THE Frequent, but unsuspected PROGRESS OF Pains, Inflammations, Tumours, Apostems, Ulcers, Cancers, Gangrenes, and Mortifications, internal.  
THEREIN Showing the secret Causes and Course, of many linger and acute mortal Diseases, rarely discerned.  Initia Morborum quamuìs levia serpunt. 
WITH A TRACT OF Fontanels or Issues, and Seton's.  
By Everard Maynwaringe, M. D.  
LONDON, Printed by J. M. for Henry Bonwicke at the Red Lion in St. Paul's Churchyard. 1679.   


EMMANUEL  
Collegium Emmanuelis Cantabrigiae   
LICENCED, Roger L'Estrange. Septemb. 16. 1678.   

THE DESIGNMENT AND NECESSARY USE OF THIS WORK.  
FEW there are that think themselves concerned in this train of dangerous diseases; because they judge themselves clear at present, and do suppose these rarely to happen, for that they seldom hear of any to die upon these accounts; and therefore do not imagine that such ill Fate should befall them: but Fevers, Scurvy, Dropsies, Consumption, or such like common diseases they expect to be their lot: but when you come to understand (as by the discovery following, you will plainly perceive) that few sicknesses or infirmities you can fall into, if they be not radicated in, or grounded upon some of these latent or lurking destroyers; yet there is a tendency towards them for a complication therewith, and their terminations therein as the last Scene; especially if the disease or sickness be contumacious, and of long continuance, or acute, dangerous, and mortal: so that upon a true information, you will find such probability to be engaged here, when any infirm or sickly state shall alter your present healthful condition of body.  
And for such as have already some warnings by pain, and a valetudinary state, may seasonably inquire, and consult some sagacious and solid Judgement, from whence it does arise, whither it tends, what progress probably it will make, if not prevented; a resolve upon the question very likely will fix here, if the case be throughly examined, and duly searched into.  
Considering that pain most frequently either ariseth from some of these already begun to act their parts; or that some of them will most likely follow thereupon, although veiled under the covering of a more known and familiar Disease; as fully declared in the subsequent Discourse: for whether the manifest Disease afflicting be the Scurvy, Consumption, Dropsy, Ague, Spleen, Pox, or other chronic Disease; very often it falls out (though seldom taken notice of) that some of this train is complicated and joined therewith, if good Medicines or great Providence stop not the progress. And if the sickness be acute, malign, pestilential, or other; as small Pox, spotted Fevers, Plague, or any general Phlogosis and febrile scorching distemper; they come on commonly by Inflammation in some particular part, and proceed on to tumify, apostemate, and gangrene, when such a disease is not checked, but grows desperate, and becomes fatal to the sick: and thus Pleurisies, Angina's, Peripneumonia's, Inflammations of the Brain, Ventricle, Liver, Spleen, Mesentery, etc. they go on in this road, by these stages and transitions, from Inflammation to Tumour, and so forward, finishing the course with a Gangrene and Mortification, if good means take not good effect to prevent and stop the progress.  
Observing therefore in constant Practice, the frequency, latency, and danger of this association and confederate train, disguised and couched under some more appearing and known disease; I thought it a Work necessary and grateful to unmask and lay open such secret destroyers, that in the designments and methods of Cure, they may strictly be sought after, and aimed at, thereby preventing the danger threatened, and securing the Patient.  
Novemb. 15th 1678. Wine-Office Court in Fleetstreet.   

The principal Occurrences, and chief Heads treated of.  

PAins, Inflammations, etc. their order, connexion, commutation, and transition.  
The frequency and latency of this train in most Sicknesses or Diseases.  
The disguised Progress thereof.  
The danger and frequent Mortality from not discerning them.  
Fevers mistaken; and the common courses for Cure erroneous.  
Pains in general; their different nature, causes, and tendency to farther mischief.  
Pains of the Head: the causes, and various parts affected.  
Pains in the Breast, and the several causes thereof.  
Pains of the Dugs; of the intercostal Muscles; of the Pleura, or Pleurisies: pains of the Lungs, of the Heart, Mediastinum, Diaphragma, and Cartilago mucronata.  
Pains in the Abdomen or Belly, and various causes thereof.  
Pains of the Stomach; of the Guts, Colic-pains, Dysenteric, and Haemorrhoidal; pains of the Spleen; an eminent Cure, and how performed: pains of the Liver; pains of the Reins and Bladder.  
Gout-pains and Rheumatism; their causes and indications of Cure.  
Inflammations internal: what they are; how they arise; what parts they possess; the material and efficient causes thereof; directions for Cure.  
Tumours internal: the occasional causes thereof; the modus generandi; how to know them; their way of resolution, fixation, and translation: their different state and condition, scirrhous, apostemate, and cancerous: cautions in Cure.  
Ulcers internal: the essential differences; their manner of generation; the continent causes; the manifesting signs.  
Gangrenes and Mortification: what they are; the difference between them: the external and primitive causes of Gangrenes; the internal and conjunct causes: the Characters declaring a Gangrene: their state of curability, and incurability: many thousands die gangrened not taken notice of; instructions before curing; amputation when, and where to be made.  
The Result of the whole matter.  
Fontanels and Seton's: what they are; how made; where to be placed; for whom beneficial; the due ordering them in several conditions; the time when to heal them safely.    

THE ORDER, AND DEPENDENCE OF Pains, Inflammations, Tumours, etc. internal; cautioning their proceeding and complication.  
THE natural oeconomy and government of humane Bodies, may well be compared to a body Politic, subjected to State-discipline, Order and Conformity: the former hath a regular course instituted and implanted, by Nature; the latter hath Laws imposed and enjoined by humane Authority to be observed.  
In both these Governments so long as Order and Laws are obeyed and kept, the whole is preserved sound, safe, and in quietness: but when the subjected parts of either do mutiny, rebel, and shake off the Government, refusing to act in their stations and subserviency; the whole then is put into disorder, the union of Community is broken, and the public safety endangered thereby.  
If a part of the body decline its office and performance of duty, acts perversely and inordinately; the mischief stops not there, but other parts also are perverted thereby, and drawn into consent: likewise if one Member of State be sick of tranquillity and peace, be disturbed at the Government, and gins to be dissenting, disobedient or mutinous, ten to one but this infection begets another of the same mind, and faction, and the second makes a third, and thus the malignity spreads.  
When any part of the body gins to fail and be out of order, it seldom stops at its first degree of declension, but makes a progress from bad to worse, if not remedied and prevented: So a Member of State gins to be distempered, first with discontent, afterwards anger and malice ariseth; and after that perhaps Rebellion follows, if fear of miscarriage do not choke and deter the Plot.  
If a finger aches, you will not be much concerned; but if the Head be pained, or sick at Heart, you then consider of seeking remedy, as not able to bear the trouble, or run the hazard: So if a mean inconsiderable man be disorderly, contemptuous and drunken, little notice is taken thereof, as to the public detriment and injury: but if a great Statesman or Magistrate be corrupt in his place or office, or be seditious; 'tis time at the first appearance or discovery to correct that insolency, and reform the abuse, as of dangerous consequence.  
As the member is in office, dignity and power, greater or less, the care, inspection and regard thereto is to be had accordingly, being of greater or less concern; and yet no part so mean as to be contemned or slighted, for a pain but in the Toe, may tumify, inflame and gangrene, endangering the whole body; and a Fisherman of Naples, beginning but with a Tumult of Boys, thereby subverted the Government, and usurped the Power.  
But to quit the Analogy and prosecute directly the subject proposed; here is first Pain which most commonly is the leader; a signal or warning of a defection or disturbance in the part where it is seated; which although sometimes it vanisheth and comes to nothing, yet it is not so always, but often otherwise; for either by the continuance in a remiss and low degree, or by speedy advancing to extremity, it ushers in other consequents of great concernment and fear, and sometimes fatal.  
The greatest Diseases have small beginnings and seemingly contemptible; yet by time and neglect, or by unfit and improper means, or management, they arrive to a formidable height, and become mortal. Obsta principiis is good counsel; the beginnings of evil are to be checked, lest they grow too big to be mastered and become irremediable.  
If pain seize a part here or there, you know not what will follow, nor by what gradual steps it will advance, what progress it will make, and what the issue and event of all.  
If pain gins, Inflammation or Tumour or both may follow, and perhaps not stop there, except prevented by a prudent course to obviate the mischief.  
And further, if a part or member be disabled, or put out of its office and the rectitude of its function by pain and anguish, the detriment does not rest here only, but other parts are drawn into consent, they far the worse for it, and by time the whole is become a sufferer and made sensible of that prejudice. And every one's experience by the death or long languishing diseases. of their Relations, Friends or Acquaintance can testify this truth; how small their complaints were at first, what little appearance their infirmities did make, how unsuspected the progress, and such an event, or the arrival to such a height how unexpected; and therefore not so timely, not so prudently and carefully applied to for help and remedy.  
A small pain gins, greater comes on, and that's a groundwork for Inflammation, and this most likely to beget a Tumour, which if not discussed in time, and the anguish of the Archaeus or vital principle appeased, a scirrhous hardness is fixed there, cancerous or otherwise; or it degenerates into purulent matter and apostemates: it stays not long in that capacity, but it breaks forth and presents you with an Ulcer, if the place be in view; but if not, and the part affected be internal and hid, then there will be a discovery or discharge of matter by some Emunctory or common vent, or sudden death must finish the course: thus every Scene more tragical, threatening and more dangerous than other.  
True it is, that Nature by her own struggling and endeavours does quit herself sometimes without assistance and help, and stops the course and progress of a disease; but this is hazardous to trust to or rely upon; and Providence usually works not wonders but where the means is wanting: your presumption therefore and neglect may justly be chastised with a smarting sense of what you slighted, and your contempt of means punished with the loss of that, which others by good means do frequently obtain.  
As Nature is regular, and observes her order and course in a state of integrity; so likewise in a preternatural state of defection, there is sometimes a Method and Series, or a gradual progress from one disease to another, or a complication of diseases gradatim brought and linked together; that a sagacious foresighted and complete Physician, seeing one disease to present itself, looks beyond that, takes a farther prospect, and discovers the train that will follow, knowing their connexion and dependence upon each other; and there is much reason for it: for, as the parts and members consent and comply with each other in sanity and a state of health; so likewise the members do complain, condole and suffer with each other, and become partners in disorder, infirmity and a morbous state: for the members having a mutual commerce, supply and help one from another, of necessity then if one be out of order and defective, the other will be disordered thereby, wanting the assistance of its fellow and consort in the common work.  
As every part of the body labours to support itself; so each endeavours by the duty and office imposed by Nature, to maintain the society and harmony of the whole Corporation: for every part hath such dependence upon, and relation to each other in the common safety, that the good of one is the benefit of another, and the sufferings of one redound to the prejudice of the rest; and as the part is more noble and principal in office, the sooner is the whole made sensible of its grief; and a single Malady becomes the common calamity, and a public evil.  
But to come yet closer to the matter in hand, and to illustrate this Series of Diseases, the subject proposed in the front of this Work; and that you may know how common this case is in practice, how rarely discovered, and therefore erroneously adjudged, and the fatal consequences thereof; which to handle the more distinctly and clearly, and to prove more convincingly and unanswerably, I shall part my Discourse into three divisions, and raise Arguments under these three Hypotheses, comprising the whole story of our design.  

1. That this Series of Pain, Inflammation, Tumour, etc. is very common, and the most frequent train of mortal Diseases incident to man's body.  
2. That this progress and complication is seldom determined and adjudged, except they present outwards and are discovered by the eye.  
3. That many curable diseases or sicknesses become mortal; and many thousands have died for, and upon the mistake of not discerning this series for the case; but appointing or adapting a course of Physic by other indications which have proved either very injurious and destructive, or at best of no advantage to remove the disease, or retard its course.   
To set forth and make evident the truth of our first Position, you must know that Pain is commonly the first Symptom of most diseases; and if it does not appear as a leader, yet very frequently it comes in early, or soon after the disease hath discovered itself; and few that complain of sickness, but complain of some pain that attends it, and this our Practice must own and confirm: and taking a survey of the Catalogue of Diseases belonging to man's Body, you will find no Symptom so frequently adjoined and appertaining to them, as that of pain; and the reason hereof in part may be this: That all the Symptoms of diseases are the objects of sense; that is, they do come under, or are discernible by some of the senses; which being compared amongst themselves, are of greater and lesser latitude: now pain belongs to, and is adjudged by the sense of feeling only; which sense is of the largest capacity of all the rest; being extended throughout the body, even through the Organs of all the other senses; whereas the rest are confined to particular parts, the Eye, the Ear, etc. and have no larger extent or place of residence, (as hereafter we shall have further occasion to discourse.) For instance; seeing may discover what is amiss upon the external parts or superficies of the body, and discern what comes forth, that it may be adjudged; but feeling takes cognisance of inside and outside, and what we cannot see we feel, and are sensible of by pain, even amongst the most secret and hidden parts of the body: so that pain is known to be, and does manifest itself, whether it be within, or without. Hence it is, that pain is the most usual and most frequent Symptom amongst diseases.  
Pain therefore belonging to this capacious sense, and being an appertainer thereto, and having admission into all its quarters and confines; no wonder then if pain so frequently occurs, and is the most usual attendant, or most troublesome intruder upon the sick.  
Having thus proved (and might farther confirm it, if needful) that pain is the most general and frequent complaint of the diseased; we shall proceed and inquire farther, how Tumours, Inflammations, etc. do follow thereupon, and how pain introduceth and ushers in the rest of its fellows, and how pain is introduced sometimes by them; and how they appear very often with their consorts, having relation to and dependence upon each other by way of causation; that some of them, and sometimes all, are principal Actors in the Tragedy of most mortal diseases, though seldom discerned.  
Mortal diseases I said; because where diseases are stopped in their progress, and have not their full course, but are taken off by effectual means, or great Providence, the links of this chain is broken, and then perhaps pain may exercise its power singly and alone for a time, and by intervals; or pain may contract or associate a Tumour, and sometimes an Inflammation, and yet all end well; these may go off, or be sent off by Medicine, and proceed no farther, and the Patient recover, or return to a good and sound state of Health: but too often it proves otherwise, either by neglect and delay, by improper methods and erroneous proceeding, or for want of exquisite means, the progress goes on gradually to the last, and ends with Death.  
In this train of Diseases, pain for the most part is a leader, and sometimes a follower; but seldom misseth to be the discoverer.  
Pain gins and gives the Alarm, discovering a disorder or disease in this or that internal and hidden part of the body; gives warning betimes, and implores aid: but none coming, at least not sufficient and effectual, the pain continues, as the cause is yet remaining: if the help of Art be wanting, yet Nature is not wanting to herself, but summoneth all her power and endeavours to dislodge and expel this morbific cause, and raiseth all her Spirits, though in a febrile disturbance and confusion, against this common enemy: to the part grieved these Spirits resort plentifully, and with them the blood is conveyed, which flowing in and remaining there, a Tumour is generated, and by this concourse of Spirits the part grows fiery, and an Inflammation is planted here and superadded.  
The case remaining thus for a while, and this confluence not dispersed, discussed or drawn off; the Tumour perhaps grows cancerous, afterwards gangrenes and mortifies, than death immediately ensues and concludes all.  
But sometimes the Tumour suppurates or apostemates; and then the contained purulent matter breaks forth and begets an Ulcer, if the Patient survive and hold it out: and with this the diseased may continue a longer or shorter time, according to the nature of the Ulcer, and as it is more or less dangerously seated: for if it be a principal part, or adjacent; or this ulcerous matter issuing, falls into some inconvenient cavity where it is lodged again, and finds no Emunctory or passage out, or erodes and rots some choice vessel of great use, the case is deplorable, and scarce remediable.  
Now to comment a little upon this series and progress, consider that where there is pain, and it continues, especially in a high degree, you may rationally expect a Tumour, or flux of Humours congregated to be the consequent (if not prevented) which is brought to pass and effected after this manner, or upon a threefold account.  
First, Because Nature in a time of exigence and need, does endeavour to help herself, and exerts her power to the utmost; and therefore when pain afflicts a member, the Spirits resort thither, and with them the blood also to relieve it.  
Secondly, The part pained by reason of this plenitude of blood and confluence of Spirits, does wax hot, and this heat begets an attraction, and draws more humours to the part.  
Thirdly, Pain debilitates and disables the part, whereby it is become uncapable to defend itself, but lies obnoxious to this flux of humours, which being out of their proper place, and remaining in a distempered part, they degenerate variously.  
Now upon a survey of the whole matter, although Nature intends well in this hurry and bustle, being roused up and pricked by pain (and success sometimes happens upon it, or no damage) yet commonly it falls out otherwise, and there is an oppression and over-charge brought upon the part: The confluence of Spirits together with the innate, tumultuate and inflame the grieved member; which being thus discomposed and out of order, cannot moderate and check the flux and attraction of humours, but is overloaded, crowded therewith, and distended: And unless the help of Physic, directed by a prudent hand, steps in to appease and allay this disturbance, by casting out the morbific seminary or matter, and reduce this disorder, it goes on from bad to worse frequently, and from thence to extremity, and perhaps to an irrecoverable state, in manner and by such gradations as before related.  
And besides what pain does thus effect as a leader; Tumours sometimes do take their rise not from pain, but either by congestion, or a congested matter in an infirm part, be it never so small, if noxious and preternatural, it is sufficient to be the groundwork of all this mischief: or else sometimes by defluxion, from some part mandant; in both which cases pain follows as a consequent and effect; (as hereafter more at large) but then Tumour and pain being thus met together, the progress will go on as before, being now in the same road as formerly, when pain preceded. And although pain does not begin to raise a Tumour, but the foundation is laid by congested matter there bred, or defluxed and transmitted thither from some other part; yet rarely but pain supervenes, and comes in as an associate to hasten and set forward the Tumour: for matter congested or defluxed, is injurious and a burden upon a part, and then the vital principle or Archaeus (which hath the government and tuition) is molested and troubled therewith, and seldom lies calm or quiet under that oppression, but gins to be incensed and enraged (more or less, pro magnitudine causarum) and this ira Archaei is the ratio formalis of pain, the very pain itself which is felt.  
By the whole current of our Discourse you see, and by your own experience you may observe, that pain is most frequent with infirm and diseased bodies; so likewise it is apparent to reason, and experience confirms it, That Tumours, Inflammations, etc. will often follow thereupon as dependants thence: and è contrà pain does supervene and follow preternatural Tumours. And we see commonly that external pains continuing, do produce a Tumour or distension of the part, at least is coadjuvant or concomitant: after the same manner, and by the same way of causation, internal Tumours are bred also, and we cannot in reason imagine otherwise: for the course of diseases, having the same radix, and taking their rise after the same manner, are alike internal and external; for as pain begets a Tumour externally and in view, so doth it produce the like effect, and makes the same progress in the interior and hidden parts.  
And thus much may suffice to prove and confirm our first Thesis or Position, and to satisfy the rational and , of that truth. I proceed now to the second, viz. That this progress and complication of Pains, Tumours, etc. are seldom determined and adjudged aright, except they present outwards and are discerned by the eye.  
And having remarked the frequency of this Series among the sick and diseased, and its manner of progress; we shall now take notice how seldom it is looked upon and judged for the case in practice, but supposed to be something else, until dissection sometimes informs their judgement, when too late.  
The first discovery of this mistake, and the argument drawn from thence sufficiently convincing, is from the aims of the Physician, the Method and Course of Physic, and adaptation of Medicines; which being leveled quite beside the mark, does plainly show, that this Series of Diseases is not thought of, when they lie but seemingly obscure, internally; as very frequently they do, when diseases run to some height of severity, having no check or stop put upon them.  
The second discovery or conviction of error (when too late) is from dissection after death, and is plain demonstration to the eye: as when Relations are not satisfied concerning the death of the Patient; and the Physician dubiously or unsatisfactorily giving in the account; dissection lays open, and presents to view a Tumour or Ulcer, rottenness or putrid decay of the part, gangrened or mortified; which makes evident what before was little thought of. Now upon such miscarriage indemnification is thus framed with a salvo judicio: that when the Corpse bears any of these characters, the account is given in, as plain to be seen, that the Patient was in such a desperate condition, as it was impossible to retrieve or recover; and so the blemish is wiped off the Physician, and he passes for an able man as before; when indeed this funeral conclusion was brought about for want of a prevision, true notion and due apprehension of this frequent progress of diseases (our subject) which might have been prevented or stopped, if the design of Cure had looked that way.  
Now the grand occasion of passing over and hiding this Series or commutation from Practisers, does arise chief from the erroneous account in the general division of Diseases; viz. ranking all Diseases under these three Heads.  

Similar.  
Organical.  
Common.   
In the first rank (and to examine no farther for error) are comprised all distempers or intemperatures of the first or second qualities: by the first qualities are understood these four: Heat, Cold, Moisture, Dryness; so that any person complaining of sickness, or not being so well, and altered from their wont condition, the Physician examines the state of the Patient by this triple division, Or some part thereof, to find out what rank the Patient comes under; and according to order and method set down, he first inquires and feels what temper the sick is of, whether hot or cold, dry or moist: or whether there be a complication of these, as hot and moist, or hot and dry; cold and moist, or cold and dry  
And finding the Patient's case to be one of these, he pronounceth strait accordingly, that he hath such a distemper, which must be corrected and reduced to quality and good temper again. The diseased person being made sensible hereof, that he is hotter or colder, etc. than formerly, is well satisfied that the Physician hath hit it right; and this distemper being a grand one, must father all or most of the other ailments, as the offspring from thence; so that getting but the mastery of this, all will be well.  
The organical Diseases internal, being more difficult to be detected, are passed over as obscure; at least the disquisition is not sufficient, insisting too much, and relying upon the discovery of a disease or distemper in the first general division; that what pain there is here or there, it passeth for wind, or obstructions in the part. And as for the third rank, it is rarely thought of, except something present outward.  
All which does appear from the endeavours of Practice, which more especially and most frequently do aim at, and are bend against diseases of the first Classis: some of which are so inconsiderable in the design of Curing, as not to be looked upon for diseases, but only Characters and Signals following and depending upon diseases per accidens; with whom they appear in such degree, and vanish again, as diseases do increase or decrease, and go off.  
To contract our Discourse into as little room as we can, and yet to prove our assertions clearly; I shall pitch upon one distemper only, intemperies calida, a hot constitution, a febrile heat or Fever; the prime and notable distemper of the first rank, which makes the great bustle in Practice, though to little, or bad purpose, (and by this you may judge of the error and folly of the rest:) for by insisting so much upon this heat, the supposed obstacle of Cure, or the thing to be cured; the opportunity perhaps may be lost; but the Patient certainly injured by the vain use of Medicines leveled at this mark.  
Few diseases there are amongst the Chronic or slow of motion, but some febrile or preternatural heat, (more than the ordinary and natural temper) does attend them; especially at such times, if the disease have any manifest intentions of degrees, or Paroxysms of pain: and scarce any among the acute or swift, but a brisk and high Fever does always accompany: for in all cases where pain is continuing, especially if severe, a Fever is adjoined, and they become fratres in malo; or rather a branch from that stock, and the order of causation runs thus.  
First, there is the morbific cause planted in this or that part, or transient; which is either some degenerate or peccant humour there infesting, or corruptive seminary (the fundamental matter of Pains, Tumours, etc.) or some extraordinary production; as stones, worms, etc. These preternatural causes do seldom lie dormant but raise pain, by obstruction, by oppression or compression, by convulsion, distension, corrosion, putrefaction, etc.  
The parts being thus affected and grieved, the vital principle residing as governor there, is hereby excited and irritated, to remove, expel and cast off the offending cause: this struggling and irritation of the life, is the very pain and anguish that is felt in the part; for the Organ is not capable of pain, of itself; but the life inhabiting and enabling the part to perform vital offices, that does dolere and aestuare.  
Now a Fever (which is pain diffused) ariseth from particular pains thus; As the members or parts of the body being many, do consent with one another, some more immediately and peculiarly, than with the rest, by vessels of communication, partnership in office or vicinity; yet the life being one entity or common being, extended and expanded throughout the whole fabric of the body, cannot suffer here or there, but the whole is injured, disturbed and drawn into consent, more or less, manifestly or secretly; and the Spirits (upon great occasisions) are raised up in commotion throughout the body, as instruments to vindicate the public from an enemy invading.  
And farther, take notice that particular pains beget (the general) a Fever greater or less, sooner or flower, upon a double account.  

1. From the Nature and Quality of the Part, in formation and office.  
2. From the greatness or inconsider ableness, fierceness or mildness of the morbific cause.   
For example; Sickness (which is pain) at the Heart, or Stomach, raiseth a Fever great, and soon; and this by reason of the excellency and necessity of their offices, whereby the whole body consents forthwith; that what afflicts these, is a general complaint more immediately: but other parts in a lower station, subservient and ministerial, whose function being not so general, but of particular and private use, do not communicate their diseases so soon; nor the whole body so highly resenting their ill affects, because the public can spare their offices, and be without their exquisite or complete assistance for a time, without great complaint, or manifest want.  
Secondly, the cause or morbific matted, being greater or less in any part, does thereby affect more or less, sooner or later: and therefore sand, or small gravel in the Kidneys, do not afflict the part, nor raise so great a disturbance in the body, as a stone there, that obstructs the ducture, and stops the current of the Urine, and is much more difficult to be removed. And sickness or pain at the Stomach, by little over-drinking of good liquor, Wine or Beer, etc. is not so lasting, nor molesting, nor preading in the effects over the whole body; ●s a surfeit of meat, fruit, or an over-charge of bad liquors; these shall produce not only sickness or pain in the stomach, but sickness or a hot pain in the whole body, which is called a Fever; and this sickness may be dangerous, as sometimes it proves mortal.  
Pain is fixed in one part, but the Fever is universal, spread throughout the body; for from this pain of a particular part, the whole life estuates, is incensed and disquieted: as if a cord be tied or fastened at both ends, of great length and strait; strike it hard in one place, and it jars the whole length; but at the place struck, the vibration is greater and more manifest: So where the disease is seated, the pain is more apparent, and that part most sensible: where the wound is given, where the oppression lies, where the obstruction is where the humour is corroding, putrifying, etc. there pain is eminenter; limited or bounded▪ and to be pointed at particularly, here and not there eminently: but from hence ariseth the Fever, which is pain diffused, in a remiss degree, and seemingly of another nature or quality, a different thing supposed by some, therefore denominated a Fever.  
This Fever, although it be a pain, yet it is not so felt by the Patient, nor so understood by others, because of the greater particular pain that drowned it; and because of its expansion and latitude, all parts bearing their proportion and share; so that where a Fever stands alone without a particular pain in this or that part; yet the Fever, the general pain, is not so manifest to the sense of the Patient, because every part hath its portion, and therefore is not so discernible and uneasy: for a Fever is pain expatiated through the body, and you are not so sensible of it, as when pain is contracted into a narrow compass, the rest being free and at ease.  
That all Fevers are pains, greater or less, examine but the definitions of Febris, and that of Dolour, Fever and pain, you will be fully informed how they agree; a Fever being comprised under pain, as a Species of that Genus, being a hot pain, or the pain of heat.  
Dolour est tristis sensatio in tactu.  Gal. 
Febris est calor contra naturam in cord accensus, & ex eo in totum corpus diffusus, which is Hippocratic and Galenic Doctrine.  
Now where there is heat, higher or exceeding that which is natural, it must affect the sense of feeling and cause pain: and although I do not like the definition of Febris, yet it will serve my turn here, being right, in the opinion of those Galenists with whom I now contend.  
From hence we must understand (and be untaught again) that Dolour and Febris do differ as genus and species; a Fever being contained under, and is one sort of pain, viz. a hot scorching pain; and sometimes a Fever is a cold pain, as the rigour of intermitting Fevers (called Agues) do testify. And since that all Fevers we pains little or great, we shall not need to institute a Method of Cure different upon the notion of a Fever; but only having respect unto the cause that raiseth this feverish or hot pain: and therefore Fevers are to be cured as other pains are; that is, by adapting Medicines to remove the morbific matter or cause of pain, and not otherwise.  
And here by the way I must observe the error and mistake of Authors, distinguishing Fevers into essential and symptomatical, whereas no Fevers are essential, but all dependent upon some disease, morbific Miasm or seminary, and is a Symptom thereof.  
Where the seminary or morbific cause is fixed or seated, there is particular pain eminenter to be pointed at; and there is a febrile or inflaming heat, occasioned by this Spina, thorn in the flesh, which provokes the vital principle to estuation: this heat is carried and spread more remote, and conveyed by the venal and arterial current through the whole body; so that this pain being spread or scattered, loseth its denomination of pain, and then takes up the title of a Fever: (as Tradition will have it) which deludes most Practisers, thinking now they have some new thing to deal with, and another disease: when indeed Dolour and Febris do not differ at that rate; and we may say, that pain is a Fever contracted; a Fever is pain diffused.  
Now whereas it is vulgarly said sometimes, that the Patient hath no pain, but only sick at the Heart, or the Stomach; this is very improper, and cannot truly be said; for Stomach-sickness or Heart-sickness is nothing but pain and anguish of those parts, which is tristis sensatio in tactu; it is feeling that makes you sensible of sickness at the Heart or Stomach, and by no other sense; and this is pain, but different from other pains, by reason of the Organ differing from the rest in structure and office; and also from their causes, which makes these sick pains to be various and different in themselves: So that all sickness of this nature and kind, is pain, tending towards and bringing on this Series of Diseases, the subject and design of our Discourse: but in regard these sicknesses are often taken off, and checked, the progress is prevented, and it goes no farther than the attempt.  
And farther, the reason why these sick pains do not produce and bring forth Tumours, Inflammations, etc. more frequently in the parts where they are seated, is because the humour or matter offending is not always fixed in the Parenchyma, fleshy substance of the member or any solid containing part thereof; but floating in some vessel or cavity; so that having no root and solid foundation, it cannot form a Tumour otherwise than by obstruction and distension of the cavous part; having no seminary for augmentation planted in the substance of the Organ. But this may happen, as sometimes it doth, that any sharp serosity, or eroding putrid matter, may excoriate the concave superficies of any ducture vessel or cavity of a member, planting an Ulcer there, which may produce sad effects, and complete the course of our Series proposed per saltum; omitting these gradations of Tumour and Inflammation.  
The result of our Discourse upon this second Theorem we shall draw out and sum up into six Corollaries, for the more distinct and clear understanding of this Doctrine.  

1. That Diseases or Intemperatures of the first Classis, being most discernible and apparent, do interpose too often, and cover the common Series of Diseases chief to be feared.  
2. That hot and cold distempers, generally attending most diseases, have diverted and biased Practisers from a true course against those diseases and causes thereof: for the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of distempers being obvious and manifest to sense; the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 abstruse upon a general false notion thereof, the process of Cure necessarily must be erroneous; not discerning from whence they did arise, nor upon what they do depend.  
3. That these distempers of hot and cold do not arise elementally from any corporal constitution or composition of the four Elements (so supposed) their variations and predominations; but only as effects and signals discovering the Crasis and state of the vital principle, whether vigorous or depressed; whether in a natural placid condition, or disturbed and forced into a preternatural fiery temper.  
4. That inequal Temperaments or Distempers of the first general Classis of Diseases, have so engrossed the Practice of Physic, that most endeavours are spent thereupon, much time lost, and the more considerable and important overseen; as witness this our frequent Series of Diseases, seldom under consideration.  
5. That where pain is seated in any part, being a warning-piece, or the first manifest gradation or step of this common Series of Diseases; regard there is mainly to be had for precaution, to obviate and prevent a farther progress of Inflammation, Tumour, etc.  
6. That this latent and dangerous progress of diseases, being frequent, but rarely discovered, or sought for, hath brought more to the grave, than any complication or transmutation of diseases whatever: for although there be a vast number of diseases, whereunto humane bodies are liable; and many of them do come and go in the course of life; yet most of them in their height and contumacy, and such as become mortal, do terminate in this series, as the Catastrophe and last Scene.   
Having proved in our first Position the frequency of this dangerous Series; as also in the second, the latency thereof, and the disguises that cover their transition from knowledge: I come now to the third and last Thesis, briefly to declare from thence the fatal consequents of not discerning this lurking train, but adapting Medicines to other purposes and diseases, supposed the grand complaint of the sick.  
Many people upon the first seizure of sickness, and some a while after, complain of a pain particularly in the Head, Breast, Bowels, etc. here or there: this pain (especially if great) takes off the appetite, prevents sleep, and procures a Fever: for all acute diseases are accompanied with Fevers, and most of the chronic; at least in their Paroxysms of intention and exacerbations, have a febrile heat attending them. This is the common road of diseases that are any thing severe; and such as are acquainted but with the common road of Practice, have their eyes upon this external appearance, and general outward garb, by which, as their compass, they steer and direct their course.  
This Fever (a great , not known but by its name) a general Symptom of all sharp distempers and dolorous diseases; being obvious to the standers by, and confirmed by sentence of the Physician, takes up most of their thoughts in design how to master and secure this common enemy that stands foremost in view: and as their eyes are most or chief upon the Fever, so their fears are from thence, and their endeavours are bend to suppress and abate this heat, and their aims leveled at this mark: and where this preternatural estuation is coming on, and feared only; or if already raised to a degree, all helps are then thought of, and used to damp and extinguish this kindling flame, as great and threatening danger from thence, which byasseth the Physician from his right aims at the morbific cause.  
Hence ariseth all the inventions of cooling, and so frequently used in most cases: repeated Phlebotomies, Ptisans, Juleps, Emulsions, cooling Apozems, Embrocations, Liniments, etc. which make the great clutter of Pots and Glasses about the sick, and nothing more advantageous to the Apothecary than trifling away the time thus, with a number of these hazardous, but many times and too often, pernicious Medicines.  
This mode of Practice, and these devices for cooling feverish bodies, I suppose are taken up in imitation of Galen, a famous Master of this Art, who appoints exhaustion of blood by Phlebotomy ad animi deliquium, until the Patient faints: and large draughts of cold water, until the Patient turns pale, shakes or quivers, and the whole body cooled.  
And an Author of our time, in his Writings de Febribus, appoints the casements to be set open, to cool the sick (upon what design I know not, except to fan the house, lest the heat of the Fever should fire the chamber.)  
And a late Author of great Fame, in his Works de Febribus, supposing Fevers to arise à sulphur accenso & exaltato, from a sulphurous deflagration of the blood, prosecutes upon the indication of refrigerating and quenching this fire by cooling Liquors: and for encouragement herein gives an example (I suppose his own Patient) of a young man about twenty years old, that by immoderate drinking of Wine, fell into a Fever, with thirst, and insignal burning about the Heart; who after Phlebotomy, and plentiful drinking of water (aquae fontanae ingentem quantitatem ebibit, the Author's words) he recovered. The success was good, and I may say, wonderful; but whether from the means or Providence, judge you: but I shall not imitate the Practice, lest ten die for one that lives: but this learned Doctor hath highly deserved in some other parts of his Writings, and therefore I tread softly.  
Now to consider all this in gross (for brevity sake) and apply it to our purpose in hand: these ways truly are very probable (not rational) to cool a feverish, hot, sick man, and to make him in a short time stone-cold: and the probability thereof upon good ground does appear thus.  
First, Upon the account of this latent Series and progress, Inflammations, Tumours, etc. ushered in by pain more frequently than discerned (as already proved) this refrigerating course, the insisting upon, or intermixing these cooling Medicines now and then, to quench a preternatural heat is destructive; at best a great delay and impediment in the Cure: and this is the common way of Practice, which needs no farther confirmation but a review.  
Secondly, In all other cases, and from what cause soever a Fever doth arise, this juleping and cooling mode of Practice, is dangerous more or less, as the case is in itself; but in no wise advantageous; making acute diseases to commute and terminate in chronic: and chronic or linger diseases to hold on their course, and become more contumacious.  
To prove the first, we shall compare that series and commutation of diseases, with the designment and nature of these cooling Medicines; and by that you shall see what probability and season there is to expect from thence any good effect; but rather the contrary, promoting of mischief begun, and setting forward those diseases.  
Whatever causeth pain, whether it be obstruction in the part, or oppression by indigested or degenerate incongruous matter; by wind and flatulency, by any exotic generation, as worms, stones, etc. any Tumour or Apostem breeding, Inflammation or Ulcer planted, etc. these cooling and cold inventions touch not the disease, (except to do mischief and exasperate) and remove no morbific cause: for the nature of these causes and diseases requires Aperitives, Abstersives, cathartics, Discussives, Diaphoreticks, Dissolvents, sarcotics, etc. pro re nata, each case requiring some or more Medicaments of these Operations.  
But these Coolers è contrà, stand in opposition, and act repugnant to these properties, and consequently to the Cures of those infirmities: by obstructing of Ductures and Pores, incrassating what should be attenuated; coagulating what should be kept fluid; condensing what ought to be rarified and discussed; fixing and retaining what should be moved and sent off; impeding transpiration, but promoting putrefaction: generally, they check and damp the power of Nature, endeavouring to extricate and quit herself from those encumbrances and growing evils that assault and beset her.  
To make good the second part, that in what other case soever, a Fever or vehement heat shall arise with ebullition of the blood and preternatural fermentation; cooling Medicines are very prejudicial, in many cases mortal; for whether it be a pestilential or other malign Miasm, seminary or taint, or other impurity and feculency of the blood, that Nature intends by this febrile disturbance and irritation to throw off and separate, which Nature sometimes without help does perform and makes a good Crisis: but these Coolers act counter to, and prevent Nature's good work, checking the fermentation, and thereby hindering the separation of any degenerated or noxious admixture.  
And the reason of these ill consequents from Coolers, does mainly lie here: for as the stomach doth preside over, and hath great influence upon the other faculties and subsequent digestions, whose briskness and vigorous performance depend much thereon; so likewise whatever subverts the tone of the Stomach, and flats the acuteness of this principal part, and prime office of digestion, injures, allays and abates the energy of the rest, impedes the fermentation of the blood for depuration in such cases, as also for conservation and. supply in the constant daily work.  
And although the Patient escapes this Fever and comes off with life; yet by this male Practice they fall into Dropsies, Scurvies, Jaundice and cachectic foul habits of body; an obstructed or tumified Spleen, Liver, Mesentery, etc. Or it breaks out upon the Skin, and some eruption or cutany defedation will appear in time: or it settles in some Limb, and disables the part.  
And it is but reasonable to expect, that Patients thus cured, should soon be Patients again upon the old account, the relics of the former sickness; for that morbific matter and cause of Fever, being retained, by checking and cooling the febrile fermentation, and not observing Hippoc. advice, Quò natura vergit— this morbous impurity and foulness must precipitate and settle somewhere, and then you may well imagine it will make some appearance or alteration in time upon some part or other; and then an aftergame is to be played; for not having its due fermentation, secretion and passport formerly, when it did turgere, and was upon the flight, only wanted the Physician's direction and guidance, hinted by Hippoc. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉,— Aphor. 21. Sect. 1. Now a hole in the skin perhaps is thought on; an Issue for a tedious and troublesome vent, to discharge the matter, which a good laudable course in due time might have prevented.  
And thus, or by this means the Patient comes into the Physicians hands again, and the same especially that cured him of the dangerous Fever: and thus the supposed good Physician drives on, and is thought a very necessary Advisor and an able Assistant upon all occasions emerging. Truly this is according to the homely Proverb, but Tinkerly do, stop a Fever (if it can be this way) and introduce what is more contumacious, difficult, and worse to be dealt with.  
But some may object and say, That Lemons and Oranges are used in Fevers, and with good effects from their cooling: I answer, That Lemons, Oranges, Barberries, and such like, are allowable, and what good ariseth from thence, is not to be ascribed to their cooling virtue (if any) but to their acidity, which acuates and sharpens the ferment of the stomach; by whose reinforcement and strength regained by this means, the whole body is refreshed, fares the better, and some allay, at least more ability to bear the febrile heat: and therefore likewise such Liquors are to be granted the Patient for refreshment and support, as are most agreeable to the stomach and desired; and the dictates of Nature in these cases are to be marked, who prompts for her own help and satisfaction: and generally, the Drinks so desired by them are fermented Liquors (no Juleps) Beer, Ale, Cider, Wine, etc. and such are most agreeable to the stomach, which discreetly used, are no promoters nor continuers of the Fever, but beneficial in their kind, and a relief to the sick: but always to impose medical drinks upon a weak sick man, as if he were to be nourished and live by Physic, is very absurd and irrational.  
And here pertinent to our Discourse, I must recite what I have formerly noted elsewhere: but by the way I must tell you, wherein I differ from other Physicians, when I grant my Patients cooling Drinks, as Whey, Cider, or such like, when desired in Fevers, or hot bodies: they lay a stress upon Coolers, as principal means against the Disease, and to reduce the distemper; I allow them not as Physick against the Disease, but as refreshment to Nature, being delighted therewith and coveted: So that I do not impose them as of necessity, because the Disease does not require it; but observing the propriety of the body, being comforted and refreshed with such of such cooling Liquors. So that these are not given as Medicine (for they cure not, nor is heat to be regarded otherwise than as signal) but they may be allowed as refreshment. A labouring man that toils and heats himself, must have drinks to refresh him: even so it is with a man in a Fever; his Spirits labour more than at another time, and more thirsty he is, requiring drink more than at another time, and it must be such as delights him, that Nature does desired; not Barley water, Juleps, and such slops, that the Patiented nauseats, and give him no satisfaction. Tract. Of the Scurvy, Chap. 11. Edition 4.  
And in the same Chapter (controverting with Dr. Willis about Antiscorbutic Remedies) there is much more to this purpose, showing the indirect proceeding against Fevers, with repeated Phlebotomy and cooling Medicines, whither I refer the Reader.  
And here I might animadvert and take notice of the strange invention and irrational use of epispastic or blistering Plasters to draw away a Fever; showing thereby also that Fevers are wholly mistaken in the notion of them; but I must wave the Argument as collateral, which otherwise would interrupt our present occasion, and divert me from the direct prosecution of the business in hand.  
Now in tlje close, to observe the order and dependence of this Discourse, and to take a review of the whole matter compendiously drawn up; you will find we have not deviated from the subject proposed, but prosecuted. directly the scope of this designment, which in short is thus.  
That this latent internal Series of Diseases (more frequent than discerned) their dangerous transition and complication is masked and covered with an apparent or outside garb of a Fever, or febrile preternatural heat; which signature and external character, hath so engrossed the Physicians endeavours, and taken up the Practice of this Art, that little hath been done in searching out the radix of diseases, and opportunity neglected for prosecution against the morbific causes.  
And for as much as this Fever being only the estuation of the vital Principle throughout the body, generally attending these and most other diseases, is no farther to be taken notice of, than as signal; showing the cause to be greater or less in provocation, as the heat is more intense or remiss; and does in no wise divert the Physicians intentions and design of Cure, nor aught to be applied unto, since it is only a consequent and dependent occasionally, from the morbific cause: which febrile heat riseth and falleth, as the said cause does more or less provoke and irritate; and vanisheth quite away when that cause is removed, or ceaseth to disturb: It necessarily then follows, that these Coolers generally used and mainly insisted on, are generally noxious, often mortal: giving great advantage to the train of diseases (our subject) towards a Cure whereof they contribute nothing; but è contrà, promote the progress.  
I might have amplified and enlarged thisDiscourse in several parts thereof; but this will suffice at present for a dawning and discovering light; which hereafter may appear with greater lustre, as occasion shall be offered by any opponent to these Truths.  
And thus: much in general touching this Series of Diseases; their latency, their frequency, the danger by in advertency and improper mistaken means, and too late discovery.  
Our next undertaking is, to view more particularly the gradations of this progress, tracing from stage to stage, and remarking the capital occurrences, the chief causes antecedent and conjunct: beginning with Pain the common leader, or warning Sympton.  

Pains afflicting humane Bodies, the different Nature and Causes thereof.  
OF all Symptoms that attend, or are the consequents of Diseases, Pain is the most troublesome and irksome to bear. Weakness and languishing are tolerable evils; but pain is restless, tormenting and full of complaints. And although this be the worst (in extremity) to abide, and the most mournful accident that befalls man's Body; yet no part thereof hath a privilege by Nature to be exempt, or protection from this calamity: the reason whereof we will inquire into.  
All parts of the Body wherein is the sense of feeling, are liable to pain: and by virtue of this sense, pain is communicated to this or that part: and therefore dead Bodies, parts paralytic, benumbed or mortified are not capable of pain, because in them there is not that sense of feeling: and although the Organs of the other senses are subject to pain, as the Eyes, Ears, etc. yet pain is not proper to them (quatenus) as they belong to those senses; but as the sense of feeling is seated there also, having a greater latitude than the other; and is extended through the Organs of all those Senses. True it is; the other senses have their inconvenient and disturbing objects, as the Philosopher says, Excellens sensibile laedit sen sum: as the light of the Sun, or flame is troublesome to the Eyes; and great noise, as of a Bell or Gun, if near, especially sudden and unexpected, does offend the Ears: and a strong or stinking scent is offensive to the Nose: and an ungrateful taste, as too salt, too sour, or bitter, is unpleasant to the Palate: but pain affects the sense of feeling.  
Parts therefore that are capable of pain are endowed with the sense of feeling; and those parts are membranous; that is, they are invested with, or lined with some Membrane, by which the sense of feeling is communicated; and hence the Bones are capable of pain, by the Periosteum, that Membrane which covers them. And this sense as it is more general, extending through all parts, and more useful than the rest of the senses; so the disturbance arising thence is more insufferable and grievous to be endured: and better it is to want any other sense, than this, yea all; for where feeling is departed, the life is ceased in that part. This sense therefore being supreme, the defections and disturbances thereof must be of greater importance and concernment than the rest.  
The other Senses are confined to, and exercise their functions in one Organ or part of the Body, the Eye, the Ear, etc. but feeling is not restrained to so narrow a compass, but is seated in all parts of the Body, even in the Organs of those other senses. The great Prerogative of this sense above the rest, having no limits, but reaching through the whole Body, and exercising its power among the other senses, and an inseparable consort with the life; were worth enquiring into the reasons thereof, if time would give leave for that diversion.  
What pain is, scarce any one but can tell; and some by woeful Experience; whereby they will consent with the definition thereof, dolour est tristis sensatio in tactu: pain is a trouble arising in the sense of feeling: but that which is so plainly felt, is not very easy to be understood from whence it does arise.  
The Causes of pain are as various as the Objects of the sense of Feeling: for whatever objects assault that sense violently or extremely, as too hot, cold, hard, sharp, heavy, etc. are offensive to the Organ of Feeling, and do raise pain.  
Concerning the approximate cause of Pain, there are several opinions; I wave the more extravagant and improbable, and shall recite those in which the most Philosophers and eminent Physicians do consent and pitch upon as most agreeable to reason.  
One Party asserts, That a sudden and violent mutation of the active qualities, or the tactil qualities suddenly and violently acting upon the sense of feeling, are the approximate cause of pain.  
The other Party determines, That solutio continui, a solution or disjunction of continuity is the immediate cause of all pain.  
The third Opinion joins these two together, and will have pain to arise from them both; according to the definition of Plato: Est itaque dolor tristis in sensu tactûs affectio, à membri intemperie & continuitatis divortio subitò facta. And Hippoc. before him taught the same doctrine: Quae naturam (inquit) mutant ac corrumpunt, dolores excitant. To which Galen does subscribe.  
Now to comment a little upon these different Judgements I cannot but observe and do own that there is something of probability and reason in these several sentiments; but not a full satisfaction to the matter queried; nor the whole truth rightly stated: and for this reason I am the more nice and strict in this inquiry, because from hence the nature of Anodynes or assuagers of pain are discovered; and this is the groundwork upon which they are form and rightly adapted.  
I allow that unity is the perfection of Bodies, and is necessary to perfect sanity; disjunction or separation dissolves the harmony, and leads or is the progress to destruction: for whatever tends to disjoin or make a separation of parts, does threaten to ruin the whole. And true it is, that the active qualities or tactil objects, do cause pain as they do make their impulsions violently upon the Organ of Feeling; which when they do it moderately, placidly and amicably, they cause pleasure or no pain. But whether the impetuous and vehement acts of those Agents raising pain, do always cause a solution of continuity approximately and immediately, is much to be doubted.  
I yield that the vehemency of these tactil objects may procure a solution of continuity sometimes, as we see from pain, that Imposthumes, Ulcers, Gangrenes and Mortifications do follow; but these are not inseparable and necessary consequents, for they happen but sometimes: pain may continue for a time, cease again, and no breach of continuity remain a● an effect thereof.  
To which our Adversaries have this evasion by way of Reply; That pain is caused à continui solutione, non à soluta unitate: which, as I conceive the meaning, is as much as to say; solution of continuity in fieri is sufficient, though it be not in facto esse.  
But to pass over this Sophistry, as not worth the expense of time to lay it open; and if we make appear that the whole matter or controversy is bottomed upon this error, mistaking the cause for the effect, and the effect for the cause. Cujus contrarium— then the plead of our Antagonists will be put to silence as absurd, the doctrine laid aside, and practice grounded upon better principles.  
They affirm solution of continuity to be the approximate cause of pain; the contrary whereof we will set forth and prove, that pain is the cause of solution of continuity. And here we must first distinguish between violent external Agents, as sword, staff, bullet, fire, etc. causing wounds, contusions, fractures, combustions, etc. and internal causes gradually arising in the Body, as products of a degenerate state.  
In the first cases, solution of continuity causeth pain: as when the wound is given, pain follows as an effect: so likewise upon a sudden fracture, or rapture in the latter, pain precedes as the approximate cause, solution of continuity comes after as the product or consequent. For example; some indigested or degenerate matter lodgeth or fixeth in this or that part of the Body, Nature not able to subdue or transmit it away, this like a thorn irritates and provokes the vital principle to a disquietness and disturbance, which is pain: this pain draws a confluence of humours to the part grieved, and increaseth the first offending matter, causing Inflammation and Tumours; this apostemates, and then breaks forth into an Ulcer.  
Observe the Series, first here is peccant matter as the occasional cause raising pain; this pain attracts humours from other parts, which being transplanted out of their proper place, they degenerate, corrupt, and then produce an Imposthume and Ulcer. Thus you see pain goes before, solution of continuity follows after, and therefore it is plain, as in this, so in all other cases where separation of unity does happen from an internal cause arising in the body; that it is the consequent of pain, and not (as those learned men would have it) the approximate cause of pain.  
To illustrate this truth a little farther, and that you may the better understand and have a clearer satisfaction herein (practice depending upon it, I mean the allay or remove of pains) consider and know, that the sense of Feeling being spread through the whole body, is as the last or inmost covering, that does inwrap or enfold the life; and is as it were the watch or guard upon the confines thereof. Now any thing that does stir up Feeling, that thus nearly and intimately approaches the life; if it exceed the bounds of moderation and is violent, if it be any way unnatural or injurious, it raiseth a disturbance in the vital principle of that part, which is pain: so that the assault is first made upon the life, which governs and preserves unity and continuity of parts; but that vital principle being fretted, distracted and put by its placid, regular oeconomy and government, the Organ perisheth as the life of the part decays, or is out of course; being then unable to protect and preserve it.  
From hence I am persuaded to believe and must assert, That the approximate cause of pain is every thing that does intimately and approximately affect and disgust the vital principle in every part pained; which pain is the estuation, anguish and fury of the life or vital principle, which does dolere, being exasperated and provoked by those causes: and if solution of continuity does happen upon this disturbance, it is wrought and caused by the exorbitance and enormity of the vital principle, deserting or being put by the charge and due management of the part.  
Moreover, pain sometimes continues long by intervals and remissions to molest a part, and no separation of unity to be caused thereby; although it is an interruption and breach of Harmony: so that this ira sive dolour, this pain of the vital principle does not always arise to the height of producing discontinuity; and is so far from being the approximate cause of all pain, that many times it never happens either before or after pain, to be a cause or an effect.  
Now what this vital principle is, residing in and governing every part in their several functions of vitality, whether it be Anima; or Archaeus according to helmont's doctrine; or spiritus impetum faciens, according to Hypocrates; I shall not enter into the controversy, because it will require a large discourse, or rather a peculiar Tract to determine this Problem, and clear up the truth of our novel opinion, disintangling it from the objections and prejudice of ancient received doctrine; which will disjoin and delay our matter chief intended, therefore I forbear the digression, and proceed.  
Pains are various, or do affect the sense in a different manner; and this either from the nature of the part grieved, or from the variety of causes, or both.  
Now the nature and condition of parts are different and various these ten several ways, or may be reduced to these heads: Ducture, Figure, Situation, Composition, Beginning, Progress, Substance, Temperature, Number and Office. And as parts are varied by these differences, so pains thereby are made various, and not only pains, but also all other Symptoms and diseases have a specification from hence.  
Pain sometimes is obtuse or heavy, as if a weight were pressing upon the part pained; as when the Parenchyma of the Liver, spleen, Lungs or Kidneys is grieved; and this by reason they hang or depend on Ligaments and Membranes.  
Pain sometimes is acute, sharp and punging; as if the part were perforated or pricked with a Needle; as in a Pleurisy, and this is caused from a thin, acrid or acrimonious humour penetrating the Pleura; for nothing but what is subtle and acute can procure this or the like punctures, and invade the dense substance of a Membrane.  
Pain sometimes is with pulsation, that is, a beating pain like to the motion of the Pulse: and this pain happens commonly upon an Inflammation, and also where an Artery is seated in the part; for where there is no Artery, there is no pulsation, it being the office of this Vessel only to make a pulse. From hence Galen 2. de loc. affect. 3. took notice, that upon an Inflammation of the Lungs or the Pleura, there was no pulsation or beating pain, because there were no Arteries in the parts.  
Pain sometimes is mordacious or biting, from sharp humours vellicating the sensible parts.  
Pain sometimes is frangitive, as if grinding or bruising, and this is proper only to the bones, or rather the Periosteum that covers the bone, by which Membrane the bone is made sensible, and the pain lies deep.  
Pain sometimes is tensive or stretching, and this happens from a repletion or fullness of some humour, wind or vapour, filling and extending the part: if this stretching pain be cum gravitate & pondere, with heaviness or weight, than you may conclude it is humoral, or something of more solid substance; but if the extensive pain be without weight, than it signifies wind or vapour: as very often such are Colic pains, from a collection of wind between the tunicles of the guts.  
Pain sometimes is convulsive; and this is proper to the Nerves and Tendons; because the nervous filaments are so united, that they cannot be torn, but are contracted to their original.  
Pain sometimes is lacerating or tearing: and this is proper to the flesh; because the flesh hath Fibres and small Nerves not so united as the Membranes, and therefore à causa solvente continuum are easily lacerated. And thus much for the various kinds or different sort of pain: next the situation or extension, and the duration is to be regarded.  
Pain is either universal affecting the whole body, from some general cause; as in Fevers, Agues, etc. Or else pain is seated in some particular region or part of the body; as the Head, Breast, Stomach, Belly, etc.  
Pain sometimes is more outward or external upon the superficies of the body, whose seat is more easily discovered and known, laying hand upon the place, by the Patient's direction. Sometimes pain is internal and deep, with difficulty to be certainly determined, which part is grieved, and requires good anatomical judgement to assign the part or member. From hence pains some may be said to be manifest, others abstruse; as also from their causes, evident and latent.  
Pains some are constant as to place, or fixed; others erratic or shifting from one place to another.  
Pains some are constant as to time, or continual; others intermitting and by intervals, having cessation for a time and returning again.  
In all pains there ought to be considered these four things: the Greatness, the Kind, the Property, the Place.  
Greatness and vehemency of pain does arise from the greatness of the offending cause, and the sensibility called tenderness of the part. All pain spends or wears and abates the strength of Nature; but violent and vehement pain requires sudden relief, lest the sick faint or expire. Upon the first assault Nature does insurge and raiseth all her strength to bear, resist and overcome the offending cause, and cooperates vigorously with the means for relief and ease; but help not coming, strength abates, grows weaker and weaker, as not able to hold it out long: and this is perceived and known by the Pulse, which at the first access of great pain, beats high, strong and quick; but afterwards falls off, grows weak, small, slow, or swift, labouring and languishing,  
Secondly, The Kind and nature of the pain is to be observed and noted; whether tensive, heavy, acute, biting, etc. that accordingly fit Remedies may be adapted to such variations.  
Thirdly, The Property is to be regarded; whether pain be movable or fixed: continual or constant; or returning by intervals; whereby the fallacy or certainty of the Cause may be adjudged.  
Fourthly, The Place of pain is to be distinguished: for that which will be a good remedy and proper to one part or member, may prove of little advantage or injurious to another; because some parts have Antipathy or disgust and dislike to some remedies, which ratione morbi, in respect of the Disease may be proper and requisite, but the part will not admit it: as Oil generally is anodyne and asswaging; but hot in pains of the Eyes, for there it is injurious to the part: and a puncture of the flesh and a puncture of a Nerve, will require different remedies. And upon this account Galen 4. Meth. 5. would not allow of Suppuratives to every wound, and chief in the Tendons and Nerves, and condemns those Surgeons that make not that distinction.  
And here you must diligently search and examine, whether the pain be idiopathical or sympathical: that is, whether the part pained does suffer per se, from a cause residing in that part; or whether the cause lies in another part, and the part pained does complain per sympathiam seu consensum, only by consent from some other diseased or distempered part.  
And this distinction ought strictly to be observed, without which no Cure can succeed: for if the peccant matter or cause offending lie in one part, and the remedy be applied to another, you cannot in reason hope for a good effect thereon. This therefore is to be received as a fundamental Truth, That all parts of the Body may fail in their office and true performance of their duties, vel vitio proprio, vel alieno, either by a deficiency of their own, or depravation and injury from other parts: and this not being duly taken notice of by some Practisers, no wonder if Patients languish so long under their hands, waiting in vain for their relief and Cure: for, finding the Patient to complain of pain in this or that part, they think of nothing but applying to the part pained; concluding with the common saying: Vbi est dolour, ibi est morbus, which is oftentimes a great mistake. For example: the Head aches and complains many times, not from any defect of its own, being firm and sound; but either from the Stomach being foul or otherwise diseased, whose ill affects also are communicated to the Head by the Nerves of the sixth conjugation: sometimes from the Spleen; sometimes from the Womb; and sometimes from other parts, by reason of the Nerves propagated into all parts of the Body, having their original from the Brain and spinal Marrow, derived from thence and of the same nature; from whence the Head does consent with all those parts.  
And the Arm may complain, wanting its power of due motion or strength, although the Arm be sound and well; yet if the Nerves that supply those Muscles of the Arm with Spirits be hurt, the Muscles are deprived of their use or act deficiently and depravedly. As by a blow upon the Back (or by other causes there not so manifest) the Arm may fail in its due motion, the Nerves being injured: in vain than it is to apply Topical Medicines to the Arm, but application must be made to the Vertebrae of the Back, from whence the Nerves are derived and implanted into those Muscles.  
And since the several parts of the Body do complain, sometimes by their own fault or decay in themselves; and sometimes only by injury transferred or received from other parts; we will conside how many ways there are for parts of the Body to be ill-affeced and receive prejudice one from the other.  
The Sympathy or consent of parts, whereby one suffers from another, may arise upon a triple account.  

1. Per Sympathiam generis.  
2. Ob Familiaritatem operis.  
3. Propter Vicinitatem.   
First, Per Sympathiam generis, by which we understand that consent and affect that is communicated by continuity of parts of the same kind: as when the Neck being hurt, the Hand consents and complains; because the Nerve serving and coming down to the Hand, is derived from the Neck: and this way of consent may also be effected, not only by the long Nerves, but also by the long Muscles, and the Veins in other parts: as sometimes it happens that the Leg is stiff and wants its flexibility and bending inwards by reason of some disease, not in the Leg, but in the Hip, where the original of the Muscle is, that serves for this motion; and therefore erroneously some have applied Fomentations, Unguents and Plasters to the Leg upon this supposition, Quò ubi est symptom, ibi sit morbus; not considering that the Tibia does suffer by consent, and the root of the disease lies in Coxendice where the Muscle does arise. And thus it falls out very often, that the Disease is far distant from the Symptoms; and therefore the original and progress of the Muscles ought diligently to be observed in such cases as these, that the part primarily affected, and the part affected by consent may be distinguished, else the designment of Cure will fail and be insuccessful.  
Secondly, Consent of Parts is procured ob Familiaritatem seu per consortium operis: and this consent is common to all those parts that are ordained by Nature to concur together in some common office: and thus it is between the Womb and the Dugs.  
Thirdly, Consent of Parts is frequent propter Vicinitatem, by reason of vicinity & adjacency: when parts are situate near to each other they are mutually affected, either by some sensible passages or insensible, for totum corpus est perspirabile, the whole body is perspirable by Pores latent arid invisible, by which there is conveyance to and reception from each other, and do thereby sympathise with the good or ill of one another, although the ways of communication are not manifest: and thus it is between the Stomach and the Lungs, and is easily perceived by fuch as are Asthmatical, Phthisical or have Coughs, that by eating or drinking this or that, those infirmities will be exasperated and made worse, almost presently: and è contrà, they will receive some ease and benefit by that which is good, soon after it is received into the Stomach; long before it can make a progress the common way out of the stomach. And this consent likewise is between the Oesophagus, the mouth of the Stomach and the Heart: and thus it is between the Bladder and the Intestinum rectum the last Gut; and from hence pains of the Bladder are mitigated and eased by Clysters, through insensible passages, and not by any manifest ducture or Vessel of communication.  
From hence we may learn by such Examples, that Sympathy and consent of parts is strictly to be marked, else it is not possible to know where the root of a Disease is, and from whence pain or other Symptoms do arise: for, one part may be pained, and the disease lie in another; and if this be not rightly distinguished, there cannot be a true adaptation of Medicines, nor due application made where it ought to be, which renders all endeavours frustraneous.  
But to descend from generals, and to make our Discourse more profitable and satisfactory to the particular cases of the Reader, enquiring after his own peculiar concern and present complaint; we will take notice of some pains incident to particular and principal parts of the Body remarkable and frequently occurring, examining their causes.   

Pains of the Head.  
THat the Head aches, every one can tell that suffers under it; but the causes and the parts affected distinctly, are known only to the Physician: and he by questioning and examining the Patient, draws his conclusions by collating the several answers, and makes Judgement thereupon. All which depends upon a due observance of these four Particulars, rightly to determine the case.  
First, Inquiry is to be made of the Patient concerning his course of life for some time before, whether regular or irregular; in labour, exercise, or ease; if thereby any thing hath been done to procure or introduce the present complaint, and of his former state of Health and Sickness.  
Secondly, Of his state and condition of Body as it now is.  
Thirdly, The place or seat of pain, the compass and extent of it.  
Fourthly, The quality or condition of the pain; vehement or moderate, continual or intermitting, acute or obtuse, etc.  
Having made disquisition by these Topics, and traced the Patient through these grand inquiries; you will then understand something of the rise and progress of the pain sought after, giving you then occasion to take a farther prospect and consideration of the various differences of pains in the Head, wherein your present case will be found, and exhibited to your view, as followeth.  
headaches are either more general and dilated, affecting the whole; or else one side of the Head; or some particular part, as Forehead, Temples, etc.  
2. Head-pains are either internal or external.  
3. Idiopathical or Sympathical.  
4. Recent and of late standing, or inveterate and of long continuance.  
Pain of the whole Head or major part does denote the cause to be more general and of large extent; as in Fevers and plethoric persons, wherein the whole body is distempered, and from thence the whole Head or most part therewith affected.  
Pain in particular places; as of the right or left side, forepart or hind-part, the top or the crown, signifies the cause to be, or act there only; and does arise from some defect or trouble in the part itself, by some peccant humour there bred, or by transmission of morbific matter from, or by consent with some other part diseased, adjacent or remote. As more particularly hereafter.  
Now you must understand, that although every person seems to be equally disposed alike, and liable to these pains; yet it is much otherwise; for some are often complaining of Headache, some rarely or never: and this by reason of the different fabrication and formation of parts, as well within as without the man; and also by reason of the soundness and strength of parts that some have above another; by which they endure long, and free from pain or other infirmities.  
Internal pain is seated within the Cranium or Skull, and signifies the Brain itself, or Membranes investing the Brain; or some Vessel, Vein, Artery or Nerve to be affected: if the Brain aches, the pain is obtuse and heavy, the Patient is much inclining to sleep or drowsiness: so likewise when the Veins are molested, the pain is remiss: but if the Membranes or Nerves be the complaining parts, the pain is more acute and punging; and than it reacheth commonly to the roots of the Eyes; because these Membranes do cover the Optic Nerves which lead to the Eyes: and it may be known what Nerve is affected, by the part consenting, which that Nerve does supply and serve; and thus sometimes the Ear, or Tongue; sometimes the Shoulders, or Breast complains, by that Nerve inserted into them for their use: but if an Artery be the place, than the pain is beating, Pulse-like.  
External pain is superficial and without the Skull, showing that the Pericranium or Membrane covering the Skull is the part grieved: and sometimes the Cutis or outward skin only, and then the pain is more remiss; but both are known and aggravated by compressing the part or place: and if the pain be in the forepart of the Head, and extend to the Eyebrow, the Periosteum is affected.  
Pains of the Head per essentiam or Idiopathical, are when the cause of pain is seated in the part pained, by reason of debility or dyscrasy and infirm state thereof: from whence ill matter is congested and accumulated, causing a disturbance or distemper; and sometimes pains fixed from extraordinary productions there engendered and bred; as worms, stones, etc. as hath been noted by Authors of repute and credit: Hollerius, Schenkius, Kentman, and others.  
Pains of the Head sympathical are when the cause lies remote, and the part pained suffers by Sympathy, transmission or consent from other members, and not by any proper defect or disability of its own. And thus the Head is very apt compati to suffer and condole with most parts of the Body; by reason the Nerves are branched forth and dispersed in all parts of the Body from the Brain and spinal Marrow; which being of exquisite sense does affect their original and fountain by this communication and intercourse with other parts: and not only by the Nerves coming from the Head is this consent maintained, but also by the Veins and Arteries going from other parts up to the Head, conveying good or ill. Hence it is, that very frequently the Head is pained from distempers of the Stomach; sometimes from the Spleen, Womb, Intestines, etc.  
Having given you the various differences of Head-pains as to the quality or condition of them, and also pointed at the several parts affected per se & per consensum: I come now to set forth the causes or rise of these pains from whence they spring; whether generated in the Head, or communicated to it from other parts.  
Causes of. head-aches or pains are, external and internal.  
External Causes may be such as these; as when the Head is exposed to heat or cold, a strong scent sweet or stinking, Fumes or smoke, a blow or fall, etc. occasioning disturbance of the Spirits, Obstructions in the Pores and Vessels, Inflammations, Tumours or Imposthumes.  
Internal Causes are, sometimes plenitude or fullness of blood, which then upon small occasions is ready to estuate and ferment, causing extension of the Vessels and Membranes: or else depravation and foulness of the blood which may offend the Brain, or other parts of the Head by its noxious properties.  
Now the degeneration of the blood from its due and laudable state, to an evil and bad condition is various, and does manifest itself by divers Symptoms in several parts of the Body; and also when it is let out of the body, by colour, sapor, consistence, heat, etc.  
Either the blood is impoverished and deficient in vital Spirits and heat, slow in motion, feculent, gross or grumous, and thereby apt to be stagnant or obstruct: or else too hot and fiery, causing inquietude of the Spirits and irregular motions of that vital stream, disturbing the Head with pain and watchfulness.  
Secondly, The blood degenerates sometimes from its Balsamic qualities, into an acrid, sharp or acrimonious condition; and then most commonly there is an abounding serosity, or a superfluous latex or water; which state of the blood, as very remarkable, causing many diseases, I shall set forth in another Work (Deo volente) to be made public.  
Thirdly, The blood may be contaminated with a contagious, malignant or virulent Miasm and taint; as in the Plague, small Pox, highly graduate Scorbute, Venereal Lues, (as more fully appears in my Tracts of the Scurvy and that of the Venereal Lues.) In all which cases the Head frequently is offended and suffers pain.  
And here: also we must account amongst the internal causes,  
Impotency and weakness of some Organical parts of the Head, not performing their office.  
Obstructions of some ducture or porosity, by constriction, compression or coagulation.  
Congested matter infesting any part of the Head raiseth pain.  
Wind or flatulent Spirits roving here and there may produce the like.  
Watching unseasonably, which tires the Spirits, causeth disturbance in the Head.  
Immoderate study or cogitation weakens the Brain, and renders it liable to pain.  
Violent motion agitating the Spirits furiously, and driving the humoral currents out of their natural placid course, discomposeth the Head and may cause pain.  
Immoderate Venus, or long forbearance: the first by too great exhaustion and draining the Nerves; the latter by plenitude, overcharging the Genital Vessels, reverberating back, or by consent affects the Head.  
And now briefly I shall show here, what parts chief and frequently the Head consents with, from whence internal causes of pain are communicated; and as these parts are well or ill by intervals, so the Head is better or worse thereby.  
The Stomach in the first place, as being the general and grand office of preparation to supply the whole body with nutriment; so is it the part that most frequently afflicts the Head by communication, through Vessels of intercourse conveying to each other.  
The Head complains from the Stomach either before meat, when supposed to be empty; or after meat, when replete and filled.  
If the Head complains before eating, it argues the Stomach to have some remainders or relics from former digestions not wrought off, that does disturb the Stomach, and from thence the Head: if after meat the Head aches, it does declare the Stomaches indisposition to digest, and imbecility to overcome what is received, and labouring under the burden, the Head suffers also.  
Now to know that the Stomach is not in good order or ability for the true performance of its office in digestion, is manifest by these signs: Vomiting or nauseating, pain, oppression or heaviness, eructation or belching, want of appetite, or thirstiness.  
But here by way of caution in this consent between the Stomach and the Head, you must rightly distinguish, lest it happen, as sometimes it doth, that the Stomach suffers from the Head, and not the Head from the Stomach: and since the consent is reciprocal and mutual, you must nicely observe which is the part primarily affected, and which the part by consent; else endeavours of relief will be frustrate, if you begin not with the part primariò diseased, to free and set that right, for then the other spontaneously and of course will be reduced.  
The Spleen being illaffected, draws the Head into consent sometimes, and participates of its evil: and this is to be known by examining the Spleen, whether any Symptom of disorder or distemper is manifest there or from thence. Now the signs of a diseased Spleen are these; pain, hardness, tumour or extension, flatulent motions in the left Hypochonder or side under the short Ribs: And most commonly the Head is affected or pained on the same side, or else the forepart.  
If the Liver occasions the disturbance or pain in the Head; for the most part the pain is seatted on the right side, and then some Symptoms of a distempered Liver will appear; as heaviness or fullness in the right side, hardness, pain or heat, affecting also the Stomach, and causing thirst; also dryness or heat in the palms of the hands and soles of the feet: and as these signs have their intention or remission, so the Head is better or worse.  
If the Womb be in fault, and cause pain of the Head (as frequently it doth by the great communication and consent between these parts) then either there is a suppression of the menstrual purgation; or irregular and out of due course, not keeping the due times; or insufficient in quantity, or abounding: or too long retension of semen; or too great a profusion and wasting. Some of these causes are sufficient, not only to disturb the Head, but also divers other parts of the body; and these pains of the Head arising by consent from the Womb, do most commonly affect the top or hind-part of the Head.  
If from the Intestines pains of the Head do proceed, than either worms are bred there; or the Guts are troubled with sharp or corrupt humours; or else there is costiveness and siccity of the Bowels, whereby the Excrements are baked and hardened, causing too long retention▪ and from hence by Vessels of communication the Head complains also.  
If from the Kidneys the Head is grieved; then inquire into the condition of the Kidneys, and you will find some signals of a Disease there: either stone or gravel, or a sharp Serum, an Inflammation or preternatural heat, an Ulcer or Excoriation.  
Now as concerning the Cure of head-aches, and likewise of all pains that arise by consent from other parts, take this general Rule; That in the first place application be made to the part primarily affected, to reduce that into a state of integrity; then consider the part that suffered by communication and participation, if by continuance or length of time, any impressions remain there, or debility, that may require help, although the foundation or first cause of complaint be removed; else you begin at the wrong end: for in vain it is to endeavour amendment in the part consenting, until the other be in its rectitude, sublatâ causâ tollitur effectus. For example; if the Head complain from the Stomach, let the Cure be designed upon the Stomach, and that being performed, the work is done.  
Thus you see plainly, that the Cure of Head-pains by consent, is as various and different, as the parts of the Body are different in organization, situation and office; whereby they become liable, and are seized with various diseases, requiring a different manner or methods of curing, which are to be treated of in their proper places.  
Touching the Cure of Head-pains that are the products or consequents of essential or idiopathical Diseases seated in the Head; the removing or taking away those pains depends upon the Cure of those Diseases, whereof they are the effects and concomitants; and do require their due and regular course of means, suitable to the nature of the disease: but in cases of extremity, and for mitigation of pain, and the inconveniencies arising thence, as long watching or want of rest, and prostration of strength; there are such good Remedies, as Anodynes, prudently to be used for allay and giving ease or respite, until the causes can be eradicated, and a perfect Cure wrought.   

Pains in the Thorax or Breast.  
AMongst the several divisions of man's Body into parts, we may observe three insignal Cavities, each containing principal Members of the Body: the first and supreme is the Head, and all contained therein: the middle cavity is the Breast, which contains the Lungs and Heart: the lower region called the Abdomen or Belly, comprehends the Stomach, Liver, Spleen, Guts, Kidneys, etc.  
And having taken cognizance of those pains incident to the Head; we now come to remark what pains happen to the containing and contained parts of the Breast. Hence we may note, that these pains from their situation and place, may be distinguished into external and internal.  
External pains we may call such as are outward amongst the musculous and fleshy parts, as the Paps, Dugs and intercostal Muscles.  
Internal pains are such as seize the Heart, Lungs, Mediastinum, etc. parts contained.  
The Breast is circumscribed thus; the upper part is from the two Canal-bones called Claviculae, about the bottom of the Neck; the lower part is bounded by the Diaphragma or Midriff spread just above the Stomach and Liver from side to side: the forepart is the Sternon or Breastbone seated in the middle, which joins and fastens the Ribs: on the backpart is the Vertebrae or Spine, consisting of many bones knit together, where also the Ribs have their articulation: the sides are compassed with Ribs swelling outwards, and they reach from the Spine to the Sternon. And this is the extent or limits of the Breast.  
Pain may fall into the Paps or Dugs of both Sexes, but most commonly it happens so to women (except from external causes, blows or falls) and thus it is upon a sixfold account.  
First, Because those parts are more capacious and swelling outwards in Women, which being glandulous, spongy, soft and porous, are thereby apt to imbibe or receive any vagrant humour coming to this part.  
Secondly, More liable to the impressions of cold, from its tender soft nature, and being by them more frequently exposed to the air; which may occasion and lay a foundation for pain and other Symptoms to follow.  
Thirdly, In Women these parts being furnished with more Vessels of use for lactation or suckling, are thereby more liable and obnoxious to disorder.  
Fourthly, From the communication and intercourse between this part and the Womb, whose diseases and distempers may affect the other by consent.  
Fifthly, From the attraction of suckling, ill humours may be drawn and gathered there, which otherwise would not resort to that part.  
Sixthly, Pain seizeth this part in Women from the various conditions of their milk.  
Now the variations of milk causing this effect arise upon a double account: redundance or plenitude, and Cacochymy or alienation. Sometimes by plenitude; for milk abounding and distending the Vessels causeth pain and trouble in the part. Sometimes by alienation of milk from its natural good condition to a degenerate state: and this proceedeth from a cachectic or vicious habit of body; for as the blood is good or bad, so likewise the milk, which is sanguis dealbatus, blood changed white by another digestion.  
This milky substance being balsamic, dulcet and pure in its integrity; yet is very subject to alterations and change from distempers and various dispositions of the Body: as sometimes from thence, being not so sweet; but saltish, bitter, acrid and punging; sometimes curdling and coagulating, thereby not flowing freely in the Vessels, but causing obstructions in those small ductures: hence arise pains, inflammations, hardness, tumours, etc. if not prevented by a due course with good means.  
And such inconveniencies as these are frequent to Women after the birth of children, when milk flows plentifully into those parts; and this many times or for the most part does proceed from the imprudent custom of managing Women in childbed, especially some Nurses, who would be thought more careful, kind and diligent to their Mistresses; do feed them too plentifully, giving them Caudle at every 〈◊〉 or after every short sleep night and day; telling them they are empty and must fill up again and make up their loss: which after this manner being done too hastily, and the body changing from a large evacuation to a sudden ●epletion; the Stomach thereby fails and is clog●●…, the blood ferments into disorder, causing ●●…e and dangerous Fevers, of which the milk ●●…ticipates, and thereby degenerates, endangering both the Mother and the infant.  
But indeed by experience I have found, and reason urgeth the same, that nothing is more safe than a spare diet, which preserves the Stomach quick and sharp, and keeps the whole body in a moderate temper and a regular condition, not occasioning such overflowings of milk, or otherwise flooding: and this I have cautioned and made some Nurse's sensible of, who by observance thereof afterwards, found their offices more successful and have given me thanks for my advice, as being the safest and best way to discharge the trust and care reposed in them.  
In the next place we are to take notice of pains that are seated in the musculous parts, namely the intercostal Muscles, in number 44; so called from Costae the Ribs, which these Musc; les do cover, and also are inserted, filling up the spaces between each Rib. In these parts pains sometimes do fix and settle, and are most perceived upon drawing in of the breath, when the Muscles are upon extension and swelling outward. These pains are called by some Bastard Pleurisies, though improperly and by mistake; for pains of the Pleura are different. Sometimes these pains are not of continuance as to time; nor constant as to place, but move here and there; and these are commonly called Stitches.  
Pains are incident to these Muscles from external injuries, as contusions, and impressions of cold: or else internal causes; and these are, either by defluxion of humours that may flow in; as most frequently from an abounding serosity being thin, sharp and extravasated, falls in amongst these Muscles: or else, by congestion matter is accumulated, which Nature not being able to discharge, lies there as a burden, impeding the muscular motions, and causeth pain. Sometimes from flatulency and wind, getting into the Interstitia of the Muscles, thereby causing intercurrent and fleeting pains.  
And for remedy in such cases, Fomentations and hot Bags applied are advantageous; Evacuations being premitted, according to the condition of the Body requiring.  
We come now to consider of Pleurisies or pains in the Pleura; that inward Membrane that does invest or line the Breast: a disease very eminent and frequently occurring, that both Hippoc. and Galen often mention it by way of example.  
These pains are acute and sharp like punctures; and have no constant place, but in some persons they seize the right side, in others the left; in some the pain is higher, in others lower towards the Hypochonders; sometimes more backward, and sometimes forward: and although chief and more manifestly the pain be here or there, to be pointed at; yet the whole Membrane by reason of continuity, is thereby affected, and the parts adjacent do suffer by consent: from whence various Symptoms, as concomitants and attendants, do inseparably accompany and consort with this pleuritic pain.  
Hence it is, that difficult and short breathing is constantly annexed to it; and this because the parts for respiration are hereby impeded, and have not their due motions and liberty of extension, but are restrained and kerbed; which is done in favour, to avoid compressing the grieved part, otherwise would exasperate and increase the pain: and therefore the sick fetch their breath short and quick, because they cannot take it fully and largely, and do repeat it the oftener by way of recompense.  
To this (and by consent of parts) is adjoined a short and dry Cough, which irritates and provokes the pain by moving and straining those parts, and therefore is very troublesome and grievous to the Patient.  
Here also a continual acute Fever does necessarily follow as inseparable: for the Archaeus or vital Principle being invaded in those parts by something hostile, does therefore insurge, becomes enraged, grows hot and fiery, raising a burning distemper throughout the body.  
To these we may add another constant Character; namely a hard, swift, but small Pulse.  
And these are the pathognomonical signals that are always attending upon, and do distinguish Pleurisies from other diseases of adjacency or affinity and likeness with them: for, when pains fall in amongst the intercostal Muscles, although there may be some punctures or prickings because of the Membranes there, yet not so great, the Fever not so high, nor the breath so short, nor the Cough so troublesome, if any.  
If the Lungs be inflamed only, the pain is but little; not punging, but obtuse; not in the circumference or sides, but in the cavity or middle of the Breast: yet the difficulty of breathing is greater here than in Pleurisies, from angustness that seizeth the parts of respiration.  
Pleurisies differ from Inflammations of the Diaphragma; because in this there is no pain in the sides, but only at the end of the short Ribs, and the upper part of the Belly is extended; and with it a Delirium.  
Pleurisies also are distinguished from Inflammations of the Liver; in the seat or place of pain, which always is in the right side, under the short Ribs; the pain not punging, but heavy and obtuse; the Cough less, difficulty of breathing less; but the Urine higher-coloured, or tinged red.  
And now I see the reason (though very weak) why some Authors have distinguished Pleurisies or differenced them into legitimate and spurious, which indeed is a division of Pleurisies into Pleurisies and no Pleurisies; for I account no disease to challenge that denomination, but such as have their foundation in the Pleura: else by the same reason all diseases may admit of the same distinction of legitimate and spurious; for as much as every disease hath some Symptom which is common to other diseases that may give them some resemblance or affinity with each other, or be affected by consent from another: but I pass it over and come to examine the causes from whence pleuritic pains do arise.  
These causes are external, and internal.  
External causes are such as remotely prepare and dispose the body to a likely capacity of reception or aptness to this disease, laying the foundation for internal causes; and they do arise out of, or from the irregular, unfit or improper use of the Diaetetics, which leads to a morbific or unsound state.  
For example: violent exercise or otherwise, raising great heat in the Body and opening the Pores; by neglect upon it, as not to preserve that warmth for some time, and suffering it gradually to abate and go off, by keeping on  and forbearing cool drinks; this may introduce a Pleurisy. So likewise in the heat of Summer to throw off , and be exposed to the wind at a Casement, or the cool Air in the evening. To overheat the Body with strong Liquors, and suddenly endeavour to cool it again with small Beer, may effect the like. Cold North-winds after Southerly, and hot weather, does alter the texture of the blood, and is previous to pleuritic or similar pains.  
But here you must take notice and know, that quicquid recipitur, recipitur per modum recipientis; all Bodies are not alike nor equally disposed for reception; for in some these causes produce Pleurisies, in others Angina's, in some Dysenteries, in others Arthritic pains, etc. According to the aptitude and disposition of Bodies in fabrication or organization, and peculiar properties, have the same general external causes various and divers effects; being determined and specificated by different states of Body, more liable and apt to this or that disease, rather than another. Hence it is that external causes, as Diaetetic errors, have heterogeneous effects, and procure dissimilar diseases, according to various constitutions, purity and impurity, stability or debility, concurring with or resisting their influence: which consideration brings me directly to the next stage; being the latter part of the preceding division.  
Internal causes, are antecedent or conjunct.  
Antecedent; as plethory, being fullness of blood: or Cacochymy, a depraved or degenerate blood: both which are previous states or conditions of Body, disposing or rendering more liable to this disease: for, the great Vessels being full and distended, upon any Effervescence and Superfermentation of the blood, this impetuously like a torrent is impelled into the smaller Pipes, as those of the Pleura, where not having a free passage, it does cause pain by distension and Inflammation. Now this plenitude is brought on, or aggravated and increased, sometimes by a suppression of some accustomed Evacuation; as those that are wont to discharge and abate blood by the Nose, by the Haemorrhoids or Menstrual purgations: sometimes by plentiful feeding, and too much ease; so that evacuation and transpiration, is not proportionable in abatement and to balance the imported food.  
Conjunct causes are such as more immediately and nearly concur or conspire actually in forming of these pleuritic pains: and they are either acidity, or viscidity within the Vessels of the Pleura; or a violent fluxion from the larger Vessels, too great for the capacity and reception of these exiguous canals.  
2. Acidity or an acrid serosity does sometimes fabricate and finish this disease by punging and lancinating the Pleura; (for omne acidum extra stomachum corpori est hostile, says Helmont) thereby irritating and exciting the vital spirit to estuate and be incensed; and from this focus a febrile heat is kindled and communicated to the whole Body: and that oftentimes and for the most part, it is a sharp serous humour predominant in the blood which caused this disturbance in the Pleura, is confirmed by the manner of solution or termination of the disease, which most frequently is by a sudorific evacuation, or insensible transpiration: and therefore Hippoc. in his Predictions says; Sudores & urinas in Pleuritide probè fieri bonum esse & salutare, Friendly Sweats and effusion of Urine presageth a good event.  
2. Viscidity, or grumosity of the blood does sometimes cause pleuritic pains; for by obstructing those small ductures of the Pleura and stopping the Circulation, a Tumour thereby is raised within this double Membrane; for the Veins, Arteries and Nerves lie between these two Coats of the Pleura.  
And that the blood is thus apt to be stagnant (especially in the smaller Vessels) by coagulation, grossness, or congelation, is confirmed by Phlebotomy; for being let out of the body, it is sometimes found destitute of its Serum or Latex, that keeps it fluxile, thin and transient: and also is manifest so to be when it is in the Vessels; as in Gangrenes, where the blood is fixed and the part almost mortified: and when Pleurisies do happen upon this cause of concretion, they commonly tend to suppuration, as not capable of being discussed, or put into motion for a discharge of the part.  
Now the Blood becomes thus incrassated, gross and viscous, from every cause that does too much exhaust and expend the serosity thereof; as too great transpiration or sweeting, or immoderate making of urine: and sometimes from a malignant, or a venomous Miasm that curdles or congelates the blood.  
3. Fluxion or ebullient and preternatural Fermentation causeth pleuritic pains: and thus it happens when a Pleurisy is the consequent or appendent to a Fever preceding: for sometimes a Pleurisy does precede and is the cause of a Fever; as when the dart is felt to strike the Pleura before any febrile distemper appears: sometimes a Pleurisy does supervene and follow a Fever as an effect from that general ebullition, the hot spumous blood rushing into the Pleura.  
Having established these causes in their due Series, presenting them in the method and order of their causation and action; we shall not trouble ourselves with Choler, Phlegm and Melancholy, the supposed materials of every disease; nor shall I controvert the insufficiency of that doctrine here.  
For Indications of Cure, prompting what is to be done, which way, and with what; they are various as the case presents.  

1. Plethory indicateth Phlebotomy, and requires a depletion or abatement of the redundance of blood; that there may be room for the peccant matter to retire, and for a revulsion and derivation thereof; as also to avert the current and flux tending towards the pained part.  
2. Purgation (by sedate and amicable Cathartics, if you can procure such; else by Clysters the best substitutes in that defect) is necessary to absterse and cleanse the whole Body, thereby subducting fuel from the fire, and for rendering the Patient not so liable to effervescency and turgid estuation, and for a retraction from the part affected.  
3. Topical Discussives are available and contribute to the remove of the morbific cause; both as defensatives, giving robor to the grieved part for resistance of the humours flowing in; and also for a transmission and discharge of the conjunct matter residing.  
4. Diaphoretics to rarify, dissipate and set open the Pores, for a free transpiration and exsudation, are not only safe, but exceeding necessary; thereby to avert the antecedent cause resorting to the pained place, and to disperse and scatter the morbific conjunct cause from the part affected; if possible to prevent suppuration, which is very dangerous and commonly mortal.  
5. Anacathartics, or proper and truly expectorating Medicines are auxiliary and profitable in promoting expectoration, by digesting the peccant matter, and rendering it more apt and easy to be brought up: and of these some are attenuating, others incrassating; to be used pro re nata suitable to the offending cause; which if it yields soon and freely, and Nature throws it up by cough and spitting, it portends good, promising shortness of the disease, and a prosperous event: which Hippoc. 1. Aphor. 12. confirms.  
6. Anodynes, elected by a discerning Judgement, and cautiously used, may be of good advantage in some cases, and at some times, else may prove very pernicious.   
Having dispatched these pleuritic pains, we are next to take notice what other pains are incident to the Thorax or Breast. And here we find pain to arise from Inflammations of the Lungs, of the Mediastinum, and of the Diaphragma: whereof an account will be given in their proper places hereafter, when we treat of Inflammations.  
But the Lungs do suffer pain also from other causes, as from Tumours not inflamed; sometimes from adhesion or sticking of the Lungs to the sides of the Breast: sometimes from stones and worms that have bred there, observed and found upon Dissections: and sometimes by Erosions and Ulcers, of which in their due place following,  
Back-pains of the Thorax, are either upon the Spine, between the shoulders: or upon the Scapulae, the shoulder blades. And these pains do arise from some impressions of cold lately taken, or from defluxion of a serous humour from the Head; or sometimes from a malign Miasm Venereal or Scorbutic, that infests those parts.  
Pain sometimes is seated at the bottom of the Sternum, between the short Ribs, under the Cartilege mucronata; vulgarly called the Pit of the Stomach, but improperly. This Cartilege hangs down, being as it were a defensative to the subjacent parts, namely the Stomach and Liver; yet is flexible to give way to the extensions of the stomach without compression. This place is very tender at all times, insomuch that a blow here is ready to make a strong man faint: the part being thus sensible, pain therefore here must be very troublesome. Now this place is of acute sense or feeling, in regard the upper Orifice of the Stomach (being very nervous) and almost subjacent to this Cartilege, and the Heart adjacent; hence it is that a blow or pressure here, raiseth a fainting pain, the Cartilege yielding and giving way to any force.  
But sometimes a pain is planted here, not always by any external manifest cause, but from internal, and preternatural state of the parts: and this pain is rarely taken notice of by Physicians, and mentioned but by a few practical Authors. Now to examine into the cause of pain, you must know that this Cartilege is flexible and yielding in its natural condition, being of a middle nature between a Bone and a Ligament, and therefore may be curvated and bend inward upon a threefold account.  
By Laxation, Exsiccation, and external depression.  

1. By Laxation, as when too much moisture resides here mollifying and loosening the part; from any small occasion the Cartilege may be inflexed and turned inward, changing its due position and rectitude: and from the like cause Ligaments are sometimes relaxed, which renders Junctures ready and apt for dislocation and disjuncture; and upon this score the Vertebrae of the Spine have been displaced; also the Hip and Ankles.  
2. By Exsiccation this Cartilege may be distorted and wrested from its posture: as sometimes that which was strait, green and pliable, by drying and shrinking becomes crooked, bend and drawn aside: So this Cartilege that was a Gristle, tender and pliable, sometimes becomes dry, hard and bony, and fixed upon distortion or writhing, as not returning to its rectitude or straightness, and distance from the subjacent parts, over which and for whose guard it is placed.  
3. By external Depression, as from a blow or fall, any thing too much or too long pressing upon that part, may pervert and alter the situation and due posture: and those whose business or employ keeps them bending or pressing forward too much and constant, renders them liable to this inconvenience; and therefore Students and Clerks that writ much pressing upon this part are injured thereby, and find it upon age, though youth bears it off for a time.   
Now since this Cartilege is thus exposed to depression and bending inward, and thereby the tender parts subjacent to be pressed upon and molested; the cause of pain and manner how is made evident: and which most commonly is felt after eating and upon a full stomach, when the parts are dilated and swelling up to this Cartilege. And farther, as all parts of the Body in several persons do vary and differ much in figure, position, magnitude and distance; so thereby some are more liable and apt for this pain than others, although subject to the same external procuring, or internal antecedent causes.  
And so I dismiss this particular pain and pressure, and must take cognizance briefly of that which is more general upon the whole Breast.  
The Thorax or Breast suffers by compression or constriction, whereby a general obtuse pain of angustness is perceived, and that chief upon inspiration and drawing in of the breath: and why now more than at another time, is because the inspired air fills and distends the Breast, which makes opposition to, or resists the compressing causes.  
Now the cause of angustness or coarctation is from the Genus nervosum that gives motion to the Muscles and other parts of the Breast; which Nerves sometimes are impedited and contracted, that their functions are not freely executed: and therefore to this Symptom of compression is commonly adjoined shortness or difficulty of breathing, upon the same score; and sometimes spasms or convulsive motions. And this complaint of straitness or contraction of the Breast: does frequently happen to scorbutic persons, whose nervous juice being degenerate and tainted, their Organ or Vessels perform not their office duly as they ought, in giving the full motion and extension or every part: for, this nervous liquor being fed and supplied from the mass of blood which is scorbutic, feculent and depauperated in spirit, that also which is extracted thence must be answerable, and of a degenerate nature: so than this nervous juice which should be vegete, noble and spirituous, for putting the motive faculties into action with vigour and briskness, is become dispirited, flat and depraved, and the Organs acted thereby, move heavily and irregularly: so that upon inspiration or filling the Breast with Air, the parts do not readily give way by expansion to let in; hence the Patient feels himself girt or straitlaced.  
It remains now in the last place, that we finish this second division, in examining and searching into the nature and causes of those pains that more peculiarly and eminently afflict the Heart.  
The Heart being a noble (or the noblest and principal part, is as the Sun of the Microcosm, whose irradiating lustre and beams of vital heat, enlivens and refresheth all the regions and parts thereof: the Eclipses, storms and clouds then that happen as the consequents of its distempers and sufferings, must needs be eminent and remarkable. This supreme Organ that bears the government of vitality, is so generally concerned in all diseases and discomposures of the Body, that few there are but the Heart is made sensible thereby, and gives notice thereof by variation of the Pulse, as a sigrial from thence. And not only distempers of the Body, or the defect and decay of some particular member or faculty does affect the Heart; but also the disorders and passions of the Mind, have influence thereon, that from thence the Heart aches, beats, or suffers pain and restless disturbance: hence it is that grief, anger, fear, desire, etc. Changeth the regular motion of the Heart, and the Pulse altars as a token and manifest character of its sufferings.  
Now the Heart is made thus sensible of the Bodies infirmities and preternatural mutations, from the vital government that is planted here; having commerce and communication with every member, from the circulating afflux and reflux of the crimson vital stream, continually transmitted through this Organ, which thereby is affected well or ill, as the blood is better or worse, in the current and quality thereof. And the Heart is also affected from the mind; for as much as the Soul exerciseth her power more eminently here; and if a particular part may be assigned, this may be said to be the seat or Throne of Regality.  
The Heart being of a solid fibrous flesh, the pain thereof is obtuse, not so accurately perceptible, so acute and sharp, as those of the nervous parts: notwithstanding the effects and consequents thereof are impressed upon the whole Body, and each member is impaired in its vivacity and vigour: and although this Heart- pain by the nature and substance of the Organ, is not so great commonly and perceptible, as that of some other parts; yet when this pain does arise to some degree, a Syncope seizeth the, Patient, a deprivation or cessation of life for a time; that what it wants as to sense is doubled in the consequents, as threatening and endangering the life: so that extremity of pain is not perceived here, because sense decays, as the cause of pain increaseth.  
The Heart is molested and suffers pain these several ways: by extension, constriction, obstruction, inflammation or intemperate heat, Imposthumation, by erosion, by exotic generation.  
1. The Heart is pained by extension, from a sudden ebullition and turgid fermentation of the blood raised by passion, or otherwise; whereby the Vessels are suddenly forced upon distension to receive and transmit the inundation and swelling current of the blood; and from hence pain and trouble ariseth at the Heart.  
2. By constriction the Heart is pained, and that from external and internal cause: externally from the Pericardium compressing, whereby the Heart is denied the full liberty of its Diastole or expansion: and this may arise upon a double account; either from. the Pericardium being too replete and full; or too much exhausted and empty. You must understand therefore that this Pericardium or Capsula cordis, is a Membrane designed by Nature to involve and enclose the Heart for its defence; as also being a moist Bath to irrigate and keep it supple, containing a Serum or water; and this Membrane should extend and be enlarged according to the motions of the Heart being greater or less: now when this water does abound filling the cavity of this enclosure, the Heart thereby is prohibited its full expansion: and è contrà, when this water is too much wasted and dried up, the Pericardium cleaves to the Heart, and impedes its pulsific motion: thus either plenitude or vacuity begets anxiety and trouble at the Heart.  
Internal cause of constriction is, when the Heart itself is seized with a Tabes or vehement exsiccation, and the fibres so contracted, that it hath no capacity, or less for dilatation, and permission of the transient blood.  
3. Obstruction causeth pain and trouble at Heart, when the free current of the blood is impeded from within due Vessels; and this is procured sometimes from a perturbation of the movent spirits, and sometimes from an indisposition of the impulsed blood.  
First, from a sudden and violent recurrence of Spirits from other parts, and tumultuous confluence at the Heart, whereby the circulation is checked, and the blood stopped in the Ventricles, causing a suffocation for a time; and this happens upon vehement passions, and consternations of the mind.  
Secondly, From an inability and incapacity of the blood being gross, concreted or grumous, that it hardly or with difficulty passeth through this Organ, causing thereby an obtuse pain, oppression or heaviness at the region of the Heart, and sometimes a Lipothymy or Syncope, fainting or swooning.  
4. By Inflammation or intemperate heat, the Heart is pained; as in most Fevers where intenseness of heat is accompanied: and this heat continuing does exsiccate, and contract the heart, and brings a Tabes or Consumption upon the whole Body.  
5. By Imposthumation the Heart is pained sometimes, as also by other Tumours there bred, Which by dissection hath appeared after death.  
6. By Erosion or ulceration sometimes the Heart is pained, and suffers by continual palpitation.  
7. By exotic Generations, and strange productions the Heart sometimes is pained; as when worms, stones or bony substance is bred in the Parenchyma of ' the Heart; which hath been found there upon dissection after death: and to these diseases, and such as most of the forementioned, the Symptom of Palpitation does necessarily belong; showing the continual molestation and trouble the Heart lies under, who endeavours to acquit and extricate itself by laborious, lofty and strong pulsations.   

Pains in the Abdomen or lower Region of the Body.  
NOW we have done with those pains incident to the middle Cavity, namely the Thorax or Breast: I come in the next place, and by the order proposed to the lower Region, called the Abdomen or Belly, containing the Stomach, Liver, Spleen, Kidneys, etc.  
And here first as the principal member we shall inquire into pains belonging to the Stomach or Ventricle; being the great Office and Laboratory to prepare Aliment to supply and maintain the whole Body; therefore if this part be pained and out of order, all the rest must needs far the worse for it, every part having a concern from hence.  
Pains of the Stomach are various both in respect of their causes; and also from the different parts of the Ventricle where they do infest, and those are three; the upper Orifice called Os Ventriculi; the lower Orifice called Pylorus; and the whole cavity of the Stomach.  
The upper Orifice or mouth of the Stomach is subject to great pain, as being very tender and sensible, in regard it is very nervous, and this pain is the more eminent and remarkable, for that commonly two principal parts are hereby affected and drawn into consent, the Brain and the Heart: the former, by the Nerves of the sixth conjugation derived from the Brain, whose ramifications are wreathing or twining about this Orifice; and therefore from, hence headaches, Vertigoes and Epilepsies do often arise. The Heart also is affected, both in respect of vicinity as near adjoining to this Orifice; and also for that the same pair of Nerves doth serve both the Heart and Stomach, whereby of necessity there must be a communication of pain; and therefore it is that this pain in extremity causeth Fainting and Swooning: and hence it is that this pain by a peculiar distinguishing title is called Cardialgia; and also for that the ancient Greeks called the mouth of the stomach 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉.  
As for the causes of this Cardialgia or stomach-pain; sometimes they are sharp, acrid and hot biting humours, fluctuating and rising up to the Orifice of the stomach, where they cause an eroding or gnawing pain, and sometimes a scalding or heat there; and this vulgarly is called the Heart burning.  
Sometimes flatulency and wind causeth this pain by way of distension and a swelling fullness; and the Orifice is constringed and shut up so, as denying vent: in this case the Patiented labours and strains to belch, but cannot unlock or loosen the Orifice of the stomach; but so soon as the Orifice does slacken and give way, the wind breaks forth, and ease followeth.  
Sometimes Worms do cause this pain, having gotten up to the mouth of the Ventricle, where they gnaw and by't.  
Sometimes churlish and deleterious or ill prepared Physic; or discordant food having such properties as may irritate and provoke this tender part: or food received in too great a quantity, above what the stomach is able to master and digest, than it riseth up to the mouth of the stomach, causing oppression and pain there, until it be discharged upwards or downwards, by the strength of Nature, or the assistance of Art.  
Besides this Cardialgia, there is also another sort of pain that afflicts the mouth of the stomach, and that is Singultus a Hicket, or Hickop: and although the whole Ventricle be molested therewith, yet the chief pain or trouble is at the Orifice or mouth of the stomach. This Hickop is a convulsive motion of the stomach, thereby causing pain. The general causes assigned by Hypocrates are two, repletion and inanition: under repletion is comprehended whatever humour or vapour is in the stomach and disgustful, to irritate and provoke the expulsive faculty: but a Singultus by inanition, is a vellication of of the retentive faculty, and is the effect of exhaustion and large evacuations: and accounted more dangerous than the former. Therefore Hickops after great vomiting or purging, Hectic Fevers, and long-wasting sicknesses, are very bad signs.  
There is also a pain belonging to the mouth of the stomach, which although it be a real pain and properly so called (according to the definition of dolour) yet Physicians have given it another denomination, and that is Nauseousness, or a nauseating sick pain at the Orifice of the stomach. The causes of this nauseating pain are various: as whatever is disgustful there, whether it be meat or drink offending in quantity or quality: or indigested depraved matter, the relics after former digestions, floating upon the stomach: or only imbecility and weakness of the stomach, being not able to close with and digest, although good food be sent in: and thus it is when the Tone of the stomach is altered by intemperance and ill usage; by great or long sickness; or decayed and worn out by age. Sometimes the cause is organical, as when a Tumour or Apostem is forming there.  
And not only thus idiopathically, but also sometimes the stomach complains and nauseates sympathically, by consent from other parts, by reason of vicinity or communication: and thus a Tumour of an adjacent part may molest and afflict the stomach: and other remote parts discharging and emptying themselves into the stomach by Vessels of intercourse, Veins, Arteries, and Nerves.  
In the cavity of the stomach, there is sometimes a pain of oppression or heaviness, being overcharged or loaded and grieved with something difficult to be digested and sent off: or a pain of distension and inflation, from wind and phlegmatic turgid humours: or a punging and pricking pain in this or that part of the Ventricle, from some acetous, sharp humour: or an eroding and gnawing pain, from worms, or a mordicant fretting bilious matter.  
Pain of the stomach ariseth sometimes from Inflammation, accompanied with very severe Symptoms; but of this in its proper place hereafter, where we treat of Inflammations.  
Pain also afflicts the stomach from Apostems and Ulcers, of which in their due place also.   

Pains of the Intestines or Guts.  
HAving gone through those Pains belonging to the Stomach or Ventricle, in the next place and in order, we come to treat of pains incident to the Intestines or Guts; being derived from the Ventricle, and are one continued body and passage from the Pylorus to the Anus: notwithstanding for distinction sake, and because this long cavity is different in several parts thereof, as to magnitude, substance, figure, place and office; therefore it is divided into parts, having several names, for a more distinct knowledge, both in relation to the different formation thereof, as also to point particularly where a disease is in any part thereof.  
The division is made into small and great Guts; the small or thin are three; Duodenum, jejunum and Ileon; the great or thick are three also, caecum, Colon and rectum; and in this order they lie from the Ventricle to the Fundament. The three first are circumvolved about the Vmbilicus or Navel, and take up the centre of the Abdomen, the other are subjacent and circumferential.  
Pains do frequently molest the small Guts, but chief the Ileon; which when they arise to extremity, the disease is called Iliaca passio, from that Gut most affected.  
The seat of these pains are above the Navel chief, extending to the Hypochonders.  
These pains differ in their causes, and therefore some are weak and transient, arising from wind and acidities, which cause some punctures, gripes, or distensions, and continue not: but sometimes these pains are more grievous, depending upon causes greater and more contumacious; and therefore attended with other Symptoms in great rigour: as constipation of the Belly, violent heat, fainting, vomiting and casting up whatever is received; nothing passing downwards, but moves upwards, that sometimes the excrements are voided by the mouth.  
About the causes of these violent pains Physicians do not concur. The general opinion (taken from Galen) will have these pains to arise from an Inflammation of the Guts: others (modern Authors) from a peristaltic motion, or the motion of the Guts inverted: for whereas in the course of Nature the expulsive faculty moves downward by a contraction of Fibres from the Ventricle to the Anus è contrà, in this case the Fibres contract below and drive upwards.  
But this difference may be reconciled, and neither opinion to be faulted, being rightly underftood: for Inflammation may begin, and cause the motion of the Intestines which naturally tends or moves downwards, to be changed upwards, by a different contraction of Fibres: So that Inflammation causeth mediately, peristaltic motion immediately; and sets forth the order of causation; the one superior, the other subordinate. Quod est causa causae, est etiam causa causati.  
All the Guts are capable of Inflammation; but the small Guts more usually, as being most liable, for having more Veins and Arteries than the rest.  
These Iliac pains from Inflammation are very dangerous, if they arise to a great height; because the Inflammation is apt to make a mortal transition into a Gangrene: and indeed all Inflammations of the Guts are difficult and doubtful, because they easily gangrene and mortify.  
And not only Inflammation inverts the motion of the Guts, but also other causes may beget this Iliac passion, or join with it as partial causes: as an Apostem or other sort of Tumour; a Rupture, an Exulceration, indurated Excrements causing great obstruction: also whatever by compression or constriction of the Guts, constipation or coalescence, may cause contortion, and turn the natural course and motion thereof: and of these frequent examples in practice do manifest and confirm.  
Pains of affinity and adjacency to the Ileon, and which are often complicated therewith, are Colic pains, so called from the Gut Colon, the part wholly or chief affected. This Intestine is last but one, and more capacious than any of the rest; furnished with many little cells or private receptacles, to receive the excrements and retain them, else they would pass away too frequently and inconveniently.  
This Gut is seated almost round the Abdomen or Belly; so that Colic pains are not easily distinguished by the place, being sometimes here and sometimes there; left side, right side, or under the Ventricle; hence it is that Colic pains do counterfeit sometimes the stone or pain in the Kidneys, left and right, and sometimes they are supposed to be pains of the spleen: but most frequently these pains are towards the left side near the flank, where the Colon is more angust, tortuous and circumflected: and therefore when the excrements are hardened in the superior and more capacious part of the Colon, and are then forced down by wind or otherwise, into the narrower, great pain must needs arise thereupon.  
But concerning the causes of Colic-pains they are various, and may be ranked under these Heads.  

1. Obstruction of the Meatus felleus.  
2. Wind and flatulent Vapours.  
3. Acrid, punging and sharp Humours.  
4. Indurated Excrements.  
5. Stones generated in the Colon.  
6. Worms.  
7. Compression.  
8. Inflammation.  
9 Venenous and malignant Matter.  
10. Apostems and other Tumours.   
By the first it appears, that Obstruction in the Guts (which produceth Colic pains) does sometimes arise from an antecedent obstruction in another part: as when the Meatus cysticus, the passage of the Gall into the jejunum is stopped, it causeth also a stoppage in the Guts: for the Gall being naturally discharged into the Guts does stimulate them to expulsion, and moves the excrements downwards; but for want of this exciting and provoking matter, the Guts fill up, are obstructed and distended, thereby raising pain.  
Wind and flatulency begets Colic-pains sometimes; and these are not fixed, but roving here and there; and commonly attended with a rumbling and noise in the belly: and this is an effect of crudities and weak digestion, rising from a natural debility, or occasioned by intemperance and a bad diet. And this flatus is either in the cavity of the Colon involved in a viscous tough phlegm enclosed as in a Bladder; or sometimes shut up within the Tunicles of the Intestine, where forcing its way out, does cause great pain in the part.  
Sharpness of an humour indigested or degenerate, does sometimes cause Colic pains; and this is either a mordant biting Choler, or an acid serosity.  
Dryness and hardness of Excrements do cause Colic-pains sometimes; for as much as they stop the passage and extend the Intestines, denying vent to any sudden fermenting humour, wind, etc. that should freely pace away. This costiveness and constipation is acquired, by ill diet, in the use of hot, dry, astrictives: by watching or sleeping too much; immoderate Venus; by heating the body, and sweeting much, through exercise, labour, intemperate Air, etc. These are great dryers, and take off the lubricity of the Guts, that they perform not their office as they ought: thus excrements not being transmitted and sent away duly, they accumulate, fill up, distend and obstruct the Intestines, and give great occasion to Colic-pains.  
Stones sometimes are generated in the Colon, and do cause Colic-pains: also a clot of worms gathered and twisted together, obstructing the Guts, have raised Colic pains.  
Compression and contraction, by Inflammations and Tumours, in the Guts or parts adjacent, do sometimes cause Colic pains.  
Also malignant and venenate matter hath procured the like; as Paulus Aegineta relates of a pestilential Colic that arose in Italy, and afflicted many of the Roman Provinces.   

Fluxes of the Belly.  
HAving spoken something concerning pains of the Guts, Iliac and Colic, attended with astriction of the Belly and costiveness: I shall briefly set forth those pains that are accompanied with a Flux or looseness.  
There are three sorts of Fluxes of the Belly distinguished by several names; Lientery, Diarrhoea, and Dysentery.  
The first is a Flux of indigested or semidigested food, passing away before its due time from an imbecility of the digestive faculty. But this not being dolorous; or painful, we shall pass it by, as not our subjeut in hand.  
The Diarrhoea is a flux of humours depraved and injurious, which stimulates Nature to expulsion; and is for the most part painful and irksome to bear.  

1. This kind of Flux is various in the matter of  
2. Different in the efficient cause (as some are of opinion.)  
3. Unlike in the manner and circumstances.  
4. Various in respect of place; as issuing from several parts of the body.   
Touching the diversity of matter in this flux, physicians have distinguished it into phlegmatic, choleric, melancholic▪ and serous or watery: which distinction is not simply manifest, but a complication and mixture of many sorts, whereof one may abound and be predominant; yet the denomination and character of the whole is hard to be given.  
The variety of depraved matter that happens in man's body, is not to be reduced to four Heads, nor three times so many: for this stimulating matter thus sent forth by a Flux, is the manifold different material cause of hundreds of diseases: which preternatural variation of humours or juices are not to be comprised within so narrow a compass, nor reducible to four Cardinal points: for admit there were four natural constituent humours in man's body (as common doctrine teacheth) yet these in their sundry variations and complicate degenerations, would be so variously changed, as not to retain any relict or smack of their original descent; that a denomination from thence, if possible to be distinctly given, would no way answer in the similitude or nature thereof, and consequently of no use in practice.  
In respect of the efficient cause, Authors have distinguished these Fluxes into critical and symptomatical: by critical they understand, when Nature in due time, and with good success, throws off and expels any peccant matter, and finds relief by it in any case. A symptomatical Flux they mean, when Nature irritated untimely or immoderately, is not benefited thereby, but rather injured and endangered.  
The 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 of this is true, and it often falls out thus; but the distinction of critical and symptomatical, relating to the efficient cause, and the reason thereof, I do not assent to nor comply with, since every Flux is symptomatical, whether it produce good or evil: for that which they call Critical, and is seasonable and duly performed with good effects attending, is but symptom morbi, the Symptom of some disease, as well as the other: so that the difference is in the nature of the disease afflicting, the matter excreted or voided, the fortitude of Nature, the time where, the way by which it ought or ought not to pass, which does distinguish these Fluxes in their effects to be good or ill; but shows no diversity in efficient causes, which is one and the same: for Nature is efficient, whether irritated unseasonably and frustrated of her end; or performing these endeavours in due time and to good purpose.  
But although the efficient cause of Diarrhoea's be simple and single, yet the occasional causes are many; for these Fluxes are occasioned sometimes by change of air or place, and variation of the seasons; by some kind of meats or drinks, taking cold or other casualties and accidents, which puts Nature upon some disorderly fermentation and excretion; and this commotion occasions and stirs up any morbific matter and noxious humours, which before perhaps lay dormant and still, now to grow turgid and active, contributing to advance and promote the Flux begun: but this managed by a discreet hand may not prove injurious, but some advantage gained; which if neglected, and Nature not governed and guided in this prodigal expense, much detriment may come thereby, an exhaustion of nutritious Juice, with great debility and weakness.  
As this Flux Diarrhoea is various in the matter discharged; so likewise in the manner and circumstances: as greater and more violent, or moderate and gentle, making a profitable secretion: without gripes or pains, but for the most part with these more or less; which by continuance and shaving the guts so thin, at last do come to the quick, and cause excoriations: and this difference ariseth from the nature and quality of the humours or stimulating cause, which sometimes is so extreme sharp, introducing a Dysentery or bloody Flux.  
These Fluxes sometimes produce good effects, when the peccant matter of any disease, or an exuberant humour is timely and moderately discharged and sent off; but otherwise not: and therefore saith Hippoc. In turbationibus alvi & vomitibus sponte contingentibus, siquidem qualia purgari oportet, purgentur, confert & leniter serunt; sin minùs, vice versâ.  
In respect of place, or parts mandant, from whence these Fluxes take their rise, and the terminus à quo; they proceed sometimes from morbific matter congregated and concentred, issuing from the whole body: and of this take the example of Hippoc. giving a Prognostic in this case, 7. Aphor. 29. Si Leucophlegmatiâ detento fortis Diarrhoea supervenerit, malum solvit. Which is to be understood, in the beginning of the disease, strength firm, and the Viscera sound, else it is commonly mortal.  
But sometimes also these Diarrhoeas do emerge from particular parts: as the Ventricle, Brain, Spleen, Liver, Mesentery, etc. and therefore in the Cure of these Fluxes, regard must be had to the part principally affected, from whence as the original and fountain these Diarrhoea's do assurge. And therefore examination is to be made by the Diagnostic signs of every principal part; discovering thereby which performs their offices in integrity, and which of them decline their functions, and are depraved, as being the Authors of this disturbance.  
The third sort of Flux is a Dysentery or bloody Flux: which is a dolorous and frequent excretion of blood, from an Exulceration of the Guts.  
There are several voidings of blood by stool, that are to be distinguished and know from Dysenteries. Galen mentions four, others add two more.  

The first, is a profusion of blood arising from plenitude or fullness of good blood; Nature over-burdened dischargeth herself this way by the Guts.  
The second, is an evacuation of crude and watery blood, not having its full tincture.  
The third, is of a feculent and foul blood.  
The fourth, of an acrid and salted blood.  
The fifth, is of a tabefied blood in acute diseases.  
The sixth (which is Galens fourth) is a Dysentery, distinguished from the rest, by Ulceration and great pain.   
To examine this division in the several parts thereof, and to set forth what truth and error it contains therein, is not our business at this time: I shall only discourse upon the last, viz. a Dysentery being painful and grievous to bear; which kind of bloody Flux ariseth from, and is accompanied with an Exulceration, and commonly is the consequent of long, or severe; Diarrhoeas; for those Fluxes not being checked, do sometimes make their transition and terminate in Dysenteries.  
This word Dysentery taking its name from the part affected, imports only a difficulty of the Intestines; but may as properly be used for other diseases and pains there: but Authors having fixed it to bloody Fluxes from Exulceration; its general signification is restrained, and custom amongst Physicians hath fastened it here, as the character of this disease only.  
The parts affected are the Guts, either the small or the great, and sometimes both: but pains of the small are more grievous than those of the great: the small Guts being of more exquisite sense.  
The external and procatarctic causes that predispose and introduce a dysenterical disposition, or promote and set forwards an inclination already begun, are  
First, the constitution of the Air.  
Secondly, a bad Diet conspiring therewith, or some unwonted kind of Meats or Drinks: and therefore it is that many people upon the change of Climate, and a new sort of Food, do fall into bloody Fluxes: hence it is also, that these Fluxes are sometimes epidemical and malignant, infesting many together in a City or Country, as of late years in London, and some other parts of England, this disease was raging. These epidemical Dysenteries arise sometimes to to the height of pestiléntial, and are very contagious, that it is not safe to converse with, or be near the diseased, but especially such as attend upon the sick are in most danger, from the Excrements that send forth a pernicious and infectious vapour.  
For the time of the year, Autumn is most ready, and does more frequently produce these Fluxes: partly from the change of the season, and partly from the effects of Summer- fruits, to which many are intemperately given: the consequents whereof are commonly Diarrhoeas and Dysenteries.  
Now the reason why these Fluxes do break out more frequently at this time of the year is; because the external ambient Air and cool blasts condensing and incrassating the Juices of the body, as also occluding and shutting up the Pores, denying and hindering the former Transpiration (which in the Summer and hot weather did spend and evaporate that way much superfluous matter) which vents being stopped, humours accumulate, ferment and grow turgid, and forceth a discharge inwards by the Guts.  
And not only this change of Air from hot to cold, or Summer- fruits are procuring causes; but also some astral and inimical influences, drawn in with our breath, may deprave and alter the Crasis of the blood and nervous juice, as to effect this disease, and make it popular in like manner as other Epidemical diseases are sometimes procured. Also some sorts of Meats in quantity or quality offending and disagreeing, and for want of good digestion, may corruption and dispose to these Fluxes. To these we may add as procurers, some ill prepared Medicines, and medicinal Drugs not well corrected that have, and will produce a Dysentery.  
But concerning the proximate cause and manner of generation of this disease, we must farther declare: And whereas before we mentioned several sorts of bloody excretions or fluxes not dolorous, nor depending upon or conjoined with exulceration of the Intestines, and therefore not denominated nor to be understood as Dysenteries in the strict and present sense; therefore I must wave the mentioning of their causes, and only give an account of Dysenteries in the usual acceptation of the word.  
In the forming or generating of this Dysentery you must understand, that sometimes the ulceration is planted first and hath the priority, and a Flux of blood follows as the consequent: but sometimes the voiding of blood precedes, and an Ulcer or Ulcers is procured thereby as the effect: and this consideration is not of small moment in the designment and intentions of curing; for both the former and the latter happen in several persons.  
Sometimes ulceration is made by sharp corrosive humours, as in Diarrhoea's, which ulcerate the guts first, than a Dysentery of blood follows. Or,  
Sometimes from an Inflammation of the Intestines, or other Tumour coming to suppuration, which breaks and makes a Dysentery, sending forth blood and corrupt matter.  
Sometimes a bloody Flux continues a while without ulceration, and afterwards ulcerates the guts and makes a Dysentery: that is, when this extravasated blood lodging in the guts degenerates and putrifies, it does thereby erode and plant an Ulcer, which completes a Dysentery.  
Now this kind of Dysentery ariseth from an impurity or corruption of the blood, which causeth a preternatural fermentation or effervescence in the whole mass; but Nature not being able to depurate and separate from this degenerate admixture, either by Transpiration or Urine, is forced upon this emission by the Intestines without a secretion, and throws out both the good and bad together.  
In the prosecution of Cure, as these causes are rightly adjudged, and Medicines adapted thereto, depends the success: and therefore that course and Method which is advantageous and proper to one, may be injurious and altogether disagreeing to another.  
And here you must take notice, that Dysenteries are sometimes malignant (as commonly when Epidemical) and then Alexipharmacal Medicines are not to be omitted.  
Now concerning the degrees of Dysenteries, as to a better and worse, curable or deplorable state, and the signals declaring them; as also several Queries that might be raised, and satisfaction given to each; the conciseness of this Work will not admit to enlarge thereon.  
In the next place and of great affinity with Dysenteries is a Tenesmus; agreeing in the causes and Symptoms, but differing in the part affected; a Tenesmus being seated at the lower end of the right Gut or Fundament.  
The Etymology of the word imports something of the nature of the disease, being a frequent desire and straining downwards to the stool; but instead of excrements, blood and mucous matter is brought forth, and with great pain. This ariseth from an Ulceration of the last Intestine procured from the same causes as Dysenteries, which we need not repeat.  
This disease is most dangerous to women with child, for that it causeth abortion: but to all persons it is very troublesome and painful; and if it continues long, the Ulcer becomes fistulous, and difficult to be cured.  
And now I remember the Cure of an old Ulcer in this part, notwithstanding the contumacy and difficulty thereof. In the year 1653. when I was but a young Practiser; yet by the blessing of God upon my endeavours I cured a Gentlewoman afflicted with an Ulcer in ano for seven years; who could not in all that time receive help, though she had tried many Physicians and Surgeons, having a plentiful Fortune to allow it. She was aged between fifty and sixty, an Alderman's Wife of Maxfilde in Cheshire, where I happened to stay in that Town for some time, whereby this Gentlewoman beyond her expectation, received a perfect Cure.;  
To finish our Discourse of Pains belonging to the Intestines, we shall conclude with the Haemorrhoids. A disease frequent, and sometimes of great complaint.  
The word Haemorrhois signifies a Flux of Blood in general; but custom hath restrained it, and amongst Physicians it is used and understood only, that effusion of blood by the Haemorrhoid Veins, which Veins terminate at the lower end of the last Intestine, and about the Fundament.  
These Haemorrhoid Veins are internal and external; although most of the Ancients and some modern Authors acknowledge only the internal, but erroneously.  
The internal and external Haemorrhoid Veins do differ much.  
As first, in their rise or descent: for the external do proceed from the Hypogastric branch of the Vena cava; and the internal from the Vena portae; and commonly from the splenical branch thereof.  
Secondly, in number; the internal being but one, though orbicularly multiplied and divided about the Anus. The external are threefold.  
Thirdly, in their insertions: the internal being inserted into the membranous substance of the right Gut: the external into the musculous substance of the Anus or Fundament.  
Fourthly, they differ in their contents: the internal carrying a gross and blacker blood: the external more thin, and ruddy.  
Fifthly, in their office and use: the internal evacuates the Vena porta, and splenical Arteries, thereby advantageous in some diseases of the Spleen, and Cacochymies. The external do empty the Vena cava, and correct such diseases that depend upon Plethory or redundance.  
Sixthly, they differ in evacuation: the internal not so copious: the external commonly large in the profusion, and sometimes very injurious, and to some mortal.  
Seventhly, in pain: the internal for the most part painful; the external not, in evacuation.  
Lastly, they differ in association: the internal descending without Arteries: the external are adjoined with Arteries to the Anus.  
The Haemorrhoid Veins are liable to contrary affects, and the diseased do suffer in a different way: sometimes these Veins abound with blood and swell for want of apertion, and a discharge; and this is called the blind Haemorrhoids: è contrà, sometimes the mouths of these Veins do open and pour out too plentifully, either suddenly, or by too long continuance; and this is called the open Haemorrhoids. Both these extremes are grievous to suffer.  
The swelling of the Haemorrhoid Veins, and pains from thence, have the same causes as provoke and continue the Haemorrhoidal Flux: viz. blood offending in quantity or quality, which if it find not vent by the terminations or mouths of the Veins, they are extended and swell big, and sometimes inflame; which if it continue is dangerous, lest it become cancerous and gangrene. On the other side, an immoderate Flux is very pernicious and induceth Dropsies, Consumptions, Cachexies, etc. by exhausting the treasury of life.  
These Haemorrhoidal Fluxes continuing unduly and injuriously, argue the blood to be hot and sharp, or too thin abounding with an acrid serosity, which provokes the expulsive faculty, and opens the mouths of the Veins. But the blind swelling Haemorrhoids denote the blood to be gross and thick, or the coats that cover the extreme ends or mouths of those Veins, to be dense and impenetrable, not permitting an exsudation.  
Here it may be queried, how it comes to pass, that these Haemorrhoid Veins should be more troubled with blood, and more frequently suffer an apertion, since many other places of the body receive the extremities or terminations of the Veins, and so equally capable of effusion.  
In answer hereunto you must understand, that although Nature hath form the like, and planted them in divers parts of the body, which sometimes, though more rarely, do issue and send forth blood; yet these Haemorrhoids are placed more commodiously for voiding of superfluous and feculent blood, being near the common vent and outlet for excrements to pass away; and their situation being downwards, together with the straining upon occasions at the stool, the extremities of these Veins are filled, and sometimes forced to evacuate more frequently than others.  
Now concerning the blind Haemorrhoids you may take notice, and know that there is this difference: sometimes the Tumour or extension is in the trunk or cavity of the Veins, and then there is no apertion; and sometimes the extuberance is out of the Veins: that is, when the extravasated blood is lodged between the mouths or terminations of the Veins, and the covering coats. In the former case, and when the external Haemorrhoid Veins be so affected, Phlebotomy may alleviate, make a revulsion, and draw away the plenitude; but in the latter it gives no relief; for the extravasated blood will not return into its canal or pipe again; and besides it soon coagulates and putrifies out of the Vessels, the proper place, and then suppuration is to be promoted, the Apostem to be broken, after that abstersion and healing to be designed and endeavoured.  
And here you may discern the difference between these two Haemorrhoid painful swell, that the first kind does abate and retire of its own accord sometimes, Nature retracting and turning the current of blood to some other part, at least it sooner yields to means, and is more easily remedied: but the latter will not revert, nor is easily cured; but proceeds to Apostemation, and after breaking sends forth corrupt and bloody matter.  
From hence you may perceive, that as there are many sorts of Haemorrhoids, so many questions might here be started, and much more to be said concerning them to complete the Discourse thereof: as why the Hemorrhoids should swell and not bleed sometimes? Why they are painful, and sometimes not? Why they appear and pass away without injury sometimes? What difference between an Inflation and Inflammation of the Haemorrhoids? etc. But to enlarge hereon and give full satisfaction, would swell this Work beyond intention and our limits set at this time.   

Pains of the Spleen.  
THE Spleen being a principal part, and of great use in the Body, is also subject to disturbance and great pain.  
This member is seated in the left Hypochonder, over against the Liver, below the Diaphragma and under the short Ribs, hanging downwards, in figure like an Ox-tongue, inclining rather to the backparts, and near the left Kidney.  
To pass over the different Opinions amongst the ancient and modern Authors, concerning the office of this Organ, we shall concur with those that assign the use of this member for a depuration of the blood, transmitted from the Heart, to receive a farther elaboration there, that the whole mass of blood may be purified and kept in a due state. From whence it comes to pass, that when the Spleen is injured, out of order, or decayed, and performs not this office aright, the blood becomes foul, and many diseases arise from thence, which causeth much alteration in the body: for with the Spleen do many parts consent, and well or ill as that is in a good or bad condition.  
The Brain, though remotely seated, is much affected from hence, causing sometimes Epileptic fits, Vertigoes, headaches, mad Melancholy, and many other Symptoms, which Hypocrates hath observed, 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉.  
The Heart also from a tumified or obstructed Spleen is drawn into consent, causing palpitations and oppressions. Hence also difficulty of breathing, from a swollen big Spleen, hindering the free motion of the Diaphragma.  
The Liver also seldom stands firm, if the Spleen be diseased.  
And the Pancreas for the most part incurs prejudice, being obstructed or scirrhous, from an ill affected Spleen.  
Hence it is, that the Spleen challengeth a great share in the production of divers Cachexies or ill habits of body, Dropsies, Scorbute, black Jaundice, Haemorrhoids, Cancers, etc. of which I might give you many examples: but I shall recite one only, and that very eminent, plainly showing, that the rise thereof and dependence is sometimes from the Spleen.  
In the year 1658. a Cheshire Woman named Elizabeth Swain, a Farmer's Wife, aged 39 years, came to me at Chester, where I then practised, she living about a dozen miles off; her complaint was of pain, hardness and Tumour of the Spleen: before which happened, she had a tertian Ague for some time; but after that had left her, the left side began to swell, and pain upon the region of the Spleen: this increasing, and when she came to me the Tumour was raised very high, and the compass of a penny-loaf, being very hard and scirrhous, not yielding when it was pressed with a finger. Her desire was to be under my care, and I was willing to undertake the Cure; but she not having brought conveniencies with her to stay, would go home and return speedily with such necessaries as she should want; but came not again until three months after; and then not only the left Hypochonder, but the Abdomen, her whole belly was tumified and extended as big as if she were ready to be delivered of a child: so that the Tumour of the Spleen was then hid, the whole belly being equally raised up to it by a Dropsy Ascites. This neglect of hers, and thereby rendering the Cure much more difficult and uncertain, made me to refuse meddling with her, since by her folly she had lost the opportunity; for I was doubtful and feared that the Spleen by that time was become scirrhous, and the Tumour not to be discussed, or otherwise decayed and putrified as not be restored: but she having a Sister living in that City, who had been my Patient before, upon both their importunate entreaties (though I would give little encouragement) I unwillingly did put her into a course of Physic; but after I began I endeavoured the best I could for her, which was as followeth.  
First, I appointed a Preparative to be given: which was this.  
R. Radie. utriusque bugloss. gram. cichor. apii, ana ℥ j polypod. quercin. ʒ vi. court. cappar. median. fraxin. liquirit. ana ℥ ss. herb. scolopend. ling. cervin. chamaed. ana M.j. Tamarisc. Mss. sem. foenic. dulc. ʒ iii. passular. maj. exacinat. M.j. Coq. in aq. & vin. alb. ad lib. two. colat. ℥ iv. add syr. de pomis magistral. ℥ j rosar. solut. ℥ ss. tart. vitriolat. ℈ ss. Misce pro does.  
After that I ordered Leeches to be applied to the Haemorrhoids, and much watery blood came away, and she found herself something better. Then I appointed a purging Apozem for four doses; and it was this.  
R. Rad. filicis mar. court. cappar. polypod. ireos nostr. liquirit. ana ℥ j herb. scolopend. M.j. cuscut. tamarisc. ana M. ss. sem. alkekeng. foenic. dulc. anaʒ iii. stor. bugloss. p. j Coq. in aq. & vin. alb. ad lib. jss. colat. infund. sennae oped. mund. ℥ jss. epithymi ℥ j agar. troch. ℥ ss. rhabarb. oped. ʒ three maces, caryophyll. ana ℈ two. calam. aromat. schoenanth. ana ℈ j Fiat colat. pro 4 dos. addendo unicuique dosi syr. rosar. solut. ℥ j aq. cinnam. ʒ ss. tart. vitriolat. ℈ ss.  
Which being taken, the distension of her belly began to abate. After the Apozem I gave her a Chalybeate Wine for four days, mornings, and at four a clock after noon, with exercise; and at nights three aperitive Pills not purging. The Chalybeat Wine was this.  
R. Cort. rad. cappar. polypod. ireos nostr. liquirit. ana ℥ two. herb. scolopend. cuscut. tamarisc. ana M.j. chalyb. praep. ℥ two. vin. alb. lib. iv. Diger. s●…a. in balneo Mariae per dies iv. colat. duleoret. syr. byzantin. simp.  
The aperitive Pills were these following.  
R. Gum. ammonias. acet. scillit. solut. ʒ two. myrrhae rub. tart. chalybeat. anaʒ ss. croci ℈ j ol. foenic. dulc. chym. gut. viij. succi cochlear. q. s. Fiat massa.  
During which time from the beginning, she was anointed with a Lineament all over her belly, morning and evening. The Lineament was this.  
R. Ol. cappar. unguent. è succis aperit. ana ℥ j Misce.  
After this, a Cataplasm was applied to the region of the Spleen, every day for a week. The Cataplasm was made thus.  
R. Panis alb. farin. sem. lini. ana ℥ iv. farin. hoard. ℥ jss. lactis vaccin. lib. jss. Coq. ad exsiccationem, add mucilag. rad. althaeae, foenugr. ana ℥ j ol. chamaem. cappar. ana ℥ j gum. ammoniac. acet. scillit. solut. ʒ iii. galban. bdellii▪ styracis liquid. anaʒ two. crociʒ ss. Misce, f. Cataplasma.  
After this the pain was gone, and the Spleen began to be soft and yielding. Then I appointed the former Apozem to be repeated; which being taken, the swelling of her belly was much gone down. After this I caused a Fomentation to be applied, morning and evening, for some days; and then ordered the Chalybeat Wine to be repeated. The Fomentation was this.  
R. Rad. bryon. ireos nostr. ana ℥ iv. rad. cyclamin. cucum. agrest. filicis mar. ana ℥ two. fol. lauri, abrotan. absinth. menthae, salviae, hyssop. ana M.ii sem. cymin. foenugr. ana ℥ j flor. chamaemel. melilot. ana M.j. Coq. in aq. fabror. lib. x. acet. vin. alb. sub finem addit. lib. two. ad tertiae partis consumpt. pro Fotu.  
After which one purging Potion was given, and an Emplaster applied to the Spleen, and then both the Spleen and Abdomen, the whole belly as flat and soft as ever she was, and perfectly cured, and returned home. All which was performed in the space of about seven weeks: and two months after she conceived with child, as I was informed by her relations; and she stood firm in health long after. Notwithstanding the success was very good, and the Medicines well designed, as such preparations will afford; yet in the like cases I do not use the same now.  
This in short; and I could not rehearse the particulars so exactly (being twenty years since) but that I have the whole story, with the several Medicines, in writing now by me: and this I have related to confirm what I asserted here before, that a diseased Spleen may lay the foundation for, and introduce a Dropsy: and now I proceed on to set forth the causes of a pained Spleen; which being rightly stated, applications may more successfully be made in that complaint.  
The most frequent and apparent Symptom that afflicts the Spleen is Pain; and this doth arise and depend upon some of these several diseases; Obstruction, Tumour, Inflammation, Apostemation, Compression, ulceration.  
Obstruction in some of the Vessels of the Spleen, is a frequent cause that produceth pain; and this obstruction is procured from a feculency and grossness of blood, which ariseth either from a natural debility of the Spleen not able to perform its office duly; or occasioned by a melancholy disposition, a studious, sedentary, inactive, or a careful and afflicted life; to which, or singly, an evil bad diet and irregular diaetetic customs may contribute, or effect: (as more fully you may be informed in a late Tract of mine, entitled, The Preservation of Health and Prolongation of Life.) All which impedes the due fermentation and volatization of the blood in the Spleen, from whence it becomes thick and foul, and begets a stoppage, or too slow a motion and fullness in those Vessels.  
And whereas the office of the Spleen (as before determined) is to ferment anew, spiritalize, exalt and rarify the thick, indigested and melancholy blood, sent thither for a farther elaboration and depuration; it is most rational that this not being performed (from some of the impediments aforesaid) obstruction and stagnation there will be the consequent; and the Patient from hence will feel a pain and heaviness about those parts.  
But for a more promptness or aptness to these obstructions, angustness and straitness of the Vessels, so form by Nature, does render some persons more prone than others to obstruction and these splenetic pains.  
And farther, this obstruction does arise not always from the causes aforesaid; but sometimes from a compression of other parts adjacent that may incommode and offend the Spleen, or by contusion from a blow or fall; or by an injurious dress and too straight lacing or girding, as frequently amongst the female Sex.  
These obstructions when continuing and contumacious, are so aggravated and increased with additional influx, that they form a Tumour: this distension being perceptible by sight sometimes, but always by ceiling, is to be adjudged and distinguished; whether soft and flatuous, or hard and scirrhous; the former sooner yielding to means, but the latter more difficult of cure.  
Inflammation, though rarely, yet sometimes does affect the Spleen; and this inflammation does arise from obstruction; for the blood being stopped in its current and passage, and upon some extraordinary causes being more hot and fiery, does make a sudden ebullition and inflame, causing great pain, heat and extension; and this pain is distinguished by pulsation and beating of the part, having many Arteries. This Inflammation not rightly applied unto by diligent and good means, does make transition, and passeth into Apostemation; and sometimes terminates in a scirrhous Tumour: but these two dangerous commutations are to be prevented with great care and industry: therefore before the disease arrives to this height, and when only pain or heaviness gives warning, and tells you of a distempered Spleen, it is then most seasonable and opportune to apply the means; and then a little may prevent that, which afterwards perhaps a great deal cannot cure.  
And first the procuring causes, if any there be apparent, are to be avoided; as a sedentary slothful life, intemperance and gross feeding, or unseasonable eating, as late suppers; immoderate study, melancholy, grief or care; which introduce sometimes, but always contribute to aggravate splenetic distempers: and although a natural debility and infirm constitution of the Spleen, may procure the effects aforesaid without other provocations, yet most frequently they are so caused, at least much heightened thereby; and therefore for prevention, as also for cure, those injurious habits are to be abandoned, and such a diaetetic course of life observed, as may check this disposition of body, as at large you may be directed in the  Book, The preservation of Health and prolongation of Life, etc.  
For Pharmaceutic Remedies (that are made public) I shall commend the aperitive Tincture of Mars; Pil. Antihypochondriac. Swelferi: chalybeated Tartar; Sal volatile. Succini; Spir. Veneris rightly prepared: which prudently used pro re nata, as the several cases require, may prove advantageous.   

Pains of the Liver.  
BEfore I inquire into the nature and causes of these pains, it will be necessary to let you know, the office and use of this member, its situation, figure and vessels; for hereby the disease (upon which pains depend) will be more manifest and apparent, as also such parts as suffer by vicinity, connexion and consent from hence.  
To enumerate the various Opinions that have been held by Learned men in all Ages, concerning the office of this member, would be too tedious; therefore I shall only mention what latter discoveries have proved most rational from the motion of the Chyle and Blood, which is this: That the Liver primarily is appointed to receive the blood coming from the Heart, to give it a farther digestion and depuration, by separating the bilious matter; and secondarily, by embracing the Ventricle, to cherish and promote the stomaches digestion, or chylification: for which purposes this member is fitly seated, form and furnished with vessels to import and export.  
The Liver is placed in the right Hypochonder under the Diaphragma, covered in part by the short Ribs, and covering the upper and forepart of the Ventricle: and for firmness of situation it is fastened by three Ligaments, to the Abdomen, to the Cartilege ensiformis, and to the Diaphragma.  
The figure of this member upon the superior part is convex or round, the better to give way to the motion of the Diaphragma; but the under side is concave or hollow, fitly to apply to the extension of the Ventricle.  
As for magnitude, it is various in divers persons, greater and less: and also different in the same persons, in health and sickness: this member sometimes being wasted and shrunk; and sometimes swelled or increased wonderfully big.  
This Organ hath vessels appertaining to it, as Veins, Arteries and Nerves: the two eminent great Veins of man's Body, Vena cava and Vena portae, having their roots variously dispersed here through the Parenchyma or body of the Liver; the trunk of the former rising out of the superior gibbous part; the latter from the concave and under-side.  
The Liver being designed for the use aforesaid, seated and accommodated after this manner; we shall inquire into the impediments and preternatural conditions, from whence pain and trouble ariseth: for many complain of pain and heaviness in their right side, about the short Ribs, sometimes more forward, sometimes backward, sometimes inward, and sometimes more outward. To what parts these pains belong, and the causes from whence they arise, is worth our labour to be resolved: for sometimes pains of the Liver have erroneously been taken for Pleurisies, because the pain hath extended upwards and affected the Thorax, by reason of vicinity: and sometimes the muscular pains of the Abdomen in the right Hypochonder, have been adjudged to be hepatic, not rightly discerning the diagnostic signs.  
Diseases which the Liver is most subject to, and procuring pain, are these: Obstruction, Adhesion, Inflammation, Inflation, scirrhous Tumours, Apostems, Ulcers. From hence we may understand, that as these pains are various in their causes, so are they dissimilar and unlike in the sense of feeling, and differently seated.  
Obstructions that impede and injure the office of the Liver, and producing pain are frequent; and these are either in the outmost gibbous part, and do belong to the trunk of the Vena cava: or else in the hollow inferior part, and the Vena portae is concerned herein: or else the obstructions are fixed in the body of the Liver, and then the small ramifications of either or both Veins are affected. Hence it is, that this member is most frequently infested with obstructions, because it is stored with so many vessels as none more.  
But besides these obstructions of the Vessels, there are also obstructions in the Parenchyma or substance of this Organ; that is, when the small Meatus or Pores are shut up, that ventilation and transpiration is denied: hence it is, that this member sometimes is preternaturally extended and increased in magnitude, through all its dimensions: for having a continual supply of additional matter, and not duly expended, the part of necessity must be augmented and enlarged. And it is observed by some, that those have the greatest Livers, that are of a colder temperature, and such as are great eaters: of this Cornelius Gemma gives an example of an Old woman that could not forbear eating and drinking scarce a moment but with great trouble and anguish; and being opened after her death, her Liver was found to be wonderfully big.  
Signals declaring the Liver to be obstructed are; a heaviness, fullness, or an obtuse pain in the right Hypochonder; and chief after meat, or exercise; and upon more than ordinary motion, the face is apt to be high-coloured, the hands to look red, and the breath to be short, and they are apt to be feverish upon small occasions; but upon rest and ease commonly they are inclined to be pale.  
Causes from whence these obstructions arise and do depend, are; first, such as remotely dispose; as a plentiful and bad Diet, or a gross feeding upon such meats as are difficult to be digested and distributed (what those are, you will find in the Preservation of Health, etc.) also a thick unwholesome Air, to be without exercise, and to indulge sleep too much; which over-clogs the body, makes a Plethory and fullness, whereby the circulation is retarded, laying the foundation and an aptness for obstructions in general.  
Secondly and more immediately; from a viscidity and grossness of the blood, rendering it influid, slow of motion, and apt to stop in the vessels: and this is generated in the Liver from its distemper, debility and decay of the faculty; or is transmitted from other parts, and brought in from the antecedent causes aforesaid: to which we may add angustness of the vessels in some persons disposing to this inconvenience.  
Obstructions of the Liver are carefully to be looked after and removed; because they introduce many other diseases, as Jaundice, Dropsies, Fevers, Inflammations, scirrhous Tumours, etc.  
Adhesion or Coalescence sometimes is the cause of pain in the right Hypochonder: as when the Liver sticketh to, or groweth together with the Peritonaeum. And this may happen from too much and constant lying on the right side; or by the magnitude of the Liver extending to the Peritonaeum, whether tumified preternaturally, or increased by a natural nutrition and growth.  
Now pain ariseth hence: the Membrane that invests and covers the Liver being very sensible, as all Membranes are; that cleaving to the Peritonaeum is disturbed and strained by motion or shaking of the body; or by lying on the contrary side, the weight of the Liver endeavouring a separation.  
Inflammation sometimes seizeth the Liver, and causeth great pain: and this commonly proceeds from, or is the consequent of obstructions: for the blood being stopped in its current, and overflowing, especially being more hot and fiery, is then apt to inflame the part: and this is manifest to sense, by heat and tension of the right Hypochonder.  
Inflammation is known from other diseases of the Liver, by the vehemency of the Symptoms that attend this more than in other cases; for the pain is greater, the Fever higher, and other Symptoms more fierce and sharp.  
If the Inflammation be upon the superior gibbous part of the Liver, it counterfeits a Pleurisy, and affects the breast much, by short breath and a dry Cough; the Tumour then extending to the Diaphragma, the Vitals are most affected, and pain reacheth up to the Jugulum sometimes: but if it be in the cavous inferior parts, than the Stomach is most sensible thereof, by great thirst, nauseating or vomiting.  
But lest you be mistaken between an Inflammation of the gibbous part of the Liver, and that of the Muscles, you must observe the difference by sight and feeling: that the former hath its extension circular according to the figure of the Liver; but the latter not: besides the former may be perceived to lie deeper; the other a more superficial distension.  
If the Inflammation be in the body or flesh of the Liver, the pain is obtuse and heavy: but if the Membrane investing be the seat of the Inflammation, the pain is more sharp and punging.  
Inflammations are better or worse, as the blood is good or bad; for according to the degrees of pravity and goodness, the Inflammation varies; and therefore a Phlegmon is not so vehement as an Erysipelas.  
Inflammations are very cautiously to be dealt with, both in regard of the present danger, as also for future consequents: for if a right course be not observed in the Cure, although the Patient may escape the acute sickness, and recover; yet he may fall into a Dropsy or Consumption, and that perhaps incurable; the Liver being so decayed and tabefied, as not to be reduced to soundness: hence it is, that after Inflammation, Apostemation so frequently follows, or a scirrhous Tumour.  
If the Inflammation terminate in, or leave an Apostem behind it; if it be deep in the Parenchyma of the Liver, it is more desperate: but if the Apostem or Abscess lies between the flesh and the covering Coat of the Liver, their case is more hopeful: because the matter may be better discharged, and the Liver not in so much danger.  
Concerning the termination of this Phlegmon or Inflammation; either it spends itself and goes off by resolution; or it arrives to maturation; or it ends in a scirrhous hard Tumour. The first is only desired, and that which all Practisers should aim at in the administration and application of Medicines: the two latter are doubtful and dangerous. In the beginning therefore, Discussives and Diaphoretic resolvers are the chief means to oppose this disease; not neglecting to abate Plethory, and to make evacuation, thereby to retract and withdraw fuel from the fire.  
But if the Apostem cannot be discussed, than the best way is to bring it to suppuration as soon as may be, left the part gangrene: and if the faculty of the Liver be strong to digest and beget a laudable white Pus or matter, than there may be hopes of the Patient's recovery; but if it be sordid and stinking, the case is desperate. This matter is evacuated sometimes by stool, and sometimes by Urine; but if it fall into the Abdomen, section must be made to let it out, if Nature cannot discharge it other ways. Natura in statu praeternaturali ab interitu se liberatura saepe mirabiles quaerit vias ac meatus. Moebius.  
The Apostem being thus generated, and arriving to suppuration, it breaks, and then the Scene is changed; for now it becomes an Ulcer, and challengeth that denomination. But an Ulcer is generated sometimes without Inflammation, by sharp eroding humours, which is not so dangerous as the other; because it comes on gradually, the Symptoms milder, and gives more time for the use of means.  
An Apostem likewise is gathering in the Liver sometimes without Inflammation; is not then so painful, nor comes to its height so soon.  
Apostems do not always come to suppuration, but sometimes they grow hard and scirrhous: and such Tumours the Liver, and also the Spleen are subject to.  
These scirrhous Tumours do depend upon impacted matter that will not be discussed; and are the consequents of Inflammations or inveterate obstrictions; procured sometimes by an ill management of their intended Cures, drawing away the thinner matter, and leaving the grosser behind; as by the use of too great dryers and heaters: or by refrigerating and constringing Medicines, do so incrassate the humours as not to be resolved.  
This Scirrhus of the Liver is painful in the beginning before it come to be exquisite and confirmed; but afterwards not: and that which is with pain is more hopeful; the other desperate, because it is in the way to gangrene. Those that are thus affected, lie more easy on their right side than on the left; in regard the weight of the Liver presseth upon the Ventricle, when they are upon the left.  
You are to take notice, that pains of this Scirrhus, and also from other Tumours of the Liver or obstructions, do not always possess the right side, but pain is felt sometimes forward upon the region of the Stomach; for as much as one part of the Liver lies forward upon the Ventricle: hence it is that many are mistaken sometimes, in judging all pains about the region of the Stomach to be pains of the Stomach, when indeed they are seated in the left part of the Liver.  
There is also an Inflation of the Liver, which is a Tumour or extension thereof, from wind and flatulent humours, sometimes in the vessels, and sometimes lodged between the investing Membrane and the Parenchyma.  
This Tumour is not hard, but yields to pressure; the pain from hence is mutable, shifting its place, greater and less, sometimes ceasing, but returning by intervals.  
There are also other causes that have and may produce pains of the Liver; as stones and worms, which have been found upon dissection: but being more rare, and scarce to be discovered but after death, I wave the prosecution thereof, and pass on to the next considerable part.   

Pains of the Reins and Bladder.  
FOR the better understanding of Pains in these parts, and their Causes, we shall first show you the formation of the Kidneys, and their use; afterwards we shall discover the impediments and morbous affects that produce pain.  
The Reins or Kidneys are two, placed one of either side the Spine or Backbone, about the lower short Ribs, the one under some part of the Liver, the other under the Spleen.  
In the structure of the Kidneys, the most observable for our purpose, are the Cavities and Ductures in the Parenchyma or body of them, and the Vessels leading to and from. The substance of the is much like to that of the Heart.  
There are two Cavities in the Kidneys being larger than the rest, into which the smaller Pipes do convey and empty themselves as containing Cisterns: and out of these again there are other small conveyances to transmit and send it forth: there are also certain pervious Caruncles or glandulous substances, through which the Serum is strained; and thus the water is transmitted by percolation.  
The Vessels bringing into the Reins are the emulgent Arteries; and these draw a Serum from the great Trunk of the Aorta Arteria, and import it into the Kidneys (the emulgent Veins from the Vena cava were thought by the Ancients to be for the same purpose; but latter discoveries contradict it▪)  
They also receive from the lacteal Veins the thinner and more watery part of the Chyle, being an expedite and shorter way: hence it is the Urine is pale or whitish, when the Kidneys are not strong enough to give this milky humour the urinary digestion: or when drink is too plentifully poured in, and forcing through before its due time; therefore great Drinkers commonly piss a pale water.  
There are also Nerves inserted into the Kidneys from a branch of the sixth pair, which also serves the Ventricle: hence it is, that the Stomach is drawn into consent, by loss of appetite, nauseating and vomiting, when the Kidneys are pained, as in a fit of the Stone it is manifest. By these Nerves the Kidneys do suffer not only a heaviness, but sometimes very acute pains.  
Vessels carrying the Urine out of the Kidneys, are the ureters; one belonging to each Kidney: and they pass from hence down by the Loins, between the two Membranes of the Peritonaeum, and are inserted into the Bladder, to convey the Urine thither.  
The length of these urinary ductures are about a span; the cavity or hollow like a straw; but capable of enlargement to the bigness of a finger, as by a stone coming down, though with extreme pain, by reason they are membranous and nervous, tightly sensible; and therefore upon any obstruction are highly urged to expulsion, especially by a solid, sharp or rugged body, as stone or gravel.  
Hereby you may understand the office and use of these parts; that is, to drain the body from a superfluous, saline and tartarous serosity; and this aught daily and dully to be performed: but this serosity is not all discharged this way by the Reins, but some passeth off by insensible Transpiration, and some by manifest Sweats, but the greatest part by the Kidneys. And from hence it appears, that the Urine is partly an excrement of the first digestion, in respect of the aquosity drawn from the lacteal Juice; and partly of the second, in respect of the Serum sanguinis exhausted from the blood by the emulgent Arteries. And here you may observe, that by a certain digestion or elaboration in the Kidneys these serosities are transmuted into Urine, and then carries an Odour or scent with it, much different from what it was before: and the like we may observe in other creatures, that their urines have peculiar smells, which argues a digestive transmutation.  
But although Nature intends and endeavours this work constantly; yet there are many casualties and impediments to disturb these parts, and frustrate in some measure the designment of Nature: the errors and failings herein we shall recite; but those chief that are accompanied with, or produce pain we shall discourse of with brevity.  
The general and most frequent Symptoms that manifestly afflict or incommode the Reins are Pain and Weakness, or Tenderness about those parts.  
Diseases planted there, from whence those pains or weakness do arise and depend are, 

Intemperate Heat.  
Imbecility and a declining state.  
Consumptive diminution and wasting.  
Inflammations.  
Scirrhous Tumours.  
Angustness and Obstructions of the Cavities and Ductures.  
Apertion of the Vessels.  
Apostems.  
Ulcers.    
Some there are whose Pains are hot and molesting; not by a natural constitution, but acquired by time and evil customs, or accidents happening to those parts: and this begets a tenderness there, and it is painful to lie on the Back.  
The Urine most frequently is hot, or high-coloured; sometimes sharp, and then apt to make water often: prone to Venery, at least the constitution of those parts does dispose that way.  
Causes introducing this distemper are, too frequent use of Wine, strong Drinks and hot Spices, much Riding, lying on the Back, and soft Beds, or too frequent Venery: and for a correction of this distemper all these procurers and aggravators are sparingly to be used, and some of them to be avoided and forborn.  
But if this intemperate Heat depend upon any other disease seated there, disturbing the office of the Kidneys, and raising a preternatural heat; then Remedies must be applied to that, as the nature thereof does require, which being removed, this heat will allay and cease.  
Imbecility and weakness does sometimes affect the Reins, and a decay in the performance of their office may be perceived; and if this be not the consequent of some manifest disease, debilitating and rendering them incapable, than you must know that  
There is a natural Robor and fortitude implanted in every part by Nature, whereby they execute their functions with integrity and constancy: there is also an inequal distribution of this vigour and strength, that some parts naturally are strong and durable in their stations; others are not so firmly radicated in their principles, but by time spontaneously fall off from their duties, and decay much sooner than other parts of the body. Hence it is that some, though regularly living, complain of this part, others of that.  
There are also occasions, accidents, and different manners of living, which we call Diaetetic customs; which as they are various, do variously injure and decay this or that part of the body, and cause it to decline sooner than the rest. Imbecility therefore of the Reins comes under some of these notions, and hath its original from thence; which when such a case present, examination is to be made, to which of these the case belongs and is to be ascribed.  
Now that which I call Imbecility or a decayed state, is when the Reins do not make a due secretion or separation of the Serum from the blood, and give it the urinary transmutation: so that from hence the Urine is but little, and that not well digested: the injurious consequents whereof are many; for the blood remaining too much diluted, and overcharged with the Serum or watery part; which being distributed throughout the body, and falling upon this or that part, cause many Hydropic diseases, and some of them mortal: as examples hereof might be given.  
The next considerable is, Consumptive wasting, diminution, or lessening of the Kidneys, not by ulceration, but exsiccation; proceeding from a hot and dry distemper of the Kidneys, arriving to a colliquating Hectic, or Tabes; which by time begets a Consumption of the whole Body: procured sometimes from a fallacious temperament.  
There is felt a heaviness and weakness about the Loins, and the Kidneys do not perform their office aright.  
Inflammation sometimes possesseth the Reins: caused by pain of the stone, gravel, or otherwise by obstructions: sometimes by a blow or fall; also by an influx of blood, or any foul corrupt matter transmuted thither and lodged there, obstructing the passages, and causing a suppression of Urine.  
This disease is always accompanied with an acute Fever, great Thirst, astriction of the Belly, heat of Urine, and great pain about the Loins: and if the Arteries be affected, the pain will be with pulsation: Sometimes a Delirium attends, with long watching; and if the Inflammation be in the Membrane, the Patient is scarce able to sit upright, because the pain thereby is exasperated.  
If the right Kidney be affected, pain extends upwards to the Liver and short Ribs, and downwards to the Genitals; also a stupor seizeth the right Thigh by consent; the Nerve being compressed that passeth thence down to the Thigh. But if the left Kidney be the part affected, that side is most grieved, and in like manner: but if both the Kidneys be attacked, than the Symptoms on both sides are equal.  
The termination of these Inflammations are either by an Apostem or Abscess; by induration and a scirrhous hardness; or by Transpiration and resolution: which last is the only safe and secure way, and this the Physician ought to design for, and aim at in his administrations.  
But if contrary to his endeavours, the Inflammation apostemates, suppurates, and breaks, evacuating the purulent matter by the ureters into the Bladder, there is good hopes of safety; but if it be discharged inwards by the emulgent Veins, the case is desperate.  
Scirrhous Tumours in the next place come to be viewed; and these are hard Tumours very difficult to be removed: being the relict of an Inflammation or other Tumour preceding, and not well cured: or form by gross matter congested and accumulated there, causing contumacious obstructions: for humoral matter flowing thither, and being obstructed in the transition, the heat of the part does exsiccate and harden it by time more and more; and then by accumulation and addition forms a Tumour.  
This causeth heaviness about the Loins, but little pain: the Urine is but little also, and that pale and watery, in regard the office of the Kidneys is debilitated, and by reason of the angustness of the passages, letting pass the thinner, but retaining the thicker part of the Urine.  
The longer this Tumour continues, the more difficult and incurable it becomes; and withal, it brings on hydropic Cachexies: for the superfluous serosity not being drained away, regurgitates back into the body.  
The Cure is to be set upon with internal and external Medicines: Aperitives, Resolvents, Discussives and Emollients.  
Apertion of the Vessels, contrary to Nature, sometimes does threaten danger, by the appearance of blood staining the Urine: and this proceeds from a weakness of the Vessels, being relaxed in their retentive faculty; or by a plenitude and fullness of blood; or because the blood is thin and sharp, which causeth the mouths of the Vessels to open.  
On the contrary; Angustness or straitness sometimes does incommode the Vessels appertaining to the Reins, which hinders the free ransmission of the Urine.  
Now this angustness of the Vessels does arise either by compression from some Tumour, or distended part that presseth upon the Vessels and straitens them from without:  
Or by contraction or constriction of the Vessels that are shrunk; as by great heat in long Fevers, or a Tabes that seizeth the Kidneys:  
Or lastly, by obstruction within from some viscous matter, grumous or clotted blood, sand, gravel, stone, etc.  
The Sign declaring these obstructions, is a suppression of Urine with pain; or an abatement of the usual quantity, not answerable to the drink received. The place or part affected, whether in the Kidneys or ureters, is known by the seat of pain.  
The causes that obstruct are known by their proper signals, and by examining into the preceding state of the Patient.  
The place or part grieved with these obstructions, whether in the Kidneys or ureters, pain discovers, and the dislodging or shifting thereof.  
Of all the obstructions that infest the Kidneys, the most frequent and saddest complaint is from the Stone; this being the most contumacious obstruction, the most painful, being a hard solid body, and the most uncertain Remedies for relief.  
Concerning the generation of these Stones, there have been various Opinions amongst Learned men: in short, the difference and contest hereupon may be reduced to these two Heads; what the material cause of the Stone is, and what the efficient.  
For the material cause, or matter whereof the Stone is bred; Galen and most of his Disciples will have it to be, a phlegmatic, gross, or viscous humour apt for condensation and induration: and the efficient to be heat exsiccating this matter, and bringing it to a stony hardness; but others of them will have this to proceed from cold, by way of congelation.  
But this Doctrine cannot hold as rational, nor does it answer experience: as for the matter we cannot allow it to be such; for as much as many that abound with a viscous tough Phlegm and slimy matter, as most ancient people do, yet many of them are never trouble with stone or gravel. And for a concurrence of both the causes, material and efficient, we have examples of the Aged, who are most cold and phlegmatic; and for abounding heat with the like matter, we may produce Fevers; yet no stony concretion or signs thereof to be found from such sicknesses: So that we are now to seek for other causes both material and efficient, whereon to ground our endeavours for the relief of such as are afflicted with this disease.  
The matter therefore and substance of the Stone, is from a tartarous and saline succus, with the addition of a terrestrial feculency, concreted or petrified by a lapidifactory Spirit or disposition of the Reins, which is the efficient and seminal being of that production.  
The concurrence of both these causes does much produce the Stone, and afflict the Patient in a high degree: but one of them is sufficient, viz. this petrifying power of the Reins, to coagulate any laudable good matter imported there, into a stony substance: To confirm this, Fernelius relates upon his own knowledge of one that for three or four months together, above a dozen small stones came from him every day; all which time notwithstanding, he eat nothing but Broths and Panadoes, being confined to his Bed by weakness and pain.  
But allowing this to be true from the credit of the Author; yet we must own and acknowledge, that besides this principal cause of a petrifying Spirit in the Reins, there are also antecedent and procatarctic causes adjuvant and promoting; as some sorts of meats and drinks, and other errors in the Diaetetics, that increase and set forward this disease, which otherwise might be much slower in generation, nor yet arrive to so high a degree of torture: also the Stomach, Spleen or Liver not performing their functions rightly, may contribute matter to the promotion hereof.  
For relief of the diseased in this case, there are two grand intentions to be prosecuted, and aimed at: a dissolution of the body of the stone already generated; and secondly, the taking away of the petrifying disposition of the Reins, and abolition of that coagulating ferment: and for these purposes were Paracelsus his Ludus and Aroph; also the Alkahest cannot fail herein.  
But such as have not acquired the great Arcana's, and cannot procure a dissolvent for the Stone, that is, to make an Analysis or resolution of it into a liquid juice, and reduce it back again to its humoral flowing state, capable of abstersion and cleansing out, must endeavour to facilitate the exclusion of this hard body, by the best and most hopeful means for that purpose, by lubrifying, relaxing, and dilating the passages, and assuaging the Spasm and contraction of the ureters, that the stone may slide away much sooner, and with less pain: hence by way of caution observe, That Diuretics and provokers to expulsion are not to be given, before this preparation be made, else you precipitate the Patient into danger, and increase his torment, dislodging and forcing the stone through angust and very tender cavities, not provided to give passage without detriment to this unwelcome stranger.  
And thus much briefly concerning petrifaction, or the production of Stones in the Kidneys; I proceed on to the next, a most difficued and painful disease belonging to this Member, namely Ulcers.  
Ulcers of the Kidneys are introduced several ways, or take their rise from several causes.  

1. Acrimony and sharpness of humour passing this way, and continuing long, does excoriate; which not timely observed and remedied (because pains at first are but small) does corrode farther, eat into the flesh, and plants an Ulcer.  
2. The Kidneys are ulceratedsometimes from an Inflammation or other Apostem there, coming to suppuration and breaking, which dischargeth the matter by Urine, or otherwise, but leaves a putrid Ulcer behind.  
3. Sometimes from a clot of blood extravasated or out of its place putrifying, does infect the part, tabifie and ulcerate; and not to be neglected, lest this be the consequent.  
4. Sometimes a Stone, being rough, angular or sharp, frets or grates upon the parts, and makes a solution of continuity, which at first sends forth a bloody Urine, afterwards purulent and begets an Ulcer: and this last is the most frequent cause that generates Ulcers in the Kidneys.   
These Ulcers are discovered by pain about the Loins, a purulent Urine, and sometimes Caruncles or small fleshy rags, or strings of concreted blood is brought forth with the Urine, accompanied commonly with heat in the Back, and sometimes faint Sweats, which continuing, bring on a Consumption and Hectic Fever.  
Of these Ulcers some are more sordid, foul and stinking, as the Urine does declare: others not ill scented, the Pus white, not viscous, but cloudy and light.  
The difficulty of these Cures lies here; for that the Urine which is acrid flowing always by the Ulcer, hinders the consolidation of the part: besides, the situation being remote, the virtue of a Medicine is much altered before it arrive to the part: but in the designment and managing of these Cures, the body must be well cleansed, not with the common deleterious Purgers, but balsamic Detersives; and so kept with a proper Diaetetic regimen, as no impurity or sharp humours disturb or abate the power or Medicines, which must be truly balsamic and healing.  
The experience of these Ulcers I have had several times, both many years since and lately. I remember in the year 1652. I cured an Ulcer of the Kidneys in a man about thirty years of age, living near Sheffield in Yorkshire, who came to me four miles twice a week during his Cure; I being then for a while at Norton upon the edge of Derbyshire. His Urine was hot, sharp, and stinking, with a great purulent sediment; a great pain in his Back, with scorching heat, and often flushing faint Sweats all over his Body. Indeed I have wondered since how I did perform such a difficult Cure then, having so little practical knowledge, I being but a Tyro in this Art, it being in the first year of my Practice, and newly graduated Bachelor in Physic: but Providence had appointed me the instrument to free this poor man out of his pain and languishing condition. Since I have been acquainted with several of the like cases, and may with better assurance promise a Cure, from tried Medicines acquired by experience, beyond what Book-practice does communicate: and this last year here in London, I cured a Gentlewoman of an Ulcer in the Kidneys.  
In the next place we are to take notice of Pains belonging to the Bladder.  
The Bladder is the last receptacle for the Urine, and performs the office of a Cistern to the Body, for keeping and discharging the Urine at convenient times; and therefore is capable of distension and contraction, being a membranous bag, furnished with right, transverse, and obliqne Fibres for that purpose: and hath two Muscles at the neck of it, to let go or retain the Urine.  
This part is liable to great grievances and painful infirmities: as Distension, Obstructions, Inflammation, Excrescences, Ulcers, scirrhous hardness. From hence come suppressions of Urine, imminution or small quantity, ardour or heat of Urine, Strangury or dolorous emission and dropping, incontinency of Urine or difficulty of retaining it.  
Distension of the Bladder happens from too long retaining of the Urine, whether it be voluntary or involuntary: so that afterwards the Fibres do not recover again the power of contracting the Bladder: and this may prove of dangerous consequence, and to some it hath proved mortal.  
Obstructions of the Bladder, causing a suppression of Urine, or diminution, dolorous or difficult excretion, does arise from many causes: as a stone in the Bladder or gravel, coagulated blood, worms, a viscous humour or purulent matter, a Caruncle or Tumour in the neck of the Bladder: or by compression from a tumified part adjacent; as the Womb or right Intestine.  
Inflammation sometimes happens from extremity of pain by the Stone, Ulcer, or other torturing cause; and these Inflammations are commonly mortal.  
Ulcers do possess the Bladder sometimes, and most commonly in the neck thereof, caused by a stone or gravel excoriating and wounding the part: or by an eroding purulent matter coming from other parts, and lodged there; or by a continued Acrimony and sharpness of Urine corroding: sometimes from an Inflammation or Abscess: more rarely, but it hath happened sometimes, from a Gonorrhoea ill cured; and I may say very ill indeed; for the Ulcer thus procured, is of far greater difficulty and danger than the Gonorrhoea.  
Not long since an Ulcer of the Bladder was committed to my care, being the relict of a Gonorrhoea ill managed by a Chirurgeon, using Restringents unseasonably.  
Ulcers in the meatus Penis, as also in the Prostates, are more frequently offered to our help: as lately another person applying to me having an Ulcer procured in the Prostates, from the like improper and pernicious course: and although Gonorrhoea's are frequently cured, and may with much certainty and safety in skilful hands; yet there are many that patch up a seeming Cure for the present, but future consequents are sad mementoes of their Undertakers folly. And at this time I have a Patient, repenting that ever he committed himself into the hands of a practising Apothecary; for he by stopping his Gonorrhoea before the virulency was eradicated (which I judge was done by astringent Medicines) the Patient was forced to leave his Undertaker, and came to me in a painful and dangerous condition; one of the Testicles being inflamed, hard, and swelled as big as a Turkyegg.  
By such miscarriages some have been quite lost; others have been perplexed and almost ruined afterwards with difficult and very chargeable Cures: as not long ago, a Gentleman came to me, who had spent above five hundred pounds, having been under several Physicians and Surgeons of good repute, for some years; being reduced to such a difficult state, from the imprudence of his first Undertaker.  
Ulcers in the Bladder are known by pain about the Os pubis and bottom of the Belly; a strong or stinking Urine, if the Ulcer be fordid; a purulent or furfuraceous matter floating; a hot or sharp Urine, which causeth a painful discharge thereof, and sometimes with difficulty, if any excrescence or viscous matter obstruct the passage.  
These Ulcers have been accounted incurable by our Predecessors; but this Age hath given testimony of their curability; and myself have had good success in these undertake to the relief of some thus affected, and great satisfaction to myself.  
Verruca's, Caruncles, or fleshy Excrescences do infest the neck of the Bladder; and sometimes the Vrethra or urinary ducture; and these commonly are the products of a preceding Ulcer or Gonorrhoea, and sometimes conjoined therewith.  
And now we have briefly declared and run through the several pains that belong to the Kidneys and Bladder, remarking the diseases whereto they belong, and from whence they do arise: it remains in the last place, that we set down the principal morbous affects, discovered or intimated by the Urine.  
Capital Symptoms that attend the Urine, denoting some diseases or infirmity considerable, in the parts that belong to this urinary office, are chief these: a bloody Urine, sand or gravelly, oily or greasy, purulent or furfuraceous: too much Urine, or too little, a painful suppression, or emission: a white water, red or black: stinking, or strong-scented: hot or sharp.  
And thus having traced through the Head, Breast and Belly, examining the most frequent and remarkable pains thereof; it remains that we inquire into those pains that possess the Limbs, as Legs and Arms, of which in the following Paragraph.   

Gout-pains and Rheumatism.  
IN this our Catalogue of Pains, We must not forget to insert Arthritic or Gout-pain, being so eminent a Tormentor, so contumacious and resisting, that oftentimes it hath bid defiance to the potent means of the most reputed Physicians; hereby gaining the name with many, and accounted amongst the number of incurable Diseases: from hence the endeavours of the most are rather to palliate than to cure, as having no hope to effect so great a work.  
I must confess that mitigation and allay of pain is very acceptable to the tortured Patient, and not without a deserved praise to the Physician; but to acquiesce and rest here as the ne plus ultrà, is too inferior a station, and below the dignity of his function: we will therefore make a farther inquiry into the nature and difficulty of this contumacious Malady, thus posted; possibly thereby to meet with some encouragement, and to find out a way conducting us to such advantageous approaches, as may dispossess and subdue this grand enemy.  
Arthritis the Gout, is so denominated from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Articulus the Joint, and is the generical word comprising several particular species thereof, having their distinguishing names from the part affected: as Podagra the Foot-gout, Gonagra the Knee-gout, and Chiragra the Hand-gout: but Rheumatism takes denomination from motion or fluxion; Rheumatismus, fluxio, from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fluo; this kind of Gout not fixing here or there, but moving from part to part, is therefore called the running Gout.  
I shall treat of these several Gouts together, because of their affinity with each other in their continent cause, and differing only as to the sedes morbi, which may cause some variation in practice, but not much.  
Concerning the continent cause of the Gout, there are various Opinions; some determine it a sanguine humour, others phlegmatic; some a choleric, others melancholy, and some a mixture of these humours. Hippoc. lib. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, will have the Gout to arise from Choler and Phlegm; Galen de comp. medic. says, the humour is sometimes sanguine, but for the most part phlegmatic, or Phlegm and Choler mixed. Trallianus also an ancient Greek Author lib. 11. derives the Gout from Blood, Choler, Phlegm and Melancholy; farther affirming, that if the several kinds of the Gout, arising from the different mixture of these humours were rightly known, this disease were easy to be cured.  
Thus from the difference of opinions and mistakes concerning the Gout, the designment of Cure, and means adapted thereto have been various, and also frastraneous: other improbable opinions there are, but I wave the recital? of them, and come to set down what is most consonant with reason, established upon latter and clearer discoveries.  
And here I must premise a few things as introductory, but necessarily serving to our present purpose.  
Food which sustains and repairs the body is meat and drink; of meats some are liquid, others solid: but the solid and drier meats coming into the stomach, are macerated, liquefied and transmuted (by the digestive power thereof, and assistance of ingested liquors) is changed into a liquid juice called Chyle: this Chyle being exported out of the stomach, receives several alterations afterwards in the various parts through which it passeth, and is become a milky juice in the Venae lacteae, blood in the Veins and Arteries, water in the Lymphae-ductus, and a spirituous exalted Succus in the Nerves; and all these for various uses and purposes; but still keeping in a liquid form, and flowing in the Vessels containing. And to prevent stagnation or stoppage of their motion in the several small Pipes of conveyance through the body; hence it is that all the humours or juices of the body, do participate much of water, or a thin watery and fluctuating substance called Serum, by some Lympha, by Helmont Latex: which being thus appointed for a distribution of the Chyle and Blood; hence it is that Hypocrates fitly calls it 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, Vehiculum nutrimenti.  
This Serosity or watery part abounding, is not easily contained in the Vessels or Conduit-pipes, especially being depraved, become sharp and penetrating with a Tartarous saltness; but either by apertion or exsudation is let put; and where it takes its course, discharging itself upon some tender part, there pain and trouble ariseth.  
Thus the Gout takes its beginning from an acrid or sharp saline serosity, invading the Ligaments, Membranes and nervous parts about the Joints, lancinating those tender and very sensible parts.  
But how this Serum comes to abound, and how to be depraved, is worth our inquiry; for from hence is the designment of Cure grounded, to prevent and take off both the one and the other. So long as it remains in its due state for quantity and quality, it is very necessary and useful to the body; but when it degenerates or is redundant, it raiseth disturbance variously, according to the parts it does infest: hence Catarrhs or distillation of Rheums into the Eyes, causing them to be sore, hot and inflamed; sometimes upon the Lungs, causing vehement Coughs and shortness of breath: from hence punctures, stitches or sharp pricking pains in divers parts of the body; headaches, Tooth-aches, spurious Pleurisies, Rheumatisms, Arthritic or Gout-pains.  
Now this serosity does abound, either from a deficiency of the digestions, and transmutation of alimentary matter received: or from a deficiency of secretion or, discharge of it by those Emunctories appointed for that purpose; for as there is a continual supply by eating and drinking, so there aught; to be a proportionable discharge.  
First, From a defect of digestion in the Chyle and blood, when they do not attain that complete state as Nature hath required; but receive only a crude and imperfect transmutation: and this sometimes procured from an injurious sort of meats and drinks, or offending in quantity; as much Fruits, small Beer, Water, etc.  
Secondly, From an insufficient discharge, and for want of due evacuation, this Serum does abound and become superfluous: that is, when the parts destined by Nature to separate, attract and transmit this serosity of the Chyle and blood, do not perform their office duly; as when the Lymphducts, Spleen or Reins are deficient in their functions; also when the Pores are occluded, and Transpiration hindered, these occasion the overflowing and abounding of this serosity, having not its right conveyance, due vent, and discharge.  
This Latex or Serum rarely continues in a solitary state of redundance, but also is then soon vitiated and becomes depraved: for as our meats and drinks are endowed with a Tartarous and saline principle; so this Serum is impregnated therewith, and abounding variously as the food received contains variety of Salts; which discover themselves and appear more or less, according to the strength or debility of the digestive power of fermentation, being able to subdue and subject them to the service of the body; or otherwise to suffer them to be exalted in their peculiar natures: and then as they are more sharp or milder, so is the pain and disturbance from them greater or less.  
But how this saline serosity does discharge itself upon the Joints, and affect them with pain, is (by the consent of Authors) from a laxity or imbecility of articulation, or promptness of the Joints to receive: but this reason I cannot close with, since a more probable and rational may be given, which is from the formation and conformation of parts, as thus: That when the Serum sanguinis this serosity does effervescere and ebullire, estuate and grow turgid in the great Vessels of the Veins and Arteries, afterwards in the smaller Vessels; than it comes into their branches, and so to the extremities and terminations of them; which terminations (most of them) are placed in the Joints, where they do effundere, discharge and let out this hostile injurious Serum, and therewith torment the Joints, causing sharp lancinating Pains, Inflammation and Tumour of the part, etc. such Symptoms as attend the Gout.  
As the Gout makes its progress from one state to another; so the Symptoms supervening do vary and appear gradually, as the disease arrives to its height and fierceness. First, the part affected is more tender and sensible than usually, also less active and vigorous in motion: and before a fit of the Gout oftentimes a general indisposition or febrile heat disturbs the Patient; the blood then fermenting for a purification, casts off this morbific tartarous serosity upon the Joints. The part thus affected most commonly is tumefied, and sometimes inflamed, pains increase and grow very sharp, and in some by time and continuance of this disease a tophous hardness or Nodes seize the part as the relics and insignal characters thereof.  
Some have the Symptoms of the Gout in a remiss degree, only at changes of the weather and seasons of the year, and are not confined to the house by a considerable seizure and great pain, but can walk abroad, although with some complaints and indisposition: others are attacked more violently, and so disabled, that they are laid up and deprived of their liberty.  
To some the Gout is hereditary, derived from their parents in the principles of their Nature, and will show itself, although they be of a strict and regular life: to others it is adventitious, arising from the procuring causes of this disease in the course of their life; by intemperate and inordinate, or incongruous way of living in the Diaetetics, unsuitable and unfit for their condition of body.  
For Cure of this Disease, these aims, are to be intended and prosecuted.  
First, That this saline acid humour be prevented and stopped in the fountain or spring, the parts mandant from whence it does arise, that a future supply may not be generated.  
Secondly, What is already produced, may be mortified, abstersed and evacuated out of the body.  
Thirdly, That the parts recipient, invaded and debilitated, may be eased, restored and roborated.  
The first intention is performed by such means as rectify and fortify the digestions, whereby their elaborations and transmutations of aliment received may be pure in their proper natures and free from any degenerate mixture: and here both good Aliment and good Medicament is required: for election of meats and drinks, and other Diaetetic rules necessary for gouty persons to observe, consult that Book called, The Preservation of Health, etc. where at large you are advised, and too much to insert here. For Medicament, gentle Vomits are profitable, both for cleansing and removing of the fundamental matter; as also for a revulsion from the part affected, and retarding the current thither: but where that operation is not convenient, then keep the stomach clean with a good Purgative downwards: the best Shopmedicines for this purpose is Pil. stomac. and Aloephangin. also Syr. de spina cervin. and Elixir propriet. in the intervals.  
The second designment, is attained by Alcalyes, whose properties are to correct and kill all acidities and corrosive sharpness: and these are the Salts of Vegetables made by Calcination: and next to these are Absorbents that imbibe and tame acids, being alkalisate or affine to Alkalies: as Oculi cancror. Coral. Chelae canc. cran. human, corn. cer. ust. margarit. sacchar. Saturni. etc. But besides these, Cathartics, Diaphoretics, and Diuretics are to be used in due order; whereby the tartarous matter residing or fluctuating in any part of the body may be sent forth several ways.  
To perform the work of Purgation you may use Arcanum corallinum and Pilulae Antimoniales prepared to work only downwards, which are of the better sort of Medicines made public: in my own Practice I use Pil. Arthriticae nostr. which seldom fail my expectation; being seconded by some other Medicines in their due place.  
After Purgation promote Transpiration, for this does much abate and scatter the superfluous serosity, driving it à centro ad circumferentiam, and transmitting it by the Pores; and may be done with ♁ diaphoret. or with decoct. rad. bardan. sassaphras, chinae, sarsaparillae, card. benedict.  
Also Evacuation by Urine is of great advantage to spend and drain the acrid Serum that way: and to set forward this operation, use Sal succin. or the Mercurial liquor that separates from the Oil and Salt after distillation: also Sal volat. urinae & viper. are profitable.  
To effect the third intention? Topical Medicines to assuage pain, to discuss and roborate, are useful and necessary to relieve the part affected.  
For allaying pain in time of extremity, this Anodyne Cataplasm hath been used, and commended for successful: Rad. lilior. alb. althaeae ana ℥ two. fol. parietar. hyoscyam. ana M. j Coq. lact. vaccin. q. s. in mucilaginem, addend. micae panis alb. ℥ two. pulpae cassiae ℥ j croci pull. ʒ ss. ol. rosar. q. s. fiat Cataplasma, s. a. This Medicine is well designed and congruous in all its parts; and like unto this several others for the same purpose may be form, and which will perform the intended effect: yet they cause a relaxness, and leave the part weak and tender: Unguents and Liniments upon the same account are cautiously to be used: but Lixiviums to foment the part affected, are profitable to assuage, discuss, and roborate.  
But they that will take a little pains to procure a good Medicine, let them unite Sal volat. urinae cum spir. vin. rectificat. by digestion and circulation, in which if you dissolve a little Camphire, you have then an excellent Topic Remedy both curative and prophylactic, with which you are to foment the part every day.  
Or if you will make a Cataplasm cum mica panis alb. macerated in spir. vin. addend. croci parum, you have then a safe and good Medicine.  
Some do adventure to use Restringents, Repellers and Coolers, to drive back the humour flowing; and they are made of Bol. armen. sang. dracon. malicor. album. ovor. acetum, and such like; but this is hazardous and dangerous to give the morbific humour a sudden check, which may return upon some noble part; therefore I advise against such attempts, being not rational, and experience hath confirmed their fetal events.  
For a Prophylactic-Remedy, or by way of prevention, to keep off the returns of the Gout, Spigelius commends this Medicine, and calls it his Podagrical Antidote.  
R. Troch. de viper. fol. centaur. min. chamaepith. beton. ana ℥ j chamaedr. ℥ two. rad. gentian. aristoloch. rotund, poeon. bardan. ana ℥ j baccar. lauri, myrrhae, rhabarb. elect. spic. nard. ana ℥ ss. caryophyl. ʒ two. in pulverem redacta, serventur in vitro, vel cum melle despumato misceantur.  
Of the Powder he appoints a scruple for a Dose, of the Electuary a dram; and a draught of warm water to be drunk after it. The Medicine is good; but warm water to be taken after, I cannot so well comply with that. For my own Patients, I give an Extract designed for this purpose, and sometimes a Diet-drink, which strengthens the digestions, and prevents the saline serosity from generation, and are preservatives of value to those that have experienced them.  
Now as concerning the curability and incurability of the Gout, we will make some inquiriy into this matter, because 'tis acknowledged by all to be of difficult Cure; and by many 'tis accounted an incurable disease: this opinion being fixed in the minds of most people so afflicted, and despairing of help, at least of a Cure, they provide only to abide the pain, and resolve to be contented with their condition, as thinking there is no other remedy but patience, because they see few or none cured.  
But I cannot consent with this opinion, that the Gout is an incurable disease, knowing the contrary by experience; although I must confess, such Cures are rarely performed: and the reason why; not so much from the impossibility of the thing to be done, as from the intractability of the persons to be governed and ruled, and the circumstances under which some persons lie.  
For the younger sort being the most curable, or in the best capacity for it; they will not be confined to such Methods, Rules, and abstinence for such a time as is requisite for this Cure; but indulge themselves in the liberty of their enjoyments, and pleasures of sense, doing those things which are very opposite and injurious to their condition of body; whereby they set on and procure the returns of this disease, notwithstanding some former good means used, hath taken good effect, and checked the obstinacy of this Malady with hopes of prevailing.  
For the old and feeble sort, they have not that assistance of Nature to cooperate with the means; besides, the continuance and long impressions of this disease, habitually indisposing, perverting, and enfeebling the parts affected, both mandant and recipient; which makes the perfect restauration of such, of much greater difficulty, and very rarely effected.  
To these we may add, that for the most part, the Gout takes up its quarters with the rich and those that live plentifully, having all things for pleasure, ease and delight.  
Dormit & in pluma purpureóque thoro: and the people thus stated cannot, at least they will not restrain their appetites or cross their inclinations, and be observant of, and obedient to the Rules required; abstaining from the things they love and delight in; but on the contrary, do gratify their senses, although they suffer for it afterwards: and finding the disease not to be mortal, they choose rather to undergo pain for a time, than deny themselves the pleasures of their life as they account: and therefore it is, that the poor are seldom troubled with the Gout, because they far hardly, and labour much, both which are great enemies to and opposers of the Gout, giving no place for reception thereof, or long abode at least, if it chance to lodge there: hence this disease was called by some 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉.  
Thus you see, and more at large might be amplified; how the Gout becomes so triumphant and invincible, having gained the character of Opprobrium Medicorum, as able to baffle all the designs of Physicians and their Remedies.  
But amongst the vain Opinions that are raised concerning the Gout; this is not the least that alienates the minds of most people from their reason, and checks their endeavours for help: viz. that it is dangerous to tamper or provoke this Lion, because some have miscarried, and died by trying with uncertain means and hazardous Medicines; who otherwise probably might have lived a long time, the disease commonly not being mortal, but a linger and torturing sickness. And farther, it was related to me, that a great person in this Kingdom, a few years since (now dead) being often and much afflicted with the Gout, his Physicians told him, that the Gout kept him alive; and if he were cured thereof, he would die soon after.  
To obviate these objections I answer, and part hereof I grant, that some have died by their endeavours for Cure; and this not so strange, for the like may be said in all other diseases, that some have died by their Physicians, or such as they entrusted as Physicians, and not solely or chief by their disease: Examples we have had in the most, if not all diseases, the most curable and facile to be dealt with: so that by unskilful men, improper courses or designments, and by bad Medicines, or casualties happening by the Patient's folly or their Tenders, many have died in the prime and strength of their age, by endeavouring for Cure in Diseases not mortal nor of sudden danger in their own Nature, and amongst those the Gout may be reckoned: So that if you will plead for no Physic, no tampering (as you call it) with the Gout, by the same argument you may abandon Physic in all other sicknesses; for the adventure is equal, and the security depends only upon the judgement and ability of the Physician, and no more hazard in this disease than in another. I say therefore, in case of the Gout, as also in all other diseases, if you will securely proceed; take a knowing man well grounded in the Theory, and through paced in the Practice of this Art; Having a frequent experience in the progress and Cure of Diseases, and a critical Observator of the Gout in particular; this man you may as freely trust, and safely yield obedience to in managing a Cure for the Gout, as you can do to other Physicians, in all cases whatsoever.  
Now as for those Physicians (if there be any such so ignorant or fallacious) that allege the Gout to be any way a Preservative of Life, and pretend not to cure it for that cause, I must tell them plainly; first, that this is only a pretence to palliate their inability, and a crafty evasion to shift off the censure that may fall upon them, for not curing what they ought, and would willingly do if they could.  
Secondly, To show the pretence is erroneous and void of truth; we will search the Gout and see if there be any thing in it, or appertaining to it, that is a Preservative of man's life, or conducing to his health and a sound state of being.  
In the Gout there is no pleasure nor recreation either of Mind or Body; both which are promoters of Health, and consequently prolongers of Life: but on the contrary, the Gout is attended with a sedentary inactive confinement, melancholy, pain, watching, and unseasonable sleep, (the consequents and effects of which are debility ot all the faculties and enervation of strength) which as these continue longer or more violent, and return more frequently and often, by so much more is the Patient damnified, both for the present and the future, and rendered more infirm and liable to the decays of Nature.  
But perhaps you will say, this serosity and sharp punging humour, falling into an ignoble part, and far off from the Vitals, is much better and safer there than to wander up and down the body which (as it hath happened sometimes) may invade a principal part, and there threaten or cause death: therefore so long as this humour hath a recourse to the Joints, and is not turned off from that current, the Patient is not in such great danger as otherwise.  
To this I reply, That true it is, if there were a necessity that this Tartarous gouty humour must invade one part or other; better it is that it passeth a safer way, and lodgeth in an ignoble and remote part; and better it is that the Physician does nothing than do hurt, or run a hazardous course. If he cannot eradicate this morbific matter, stop the spring and fountain from whence it does arise, and where it is generated: or this being too hard and difficult a work, if he cannot derive the stream and issue thereof to the vents and outlets that Nature hath appointed and framed for a discharge of superfluous and degenerate humours, but lets them have their course (because not mortal) to the constant trouble and damage of this or that part in particular, and consequently makes the whole to suffer sympathically and by consent: such a Physician either hath not a true notion of this disease the Gout, or else he wants commanding Medicines elaborated by his own hands, exquisite and effectual to answer the indications that this disease and causes thereof will put him upon for relief of the Patient: but to pretend that this disease must not be cured, because it spends or employs the humour in a safe way (so called) is much what alike (but very unlike a good Physician) as to suffer a man to continue languishing in a Looseness or Vomiting, because it dischargeth some peccant stimulating matter: but in this case, as also in that of the Gout, the extravagancy and irritation of noxious humours are to be checked, collected and sent forth by good Medicines, in a placid gentle way, through convenient ductures and outlets, and not let to continue in a detrimental extravagant course.  
Now concerning the curability and incurability of the Gout, I do own that some are much more capable of Cure than others, by the nature and condition of their bodies: and some are not curable, as age and other cirumstances have reduced them to an incurable state: yet I say, in the worst of cases there are mitigations and helps, that check and tame the fierceness of the disease, render it more tolerable and easy: and such Prophylactics or Preventives there are (with a due Regimen of life) that will keep off the frequency, and retard the returns of this painful Malady.  
Thus much concerning the Gout fixed, or constant to a part: it remains that I deliver my thoughts and experience touching the Rheumatism or running Gout, so called; because it shifts from part to part, invading not only the Joints, but also the membranosum Genus, the Membranes both of the Muscles, Viscera, and Bones.  
Hence it is, that sometimes these pains are external in the Muscles and habit of the Body: sometimes internal, when the Viscera are assaulted; as the Lungs, Liver, Intestines, Spleen, etc. sometimes these pains affect the Bones, by pricking the Periosteum, that Membrane which covers and enwraps the bone.  
Some complain of their Arms, others of their Shoulderblades; some the Bach, others or at other times the Breast; sometimes the Thighs, and sometimes the Legs; the humour shifting and moving from one place to another: and this upon changes of the weather, turning of the wind, and seasons of the year; these pains do go and come, afflicting more or less: and yet no swelling, Inflammation, or outward appearance upon the part grieved.  
These pains continuing, or frequently infesting, do debilitate and disable the parts affected; insomuch that some go very weakly, others use their arms but with little strength, and some the use of their Limbs almost taken away.  
The material and continent cause of these fugitive and vagrant pains, is the same or of the same nature with the former Arthritis or Joynt-Gout: viz. a tartarous or sharp penetrating serosity that molests these several parts: and to confirm that this is a serous or watery humour; it makes no Tumour, nor suppurates, which were it of another kind it would: besides, the mobility and fluctuating nature thereof, argues it to be of that kind: and farther à juvantibus we may most rationally conclude so; Transpiration and copious emission of Urine, and also Purgation that evacuates serous humours, gives allay and sedation to these fleeting pains.  
But why this should be so movable, and changing its place, the other fixed or constant to a part, since one and the same humoral matter is the cause of both; the reason hereof may be this: from abundance of the humour, and for want of vent; one way not being sufficient to receive and spend it, Nature is necessitated to find out and break through several ways; that is, by forcing the anastomosis, and opening the terminations of the Veins, spewing forth this punging irritating humour into several parts: and being an unwelcome guest, hostile and troublesome, the Archaeus or vital principle defending its Territories (quoad posse) and unwilling to give it harbour, transmits' it from place to place.  
This Rheumatism and erratic pains depending upon the same humoral cause with the Gout, will require much what the same method and Medicines for Cure: as also such Prophylactics that are proper and fit by way of prevention for the other, may here be used with the like advantage; and therefore it is not needful to point out a particular methodus medendi, or peculiar Medicines: only the Topical Medicines are not of such use here as in the Joint- Gout.  
And now I have gone through and briefly inquired into the most, and most considerable pains incident to several and principal parts of man's Body: it remains now (as is proposed and promised in the front of this Work) that I proceed on to the next Stage; viz. Inflammations, and there observe what is most remarkable, and most profitable to be taken notice of.   

Inflammations internal.  
BY the common order of causation, Pain precedes, Inflammation follows. To illustrate and set forth the nature of Inflammations more evidently, and to avoid confusion and intanglement in our Discourse, we shall distribute our matter, and place it distinctly under these following Heads.  
First, What the word imports, and congruous signification with the nature thereof.  
Secondly, What Parts of the Body Inflammations do usually possess.  
Thirdly, The occasional Matter that provokes and sets forward these Inflammations.  
Fourthly, How they arise, and from what Principle or Efficient they are caused.  
Fifthly, The Use and Practice that ariseth naturally from the preceding Doctrine.  
The word Inflammatio used in the Latin, in the Greek is 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro, to burn or inflame: in both Languages signifying some extraordinary and preternatural heat kindled and begun in some part of the Body: and in the common acceptation of a Phlegmon or Inflammation, is understood thereby a hot Tumour arising from blood.  
But although Inflammations are reckoned among the Tumours, and so accounted by most Practisers: yet I must take leave to divide Inflammations from Tumours, and distinguish them apart, as properly so; for commonly they are separate, although oftentimes conjunct: and the denomination was given à calore, not à tumore.  
Bianca▪ Inflammation therefore I understand here only a preternatural or extraordinary heat begun in any part, (as the Etymon of the word imports) before a Tumour be raised; but by time and continuance Inflammation or great heat does attract matter and forms a Tumour, and then Inflammation and Tumour are coupled or complicated together: for as we plainly find external parts to burn or feel very hot, and to look red; you say then, the part is inflamed, although no Tumour or swelling appear; so is it internally, the part is fiery, hot or inflamed, before a fluxion of blood arrive thither to throng the part and raise a Tumour; so that there are Inflammations without Tumours, and Inflammations conjoined with Tumours; and here I make Inflammation a distinct Classis, and to be a gradation or step towards a Tumour, which probably may follow, if not prevented, as sometimes it doth.  
And here it is worth our inquiry, to know the reasons why some Inflammations produce Tumours, and some go off without forming a Tumour: and this is caused from the difference of the parts affected; and the copious influx, and contumacy of the material cause to be removed; from the efficacy of means timely used, or the strength of Nature to relieve herself.  
Secondly, We are to take notice what parts of the Body are subject to Inflammations; and they are the muscular flesh, the Membranes, the Parenchyma of the Viscera, and the Glandula's: hence it is, that Inflammations as they are seated in divers parts of the Body, so are they called by distinguishing names, from the part affected: as Phrenitis, an inflammation of the meanings or Membranes of the Brain.  

Ophthalmia of the Eye.  
Parotis of the Glandule near the Ear.  
Peripneumonia of the Lungs.  
Pleuritis of the Pleura.  
Nephritis of the Kidneys.  
Angina of the Muscles of the Throat.   
Now from the part affected you are to observe, that any member the more nervous it is, by so much the pain is greater; and by how much the part is more fleshy, by so much the sooner the Inflammation comes to a resolution, or collection of matter.  
In the third place we come to remark the conjunct and material causes of Inflammations: and they are generated either by obstruction, or extravasation:  
Obstruction begets Inflammation when the fluid liquors in the Vessels are denied their free motion and transition: and this happens when these Juices are coagulated, gross or thick, and thereby become stagnant in the smaller Vessels. Or by compression, when the Vessels are stopped by some adjacent part tumified or extended beyond its common bounds. Or by an influx of blood rushing into some smaller Vessels, from whence there is not a ready transmission and passage: for the venal and arterial Pipes entering into a member are commonly large, but grow smaller, as they go deeper in, and their ramifications very minute, that they may soon be overcharged by a turgid blood, more than ordinarily fermenting and flowing in.  
Thus great pain from what cause soever may introduce Inflammation, by drawing a flux of humours to a part or member, from whence they cannot readily retire or move forwards. And here you may see how Contusions, Luxations, Fractures, etc. do occasion Inflammations, if not prevented by care and skill with exquisite good means.  
By extravasation sometimes Inflammations do arise; that is, when either by plenitude and fullness, or heat and thinness of blood, the terminations or mouths of the Veins are opened, and some effusion made; which then being out of its proper place does degenerate and corrupt, and affords matter for Inflammation. Thus by Ruptures, Punctures and Wounds, extravasated blood is the material cause of Inflammations.  
Fourthly; but matter alone cannot produce an Inflammation (nor any other disease) being inactive and a dead thing of itself, except some vital Agent works upon it, forms and moves it: who or what this Agent is, we are to inquire farther.  
Since than Inflammation is not procured by matter alone, nor can it exist only by matter, there must then be an internal efficient and movent Principle joined with this matter, that fabricates and generates of this matter an Inflammation.  
But understand me rightly: I do not mean that this matter takes fire and is kindled, as if it were a sulphurous and combustible matter, and so cause an Inflammation or scorching heat, no such thing: but this morbific hostile matter stirs up the vital heat by way of irritation, provokes the vital principle to estuate and wax hot: for from hence does all heat emanare, stream, and issue forth; whether it be a temperate and natural warmth, or a preternatural and inflaming heat, both proceed from this fountain: So that hereby you must distinguish between the occasional matter of Inflammations, and the internal efficient that does excandescere & inflammare. This inflaming heat ariseth from a principle much different from the materia morbifica occasionalis: this great heat does not rise out of the morbific matter inflamed, but from the vital Principle incensed.  
A Stone in the Kidneys by raising great pain, may cause an Inflammation there; and this stone is the occasional and material cause thereof; but none can think that this contains fire in it, or is capable to be inflamed, or to communicate any heat to the containing parts, save only what it hath received from the vital heat residing in the body. And thus it is in all other cases of Inflammation, in any part of the body, from what cause soever.  
This vital Principle is seated in every member of the body, and does preside as Governor; and not only for defence thereof, but also to move and act in it so; as no vital office or function can be performed without the assistance and power of this internal invisible Agent; nor is there any heat, but what ariseth from hence: And this is that which Hypocrates calls the impetum faciens; Helmont the Archaeus, which I choose rather to call the vital Principle.  
When any thing happens out of order in the body, a Vessel obstructed, or some liquor extravasated, or what else that may disturb and interrupt any member in its office; soon the vital Principle is affected and concerned therein; and if the matter be considerable and contumacious, pain ariseth there: and this pain is the suffering and anguish of the vital Regent, struggling to resist the injury, and labouring to remove the impediment: hence the Inflammation and preternatural heat arising from this vital power.  
Fifthly, and in the last place, from the doctrine preceding we are to make some observations that may be useful for guidance in Practice, and to remark some pernicious errors that pass undiscerned.  
And first, here you must take notice of the affinity between Inflammations and Fevers: that most Fevers do arise from Inflammations of some particular part, and are the offspring from thence, or springing from that root. For the quòd sit Practice does affirm it; for rarely you shall meet with any considerable Fever, but some particular part is chief complained of; and as the grief or pain does abate there, the Fever is remiss and slackens also.  
Secondly, you are to note, that Fevers are erroneously defined, à calore praeter naturam in cord accenso: assigning the Heart to be the Focus where febrile heat is first kindled, and from whence it is maintained; when almost in any other part of the body, if an inflammation happen there, a Fever will certainly follow, taking its rise from thence, not from the Heart: so that the Heart than suffers sympathically by consent; not idiopathically and originally. And whereas I said almost any part, intimating thereby, that a slight Inflammation may be in the small and capillary Veins of short continuance, which may not communicate a Fever to the whole body: and such inflammations we see externally planted sometimes, the capillary Veins of the Cutis being affected calore & rubore, which either spontaneously vanish, or soon yield to some outward application only.  
Thirdly, From the denominations of Fever and Inflammation, you may observe the parity or near relation they have to each other; for from the Etymon of the words, they seem to import much what the same thing, denoting only an extraordinary heat, 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 ignis, and in the Latin Febris, à ferveo: 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 inflammatio, from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 uro.  
Fourthly, We shall not depend upon Etymologies, which are allegorical, and often strained; but inquire into the nature and extent of each, and know what is meant by the one and the other, and then what difference between them. Fever's are known, and defined by preternatural heat and effervescency through the whole body. Inflammation is a preternatural heat of a particular part. Hence we remark, that Fevers are general Inflammations or inflammations dilated: Inflammations particular Fevers of a member, thus differing in extent and latitude: but withal observe the order of causation; Inflammation precedes and lays the foundation, in this or that part there is the foams and miner a morbi: a Fever follows upon the whole body, caused only by consent from thence and condolency.  
Now if all or most Inflammations cause Fevers, and Inflammations so frequent, as being the certain consequents of great pain, than two things are to be noted: first, that upon the appearance or discovery of a Fever, you may suspect an Inflammation couched under it, from whence as the spring, this Fever does arise. Secondly, that the Cure of most Fevers ought to be designed and managed so, as respecting and aiming chief at a particular Inflammation, upon which the Fever does depend: sublatâ causâ— and when a Fever ariseth upon this account (as. for the most part it doth) then little regard is to be had to the general Fever, but die stress of Cure lies upon removing the occasional and material causes of Pain and Inflammation in the particular part, the foundation of all the rest, which being removed, the depending Fever falls of course.  
Thus all our Discourse tends to make a true discovery of causes; that when preternatural heat does arise in the body and beget a Fever; we may know, not only what to call it, but also what to do, by levelling at the right mark.  
But by the way I must tell you also, how a Fever sometimes does arise, and not from Inflammation of a pained part: and that is when some heterogeneous discordant matter, or some malign and venenate Miasm is mingled or got into the blood; Nature, which is the vital Principle, raiseth a preternatural fermentation and febrile effervescency in the mass of blood, for a purification and separation of this exotic mixture; and admits of no sedation and rest until that work be finished.  
Fifthly, and from hence you are to be warned of the dangerous and common Practice in Fevers, by Juleps, Barleywater and other such like cooling Medicines used to allay the heat; from a great mistake of the rise of Fevers, and from whence this heat does assurge: for, whether the Fever does depend upon a particular inflamed part; or a general fermentation of the blood for purification; in both cases of Fevers, such cooling Medicines are pernicious, and have killed thousands: for by insisting so much upon them, and aiming to suppress the Fever by Coolers, (which is not possible to be done) thus trifling the time away, the opportunity of curing is lost, and the disease prevails.  
The error of these cooling Medicines is apparent from the insuccess thereof; for never was the thirst of a sick person satisfied by a Julep; but a draught of good drink, such as the Patient's stomach calls for, that is acceptable and refreshing: so that I say, Juleps are but cold comfort to a feverish sick man; for these cold Medicines imposed upon the sick, are so far from assisting Nature to perform the work she is struggling about, that they nauseate and flat the stomach (which should invigorate the other faculties) damp the power of Nature contending, and leave her languishing for refreshment coveted in her natural common drink.  
What advantage can there be in a Julep to take off, or any way contribute to the removal of any matter that is the cause of Inflammation in the Liver, Spleen, Kidneys, Mesentery, Pleura, etc. any part of the body? truly none; but that is not all; for besides the doing no good, it does much mischief, in suppressing the fortitude of Nature, and cheating the poor Patient of that desired common assistance by drink that would be comfortable. But no more of this, because I have enlarged upon this point pag. 27, 28, 29, 30. yet it falls in here, necessarily to be taken notice of; because Inflammations always introduce Fevers, which Fever being most obvious and apparent, engrosseth all endeavours for allaying that general and expanded heat; but they go the wrong way to work, even preposterously, beginning at the wrong end.  
But now to inform what is necessary to be done, when a pained inflamed part requires help, take these directions in general, which will be advantageous in most, if not all particular cases.  
First, Examine and consider the nature of the part inflamed, being the part primarily affected, the foundation of this disturbance; from whose peculiar structure and fabrication, as also from its office, you will find what are the usual impediments that molest and disturb such a part, and how it becomes liable thereto.  
Secondly, You are to consider what way this matter is to be carried off (if it be humoral) and by what means: adapting such Remedies suitable to the condition of the part affected, and proper for the removal of such a morbific cause.  
Thirdly, The Fever that ariseth from, and depends upon this Inflammation, is not to bias you, or take you off from any thing necessary to be done, in order to reduce the part primarily affected, but prosecute directly there, and regard not the Fever; for as you get advantage in relieving the part grieved, you will find the Fever to decrease, and totally vanish when that is restored. And to tell you plainly, I know nothing you can do advantageous for the part inflamed, that may be injurious upon account of the Fever, if the Fever were independent, and had no relation to the other.  
Fourthly, If blood be the primary cause, or otherwise aggravating through plenitude, make a depletion; thereby the Circulation will be more free, turgency abated, and fluxion prevented, at least retracted; for if the cause be in the Veins or Arteries, most necessary it is to be done; for commonly then a plethory, grossness, or coagulation gave the occasion of this grief; but if it an acrid serosity, that lanceth and irritates the tender part, Phlehotomy may draw off, and make a diversion for a time, until other good means can be administered, to eradicate or blunt the sharpness of its acidity.  
Fifthly, Set open the vents and outlets which Nature hath framed, and make evacuation, to abate fullness, and remove foulness in the whole body, thereby you will prevent or allay the turgency of ill humours that are apt to ferment and move upon this disorder; and cut off a supply of morbific matter that may resort to the part pained, of raise a new disturbance in other parts of the body.  
Here you must procure, and prosecute this intention with Balsamic Abstersives, the true Cathartics, (not venenous Laxatives the common reputed Purgatives) and cleanse the lower region of the body; whereby also you will subduct and draw away from the parts affected. The grosser matter being thus removed and carried off sufficiently, the remainder discharge by Transpiration, making an apertion of the Pores, and setting open those imperceptible vents, by the use of effectual and choice Diaphoretics, thereby to attenuate, rarify, and scatter.  
For outward Inflammations Topical Medicines are applied to the part, Fomentations, Cataplasms, Unguents, &c to appease and allay: but our internal cases do not admit of such applications: therefore we are to design otherwise, and adapt such internal Medicines, and by such operations, as may reach the morbous matter to remove and transmit it: yet when an Inflammation is seated near the superficies or extern parts of the body, as the Pleura, the gibbous part of the Liver, and such like; especially if a Tumour conjoined do appear also, or any visible extension, then local Medicines may be of good use, and contribute towards a Cure.  
But here by way of caution take notice, That no refrigerating or repercussing application be made, to repel and drive back from the part pained; for this may prove of dangerous consequence, as the imprudent adventures of some in this manner have left sad mementoes, to forbid the like practice.  
But some may say, How shall we know when any internal part is inflamed, because neither the eye nor the hand can reach there to discover the disease? Yes very well; for great pain and anguish continuing in any secret internal part, and raising a febrile heat in the whole body, does as certainly declare that part to be inflamed (in the sense before expressed) as any outward signs can manifest, where seeing and handling does or can adjudge the case.  
Sixthly, and in the last place; because Inflammations do arise from, and depend much upon the continuance of pain; therefore Anodynes or allayers of pain may be profitable at some times, and in some cases; but warily to be used, and the times nicely to be distinguished and chosen, as not to displace or put by a curing Medicine; for no Opiate or Anodyne is curative, but palliative, and for allaying the extremity of pain, and to give rest only: for pain keeping the sick from natural and wont rest, does bring great weakness and lassitude of spirits. Since pain therefore and long watching enervates and debilitates Nature greatly; on the contrary, sleep refresheth and restores much, that the enfeebled Patient then may gain respite from pain, and refreshment by rest; when the sick is in danger, as being tired out for want of ease and sleep, than the case calls for Anodynes, and aught to be made use of.  
But because Opiates and Anodynes do not remove the morbific cause, therefore they are not to be insisted upon, or relied on as curing means; but they are to be used in cases of extremity for mitigation and ease; and at such due times as not to hinder the operation of any curative Remedy.   

Tumours Internal, Scirrhous, Apostemate, and Cancerous.  
TVmors may fitly be placed next to Inflammations, because Inflammations are the foundation or occasion of many Tumours; though Tumours sometimes arise not procured or cause by Inflammation preceding: but most frequently Tumours grow up and take their rise from pain; and where pain is, Inflammation (in our sense) follows of course: and there is much reason for it, because pain and heat does arise from one and the same principle, as already set forth: and when this painful inflaming heat continues, you may rationally expect a Tumour (by fluxion) to follow; if not prevented by good means, to pluck out the spina morbifica the thorn in the flesh; or Nature so powerful and prevalent to free her .  
Tumours have their denomination à tumeo to swell; and the Greek word 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 signifies protuberance or expansion; so that by Tumour you may understand a part enlarged, and increased in bigness preternaturally: for natural extensions are not to he called Tumours: as the dugs or belly of a woman with child, though they be extended bigger than ordinary, yet it is natural, or by the course of Nature.  
You are not to expect here a Chirurgical Treatise of Tumours, as if tire Cures hereof were to be performed by manual operation: but I shall show you some differences of external Tumours that require such management, only that you may the better apprehend and judge of internal: for as external Tumours do arise from internal matter, and present outwards; so hidden internal Tumours are form of the like matter, and from such occasions much what as the external, save only some outward injuries that may affect the superficial, and hot the interior parts: as Contusion, Scalding, Cupping, Vesicatories, etc.  
Galen in his Book de, Tumoribus, reckoning up all sorts of Tumours as he supposed, gives in the account to be sixty one: but Ingrassias in his Survey of Tumours afterwards, adds art hundred sixty five more to them, and gives particular names: but examining the reason hereof we find the advance of number, not any way to promote their Cures, but makes confusion and perplexity in Practice: for this variety is not from any real difference in their nature, but from some accidental difference between them in appearance; as magnitude, figure, situation, etc. so that the same in kind is repeated by another name: therefore this vast number will admit of a great abatement, and the designment of their Cures much easier and better managed, when all are reduced under a few general heads, respecting their continent matter, and many joined together under one name by the union and similitude of their nature.  
The difference therefore of Tumours arising from the variety their material causes, and the modus generandi, are chief to be looked it; for from thence is the designment of Cures more especially bottomed; but with some respect to the seat or part affected.  
The general division of Tumours from their material causes (in the common received Practice) is sixfold.  
First, from Blood, which makes a Phlegmon.  
Second, from Choler, which generates an Erysipelas.  
Third, from Phlegm, which begets an Oedema. Fourth, from Melancholy, which makes a Scirrbus.  
Fifth, from serous or watery humour, which generates watery Tumours, as Hydrocephalus.  
Sixth, from Flatulency, and this Tumour is called Emphysema, Inflatio, Tumour flatulentus.  
Under these six general Heads are comprised alfo several other subdivisions: as first, such as arise from the degenerate and depraved condition of these simple and single humours: secondly, such as spring from the composition and mixture of the simple humours one with another.  
How far I can comply with this specious Doctrine, whether it be not more notional than practical, and my exceptions against it, I shall not declare now, in regard time, and the intended conciseness of this Work, will not give me leave to establish my own opinion, and judgement dissenting in this matter; nor is it necessary to lay open the intricacy of out design in hand, by debating and controverting this Doctrine, which relates chief to external Tumours and Chirurgical Practice.  
And although internal Tumours are generated of the same matter as external; yet all these differences (supposed to be true) cannot so nicely and certainly be adjudged and determined; but indications from thence must be more general and at large, for dislodging, cleansing, and carrying off any such material cause, that infests and tumifies a member or part.  
Since therefore internal Tumours do not present themselves to the eye, for a more certain and exact: knowledge; we are to make judgement of them and determine, from the fabrication and office of the part affected and complaining; which gives some intimation thereof, what Succus, or depraved and preternatural matter may reside there: as also from the general constitution and disposition of the body antecedently disposing thereto: for that Cacochymy which is predominant in the body, is most likely to be the cause or matter of the hidden Tumour, except some other circumstances and probabilities do mainly suggest another morbous matter.  
From the nature and condition of the part affected, you may sometimes conclude the Tumour there to be of such a kind: as when the left Hypochonder is preternaturally extended, you may rationally judge flatulency and melancholy feculency to be the matter and cause thereof.  
From the signals of a serous Cacochymy, or abounding serosity in the body; you may conclude, if swollen legs or feet do happen hereupon, the Tumour is hydropic.  
For the modus generandi, and the occasional causes of internal Tumours, they may be reduced to these five.  

1. Attraction.  
2. Transmission.  
3. Congestion.  
4. Obstruction.  
5. Extravasation.   
First, By Attraction humours are brought to any part, and there accumulated: and thus pain increasing heat preternaturally (like a Ventose or a Vesicatory) does attract from the adjacent parts, and procures a confluence of humours to the part pained, and thereby forms a Tumour.  
Now if pain be so apt to beget a conflux, and consequently a Tumour; than you ought to beware, and often suspect such a product; for as much as pains are very frequent in most diseases, as before proved. Then also remember upon a cessation of pain, there ought to be care taken by proper means, for the recession and dissipation of confluxed matter: and not imagine upon a presumption, that when the pain is gone, all is gone, and the Patiented secure.  
Secondly, Transmission procures a Tumour, when the expulsive faculty of some parts is vigorous and strong to send off any excrementitious matter, and deposit it upon a weaker, which being not able to expel, it lodgeth there and generates a Tumour. Thus the principal and more noble parts have a natural robor and fortitude, to send off their superfluous and noxious matter, and transmit it to the inferior and ignoble.  
Now there are some parts that are weak by Nature; and some by Accident.  
By Nature those are weak that are designed ministerial and subservient, and therefore liable to transmited matter from their superiors: thus the Glandules are all weak parts, lax and spongious, apt to receive and imbibe: hence it is that the Heart transimts to the Glandules in the Armpits; the Brain behind the Ears; the Liver to the Groins; and the Glandules of the Mesentery are very apt to tumify, and are the latent causes of some difficult abstruse diseases. The Skin also is a weak part and general Emunctory for the whole body, and therefore many Eruptions and Tumours are there visible.  
By Accident some parts are weak; as when by a disease, inordinate living, or casual injury; some particular part, though strong by nature and original formation, may be vitiated, debilitated and made feeble.  
Thirdly, By Congestion Tumours are sometimes bred; as when a part or member does not transmute the alimentary supply into its own substance, but suffers it to degenerate there, and accumulate into a Tumour: or else the expulsive faculty may be weak, and not able to send off the excrementitious part, which remaining there may produce the like: or sometimes the fault may be in the nutritious supply, not being capable of a good transmutation, as in cacochymical and foul bodies.  
Sometimes the relics of an acute sickness not well cured, by congestion in this of that part does afford matter to beget internal Tumours; and therefore after the small Pox, Agues, Fevers, etc. purgation and cleansing aught well to be performed, else chronic diseases commonly do succeed them, from peccant matter lodged here or there: and therefore upon such neglects or insufficient performance thereof, we find commonly big and hard Bellies, or swelled Legs; some part or other pained, tumified, or hard. And these are the effects of imperfect Cures, when the morbific matter is only abated, and the storm laid; but the remainder accumulates by collection and congestion, to produce a disease of another nature.  
Fourthly, By Obstruction Tumours or extensions are begotten: for when the current is stopped in any Vessel, and by the Law of Circulation the continent Succus or humour, is still moving forwards to this place obstructed; the Vessel or containing part must needs tumify and swell, as not able to receive and contain the additional flowing matter in its former dimensions. And this is apparent to the eye in external parts, which must needs prove the internal: for a straight Ligature upon the Arm or Leg, does cause the part below the binding to swell: and for this reason; because the Vessels are obstructed by compression, that the blood cannot circulate and move on. And the case is the like in effect, when obstruction of a Vessel is made from coagulation, incrassation or grossness, or any concreted matter within the ducture or cavity, to obstruct and stop the stream.  
Now obstructions are generally acknowledged to be the frequent causes of many or most-diseases: and few cases do present in Practice, but obstruction bears a part, and sometimes the solitary cause; or else obstruction is very much wronged; for nothing more frequent in Physicians mouths than obstructions; and yet nothing more seldom mentioned than an internal Tumour: from whence we may well conclude, it is rarely thought on or not at all suspected. But obstructions are so familiar and frequent in discourse, that they are little accounted of, at least not thought to be of any dangerous consequence: not considering that this obstruction may, and does often (being contumacious) beget a Tumour; and this Tumour may cause a long and difficult, or dangerous acute sickness, if not mortal: for the progress may go on still, from Tumour to Apostem or suppuration, and then plant an Ulcer there: or this Tumour may become scirrhous and hard; then perhaps cancerous, gangrened, and then you know what follows next, mortification.  
From hence it is very reasonable to judge of the series and course of many chronic, or long linger diseases, as also or the acute mortal sicknesses; most of which do make their progress by these stages, have these commutations and transition; at last their fatal termination, because this latent train of diseases was not suspected.  
But all this while the Fever was the disease feared, and vainly endeavoured against; and the Patient is said to die of a Fever, because a Fever did attend (the life did estuate and was disquieted) in the whole course, and every transition of the sickness, even to death.  
Fifthly, By Extravasation a Tumour is sometimes generated: as when the Vessels are replete and full causing tension; by thinness, heat, and sharpness of blood; or a preternatural and turgid fermentation distending the Vessels: the mouths of the Veins are hereby opened sometimes, and a stillicidium or effusion of the contained liquor procured; which being lodged out of its proper place, does corrupt, inflame, and produce a Tumour.  
Now concerning the signs of an internal Tumour, they are not only extension and increase of magnitude; which is apparent when it makes a protuberance upon the superficies: but also a fixed heaviness or hardness; or pain upon pressure with the hand, does give great suspicion and probable conjecture of a latent internal Tumour lying deep and obscure; especially, and by way of confirmation, when the preceding causes apt to generate Tumours, do concur to strengthen the probability.  
But before we conclude this Discourse of Tumours; something more is to be said, and that touching a Scirrhus and Apostem, which are comprehended under Tumours; and do signify only the distict and special condition thereof: and here we have occasion to take notice of the different state of Tumours, and their way of resolution, fixation, or translation.  
Tumours do either wear away and spend by discussion and transpiration: or they recede by a translation of matter into another part: or they apostemate and come to suppuration: or they indurate and become scirrhous: or they tabefie and corrupt the part where they are seated.  
Discussion of a Tumour is the best that can be expected; and this aught chief to be aimed at in Practice: the next to be hoped for and endeavoured, is dislodging of it and removal from a noble to an ignoble part; or to such place where means can better be used, and more apt for recession, or egression of the continent material cause: but if the Tumour apostemates, the danger is greater or less according to the nature and condition of the member or part: if it indurates, the danger is delayed; but if it corrupts the part, the danger is greater, and more speedy in execution.  
Apostem is that degree or state of a Tumour, when it is maturated or ripe, which is called Suppuration; the material or humoral cause being then converted into a Pus or purulent matter: and while this is in fieri doing, all Symptoms are aggravated, pain, heat, pulsation, tension are greater: but being perfected, they all decrease again, and the Patient finds ease; but not out of danger in these internal Apostems; for if it be so seated, where there is no convenient vent or Emunctory to discharge it, the case is desperate.  
As the humoral matter that form the Tumour was more benign and good, as pure blood; so the converted Pus or purulent matter from thence, does commonly answer it in goodness: for of good blood and in sound bodies, the maturation is more kindly, the Pus white, mild, and not endangering to corrupt the part: but in foul depraved bodies and malignant diseases, apostemated matter is more putrid, stinking, and venenous, and does threaten a Gangrene or mortification of the part: and therefore such internal collections of matter, in pestilential and malignant Fevers, Venereal Pox, small Pox, and such like, are commonly mortal.  
Scirrhous Tumours are such, as when the continent matter does not maturate and become soft, fit to break and discharge; but grows hard and fined in the part, not apt to be discharged or removed by discussion or suppuration. And this the word Scirrhus imports, from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 induro.  
Tumours in some parts of the body are apt to suppurate, as in the carnous or fleshy: in other parts, as the Joints, Tendons, and Ligaments, more inclined to indurate and become scirrhous: and the reason may be this; that those parts which take their origine from blood, are more prompt and ready to suppurate as the flesh; but those which take their rise from seminal matter, as the Tendons, Ligaments, Nerves, &c they are more inclinable to scirrhosity or hardness.  
But besides this disposition of the parts affected, there is also, and chief a propension in the congested or influxed matter of these Tumours: for by the different nature of humoral matter, some is more fluxible and thin, participating much of serosity, and apt to transpire or be discussed: other more yielding to a preternatural digestion and suppuration, as the blood that is pure and good: other inclining to be viscous, coagulated, and consequently to indurate; as a feculent, grumous, or gross blood, deprived of its serosity.  
And farther; besides the disposition of parts, and that of the material cause inclining to this scirrhosity, there may also come in and be joined with these a third promoter, which in some cases may be the chief cause, and that is, an ill method and injurious Medicines, so endeavouring to remove, may thereby fix and fasten the matter: for thus a Tumour which might probably be dispersed, may be changed from its own capacity and tendency, and become scirrhous and indurate: as when constant or great Coolers are administered to abate the symptomatical or concomitant Fever, the matter of the Tumour is thereby fixed and impacted; which otherwise might have surrendered unto proper and powerful Medicines duly used. And e contrà, by too great Dryers and Heaters, the thinner part is evaporated, and the grosser remains; therefore medio tutissimus ibis; good resolutive transpiring Medicines, taking their turns with the use of proper Cathartics, is the safe and bed way.  
These scirrhous Tumours, although they are not so dangerous for the present, except they be very great, or cancerous; yet they are the foundation of some chronic or linger diseases, which proves very contumacious, and sometimes incurable, especially if the Tumour be latent and concealed: and Hectic Fever sometimes takes its rise from hence, which if you think to cure by Emulsions, Restauratives, and cooling Drinks, you will be much mistaken in your purpose and endeavours.  
These scirrhous Tumours, some are with pain, some without: those that have pain are more hopeful (except they be cancerous) but those which are insensible upon pressure, are more difficult, or incurable. Now according to the nature and degree of depravedness in the continent matter, and from the part affected, so are these Tumours better or worse to be dealt with. And because these Tumours are internal and hid from the eye; therefore judgement is to be given of them from their situation, and from the constitution, with other circumstances of the Patient's body.  
But although these scirrhous Tumours are thus difficult to be undertaken and managed; yet these are not the worst, and they may arrive farther, and to a more dangerous state: as when Tumours in their variation and degeneration do turn cancerous; and this is apt to be in such bodies as abound with a black feculent blood; or a thick blood adust by intemperate heat: and by how much the blood thus exceeds in this preternatural condition, by so much the Cancer is completed, confirmed, and the worse: and this supervenes a Scirrhus commonly, as being an apt previous disposition; (but may happen also without a Scirrhus preceding, from other Tumours degenerating into Cancers) and therefore in the Cure of scirrhous Tumours, great circumspection and diligence is to be used, lest by their delay add continuance, or improper usage of Medicines, these Tumours do not become cancerous and desperate, as sometimes it falls out so.  
Now a Tumour is said to be cancerous, when it turns into a dark radish, or livid and blackish colour, declaring this transmutation and degenerate state. The beginning of these Cancers are very small in compass (as those that present outwards do manifest their gradual enlargement) but by time they increase and grow big, with tumified Veins round about.  
These cancerous Tumours may happen to any part of the body, but chief and moult frequently, in the upper parts about the Face, as Nose, Lips, etc. or the Dugs, and other glandulous parts; also the Womb is thus affected sometimes from Tumour there bred, venereal or other, degenerating cancerous.  
These Tumours sometimes are occasioned from the menstrual suppression in women; and Heamorrhoidal in men: and when it happens so, those causes are to be removed with speed.  
Great skill and circumspection is to be used in Tumours of this nature; lest provoking the continent matter, it grow more fierce, eating and ulcerating; and from a cancerous Tumour, it become a cancerous presiding Ulcer, which is worse: now the signs of this Tumour inclining to break and ulcerate are, great heat and pulsation in the part.  
The difficulty or incurability of Cancers lie here; for that the cancerous matter will not yield to digestion or discussion: and this because the part affected is debilitated and overcome, by this depraved, malign matter, that it cannot exercise its transmutative and digestive power: nor will this cancerous matter obey Discussives, by reason of the viscidity and grossness thereof: wherefore Hypocrates gave sentence, That such are not cured but by section or ustion: and yet this is not to be done, except the Cancer be small, and in such a part as will admit of amputation.  
If Cancers external are thus difficult to be managed although they appear to the eye, and are subject to manual operation and tractation; the internal must be greater and more hazardous, where they cannot be applied unto after this manner, with convenient Topical Medicines: therefore prevention in time is mainly to be endeavoured when a Tumour is generated, lest it change into this dangerous condition: for I find by the design of Practisers in the Remedies appointed, that palliation is sought for, the Cure not hoped for.  
The grand intention to be prosecuted for Cure, is to change the condition of the blood, which does feed and supply this Cancer; so that the antecedent cause being taken away, the continent will then more likely abate; and until that be done, this cannot be expected.  
The means indicated for Cure of these cancerous Tumours are branched into three parts: Dieatetic, Pharmaceutic, and Chirurgical: but I shall not enlarge upon the Indications for Cure, for that these cases are so nice and difficult, as not to be handled with generals; but from a collation of all the circumstances attending the Patient, which varies every particular case.  
And so I pass from Tumours, to remark their usual commutation and transition into Ulcers, the next considerable in order to be treated of.   

Ulcers internal.  
THE Latin word Vlcus is derived of 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, signifying a disjunction of parts or solution of continuity: but to distinguish this from other solutions of continuity; an Ulcer does yield a Sanies or purulent matter; so that a Wound coming to digestion and affording pus, may then be called an Ulcer: and any part that is gauled, raw, and tender, the covering Membrane being fretted and eaten away by some sharp humour, or other cause, it styled Excoriation only, until it produce corrupt matter; and than it is properly called an Ulcer: thus internal parts are sometimes excoriated, raw, and painful, but cicatrized or skinned again before it arrive to the degree of an Ulcer. And thus it is most frequently in the urinary ductures or passages, and sometimes in the Guts; but such Excoriations are not to be slighted or neglected, lest they beget ulceration, as sometimes it falls out so.  
By external or outward Ulcers which are manifest to the eye, you may conceive of internal Ulcers; for they arise from the same causes, and have the same accidents: but I shall not enlarge upon all the accidental differences that attend upon, and distinguish external Ulcers, as not so pertinent and necessary to our subject in hand.  
The essential and most considerable difference of Ulcers does arise from their causes, and from the part affected; which bears the great sway in curing, and from whence the chief indications are taken; for although in external Ulcers other accidental differences may be observed and noted; yet in internal Ulcers, such differences cannot be regarded, as being obscured or hid: so that whether they be broad or narrow, deep or shallow, fistulous or otherwise, is hot positively to be said; and if it were known, institution or method of Cure could not be so varied as external are capable of, by reason these are subject to manual tractation.  
The continent causes of Vlers, are such matter as emane and flow from thence; and that is of three sorts: Ichor, Pus, and Sordes.  
The first is an ichorous or sanious matter, being thin, indigested and watery, or diluted bloody.  
The second is a Pus or purulent matter, of a betted consistence and concocted thicker.  
The third is a sordid foul matter, more thick and glutinous.  
The ichorous thin matter usually issues in the beginning of Ulcers, and denotes indigestion; and also at any time afterwards does declare the same, that the Ulcer is not in a good healing condition.  
The Pus or purulent matter signifies the Ulcer to be in a better state of healing; and if it be white and sweet, these are good signs.  
The sordid gross matter does intimate a preternatural heat of the parts strongly exsiccating, but not healing; for as much as this matter is foul and stinking.  
Ulcers for their manner of generation and rise, may be caused these four ways: by Erosion, by Frication, Apostemation, and Contagion.  
1. By Erosion Ulcers are begotten in any part of the body, when a sharp corrosive humour does excoriate and eat into the substance of any part: and being thus injured, is thereby perverted in its office, and self-preservation; converting that nutritious Succus which comes for its supply, into an ulcerous degenerate matter, no way useful but to be excreted and voided.  
And thus a Phthisis an Ulcer of the Lungs is sometimes generated, from a sharp Serum invading that tender part: and thus a Dysentery is sometimes begotten, being an ulceration of the Guts, from sharp excoriating humours: and thus an ulceration in the Meatus Penis is bred, from a sharp eroding Gonorrhaea: and an Ulcer in the neck of the Bladder may be planted there, by a sharp galling Urine.  
2. By Frication or attrition; as when any hard, bony, or stony substance, does fret, raze, and excoriate a part: and thus a stone begets an Ulcer in the Kidneys or Bladder, and sometimes in other parts of the body.  
3. By Apostemation; as when any Apostem breaketh and dischargeth its matter, an Ulcer is left behind, though the Apostem be gone: and thus are Ulcers generated sometimes in the Ear, from a preceding Apostem: in the aspera Arteria after an Angina or Squinance: in the Breast after a Pleurisy; in the Lungs from a Tumour suppurated there: also in the Liver, Spleen, Womb, or other parts apostemated.  
4. By Contagion or infection: and thus women whole Privities are infected, do communicate this virulency or venom, and seize the Genitals of their Partner, from whence venereal Ulcers do arise: and thus men whole Seed is tainted, do infect sound women, and cause virulent Ulcers in their Privities; which malignity not being well managed and mastered by skill, and efficacious Medicines, it spreads, breaks forth, and begets Ulcers in many other parts of the body: as at large I have set forth in another Tract, entitled, The Mystery of the Venereal Lues.  
Internal Ulcers, though they disappear, yet are known to be by these signs.  
First, Pain, which is more or less according to the nature and sensibility of the part.  
Secondly, From preceding causes, as Inflammation or Tumour preceding, whose Symptoms being allayed and ceased, yet pain remains.  
Thirdly and manifestly, From excretion of ulcerous matter, where there is any ducture or outlet for discharge: by the Intestines, by the Privities, the Nose, Ears, or Mouth: but where there is no passage or vent, it corrupts the containing part, and is mortal, except a passage can be made by section.  
Ulcers from their causes, their aptness and inaptness for healing; some are benign, mild, and tractable: others are malign, very difficult, or incurable.  
The benign and mild, are such as arise in sanguine sound bodies, and the younger people, having no ill Symptoms or adjuncts of impediment; the matter of such Ulcers is a laudable Pus, or otherwise apt for digestion, more yielding, and readily commanded by Medicines.  
Malign Ulcers, and contumacious, difficult, or intractable, are such as are sordid, fetid, ichorous, unctuous, dolorous, corroding, and depascent, of long continuance, virulent, cancerous, fistulous, cavernous; the products or effect of malignant diseases, as venereal Lues, Leprosy, Pestilence, etc. in cachectic habits of body, hydropic, hectic, aged, consumptive and decayed persons: in principal, and difficult parts of the body; as the Brain, Lungs, Liver, Spleen, etc. the Spondyls of the Back, and great Junctures.  
Since Ulcers are thus various in their nature, from the several conditions of bodies, and diseases that they arise from, or depend on, and the difference of parts wherein they are seated; a general Method of healing, and course of Medicines cannot be instituted and appointed; but every case hath its peculiar complication of circumstances, as directory indications to be remarked, from whence a designment, method, and adaptation of Medicines is form, suitable to the particularity and different case of every individual Patient; and therefore I have not proceeded to the Rules and Medicines for Curation.  
Only thus much I shall note to you, as a grand observable in the Cure of these Ulcers: That such as arise from some remarkable disease, as Dropsy, Scorbute, Venereal Lues, or other malign and Cacochymical habits of body; that these Ulcers are not to be cured until the disease and evil state of the body on which they do depend, be reduced to a good condition or mediocrity of constitution: for the antecedent cause which first produced the Ulcer, must be removed before the Ulcer is capable of healing; because of the continual supply of peccant matter brought to the ulcerated part: and therefore application is first to be made there, else all endeavours will be frustrate.  
And further, the designment of these Cures, are not to be paralleled with, nor leveled by, the methods and intentions that the common Rules in Chirurgery have laid down; for as much as many of them are erroneously grounded, and deserve great correction and amendment, which hereafter will be pointed out and discussed; for we have not room here, nor time now to engage in that Cantroversie, and must refer it to the next opportunity.   

Gangrenes and Mortification.  
THE last and worst transition of this dangerous train of Diseases, and the ne plus ultrà in vitality is a Gangrene, being a borderer upon, or next adjoining unto Mortification, or the beginning thereof.  
And although Gangrenes are thus ranked next to Ulcers, and it falls out so sometimes in the preternatural course of Nature (if I may so speak) yet it is not always so; but a part may and does gangrene sometimes before it be ulcerated, for Inflammations and Tumours do gangrene as oft as Ulcers: but Gangrenes are placed in this order after Ulcers, as being the worst and last morbous state that can come, and beyond this there is no disease: for although Mortification be set down after Gangrene, yet this is no disease, vita extincta non est morbus; for diseases are seated in the life, corpus vivens est domicilium morborum, and where no life is, there is no disease: but Mortification is posited here as the centre to which diseases move; and as bounds to stop all farther disquisition.  
A Gangrene is a corruption and change of a part or member, into such a degree or state, as beginning to mortify, or is mortifying.  
But Sphacelus with the Greeks, Syderatio in the Latin, which we call Mortification in English; is when a part is perfectly mortified and dead: and therefore a Gangrene is capable of Cure, but a Sphacelus not, because the part is dead.  A privatione ad habitum non datur regressus. 
The external and primitive causes of Gangrenes are; Contusion, Vulneration, Congelation, Combustion, Constriction, Poison.  
Contusion sometimes introduceth a Gangrene by coagulating and fixing the blood so firmly in the part contused, that thereby the life is suppressed and overcome: for communication and intercourse with other parts of the body which is requisite, being thus denied, the life extinguisheth: besides, the coagulated bruised blood remaining long undiscussed, does putrify, and gangrene.  
Vulneration or section sometimes procures a Gangrene, when the vital Principle is so debilitated, or enormous by the wound, that instead of a good suppuration and vigorous transmutation, a depraved matter is generated, which corrupts and gangrenes the part: and thus a small cut of a finger or Toe hath gangrened, and killed the person: but in greater Wounds, the danger is greater, as more frequently to happen.  
Congelation, by extremity of cold, hindering Transpiration, and condensing the blood, rendering it stagnant in the Vessels, suffocates the life, and gangrenes the member: thus in extreme cold Countries, people by casualties exposed, have their Limbs mortified sometimes: and thus a Gangrene is brought upon an Inflammation or Erysipelas sometimes, by incautelous and pernicious application of great refrigerating or cooling Medicines, thereby incrassating the blood, and prohibiting transpiration. And this is very hazardous, though advised and practised frequently by some Surgeons in these cases, using cold, astringent, emplastic Cataplasms; ex farin. hoard. bolo armen. album. ovor. aceto, &c when an Inflammation appears.  
Combustion sometimes begets a Gangrene, and destroys the life of the part; when by neglect thereupon, or improper means used, relief is not duly afforded: and thus by Cauteries and Caustics sometimes a member becomes mortified. Now ustion or great hurt by burning, causeth Gangrenes by corrugating, shrinking, and searing up the Vessels, that they cannot bring supply of vital Spirits and nutriment to the part.  
Constriction or compression procures a Gangrene, by intercepting of vital communication; so that the member thereby is as it were separated and cut off from the body, and fountain of life: for the parts are maintained by influxed rays and streams of vital heat and moisture to the remotest parts of the body, but being deprived thereof they die: thus a Ligature drawn straight about the Arm or Leg, and continuing too long, may gangrene and mortify the part, by excommunicating it from commerce with, and participation of the general life.  
And thus sometimes internal scirrhous Tumours do compress the Vessels and obstruct them: of this Fabricius Hildanus gives an example of one that a Gangrene seized both his legs, of which he died: the cause was latent, until by dissection he found a scirrhous Tumour about the Vena cava descending, between the Reins, where this great Vein divides into two parts to supply both legs.  
Poisons, some of them do gangrene by concreting and condensing the blood, stopping the canals and suffocating the life, as the Venom of a Scorpion and Asp: others by putrifying and corrupting the blood, or some other part where they chief discharge their venom.  
Internal and conjunct causes of Gangrenes are, Inflammation, corrupt, venenous, or malignant matter, that preys upon, and destroys the vital Principle; stagnation of the blood, or what else may intercept commerce and supply from the fountain of life.  
The Characters or signs declaring a Gangrene are these: the sense of feeling decays, the colour changeth and inclines to be livid or blackish, the flesh grows flaccid and frigid: but when the Gangrene proceeds on to a Sphacelus or perfect mortification, these Symptoms than are aggravated, and appear more eminent; sense is quite abolished, and the part becomes fetid and cadaverous.  
Gangrenes are very seldom mentioned in Practice; and you shall rarely hear of any person to die of a Gangrene; yet I must believe (and not without good grounds) that many thousands dye by an internal Gangrene, not taken notice of: for if the major part, at least a great part, do die with a high Fever or Phlogosis, we may rationally then conclude, that a Gangrene is frequently conjoined as the last Actor in the Tragedy and immediate cause of death: for Gangrenes do commonly supervene Inflammations where they are mortal: and thus also Inflammations from fractures and dislocations, often bring on a Gangrene.  
And in malignant high Fevers there are sometimes such vibices, marks of mortified blood, and black mouths, which do strongly suggest a Gangrene within the body.  
And for those that perish by the Plague in so short a time, whose venomous matter shows itself by Spots, Vesicles, Buboes, and Carbuncles; most of these die gangrened.  
And many of those that expire by the small Pox, have a Gangrene in some part; the putrid matter being lodged there, Nature not able to protrude and bring it forth: and it is very reasonable to assert this; for, if a Gangrene will arise out of a very small portion of matter extravasated, defluxed, or congested in a part; then where the whole body abounds with malign putrefaction and overflows with it, any part thereof remaining within the body, may and does very often corrupt and gangrene that part.  
That our Opinions are not so extravagant and excentric from the Judgement of all Learned men, as some perhaps inconsiderately may censure: take notice what Arnisaeus an eminent Physician in Germany, Professor in the University of Julia, writing to Gregor. Horstius about a Person of Quality that died of the small Pox, queried or rather concluded, that the Liver was gangrened: and farther saith, Verisimile est, multis idem accidere, qui ex variolis moriuntur.  
To which Horstius answers by Letter, and consents with his determination in these words: Cùm autem necessariò febris sanguinea cum putredine majori concurrunt, in tali casu facillimè fieri poterit, ut praevalente calore febrili 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in viscere sanguificationis prae caeteris corrumpatur; inprimis cùm, propter cutem undique pustulis exulceratam & incrustatam, transpiratio & eventilatio difficilior fit. Si enim inflammationes internae ipsiusque jecoris juxta communem nostrum amicum Guile Fabr. non rarò desinunt in gangraenam, non video cur non idipsum saepiùs etiam fieri possit tunc temporis, ubi variolis undique satìs quidem expulsis, gravissima symptomata partium internarum inflammatarum nihilominus perdurant, eo usque donec aegrum penitùs jugulent. Horst. Institut. Med. Disp. 3. coron. 1. additament.  
And in many other acute malign Diseases, either the morbific matter is not discussed and discharged from the seat of the disease; or else is expulsed thence into some other, perhaps a remote part, where it corrupts the member, and extinguisheth the vital Principle, called by some the innate Spirit.  
Now concerning the curability and incurability of Gangrenes, take these instructions before the disease be undertaken, or left for desperate and hopeless.  
First, Consider the duration or time of the disease, the age and strength of the Patient; for a Gangrene in the beginning is more easy and hopeful, than after continuance; because it proceeds on commonly and draws nearer to a Sphacelus, which is incurable: also young persons, vegete and vigorous in spirit, are more hopeful than others, aged, or worn out by long, or enervated by acute sickness.  
Secondly, Examine into the essence, nature, and rise of the disease, which will lay open much of the difficulty thereof: for Gangrenes from a primitive cause, as Contusion, Fracture, Section, ustion, Caustic, or other erosion, etc. are more curable and less dangerous, than those that arise and depend upon antecedent internal causes; for Gangrenes of this sort do declare a cachectic, depraved habit of body, and that some of the internal Viscera are damnified and vitiated, from whence a supply of ill matter: and therefore in Hydropic, Scorbatic, and Hectic febrile bodies; also in malign and contagious diseases, small Pox, Venereal Lues, Plague, etc. Gangrenes are more desperate.  
Thirdly, The part affected or seat of the disease is to be noted: for if a principal part be gangrened, recovery is very rare; also in the Guts a Gangrene is mortal, by reason of continual moisture there, and imbecility of these also in the Vagina Vteri, and Glandules of the body, a Cure is seldom performed.  
Now as touching the Cure of Gangrenes, there is not any one Method or particular Medicine for Gangrenes; but they require such variation of Cure according to the difference of their causes from whence they do arise, with respect to the part affected.  
And therefore we cannot point out any general course that may be applicable to this great disease; but indications of particular and special cases must vary, and will make exceptions against it: So that the rational Physician perpending and duly considering the nature of the disease and variations thereof, as aforesaid, with the Symptoms and circumstances attending; must design such a Method, and adapt such Medicines pro re nata, as may best suit with the urgency of this dangerous and threatening Malady.  
The means required and useful in these emergencies are taken, some from Pharmacy, and some from Chirurgery.  
Pharmaceutic Remedies are both internal and external, Internal are select and choice Purgatives, Diaphoretics, and Cardiacs, elaborated and prepared according to latter inventions, and the best Rules of Art. Topical and external are, Fomentations, Liniments, and Cataplasms, specificated and appropriated to these purposes.  
Chirurgical helps are, Phlebotomy, Cupping, Scarification, Canteries, etc. and therefore an expert Chirurgeon must here be assisting, to perform these operations.  
Now all these various means are not to be used to every person gangrened; but each case will require some of these, more or less, as the Judgement of a skilful Physician in this disease, shall determine and appoint.  
But if the Gangrene by continuance and neglect; or from acuteness by great malignity and venenate matter, hath proceeded too forward, and draws near to a 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 mortification; then these means are to be laid aside, and nothing remains to be done but amputation or dismembering; and that only if the part will allow it, as Arm or Leg, Scrotum or Dug, 
— immedicabile vulnus  
Ense recidendum est, ne pars sincera trahatur.   
And if a separation of this dead part from the living cannot be performed, there is no hopes of recovery or reduction of that to life again: à privatione ad habitum non datur regressus. Nor is there any hopes of the Patient's life, for this mortified part will corrupt and mortify the whole.  
Where amputation can be performed, this question, as a difficulty, ariseth amongst men of Art: Whether Section should be made in the sound, or unsound part. Some are of opinion, that it should be in the dying or dead part; thereby to avoid pain, to prevent the great Haemorrhage or flux of blood, and Convulsion: but I rather consent with those that determine of the other side, as the most secure way, and the arguments for it are more prevalent, rather to take away some of the sound flesh, than to leave any of the corrupt and mortified; for from that root the same mischief may grow again, notwithstanding cauterizing, or what else may be done.  
For a good performance and happy success in this operation being the ultimum refugium and extreme remedy in this desperate case, there are many things to be cautioned; some before as previous; others in the doing, and also after dismembering, to prevent the ill accidents that may attend or follow. But I must wave those particulars now, until occasion be offered to revise this Work, and enlarge upon the several Heads treated of.  
And since that these diseases now briefly discoursed, have such transitions and gradations, from bad to worse, and from thence to extremity; it behoves every one upon suspicion of these latent and obscure Maladies (intimated by pain) to begin early with them, when with a smaller matter they are capable to be reduced: but delays and neglects, or improper mistaken courses, do precipitate the Patient into languishing and difficult, or irremediable conditions.  Multae aegritudines suâ naturâ sanabiles, aegri negligentiâ, aut Medici errore, fiunt incurabiles.  

The Result of the whole matter, by way of Recapitulation.  
I Have thus briefly delivered to you the most considerable matter relating to the Subject proposed in the Front of this Work, Pains, Inflammations, Tumours, Apostems, etc. this frequent and latent progress of Diseases; which might admit of great inlargements and long discourses upon the several parts, and points touched upon; but I have only drawn out the chief Heads as a Compendium, easy to review and retain in memory, whereto many cases and the most principal in Practice do refer and belong, and may serve as a guide and caution to Practisers that jog on in the common beaten road, who little suspect this train of Diseases, and discern not their disguises in the sicknesses they undertake.  
Indeed it seems something strange, that these capital diseases, which most other are dependent upon, or move towards, should not be obvious, and more frequently the subject of Practice; these being primitive diseases, and a groundwork, from whence many others are derived and bottomed upon: or else they are such, as most diseases do fall into, and are the terminations of them.  
And it is very reasonable to expect, that both most acute and also chronic diseases should go in this road, and make their transitions by these stages; for pain is so general in diseases, and this so naturally leads on the rest, or at least does signally declare that the rest are coming on; as in pag. 9, 10, 11, 12. is set forth.  
And if you do but consider, that in diseases, both acute, and slow of motion, there is most commonly a peccant matter lodged here or there, and causeth particular pain in some part; or else this morbific matter is floating in the Vessels, and produceth only some general indisposition, or a febrile estuation and distemper: if it be lodged in any part by defluxion, or bred there by congestion, it necessarily diseaseth that part, gives some disturbance by pain, and will form a Tumour, if not removed and dislodged in due time: but if the morbific matter be roving and fluctuating, Nature either makes a secretion and sends it forth by her own strength, or assisted by Medicine; or else it is transmitted into some ignoble part, where it will not lie dormant long, but accumulates there, becomes more depraved, and lays the foundation for this train of diseases: so that either way there is a tendency to bring about this design, the subject of our Discourse.  
In the most malignant sicknesses you may discern some or more of these confederate diseases as Actors therein, whether small Pox, great Pox, Plague, etc. for eruptions and superficial Tumours are but internal Tumours transplanted; at least are the signals of Nature's endeavours and strength, with or without assistance to cast out that morbous matter, which otherwise must necessarily inflame, tumify, apostemate, ulcerate, corrupt and destroy the internal parts.  
And Fevers that are not malign, they are adjudged salutary and hopeful, when Nature makes a good Crisis, by Fluxes or Sweats, by Urine, or a Haemorrhage: and if the morbific matter be not discharged some of these ways, it lodgeth here or there, after long floating about, is sequestered and cast into some recess, Glandule or other ignoble part, where it forms a Tumour, and is the secret foundation of some chronic disease, or another acute sickness, if not anticipated or prevented by due course of Medicine: and therefore in the designment of most Cures, acute or chronic, these are the dangerous rocks you are to avoid, lest the Patient miscarry here, for want of discerning and foresight thereof.  
The method and drift of our Discourse is, to let you understand, that this grand Series of diseases is the usual progress in sickness; and by these stages most diseases do pass on, and have their gradual advance by these commutations, and thus make their approaches towards death.  
Some go but part of this way, such as Providence with good means does shorten the course, prevents the mischief threatened, and reduceth them back into their former state of health. Some are only pained for a while, it goes off and ends there: but some are pained in a higher degree, and Inflammation follows thereupon, but it goes no farther; this febrile inflaming heat is allayed, and all is quiet again. Sometimes it proceeds farther, and to Inflammation a Tumour is added; which notwithstanding by due administration of Medicine, this is dispersed, and the sick reduced to a sound state again: but yet sometimes it advanceth farther and into greater danger; as by some neglect, improper means, or other casualties, that this Tumour apostemates; and than it cannot stop there, for this must break, and then an Ulcer will follow of course: this Ulcer, if not of a very malign nature, or very ill seated, is yet curable, and the Patient may do well and recover, by care and skill of the Physician, and tractability of the diseased: but else this does corrupt and mortify the part; and then there must be dismembering (if capable) which is hazardous and doubtful; or mortification of the whole will soon follow, which is certain.  
Thus you see some go half the way; some but a quarter; and come off well: others that are engaged in a fatal sickness, must go through and finish the whole course by these gradations, or else per saltum; although they may step over, and miss some of them, yet they do arrive at the period of mortification.  
I have now finished what I intended briefly upon this Subject, having given you a prospect of this secret and lurking train of Diseases; discovering them in their causes and disguises; under what distempers they commonly are vailed and obscured: their signal distinguishing Characters: their dependence and complication: their manner of commutation and transition from one to another: the Indications belonging to each state and gradation, prompting a designment and method for redress, to obviate these dangerous and growing evils.   

Of Fontanels or Issues, and Seton's: Showing the right Use, and true Effects thereof.  
BY the course of Nature, humane Bodies are nourished and maintained, by a continual supply of necessary food daily to be received in; which before it be assimilated and incorporated into the substance of the body, this Aliment must undergo several transmutations and digestions: in which previous disposition and gradual preparation for nutrition, there is a separation made, the nutritive and useful part, from the excrementitious and unnecessary: the defecated utile part designed for aliment, is still conveyed from one digestion to another, for a farther elaboration, until it hath received the compliment and full perfection intended by Nature; the excrementitious and inutile part separated in this course, is transmitted and received by sinks, channels, and ventholes peculiarly appointed and framed for such conveyance and discharge out of the body, as the Guts, urinary Ductures, Nose, Ears, Pores of the Skin: which passages, if at any time obstructed and stopped, the detriment and sensible damage soon confirms the necessity of their use and office.  
And as Nature hath thus appointed and framed in the body these Vents and Outlets for the daily discharging of excrementitious and superfluous matter, which else would deprave and corrupt the body, suffocate and stifle the life, if not in some measure duly evacuated: in imitation therefore of Nature's contrivance, Art hath invented Fontanels and Seton's as Ports and Vents, to be placed here or there, (as the variety of occasions require) to supply Nature's insufficiency and inability to help herself in the discharge and emission of superfluous or depraved matter, which produceth various diseases and Symptoms, according to the several proprieties of their nature and degeneration; or from organical difference, and peculiar offices of the parts they invade and infest.  
And having such artificial passages of egress set open, by which Nature finds herself alleviated and disburdened thereby; does daily transmit and send any exuberant morbific humours to this new Outlet as to other common conveyances for excretion, by her own institution and fabrication.  
But for a fuller information and satisfaction in the use of these Fontanels and Seton's, we shall consider  

First, What these are, and the manner how they are made.  
Secondly, What matter is usually discharged and evacuated thereby.  
Thirdly, For whom and in what cases they are beneficial.  
Fourthly, The places and parts of the body where they are to be set.  
Fifthly, The due ordering and dressing of them; with observations upon their various conditions and accidents.  
Lastly, The Time convenient, and signs when to close them safely, with the circumstances thereto belonging.   
Vesicatories, Cupping, Cauterizing, and Scarification are used upon emergent occasions for a more speedy and present help, and do show their effects sooner: but Issues and Seton's are planted upon a future expectation, and their effects are matter of time, and therefore they are continued longer; and because they are used sometimes by way of precaution, therefore they are designed to be of continuance and constancy.  
Fontanels are so called from Fontinella or Fonticulus; because, as a Spring, they send out their moisture continually: and they are also called Issues, from such issuing forth.  
A Seton in Latin Setaceum, is so called, because that which was drawn through the Seton, and remains to keep it open, was made of hair; but now we commonly use silk.  
Issues and Seton's are used for the same purposes; but Seton's having two Orifices, and by drawing the silk to and again, do cause a greater discharge of humours, if the morbific matter be brought to the superficies, as in cutany affects: but these being more troublesome than Issues, they therefore are seldomer used. Fontanels are made by Section or Caustic; but Seton's are always made by a perforating Instrument; which being well known to the Chirurgeon, I need not say more.  
For the nature and quality of humours issuing forth, they are divers according to the various disposition of bodies diseased or sound: such as the body abounds with and is superfluous, such is transmitted thither for emission. And that the humour evacuated is not good and useful for the body, appears by the concomitant signs manifesting the nature of it; itching, pricking, sharp pain about the place, Inflammation and spongious proud flesh rising, in some more, in others less; which are not signs of a natural good humour, but a hot, fretting, sharp, preternatural humour flowing thither, degenerate and corrupt. Also any extravasated humour proceeding from the Veins and Nerves, does move and flow thither; sometimes ichorous or serous, and sometimes bloody: And such humours as were wont to resort to, and infest any infirm part, an Issue well placed does intercept and evacuate: and although the matter that issues forth is little to behold; yet because this evacuation is constant, it amounts to something considerable.  
From hence we may understand for whom, and in what cases these Fontanels are beneficial.  
For corpulent and plethoric bodies; such as feed high, and live a sedentary inactive life, whereby a liberal and free Transpiration is restrained, Issues may be good for them by way of precaution; for they are in danger of some sudden disease.  
For several diseases of the Head, idiopathically affected; Convulsions, Vertigoes, Pains, lethargic and sleepy disposition, sore Eyes, etc. Fontanels or Seton's may be used with benefit.  
In cachectic depraved bodies, and diseases from putrid humours; Issues make an abatement of the morbous matter, and give some mitigation of the effects.  
For Revulsion, Derivation, or Interception of a humour injuriously resorting to an eminent or an infirm part; Issues are advantageous to alter the course and current thereof.  
For erratic pains, cutany defedations or eruptions, and Tumours in any part; Fontanels are beneficial.  
In most chronic diseases, that give time and liberty for the use of various means, a deliberate way of Cure, and gradual spending of the morbific matter; Issues do contribute assistance herein: but in acute diseases that require speedy help, they are not a proper Remedy.  
But although these Fontanels are of good use in the cases aforesaid; yet they are not to be relied on as curative Remedies; that is, they do not eradicate a disease, because they do not apply to the spring where it does arise; but they give vent, and turn the current of a humour this way, or that way, that it shall not overflow to do hurt other ways. They minorate and lessen the morbific matter, and abate the extravagant productions and growth of a luxuriant humour, and are but remedia à posteriori: So that these Issues do not hinder, must not justle out the use of good Medicines that must take away the antecedent cause, and radically cure; by applying to the fountain and rise of a disease, the part primarily affected and deficient in office, that is the original cause of any producted noxious matter.  
For the right placing of Issues, that they may prove advantageous for the purposes intended; you are to consider whether the case requires a general evacuation only, or revulsion and evacuation, or derivation and evacuation. If only a general evacuation answers your intention, than set your Fontanel in the left Arm: but if for revulsion of a humour, it must be remote from the part affected or complaining; but if derivation be most convenient, than the Issue must be near the part affected. Sometimes an Issue is placed in the part affected, to empty and evacuate a morbific humour lodged there.  
Secondly, Having thus determined the part or member; you are then to choose a fit place for the Issue, observing diligently the position and motion of the Muscles, else your Issue will not be so beneficial nor lie easy: for if it be set upon, or too near a Tendon, or in the body of the Muscle, the motion and attrition of the Muscle will molest and disturb it with pain, and the evacuation will be but little; therefore you must place them in interstitiis Musculorum, in the place or distances between the Muscles, where the extravasated humours are most frequent in their motions and perambulations: and therefore this operation is not rashly to be attempted, but considerately to be performed by good advice, and a skilful hand in Anatomy.  
Fontanels being thus appointed for several purposes and cases, will require a different situation, some in one part of the body, and some in another. For diseases that are seated in the Head, Fontanels or Seton's may be placed in the hind-part of the Neck: but because they appear more in sight there, and also are troublesome, Issues may with the like benefit be set inter Scapulas, between the shoulders, one of each side the Spine: or else in the Arm between the two Muscles Deltoides and the Biceps, about four or five finger's breadth below the shoulder-joynt: and this is the most frequent place, because the Patient may dress this Issue without help.  
But Fontanels in the Back do not only contribute help to infirmities of the Head, but also they are beneficial for Arthritic or Gout-pains, by intercepting and evacuating the morbific humour that tends towards the Joints: also Fontanels thus placed, do divert and turn off a defluxion or current of humours that invade the Lungs; and therefore such as are troubled with Coughs from a distillation of Rheum into the Breast, and are inclining to be consumptive, will find benefit thereby.  
In the Groin Issues may be set for diseases of the Liver or Spleen, observing the rectitude of parts; the right side for the Liver, the left side for the Spleen: this place also is convenient for derivation of the morbific humour that causeth Sciatica-pains, and pains of the Back towards the lower end of the Spine, and about the Loins. The Glandules in the Groin are appointed to receive superfluous and excrementitious humours, which being readily discharged again by Issues, the current of morbific matter will then more freely resort thither, and exonerate such parts adjacent as are infested and oppressed therewith.  
The Thigh and Leg also are places for Fontanels, to make a revulsion of humours that molest and injure the superior parts; and also may serve for a general evacuation. In the Thigh an Issue is usually placed a little above the Knee, as being most fit there for a binding to keep on: as also in the Leg a little below the Knee, the inside of the gartering place.  
The Issue being made, whether by Caustic or Section, the orifice must be kept open with some pellet; for which commonly the largest sort of Pease is made use of, and so continued, except some occasion by alteration or condition of the Fontanel causeth variation; and then sometimes little balls are made of Ivy-wood, Gentian-root, Orris, or Hermodactyls, etc. as the case may require.  
The first dress of the Issue for two or three days a digesting Plaster is to be laid on; afterwards an Ivy-leaf may be used, which attracts a serous humour, and provokes the Issue to run; and over this is laid a thin paper: but for a constant wearing and common use, a piece of varnish or oiled cloth, such as the cover or riding Hat-cases are made of, is very commodious and easy to provide; very necessary for journeys or voyages, where the other is not to be had; and this you need to change but once in a week or more, wiping and turning it every dressing.  
For the due ordering and keeping of Issues, you are to observe the times of dressing: such as run sparingly or but little, once in 24 hours is sufficient; but those that send forth matter more freely and plentifully, dress them morning and night: that is, to take out the Pease, wipe the place, and put in another.  
If the Issue fills up at the bottom, and makes the Pease to start, then lay a Groat upon the place next under the binding, which will keep in the Pease, and continue the Fontanel deep.  
If the brim or edge of the Issue rise high with proud flesh, sprinkle a little powder of  Alum upon it, for one or two dress, which will bring it down even with the Cuticula.  
When your Fontanel abounds, and runs much with a sharp, or stinking ichorous humour that excoriates round about the Orifice, and causeth pain; to abate and take off the antecedent cause, you must purge sometimes with a proper and good Medicine: avoid also intemperate, or often drinking between meals; be sparing in your diet, especially at nights, and keep seasonable hours for bedtime.  
When you desire, and the case requires an Issue to evacuate more; enlarge the Orifice and Cavity thereof, by putting in pellets bigger than pease, as Horse-beans; and if that be not sufficient you may put in two.  
An Issue sometimes at the first making will not run well; the morbific matter being accustomed to frequent other places, and having not found this new vent-hole: you must then wait with patience for the desired effect, and use such means as hereafter is prescribed for a dry Issue: but if after six months' you find not some reasonable discharge of matter here, let this Issue heal up, and set another in some place else, where the humours may more freely resort.  
If an Issue runs but little, and gins to grow dry, as sometimes it happens so; then put in a pellet made of Ivy-wood, Orris-root, Gentian, or Hermodactyl.  
When your Fontanel is inflamed round about, by reason of Plethory or a febrile turgid blood causing extravasation and fluxion about the orifice; then apply Emplastr. è mucilaginibus to the place; but if it continue pertinaciously, and threatens farther mischief (as sometimes a Gangrene hath happened hereupon) then bleed and purge, which will empty the Vessels, retract and give room for retirement, and is the best way to prevent danger.  
If a Fontanel by time shifts its place, and settles lower, as sometimes it doth in the Arm or Thigh, and comes too near the Juncture; than you must suffer this to close or heal up, and another must be made higher in the proper place convenient.  
The closing or healing up of an Issue, not substituting another elsewhere, is warily to be done by advice, else you may run a hazard and be in danger thereby; for some upon this account have lost their lives: for Nature having found such a conveniency and help, does expect and requires it to be continued, until the occasion be otherwise prevented, and cause removed by Medicine, or Nature better able to discharge and free herself by the Emunctories and outlets of her own appointment. Now if prematurely and unseasonably, this artificial passage be denied and stopped up, there being cause for the contrary; the confluence of humours then meeting and gathering at the place, regurgitates back again with united force and greater current; at which Nature being surprised unexpectedly, and having made no provision to secure herself from such a Reflux, the same preternatural Symptoms and ill affects, against which the Issue was first appointed, or rather much worse, will ensue thereupon.  
Before the closing up of an Issue, these things are to be considered: the cause for which it was appointed; what effects, alteration or abatement of the infirmities since; the age of the person, whether in youth, strength of Nature, or declining years, and what state of health the person hath for some time enjoyed, and is now in: which are to be adjudged and determined variously, as particular cases and their circumstances collated do suggest: but generally the body is to be accounted in a better or worse condition, as the humour issuing does appear: ichorous, sharp, bloody, and sordid matter, smelling strong or stinking, much in quantity, declare the body to be cacochymical and foul, the Juices depraved and degenerate, and require the Issue to be continued: but the matter issuing white, reasonable thick, sweet, little quantity, not sharp or painful, nor causing Inflammation about the place; these are good signs, and show soundness of body, the nutritious Juices to be in their natural condition, amicable and friendly to the body, and permit an Issue to be healed, caeteris paribus: but withal let due Purgation succeed by intervals, and a spare diet for some time.  
London, from my House in Wine-Office Court in Fleetstreet.  
FINIS.    

Books lately Printed and Publish-by the Author.  

Morbus Polyrhizos & Polymorphaeus.  
A Treatise of the Scurvy: examining the different Opinions and Practice of the most solid and grave Writers, concerning the Nature and Cure of this Disease: with Instructions for Prevention and Cure thereof. The fourth Edition. By E. Maynwaringe Dr. in Physic.   

Tabidorum Narratio.  
A Treatise of Consumptions: Scorbutic Atrophies, Tabes Anglica, Hectic Fevers, Phthises, Spermatic and Venereous wastings: radically demonstrating their Nature and Cures from vital and morbific Causes. By the same Author.   

The Mystery of the Venereal Lues.  
Gonorrhoea's, etc. disclosed: comparing the dissenting Judgements of most eminent Physicians hereupon, and the various Methods of Cure, practised in Foreign Countries. Resolving the Doubts and Fears of such as are surprised with this secret perplexing Malady. By the same Author.   

Vita Sana & Longa.  
The Preservation of Health, and Prolongation of Life; proposed and proved in the due observance of some considerable Precautions, and daily practicable Rules relating to Body and Mind, compendiously abstracted from the Institutions and Law of Nature. By the same Author.   

Medicus Absolutus ', 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉.  
The complete Physician, qualified and dignified: the Rise and Progress of Physic, Historically, Chronologically, and Philosophically illustrated: Physicians of different Sects and Judgements, charactered and distinguished: the abuse of Medicines, Imposture of Empirics detected, etc. By the same Author.   

Praxis Medicorum Antiqua & Nova.  
The Ancient and Modern Practice of Physic examined, stated, and compared: the Preparation and Custody of Medicines, proved the Physicians Charge and grand Duty, etc. By the same Author.  
Sold by the Booksellers.