pears, how dangerous it is to move any thing in bodies that are impure and full of ill Humours: Wherefore Galen was in the right, that Wounds should be judged dangerous, not onely for the Ex­cellence of the Part affected, or for their great­ness; but for the impurity and cacochymy of the Patient: for we often see most grievous and dead­ly Diseases do arise from the least wound, nay, from a little worm; while the Humours flow from the whole body to the part that is hurt,Fabricius Hildanus, Cent. 4. Obs. 71. as to their common sink, and so destroy the innate heat of that part, and excite various symptomes.

III. A Person of Quality about five and forty years old had his Arm shrunk; He took an Extract of Grana Acanthalidis, and Pulp of Coloquintida for fifteen days, by means whereof the Humours that were gathered there, were dissolved and expelled; In the mean time the part was outwardly fomented with this D [...]coction;P. Poterius, cent. 1. curat. 79. Take of Mallows, Violets, Cala­mint, Chamaemil, Melilot, each 1 handfull; Let them be boiled with a Neats-foot in Water and Wine.

Bronchocele, or the Throat-Rupture.

I. CElsus defines Bronchocele to be, A Swelling in the neck, betwixt the skin and the Aspera Arteria, wherein sometimes dull flesh, sometimes some Humour-like Water or Honey is contained. Platerus makes the cause to be Wind breaking in under the skin, and the general Membrane under, and adhering to the skin, in the forepart of the neck: But the cause of that Aërial Collection he makes to be the loosening or separa­tion of the skin with its Membrane (which is thicker and redder in that place than elsewhere) from the seat of the Aspera Arteria, and fore-Muscles of the Neck, into which space, when made, the Air or Wind, to avoid a vacuum, breaks in, and not one­ly by filling it raises the skin and Membrane into a Tumour, but by continuance distending it, much en­creaseth it, whence it is rightly called Bronchocele, as if it were a Rupture of the Throat: And he makes the cause of the separation of the Membranes to be violent straining, either in going to stool, or in la­bour in Women. There is truth in both opinions, although Sennertus thinks it scarce probable, that Wind alone can procure so lasting an evil. ¶ I saw an example of the first kind, Anno 1660. in my own Maid, Petronella Definod, a faithfull servant, who died of a Consumption and Dropsie in her Breast and Belly: In the process of her Disease s [...]e had a huge Throat-Rupture, which had disfigured her Neck for ten years: I ordered the Swelling to be opened with a Razor; there was underneath glandulous flesh, swimming in great store of purulent Matter, which had flowed thither from the Breast and Lungs. ¶ I had an example of the latter kind in a noble Matron, who, upon her straining in Travel, and holding her Breath, contracted that Ail on a sudden: She went with it two years, but at length it dispersed of it self, without any Medicines or remainder of it behind. ¶ That driers may pro­perly be prescribed for this Disease, the example of a Small-coal-man in Geneva doth shew, whose Neck was beset with one of these Swellings as big as his head: but by his continual stirring in, and carrying of Coals, and by inspiration of the Dust, he obtained a perfect Cure; and, at this very time, his Dewlaps hang at his Neck, as upon an Ox. Arnoldus de Villa nova his Powder is very Efficacious, and deserves commendation, while the Disease is new; Take of Sea-Spunge, Pila marina, Pepper long and black, Ginger, Cinnamon, Sal Gem, Pellitory of Spain, Galls, Sponges, Bedegar, each 1 drachm, pound them all together, except the Sea Sponge, which must be burnt, and its ashes mixt with the rest, and sier­ced; let him hold a little of this frequently in his mouth, both night and day, he may take a little of it often in a day. ¶ Amongst topical Medicines this of Aetius discusseth, which hath, Of Quick-lime, Gum-Ammoniac, Bdellium, Shells burnt in an Oven, Verdi­greece, live Sulphur, each alike quantities, mix them up with Vinegar, and then make them up with Sew­et, or Turpentine, and apply it. ¶ Also Ʋnguentum Valesci is good; Take of Euphorbium 1 ounce, Sulphur, Sandarach, each half an ounce, Wax and Oil as much as is sufficient. Make it into an Ʋnguent, with which anoint the Neck, and apply the Plaster above prescribed: For (saith he) in good ones of a years standing, we wrought by way of Resolution, as we said but [Page 44] now, and thereby we had honour, and obtained benefit.

II. One called Blandin had his neck wonderfully swelled with the Throat-Rupture; upon it there grew a painfull Tubercle, which being brought to Suppuration by Steven Dentand, a skilfull Surgeon of Geneva, and it running good matter for several days, the Swelling wholly fell, without a Relapse.

III. A Collier importunately dunned a Smith as he was turning a hot sharp Iron on his Anvil, for Money for a sack of Coals which he had bought of him. The Smith being earnest at his work, after se­veral threatnings, if he gave him any farther di­sturbance, told him, he would run his Iron into his swollen Throat. Notwithstanding the Collier ur­ges him, whereupon the Smith enraged, runs the red-hot Iron through his Swelling. The Collier drops, and the Smith secures himself by his heels; but the Collier being carefully looked after, reco­vered both of his Burning and Swelling.

IV. We may question whether the matter of the Throat-Rupture be contained between the broad Muscle and the skin, or lye hid under the broad Muscle; for the matter gathered here cannot be got out, because insinuated into the Spaces of the Muscles: If it lye without, it may be cured and rooted out: It uses to begin from Wind, that distends and separates the skin from the fleshy Mem­brane,Riolanus, Enc [...]ir. p. 304. or the broad Muscle it self is separated from the parts under it.

V. But if the Disease will not give way to Me­dicines (among which Aetius commends Bdellium mixt with Honey; and Quick-lime mixt with Hog's Lard; Goat's dung dissolved in Vinegar; Ly well mixt with Honey, &c.) by Rogerius his Counsel, two Setons are to be applied, that the Humour may by degrees run out, and what remains, must, by little and little be consumed with eroding Medicines, as with Powder of Affodils, and the like. In fine, if it be not implicated with the Veins,Chalmaeteus, p. m. 119. Arteries and Nerves, it must, with its Bladder, be taken out by Incision, as we have said of the Glands, and as we have done three or four times. ¶ But if it is not cured by these things, nor dissolved, then we must come to putre­factive and eating Medicines: For, as Galen saith, 14 Artis parvae. The Cure of the Throat-Rupture is perform­ed either by dissolvers, putrefiers, or by Surgery, namely the Knife. And it is said there, that because Putrefi­ers and Corrosives are a long time in working, are troublesome to the parts, and especially torment the weak; Therefore it is good to cut them as far as the skin, and (if it can be done) to draw them out bag and all, and if any of the Bag remain, then to apply Corrosives (Butter of Antimony is excellent for this purpose) and Putrefiers, afterwards Mundifiers, Sarcoticks, and things to heal the Wound must be applied: But the skin, with the adjoyning Coat, is eaten away by Causticks, which being done, if it be an Humour it runs out, if any thing thicker, it is drawn out with the fingers,Valescus. then the Sore is healed with Lintments. ¶ But this Cure is half Chirur­gical, and threatens danger of a Fistula. But the Cure which is performed by Surgery, by drawing out the Matter contained in the Tumour by Incisi­on, is shorter, but more difficult, and rarely hath a good issue: But Rogerius bids two Setons be made with a red hot Iron,Forest. Obs. Chirurg. l. 3. Obs. ult. one length-way of the Swelling, the other a-cross, and that they be removed twice a day, till all the Matter be got out. But this seems rather to have place (according to Valescus) when some Watrish Matter is contained in a Bag, or some other Phlegmatick Matter which can run. ¶ I saw, Anno 1663. a Throat-Rupture, which threatned Suf­focation by its bulk, through compression, and strait­ning the Wind-pipe of Captain Rolin's Wife, a Newen-burger, diminished by help of a Seton, which I advi­sed to be made in the lower part of her Swelling.

Bubo, or a Swelling of the Glands in the Groin or Armpit.

I. WE must observe, that what Digesters we use, must be stronger than in other In­flammations, seeing the Glands are colder, and more ignoble parts, and have no exquisite sense.

II. If the Tumour digest not, it must be turned in­to Pus, and the Bubo must be ripened; which is gene­rally the safest way: For except this be done, as I have often observed, after a little time a new Bubo usually rises, either in the same,Sennertus. or in some other part.

III. The Physicians of Zurich in Switzerland publish­ed a Book of the Plague, wherein they propose a way to cure a pestilent Bubo never till then in use, viz. to take up the skin under the Bubo with a pair of Nip­pers, or with ones fingers, run a red hot Needle through it,Hildanus, cent. 6. obs. 30. and put some root of black Hellebore in the hole. I had rather make the hole with a good cutting Needle, than with one red hot.

IV. There are some that anoint their Body with Ointment of Quicksilver, not knowing, that it being cold and moist, must drive back calamitous infection of the Venome with the Humours, and bring death to the infected Inwards, as I have observed hath hap­pened in several. Sigonius, Palmarius, de feb. pe­stil. c. 24. D. M. using this Remedy for himself, to digest a pestilent Bubo in his Groin, presently perceived his strength to fail, and shortly, as his Bubo disappeared, he died.

V. Some pestilent Buboes, when they would yield to no Remedies, at last we left them to Nature, es­pecially seeing they created the Patients no trouble in their walking, nor pain, nor indangered life. Nor indeed do I think it necessary to open all such Tu­mours, seeing Nature, in a long tract of time,Greg. Horsti­us, Obs. 33. l. 7. can best digest them: When, on the contrary, the hazard of an incurable Ulcer may be run by unseasonable and violent opening: Yet these things should be mana­ged with great judgment, as the nature of the thing shall require.

VI. Pestilential Buboes should, if possible, be dis­cussed, and if they cannot be discussed, they must be brought to ripening and suppuration. Now the cure is to be performed by the same Medicines, wherewith the Swellings of the conglobated Glands are usually cured, always with respect to the pesti­lent poison, for whose sake Treacle, Mithridate and the like, which are good for it, ought ever to be added to other things. To this purpose distilled Oil of Hartshorn, and other things, consisting of a volatile oily Salt, may be mixt with common Medi­cines. I have observed that Ʋnguentum Martiatum mixt with Treacle, is excellent for dispersing, and that Emplast. Diachyl. cum Gummi, promotes Suppuration. Un­less the violence of the Pain be urgent, I would not precipitately use Scarification of the Buboes, much less Blistering and Cupping: But when the Buboes are great and burning, and the Patients strength firm, I could allow Cupping and Scarifying, but never [Page 45] Blistering, from which I could never yet apprehend what good could be expected, or did ever follow: For the pain which is then increased, together with the great heat, and a kind of Erysipelas, can doe the Patients no good, who are already sufficiently weak­ned with the violence of the Disease. But by gen­tle Medicines, outwardly applied, the sharpness of the Humour is qualified, when there is any in the Buboes, the Cure at least is promoted by degrees, if so be that things convenient inwardly be not neg­lected, by which the Discussion, as well as Suppu­ration of the Buboes may not a little be promoted: As soon as the Buboes are suppurated, the opening of them must be hastened, either with a Penknife, or some breaking Medicine, though I prefer a Pen­knife;Franc. Syl­vius de le B [...]ë, Appen. ad Prax. Tract. 2. Sect. 677. after the Bubo was opened, I have put in, with good success, Balsamus Sulphuris Terebinthinatus & Anisa­tus, with Ʋnguent. Basilicon, and Treacle: for by this means I quickly cleansed the Ulcer: Moreover, by means of this same Balsam it heals up more happily and quickly, if you apply but a little Emplast. Diapompho­lig. or some such like to hasten the Cicatrice. ¶ I use to treat a Pestilential Bubo in the manner fol­lowing; At the very first I clap on a Vesicatory, although the Tumour be of no considerable bigness, and neglect Cupping-glasses, which I therefore re­ject, because they cause pain and a Fever, draw out the good Humours as well as the bad, and do yet alter the whole bloud more: Within 7 or 8 hours I cut the Blister, and apply Emplastrum magneticum arse­nicale: Certainly its virtue is such in this case, that I know not a more noble Medicine, as will appear to any one that uses it: The Description of it is in Hartman. I have experienced these good qualities in it, that if it be applied to a hard skin, it produ­ces not the least Eschar, and in the mean time draws out the Malignant Humours so egregiously, that a Bubo, as big as a Walnut, is taken away in four or five days time: But this does not always succeed so quickly, and this is the reason why a Blister must be first drawn, that the Humours may the sooner be eva­cuated. Nay, in robust Bodies it will produce no Eschar, unless by help of a Vesicatory, not onely the Cuticle, but some part of the skin also be first corrod­ed: But in children, and more tender bodies, it is able to raise a Scab of it self, without any blistering premised. This Scab is the true seat of the extract­ed Poison, wherefore it is found pretty thick, and the skin onely superficially corroded, which is a thing truly worth consideration: For this, as I think, is the reason, why this is sooner separated than any other Scabs raised by Art; for in 24 or 36 hours it hath fallen off, by the help onely of a Spatula, with­out any precedent Scarification. It may be taken away without any, or but a very little pain, if to your Antipestilential Plaster, whatever you use, you add a little Ʋnguent. Basilic. or Treacle. Other­wise this Unguent excellently promotes the falling of the Eschar. Take of Virgin Honey, Ducks grease, each 1 ounce, Soot 6 drachms, Stratsburg Turpentine 1 ounce, Yelks of Eggs N^o ij. Treacle 3 drachms, Oil of Scorpions what is suf­ficient. Mix them and make an Ʋnguent. But if when the first Scab is fallen, the Tumour be not sufficient­ly abated, you may raise a second and a third with Emplastrum Magneticum Arsenicale, and then proceed as you did before. You may heal up the Ulcer with Emplastrum de Minio, Barbette, Tract. de Pe­ste. p. m. 191. or some other drying and cica­trizing Plaster; but do not make too much haste to heal it, lest the Poisonous Humour still remaining in the Body should cause a new Disease, or Death at last.

VII. If there be a Venereal Bubo in the groin, you must not bleed in the Arm; For there would be danger, lest the morbifick matter should be drawn upwards. I have known some, who just upon the appearing of the Bubo, after letting of bloud and Purging, have fallen into a stubborn Pox, if not per­petual. But if the Bubo give no hope of Suppuration, and several days have past, and the Pain and Swel­ling do not encrease, then you may safely let bloud below; for the matter is drawn downwards, and by the approach of hotter bloud to the Bubo, some­times it is easily suppurated. But when you have used Suppuraters a long time,Epiphanius Ferdin [...]u [...] histor. 17. if the thing succeed not according to your desire, then you may freely breathe a Vein in the Arm.

VIII. In the same, since the Humours want vio­lence of motion, there is no necessity of Revulsion, but it is rather better to draw all the Humour to the place affected, as in pestilential ones, that all the force of the poison may expire by the Bubo: for when it is otherwise, more grievous Symptomes and Difeases spring up. Which is the reason that I have always perswaded my self, they are in a grievous errour who try to dissolve them; for although it be a safer way of evacuation, yet in this case it is the cause of much mischief; seeing, in dissolving them, that matter onely vanisheth, which is contained within the Bubo. Whence it comes to pass, when nothing of the peccant matter in the whole body, and especially in the parts about the Liver, and in the Liver it self, is diminished (as is usual in suppurated Buboes, by which the matter of the whole body runs out, and is purged away, so that then the Body is more purified) that the mat­ter left within causeth falling of the hair, Pustules,Mercatus. de indicat. Med l. 1. c. 4. Sore heads, and grievous Pains. For which reason I reckon it most advisable to endeavour suppuration in all these, as a present remedy for this worst of Diseases.

IX. Buboes that are caused by thick, tough and cold Humours, are ripened with difficulty, and require a long time to cure: For sometimes when Nature is not strong enough to drive such matter to the out­er skin, it remains between the Peritonaeum and the Muscles, hence it continually sends Vapours to the Liver, sometimes it causes large Sinus's, and divers symptomes, for the matter polluted with this In­fection returns to the Liver, and infects the mass of Bloud, and other parts. ¶ A certain person had a Bubo in his right groin, who deferred opening of it, till the malignant matter fell upon the fourth and biggest Nerve of all that move the Hip; where­upon there was violent and continual pain in the Hip, attended with Convulsions, a continual Fever, &c. after that there was great Leanness and Weak­ness. Many things both inward and outward were tried, but in vain; for the Bubo did scarce ap­pear outwardly, onely the Groin was hard; there was no pain almost; for the violence of that in the Hip had stunned it. At last the Bubo was broken by help of a Caustick, out of which, in six or seven days time,Hildanus, cent. 5. obs. 65. there ran above Ten pounds of Mat­ter: And he difficultly escaped by help of the Pep­per Bath.

X. They that use Emplast. de Ranis cum Mercurio, Barbette, tract. de pe­ste. are most impudent and audacious Asses in this Art, for they drive the Venome inwards, and greatly indan­ger their Patient, as both Writers and Experience do clearly inform us.

XI. If there be suspicion of a Malignant Bubo from its green colour, or blackness and inflammati­on, such as come of Melancholy turn'd into black, thick and rebellious choler, so that from its more plentifull influx into the part, there be danger of a Gangrene and Mortification;Paraeus, l. 21. c. 31. then the places round about the Abscess must be defended with Repellers, but the Abscess it self not at all.

XII. Buboes, as they rise from bloud, stagnating in the conglobated Glands, and tending to Inflam­mation, so as a saline or acid Acrimony is joyned with the bloud, they shew their peculiar malignity. From Phlegm joined with the bloud Buboes rise more Oedematous; from common Bile, more like an Ery­sipelas; but from an austere humour more hard and schirrous: from a corroding Acrimony malignant [Page 46] ones; which Acrimony notwithstanding is often al­layed, both by the bloud it self, and by Phlegm mixt with it; wherefore the malignity and Acri­mony can seldom be deduced from the Buboes alone, but from other Symptomes usually accompanying them, and in the Plague indeed from Carbuncles and black Spots; but in the Pox, from the Gonorrboea, cancrous Ulcers of the Genitals, &c. Therefore Bu­boes alone, since they never are the diagnostick signs of a Pox alone, neither from them alone can its Essence be derived, but from other Symptomes ac­companying them. Except some will have Venere­al Buboes not to be extended length-ways the thigh, but athwart, and that they resemble the Site of the Spermatick Vessels, as some do teach, in which thing notwithstanding I think they pronounce more out of prejudice, than from accurate observation, while they imagine that different Glands are affect­ed in the Plague,Sylvius. Ap­pend. ad Prax. m. Tract. 3. Sect. 133. and in the Pox: except may be it happen, that seeing there are many Glands a­bout the Groin, in the Pox those especially be af­fected, that are nearer the Spermatick Vessels, whether the Praeparantia, or the Deferentia are: Af­terwards the Poison rises through them, and insinu­ates it self partly into the whole mass of bloud, and partly into the parts adjoyning, and so into the Glands themselves, and infects them.

Bubonocele, or Groin Rupture.

I. A Country Man labouring under a Groin-Rupture, went to a Barber-Surgeon, who taking it for a Venereal Bubo, perswaded him to have it opened, which the poor wretch consented to, and when the Excrements came out, he presently fell in a Swound: I being called, presently put the Gut back witn my finger, having applied the White of an Egg with Dragons-bloud, and then making some compression with a Linnen-cloth four double, I bound it pretty strait for four days,Marchetti, Observa [...]. 55. then I used A­quapendents Cerecloth for the Rupture, and the cut parts grew together in ten days.

II. A Matron Forty years old, subject to a Rup­ture for several years, when the Gut had slipt into the cavity of the Groin, which it had made, and she did not presently put it back, began to be pain­ed, afterwards she Vomited, and went not to stool; all this while concealing the cause, that is, falling out of the Gut, at last she brought up her Excre­ments at her Mouth. I being called the Sixteenth day of her Disease, and inquiring the cause, found a hard and painfull Swelling, as big as ones Fist, in her right Groin. I foretold the Disease would be mortal, because some part of the Gut was cor­rupted. It's true, by the help of Fomentations the Gut was put back, and much Excrements discharg­ed, and also a piece of the half rotten Intestine, about a finger long, whereupon the Patient found ease; yet the next day,Fabricius Hildanus, cent. 6. Ob­servat. 37. which was the Nineteenth of her Disease, she died. The Cure might have been easie, if the cause of her Disease had been known to her Physician at first; but her imprudent Modesty was the cause of her Death. Except this woman, it was never my hap to know another die of a Rupture: for the part affected in Women does not easily ad­mit any large Dilatation, or Sinus to be made by the Gut, as it does in Men.

III. A Woman Forty years old, formerly my Pa­tient, after carrying a heavy Pail full of Water, complained of a pain in her Groin. This was fol­lowed with a Groin-Rupture on the left side, which, in a short time after, having broken the skin, burst out, whereat all the food she took, and Worms, came out. When the Wound was healed, the Rup­ture remained, the Pain in her Belly continued, and she was troubled with Wind continually, especially when she lay down, the Guts then returning in­ward. She thought her Belly was full of little Ani­mals, coursing this way and that; But, by handling her, I perceived this her torment was owing to Wind, which proceeded from some days Obstructi­ons; she Vomited also every Morning. When she had taken a Clyster, the Obstruction removed, and her pain asswaged; yet at certain times an appa­rent Swelling returned, with a rumbling: When it hid it self in her Belly, and she had a rumbling, she was much tormented: but when it came out in a great lump, she was free from torment. Before the Gut could conveniently be put back, and the future mischiefs provided against, I ordered,Bartholinus, cent. 1. hist. 3. that when she had broke the Wind, which distended her Guts, the Excrements, the fuel of putrefaction, should be Purged out, the Worms should be killed and brought away, with Remedies proper for this Pest. [Page 47] But while the Remedies were delayed, the poor Woman died of the violence of her Pain.

IV. It is Queried, Whether a Maid 22 years old, Marriageable, of a middle stature, of a good habit of Body, if she should Marry, would she be Barren, by reason of a Rupture in her Groin, but well cured? And, If she be not Barren, Whether for the same reason she would not be in great danger in her Travel? It seems to me, that for that Reason alone she will not be Barren, because an incision there comes neither to the Womb, nor to its neck, nor to any part deputed to Generation, as is evident from Aëtius, l. 16. c. 103. Therefore, since in such an Operation the foresaid parts are not hurt, no­thing hinders but she may conceive. And since the Cicatrice in a Girle 13 years old, at which time she was cured of her Rupture, is long since grown together, and well cured; it will not break; and by consequence, when she has conceived, she will be in no danger for this in her Labor. This is clear, not from Reason alone, but from Experi­ence likewise;Pet. Fores­rus, l. 26. obs. 56. for such Women have both Con­ceived, Gone with, and happily Brought forth Children without any danger.

Cachexia, or a Cachexy. Leucophlegmatia, or the White Dropsie.

I. LETTING Bloud with a Lancet may sometimes be proper in those Cachexies, where there is an ob­struction of the Liver, and a Ple­nitude, because perhaps the bloud being so in motion, and that quick­ned, some of the corrupt Humours in the Vessels of the Liver will come out with the bloud: But e­specially if there be a Cacochymie in the bloud, it will be convenient to draw it out. ¶ The opening the Haemorrhoids, as it is a Revulsion by the Mesa­raick Veins, will be very good against obstructions of the Liver, [...] Spleen and Mesaraick Veins; so also as it draws out the Cacochymie gathered there.

II. Letting bloud is sometimes necessary for a Cachexy: Which I experienced in my self, when af­ter a Quartan Ague I was so far gone in a Cachexy, that I was fore afraid of a Dropsie. And certainly I was cured by no other means than by frequent bloud-letting, so that in ten days time I let my self bloud five times; at first the bloud came out exceed­ing foul, at last very pure,Botallus, lib. de cura [...]. per S. M. which was the conclusi­on of my bloud-letting. I have tried it in several others.

III. Physicians proceed amiss in curing the Cachexy of several persons, while at the very first they endea­vour to promote the stopped Months, by letting bloud in the Foot, without any preparation of the Humours, or clearing the obstructed passages: For Nature discharges not the bloud by the Veins of the Womb, till the innate Heat have recovered its for­mer Vigour, and Crudities be in a great measure consumed, which being done, we may proceed to bleed in the Foot, and to give Medicines to promote the Menses. And for the most part it falls out, when Crudities are concocted, and the Oeconomy of the whole body restored,Enchirid. Med. Pract. that what Natural Evacuati­ons were suppressed, do then return of them­selves.

IV. We should not give Purgatives to Cachec­tick persons; because it is most certain they hurt the Liver, and weaken the Ferment of the Bile:Freder. Hof­mannus, m. m. l. 1. c. 7. But we should give Lenitives repeated, equal to them; for a weak Agent reiterated is able to doe as much as a strong one can doe at once, and with less danger. ¶ I find our Physicians often commit this Errour, insomuch that they abstain not from most vio­lent Purgers in Cachectick persons, and so bring those bodies, that should have lived longer, to an untimely end. ¶ Some sick persons will Purge al­most every day, because of some small alleviation they find thereby: But this is very bad for them, and they die in a short time;Idem. l. 2. c. 6. for it is very sure the bowels are exceedingly hurt thereby.

[Page 49]V. Seeing a thick and feculent Melancholick hu­mour turns not easily into Sweat, more frequent Purging is necessary in this Cachexy than in a Phleg­matick one:Enchirid. Med. Pract. p. 170. for this may without the help of Ca­tharticks be almost all concocted and consumed with drying Medicines: But the Melancholick Mud ga­thered in the Veins or Arteries of the Spleen, as by degrees it is concocted, so it must gradually be taken away by Catharticks.

VI. A certain great Drinker had so inflamed his Liver, that continually, even while he was fasting, or but just sate to table, before he had scarce eaten one mouthfull, he was forced to drink, which I have observed in several to be a certain sign of a Dropsie coming upon them from the too great drought of the Liver, depending upon the heat; some fore-runners whereof I saw in his cachectick face. Because he desired to drink the Spaw-waters (for he refused other Medicines) he fetched them sometimes from Griesbach, where the Well is, and kept them at home, and according to my advice, when he had over heated himself with Wine, he accustomed himself to drink of them, to quench his preternatural thirst, which the Wine had caused. I gave him leave to go to the Wells, and to drink the Waters, as others use to doe. After this manner the use of the Spaws did both him good and others that laboured of the like intemperature of Liver; which the Vulgar abuse, thinking them to be good in most desperate Diseases, and drinking them by Quarts,Platerus, Observ. l. 3. p. 8. whereby the natural Parts and nervous Kind (for which sharp things are bad) are hurt; besides, they are very bad for the Breast, and therefore for all that are troubled with a Cough and Shortness of breath. Sometimes I have prepa­red artificial Spaw-waters, which I have given for a Cachexy, and they have done good. ¶ The drin­king of natural Vitriolick Spaw-waters continued for some Weeks, is very good to correct the Heat of the Liver, if it be used in time, before the Dropsie invade a man, and the Water be gathered in the Legs and Belly: for when it already falls out of the Veins, by reason they encrease its store, they will doe no more good, but will rather encrease the Swelling in the Dropsie,I [...]em, Praxe­os, l. 3. especially if (as they usually then do) they piss but little, and yet in the mean time drink much, which therefore, I have observed, hath hurt a great many people.

VII. Sweating with a Decoction of Guaiacum in a Stove or in Bed cures a Cachexy. But in a Chole­rick one you must sweat in a Stove, with a gentle heat: In a Melancholick one with a little more in­tense: And in a Phlegmatick one with a most in­tense Heat, that is, as great as the Patient can en­dure without fainting. This Cure is proper for such a Cachexy as happens to Maids or Women from Grief, eating of crude things or drinking cold liquours, but not for elder persons in whom it is bred by the use of strong Wine, Hippocras, Mus­kadel, Salt and peppered Meats, and such heating and drying things: for since in this case the Liver is exceeding hot and dry, and that there is great store of the Atrabilarious humour in the first and second region, that is, in the Veins of the Liver, Spleen, Mesentery, and in the greater Veins and Arteries,Enchirid. Med. Pract. Bathes are more proper than a Stove, for a hot and dry Liver requires to be moistened, and not to be dried: And an Atrabilarious humour is but enraged and irritated by using hot things and profusion of Sweat.

VIII. It is worth observation, that a Cachexy in persons troubled with the Stone in the Kidneys, has had its original from an Ulcer in the Kidneys, when the purulent matter by reason of the obstruction in the Ureters regurgitating into the Kidneys, and in­fecting the Bloud,Sennertus. hath infected the whole habit of Body.

IX. It often falls out, that a Man's Body be­comes swollen, turgid and languid; and then the ti­morousness of the Physician, grounded on no rea­son, predicts danger: But they may very properly be cured in a short time by Sudorificks used inter­nally and externally. The cause of this Evil hath not its rise from the Intemperature or weakness of those parts, that the Ancients called Noble: Besides, it may easily be distinguished from the Dropsie, which the said parts do cause; for although the Pa­tients be very sluggish and lazy, yet they are oppres­sed with no anxiety of heart, they breathe freely and from an open Breast, and their Belly swells not much: The watry matter is gathered first in the face and limbs, and if the tumid parts be prest with your finger, experience will shew that the parts are not so full as in a true Dropsie;Bar [...]tte, A­n [...]t. [...]ract. c. 14. wherefore some that are ignorant of the true cause, ascribe this Swelling to Wind. The Lymphatick Vessels being compres­sed, broke, or some other way obstructed, so that the natural motion of the Lympha is hindred, do cause the Ail.

X. When N. who was troubled with the Pox and a Water Rupture had been cured of both h [...]s Disea­ses by anointing with Mercury; after the same ex­ample he ordered one Aldr. de Aldrighettis, a strong Woman of a full Age, that was swollen with the White Dropsie, to be likewise anointed:Binodius, cent. 3. obs. 9. She made much Urine without any Salivation; yet she felt a little pain in her Neck, and perfectly recovered.

Calculus Renum, or the Stone in the Kid­neys.

I. a. GRavel not subsiding in the Urine, but stick­ing to the sides of the Chamber-pot, signi­fies not a calculous disposition, but exceeding heat of the Liver. Spigelius saith, he hath sometimes found the bloud in the Veins full of small Gravel. Nor does the subsiding Gravel necessarily indicate the Stone, but sometimes the material cause onely of the Stone, (for many that are free from the Stone do make Gravel) yet it intimates a disposition to the Stone.Plempius, in Institut. When Gravel that used to appear is af­terwards suppressed, and pain is felt, and the U­rine white and thin, it is a sign the Gravel is con­crete into a Stone; and when it is made with pain and strangury,Epiphan. Ferdinan­dus. it is a sign of the Stone. ¶ Gravel that is bred in the Veins is mixt with the Urine and with the Sediment. But what is in the Kidneys, U­reters and Bladder, presently resides as the Urine is made. ¶ Gravel frequently proceeds from adusti­on of the humours, which is bred in the Liver and Veins, and sticks to the sides of the Glass, nor does it sink to the bottom, as that which comes from the Kidneys. Besides, it breaks with rubbing in ones fingers, and appears of a Saline Substance, whereas the other neither yields to the fingers, nor can it any way be dissolved. And finally, because this Gra­vel hath a Saline Substance, it is dissolved in warm Urine, and no way appears in it while it is yet hot; but when the Urine is cold, it coagulates and sticks to the sides of the Urinal, just as Crystals of Tar­tar, which are dissolved in hot Water, do, when it is cold, coagulate and stick to the sides of the Vessel. So that the nature of this Gravel and Crystals of Tartar is very like.Riverius.

I. b. Hippocrates, 6. Epid. and in his Book Of the na­ture of Bones, orders bleeding in the Ham. Galen, on the contrary, 6 Aphorism, 36. advises bleeding in the Arm, if there be a Plethora, and violent pain, and the Disease be new, and he advises well: For if the humours flow from the whole body to the Kid­neys, such a Remedy must be chosen as may make a Revulsion from thence; such as Bleeding in the parts above: If the Disease be inveterate, or blee­ding in the Arm have preceded, then it is proper to bleed in the Ham. Leeches also applied to the Seat are very good, according to Aphorism 6. 10.

II. We must diligently take notice, that a Purge must not be given till the Pain be something asswa­ged: For even a strong Cathartick given while the Pain is violent, often does not purge, because at that time all the parts contract themselves,Riverius, Pract. l. 14. and do not assist the Medicine.

III. Some commend Cassia for the Stone; but I would caution the carefull Physician, that some have found themselves exceeding ill upon using it, and have encreased their Disease: One complained to me, that heat of Urine always followed the taking of it. ¶ Petrus Pigray, l. 7. c. 4. writes, that Cassia a­grees very ill with those that are troubled with the Stone.Fabr. Hilda­nu [...], l. de Li­thot. c. ult. ¶ Two ounces and a half of Cassia given one in a continual Fever raised such a flux of Urine, that for three days together he made his Urine so hot, that every time he made it, he thought a red hot Wire had been drawn through his yard.

IV. Nephritick persons should have some famili­ar Medicine, that may help them to a Stool. For those who are loose and troubled with Fluxes, have not the Stone and Gravel provided notwithstanding the Purges be not made up with Diureticks. I speak this, because at this present there are several who use Receipts that purge both by Stool and Urine. When there is mention made of Medicines to divert the Matter, there is no need of a Diu­retick. Wherefore they doe very ill who in time of Prevention and for Revulsion's sake do use Cassia; for Cassia is both purgative and diuretick, therefore not to be used in diverting the Matter,Saxonia, loco cit. and I look on Valeriola to be of this opinion, 6. Enarrat.

V. In the Stone in the Kidneys although Hippocra­tes order violent Medicines, such as Spurge, to move the Stone; yet I think it safer to use Leni­ents, that may onely dilate the parts, then more violent ones, which perchance may draw greater plenty of humours to the Parts affected; Where­fore as in prevention we must use gentle Medicines,Mercatus, de Praesi [...]. l. 1. c. 6. so I think we must use the same in the Cure.

VI. Crato consil. 136. prefers the simple Decoction of Speedwell before all more generous inward Me­dicines for the Stone. The use (saith he) of a Clyster made of the Decoction onely of Speedwell with Sugar will doe more good than any Medicines taken by the mouth. You may put in the Decoction some fat of a Loin of Mutton, of a Rab­bet, or a Capon, that so it may make smooth; if you can get none of these, you may take some fresh Butter. Therefore young Physicians may take notice, that a great Med­ly of many Simples is not always necessary to make [Page 51] a Clyster. I can safely attest, my Patients have of­ten found more benefit and ease in the Colick or Stone from a simple Clyster of Milk and Sugar, in which after Crato's example I boiled either Speed­well or Chamaemil-flowers, not Roman, but the com­mon,S. Pauli, Quadri [...]. p. 512. that is more temperate than the Roman; than from Clysters of more ample furniture, made of Pennyroyal, wild Marjoram, Rue, Calamint, &c. Because these hot things by discussing do raise Wind, whereupon the Pain encreaseth, which is mitigated with Anodynes properly so called.

VII. We must take notice, that in Nephritick Pains Clysters must be given in less quantity than in other Distempers,Zecchius, Consult. 50. lest the Quantity by distending the Intestines press the affected parts circumjacent, and exasperate the Pain.

VIII. Whether is a Vomit proper in this Disease? There are many young Physicians, who commend it for prevention, to expell the tartarous matter, be­fore it be derived either to the Reins or Bladder: Some admit it in the very fit; because Nature seems to shew the way by reaching and vomit. Hippocrates saith, 6. Epidem. that men are better after eruginous Vomit. In my Judgment Vomit conduces by strai­ning to the expulsion of the Stone or Gravel, as it does to the Delivery of a Woman, namely, by the violent commotion of the whole Body, and com­pression of the Muscles of the Belly. But we must take diligent heed, lest a Vomit be given to all per­sons without distinction of those that cannot bear one,Tho. Bartho­linus, Cent. 1. Epist. 55. and so Disease be added to Disease. Severinus advised me to this Remedy for a pain in my Bladder, but, I was very near a Pleurisie upon it. Mr. N. by his prescription took the Antimonial Wine, with great success, and lived very healthy after it.

IX. As Diureticks in the Cure of this Disease are fit and necessary to get the Gravel and Stone out of the Kidneys; so for prevention and in time of Health, we must abstain from them, lest while they provoke Urine they by use open those ways,Rubaeus in Celsum, l. 4. c. 10. and make a Passage to the Kidneys, whereby all the crude and bad humours that are bred in the body may tend thither, and afford matter to breed Gra­vel and the Stone. ¶ I warn my Patient that he carefully abstain from diuretick Medicines, and such as expell the Stone;Crato, con­sil. 246. for unless this be done, he will be certainly troubled with the Stone. ¶ They that in calculous persons use hot Diureticks, com­mit a mistake; because such Medicines bring filthy matter with them, and open the Passages: Second­ly, they displace the Stone, and make it unequal and rough. Lest the Reins or Bladder should be hurt by the asperity of the Stone, Sagacious and Prudent Nature hath clothed it with a mucous and slippery Phlegm, lest it should pinch the live part. Diureticks do much harm, because they strip the Stone that was covered with viscid Phlegm, which by reason of its raggedness doth so prick, that in a short time it causes a mortal Ulcer, attended with cruel Symptoms. A certain Mountebank gave a Wretch troubled with the Stone most violent Diu­reticks, which caused exceeding dreggy Urine, the viscid Phlegm being scraped off, which was as a bed to the Stone:Sanctorius, Meth. vit. error. l. 18. c. 4. He presently felt himself better; but in a little time, the Stone being naked and sharp, ate and pierced through the sides of the Bladder, upon which there presently came an Ulcer, and that a Gangrenous one; and I never saw a man die so violent a Death.

X. In the Stone both of the Reins and Bladder, Diureticks to break the Stone must be given a long time after meat, and on an empty Stomach, and if it may be done, after the body is purged; for Diu­reticks are quickly carried to the Kidneys, and they drag along with them the Food crude and in­concocted, so they rather load the Reins and Blad­der,Frid. Hof­mannus. m. m. l. 1. c. 18. and encrease the matter of the Stone. There­fore they doe very ill, that boil Parsly-roots or some other Diuretick with their meat and eat it for their Dinner or Supper.

XI. All Stones, at least those that I have yet found, are dissolved in the acid Spirit of Nitre, whence I conclude none can imagine that the coagulation of Stones, can proceed from an acid; therefore from something contrary to it. Now if a man do but consider the various things that promote the concretion of natural things, he will find the vir­tue lie in austere things, upon which score they give glutinosity and toughness to Fluids, to which if the earthy and saline volatile parts be joined, something not unlike the Stone will arise.Fr. Sylvius, Prax. l. 1. cap. 55. sect. 50. There­fore I incline to the opinion, that the earthy mat­ter, and saline volatile joined with the glutinous do by the help of the austere humour grow into a stone: But the virtue of the coagulating Austere is infringed by the sharp Acid, such as is found in the Spirit of Nitre. ¶ When larger Gravel comes away, and sinks to the bottom of the Urine, and is laying the Rudiments and Growth of a Stone, we must beside volatile oily Salts use things that dissolve the Stone, among which we deservedly ascribe the first place to Spirit of Nitre, seeing in it Stones are so easily and so manifestly dissolved and broken. And the Spirit of Nitre may conveniently be dropt into ones com­mon drink, Beer, Wine, Broths, &c. Idem, sect. 91, & 92. to make them a little sharp, and so be used a considerable time, whose excellent Effect all will admire. ¶ Diure­ticks to break the Stone must, 1. Be apt to turn to Urine, to wit, (as Helmont saith) that they may touch the place affected. 2. They must have power to dissolve the Stone. 3. They must possess it in a spe­cifick Propriety. 4. They must be subtile, that they may spread every way. 5. They must be amicable to nature, lest they destroy all. 6. They must not be very hot. You should rather give such things as consist of an abstersive virtue from a volatile Alkali and an acid, and that by their gentle sharpness do incide and cleanse the filth of the urinary passages, as also by their sweet fragrancy affecting the Reins do hinder the dregginess of the Ferment, and so prevent all occasion of the Stone. Such things also are good as asswaging the Pain of the Kidneys, do better fit them to expell what is hurtfull,Frid. Hof­manus, m. m. l. 1. c. 12, such as Saffron, and Cassia and Rheubarb deprived of their purgative Faculty. ¶ I will relate what I have observed concerning Spirit of Vitriol in the Stone of the Kidney and Bladder. Diureticks are of two kinds, one aperitive, and the other incisive. Aperi­tives draw the matter to the Kidneys, and there­fore if these be affected, are very suspicious, be­cause we draw the matter to the part affected: But Incisives carry not the matter to the Kidneys, but onely by inciding subtilize, and so the matter being made subtile passes the Kidneys. Hence it is (and I ever use it with success) that if in the beginning I give Spirit of Vitriol to break the Stone or cut the gross humour, I quickly see a happy Issue. And the Spirit of Vitriol, though it be diuretick, yet it onely incides, upon which subtiliation while the matter passes out, the Urine appears more copious, and it is truly a Diuretick by accident, not that it carries ought to the Kidneys, but because the mat­ter, when it hath no impediment, finds an easie pas­sage. And that is attempted in vain after the third or fourth day, which may be done the first, with­out which the Pain is prolonged three or four days to the great damage of the Patient; for then we must stay for universal Evacuation,Panarolus, Pent. c. 3. obs. 41. which in this case is not necessary in the beginning, but may very con­veniently be celebrated when the Pain is over.

XII. Of which Diureticks nevertheless distincti­on must be made,Hofmannu [...], ibid. that in the first place the milder be used, and the more temperate, before we arrive at the sharper, which do enflame the Archaeus of the Liver and Reins.

XIII. In the use of Medicines that break and ex­pell the Stone, we must take notice that they must not be used once or twice onely, but oftner, till the obstructed passages be opened: And while they [Page 52] are given, the Reins and Bladder must be fomen­ted with Baths, Fomentations, Unctions and Cata­plasms, that they may work the better: And also some liquours, that are of thin parts, such as vinous White-wine, must be given now and then, and in­ternal Emollients,Riverius. Laxatives and Smoothers of the passages must be made use of, that the ways may be open, and the acrimony of other Medicines may be qualified.

XIV. Medicines that attenuate the Stone with­out violent heat, conduce much to health: for the hotter sort of things consume the finer parts, and leaving the grosser do harden the Stone, and draw new matter to the Reins and Bladder from the whole Body:Heurnius. Therefore rather let them be of te­nuious parts and cold.

XV. Some in the retention and interception of the Stone in the Ureters do commend the Powder called Pulvis Lithontribos and some stronger things, which before purging the whole body do drive ma­ny bad humours from above to the Kidneys, where­by the Stone is not onely firmer fastened in the Ure­ters;Fabricius Hildanus. but internal Inflammations are also bred, and Death it self follows, which I have tried.

XVI. Gainerius hath taken notice, that we must ob­serve first to join piercing Remedies with those for the Stone, as Cinnamon, Nutmeg. 2. To add such a thing as may strengthen the virtues of the Me­dicine, to the end they may play upon the Stone with their whole strength, as Mastick and Gum. 3. That they have fineness of parts to pass the better. 4.Heurnius. Something that takes off acrimony may be ad­ded, as Roses, Liquorish, Linseed.

XVII. Whether is Spirit of Turpentine proper for the Stone in the Kidneys? It is good, for it is a dispersing Medicine, penetrates deep, and hath an excellent virtue in purifying the Bowels, dis­solving gathered Tartar, and discharging it by U­rine; yet lenitive Purgers should be made use of before we come to the continual and daily use of it: Although in the use of Turpentine it self in sub­stance this is not requisite, because it hath it self a purgative virtue, especially when it is mixt with powdered Rheubarb, according to Crato's descripti­on in Scholtzius, cons. 152. It helps by its temperate heat, whereby it befriends the parts destined to concoction, for which reason it is good for those that are troubled with the Stone, as it helps con­coction, that so the peccant matter may the better be separated from the Bloud.Gr. Horstius, Probl. Dec. l. 8. q. 1. You may see in Ama­lus, cent. 1. curat. 63. the History of a Monk who eve­ry morning for several months swallowed a piece of Turpentine as big as a Nut fasting, and was so cured of the Stone and Gout, when other Medicines would do no good.

XVIII. They are in errour, who always use at­tenuating and inciding Medicines, as if there could be no Gravel without a fulness of gross humours, and as if there were not some very cholerick per­sons to be found who have their bloud and other humours very thin, and are troubled with the Stone. For I am of the opinion that there is no one living, but hath so much grosness of humours, that, if it stay in the Kidneys,Sanctorius, Meth. l. [...]. c. 7. may cause the Stone: And that there is so much Phlegm in a man that is not phlegmatick, as may make up one Stone.

XIX. When the Stone is voided, although all dan­ger be over; yet I use for two or three days follow­ing to procure a perfect abstersion and cleansing of the Reins,Fortis, con­sult. 96. cent. 3. by giving a Bolus of our Turpentine washed in Mallow-water with Liquorish powder, and drinking upon it an Emulsion of Melon-seeds, made with Mallow or Barley water, but very thin.

XX. A certain person fell into grievous pain in his left side under the bastard Ribs, attended with vomiting much Bloud, as often as he stooped it re­turned upon him, so that he grew very weak upon it. Dr. Moebius judged there was some large Stone lodged in the left Hypochondrium, and that by moving it the Bloud was extravasated in so great quanti­ty, powred into the Stomach, and then vomited up. He durst not prescribe things to force the Stone, lest when the Vessels were unstopt, they should o­pen wider, and by farther vomiting of Bloud his life might be endangered: Therefore he gave him calcined Harts horn for several days in some fresh broth: He ordered the pained part to be fomented with Mallow leaves, Chamaemil flowers and Lin­seed boiled. And so his Vomiting ceased, the Stone was moved to his back, and then to his bladder, it stuck in the neck of the Bladder, and put him to cruel pain.Frid. Hof­man. m. m. p. 353. Then he gave his anodyne Salt in a de­coction of Mallows: he ordered Mallow leaves and Linseed boiled in Milk to be often applied to his Loins and Privities, anointing his Privities with oil of white Lintree. And so within 6 hours he voided a Stone as big as a Bean, and the Patient, through God's Mercy, was restored.

XXI. If in the Stone of the Kidneys the Patient piss much Bloud and often, and so two contrary medical Intentions do continue, the case will be hazardous; for it is the most difficult thing to find a Remedy in the Art, which will perform opposite operations, namely, open and bind, break and close: And therefore, setting aside all other things, we must presently have recourse to the Remedy by Aristotle called Sacred, namely, the Bath-waters, wherein the vitrioline virtue is most eminent, than which no safer or better Remedy can be thought or used in the present case.Fortis, con­sult. 95. cent. 3. For such Waters expell violently and efficaciously, and therefore are lithon­triptick, and upon score of the Vitriol staunch bloud; besides that in strengthning all the Inwards, they very much cool the Liver and Reins.

XXII. In the cure of the Stone many examples teach us, that much caution is necessary: For strong Diureticks do not onely encrease the Pain, the Stone being violently moved, and not removed; but they cause pissing of bloud, excoriate the urinary passa­ges, and sometimes impact the Stones into the nar­row passages; nay, and raise Convulsions and Epi­lepsies, while the Stone is violently driven in, and not driven quite out, as I have observed. Therefore we have eased those of their pains that have had large Stones in their Bladder, onely by lenient and emollient Clysters, so that for several years they have lived without any evident trouble in fits of the Stone. And no wonder, since emollient and abs­tergent Clysters do bring away the mucous matter always in a manner joined with the Stone, and clear the urinary passages of Obstructions: they bring a­way Gravel also, and make way for the Urine. Some years ago I experienced this in my self, when I was troubled with a most violent pain in my left flank, I discussed it onely by taking three mollient Clysters in one day, the Gravel being loosened, and the viscous thick matter joined with it scoured like­wise, and brought away with the Urine for several days together.Oethaeus, a­pud Skenchi­um. And by these gentle means so much was done in cleansing the urinary passages, that from that time to this I never fell into any such pain.

XXIII. There are some that think that Asses Milk is good for People troubled with the Stone, be­cause, in that it exceeds all sorts of Milk in subtilty and serousness', it possesseth rather an opening than a stopping faculty: But if in Bodies prepared for it, the Stone be bred of Cheese; If all Milk consist of three substances, Cheese, Whey and Butter, and therefore whatever things participate of Cheese, they do retain this faculty more or less, according as the caseous substance abounds more or less in them: the Consequent is, that the Stone may be bred by the use of Asses Milk, though not so easily as by a thicker sort. However a Milk of much Serum does the Bowels sometimes more good by reason of its serous substance, whereby it deterges, than by its caseous substance hurt, whereby it should obstruct: nay, it [Page 53] cures obstructions, as frequently it happens in the milk of Camels that have newly foaled, which is ve­ry good for a Dropsie, as Avicenna, l. 2. c. 442. saith. But this happens to their Milk upon account of their Pasture; for Camels feed upon Spurge, Widow­wail and the like, from which the Milk acquires a purgative faculty, and by reason of the Serum very detergent. Now Womans Milk and Asses are ex­ceeding like, and both of them moderately partake of Cheese. That Woman's Milk breeds the Stone, Galen. lib. 6. Epid. Sect. 3. com. 15. and Avicenna, lib. 3. sen. 18. tr. 2. c. 16. do shew. Galen indeed 6. de sanit. tuend. allows Asses Milk to the calculous; but then it is for preservation, and for the removal of those inconveniences, which the Stone, while it is expel­led, usually leaves in the body, that is, of an Ulcer in the parts which serve for expulsion of Urine, these being exulcerated by the ragged substance, or great­ness of the Stone in its passage; and of the dry in­temperature introduced by an extenuating diet, watching, vacuation and pain: Asses Milk corrects this by moistening, cooling and nourishing; it cures the Ulcer by cleansing, mitigating pain, and by glu­tination: ¶ Aetius allows of it; but after cutting in the neck of the bladder, and that the Stone is got out. See him, cap. 5, 8 & 10. lib. 11. And I say, that Asses Milk of it self cannot deterge and expell Gra­vel:Gr. Vir. Au­ [...]enius, tom. 1 lib. 2. Epist. 1. because Serum does not purge the Reins and Bladder on its own account, seeing this office be­longs properly to Diuretick Medicines: But by ac­cident it may, that is, given in great quantity, whereby running by the Urinary passages, it may carry with it all manner of Excrementitious Hu­mours it finds in its way, if so be it pass by way of Urine, and be not kept in the body; for if it be kept, and be not purged out by the Urinary passa­ges, it cannot do any good. There might be also another way of giving it, that is, mixt with Diure­ticks, as the Ancients used.

XXIV. If the Patient be consumptive, and there be an Indication to break or diminish the Stone, As­ses Milk cannot be convenient, because it neither breaks nor diminishes the Stone. Nor can the ex­tirpation of the Stone, and the cure of the consump­tive body concur in this Materia Medica; for the Consumption requires the Milk to be kept a long time in the body, that it may moisten, cherish and refresh all the solid parts: But the Stone requires it to be expelled much sooner by the Urinary pas­sages,Idem, ibid. because, if detained, it would cause grievous inconveniences.

XXV. For those that are troubled with the Stone in the Kidneys, Broths may be made of Pease, and seasoned with Anniseeds, Fenilseeds, Juniper Ber­ries, &c. And that the pains of some Nephritick persons are exasperated by such Broths, and others on the contrary are preserved by them, neither of these matters wants a Reason. For we must know that they onely are ill after eating of Pease Pot­tage, whose Pelvis of their Kidneys is beset with the Stone, covered with a slimy Mucus, which while the Pease Pottage does as it were rub off by its absterging Quality, these sharp stones prick the U­reters, whence comes grief and other symptomes, which draw the sixth pair of Nerves of the Brain into sympathy. So likewise even Turpentine it self, than which there is not a better Medicine a­gainst the Stone and difficulties of Urine (even those which the filthy Pox causeth) sometimes does encrease nephritick pains. But this Pease Pottage doth preserve others from nephritick symptomes, and those especially who have not a slimy, viscid and tough mucus turned into Stone in the Kidneys, or those from whom it forces gravel or little stones,S. Pauli Qua­dripart. Botan. p. 435. the Kidneys not being Ulcerous. And thus not one­ly both these sorts of people, but all in general may be secure from the flatulency of the Pease.

XXVI. Trallianus approves of Myrtle to evacuate the Stone: Yet it may be questioned what way we may safely use this Adstringent Medicine to expell the Stone. It consists of contrary faculties; for it does not onely bind, but hath also something of A­crimony in it by reason of its tenuious and hot parts. This is the reason why Diascorides saith, that Myrtle provokes Urine. In the mean time we must note, that Astringents are used against the Stone and dif­ficulty of Urine, both joyn'd with diureticks, that these may the longer be detained in the Kidneys: and sometime by themselves alone,Capivaccius. that strength may be added to the weak Kidneys. ¶ I have heard from great Practitioners, that most men suffer this torture for their flaccid reins; hereupon Astrin­gents came in use,Hofmannus 2. de medic. offic. p. 310. as Syrup of Lemons with Water of the herb Horsetail, &c. ¶ Seeing none but hot Kidneys breed the Stone, and that they are much weakned by strong Diureticks, it is no won­der if by the use of the Brier Sponge,Idem, ibid. p. 74. called Bede­gar, the Reins be strengthened, and thereby more fit to expell the Stone. ¶ If in the cure of the Stone we could well distinguish Medicines, we should have fewer troubled with it. For they that perpetually use Diureticks, properly so called, e­specially the first ways not cleansed, when they have thus brought the calculous matter to the Part af­fected, they make that which is ill worse. How much better do they that once every quarter in the year do scowre the first ways, as they call them, and then they take Almond-Milk for several days, And for the Cure,S. Pauli Qu [...] ­drip. Botam­ci Class. 2. voce Cynos­batos. before all things they purge gently, afterwards they use Diureticks, improper­ly so called, that is, cold ones, which restore the tone to the Kidneys, as Syrup of Lemons, Chamae­mil, &c. with the Water of Sloe-flowers, Strawbe­ry, Violet, Mallow common and Marsh, Horsetail, Toadflax, Plantain, &c. some of which are astringent, and not diuretick: others are diuretick onely for their watry substance.

XXVII. Where we must note, that cooling Ca­taplasms and Inunctions should be applied to the Li­ver before the Kidneys, when the heat of the Kid­neys proceeds from it; or when some strange Salt,F [...]id. Hof­mannus, m. m. l. 1. c. 12. bred by the digestion of the Liver, hath crept, by means of the bloud, into the Kidneys, then this be­ing inclosed, and because not vital, troublesome to the Archaeus, in process of time grows hot: hence proceeds this heat of the Kidneys.

XXVIII. Empiricks are in an errour, that cool miserable nephritick old men, who are deprived of heat, giving them Spaw-waters, and Whey; be­cause they believe, excess of Heat must necessarily concur to the production of the Stone, and they urge, that heat must necessarily be a mean to dissolve the thin parts, and leave the gross. But a moderate heat is able in process of time to harden and condense the clammy matter that is settled, as is evident from Galen, 6. Epid. 3.15.Sanctoriu [...], meth. vn­err. l. 3. c. 7. Heat, saith he, if it be but moderate, is sufficient to harden this matter, seeing in warm Waters that spring of themselves, though but a little warmer than ordinary, tophi are seen to grow. So Stones grow in the bladder, which is far colder than the Kidneys, both by reason of its ner­vous substance, and of the Cavity, into which, after making of water the air gets, lest there should be a Vacuum.

XXIX. Outward Coolers applied to the Kidneys in fat and fleshy Bodies are of no use, because their virtue cannot reach the part affected,For [...]i [...]. and by onely condensing the outer parts they are apt to encrease the heat inwardly.

XXX. There are some that prescribe a Bath of sweet Water, which I have ever suspected, as too much loosening: Instead whereof the Reins should be anointed with Ʋnguent. Rosac. Mesues, Idem consul [...], 98. cent. 3. and Infrigidans Galeni, and Water-Lily-leaves applied to them.

XXXI. In meat and drink, seeing thence the matter of Gravel and Stone takes its beginning, that we may prevent breeding of it; Moderation must be used, and the food we eat must be of good juice, [Page 54] but we should especially accustome our selves to tem­perate Meats, and therefore we must seldom and sparingly use salt-meats; for it is a principal Rule in the Cure to abstain altogether from very salt things, as also from the earthy and dry, since from such the matter of this earthiness do [...]s arise; and from very sharp and hot things, seeing by the Gravel compacted into a Stone, the Kidneys are heated and dried. And therefore we are rather solicitous in prohibiting all salt and spiced meats, than crude and clammy ones, and such as are accounted to breed phlegm: seeing these do indeed breed a thick juice, which creates obstructions; but they cannot be converted into an earthy matter, unless some other earthy matter be mixt with them.Platerus.

XXXII. This must never slip your memory, that nothing is better to bring away the Stone in me Kid­neys than warm Water,Zecchius, consul [...]. 13. or Chicken, or Veal, or Mutton Broth, if four or five ounces be drunk pret­ty warm immediately before meat, morning and e­vening. ¶ That the great heat of the Kidneys may be remitted, which is as the efficient cause of the Stone's returning, I commend the taking of boiled fair Water, to the quantity of six or seven ounces, before every meal, twice, or at least once a day: for nothing renders the Kidneys so free from Recre­ments, and so temperate. And their fiery heat is at length extinguished with the warm Water, that they can never after breed a Stone.Idem consult. 17.

XXXIII. It is my advice, that when other things do no good, the Matter be retracted to the Joints: for the turning of the Stone into the Gout is most easie, and of this into that, and it is less dangerous to be troubled with the Gout than with the Stone: for the Gout pain never endangereth Life by its trouble; but the Stone in the Kidneys and Bladder, by their many Agonies, and those incessant, kill the miserable Patients.Saxonia Praelect. pract. c. 36. Therefore the matter must be diverted to the Limbs by Frictions, frequent Bath­ings, hot Inunctions, Sinapisms and Blisters.

XXXIV. Cutting for the Stone in the Kidneys is indicated by Hippocrates, lib. de intern. affect. t. 15. But when it swells, and bunches out, about this time you may cut upon the Kidney, and when you have taken out the Pus, you may cure the Gravel with Medicines that provoke Ʋrine. Whence it is manifest, that cutting for the Stone in the Kid­neys was known to the Ancients. Avicenna also makes mention of it, but with Bacchanellus I think it impossible, because way must be made through the Muscles, through the Back, through the great Bones, through the Nerves and Arteries and great Veins. I think this cutting can then onely be ad­ministred, when according to Hippocrates, the Kidney is swollen and elevated, or when it is suppurated: for in this case Nature prepares a way for her self, and those that have been so cut have recovered, as Schenckius out of Coelius relates, &c. And I also ob­served it in a young man, from whom two Stones with matter came out, through an Abscess in the Loins, that opened of it self: but in any other case I believe it altogether impossible. It were an ex­cellent thing if it could be done with safety; but no man is obliged to Impossibilities. But if this be done by Nature,D [...]m. Pan [...] ­rol, Pent. vlt. observ. 42. May it therefore be done by Art? I Answer, that many things are done aright by Na­ture, which in no wise can be done by Art; We have an example in Hydropick persons, in whose Legs, if Ulcers arise of themselves, Health appears; but if they be made by Art, they corrupt, and death follows. Ambrosius Paraeus, in his Chirurg. magn. lib. 24. c. 16. relates, how a Nobleman of Mante, who was troubled with the Stone in the Kidneys, was con­demned to be beheaded; but at the request of the Physicians in Paris, with the Magistrate's leave, he was cut, the Stone taken out, the wound healed, he cured, and this was his punishment. But if this operation be performed in the Loins right against the Kidneys, it is joyned with great and immi­nent danger, because by that way you must come at it through the Muscles of the back, the Nerves,Ben. Sylvati­cus, cent. 3. consult. 55. the Aorta and Vena cava, with hazard of fainting and death. Which if it be tried to be done by the flank, and by drawing the guts on one side, way be made to the Kidney, although indeed there be less danger in this (as Roussetus de partu caesareo observes) yet the conflux of the bloud into the Cavity of the Abdomen is not without some, and a Cicatrice in the Kidney is very difficult, so that for these causes, it is either not to be attempted at all, or at least with the prognostick of death premised.

XXXV. I knew a certain Woman, whom several Physicians affirmed to be troubled with the Colick: But I at the first visit (because she was very numb, and there were other signs of the Stone) judged it to be the Stone, which nevertheless they said was false for several reasons. So I was discharged, and they persevered in the Cure,Gerardus Bergensis, de artic. & re­num morb. curat. and continually gave her hot and dry things, till she changed life for death. When her body was opened, a great Stone was found in her Kidney, and I regained my cre­dit.

Calculus Vesicae, or the Stone in the Bladder.

I. WHether can the Stone in the Bladder be broken with Medicines? Many utterly deny it, many affirm it but coldly: I with Galen, Hippocrates, Dioscorides, Rhasis, Avicenna, and infinite Classick Authours (who prescribe many Simples and Compounds, acting by their tenuity, acidity, aspe­rity, and by their Diuretick virtue) do hold, that there are things in Nature which break the Stone. What hinders it I do not see, since there is a dissolv­ing Salt, as well as a coagulating one, and that the virtues of things must not be denied in Plants, Herbs and Stones: We see also how soft Water, by continuance, doth hollow the Stone, that Iron is e­roded by virtue of Simples, and that there are Sim­ples which soften Stones, and why not break them. We read in Aetius, l. 2. how Philagrius cured the Stone in the Bladder with Goats-bloud, and a Hedge-Sparrow mixt together: How a Jesuite at Rome cu­red a Printer's Son with Millepedes rightly prepa­red:Joh. Fre [...]ta­gius apud Gr. Horsti­ [...]m, l. 4. [...]bs. 4 [...]. How Rhasis, lib. 9. cured an old Stone in the Bladder with his Pills, with which Horatius Augenius and his Father, and other Physicians, cured several of the Stone. If the fore-cited Authours com­mended their Medicines, and they had no such Vir­tue, What did they in so weighty an affair, but put a cheat on Mankind, which to say of Hippocrates is Blasphemy, who, according to Macrobius, never de­ceived others, nor himself? ¶ Bartholomaeus Turrianus in latrob. lib. 4. f. 269. broke a Stone that was then designed to be cut, by giving a little powder of Cry­stal to drink, or rather the dissoluble substance thereof; which same Liquour Th. Muffetus mentions, de jur. & praestant. Chymicorum. Now Crystal is made soluble, if it be calcined in a Potter's Furnace at least nine times, then it becomes of a brittle sub­stance, and put in a Cellar, it melts like Oil of Tar­tar: Or let the Crystal Stone be heated in the fire, and quenched seven times in the water, or Spirit of the Lesser Nettle. According to Johannes Praevo­tius, the Stone in the Bladder is broken by a Plaster of White Onions, boiled, and applyed to the bot­tom of the Belly. If therefore Histories be extant of persons troubled with the Stone, that have been cured by Medicines, the chief Remedies must be tried, before the Patient commit himself to the greatest hazard. Gul. Laurembergius his History of a person cured of a great Stone by the use of Sows; and Horatius Augenius his History of another Patient are well known. But such examples establish no rule: they onely convince men of the possibility, which we do not deny: Several circumstances also cannot be known, as whether these were onely gra­velly coagmentations, and not flinty. In this therefore, or the like case, I can approve of no sort of true Diureticks, if the Stone be great, hard, and like a flint; for neither thus can we hinder its in­crease. The distance of the place is far, and the ways by which the Medicines pass, many; if they be weak, they lose their virtue before they come at the Urinary passages; if strong, they carry matter from the whole Body to the Bladder; nay, these doe more hurt, for by their acrimony and tenuity they take away, and wash off that Lentor and phleg­my matter, that like Mucus usually sticks to the Stone, and serves it for a bed: this gone, the Stone is made sharper, raises more intense pains, and hurts the Bladder more. A Patient of mine experienced this, who having used Diureticks for two years, found no benefit, whether he took Chymical or Gale­nical things, nay, he rather daily found more pain. Crato, Rolfin [...]iu [...], l [...]b. 9. Co. s. 9. Physician to three Emperours experienced the same, who seriously disswades men in the pain of the Kidneys from those Diureticks, that force the Stone. His Eminence Cardinal Cornarius, when he had a fit of the Stone, and was afflicted with diffi­culty of Urine, being unwilling to observe the Dis­swasion of his Physicians, went (contrary to Mercu­rialis his advice) to the Bathes that work by Urine, when he took the Waters his pain increased, and he died. ¶ Guarinonius saith, Cons. 300. That scarce ever any one saw the Stone broken by Medicines. Yet I broke the Stone in the Bladder of a Boy twelve years old, and brought it away piece meal by this one Medicine;G [...]t. C [...]ist. Winclerus, in Misc. [...]r [...] ­ri [...]s. in. [...]. chs. 102. Take of purple Violet Seeds half an ounce, of Water of Strawberry, Rest-harrow, Alkekengi, each what is sufficient; make an emulsion according to A [...]t. Add of prepared Sows 1 drachm, Goats Bloud 2 pounds, Species Lithontriptic. 1 Scruple, Spirit of Turpentine half a scruple, mix them, let 2 spoonfulls be given frequently. He voided pretty large pieces, and inclining to black­ness, so that one shell seemed to have grown over another.

II. Mercatus makes four Classes of Medicines that break the Stone, and he reckons those in the third, that he thinks do improperly break the Stone, and he saith, they doe good onely by absterging and rubbing the surface of the Stone. And he teacheth that all are such, which by their asperity absterge, and as it were rub, for when two rough bodies rub one against the other, they wear: Hither belong the Lapis Spongiae, Lyncis, powder of burnt Eggshells, &c. Some do reject the use of such things, because it is scarce likely, they should break the Stone in the Bladder, and not hurt the intermediate parts: But we must observe, that such things are not gi­ven whole, but reduced into subtile powder, yea dis­solved and reduced into Magisteries, where their efficacy does as much depend upon their Saline Spi­rit which gets into the Stone, and dissolves it into Atomes; just as Metals and Minerals are dissolved in Aqua sortis, and Coral, Pearl and the like in Vine­gar. [Page 57] For which reason the use of such Medicines should not be neglected.Sennertus.

III. All things premised that should be premised, we must of necessity come to some effectual Diure­tick, that may be able not onely to cleanse and wash the Reins, but to run to the Bladder also, that it may make the Stone to move and swim as it were in the hollow thereof, that so it may more easily come to the neck, and either be forced out, or ta­ken out with an Instrument by a skilfull Chirurge­on. Neither let Avicenna, nor the advice of almost all Physicians, deter you from this work, because forsooth the use of Diureticks must wholly be avoi­ded in the Stone of the Bladder, by reason they deprive it of its mucilaginous coat, and therefore may cause more cruel and bitter Pains. Indeed the Objection might have place, if the Debate were a­bout prevention, which requires diversion from the Bladder: but while we are treating of the Cure, that is, of discharging a Stone, that is as yet but small, Diureticks,Fortis, con­sult. 13. cen­tur. 4. yea the stronger sort, are requisite, be­fore it be so large that it can get no more into the Neck of the Bladder, much less pass the Ʋrethra.

IV. Some are of opinion, and that not without reason, that the Stone may be broken with liquours injected by a Catheter into the Bladder. For seeing these liquours are nothing altered, nor lose any thing of their virtue in their passage, as Medicines which are taken at the mouth do; but that they reach the Stone in the Bladder, they may exert their whole virtue upon it. You may try the vir­tue of such liquours without the Body of Man, upon some Stone that hath been cut out or voided from the Bladder. Cardan requires these Conditi­ons in such Waters, that they break the Stone, and doe no harm to the Bladder: And he commends a Water made of the Ashes of Scorpions, Parsly, Roots, of Butchers-broom, Crabs-eyes, Pigeons-dung, Pellitory of the Wall; and he had rather have it made of many things mixt together, than of one Simple.Sennertus. ¶ Rolfinccius, cons. 3. l. 9. intimates that they are Cheats, who boast of any thing they have done by injection with a Siphon. ¶ Zecchius judges such Injections are to no purpose.

V. I knew a person that was for a whole year and a half treated by his Physicians as one that had the Stone, because he had the Pathognomick signs, a Weight or Load about the Pubes, Strangury, Disury, Falling out of the Arse-gut, Itching of the Glans, &c. He takes a Journey into France, intending to commit himself to a Lithotomist.Ph. Salmuth. cent. 1. ob­serv. 25. When he had been at Pa­ris two months, and drunk strong Wine, in the third month, and for forty weeks, he voided by Urine a great deal of clayish matter: And from that time he was very well, nor felt he the least of it any more; onely he ever after used a Diuretick drink, i. e. small Wines.

Riolanus, Anthropogr. lib. 2. c. 24.VI. A bad conformation of the Bladder is very rare, yet it may be; and you must carefully observe in searching for the Stone, if, when all the Patho­gnomick signs are there, you cannot find it with your Catheter. For in some a double Bladder hath been found, in others it hath been divided by a Membranous Partition.

VII. We are often deceived by the Likeness of the Stone,Scholiagr. od l. 1. c. 50. Holler. as in a Nobleman, who, after he had been tormented with his Urine eight months, the Physi­cians and Chirurgeons doubting whether there was not a Stone, having used Medicines to no purpose, was cut for the Stone, as Lithotomists use to doe. He was eased of his pain; yet they found no Stone, but Flesh in the Neck of his Bladder, which by de­grees was consumed with convenient Medicines.

VIII. Within the Ʋrethra, upon the Caruncle, that closes the Extremities of the Vasa ejacuiantia, you will find a thin Membrane circumtended like a Valve, at the orifice of the Neck of the Bladder, which hinders the reflux of the seminal humour into the Bladder, and that no drops of Seed hang about those places. You must have a care, when you put in your Probe, that this Membrane be not torn; for it is easily broke by putting a Catheter into the Bladder,Riolanus, Anthr [...]po [...]r. lib. 2. cap. 28. or a Wax-candle for the cure of a Car­nosity.

IX. When a Stone grows to the Bladder it is ve­ry hurtfull, for whether you take it away or leave it, you either way kill the Patient. I saw an ex­ample of such a dangerous Accretion in a dead body, whose bladder contained a Stone wrapped in a Membrane, and so close knit with Fibres to the coat of the bladder, that I could scarce pull it thence without tearing of it. ¶ As a Lithotomist was ta­king the Stone from a poor Wretch, he pulled out bladder and all; for it was so grown to the Stone by so many and so strong bands, that no skill was able to separate it. Let Lithotomists here consider how easily the Wax-candle may deceive them, and how little they ought to trust to the putting in of an Iron Probe: for a resisting Hardness is an infalli­ble token to them that there is a Stone: But the Stone wrapt in its coat, neither resists the touch nor struck upon gives any sound, wherefore they must not trust to these experiments alone, but should call other Signs to their assistence. But what shall the Lithotomist doe, when he hath found such a Stone, cut the Ʋrethra, and laid the neck of the bladder open, as it should be? Shall he take it out or leave it there? He must take it if it will come, he must leave it, if there be reluctancy. Nor indeed do all, that are inclosed in a coat, grow to the bladder, but some of them fluctuate freely hither and thither, and come out as easily as if they had not been co­vered with any Membrane at all which I saw in two Women. But if the bladder be ill conformed, whe­ther for a membranous partition that divides it, which C. Bauhinus observed; or an Ecphysis sticking to it, as in the famous Casaubon; or for its complicated Membranes growing closer to the os pubis than that Section can be made without evident hurt to the bladder, such a position of this part as I once in­deed observed in one that was designed to be cut, then there is no less need of circumspection, as one may see in the example here instanced, upon whom the Lithotomist had certainly done his office little to his own credit, had he not, being frighted with this perverse situation of the bladder, in prudence desisted: for this Stone was implicated in so per­plexed an errour within the contorted bladder, that (as Anatomy informed me) Aesculapius himself could not have got it out without manifest danger of life.Nic. Tulpi [...]s, lib. 3. observ. 5, & 6. ¶ One man's bladder contained two encom­passed so close by its corrugated coats, that it was scarce capable of an ounce of liquour besides them.

X. Although Stones that stick and are fixt, can hardly be pulled away, and the greater number of these that are troubled with such do dye; yet the Cure is not impossible, seeing it is observed daily that several such have recovered: amongst which I saw one, from whom a two ounce Stone was taken,Augenius, Epist. 2. l. 4. inclosed in a bag, which rarely happens.

XI. Many Errours are wont to be committed by vulgar Lithotomists in taking out the Stone; the First is, When they allow the Patient the days next preceding, and in the whole course of his Cure to live as he list, neither premitting Diet nor Pre­paration, whence many Inconveniences and Death do follow, for all things run from a plethorick and cacochymick Body to the place affected: Therefore let Diet, Preparation and Purging go before, &c. 2. They think they have done the business, when before cutting they have purged their Patient with Antimony, Mercurius vitae, &c. But these violent things debilitate the Strength and native Heat; whence the Patient often dies after the operation. 3. Some for a few days before the operation give a full draught of a decoction of Rest-harrow-roots or Mil­let-seed morning and evening, to bring the Stone to the neck of the bladder; but many mischiefs flow [Page 58] from thence, for much humours are carried from the whole to the urinary passages,Fabritius Hild. c. 23. de Lithot. whence follow af­ter cutting dangerous Symptoms, Inflammation, Gan­green, Convulsion and Death. Wherefore onely gentle purgative Potions must be given, because if Lenitives do purge also by Urine, how much more will strong Purgers, which have also a diuretick virtue, do it?

XII. Lithotomists, when they have got out the Stone, often commit many Errours, which want rectifying. Some think the Wound should be drawn together with one Suture or two, that it may the sooner heal: but they doe ill, 1. Because a Tent cannot be put in as it should, nor the bloud gathe­red in the bladder (whence come many Symptoms) be got out: 2. It is known that after the Stone is got out, there often remains Gravel, Phlegm, clot­ted Bloud and Matter, which not taken out doe much hurt. 3. Suppose there be no such things; yet it is certain that the bladder afflicted so long, does crave time to purge out the gross and viscid Phlegm, that it daily breeds; but this must needs be done by the open Wound; for seeing the urina­ry passage is long and turning, therefore it cannot be voided that way, especially when the expulsive faculty is weak. II. Many Lithotomists immediate­ly after the operation clap the Patient in a Semi­cupe (in which they boil indeed appropriate herbs) and keep him there half an hour for the easing of his pain, and heating his body which was cooled by cutting: But so there is imminent danger of an hae­morrhage (the Vessels being opened) which is at­tended with fainting and weakness, and is one cause of Death after operation. Thus they offend against Aphorism 5. 23. Then after bathing much Vapours ascend, another cause of fainting: It is the proper­ty of the Bath also to draw, whence a great quan­tity of humours is drawn down in a manner violent­ly from the parts above, from the Loins especially, which were stirred by the operation, and other Sym­ptoms follow, all the ways and passages being loos­ned by using the Bath; so that all the excrementitious humours flow to that Wound, and hinder the healing of it. III. Some Lithotomists reject the use of Tents, and doe all their endeavour to heal it quickly: The Physician indeed should cure quickly, but safely al­so; now there is no safety, unless the Wound be kept open by the help of Tents, for some days after cutting, and the bladder be cleared of gravel and phlegm, which would grow together again by rea­son of the heat and inflammation left in the bladder; whereupon the latter Evil is worse than the first; for a Gangreen doth easily follow. IV. The Errour of a renowned Chirurgeon must be remarked, who writes, that 'tis sufficient when the Stone is taken out, if the Wound be closed with clean Lint, for the Ʋrine is enough to heal the Wound by its detersion and consolidation, wherein it excells, if so be (he adds) that no symptoms supervene. And he says well, for how will you obviate the Symp­toms, Pain, Swelling, Inflammations, &c. which usu­ally follow wounds joined with confusion? But if you would prevent them and Death that would otherwise certainly follow, keep the Wound open with Tents, which would otherwise so close with the swelling, that neither Urine nor the viscid humours, bloud nor matter that remained after cutting, can run out: Besides, Urine cannot serve the turn of a Medicine, when it has got an acrimony and corro­sive faculty from pain and a preternatural febrile heat. They that have tried it know that Urine re­tained is the chief cause of the Symptoms which usually follow cutting for the Stone: therefore a prudent Chirurgeon will provide it an easie pas­sage, by the help of Pipes and Tents. V. Nor is their errour less, who make it their business by frequent traumatick Potions to cleanse the Bladder of Impurities, Phlegm, Gravel, &c. expecting hence a perfect Cure of the Wound: But who can believe that there can pass to the Bladder, or bring any be­nefit, when Diureticks (though endued with sub­tile parts) cannot, according to Galen, Art. Med. c. 96. penetrate thither? VI. There are some who pre­sently after the operation give a little Powder in a Glass of Wine as a singular help, and not in the beginning onely, but in the whole course of the Cure, hoping from thence for an abatement of Pain, a Repulse of the afflux of humours, stopping of bloud and suppuration: But Wine, that is hot and sharp by nature will not stop a flux of bloud, for which work cold and dry Medicines are requisite: and it will not asswage Pain, nor promote Suppura­tion, as being hot, it rather being fit by its acri­mony to enrage than appease a Wound, which of­fice is onely granted to hot and moist things,Hildanus. and those void of all acrimony.

XIII. Authours propose three places, by which the Stone may be taken out; 1. The orifice of the Bladder (as is usual in Women) by which Alpinus testifies, lib. 3. cap. 4. that in Egypt he hath seen a Stone taken from Men, the Ʋrethra being dilated by blow­ing. 2. That part of the Hypogastrium that we call Pubes in a larger acceptation; which place Roussetus, lib. de Partu caesar. c. 7. proves to be commodious and to be preferred before the rest, after he had heard how it once happily succeeded with Pet. Franconi, who not­withstanding does not himself approve of this way. 3. The ordinary place, and that which is received hitherto by all Men, in Men and Boys is the Perinae­um. But Mr. Collet, a Lithotomist of Paris, descended from a Family of Lithotomists, uses the great Appa­ratus, whatever age the Patient be of, because he thinks, by thrusting the fingers into the Anus, and al­so by the violent squeezing down of the belly (which according to the old method they used in Children) that not onely great pain was caused, but besides that, an Inflammation and Gangreen of the said parts. They testifie as much, who have at any time had the experience of a search for the Stone by the fin­gers thrust into the Anus; for they plainly declare, that neither the cutting, nor taking out the Stone put them to so much pain as the Search did.J. Van Horne, Microtech. p. 151. How much more must this hold true in Children, in whom these parts are exceeding tender and strait?

XIV. Cutting for the Stone may by no means be performed while the Moon is in Scorpio (according to Ptolemy's rule in Centiloq. c. 20. Do not cut any part [...]ith an Instrument, while the Moon is in the Sign, under whose dominion that part is,) as among others it happened to a Religious Person, who being cut at this time died. For seeing at that time the Moon doth fill the Pudenda and Parts adjoining with her great Humidity,D. Panaro­lus, Pont. 3. obs. 11. which being placed below are forced to receive the floud from above; certainly if they be cut, they will easily be obnoxious to putrefaction, and death must attend them.

XV. In the beginning of August, Anno 1675. Franc. Sabourin, a Poictevin, a skilfull Chirurgeon in Geneva, committed himself to Lithotomy. Some months be­fore, he had gone to St. Claude, to which Town the way is very rugged through Rocks and uneven ways, whereby his Reins grew hot, and the first occasion of his illness sprung; for upon this he voi­ded Gravel and had tokens of a Stone being bred in his Bladd [...]. Upon his own proper motion he drank the Waters called Vicecomitenses for three weeks, whereupon the heat of his Kidneys abated, but the Stone in his Bladder began to torment him more, to wit, the mucus being wiped off which in­wrapped it, and rendred it less troublesome. Out of mere impatience he called from Lions a most ex­perienced Lithotomist, Labutte by name, and joined with him Masseneau, a most skilfull Chirurgeon. The Lithotomist falls to his work; but first foretold the danger because of the season, although no Heat had troubled us that whole year, and the Sun see­med every where as if he had forgot his Office; witness the Harvest protracted to the latter end of August, and the Vintage to November. The Operati­on [Page 59] succeeded well enough, for presently a ragged Stone as big as a Pigeon's egg in shape of an Al­mond appeared, and was taken out without vio­lence: Death notwithstanding followed on the se­venth day (a Gangrene arising in the Perinaeum and Scrotum) and it was ascribed to that unlucky Star. Which indeed I do not deny; but I think the grea­test part of his Fate must be ascribed to the easie coming out of the Stone, by reason less blood came from the Wound, than the condition of the Patient, who was a plethorick Man, required. For present­ly, as the Operation was over, an astringent Ca­taplasm, according to custome applied, did repell the bloud inwards which was found in the Bladder clotted and black, in great quantity, whence a Mortification was brought upon the neighbouring parts.

XVI. In these times the most usual way of ta­king out the Stone among vulgar Lithotomists is by that they call Apparatus parvus. When the Patient is bound as he should be, the Chirurgeon puts the middle finger of the left hand into his anus, and with his right hand presses his lower Belly down to­wards his Bladder. Yet his Belly is not to be squee­zed with a bare hand, but he must hold a soft Cloth several times doubled in his hand, or some Tow: because when the Belly is this way pressed by the hand, the Muscles oftentimes happen to be hurt and bruised, upon which Pain, Swelling, Inflam­mation, &c. do follow. When therefore he hath found the Stone with his finger put into the anus, he thrusts it to the Neck of the Bladder, then he makes his Incision upon the Stone, and with his fingers put into the anus he endeavours to force it out: which indeed in some, especially when the Stone is small, succeeds well; if not, they get the rest out with hooks. How dangerous this Operati­on is, any wise man may gather, when he considers, that in performing it, the Chirurgeon may easily cut through the parts adjoining to the Neck of the Bladder, or the Neck it self; yea, and sometimes, the very Muscle of the Bladder; whence proceeds, 1. A great Haemorrhage, by reason of a multitude of Veins meeting in the place, and raising a dange­rous flux of bloud. Then it is to be feared, the Pa­tient cannot hold his Urine, or that a fistula remain in the part affected. It is observed also that in this operation the Bladder it self, because when evacua­ted, it falls within it self, yea, and the Intestinum rectum likewise have been both wounded, and so cut, that the Lithotomist (as Peter Franc observes) hath hurt his own finger with his Knife, and then the Urine came through the Intestinum rectum, Hildarus, lib. de Li­thot. cap. 13. and on the contrary the Ordure through the Wound. There­fore though this way was used by some of the An­cients; yet I would persuade the Operatour to find a more carefull way. ¶ However I saw it twice successfully performed upon the self same Boy, by Mr. Covilliard of Monte-limar, a most expert Lithoto­mist. He, anno 1655. took out a Stone as big as a Pigeon's egg, in a very short space of time, so that the whole Operation was over before you could say a Pater noster. The next year the same Boy relapsed into the same illness, by reason of a Petrifick minera remaining in his Kidneys. This experienced Chi­rurgeon, putting his finger into his anus, told them there lay nine Stones in the Bladder; he gathered them on a heap to the place designed for Section, which lying under the Knife, when the Incision was made, came out in the aforesaid number, some as big as Beans, others as Pease. But the Boy, through the calculous disposition in his Reins and Bladder, died consumptive the year following.

XVII. The Operation in a Patient, of a good ha­bit of Body otherwise, and in perfect strength, if he fall into skilfull hands, is ever very safe, on this condition, that the Incision be rather too large than too little, when one is not certain of the bigness of the Stone: for if it be too little, the parts are torn in getting out the Stone,Silvaricus, cons. 59. cent. 3. and so an Ulcer ari­sing, a Fever sometimes hastens the man's End.

XVIII. I would have Physicians know, that the outer extremity of the Neck of the Bladder does not appear in the same place in all Women: For it is seen inmost under the Nympha, above the outer straits of the neck of the Womb, few have it lye in­wards in the upper part of the pudendum. There­fore there is a necessity to dilate it, whenever you would put ought into it. And it is worth the while to consider, that this passage, and the whole neck to the bladder may very well be so stretched by a dilating Instrument, as to admit ones Thumb with­out difficulty;Wic [...]s, ob­ [...]rv. p. 95. if perchance a Stone should pitch there, or that so great dilatation should be requi­site on any other necessary occasion.

XIX. It is certain that the Stone grows in Wo­men as well as Men. A certain Nun could not make water for 12 days, the passage of her Urine being stopt by a Stone, where also there was a confluence of much water. Wherefore when this mischief could neither be conquered by the Brass-pipe nor Medi­cines, I bethought my self of a course, unusual indeed, but very opportune. I cast a hook up­on the Stone, lest it should slip back into the Blad­der; then with a piece of Iron blunt at the end, I struck upon the Stone, till at several blows it broke into pieces, and then with what care I could, not to hurt any thing inwardly,Ant. Beni­ven. I drew out both the hook and the Iron, upon which both the Urine and the Stones being voided, she presently reco­vered.

XX. When a small stone, forced out of the Blad­der into the Ʋrethra, stops the passage of the Urine, it may be taken out three ways, by a Knife, a Hook, and Suction. Hildanus advises to spare the Knife, as much as may be, because a hard Scar always remains in the cut place, hindring the dilata­tion of the urinary passage, whereby also there will be an interception of the Stone that is bred after­wards, which requires a new Incision there or ve­ry near it; which Wound is often followed by a Fistula. But if the Stone stick near the Glans, you may cut without fear, because in the fleshy end of the Member a less and softer Scar doth succeed, than in the middle duct of the Membranes. Whi­ther notwithstanding we must proceed, unless Diu­reticks, mollient Potions, and sitting in a loosening Bath, have been ineffectual. From the Hook there is danger of scratching the smooth coat of the Ʋrethra, instead whereof you may use the parva te­rebra of Paraeus, l. 17. c. 40. or Hildanus his tenaculum. Stones, in Tulpius his opinion, though never so rag­ged, may most safely be got out by Suction, although Hildanus disapprove of it, because thus the Bladder's passage is rather contracted than dilated, and store of humours and bloud is drawn to the Penis, where­by the Evil is increased. There is a fourth way in­vented by the Aegyptians, of which Alpinus treats, de Med. Aegypt. lib. 3. cap. 14. It is the blowing up of a man's yard with ones breath, the part next the belly being tied strait, so the Ʋrethra being dila­ted, there is a passage open for the Stone, if it be a little one; for a great one sticks. Sometimes it is got out onely by the help of a Catheter; a tri­al whereof (saith Tulpius) when a Lithotomist was about to make not long since, with it alone he brought a Stone out of the Bladder, as big as an Olive Stone, more than half way the Ʋrethra: wh [...]re when it stuck fast, he happily got it out by help of an Incision made underneath.

XXI. The Stone, if it be a little one, is more difficultly got out of Men than Women: Yet no violence must be offered, because the Bladder is a sensible part, as also are the Privities, which when much afflicted raise Convulsions and mortal Inflam­mations. As it happened to Vetius, who when he had a Stone pitched in the passage of his yard, he got it drawn out with great violence and trouble: [Page 60] Hereupon his lacerated Member conceived an In­flammation and Mortification, whereof he died. This operation may be tried, when the Stone is small and will pass with ease; if it will not come away so, you may proceed to cutting.

XXII. We meet with another way of getting out the Stone. The Chirurgeon, with his fingers put into the anus drives the Stone to the fore part of the belly, then by a hole cut in the Musculus rectus, according to the duct of the Fibres, above the Os pubis, he takes out the Stone by the help of a Pair of Nippers. If the operation be performed this way, a dribling of Urine need never be feared; and be­sides, a larger space is allowed to take out the Stone.Barbette, Chir. part. 1. cap. 26. But in the mean time this operation is in it self dangerous and troublesome; for if the Lips of the Wound made in the Bladder be not united to the Muscles of the Abdomen, an Exulceration of the Bladder follows, which does not onely create no­table Pain, but is esteemed more incurable than the Stone it self. ¶ Roussetus out of one Franc commends Cutting for the Stone in the Groin, whence it is called the Franconian Cutting, in Children especial­ly. Nor is Hildanus averse to it in larger Stones, which cannot be brought to the Perinaeum; for it is taken out there with less pain and danger of an Haemorrhagy.Barth [...]linus, cent. 4. epist. 20. The healing of the Bladder need not fright a Man, because it hath carnous Fibres, by the benefit whereof its innate Heat is cherish­ed and its Wounds cured. There are several ex­amples of a wounded Bladder being happily cured. And since the very Stomach and Womb may be wounded and cured without damage, what danger there can lye in this Cutting of the Bladder I do not see, so that an expert hand undertake it.

XXIII. In very old Men, who labour of a most cruel Dysury from a great Stone, that cannot be taken out without manifest peril of Life, that we may alleviate the miseries of Life, we cut the Pe­rinaeum after the same manner as is usual in taking out the Stone, and keep open the hole with a lit­tle Pipe.J. Riolanus, Enchirid. Anat. l. 2. c. 3. As long as Life is prolonged, the Pipe is stopped with a Cork, and a Sponge is applied to receive what drops, if there be any thing. When they have a great desire to piss, they pull out the Cork, then put it in again, and so the torment of Micturition in persons troubled with the Stone is mitigated.

J. Jac. Wep­ferus, Misc­cur. anni 1672. cos. 167.XXIV. If Stones must be cut out of the Ʋrethra, and can be got out no way else, they are to be held fast with the fingers both above and below, nor after the Wound is made must they be let go, till the Stones start out, or be taken out with a pair of Pliers: For if they be let go, the Wound of the Ʋrethra is so hid by the Skin that covers it, that it cannot be found again, by reason of the convex su­perficies of the Ʋrethra, and the lax Skin over it.

Cancer, or A Canker.

I. A Canker can difficultly be discerned from a Scirrhus, except thus, that is, If you lay some lenient and emollient Medicine upon the Tu­mour, and after two or three hours if you see it either diminished or quite gone,Walaeus, Meth. med. p. 11. there is no suspi­cion of a Canker: But if the Swelling abate not, but grow into a Spongy substance, it is for certain a Canker.

II. It is observed, that there is a double poison in a Canker, one Putrefactive, another Corrosive. If you apply hot and moist Medicines (which use to promote pus in Imposthumes and Ulcers, that are capable of ripening) then it will degenerate into deep Putrefaction,Heurnius, com. ad aph. 38. Sect. 6. and will corrupt all near it with Rottenness: But if you would correct this foulness by Causticks, the other Poison that in Can­kers is Corrosive will rise and burn all things near it. ¶ A Matron that had passed her 50th year, her Menses leaving her, was taken with a Swelling in her right Pap, at the first hard and without pain: Some years after, when it increased and caused pain, she made use of a Surgeon, who, when he had applied Emollients and Suppuraters for almost a Month, as the pain increased by degrees, the Swelling broke, which presently turned into a malignant, painfull and foetid Ulcer, which at length proved mortal. ¶ An occult Canker often lies hid a long time without any harm,Hildanus, cent. 3. obs. 89. but when provoked, it eats the skin: And when that is open, either of it self, or by the unskilfulness of him that hath it in hand, ever after it will be kept within no bounds, but like a ra­venous wild Beast devours whatever comes in its way. And by how much the more freely the va­p [...]ur contained in it exhales, by so much the more violently doth the humour flow likewise, which will encrease the Swelling: into whose intimacy, if the circumfluous Air, which was excluded before by its coats, do indeed penetrate, presently there follows both a greater putrefaction, and a more luxuriant rankness in the part affected: which, if you do but endeavour to hinder, either by Instru­ment or sharp Medicines, you do but twist ropes of Sand. The Daughter of Geropius Becanus carried in her left Temple, for above Fifty years, a hard and uneven Carcinoma, but without an Ulcer, or any great harm:Nic. Tulpius lib. 1. obser. 47. however, the pain and itching, by lit­tle and little encreasing, she imprudently applied to the Tumour, I know not what Caustick Medi­cines, which corroding the Skin, it quickly dege­nerated into an Ulcerated Carcinoma.

III. There scarce occurs any one disease this day in Surgery, about which greater errours are com­mitted than in the Canker; Do you ask the cause? The Disease and the Essence thereof is not suffici­ently clear to them; and in the Cure they too strictly observe that Axiome of Physicians, Contraries are Medicines for their Contraries. For when they see the Tumour very hard, they endeavour by Emolli­ents and Resolvers (contrary to Galen's opinion) to amend that hardness; afterwards, when the Tu­mour is degenerated into an Ulcer, they consume the Lips that are hard, with Escharoticks and Cor­roders, they correct the filth and stink of the Ulcer with Aegyptiacum, Hild. cent. 6. obs. 81. and such things, all which, how unreasonable and pernicious they are, many exam­ples do shew.

IV. Carcinoma's, or Cankers, if they be cured to the bottom, can be cured no other way than, if they be Ulcerous ones, by burning; if not Ulcerous by cutting. For that there are some which may be cured, is evident from Hipp. lib. 7. Epid. about the Man that had a Carcinoma in his Jaws burnt, and was cured by him: And others, that neither can be cured, nor ought to be medled with, appears from Celsus, because they are but provoked, and do in­crease till they kill. And the difference lies not in the kind of the Disease, but in the Quality of the humour; for in the very several sorts of Melan­choly some are sharper or milder than others. If therefore you perceive by any symptomes that a Man's Melancholy is so sowre, as that it is much ir­ritated upon a slender occasion, perchance you must not dare to touch it: But if by other symptomes you perceive the Melancholick humour, that is in a Man, doth incline to an earthy or sanguine na­ture, you must try to burn it with Causticks; and then if the thing succeed well, you must proceed presently to fire, especially if the evil be in a part, which the disease can easily and speedily eat away, such as the Jaws: For in such cases,Vallesius, l. 7. E [...]id. p. 89 [...]. although you be not sufficiently ascertained whether the humour be able to bear this Remedy, you must try even with danger to burn it; because if the cure should be neglected, the disease might eat away the part, though coming of no ungentle Humour. There­fore you must try even with danger to cure a Di­sease, that would certainly kill.

V. Purging should rather be used in the begin­ning, according to the redundance of the Humours in the Body, if perchance the encrease of the Can­ker may be hindred by it, than that we should ac­commodate it onely to carry off Melancholick Hu­mours, as they commonly doe, who think Melancho­ly to be the cause of it: which indeed (for a cos­tive body may be better treated) can upon this ac­count especially doe no good, because it cannot take away the cause of the Canker, that is poiso­nous besides. It is granted, that other poisons, as that which causeth the Pox, may be discharged the body by strong Purges often repeated, which it is not safe to doe in very weak bodies,Platerus. T [...]m. 2. p. 704. that are trou­bled with the Canker, nor if it should be done, would doe any good.

VI. Galen. 4. aph. 47. acknowledges he cured a Cancrous Tumour, that came in the breast of a cer­tain Woman, by violently and often Purging her of black Choler in the Spring and Autumn.H Montuus. And by the like method of cure I also freed a certain No­ble Countess of a Carcinoma in her Breast.

VII. We have no reason to question the repeti­tion of Bloud-letting again and again, for there is a fault in the Bloud, upon its being vitiated the Tu­mour depends. And though a Cacochymy should rather be discharged by proper Purgers; yet when there was hot, exust and melancholick Bloud in the whole, it ever pleased Galen, 3. de lec. affect. 7.Fortis, con­sul. 86. cent. 4. & ad Glauc. 11. and Hippocrates also, to abate us plenty by breathing a Vein; which is the more convenient, if heat and redness be perceived in the part, a to­ken of the Fire's being onely kindled, and not that all is in ashes.

VIII. Cordials, especially those that resist poi­son, will doe more good in subduing the strength of this poison, than such as are accommodated to other humours; And these are the chief of those things that are given inward in this case, and should rather be used than vulnerary Potions; which ne­vertheless some, that they may try all things in a desperate disease, do prescribe in an Ulcerous Can­ker: And they most esteem of one that is made of a Decoction of Winter-green, and Ground Ivy in Wine, for the Canker in the Breast,Platerus. and for all o­thers.

IX. If in the part affected the peccant matter be but in a small quantity, then there is no inconveni­ence in strengthening the Part; because, when the Part is strengthned, that little which is left is easi­ly dissolved by Nature. This Rule is gathered from Galen, 14 Meth. cap. 9. where he saith, That in the beginning of a Canker the excrementitious humour, if it be but little, may be repelled to the principal parts; because un­less it be suddenly repelled,Sanctorius, lib. de R [...]m. Innent. c. 15 the Melancholick hu­mour does presently distend the veins, which when distended, the Canker is rendred incurable. But [Page 62] that it is so, appears from Galen, 6 aph. 38. where he saith, the Roots of the Canker are Veins that are distended by melancholick Bloud, which unless it be removed, the Canker cannot be cured.

X. Sometime the Pain is most outragious, which will not allow one to take any rest or sleep; where­fore we are often forced to have recourse to Nar­coticks, which, in this case, by reason of the intense heat of the humours, doe less harm. For once I saw a Woman, that laboured of a Canker in her Breast,Riverius, pr [...]ct. l. 15. c. 10. wh [...] every night for four months took four or five grains of Laudanum without any hurt, and to her great comfort.

XI. A Noble Woman had all the right-side of her face,Mauritius Cordaeus, con. 7. in lib. 1. de morb. mulier. Hipp. for a long time, beset with an Ulcerous Canker: She, after she had made use of several means prescribed by the Physicians of Italy, France, Germany and Spain, was at length eased by this com­mon Barber-Surgeon's remedy; she cut young Chickens into thin and broad pieces, which she applied to the part affected, changing them often every day. Some use the Flesh of young Pige­ons.

XII. Septicks, unless they be tamed by frequent washing in the juice of Purselain, Lemons, Night­shade, or Housleek, may not be applied to any Ul­cer; and then they must be mixt in a small quanti­ty with some gentle Unguent, and used onely to a part that is far from a principal one: for I have observed them, especially Arsenick, and sublimate in a greater quantity, and not tamed, applied to Ul­cers near the heart, as to a Cancer in the Breast, that they once carried off a Woman in 6 days: A­bout three hours after the Powder was strewed on her Breast, she, just as if she had swallowed it, was taken with a Shivering, then with a Vomiting, and frequent Faintings, with a languid Pulse; which symptomes encreasing by degrees,Fernel [...]us, m. [...]. 6. c. 18. her extreme parts growing cold, and her Face and whole Body swelling beyond measure, she was miserably mur­thered. ¶ Have a care you do not use Fredo's Me­dicines for the Canker, for they consist of Arsenick: but that Arsenick is a destructive Medicine in can­crous affections, is certain. ¶ Therefore Penotus must not be harkened to, who, lib. de vera prepar. & usu med. Chym. extolls his Medicine made of Arsenick to the Skies: But he, good Man, was seduced by others, and never made trial of it himself; as neither did Philippus Mullerus of his, which he describes in Myste­riis & Miraculis Chymicis. The original of the Cheat and Errour is from hence; Because Theodorick and Lanfranc, whom Guido follows, distinguished a Can­ker, into a Canker an Imposthume, and a Canker an Ulcer. The Canker an Imposthume is the disease so called by Hippocrates, Galen, Avicenna, and others, ra­tional Physicians and Surgeons: But the Canker an Ʋl­cer (so Guido calls it) is, when by reason of Ʋlcers or Wounds, irritated by sharp Medicines, bad melancholick humours become adust and troubled, and are drawn from the whole and parts adjoyning to that place, where they putrefy, grow hot, and ac­quire an acrimony and poisonous quality, whence there is an en­crease of the evil disposition, and it becomes a Canker: So Gui­do. But such Ulcers, though malignant, and often­times stubborn, are not yet Cankers, nor ought to be confounded with a Canker, whose Contumacy far surpasses the Malice of all Ulcers. Moreover in the Canker an Ulcer, or rather in bad and ma­lignant Ulcers,Fa [...]ritius Hi da [...]us, cent. 6 ob­servat. 82. I have known the Powder or Arcanum of the Physician of Norimberg, as also my Escharotick Unguent, to agree well with several; but in a true Canker neither of them can be used.

XIII. A plate of Lead smeared with Quicksilver is no contemptible Medicine for Cankers, that are not Ulcerous: for Galen testifies, that Lead is a very usefull Remedy for malignant and inveterate Ul­cers: And that such Leaden Plates smeared with Quick-silver, are a kind of Alexipharmack, where­by the evil disposition of Malignant Ulcers is sub­dued and spent, when they elude the virtues of o­ther remedies, Guido is witness. When this sort of Remedy was prescribed, the Lady M. for a Canker as big as a Walnut in her left breast, it's true, it did not cure her; yet it hindred the encrease of her illness. But growing weary of it, when she had committed her self to a certain Physician, who boldly promised her a speedy cure, she proved by the loss of her life, how dangerous the cure is, which is undertaken after the manner of other Ul­cers: for when her Physician had thrown this Re­medy out of doors, and applied remollient, heat­ing and drawing things, the Swelling increased to such a bigness, that her breast,Paraeus, lib. 6. c. 30. through mere disten­sion, burst in the middle, whereupon an haemorrhagy arising, that could not be stopt, the poor Lady ex­pired in the Armes of her Physician.

XIV. An occult Canker had invaded a Matron's right breast, after two years time it rose to a mani­fest Tumour. The Physician that was consulted or­dered a Plate of Lead to be applied, and every o­ther day to smear it lightly with Quick-silver; ac­cording to the example of Galen, Guido, Paraeus, &c. But through the carelessness of those that lookt af­ter her, the Plates did more harm than good. In the mean time the Canker encreased, and came to Suppuration; therefore the use of the Plate was laid aside. The Swelling broke of it self, and her torments ceased a little; but by and by they re­turned more violent and pungitive, the Canker en­creasing in all its dimensions. It deserves admirati­on, that the Mercury which was formerly imbi­bed from the Plate, should drop so visibly, and in a pretty quantity out of the Carcinoma, which shaded the adjacent parts with its shining, nay,Bartholinus. cent. 1. hist. 7. and sweat at the shoulders through the whole skin. I order­ed a Plate of Gold (which Mercury uses to fol­low) to be applied, and a tent of Gold for the Ulcer.

XV. The Canker is taken away both by Medi­cines and the Knife. The Knife is better than Me­dicines; for eroding and sharp things cause pain, and this a greater flux of Humours. Yet the latter way of cure is sometimes proper; for erosion must be made in the Interstices of the Fingers, and in the Groin, because the tendons and membranes in these parts would make cutting very painfull. Among the caustick Medicines there is the Holosericum Fer­nelii, and Vinegar some use, that is better, the Ly of Sope boil'd up to a consistency: Arsenick, which pleases some, displeases me: Lest an Inflammation should be raised in the Neighbourhood, apply a de­fensative round about. Thus indeed a Canker may be taken away by Medicines; but it is better to cut it out with a Knife: This cutting is either speedy or slow. I saw a Canker so quickly cut from the Breast, that in the time of the operation I was scarce able to speak three words: But when a Canker is come to a great bigness, then this speedy cutting is not proper, for much good flesh is taken away, and a great hole is made, out of which the spirits can more freely pass, and thereby the Patient is more weakened. In this case, to re­cruit strength, Cataplasms steeped in Wine are ap­plied: In less Cankers we may make the Section all at once, except in those of the Lips. But it must be all taken away; therefore first let the Opera­tour take the part affected, and these adjacent, in his fingers, and try well, whether all that is amiss may be taken away. A Canker once cut out doth often come again. 1. When all was not cut out, through timorousness, either in the Operatour, or in the Patient. 2. Because the Arteries that emit this vitious bloud, by reason the less Arteries are cut away from the part affected, must contain more bloud than before, and therefore when they are open, will discharge that bloud upon some other part, whence comes a new Canker. 3. Because there is so much malignity latent in the Body, that a Canker will always grow afresh. A [Page 63] Canker is easily cut out of the flesh; difficultly (but it may be done) out of a Membrane and Tendon, so that these parts be such as may be taken all away. For this reason, a Canker that possesses the intercostal Muscles, cannot be cut, because of the Pleura, that is joined to all the ribs.Walaeus, meth. med. p. 128. A Canker in the bone is most difficultly of all cut: Therefore this disease re­quires a Cautery. The dissection of the Canker must not be made at a great distance, as is the cu­stome in a Gangrene; yea, if it may be done, we must cut off no good flesh.

Amatus, cent. 3. curat. 32.XVI. I have known some Women, who had Can­kers in their breasts, that by a good order of life, without any trouble of Topical Medicines, lived a long time, as well as if they had been troubled with no Disease.

XVII. Although no peculiar Operation be owing to a Lip which is troubled with a Canker, other than what is due to a Canker in any other part, namely, the extirpation of the Disease, with the part it is in; yet let me caution young Operatours, that the way described by Aquapendent, to wit, to doe it with a sharp piece of Money, or hard Wood dipt now and then in Aquafortis, Van Horne, Michrot. p. 120. is by no means to be appro­ved of; because the Carcinoma will be enraged by such a Liquour.

XVIII. I will add the observation of the excel­lent Scultetus, that a pair of Scissers is very incom­modious to cut away part of the Lip, troubled with a Canker. The reason is, because something of the Ill is always left; whence it comes to pass, that it breaks out again,Bartholinus, cent. 1. Hist. 7. which he saith he observed twice in the same Subject.

XIX. I cured an old Man of 84, of an exulcerate Canker in his nether Lip. I cut it out by the roots with a sharp Incision Knife; the bloud ran vio­lently out, which, when I had let it run on pur­pose about ten ounces, I staunched, without any Searing, onely with a little burnt Cotton and A­stringent Powders. After the use of Digesters good Matter ran out (a token that the whole substance of the Canker was taken away.) Afterwards with a Camphorate Ointment of Ceruss made in a Lea­den Mortar, I brought a Cicatrice in twenty days time. But three years after a new Canker arose in his Jaws, of which he shortly died, contrary to my own, and all mens expectation, when it was not likely at these years, that an adust, Melancholick Humour should breed again, and cause a new Can­ker in another place. I was confirmed in this opi­nion, because I had seen a Woman of 70, that had an Ulcerous Canker in her Nose, to whom I pre­scribed the same Ointment, rather to ease her pain, than to cure her, who yet, beyond all hope, in a month's time, was perfectly cured. I also cured a Man of 40 of an Ulcerated Canker, as big as a Pi­geon's Egg in his nether Lip, after the same man­ner, i. e. by cutting; with the addition of preparati­on, and purging of the Melancholick Humours, and yet there arose no Canker in any other part of the body.P. Marchet­ti, obs. 29, & 30. So therefore sometimes we need not cast away all hope of curing those diseases.

XX. A Canker in the Breast is sometime occult, sometime Ulcerous and manifest: besides, the di­sease is sometime in one part, sometime the whole Breast is affected, yea, sometime it creeps farther, and gets into the Glands under the Arm-pits. Keep your hands off such, for the cure is in vain, as also experience shews that to be which promises a re­covery by Medicines. Truly there is no cure here, but what is heteroclite (as Aquapendent saith) that with the Disease taketh away also the part affect­ed, which is the most usual operation. But Hiero­nymus is too scrupulous,Van. Horne, Michrot. 135. in that he would first take a­way the pain, and hinder the profusion of bloud: for the pain is but momentany, and onely small Ar­teries are cut.

XXI. In the operation, first of all two Needles, or a double Thread are drawn across through the Breast: Yet the Patient is not always to be tor­mented with the double pain of crossing the Needles; sometimes the Carcinoma is onely taken hold on with the left hand, viz. when it is pretty moveable. Af­ter the same manner you may conveniently take away remarkable Wens or Cankers,Idem, p. 1 [...]. that grow in any other part of the body.

XXII.Idem, ibid. And the vessels that are cut must not be seared, but Medicines which stop bloud must be applied.

XXIII. In Cankers of the Breast it seems as if we should prescribe Repellers, to intercept the greater flux of humours, if we observe the part affected to swell daily, this being a token of a continual afflux, that should be repelled another way; and the part affected must be strengthened with moderate astringents, that it may not be so liable to receive the flux of humours. On the other hand, we have Hippocrates his Rule, It is better not to cure occult Can­kers. Nay, if according to Galen, evacuaters be more convenient than repellents in the Parotides, lest the matter should be driven into the Brain; how much rather should we abstain from Repellers in a Cankrous Breast, that is so near the Heart? Wherefore it is my opinion, that if we were in the beginning of a Disease that is but coming, then we need not abstain from some of the weaker Re­pellents, mixt with weaker Digesters. For which purpose it is my custome to make use of Oil of Ro­ses complete, beaten up in a leaden Mortar, with a leaden Pestil, to a moderate consistence: for by the benefit of this Liniment I have more than once con­quered Cankers as they were beginning. But we may not proceed to the stronger Repellers, neither in the beginning, because if the Spongy substance of the Breasts be condensed, the bloud has recourse to the Womb, where it breeds a Canker: nor in the progress of the disease, because they hasten ex­ulceration.

XXIV. Magius being called to a certain Noble­man that had a Swelling in his right Breast, which they took for a Canker, judged it rather to be a Phlegmone, because it was of no long standing. First of all therefore he ripened this Swelling with Wheat­flower boiled (as Galen teaches) in Water and Oil, and when signs of its ripening appeared, he opened it with a Knife; which being done, good matter ran out. But before opening, he felt some palpita­tions within it, which also argued the Tumour to be no Canker. Then he used Digesters,Schenckius. as Turpen­tine mixt with the Yelk of an Egg, and cured his Patient.

Capitis affectus in genere, Intemperies, Or, The Diseases of the Head in general, its Intemperature.

I. PHysicians do not all agree, what Vein should be opened in diseases of the Head; yet it is altogether necessary a distinction should be made; and we must take good notice what the Laws of Evacuation from the whole, what those of Revulsion and Evacuation from the part affected do require. For in the beginning of the Disease we must not have respect onely to the Head, but to the whole Body also, and to the part whence the flux of Bloud comes; and we must so order Bloud-letting that it may doe good and not hurt, that is, that we may hinder the bloud from running to the Head. There­fore in the beginning such a Vein should be opened, as may both evacuate the abounding bloud, and draw it from the Head; but we must by no means in the beginning open a Vein in the Head it self. But if the fullness come from the whole Body, we must bleed in the Arm: if abundance of bloud, and the disease of the Head proceed from suppression of the Menses, or Haemorrhoids, we must consider the quantity of the abounding bloud, and the greatness of the Disease in the Head, that depends upon it: For if the quantity of bloud be less, and the Di­sease will give truce, we may bleed in the foot first, and that several times, because these Veins make both Abatement and Revulsion. But since these Veins in the feet, as being small, do evacuate the bloud but slowly, if there be a great quantity of it,Sennertus, l. 1. p. 1. c. 8. and the Disease be violent, and therefore present help be required, we may first bleed in the Arm, [Page 65] and then take care to recover the course of Nature. At length, when the Body is evacuated, and the Flux ceased, if the Illness go not off, a Vein may be opened in the Head.

II. The Circulation of the Bloud teaches, how we may succour the Head,Riolanus, Anthropogr. in fine l. 6. when sick: For if the Bloud ascend to the Brain onely by the Carotides, and descend by the Jugulars, to bleed often in the Arm will doe good: And Cupping bloudy and dry, frequently applied to the top of the Shoul­ders, the Neck and Poll, hard rubbing of the Limbs both above and below, will conduce to the revulsion and derivation from and evacuation of the part affected. ¶ But Experience shews, that ope­ning the Saphaena does better and sooner quiet several cephalick affections, especially the Head-ach, than any Vein in the Arm: Perhaps the Reason may be brought from the same Circulation of the Bloud, because the mouths of the Arteries lye here more open to the Veins, the Bloud that is drawn thence is of a more arterious nature: The same Reason may be given for the Salvatella in the Hands, of the Efficacy whereof no one doubts.

III. Hippocrates, 2. Epidem. Sect. 6. v. 36. proposes a Vomit, for taking away a fulness of the Head, whereby it is successfully and quickly purged: and those that vomit know as much, for when they vo­mit, great store of Humours run out at their Mouth, Eyes and Nose. Wherefore, 4. Aphor. 18. Diseases above the Diaphragm, that want Purging, signifie, they should he purged upwards. And, lib. de loc. v. 173. sect. 2. In a Defluxion from the Head a Vomit is good. There­fore farewell they, that are so fearfull of a Vomit in Diseases of the Head, and think the Head is stuf­fed the fuller by it:Martianus comm. in Hipp. For although in the very act of Vomiting it seem to be a little filled, yet be­cause such fulness is from Vapours, which, as soon as the Vomiting is over, do vanish, we cannot say, the Head is filled by Vomiting. ¶ Extraneous Fer­ments, whereever in the Body they be bred, and the deeper Seeds of Diseases, can never be got out without the use of Vomits: but Vomits are found very beneficial in the Diseases especially of the Brain and nervous kind: for by this sort of Physick not onely the filth of the Stomach and Bowels, that corrupts the Chyle and Bloud, is plentifully dis­charged; but the Glands likewise, which are plan­ted in the Bowels for Emunctories of the Bloud and nervous Juice,Willis, Tharm. rat. cap. 2. sect. 2. are squeezed out, the choledochal vessels, and other receptacles of Excrements are a­bundantly evacuated, insomuch that these being emptied are more ready to receive the recrements and superfluities of either humour, that would o­therwise be apt to overflow the Head.

IV. Galen's advice, lib. 1. [...]. must be obser­ved; that in all Diseases of the Head, whatever hu­mour be the cause, Medicines that purge Phlegm must be mixt with the rest.

V. Paulus, lib. 7. cap. 4. writes, that they who give a Purge at night or after meat, doe harm, the Food corrupting, and the Physick working less than it should: Reason seems to confirm this, for so concoction is interrupted, distribution of the Ali­ment vitiated, and the Physick works imperfectly, its purgative virtue being weakned by the Food: But Experience contradicts it, which shews, that Pills given after Supper do purge the Head very well, without the forementioned Inconveniences; as J. R. Saltzmannus declares, in Hildanus, cent. 3. obs. 72. I light (saith he) not long since on Damascenus, and upon that Aphorism of his, wherein he orders, if you have a mind to purge the Head or any other remote part, that you give Pills after meat. But our Methodus medendi is contrary to this which persuades us to give our Purges, especially such as purge any particular hu­mour, upon an empty Stomach, or if they are very strong to take a little Broth before them. I shall not here give reasons; But Experience confirms Da­mascenus his rule, for oftentimes in several cases our chief Physicians give Pills after Supper with great success, as I after their example have done several times. And, to speak the truth, I have not yet ob­served a more present Remedy to purge the Brain from all superfluous humours. And, which is won­derfull, they are given in a much less Dose than those that are taken in the morning fasting. They are taken an hour or two after a light Supper, slee­ping upon them: About four, five or six by the clock in the morning they work gently, and with­out any grievous symptom, viz. reaching, vomiting, loss of appetite, gripes, or any other: And they may be repeated sometimes every night, sometimes every other night. And thus several have been pur­ged by a little Dose, who before could not be mo­ved with twice as much, when they took it in the morning fasting.

VI. It is also the opinion of many, that the Head is emptied better by Pills, than by Potions or Bo­lus's, because they draw more violently from the distant part, through their long abode in the Sto­mach: This indeed is certain, that Pills do purge the Head effectually; but they have this not from their form, but from the strong Medicines of which they are made. This mistake had its rise from a false supposition, that Purgatives taken into the Stomach, did draw the bad humours from the whole Body thither, which is not true (for were it so, Plasters to the Navel, and Purgatives held in ones hand, or smelled to, would not purge) but they doe it by transfusing something of themselves into the Body, whence there arises a commotion and fermentation of the humours, upon which the expulsive faculty being provoked, and driving the humours with the Purge headlong into the Guts,Sennertus. excretion follows.

VII. Do not purge the Head of a man in a Fever, lest he go mad; for purgative Medicines heat the Head, and the Heat that is in the Medicine joining the febrile heat, causeth Mad­ness, saith Hippocrates, lib. de loc. in hom. Which to me seems very consentaneous to reason, and therefore if a man have a violent Fever, and especially in his upper parts or have his Head inflamed, or if his Head ake, or he be phrenitick, or if he have a great Ulcer, which cannot safely be irritated, I avoid Physick as much as I can, knowing for certain, that it affects the Head: Sleep shews this, which pre­sently seizes them that have taken a Purge. If I can, I content my self with sharp Clysters and a low Diet.Vallesius. 2. Epid. 6. p. 225.

VIII. In an Intemperature of the Head with Me­lancholy, always some Moistner must be mixt with Purgatives: Nor may a Purge be prescribed till the body be first moistned.

IX. The Ancients said, that Sneezers and Apo­phlegmatisms were indicated by excrementitious hu­mours gathered in the Ventricles and substance of the Brain. This latter Age thinks not that these parts do empty the humours gathered there by the Nose and Palate; nor that what is evacuated, is excrements of nutrition gathered in the Meanders of the Nostrils and Membranes of the Palate and Jaws; but in some mens opinion they are bilous, phlegmatick, melancholick and serous humours, derived thither partly by the Arteries from the whole body, and partly from the Salival ducts.Rolfinccius, meth. med. specialis. p. 605. For this reason they are indicated by the cacochymick impurity of the bloud, diluted with much Serum, that its flowing into the Brain, its farther mixture with the circulated bloud, and its approach to the more noble parts may be prevented.

X. If you make use of Sneezers, to unload the Brain in its Intemperature with Phlegm, you must abstain from violent ones, as Powder of white Hel­lebore, Root of Lily Conval, and the like, because of the great agitation they cause in the Brain, con­venient onely for such as are in a Lethargy or Apo­plexy; it is sufficient if you onely put a Fibre of the Root into the Nostril, and then pull it out again.

[Page 66]XI. Some think, that the use of Ptarmicks does rather encrease than hinder a defluxion of humours from the head to the breast, and that this should not be used but in case of extreme necessity, and universals premised. But in my opinion they are grievously out, seeing in great and sudden suffoca­ting defluxions they are very properly and succes­fully used.Quercetan. Phr [...]m. degm. re­s [...]t. c. 18. For Nature hath ordained these Chanels for the emptying of the Brain, whom Art imitating doth so promote, that in an open and free passage through this same way the course of the serous hu­mours is expedited and turned back. Avicenna uses a certain vaporous Sternutatory, made of very strong Vinegar, in which he dissolves a little Ca­stor, the steam whereof causes violent sneezing.

XII. As much Extract of Tobacco, made with A­qua vitae, as a Pease, laid on the Tongue, brings off a great deal of Phlegm.Riverius. Exceed not this quantity; for if it get into the Stomach, it will cause grie­vous vomiting.

XIII. As often as the Head is indisposed by out­ward Cold of the Air, Water or Snow, or the Nose doth run, or they be troubled with a defect of ani­mal Spirits, so often I have observed my Patients succesfully and quickly cured, if, as quickly as may be, that be driven out of the Head again which was got into it, or any other part of the body, and was hurtfull to them. And this either by one Sweat, or, which I prefer, by several; but they must be spirituous and volatile: because they must be such as not onely alter and correct the cause of the Cold and of other evils attending it, but amend whatever amiss is introduced into the body, contai­ned or containing. For this purpose I commend the following Receipt: Take of Water of Fumitory, Fenil, each 2 ounces, simple Treacle or any other Aromatick water 1 ounce, Spirit of Sal Ammoniack 20 drops, Oil of Cloves 3 drops, Bezoarticum minerale half a drachm, Laudanum Opiatum 2 grains, Syrup of red Poppies 1 ounce; mix them. Let the Patient take two spoonfuls of this Medicine, and when he is moderately covered ex­pect a Sweat, which he will facilitate and obtain his desire, if every half hour he take as much of it, till the Sweat burst out, for then he must use it more seldom and sparingly: he must use now and then some plain broth, with a little Wine in it, to repair his strength, and make him the more able to sweat the longer; for nothing does them so much good as a gentle Sweat sometime. As often as the natu­ral and competent Secretion of the animal Spirits is hindred by an inward or aguish chilness, or by any other, that without an Ague fit doth now and then seize a man; so often by the like Sudorifick rightly used, the Sweat arising sometimes sooner, sometimes later, the desired Secretion of the ani­mal Spirits, so necessary to humane felicity is soo­ner or later restored: for by help of this or the like spirituous,Syl [...]ius, [...]ax. med. l 2. cap. 1. s [...]ct. 21. ad. 36. volatile and aromatick Medicine the hurtfull and cold Vapour is discussed and dissipated in Sweat or insensible Transpiration, which caused that dulness in the sense and liftlesness in motion. And whoever in such an internal or external Cold do think to cure by Bleeding, Vomiting or Purging, they cast their Patients into greater hazards, e­ven of Life it self, as I have observed more than once, &c.

XIV. The natural temperament of the Brain see­ing it is very moderate, we should therefore use both inward and outward Medicines for the Head, with great caution, lest while we change its native temper, we bring some great mischief on this most noble part. Wherefore their boldness is not to be approved of, who attribute so much to those Wa­ters called Aqua vitae, being made of violent hot things, that they affirm all Diseases of the Head may be both prevented and cured by the use of these same Waters; not considering, that most Dis­eases of the Head do come rather from hot causes than cold, especially in those persons that are either in their youth or manhood. Besides, in our Germany the way of most mens living is such, that there is scarce one in a hundred who gathers not a particu­lar Plethora in his Head: Whence it happens, if the use of Aqua vitae be prescribed to one of these men, that it, seeing it is altogether vaporous, immedi­ately gets into the Head, and disturbs it, being full of various humours, and disposes it either to the Epilepsie, Apoplexie, or to dangerous Catarrhs. But that this opinion does not want experiment, you may understand from this, that those Apople­ctick persons to whom these Aquae vitae are given,Oethaeus, a­pud Schenc­kium. do almost all of them dye or grow worse, as I have of­ten observed, and do find it observed by others.

XV. Some prescribe an Issue in the Coronal Su­ture to be made with a Cautery, and do commend it for drawing out and evacuating the humours from the Brain and its Cover. Although this is ve­ry familiar in some mens practice; yet I have known it succeed but ill with several, so that I have orde­red many Issues, thus made in the top of the Head, to be stopt up, and that, convinced of it by reason as well as by experience: For the Bloud transfers more Feculencies towards the place, where it used to lay its Recrements, and discharges them all thereabout, and especially in the part affected (as being weaker and more susceptive of them) whence it happens that the Disease is oftner increased than cured. For the same reason, namely, to derive the humours from within the Head to without, some [...]ig fontanels in the Bregma, above the Coronal Su­ture, and others behind in the head, at the begin­ning of the Lambdoeidal Suture: but the same Ex­ception is against this as against the former. But much better certainly doth an Issue in the Arm prevent the morbifick matter that used to be discharged on the Brain, one in the Leg makes Revulsion of it, and one made a little below the Head derives it thence. Therefore for the more grievous Diseases of the Brain or its Meninges in Infants and bigger Chil­dren, we cut a hole in the nape of the Neck; in grown Persons and old Men we make Cauteries on each side the Spine between the Shoulders, and there we make Issues big enough to receive several Pease, with great benefit. As for holes cut or burnt behind the Ear, or a Seton drawn through its carnous lobe, I have seldom observed them to doe any good, but often to create much trouble; inasmuch as the Solution of continuity made in these parts doth not run much ichorous matter, nor long: for alth [...]ugh the hole be stopt with a Pease or Pill,Willis. yet the skin will grow over it in spite of ones Teeth.

XVI. Avicenna, lib. 3. fen. 1. tr. 2. c. 33. proposes Incision of the Arteries in the Temples, or burning them with Cauteries, for the interception of Va­pours which ascend with the arterious bloud through the Arteries; and he describes the man­ner, and things necessary for such an operation at large. And he orders three Cauteries to be appli­ed to the Head, that the humours may be drawn from the Brain; two upon the Temples, to inter­cept the humours and vapours ascending from be­low, and one in the Nucha, or behind, between the Head and the Neck. But Jacobus de partibus doth not without reason add in his Commentary, Since most Patients will scarce admit of gentle Remedies, who will endure to be so often burnt? And therefore he advises the Phy­sician, never to attempt the use of so many Caute­ries, except they be earnestly requested by the Pa­tient and his Friends: because it is a question whe­ther by the use of them the Disease will determine, and it may be feared, when the Ulcers are healed, the Disease will return.

XVII. Whether is the application of hot things good for the hot intemperature of the Head? This hath been tried especially by our modern Chymists, who in a hot cause use the most subtile Spirit of Wine outwardly, that the Pores may be opened, [Page 67] and the hot Spirits drawn out by a similitude in sub­stance; and this hath place in a hot Intemperature coming from a hot cause, but not in all; which is effectually performed by Camphire, drawing out the hot vapours by reason of its likeness, so ma­king way by the tenuity of its parts for other Me­dicines, and not as is commonly thought: For Phy­sicians being convinced by the evidence of the thing it self do well conclude it to be hot. Upon the like reason Snow and cold water are applied to the Limbs benummed with Cold, and not cold but hot things to a Burn; so the Fish of Cockles outward­ly applied sokes up all moisture.

XVIII. Three things must be observed in washing the Head, viz. that contrary to the common custome, the Head must so lean back, as that the Eyes may look upwards. To use bitter Almonds instead of Soap,Zecchius, Co [...]sult. 27. and not to rub with too hot Cloths, nor over­heat the Head with too violent rubbing.

XIX. Washes prepared by Art doe the Head more good, and are used with less danger than Bath-wa­ters. Some are of opinion that the Head is weak­ned with frequent Washing: And it holds good in a strong head, and one unaccustomed to washing; but of an infirm head, and such as is accustomed to wash off the filth, it is not true. We must wash in Summer time in the Morning, in Winter be­fore Supper; and the same day the Feet must be washed.Crato.

XX. For Epileptick persons, and those that are any other way troubled in their Head, a Plaster of Gumms is very good applied to the Nape of the Neck; from which a certain Nobleman, by the advice of an Empirick sound much benefit. Either because it hinders the ascent of Vapours and hot bloud to the Head, or because it wastes the vellica­ting Humours from the original of the Nerves. Three are laid on the Nape one after another,Bartholinus, Cent. 5. Hist. 25. and there let alone till they fall off of themselves, which will last for some weeks; then the place must be washed with some warm water, and another appli­ed. Thus Plasters of Tacamahacha, Caranna, &c. applied to both Temples and the Forehead do in­tercept the Humours that fall upon the Eyes and Teeth, and do bind the passages in the Veins.

XXI. Rubbing the extreme parts is commended; but such a rubbing of the Head as fills it with Va­pours, and does not empty it, must be avoided. Let universal evacuation precede it, then let it be done in this manner, first, let the Neck, Arms and Spine of the Back be stoutly rubbed, then the Thighs and Legs, and last of all the Head: for then there is no danger of drawing Vapours or Fumes to the Head, because they are already diverted to the parts afar off. Thus it may be done, the Brain be­ing first evacuated: Friction must be made in other parts of the Body with a course Cloth hot, but in the Head not with a very hot Cloth, it is sufficient if the Cloth be onely dry and not hot at all; and this must be observed in the Epilepsie, Apoplexy, Catarrh and other Diseases of the Head, that we be­gin our Friction from the Neck, descending by de­grees to the lower parts,Rond let [...]us, Pract. Med. 77. even to the Legs and Feet.

XXII. Anatomists and Experience it self do shew, that the Heart has a great sympathy with the Brain: for the Heart supplies the Brain with vital Spirits, and in Swoonings it is known that the hurt is com­municated to the Brain; so when the Brain is hurt, the Heart also sympathizeth: Therefore in an Epilepsie the trembling of the Heart does ensue, that malignity which troubled the Brain, being communicated also to the Heart. And the case standing thus, it will not be amiss in great hurts of the Brain, to apply comfortable Topicks to the Heart. I will confirm this with Experience; As I was upon Recovery from a malignant Fever, that had cast me into a Lethargy, upon any slight oc­casion I used to fall into Watching, which present­ly brought me very low: Wherefore when I was once in great danger of my life, and I perceived not onely the Faculties of my Brain, but the Strength of my Heart to be much wasted, I ap­plied a Cordial Epitheme to the Region of my Heart, and then I composed my self to sleep: And as the virtue of the Epitheme penetrated and strengthened the Heart, I perceived as it were a certain Beam ascend from my Heart to my Brain, which gave wonderfull Relief to my Head;Orthaeus a­pud S henc­kium. after­wards I fell into a sweet Sleep. And after this, I perceived the same Experiment did good to others.

XXIII. I shall confirm the efficacy of Plasters to the Feet in Diseases of the Head, from a very rare Observation. Some years ago a young Dane be­ing returned from a far Travel beyond the Seas, up­on altering his Diet fell into a grievous Ophthalmy, or a Chemosis rather, the Balls of his Eyes starting out, and his Eye-lids inverted, he could neither endure the Light, nor the least Breath of Air, &c. so that neither I, nor a very skilfull Chirurgeon, could find any Remedy doe good to this growing and per­tinacious Evil; but we were forced to make use of the last Remedies, which Hippocrates in the last Secti­on of his Aphorisms commends; nor yet did the Pa­tient perceive the least benefit by all these things; wherefore I thought with my self either to leave my Patient to the Prognostick upon the sacred au­thority of Hippocrates; or apply my self according to his rule, to undertake the Cure of this Chemosis another way. I enquire therefore more carefully and narrowly into my Patient's former course of life: He told me how he had undergone the great­est hardships, and that he was almost killed with his Toil in Candy, when he served the Venetians as a Foot-soldier: He protested ingeniously, he never defiled himself with those Vices, which are the fruits of Youth, and with which some Travellers of all Na­tions come home filthily polluted, like Dogs that have lost their tails. Seeing therefore this civil young Man did, among other things, complain of great heat in his Feet, for which he could not sleep; I ask him farther, whether his pain went some time off, or were continual, and whether new or old? He told me it was continual, and old. Therefore I ask him, how long since it began? He said, he could not resolve me that. I could not rest here, being willing to get out of him the true cause of this Disease or Symptome: wherefore, when, among other things, he had told me how he had travelled long Journeys and very fast on foot from Padua to Hamburgh, and that he had performed this foot Jour­ney in five weeks time. I began to suspect that the heat of his feet had overheated his bloud, yet with­out a Fever, and that this bloud either caused or fomented the Disease in his eyes. Upon this I had a mind to try how far carefull Reasoning could help practical Studies, or how much Anatomy (some­times by Authours called useless, and which even Galen, 4. Anat. adm. c. 1. seems to style rather wran­gling than profitable) could conduce to the Study of the Practice of Physick, or whether the Circulati­on of the bloud could doe as much in curing an Oph­thalmia, as it does in curing an Agrypnia (or Want of Sleep.) Therefore I obeyed Hippocrates, l. de loc. his Axiome, That old Diseases must be made new ones, that is, as I ever understood it, they must be pressed upon with new proper Remedies afresh, just as if a fresh fit of any Disease should come upon one: And I re­newed the Cure of this Chemosis: Besides, in the fore­cited place He gives in cha [...]ge, that In Diseases, that a man understands not, he must give a violent Purge, which Rule I followed, as Ariadne's Thread. Therefore, Universals premised, I commend to my Patient Em­plastrum Imperiale Jac. Fabricii as a thing, whose excel­lent virtues I had often tried in asswaging Pains of the Gout; But because in this individual a bare hot Intemperature without matter had seized his feet, I mixed with one ounce of this Plaster of Nitre [Page 68] prepared and Gum Caranna each half an ounce, and in five or six days time not onely the Intempera­ture of his Feet was corrected, but by chance also I found a Remedy for Corns in the Feet; for when the Soles of his Feet were uneven and thick beset with innumerable Corns, it happened, that by u­sing this Nitrous Plaster they every one withered away. And by this method was this young Man freed from an enormous Ophthalmy, that had laid him up in a dark hole eleven weeks, who to this day (as it is now three years since) hath not suf­fered the least Taraxis (or Bloud-shed) in his Eye. Henceforth therefore let them hold their Tongue, who frowardly deny the Circulation of the Bloud: for I verily foresee, that in future Ages, it will give light to many abstruse Diseases, even those they call Diseases of the Form. But here this Quaere must be resolved, Why those things we apply to the Feet are commonly believed to benefit the Head? The Reason is at hand, Because by application of hot or cold things to the Feet or the Soles thereof, the Bloud is quicklier altered by reason of the nu­merous Anastomoses of Veins and Arteries there, which being altered, is by means of Circulation carried to the Head: So Blisters applied to the Wrist either take away or abate the Fever: they take it away, when the febrile ferment, that is then in the Veins, runs out with the Serum into the Blister raised on the Wrist: they onely abate it when part remains behind. And cold Alteratives cool the Bloud, as when we apply Nitre dissolved in Let­tuce-water, or the pulp of a Lemon to the Wrist. He therefore that would have a care of his Health, would doe well,S. Pauli Di­gress. de Fe­brious ma­lignis, p. 83. if by reason of the said Anastomoses he fence his Hands and Feet well against the inju­ries of the Air, and avoid such Objects, especially extreme cold ones. A certain person (saith the fa­mous P. Marquardus Slegelius) being employed in clear­ing away some Ice, wherein he used an Iron tool, sell suddenly into a Swoon, the Cold being trans­mitted by his Hand to his Heart, &c.

XXIV. In all Diseases of the Head, most Men ac­knowledge, it is good to keep the Body loose; but few shew a reason for it. Now I think Costive­ness is pernicious, not chiefly, because the matter retained in the Guts often hinder the necessary use of Remedies; but because Vapours are perpetual­ly elevated from the matter retained, and from o­ther Humours of the lower Parts, to the higher Parts of the Body, and especially to the Head: For these Vapours, while they continually affect the Head, otherwise afflicted, are not onely burthen­some in quantity, but according to the different qualities disturb and corrupt the animal Spirits, whereupon all the ills in the Head grow worse,Oethaeus a­pud Schenc­kium. and new Symptomes frequently arise: Therefore it is good in all Diseases of the Head to keep the Body open.

XXV. It is very well known that Coriander is given to suppress Vapours arising from the Stomach to the Head: Yet some disapprove the use of it, because it is its nature to affect the Head, nor does it hinder the ascent of Vapours, but rather carry them with it self to the Head; yea, and according to Dioscorides, cause Madness: But this is, if it be immoderately taken, which is common to it, with Saffron, Nutmeg, Frankincense, &c. yet this is no reason that it should be rejected, if moderately ta­ken, especially prepared: For that vaporous and volatile part (as Chymists word it) that is in the Coriander, and which taken immoderately hurts the Head like Poison, is fixt and corrected by the Vinegar, so that it becomes a proper Remedy to help Concoction,Sennertus, Pract. l. 1. part. 1. c. 2. and clear the Heart and Brain, as experience shews.

XXVI. Concerning Quilts and Caps we must take notice, that such as are made of very strong scented things do affect the Head, and cannot be endured of all people: And this is true not onely of Muski­fied things alone, but of all strong smelling things in general, though gratefull, if they be beyond measure such: And they make the Head to ake, and cause a turbulent motion in the Spirits: for this Maxim holds true here; Every extreme Sensible hurts the sense. Wherefore I have seen some,Wedelius, de Med. [...]t. p. 202. especially at the beginning, that could not wear these Spice­caps without the Head-ach.

XXVII. Nor yet must the Ingredients be too hot, nor too cold and astringent; not too hot, lest they melt over much, dissolve and precipitate the mat­ter into the Vessels, which would gladly get out at Nature's High-way; thus hath a dangerous Fever come of a Catarrh, by unseasonable applying Oil of Amber to the mold of the head: We must have a care of Astringents, lest the Brain be hurt by pow­erfull Astriction,Idem. and the motion of the Humours be stopt.

XXVIII. Caps are most proper in essential Dis­eases of the Brain: They alter and strengthen it, that it is not so apt to receive Defluxions and Im­purities: They discuss both the footy Vapours blended with the Lympha, and the abounding serous Humours; They intercept, especially those that are made of Astringents, not so much, as the Head is the first Spring and Original of all Catarrhs, which nevertheless was the opinion of the Ancients; but as at least it is not altogether without fault, so the Moderns hold: Thus they keep back the shower of a Catarrh: Thus they stop the Lympha when it is run­ning into the Pores of the Brain,Idem, p. 206. and put a stop to all manner of Defluxions.

Capitis dolor, or the Head-ach.

I. HIppocrates in the Head-ach depending on a Cacochymy which is cured by concoc­ting and purging the humours, abstains from Bloud-letting, as is manifest from lib. 3. de morbis, v. 14. because, the Brain being cooled by Bloud-letting, Concoction is hindred, and thence arises great Pre­judice to the Patient, which Halicarnassensis perceived, who is mentioned 7. Epid. sect. 2. v. 462. Halicar­nassensis his Ear aked in Winter, and his Head very much, now he was about 50 years old, he was let-bloud, Pr. Martia­nus, comm. in V. 34. l. 3, de merbis. his Head being evacuated and cooled was hurt, for no Suppuration was made, he became phrenetick, and died. For seeing the Patient could not escape this Disease, unless, as Hip­pocrates saith, the humour had run at his Ear, letting­bloud did cause Death, by hindring this running: Which I would have our modern Physicians, who let bloud so confidently, take good notice of. ¶ The Head-ach is either by Idiopathy, or by Sympathy from the Bowels below, and from the heat and e­vaporation of humours. The idiopathick Head-ach, when a Cacochymy is gathered in the Brain, or some cold Mass of humours, requires Purging; the other by Sympathy, Bloud-letting. So 5. Epidem. A Woman in Pheri that had been long troubled with the Head-ach, and to whom no body could give any relief, no, not when her Head was purged; yet she was better when she had her Menses easily; and when her Head did ake, she found benefit by Sweets applied to her Womb. Lo, a Head-ach by Sym­pathy from the Womb grew appeased by the dis­charge of Bloud and applying odoriferous things to the Womb. So 2. de morbis in Head-aches, where the Veins discharge the bloud into the Head, he makes no mention of Purging, but onely recounts the ad­vantages of Bloud-letting: But in lib. de affect. spea­king of the Head-ach by Idiopathy, these are his words, The Pains come from Phlegm that is gathered and moved in the Head, therefore if you will ease the Head-ach you must purge Phlegm. And 2. de morbis, when he had proposed a sudden Head-ach, with loss of Speech and throtling, he lays the whole stress of the Cure in Purging. But Hippocrates, lib. de locis, intimates that Bleeding, not Purging, is proper in the Head-ach by Sympathy from some inflamed part or boiling humour, Purge not the Head of a man in a Fever, lest he go mad, for Purgatives heat the Head, and tru­ly the heat that is in the Medicine added to the febrile heat, Sinibaldus, Antiphon. l 3. Ant. 15. causes Madness. For such a Head-ach is by accident, from the heat of the Fever, therefore we must not provide for the head by Purging, which would cause Madness, but by such things as chiefly destroy the Fever, among which Letting of bloud has the chief place.

II. One was held with a grievous Head-ach by Sympathy from the whole, by Bleeding in the right foot the pain was taken away from his head on that side, and after that,J. Rhodius, cent. 1. obs. 73. the same succeeded according to his desire on the other side also.

III. Nor must I conceal a present Remedy for a pertinacious Hemicrania, tried by Spigelius upon him­self and several others, The opening the Vein that runs between the Forefinger and the Thumb.Idem, obs. 50.

IV. One that was grievously troubled with the Head-ach, through the violence of the Vital Bloud turned that way, made use of several Remedies, but all in vain; but at length letting bloud in his Temples he recovered: And this Bloud was of a florid colour, but of so thin and light a substance, that like a Sponge it swam upon its Serum: Its sur­face was smooth and shining, as if it had been co­vered with a fatty film: And the whole texture of it was so rare,Tulpius, lib. 1. c. 48. that you could scarce touch it with the edge of a Knife, but it would sever into vari­ous [Page 70] parts. ¶ A Man of fifty was troubled with a sharp Head-ach for two years, which seized the right-side from his Crown to his Temples: It would return three or four times a year, make him keep his bed, and bring him almost to despair, without either Fever, Thirst or Heat; but with a great beat­ing in his Temples on that side.Pachequus. obs. Riverio comm. When I had tried many things in vain, and the Pain was violent, I pro­ceed to open an Artery in his Temples; the Bloud lept forcibly out to five ounces; his Head-ach went away in half an hour, and never returned. ¶ When the Arteries beat,F [...]odius cent. 1. o [...]s. 7 [...]. the Pain is onely on the out-side, which the Physician ought to take especial notice of.

V. A Woman had been held with a violent pain in her head twelve days; her Physicians prescribed her Clysters, Purging, Bleeding in the Arm, Sheeps Lungs; her Head-ach continued, at last having ap­plied Cupping-glasses to the part grieved,Vels [...]hius. Syll [...]g. [...]s. 10. a great quantity of bloud run out by Scarification, for stop­ping of which, Tinder made of Linen-cloth was strowed on it: And presently her Head-ach cea­sed.

VI. In the Head-ach oftentimes Matter lies be­tween the Skull and the Pericranium: You must touch the place gently with your finger, that if you find any Matter there, the place may be open­ed, and much rather, if the pain be fixt in that very place. For frequently, when the place is opened, and the matter run out, the Patient has ease: and there may otherwise be fear of corrupting the bone. If any vein be there, it may be opened, or cut quite through, unless it be very large. In intolerable torment of the head, that is also continual, and will not yield to other Remedies,Hollerius, obs. s [...]ng. 3 & 1. we must use the Knife and Fire: for Purging, Cupping, Topical ap­plications, &c. are found ineffectual, because there is a certain Hectick intemperature and infirmity in the head.

VII. When I could not conquer a most stubborn outward Head-ach, coming of a cold intempera­ture with matter, by very strong Medicines, guessing, that either the Pericranium, or the Bone un­der the Pericranium was prejudiced by that matter, I proceeded to burning with good success, in which I always took care to run the hot Iron to the Bone (which I ever found abounding with moisture.) Sometimes I found the Bone it self rotten, which being scalded, all the Pain ceased. I did not make this burning behind or before in the Head, upon the Coronal Suture (as most use to doe, to divert the better) but on the right or left side of the Head, according as this or that side was pained, with success. But that men may know, how the Bone, while the Skin is whole, may be discerned to be carious, let them go to Hippocrates, lib. 2. de morbis, where he gives notice,Salius Diver­sus, Annot. in Altimar. c. 9. that in such a case the Skin parts from the Head to this side and that, i. e. the Skin may be perceived by the touch to be parted from the Bone, which must be taken special notice of, because it is a certain sign that the Bone is soul.

VIII. The Chirurgical means, commended espe­cially for a cruel and inveterate Head-ach, is usual­ly the burning or cutting an Issue in divers parts of the Body. Without doubt when they are made in the Arms or Legs, they are both less troublesome, and doe some good, inasmuch as they withdraw the fewel of the Disease from the part, and remove it far from that place. Moreover, an Issue in the nape of the neck, or a Seton in the neck, or in the tip of the Ear, or near it; also a pin of Bastard Hellebore root, put in a hole bored in the tip of the Ear, are often used with advantage, inasmuch as they evacu­ate many Serosities, and draw others towards the Emunctories, that is, the Glands. But now the most talk, and greater expectation is, of Issues made either in the very place grieved, or near it; so that large i [...]ues are made in the crown of the Head, or upon the joyning of the Sutures. If we measure the fruit of this Practice by the success, it will appear little and seldom profitable, but often unfortunate: for I never knew any cured of their Head-ach by such Issues; but several have been made worse by them. And Reason tells us plainly as much, for wherever an Issue is made, the Serous Humour flows thither from the whole Mass of bloud, and consequently from the whole Body, and is often gathered there in greater plenty than that it can find a passage by that outlet; for which reason Inflammations,Willi [...], cap. de Cephalal­g [...]. Pustu­les, and divers Humours gather about Issues. What other therefore can we think, than that Issues ap­plied to the Head in the Head-ach, do cause more morbifick matter to be gathered there?

IX. A young Maid had been above a year won­derfully tormented with a piercing pain in her Head. The Physician, suspecting (as it proved) that something lay on the Membranes, trepann'd her with good success: for when her skull was open, a small drop of foetid matter, scarce so big as a Millet seed, came out; nor did her pain ever after trouble her.J. Rhodius, cent. 1. obs. 69 & 70. ¶ N. had conflicted several years with a most violent Head-ach, and he was cured by boring his Skull five times; onely his Head, the Membranes being cooled and thickned by opening, was a little dull. ¶ A cruel Head-ache, caused by the Pox, without Gummata, in a Man of 70, was eased by re­peated trepanning (which laid all the corrupted bone open, whence Matter ran in great plenty) and returning at certain Intervals, it was then cured by the same means. ¶ I resolved to trepan a Farmer, who had got a most grievous Head-ach by the Pox, on that side where his pain was most, in three or four days after trepanning his pain abated, and in twenty days time he was perfectly cured. ¶ I trepanned a Woman that was afflicted with a grievous Hemicra­nia (or half-head-ach) who was well,Marchetti. obs. 18, 19 & 20. while the hole was open; but it being closed within a few days, she relapsed into her old disease. ¶ An ancient Man had been tormented three years with a cruel pain in his Head, he submitted himself to trepanning, it was done in the right side, and the fore-part, a lit­tle above his forehead, and he quickly recovered.Panarolus, Pentec. 5. obs. 25. Perhaps the vaporous matter that affected the Head, while it had no egress, caused pain; but when a pas­sage was made, it went out daily. ¶ Willis, in his Chapter of the Head-ach, thinks, a Man can ex­pect little good from Trepanning. Truely (saith he) it does not appear to me, what we can expect for certain from opening the Skull when it akes. If an Abscess lay there, this were the onely way of cure; but an Abscess would sooner cause drowsiness, and mortal convulsions, than remove an Head-ach: If an Inflammation or Pustules, or Erysipelas had seiz­ed the Diploë (or the second place of the Skull) I know not whether these Tumours, exposed to the open Air, would more easily evaporate, or whether Re­medies applied to them thus bare would doe any good or no: But if the pain be caused by any Tu­bercle, or Scirrhous, or Callous Swelling in the Me­ninges, I think, opening of the Skull will doe very little or no good at all.

X. A Woman had endured pain for some years about her forehead and eye-brows: A certain per­son rubbed and pulled the lax tip of her Ear, till a Vein appeared, then he cut it with a piece of a flint, that Men strike fire withall,Solenander, cons. 15. it bled very black Bloud; and by this bleeding she was cured.

XI. A Nobleman 30 years old had laboured un­der a Head-ach, with a Catarrh falling on his Breast, and an extenuation of his whole body for se­veral years: After I had applied potential Caute­ries to each arm,Fabritius Hildanus, cent. 4. ob­servat. 71. he was first freed from the pain in his Head, and then perfectly from his other sym­ptomes: I could produce many such examples.

XII. A certain Person was troubled with a most bitter Pain in his Head, taking and leaving him at set hours, which periodical pain lasted fourteen [Page 71] days,Tulpius, obs. l. 1. c. 33. though no remedies that were requisite were omitted, as neither Cupping with Scarification, nor application of Vesicatories to the hind part of his Head; from which last Remedy I saw not onely this Patient, but many others reap great benefit. ¶ A Girl about seven years old had been troubled for two months with a grievous pain in her Head, returning once almost every hour so sharp upon her, that she wished her head were cut off: An Epilep­tick fit took her out of this life: The Substance and Ventricles of her brain were found full of Serous Humour.Riverius, cent. 1. obs. [...]7. ¶ Another Maid, who had been long afflicted with such a pain, had her whole head sha­ved by a Chirurgeon, and covered with a Vesicatory like a Cup; when the Blisters were raised, it run great store of Serous Humour, and so she was cu­red. ¶ The Ancients frequently used Phaenigms and Sinapisms; and it is the Modern Practice in vio­lent Head-aches to apply Vesicatories sometimes to the fore-part, sometimes to the hind-part of the Head: Now, whenever ease is found by these fiery Topicks, it is because great store of sharp Serum is by such administrations discharged from the part affected.Willis.

XIII. A Matron was troubled with a tedious and bitter pain in the left side of her Head: About four years before, she had been troubled with the Tooth-ach for six weeks together in her left jaw, which going off was attended with a pain on the same side of the Head: Hence I knew, the Hemicrania had its rise from the roots of some rotten Teeth;Fabritius Hild. cent. 2. obs. 10. for four of her upper Teeth were rotten, and their roots stuck close together, which when they were drawn out, she grew perfectly well.

XIV. There was a person grievously tormented with the Head-ach: by the advice of Sylvaticus he was pumped with hot Sulphureous Water, and within fourteen days his disease was totally con­quered.Rhodius, cent. 1. obs. 75.

XV. A Woman, too well known, was sick of a most cruel Head-ach, it was wandring and worst at night, which made me suspect it to be Venereal, because there were besides spontaneous lassitude of Body, slothfulness and dulness to motion, sometimes thickness of hearing, with a tingling in her ears, but especially because she had often used Mercuri­al Unctions, and Pills: I judged the pain was pro­duced by some malignant Quality of the Mercury, that was got into the Brain: Therefore I twined two pieces of Gold round, and put one in each Nostril, and when she had kept it there some hours, it was taken out, and appeared tinged with Mercury: she held a piece of Gold in her Mouth, and that was ta­ken out white also,S. Jacos. i [...] obs. River. and put in the fire, it recover­ed its ancient colour: And by this course often re­peated her Head-ach was removed.

XVI. A phlegmatick Person about forty was troubled with so cruel a Head-ach, that he could not endure the least noise, so that if one stept but into his chamber, he thought a Knife was run into his Brain. Many things were used to no purpose, at last I perswaded him to have a Seton made, which succeeded so happily, that he daily found a mani­fest abatement of his pain. After half a year he let his Seton close,Hild. cent. 4. obs. 7. instead whereof I made him an Issue in his Arm.

XVII. A Nobleman having the Pox, was among other symptoms taken with so violent a Head-ach, that every evening he not onely doted, but was ta­ken with such cruel Convulsions, and Fainting-fits, that the By-standers thought more of his death than recovery: Which cruel symptome would yield to no Medicine at all taken inwardly,J. F. Freu­bler. in Epist. Bartholinus, cent. 3. Ep. 55. till at last I applied Emplast. ranarum cum Mercurio, upon which the pain went miraculously off within half an hour, and never came again.

XVIII. A Noblewoman of Padua was cured of an old Head-ach of many years standing, caused by cho­ler, onely by taking old Sugar of Roses; the Acri­mony of the Bile, and its exhalation,Rhodius. cent. 1. obs. 71. that troubled the brain, being repressed: for the Rose cools and binds.

XIX. Fr. Bonardus Professour at Padua tells,Vels [...]hius, S [...]ll [...]g, obs. 12. how he perfectly cured a Hemicrania, caused by the ascent of vapours, with bread sopped in Pomegranate juice, and given for three days.

XX. One was complaining to me, how miserable his life was, through want of sleep, which a grie­vous Head-ach had brought upon him, now well-nigh a year, which was enraged by touching, and grew worse towards night: When I had felt [...]is head, and found an humour setled under the Skin; besides this, the bitterness of his Pain, and his continual watching, gave me suspicion of some Infection: But on the contrary, whereas I knew him now in a live­ly old age, and that he had ever been of unspotted reputation, and free from any dishonest disease; and that his temper was Melancholick, and I see with my own eyes, he led his life exposed to the open air; then indeed I thought the humour, the con­tinent cause of that Swelling, was a watrish one, but mixt with a sharp and bilous Ichor. When he had used all things to no purpose,C. Piso, de [...]. I cause a Caute­ry to be immediately applied to his head behind: It was no sooner done, but a greenish water, much like green Choler, came away, and that for seve­ral days, and so he recovered.

XXI. I cannot but remember that healthy Scurf, which did very seasonably deliver N. from an inve­terate Head-ach, the Viscid Phlegm being expel­led by the insensible vent-holes of the Skin, and sticking to the roots of the hair like glew, and by little and little producing a true Scald. Hence let Physicians learn how to imitate Nature,Tulpius. obs. l 1. [...]. 32. and with judgment observe, of how great use, both Sneezing seasonably provoked, and Issues timely made, are: for Nature is the best guide.

XXII. A most bitter Pain racked a Woman, creep­ing with manifest sense of heat, sometimes from her foot to her head, and sometimes from her head to her great toe: Into which, when it was come down, I ordered a Cupping-glass immediately to be clapt to it, to get out that Volatick Spirit, which daily ranged the whole body with so swift a course; and when it was drawn out,Idem, l. 1. c. 33. I found those reciprocal circuits did cease, and the Patient cured.

XXIII. Whether may a Purge be given in every Head-ach? Rhases purgeth both in a Bilous and Sanguine, because the thinner part of the bloud may easily turn into choler: Avicenna prescribes it in a Head-ach, caused by an immaterial intempera­ture of the head, as by the heat of the Sun, that the hot humour being carried off, the head may be cooled: He also purges in a cold immaterial Head-ach, that the cold humour being purged, the head may be made hotter: He purges for prevention sake, that he may decline the imminent danger of a flux of humours, which pain doth raise. ¶ Hol­lerius Perioche 2. tells us, we must take notice in the Head-ach which is caused by Vapours, whether those Vapours be bred of Food, or of other Mat­ter: For if they be bred of Food, Purging will be to no purpose; if of other matter, he bids us di­stinguish; for if the matter be small, and contained onely in the head, it must be got out by other Me­dicines: If it be much, or gathered in the whole body, we must Purge; But if it be thick and cold, we must first use preparatives and iniciders: Which, if it can be concocted, and the Palegm be sweet, he says, it needs no Purge; if salt, putrid or cor­rupt, we must of necessity Purge.

XXIV. A greater Dose of Physick must be gi­ven in the Head-ach,Rondeletius pr, c. 7. both because the humours ascend, that revulsion may be made, and because the sense of the parts is less exact, by reason of the re­solution or retraction of the Animal Spirits. ¶ While the head glows with pain, all the humours, because they are inclined upwards, will not easily, by Phy­sick, [Page 72] be persuaded downwards; therefore the Purge must have a more lively virtue than ordinary, that the working may answer expectation.

XXV. Clysters for the Head-ach will not admit of things that fill the head,Aetius. Cummin, Faenugreek-Seed, Nitre, and other odoriferous things.

XXVI. In the Head-ach, and also in Fevers, we must not be too sparing in giving Syrups and Poti­ons:Mercatus. but we may give to grown persons ten ounces in a Potion mixt of Syrups and distilled Waters, be­cause in a less quantity they will not reach easily to all the Parts, and to the head.

XXVII. In a Head-ach caused by serous humours Diureticks are of great virtue, to carry off those that tend to the head, while they derive them with themselves, as they are circulated through the mass of bloud:Frid. Hof­m [...]nus, m. m. l. 1. c. 12. for Diureticks, after they are carri­ed with the chyle to the heart, and from thence by the Arteria Aerta, with the bloud, into the whole habit of the body, do lead the noxious, tartareous, gritty matter, and the filthy, salt dregs, to the uri­nary passages.

XXVIII. Sweats indeed are not proper in essen­tial Head-aches, because the serous morbifick matter is thereby more and more moved upwards towards the head: But in a Symptomatick one they are more requisite,Idem, ibid. especially if the Hypochondria blow the coals, or an Itch be driven in: And this may ve­ry well be done in the cure of a Vertigo.

XXIX. Galen advises those that are drunk to wash with warm water the next day, and after washing to lye down to sleep, that they may concoct their crudities:J Langius, Ep st. 30. l. 1. Yet he would not advise washing in eve­ry Head [...]ch; but then to doe it, when the head is hot, without a Fever, and after washing to eat Let­tuce, and sup some Ptisan.

XXX. Plasters are very convenient, and often prove very beneficial; they must not be very hot, and such as draw the humours to the place affect­ed, but moderately disc [...]tient and strengthening. I usually prescribe Empl. de minio, or Diasaponis, with half as much Empl. Paracelsi to be applied to the head when it is shaven.Willis.

XXXI. Liniments of Oils and Unguents, though often used, doe little good; inasmuch, I think, as they make lax the tone of the fibres, if they pene­trate deep, and so they lay more open to the incursi­ons of morbifick matter; Moreover, they so stuff the pores of the [...]kin,Idem. that the Effluvia cannot eva­porate.

XXXII. For the same reason hot Fomentations of Aromatick Decoctions, and other Cephalicks, of­ten doe more hurt than good, inasmuch as they draw the humours towards the parts, and also open the pores and passages, that they may more easily be received. Therefore it is, that bathing the head, or Embrocation of it with a Pump in the hot Bathes is used to persons in the Head-ach, with no better success: When on the contrary it has done several good, to wet their Temples and Forehead with cold water morning and evening; yea, every morning to embrocate the whole head with cold water at a Pump, or at least to dip into a deep Ves­sel,Idem. or Well.

XXXIII. In the use of local Medicines, we must have a care of all that have Euphorbium in them, indif­ferently used by many people; for Euphorbium is hot in the fourth degree, whence it is, that it exulce­rates, and causes redness and inflammation: Where­fore Galen indeed, 2. de Med. local. used such a Medi­cine in a Hemicrania, coming from a cold Phlegmatick humour. But instead of this, there is one Medi­cine to be met with, that without any redundant heat, doth wonderfully draw out all the humour that causes the pain, though it lie never so deep: It is made of the fish of Cockles, pounded in a Mor­tar,ecchius, onsult. 56. and reduced to a smoothness, with a little Fran­kincense and Myrrhe in Powder; for the fish of Cockles draws all the superfluous humour from the inside outwards.

XXXIV. When the Head-ach is so cruel, that the Patient is in danger of his life, then there will arise an Indication of taking away sense; yet, with great caution, seeing it cuts not off the morbifick cause: However, when the Patient grows weak, is in much pain, cannot sleep, and is in danger of a De­lirium; we may so long resist pain, till he recover strength: Let the scope of Narcoticks be gaining of strength; we must begin with the milder sort, and first use them outwardly, then inwardly. Take this for a caution, Never apply Opium to the coro­nal future, for the brain lies much under it, and the entrance thither is easie; but rather to the Tem­ples, Nostrils and Forehead, though Rhases put a lit­tle into the Ears. When the pain is ceased, and watching overcome, let the place be anointed with oil of Chamaemil, Nutmeg,Heurnius, &c. to take off the strength of the Opium.

XXXV. Salivation raised by Mercury, if so be it succeed aright, sometimes removes difficult and plainly Herculean diseases, and such as turn a deaf ear to all other Remedies: Inasmuch namely as this operation doth perfectly purge the bloud and ner­vous juice, and the other humours, by a long spit­ting, destroy all exotick ferments, rectifie all enor­mities in the Salts and Sulphurs, and besides re­moves, and often carries off the morbifick matter settled and overflowing every where. Yet this Me­dicine is not without hazard; inasmuch namely as the Mercury becoming unruly, and carrying along with it a great quantity of very sharp, and in a man­ner poisonous Serum, and so rushing impetuously in­to the noble parts, and especially into the brain, with the medullary and nervous appendices, or into the Lungs, and about the Heart, leaves an indelible and sometimes mortal fault upon them. Where­fore in an old and grievous Head-ach, there is dan­ger, lest the fibres being indisposed by the Mercu­ry, and much corrosive Serum passing through them, should be more irritated, and be cast into greater spasms, and painfull corrugations: and farther,Willis de ce­phalalgia. lest the brain be invaded by the violent motion of the humours to the head, and then, which happens too frequently, sleepy, or convulsive diseases be brought on. ¶ Some, for inveterate Head-aches, after once or twice purging, fly to Quicksilver, wherewith they rub the head and other aking parts: These Men,Encheir. med. pr. though sometime they remove the Pain, yet they al­ways increase the Cause, and cool and moisten the brain more. ¶ There are some that commend Empl. de Vigo cum Mercurio, because it has been observed,Ibid. that it hath put an end to an inveterate Head-ach, ha­ving evacuated much phlegmatick humours by spit­ting. ¶ Salivation terrifies several that are imploy­ed in inventing dissuasives against it: but experi­ence dispels this vain fear.Rolfinc. meth spec. p. 164. One that was sick of a grievous Head-ach, and miserably afflicted with it, being salivated, recovered under our care; and there was no sign of the Pox in him. ¶ Willis, in the place fore-quoted, approves of Salivation in the Head-ach arising from the Venereal Disease; In other cases he disapproves of it, and produces some examples of ill success.

XXXVI. An Oxyrrhodinum may not be applied in every Head-ach; Abstain 1. When a Catarrhe is joined with it, for the application of cold things increases the distillation, and by its driness strains out the humour down to the Breast; yet Trallianus allows it, when the Head-ach has its original from the violent heat of the head, which draws the hu­mours like a Cupping-glass from the whole body; this way it does good by taking away the cause. 2. When plenty of gross humours or vapours cause the Head-ach; in which case Oxyrrhodina doe more harm by obstructing, than good by Repulsion. 3. If the Head-ach be critical; you may reckon it cri­tical, if in a Fever it fall upon a critical day, if signs [Page 73] of Coction have preceded: yet if the Crisis should be by Vomit, they may safely be applied; otherwise, if Bleeding at the Nose were drawing on, by dri­ving back you would cause Death. 4. They doe harm, if bloud or another humour be firmly settled in the head; for then Digesters must be made use of, as Galen 13 m. m. 6. adviseth. 5. In a Head-ach that is malignant, or contracted from the Bite or Sting of a venomous Creature; the Venom must rather be drawn outwards by Rarefiers.

XXXVII. In the Head-ach caused by heat the jui­ces of Purslane, Housleek, Kidney-wort, and other things of the like nature;Hollerius, Perioch. 2. but these things must be fresh, not parched with heat and without juice. Vinegar is good in Liquours; but it is forbidden to Children and tender Bodies.

XXXVIII. It is known that some Empiricks rashly undertake that they can cure all sorts of Head-aches with their Cephalick waters, whereby many have been brought into perpetual tortures in their head. I knew a Nobleman, then but young, who, suffering a violent Head-ach from the ebullition of hot bloud, through some bodie's persuasion washed all his head in very strong Aqua vitae: but by this un­skilfull advice he was almost cast into Madness.Oethaeus.

XXXIX. Castor asswages pains in the Head coming from the Womb, saith Hippocrates, lib. 7. de Epidem. and lib. 6. Great pain about the forepart of the Head, and what-ever o­thers arise from the Womb. Now, indeed, that Diseases by Sympathy are removed by curing what is first in fault, and that this is the legitimate way of their Cure, is very well known. But Castor is commended for all Uterine Diseases (I say those that are impro­perly called Uterine, such as Fits of the Mother, whether they be caused by suppression of bloud or seed, or by wind) by the joint consent of all Phy­sicians. Hippocrates, in lib. de morb. mulier. makes fre­quent mention of it: for the same purpose lib. 2. he prescribes Castor or Fleabane. Therefore Castor taken inwardly cures the Head-ach from the Womb, but then it cures Diseases of the Womb that are accompanied with the Head-ach, i. e. Suppressi­ons of the Menstrua, retention of Seed, and of the cold juices and wind. Nor does it cure all Disea­ses of the Womb, but onely cold ones; for it will rather increase Inflammations and the Erysipelas. Wherefore since the head-may ake for Inflammati­ons of the Womb, it is clear that Castor cures not all Head-aches from the Womb, but such onely as come from its cold Diseases,Vallesius, Epid. p. 865. such as Galen affirms Fits of the Mother to be.

XL. It may so happen, that a Disease of the head, or of any one place may increase or grow better with the Disease of another part or place; nor yet for all this be affected by Sympathy from that other part: for it may chance that matter may flow from the self same fountain to divers parts at once, and there may be no pain in the part that sends it, nor any thing amiss known or perceived there: As Hippocrates observed it happened to Agesius his Daughter, 6. Epid. 3.4. who when she had a pain in her hip, was oppressed with an Asthma, and when her pain was eased, she took her breath well. Now seeing there is no communication between the Hip and the Breast, it was very reasonable to su­spect, that the humour ran into each part from the same place, and was dispersed at the same time. The flux might be from the Brain, or it might be from the Womb; And therefore when two effects happen together, a man must diligently observe, whether the communication be from the head or from some other place. Although Galen in his Com­ment upon this place, says, that an Imposthume was broken in her breast, and when she had raised the matter, her Asthma seased; but upon small ground: for it is more reasonable to think, that in a Woman newly delivered, the pain in her Hip came from the Ligaments of the Womb, and her Asthma from the Sympathy of her Breast with the Womb, and espe­cially when she did not cleanse well, which caused both these Ails, and both these Accidents ceased, when she did clease: For the Womb in Lying-in-women, is the occasion and root of all their Evils,Casper. Cald. li­lustr. & Obs. Med. 8. l. 2. and there is a great Sympathy between the Geni­tals and the Breast.

XLI. That it is requisite the outer substance of the Brain and the Cerebellum should be open, to the end, the most spirituous part of the Bloud may pene­trate it, and be as it were percolated through it; the cold of the Air, Water or Snow, vehemently af­fecting the head seems to prove; after which not onely a Rheum, but a more spare production of A­nimal Spirits uses to follow. But whoever upon ta­king such a cold do let bloud, or think to take away the cause of this evil by purge or vomit, they in­danger their Patient's life; as I have more than once seen it done by men,Sylvius de le Boē, p. m. 402. that are more conversant in Books than in Observation of Symptoms that be­tide sick persons.

XLII. I think the inward Cold of the head is caused by Vapours breeding Cold, carried to the head together with the bloud, partly indeed by their austerity rendring the bloud inept to part with its spirituous parts, and partly contracting the external substance of the brain, or straitning its sinuous pores, and so in some measure at least de­nying a passage to the most spirituous part of the bloud. Then is the time to swear; for by this means the Vapours, that produce the troublesome Cold are dispersed. But in this case,Idem, ibid. as in the fore­going, it is hurtfull to bleed, purge or vomit.

XLIII. The nervous Liquour gathered among the Fibres of the Meninges and other parts of the head, sometimes by its proper incongruity, whereby be­ing sowre or otherwise degenerate, it becomes disproportionate to the Fibres; sometimes, for that it ferments with some other humour, viz. the nutri­tious or serous, flowing thither, doth vellicate the containing parts and irritate them into spasms and painfull distensions. When it is thus morbifick, it is either peccant in the whole mass and inflicts its mis­chief on the head predisposed: or in it self innocent, is so affected within the fibres, that it is perverted, and so secondarily it becomes morbifick: The cure of which then depends upon the restitution of the containing parts, namely, if the weakness of the fi­bres, or the hurt conformation be amended, the hu­mour that bedews them will immediately be with­out fault. In the mean time, if, being degenerate in the whole mass, it impart its mischief to the head prepared for aking, such Medicines and me­thod must be used, as may reduce the nervous juice to its due crasis, that as it gently traverseth the fi­bres it may not irritate them. For which purpose neither strong Purges, nor large and frequent Blee­dings are convenient, because they put the bloud and humours into violent motion, and waste the strength; and therefore impress a greater acrimony upon the peccant nervous liquour: Yet gentle Solu­tives and a little bleeding will sometime doe service, that the bowels may be cleansed and the mass of bloud a little purged, and way may be better made for succeeding Medicines. Now the Medicines that render the nervous liquour more amicable and be­nign to the Membranes of the head, which use to be disturbed by it, are such as are vulgarly held to be Cephalicks, scil. whose particles being active e­nough and also thin and subtile, do pass the bloud without turgescency or tumult, and then insinuating themselves into the nervous liquour, they gently actuate it, and so make the nervous ducts to open themselves,Willis, cap: de Cephalat­gia. so that all sensible and motive bo­dies do more freely irradiate the animal spirits, and inspire them with Faintings, Spasms or Dis­tensions.

XLIV. Sometimes the nutritious juice is the cause of a periodick Head-ach, scil. inasmuch as it being mixt with the bloud, and not rightly assimi­lated, [Page 74] by reason of the disagreeing particles it gives it a turgescence, so that the bloud boiling up into the head, leaves its Refuse in the Meninges and those parts of them that were predisposed, and so irritates the Fibres into painfull Spasms. For this very reason I have known several after the Small-pox and Measles, and other Fevers or Sicknesses, whereby the mass of bloud is usually vitiated, who were subject to the Head-ach every day, viz. so many hours after eating, sometimes sooner, some­times later; first a flushing in their face, then a ful­ness and pain in the head did invade them. More­over, they were more grievously plagued upon drinking Wine or eating windy Meats: The fit of the Head-ach was more or less distant from their food, altogether as the Chyme began to grow tur­gid either upon its first entrance into the bloud, or after some little stay there. After provision for the whole, Medicines which restore the crasis of the bloud, doe much good, such as Antiscorbuticks especially,Idem. and Chalybeates.

XLV. One infected with the Pox was cured by a sweating Diet and anointing with Mercury, after which for some time he seemed free of his Disease: But afterwards the same Distemper returned, and he was again cured by using a Sudorifick decoction a good while, and then by a Suffitus of Cinnabar he seemed again to be perfectly cured: Yet after­wards he began to be afflicted with a grievous Pain in the left side of his head, which in the changes of seasons, especially at the coming in of Autumn, tor­mented him sorely, and kept fixt in the same place like a Nail. Many Medicines were tried to no pur­pose. I judged this grievous Head-ach did proceed from the reliques of the Pox that was not perfectly cured; yet that its next and immediate cause, or at least the fomenting and encreasing cause of the pain, besides the Venereal virulence, must be either a sharp and biting humour flowing to that part of the head, or Mercury it self gathered in that part of the head, or a Caries in the skull. That I might have respect to all these causes, 1. I prescribed universal Evacuation by bleeding and purging with an Apo­zeme for four days; then a Sudorifick diet of a Decoction of Guaiacum and Sarsa for thirty or forty days: for often a Pox that could not be cured by Mercury, has been cured by long use of the Decocti­on. And if the Head-ach came onely from virulent humours, vellicating the membranes, it could one­ly be cured by a long diet. If it would not yield to the long use of the Decoction, we ought to see, whether no Mercury were gathered in the part, which may be known, if a Bullet made of Gold be put deep into the left Nostril, and if after some stay in that place it be taken out white, it is a sign there is Mercury: You may try the same by covering a ce­phalick Plaster with Leaf-gold, and laying it on the part grieved: for, if the Gold grow white, it is a sign there is Mercury, which may be got out by de­grees, if a thin plate of Gold be always worn up­on the aking place, and a golden Bullet be often put into the Nostril. If by this means neither, the pain do cease, the place must be laid open and bored; for often the Cranium is corroded by sharp, virulent hu­mours, and a Caries is got into it, when the Skin re­mains whole: And though no Caries should appear; yet the Trepan often does good, by drawing out the virulent matter,Riverius, Cent. 2. [...]s. 91. that was gathered upon the Meninges of the Brain.

Capitis Vulnera, or, Wounds of the Head.

I. IT is customary with unskilfull Chirurgeons, when they are called to cure Wounds, that reach not beyond the Pericranium, to open all Wounds whatever in the head with a large Incision in the figure of a Cross, and (that I may use their own phrase) to lay open the Skull, to the end they may know whether it be broken or cut. From which mistake of theirs many Inconveniences follow: Because, first, it protracts the Cure, for if such Wounds or Contusions were cured according to Art, they would be well in eight, or at farthest ten days, though they were very large; whereas these fellows scarce cure them in two, or sometimes three Months. Besides, while they open the Wound to the Skull, they endanger the Patient's life, be­cause sometimes, before he is cured, they must of necessity take out no small portion of his Skull, it being corrupted by the open Air getting to it, which otherwise had neither been corrupted nor hurt: And it often happens,Franciscus Ar [...]aeus. l. 1. c. 1. that not onely the Su­perficies, but the whole Thickness of the Skull is cor­rupted. One had a Wound in the right side of his head laid open in form of a Cross three Inches square, when there was not the least sign of a Frac­ture: whence it came to pass, that not onely so much of the Skull as was laid open, but a greater Portion on all sides, was corrupted. ¶ If it chance, that upon a blow a Patient lose his Understanding, with a deprivation of sense or motion, unless the o­ther symptoms enumerated by Hippocrates do also appear, there is no danger of Life:Marchetti, obs 15. and therefore you must let alone all manner of operation, as lay­ing open and trepanning the Skull: for I have seen some, who, having their head hurt by a fall or a blow, and this Symptom onely appearing, were well the next day. ¶ Such a Contusion is with admirable success cured by applying the Skins of new killed Animals, especially of a Dog or a Mouse; for if they be applied while they are yet hot to the contused place; and left on for 20 hours or more, they notably discuss the Tumour: I prefer a Lamb's skin, being both easily come by, and having as good a faculty to digest.Sculterus & Cattierus. By this one and well experien­ced Remedy I have cured several children and grown persons.

II. There are often in children under 7 years old Contusions, very like those faults we see in brass Ves­sels, so that when the Skin is not hurt, and when the Table of the Skull behind is not crackt, yet that be­fore is often hurt: for the tenderness of the Bone at that age sometimes is the Cause, that the Skull may be depressed and yet now and then not hurt otherwise, oftentimes also that it is both hurt and broken, and that the Skins encompassing the Brain are broken. Lately a Boy about four years old was brought to me to be cured, who had received a violent blow upon the coronal Commissure by the fall of a wooden Shutter from a Window, by which blow both sides of the Bone and both the Membranes were broken, and also some part of the Brain came out three several times in the process of his cure: yet the Child was cured without laying open the Wound, and without any loss of his Skull; and he was not above twenty days under cure. Now, to cure such Compressions in Childrens heads, there is no need of any more laying open the Wound, than what is made by the blow it self: And if there be no Wound made, nothing must be opened, no, not if one certainly knew that all the Bones were hurt and broken to pieces. And this will be the sa­fest way of curing such Wounds: for whatever useth to be done contrary to this method, we have now mentioned, it hath most certain danger. The way of Cure is this, if the Contusion shew no manifest Wound, in the first place we use this Re­medy; Take Oil of Roses, Chamaemil, each half an ounce, Oil of Myrtle one ounce, the White and Yelk of an Egg, with a little Bean and Barly-flower of each alike, Myrtle powdered 1 ounce: Mix them all into the form of a Plaster, and lay it on the bruised place. And the next day we use another Plaster, but scrape the first clean off. Take of the Dross in Beehives, or of new Dreggy Wax, common Honey, each 1 ounce, Powder of Bloud-stone, Pumice-stone, each 1 ounce, of Cummin-seed, Wormwood, common Bran, each 2 drachms: Mix them upon the Fire and make a Plaster, to be laid to the depressed place, two inches broader than the place round about: The efficacy of this Plaster is so wonderfull, that within twelve days it raises the contused and compressed Bones; and, I think, for [Page 76] this purpose, there is no Medicine more effectual. But if, beside the Depression and Fracture of the Bone, there be a Wound also, it must first of all be cured with the White and Yelk of an Egg stirred together, applying soft and thin Raggs, Tow and Bol­sters, wherewith the Wound must be covered. And the next day we must use the Balsam often commen­ded by us. The Wound must be gently anointed with a Feather dipt in the Balsam, whose present virtue in this kind will easily be seen: for it won­derfully concocts, mundifies, and breeds flesh: but it must be melted, yet not too much, lest it should burn the Patient, or the Medicine should lose its virtue by over-heating, (but this you must have a care of, that you take not out one bone, though it were manifest they were all broke to pieces) and you must cover the wound with dry lint, and press it not too much: Upon this you must lay the Plaster hot, that we but now described, which to the great delight and admiration of him that cures, sucks out all manner of Pus, that is bred within, and also quickly raises the compressed bones, and re­stores them to the same state they were in by nature: For I safely affirm I have frequently used this and the like method of cure,Arcaeus de cur. vuln. l. 1. c. [...]. and do attest, that by God's blessing I have cured them of most grievous wounds.

III. On Saturday the 28. of February, 1679. a Child about four years old, the son of Mr. John Stone of Pli­mouth, had his head crushed between the heavy end of a Field-gate (so heavy that a Man could scarce lift it) and a small Stone, that stood above the level of the ground; this stone bore against the left Bregma somewhat above the Ear, opposite to which on the other side, about the same distance from the Ear, a pin of wood an inch square, that stood out half an inch from the gate, being forced by the weight of the gate, made a small wound, but a very great de­pression; it bled much, the Child cried a little, did not faint, nor convulse, onely vomited two or three times. I presently laid it bare, and upon examination by my fingers, found where this little wound was, and that the Skull under it was largely depressed, I shaved it, and entring my Probe at the wound, I found the Scalp separate from the Skull a great way, and a large depression of the latter. When I withdrew my Probe some of the Brain came out upon it: I entred my Probe again with the eye forward, and brought out as much as two pease; and upon dilating it several parcels of Brain appeared among the bloud. I drest it up with Dossils, dipt in Mel rosatum, and Spirit of Wine made warm, and covered all with a Plegent of Linimentum Arcaei. I examined the rest of the Head, and found on the other Bregma an Ecchymofis, and un­der it another depression. I shaved off the hair from thence also, and with the same Rasor excised a piece of the Scalp as big as a shilling, which laid bare the depression and fracture, which was such as I could not then elevate, I filled this with dossils of dry Lint, covered with a plegent of Arcaeus Liniment, over all laid a Plaster, rolled up the Head, and laid the Child (who endured all with incredible courage) to bed, his head bolstered as high as he could well lie. I gave the Father a dreadfull Prognostick, and desi­red the assistence of Doctor Spenser. That evening I gave the Child a Clyster, which wrought twice or thrice, I gave him something Cephalick and Diapho­retick, to comfort the Brain, and prevent Coagula­tion, or other mischievous effect of the Contusion. The Child slept quiet, and sweat well. The next morning the Child being brisk and lively, the Doc­tor came, a fomentation and all things ready, he be­ing taken up, and held on a woman's Lap, I cut off all the hair close to the head, and opened the left wound first, where we found a depression with a fracture. I could not enter an Elevatory, and therefore at that time left it as it was, and drest it up as the day before. Opening the other wound, and taking out the dossils that I had laid in the day before, several small portions of the Brain shewed themselves among the grumous bloud, and on the dress; and a prodigious piece of skull bea­ten in, and wholly separated from the rest, and (which was a very ill circumstance) the outward Ta­ble being broken narrower than the innermost, made the deepest piece larger than the hole it had made, so that at that time we could not get it out. So that having cleared the part of Matter, I then onely made yesterdays incision into a Cruciate; we dressed him as before, I rolled up his head upon a Stuphe, dry wrung from the fomentation. The Clyster was re­peated every day for some considerable time; his diet was Water grewel and Chicken broth, with some proper things boiled in them; his drink was sometime small bear with a tost and Nutmeg, some­time his Cordial Julep. The second night the Child slept indifferently well. We again opened the left side, and after some attempts in vain to raise the de­pressed Skull, we strewed Cephalick powder on it, and dressed it up with dry plegents of Lint as before. Upon opening the other, we saw again some little owzing of the Brain among the matter: we now re­solved to extract the piece of Skull. After some little time I did it, by turning it so, that the nar­rowest part of it might come to the broadest of the Gap, when holding it fast with a Crow's bill, it easily came forth, and left a dreadfull breach. The wound on the Membranes we saw plainly, with some effusion of the Brain, but it happe­ned that it was below the edge of the sound Skull, so that it became succored thereby, and (the Child being young, the Membranes more soft, and apt to consolidate) coalesced the sooner, for after four days we saw no Brain. We made our dress this time after this manner. We had a good guard of hot Stu­phes, to defend from the air, and having cleansed out the Part, and smoothed the uneven edge of the Skull, we dipt a Syndon (that is a piece of fine cloth, bigger than the extracted Skull, having a thread fas­tened to the middle to draw it forth by) into a mix­ture of warm Spirit of Wine, Honey of Roses, and Balsam of Peru, and with a Probe thrust the edge of it between the Skull and Dura Mater. Upon it was strewed Cephalick Powder, covered with dry Lint. Then I snipt off the lips of the Cruciat, and, laying on a plegent, armed with Arcaeus Liniment, rowled him up. This day we ordered Tinctura Ambrae Griseae in his Cordial six or eight drops at a time, as there appeared need. The next day, being the fourth from his hurt, we found he had had a good night. I shaved the whole head, anointed with a Cephalick balsamous liniment, and laid on a Plaster of equal parts of Opodeldoch and Empl. de Betonica, then dressed the wounds as before, and covered them with Plas­ters made of equal parts of Diapalma and de Betonica. The Skull scaled but slowly, as is usual in Children, therefore towards the end we used more drying Ce­phalick Powders than ordinary, to prevent a fungus and quicken desquammation, mixing Guaiacum Bark in Powder. The Dura Mater united in four or five days, the unition was confirmed, so as we used digestives after five more, digestion was procured in a week after. And in about six weeks from the first dress the Skull scaled, the flesh grew up from the Dura Mater, and under the scalings of the Skull, and be­came level with the skin; it would sometimes be ex­uberant, and soft or spongy, before it could be ci­catrized, a gentle touch of Roman Vitriol, and some­times strewing prepared Lapis Calaminaris thereon, shrank it up, and cicatrized the lest wound in seven weeks; but the right remained three months. For it was not onely difficult to make a final deficcation thereof, because of the moisture gleeting from with­in the Cranium, but necessary to delay it, that the matter might discharge itself, as it gradually decrea­sed.James Yonge, Wounds of the Brain proved cu­rable. In performing this last part I used a very desic­cative Sparadrap Plaster, (that is, made by dipping cloths in it when relented) which being laid double, served not onely as a desiccative and a defender [Page 77] from confluxion, by its gentle adstringency, but by its stubbornness and strength defended the part from hurt by blows, falling, and such other accidents, as Children are liable to.

IV. The depression of the Skull has been cured in several, by setting a Cupping-glass with much flame upon the Depression, after once or twice being let Bloud, sometimes with incision, and much scarifica­tion, and sometimes without them. A certain man was struck with a stone on the left side of the head, and was left for dead, bloud came out at his mouth and nose, he could scarce speak or open his eyes. If one pressed the depressed part of his skull a little with ones finger, he was troubled with a reaching to vo­mit. I ordered him to be shaved, and a large Cup­ping-glass to be applied with much flame, which, though it was set on the sound and solid parts, put the Patient to much pain: After the Cupping-glass was taken off, and incision made upon the part af­fected, and the Cupping-glass was applied again, he found great ease, and his pain was over, after which he began to speak,D. Des Grand. Pres. Observ. 3. a­pud Riveri­um. and knew those about him: And although I had taken seven or eight ounces of bloud away by cupping, yet the next day I order him to bleed again, and so in a few days he recovered.

V. Whether should Wounds of the head be healed by sowing, or by regeneration of flesh? The best Chirurgeons neglect sowing, lest the matter kept in under the sowing corrupt the Pericranium and the skull, and so pain and other symptomes follow; also for fear of hurting the Pericranium in sowing, which in all like­lyhood cannot be without hurt, when the whole skin is cut. And sowing of the Flesh is not properly opposed to generation of Flesh, nor is the cure by agglutination and future the same thing; for the ag­glutination of the skin of the head, which requires a long time, can never be, without generation of flesh, which generation of Pus doth precede, where­fore it is necessary, that new flesh should grow in the room of that which turned into Pus. Sennertus. Let the Chirurge­on therefore make it his business first to close the lips of the wound by binding, applying necessary medi­cines, and let him leave the rest to nature.

VI. Whether when the Skull is fractured under the whole skin should this be cut? Vidus Vidius reports, that Perusinus, a famous Chirurgeon, did by long practice observe, that more of those are saved, who are cured without cutting, by lenient and drying Medicines, than of those whole skin is cut and their bone laid open; and herein he shews that there is a vast diffe­rence between a fractured skull bare, and one cove­red with the skin: For if the skull be uncovered, if it be left without cutting, the humour that falls up­on the Membrane of the Brain, cannot be discussed by the heat which expires; and therefore putrefy­ing it kills a man: But when the skin is whole, the heat expires not, therefore it can digest the Sanies, and solidate the Bones, which we daily see in other fractures, that are covered with flesh and skin. This opinion may be allowed of, if onely a small quantity of bloud be poured under the Cranium; if no broken bone prick the membranes; and if the broken skull compress not the Brain. But if there be store of bloud, if the corruption of the parts underneath by the Pus, be feared, if a membrane be prickt or com­pressed by a broken bone, according to Paulus, Celsus, and most Chirurgeons minds, the skin must be cut, that the fracture may lie open, and other things may con­veniently be done as they ought:Idem. For Nature is not able to rectifie such faults; and granting that the Sanies could be drawn through the skin; yet the small bones and skales, that stick within, are not easily drawn out.

VII. A certain person fell backwards from on high, and remained as if he had been quite dead. Where­fore by the Advice of D. Pimpernelle, and D. le Juif, af­ter his head was shaved, a cataplasm of Bean-flower was applied all over it: And because the case requi­red haste, (for the Patient had lost his speech) that the Cataplasm might sooner drie, they got hot cloths applied to the cataplasm for the space of six hours: when it was dried and taken off, the figure of the latent fissures of the skull was found plainly delinea­ted on it:P. Borellus, cent. 2. obs. 20. for the cataplasm will not grow dry in the places of fissures or fractures: And a great fissure ap­peared in the middle of the Crotaphitus Muscle.

VIII. A little Girl fell down a pair of Stairs, and knockt the hind part of her head against a stone step, so that it made a great depression of the bone with contusion onely: And when her Parents would not yield to cutting, nor the necessary operations, but would onely have Medicines applied proper for the inflammation and contusion; she was beyond ex­pectation cured by Nature, yet there remained a no­table depression of the bone. We need not there­fore be much afraid for Children bruised after this manner, by reason of the softness of their skull.Marchetti, obs. 5.

IX. Aquapendent Chirurg. l. 2. c. 8. shews when Tre­panning the skull may be used. Trepanning (sath he) may be used in these two Cases. 1. If a descent of the matter be feared. 2. If there be not a sufficient outlet for the matter. On the contrary, if the Fissure be open, or the fracture reach not through the whole bone, and if there be no contusion, so that there is no fear of Sanies contained within, the skull must not be opened, nor the dura meninx exposed to the air to no pur­pose. We must observe that if the Fissure or seat of the Instrument descend to the middle part of the skull, scraping will not be sufficient, but we must proceed to trepanning, although no other [...]ymptome appear; upon this account, because the purulent mat­ter running from the lips of the wound to the mid­dle part of the skull, doth also by its vessels pene­trate to the membrane also, betwixt which and the skull it being gathered, causeth death: I have ob­served this in several,Marchetti, obs. 15. who for this reason were tre­panned, that they all recovered.

X. We put the Trepan to the broken or contused skull, that partly we may raise the depressed bone, partly that matter or bloud stag [...]ating in the dura meninx, may, when the hole is made, be evacuated: Yet Peter Marchetti saw matter evacuated without the Trepan. ¶ A young man falling from a window contused his skull, which caused Convulsions and o­ther symptomes: The skin, after incision made, sweated out Pus by the Pores of the Skull, as sweat useth to come through the skin. ¶ A Boy having contused his Skull, voided bloud at his Nose, Mouth and Ears; his Mother refused the Trepan: The Boy being neglected thirty days, an abscess and in­flammation arising in his head, Pus ran out at his Nose in great plenty. Marchetti being called at last, performed the opening of his Skull with a Trepan excellently well indeed; but because thirty days had past, the Boy at length died: for according to Hippocrates, in wounds of the Skull of this nature we must not tarry four days. The nature of our Soil and Clime is otherwise, and doth not exactly agree with the seasons of Hippocrates his Air, nor will admit of such generous operations: Our colder air retards the quickness of the inflammation, and stronger bo­dies, if a little time be allowed them, do with Na­tures assistence raise the bones of the Skull of them­selves:T. Bartholi­nus, cent. 2. hist. 41. For I have seen profound contusions of the Skull cured in our City without a Trepan, onely by applying Emplastrum magneticum & de Betonica. ¶ A Walker in his sleep, at his full growth, and of no small bulk of body, in the Summer 1673. fell from the second story upon a flint pavement, he fell not with his whole weight upon his head, but the trunk of his body first bore the chiefest force of the fall, o­therwise he had hardly escaped the abolition of all his animal actions, and immediate death; yet in the mean time he had grievously knockt his head, for his Skull was cleft, not without effusion of bloud within it, which is the perpetual concomitant of Fis­sures: The Italians, and other hotter Countries, would immediately have taken the Trepan in this case; and so would the excellent Mr. Burgowerus have done, but that the Patient and by-standers were [Page 78] absolutely against a Remedy not usual in these parts, and which to most men carries terrour in its very name, and so hindered his Intention. He endea­voured therefore to stop any farther profusion of bloud within the Skull, and to consume what was already extravasated: He diminished the bloud by repeated letting of it: He rubbed all his back with discutient Oil: He wrapped his Body in Lamb­skins just flain: He applied Cephalick bags boiled in Wine to his head: He denied him Wine: He gave him a decoction of Harts-horn to drink: He restrained the motion of the bloud, disturbed by the fall and grumous bloud, that was beginning to be inflamed here and there all over the body, and so made very impetuous: By taking away some quantity of bloud he made the veins as it were hun­gry, that they might suck back what was effused more greedily; to which purpose also pertained his thin and cooling diet: By giving a Traumatick tincture, and outwardly applying bags stuffed with Cephalick herbs, and boiled in Wine, he so dispo­sed the extravasated bloud (which would have be­come grumous, and might have caused much da­mage by its putrefaction) that it could enter either the bloud-vessels, or the pores of the Glands. And he did all this not without good success, nor with­out a precedent; for the same course, without tre­panning the Skull, has often succeeded as well as one could wish. I cannot believe, the extravasa­ted bloud passed into thin air, and vanished like a vapour; for the thickness of the Skull, and dense­ness of the Dura meninx, would hinder that; which is the reason, that it pertinaciously detains even mere water in the Dropsie of the head, so that the wit of Man cannot get it out without opening,Wepf [...]rus, de Ap [...]plexia, p. 340. and that is very dangerous. We see daily, how Swel­lings, half as big as a Hens egg, arising in the fore­heads of little children from violent falls, and grow­ing black and blew with suffused bloud, do pre­sently sink by applying cold Iron; or if this re­percussion at first be neglected, by applying a piece of warm flesh, how in a few hours space they vanish, without any manifest evacuation.

XI. Although Instruments are often applied to the Skull in fractures or fissures; yet sometimes they may properly be applied to it whole,Tulpius, lib. 1. obs. 2. especial­ly if there be fear that any veins are broken: For by this means not onely the effused bloud is got out; but moreover inflammation, putrefaction, de­lirium, a fever, and other Symptomes are prevent­ed.

XII. One had got a wound in the fore-part of his head, w [...]ich the Chirurgeon, by reason there were no Symptomes, cured in fourteen days time, according to the first intention (Anno 1629. in the month Sep­tember.) Thus cured, he came to Ʋlm, Anno 1639. in March, and complained of a great pain all over his head, of a Vertigo, dimness of sight, and a Palsie in his right Arm. Now, by reason of the great sus­picion I had of a fissure in his Skull, twenty weeks after he had received the hurt, I made a triangular Incision into the skin and Pericranium, upon the Sin­ciput, and I sufficiently dilated the wound, separa­ting the Pericranium from the bone, and applying Lint dipt in a Stegnotick. On the 13th day of March, when the bloud was stopt, I found the Skull cleft, and I bored it twice with a trepan, upon the edge of narrowest part of the fissure, and took away the interstice between both holes with a turning Saw. The matter being evacuated, that fell by the fissure upon the dura mater of the brain,Scultetus, Armam. obs. 1 [...]. the said Symptomes ceased, and the Patient in a months time recovered.

XIII. A Man of Threescore had a blow on the left bregma, with fracture and depression of the Skull: I was called to him on the 10th day in the evening: I found him in a Fever, delirous, and speechless: having given the prognostick,Fab. Hilda­nus, cent. 4. obs 4. I undertook the cure: I made a Cruciate and laid open the Skull; the next day having taken out a few bones, that were separated from the first table, I trepanned him. And so he that was given up for lost, happily escaped.

XIV. One was wounded on the right-side of his head, the wound reached all over the Cranium, and Membranes themselves, so that a piece of the La­mina vitrea, where the wound did almost end, did so prick the Membranes and Brain, that besides other Symptomes, there was this peculiar, a Palsie in the opposite Arm, and the Tongue. Beside common Medicines, the next day I trepanned the Skull in the midst of the wound, but with no relief: and therefore I resolved to try a new trepanning, but in vain: Then I tried two more, being fully assured that the Membranes were hurt, and the brain velli­cated by some piece of bone, which I found true: for in the very operation I hit my Trepan against a piece of bone, which I took hold of, and drew out with a pair of plyers,Marchetti, obs. 5. to which a portion of the Membrana pia, and the brain, were annext: Upon which, within half an hour, he recovered his Speech, and the use of his Arm, and lived long in good health.

XV. We must observe, that the Trepan and the Elevatory must never be applied to a bone that is totally broken off, lest by compression of it the Membranes under it be hurt. Therefore they may be applied to the firm bone; but as near as may be to the fracture, that less of the Skull may be taken out, lest the brain, deprived of its bony cover, get some hurt. Nor may you follow frac­tures, or fissures, if they reach any thing far, to their very end; you must be content to procure a passage for the Sanies, and with the taking out of so much bone as pricks the Membranes; for when a Callus is bred and grown under, Nature will make up the fractures of the Skull, as she uses to make up those of other bones: For which purpose, she, by a singular providence, hath filled the two tables of the Skull with a certain alimentary and sanguineous matter, that herewith, as with Marrow, she might repair the hurts of this bone. The truth of this appeared lately in Mr. Grolo's Servant, who suffered a grievous fracture upon his coronal bone by the kick of a Mule. When I understood this, I made a triangular section, that so I might apply the Tre­pan: The day after I had bored the bone, I thought to take it out; but as I was trying to get it out, af­ter I had separated it with the Trepan, I found, by the loosness of the bone yielding under my hand, an enormous production of the fracture; for it reached from the middle of the forehead to the outer corner of the eye: Therefore laying aside all thoughts and endeavours of taking out the bone, I thought it sufficient for my Patient, if I raised the depressed bone a little higher, for then it would not be troublesome by compressing the thick Meninx, and there would be sufficient passage for the matter by the division, which the Saw made.Paraeus, l. 9. c. 6. Up­on this, at length he recovered, onely he lost the sight of his eye next the fracture.

XVI. Carpus, in his Chapter of the signs when a bone pricks the Membranes and Brain, saith thus; ‘That the Skull is nourished by the veins of the dura mater. I saw by experience in a Boy twelve years old, that was kickt by a Mule, and had as much of his Skull broke as a large Wafer, pressed in, and eve­ry way separated, the thickness of a Knife. When I saw the bone depressed, I was willing to have totally raised it with apt Instruments; but in raising it, I saw one notable vein broke, that bled much, from which I knew the danger was great, and I let the bone alone, because it stopt the bloud, thinking to remove it in time; and in curing, I see the bone always of a good co­lour, and there were no bad signs, and so I pro­ceeded in the cure afterwards, and I saw the bone close up on the edges, and I let the bone alone, and so he was perfectly cured; and I have seen [Page 79] others both before and after which I will not speak of.’ ¶ When these veins, by which the Cra­nium is nourished, are torn, it so falls out, that they are retracted inwards, and the bloud runs from them, which putrefying, and no manifest hurt in the bone being seen at first; but at length cruel Symp­tomes arising,Marc. Dona­tus, l. 5. c. 4. hist. mir. the Patient dies. Besides, it may so happen, that though no veins be broke; yet by the violent blow, and concussion, much bloud may be drawn into the veins, that lie under the Skull, and the bloud being forced into, and retained in a nar­row room, and not duely purged, difflation being prohibited by its standing, and it conceiving an ex­traneous heat, Inflammation ariseth, which is usual­ly attended with death; though the wound appear very slight to the beholders eye.

XVII. It is the common opinion, if both tables of the Skull be broke, that the Skull must be open­ed, that there may be a passage for the Sanies; but others think application of Medicines more proper than the Instrument. 1. Because by Medicines no­thing more is destroyed, as is by manual operation; but what is broken, is presently restored. 2. In­flammation and other things often follow opening of the Skull. 3. Inflammation of the Membranes of the brain is cured onely by Medicines, and not by manual operation. 4. There are Medicines that draw out Arrows, Thorns, &c. Why not Sanies? 5. Many have been cured onely by Medicines. I grant this to be true, if it certainly appear, that the Skull is neither broken nor deprest, and that there is nothing which hurts the brain, and but a small quantity of Sanies; which the Symptomes do shew: But if there be a great quantity of Sanies; or if the brain or membranes be hurt by the Skull, opening must by no means be omitted; and it is bet­ter to prevent those Symptomes, which if they do follow, will render the operation more difficult and dangerous.Sennertus.

XVIII. We must take notice, that if it chance by a violent blow and great wound, that a portion of the bone should be so cut, as to be wholly severed from the rest of the Skull, and hang onely pendu­lous by the Pericranium and Musculous skin; it must not be pulled from the Pericranium, nor be cast away as useless, but it must be restored to its place and posture, that when the Callus is bred, it may, by the power of Nature, be glutinated with a kind of bo­ny cicatrice, as is noted by Celsus. I found the truth of this thing not long since in Captain Hydron. The middle portion of his coronal bone, three inches long, and as many broad, was so cut off with a strong Sword, that then it had no coherence with the neighbouring Skull, but scarce sticking to the Peri­cranium and Musculous Skin, it lay turned over up­on his face, and gave us a prospect of the crassa me­ninx: Therefore I was going to pull it from the skin and cast it away, unless Hippocrates his Precept had come in my mind, which bids us have a care of disarming the brain of its cover, and leaving it na­ked: Wherefore first of all I wiped off the bloud, that had fallen upon the thick meninx, whose motion I could observe by my eye; then I restored the piece of the bone turned out to its place, and tacked it to the upper part with three stitches with a Needle; and that there might be a passage left open for the rest of the Sanies, I filled the edges of the wound with Liniments: by this art it came to pass, that, though he had many large wounds in other parts of his body, yet through God's Mercy he recovered. Which may be a Precedent to us, that nothing,Paraeus, l. 9. c. 7. neither of the Cranium, nor the Pericra­nium, no, nor of the Musculous Skin must be cast a­way, except necessity require it, and much less that the Brain should be left naked of its cover.

XIX. Let not the Chirurgeon that trepans the Skull imitate Glandorpius, who holds on boring, till the piece that is cut out of the Skull stick to the Tre­pan; but when the piece of bone almost cut out begins to give way,Scultetus. having put in a weak elevato­ry, let him pull it out with a pair of plyers.

XX. If the Skull being laid bare, be either alter­ed by the ambient air, or grow black, then it must be scraped away, either to the change of colour, or till it bleed, that is, when good pus appears, and the wound cleanseth: If the Chirurgeon observe this time, after once scraping, and sprinkling with Cepha­lick Powders, and treating the bone with dry Lint, he will find it the next day covered with flesh. For we must not listen to Jac. Berengarius, who, l. de fract. Cranii, c. 42. orders the bone to be rasped superfici­ally every day; because the derasion made at the foresaid time is sufficient: but if it be used before that time, it must be often repeated, not without danger to the Patient, because by this means the rasp will at length come to the Diplors by degrees; They that are too timorous,Scalretus, Tab. 29. par. 3. leave the desquamma­tion of the altered bone to Nature's management, but they protract the cure.

XXI. If the fissure of the Skull be deep and broad enough, to let the matter purge freely from it, neither trepanning the Skull, nor violent dilatation of the wound with a Knife is proper: Therefore Chalmetaeus, l. 2. Enchir. c. 14. doth right­ly judge they deserve censure, who not onely in a little fissure of the brain (although it be not deep) but also in a large one, that is open enough,Idem. Tab. 29. par. 7. do boldly use the trepan: by which no small errour of theirs the cure is protracted a very long time, to the Patient's great damage, and the Physicians discredit.

XXII. I think we should have the same opinion of all those that dilate every wound of the head; whereas Section should onely be used, when we know not but that the Skull should be trepanned, or rasped. What should be done, when the wound of the head with a large fissure, refuses the rasp and the trepan, Scultetus, parag. 6. doth shew; con­firming it by the example of one, whose left-side of his sinciput had so large a fracture in it, that he could easily have put his fore-finger into it; to which fra­cture a Phlegmone of the Dura mater was joined, which nevertheless, universals premised, vanished in three days, by the diligent use of oil of Roses applied warm with Silk, and Hippocrates his Cataplasm.

XXIII. They proceed without reason, who, in all manner of wounds in the head, make a cruciform section. If the wound be given on the right or left side of the Sinciput, the Chirurgeon must dilate it into a Triangle, that, if it may be necessary, he may safely use the Trepan: He makes his section trian­gular, because the coronal future, and the right temporal muscle forbid it to be cruciform. He be­gins the section from the forehead,Scult. Tab. 27. lest he should cut cross the Temporal muscles, that he should a­void.

XXIV. Marchetti observat. 15. denies that the tem­poral muscle can be cut without danger, as often as the wound or contusion is with the fracture of the bone, for that most who are so wounded do die: yea, he affirms, that a fissure onely of the bone, ly­ing under the temporal muscle, has often caused death. Yet examples are not wanting of its being cut without such danger: Cattierus, observ. 9. tells, how a young Woman had a contusion without a wound, upon that muscle, against the corner of a Table: upon which she became speechless, with other grievous Symptomes: That the Chirurgeon le Large did reckon the contusion of this muscle, and the dilaceration of its fibres, and the compression of the Pericranium that involves this muscle, were the cause of these things: Yet because he doubted whether there were a fracture of the bone under it, he made a small incision, according to the duct of the fibres, and a little while after her Symptomes ceased, some sharp Sanies ouzing out, which vellica­ted the part of a most exquisite sense. ¶ And Bo­rellus, cent. 2. obs. 20. relates, that Count Breve had [Page 80] got a large fissure under the middle of that muscle by a fall from on high, and that Mr. Le Juif, contrary to the doctrine of Authours, made a section in the muscle, without any regard to the fibres at all, which he affirmed he had done several times in others; he saith, that when the section was made, the Arteries spurted out the bloud, which was stopt with Astrin­gent powders and lint; when the Skull was laid bare, there stuck out a pretty large scale of a bone, which the said Le Juif forced violently out with his Spatula, saying, there was no need of any other tre­pan, when that would doe as well, after which the bloud gushed violently out, which when it was stopt, the brain was anointed; he presently recovered his speech, and had his health well after. ¶ One Smith, sometime a Tanner in Chester, was afterwards a Cap­tain of a Company of Dragoons, which he pickt up in haste, to disturb us in our Retreat from the battel of Worcester. He was wounded by some of our Sol­diers transverse the right Temporal Muscle, and was bleeding almost to death, when I was brought up to his Quarters. I stitcht his wound, taking the Artery up with the Lips, and, for want of other re­medies, drest it with a little Wheat flower, and the White of an Egg, applying over it a compress prest out of Vinegar, with convenient Bandage. The third day after I took off the Dressings, and sound the lips near agglutinated. I being then better pro­vided by an Apothecary from Warrington, sprinkled the lips of the wound with pulv. thuris & sang. draco­nis, and applied a Pledgit spread with Liniment. Arcaei, and over it empl. diachalcit. The second day after I cut the stitches, and applied Epuloticks; and after­ward by a dressing or two more cured him: I am sure he was well of his wound,Wiseman's Chirurg. l. 5. c. 9. before he had re­cruited his spirits he lost with his bloud.

XXV. It is very doubtfull, when driers, and when moistners should be applied to the dura meninx, when it is laid open. Truely since Moistners and Driers are diametrically contrary one to another, it must be of some moment, which of them to use. Some use spirit of Wine, either alone, or with the addi­tion of Turpentine, and such like things, relying on these reasons; that all Ulcers require drying; that oils are hurtfull to the nerves, and all nervous parts, as the meninx is; that cold things are not less hurt­full; such as oil of Roses, which is commonly used. Some use Moistners, some oil of Roses, others Pi­geons bloud dropt in, because through similitude of Temper they foster the native heat, keep off defluxi­ons, and asswage pain, the cause of Defluxions. Now, to determine aright, we must examine the nature of the wound, the body and the clime: If the mem­brane be not hurt, if it be free of inflammation and pain, and if it look white, dry Cephalicks must be used; in such a case mel rosatum, with 4 or 5 drops of Aqua vitae, may successfully be applied: But if pain and inflammation be feared, and the membrane be not free from hurt, Oleum rosaceum omphacinum is most proper, because of its astringent virtue and mo­derate cooling, whereby inflammation is prevent­ed, and suppuration quickly promoted. Upon ac­count of the Clime, Meges Sid [...]nius, in the hard and robust heads of the Persians, onely used Isis (a Plaster so called) the Italians dare not use it without twice as much oil of Roses added to it. In respect of the constitution of Bodies, oil of Roses alone is suffici­ent for the more tender and moist; in drier bodies, such as Seamen, Plowmen, the elder sort especial­ly, and such as have curled hair, a little Turpen­tine, or oil of St. Johns wort may be added. So in Summer, oil of Roses is more proper, in Winter Tur­pentine. J. Griffonius, as Fabricius Hildanus relates it, made such reckoning of the distinction of bodies, that he made no scruple to use the syrup of Ʋnguen­tum Aegyptiacum, that is, the thinnest part, that swims at top, not with lint indeed dipt in it, for so it might run to the sound parts, and breed grievous Symptomes; but he gently touched the superficies of it with a Painter's Percil dipt in it. Now, he made use of it in a robust Swisse, the Membranes of whose brain were infected with manifest putrefaction; or corruption, which was presently stopt by help of this Syrup. And the same Fabricius advises us to use such remedies, but sparingly, and to desist immedi­ately, when the violence of the disease is repressed: And he grievously rebukes some Barber-Chirurgeons for using Oxymel in wounds of the head, and in the membranes made bare: for by the sharpness of the Vinegar many grievous Symptomes are caused, great pain, then presently inflammation of the mem­branes, a fever, convulsion, &c.

XXVI. It is doubted whether the dura meninx may be cut, to make a passage for the Sanies that is ga­thered upon the Pia, or the brain: For when it is prickt, there is great danger of convulsion and therefore of death; which I think to be none, if the Skull be pierced in two places, and the hole so laid open, that a long section may be made upon the hard membrane; and indeed, for this reason, be­cause great wounds of the head, which not onely cut the membranes, but the brain it self, are cured. When therefore it doth certainly appear, that matter is gathered between the two membranes, then we may safely proceed to this operation, how­ever not void of danger; because otherwise, if no remedy were used, death would certainly follow,Marchetti, obs. 14. and according to Celsus, it is better to try a doubt­full Remedy than none.

XXVII. I would give all Chirurgeons this Caution, in perforation to elevate the Cranium, that if possible, they do not pass the Diploïs: because the perforation of the second table, which is not so thick, but very brittle,Hildan. cent. 2. obs. 5. leaves some roughness up­on the Skull, which afterwards, by pricking the brain, doth cause Pain and other Symptomes.

XXVIII. Sometimes Physicians do admire, that the cure of some wounds in the head should be too long protracted: This is often observed to proceed from some little piece of bone, which, unless it be removed, the cure will never succeed as you desire; which I have several times observed, and which Car­pensis testifies in these words. Because bones are for the most part brittle and glassy, and when a notable fissure is made in the Skull, that reaches inwards, some pieces of the bone fall down upon the pannicle, and they are notable because greater, i. e. with a greater fracture in the second table, i. e. in the inner, than in the upper, and they prick or press the Pannicles. And the Physician in such cases should saw the Skull on the edge, enlarge the fissure and take out the bone, because such a disposi­tion is not otherwise cured. And I had this notable case in a certain man, who had stood for a whole year with a great piece of bone under his Skull, and the wound was remarkably long, and healed all up, but that the end of the wound could never heal or close up; and there were two little orifices, out of which the Sanies ouzed at least for six months. When I came I laid open the wound, and dilated it both in length and breadth, and with a Saw I removed the edge of the Skull, Marc. Do­natus, hist. mir. l. 5. c. 4. and I found a long and thick piece upon the Pannicle, which I took out, then I cleaned the Pannicle, and in a short time I cured him, and he lives yet in good condition.

XXIX. Charles, the Son of Philip King of Spain, fal­ling down a pair of stairs, got a grievous wound in his head: Chirurgeons were called, who bind up the wound, and being intent upon healing it up, neg­lect the discharging of the Sanies: Therefore his whole head swelled like a Puff ball, and the youth lay like one in an Apoplexy. Then King Philip brought Vesalius to him, who affirming, that in this desperate case, his onely hope lay in opening the Pericranium; and having got leave of Philip, he laid the Swelling open cross-ways, and by degrees eva­cuated most fetid pus: Schenckius. Then the youth came to himself again, as if he had awaked out of a deep sleep.

XXX. When I practised at the Hospital in Flo­rence, I found it most certainly true in the event, that of 40 persons, whom we have had wounded in a [Page 81] year, scarce five escaped: For there it is very fre­quent for the slightest wound in the head to prove mortal; and they reckon it a certain sign of death if the wounded Man fall to the ground, and begin to vomit; because this shews that the meninges and nerves do also suffer. I have sometimes thought, that perhaps this might happen from too much, and almost superstitious diligence in the cure, while they immediately sequester the wounded Man from all company, let him bloud, prepare the humours, and purge him: And their meaning is good, yet in the mean time they almost starve him, giving him onely a little Panada. They labour mightily to suppurate the wound, and keep him from the Light, which means alone are sufficient to weaken Nature. But they ascribe all to the subtilty of the Air, which in­deed, as it cannot be denied, so whether these other things be so proper,J. V. Rum­lerus. obs. 76. I leave for any man to judge. As many things are done negligently, so now and then some are done with care without necessity.

XXXI. I think it not fit to conceal an Errour very common among some unskilfull Chirurgeons, who, in winter time, that they may keep off the hurtfull cold of the ambient air, do not onely keep the Chamber exceeding hot, but wrap their Patients heads in many clothes and swathes: Yea, I have seen some that have held heated Tiles over their heads, while they were dressing; Whence we find very slight wounds of the head sometimes prove mor­tal: It's true, cold must be avoided, but it must be with moderation, as Hippocrates, l. de med. offic. saith. But unless the clothes that are used be thin and smooth, heat and inflammation in the part will be raised:M. Donatus, hist. mir. l. 5. c. 4. And in his Book of Fractures, when he fears inflammation he avoids a multitude of swathes and clothes.

XXXII. A Soldier received two blows one up­on another behind in his head, and was knocked down: There was no bloud, no fissure of the Skull, nor any evident depression: After nine weeks he could speak and walk well, and when he found no pain from the contusion, and was resolved to be gone, he went (to all Mens thinking) to bed well, but he died in his sleep. When his head was opened, there was not the least fissure nor appearance of any depression; but just under the blow, the substance of the brain, for about an inch, was putrefied ex­tremely, and the putrefaction reached to the ventri­cles of the brain. From this observation let Chi­rurgeons take notice, that they never judge any blow in the head little, though they find the parts containing the brain unhurt: Let them never pro­mise an undoubted cure in them. And above all, let them allow no errours in Diet; but rather let them treat their Patients with wary Art,Scultetus Armam. Chi­rurg. obs. 8. and a pru­dent Diffidence, that they may approve themselves their Craft's-Masters.

XXXIII. A Woman's head was grievously bruis­ed with a Plank, and the skin and flesh were laid open by a Chirurgeon to the bone, and the Pericra­nium was taken off, with some substance of the bone: The wound was left long open, and there were no signs of the bones being broke: And when the bone at length scaled, some portion of the bone that was separated, was taken off violently by the Chirurge­on,Cat [...]ierus, obs. 8. presently the bloud was seen to ouze out, then an acute fever, and at length she died. ¶ When either by reason of a contusion, or the injury of the air, the bone is about to scale, it is enough, if with­out any manual operation, some Cephalick Powder be strewed on it: And as the flesh grows under­neath, the dry and dead skale will be thrust out of the wound, and part from the rest of the bone which is alive and hath moisture in it. As it hap­pened to N. whose head was bruised by a fall, after the 40th day a large and notable scale parted from the rest of the bone: This the Chirurgeon got out of the wound with small trouble; now, he dressed the Man every day, by my advice, with those Me­dicines the Ancients have compounded for fractures of the Skull: And the Man was perfectly cured.Vidus Juni­or, lib. 6. c. 3. de cur. [...] memb.

XXXIV. In simple wounds of the head, whereby the Skull is not hurt, how much harm the common custome of the place in opening, or how much good the letting them alone does, in reference to cure; beside many other examples this one doth set out, which was given by J. G. who was struck oblique­ly, but with no great force, with one tooth of a Prong upon the right side of his head, upon the Bone called Laterale: An unskilfull Chirurgeon, by laying open the wound, made it much the worse; he made a Cruciate three inches every way, and laid the Skull sufficiently open, as he thought fit; then he u­sed digesters and oil for several days; whence it came to pass, that not onely so much of the Skull as was laid open,Arcaeus de curand. vuln. lib. 2. but a great deal more every way was corrupted, and must of necessity be taken out: And now the Man, through God's Mercy and my means, is well.

XXXV. The Trepan must be applied the second or at farthest the third day after the hurt (especi­ally when any sharp bone pricks the dura mater) while strength is good: for after three days, and as long as there is an inflammation actually, or one immi­nent, all use of the trepan is dangerous. Nor are they to be heeded, who, according to Paulus, tarry in Summer till the seventh day, in Winter till the fourteenth, because then it is too late to trepan,Scultetus, Tab. 29. Sect. 6. when strength is gone, and it may be suspected, that the membranes of the Brain are already infect­ed with the matter falling upon them.

XXXVI.Id. Tab. 29. parag. 4. When the Chirurgeon is to search how far a fissure reacheth, let him (according to J. C. Arantius his counsel) rather make use of Printers, than writing Ink, because of the sharpness of the Vitriol.

XXXVII. In some places the Skull is simple, thin and pellucid, without any Pith;T. Barthol. Anat. ref. li­bel. 4. c. 5. Wherefore some Chirurgeons are mistaken, who think they may in taking away the first Table, cut and bore so long till the bloud come.

Carbunculus, or, A Carbuncle.

I. ALthough the hot bloud, from which the Carbuncle ariseth, should be taken away by bloud letting; yet it must not inconsiderately be used in all; but if at all, especially in that which is not Pestilent; of which Galen, 14 method. m. c. 10. and other Authours must be understood to speak, when they talk of letting of bloud to fainting. But in a Pestilential Carbuncle we must not easily doe any thing that may waste strength, which we should have the greatest care of in the Plague and Pestilen­tial Fevers: among all which things letting of bloud to fainting is the chief; because it evacuates the humour most amicable to nature, and the best trea­sure of life, with the Spirits: Nay, sometimes when a Pestilential Carbuncle is just breaking out, we can­not safely let bloud: because the Carbuncle riseth not at the beginning of the Plague or Pestilential-Fever always, but oftentimes four days or more af­ter,Sennertus. when the strength is already spent in contend­ing with the disease.

II. But we must have a care, when we let bloud, that we draw it not to a noble part, nor by a noble part, lest it be affected with its Malignity: There­fore such a vein should be opened, as may rather draw to the part affected, than retract from it: If the Carbuncle be above, you must bleed above;Idem. If it be below, then bleed below.

III. Because bad humours can scarce be evacua­ted by bloud-letting, some think it necessary to purge, that so they may be evacuated, lest the in­nate heat be suffocated and extinguished by them, to the end that Nature may afterwards better man­nage expulsion, and the part it self may not be cor­rupted by the multitude of humours. But it is greatly to be feared, lest the humour, that Nature endeavours to throw out, should be drawn inwards by the Purge: And this is most to be feared in a Pestilential one; in one not malignant it seems more safe: But when there is a Fever with it, and that acute, the crudity of the matter often hinders Purging; and there is scarce any Carbuncle, where­in there is not something of malignity: And there­fore the malignant matter is with more safety thrown to the out-parts by Alexipharmacks,Idem. than drawn inwards by Purging.

IV.Chalmetaeus, Enchir. Two days after bleeding you may give a Purge: but let it be weak, lest it cause an immo­derate motion in the Humours, which I have found ever hurtfull, and sometimes mortal.

V. After letting bloud, the part affected must be presently scarified, and with indifferent deep gashes, that the corrupt and poisonous bloud may be got out, which otherwise would corrupt all near it: You may also apply a Cupping-glass, or Leeches to the place, when it is scarified. Yet if the Hu­mour flows thither with great violence, drawers cannot safely be used, lest when the matter flows yet more abundantly, the pain grow more violent, whereupon want of sleep, increase of the Fever,Sennertus. &c. do follow.

VI. N. in the time of the Plague was tormented with a Pestilential Carbuncle in his Anus, it was large and black, and when it struck in and disap­peared, it threatned certain death to the Patient: for retraction, I held first one red hot Iron, and then another to his Anus (yet so, as not to irritate the A­nus by touching it with the Irons, but that it might feel the heat of them as hot as the Patient could well endure) till the Carbuncle was drawn back to its old place: When it was returned, I feared it with an Iron, and laid on a Cataplasm, which in two days removed the Eschar. Take of common Salt half a Scruple, Pepper 1 drachm, fat Figs N^o iij, leaves of green Rue 1 handfull, old sowre Leaven 1 ounce, Mix them all very well in a Marble Mortar. Renew it twice a day. (Adrian Spigelius his predecessours had this for a secret.) The Eschar of the retracted Car­buncle being removed, I applied to the Sore Ʋn­guentum Citrinum with lint, which hath a power to di­gest, attract, breed flesh, and resist Poison. This is Ʋnguentum Citrinum. Take of Tobacco juice 6 ounces, new yellow Wax 4 ounces, Pine Resin 3 drachms, Scultetus, Armam. Chirurg. p. 1. p. 28. Turpentine 2 ounces, Oil of Myrtle what is sufficient; make a soft Ʋn­guent. So Aquapendent describes it, Pentat. Chirurg. cap. 20.

VII. If there be any that cannot bear Scarifica­tion, or if the Carbuncle will not yield to Medi­cines, and if corruption, blackness, &c. do seem to increase, we must presently have recourse to cau­teries, seeing there is danger in the least delay: And potential ones are not so safe, seeing the Scab made by them falls off more slowly, and so the ex­halation of the corrupt and malignant humour is hindred: An actual one is reckoned safer, because the heat and driness of the fire doth strongly resist [Page 83] putrefaction, preserve the sound parts from pu­trefaction, and draw from far: Nor need it be thought so grievous a Remedy, when the Patient can scarce feel it, because the Flesh is dead, and we give over Burning, when there is a sense of pain all over it. Yet it hath this Inconvenience in it, that it leaves a Scab, which hinders the malig­nant and venomous matter from exhaling. If there­fore any one will use it, let him have a care that the Scab hinder not the exhalation of the malignant humour; therefore it must be removed within twen­ty four hours, not by moistners and suppuraters, in which there is danger of Putrefaction; but with things that deterge, dry, resist Putrefaction, and break off the Fibres, whereby the Scab doth stick. Fabricius Hildanus uses this Ointment; Take of bitter Vetch flour, root of ro [...]nd Birthwort, of Florentine Orrice, Swal­low wort, each half an ounce, Treacle two drachms; with a sufficient quantity of Honey of Roses; Make an Ʋnguent. Au­genius commends this; Take of Misy, or Vitriol, 2 drachms, of the best Honey half an ounce, Hogs lard 2 drachms: Mix them. I had rather use such Medicines to bring a Scab, which usually comes upon a Carbuncle, than use Cauteries; because there is not onely simple Putrefaction,Sennertus. but a malignant Humour.

VIII. The Cure of a pestilential Carbuncle re­quires that, as soon as may be, Suppuration be pro­moted, and the fatal propagation of the evil be prevented. To doe this, I have not found any bet­ter means than an actual Cautery, which also is a way acceptable to most Chirurgeons; but to some this seems too cruel an operation, and out of a per­verse pity, being more sensible of its violence than the Patients themselves, they chuse a potential Cau­tery or a Vesicatory,Barbet. de Peste, p. 197. both which I also use, when I think they are either strong enough, or I cannot use any other means: For sometimes the Physician is forced to give way to the pleasure of the All-knowing By-standers, though it be to the Patient's hurt. ¶ Carbuncles may be cured by stopping the spreading mortification of the adjoyning parts; by separating the mortified part; and by cleansing and healing the Sore that is left. I have not hitherto known any thing that more powerfully, certainly and sooner stops the spreading mortification of Car­buncles, than Butter of Antimony, if it be anointed round the part affected; for then the corruption of the part, which so spreads and eats all before it, stops. Next to this I reckon Magnes Arsenicalis, made of e­qual parts of Arsenick, Antimony and Sulphur, and mixt in convenient Plasters: by help whereof the corrupted part is disposed to its separation: which same thing also the Butter of Antimony performs, for it does not onely put a stop to the progress of the pestilent Venome, but moreover separates the corrupt parts from the sound. All Balsams of Sul­phur, and especially anisatus, mixt with Ʋnguentum te­trapharmacon and basilicon, and applied to the Sore, do effectually clean [...]e the parts, when freed from the pestilent Carbuncle:Sylvius de le B [...]ë, Ap­pe [...]. ad pr. Tr. 2. in fine. And the same Balsam mixt with some common known Plasters doth [...]eal up the Sore when it is cleansed.

IX. Sleep is severely prohibited in a Carbuncle, because in it men think the Poison is drawn inwards, whereas notwithstanding one would conjecture, t [...]at in Sleeping the heat inclined outwards, from the Heat and Sweats that people are in while they sleep: Therefore it is not at all necessary to keep Patients several days from sleep,Platerus, Pract. l. 2. p. 714. as I have some­times seen, and so afflict and weaken them.

X. A Boy four years old, had been afflicted three days with a Carbuncle in the middle of his Forehead with a red Swelling, black in the middle; all his Face was puffed up. To stop it, I order presently a Caustick to be applied to the black part, and Ʋn­guentum basilicon with Treacle, Oil of Scorpions of Ma­thiolus and the Yelk of an Egg to the Eschar; and a Cataplasm of Plantain to the whole Tumour: be­sides repeated Bloud-letting and Cordials, I applied a Vesicatory to his Neck; the next day I find the Fever much abated, the Inflammation of the Tumour remitted, and all things asswaged. The benefit of the Vesicatory was here observable; for by deriving a great part of the virulent humour, it must be believed it performed the greatest share of the Cure: Therefore, I think, it should be used in every one, and applied near the part. I used no de­fensative of Bole,River [...]ius, Cent. 4. Obs 9, because of the hurt of Repellents in Diseases of the Face.

XI. In the City Rupecurvensis there is a Disease cal­led Malvat, which is a sort of Carbuncle, of which all men, unless they pass nine days without sleep, do dye; In the mean time they make section round the Carbuncle, and apply Cupping-glasses, and at last they are cured with Ʋnguentum basilicon. Without doubt this Disease is contracted from some latent Contagion in Sheeps wool: for all the Inhabitants employ themselves in Woollen Manufacture; and therefore it onely comes in the Face or Hands of the poorer sort.P t. Borel­lus, Cent. 2. Obs. 12. And Watching procured by any means does good, because in Sleep, a concomitant of this Evil, the Poison centres to the Heart.

XII. It is distinguished from a Gangrene,S [...]m. Clossae. us ad Greg. Horsii m, l. 7. ob. 13. not by sense of the part, for that is lost in both, but by scarifying the place: for if when the Flesh is cut deep, it be black, and neither froth nor corrup­tion come out, but remains dry, with inward hardness, it is a Carbuncle. ¶ The greatest part whereof, which gave the denomination to the Dis­ease, is as it were turned into a Coal; wherefore it is void of sense, and treated like a Gangrene, cir­cumscribing and limiting it either with Medicines or Instruments. Yet a Gangrene requires another Cure, because it often happens, that the Gangrene is corrected, and the part is restored to its natural state, those things being evacuated which should be, and those applied which vindicate the part from putrefaction.

Cardialgia, or, The Heart-burn.

I. IT is no season to let bloud, when sincere bile offends, and it is onely admitted in three Cases. 1. When there is a hot Intemperature of the Liver, that produces very hot bloud, which is the reason, neither any fleshy nor fat substance can be produced. So in Hippocrates, 5. Epid. A man in Oe­nia [...] was taken with most violent pains of his Stomach, after he was let bloud in both Arms, and a good quantity taken away he was cured. 2. When a blou­dy Ichor flows from the Liver or the whole Body to the Stomach, because of the Suppression of the haemorrhoids.Fortis, con­sult. 68. c [...]n­tur. 2. 3. When it proceeds from the Sup­pression of the menstrua.

II. Its legitimate and proper Cure is taking away the Cause, which must be done in this order; When the fit is coming, Vomit must be provoked immedi­ately, after Galen's example, 6. in 6. Epidem. comment. 5. who raised Vomiting either with simple Oil, or mixt with Water. We give some Meat-broth to six oun­ces, with Oil of Almonds and Syrupus acetosus, each 3 ounces. When a Man has vomited, if the fit con­tinues, it is a sign of thick Bile sticking to the Sto­mach; therefore give 4 or 5 ounces of the Syrup; and an hour after, except he vomit again of his own accord, give him 6 ounces of new Oil of Al­monds: for the matter being thus incided, deter­sed and attenuated by the Syrup, may more easily be carried off either by Vomit or Purge. Nor let the Syrupus acetosus make you afraid at all, because (as Avicenna teacheth) it converts Bile into Phlegm, and Phlegm into Bile. And presently after Vomiting, when the gnawing is laid, some astringent, strength­ning thing must, according to Galen's advice, be ap­plied outwardly. And thus you must proceed in preventing remedies; you must again diminish the matter, temper the heat of the Bile and Fever, withdraw it from the Stomach, intercept its pro­gress, and strengthen the mouth of the Stomach: In the Cure thus; you must sometimes allay the Pain with Anodynes or even with Narcoticks; sometimes you must discharge the cholerick matter by gentle purging and vomiting, till the Heart-burn and Fe­ver be diminished and quite taken away.Idem, ibid.

III. In a Heart-burn with a Fever sometimes a Vomit must be given, sometimes not: And at other times it is more expedient either to purge or take off the acrimony of the humour. If the Disease be very small or moderate, though the strength be good, you may omit cleansing the Stomach, and proceed to strengthners and qualifiers: If the Disease be violent, you must qualifie the acrimony and also cleanse the Stomach: And when the Heart-burn is laid, you must evacuate the whole Body either by bloud-letting or purging, as the nature of the Dis­ease shall seem to require. Galen, 1. ad Glaucon, puts this case. Come on (saith he) if one be in a Fever, and there be a plethorick disposition, but proceeding from fresh cru­dities, and he be heart-burned: or also, if he should vomit any bad humour, and in his discharge shall be much offended, so as to be very sick and restless, shall we here with respect to the Fever try onely to evacuate the Plethora, which otherwise without trouble we might doe? Or shall we rather provide for the mouth of the Stomach; and afterwards, when this is grown something better, evacuate the whole body, as much as the case requires? I think we should doe this last: for I have seen many who have been thus held, some of them dye, others brought to death's door, when the Physicians have attempted to cure them, before they had strengthned the mouth of the Stomach. Hence it appears, that when the Heart-burn is vi­olent, we must not vacuate the whole Body; but strengthen the Stomach, take off the acrimony of the humours, and afterwards proceed to purge. This indication of taking off the acrimony of the Bile bore such sway with Hippocrates, that he, 4. acut. in an acute Fever with Heart-burn, fearing the fu­ture Symptome, gave boiled Asses milk. These things must be done in the Fit: but in the time of Interval, when this Symptome is laid, we must go to the ordinary Cure; but when the Disease is very violent, we must doe all at once, i. e. purge and strengthen the Stomach, and take off the acrimony of the humours. Now the Question is, What way we should purge. As to vomiting, Galen in the fore­cited place speaks thus; But such (saith he) as are wasted with bad humours, gnawing the mouth of their stomach, you must cause them to vomit with warm water, or water and oil: If they be hard to vomit, you must first warm the places near the mouth of the stomach, and the hands and feet; but if they cannot vomit this way, they must provoke it by putting their finger or a feather in their throat: But if this way neither will doe; they must again take the best Oil can be got, a little warm: for Oil usually does not onely provoke to vomit, but also makes the Belly loose. And this is very good in the pre­sent case: wherefore unless it happen of it self, it must be procured by Art, and this thing above all we must attempt with proper remedies. Where he proposes Medicines to purge sharp and biting humours; such as both take [Page 85] off the acrimony, and purge not onely by vomit but by stool: Water and Oil moisten, loosen and obtund; Oil answers this intention best, for some­times it causes vomit, sometimes it gives a stool; yea, and sometimes it doth both; but because it doth not strengthen, but make lax, he therefore gives Wormwood boiled in Honey and Water: And at length, when Superfluities are every way purged out of the Stomach and Guts, he then ap­plies himself to strengthning with astringents inward and outward. This way of cure differs from the former, where he supposed the Heart-burn less than to cause sainting, namely, such a Heart-burn as comes by sits and may be cured in the intervals: But here he supposes a dangerous Symptome, name­ly, Fainting. Therefore in the former Cure Galen would have us first strengthen the mouth of the sto­mach, and proceed afterwards to vacuate the whole by letting bloud or purging, but here he makes no mention of evacuation: Again, in the former he would have us onely take care of the mouth of the stomach; but here he explains the way to mitigate, to purge by vomit and stool, and to strengthen. What therefore is the reason of this diversity? No other certainly, but because the Heart-burn, and all Gnawing of the stomach, is rather to be correc­ted with obtunding and alterative Medicines, than enraged with evacuating ones: But when necessity is urgent, we must make use of these, but then they must be moderate in their kind, such as both obtund and purge from the place,Hor. Au [...]e­genius, Tom. 1. Epist. l. 1. p. 128. as in the case pro­posed by Galen, i. e. when Fainting is either expec­ted, or actually present.

IV. Celsus, l. 3. c. 19. saith, the first Indication in the Heart-burn is, to apply Cataplasms to the Sto­mach, which may repress it: Secondly, to stop Sweating. For this he is grievously found fault with by some, because, when this Disease sometimes takes its original from the sole acrimony of humours in the Stomach; sometimes, beside that, from a base, poisonous quality; yet, before the peccant humour be either vomited or purged; or, if it cannot be e­vacuated, before its acrimony be taken off, or its base quality subdued, he applies astringent Medi­cines to the mouth of the stomach, whereby the matter is more stufft, and rendred more stubborn in evacuation and alteration. Yea, Galen, 1. ad Glauc. 14. while the bad humour is yet contained in the part grieved, he bids us in the beginning onely warm the parts near the mouth of the stomach, and the hands and feet to make the part affected lax, that so it may more easily discharge and divert the matter. All which things indeed, as they are true when the Disease gives truce, and time allows the use of such Remedies; so when the case is hazar­dous, and strength sinks (which is Celsus his case, wherein the Body is melted with immoderate Sweat, and the Pulse is low and weak) we must imme­diately have recourse to strengthners, as Galen there advises, (See the place at large above.) Besides, astringents first strengthen the mouth of the sto­mach; but then they are the cause, that when it is strengthned, it forces the noxious humours down­wards that used to rise upon it, which falling down­wards,Rubeus, com. in loc. citat. and stimulating the lower passage of the sto­mach, are at length discharged by stool.

V. While the Heart-burn continues, and the matter is much diminished, we may safely proceed to things that intercept the course of the humours to the stomach, to be given two hours before the Fit (if a Fever be joined with it) And they are incrassating and astringent things; as, Take of prepa­red Pearl 1 drachm, true terra sigillata half a scruple, Scorzonera-water 4 ounces, Pomegranate-wine 2 ounces. Give a spoonfull often. You may add 5 drops of Tinc­ture of Corall. Fortis. If it be malignant, give new Treacle with Pearl.

VI. Hippocrates cured a Woman of the Heart-burn without intermission, by giving her Barly grewel, with some juice of Pomegranate in it, and eating once a day. Now if the Pain came from Cold, how could Pomegranate-juice be proper? If from Heat, why must she eat no more than once a day? For they that are so held, are hurt by nothing more than Fasting; insomuch that unless they eat some­thing in the morning before their usual dinner time, they either faint, or at least feel a greivous gnaw­ing; and they are never better, than when their Sto­machs are full of victuals, whereby the Bile is im­bibed, and the close contracted Stomach is not re­ceptive of it. Certainly her Disease was from a fluxion of hot humours, and they that are so held, must take food neither in a small quantity, nor thin, because such corrupts and increases the Cacochy­my; but if a good quantity and substantial be taken, it frees from fluxion and concocts. Nevertheless a great quantity taken often can never he concocted, especially in an indisposed Stomach; therefore they must eat plentifully, and but once. But because they cannot pass any long time without all manner of food, they should use some light and medicinal Breakfasts and Suppers, such as Barly-grewel with Pomegranate-juice. Therefore Hippocrates does not here mean by [...], all tasting of Food, but, one full dinner; so his advice is to dine once well, and at other hours to take a taste of something medici­nal, which cannot load the Stomach; as if you should advise one to take a Tost and small Wine for Breakfast in Winter,Vallesius, sect. 2. Epid. lib. 2. and Pomegranate-juice in Summer; and for Supper, Barly-grewel, with that juice or a baked Pear.

Catalepsis, or, A waking Senslesness or Stu­pidity, wherein a man retains the form and figure of one awake, when neverthe­less all the functions of his mind and sen­ses are asleep.

I. A Girl not full eight years old in a Burn­ing-fever was first taken with a deep sleep, and then with a Catalepsis, her Eyes being quite open: She took nothing down for seven days, but a little Chicken-broth with Purslane boiled in it; she lay pale,B [...]nedictus, l. 1. c. 26. [...]ur. mori. speechless, and without motion, onely she breathed with difficulty. The Mother, in utter de­spair of her Daughter, gave her a Suppository of Honey, with which she voided a knot of forty two Worms without any excrement, and presently came to her self. Some caliginous Vapours from these Animals in her Belly seized all the Senses of her Brain.

F [...]rtis, cons. 34. c [...]n. 1.II. Galen, 3. simpl. allows Malmsey-wine to Cata­leptick persons, after whose example Amatus permits Cretian. Wine is best with some Sage or Rosemary in it.

Catarrhus, or, A Catarrh or Defluxion.