PHTHISIOLOGIA: OR, A TREATISE OF Consumptions. WHEREIN The Difference, Nature, Causes, Signs, and Cure of all sorts of CONSUMPTIONS are Explained. Containing Three BOOKS, I. Of Original Consumptions from the whole Habit of the Body. II. Of an Original Consumption of the Lungs. III. Of Symptomatical Consumptions, or such as are the Effects of some other Distempers. Illustrated by particular Cases, and Observations added to every Book. With a Complete TABLE of the most Remarkable Things. By RICHARD MORTON, M. D. And Fellow of the College of Physicians. Translated from the Original. LONDON: Printed for Sam. Smith and Benj. Walford, at the Prince's Arms in St. Paul's Churchyard. 1694. TO THE High and Invincible Monarch, William IIIᵈ. By the Grace of God King of Great Britain, France, and Ireland, Defender of the Faith, etc. Dread Sovereign, NOW that you have with the greatest Difficulty and Danger happily expended so many, and such vast Labours for the sake of Religion and the Commonwealth, now that you have had so many Remarkable and Eminent Rewards conferred upon Your Majesty (as we must think) by the Hands of Heaven, with the Suffrage and Applause of all Good Men for your Virtue and Piety both towards God and Mankind, which every way imitate and equal what has been always found in the Family of NASSAW, permit me, who not by my own Merits, but by Your Favour alone, was some time since advanced to the Doctor's Chair, to Present to your Majesty these First Fruits of my Studies, how mean soever they be, as an Expression of my most Humble Gratitude, and to lodge them securely under the Protection of Your Most Mighty Patronage. From which if any thing shall redound to the Public Good, I shall have Reason abundantly to Congratulate my own Felicity. And may it please Almighty God, that his free and infinite Goodness towards Mankind may especially at this time be manifested to all the World, to bestow upon Your Majesty, and upon the Most Illustrious Consort of Your Bed and Throne, MARY, Queen of Great Britain, perpetual and unshaken Health, a Long and Prosperous Reign, and an Heir in every thing like his Parents, and at length a late arrival to the Regions of Immortal Bliss. This all Good Men particularly Pray for, this they passionately desire. In the mean time go on, Most Renowned Monarch, to Compose the disordered state of Religion and the Commonwealth, to Secure the Christian Part of Europe, that is just ready to perish, to give Peace to the World; and finally, to take off every Unjust and Tyrannical Yoke, that in after-ages you may for ever be styled under God the only Deliverer and Saviour both of Your Country, and of Mankind, which is the most ardent desire of Your MAJESTY'S Most Humble and Devoted Subject, RICH. MORTON. TO THE READER. THIS Book had remained concealed from Vulgar Eyes in the Learned Language in which it was writ by the Author, had we not been certainly informed that the Translation of it was intended and attempted by other Hands. And having also fresh Experience how by such means two late Treatises of Dr. Harris and Dr. Sydenham (whose Copies were our Proprieties) were surreptitiously invaded, and by false and unintelligible Translations, the worthy Authors themselves much defamed and injured; we thought in Justice to ourselves as well as the learned Author, to anticipate such an ill Design, by procuring, and putting forth this Exact Traduction, wherein not only the Sense, but also the Life and Elegancy of the Author's Style is fully set forth. And we do here at once declare to the World our Intentions to frustrate the Designs of any (whoever they be) who for the future shall go about to Translate and Publish any Copy of Ours. S. Smith. B. Walford. The CONTENTS. BOOK I. OF Consumptions in General, and particularly of a Consumption proceeding from the whole Habit of the Body, or an Atrophy, both that which is Nervous, and that which is caused by Evacuations. pag. 1. Chap. 1. Of a Nervous Consumption. pag. 4. Chap. 2. Of a Consumption proceeding from some Evacuation. p. 11 Chap. 3. Of a Consumption from Bleeding p. 14. Chap. 4. Of a Consumption from a Gonorrhoea and the Whites. p. 19 Chap. 5. Of a Consumption proceeding from Apostemes and large Ulcers p. 23. Chap. 6. Of a Consumption happening to Nurses, from the giving of Suck beyond what their strength will allow p. 32 Chap. 7. Of a Consumption from a Bloodyflux, and from a Looseness p. 37 Chap. 8. Of a Consumption from a Diabetes, or too great a Flux of Urine p. 41. Chap. 9 Of a Consumption caused by Salivation, or Spitting p. 45 Chap. 10. Of a Consumption proceeding from a Dropsy p. 47 Chap. 11. Of a Consumption caused by profuse Sweats p. 52 The Appendix p. 57 BOOK II. OF an Original Consumption of the Lungs pag. 62 Chap. 1. Of the Causes of an Original Consumption of the Lungs p. 64 Chap. 2. Of the Degrees of an Original Consumption of the Lungs, and the Signs which give us warning of it, together with the Preservatory Indications, or what we are directed to do in order to prevent it p. 69 Chap. 3. Of the Diagnostic and Pathognomonick Signs of the beginning of a Pulmonary Consumption p. 82 Chap. 4. Of the Pathognomonick Signs of a Confirmed Consumption of the Lungs p. 100 Chap. 5. Of the Differences of an Original Consumption of the Lungs p. 117 Chap. 6. Of the Prognostic Signs of an Original Consumption of the Lungs p. 122 Chap. 7. Of the Indications of Cure in an Original Consumption of the Lungs p. 127 Chap. 8 Of the Method of Cure in an Original Consumption of the Lungs p. 138 Chap. 9 Of the Cure of a Consumption in the Second Degree of it, to wit, when from the want of a due Expectoration, and from the Matter, that was lodged in the Lungs, thereupon staying long in them, some crude Tubercles arising from the knotty Swelling of the Glands of the Lungs, happen to come upon a long Cough p. 155 Chap. 10. Of the Cure of an Original Consumption of the Lungs in the Third Degree of it, to wit, when the Patient is reduced by the Inflammation, the Apostems, and Exulceration of the Glandulous part of the Lungs, to the state of a Marasmus, together with an extraordinary Weakness, a Consumption of his Flesh, an increase of his Hectic Fever, and likewise the addition of a Peripneumonick and Putrid Fever, and the other direful Symptoms, which are wont to accompany the Fatal state of a Consumption p. 171 Chap. 11. Of the Relief of the Symptoms of a Consumption in the Third Degree of it p. 182 BOOK III. OF a Symptomatical Consumption of the Lungs pag. 191 Chap. 1. Of a Scrofulous Consumption p. 194 Chap. 2. Of a Scorbutical Consumtion p. 202 Chap. 3. Of an Asthmatical Consumption p. 212 Chap. 4. Of a Consumption proceeding from Melancholy, as also from an Hysterical and Hypochondriacal Affection p. 217 Chap. 5. Of a Consumption caused by Spitting of Blood p. 225 Chap. 6. Of a Consumption caused by Stones bred in the Lungs, and by things slipped down into them from without, as also by the Stone in the Kidneys and Bladder, p. 238 Chap. 7. Of a Consumption proceeding from the French-Pox p. 250 Chap 8. Of a Consumption proceeding from the Suppression of a virulent Gonorrhoea, of the Running of Old Ulcers, but especially Fistula's in the Fundament, and Scrofulous Ulcers, Issues, and the Whites p. 254 Chap 9 Of a Consumption proceeding from the Green-Sickness, and a Suppression of the Monthly Purgations in Women p 258 Chap. 10. Of a Consumption caused by a Peripneumony and a Picurisie p 263 Chap. 11. Of a Consumption proceeding from the Gout, and from a Rheumatism p. 276 Chap. 12. Of a Consumption proceeding from Fevers, especially such as are from Surfeits, Scarlate, and Intermitting Fevers; as also from the Smallpox and Measles p. 294 Chap. 13. Of an Icterical, or Hepatick Consumption p. 307 Chap. 14. Of a Consumption of the Lungs proceeding from Internal Ulcers of the Viscera and Membranous Parts p. 340 A TREATISE OF Consumptions. The First BOOK. Of Consumptions in general, and particularly of a Consumption proceeding from the whole Habit of the Body, or an Atrophy, both that, which is Nervous, and that, which is caused by Evacuations. THAT I may give such a Scheme of this whole Work, as will lie under a single View, and open a Prospect into my Design, I shall here by way of Preface first give a Definition, and make a Division of the Subject about which we are to treat, whereby, as by Ariadne's Thread, we be easily, and safely directed to, and proceed through all the parts of the Work. The Definition of a Consumption in general. A Consumption in general is a wasting of the Muscular parts of the Body, arising from the Substraction, or Colliquation of the Humours, and that either with, or without a Fever, and it is either Original, or Symptomatical. Of an Original Consumption. An Original Consumption is that, which arises purely from a Morbid Disposition of the Blood, or Animal Spirits, which reside in the System of the Nerves and Fibres, and is not the effect of any other preceding Disease. Of which there are two sorts, to wit, an Atrophy, and a Consumption of the Lungs. Of an Atrophy. An Atrophy is an Universal Consumption proceeding from the whole Habit of the Body, and not from any Distemper of the Lungs, or of any other Entrail; without any remarkable Fever, and is either Nervous, or the effect of Evacuations. Of a Nervous Consumption. A Nervous Atrophy, or Consumption is that, which owes its Original to an ill and morbid state of the Spirits, and to the weakness, or destruction of the Tone of the Nerves, from whence as an imbecility, and an Universal Consumption in the whole Habit of the Body upon the want of a due assimulation of the Nutritious Juice do at length proceed; so from the beginning of the Disease there is to be found a want of Appetite, and a bad Digestion in the Stomach from an imperfect Fermentation and Volatilization of the Chyle. Which sort of Atrophy may justly be reckoned one of the Fatal Symptoms of the Scurvy. An Atrophy from Inanition or an Expense of the Humours, Of an Atrophy from Evacuations. is that which derives its Original from a preternatural Defect, or Evacuation of the Nutritious Juice, and that long and habitual, which differs according to the variety of the passages form in the Body either by Nature or Art, by which this precious Liquor either has, or may run off, and be wasted. A Consumption of the Lungs is an Universal wasting of the Parts of the Body, Of an Original Consumption of the Lungs. caused by some Distemper of the Lungs, as a stuffing, swell, inflammation, and exulceration of them, and thereupon it is attended with a Cough, difficulty of Breathing, and other Symptoms of the Breast, and accompanied with a Fever, which at first is slow, and Hectical, afterwards Inflammatory, and at last Putrid and Intermitting. A Symptomatical Consumption is that, Of a Symptomatical Consumption. which although it does immediately proceed from a Preternatural, and ill state of the Blood and Spirits, yet has a mediate dependence upon some other preceding Diseases, which had given that ill Tincture to the Spirits and Humours. And because it is necessary, if we would be successful in the Cure of this kind of Consumption, to have a respect to the Disease which the Patient first laboured under, I shall in the end of this Treatise speak of all the several kinds of this Consumption, which I have hitherto had an Opportunity to observe in my Practice; but I shall begin, and discourse first of an Original Consumption. CHAP. I. Of a Nervous Consumption. A Nervous Atrophy, or Consumption is a wasting of the Body without any remarkable Fever, Cough, or shortness of Breath; but it is attended with a want of Appetite, and a bad Digestion, upon which there follows a Languishing Weakness of Nature, and a falling away of the Flesh every day more and more. A Nervous Consumption that which Virginians are most incident to. Which kind of Consumption I have sometimes observed in England, but most frequently amongst those that have lived in Virginia, after they have come over hither. In the beginning of this Disease the state of the Body appears oedematous and blouted, and as it were stuffed with dispirited Chyle; the Face is pale and squalid, the Stomach loathes every thing but Liquids', the strength of the Patient declines at that rate, that before the fleshy Parts of the Body are evidently consumed, he is rendered plainly feeble, and almost always confined to his Bed. The Urine also keeps not constant to any colour, though for the most part it be high-coloured, and but little in quantity. Yet it is sometimes, (as it happens commonly to be in Nervous Distempers) though seldom, pale and plentiful. But there is no considerable Fever to be discovered, either by the Pulse, or a Thirst, or Heat, how high-coloured soever the Urine appears. So that the Pathognomonick Signs, or those which do evidently manifest the beginning of this Consumption, are a decrease of the Patient's Strength, and a loss of Appetite, without any remarkable Fever, Cough, or shortness of Breath, though in the Progress of the Distemper, when a Consumption of the Flesh has gradually affected the whole Habit of the Body, there is some difficulty and trouble in breathing to be observed, as it uses to happen to all those who are under a great Weakness. The immediate cause of this Distemper I apprehend to be in the System of the Nerves proceeding from a Preternatural state of the Animal Spirits, The Causes. and the destruction of the Tone of the Nerves; whereupon I have used to call this a Consumption in the Habit of the Body. For as the Appetite and Concoction are overthrown by the weak and infirm Tone of the Stomach, so also the Assimilation, the Fermentation, and Volatilization of the Nutritious Juice are hindered in the whole Habit of the Body from the distempered state of the Brain and Nerves. The Causes which dispose the Patient to this Disease, I have for the most part observed to be violent Passions of the Mind, the intemperate drinking of Spirituous Liquors, and an unwholesome Air, by which it is no wonder if the Tone of the Nerves, and the Temper of the Spirits are destroyed. This Distemper as most other Nervous Diseases is Chronical, but very hard to be cured, The Prognostics. unless a Physician be called at the beginning of it. At first it flatters and deceives the Patient, for which reason it happens for the most part that the Physician is consulted too late. And at last it terminates in an Hydropical and Oedematous swelling of the Body, especially of the lower and depending Parts, in which case there remain no hopes of the Patient's Life, neither is there any thing more to be done for his Cure, than giving him some ease, whereby his Miserable Life may be lengthened for some days. The Cure. The business of Cure, if it be so that the help of our Art is called in in due time, consists in the convenient use of Stomack-Medicines, and such as comfort and strengthen the Nerves; such are Chalybeates, Antiscorbutick, Cephalick, and bitter Medicines of all sorts. As for Example, let the Patient, if his Body be costive, take every third or fourth Morning four Ounces of the bitter Decoction with Senna, or every fourth Night two Ounces of the Sacred Tincture, or of our Sacred Cephalick Tincture made with Hiera Picra infused in Rue-water, Black Cherry-water, and strong Piony-water. For his common Drink, let him use Ale, in which a Bag of Cephalick and Antiscorbutic Ingredients has been hung. An hour before Dinner let him take xxx drops of Elixir Proprietatis in a draught of Wormwood-White-wine. To the Region of the Stomach let there be applied the Magisterial Stomack-Plaister, with some Drops of the Chemical Oil of Cinnamon and Oil of Wormwood. Or let the Stomach be fomented every day with some Aromatic Bags made of the Leaves of Mint, Wormwood, Cinnamon, Mace, Zedoary, Galingale, Cyprus-roots, Calamus Aromaticus boiled in Claret. If it be in the Summer, let him use the Chalybeate Waters: But if it be the Winter time, let him make use of a Chalybeate Syrup, or our Chalybeate and Aromatic Wine made with the Filings of Steel quenched three or four times in strong White-Wine, and with Zedoary-roots, Galingale, Nutmegs, the best Cinnamon, Mace, Cubebs, Cloves bruised, and steeped in the same Wine. But for Chalybeates, I do prefer Mynsicht's Extract before any other, which I order to be given for xx. or xxx. days in the form of a Bolus, or Pills. As for Example. Take of Mynsicht's Extract half a Scruple, Balm of Gilead (which in this case is very proper and beneficial, because it is not a little grateful to the Stomach and Nerves) seven Drops, Old Conserve of red Roses a Dram, mix them, and make them up into a Bolus to be repeated every day. Or if the Patient chooses to take Pills, let the Extract be made up into that form in the manner following. Take of Mynsicht's Extract half a Scruple, of Balm of Gielead seven Drops, of Haly's Powder six Grains, of the compound Powder of the Roots of Wake-Robin four Grains, of Powder of Liquorice so much as will make them into the due consistence of Pills, and make the Mass into Pills of a middle size, let them be gilded, and repeated once every day. Also Natural Balsam by itself, as likewise Spirit of Hartshorn, and Spirit of Sal ammoniac are of use in this case, because they are good for the Nerves. As for Example: Let the Patient take viij. or x. drops of Natural Balsam, or Spirit of Hartshorn in a convenient quantity of Sugar-candy twice a day. Rules for Exercise, Diet, etc. Let the Patiented endeavour to divert and make his Mind cheerful by Exercise, and the Conversation of his Friends. For this Disease does almost always proceed from Sadness, and anxious Cares. Let him also enjoy the benefit of an open, clear, and very good Air, which does very much relieve the Nerves and Spirits. And because the Stomach in this Distemper is principally affected, a delicious Diet will be convenient, and the Stomach ought not to be too long accustomed to one sort of Food. History 1. Mr. Duke's Daughter in St. Marry Axe, in the Year 1684. and the Eighteenth Year of her Age, in the Month of July fell into a total suppression of her Monthly Courses from a multitude of Cares and Passions of her Mind, but without any Symptom of the Green-Sickness following upon it. From which time her Appetite began to abate, and her Digestion to be bad; her Flesh also began to be flaccid and lose, and her looks pale, with other Symptoms usual in an Universal Consumption of the Habit of the Body, and by the extreme and memorable cold Wether which happened the Winter following, this Consumption did seem to be not a little improved; for that she was wont by her studying at Night, and continual poring upon Books, to expose herself both Day and Night to the injuries of the Air, which was at that time extremely cold, not without some manifest Prejudice to the System of her Nerves. The Spring following, by the Prescription of some Empiric, she took a Vomit, and after that I know not what Steel Medicines, but without any Advantage. So from that time loathing all sorts of Medicaments, she wholly neglected the care of herself for two full Years, till at last being brought to the last degree of a Marasmus, or Consumption, and thereupon subject to frequent Fainting Fits, she applied herself to me for Advice. I do not remember that I did ever in all my Practice see one, that was conversant with the Living so much wasted with the greatest degree of a Consumption, (like a Skeleton only clad with skin) yet there was no Fever, but on the contrary a coldness of the whole Body; no Cough, or difficulty of Breathing, nor an appearance of any other Distemper of the Lungs, or of any other Entrail: No Looseness, or any other sign of a Colliquation, or Preternatural expense of the Nutritious Juices. Only her Appetite was diminished, and her Digestion uneasy, with Fainting Fits, which did frequently return upon her. Which Symptoms I did endeavour to relieve by the outward application of Aromatic Bags made to the Region of the Stomach, and by Stomack-Plaisters, as also by the internal use of bitter Medicines, Chalybeates, and Juleps made of Cephalick and Antibysterick Waters, sufficiently impregnated with Spirit of Salt ammoniac, and Tincture of Castor, and other things of that Nature. Upon the use of which she seemed to be much better, but being quickly tired with Medicines, she begged that the whole Affair might be committed again to Nature, whereupon consuming every day more and more, she was after three Months taken with a Fainting Fit, and died. History 2. The Son of the Reverend Minister Mr. Steel, my very good Friend, about the Sixteenth Year of his Age fell gradually into a total want of Appetite, occasioned by his studying too hard, and the Passions of his Mind, and upon that into an Universal Atrophy, pining away more and more for the space of two Years, without any Cough, Fever, or any other Symptom of any Distemper of his Lungs, or any other Entrail; as also without a Looseness, or Diabetes, or any other sign of a Colliquation, or Preternatural Evacuation. And therefore I judged this Consumption to be Nervous, and to have its seat in the whole Habit of the Body, and to arise from the System of Nerves being distempered. I began, and first attempted his Cure with the use of Antiscorbutic, Bitter, and Chalybeate Medicines, as well Natural as Artificial, but without any benefit; and therefore when I found that the former Method did not answer our Expectations, I advised him to abandon his Studies, to go into the Country Air, and to use Riding, and a Milk Diet (and especially to drink Ass' Milk) for a long time. By the use of which he recovered his Health in a great measure, though he is not yet perfectly freed from a Consumptive state; and what will be the event of this Method, does not yet plainly appear. CHAP. II. Of a Consumption proceeding from some Evacuation. TO this sort of Original Consumption from the whole Habit of the Body belongs also another kind of Consumption (which I have often met with in my Practice) arising from the empoverishment of the Blood, The loss and want of Nutritious Juice empoverishes the Blood, and causes a Consumption. occasioned by the Preternatural substraction and loss of the Nutritious Juice. Whereupon the whole Mass of Blood being deprived of the Nutritious and Oily Juice, grows sour and too hot, affording none or very little Nourishment to the Muscular Parts; and thereupon there follows a Consumption of the whole Body, and a Hectical heat fixed in the whole Habit of it, without any considerable Cough, or difficulty of Breathing, or any other remarkable affection of the Lungs, at least in the beginning of the Distemper. But it must be confessed that in the Progress of it the Lungs seem to be in some measure affected, At length the Lungs seem affected in some measure. especially where the Preternatural Evacuations, which are the cause of the Distemper, are stopped by Art without any correction or sweetening of the Mass of Blood, by which means it might recover its Natural, Oily, Benign Nature, and such as renders it fit for Nourishment. In which case there is no reason to wonder if the hot and sharp Serum of the Blood continually passing, after the other Sluices of Nature are stopped, through the soft and glandulous substance of the Lungs, does at length stuff, inflame, yea, and at last exulcerate them too; whereby it comes to pass, that this Consumption, which was Originally in the Habit of the Body, does a little before Death end in a Consumption of the Lungs, with a Cough, difficulty of Breathing, and other Pathognomonick Signs of that Distemper. And therefore I have often observed, that if the Appetite and Digestion are not restored by such Medicines as have a peculiar quality of altering the Blood, and strengthening the Stomach, so that the Mass of Blood may thereupon be supplied and filled with a sweet and Oily Juice, the Consumption is not cured, This Distemper sometimes turns to a Consumption of the Lungs. but at length is changed from a Consumption in the Habit of the Body, to a Fatal Consumption of the Lungs. This Consumption is akin to that which is Nervous. And this Consumption is in truth akin to the Nervous Consumption, which I have before mentioned. For as in that, which proceeds from a Preternatural state of the Nervous Juice and Spirits, the Nutritious Chyle, which is continually carried into the Blood, is rendered less fit for the Nourishment of the Parts, and thereupon as the Mass of Blood is filled with stolen and dispirited Chyle, such as is unfit for Nourishment, and not craving any new, there follows a loss of Appetite, and a sickness in the Stomach, and consequently a Consumption of the whole Body, and at length a fixed Hectical and Colliquative heat in the solid Parts from the heat of the Blood and Spirits: So in this kind of Consumption the Nutritious Juice running off from the Mass of Blood with a full stream, the Muscular Parts of the Body being thus deprived of their due Nourishment, fall into an Atrophy; whereupon likewise the Mass of Blood which remains, for want of new Oily Chyle is not only dispirited, and rendered unfit for Nourishment, but a preternatural, fixed, and hectical heat is kindled not only in the Blood, but also in the Spirits, and all the solid Parts; whereupon there follows a Drought and want of Appetite. Which kind of Consumption is that, which we are now in the first place professedly to treat of. The Cure of this Consumption is to be altered according as the Evacuation varies. But because the Cure of this kind of Consumption is to be altered according to the variety of the Evacuations, which are the cause of it, I shall add nothing concerning the general Cure of it, but refer that to the several kinds of Evacuations, which are the cause of this Distemper, to be spoken of under their proper Heads. Of which (so far as I have had an Opportunity to make Observations) I come now particularly to treat. CHAP. III. Of a Consumption from Bleeding. THat which here first offers itself, is a Consumption from Bleeding, whether it be at the Nose, or from the Lungs by coughing, from the Throat by hawking, from the Stomach by vomiting, from the Kidneys by the passages of Urine, from the Haemorrhoids, or Vessels of the Womb in the ordinary Monthly Purgations, or difficult Labour, or lastly, from Wounds, where there happens a plentiful and long flux of Blood from the opening of the large Blood-Vessels. Moderate and frequent bleeding makes People grow fat. For although frequent and moderate Blood-letting (as every ignorant Fellow and Barber knows) will make one grow fat; forasmuch as the emptying the Vessels with a moderate hand does make room for a greater quantity of new Chyle, whereupon the Mass of Blood growing richer, is rendered more fit for Nourishment, and consequently the Appetite is excited: But an immoderate bleeding impoverishes the blood, and causes a Consumption. Yet every immoderate and long Bleeding impoverishes the Blood, and creates a Hectical heat in the Spirits and solid Parts, thereupon destroying the Appetite, and bringing the whole Body into a Consumption and Leanness. Here the bleeding must be stopped. In this case the bleeding must be stopped as soon as may be, and the return of it is to be prevented by Incrassating, Opiate, and Glutinous Medicines, of which we are to speak more fully in the Chapter of Spitting of Blood. As for Example: The manner how this is to be done. Let strong Ligatures be made upon the Arms and Thighs, yea, if it be necessary, and the strength of the Patient will bear it, let a Vein be opened with a Lancet, and Blood taken away frequently, but in a small quantity, to divert the present Flux of Blood, and to prevent the return of it. If the Part where the Blood breaks out will admit of it, let Galen's Styptic Plaster, the Royal Styptic, cold Oxycrate, Ink, the ashes of Humane Hair lightly burnt in a Retort, and made into the form of a Pultise with Vinegar; true Bole, Dragon's Blood, and other things of that Nature, be in a convenient manner presently applied, and often renewed. Inwardly let the Patient take three or four times a day xx. or xxx. drops or more of the Royal Styptic in a draught of Milk-water. Also v. or vj. spoonfuls of the clarified Juices of Plantain and Nettles; or let him frequently take the following Linctus out of a Spoon. Take of Syrup of Purslane three Ounces, true Bole, Dragons-Blood, Troches of burnt Ivory, sealed Earth, of each two Scruples, Japan Earth a Dram, of Gum Tragacanth dissolved in Plantain-water, a sufficient quantity, mix them up into a Linctus. Or let him take the quantity of a Nutmeg of the following Electuary. Take of the Conserve of red Roses an Ounce, Troches of Amber three Drams, true Bole, Dragons-blood, of each half a Dram, Syrup of Myrtles a sufficient quantity; mix them up into an Electuary. Let him likewise take every Night v. or vj. Spoonfuls of the following Julep, shaking the Bottle. Take of Plantain-water six Ounces, small Cinnamon-water three Ounces, distilled Vinegar half an Ounce, true Bole, Dragons-blood, of each half a Dram, London Laudanum three Grains, Syrup of Myrtles an Ounce and half, mingle them, and make a Julep. After the bleeding is stopped the blood must be supplied with new Chyle. The Flux of Blood being thus sufficiently stopped and cured, we are to use our most diligent Endeavours that the Blood may be quickly replenished with such new Chyle as abounds with sweet and Nutritious Juice, and that the Feverish heat (if there be any) may be extinguished, to prevent a Consumption. And therefore the Patient is to be nourished with the frequent taking of Jelly-Broaths, poached Eggs, and variety of Food that affords good Juices, and is both easy to be digested, and most grateful to the Stomach. Nevertheless he is to abstain from Wine, and from things that are salt, or have Spice in them, lest they increase the heat of the Blood, which was before too hot from the defect of its Nutritious Juice. And because this sort of Patients, as all that are upon the Confines of a Consumption, are subject to Anger, to Sadness, Hypochondriacal Oppressions, Hysterick Fits, and to a want of Appetite, whereupon they can neither take, nor digest much Food, and consequently uncapable of making up the loss of that Blood which has been spent; therefore the sick Person ought to be diverted and humoured by his Friends, and to be sent as soon as may be into an open and wholesome Air, The Patient must be diver●ed, and sent into the Country Air. which in truth I have, being taught from a great deal of Experience, observed to conduce more than any thing of Medicines to the comforting and fortifying of the Nerves and Spirits, to the recovery of an Appetite, and a cheerful Mind, and consequently to the preventing of an approaching Consumption. But if the Patient seems either through his own neglect, When there is a Hectical heat, it must be taken off with the Bark. or the sudden advances of the Distemper, to be affected with a Hectical Heat, and some degree of a Consumption from his bleeding, then let the Physician make it his whole business perfectly to put out this flame as soon as ever he can with the help of the Peruvian Bark given in a large quantity, the efficacy of which I have often found to be wonderful in this case. Afterwards, What is afterwards to be done. if it be necessary, let the Patient be put into a Milk Diet, or upon the use of the Chalybeat Waters. But he must forbear the use of all Purging Medicines. And some benefit may be reasonably expected from the giving of Crabs-Eyes, Coral, Pearl, and other such kind of altering and sweetening Medicines. A History. Mr. Hotchkins, a Merchant of London, a Man that was Scorbutical and Hypochondriacal, was subject to a frequent bleeding at the Nose from the twentieth almost to the thirtieth Year of his Age, so that he sustained a great loss of Blood from the heat of his Feverish Blood at lest once or twice a Month, though it did not observe any certain periods, till at length the Blood that was let out with a Lancet, or that which he bled at his Nose, did appear just like the Water that Flesh has been washed in. From the return of which bleeding I could not then free that Excellent Person, and my very worthy Friend, either with Phlebotomy, or the temperating Juices, Opiate, and Incrassating Medicines, a Milk Diet, Antiscorbutick, and Chalybeate Remedies, or any other manner of Medicines. From which he first fell into the state of an Atrophy, and at length into a true Consumption of the Lungs, together with a very great difficulty of Breathing, and thereupon falling into an universal colliquative state, he suffered a little before he died an exulceration of the Salivatory Glands after an extraordinary swelling of them. By the opening of which on the outside there flowed out so great, and such a continual stream of the Salivatory Juice, as very much hastened the Death of that worthy Man, that was before brought almost to the state of a Marasmus by the Consumption of his Lungs, which was caused by his Bleeding. But I was extremely troubled that I did not at that time know the Efficacy of the Peruvian Bark, in suppressing this effervessence of the Blood, upon which that Bleeding, which returned frequently, did certainly depend; for from the use of this Medicine we may justly expect more Service in the preventing of a Haemorrhage proceeding from the effervessence of the Blood, than from a Milk Diet, or any other manner of Medicines. CHAP. IU. Of a Consumption from a Gonorrhoea and the Whites. THIS Consumption seems to have been known even to the Ancients, This Consumption was not unknown to the Ancients. under the name of a Consumption of the Back, when it proceeds from a Gonorrhoea. Galen also notes the Story of the Wife of Boethius, a certain Nobleman of Rome, who fell into a Consumptive Dropsy from the Empirical suppression of the Whites, that had flowed in too great a quantity, and a long time. 'Tis very true indeed that a Gonorrhoea, A Venereal Gonorrhoea and Whites often end in a Consumption of the Lungs. and the Whites, that are of an ill Nature, and Venereal, (when the Impurity proceeding from that Venom has once infected the Humours) do often terminate in a Consumption of the Lungs, unless they are timely and perfectly cured. But of this kind of Consumption, and of the Causes, Degrees, and Cure of it, I shall Discourse more fully in its proper place, to wit, in the latter part of this Treatise, when I shall professedly speak of a Symptomatical Consumption of the Lungs. But for the present I do from a long Experience and Observation affirm, that a Consumption does often arise from a simple or benign Gonorrhoea and Whites, A Consumption sometimes proceed from a simple Gonorrhoea, etc. and therefore this sort arising from the continual substraction of the Nutritious Juice by the Seminal Glands, must be reckoned under the Head of an Originary Consumption. For in a Gonorrhoea and the Whites, sometimes the Flux is so extraordinary, and continues so long, that the Mass is thereby plainly dispirited, and rendered unfit for Nourishment, whereupon the Blood being loaded with Heterogeneous and disagreeable Particles, grows hot, and at length a Hectic Disposition is by degrees brought upon the solid Parts and the Habit of the Body, which is the same sort of Consumption that we are now treating of. The presaging signs of this Consumption. The Symptoms which presage this Consumption, I have for the most part observed to be these, to wit, an Hypochondriacal Oppression, Melancholy, and too much Thoughtfulness, with a decay of Strength, and loss of Appetite in Men that are affected with a plentiful Running of the Reins; but in Women that have been long afflicted with the Whites flowing in a great quantity, a soft and blouted Habit of the Body, a squalid and pale Countenance, together with Hysterical Fits, a remarkable Weariness, and decay of Strength; all which Symptoms proceed from the same cause, to wit, from the poor dispirited Nature of the Blood, caused by a want of new Chyle, whereby not only the Spirits are weakened and oppressed, but also the Habit of the Body is rendered Oedematous from the waterish disposition of the Blood, as it is full of old and dispirited Chyle. And therefore the Signs which presage this Consumption are, as I said before, Hypochondriacal Oppressions, Hysterical Affections, a decay and want of Strength, a blouted habit of the Body, and a want of Appetite. Which Symptoms in progress of time, that is, when the Distemper comes to be confirmed, are followed also by some others, as a Thirst, a Hectical disposition, Atrophy, and wasting of the Flesh, till at length the Body is plainly brought to the highest degree of a Consumption, and that very often without any Cough, or any other remarkable sign of a Consumption of the Lungs. This Distemper is easily cured, if the antecedent cause of it can be removed, that is, if the Gonorrhoea and Whites can be cured. When confirmed, it is incurable. But when it comes once to be confirmed, it is plainly incurable. And therefore a Prudent and Honest Physician, that is carefully concerned for his own Reputation, will not do well to undertake the Cure of it, but ought rather to take his leave, and walk off from such a Patient, after he has made a Prognostic of his Death; and so he will be just to his Art, and may satisfy his Conscience, though he loses some Fees, and defrauds his own Pocket. But if the Physician be sent for in time, What a Physician is to do in the Cure of it, when he is sent for in time. he ought to do all he can by all proper means, and a convenient Method to stop the Gonorrhoea, or Whites, which are the cause of this Consumption. Which thing we shall speak of at some other time, and show how it is to be done in the Chapters of a Gonorrhoea, and of the Whites. This efflux of the Nutritious Juice being once stopped by Art, we must endeavour with all our Power to replenish the dispirited and impoverished Blood as soon as may be, with new, oily, and benign Chyle. And therefore, as we hinted in the former Chapter, such Food as is delicious, and affords a good Juice, and is most grateful to the Patient's Palate and Stomach, must be given often in a day, though in a little quantity at a time. And that his Appetite may be the more excited, let him be advised to be cheerful: For there is nothing that destroys the Appetite, and confirms a Consumption more than Grief and Sadness. Let him also enjoy the advantage of an open and benign Air, which is very beneficial to the Nerves, and consequently to the Appetite and Stomach. Let him likewise use Exercise every day, and rubbing of his Body even to the procuring of moderate Sweats (if his strength will bear it) that the load of old dispirited, and unprofitable Chyle, with which the Blood-Vessels and Habit of the Body are stuffed, may be sweated out, to make more room for new and useful Chyle, and consequently for the improvement of the Appetite in the Stomach. But he must Religiously abstain from the liberal use of Wine, Spirituous Liquors are to be avoided and Spirituous Liquors, which are wont to put the Blood, which is before become too hot, No considerable Evacuations are to be made. into a greater flame. Let the Physician also take heed he does not prescribe any Purges, or any Medicines whatsoever, to procure any other considerable Evacuation, which may create farther Expenses to Nature, when she is already weak. But if a Hectical heat, even in the least degree be kindled in the solid Parts, he must presently endeavour with all his Industry to quench this flame by the use of Ass' Milk, a Milk Diet, and of such Mineral Waters as are Chalybeate. CHAP. V. Of a Consumption proceeding from Apostemes and large Ulcers. I Have always observed that Apostemes, Large Ulcers in any part may cause a Consumption. and large Ulcers, let them happen to any part whatsoever of the Body (whether external or internal) if they continue long, and throw out much Serum, or waterish Matter, have at length rendered the Body of the Patiented Consumptive, and that even to the degree of a Fatal Consumption; and I can say, I have taken notice that these kind of Ulcers do bring on a Consumption as well when they are in the Muscles of the Back, and in the Testicles, yea, in the Knee and the Foot, as when they are in the Kidneys, or Liver, or in the Lungs themselves. Besides that, I have often observed that a Consumption of the Lungs has come upon these large and old Ulcers. The cause of this Consumption without all question is the long and plentiful substraction of the Nutritious Juice continually flowing out of the Mass of Blood by the Ulcers; The reason of this Consumption. whereby the Blood, which remains in the Vessels being deprived of its Oily, Nutritious Juice, does grow sour, and contracts a Preternatural heat, and is thereupon rendered unfit for the Nourishment of the Body; whereupon a Feverish and Hectical heat not only is kindled in the Blood and Spirits, but also remains fixed in the Habit of the Body, and the solid Parts, together with a Thirst, a decay of Strength, want of Appetite, sickness of the Stomach, an Atrophy of the Parts, and at length a want of Sleep, Lightheadedness, and the other signs of a Fever, until the sick Person, being brought into the state of a Marasmus, or consummate Consumption, does miserably end his days, though for the most part without a difficulty of Breathing, Cough, or any other Pathognomonick sign of a Consumption of the Lungs. This Consumption may be costly cured, if the Ulcers are healed in time. This Consumption (as we have observed of that in the foregoing Chapter) does easily admit of a Cure, if it be so that the Ulcers, which are the cause of it, can be timely cured by the internal help of Physic, and the external Applications of Surgery, that is, before the Patient is fallen into any degree of a Marasmus. But (alas!) the Patient too often in this case being deceived by the fair Promises and Encouragement of some ill Surgeons, does not send for the Physician, till such time as it is more proper to have the good Counsel of some Divine about the future state of his Soul, or the Advice of a Lawyer about making his Will. Where the Patient is too far gone, the Physician should not undertake the Cure. In which case it is convenient for a Prudent Physician, after he has foretold the Fatal Event of it, rather to take his leave of the Sick Person, than to deceive him, when he despairs of his Recovery, with the hopes of an impossible Cure. What is to be done, when the Physician is sent for in time. But if the Physician be sent for in time, before the Patient be too far gone in a Consumption, and Hectical, the Cure of the Ulcers is to be endeavoured as soon as may be, and to be pushed on with all speed by the internal help of the Physical Art. To which end a plentiful use of the Decoction of Sarsa, etc. is of great use, not only to give a softness to the Blood, that the Blood being freed from its sharpness and preternatural Heat, may be able more easily to assimilate to itself the fresh Chyle, and to change it into its own Nature, and that the efflux and loss of the Chyle by the Ulcers may be moderated, which does much promote the Cure of the Ulcers; for which reason without doubt these Decoctions are commonly called drying; but also to carry off that load of dispirited, and unprofitable Juices, which lurk in the Habit of the Body, and in the Vessels, by the pores of the Skin in sweats, and insensible Breathe. It has been my Practice to use the following Decoction. Take of the best Sarsaparilla sliced six Ounces, A Diet-drink to be used in this cose. Chinaroots two Ounces, Sassafras Chips, red Saunders, shave of Hartshorn, of Ivory, of each half an Ounce, Raisins of the Sun stoned a quarter of a Pound, Liquorice sliced an Ounce, one Nutmeg sliced. After they have been steeped a convenient time in six quarts of Spring-water, boil it with the Ingredients to three quarts, adding at the end of the Decoction (if there be the least suspicion of any Mischief in the Lungs from a Cough, or difficulty of Breathing) the Leaves of Coltsfoot, Maidenhair, spotted Lungwort, Tunhoof, Fluellin, Flowers of great Daisies, of each a handful; then strain it, and let the Patient drink plentifully of this Decoction for his ordinary Drink. Yea, if the Ulcers are old, If the Ulcers are stubborn, Limewater must be used. and hard to be cured, let the Sick Person also drink at Physical Hours six or eight Ounces of Limewater, by the excellent Salt of which the sharp and acid Particles of the Blood being precipitated, the whole Mass becomes more mild, and thereupon does more easily embrace the new Chyle, and change it into its own Nature, whereby the Flux of the Chyle to the ulcerated parts is rendered less, and consequently the Cure of the Ulcers by the Surgeon's Art is more quickly performed. For which reason this Drink is also thought to be drying. And here I shall add the Prescription for that Limewater which I commonly use. A Prescription for the making of a Limewater. Take of the best Sarsaparilla sliced six Ounces, Currants half a pound, after they have been steeped for a convenient time in six quarts of Spring-water, boil them till the Liquor comes to three quarts; then strain it. Then in this Decoction quench half a pound of Quicklime, and after it is cleared by settling, and impregnated with the salt of the Lime, let it be poured off clear, and kept in Glass Bottles for use. Such Purges as are pretty strong must be given every fourth or fifth Night, unless there be a manifest Hectic heat. Yea, if there be not a manifest Hectical Disposition, let the Patient during the use of these Decoctions be Purged every fourth or fifth day, and that not only with gentle Medicines, as a Decoction of Senna with Manna, etc. but also with such as are stronger, as with half a Dram of Extractum Rudii, or a Dram of the lesser Pil. Cochiae. Yea, if the Patient bears Purging well, and it be necessary, he may ascend to the use of Scammony, and of Rosin of Jalapp itself, to which it is always convenient to add a Dose of Calomelanos. Which Medicine, by correcting and altering the disposition of the Blood, is in an extraordinary manner serviceable to the Cure of Ulcers. I have in my Practice used the following Prescription. In the form of a Bolus. Take of Diagrydium, or Rosin of Jalapp sixteen Grains, Calomelanos five and twenty Grains, or half a Dram, Conserve of Damask-Roses, or Syrup of Buckthorn-berries a sufficient quantity: Mix them up into a Bolus. Or let the Patient take a Mercurial Purge in the form of a Powder in a Spoonful of Milk, Or of a Powder. observing the Rules which are common in a Purge. By which Medicine the load of dispirited, and unprofitable Chyle, which was retained in the Blood, and Habit of the Body, is in an extraordinary manner discharged by Stool, and thereupon the Cure of the Ulcers is hastened. Yea, if the strength of the Patient be firm, If the strength and temper of the Patient allows it, Salivation. and no degree of a Hectical disposition has yet seized him, a Mercurial Salivation must be raised by the help not only of Calomelanos, but also (if it be necessary) of Turbith Mineral itself. Which in truth is the last Refuge, Which is the last, and most powerful Remedy. and a Powerful Remedy, and is also safe enough (if it be cautiously given) in the Cure of old and obstinate Ulcers. Here also internal Balsamic Medicines may be prescribed with advantage, Balsamic Medicines. such as the Balsamic Syrup, Leucatella's Balsam, etc. As for Example: Let the Patient take every Night, Leucatella's Balsam, Conserve of red Roses, of each half a Dram, or two Scruples with three or four drops of Balsam of Peru. Or a spoonful of the Balsamic Syrup truly made, twice or thrice a day, either by itself, or dissolved in a draught of Sarsa Drink: Or half a Dram of Balsam of Tolu made up into Pills at Physical Hours, drinking a draught of the Sarsa Drink after it. Or if there be no Feverish Heat, let him take twice a day eight or ten drops of Natural Balsam mixed with a little Sugar-candy. But when the Ulcer comes to heal, Care must be taken, that a Consumption of the Lungs does not follow upon healing of the Ulcers. there must be a great deal of care taken, lest a true Consumption of the Lungs follows in the room of a common Consumption from the substraction and loss of the Chyle, which indeed does very often happen. For this passage, by which the Nutritious Juice uses to run off, being now stopped by the Surgeons and Physicians Art, if the Blood still remains dispirited, and does not recover its former Balsamic and Oily Nature, it is wont to grow more hot and sharp, and thereupon that sharp and hot Nutritious Juice (which was used before to be thrown out by the Ulcer) it usually comes now to cast off upon the substance of the Lungs, as being spongy, and apt to receive the Humours. Whereupon follows not only a stuffing of the Lungs, and upon that a difficulty of Breathing; but also a considerable swelling of the Glands, which do often enough happen in these parts, and upon that a dry and troublesome Cough, yea, a Heat and Inflammation, and thereupon a Fever, not only a Hectical one, but also a Putrid, or rather Inflammatory Fever, and at length an Apostem, and Ulcers, with a Thirst, and want of Appetite; all which do at last end in a fatal and confirmed Consumption of the Lungs. The Signs which threaten it must be attended to. And therefore as soon as ever these external and remote Ulcers begin to heal, the Physician ought to make what Observation he can, to find whether the least degree of a difficulty of Breathing, or any other sign of an Affection of the Lungs comes upon it. Yea, if the Appetite continues weak, or if but the least degree of a Preternatural Heat in the Habit of the Body does appear, If they appear, what is to be done. which may give us the least occasion to suspect a Consumption of the Lungs, the first Attack and Progress of it ought to be prevented with all the Physician's Power, in the manner following. Let several Issues be made, the Head shaved, the use of the Balsamic Remedies before mentioned, and the Sarsa Drink, with the aforesaid Vulnerary Herbs be continued; or for the farther temperating and altering of the Blood, let the Patient be put into a Milk Diet, and kept strictly to it. For the same reason the Chalybeate Mineral Waters are here also of great use. Also the Physician must make all the hast he can, and disburden the Lungs that are stuffed, by Pectoral and Pulmonary Apozems, expectorating Linctuses, and other Medicines of that Nature, which we shall afterwards describe in the Book of a Consumption of the Lungs, before the Tone of the Parts is injured, and a Feverish heat is brought on by the continual stagnation of hot and sharp Juices. Let the Patient also have a very great care to preserve himself from Passions of his Mind, Passions of the Mind, Cold, and violent Excercise are to be avoided. and Cold, and use no violent Exercises; let him also abstain from the use of Wine, and Spirituous Liquors, which may make the motion of the Blood to and through the Lungs quicker than it ought to be, and kindle a Preternatural heat in the Blood. But if there be no suspicion of the Lungs, What is to be done after the Ulcers are healed, when there is no suspicion of the Lungs. when the Ulcer comes to be healed, let the Patient be enjoined to be cheerful, let him be placed in a benign and open Air, and eat plentifully of such Food as affords a good Juice, but yet is mild, and free from a sharpness; and lastly, let him use moderate Exercise, by the use of all which the Blood may as soon as is possible recover its former Balsamic, Temperate, and Oily Nature, and the Appetite of the Stomach may be increased. By which Method we may not only prevent a Consumption that is coming, but also cure one that is begun, when it proceeds from external Ulcers, as I have before discoursed more largely in the former Chapters of other Original Consumptions caused by the loss and want of the Nutritious Juice. An History. Mr. Wheatley's Wife near St. Sepulchers in London, about Fifty Years old, having been tormented for the space of two Years with an intolerable pain of her Loins, first from an Inflammation, and then an Aposteme of the Muscles of the Loins following upon the Inflammation, was in progress of time by the uninterrupted pain racking her both Night and Day, and by the continual loss of the Nutritious Juice discharging itself daily and plentifully into this Common-shore, put into a Fever, and at length brought into a Consumption, and that even to the degree of a Marasmus, with an intolerable Thirst, a continual Weakness, want of Appetite, and want of Rest, yet without any sign of a Consumption of the Lungs; so that the poor Woman being always confined to her Bed, lingered a long time, crying out dreadfully, as if she were ready to expire presently. By reason of her mean Circumstances she did not ask the Advice of a Physician, but thinking her Distemper to be the Stone in the Kidneys, she miserably tormented herself every day with I know not what Medicines to break and dissolve the Stone, such as every sorry Woman, that came to see her, did with assurance warrant should do her good. But I being at length desired by the most Ingenious Dr. Tyson to go and see her, and together with him observing the parts of the Loins to be swelled, and to resist a Pressure, and perceiving the fluctuation of purulent Matter under our fingers, when we pressed it, (though it lay somewhat deep by reason of the thickness of the Muscles, and of the Skin) with the consent of my most worthy Colleague, I ordered that after the application of a Caustick, the Tumour should be opened in a convenient place: Which was no sooner done, but a great quantity, first of clear then purulent Matter, and a great Number of little Bags filled with a very clear Water, at least Five Hundred, gushed out with a great force. We brought away for three Weeks, or more, taking out the Tent every day, a great deal of Matter, and small Bags filled with Water. From the first opening of the Apostem her pains were very much abated, and by the moderate use of Syrup of Meconium, she got convenient Rest; and by the help of Surgery outwardly administered, and the continual use of a Decoction of Sarsa given inwardly for her ordinary Drink, the Ulcer within the space of a Year and half (which we did designedly keep open so long with a Silver Tent that was hollow quite thorough) was at length perfectly healed; her Hectic Fever and Thirst went off, her Strength increased, her Appetite returned, and she was plainly freed from the state of a Marasmus; and being sent into the Country Air, such as was open and benign, and put into a Milk Diet, she grew fleshy within six Weeks, and recovered without any sign of a Consumption; and being yet alive after Eight Years which are since past, enjoys her Health very well. Several Histories of this Nature I do designedly omit for Brevity's sake. CHAP. VI Of a Consumption happening to Nurses from the giving of Suck beyond what their Strength will allow. What the Milk is. MILK is nothing but the Nutritious Juice continually separated from the Mass of Blood by the Glandules of the Breasts. And therefore if by reason of the want of an Appetite there be more Nutritious Juice sucked out of the Blood through the Breasts for a long time, than is supplied to the Mass of Blood by the new Chyle from the Lacteal Vessels, When, and how the giving of Suck does cause a Consumption. it is in, possible but an impoverishment of the Blood should follow, and thereupon an Atrophy of the Body (seeing it is deprived of due Nourishment) and consequently an Hectical heat in the Blood, Spirits, and Habit of the Body, which is another kind of Original Consumption proceeding from the substraction of the Nutritious Juice; of which we shall now treat. Yet a Consumptive disposition is sometimes cured by giving of Suck. Yet I must ingeniously declare, that I have sometimes observed a Consumptive Disposition cured by giving of Suck, and that not only in my most dear Wife, but also in very many other Women. As for Example: My Neighbour Mrs. Wilson, who at other times is Consumptive, and goes up and down like a Ghost, does always grow fat all the time she gives Suck. Yea, Mrs. Thompson upon Snow-Hill did manifestly fall into a fatal Consumption in the Habit of her Body, and upon that into a Consumption of her Lungs from the sudden weaning of her Child. But at the same time it is as obvious to our Observation, that all such Nurses as grow fat in this manner from giving of Suck, But such Nurses have always a good Stomach. have a good Stomach, yea, that during the time of their giving of Suck their Appetite is very much increased, and from thence it is very easy to give an Account for this appearance; to wit, that the Appetite being increased by the continual drawing off of the Nutritious Juice by the Child's Sucking, there is room made for a greater quantity of new and oily Chyle, by which the Blood is every day enriched, which does conduce more to the Cure of a Consumptive Disposition than all the Medicines in the World. But if the Appetite during the time of giving Suck grows languid, and thereupon by reason of the little Food that is taken in, a less quantity of new Juice is supplied to the Blood, than is carried off by the Breasts, a Hectical Disposition in the Blood and Spirits must inevitably follow; and an Atrophy, or Consumption in the Habit of the Body, and that for the Reasons which we have just now given. The first thing that presages the coming of this Consumption, is a want of Appetite; The presaging signs of this Consumption. and therefore I give this Caution to all Nurses, that when they find their Appetite to abate for some time, they forthwith wean their Children. The second sign is a weakness and faintness of the Spirits, proceeding from a dispirited and impoverished state of the Blood. A third sign is an Hypochondriacal Oppression, and frequent Fits of the Mother, and Choaking. Which appearance does not proceed from the sucking of the Child, drawing the Vapours upward (as is commonly thought) but a too plentiful substraction, and too great an expense of the Nutritious Juice. By which means the Spirits themselves become in the same manner as the Blood, poor and windy, by reason they have lost their Natural and Original Vigour, whereupon there follows an Obstruction, and this inordinate and ungovernable motion of the Spirits in the Nerves and Fibres of the Muscles, and upon that Oppressions, and Suffocative, and Convulsive Contractions of some Parts, commonly called Hypochendriacal and Hysterical. This Consumption often terminates in a Consumptions of the Lungs. These presaging Symptoms in the Progress of the Distemper have an Atrophy, and a Hectical heat following them, (which is not strange) and do often terminate in a Consumption of the Lungs, together with a Cough, shortness of Breath, etc. Nevertheless this Consumption is Originally in the Habit of the Body, and that from too great an expense of the Nutritious Juice. And is then fatal. This Consumption, when it once comes to the degree of a Marasmus, and to terminate in a Consumption of the Lungs, proves plainly fatal and incurable. The Method of Cure. But in the beginning it is easily cured; first, by the speedy weaning of the Child, whereby the cause, which disposed the Person to it, is removed. Secondly, by giving the Patiented plentiful Nourishment of such Food as affords a good Juice. Thirdly, by exciting and restoring the Appetite by cheerfulness of Mind, the enjoyment of a benign and open Air, by moderate Exercise, etc. Yea, and lastly, if her Hectical Disposition requires it, the Sick Woman must be put upon the use of a Milk Diet, A Caution. or of the Chalybeate Waters. But let her abstain from Wine, and all Evacuations, but what are necessary, as we have already hinted in the Cure of a Consumption proceeding from other Evacuations. A History. The Wife of Mr. Bird my very good Friend, who lives in Fetter-Lane, being about three and thirty Years old, gave Suck to a lusty Boy for the space of a Year, or more. But after she had given Suck for four Months she lost her Stomach, and took very little Nourishment at any time, and thereupon her Strength declined, and she was troubled with Choaking, or Hysterical Passions, but without an Atrophy, or Cough, or any other Distemper. Being sufficiently directed by these things, (I going at that time by chance to see her) advised her to wean her Child without any delay, lest she should fall into a Consumption: But she however persisting in the giving of her Child Suck, when she had lost her Stomach, did at length fall into a Consumption or Atrophy of her Body, but without a Cough, or any remarkable Fever. But yet she very much, and almost continually complained of a dryness, and very troublesome heat about the Tonsils and Palate of her Mouth, and the Parts which serve for swallowing (the same that I observed to happen to Mrs. Thompson, and to almost all Women that have a Consumption from giving of Suck.) Which appearance to me seemed to arise from the impoverished and heated state of the Blood, by reason of too great an expense of the Milk. At length, though too late, following my Advice, she weaned her Child, and made use of a Milk Diet, and the Chalybeate Waters, with very much benefit. But her Appetite not being restored by these means (as not being made use of in time) she could not make up a sufficient quantity of new Chyle to recruit the Mass of Blood; and thereupon loathing all sorts of Medicines, at length (though she had the Advice of very good Physicians) falling into a Consumption of her Lungs, with a Cough, shortness of Breath, and Hectic Fever, she died plainly choked. CHAP. VII. Of a Consumption from a Bloodyflux, and from a Looseness. MANY times in a Scorbutical Disposition of the Body, A sharpness of the Blood often arises from the Scurvy. the Blood grows sharp to that degree, that being disturbed upon every little occasion, it cannot assimilate the new Chyle to itself; whereby it comes to pass that it is thrown out by the Glands of the Intestines in a continual flux like a stream. Which Chyle, if it is benign, and more mild, Which in a lower degree causes a Looseness: In a higher a Bloodyflux. forms a Distemper in the manner of a Looseness; but if it be sharp, and of a Malignant Nature, produces one in the form of a Bloodyflux. By this continual efflux of the Chyle, the Blood is much impoverished, and grows hot, so that although the Bloodyflux, or Looseness be overcome by the use of Opiates and binding Medicines, (such as are particularly to be described in a Chapter of a Bloodyflux, Which cause a Hectic heat, etc. and Looseness) yet a Hectical heat still remains in the Blood, together with an Atrophy, and dryness of the Skin, arising from the impoverished and dispirited state of the Blood: As it happened to mine only, and most beloved Son, and to very many others. And this Consumption often terminates in a Consumption of the Lungs. Which Consumption does very often terminate in a Consumption of the Lungs. But the way to prevent it is (after the Looseness and Bloodyflux are cured by proper Medicines) by a long use of a Milk Diet, the Peruvian Bark, the Mineral Waters, which are Chalybeate, and of the white Decoction for ordinary Drink. It often happens to Children 〈…〉 of their Tee●●. This Consumption often happens to Children that breed their Teeth. But by the long use of the white Drink, of Pearl Juleps, and binding Medicines mixed with some little Opiate, it is easily cured. History 1. Mr. Tindal's only Daughter, a very fine Young Woman, but Scorbutical, and something Melancholic, about Eighteen Years of Age, upon the suppression of her Monthly Courses, fell into a Colliquative Looseness, with Stools that came away like Water, which by degrees brought her in the space of a Year into an Universal Atrophy, even to the degree of a Marasmus, but without any sensible Fever, or Cough, or shortness of Breath, or any other sign of any Distemper of the Lungs; so that she was not at all taken for a Consumptive Body by the Physician under whose care she was before I was concerned. Being called to go and see her, as one that had only a Looseness, when she was now by reason of her Weakness almost always confined to her Bed, I found her worn away clearly with a Consumption, even to a Marasmus, and that I plainly told her Friends, as my Opinion, although her Lungs did as yet seem sound, neither was there any sign of a Hectic Fever. But when this expensive Looseness, which the former Physician for want either of skill or care had suffered to run on so long, came once to be stopped by a due government, and the use of Efficacious Medicines, presently a Hectic Flame began to be kindled in the Habit of her Body, and her Lungs also began to be affected with a Cough, that was almost perpetual, and a shortness of Breath, which Symptoms being at length followed by Colliquative Sweats, a swelling of the Legs, and other signs of a Fatal Consumption of the Lungs, soon brought the fair Virgin amidst the Lamentation of her Friends to the last period of her Life. Two things were here particularly worthy of a Remark: First, that the more her Looseness was stopped, so much the more always were her Lungs presently affected. And Secondly, that although this Consumption had prevailed upon her almost for the space of a Year, even to a Marasmus, before the Lungs did seem to be in the least touched, yet in the Body, when it came to be opened after 'twas dead, the Lungs appeared full of little swell here and there, and that not only such as were crude and hard, but also some that were ripened into Apostemes. History 2. My only Son, before he was Eight Years old, whilst I was out of Town, was taken with a most severe Bloodyflux, by which he seemed to be brought into a Consumption, even to a Marasmus, before I returned. But after the Bloodyflux was plainly overcome by the diligent use of all sorts of convenient Remedies, and his Body, with respect to his Stools, was reduced to its Natural state, there still remained a Hectical heat, a dryness of his Skin, a quick Pulse, with other signs of a Hectical heat. Moreover his Appetite failed him very much, a dry Cough came upon him, and a thickness of Hearing, with a dulness of his Brain. But yet with the choice of a wholesome Air, the use of a Milk Diet, and afterwards of the Peruvian Bark, and of a Plentiful Nourishment, which afforded a good Juice, he recovered a good Colour, and his Flesh within the space of three or four Months, without any other inconvenience but only that he has been ever since very subject to an Asthmatical Cough upon the least occasion. CHAP. VIII. Of a Consumption from a Diabetes, or too great a Flux of Urine. A Diabetes is commonly called a Dropsy of the Chamber-pot, What a Diabetes is. and it is a continual Flux of the Nutritious Juice running down through the Kidneys, The Causes of it. which for the most part happens to those that are very thoughtful, and to such as are drinkers of French Wines, and Diuretic Liquors. Whereupon the Urine (by reason of the great quantity of new Chyle which flows to it, and mixes itself with it) being deprived of its Saltness, becomes sweet, even like Honey. A Diabetes causing a poorness of the Blood, and a Hectical heat, produces a Consumption. By this continual efflux of the Chyle the Blood is impoverished, and thereupon the Strength of the Patient grows extremely languid. By the burning Flame of the Blood a Preternatural Heat is kindled in the solid Parts, by which the Nerves are weakened, and upon that Convulsions, a Giddiness, and other Affections of the Nerves do follow, and at length the Muscular Parts being deprived of their Nutritious Juice, do fall into an Atrophy, or Consumption: As it happened to Mr. Pettit's Son, and to Mrs. Wells, and very many others. The Method of Cure. The way of Curing this Consumption is by a long use of a Milk Diet, Conserve of red Roses, Bole Armenack, Gum Arabic, Gum Tragacanth, etc. by drinking the Bath or Islington Waters, or any other Mineral Water, that is Chalybeate, for a long time. But the Patient must abstain from Wine, especially French Wine, he must not Bleed, nor use any Purging Medicines, except Rhubarb, Myrobalanes, and other such like gentle things, which have also some styptic and binding Particles, of the Virtue of which in Curing this Distemper, I shall presently give a very Remarkable History. History 1. Mr. Pettit's Son, upon a Diabetes, which they had a long time neglected the Cure of, was not only frequently troubled with Fits of the Falling-Sickness, and a swimming in his Head, but also in the Progress of the Distemper became very Consumptive. But with the use of Tunbridge Waters, a Milk Diet, and Astringent Electuaries, he was perfectly recovered, and is now after Ten Years in perfect Health. History 2. Mr. Pettit himself, the Father of the Patient I just now mentioned, living in Long-Lane, being then about Seventy Years old, who was brought by a Diabetes into a high Hectic Fever, and to the utmost degree of a Marasmus, and kept his Bed for three Weeks, got well off his Diabetes and Fever, and at length his Consumption too by the use of a Milk Diet, which he very strictly observed, and of Astringent Juleps and Electuaries, and is now, as far as I know, after five Years still living. History 3. Mr. Wheeler, living in Prince's-Street, though he has now three Girls living, and well, yet he lost all his Sons, who were taken off in their first Infancy (to wit, as soon as they began to breed their Teeth) with a Consumption from a Diabetes. As for the Name of the Distemper, that he was ignorant of, but when he observed that he lost all his Sons in the same manner, and that they were extremely emaciated with a continual and unquenchable Thirst, and a strange flooding of Urine, he at length asked my Advice for his fourth, who at that time was breeding of his Teeth. And he began, just like the three former that were dead, to be very thirsty, and to make Water at the same immoderate rate, that they had done, whereby his Flesh was become very lank, and a Hectical heat began to arise. So being confirmed in my Opinion by so demonstrative an Argument as the sweetness of his Urine, being like Honey, I pronounced it a Consumption from a Diebetes, caused by the breeding of his Teeth; which could not possibly admit of a perfect Cure till the Child had bred all his Teeth. Within the space of a Month or two the poor Infant seemed to have a Hippocratical Face, and to be reduced to that degree of a Consumption, as to be come to the last Scene of his Tragedy, for that he laboured under a Colliquation as well by a Looseness as a Diabetes, though he had no Cough, nor any other Affection of his Lungs. However for the present relief of the Symptoms, I ordered a Milk Diet to be strictly observed, and an Astringent Electuary, and gave Orders that for his Thirst he tory ducts to no purpose, is restored to Nature to make up the loss which the Mass of Blood sustains. When a Consumptive disposition is to be expected from an Artificial Salivation. How the Patient is to be managed in this case. It is also as certainly true, that every Salivation procured by Art, that is, raised with Mercurial Medicines, (if it continues long) does bring a Hectical and Consumptive Disposition. In which case (the Salivation being ended) the Patient must be put into a Milk Diet for a long time, by which the sharpness of the Blood may be corrected, and a Consumptive Disposition may be prevented. After that he must be sent into an open and benign Air, and be nourished with the plentiful use of such Food as affords good Juice; and besides all this (if it be necessary) he must drink the Chalybeate Waters. An Observation of a Consumption from an Artificial Salivation. I met with a very Remarkable Instance of this kind of Consumption in Mr. Daulton an Apothecary's Daughter, who from a Salivation, that was raised with Mercury to Cure the Kings-Evil, fell as soon as ever the Salivation was ended, into a fatal Consumption, and by reason of the great expense of the Humours caused by her spitting, she could never be restored, either by the help of the Air, or by a Milk Diet, or any other Art, but being gradually wasted away with a Consumption, after a Month or two from the end of the Salivation, she died without any sign of a Consumption of the Lungs. CHAP. X. Of a Consumption proceeding from a Dropsy. A Dropsy is caused by a Rupture of the Lymphducts, or of the Chyliferous Vessels, The cause of a Dropsy the breaking of the Lymphatic, or Chyliferous Vessels. whereby the Nutritious Juice (which is Naturally conveyed by these Vessels as it were in certain continual Streams into the Mass of Blood in the form either of a Lympha, or of Chyle, in order to recruit it) does now continually flow out of those Vessels, and distils into the cavity of the Belly and Breast, or into the Limbs themselves, and Habit of the Body. How it causes a Consumption. By which means the Blood being deprived of its usual recruits of Chyle, or Lympha, or of both, is very much impoverished, and thereupon grows sharp and hot; upon which consideration no one has reason to think it strange that a Fever does arise with a Drought, and other Symptoms of that kind, as also a Consumption, or Atrophy of the Parts, with a great Weakness following upon it by reason of the want of fresh Nutritious Juice; and finally, a difficulty of Breathing, by reason of the distension and fullness of the Muscles, that serve for Respiration, from the Dropsical Humour which is contained within them. The most usual cause of the breaking of these Vessels, The usual cause of their rapture. is the swelling of the Glands of the Belly, or of the Breast, or Limbs, through which, or just by which these Vessels have their course, and by which they are propped. By which swell those tender Vessels being straightened and compressed, they cannot give a free passage either to the Lympha, or the Chyle, and thereupon these Vessels being distended beyond their Natural Tone by the continual flowing in of fresh Liquor, that has its tendency to the parts of the Vessels, that are compressed, and does press on behind the Liquor, which goes before it, and stops at the compressure, are at length broken. This Distemper is very hard to be cured, neither indeed is there any possibility of doing it without healing and closing the Breaches in the Lymphducts, or Lacteal Vessels, and consequently taking down the swelling of the Glands, which causes the rapture of the small Vessels by compressing them. The Indications of Cure. Therefore in this case the Indications of Cure are these which follow. 1. To evacuate the extravasated Humours. First, to bring down and evacuate that load of the Nutritious Juice that is extravasated, with Cathartick Medicines, that purge off Water, as Rosin of Jalap, Gum Gottae, and others of that sort, which are more particularly to be specified in the Chapter of a Dropsy; as also by Diuretics, as Salt of Amber, Wood-Lice, etc. 2. To open the Obstructions. Secondly, to open the Obstructions of the swelled Glands, and to dissolve their swell, which cause the Obstruction of the Chyle, and upon that to restore and strengthen the Tone of the Parts that were swelled, by a long continued use of Chalybeates. Which being done, the Sick Person must be plentifully Nourished with Food that affords good Juice, and at length be sent into a free and benign Air, and drink the Chalybeate Waters, not only for the farther temperating of the heat and sharpness of the Blood, but also in order to the perfect opening of the Obstructions of the Glands. But in this case we must carefully abstain from a Milk Diet, because it does stuff the Glands, that are already obstructed, more, and consequently promote the cause which disposes the Patient to this Distemper. A History. The Son of Thomas Lechmere, Esq being about two Years, and breeding of his Teeth, fell into an Inflammation of his Lungs upon taking of cold, and was treated very ill by an Apothecary, who had omitted Bleeding, and other things, that were very requisite to a true and skilful Method of Cure. But at length I and my Famous Colleague Dr. Croen, though we were called in late, recovered him in some measure, by taking away some Blood, and the application of Blisters, and Liniments, that were convenient for his Breast, as also by giving inwardly such Medicines as were proper for his Lungs: But yet he continued sickly with a Cough and difficulty of Breathing, for the space of a Twelve Month at least, from which time the poor Child began to be seized with a Hectic Fever, which intermitted every day, which although it was several times taken off with the Peruvian Bark, yet soon returned again, and indeed came upon him by uncertain intervals for a whole Year, even to his dying day. But at the very beginning of the Fever his Belly began to be distended with a Dropsical swelling, which increased strangely every day; his Cough and shortness of Breath at the same time growing worse: All which Symptoms were at length accompanied with an Atrophy of the Parts, even to the degree of a Marasmus. But yet when his Body was a perfect Skeleton, and the Dropsy at a high Tide (which was very remarkable) he had a brisk and healthful look, and a lovely Countenance, without the least Tincture of a Yellowness, and a good, or rather greedy Appetite, and that to the very day he died. From whence I did rightly conjecture, and always told his Friends, as my Opinion, that his Dropsy was truly Chylous, caused by the Chyle flowing into the cavity of the Belly by the Lacteal Vessels, which were broke by some Accident, and that the Consumption which accompanied it was not a true Consumption of the Lungs, but such as proceeded merely from an inanition, that is, the draining of the due Nutritious Juice out of the Lacteal Vessels, upon some rapture that had been made in them; which appeared very plainly from the Event. For in Tapping of the Child's Belly, whilst he was yet alive, we took out several Pints of Milky Chyle, and very sweet, such as is found in the Dust itself, which conveys the Chyle. But when we opened the Body after he was dead, we found for all the difficulty of Breathing, and long Cough he had had, the Lungs themselves sound, without any Distemper, but only that in the hinder part near the Windpipe there appeared a great many Glands, and those pretty large and hard, which made a hard and very considerable pressure upon the Chyle-duct itself, almost in that Part where it arrives at the Subclavian Vein; and they were of so great a weight and bulk, that it seemed very difficult, if not plainly impossible for the Chyle to pass into the Blood by reason of the pressure they had made upon the Dust, which had straightened it, as if it had been tied with a string. And thereupon without doubt it came to pass that the tender and thin Lacteal Vessels which are in the Belly (the Chyle continually pressing, and not finding a free passage above by the Chyle-duct) being distended beyond their Tone, did at length break, and so threw the Chyle, which was designed for the reparation of the Blood, as it were in a continued stream into the cavity of the Belly. From what I have now said, it is plain almost to a demonstration, first, that these Tubercles, or tumifyed Glands of the Lungs did at first proceed from the ill Method of Curing the Inflammation of his Lungs, that is, for want of timely Bleeding and Expectoration. Secondly, that as the troublesome and dry Cough was caused by the constriction of the Vessels of the Lungs, which convey the Air, by these swell, so the difficulty of Breathing proceeded from the pressure of the extravasated Chyle below the Midriff. Thirdly, that this Consumption was not a true Consumption of the Lungs; because tho' there were Tubercles or Swell in the Lungs, yet they were not like Apostemes, nor Ulcerated. But this desperate Consumption did really proceed from that Chylous Dropsy, upon which that Nutritious Juice, which ought to have been employed for the reparation of the Blood, and the Nutrition of the Parts, was continually substracted, and carried another way. Fourthly, that this Dropsy did proceed from a rapture of the small Lacteal Vessels that are in the Belly; and lastly, that this rapture of the small Lacteal Vessels was caused by that continual pressure, which the swell in the Lungs had made upon the upper part of the Chyle-duct. CHAP. XI. Of a Consumption caused by profuse Sweats. Profuse and long sweats often turn Colliquative. SUch Sweats as are profuse, and last long, do very often become colliquative, that is, they carry off a great quantity of the Nutritious Particles, as if they were melted, and more fluid than ordinary: For by these Sweats not only the load of old, dispirited, and unprofitable Chyle, but also a great quantity of that Chyle, which is fresh and Oily, is readily cast out by the pores of the Skin, by reason the Blood cannot assimilate it from its own too great and Scorbutical sharpness, which it had contracted by degrees. From whence it comes to pass by reason of the continual impoverishment of the Blood, And from hence a Consumption arises. that not only the Mass of that becomes sharp, and grows hot with a Feverish and Hectic flame; but also the solid Parts of the Body being at the same time deprived by this means of their requisite Nourishment, do by degrees fall into an Atrophy, and perfectly waste. Colliquative Sweats attend every Consumption when deplorable. This Colliquative Sweat, as it accompanies every Consumption of the Lungs in the deplorable state, and highest degrees of it, that is, when it is now hastening to a fatal period; so it is found in the lamentable state of every Distemper, and the sudden ruin of Nature always follows it: And therefore these Dews, or Colliquative and Oily Sweats are commonly called clammy Death-sweats. Sometimes also, though seldom, I● the Scurvy Colliquative Sweats the Original of an Atrophy. I have observed in a Scorbutical Disposition that this kind of Colliquative Sweat has the place of an Original Distemper, by the excess of which I have seen the whole Body brought into a Hectic and Consumptive state in a few Weeks: Which comes to pass, because the Mass of Blood is by these profuse Sweats continuing long, reduced to an impoverished state, and rendered unfit for Nourishment: Upon which there necessarily follows a Hectic heat, and an Atrophy of the Parts, with a great Weakness, and other usual Symptoms of a Consumption in the Habit of the Body. I have a mind to add here to the end of this Chapter an Instance or two of this Nature, by the relating of which, the cure of this Consumption will be shown so far as I have observed, and am able to give an Account of it. History 1. Mr. Luffe, a Presbyter, being about Sixty Years Old (who was also the Father of Dr. Luffe, a Famous Professor of Physic at Oxford) a Man that had for many Years passed been Scorbutical, and Melancholic, was frequently subject to a Giddiness, Palpitation of the Heart, and many other Affections of his Brain and Nerves. But above all he was wont to complain of Colliquative Sweats, that followed him continually both Night and Day, and that as well in the Winter as the Summer time. From whence it came to pass, that not only he was very subject to take cold, upon which he always felt great pains in his Nervous Parts, but also his whole Body wasted so, that he was justly to be reckoned in the number of those that were in a Consumption. However with Issues made between his Shoulders, and the use of a Diet-drink made with Antiscorbutic Ingredients steeped in Ale for his ordinary Drink, and especially the long use of the Mineral Waters, both the Chalybeate and Purging, which he took as well in the Winter as the Summer, he was perfectly freed not only from those other Distempers which affected his Nerves, but also from these Colliquative Sweats: By which means it came to pass, that he lived several Years in the latter end of his Old Age with a strong Habit of Body, an uninterrupted Health, a cheerful Mind, a fresh and brisk Look, as if he began to grow Young again. History 2. The Wife of one Mr. Clapton, who lived in Lothbury, being about Forty Years old, a Woman that had been for many Years very Scorbutical, and Asthmatical, a Month after a Lying in, fell in the Springtime into most violent pains a little above the Groin. To whom besides the outward application of an Anodyne Lineament, I gave a Draught, that might put her into a breathing sweat, Of Carduus-water, Treacle-water, Venice-Treacle, and the Syrup of Meconium; upon which it happened that she fell and dissolved into most profuse and very stinking Sweats, which though they took some of the Bed-cloaths off from her by degrees, did nevertheless continue for a fortnight or more, with an extraordinary decay of her Strength, and a pining Consumtion of her Body. Which when I observed, I forthwith prescribed such Electuaries and temperate Juleps as were binding, and proper to stop the pores of the Skin, and other things of that Nature; whereupon her Sweats presently decreased, but although the pores of the Skin were then stopped by Art, yet the new Chyle, which by reason of the Acrimony that remained in the Blood, was not so well assimilated and united to that Mass which remained, being mixed with it, the fresh Nutritious Juice attempted to find out a new way, and to discharge itself by Stool, and so in the room of her Colliquative Sweats there succeeded a Looseness that was as Colliquative as they were, together with griping pains, the Habit of her Body every day running farther into a Consumption. But this Door being in like manner barricadoed with the use of Opiates and Emplastic Medicines, the Nutritious Juice found out another by the Kidneys, whereupon the poor Woman fell into a Diabetes, which still promoted her Consumption, almost to the degree of a Marasmus. But when the Diabetes was overcome with the use of Gum Arabic, Astringent Electuaries, etc. at length her profuse and colliquative Sweats returned again. And therefore I resolved to send this Miserable and Consumptive Woman into the fresh and open Air at Hampstead, (the time of the Year encouraging me, it being the Spring) by which change of Air (the pores of the Skin being now suddenly stopped) the Distemper was turned into an extraordinary Spitting for Twenty days or more, her Consumptive Disposition still remaining, or rather increasing; but with the plentiful use of a Milk Diet, and the benefit of the open Air, the Mass of Blood being softened by little and little, and its Acrimony corrected, the colliquation also of the Nutritious Juice was by degrees overcome; and thereupon being freed not only from her Spitting, but also from the Consumptive disposition itself, she improved every day in her Flesh and Appetite, till she had perfectly recovered them: A large Apostem at length gathering upon her Groin, where the pain first seized her, which was opened and cured by a Surgeon. And by this means the Woman lived, and was well for Ten Years, or more, though she afterwards died of an Asthma. History 3. Mr. Fortescue, a Man about Sixty Years old, who had been Scorbutical for many Years before, and something Asthmatical, was for three or four Summers troubled with a continual heat and burning of his Loins and Limbs. Whereby it came to pass, that he was plainly exhausted, and brought almost into the state of a Marasmus by profuse and colliquative Sweats, which followed him more especially when he was in Bed. But in the Winter time he was well, being in a manner freed as well from his Heat as from his Sweats, tho' he never mended his very thin, Hippocratical look. But this Summer 1688, the burning in his Loins, and his profuse Sweats grew so much upon him, that he could not lie in his Bed to sleep; from whence at length it came to pass, that having lost his Appetite, he fell into a Dropsical and Oedematous swelling of his Legs. After many things had been tried in vain by other Physicians, at length I was called, and quenching the flame, which was in his Blood and Spirits, by the use of the Peruvian Bark, I also brought his sweats within moderate bounds: By which means the sick Person lying in Bed as he ought to do, the swelling of his Legs also plainly vanished, though he still appears lean and Consumptive. The APPENDIX. THIS general Consumption proceeding from Evacuations does often depend upon other Distempers; This Consumption from Evacuations often depends upon other Distempers, as, A Lientery. and therefore it may justly be called a general Symptomatical Consumption. As first, upon a Lientery, to wit, when the Faculty of the Stomach, which makes the Chyle, is injured by a Preternatural disposition of the Spittle, and the ill Temper of the Nervous Liquor: Whereby it comes to pass, that the Blood and Habit of the Body (since the Food that is taken is carried down through the Guts, and comes away as it went in without any alteration) cannot receive any Recruits from the Food; and from hence there necessarily follows an Atrophy caused by Inanition. Many times this general Consumption proceeds from a Preternatural alteration, The Celiack Passion. or obstruction of the Gall and Pancreatic Juice, or else of the Juice, which is naturally, and uses to be separated by the small Glands, planted through the whole Pipe or Dust of the Intestines, and which serves for the separation of the Excrementitious parts of the Food from those, which are for Nourishment. For from hence it comes to pass, that the Chylous parts of the Food, that goes down out of the Stomach, slipping by the small mouths of the Milky Vessels, are thrust out together with the dreggy Excrements by Siege; and that either in white Stools, and such as are plainly Chylous from the defect, or preternatural disposition of the Choler, (which is the proper Liquor for separating the Chyle) as it commonly happens in the Jaundice, together with a great weakness of the Body, and wasting of the Flesh: Or else in yellow Stools, as in the Celiack Passion, which either is from an Obstruction of the Pancreatic Juice, and that which is separated by the Glands of the Intestines, or uses to happen from the depravation of the Nature of those Juices. In the first case the Urine is much tinged with a Yellow, or Jaundice colour, but in the latter it is quite contrary. In both of them, the Chyle not being separated from the Excrementitious parts of the Food, the Blood is deprived of its due recruits, upon which I have often observed that an Atrophy, or Consumption, and that no lingering one, has seized the sick Persons. Scrofulous Glands in the Mesentery Finally, this general Symptomatical Consumption is sometimes caused by many and large Scrofulous Kernels preternaturally situated in the Mesentery, by which (the Milky Veins being straightened as with a Thread, or being compressed) the passage of the Nutritious Liquor, which is separated in the Intestines, and taken in by the mouths of the Lacteal Veins into the Mass of Blood, is either totally, or in part hindered. In which case the Stools are large, and Chylous, the Belly grows hard, and is swelled, but the Urine flows in a very little quantity, yet keeps its Natural colour. Thereupon, the Blood not being every day replenished with new Chyle, the Muscular Parts are deprived of their due Nourishment, and daily pine away, and at length are wasted to the degree of a Marasmus, though the Appetite at the same time be greedy, and the Patient continues almost always free from any thing of a Fever; an Instance of which kind I once met with in a Boy about four Years old; the History of which, because it was a very rare case, I shall presently relate. All these Symptomatical Consumptions are plainly incurable, In the Cure of these Symptomatical Consumptions respect must be first had to the Original Di●●●se. unless a particular respect be first had to the Distempers upon which they depend, but if these are once removed by Art, this kind of Consumption ceases of its own accord; and therefore the Cure of this Consumption is to be sought for in another place, to wit, in the Cure of those Distempers which are the cause of it. History 1. A certain Citizen's Son, in the Street commonly called Wood-street, being about four Years old, seemed without any Fever or Cough to be brought by degrees to the highest degree of a Marasmus; but his Belly was unequally hard and swelled, his Urine very little in quantity, yet of a good colour; his Stools frequent, large, and plainly chylous: Nevertheless his Appetite continued good, or rather greedy all the time of his illness; whereupon I did easily conjecture that the passage of the Chyle through the Milky Veins was much hindered by the many and very large Glandulous Swell placed up and down in his Belly, and that his Consumption had its Origine from the Evacuation of the Chyle caused in this manner. I ordered the Plaster Diasaponis to be applied to his whole Belly, and the following Julep to be given him plentifully, and frequently. Take Parsly-water, Fennel-water, of each four Ounces, the Magisterial Water of Earthworms, Syrup of the five opening Roots, of each two Ounces, of the purest Salt of Amber very well freed from the Oil, half a Dram; mix them, and make a Julep. This Liquor he very greedily coveted beyond all expectation, plainly refusing any other, so that in the space of Four and Twenty Hours he drank up double the quantity of the Julep that was prescribed. Upon which he made Water at a strange rate, and had fewer, and less chylous Stools, the swelling of his Belly falling at the same time, and in a short space with the frequent and plentiful use of this Julep, and torrefied Rhubarb made up into the form of a Bolus with Diascordium, the little Boy was freed from his Marasmus beyond the expectation of all his Friends. History 2. Very lately (which was just after I had wrote this Treatise) I was called to go see Mr. Gouge's Son at the Sign of the Cornelian Ring in the Strand, a Boy about six Years old, and perfectly reduced to a Skeleton by a Marasmus: As soon as I had made a diligent Enquiry into the cause of this Consumption, I presently found his Belly, which was very much, and unequally tumifyed, every where full of swell, which were disposed here and there in clusters, which yet could not be discerned without pressing very hard with ones fingers. His Stools also were frequent, and chylous, his Urine little, but of a Natural colour; he had no Cough, breathed freely enough, but he had a very Melancholic and plainly dead Look, and his Countenance was squalid and pale. I ordered him the White Drink, and a Bolus with Diascordium, and torrefied Rhubarb, of each half a Scruple, to be taken once a Week; the Plaster Diasaponis to be applied to his Belly, and the Julep I just now mentioned in the last History, which was made very strong of the Salt of Amber, to be drank as often as he would take it. What I have been telling of the former Patient, the same thing did happily fall out here in this. For the Boy refusing all other Liquors, did covet the Julep Day and Night, so that he drank almost four and twenty Ounces every day. By which means it came to pass, that in the space of a fortnight or less his Stools were brought to a Natural consistence, colour, and quantity. His Urine also flowed plentifully. The swelling of his Belly went down to a Miracle. Neither could I any more perceive any Swell that lay concealed within it, though I strictly examined with my fingers. His Appetite and desire of Drink were Natural, and as they ought to be. His Flesh likewise seemed gradually to increase every day. And now his Melancholy and Weariness being overcome, the Boy seems to recover not only the wont vigour and activity of his Body, but also a good Look, and a fresh Colour in some measure; so that I am not at all solicitous about what remains to complete the Cure. A TREATISE OF Consumptions. The Second BOOK. Of an Original Consumption of the Lungs. What a Consumption of the Lungs is. A Consumption of the Lungs is a Consumption of the whole Body with a Fever, proceeding first from an ill Affection, and at length an Exulceration of the Lungs. Which indeed is the most Famous Consumption, and that which is called so by way of Eminence, and of which Authors use to treat, as if there were no other kind of Consumption; and therefore I shall now speak more largely of it. It is either Original, or Symptomatical. This Consumption of the Lungs is either Original, which from the very beginning depends upon an ill disposition, and an Exulceration of the Lungs: Or Secundary, and Symptomatical, when ever the Lungs receive any great Injury from preceding Distempers. But seeing that we ought always in the Cure of a Symptomatical Consumption of the Lungs to have a particular regard to the Primary Distemper, from which this Consumption has its Origine; and the Cure of it does require a variation in some things, according to the Nature of that Distemper, I shall make it my business in the last Book of this Treatise to treat of the Cure of this kind of Consumptions, having first given in this Second Book (so far as I have been able to observe) a general Account of the Nature, Causes, Differences, Diagnostic, and Prognostic Signs, Indications of Cure, and the Method of Curing an Original Consumption of the Lungs. CHAP. I. Of the Causes of an Original Consumption of the Lungs. The general cause of a Consumption. THE cause of a Consumption of the Lungs in general is a vitiated disposition of the Mass of Blood, and of the Spirits in the Nerves, contracted gradually from several Procatartick or predisposing causes, in which the sharp or Malignant Serum or Water of the Blood being separated by the soft and Glandulous substance of the Lungs, does stuff, inflame, and at length also exulcerate the Lungs themselves, which is the immediate cause of this Distemper. The Procatarctick causes of a Consumption. First, the stopping of Evacuations. The Procatartick causes, or those which give the first occasion to this Disease, are, First, the stopping of some usual and necessary Evacuations, as the Monthly Courses, Childbed Purgations, Old Sores, and especially Fistula's, Issues, Sweeting in the soles of the Feet, or any other parts of the Body, a Gonorrhoea, the Whites, and other Evacuations of that kind, when they are stopped without correcting or removing the causes upon which they depend: From whence it comes to pass that even the Blood itself is polluted and distempered by those Humours, which are condemned by Nature to be thrown off, or banished, but by some Bars and Impediments lying in their way are stopped, and retained in the Mass of Blood longer than is convenient. 2. Passions of the Mind. Secondly, troublesome Passions of the Mind, but especially Fear, Grief, Anger, too much Thinking, and Solicitude, as also unseasonable and too long Studies, with other things of this Nature; which contribute very much to this Distemper, not only by vitiating the Animal Spirits, and thereupon hindering the Natural Fermentation of the Blood, but also by fixing almost a continual Spasmodick Contraction, or Convulsion upon the soft substance of the Lungs. Thirdly, 3. Intemperance in eating and drinking. a too plentiful, and an unseasonable gorging of Meat and Drink, and also an imprudent choice of such Meats and Liquors, as abound with Excrementitious parts, and are not very easy to be digested; but especially the drinking too much Wine, and Liquors that are very Spirituous. Which when it is joined with Cares and Grief, and other suchlike Passions of the Mind (so far as I have been able to observe) is commonly the cause of a Consumption of the Lungs. For the Habit of the Body being from hence filled with a load of dispirited and unprofitable Humours, as it is, when it is Oedematous, the whole Mass of Blood is polluted, and rendered waterish and sharp, and at length is disposed to a Hectical heat. Fourthly, the neglect of due Exercise, 4. Want of due Exercise. for want of which the Excrements, which ought by the usual Law of Nature to be thrown out by the Skin, being detained in the Blood, are wont by degrees to destroy the Crosis or mixture of it. For want of this the Humours also are wont to stagnate in the Habit of the Body, and various Obstructions to arise here and there in the small Fibres themselves; which contribute very much to the corrupting of the Blood, and the weakening of the Spirits. Fifthly, Night-studies, 5. Night Studies, and long Watch. and long Watch, which not only weaken the Animal Spirits, which are necessary for the Fermentation of the Blood, but also keep within the Body those Excrementitious parts, which are wont to be thrown out in the Bed by Sweat, or Perspiration; and who will think it strange, that the whole Mass is by degrees vitiated by this means? Sleeping in the day. To this we may also add sleeping in the Day, and sleeping much, but especially presently after eating, which as it dispirits the Mass of Blood, and fills it with useless Chyle by hindering the Digestion of the Food (from which cause frequent and troublesome Coughs are wont to proceed:) So by putting the Animal Spirits to sleep at an unseasonable time, and thereupon hindering the Fermentation and Volatilization of the new Chyle, it makes the whole Mass of Blood too waterish and sharp. 6. An ill Air. Sixthly, also a foggy and thick Air, and that which is filled with the smoke of Coals, does extremely promote a Consumption by vitiating the Animal Spirits, which are so necessary to the Natural Fermentation of the Blood; and also by stuffing and weakening the Lungs, that serve for Respiration, which are the Seat and Theatre of this Distemper. 7. An Hereditary Disposition. Seventhly, An Hereditary Disposition from the Parents does very often bring a Consumption of the Lungs, when every Body knows very well, that those who come of Consumptive Parents, are apt to fall into the same Distemper. 8. An ill formation of the Breast. Eighthly, an ill formation of the Breast, whether it be Natural or Accidental, is another cause of this Disease. I call that Natural, where the Breast is narrow, the Neck long, and the Shoulderblades stand out like Wings: And that I call Accidental, where there is a crookedness, or distortion of the Breast, whereby not only the parts of the Breast, and especially the Lungs being once weakened in their Tone, are rendered subject to the Flux of Rheums; but also the Lungs wanting their necessary expansion, and being straightened, do heap up in themselves, and retain the vitiated Serum of the Blood, from whence it comes to pass, that at length they come to have Obstructions. Ninthly, 9 Infection. This Disease is also propagated by Infection. For this Distemper (as I have observed by frequent Experience) like a Contagious Fever does infect those that lie with the Sick Person with a certain taint. Tenthly, 10. Chalky stones, and such like in the Lungs, also Chalky Stones, that are Preternaturally bred in the Lungs; or Nails, and other hard Bodies slipping down into the Lungs, when Persons laugh, are to be reckoned among the Causes of a Consumption of the Lungs. By which not only a troublesome Cough, provoking a Flux of the Humours is caused, but also Apostemes and Ulcers, where also for the most part a spitting of Blood preceding does dispose the Lungs to those Apostemes and Ulcers. Of which I shall afterwards give some Histories. Eleventhly, 11. Some preceding Distemper. Also some particular Diseases, which corrupt and overthrow the Nature of the Blood and Spirits, do occasion this Distemper. From whence there follow a Symptomatical Consumption (of which I shall make it my business to discourse in the end of this Treatise,) as the Scurvy, Kings-Evil, Convulsive, and especially Hysterical Affections, if they have been of a long continuance; also Fevers, and especially Intermitting, and Scarlet Fevers, and such as proceed from a Surfeit; so the Smallpox, Measles, Stone in the Kidneys, the French Pox, an Asthma, spitting of Blood, Inflammation of the Lungs, Pleurisy, and other Distempers of the Breast ill cured; likewise the Green-sickness, a sixth Melancholy, Gout, and Rheumatism. The more immediate cause is taking of cold. The Body being thus predisposed to a Consumption by these and other suchlike Procatarctick Causes, the more immediate cause of this Distemper is for the most part the taking of Cold, from whence it comes to pass, that in the Body disposed in such a manner by a load of Humours, or Water continually derived from the distempered Habit of the Body into the Lungs, a Cough is caused, that is not easily shaken off, as that is wont to be, which happens from a mere accidental Cold, where the Matter is concocted within a few days into a putrid Phlegm, and upon that is all perfectly thrown out by a Cough (as I shall show more largely in the Chapter of a Catarrh.) Moreover from a stock of very sharp and Malignant Humours, which were gathered before in the Habit of the Body, (as there is a continual supply of new Matter from the Circulation of the Blood) there is a continual and troublesome Cough produced, and sticks upon the Patient to his dying day: The Serum, or Water of the Blood being separated, as it were in a perpetual stream by the Glandulous parts of the Lungs, and not admitting of any Concoction until the Lungs, especially the Glandulous parts of them, swell from their being stuffed, and grow hard, and at length the Tone of the parts is quite destroyed, and they are ulcerated by the sharpness of the Humour, that is separated by these tender and soft ways: Which indeed is the immediate Cause of a Consumption of the Lungs. CHAP. II. Of the degrees of an Original Consumption of the Lungs, and the Signs which give us warning of it, together with the Preservatory Indications, or what we are directed to do in order to prevent it. THE degrees of this Distemper are these which follow, to wit, first, The first degree is a stuffing of the Lungs. 2. A Swelling. a stuffing of the Lungs from the Serum, or Water of the Blood, that is plentifully separated in them. Secondly, a hard Swelling, but more especially in the Glandulous parts of the Lungs arising from the same Serum distending those parts too much, and not having a free passage out of them. Which Tumour I take to be the crude Tubercle mentioned by Galen; which Tubercles, or crude and glandulous Swell I have often found in the dead Bodies of Consumptive Persons, when the other parts of the Lungs have been full of Apostemes and Ulcers. Thirdly, 3. An Inflammation. an Inflammation of the Lungs arising from the heat and sharpness of this Serum. And lastly, 4. An Impostumation, and Exulceration. an Impostumation and Exulceration of these inflamed Parts, when the Distemper comes once to its height and extremity. The signs which respect a Consumption of the Lungs, are either the Prognostic, or Diagnostic, and Pathognomonick signs: Those of the first sort are these which follow. First Prognostic Sign being born of Consumptive Parents. First, the being born of Consumptive Parents; for this Distemper (so far as I have been able to observe) is more Hereditary, and oftener propagated from the Parents than any other. 2. An ill figure of the Breast. 3. A shrill squeaking Voice. Secondly, an ill conformation and figure of the Breast, whether it be Natural, or Accidental. Thirdly, a Voice that is naturally small, and squeaking, or at least so by use, and a habit; as being that which proceeds either from a Natural weakness of the Lungs, or from an Obstruction of the Glandulous Coat of the Windpipe, and the branches of it, caused by a glutinous and tough Phlegm. But from which soever of these Causes that appearance arises, still it threatens a Consumption of the Lungs, which is afterwards like to follow. 4. A white soft Skin. 5. A blouted habit of the fleshy parts. Fourthly, a white and soft Skin, together with a thin Habit of Body. Fifthly, a soft and blouted habit of the Muscular Parts, proceeding from their being much stuffed with old and dispirited Nutritious Juice. 6. Melancholic Oppressions about the Breast. Sixthly, long Hypochondriacal Oppressions about the Region of the Breast, that feel heavy like some troublesome weight, as also Hysterical Choaking, that are frequent, of long continuance, and unusual, being in the same places. 7. Thoughtfulness, and some Passions of the Mind. 8. The stopping of Customary Evacuations. 9 Spitting of Blood. 10. The hawking of black and tough Phlegm Seventhly, Thoughtfulness, Anxiety, Sadness, and an unusual proneness to Anger, especially if they be without any evident cause. Eighthly, the stopping of customary Evacuations by Issues, or old Sores, so likewise of Childbed Purgations, the Whites, and all others of this Nature. Ninthly, spitting of Blood, though it be accidental. Tenthly, the hawking of black and tough Phlegm constantly in a Morning, for a long time: For that it proceeds from those Glands being filled with a black Humour, which are placed in the Lungs near the Windpipe. Which Symptom, as it is a common thing with those that have the Scurvy or Kings-Evil, so it does in progress of time afford us a Prospect of an Asthmatical Consumption that is like to follow. Eleventhly, 11. A sharp and salt taste of the Phlegm. a salt taste of the Phlegm that is hawked up; which discovers a saltness and sharpness to be in all the Serum, or Water of the Blood. Which, when a great deal of it passes through the soft substance of the Lungs, and is separated there upon the getting of a great Cold, is apt to inflame and ulcerate them in a strange manner. Twelfthly, 12. A proneness to spit much. A proneness to have a great flux of Spittle by the glandulous Coat of the Tongue, and by the Salivatory Ducts and Tonsils, and that whether it be with, or without any evident cause. Which Symptom is a thing that is very common with those that have the Scurvy, and such as are Hypochondriacal, and shows a Colliquative disposition of the Blood: That is, that it cannot by reason of its too great and preternatural sharpness, perfectly assimilate to itself the new Nutritious Juice, nor make it duly mix with itself, and therefore throws it off upon these Glandulous Parts, and consequently does in progress of time oblige the soft substance of the Lungs to receive it; from whence a Consumption commonly has its Original. 13ly, 13. A want of Appetite, that lasts long. A want of Appetite, that continues long, and still grows worse without any other Distemper accompanying of it; so that the sick Person, unless he uses much Exercise, and abstains from eating a great while, and pleases his own Fancy in the choice of such Food, as is very grateful, cannot make a full Meal as he used to do without the turning of his Stomach, and making him sick: Neither indeed can he digest, or distribute the Food, which he takes, be sure if he eats much, without an Oppression at his Stomach, and a gravative weariness in his Limbs. Which is the very Symptom that opens the way to a Consumption: For it proceeds from too great a fullness of the Vessels, and the whole Habit of the Body, caused by stolen and dispirited Nutritious Juice, by which means there is not room to receive new Chyle, and therefore Nature does not desire it. Which want of Appetite does yet grow worse, if it happens so that a flame is kindled in the whole Mass of Blood by the present Catarrh from the continual and violent motion of the Lungs, and by reason of the serous and colliquative state of the Blood. In which case, as the Thirst increases, so the desire of Food grows less: Or else there follows an universal want of Appetite from too great a fullness of the Vessels, so that the sick Person plainly refuses Drink as well as Food. 14. A Chronical heat. 14ly, A troublesome and Chronical heat, at least in the soles of the Feet, and the palms of the Hands, especially after eating, together with a Pulse somewhat quicker than it ought to be. For this Symptom shows an Inflammatory and Hectical state of the Spirits, and consequently a sharp, serous, and colliquative disposition of the Blood, from which causes a Consumption of the Lungs does commonly proceed. 15. A straightness of the Breast, and shortness of breath. 15ly, A straightness and oppression of the Breast, with some difficulty and shortness of Breath almost always joined therewith. Which Symptom is very common, not only with such as have the Kings-Evil, by reason of the swelling of the Glands of the Lungs; but also with those that are Scorbutical and Hypochondriacal, by reason of the constriction of the Lungs, the Diaphragm, and other Muscles that serve for Breathing, which is from a light degree of a Convulsive Affection of the Nerves that are assigned for their motion. 16ly, 16. A disposition to Catarrhs. A disposition to Catarrhs, that is, when the sick Person is frequently subject to a Cough, even upon every little occasion, yea, and sometimes without any evident cause. For this Symptom shows a sharpness and colliquative state of the Blood. From whence it comes to pass that the sharp Serum, or Water of the Blood, supplied from the load of Humours lurking in the Habit of the Body, uses to be almost continually separated, and thrown out by the glandulous Coat of the Windpipe, and by the soft substance of the Lungs. Which is a very evident sign that a Consumption of the Lungs is then just at hand, which will most certainly seize the Patient, whenever the serous part of the Blood has contracted so great a sharpness as is sufficient to inflame or exulcerate the Lungs, either from the liberal drinking of Spirituous Liquors, or from taking of great Cold, or any other cause. 17ly, 17. Any of those Distempers preceding, which are apt to dispose to it. All those Distempers before mentioned, as the Scurvy, Kings-Evil, a Chronical Green-sickness, an Inflammation of the Lungs, spitting of Blood, Pleurisy, Rheumatism, Asthma, etc. which are wont to occasion a Consumption of the Lungs. For the Body being in this manner as it were habitually predisposed, a Consumption of the Lungs, and that many times an incurable one, does very frequently seize upon the Patient upon the next great Cold he gets. And indeed almost every Catarrh, when it afflicts the Patient, does at the same time threaten a Consumption that is like to follow. To prevent a Consumption, the great business to be careful in the six non-natural things. Therefore in the preventing of a Consumption (which is much easier than the Cure of it) the great business whilst the Patients remain in this sickly condition, is to take all possible care that no Error be committed in those six things, which we call not Natural. For in this so slippery a state of Health they are wont upon every little occasion of this Nature to fall headlong into a Fatal Consumption. As for Example: First, 1. In eating and drinking. they ought to be Prudent in the choosing of their Meat and Drink, that the Chylous Liquor may be made to abound with good Juice, and that the Nourishment may create very little trouble to Nature in digesting and dispensing of it. Let them also take heed they do not eat too much Food, though it be such as affords a good Juice, as also that they do not drink too much Wine and strong Liquors. 2. Sleep. Secondly, let them sleep the forepart of the Night: But let them avoid sleeping in the daytime, yea, and sleeping too long in the Morning; because such sleep is wont to retain and heap up a great load of Humours in the Habit of the Body. 3. Exercise. Thirdly, let them every day use moderate Exercise, and rubbing for a good while together, to fetch out the dispirited Humours from the Habit of the Body by the pores of the Skin. 4. Evacuations. Fourthly, let them strictly avoid all strong Purges; forasmuch as they not only weaken Nature, but also by putting the Blood into too great a motion with their sharp Particles, they make it grow acrious and hot, and bring it into a more Serous and Colliquative state; upon which a Catarrh, and a Consumption of the Lungs are wont to follow. Fifthly, 5. Passions of the Mind. let the Patient by all Lawful ways industriously lay aside Care, Melancholy, and all poring of his Thoughts as much as ever he can, and endeavour to be cheerful. For I have very often observed, that a Consumption of the Lungs has had its Origine from long and grievous Passions of the Mind. Sixthly, 6. The Air. let the Patient enjoy an open, fresh, kindly Air, and such as is free from the smoke of Coals, which may not only cherish the Animal Spirits, and comfort the Nervous Parts, and consequently restore the weak Appetite, but likewise procure quiet (at least in some measure) to the Lungs. But there must be great care taken, that he does not get new cold. For the Body being in such a manner filled with a load of Humours, every new Catarrh or Cold tends to a Consumption, and from hence come all our Sorrows. And here I shall earnestly beg Pardon for being too quick with my Pen (if any one can resent it as preposterous) whilst I offer something more in this Chapter (though briefly) concerning the Indications for preventing this Distemper, and that before the Methodical Thread of my Discourse brings me to the more copious subject of the Indications of Cure. The general Indications for preventing a Consumption in this sickly state, are chief three. The Indications of Cure The carrying off by some way of Evacuation the dispirited Chyle, that lurks in the Habit of the Body. The tempering of the Preternatural and Hectical heat in the Blood and Spirits newly caused by the stagnation of the Humours. And lastly, the strengthening of the Tone of the Parts, and consequently freeing them from their Obstructions; which being neglected, there is all the reason to fear an ill Habit of Body, and a return of the Preternatural Heat. Gentle Purges to evacuate the Humours. For this end, though strong Purges (as I have before hinted) are in this case to be condemned, yet it is very convenient to carry off the load of Humours by Stool gently, and by degrees, with kindly and Stomatick Purges, until the Body is freed from its bloutiness and Obstructions, and reduced to its first and Natural state. The Purges of this Nature are, the Stomach Pills with Gums, Aloephangin Pills, Aloes prepared with juice of Roses, Mastic Pills, Pill Ruffi, the bitter Draught with Senna, etc. But I prefer the Tinctura Sacra, and the Purging Mineral Waters before any other sort of Purge, which as they carry off the vapid Humours by little and little with ease, and without putting them into too great a motion, so they also rather temper the Heat, than kindle a new flame in the Spirits and Blood (which is often the effect of other Purges) and strengthen the Tone of the Stomach, which in this case is weak and relaxt, and withal increase the Appetite. Diuretics and Diaphoreticks for the same end. For the same purpose likewise such Medicines as provoke Urine and Sweat, are of great use in order to the more effectual carrying off of the nasty Serum of the Blood. But a Physician must be very prudent in the choice of these Medicines. But in choosing of these Medicines a Physician ought always to be very cautious and prudent, preferring those which communicate the least heat and sharpness to the Blood before others. For Diuretics, I prefer before any others, Wood-Lice, raw, or prepared, Turpentine, Leucatellus Balsam, Balsam of Sulphur, and other Preparations made of Turpentine; but especially the Chalybeate Mineral Waters, Amongst the Diuretics the Chalybeate Waters are the best. and amongst them Sadler's Waters at Islington; the Virtue of which I have had the Experience of now for five Years, not only in many others, but also in myself, with very good Success, because that they are impregnated with more of a Mineral Spirit than any others (that I have ever yet tried in several Parts of England) by which they penetrating like Lightning the farthest corners of the Body, open Obstructions, and provoke Urine very plentifully; and yet they do not affect those that drink them, so as to make them giddy, and as it were fuddled, to oppress the Stomach, or to cause a great heat in the Hands and Feet at the end of their passing off, so much as other Chalybeate Waters use to do. Among those Medicines that are Diaphoretic, a Decoction of Sarsa deserves the preference, Amongst the Diaphoreticks, a Decoction of Sarsa. which not only causes a gentle breathing by the pores of the Skin, but also tempers and softens the Mass of Blood: As also Ceruse of Antimony, Diaphoretick Antimony, etc. which Antimonial Medicines provoke Urine as well as sweat. If the Blood seems but in the least degree to grow preternaturally hot, If the Blood be at all preternaturally hot, some must be taken away. it is convenient in the very beginning to take away a moderate quantity of it, in order to cool it, and to abate the fullness of the Vessels. For although Bleeding is condemned in a Consumption, when it is once confirmed, because the use of it at that time not only affords no benefit, but also procures the sudden destruction of Nature: Yet nothing does conduce more to the preventing, or extinguishing of that Hectical Flame which is in the Blood, if it be administered time enough. By which means (other necessary Medicines being also given in a due Method) the Inflammation and Swelling, and consequently the Exulceration of the Lungs themselves; yea, and the Consumption itself, together with a Cough, difficulty of Breathing, and the rest of the train of direful Symptoms may be happily prevented. And indeed from what I have learned by a great deal of Experience, I do not doubt but many fall into fatal Consumptions from an Inflammation of the Lungs, Many fall into Consumptions for want of due Bleeding. a Pleurisy, ordinary Catarrhs, and other Distempers of that kind, because through the carelessness of the Physician, or the Patient's fear, and the timorousness of his Friends that are about him, there was not Blood taken away in due time, or so often as there should be, or in a sufficient quantity by opening a Vein. From whence it comes to pass, that the Blood retaining a Hectical heat, the Lungs for a long time remain hotter than they ought to be, and upon that there is a conflux of the Humours flowing into the Part affected, or rather a plentiful separation of the new Chyle by the Glands of the Lungs: From which there follow violent and dry Coughs, Inflammations, and at length (when the Consumption comes to its height) Exulcerations. And therefore I never do take away so great a quantity of Blood from other Persons, that have a Fever, as from these sickly Consumptive People, whenever they happen to be Feverish, and this I have done with very good Success, so that I do not remember that I ever yet repent of doing it. If there be any Hectic heat with a Catarrh, an Opiate must be given. If the Catarrh has but the least degree of a Hectical heat joined with it, and the other Circumstances of the Patient allow it, the frequent use of an Opiate is also very necessary in this case, and that not only to quiet the Lungs, which at this time are heated by the continual and violent motion of the Cough, but also to temper and calm the whole Mass of Blood. So that it is plainly convenient every Night, or every other Night to give a Grain and half of London Laudanum in a little Conserve of Red Roses, or an Ounce of the Syrup of Meconium with three Ounces of Milk-water, and three Drams of old Epidomick Water, or twenty Drops of Helmont's Liquid Laudanum in a spoonful of the Balsamic Syrup, which I shall afterwards describe; or half a Scruple of Hounds-tongue Pill, or the Pill of Styrax. Yea, And in this case every Purge, excepting the Mineral Waters, should have an Opiate mixed with it. and in this case no Purge except the Purging Mineral Waters ought to be prescribed without mixing an Opiate with it, lest the Cough and Heat should happen to be increased by too great a Commotion of the Humours. As for Example: Take a Scruple or half a Dram of Aloes rosate, half a Scruple, or twelve Grains of Hounds-tongue Pill, mix them, and make them up into four Pills to be gilded, and taken when the Patient is to go to sleep. Or, Take two Ounces and a half, or three Ounces of the Sacred Tincture, fifteen or twenty Drops of Helmont's Liquid Laudanum. This kind of Purges may be ordered every third or fourth Night, and two Quarts of the Purging Waters the following Mornings, either cold or boiled, according to the Season of the Year. Those days the Patient does not Purge, When the Patient does not Purge, Diuretics and Diaphoreticks are to be taken. the Physician must go another way to work, and endeavour to carry off the Humours gently by the Pores of the Skin, and by the Kidneys, and do it with the use of such Diuretic and Diaphoretick Medicines, as may rather abate than increase the Preternatural heat of the Blood. For Example: Let the Patient take three times a day Fifty Wood-lice bruised in small draught of Milk-water, Parsley, or Fennel-water, sweetened to the Palate with the Syrup of the five opening Roots. Or, Take two Drams of Wood-lice prepared, a Dram of Ceruse of Antimony, so much Turpentine washed in Plantain-water as will make them into Pills, mix them, and make them into Pills of a middle size, to be put up in Powder of Liquorice, of which let him take three three times a day at Medicinal hours, and drink after them half a pint of the Decoction of Sarsa and China, keeping himself from the open Air. The Chalybeate Waters are excellent in this case. But for this purpose I generally prefer the Chalybeate Mineral Waters before all others, it being what I have learned from long Experience; for that they are found by precipitating the serous Liquor out of the whole Habit of the Body by the Kidneys in a great quantity, and tempering the Hectical heat of the Blood and Spirits, likewise by opening Obstructions, and restoring the due Tone of the Parts to perform every thing that is requisite to a preventive Cure, even Reason itself being Judge. Which I have also found by much Experience ever since this kind of Waters here near us (that is, at Islington) have first come into Public use with the Approbation of our Famous College. Many preserved and cured by them. And by the help of these I have seen a great many preserved, and indeed others miraclulously recovered from a Consumption, such as I had plainly thought could never be cured, no, not with all that vast stock of Medicines, which are Sold either in the Apothecary's or Chemist's Shops, and the most approved Method of giving them, at least that I knew, unless I had had those Waters, or at least some others like them ready for my purpose: I shall afterwards at the end of this Treatise, give a short Account of some few Histories, out of many, that are pertinent to this business. Here also Issues made in the Arms, Issues. or between ●he Shoulders, are serviceable for abating the quantity of the Serous Liquor of the Blood, and consequently for comforting the Brain and Nerves, and tempering the Animal Spirits; which doubtless contribute very much to the extinguishing of the Hectical Flame, and to the prevention of a Consumption. Shaving of the Head. And perhaps ●ut little less benefit may be expected from the ●●equent shaving of the Head: When by this the ●assage of the Humours through that very thick ●kin of the Head is rendered more free, the use ●f which thing in relieving obstinate Catarrhs, 〈◊〉 approved almost by universal Experience. But alas! Physicians seldom consulted for the preventing of a Consumption. Physicians have very seldom an occasion to give their Advice about preventing this Distemper (when in the beginning perhaps it ●ay be cured as well as other Diseases, although ●or the most part by neglect it proves fatal) ●e sick Persons seldom imploring Aesculapius ●elp before the Distemper has run on so far as 〈◊〉 be a fatal case, and then they in vain expect Miracles from the Art of Physic, when it is ●ore convenient for them to have the good Counsel of a Minister about the future Salvation of their Souls, and the Advice of a Lawyer ●bout making their last Will. Wherefore I ●●all spare that labour, which will be to so little purpose, and without any farther delay proceed 〈◊〉 the Diagnostic and Pathognomonick Signs ●f this Distemper. CHAP. III. Of the Diagnostic and Pathognomonick Signs of the beginning of a Pulmonary Consumption. THE Diagnostic and Pathognomonick signs of a present Consumption, The signs either show the beginning or confirmation of a Consumption. are either such as discover it when it is but begun, or when it is once confirmed, and deplorable. The Pathognomonick signs of the beginning of a Consumption of the Lungs are, First, a Cough, which one may, and that by very certain signs distinguish from a simple Catarrh, how violent soever, and Chronical it may be, because, strictly speaking, the Part affected, or seat and source of both Distempers are not the same. The beginning is known by a Cough different from an ordinary Cough. For a Consumptive Cough proceeds from a Glandulous Swelling, or Tubercle of the Lungs themselves, and that with the sense as it were of some heavy weight in the Breast, as also a difficulty of Breathing, and other Symptoms of the same Nature, which I shall by and by particularly, though briefly, run thorough. But on the contrary, a simple Catarrh owes its Original from a distillation of Rheum cast out as it were in continual drops by the Uuula and Almonds, and the other Glands seated in the upper part of the Windpipe, yea, and by all the glandulous Coat of the Windpipe itself. For the Windpipe by a certain Providence of Nature is covered on the inside with a Nervous Membrane that has a very exquisite sense, which will by no means admit of any thing but the Air itself, no, not a drop of the clearest Water without grievous trouble and opposition, and therefore when it is tickled by the going down but of the least disagreeable Particle, it presently endeavours with all its might to throw it up again by Coughing: And indeed Nature has made this Provision for very great Reasons. For if a free and quiet passage were every day allowed but to the smallest Body, or Particles, that are heterogeneous, how soon would there be an end of Man's Life by the stuffing of the small branches of the Windpipe, which by reason of the straightness of the passages use sometimes to be stuffed, and Asthmatically stopped even by the Air itself when it is thicker than ordinary. But how fierce soever and continual this Catarrhous Cough is, as being provoked by a tickling from a continual Excretion and Distillation of Rheum from the Glands in the Windpipe, yet as it is always at the beginning moist, and joined with a great flux of Humours; so likewise it is accompanied with no weight, or oppression of the Lungs, or shortness of Breath, which for the most part are obvious to our Observation in a Consumptive Cough, and that in the very beginning. Therefore this I make to be the first distinguishing sign of a Consumptive Cough; to wit, This dry Cough from Tuber●l●s of the Lungs. that it is dry, at least in the beginning, because it proceeds from a swelling of the Lungs rather than from any thin Rheum owzing out of the Internal Membrane of the Windpipe, and the Glandules seated in the upper part of it. Yet it cannot be denied but these Patients in the beginning of this Distemper, Yet these Patients spit a great deal of thin Rheum. whenever the Lungs happen to be violently moved by an extreme and deep Cough, so as to make them Vomit (either after eating, or from any other Accident.) I say, these Patients do throw out a great plenty of thin, clear Spittle from the Salivatory Ducts, and likewise hawk up from the Tonsils some Glutinous Phlegm, that is sometimes salt, sometimes insipid, which may happen also to those that are well sometimes from the same cause, to wit, by reason the Salivatory Ducts, and Glandulous Parts seated in the Throat are squeezed, and as it were milked by this violent motion. But yet it is a dry Cough. But nevertheless this Cough is to be reckoned a dry one, because there is no Rheum or Phlegm thrown out of the Windpipe, or the branches of it. And it is as true that this dry Cough uses sometimes to turn to a Catarrhous Cough, and such as is attended with a flux of Rheum, as the Windpipe and the branches of it supply a continual flux of Humour, which is sometimes crude, sometimes in the form of concocted Phlegm (as it uses to be in a true and genuine Catarrh.) Which comes to pass from hence, because the Glandulous Coat of the Windpipe itself, and the branches of it being irritated by this long and violent motion of the Lungs (in the Nature of a dry Cough) caused by the Swell dispersed here and there through their whole substance, is continually emptied of its Liquor as if it were milked, and thereupon does throw out daily an abundance of Serum, or Water almost in the same manner as Milk is fetched out of the Breasts, and Spittle from the Salivatory Ducts, by drawing them in a manner continually; or as an involuntary flux of the Seed in a simple Gonorrhoea proceeds from the Glandulous seminal Parts by frequent fribling. How it may be distinguished from a true Catarrh. But yet this Consumptive Cough, when it is attended with a Catarrh, may be distinguished from a genuine Catarrh especially two ways: First, in that a Consumptive Cough is from the very beginning dry for some Months (and sometimes it may be for some Years;) whereas a simple Catarrh is at first humorose, as I said before. Secondly, in that a simple Catarrh goes off in a few Days, at most in a few Weeks; to wit, so soon as ever that accidental Feverish Ferment occasioned by taking of cold does by degrees once cease to put the Mass of Blood any longer into an extraordinary motion. Which being once done, the Glandulous Coat of the Windpipe does no more separate or spew out any Humour, but what it does Naturally. From whence it comes to pass, that what remains of that Rheum, which is separated by these Glands, being no longer attenuated with a new flux of the Humours, is by degrees concocted by the Natural heat of the parts into a Phlegm that resembles purulent Matter, and is coughed up in that form, and thereupon the Serum or Humour being thrown out when it is first separated, the Glandules quickly recover their Natural Tone without any hard Swelling, or Tubercle remaining. By which means it also comes to pass, that the Cough, together with the tickling, wheesing, shortness of Breath, etc. cease of their own accord. But on the contrary, in a Consumptive Cough, as the lasting and inexhausted Fountain does supply a distempered Humour to the Glandulous Parts from the Mass of Blood, predisposed by a long abuse of those six things, which we call not Natural, and put continually into an inordinate motion by a Feverish Ferment habitually fixed in it: So from the Swell dispersed here and there through the substance of the Lungs, and compressing the branches of the Windpipe, not without some trouble, the Windpipe itself is provoked to cough by a certain continual tickling: And this causes as continual a spewing out of a sharp and distempered Humour all along the inside of the Windpipe, until at length those Tubercles growing very large begin to be inflamed, and to turn to Apostemes. Whereupon as soon as any one of the Bags, or Cavities, which contain the Matter breaks, there is plainly in coughing (if there be a passage for it) a true and stinking Corruption thrown out from these ulcerated Swell, mixed with some thin Humour, or Phlegm, that is plentifully supplied from the Glandulous Coat of the Windpipe. Neither indeed can the Patient (when the Distemper comes to be a Fatal Case) be ever freed from this Cough by any Art, till Death effectually stops it. But let no one admire how those Tubercles, or Swell that are placed in the Lobes of the Lungs far from the top of the Windpipe, can provoke this dry Cough, together with a tickling in the upper part thereof; when he may every day observe the same kind of Chronical dry Cough caused and continued a long time by chalky stones generated in the substance of the Lungs. Yea, and once I observed the same Symptom to happen from three Nails, that slipped by chance (as the Person was laughing) through the Windpipe down into the Lungs, and to continue for a whole Year, the sick Person all that while being in other respects very well. How the Tubercles, which are remove from the top of the Windpipe, do affect that part. And indeed the thing itself shows it, for the Windpipe is every where divided through all the Lobes of the Lungs into many branches, which are a great way distant from one another, so that the very fine and small Pipes of those branches are propagated to the very extremities of the Lungs by the continuity of those Membranes, which had their Original from the beginning or upper part of the very Windpipe. From whence it necessarily follows, that as those Tubercles, in what part soever of the substance of the Lungs they happen to be bred, cannot but make a troublesome compression upon some of these small Pipes, and straighten them: So that troublesome sense, by reason of the continuity of the Membranes, does affect the upper extremity or beginning of the very Windpipe, by a consent of parts, as we commonly say; whereby it provokes the Windpipe to cast out its Enemy by a vain and dry Cough: Just as we see every day in a Strangury, or difficulty in making Water from a stone pressing uneasily upon the Ureter; yea, if it be the very Kidney, a great pain felt in the extremity of the Yard itself, from the continuity of the Membrane: For in Nature's endeavouring to expel the Stone, there arises a Spasmodick Contraction of the whole Urinary passage from the very Kidneys, which yet does very much affect the extremity of the Yard with a kind of heat of Urine. The Nature of this Cough shows it to be from the Tubercles. And even the Nature of this Consumptive Cough does likewise favour much this Opinion, whilst it yet continues to be dry (as being caused only by Tubercles) and before a disposition to a Catarrh does in progress of time come upon it. For as it is dry, and without any expectoration, so it is not great, nor the Fits long, and is rather made of its own accord to relieve the Oppression of the Lungs, then excited by a violent tickling, or accompanied with that great straining, which usually accompanies a Catarrhous and fierce Cough, that is caused by the continual excretion of a Waterish Humour by the Windpipe, and the branches of it. But if any one should be inquisitive about the Original of the Tubercles in the Lungs, A general Account of the Original of the Tubercles in the Lungs. which are the first occasion of this dry and truly Consumptive Cough, I shall give this general Answer: That the substance of the Lungs not only seems more obnoxious to a flux of Humours (as the Ancients love to Phrase it) than any other parts of the Body, from the continual motion of these parts caused in respiration; but also by reason of its spongy softness (because it consists wholly of small Bladders and Vessels) is wont to suck in, and retain the Humours. And therefore, when all the internal and external Parts, as well those that are Muscular, as those that are Glandulous, are very often affected with several sorts of such Swell, why should it be strange, if they are frequently found here also, as they are in other parts of the Body? Yea, when I consider with myself, how often in one Year there is cause enough ministered for producing these Swell, even to those that are wont to observe the strictest Rules of Living, I cannot sufficiently admire that any one, at least after he comes to the Flower of his Youth, can die without a touch of a Consumption. And without doubt the breeding of these Swell is so frequent and common, The breeding of these swell is very common. that a Consumption of the Lungs would necessarily be the common Plague of Mankind, if those Swell did not vanish, or were not removed by Art as easily as they are bred at first: And indeed I have been used to think, not without Reason, that as the more Benign Tubercles are wont to go off of their own accord, and that quickly, so none of them lay the Foundation of this great Disease, And when they are Malignant, they occasion a Consumption. of which I am now treating, but only those, which are in some degree Malignant, and ill-natured, and that are wont to putrefy sooner or later from some peculiar quality in their Nature, from what part soever of the Body they have their Original. But that I may more particularly say something of the beginning and rise of these Tubercles: A particular Account of the beginning of them. As far as I have been able hitherto to learn, either from the inspection of the dead Bodies of such as have had a Consumption, or by Reasoning; a crude Tubercle or Swelling is bred from the Obstruction of some Glandulous part of the Lungs; to wit, when a greater quantity of Serum, or Water is separated from the Blood, than is thrown out by the Dust of the Glandule: From whence it comes to pass, that as the Part affected being too much distended by the Humour that is imprisoned in it, is deprived of its Natural Tone, and thereupon is no longer able to spew or throw out the Serum, or Water that flows into it, or is separated; so likewise the Humour, that is so shut up, not being any more renewed by an influx of fresh Humour, does by degrees grow dry and hard from the Natural heat of the Part: From whence arises a hardness, that resists a pressure, or a Tubercle (of which we are now speaking) which in progress of time, after the Natural Tone of the Part is in this manner destroyed, is wont to be inflamed, and to turn to an Apostem sooner or later, according to the Nature of the Lympha, or included Humour, and of the Blood, from which it is separated, which indeed is the whole immediate cause of a Consumption of the Lungs, and of the dry Cough which attends it. The causes of that Obstruction, which produces the Tubercles. There remains yet some Enquiry to be made from what cause this Obstruction, or Stagnation of the Humour in the Glandulous parts of the Lungs does proceed. And this is sometimes from the thickness, and glutinous quality of the Lymphatic Juice, that is separated in the Glandules; from whence it comes to pass, that it is not easily driven on, nor thrown out by the very small and strait poor or passage of the Glandule: And this is wont to happen to those that have the Kings-Evil swell, and such as have the Scurvy, by reason of the great quantity of fixed Salt, which their Blood has too much of. From whence it comes to pass, that Persons so distempered are more subject than other People to fixed and cold Swell, and those in the Lungs as well as in other parts of the Body, and sometimes they die of a very Chronical, or lingering Consumption. Sometimes also there is so great a quantity of Humour separated in the Glandules from a violent and great Catarrh, that the excerning Faculty or Power by which the Part empties itself, is plainly unable to throw it out. From whence it comes to pass, that the way by which new Serum should flow into it being stopped, the Water which is then retained within the Glandules, and stagnates there, does by the Natural heat of the Part gradually turn to a drier Matter, and so into a substance that looks like Honey, or is of the Nature of a Suet, until the Tone of the Part being at length perfectly overthrown by being too much distended, there follows an Inflammation, and an Apostem upon it. And for this reason a Consumption of the Lungs does often succeed to a Catarrh itself, when a dry and hesky Cough comes in the room of that which was Catarrhous. Which dry Cough is caused by a Tubercle, or Glandulous Swelling, occasioned by a Catarrh upon taking of Cold. Moreover it is easy to observe that a dry Cough, The ill Cure of a Pleurisy, etc. sometimes occasions them. and a very Acute Consumption do often come from an Inflammation of the Lungs, a Pleurisy, or some other Disease of the Lungs; to wit, because either through the neglect of the Physician, or the timorousness of the Patient's Friends, such timely, or frequent, or such plentiful Bleeding as is necessary to answer to the greatness of the Inflammation, is omitted. From whence it comes to pass, that the Tone of the Parts, especially those that are Glandulous, being destroyed, are never able to recover their Natural state again; but here and there, in those places where the Inflammation has before for some time prevailed, there are hard Tubercles to be found dispersed up and down, together with a dry Cough, and a continual Hectic Fever; from whence such Patients, being once seized with a very Acute Consumption, die within a few Weeks; for the Lungs having been before inflamed, do very quickly Apostemate, which brings on the last Scene of this Distemper, with all the usual and fatal Symptoms accompanying it. There is another Error in the Cure of this kind of Distemper no less fatal, and that is, Sometimes from the want of Pectoral Medicines. when the necessary clearing of the Lungs from the Phlegm, with which the Glandulous Parts especially are stuffed, is plainly omitted for want of using Pulmonary and Expectorating Medicines; or when these Remedies are administered with too sparing a hand. And much more, Or from the unseasonable use of Opiates. when that plenty of Lymphatic Juice, which is separated in the Glandules, is kept locked up there by the unseasonable, and indeed fatal use of Opium, given in order to ease the pain. From whence it comes to pass, that although the Patient be delivered from the danger of the present Distemper, (which yet is very seldom the effect of it) yet by those Tubercles, or Glandulous Swell, which are left by this Method, a ready way is made to a Fatal and Acute Consumption: Which shows itself first by a Cough, shortness of Breath, and a Hectic Fever, but afterwards does quickly bring on all the direful and fatal Symptoms of this Disease. The most usual couse is some Spasmodick contraction of the Lungs. But the most usual cause of these Tubercles is some little Spasmodick, or Convulsive Contraction of the Lungs, that is long and continual, with the sense of a weight and oppression, caused by Grief, Fear, Cares, too much Thinking, and other suchlike Passions of the Mind. For as the soft substance of the Lungs, when they are contracted so long, and continually compressed or squeezed together, is wont to grow hard of its own accord; so likewise the Glandulous Parts of them being once deprived of their usual expansion, are not able to throw, or spew out, be sure in a sufficient quantity, that Lymphatic Liquor, which was separated in them. Wherefore no body has any reason to wonder, that as a stuffing of their whole substance, so likewise a hardness in the Glands themselves, that resists a pressure, follows upon it. And thereupon it is easy to observe, that as Hypochondriacal and Hysterical Persons are more subject than other People to a Consumption, though it be a Chronical and lingering one; so likewise that Distemper seizes them for the most part from the occasion of some Misfortune, which thing does first cause Fear, Grief, Thoughtfulness, or some other grievous Passions of the Mind, and that long and fixed. Secondly, A Consumptive Cough, 2. A Consumptive Cough is moderate in the day time in the very beginning. as it is for the most part dry, so in the beginning of the Distemper, at least in the daytime, it is mild, and without any very great and vehement irritation, and often returns by long and uncertain intervals. But a Catarrh is in the very beginning fierce, and almost continual. It must indeed be confessed that both Coughs are violent and troublesome enough in the nighttime; to wit, a Catarrhous Cough, because all separation of the soul Serum by the glandulous Coat of the Windpipe and its branches is more plentiful at the time of lying down in our Beds; but a Consumptive Cough, because the Lungs are more constringed and straightened in this posture of the Body. Whereupon as the branches of the Windpipe being more compressed by the glandulous Swell, have upon this occasion more trouble from their compression: So likewise there is a greater quantity of glandulous Liquor at such a time pressed out of the Glands into the branches of the Windpipe, by which the Lungs are more stuffed, and thereupon are likewise more provoked to cough: And from this continual motion of the Lungs caused by the Cough, proceed those pertinacious Watch, which contribute more than a little to the increase of the Fever, which at first depended upon the Colliquative and Tumultuos state of the Blood. Though I have sometimes observed, especially in Consumptive Persons, that have been Hypochondriacal, long and troublesome Watch without any Cough, especially after their first sleep. 3. A Vomiting after eating, discovers a Consumptive Cough. Thirdly, as there is almost always a want of Appetite, and a Thirstiness accompanying a Consumptive Cough, so likewise a Vomiting after eating uses commonly to follow upon it; so that usually the sick Person, when he has eaten, coughs, and never ceases, till he has vomited up the Food he has taken. The Causes of it. Which Symptom proceeds not only from a weakness of the Stomach, by reason that the Concocting Faculty is impaired by the distempered state of that Liquor, which is continually thrown into the cavity of the Stomach by its glandulous Coat for the sake of Fermentation, and is at this time supplied from the Mass of a Feverish Blood; but likewise from too great an agitation of the Stomach, caused by the violent motion of the Lungs coughing just by it: For as soon as ever the Lungs begin to be swelled with a new influx of fresh Nutritious Juice conveyed into them, there gins to be a plentiful separation and excretion of the Lymphatic Liquor by the small Pipes of the Lungs, and the glandulous Coat of the Windpipe, and upon that a continual tickling, and a troublesome and violent Cough; by which commotion the Stomach being by reason of its Vicinity brought into a consent is also shaken, till at length the Natural motion of it being perfectly inverted, it throws up by Vomiting whatever was contained in it. From whence it comes to pass, that the stock of new Chyle being in this manner thrown out, there is no more of it for that time carried into the Lungs, and so the Lungs being quiet upon it, as not being irritated any more by an influx of new Chyle, the Stomach is at quiet too, and so the Cough and the Vomiting come to cease together, until the Lungs begin to be irritated again from the taking in of new Food. This is one of the most certain signs of a Consumptive Cough. And verily this disposition to Vomit being joined with a Cough, I reckon one of the most certain Pathognomonick signs of a Consumptive Cough. For although I have known some that have been in a Consumption, who have had for the most part a good Stomach, (that is, when the Fever, that has gone along with it, has been very mild) yet I scarce ever met with any, but had this disposition to Vomit after eating joined together with a Cough. Though a vomiting does attend the Chincough; It must indeed be confessed that this Diagnostic sign is not proper to a Consumptive Cough in the fourth Mood (as the Logicians use to speak) that is, so that wherever this is found joined with a Cough, that Cough is a Consumptive one. For although all Persons, who are in a Consumption, are wont in that manner after eating, to vomit up what they have taken, with their coughing, yet the same thing happens likewise every day to Infants, and Children that have a Chincough. Yet it is easy to distinguish them. However it is very easy by the Age of the Patient, the continuance of the Symptom, the fierceness of the Cough, and other Circumstances to distinguish this Catarrhous Cough from that which is truly Consumptive. Fourthly, Likewise a hoarse, 4. A hoarse, or squeaking Voice, joined with a Cough is a sign that it is Consumptive. or shrill and squeaking Voice, joined with a Cough, if it be frequent, much more if it be continual, and Chronical, shows it to be plainly a Pulmonary and Consumptive Cough: For as the hoarseness proceeds from a roughness of the Coat which covers the inside of the Windpipe, which being continually moistened with a salt Rheum, puts the whole Pipe or Instrument out of Tune; so likewise the smallness of the Voice depends upon the stuffing of the small Pipes, that are clogged with glutinous Phlegm. 5. A weight in the breast, and difficulty of breathing shows a Consumptive Cough. Fifthly, as this Cough is accompanied with an Oppression of the Breast like a weight from the beginning, so likewise with some trouble, and difficulty in breathing, and a shortness of Breath, especially upon walking faster than ordinary. Which as it proceeds from crude and hardened Tubercles scattered up and down through the Lungs, so likewise from the small Pipes being stuffed with tough and glutinous Phlegm. But in Scrofulous, Which shortness of breath is more remarkable in some particular Persons. Scorbutical, and Asthmatical Persons, that are in a Consumption, this Symptom by reason of the Convulsive contraction of the Nerves of the Breast, is more remarkable, and more troublesome than it uses to be in others; and therefore a fresh and open Air, and such as is free from the smoke of Coals, is more beneficial to these Patients, than to other Consumptive Persons, as we shall show more in its proper place. 6. Fretfulness and Sadness, with a Cough discover it to be Consumptive. Sixthly, when some of the Glandulous parts of the Lungs happen to be very much distended by the long gathering of the Humour, which could not find a way out by the small Pipes, and to become hard, there grow crude Tubercles scattered here and there in the soft substance of the Lungs. Whereupon there follows not only some difficulty of Breathing, and a shortness of Breath, but also an Oppression of the Breast, and a weight under the short Ribs, accompanied with an unusual Fretfulness, Sadness, and Thoughtfulness. Which Symptoms, when they are joined with a Cough, I always reckon among the Pathognomonick signs of a Consumptive Cough. Seventhly, 7. When the Patient coughs more as he lies on one side, then as he lies on the other. when at length those Glandulous Parts from a long infarction or stuffing of the Lungs, that are loaded with a filthy Serum separated in the Glandules, are very much swelled, and grow hard in one or other of the Lobes, (this Serous Matter being then contained in large bags) that Lobe of the Lungs which is affected, is heavier than the rest, and there is a greater weight evidently perceived in that part of the Breast; from whence it comes to pass, The cause of this. that the Patient likewise coughs more when he lies on one side, than on the other, because the Glands that are affected, are compressed more in one posture than in the other; from the compression of which there follows a continual spewing out of Serum, or Whey-like Liquor into the small Pipes of the Lungs, together with an incessant tickling, and a troublesome Cough. And this likewise is always to be reckoned one of the most certain signs of a Consumptive Cough. For although I have known some, that have been affected in this manner, to have lived several Years, yet they always remain in a sickly and Consumptive state. Eighthly, 8. When the Tubercles Apostemate, there arises new Symptoms. when at last those swelled Glands of the Lungs begin to be inflamed, and to turn to Apostemes, with a Collection of purulent Matter contained in their proper Bags, whether they are of the Nature of a Steatoma, where the Matter is like Fat, or of a Meliceris, where the Matter is of the colour and consistence of Honey, or of any other kind of Swelling whatsoever, (which variety proceeds from the different Nature of the Serum, or Water of the Blood, as we shall show afterwards) then the Consumption gins to be confirmed, and to become Fatal, upon which there follows a new company of deadly Symptoms; which are the Diagnostic signs of a confirmed Consumption, of which I shall hasten to discourse more largely by and by, as soon as I have given some short Account of the two other signs of the beginning of a Consumption, viz. a Fever, and the wasting of the Solid Parts. The Second Pathognomonick sign of a Consumption is a Fever. The Second Pathognomonick sign of the beginning of a Consumption, is a Fever, which does, at least in some degree, accompany this Distemper, when it first seizes the Patient, together with the loss of Appetite, some Thirst, a Urine somewhat high coloured, a quick Pulse, want of Sleep, a heat of the Parts, especially the extreme Parts, and other suchlike Symptoms. By which we may know a Consumptive Cough. This Fever at first is sometimes moderate. And by this means a Consumptive Cough may almost at any time be distinguished from an ordinary Catarrh. Indeed this Fever in the beginning of the Distemper is very moderate in Scorbutical and Phlegmatic Persons; however, some Preternatural heat (if they make a diligent Observation) may be discerned, especially in the palms of the Hands, and the soles of the Feet, together with a quickness of Pulse, and sometimes also a fixed redness in the Cheeks, more especially after eating. But this Fever is purely Hectical, and continues almost always alike, because it proceeds from the Solid Parts, and the disposition of the Blood, by reason the Mass of Blood has lost its due mixture, and runs a great deal of it into a Serous Matter, which is occasioned by an Acid, or sharp Ferment that is in it, and is continually disturbing, Afterwards it increases. and putting it upon the fret. It is very true, this Fever is in progress of time very much increased by the continual motion of the Lungs, and they being heated with the Cough, and the want of Sleep occasioned by it; as likewise by the addition of an Inflammatory and Putrid Fever, proceeding from the Inflammation of the Tubercles of the Lungs, and the Apostemes that follow upon it: Of which we shall presently Discourse more largely when we come to speak of the Diagnostic signs of a confirmed Consumption. The Third Diagnostic sign of the beginning of a Consumption, is a wasting, The Third Diagnostic sign of an incipient Consumption is a wasting of the Flesh. or extenuation of the Muscular Parts, which in the beginning of the Distemper is very slow, and almost insensible (the Parts at this time rather growing lose and flabby, than wasting) until from an Inflammation of the Tubercles, or from Apostemes, or some other Accident an Inflammatory or Putrid Fever comes to be joined to the Hectic; and then as the new Fever not only spoils the Appetite and Digestion, but also melts down the Nutritious Juice, and throws it out of the Blood, the Consumption increases apace, so that within a few Weeks the Patient has a Hippocratick Face. From which time the Diagnostic signs of a confirmed Consumption appear, of which we come now to speak. CHAP IU. Of the Pathognomonick signs of a confirmed Consumption of the Lungs. The signs of a confirmed Consumption are, 1. A new Fever. THE Pathognomonick signs of a confirmed Consumption, are, a new Fever added to the Hectic, and that first, Peripneumonical from an Inflammation of the Lungs, and Continual, afterwards Putrid and Intermitting; and a greater colliquation of the Blood, 2. A greater Colliquation. which is mightily increased by the new Fever, and discovers itself by Prodigious Sweats, a Catarrhous Cough, a Looseness, Dropsy, Thrush, and a particular soreness of the Throat in swallowing. By which the Patient being at length brought to the last degree of a Consumption, is reckoned to be in a deplorable Condition, even by those that understand nothing of Physic. Of all which signs I intent particularly, though briefly, to subjoin my Observations. The causes of the second, or Inflammatory Fever. And first, of the Inflammatory Fever, or the Fever from an Inflammation of the Lungs. This Fever has its beginning from an Inflammation of the Tubercles of the Lungs, to wit, whenever one or more of those Tubercles happen to be inflamed by the taking of Cold, the liberal drinking of Spirituous Liquors, too much Exercise, or from any other suchlike Accident, which by putting the Blood into too great a motion, may make it too hot, or else by too great a distension of the Tone of the Glands, or from the peculiar Nature of the Humour contained in the Bags, and its disposition to ripen, this Fever (which I use properly to call a Peripneumonick, or Inflammatory Fever) cannot but arise, and that with the conjunction of a difficulty of Breathing, (the expectoration or raising being then stopped, though the Cough continues violent) and oftentimes also of a pain of the Side, a Drought, Restlessness, want of Sleep, a great and continual Heat, and other Symptoms of a Fever from an Inflammation of the Lungs. By which the Patient, so long as the height and violence of it continues, is almost always confined to his Bed, and many times never comes out of it again. And indeed this Fever is to be treated wholly in the same manner as other Fevers that are attended with an Inflammation of the Lungs, This Fever is to be treated like other Fevers with an Inflammation of the Lungs. that is, with a very thin Diet, the plentiful use of Pectoral and Expectorating Medicines, the outward application of Anodyne Fomentations and Liniments, Pearl Cordials, and Temperate Juleps, but above all, with Bleeding, and that such as is administered in due time, frequently, and plentifully, let the Patient be never so lean and Consumptive. For by this means only is it possible to prevent the fatal Event of the Distemper at this time. For the Blood being once cooled by bleeding in time, and in a sufficient quantity, the Fuel, which would maintain the Inflammation, is taken away, and the Flame, which is kindled in the Tubercles, is with the same ease extinguished in a day or two. But if this be neglected, the Patient dies within seven days with an Inflammation upon his Lungs, and all the Fatal Symptoms of this very Acute Distemper, which many times happens from the negligence of the Physician, of the Patient, or his Friends; or at least, though if he does not die so quickly, yet he dies as certainly, having an Aposteme succeeding to the Inflammation of the Tubercle about the seventh day, and from thence this Acute and Inflammatory Fever turns to a Putrid Intermitting Fever, which though it be Chronical, yet is altogether as Fatal and Incurable. This Fever sometimes returns often in a Year. Sometimes I have found (as in Mr. Tib's in Pater-Noster-Row, and in a certain Merchant in Philpot-Lane) that this Peripneumonick Fever has returned several times in a Year, to wit, as often as any new Tubercle happened to be inflamed, whether it were from some evident cause, or from the Natural disposition of the Tubercle itself to ripen, Some Apostemes ripen sooner than others. and become an Aposteme. For all the swelled Glands are not disposed to an Inflammation at the same instant of time, as it was evidently apparent to me in the Body of Mr. Davison, who died of a Fatal, though a Chronical Consumption, when we came to open it. For in the Lungs of the dead Body we found at the same time some Tubercles that were turned to Apostemes, and others that were inflamed; and lastly, some that were crude and unripe. But for the most part such Consumptive Persons die of a Peripneumonick Fever proceeding from a new Inflammation of some Tubercle, which the Patient has not strength enough to overcome, having been weakened by grappling with his Distemper before. The degree and da●ger of the Fever answers to the degree of the Inflammation. As the duration of this Fever, so the degree and danger of it is to be calculated from the Inflammation of the Tubercle, upon which it depends. For as soon as the Inflammation goes off, whether it be of its own accord, or by the help of Physic, this Fever likewise ceases, tho' as often as the Part that is inflamed happens to be turned to an Apostem, there forthwith comes in the room of it a Putrid Intermitting Fever, arising from the collection of Matter. And generally speaking, according to the Nature of the Swelling, and its disposition sooner or later to ripen into purulent Matter, the Peripneumonick Fever itself, which proceeds from it, is sooner or later cured; and according to the Malignity of the Humour, and the bigness and number of the Swell that are inflamed, it is more or less Acute and Fatal. Whereupon tho' this Fever does for the most part come to a period within the compass of seven days (for in that space of time inflamed Swell begin to turn to Apostemes) yet Scrofulous Tubercles, This Fever generally terminates in seven days. as they ripen very slowly, Where the Consumption is Scropholous, the time is uncertain. so they bring an Inflammatory Fever, which, though it be almost insensible, and less dangerous, yet is Chronical, and ends in no certain number of days. But by how much the Fever is more Acute, so much the shorter it is; and by how much the more moderate, so much the longer it lasts. I come, Secondly, to speak of the Putrid Intermitting Fever of Persons in a Consumption. As soon as these inflamed Swell of the Lungs begin to be Apostems (whether it be for want of Bleeding in time, A Description of the Putrid Fever in a Consumption. or a sufficient quantity, or from the Natural disposition of the Swell to putrify) this Inflammatory Fever is changed into a Putrid Intermitting Fever: Whose Fits for the most part observe no certain Order at first, but the cold and shivering Fits return often the same day, as it uses to be when purulent Matter is breeding. But when the Matter is once perfectly made, this Fever imitates the Type of a Quotidian, and sometimes (though seldom) of a Tertian, and that at a certain time of the day, beginning with a chillness and coldness, proceeding with a great heat, and so at last ending in profuse and colliquative Night-sweats. During the time of the chillness and hot Fit, the Cough and shortness of Breath, with the other troublesome Symptoms are increased: But during the time of the Sweat, and the abatement of the Fever (the Cough and other Symptoms being mitigated) the Patient sleeps quietly, recruits his Strength, and flatters himself with the hopes, he is then ready to have, of his Recovery. And this Putrid Intermitting Fever I always reckon one of the most certain Pathognomonick signs of a confirmed Consumption; because as it proceeds from purulent Matter bred in the Lungs, so it is an Infallible Evidence of corrupted Lungs. And from thence it comes to pass, that this Putrid Intermitting Fever uses to accompany a Consumption (whenever this Distemper happens to be Fatal) to the Patient's dying day. Whose Fits, and the Colliquations proceeding from them, are greater or lesser, longer or shorter, according to the greatness and number of the Tubercles that are ripened into Apostemes. This Fever not to be cured without the Cure of the Ulcer. Neither indeed can this Fever be perfectly cured with the Peruvian Bark, Poterius' Antihectick, or any other Specific Medicine (having often tried what they could do in this case) nor by any other Method that I know of, unless the Ulcer be so benign, that that can be healed by the help of Balsamic Medicines given inwardly, and the Mass of Blood itself (where the fuel of the Distemper lies) can be brought to a good state by the plentiful use of temperating and altering Medicines; Or of the Distemper upon which the Consumption depends when it is Symptomatical. The colliquation of the Nutritious Juice is another sign of a Consumption. or at least unless the Consumption be Symptomatical, and depends upon some other Distemper, which may admit of a perfect Cure with the use of Specificks. The Second Pathognomonick sign of a confirmed Consumption, or that plainly discovers it to be such, is a great and continual colliquation or melting of the Nutritious Juice, and a continual and plentiful separation and running off of it from the Mass of Blood by all the ways of Evacuation that Nature affords; from whence it comes to pass, that a sudden sinking of strength, and a Marasmus with a Hippocratick Face follows in a short time, though it comes gradually. This Colliquation is proportionate to the degree of the Hectic Fever. Indeed I must confess a Consumption has from the beginning always something of a Colliquation joined with it proportionable to the degrees of the Hectic Fever, from which it proceeds, which discovers itself by Night-sweats, a Looseness, or some other way. Which Colliquation, though it be very hard to be cured, because it depends upon a Hectic Fever, that is incurable, yet is always moderate, and brings but a very slow, and less sensible Consumption, till first a Peripneumonick Fever from the Inflammation of the Swell of the Lungs, and then a Putrid Intermitting Fever from the Exulceration of them, comes upon, and is joined to the Hectic. And then indeed as the Fever, so the Colliquation which proceeds from it, is increased. For the Blood being then continually fouled by purulent Particles communicated to it, as it circulates through the Lungs, by the Swell that are ripened, Nature when she is so much loaded, and oppressed with such Heterogeneous Particles, that she cannot bear them any longer, riseth up against them, and gins a Fight (or Feverish Fit) in order to thrust them out, and this Combat she renews every day. In the beginning of this Conflict she is too much oppressed, and therefore is affected with a chillness and coldness; but as soon as she rallies her Force, and gins to get the better, there is so great an ebullition and commotion made in the whole Mass of Blood, that the fresh Nutritious Juice, which is then carried into the Blood-Vessels, can no longer unite itself to the Blood, but is thrust forth, and thrown out in a large quantity together with the purulent Particles by any of the parts of the Body that are open and passable, as if they were melted, not without a great loss of Strength, nor without a wasting of the Body, that is by this means continually deprived of its Food, which should restore and nourish it. And the greater the Ulcers are in magnitude, and the more they are in number, the greater quantity of Heterogeneous Particles are mixed with the Blood as a Preternatural Ferment, and the more severe is the Feverish Fit, the Colliquation likewise is so much the greater, and the Consumption makes so much the quicker dispatch. This colliquated matter runs off first by the Glands of the Windpipe and the Bronchia. 1. This separation of the colliquated Matter is first made by the Windpipe and the branches of it, by which the Cough, that at first was dry, is now turned to such a one as is attended with a great Catarrh, especially when the Feverish Fit is going off: At which time a great quantity not only of a crude thin Matter, but likewise of concocted Phlegm, either purulent, or like Pus or Matter, and of several colours is thrown out of the Lungs by Coughing, until the Mass of Blood, having thrown out that heterogeneous and purulent Ferment, or Leaven, does by degrees cool, and come to be quiet. And this Calm lasts no longer than till this deceitful and uncertain Truce happens to be broke by a new Fit. Secondly, Then by the Pores of the Skin. this separation of the colliquated Humours is made likewise by the pores of the Skin in large and colliquative Sweats. For these Sweats differ in their degree, to wit, according to the different degree of the Colliquation of the Blood, and of the Fever Fit, which precedes, and is the cause of it. For the Sweats always come on, when the Putrid Fever is going off, to wit, after Midnight. For this Fever (whether it be a Tertian or Quotidian) comes like other Intermitting Fevers at a certain hour (which is about Noon, or a little after) with a manifest chillness, but then proceeding for some hours with a burning Heat, Drought, Restlessness, Vomiting, shortness of Breath, a continual, fierce, and violent Cough, want of Sleep, yea, sometimes also Lightheadedness, and a very red colour in the Cheeks, proceeding from the Oppression of the Lungs, and those parts that are seated under the short Ribs: But at length, to wit, about Midnight, it ends in vast and colliquative Sweats. At which time the Patient sleeps quietly, breathes not so short as before, and plentifully coughs up concocted Phlegm without any difficulty or pains, having the Symptoms of the Fever all gone off altogether of their own accord. For at this time the stream of the colliquated Humour is turned from the Lungs, and carried to the Pores of the Skin. And by that means the Patient seems all the Morning to be free from a Fever, his Heat is moderate, and his Pulse low, until at length another new Fit seizes him, and breaks the Treacherous Peace. And from these remissions of their Fits it often happens that these kind of Consumptive People, even when they are looked upon as deplorable by others, flatter themselves extremely with the hopes of their Recovery; so that the same Persons that at Night use to think themselves irrecoverable, and tell those about them they should certainly die, yet the next Morning they always pluck up their Courage, and in vain entertain the hopes of living long. The stopping of these Sweats does no ways relieve the Patient, but thereupon the Matter runs off from the Blood some other way. 'Tis true indeed, these Colliquative Sweats causing a great expense of the Nutritious Juice, do commonly spur on the Patient's Consumption, and quickly make him a Skeleton. And yet he must not expect any relief or benefit from the violent stopping of them, either by the change of Air, or rising out of Bed in the Night; which I have often seen proved true by Experience. For the Blood thereupon growing hot, does not melt or dissolve ere the less, but when this passage of the colliquated Humour is once stopped by Art, Nature presently opens some new Sluices to carry that troublesome Load another way, (though it may be more inconvenient) as either into the cavity of the Breast, As into the cavity of the Breast or Belly, etc. from whence there follows a Dropsy of the Breast, with an increase of their Cough, and an intolerable difficulty of Breathing; or into the cavity of the Belly, and into the Legs and Thighs, in the Nature of a Dropsy in those parts; or else by the Glandules of the Guts, whereupon there arises a violent Looseness, that is no less Colliquative than the Sweats themselves: Yea, and sometimes even a Bloodyflux (if the colliquated Humour be very sharp) attended with dreadful Convulsions and Torments of the Bowels, which bids defiance to all the Medicines that are used to cure a Dysentery; as I found in the deplorable case of Mr. Lechmere, and likewise some other Persons that have been in a Consumption, who being by that Symptom thrown into the last degree of a Consumption, with a Hippocratick Face, died as quickly as they did miserably. But this Thread of my Discourse has unexpectedly brought me to the other Diagnostic signs of a confirmed Consumption, of which I must likewise say something briefly. Thirdly, The colliquated Matter when the Consumption is confirmed is exerned by the Guts. This Colliquation (as soon as the Consumption comes once to be confirmed) is often made by the Glands of the Guts, in the Nature of a thin and waterish Looseness, or else of a Bloodyflux. For the Blood when it cannot in this colliquative state assimilate the fresh Nutritious Juice to itself, nor unite it to the solid Parts, by reason of its own Preternatural Heat and Sharpness, does frequently endeavour to drive it down, and throw it out as an unprofitable Burden by these Glandules likewise. But Nature does not use to endeavour the expulsion of her Enemy this way, unless it be either for want of Care, or designedly that the Highway by the Pores of the Skin is stopped, or at least, when this way alone is not sufficient to serve her purpose, by reason of the greatness of the Colliquation. And therefore a Looseness is justly to be reckoned, for the most part, one of the last and fatal Diagnostic signs of a confirmed Consumption. For excepting only the case of such Persons as have the Scurvy with their Consumption, who are always subject to Colliquations of the Serum by the Glands of the Guts, and Salivatory Glands, a Looseness is wont to arise, and join itself to a Consumption not long before the Patient dies. For as it shows Nature to be in a very great flame, so it strangely hastens and promotes its farther Destruction. This Looseness is proportionate to the present state of the colliquated Blood. This Looseness is sometimes moderate, in as much as it is always proportionate to the present state of the colliquated Blood, but in others it is violent, and accompanied with racking pains, which usually defies the power of Opiates, and all manner of Astringent Medicines; or at least returns upon taking of the least Cold, or drinking a draught of Beer, or omitting the use of Opiate Medicines. And so long as the Looseness is stopped by the Narcotick Power of Medicines, we usually have a difficulty of Breathing, in which the Patient is almost choked, or a Dropsy, or some other Symptoms no less troublesome, nor less dangerous arise. For the Blood being once brought by degrees to an irreparable and incurable state of Colliquation, the crude Nutritious Juice, that is continually carried about in the Mass of Blood, does, when one Door is shut, find some other, and it may be one that is more prejudicial and troublesome to the Patient. The colliquated Humours producing a Dropsy, is another sign of a confirmed Consumption. Fourthly, But when in this colliquative, or melting state of the Blood, the Nutritious Chyle that is quite dispirited, does not find a convenient passage through the Glands of the Skin, by reason they are stopped by the cold of the ambient Air, or by the Glands of the Guts being shut up by the use of too many Opiates, either a Dropsy of the Breast, or else of the Belly, and the lower Limbs does usually follow. Yea, a blouted swelling in the whole Habit of the Body, if the passages into the aforesaid Cavities of the Body, and the lower Limbs, are either by Art or Accident stopped. And in plain terms, a Dropsy coming upon a Consumption, of what kind soever it be, And not only of a confirmed but of a deplorable Consumption. is to be reckoned amongst the signs not only of a confirmed, but likewise of a deplorable and incurable Consumption. And that not only because it shows a very great flame in the Blood, and that the state of it is extremely colliquative; but likewise because the Patient by reason of his too great weakness is not able to bear such an Evacuation of the extravasated Serous-water, as is necessary, by such Medicines as purge forth Water. And for Diuretics, they are plainly of no use in this case, because even the strongest of them cannot promote a Flux of Urine, but rather cause a greater Colliquation in the Blood, by attenuating, and heating of it more. Whereupon there is caused a greater and quicker flux of the Water into the cavities of the Body, and into the lower Limbs, where it has a free passage, so as to increase the Dropsy. Fifthly, and lastly, At last the colliquated Humours are thrown out by the glands of the Throat. In this universal Colliquation Nature sinking a little before the Person dies, makes it her business to throw out the Serum, or Juice that is full of distempered and purulent Particles, by the Tonsils, and other Glands, that are seated in the Throat, as also by the Salivatory Ducts of the Mouth. From whence arises, 1. A heat in the Throat. From whence there are wont to arise two new Symptoms, and they very troublesome ones; to wit, a great heat about the Tonsils, and the Parts that serve for swallowing. Whereby it comes to pass, that the Patient can scarce swallow any thing but with grievous pain. Which Symptom is wont to proceed from a light Inflammation of these parts, caused not only by the perpetual agitation of them by the Cough and external Cold; but likewise by the separation and spewing out of the Feverish Serum and sharp Matter. Secondly, 2. A Thrush. long and troublesome Thrushes dispersed through the whole Mouth, which arise from the distempered state of the Spittle: But especially if the Looseness that they have been followed with, has been violently stopped with Opiates, and Astringent Medicines. For hereupon Nature (when the Door by which the Serum uses to pass, is once stopped) endeavours, though in vain, to force out her Enemy by the passages of the Spittle. By which means it comes to pass, that the parts of the Mouth being tinged with that sharp Humour, happen to be inflamed and ulcerated with the Acrimony of that distempered and feverish Serum, which is separated and thrown out by the Glandulous Membrane of the Mouth. Which indeed is the immediate cause of this Symptom, which how troublesome soever it is, does nevertheless plainly defy whatever either Art or Nature can do, because the stock and fuel of it, that is heaped up in the Mass of Blood, This universal Colliquation quickly brings a Marasmus. cannot be spent. Thirdly, this universal Colliquation, through what Sluices soever of the Body it happens to be made, uses very quickly to bring a Marasmus, with a Hippocratick Face, which is a total Consumption of the Muscular Flesh, from the defect of the new Nutritious Juice, which by adhering to the Solid Parts might repair the continual loss that they sustain. And when the thing is at length come to this pass, there are no hopes of the Patient's Life. And therefore this Symptom has ever been reckoned by all Persons one of the most certain signs, not only of a confirmed, but likewise of a deplorable Consumption. Observations Besides these Diagnostic signs, which I have already mentioned, it may perhaps be beneficial to add likewise my Observations concerning the Pulse, the Urine, and the Matter which they bring up in their coughing, in the several degrees of this grand and stubborn Distemper. And first, of the Pulse: 1. Of the Pulse. When there is only a Hectic Fever. In the beginning of a Consumption, whilst there is no other Fever but a Hectic, as the preternatural heat is continual and moderate, so likewise the Pulse is somewhat quicker than it ought to be, according to the degree of the Fever; yet for the most part it always observes the same strokes, and is always alike, but only that after eating, as a feverish Heat, so likewise a quickness of the Pulse may more easily be discerned. And indeed some Persons in a Consumption, that are more cold and Phlegmatic, do use to perceive nothing amiss, either in their Pulse or Temper at any time but only then. When there is an Inflammatory Fever. But as soon as ever the Peripneumonick Fever, with an Inflammation of the Lungs seizes them, the Pulse, as it uses to happen in other Peripneumonies, is not only quick, but also hard and strong, yea, likewise rises up more in one place than in another, so as to feel somewhat like a Saw, when one feels it with several Fingers together. Though sometimes, by reason of the violence of the Spasmodick pain caused by the Inflammation of the Tubercles, it is no rare thing to observe a weak Pulse, together with a coldness of the Extreme Parts for a time, which may employ the Sagacity of the most Skilful Physician, to know whether he ought to prescribe Bleeding, or no. For as the taking away of Blood does suddenly destroy Nature, and ruin the Patient whenever the weakness of the Pulse, and the coldness of the Extreme Parts proceed from an habitual Weakness: So Bleeding by abating the Inflammation, makes the Pulse stronger, and restores heat to the Extreme Parts, whenever this Weakness proceeds accidentally from a painful Spasm of the Lungs caused only by an Inflammation, which is often immediately relieved by Bleeding. When there is a Putrid Intermitting Fever. But when in the progress of the Distemper a Putrid Intermitting Fever comes on from the gathering of Matter in the Lungs, the Pulse is very uncertain, to wit, in the Morning before the Fit it is somewhat quick, and weak; quick from the Hectic Feverish disposition of the Blood; but weak from the exhausted and impoverished Habit of the Body at this time for want of the reparation, which should be made by due and sufficient Nourishment: But in the Fit it is quick and strong; quick from the Hectic Fever, strong from the present Orgasm, or preternatural Commotion of the Blood. But when the Sweat gins to come on, both the preternatural quickness and the strength of the Pulse are by little and little abated, until the strength of it is renewed by the next Fit. 2. Observations of the Urine. Secondly, the Urine, when the Distemper first seizes the Patient, is in some degree less than usual, and somewhat high-coloured, according to the degree of the Hectic Fever, and being exposed to the Air, turns thick with some settling at the bottom, as abounding with more Chylous Particles than it should do. But when the Tubercles begin once to be inflamed, it is very red, and high-coloured: But as soon as the Putrid Fever from the Apostemes of those Tubercles succeeding the Inflammation of them comes to be one of the Symptoms, it is high-coloured, as it uses to be in Intermitting Fevers, and thick, and at length being exposed to the external cold, has a white settling like Meal, and sometimes a little red; for the Blood in this Colliquative state separates the Nutritious Juice by the Glands of the Kidneys as well as by other Glands. Though it must be confessed, that Persons in a Consumption, that are Scorbutical, and Hypochondriacal, but especially where the Nerves are affected, or upon drinking of French Wine, or other Diuretic Liquors, do make a good quantity of Urine that is like Water, thin, and pale at some times, after which there presently follows a high-coloured and thick Urine. Thirdly, 3. Observations of the Matter that Consumptive Persons spit. that which Persons in a Consumption spit at first (that is, when the stuffing of the Lungs gives the first occasion of it) is plentiful, sometimes crude, sometimes concocted, as it uses to be in a common Catarrh. Or else it is thin and waterish, because for the most part (to wit, whilst the Cough is dry) it is thrown out of the Salivatory Glands from the extraordinary shaking of them by Coughing, excepting some little quantity of viscid Phlegm, which is wont to be hawked out of the Tonsils. But in the progress of the Distemper, especially when it is concocted by sleep, or the use of Opiates, it is of an ash-colour, or yellow, or greenish; the like Concoction to which the Serum admits in the Glands of the Nose, or Windpipe, in the latter end of a Catarrh. But after the Lungs are ulcerated, if the purulent Matter not being contained in a proper Cystis, be thrown into the branches of the Windpipe, that which they spit is purulent, and stinks, and is sometimes also mixed with streaks of Blood, like that which uses to run out of old and foul Ulcers. But we must not make a Judgement of the spitting of purulent Matter, We must not judge of purulent Matter by the yellow or greenish colour of it. from the yellow or greenish colour of it: For this kind of colour not only the Serum, that comes from the Glands of the Lungs has, but likewise that which is separated by the Glands of the Nose in the end of a Catarrh, to wit, as soon as it comes to be concocted. Neither is that that Persons spit to be presently taken for purulent because it sinks, or dissolves in warm water. Nor by its sinking and dissolving in warm water. For the spitting of Scorbutical Persons, because it is much impregnated with Salt, and thereupon glutinous, and heavy, is wont to dissolve, and to subside in hot Water, How true Pus may be known. though the Lungs are sound. But true Pus or Matter may be known by these three signs. First, it affects the Nose with a stinking smell. Secondly, though it be something thick, yet it is not at all glutinous, but fluid, having no strings or ropiness. Thirdly, it is of several colours, to wit, yellow, greenish, etc. but for the most part of an ash-colour, and something black. CHAP. V. Of the differences of an Original Consumption of the Lungs. HEre I could easily make several Divisions of a Consumption of the Lungs, and those such as are confirmed by daily Experience; but, because they neither afford any light to the forming of a true Notion of this Distemper in general, nor help us to a clearer, or more distinct Understanding of the general Prognostic Signs and Indications of Cure, I shall not so much as mention them, at least in this place. But yet there is one Division of a Consumption of the Lungs, which is into an Acute, The Division of a Consumption into Acute and Chronical. and a Chronical Consumption, without the knowledge of which, a Physician must needs be very often mistaken, as well in the making of his Prognostics, as in the discovery of the Indications of Cure. And therefore no one ought to think it improper, if I here add with what Brevity I can, my Observations for a fuller explication of it. For as I have seen some taken away by this Distemper within the space of one, or at most of a few Months, so I have observed a great many others, that were far gone in a Consumption, by due care, and by making use of proper means, who have lived, though in a sickly and crazy state, for many Years; as for Example, Mr. Haither, who after the Cure of a spitting of Blood, which he had been seized withal when he was a Youth, is yet living in the fiftieth Year of his Age, though in the whole course of this time he has been lean, troubled with a Cough, and often had touches of a Fever, and been freed from several Putrid Fevers by our Art. And thus my dear Father, who himself was a very skilful Physician, though he was troubled with a continual Cough, a difficulty of Breathing, frequent Putrid Fevers, a light degree of a Hectical Heat, though continual, did nevertheless by this means spin out his Life, though he continued sickly, from the thirtieth to the sixtieth Year of his Age; and at last did not die of a Consumption of his Lungs, (from which he seemed for the last three Years of his Life to be more free than he had been before) but of that Epidemical, that continued Putrid Fever, which reigned publicly all over England in the Year 1658. The same thing I observed in Mrs. Davison, a Merchant's Wife in London, for the space of fifteen Years, and in a certain Merchant that lived in Philpot-Lane, who after several Inflammatory Fevers, that returned often in a Year from every little occasion, at length happened to have such an extraordinary exulceration of his Lungs, that he died of it, together with a Dropsy, and the other usual Symptoms of a Fatal Consumption of the Lungs, when he was about Sixty Years old. I could likewise give several Histories of this Nature, but at present I study brevity. The cause of this difference. As for the cause of this difference, to me it seems to proceed from the different disposition of the Blood, and of that Humour, which is supplied to the Tubercles of the Lungs, and differs according to the various dyscrasy of the Blood. For if the stuffing of the Lungs, and the Tubercles, which arise from it, by reason of some peculiar dyscrasy of the Blood, have their Original from some malignant or cancrous Humour, or a Humour that is apt to cause a Gangreen, (as I remember it has sometimes happened) the Distemper is not only certainly Mortal, but also quick, and very Acute, and such as carries off the Patient in a few Months, and it may be Weeks. But if they arise from some benign, mild, and cold Humour, such as is less apt for Inflammation and Putrefaction, the Patient gains a longer, though a miserable Truce for his Life. But if the Mass, that is contained in the hardened Glands, be (as it is often seen in some Scorbutical Persons, and much more in those that are Scrofulous) either not at all, or at least but more slowly disposed to an Inflammation and Putrefaction, the Distemper is very Chronical, and the Patient living in a Consumptive and Sickly state for many Years, is at length sometimes seized, and carried off by some other Disease, as appears plainly from the instances I have before mentioned. For so long as the Lungs are only stuffed, or the Tubercles, that arise from that stuffing, remain in a crude state, the Person's Life, though it be miserable, yet is not brought into any sudden danger, though he is troubled with an Oppression of his Breast, some difficulty of Breathing, and a frequent Cough; all which Symptoms are wont to be increased even from the taking of the least Cold, or the committing of any Error in his Diet, and that with the addition of an uncertain Fever for a time. Likewise some degree of a continual Hectical Heat may be perceived in the Solid Parts, but especially in the palms of the Hands, and the soles of the Feet; as also a redness in the Cheeks, especially after eating, and the drinking of Wine. The Pulse also is something quick, and sometimes intermitting; the Appetite unconstant, and for the most part weak, at least upon the taking of cold. There is likewise rather a lankness of the Muscular Flesh, than a plain Consumption. That which they spit is sometimes viscid, and black, or of an ash-colour, according to the colour of the Matter contained in the swollen Glands. Many times too a spitting of Blood uses to return pretty often upon the least occasion. Which are the Symptoms, or Diagnostic signs of a lingering Consumption of the Lungs, which notwithstanding a Person, though he must expect to be always crazy and sickly, may many times live a long time; but 'twill not be safe for him to indulge himself in the free use of Wine and Meats without any distinction, and the choice of such as are most convenient, nor of several other things, that conduce to the pleasure of Humane Life, as others do. But as soon as a new Inflammatory, or Putrid, and Colliquative Fever is produced by the Inflammation and Apostemation of these Tubercles, all the Symptoms of a confirmed and deplorable Consumption are wont to follow; which are more or less certainly and suddenly, according to the Nature of the Swell, as they are more or less disposed to an Inflammation, and a quick Exulceration. And here perhaps it may be worth the while to add farther some particular Observations. As for Example. Observation 1. T●● Nature of the S●●lling makes the Fever more or less 〈◊〉. First, As the Inflammatory Fever, or the Putrid which arises from it, is more or less acute and dangerous, according to the Nature of the Swell, as they are more or less Malignant, and disposed to an Inflammation, and an Exulceration; so likewise the Consumption from thence grows more or less quick, and incurable. Secondly, The frequent taking of Cold, Observe. 2. Taking of Cold, etc. make a Consumption more Acute. and often committing of Errors in their Diet, Exercise, and Passions of the Mind, etc. do by bringing Inflammatory and Putrid Fevers, that return in the same manner, upon the Hectic Heat they had before, bring this Distemper sooner to a fatal end, making that Acute, yea, very Acute, which otherwise would have been in its own Nature Chronical. Thirdly, The Consumption of Young Men, Observe. 3. A Consumption more Acute in young than in old Persons. that are in the Flower of their Age, when the heat of the Blood is yet brisk, and therefore more disposed to a Feverish Fermentation, is for the most part Acute. But in Old Men, where the Natural Heat is decayed, it is more Chronical. Fourthly, Observe. 4. When is from Acute Distempers, it is Acute. A Consumption that proceeds from Fevers, especially such as are from an Inflammation of the Lungs, or from the Suppression of Malignant Ulcers, is almost always Acute: But when it depends upon a Scrofulous and Scorbutical disposition, so in a cold and phlegmatic Temper, it is Chronical. Fifthly, The omission of Bleeding, Observe. 5. For want of B●eeding in the 〈◊〉 Fever makes a Consumption to be Acute. or taking away too little Blood, or bleeding too late in the Inflammatory Fever of such as have a lingering Consumption, makes that Consumption, which otherwise was in its own Nature slow and lingering, very Acute, and presently Mortal; because the parts of the Lungs, that are stuffed and hardened, having been heated for some time, do from that grow more apt to he inflamed, to putrefy, and to be exulcerated. CHAP. VI Of the Prognostic signs of an Original Consumption of the Lungs. WHat will be the Event of this Distemper, does plainly appear in the several Stages or Degrees of it, as well to our very Reason, as to Experience, from what I have already said; and therefore I shall not propose my Prognostics, though found out by much Practice and Experience, after the usual manner, that is, like a Dictator, and Magisteriously, any further than as they are confirmed by Reason, and proved the Nature of the thing itself. As for instance, Every Consumption of the Lungs is Chronical. First, Every Original Consumption of the Lungs, strictly speaking, is Chronical, though when we compare them, one Consumption may be more quick than another, and in that respect may be said to be Acute. But let it be whither it will, it is always very hard to Cure, because it depends upon a load of Humours, and a stock of them heaped together in the Habit of the Body, which cannot be emptied, or drawn out by any sudden Crisis, like a Fever and other Distempers, that are properly called Acute. A Consumption in the beginning is curable. Secondly, But yet in the beginning, when the Lungs are only stuffed, yea, in the Second degree of this Distemper, when the Tubercles are already bred from a long stuffing, and whilst they remain crude, and not so subject to be inflamed and ulcerated, a Consumption does admit of a Cure as well as other Distempers, but especially in the Springtime, which is wont mightily to conduce to this Cure, whilst the Sun is advancing towards us. It admits of a Cure, I say, either true, or at least palliative, according to the Nature of the Swelling, and the present state of the Blood, from which there arises a Swelling more or less Malignant, and apt to be inflamed and ulcerated: To wit, a true Cure, as often as these Swell (being but few and benign) happen to be dissolved by the Art of Physic: And a palliative Cure so long as those Swell can but be kept from an Inflammation and Exulceration, Though the Cure is sometimes only palliative. by the help of Balsamic and other suchlike Medicines. By which means it comes to pass, that the Patient, though he is sickly, and subject to Fevers, even upon every little occasion, yet is able to do his ordinary business, and many times lives to grow Old. The Reasons why it is thought incurable. And this Distemper comes to be reckoned such a stubborn and incurable Disease, either because the Patient being deceived by the flattering Nature of the Distemper, or through carelessness, and the fear of Charges (who commonly sets a lower Price upon himself than any thing else) comes to desire the Physician's Advice too late (which very often happens;) or else lastly, through the Ignorance of the Physician, who not having a true Understanding of this Distemper in the several degrees of it, knows not therefore how to treat it in a due Method. Thirdly, but a confirmed Consumption, A confirmed Consumption rarely cured. together with the Putrid Fever that is added to it, caused by an Inflammation, or Exulceration of the Lungs, does very rarely admit of a perfect Cure. But yet if it be but a small part of the Lungs that is ulcerated, and the Matter be benign, and contained in a proper Bag, the Life of the Patient may be preserved many Years by the careful management of himself, and the use of proper Medicines; but he will be always sickly, and subject to a Putrid Fever even upon the least occasion. The more Acute, the harder to Cure. Fourthly, A confirmed Consumption, by how much the more Acute it is, by so much the more difficult it is to cure, because it depends upon more Malignant Tubercles, and is accompanied with a greater Colliquation, and likewise a quicker decay, and loss of strength. An hereditary, etc. Consumption generally Mortal. Fifthly, If a Consumption be Hereditary, or proceeds from an ill conformation or make of the Breast, for the most part it is Mortal, because the cause which produces it, lies beyond the reach and power of our Art. Very hard to Cure, when 'tis got by Infection. Sixthly, A Consumption that is got by Infection, but especially whenever that Infection is derived from one that has an Acute and Malignant Consumption, is, when all other Circumstances are alike, more difficult to cure, and for the most part more Acute and Fatal than other Consumptions. A Consumption in young Persons is very hard to Cure. Seventhly, A Consumption in Young Persons (by reason it is more Acute, and apt to bring a Putrid Fever sooner) is harder to cure, than when it falls upon one that is of a greater Age, where the Blood as it is less disposed to be hot, so it threatens a slower Fever, and not so sudden a destruction as in the flower of their Age, where all the Essays of Nature are made with strength and violence. It cannot be owed in the Autumn, or Winter. Eigthly, A Consumption in the Autumn, or Winter, though it may be relieved by a careful management, and the convenient use of Medicines, yet it can never be perfectly cured without the benefit of the Spring, and of the approaching Sun. For as the vesiculous substance of the Lungs is almost continually penetrated by the Air, and by the Decree of Nature is blown up in the farthest corners of it by the continual succession of new Air, that is driven in and out by Respiration, so the present state of the Air must necessarily be of very great moment, seeing it may either hinder or promote the Cure of this Distemper, as it is found to be wholesomely dry and warm, or unwholesome by being cold and cloudy. So that the due constitution of the Air contributes not only to the Preservation of the Lungs, when they are out of Order, but also to their Cure more than the most pompous heap of Medicines, which cannot be conveyed into the Blood, and the Part affected so continually, or in the same quantity as the Air is. And therefore 'tis usually in vain to expect the Cure of a Consumption in the Wintertime, and in Autumn, to wit, whilst the state of the Air being cold, thick, and moist, and consequently unwholesome, does continually promote the Distemper more than a store even of the most proper Medicines can stop and check it, when the edge of the most Powerful Remedies is taken off, and their Efficacy weakened in this manner by the extremely incommodious state of the Air. Ninthly, Every Putrid Fever, Every Putrid Fever promotes a Consumption. though it proceeds merely from an accidental Catarrh, or taking of Cold, does by heating the Lungs, mightily promote a Consumption; but especially if Bleeding be omitted in the beginning. Tenthly, An Original Consumption is harder to cure than one that is Symptomatical. An Original Consumption of the Lungs is for the most part harder to cure than a Symptomatical Consumption, because this last seems to arise not so much from the Habit of the Body, as by Accident; and many times the Original Distemper, from which it takes its beginning, is easily cured. Though I must confess, that whenever a Consumption happens to arise from a Peripneumony, or any other Distemper of the Breast ill cured, from the drying up of old external ●ores, or the running of internal Ulcers, it is a very hard thing to cure it. Every Consumption when 'tis cured is oped to return. Eleventhly, Every Consumption though it be cured, is apt to return, and he that has once been in a Consumption, unless he governs himself very regularly, falls back into the same condition, even upon the least occasion. For not only the Lungs, being already impaired by a former Attack from the Distemper, are the more apt to receive a new impression, but there is likewise found a greater inclination and disposition to this Distemper from the Habit of the Body itself in these, than in other Persons. Yea, moreover, even after the most perfect Cure of a Consumption, there is reason to suspect that there are some crude Tubercles yet remaining, which at length may by often meeting with an occasion be inflamed, and ripen into Apostemes, and so at last become Ulcers. The sooner the Cure of a Consumption is begun, the easier it is. Twelfthly, The sooner the cure of a Consumption is begun, the better it usually succeeds; and from hence this Distemper especially proves fatal, because the Physician is consulted when 'tis too late; it being a common thing for Patients to neglect our Advice so long, till they are not capable of any of those Evacuations, and several other Medicines that are very necessary to this Cure. CHAP. VII. Of the Indications of Cure in an Original Consumption of the Lungs. IN the beginning of this Distemper, to wit, whilst the Lungs are only stuffed, and being filled with dispirited Chyle, and obstructed (with the Habit of the whole Body at the same pass) they have a Hectical Heat, and spew out a great quantity of Serum (which does often happen in a Consumption proceeding from a Catarrh, and taking of Cold, that is, where the Body has been so predisposed, and indeed continues a long time before the Tubercles, and the dry Cough, that proceeds from them, are produced.) I say, at this time the Indications are plainly these. First, The first Indication is to temper the heat of the Spirits, etc. This is to be done by alterative Medicines. To temper the heated disposition of the Spirits, by procuring a quiet and cheerful Mind, and to mend the Mass of Blood, that has been by degrees reduced to a sharp and hectical state, by the plentiful use of alterative Medicines. And such we must reckon not only a Milk Diet, the Chalybeate Mineral Waters, and those Medicines that are commonly called Pectoral, as being soft and mucilaginous, and so obtunding the sharpness of the Humours, but also Balsamicks, and Specificks, which have a respect to the proper Constitution of the Patient. But the Remedies of this Nature must be taken plentifully, and so must be given (as much as can be) in the manner of a Diet, and they must persist in the use of them for a long time: For the sharp and distempered state of the Humours, which has been contracted by little and little, is not corrected without a long and plentiful use of proper Medicines. The second Indication is to carry off the ill Humours by Evacuations. Secondly, Gently to carry off the load of the dispirited and diseased Humours lodged in the Habit of the Body, with convenient Medicines, as Vomits, Purges, Diuretic, and Sweeting Medicines. Which must be always gentle. But all manner of care must be taken in the choice of these kind of Remedies; to wit, that they be very gentle and benign, left that by heating the Blood, and putting it into too great a commotion, and by that means bringing it farther into a colliquative and waterish state, they should by Accident increase the Distemper. The third Indication is to open Obstructions, etc. Thirdly, To remove Obstructions, and to strengthen the Tone of the Parts, especially of the Lungs, that are weakened by the Humours they have imbibed, and disposed to a Convulsive Contraction, by the use of Steel prepared either by Art or Nature, of Balsamic Medicines, of good and agreeable Air, of Volatile Salts, and other things of this kind. The fourth is to correct the Colliquative state of the blood. Fourthly, To prevent the Hectic and Colliquative Heat, or Catarrhous state of the Blood, or at least to lessen it by timely and plentiful Bleeding; which, although it may do mischief sometimes in a confirmed Consumption, yet in the beginning of one it is very beneficial: And I do not at all doubt but the Tubercles for the most part are occasioned by the neglect of it, or for want of Bleeding to a sufficient quantity in the beginning of the Distemper, whereby the Consumption uses to run presently into the second, and more fatal degree. The fifth is to concoct and thicken the Rheum in the Lungs. Fifthly, To take all the care that we possibly can of the Part affected, to wit, the Lungs, by hastening (as much as may be) the concoction of the thin Rheum, that flows continually into them, whereby the troublesome Cough itself, together with the cause of it, may be wholly removed. What Medicines are convenient for this purpose. Which is done not only by alterative and mucilaginous Medicines, commonly called Pectorals (which being taken plentifully, do by taking off the sharp disposition of the Blood and Humours, hinder any farther colliquation and heat in them; by which means the new influx of them being once rendered less, the Humours, that are already sticking in the Lungs, may be more easily and sooner concocted by the Natural heat of the Part:) But likewise by gentle evacuating Medicines, which by diverting the Humours from the Lungs, do for the Reason already mentioned, conduce very much to the more speedy concoction of those, which had been before collected. But above all by the prudent and alternate use of cleansing and inciding Medicines, as there shall be occasion. For as Incrassating and Opiate Medicines prudently given, do much promote the concoction of the Humour, that is already fixed in the Lungs, by stopping the influx of fresh Humours into them, at least for a time; so likewise by that respite, which they procure to the Lungs from coughing, the Lungs themselves, not being for that time so much distended beyond their Tone, and recovering their Natural strength, are very much comforted. But by the use of Oily and Lubricating Medicines, the Humours that are lodged in the Lungs, and concocted, are more easily brought up by Expectoration. And if in their concoction they happen to grow more hard and tough than they should be, they may with the help of cutting, and cleansing Medicines be brought up without violent straining, or force of their Cough, which, if it happens, may raise a new Flux (and that a very troublesome one) of thin Rheum, from the Glandules of the Windpipe and Lungs, like the sucking of a Pump. In the second degree of a Consumption the Indications are almost the some as those above mentioned. In the Second degree of this Distemper, that is, when the Tubercles are first bred in the Lungs, with a dry and troublesome Cough, and so long as they remain crude, without any great Inflammation and Exulceration, the Indications are almost the same as before, excepting that they must insist more diligently upon a very plentiful use of altering Medicines, according as the degree of the Hectic heat is increased; but according as their Weakness, and the Colliquation of the Humours are greater, all manner of Evacuations must be made more cautiously and sparingly; but especially we must endeavour all we can to dissolve those Swell with the use of Balsamicks, Chalybeates, Antiscorbutic Medicines, of Wood-lice, and other things of that kind. But in the last degree of a Consumption there are new Indications. But as soon as the Distemper comes by the Inflammation, and ripening of the Tubercles, at length to the last, and for the most part fatal degree of a confirmed Consumption, (which commonly shows itself not only by the vast increase of the Colliquation, and the accession of a new Fever, not only an Inflammatory, or Peripneumonick, but likewise a Putrid Intermitting Fever) there presently arise new Indications of Cure. 1. For when the Lungs are affected with an Inflammation of the Tubercles in the manner of a Peripneumony, as there is an Indication of timely Bleeding, and of Temperate and Cordial Juleps to soften the Blood, and to keep up their Strength, so also of a very thin Diet, and a plentiful use of Pectoral Medicines (but especially such as are Oily and Mucilaginous) to take off the Convulsive contraction of the Lungs, by their Anodyne Power, and to facilitate and promote the bringing up, or expectoration of the Phlegm out of the stuffed Pipes. But as soon as the Peripneumonick Fever happens to be succeeded by a Putrid Intermitting, In the Putrid Intermitting Fever all Evacuations are to be avoided. and extreme Colliquative Fever, together with a sudden decay of Strength after the Inflammation of the Tubercles turns once to an Exulceration; as all Evacuations are contradicted by that Weakness, so there is an Indication for the use of Temperate Pectoral Cordials, Pectorals, Opiates, Slippery, and Cleansing Medicines. We must likewise endeavour to root out the Putrid Fever, which, although some deceitful Truce may be gained with the use of the Peruvian Bark, The Peruvian Bark must be given. yet does never admit of a perfect Cure without the Ulcers are healed, which, when they are small and benign, is not altogether impossible with the help of a convenient Diet, and good Air, and the use of Balsamic Medicines. But however that may be, we may endeavour to give some check to the Colliquation, by mitigating the Fever Fit, and to alleviate the fatal Symptoms, which arise on every hand from the Colliquation. Of which I shall speak more largely by and by in the Method of Cure. The Medicines that are proper in this Disease, What Purging Medicines are convenient in a Consumption. are, First, Purging Medicines, which ought always to be mild and benign, as Manna, Lenitive Electuary, the greater Compound Powder of Senna, Aloes prepared with the Juice of Roses, Mastic Pills, Pills of Amber, Alaephangine Pills, Stomack-Pills with Gums, my Magisterial Stomack-Pills (by the Prudent use of which at due distances my most dear Father, who was himself a very Skilful Physician, for the space of Thirty Years, lived till he was an Old Man, though in a Consumptive and Sickly state) the description of which I am willing to publish out of his own Manuscript, for the Public Good. Take of the finest Aloes an Ounce, the best Myrrh, Mastic, of each half an Ounce, Cinnamon, Saffron, of each two Drams, Cloves, Roman Wormwood, Red Roses, Nutmeg, Mace, Calamus Aromaticus, of each a Dram, of the best Rhubarb two Drams, Galingale, Schaenanthus, Yellow Saunders, Wood of Aloes, the lesser Cardamons, of each half a Dram, of Oriental Musk four Grains, with a sufficient quanty of Syrup of Wormwood. Make them up into a Mass for Pills, according to Art. Likewise the Purging Mineral Waters, and in general all gentle Purgers, that are grateful to the Stomach and Nerves, and which cause as little heat as may be in the Blood and Spirits, are of use here. What Vomits may be given. To this Head we must also refer Vomits, as Honey of Squills, and in the beginning of a Consumption especially, when it is from a Surfeit, the Infusion of Crocus Metallorum. What Diuretic Medicines are proper. Secondly, Diuretics, as the Mineral Waters, both Chalybeate, and Purging, Wood-lice both crude and prepared, the four greater cold Seeds, common Turpentine, Natural Balsam, Balsam of Tolu, of Peru; and Compound Medicines made of these, as Balsam of Sulphur made with Oil of Turpentine, and with Oil of Aniseeds, Dr. Goddard's Balsamic Syrup, both the Simple and the Anodyne; the Roots of Fennel, Parsley, Eringo, and those either raw or candied, of Elecampane, the Seeds of Mallows, of Marsh-mallows, Plantain-leaves, Juniper-berries, Elderberries, simple Honey, Honey of Violets, Craw-fish, Syrup of Marsh-mallows, Sweet Almonds, etc. Thirdly, Diaphoreticks, The Diapheretick Medicines that proper. As Sarsaparilla-roots and China, in decoctions, Venice-Treacle, Laudanum, both liquid and solid, Mithridate, Confection of Alkermes, Saffron, Sassafras-wood, Lignum Vitae, Saunders, yellow or red. Fourthly, Pectorals, The several sorts of Pectoral Medicines, As those that are soft. to which Head I use to refer, First, all Simple and Compound Medicines, which by taking off the Acrimony of the Humours, do abate the Colliquative state of the Blood, whereby it comes to pass, that the Rheum is not separated so plentifully by the Windpipe and Glands of the Lungs. As for Example, Coltsfoot, Maidenhair, Alehoof, Brook-lime, Water-Cresses, Pine-tops, Scabious, spotted Lungwort, the Flowers of the great Daisy, of Rosemary, Betony, Sage, Violets, of borage, Bugloss, Lily of the Valleys, the Roots of Polypody, the Leaves of Yarrow, Mouse-ear, Burnet, Dandelion, Plantain, Self-heal, Sanicle, Fluellin; and such mild Plants abounding with a Volatile Salt; with Syrups, and other Compound Medicines made of those Simples; the Leaves of the Oak of Jerusalem, of Sun-dew, Golden Maidenhair, and other Herbs commonly called Vulnerary, which by altering the Mass of Blood, do very much help the Concoction of the Humours, that are lodged in the Lungs. Likewise the Balsam of Tolu, of Peru, Natural Balsam, Storax, Benjamin, Gum Elemi, Balsam Capivi, with other Gums and Balsams; Brimstone, and the several Preparations of it; Crabs-eys, Eggshells, Chalk, Coral, Pearl, Wood-lice; the four greater cold Seeds, the Seeds of Mallows, Marsh-mallows, and Lettuce: the Roots of China, Sarsaparilla, the shave of Hartshorn and Ivory, with the Compound Medicines made of them, such as Haly's Powder, the Analeptick, or Restorative Antidote, the Pectoral Decoction, the Decoction of Sarsa, and China; Pectoral and Antiscorbutic Ingredients in their ordinary Drink, Emulsions of the four cold Seeds made with Barleywater, a Milk Diet, but especially Ass' Milk, things made with Barley, the Chalybeate Waters, Oysters, Snails, and Medicines made of these. These that are lubricating and inciding. Secondly, Lubricating and cutting Medicines, which promote the Expectoration of the Humours, that stick in the Lungs; as Liquorice, Honey, Mead, common Oil, Oil of Sweet Almonds, but especially linseed-oil fresh drawn without fire, Turpentine, Natural Balsam, fresh and sweet Butter, Almonds, Figs, Raisins of the Sun, Dates, Sebestens, Jujubes, Juice of Liquorice, Gum Ammoniack, Benjamin, Balsam of Tolu, Lohoch Sanum, & expertum, Lohoch of Fox's Lungs, of Coltsfoot; Sugar-candy, or Loaf-Sugar, with several Linctuses, and other Medicines in which that is an Ingredient, such as the Syrups of Hedg-Mustard, Maidenhair, Colts-foot, simple Syrup of Horehound, Syrup of the Flowers of St. John's wort, of the five opening Roots, the Balsamic Syrup, Syrup of Jerusalem Oak, of Liquorice, Hyssop, Horehound, Marsh-mallows, Jujubes, Violets, as also Honey of Violets, the Compound Powder of Orrice, Haly's Powder, Trochisci Bechici, or Cough-Lozenges, both white and black. Those that are Carminative. Thirdly, Carminatives, which by comforting the Nerves, and freeing them from Obstructions, do remove the Convulsie Constriction of the Lungs, upon which there follows a freer Respiration, and consequently a more easy Expectoration; as Aqua Mirabilis, Spirit of Hartshorn, of Salt ammoniac, the Compound Waters of Briony and Peony, Aniseeds, Fennel-seeds, Elecampane and Orrice-Roots, Orange-flowers, Rosemary-flowers; the Leaves of Hyssop, Sun-dew, with the Waters and Syrups made of them; Orange and Citron Pills candied, Bay-berries, Juniper-berries, Honey, Civet, Gum Ammoniack, Benjamin, Cinnamon, Nutmeg, Mace, Balsam of Peru, Natural Balsam, Syrup of Hedg-Mustard, of Hyssop, the Compound Powders of Orrice, of Calamint, Treacle, Mithridate, Laudanum, and others of that kind, which yet must be used very cautiously, and sparingly, and not without urgent Necessity, if there be any considerable Fever. Fourthly, Those that are Incrassating and agglutinating. Incrassating and Agglutinating Medicines, which conduce very much to the speedy Concoction, and consequently the Expectoration of the Serum that flows into the Lungs; as Comfrey, Alehoof, Yarrow, Dandelyon, Mouse-ear, Plantain, Self-heal, Sanicle, Scabious, and in general all Vulnerary Herbs; the Flowers of Red Roses, of Red Poppies, English Saffron, Liquorice, Saunders, yellow and red; Pectoral Fruits, as Raisins of the Sun, Figs, Dates, Jujubes, Sebestens, Sweet Prunes, Pine-Kernels, Fistick-Nuts, white Poppy-seeds, the four greater cold Seeds, Seed of Henbane, with the Emulsions and Syrups made of them; Sugar penidate, Sugar of Roses, old Conserve of Red Roses, Juice of Liquorice, Starch, Honey, Olibanum, Gum Arabic, Tragacanth, Syrups of Comfrey, Marsh mallows, dried Roses, and of Liquorice, Lohoch of Fleawort-seed, of Coleworts, Poppies, Purslane, of Pines, Sanum, & expertum, and of Raisins, Jelly Broths made of Calves-feets, etc. Jellies of Hartshorn and Ivory, the species Diatragacanthi frigidae, Haly's Powder, the black Lozenges for a Cough, Mithridate, Diascordium, Venice-Treacle, Syrup of white Poppy-heads, and in general all Opiates, as Laudanum, both solid and liquid, Hounds-tongue-pill, Styrax Pill, Philonium Persicum, and Romanum, etc. Which by stopping the present influx of the Humours into the Lungs (as the Ancients love to speak) do likewise contribute very much to the Concoction of the Humours, which had been lodged in the Lungs before. And therefore without the cautious and prudent use of them there is no great matter to be done in the Cure of a Consumption. And lastly, Deobstruents. Fifthly, Such Medicines as open Obstructions, which by freeing the stuffed Glands from their stoppages, do lessen them. As the Roots of Orice, Sarsa, China, Sassafras-wood, Saunders, Bay-berries, Juniper-berries, Gum Ammoniack, Benjamin, Balsam of Tolu, of Sulphur, of Peru, Opobalsam, Steel, either of Nature's Preparation in the Mineral Waters, or prepared by Art in the form of a Syrup, or Electuary, or of Pills, etc. Wood-lice; with many other Antiscorbutic and Antiscrophulous Medicines. From this Treasure of Simple and Compound Medicines, a Prudent Physician ought with the Direction of his Judgement and Experience, to compose and prescribe divers Medicines in the several degrees of the Distemper, and according to the Exigence of the Symptoms, as there shall be occasion, in that form which shall be most grateful to the Patient, that he may be always able to answer the present Indications in the whole course of the Distemper, and not insist, like a Quack, upon one single Medicine, as a Charm for the Disease. The Method of which Rational Cure in the various state and Symptoms of this Distemper as it proceeds, I shall immediately propose. The Chirurgical Remedies in this Distemper are Issues, Blisters, Shaving of the Head, What are the Chirurgical Remedies. the application of the Head-Plaister, Betony-Plaister, or any other of the like Nature as also Bleeding; of the Use, and Reason of which I shall Discourse more largely in the following Method of Cure. CHAP. VIII. Of the Method of Cure in an Original Consumption of the Lungs. In the Cure of a Consumption in the beginning the influx of Rheum into the Lungs must be stopped. IN the beginning of this Distemper (to wit, when the Lungs, the Windpipe, and Glandules that are dispersed through all that Pipe, and the branches of it, are at first only stuffed by the constant spewing out of the Serum, that is separated from the Mass of Blood, and they are troubled with a continual Cough, especially in the Night, proceeding from thence) the new influx of Catarrhous Rheum into these parts is to be stopped by all proper means, and the Humours that are already lodged there, must be concocted as soon as may be. And therefore, First, Some Blood must be taken away. First, There must be some Blood taken from the Arm, (especially if the Patient has a fullness of Blood, and has before been accustomed to Bleed) to the quantity of Six, Seven, Eight, or Ten Ounces; not only to abate the Effervescence, and consequently the Colliquation of the Blood; but likewise to prevent the Swelling and Inflammation of the Lungs themselves, and to take away the Feverish Heat, which is usually caused by the continual agitation of the parts of the Breast by the Cough, and by the want of Rest, This must sometimes be done more than once. which follows upon it. This opening of a Vein (where the Indications require it) is to be done once, twice, or thrice, at due intervals; especially where there is a flux of colliquated Serum, in the form of a suffocative Catarrh, together with a plentiful Expectoration of crude Phlegm, that comes near to the Nature of a Rheum; or where there is a very Asthmatical difficulty of Breathing, a pain of the Side, or any signs of a Rheumatic, Pleuritic, or Peripneumonick disposition; or lastly, where a Surfeit, or a too plentiful drinking of Wine, or other Spirituous Liquors have preceded. And indeed I do not at all doubt but Catarrhs, For want of this, ordinary Coughs sometimes turn to a Consumption. and ordinary Coughs do very often turn to a Consumption of the Lungs for want of due Bleeding and fanning of the Blood in the beginning of this Distemper: And moreover we have reason to suspect that the Concretion, or hard knots in the Glandulous parts of the Lungs, and the Hectic Heat proceed from thence. Secondly, After Bleeding it is very necessary, After bleeding a Vomit is necessary. especially if the Distemper had its beginning from a Surfeit; or if there be a nauseating and disposition to Vomit joined with it, to prescribe a gentle Vomit of Honey of Squills, or Oxymel of Squills; yea, and sometimes of the Infusion of Crocus Metallorum, to be taken in a moderate quantity. By which Vomiting not only the Stomach, that was oppressed with a load of Humours, may be eased, and the sickness of the Stomach arising from thence, may be removed, and the Digestion restored (all which are to be highly valued;) but likewise the heap of Humours which were before lodged in the Lungs, uses by the exagitation or shaking of these parts in Vomiting, to be expectorated very considerably, not without a remarkable easing of that heavy weight, which was caused by that load. And I have not only seen several Empirics boast, and that not without good Success, that they could cure any incipient Consumption this way, but likewise I myself, by the Direction of Reason, and the Encouragement of Experience, have many times in the same manner stopped the Progress of a Consumption in the beginning of it, in a very short time. And is sometimes to be repeated. This Vomiting (especially if the Patient bears it well, and finds Relief by it, and if it be necessary) may be repeated every third or fourth day, for three or four times. The most convenient time to give a Vomit. The most convenient time to give a Vomit in this case, is a little before the Evening, but they ought to bleed first the day before, for fear the Blood should be heated by the violent agitation of the Parts, and by that means a Fever should be brought on, or increased if there was one before: And likewise to prevent a spitting of Blood, which is wont to arise from the more vehement straining of the parts of the Breast caused at this time by Vomiting before the Blood-Vessels have been emptied. It is also very convenient when the Vomit has done working, When the Vomit has done working we must give an Opiate. to Order some Opiate, not only to temper the heat of the Blood excited by the straining and agitation, but likewise to hinder a new influx of Rheum into the Lungs, which uses to arise from this violent agitation of the parts. The forms of the Vomits and Opiates, which I commonly use in this case, are these which follow. Take of Honey of Squills half an Ounce; let it be given in a Draught of Posset-drink, and repeated twice or thrice in an hour, if the Patient does not Vomit sufficiently. Which is a Vomit mighty proper for Children and Young People, being gentle, and very grateful. Or, Take Oxymel of Squills, Oil of sweet Almonds, of each an Ounce. Mix them. Let the Patient take it dissolved in a large draught of Posset-drink, and repeat it twice or thrice in an hour (if it be necessary) to promote his Vomiting. Or, Take of the Infusion of Crocus Metallorum seven Drams, Syrup of Violets two Drams: mix them for a Vomit. And in the time of its working (if it be needful) give Oil of sweet Almonds, and Oxymel of Squills, of each half an Ounce, in a draught of Posset-drink once or twice. Salt of Vitriol is not so convenient, because it continually twitches, and irritates with its stypticity the Glandulous parts about the Throat, and so uses to cause a greater flux of Rheum, and so a troublesome and long Cough after the Vomiting is over. The forms of the Opiates to be given after Vomiting, are these which follow. Take Cordial Milk-water, Carduus-water, of each an Ounce; of Barley Cinnamon-water half an Ounce, Syrup of white Poppies six Drams. Mix them for a Draught. Or, Take of the clear Pectoral Decoction four Ounces, of Tincture of Saffron two Drams, of Helmont's Liquid Laudanum fifteen drops, of Syrup of Violets two Drams. Mix them for a Draught. Or, Take of Coltsfoot-water two Ounces, Oil of sweet Almonds fresh drawn, Syrup of white Poppies, of each an Ounce. Mix them. Or if the Patient likes the form of a Bolus better, Take old Conserve of Red Roses, Mithridate, or Venice-Treacle, Conserve of Woodsorrel, of each half a Dram, of London Laudanum half a Grain. Mix them into the form of a Bolus. Or, let him take in the form of Pills, half a Scruple of the Cyncgloss Pill, or as much of the Storax Pill. Gentle Purges are convenient. Thirdly, it is convenient also gently to carry down the load of Humours by Stool and Stomack-Purges, and others of that Nature, such as may cause but a very little Effervescence, and Colliquation of the Blood. As for Example. Take the best Manna, Oil of sweet Almonds, of each an Ounce and half, or two Ounces, dissolve them in a Pint of hot Ptisane. Let the Patient drink half of it in his Bed, the other half, half an hour after rising out of his Bed. Or, Take of the best Senna too Drams, Cassia broken with the Canes, Tamarinds, of each half an Ounce, of Coriander-seed prepared, half a Dram; boil them in a sufficient quantity of Spring-water, or Barnet, or any other Purging Water, to half a pint. Dissolve in the Liquor strained an Ounce of the best Manna, half a Dram of Salt of Prunella. Mix them. Let the Patient take half of this Potion in the Morning, and the rest half an hour after, with due care. After the working of a Purge, we must give an Opiate that Night. But whenever he takes a Purge, that Night after it has done working there must be an Opiate given, as after the Vomits, to calm the Commotions in the Blood, and to give the Lungs some quiet, for fear there should arise a new influx of Humours into the Lungs from the agitation of the Blood by the Purges. And for the same Reason it is convenient to mix some Opiate with Stomachick Purges, to be taken just before they go to sleep. As for Example. Take of Rose-Aloes a Scruple, or five and twenty Grains, of Hounds-Tongue Pill half a Scruple. Mix them, and make them into four Pills to be gilded; which must be repeated every other Night, after the Patient has been duly blooded. This Pill commonly goes by the Name of the Catarrh Pill amongst Apothecaries, because it not only carries the Humours down by stool, but also hinders a new influx of them into the Lungs. Or, Take of the Stomack-Pill with Gums, Aloephangine, Mastic Pill, or Pills of Amber, half a dram, or two Scruples, of London Laudanum one Grain; mix, and make them up into four Pills, to be gilded, which must be repeated every third Night, for three times. Yea, if the flux of Rheum be violent, An Opiate must be given every Night conditionally, and a shortness of Breath, or weight, or straightness of the Breast does not follow upon the use of them, some Opiate must be given every Night; because it may not only procure sleep, and so hinder the Effervescence of the Humours and Blood; but also by stopping a new influx of the Humours into the Lungs, may promote the Incrassation, Concoction, and Expectoration of those Humours, which are already lodged there. So that I can from Experience confidently affirm, that although Opiates are for the most part of some use in the whole course of the Cure of a Consumption, yet they are more safe, beneficial, and necessary in the beginning, and without the use of them no great matter can be done in preventing the progress of this Distemper. Fourthly, Diaphoreticks are very useful. in this state of the Disease Diaphoretick Medicines are likewise very profitable, because they plentifully carry off the Serum, which is continually colliquated from the Blood, by the Pores of the Skin, whereby it comes to pass that the flux of it into the Lungs being lessened, that which was fixed there before, is more easily concocted. But yet in the use of Sudorific Medicines, we must diligently observe these following Rules. But in the use of them, 1. An Opiate must be always mixed with them. 1. That Diaphoretick Medicines have always something of an Opiate in them, lest by a new Colliquation caused in the Mass of Blood by them a fresh stream of colliquated Serum (by the Lungs as well as the Pores of the Skin) should be produced, and the Cough too thereupon should be increased. Which I have always observed to happen from the imprudent use of Diaphoreticks, that have been given by Women, and Quacks in this case without mixing an Opiate with them. But now with a convenient quantity of Laudanum mixed with a Diaphoretic, the Lungs are quiet so long as the Sweat lasts. Whereby it comes to pass, that the stream of the Lympha of the Blood is turned from the Lungs by the Pores of the Skin with great benefit, the Cough is then easy, and the Serum that is lodged in the Lungs is concocted. 2. We choose such as are least hot. 2. We must choose such Diaphoreticks as have the least heat, such as may cause the least Effervescence, or new Commotion in the Blood, that the old load of Humours that had been collected before, may be evacuated by the Pores of the Skin without breeding more of them by a new Effervescence. 3. We must not give them before convenient Evacuations by bleeding, etc. 3. We must never give Diaphoretick Medicines before the use of Bleeding, Vomits, and Purges, whenever these are necessary. For I have always observed a new Colliquation to arise from a Commotion of the Blood, that has been made before the Vessels have been emptied, together with an increase of the Cough, and other Symptoms, that depend upon it; yea, and sometimes with new Accidents of a spitting of Blood, of Rheumatic and Pleuritic Pains, and other dreadful Symptoms. The Diaphoretick Medicines that I commonly use, are these which follow. Take of Venice-Treacle half a Dram, or two Scruples, of Old Conserve of Red Roses half a Dram; mix them for a Bolus. Or, Take Diascordium, Conserve of Woodsorrel, of each a Dram. Mix them together. Or, Take of Matthew's Pills fifteen Grains, make them into two Pills, to be gilded, and taken when the Patient should go to sleep. Or, Take of the Cynogloss Pill twelve Grains, of Antimonium Diaphoreticum a Scruple, of the Tincture of Saffron a sufficient quantity. Make them into four Pills, to be gilded. The most seasonable time to give these Diaphoreticks is at Night, What is the best time to give Diaphoreticks. and that presently after an Evacuation by Bleeding, Purging, or Vomiting, because they procure sleep. The Patient also must be freed from his Sweats with a great deal of care, lest by the Pores being suddenly stopped in this colliquated state of the Blood, he should take new Cold, and thereupon the Cough and other Symptoms should be increased. During the use of these kind of Evacuations, Whilst these Evacuations are making, there are other things to be done. the Application of Vesicatories to the Arms, and between the Shoulders is very beneficial for diverting the violent flux of the Humours from the Lungs. But when we are making these Evacuations (which are very useful for lessening the colliquated Serum of the Blood, and so for the Concoction of the Humours, that are already lodged in the Lungs) we must not by any means neglect the frequent use of those Medicines which are commonly called Pectoral, or Pulmonary, Pectoral Medicines must be given plentifully. which in the time between Evacuations must be given very plentifully, as it were in the manner of a Diet, but always in such a form, as is most grateful to the Patient. For there must always be a peculiar respect had to the Stomach, (which in this Distemper is commonly affected with a Sickness, want of Appetite, and Vomiting) lest being offended with the form, and tired with the great quantity of them, it should be used to a Habit of nauseating, and throw up not only the Medicines, but also the most grateful Food. The best Medicines in the beginning of this Distemper are such as are Incrassating and Lubricating, What of this fort are best in the beginning. which by softening the Serum of the Blood, conduce very much not only to the allaying of the Cough, but likewise to the Concoction and Expectoration of the Humours, that cause the Cough. But these Incrassating and Expectorating Medicines may be given sometimes separately, but for the most part mixed together in a compound form, that we may answer both Indications at once. So for Incrassating Medicines, let the Patient be enjoined the frequent use of Sugar-candy, Saccharum Penidiatum, and Sugar of Roses, as also Old Conserve of Red Roses, Juice of Liquorice, the black Lozenges for a Cough, which must be often and gently swallowed down, that they may retund the Acrimony of the Humours, that ouze out by the Windpipe, by their soft, mucilaginous, and incrassating quality, and so mitigate the troublesome Cough. For Lubricating Medicines, let the Patient plentifully use New Butter, that has not been salted, in all his Spoon-meat, Butter'd-Ale, and (if he bears it well) common Sweet Oil, or rather Oil of Sweet Almonds, but especially linseed-oil fresh drawn without Fire, of which let him take a Spoonful every hour, unless there be a Looseness, or some other Symptom that forbids it. Let him also chew Raisins of the Sun, Figgs, etc. But the Medicines compounded of Lubricating and Incrassating Ingredients, and which satisfy both Indications now mentioned, are those which are commonly called Pectorals, and Expectorating, the more neat forms of which I shall very willingly subjoin. Take Oil of Sweet Almonds, Syrup of Maidenhair, Jujubes, Violets, or of Marsh-mallows, of each an Ounce and half, of white Sugar-candy a Dram and half; mix them very well for a Linctus, of which let the Patient take a Spoonful every four hours, and drink four Ounces of the following Apozeme warm after it. Take of the Pectoral Decoction when 'tis clear, a pint and half, Tincture of Saffron extracted with Treacle-water, Syrup of Maidenhair, Scabious, or Jujubes, of each an Ounce; mix them, and make an Apozeme. If you have a mind to incrassate more, Take Oil of sweet Almonds fresh drawn, Syrup of Comfrey, red Poppies, or of dried Roses, of each an Ounce and half, of Syrup of Meconium half an Ounce, of Sugar of Roses a Dram and half; mix them, and make a Linctus. But if you have a mind to lubricate more, Take linseed-oil fresh drawn without fire, Syrup of Liquorice, or Honey of Violets, of each an Ounce and half, of white Sugar-candy a Dram and half; mix them exactly for a Linctus, to be taken either by itself, or dissolved in a Draught of the Apozem abovementioned. If a Feverish Heat should forbid the use of Hyssop, or of the Tincture of Saffron, If there is a feverish heat, hot things must be omitted. let them be omitted in the Apozeme. If there be a Looseness, such things as will make them laxative must be omitted. If a Looseness, or any other Symptom forbidden their use, let the Pectoral Fruits be left out of the Apozeme, and the Oil out of the Linctus'; or else instead of the Medicines just now mentioned, let these be substituted, which follow. Take the Lohoch of Poppies, Sanans, of each an Ounce and half, Syrup of Purslane, of dried Roses, of each an Ounce, the cold species of Gum Tragacanth, Haly's Powder, of each a Dram, Saccharum Penidiatum, or Sugar of Roses, three Drams. Mix them, and make a Linctus, to be taken in a Spoon, or with a Liquorice-stick every four hours, or oftener if the Cough requires it, swallowing it gently, and drinking after it a quarter of a pint of the following Emulsion warm. Take the four greater cold Seeds, of each a Dram, white Poppy-seeds, Lettuce-seeds, of each two Drams, Pine-Kernels, Fistick-Nuts, of each three Drams, with a pint of the Water of Red Poppies, Red Rose-water, Barley Cinnamon-water, of each three Ounces. Make an Emulsion according to Art, to be sweetened with Saccharum Penidiatum. Or, Take the Lohoches of Foxes Lungs, of Colts-foot, of Purslane, of each an Ounce, the Syrups of Jujubes, Maidenhair, of each an Ounce and half, of Flower of Brimstone two Drams, of the Tincture of Saffron half an Ounce, the cold species of Tragacanth, the could species of Pearl, Haly's Powder, of each a Dram, Saccharum Penidiatum half an Ounce. Mix them, and make a Linctus, to be taken as before. Take Tacamabac, Balsam of Tolu, of each a Dram, a sufficient quantity of the Ingredients of the Pectoral Drink; boil them in a sufficient quantity of Spring-water to a pint and half, with the Liquor strained, and a Dram of each of the four greater cold Seeds, two Drams of white Poppy seeds, and as much Henbane seed, seven sweet Almonds blanched, Make an Emulsion according to Art, to be sweetened to the Palate with Saccharum Penidiatum. But if there be a greater difficulty of Breathing than ordinary from the toughness of the Phlegm, let the following Linctus be prescribed. Take the Lohoches of Raisins, of Squills, of each an Ounce and half, the Syrups of Hedg-Mustard, of Hyssop, of horehound, of each an Ounce and half, the species of Orrice, of Calamint, Flower of Brimstone, of each a Dram and half, of the Tincture of Saffron half an Ounce, of white Sugar-candy six Drams: Mix them, and make a Linctus, to be taken as before. Yea, if this Symptom be very urgent, there may be added a Dram of Gum Ammoniack depurated, and a Dram and a half of Flowers of Benjamin, to the Linctus. These Intentions (to wit, the speedy Concoction of that Mass which is lodged in the Lungs, and the preventing of a new influx of it) are likewise satisfied by Compositions made of Balsamic and Agglutinating Medicines. As for Example. Take the Pulp of Conserve of Red Roses, of Woodsorrel, of each an Ounce and half, of Olibanum three Drams, of Natural Balsam two Scruples; mix them, and make an Electuary, of which let the Patient take the quantity of a Walnut three times a day at Physical hours, and drink after it a quarter of a Pint of the following Apozeme warm. Take the Leaves of Yarrow, Mouse-ear, Burnet, Dandelion, spotted Lung-wort, Jerusalem Oak, Scabious, of each a handful, Flowers of St. John's wort, Violets, great Daisies, red Poppies, of each half a handful, Jujubes, Dates, of each six pair, of Saffron tied up in a Cloth half a dram, Aniseeds, Juniper-berries, of each three drams; steep them in a due manner, and boil them in a sufficient quantity of Spring-water to three pints. In the Liquor when it is strained, dissolve a quarter of a pound of the Conserve of Red Roses (which being in this manner added to the Apozeme, gives it a Balsamic, and very grateful taste,) strain it again, and then add Syrup of Corals, of Jerusalem Oak, of Maidenhair, of each an Ounce; mix them, and make an Apozem for use. Or instead of the former Electuary, let this be prescribed which follows. Take of the Pulp of the Conserve of Red Roses strained through a sieve, two Ounces, of the Conserve of the Fruit of the Dog-Rose an Ounce, of Haly's Powder a Dram, of Leucatellus Balsam half an Ounce, a sufficient quantity of the Balsamic Syrup; mix them, and make an Electuary, to be taken as before. Let the Patient likewise take often in a day a Spoonful or two of the Balsamic Syrup, (which is very grateful to the Stomach) and a Scruple of Balsam of Tolu, made up into little Pills, with every Dose of the Syrup. Every Night an Opiate must be given. Also every Night, when there are not some other Medicines to be taken (if nothing forbids it) it is convenient to give xv. or xx. Drops of Helmont's Liquid Laudanum in a Spoonful of the Balsamic Syrup. For this end likewise 'twill be well to prescribe a Dram of the Flower of Brimstone in a potch'd Egg, or a sufficient quantity of Honey of Rosemary-flowers. If a tickling Cough, by reason of the Acrimony, and thinness of the Humour separated by the Windpipe, and the branches of it, be very troublesome to the Patient, so that 'tis to be feared the Catarrhous Cough being irritated after the manner of Suction, or drawing the Humour more into those parts, will be increased, let the following Lozenges be always at hand, to be taken at pleasure, and swallowed gently to quiet the Cough. Take of the Pulp of Marsh-mallow-Roots pressed through a sieve, an Ounce, Sugar of Pearl, Gum Arabic, Tragacanth, white Starch, all dissolved in red Poppy-water, of each two Drams, of Saccharum Penidiatum dissolved in Rose-water a sufficient quantity; mix them, and make them into Lozenges of a Dram weight. Likewise when the Cough is very troublesome, let the Patient take often, or at pleasure, a piece of Sugar of Pearl, of Roses, Penidiate, or Loaf-Sugar, letting it dissolve, and go down gently. The Juice and Root of Liquorice are likewise serviceable to this end. But if the Cough be long and violent, If the Cough continues obstinate, we must use Balsamicks. and does not yield to the former Remedies, so that from the Lungs being long stuffed there is reason to suspect that Tubercles will at length breed; then there must be a recourse had to the use of Balsamicks. As for Example: Let the Patient take three times a day at Physical hours three of the following Pills (the good success of which in Consumptive Coughs I have now experienced for many Years) in a Spoonful or two of some convenient Linctus, drinking after them a draught of the Pectoral Apozeme already described, warm. Take of the Powder of Wood-lice prepared three Drams, of the finest Gum Ammoniack a Dram and half, of the Flowers of Benjamin two Scruples, or a Dram, Extract of Saffron, Balsam of Peru, of each half a Scruple, of Balsam of Sulphur Terebinthinate or Anisate, a sufficient quantity. Mix them, and make them up into Pills of a middle size, to be gilded, or put up in Powder of Liquorice. These Pills do mightily promote the Cure of this Disease, not only in the beginning, but also in the progress of it, in the lingering Consumption of such as are Scorbutical, or have the Kings-Evil (which are Consumptions that are very frequent) where the Fever (if there be any) is very moderate, and the Phlegm, that is spit up, is somewhat tough, like that in Asthmatical people, as I shall show more at large, under the Heads of a Scorbutical Consumption, and a Consumption from the Kings-Evil. A Physician must give Directions about the Air, Eating, and Drinking, etc. But a Skilful Physician ought in this Distemper to give Directions about the Air, Eating, and Drinking, the Passions of the Mind, and the other things that belong to the Government of the Patient, with as much care as about the Medicines. For without a careful Ordering, and a cautious Use of them, the most Noble Remedies signify nothing in the Cure of a Consumption. What Air is proper. And therefore let him choose an Air that is moderately hot and dry, and likewise somewhat thin. For that which is foggy, moist, or polluted with the smoke of Coals, by continually filling the Blood with unwholesome Particles, and causing a Commotion in it, does keep it in its Colliquative state, whereby it comes to pass, that a Catarrhous Flux of Rheum does perpetually fall upon the Lungs, and upon the Glandulous Coat of the Windpipe; and thereupon these parts being continually shaken by the troublesome Cough, the Distemper is always increased, notwithstanding the use of the most Efficacious Medicines. For no Medicines can work a Cure by the way of a Charm. Let the Food be such as affords a good Juice, What kind of Food is to be ordered. by which as few Excrementitious Particles as can be, may be heaped up in the Blood; such as Mutton, Veal, Mountain-Birds, Fish, that are fryable, and easily broke into pieces, Craw-fish, etc. Let the Patient likewise eat Flesh only at Dinner, and content himself with Panadoe, Water-gruel, Broths, potch'd Eggs, etc. at Night. Let the quantity of his Food also be moderate, and let him avoid Gorging till he can eat no more. Let him drink sparingly, and let that be not too strong, but such as may cause the least effervescence and heat of the Blood, as small Beer, etc. Let him forbear Wine, and Spirituous Liquors, but especially a Debauch, and Surfeit proceeding from overcharging the Stomach with them. It also helps to promote the Cure of this Distemper, to alter and impregnate ordinary Beer with Pectoral Herbs, and other Ingredients, which have a respect to the Distemper, from whence this Consumption had its Original (if there has been any such one.) For this way a great quantity of Medicines are conveyed into the Blood in the manner of a Diet, without making the Stomach loathe them, or spoiling the Appetite; to which a prudent Physician ought always to have a special regard. For Example. Take of the best Sarsa sliced eight Ounces, of China cut into slices four Ounces, Polypody of the Oak, Maidenhair, Tunhoof, spotted Lungwort, Coltsfoot, Scabious, Jerusalem Oak, of each two Handfuls, Flowers of Scabious, of Water-lilies, Rosemary, great Daisies, St. John's wort, of each a handful, of Juniper-berries four Ounces, of Raisins of the Sun stoned six Ounces, of Liquorice sliced an Ounce, of Aniseeds two Drams. Make a Bag for four Gallons of middling Ale, and let the Patient use it for ordinary Drink. In a Scorbutical and Scrofulous disposition, the mild, and more gentle sort of Simples, that are proper for the Kings-Evil and Scurvy, must also be added, of which I shall afterwards speak. The Patient must use moderate Exercise every day. Let the Patient use moderate Exercise, and Rubbing every day, but especially before Meat; yet he must by all means have a care he does not get any new cold, which is the greatest of mischiefs in this case. He must avoid all troublesome Passions. Let the Patient be diverted as much as may be from Anger, Grief, much Thinking, and all other troublesome Passions of the Mind, and that not only by Admonitions and Advice, but also by Society, and the Conversation of pleasant Friends. Let him also carefully avoid unseasonable Studies, and Watching, always sleeping (as much as is possible) the first part of the Night. CHAP. IX. Of the Cure of a Consumption in the second degree of it, to wit, when from the want of a due Expectoration, and from the Matter, that was lodged in the Lungs, thereupon staying long in them, some crude Tubercles arising from the knotty Swelling of the Glands of the Lungs, happen to come upon a long Cough. IT often so happens to Consumptive Persons, Consumptive Persons seldom ask a Physician's Advice in the beginning of the Distemper. that either from Want, Covetousness, or else an averseness to Physic, taking the beginning of a Consumption for an ordinary Cold, that will go away of its own accord, they very seldom ask the Advice of Physicians in the first degree of the Distemper, when it may be easily cured by Evacuations, and the rest of that Method, which we have already described. But contenting themselves with I know not what Receipts of Old Women and Empirics, they squander away their precious Time, scarce desiring the Assistance of a Physician, until by reason of the increase of the Hectic Fever, and the loss of their strength, they are plainly uncapable of the Evacuations, which we have before prescribed, which yet are very necessary to the just and regular Cure of this Distemper. Through their neglect, their Lungs come to be knotted. From which neglect it often comes to pass, that the Matter having stuck a long time in the Lungs; Tubercles or Glandulous Swell are by degrees bred in them, whereby the Cure in this second degree of the Distemper is rendered not only more difficult, but likewise more uncertain; the Disease admitting no Cure, or at least but a palliative one. And from hence it comes to pass, that a Consumption has so ill a Name, At first a Consumption is easily cured. as if it were a Distemper altogether incurable in its own Nature, when (as far as I apprehend from what I have been taught by Experience) it does admit of as certain a Cure as other Diseases, so it be timely treated in a due Method. Though it must be confessed that as other evil Affections of the Body, Unless in some particular cases. so likewise a Consumption where it seizes the Patient by Inheritance, if it arises from an ill conformation of the Breast, or depends upon an inexhaustible stock of Humours, contracted by a long and habitual use of the six things, which we call not Natural: Or lastly, where it proceeds from a peculiar Malignity, a Cancrous, or Gangrenous disposition of the Blood, or something in the Nature of it, that makes it apt to be quickly inflamed, it does not use to yield to any Regular Method of Cure, though it be observed never so early: But every day it runs on with speed to the third degree of a Consumption, notwithstanding the use even of the most Generous Medicines. The time from whence the second degree of a Consumption is to be reckoned. But this second degree of the Distemper is to be reckoned from the first beginning of the Tubercles, until those Swell in the Lungs happen to be very much inflamed, and to putrify; that is, so long as they remain in a crude state. The Tubercles are not all of the same Nature. For these Tubercles are not all of the same Nature, but they assume a various, and very different disposition; for sometimes they are Malignant, of a Cancrous Nature, apt to Gangreen, and threaten a sudden Destruction: But sometimes though they are more benign, yet they are of the Nature of Inflammations, Boils, or a St. Anthony's Fire, accompanied with a pain, and Inflammatory heat, and subject to a sudden putrefaction, and thereupon from their first breeding they cause a Peripneumonick Fever, and have a very quick tendency to Apostemes. Some quickly Apostemate, and these make a quick transition to the third degree. So that as in this quick kind of Consumption arising from Tubercles of this Nature, there is no room for this second degree of the Disease; so I shall not here say any thing more of it. For whatever relates to the Cure of it, is to be spoken of in the third degree of this Distemper, to wit, when I shall particularly make it my business to treat of the Peripneumonick and putrid Colliquative Fevers of Consumptive persons. But for the most part these Tubercles are Glandulous tumors of a Chronical and cold Nature, For the most part they are Chronical, and of a cold Nature. and somewhat like Kings-Evil Swell, having their Original from the glutinousness of the Humour, or from an Obstruction of the poor or dust of the Glandules; from whence it comes to pass that the Humour stagnating within them, is gradually concocted by the Natural heat of the part into the form of Chalk, or into a substance like Suet, or like Honey, and yet is always contained in its proper Bag; and thereupon arises immediately that hard Swelling, which I call a crude Tubercle; which although in progress of time it may grow to a considerable bigness, yet is not presently inflamed, and turned to Corruption, until from the Acrimony contracted by the Humour in its Bag, or from the Tone of the part being too much distended, there comes on from some Accident an Inflammation, and upon that an Aposteme. So long as this crude state of the Tubercles of the Lungs lasts, the Consumption remains in its second degree. The Diagnostic signs of Tubercles in the Lungs, are, 1. An increase of the Hectic Fever. The Diagnostic signs whereof are especially to be taken, First, from the remarkable increase of the Hectic Fever, which at this time does often begin in some measure to imitate a Putrid Intermitting Fever, by reason of the Acrimony that is at length procured to the Matter contained in the Bags. 2. A remarkable wasting of the Muscular parts. 3. A dry Cough. Secondly, from the notable increase of the wasting, or Consumption of the Muscular Flesh, which now at least gins to grow lank. Thirdly, from the dryness of the Cough, which how frequent and troublesome soever it is, yet is not accompanied with a Catarrh, and such a frequent spitting, as before. Fourthly, from the heavy weight and oppression which are always felt in the Breast. To which also for the most part there use to be joined a difficulty, shortness, and trouble in Breathing. Purges, Vomits, and Diaphoreticks are hurtful at this time. In this degree of the Distemper all Evacuations by Stool, by Vomit, or by Sweat are mischievous, because they promote the Fever, and quicken the pace of the Consumption. Neither is Bleeding convenient, unless for some particular Reasons. Neither indeed is it convenient at this time to bleed, unless it be to prevent an Inflammation of the Lungs; that is, as often as a Pleuritic pain, the liberal drinking of Spirituous Liquors, the taking of new Cold, and other suchlike Occasions give a Sagacious Physician ground to suspect that such an Inflammation is at hand. And then too by reason of the present Consumption and Weakness, the Blood must rather be cooled by drawing it off with a sparing Hand, than taken away in a large quantity. But yet he must diligently persist in the use of those Altering and Pectoral Medicines, which have been already described (so far as the Stomach can bear them.) But the chiefest benefit is to be expected from the long use of Balsamic Medicines, as of my Balsamic Pills before prescribed, But Balsamicks are especially proper. and of other things of the like kind (so there be no considerable Fever:) And by this means I have (with the Blessing of God) recovered a great many Consumptive Persons (whose Tubercles seemed to be of a cold Nature, and crude, and so the Consumption slow, and Chronical) to a former state of Health, and the Lives of some I have preserved several Years, though they have continued sickly. In a Scorbutical and Hypochondriacal disposition it is proper also to mix Mynsycht's Extract, or some other Chalybeates, and mild Antiscorbutics with these Balsamic Medicines; as likewise Remedies against the Kings-Evil in a Scrofulous disposition: Of which I shall speak more afterwards under their proper Heads. But now besides the altering Medicines (already described) which are given in a little quantity, and at certain hours, The altering Medicines. we must do all we can to temper the Feverish Heat of the Blood, and to eradicate the inexhausted stock of Humours lurking in the Habit of the Body, together with the Colliquation arising from it, by making the Patient take them plentifully, and continually in the manner of a Diet. And therefore we must not only diligently make choice of such Food as affords good Juice, and corrects the sharpness of the Humours, as Partridges, and Mountain-Birds, potch'd Eggs, Oysters, the Feet of Animals, together with Gelly-Broths, and Jellies made of them; also Craw-fish, and other Testaceous Fishes, with Broths artificially made of them; some forms of which I shall afterwards subjoin; but also the Chalybeate Mineral Waters, a Pectoral Mead, a Milk Diet, Asaph's Milk, Milk-water, Pig-water, Snail-water, and other Liquors, that soften and take off the sharpness of the Blood, must be ordered to be taken plentifully in the manner of Drink: Likewise Issues, shaving of the Head, and the application of proper Plasters are of great advantage. Of the use of which, and the Cautions that are to be taken in the use of them, I shall briefly and particularly propose my own Observations. If the Hectic heat is small, we must use the Chalybeate Waters And first, if the Hectical Heat be moderate, and almost insensible, from whence we may conjecture that those fixed Swell of the Lungs are crude, or at least scrofulous, and of a cold Nature, that they are stuffed with a chalky, fatty, or any other such kind of Matter; the Patient must by all means be put upon the use of the Chalybeate Mineral Waters in the Summer time. And by this means I have relieved a great many of this kind of Consumptive Persons for many Years, restoring their Appetite, their Flesh, and Strength, abating their Hectic Heat, and Cough, and giving then a greater freedom of Breathing; and that not only during the time of their drinking the Waters, but also all the next Winter. From whence we have reason to conclude, that those Swell, if they are not perfectly eradicated by the use of the Waters, at least are lessened, and the Mass of Blood mightily tempered by them. And this palliative Cure (if we cannot obtain a perfect one) is of some moment. For although the Patient prolongs his Life in a state somewhat sickly, yet still he lives, and by taking due care is able to do his usual Business, and to have a moderate Enjoyment of the common Delights of Humane Life. But I have seen some perfectly recovered from an evident Consumption by the use of these Waters, and made sound again without a Relapse; a History or two of whom I shall faithfully and briefly relate in the Chapter of a Hypochondriacal Consumption. But for the use of the Chalybeate Waters, I would recommend the following Rules strictly to be observed by all Consumptive Persons. First, in an Acute Consumption, to wit, Rules to be observed in the use of the Chalybeate Waters. where the Lungs are evidently putrefied, and where the Fever is advanced beyond the degree of a Hectic; as also in an extreme Chronical Consumption, where the Patient is come to some degree of a Marasmus, together with Colliquative Sweats, a Looseness, or Dropsy, the Waters must be avoided, which most certainly in this case are not only mischievous, but also deadly. Secondly, those that are sick of a Consumption, though they ought to spend a long time, to wit, the greatest part of the Summer, in the use of the Waters, that the Crasis of the Blood, which is almost quite destroyed, may by degrees be restored by the long use of them, yet they must drink them sparingly every day, and in a less quantity than others are wont to do, that is, four, five, or six Pints at a time, lest by too great a distension of the tender Vessels of the Lungs, there comes at length a spitting of Blood. Thirdly, during the use of the Waters, they ought to take more care, lest they get cold, and commit any Errors in their Diet, than many Persons, that are sick of other Distempers, commonly do. Fourthly, it is convenient for Consumptive People to repeat the use of the Waters for several Years in the Summertime, though after they have been used to them it is not necessary to drink them so long every Year, as at first. Fifthly, neither are Consumptive Persons to be purged during the use of them, as other Water-drinkers use to be. But if they are subject to be more costive than they should be, it is convenient before they fall upon the use of the Chalybeate Waters, and after they have made an end of drinking them, to give them the Purging Mineral Waters in a moderate quantity, and to repeat them every three or four days, till they have taken them three or four times. Sixthly, if the Waters do not pass off in a sufficient quantity by Urine, much more if they cause a Looseness, they must not persist any long time in the use of them, unless we can by Art provide sufficiently against these Inconveniences. To take off, and prevent a Looseness, I use to order the quantity of a Walnut of the following Electuary every Night, when they go to Bed. Take the pulp of Old Conserve of Red Roses, Marmalade of Quinces, of each half an Ounce, of Troches of Amber three Drams, Bole, Dragons-blood, of each half a Dram, of London Laudanum three Grains, of Syrup of myrtles enough to make an Electuary. To promote the passing of the Waters by Urine, they must dissolve a Scruple of the finest Salt of Amber very well cleared from the Oil in the first draught of the Waters. Seventhly, it likewise does very well, during the use of the Chalybeate Waters, to order their ordinary Drink to be impregnated with a Bag of Pectoral Ingredients; to which may also be added such as are proper for the Scurvy and the Kings-Evil, that are mild, if the Original Distemper requires it. Secondly, If the Hectic heat is great, and the Consumption quick, we must rather make use of a Milk Diet. The Rules that are to be observed in a Milk Diet. but if the Hectic Heat be considerable, and thereupon the Consumption quick in its Progress, it is better to temper the heat with a Milk Diet, than with the Waters. But about a Milk Diet we must observe these following Rules. First, In the use of this Diet nothing must be either allowed, or taken for Meat and Drink, but Milk, and things made of Milk (except Bread.) But they must take this Food in a good quantity, and frequently, for fear the parts should be deprived of their due Nourishment, by reason of the thinness of it. Secondly, a Course of the Milk Diet aught to be continued a Month or two. Thirdly, the Spring is the most convenient time of all for this Diet, that is, when the Flowers and Herbs, with which the Beasts are fed, are fresh. Thirdly, If common Milk will not agree, we must use only Asse's Milk. But if there be too Acid a Ferment in the Stomach that turns common Milk into a hard Curd, and makes it uncapable of being concocted, (as it sometimes happens) from whence their commonly follow Vomitings, Gripes, and a Looseness, it is better to abstain from the use of common Milk, and to endeavour to temper the Blood with Asse's Milk; concerning the use of which these following things are also to be observed. First, The Rules to be observed in the use of Asse's Milk. That the most convenient time to give the Asse's Milk is early ●n the Morning, so that the Patient may sleep in his Bed afterwards, and then again at five a Clock ●n the Afternoon. Secondly, That nothing else of a different Nature is to be taken into the Stomach either in the form of Food, or of Medicine before the Milk is concocted. Thirdly, The Quantity, or Dose of Milk for one time is from half a Pint to a Pint, or thereabouts. For ●he Stomach can neither receive nor digest a great quantity of this, as neither of common Milk, but uses presently to cast it out, either by Vomiting, or Stool, and that to the great Prejudice of the Patient. And therefore it is Prudently advised by Physicians, that the Stomach be by little and little accustomed to this kind of Nourishment, beginning at half a Pint, and increasing the quantity every day, till they rise to a Pint. Fourthly, If the Patient, by reason of the Acid Ferment of his Stomach, be subject to a Looseness from the use of Asse's Milk, (which often happens) the Milk must be sweetened with Sugar of Roses, and milked upon a sprig or two of Mint. Yea, if it be necessary, and nothing contraindicates, let the Patiented every Night take a Grain of London Laudanum, or a Dose of the Astringent Electuary, which I have already mentioned. Fifthly, This Milk ought always to be given in its own Natural Heat as it comes from the Ass. For if it has been once cold, and is warmed again, it is not only made less grateful to the taste, and to the Stomach, but also by losing its Spirituous part, it loses some of its Virtue. Sixthly, During the use of the Asse's Milk, they must abstain from all other Medicines, (which is a Rule ought to be prescribed as well in every Milk Diet) excepting Opiates and Astringents, if they should be necessary to prevent a Looseness, or to quiet the violent Cough in the Nighttime. Seventhly, But if a Looseness that is caused by the Milk should not be stopped with the use of Laudanum, and Astringent Medicines; or if a Vomiting, or at least a continual Sickness, and gravative Oppression of the Stomach succeed to the stopping of the Looseness (which are certain signs that the milk curdles in the Stomach.) Or lastly, if there are signs of a Schirrous, and very obstructed Liver, (which is no rare thing in Scorbutical and Hypochondriacal Persons in a Chronical Consumption) than they must carefully abstain from all sorts of milk: For the use of milk is wont by increasing the Obstructions of the Liver, to bring the Jaundice and a Dropsy upon the Consumption, whereby the Original Distemper becomes plainly deplorable. Fourthly, If Asse's Milk disagrees with them too, than we must use Shellfish, Testaceous Medicines, etc. Therefore in these cases it is better to alter the Blood, and to correct the Acrimony of it with the plentiful use of Shellfish, and of Testaceous Medicines; as also with Jelly Broths made of the Feet of Animals, and drinking a good quantity of Compound Waters made with Milk, of a Capon, a Pig, Snails, and other things of that Nature. The Phlegmatic Waters of Snails etc. must not be used, where there is an Obstruction of the Liver. Although what I have already hinted concerning the use of milk, is also true of these Phlegmatic Waters, to wit, that as often as the Liver happens to be before obstructed, a Jaundice and Dropsy are wont to follow upon the plentiful drinking of them. Therefore in this kind of Icterical, and Hydropical Persons it is more convenient to endeavour to sweeten the Blood in the manner following: Let them feed plentifully upon River, and Sea Craw-fish, Lobsters, and in general all sorts of Shellfish. Which sort of Food being taken plentifully, does very much temper the four state of the Blood, and correct the Acid Ferment of the Stomach. And of these Shellfish may be made by Art very pleasant Broths, which must be given in good quantities. Take of Craw-fish an Hundred, Prescripts for making of Broths. beat them to pieces alive, and then boil them in two Quarts of Spring-water, adding when they are almost boiled enough, two or three blades of Mace, one Nutmeg sliced, and half a pint of Malaga Wine. Let the Broth be strained for use. Amongst these may be reckoned Jellies, and High Broths. As for Example: Take shave of Hartshorn, of Ivory, of each four Ounces, two blades of Mace, the candied peel of an Orange sliced; boil them in two Quarts of Spring-water to a Quart, or a Pint and half. Strain it, and let the Patient, when he pleases, take three or four spoonfuls by itself, or with warmed Broths. These kind of Jellies may be made grateful to the Patient's Palate, by adding at the time when they take it, a little Syrup of Baum, of Cloves, of Raspberries, Acids do not well agree with Jellies. Oranges, or Lemons. Though it must be confessed that Acid Syrups do not so well agree with Jellies, because they do in some measure spoil their Virtue. For an Example of a Jelly Broth, take this which follows. Take one Capon drawn, and cut to pieces, two pair of Sheeps-feets, two pair of Calves-feets, shave of Ivory, of Hartshorn, of each half an Ounce, two blades of Mace, one Nutmeg sliced, of yellow Saunders three Drams, or half an Ounce. Boyl them all gently in a Gallon of Spring-water to two Quarts, adding when they are almost boiled enough, of right Malaga Wine a pint, the Flowers of great Daisies, Colts-foot, Maidenhair, spotted Lungwort, of each a handful, of fat Dates eight pair, of Jujubes' twelve pair, of Sebestens ten pair, of Raisins of the Sun stoned three Ounces. Strain it, and let the Patient take a large Draught of this Broth two or three times a day. For the farther tempering of the sharpness of the Blood, it is also very good for this sort of Consumptive Persons, that are troubled with Obstructions, to use prepared Coral, Wood-lice, Pearl, Crabs-eyes prepared, the simple Powder of Crabs-claws, and other suchlike Testaceous Medicines, which must be taken in a good quantity, and often in a day. As for Example: Take of the Cordial Milk-water, Carduus-water, or Black-Cherry-water a pint, of small Cinnamon-water half a pint, of prepared Pearl half an Ounce, of Loaf-Sugar two Ounces; mix them, and make a Julep, of which let the Patient take a quarter of a Pint (shaking the Bottle first) three or four times a day, adding (if his Stomach should require it) an Ounce or two of Epidemick-water, Aqua Mirabilis, Dr. Stephens', or some other Spirituous Water. Or, Take Wood-lice prepared, Crabs-eyes prepared, the simple Powder of Crabs-claws, red Coral, of each a Dram, of the Powder of white Amber half a Dram. Mix them, and divide them into nine Papers, of which let him take one three times a day in a Spoonful of the Pearl Julep just now described, or of some other suchlike Julep, drinking a Draught after it. Fifthly, If the Patient should seem to be plainly free from Obstructions of his Liver, and so be neither in an Hydropical, nor an Icterical state; but yet the Milk Diet before described should not be very convenient, by reason of a Looseness, and the Acid Ferment of the Stomach, besides the altering Medicines before described, for the farther tempering of the sharpness of the Humours, the plentiful use of a Compound distilled Milk-water, Capon-water, Snail-water, Pig-water, etc. may be enjoined with Advantage, of which I shall in the next place give some Prescriptions. A Milk-Water. Take the Leaves of Maidenhair, Colts-foot, spotted Lungwort, Fluellin, of each three handfuls, Hyssop, Goats-rue, Minth, Wormwood, of each two handfuls, Flowers of St. John's wort, Scabious, of each two handfuls, of English Saffron a Dram, three Nutmegs sliced, Dates, fat Figs, of each a pound, of Raisins of the Sun stoned a pound; let them be all cut, and steeped in three Gallons of new Cow's-milk, and three Quarts of Malaga Wine, and distil them in an ordinary Still, so that half of the Liquor may come over: And let all that is distilled be mingled, and reserved for Use. If it be a Scorbutical Consumption, let Pine-tops, Brook-lime, Water-Cresses, Tun-hoof, with others of the milder sort of Antiscorbutics be added in the Distillation; and instead of Malaga. Wine put in Brunswick Mum. But if it be a Scrofulous Consumption, put in three Pints of Wood-lice bruised with the Herbs, and likewise other Ingredients that are proper for the Kings-Evil. If you would make this Water not only Alterative, such as may alter the Blood, but likewise Restaurative, you may add a Capon, or a Pig in a second Distillation. As for Example: Take a Capon drawn, or a Pig with the Bowels taken out, and cut it to pieces, of the Milk-water above described a Gallon, and distil them so that three parts of the Liquor may come over. A Snail-Water. Take Three Hundred Garden Snails cleansed with Salt, of common Milk, or rather of the Milk-water before described, three Gallons; distil them in an ordinary Still with a gentle fire, until an Acid Liquor gins to come off. I think the following Magisterial Water of Snails likewise also, which I use to make, is not to be despised, because it may be kept for Use a long time. Take of New-Milk two Gallons, distil it with Mint, Roman Wormwood, of each two handfuls, to a Gallon. Then Take of Garden Snails washed first in common Water, and then in Small-beer, half a Peck, of Earthworms slit and washed a pint, of Angelica a handful and half, Agrimony, Betony, Rue, of each a handful. Put the Herbs in the bottom; upon these lay the Snails and Earthworms, and upon the top of all lay of shave of Hartshorn half a pound, of Cloves an Ounce, of Saffron three Drams. Infuse them in two Quarts of Cider, and a Quart of the best Malaga Sack, and then distil them in an ordinary Still. These Liquors must be drank plentifully, The Water of Snails, etc. where it is used, must be drank freely. and that even for ordinary Drink, mixed with an equal quantity of Milk, if the Stomach will bear it, and it will quench the Patient's Thirst enough. If you like the form of a Julep best, it may be given in the following manner. Take of the Pig-water, or Capon-water before described, a pint, of Loaf-Sugar a sufficient quantity. Boyl them up into the form of a Syrup. Take of the Milk-water, or Snail-water a pint and half, of the Magisterial Syrup just now described four Ounces. Mingle them, and make a Julep, of which let the Patient drink freely whenever he pleases. Or, Take of the Milk-water, or Magisterial Snail-water a Quart, of Sugar of Pearl ten Drams, or an Ounce and half. Mix them, and make a Julep, of which let him drink plentifully, and frequently. If there be a difficulty of Breathing, rather than a Hectical Heat, we must use a Pectoral Mead. But if it be not so much a Hectical Heat, as a difficulty of Breathing that troubles the Patient, (as it often happens in those that have a Scorbutical Consumption) a Pectoral Mead is more convenient for his ordinary Drink, than distilled Waters, that have a great deal of Phlegm. Of which we have an Excellent receipt in Riverius, in his Chapter of a Consumption; and every where else amongst Authors. And therefore I shall add no other Description of it in this place. CHAP. X. Of the Cure of an Original Consumption of the Lungs in the third degree of it, to wit, when the Patient is reduced by the Inflammation, the Apostemes, and Exulceration of the Glandulous parts of the Lungs, to the state of a Marasmus, together with an extraordinary Weakness, a Consumption of his Flesh, an increase of his Hectic Fever, and likewise the Addition of a Peripneumonick and Putrid Fever, and the other direful Symptoms, which are wont to accompany the fatal state of a Consumption. WHEN he comes once to this Third Degree of a Consumption, A Consumption in the third degree is very seldom cured. the Patient (unless the Ulcers are very small, and benign) very seldom is cured, or lives long. And therefore though a Prudent and Honest Physician, when he is called to Consumptive Patients in this degree of the Distemper, aught as much as it is in his Power to mitigate and relieve the Symptoms that afflict such poor Wretches, and should make it his business likewise to prescribe such Antiphthisical Medicines, as may best answer the present Indications, and be most agreeable to the present state of the Patient; yet he ought by no means, Therefore a Physician must be very careful how he promises a Cure. though there should be some hopes from the abatement of the Symptoms to flatter him, to injure the Reputation of Physic, and his own too, by promising a Recovery of his Health to the Patient, or to his Friends too confidently: But what good soever he should with the greatest Commiseration and Diligence do the Patient, yet he must always pronounce a Fatal Prognostic of his Life, and not suffer himself to be deceived with the vain hopes of his Friends, and those that are about him: And by this means he will secure as well the Art of Physic as himself from Reflections. The Intentions of Cure. The Intentions of Cure in this degree of the Distemper are these four. First, we must take care of the Lungs by the use of Pectoral and Antiphthisical Medicines; and promote the Cure of the Ulcers (if they are small, benign, and curable) to wit, so far as the present weak and low condition of the Patient can bear. Secondly, the Peripneumonick, or Inflammatory Fever must be taken off as often as it happens, together with the direful Symptoms of it. Thirdly, the Putrid Fever arising from the Purulent Matter in the Lungs, must be relieved. Fourthly, and lastly, we must help those troublesome Symptoms arising from the Putrid Fever by the Colliquation; that the Patient, if he does die, may at least obtain an easy passage out of this World. What we must give with respect to the Lungs. As for what concerns the first, the Medicines proper in this degree of the Consumption, are such as are Altering, Expectorating, and Balsamic or Healing; not too hot (because of the intense degree of the Fever) but always Cordial, because of the Patient's Weakness. Such also must be made choice of as are most grateful, and may be given in the least quantity, because of the weakness of their Stomach, and their aptitude to Vomit. As for Example: Take the old Conserve of Red Roses pressed through a Sieve, of Woodsorrel, Leucatellus' Balsam, of each an Ounce. Mix them, and make an Electuary, of which let him take the quantity of a Nutmeg in Wafers Morning and Evening. Or, let him take three of the Balsamic Pills already described, twice a day. Take of the Cordial Milk-water, or the Pectoral Milk-water already described, eight Ounces, Magisterial Water of Snails, Barley Cinnamon-water, of each three Ounces, of Aqua Mirabilis an Ounce, of prepared Pearl two Drams, of the finest Chalk a Dram, of white Sugar-candy an Ounce, or ten Drams. Mingle them, and make a Julep, of which let the Patient take four or five Spoonfuls after every Dose of the Electuary, and of the Pills, and likewise at any time when he pleases, if he be faint. Take of the Balsamic Syrup (which is very grateful to the Stomach) three Ounces, of the Tincture of Saffron made with Treacle-water two Drams. Mix them, and let him take a Spoonful of it often. In a Spoonful or two of this Mixture may likewise be given six or seven Drops of Opobalsam twice a day. If the Cough, Sometimes we must give Opiates; and want of Rest be very urging, let him also take sometimes, when he should go to Rest, Twelve Drops of Helmont's Liquid Laudanum. But very cautiously. But yet when the Patient is in this weak condition, Opiam must be given very cautiously, sparingly, and at due intervals; and indeed not at all, unless there be a great Necessity, lest a sudden and unexpected Death should follow, and so bring a Scandal upon Physic. Or, Take of Syrup of Maidenhair four Ounces, of Aqua Mirabilis half an Ounce, or six Drams. Mix them, and let him take some out of a Spoon, or with a Liquorice-stick often, but especially when his Cough is troublesome. Here likewise Jellies, and Jelly-Broths are to be prescribed; and indeed in this deplorable state we must fetch our Remedies rather out of the Kitchen, than out of the Apothecary's Shop. An Account of the Peripneumonick Fever. As for the Peripneumonick Fever, that always proceeds from a great Inflammation of the Tubercles of the Lungs; and therefore it is wont to return often, and to be renewed; to wit, as often as any new Tubercle happens to be inflamed, either of its own accord, and from its own Nature, or from taking of Cold, or any other Error committed in their management. So long as the Inflammation lasts this Fever constantly remains, and many times puts a sudden and unexpected end to the Patient's Life, being attended with the successions of a Chillness, that comes at uncertain times, and a great Burning, with Watch, Restlessness, Lightheadedness, Shortness of Breath, a difficult Expectoration, and with violent and wand'ring Pains of the Side, Breast, and Shoulders. But as soon as the Inflammation gins to be changed into an Aposteme which (if the Patient lives so long) commonly happens about the seventh day of the Fever, that continual Inflammatory Fever is succeeded by a Putrid Intermitting Fever, a Quotidian, or Tertian, which is a certain sign that the Tubercles are turned into purulent Matter, and without the healing of them, it is impossible perfectly to eradicate that. This Inflammatory Fever, What is requisite in this Fever. as all others of the same Nature requires a very thin Diet, together with a due Government in their Beds, that the Body be kept open, Cordial and Temperate Juleps, Pectoral Apozemes, with Lubricating and Inciding Lambitives must be given plentifully to facilitate the Expectoration, or raising of the Phlegm too much thickened by the Feverish heat, to take off the painful compression of the Lungs, and thereupon to quiet the insignificant and troublesome Cough: Likewise Diaphoreticks, that are a little Opiate, must be exhibited at due intervals, to promote the extrusion of the Feverish Matter by the Pores of the Skin: Also Blistering-Plaisters must be laid on, and external Applications made for the relief of the Brain, and System of the Nerves, which otherwise are wont in a short time to suffer much from this kind of Fevers. Also Liniments, and outward Fomentations, that are Anodyne, to relieve the painful and Spasmodick contraction of the Muscles, and Membranes of the Breast: Bleeding especially is necessary. But above all Bleeding, and that in due time, to a good quantity, and (if there be occasion) repeated, according to the strength of the Patient, and the present Effervescence of the Blood; which it may be a Consumptive state requires more than that which is Robust. And by this means I have seen Mr. Tib's, Dr. Owen, and our Famous Colleague Dr. Staines, and several others, even in their very Old Age recovered from several of this kind of Fevers, returning sometimes twice or thrice a Year (though it has been only to their former sickly state;) and that as easily, and as quickly, as if they had not been at all Consumptive. When on the contrary, it is as well known how dangerous this kind of Peripneumonick Fevers very often are to the strongest Men, let them have never so good a Habit, where due Bleeding, and any other part of a right management has been omitted. The Peripneumonick Fever may be as easily cured as an ordinary Peripneumony. Therefore though a Physician must make a Fatal Prognostic of the Consumption itself, (which without doubt is much promoted by every Fever of this Nature) yet he may set himself about the Cure of the Peripneumony with as much hopes (if he be but sent for in time) as if the Patient were not at all Consumptive, and that in the manner following. Let him be ordered a Diet of Water-gruel, Ptisans, roasted Apples, Posset-Ale, with Raisins of the Sun stoned, and Liquorice boiled in it, middling Beer warmed with a Toast, and suchlike. But in the first declension of the Fever, let it be of Chicken-Broth, potch'd Eggs, etc. He must likewise (if there is occasion) presently have a Stool procured with a Clyster made of Milk, in which Camomile-flowers have been boiled, sweetened with brown Sugar, which (as often as it shall be necessary) must be repeated. Then let Eight or Ten Ounces of Blood be taken from the Arm of that side where the pain is; which Bleeding must be boldly repeated every day, or every other day, according to the Effervescence of the Blood, and the violence of the pain in the Side, and the difficulty of Breathing, so far as the strength of the Patient will bear it, that the progress of the Inflammation to a ripening and an Aposteme (if it be possible) may be prevented. In the mean time all along the course of the Disease let a Spoonful of the following Linctus be given dissolved in four Ounces of the Pectoral Decoction warmed, every third, All the time of this Fever we must use Pectoral Medicines. or at least every fourth hour. Take Oil of sweet Almonds new drawn, Syrup of Maidenhair, of each an Ounce and half, of white Sugar-candy a Dram and half. Mix them very well, and make a Linctus. Yea, if the toughness of the Phlegm, the difficulty of Breathing, and the increase of the Pain arising thereupon require it, and there be no Looseness to forbid it, let new linseed-oil fresh drawn without any Fire, be put in the stead of the Oil of sweet Almonds, and Syrup of Hedg-Mustard, or of the five opening Roots, in the room of the Syrup of Maidenhair. Moreover let two or three Ounces of linseed-oil be likewise ordered to be taken by itself every four hours, because it is wonderfully endowed not only with a Lubricating, but likewise an Anodyne Quality. Take of the clear Pectoral Drink a Pint and half, Tincture of Saffron made with Treacle-water, and Syrup of Maidenhair, of each an Ounce: Mix them, and make an Apozeme for the Use before mentioned. For refreshing their Spirits, Something must be done to comfort them. and tempering the heat of the Blood, let four or five Spoonfuls of the following Julep be ordered to be taken. Take of the Cordial Milk-water eight Ounces, Barley Cinnamon-water, Epidemic Water, of each two Ounces, of Pearl prepared a Dram and half, of Loaf-Sugar six Drams; mix them for a Julep. At the time they should go to Rest let the following Anodyne and Diaphoretick Bolus be ordered to be taken with a draught of the Pearl Julep, but especially if their Body be too lose, which often happens in this state of the Distemper. Take of Venice-Treacle half a Dram, of Gascoin Powder a Scruple, of Syrup of Clove-gilly-flowers a sufficient quantity; mix them, and make a Bolus. Something to preserve the Brain. For the security of the Brain, and the System of the Nerves, presently after Bleeding let Blistering-Plaisters be applied to the hinder part of the Neck, to the inside of the Arms and Legs; and the Cephalick Plaster with Euphorbium to the soles of the Feet. What is to be done when there is a pain in the Side. For the relieving of the pain in the side, caused by the Spasms of the Muscles, and Membranes of the Breast, let the following Fomentation and Lineament be alternately applied to the Parts affected. Take the Roots of Parsley, of Fennel, Linseed, Foenugreek-seed, of each two Ounces, Camomile flowers, Melilot-flowers, of each two handfuls; mix them together, and boil them in a sufficient quantity of Spring-water, let the Liquor, being strained, be put into a new Ox's Bladder, till it is half full, and let it be applied hot to the Parts affected, when the pain is violent. When the Bladder is removed, lay on a warm Flannel with some of the following Lineament. Take of the Ointment of Marsh-mallows half an Ounce, Oil of white Lilies, Oil of Bricks, of each three Drams; mix them, and make a Lineament for use. For the farther tempering of the Effervescence of the Blood, and the heat of the Lungs, the following Powder may be ordered with Advantage. Take of the finest Salt-Petre two Drams, of white Sugar-candy half an Ounce; mix them, and then divide them into Eight Papers, and let one of them be dissolved in every draught of Beer the Patient drinks. As for the other things, they must be left to the Judgement of the Physician that is with him, to be prescribed as there shall be occasion. As for what concerns the Putrid Fever of Consumptive Patients, we must take notice, A Description of the Putrid Fever that although they being treated in the foregoing Method, do not die of a Peripneumony, yet the Inflammation of the Tubercles of the Lungs at this time turning to an Ulcer (which very often happens) at the end of the Inflammatory Fever, there presently arises a Putrid Intermitting Fever, which returns at certain periods every day, or every other day, with a Chillness, a hot Fit, and then Sweats succeeding one another; for the Blood in its Circulation passing now through these purulent Parts, is filled and oppressed with Heterogeneous and disagreeable Particles, by which Nature being irritated, is roused, and forms a Feverish Fit every day, or every other day, to expel her Enemy. Unless we can heal the Ulcers, Pectoral Medicines will not Cure this Fever. The Peruvian Bark will many times do great Service. Which Fever (so far as I understand) it is impossible perfectly to eradicate with the help of Pectoral and Balsamic Medicines, without healing (as often as they are small and benign) the Ulcers, from which that Fever proceeds. Yet I have very often found with very good Success the efficacy of the Peruvian Bark, in taking off these Fever Fits, at least for a time, being frequently repeated, and at due intervals: So that I have seen the Lives of some Consumptive Persons, that have been looked upon as deplorable, by the frequent use of it prolonged not only some months, but likewise some years; who, though they were never perfectly recovered from a sickly state, yet being once freed from their Fever by the use of the Bark, could do their ordinary business well enough. Wherefore I look upon this as the only Febrifuge in this case, that has hitherto been found out. For although by this means there is only a Treacherous and uncertain Truce obtained, because the Fever is wont to return of its own accord, or upon the least occasion, yet by this temporary suppression of the Fever, the Patient is not only immediately freed from many troublesome and grievous Symptoms for a time, but likewise recovers his lost Strength in some measure, and moreover gains some Opportunity for the use of Balsamic and Pectoral Medicines, which by healing the ulcerated Tubercles, may work a perfect and eradicative Cure of the Fever. We must mix Balsami ke with the Bark. And therefore it is very convenient not only to insist diligently upon the use of this kind of Balsamic Medicines at those times the Patient is free from his Fever; but likewise to mix them with the Bark itself, whenever you have a mind to repeat it, in the manner following. Take of the Peruvian Bark beat into a very fine Powder half a Dram, of the Balsamic Syrup a sufficient quantity; mix them up into a Bolus, and let the Patient take it in the Morning, and repeat it every six hours for three days one after another, drinking three or four Ounces of the following Apozeme after it. Take of the Peruvian Bark grossly powdered three Ounces, of Balsam of Tolu two Drams, English Saffron, Cochinel, of each a Scruple; boil them in a pint of the clear Pectoral Decoction to six Ounces. Then strain it, and pour on another pint of the same Decoction, so repeating the Operation thus for three times: And then mix all the strained Liquors together, and add Malaga Wine, the Balsamic Syrup, of each four Ounces. Mix them, and make an Apozeme. Let the use of this Febrifuge be repeated in the manner just now prescribed twice a month, The Bark must be repeated. Balsamic and Pectoral Medicines must be given in the intervals. or oftener, if it shall seem necessary. But in the intervals the diligent use of Balsamic and Pectoral Medicines ought to be enjoined, which must be varied according to the Temperament of the Patient, and the Nature of the Disease under the care of a Judicious Physician. If the Belly should be too lose, a Grain of Laudanum may be added to every Night- Bolus, or instead of the Boluses, a Physician may make use of Pills made of Diascordium, and the Powder of the Peruvian Bark, so that every Dose may contain half a Dram of the Powder. And in this manner I saw Mr. Houghton an Apothecary's Wife, that was emaciated with a deplorable Consumption, preserved a Year or two, and very often recovered from a Putrid Fever caused by her Consumption, by the care of my Famous Colleague Dr. Tyson; as also the Wife of Mr. Walker, a Merchant of London, and Mr. Blakey the Minister's Son restored from a Putrid Consumptive Fever almost to a perfect Health by my care, recovering their Strength and Appetite; and so several others, whose Histories it would be too tedious to give an Account of in this place. Yet I will ingenuously confess, The Bark does not answer so well here, as in Agues. that I have not observed the Bark to answer its end so certainly and constantly in a Consumptive Intermitting Fever, as in a plain Ague proceeding merely from a morbid disposition of the Blood: But where I have found it to do little or no good, I have always suspected that the Brain, and System of the Nerves have been injured, and that the Patient has been more apt to be lightheaded, and more subject to Spasms than he had been before. CHAP. XI. Of the Relief of the Symptoms of a Consumption in the Third Degree of it. AS Nature is wont to be irritated by the mixture of purulent and heterogeneous Particles with the Blood (to wit, as soon as the Tubercles of the Lungs happen once to ripen, and to become Apostemes) and to endeavour the extrusion of them in the Periodick Fits of an Intermitting Fever, by the Bowels, the Cutaneous Glands, Salivatory Ducts, Stomach, Windpipe, etc. by what passage soever there is a vent opened, according to the Nature of the Humours, and the tendency of Nature, together with an extraordinary Colliquation, and a sudden sinking of their Strength: Nature to her violent efforts makes 〈◊〉 Symptoms. So it often happens, that Nature being then spurred on too far by that irritation, does in expelling the colliquated and sharp Serum in a greater quantity, than is convenient, form some new Distempers, or at least some new Symptoms, that are more sharp, and more dreadful than the Original Disease itself; such as a Looseness and Bloodyflux, with violent Torture in the Bowels, a Cough, and pertinacious Watch, profuse and colliquative Sweats, almost perpetual Vomitings, Hiccough, Thrush, etc. For the Relief of which Symptoms the Art of Physic may do something, though it should be unable to gratify the Patient with a perfect Cure. But by what means, and by what Rules a Physician ought to help these kind of Symptoms, I shall endeavour particularly to show in what follows. And first, Of the manner of Relieving a Looseness, Bloodyflux, and Racking Pains of the Belly. All the time this Necessity continues Opiate Medicines must be given, not only frequently, In case of a Looseness, Opiates must be given. but likewise in a good quantity. For as these dreadful Symptoms cannot be relieved by any other Medicine, so likewise, as long as these Symptoms last, as the Cough is commonly more moderate, so their Breath is more free and easy, (as I sometime since observed in Mr. Lechmere, Mr. Chadwel, and several others) the Matter, which used to irritate and load the Lungs, being then translated to other parts for a time, and thereupon the use of Opiates is not contraindicated, or forbidden by any present Symptom; In this case the Patients will bear them. from whence it comes to pass, that they can bear a convenient Dose of Opium without any prejudice or danger. As long as these Symptoms last the Patient must abstain from the use of all sorts of Beer, and content himself with the white Drink, and Milk boiled with Water, instead of it. Let him also take every four hours (if it be needful) the quantity of a Walnut of my Astringent Electuary, already described when we spoke of the use of Asse's Milk; or let him take Twelve Drops of Helmont's liquid Laudanum in a draught of the Pearl Julep. To Correct also the sharpness of the irritating Hum●●r, that is wont to be thrown out by the Glandulous Coat of the thick Guts, and to restore the Tone of the Parts that are weakened by it, let there be a Clyster given every day (as a Fomentation to the Parts) of Chicken-broth, or the Broth of a Sheehead boiled in Water with the Wool upon it; or else this which follows: Take of Milk wherein Steel has been quenched several times, and in which some Red Roses have been boiled six Ounces, of Diascordium half an Ounce; mix them, and make a Clyster. When the Looseness is moderate we must give but little Opium. But where the Looseness is moderate, and where the Pains are not great, but especially if there be a difficulty of Breathing, Opium must be ordered seldom, and not much, in any form. Because for the most part upon the giving of it, as the Breast uses to be loaded, so also their breathing and expectoration become more difficult, and their Stomach is apt to be sick with it. And therefore in this case it is better to keep the Looseness moderate by the use of an Opiate every third or fourth Night, rather than to stop it quite, After an Opiate we must use Expectorating Medicines plentifully. for fear a greater mischief follows upon it. And likewise after the use of an Opiate Medicine, we must give them Expectorating and Lubricating things more plentifully, lest the Matter which has been some time fixed by it in the Lungs, be too hard for the Patient to bring up. Secondly, How to abate the continual Cough, and to help the Patient against pertinacious Watch. As a Looseness, and sometimes also an implacable Bloodyflux, together with dreadful Tortures do often come upon a Consumption, from the Colliquation of the distempered and sharp Lympha made by the Bowels, which are wont to scour in Consumptive Persons, that have a Scorbutical disposition, by reason of the peculiar Tone of their Guts, more than in others: As I have observed in very many, who have been taken away in the very Flower of their Age by a Scorbutical Consumption, attended with those Racking Symptoms. So likewise many times in this state of the Disease, The Cause of the Cough, etc. others use to be sufficiently troubled with an extraordinary Colliquation by the Windpipe, and the branches of it, caused by this Putrid Fever; whereupon the Cough that was before dry and moderate, now becomes violent, and continually troublesome, with a plentiful spitting, sometimes of a thin Rheum, sometimes of a discoloured, glutinous, and purulent Phlegm; so that the Patient by reason of his Cough troubling him both Day and Night, is wont to be afflicted with almost continual Watch till he is lightheaded. These Symptoms too are not to be relieved without the use of Opium. These Symptoms require Opium. Yet it must be cautiously given. But in this extreme degree of Weakness it must be allowed with a great deal of Caution, but sparingly, and not without manifest Necessity; because from the stuffing of the Lungs caused by it, there is wont to follow a very great difficulty of Breathing, a weak Pulse, and a faltering of the Senses, together with a coldness of the extreme parts, so that the Patient to the disgrace of the Physician and his Art, does not seem so much to die, as to be killed. Therefore in this case I commonly use the following Linctus, or some one of the same Nature. Take Syrup of Marsh-mallows, of Purslane, of each an Ounce and half, Species Diatragacanth frigidae, Haly's Powder, of each two Scruples, Syrup of Meconium an Ounce and half. Mix them, and make a Linctus, to be taken out of a Spoon, or with a Liquorice-stick, when the Cough is troubelsome, swallowing of it gently. Likewise Aqua Mirabilis, because it is Aromatic and Carminative, being mixed with Pectoral Syrups, and taken down gently, is proper to quiet the Cough. Or, Take of the Balsamic Syrup two Ounces, of Helmont's Liquid Laudanum two Scruples; mix them, and let the Patient take one Spoonful every hour, or every two hours. In this state of the Disease the Patient must seldom ascend so high as to half a Scruple or twelve Grains of the Cynogloss-Pill. Here likewise the Trochisci bechici, or Cough-Lozenges, both the white and black, or any others of that kind are good, being to be dissolved gently in the mouth, and swallowed down when the Cough is troublesome. Of moderating the vast Colliquative Sweats. From the first of the Putrid Fever there are Sweats. These Sweats are wont to accompany a Consumption after the Putrid Fever arises through the whole course of the Disease, and (as I hinted before) do very much relieve the Cough, Watch, and other troublesome Symptoms; and therefore so long as they are moderate, Whilst they are moderate they must not be stopped. they are by no means to be stopped by Art, for fear a Looseness, or some other more troublesome and fatal business arise upon the taking away of this Symptom. But sometimes (when the Consumption once comes near to its fatal Period, because the colliquative state of the Blood is at this time so much increased, that scarce any new Nourishment is united to the Solid parts, or retained in the Mass of Blood) it happens that these Sweats become so profuse, that the Patient, whenever he falls into a sleep, does not only seem to lie, as it were, in a Flood of Water, which he finds very troublesome, but likewise from a great sinking of his Spirits, caused by those vast Sweats, as soon as he awakes, he is taken with some degree of Swooning. In which case his sleeps must be short, In this case their sleeps must be shor● and (if there be occasion) he must be awaked out of his sleep, before his Spirits are too languid with long Sweeting. Also temperate Pearl Cordials must be given often, and in a large quantity, to which it is convenient to add Chalk, Coral, Dragons-blood, and other Temperating, Astringent, and Emplastic Ingredients, which may in some measure lock up and mitigate the fluid state of the Blood. As for Example: Take the Waters of Tormentil, Plantain, Oak-buds, of each three Ounces, of small Cinnamon-water four Ounces, of Aqua Mirabilis an Ounce, Pearl, and Coral prepared, Chalk, of each two Scruples, true Bole, Dragons-blood, of each half a Dram, of Japan-Earth a Scruple, of distilled Vinegar, or Spirit of Vitriol a sufficient quantity to give a grateful sharpness, of Syrup of Myrtils' an Ounce and half; mix them, and make a Julep, of which let the Patient take two or three Ounces every third or fourth hour, shaking the Bottle. Some of the Bed-cloaths also must be taken off, and let the Patient be removed into a thin, open, and fresh Air; let him always sleep in a large Chamber, and as soon as he gins to be faint, let the Sweat be presently wiped off with dry Linen clothes, and the Patient be removed into another part of the Bed. The pores of the Skin being in this manner once stopped, though Nature should make it her business to throw out some part of the colliquated Humour by the Bowels, or any other passage, and thereupon new Symptoms should arise, yet it is better for the Patient to labour under several moderate than one very extreme Symptom. Of extreme Vomiting in the latter end of a Consumption. Consumptive Persons are all along subject to Vomiting. Persons in a Consumption are in some measure subject to this Symptom through the whole course of the Disease from the morbid state of the Blood, and from the Tone and Ferment of the Stomach being thereupon perfectly destroyed, as also from the stuffing of the Lungs, and the motion of the Stomach, being inverted by the Cough, and hawking up of the Phlegm that sticks in the Lungs (as I have showed before.) But about the end of a Consumption this Symptom is sometimes so much increased, Which increases towards the end of the Consumption. that scarce any Nutriment can be retained in the Stomach; but the Food as soon as it is taken down, is apt to be thrown up again by the Stomach. Though there is not much to be done by Art in the extremity of this Symptom, yet a Physician ought to give his helping Hand, at least by prudent Counsel, if he cannot by Medicines. Therefore first, let the Patient be ordered to take (though often) but a very little quantity of Food at a time. Secondly, let him be indulged the use of Food that is most grateful to his Stomach, so it be such as affords good Juice, and is of easy digestion. Thirdly, let him (as much as ever he can) keep from Coughing, and deep hawking up of Phlegm that lies low, and let him likewise forbear sleeping and lying down presently after he has eaten. But Medicines can scarce do any good in this deplorable state. Of relieving a Thrush, a pain in the Throat, and Hiccough in the end of a Consumption. After the flame of the Putrid Fever is kindled, but especially when the exclusion of the colliquated Matter by the Bowels and other Doors is hindered by Art, it sometimes happens that Nature endeavours, though in vain, the extrusion of her Enemy by the Salivatory Ducts, and Glandulous Membrane of the Mouth and Gullet. From whence a continual troublesome spitting for many Weeks arises. Secondly, by reason of the sharpness of the Humour separated by these parts, there follows an Inflammation of the Membrane, not only of the Mouth, but also of the Gullet and Stomach. Thirdly, from the Inflammation there follows an Exulceration, and thereupon little Ulcers, commonly called a Thrush, attended with a very troublesome pain in the Throat; as I observed in Mrs. Wells, and some other Consumptive Persons, who were wont to complain of this Symptom more than of the Original Distemper itself. Fourthly, and lastly, a very troublesome Hiccough arising from the Inflammation and Exulceration of the Stomach. And these Symptoms, A Thrush and Hiccough are always fatal. as they are wont to be very troublesome, so sometimes also of a long continuance, but always fatal, and such as presage the Patient's Death; neither indeed do they admit of any Cure: For that the cause, from which they proceed, is incurable. However that may be, yet an honest Physician ought here also as much as it is in his power, to give a helping hand with the use of Gargles to be squirted into the Mouth and Throat with a Syringe, which must be made of Cleansing, Soft, Astringent, and Mucilaginous Ingredients: Such as we have often occasion to use in our Practice, the forms of which we meet with every where in Authors, under the Head of a Fever. But yet for the easing of this kind of pain in the Throats of Consumptive Persons, the keeping the backward Glands seated in the Throat continually Night and Day defended from the external Air with a covering of Flannel doubled, does a great deal of good; from whence there may be more relief expected than from Gargles, or Mucilages. A TREATISE OF Consumptions. The Third BOOK. Of a Symptomatical Consumption of the Lungs. I Call that a Symptomatical Consumption of the Lungs, which is caused by, What a Symptomatical Consumption is. and depends upon some other preceding Diseases. For it often happens so, that from Distempers, and those not only Chronical, but also Acute; and that whether they are perfectly cured or not, the Mass of Blood is so altered by the preternatural Ferment preceding, that there remain and lurk in the Blood some indelible Impressions, and the Seeds of a Consumption, that will afterwards follow, which by degrees shows itself by a Cough, and other usual Signs, until at length the miserable Patient being on every side environed with the Fatal Symptoms of the Disease, is forced to submit to the stroke of Death. Yea, sometimes also it is not only the Distemper, but likewise the Physician himself that uses to be the occasion of this Consumption; to wit, when being greedy of Gain, and a little present Fame, he does in a perfunctory manner, and without a due Method and necessary Evacuations, rather suppress than root out the Ferment of the preceding Disease; whereupon the Patient, not being so much cured, as translated from one Distemper to another, after some space of time spent in a sickly state, falls into an Acute and Deplorable Consumption. This is the most common Consumption. And indeed this kind of Consumption (as far as I have been able to observe) is the most common of all others; and where we see one Original Consumption of the Lungs, which depends merely upon an alteration of the Blood predisposing the Patient to it, there are five (and it may be ten) to be found, which proceed from Crapulous and Intermitting Fevers, from the Smallpox, Measles, Scarlet Fevers, a Pleurisy, Peripneumony, Melancholy, and Hysterick Affections; from the Kings-Evil, Scurvy, Green-Sickness, Asthma, Spitting of Blood, Stones in the Lungs, and sometimes also in the Kidneys and Bladder; from the French-Pox, Gout, stoppage of the Monthly Purgations, of Issues, a Gonorrhoea, and of Old Ulcers, especially such as are Fistulous and Scrofulous. These Consumptions have a peculiar disposition. Which Symptomatical Consumptions, besides the general Nature of a Consumption, use to have likewise a proper and peculiar Genius, or Disposition of their own; and thereupon they are to be distinguished amongst themselves as by particular Marks, and Pathognomonick Signs. And there is some variation to be made in the Cure proportionate to the different Nature of the Distemper. And a Physician can scarcely in the Cure of a Symptomatical Consumption of the Lungs rationally satisfy all the Indications of Cure by the general Method already described, so as to obtain a happy and desired event of things, Therefore in the Cure of them a respect must be had to the Original Distemper. unless he has in the whole course of his Cure as well a peculiar respect to the Original Distemper, by mixing Specificks with his other Medicines, as to the Symptoms in the Lungs, which are the effects of it, by Medicines that are proper for a Consumption of the Lungs, which we have already described. Therefore taking it for granted, that the Description and Cure of an Original Consumption the Lungs already delivered, belong likewise to of these Consumptions, that I may not draw out the Thread of this Discourse to too tedious a length by Tautologies, I thought it worth my while briefly to add under their proper Heads those things which may show the various Nature of these Consumptions, their Causes, Differences, Pathognomonick Signs, and Indications of Cure, by which a Physician with his Judgement and Sagacity may alter the general Method of Cure, so as to be able to accommodate his Remedies to the peculiar Nature of the Disease, and to answer the Indications that arise from it. CHAP. I. Of a Scrofulous Consumption. This Consumption is very frequent I Shall speak of this kind of Consumption in the first place, because it occurs most frequently in our Practice: For I remember more of this kind of Consumptive Patients that I have cured, or at least have seen cured by others, than of any other sort. For in a Scrofulous Consumption the Blood, by reason of its preternatural Acrimony, being as it were coagulated, and so unable perfectly to unite the new Chyle to itself, and the solid parts, is wont to throw it in a greater quantity than is convenient upon the Glandulous Parts, where the small Vessels do not run in a right Line as in the Muscles, but spirally; from whence it comes to pass, that the Blood is wont to make a longer stay, and to stagnate longer in these, than in other parts, and so to make a more plentiful separation of the Nutritious Juice in them; whereby it comes to pass, that these parts are apt to swell more, and to grow larger, and harder than others. And what happens in other Glandulous parts, happens also in the Lungs themselves, which are every where full of innumerable Glandules, but of some more conspicuous ones upon the Windpipe, and the branches of it, though in their Natural state they are not so easily discerned: So that 'tis no wonder if those that have the Kings-Evil, who are frequenlty subject to Glandulous Swell in other parts, are likewise many times affected with such kind of Tubercles, even in the Lungs themselves, the substance of which is Naturally spongy, and apt to receive the Serous Particles of the Blood, that are here plentifully separated by their continual agitation. And indeed from these sixth Swell in the Lungs this Scrofulous Consumption is wont to proceed: The most certain Diagnostic Sign of which is to be taken from Glandulous Swell in the External Habit of the Body accompanying of it, The Diagnostic sign of it. or at least preceding it; as also from an Ophthalmy and Scab, that often return, and from other suchlike Scrofulous Affections. Though I think I must freely confess, that sometimes it happens so that the Glandules of the Lungs only, and no others are affected with this Humour. In which case there is need of an Experienced and Judicious Physician to find out the peculiar Nature of this Consumption from what yet remains to be spoken under this Head Therefore here we must particularly observe, The Tubercles here are either Phlegmatic; That these Tubercles of the Lungs (as Scrofulous Swell in other parts) are either crude and phlegmatic, and so no ways disposed to an Inflammation and Maturation: Or more hot. Or else more hot, which will be seized with an Inflammation sooner or later, according to the present disposition of the Blood, and the different Nature of the Matter that is contained in the Cystis. For sometimes, to wit, when the Matter is concocted, and hardened into a Chalky, or Steatomatous Substance, or into the substance of a Meliceris, (which it most commonly is) the Inflammation, and the Exulceration, that proceeds from thence, are not only some considerable time before they happen, but likewise when they do, they are very slow, Chronical, and almost insensible. But whenever the Blood, When the Matter is of a hot Nature, the Swell are apt to inflame. and the Matter contained in the Cystis are of a Nature different from this (which also sometimes, though seldom, happens) the Swell are very apt to be inflamed, so to suppurate, and to turn to an Ulcer. And from hence arises the difference in Scrofulous Consumptions: For some (to wit, whenever the Swell are crude, and not apt to be inflamed) in a Consumptive state live, though they are crazy and sickly, from their Childhood till they are old, with a Cough that is almost continual, and troubles them both Night and Day, Summer and Winter, with a weight in their Breast, with a difficult, and somewhat Asthmatical Respiration, but yet without any sensible Fever; but upon the taking of the least Cold (to which also they are more subject than other People) they are wont to spit a great deal of Phlegmatic and Serous Matter. These People may be preserved from any dangerous, or fatal Effects of their Distemper, even without Physic, only by ordering themselves regularly in those Six Things, which we call Non-natural. And hence it comes to pass, that they seldom desire the Help of a Physician in this sickly crazy state, being better contented to live Miserably, A Scrofulous Consumption is curable, when the Tubercles are crude. than Physically. But for my part I do not question, but by the frequent changing of Air, and making choice of such as is thin and clear, and by the long use of Balsamic, and Mercurial Medicines, of Wood-lice, Chalybeates, but especially the Mineral Waters, and of other Antiscrophulous Remedies, these Swell may be wasted in the Lungs as well as in other parts, and so the Patient may be freed from a Scrofulous and Consumptive state, as I have often experienced. In the Cure of this kind of Consumption, A Milk Diet is not to be used in the Cure of it. we must by no means put them upon the use of a Milk Diet; because it is wont to promote and increase the Obstructions and Swell, that proceed from a Viscous Humour. Likewise those Pectoral Medicines, that are commonly called Expectoratives and Opiates, do no great good in this case, unless it be upon the taking of new Cold, to mitigate the Symptoms that arise from it, as a Cough, Fever, difficulty of Breathing, want of Sleep; and that only whilst all, or some of these do yet remain in a great degree, and violent. But whenever these Tubercles are of a hotter Nature, When the Tubercles are hot, the Consumption is Acute. and thereupon more subject to a quick Inflammation and Exulceration, this Scrofulous, Consumption is very Acute, and terminates in a few Months; and as to the manner of Cure, differs but little from a common Consumption. Neither are we to make any other Prognostic in this than in another Consumption; to wit, that it differs in the event according to the degree and progress of the Disease, as I have said before. I have many times observed this kind of Acute Consumption to proceed from the stopping and drying up of a Scrofulous Scab; The Occasion of this Consumption. as the other more Chronical Consumption is wont to seize upon those that have been subject to cold Swell of the Glands. What is to be done in the hot Swell. In the beginning of these more hot Swell, liberal and frequent Bleeding is for the most part more necessary than in other Consumptions; by which means the Inflammation and Suppuration of the Tubercle may perhaps be prevented, though the incipient Tumour, that is begun to arise, may neither be lessened, nor perfectly wasted. Here also it is convenient to add your Figwort, Dropwort, Wood-lice, and other Antiscrophulous Ingredients to the Pulmonary Medicines. Here likewise the Gums and Balsams are very serviceable: As also my Balsamic Pills before mentioned, by a long use of which I have done more towards the perfect Cure of very many of this kind of Consumptive Patients than by any other Pulmonary Medicines. When they Apostemate, Specificks do no good. But if these hot Swell begin once to turn to an Aposteme, Specificks then do no good at all; but such kind of Consumptive Patients must be treated in the same manner as other Consumptive Persons, to wit, according to the degree and progress of the Disease. If the Swell are of a middle Nature, the Consumption is so too. But if these Swell be of a middle Nature, so that though they are apt to be inflamed, yet 'tis but slowly as they concoct the Matter contained in them into the form of Chalk, into the Nature of a Suet, or a substance like Honey; there follows thereupon a Consumption partaking likewise of a middle Nature; to wit, a Chronical one, that runs on for many Years, and is attended with a gentle and moderate degree of Symptoms, to wit, with a continual Cough at all Seasons of the Year, which yet is moderate, and not very dry: But in the Winter, and when the Air is thick it is more troublesome; a very mild, and almost insensible Fever, plainly of a Hectic Nature, accompanied rather with a lankness than an evident Consumption of the Flesh, as also with a delicate Stomach, rather than a want of Appetite: Which indeed is the most common Consumption of Old Persons, and often occurs in Practice. These Consumptive Patients with due care rub on a great while. I have observed that this sort of Consumptive People have not only lived a great many Years, though they have been crazy, but also with due government and care in those six things we call non-natural, have followed their ordinary Business. But upon committing of the least Error either in the quantity or quality of their Food, or in the time of Eating and Drinking, much more upon a Debauch, and the liberal drinking of Spirituous Liquors, or upon the getting of Cold, they are very subject to Putrid Fevers, and so long as they last the Patient's Life is in danger; and the Lungs being heated suffer more Injury from thence in a Week, than otherwise they would do in a Year. For the Fever that seizes this kind of Consumptive Persons, contrary to the proper Nature of the Tubercles, is Acute. But though in the beginning that, or even the Cough, and other Symptoms of the Lungs seem to be mild, and though the Habit of the Body be never so much emaciated, we must bleed them moderately, and (if there be occasion) we must repeat it at the first Invasion of the Fever; and with all the Medicines we use for the Fever, we must mix such Pectoral and Antiscrophulous Ingredients as are proper; by which means I have with the Blessing of God recovered one and the same Consumptive Person (as Mr. Andrews, and a certain Merchant in Philpot-Lane, with many others) from several Putrid Fevers, that have returned the same Year; and that without any great mischief occasioned to the Lungs by them. But the oftener these Fevers return, so much the sooner does the Consumption quicken its pace towards a fatal end; and the nearer the Consumptive Person is to this Fatal Day, the oftener are these Putrid Fevers apt to return, arising from the least occasion: The Inflammation of any new Tubercle (as it seems to me) always giving the occasion of this kind of Putrid Fever. The Cure of this Consumption where there is no Putrid Inflammatory Fever. But when there is nothing of this Fever, the Cure of this Consumption may be very well performed by observing those necessary Rules, which concern the six non-natural things, and that perpetually: By a long use of the Mineral Waters in the Summertime, unless there be some great Obstruction of the Liver, and a Dropsy proceeding from it. In the Wintertime by a frequent and long use of my Balsamic Pills, as also of the Gums, and other Balsamic Medicines; but in the Spring, and the Autumn, with a Diet-drink made with Wood-lice, Antiscrophulous, and Pulmonary Ingredients steeped in Beer, which must be prescribed for their ordinary Drink. And by these means I have recovered even some, that have been old; but a great many others, as Mr. Tibbs, Mr. Herbert, etc. I have brought to a better state of Health, than they could enjoy for a great many Years before. Expectorating, and other Pulmonary Medicines are useful to this kind of Consumptive Patients, as well as to others; except Opium, which must very seldom be given in this case, and that not without urgent Necessity, because of its fixing and stopping Nature. But these Pectoral Medicines, though they do some good, and give some present relief, yet they do not much promote the Cure of the Original Distemper without Antiscrophulous Medicines, and the other things I have now mentioned. A History. The only Son of Mr. Davison, an Eminent Citizen, and Merchant of London, that had been troubled from his Cradle even to his Youth with a Purulent Scab scattered up and down his whole Body, and often returning upon him, proceeding from a Scrofulous Habit, being quite tired and uneasy with it in his Youth when he was a Lad, got rid of it with I know not what Repercussive Plasters and Ointments, that he made use of by the Advice of some Old Women. Whereupon presently, which was about the Year 1678. he was troubled with a dry Cough all the Summer from Tubercles in his Lungs, occasioned by driving in of his Scab; which nevertheless he wholly neglected for a Month or two, until with a light Inflammation and Exulceration of the Swell in the beginning of the Autumn, he fell into a Putrid Intermitting Fever, with a loss of Appetite, a Thirst, and other Symptoms of that kind; at which time he desired my Advice, and with the help of the Peruvian Bark, of Balsamic and Pectoral Medicines, given in the Country Air, he seemed to be freed from his Fever, and in some measure from his Cough too. But through Impatience, and his averseness to Medicines, taking no further care of himself, he had a Fatal Relapse into his Fever, and likewise his Consumptive Cough, by which, together with a Looseness, profuse Sweats, a Dropsy, and other Symptoms of an Invincible Colliquation, he was carried off in the middle of the Winter following. In the Body, when 'twas opened, we found all the Lobes of the Lungs here and there bespattered with Tubercles of a various magnitude; some that were small, and newly bred; others that were pretty large, though they were crude; but some that were inflamed and exulcerated, containing in them a purulent Matter, that was of the consistence of Honey. This I took to be a Scrofulous Consumption of the Second sort, that is, Hot and Acute. CHAP. II. Of a Scorbutical Consumption. There is a Colliquative Ferment in all Scurvies. IN all Scurvies, but especially that which is Saline, the Blood always has in it a Ferment, which causes a great Colliquation, and likewise Secretion of the Chylous Lympha in the Glands; but especially in those that are seated about the Mouth, Jaws, and Lungs; and from hence it comes to pass that this kind of Patients, as they are subject to great Sweeting, and to make much Urine, so likewise to a continual spitting by the Salivatory Ducts, to a hawking up of tough Phlegm from the Tonsils, and to a frequent Cough, proceeding from a continual spewing out of a Serous Liquor by the Glandulous Coat of the Windpipe. But this Scorbutical Lympha, that is excerned by the Tonsils and the other Glands, though it admits of some Concoction, yet (as it abounds with a fixed Salt, and is in its own proper Nature glutinous) it has always some toughness; The Cough in a Scorbutical Consumption is not violent. and hereupon the Cough of this kind of Consumptive Persons, though it be continual, yet is not so violent and dry as it uses to be in others, where the Serum, that is thrown out by the Glandules is thinner; whereupon there arises a fierce and troublesome Cough from the continual spewing out of that Serum by the Windpipe; or at least a perpetual tickling molests them from the swelling of its Glandulous Coat, whenever the Lympha does not find a convenient passage out of the Glandules; and from hence for the most part there arises a violent and dry Cough. From whence it comes to pass that in a Scorbutical Consumption, by reason of the viscousness of the Matter that is separated, by which the Coat of the Windpipe, and of the branches of it, is rather troublesomly besmeared, than irritated, the Patient is not so much provoked to Cough, as he makes a Cough of his own accord to bring up the Phlegm that sticks, and is troublesome to him; But Asthmatical. and hereupon this kind of Cough comes near to the Nature of an Asthmatical Cough, and is attended with a greater Wheesing, difficulty of Breathing, Constriction, and weight of the Lungs, than we use to observe in other Consumptions. This Consumption is very Chronical. And from hence also a Scorbutical Consumption proves very Chronical, and never threatens a sudden Fatality without a spitting of Blood, or some other great Symptom coming upon it. This kind of Consumptive Patients, Every little Error makes these Patient's Feverish. though they spin out their Life to some length without any Medicines, only by a due government and care in those six things, called non-natural, yet they live sickly, and upon committing the least Error in their Diet, or taking of Cold, they are wont to be Feverish, and to lose their Stomach. The Signs, that presage this Consumption, The signs of this Consumption. are especially two; to wit, a frequent eruption of Spots scattered up and down upon the whole Skin like the Miliary Shingles, and a perpetual hawking up, but especially in a Morning, of Phlegm, that is salt, and troublesome, thrown out by the Tonsils, which is many times accompanied with an Exulceration, and wasting of the Gums. The manner how it is to be cured. But in what manner the Cure of this Consumption is to be altered from the General Method I have already described, I shall here briefly observe, to wit, Opium is hurtful. First, Opium is always mischievous, unless it be upon the taking of new cold, and then only it must be given to mitigate the Symptoms that arise from it; because it makes the Phlegm more tough, and hard to be expectorated. Inciding Medicines are bes● of Pectora●s in this case. Secondly, Amongst the Pectoral Medicines, those that are cutting and cleansing, are always, to be preferred, for helping, and making the Expectoration easy, or at least they must be mixed with others; as Honey, Mead, Oxymel, Gums, and Balsams, Wood-lice, Syrup of Hedg-Mustard, of the five Opening Roots, the Balsamic Syrup. But above all, I commend my Balsamic Pills, which I have already described, the Use and Efficacy of which in a Scorbutical Consumption I have often had Experience of. Antiscorbutics must be mixed with the Pectoral Medicines. Thirdly, Antiscorbutics must always be mixed with the Pectoral Medicines, that at the same time, when the flux of colliquated Matter is expectorated with the help of the Pectoral Medicines, the Ferment, that causes this Colliquation, may be destroyed, or at least abated by the Virtue of Antiscorbutics. Otherwise so long as the Cause is not taken away, the Distemper itself cannot admit of a perfect Cure: But we must make choice of the milder sort of Antiscorbutics, such as may cause the least heat and disorder in the Blood; as Water-cresses, Brook-lime, Pine-tops, the Leaves of Tun-hoof, red Dock-roots, Male Piony-roots, etc. of which a Bag may be made to be hung in Ale for ordinary Drink: By which means the Volatile Salt of the Simples (in which the Energy of the Medicine consists) is better preserved, than in Apozemes, and so the Virtue of the Medicine is more freely communicated to the Blood, and the Appetite is less injured by them. Fourthly, Steel is useful. Also Steel is very useful in the Cure of this Consumption, unless it runs hastily on to its Fatal Period. If it be an Acid Scurvy, than Salt of Steel will be proper, a Grain or two of which may be mixed with every Dose of the Balsamic Pills. If it be a Salt Scurvy, Mynsicht's Extract, which we have already taught how to give in the form of Pills. Especially the Chalybeate Mineral Waters. But in all Scorbutical Consumptions the Chalybeate Mineral Waters are to be preferred before any Artificial Preparation of Steel in the Summertime (if it be so the Consumption has not reached to the third degree) because they are endued with an extraordinary power, not only to open the Obstructions of the Nerves, and to penetrate and dissolve the Tubercles▪ but likewise to temper the Hectical Heat in the Blood and Spirits, to quench the Drought, restore the Appetite, and to procure a Briskness and Cheerfulness of Mind; the Efficacy of which in curing this kind of Consumptions above any other Method of using Pectoral Medicines, I have very often experienced with great Success. And therefore I shall add at the end of this Chapter a History or two of their extraordinary Virtue in the curing of a Scorbutical Consumption. But the use of them ought to be repeated every Year, because this Chronical Distemper does not use to be overcome with one blow. Fifthly, If the Patient is costive, What is to be done if the Patient is Costive. the Purging Mineral Waters are here also very useful, as also any Stomack-Pills before described; by the help of which, being repeated once or twice a Month, my dear Father did happily prolong his Life in a Scorbutical Consumption for many Years. Diversion and Cheerfulness necessary for these Patients. Sixthly, The Patient must recreate his Mind, and all Lawful means must be used to make him cheerful: For as this Distemper for the most part takes its Original, so likewise its fatal Increase from Grief, and disturbance of the Mind. A Milk Diet seldom agrees with them. Seventhly, A Milk Diet seldom ●…ees with this kind of Consumptive Persons, by ●eason of the Acid, or Salt Ferment of their Stomaches; and generally speaking, is wont to disagree as well with Scorbutical, as Hypochondriacal Persons. The use of Tobacco is to be much suspected. Eighthly, The taking of much Tobacco is likewise to be much suspected in this Consumption; because not only it increases the Ill and Salt Ferment of the Stomach, by reason of the abundance of Salt that is contained in it (whereby the Colliquation, that is caused by a Saltness, is increased;) but also because that Saline Smoke by irritating the Salivatory Ducts, does promote a more plentiful excretion of the Spittle, and that not only by the Glandulous Coat of the Mouth, but also by the Tonsils, and the whole Trunk of the Windpipe, even to the very Lungs; from whence it comes to pass, that as the troublesome hawking up of Phlegm from the Tonsils, so also the Cough of the Lungs is wont to be promoted. Finally, the shaving of the Head and many Issues are here very advantageous, because they conduce very much to the lessening of the quantity of the Serous Liquor, that abounds in this Distemper, the one by promoting a Perspiration, the other by deriving that Liquor to themselves. A History. Mr. Hunt, a Citizen of London, that had been a Scorbutical and Hypochondriacal Man, lived almost from his Youth to the Seventieth Year of his Age in a Consumptive state, doing his Business well enough by taking care, and rightly managing himself without the help of Physic, till he was above Sixty Years old, from which time being very much emaciated he was very often subject to a Catarrhous Cough, that was also something Asthmatical, to a want of Appetite, especially in the Winter, and likewise to a light Peripneumonical Fever from a slow Inflammation of the Tubercles of his Lungs: From which he was easily freed by the Advice of a Physician. He also had three Sons, all which, though they were Scorbutical and Hypochondriacal by Inheritance, yet they seemed strong and lusty even to the Thirtieth Year of their Age. About which time they were all one after another seized by the same Right of Inheritance with a Consumption occasioned by Passions of the Mind, and the drinking of Spirituous Liquors; from whence it came to pass, that by reason of their neglect of a due Government, this Distemper (which was so Chronical in the Father) was Acute enough in his Sons; and (if I well remember) carried them all off before the emaciated Old Man died. One of these Sons, to wit, the Eldest, after he had continued his Hectical Heat for some Years by Cares and Drinking, falling into a want of Appetite, Thirstiness, a dry Cough, and heavy Oppression in his Breast, committed himself to my care. After Bleeding, gentle Purges, and the plentiful use of Pectoral and Balsamic Medicines, he seemed to be something better: But yet his Hectical Heat, Cough, and weakness of Appetite still continuing, I sent him to drink Tunbridge. Waters in the open Country Air (the time of the Year favouring that Advice) I expected more from the due use of the Waters, than from the most pompous Apparatus of Medicines: For although he did not stay so long as he ought to drink the Waters, nor fortified himself by a due Government, yet he came back after a Month recovered in his Flesh, his Looks, and Appetite; and almost perfectly freed from his Cough and Hectical Heat too, till the next Winter entangling himself with Cares and much Business, and falling to his usual drinking of Wine, he felt a return of all the former Symptoms; of which he could not be relieved by any Prescriptions of the most able Physicians, and so about the next June he died at Ebisham, where he had lived for some time for the benefit of the Air. His Widow, as well from her grief for the Death of her Husband, as from other causes, as from taking of Cold in often Watching with him, and perhaps by Infection too (because she lay with him to his dying day) but especially because she seemed predisposed to a Consumption from a Salt and Scorbutical Habit of Body; after a Month began to have a dry Cough, a very great Hectical Heat, an extreme Thirst, and almost a total want of Appetite, together with a squalid Look, an emaciated Habit of Body, a continual Oppression of her Lungs, a Weakness, and all the Symptoms of a very Acute Consumption: So that (if I must speak ingenuously) I did expect that she would within a Month or two follow the lamentable Fate of her Husband let her be never so diligent in the use of the best Medicines of the Shops that I had any knowledge of, unless the extraordinary heat of the Blood and Lungs could be extinguished by a great plenty of some diluting and temperating Liquor, which would obtund the sharp Salts of her Blood, and open the Obstructions of the Nerves at the same time. And therefore after a light Ventilation by taking away a little Blood, I ordered her (because her Body had been costive) Ebisham Waters made into Posset-drink, by way of Preparative; and afterwards, that she should drink Sadler's Waters at Islington, the extraordinary Virtue of which to extinguish a Hectical Heat, I had that very Year with great Success found in myself, as well as in several others. I ordered likewise a Pearl Julep, her Faintness, and the heat of her Blood and Spirits requiring it. But by reason of the sickness and weakness of her Stomach, she could not take any Linctuses, or Pectoral Apozemes, much less Balsamic Medicines. And because of her great difficulty of Breathing, I was very doubtful of the use of Opiates. And thus for the present I left her. The Purging Mineral Waters she took once or twice, which put her into a Looseness, that held her for three Weeks, (and I knew nothing of it) her Fever still flaming, and her Thirst, Cough, difficulty of Breathing, Consumption, Atrophy, Weakness, and other Symptoms increasing. But she wholly abstained from, and was plainly afraid of using the Islington Waters, because that was the first Year they were found out, and there were a great many Reports spread abroad of their Mischievous Nature. But one time when I was not sent for, going to visit her in her Chamber, to know certainly what Effects the Chalybeate Waters had had, because I had heard nothing either from her, or from her Brother the Apothecary; I found her in a worse condition than ever before, and her Fever, Cough, and Atrophy, with all the other ill Symptoms before mentioned, so much increased by a Looseness, that was come upon her, and had now continued so long, that she could hardly rise out of her Bed. But at last being prevailed upon by the Reasons, and the Experience that I urged I had lately had of them, she consented to try the Virtue of Islington Waters. And in order thereunto, I ordered a Dose of my Astringent and Opiate Electuary to be given every Night for her present Looseness, when it was necessary; and the next Morning always to drink a Quart, three Pints, two Quarts, five Pints, three Quarts of the Waters in Bed; and likewise for her present use a little warmed, because of the coldness of that time of the Year (for it was passed the middle of September) and to persist in the use of them a Month, if they did but pass well by Urine, and not work or go off by Stool; and that she should be of good Courage if her Appetite began to return, and her Thirst, with the other Symptoms of her Fever were abated upon the use of them; but if it happened otherwise, that she should let me know it, that I might presently do what I could to help her. But being hindered by a great deal of Business, I heard no more of her till three Weeks after, she and her Brother came to me as I was in my Study, she being now plainly free from her Fever, Cough, and Weakness, and perfectly recovered from her Consumption to a Miracle; and making no more complaint but of too great a greediness of her Appetite, which yet I promised to reduce to a moderation, as soon as she had got up the Flesh, which she had lost, by the long use of good Nourishment, the truth of which she found by Experience in a short time. Neither did I prescribe any Medicine, but only that she should use a Diet-drink made with Antiscorbutic and Pectoral Ingredients the space of a Month for her ordinary Drink. With which she recovered her perfect Health, and is yet alive, and continues well at her Father Mr. Minakin's House, at the Sign of the King's Head in St. Martin's, near Aldersgate. I could give several such Instances of the extraordinary Efficacy of the Chalybeate Waters in Curing a Hectic Fever, and an incipient Scorbutical Consumption of the Lungs, but that I endeavour to be as brief as I can. CHAP. III. Of an Asthmatical Consumption. THough every Scorbutical Consumption is of an Asthmatical Nature, yet by this I especially understand that, which proceeds from a true Asthma as the preceding Cause, and depends wholly upon it. Every Asthma has a tendency to a Consumption. For every Asthma, but especially that which is Humerose, has a tendency to a Consumption; because in this Distemper not only the Lungs are very often straitened, and drawn together in the Nature of Spasms (whereby the Tone of them is wont to be injured and destroyed, and a thick viscid Humour is wont to be pressed out of their substance into the branches of the Windpipe by that frequent compression, which sticking fast there, causes a Cough, Wheesing, and difficulty of Breathing) but likewise from the previous disposition of the Blood to be viscid and tenacious, the Lungs are almost always knotted from the very beginning of this Distemper; which Knots or Tubercles in progress of time are wont to be inflamed and exulcerated; from whence there follows a true and fatal Asthmatical Consumption. How this Consumption is distinguished from others. But this Consumption is to be distinguished from others especially by this, that it is accompanied through the whole course of the Disease with a Wheesing, and extreme difficulty of Breathing, because the Humour, that is continually pressed out of the Tubercles and substance of the Lungs into the Windpipe, and branches of it (as I hinted before) is always thick and viscid, sticking tenaciously and troublesomly to the sides of the Windpipe and its branches like Glue, and so hindering the free passage of the Air. But this Consumption, This Consumption is very Chronical. though it is usually Fatal and Incurable, yet in its own Nature it is very Chronical; so that I have seen some, who, though they have been in an Asthmatical Consumption, yet have lived several Years with the help of a due Government, and of a thin Air. The cause of which thing seems to me to be the toughness and viscidity of the Humour thrown out by the Lungs in this Consumption. For this Humour, by reason of the great quantity of Salt contained in it, easily and quickly admitting some concoction, though into a viscid Matter, loses a great deal of its corrosive Acrimony; and thereupon becomes more benign, leaving a less impression behind it upon the Lungs, than where it is sharp, thin, and perfectly crude, and admits of no Concoction at all. Old Age is such a Consumption. And indeed Old Age seems to me to be this kind of Chronical and Incurable Consumption; because all Old People, that are not seized with some Acute Disease, languishing in this manner with a Consumption, do at length come to the period of their Lives, but not without such forerunners, as a Chronical Cough, a difficulty of Breathing, a wasted lean Habit of Body, and something of a Hectic Disposition. And we need not wonder at it, when the small Fibres of the Substance of the Lungs, by reason of a great Age losing their tensness, are wont to fall together; from whence it comes to pass, that the whole Substance of the Lungs grows slabby like a Quagmire, from the Nutritious Juice being separated, and stagnating there; and upon that there is that plenty of viscid Phlegm, a Wheesing, Asthmatical stuffing of the Lungs, difficulty of Breathing, an emaciation of the whole Body, and a Hectical Disposition. And why should I use many words, when there follows plainly a Consumption of Old Age? Neither is a Milk Diet nor Opiates convenient in this Consumption. 1. A Milk Diet is seldom convenient in this Consumption, much less Opium, because by increasing the thickness of the Humours, it promotes the difficulty of Breathing, and all the other Symptoms of this Consumption; so that I have sometimes in this case seen the Life of a Patient brought into sudden danger with but one Grain of Opium. A thin Air is necessary in the Cure of it. 2. A thin and open Air is more necessary in the Cure of this Consumption, than in any others. Neither indeed can this kind of Consumptive Persons live long with the use even of the most Generous Medicines in a foggy or smoky Air. Inciding Medicines are the best sort of Pectorals. 3. Amongst the Expectorating Medicines the best are such as are Cleansing and Inciding, as Honey, Mead, Syrup of Hedg-Mustard, of the five Opening Roots, of Vinegar: We must avoid, at least we must be very cautious in giving Incrassating things. Balsams, Gums, Wood-lice, but especially my Balsamic Pills, are here of great use: As also Spirit of Hartshorn, of Salt ammoniac, etc. whenever the Consumption depends upon a Convulsive Asthma. What is to be done in violent Asthmatick Fits. 4. This kind of Consumptive Patients are many times taken with Fits of an Asthma to a great Extremity. In which case it is necessary to open a Vein, though the Patient be never so much emaciated; and it is as convenient to give Riverius' Emetic Mixture of equal parts, of Oxymel of Squills, and strong Cinnamon-water, or something of that Nature; and to repeat it often, because it takes off the Spasmodick contraction of the Lungs by its Carminative Power, and by its Abstersive Faculty it cuts and brings up the Phlegm. But yet we must bleed them sparingly, according to the Patient's strength; and we must not give that Mixture of Riverius, unless there is an absolute Necessity. A History. Mrs. Sherwin, a Virgin, that had been for many Years passed troubled with an Asthma, especially in the Winter, and when she lived in London; with the help of a due Government, of the Country Air, etc. she seemed to do her Business well enough, till she was Forty Years old, or thereabouts. From which time she began to be somewhat Consumptive, with an increase of her Cough, and her difficulty of Breathing growing worse and worse every day, her Appetite likewise being spoiled from her Feverish Hectic Heat, which then began to seize her. But with using the Chalybeate Waters, my Stomack-Pills, my Balsamic Pills, and other Pectoral Medicines (the Country Air likewise contributing very much) for two or three Years she seemed much relieved, and almost perfectly recovered. But at length upon a Peripneumony arising from an Inflammation of the Tubercles of the Lungs, she fell into a Colliquative Fever, together with a Looseness, Dropsy, Vomiting, profuse Sweats, and the other Symptoms of a Fatal Consumption, and died almost in the Flower of her Age of this Consumption, which I call a Consumption of Old Age; and if you had seen her before she died, you would have taken her for an Old Woman. When the Body was opened, we found the Lungs every where knotted, and in many places inflamed, yea, maturated and ulcerated. The same I observed in Mr. Baxter, an eminent Citizen of London; who from a Chronical Asthma fell at last into a fatal Consumption, of which he was much, and a long time relieved with the use of Spirit of Salt ammoniac, and Pectoral Medicines, but especially Balsamicks; but after a Year or two, his difficulty of Breathing being very much increased, and having a Looseness come upon it, together with the Gripes, a Dropsy, and other Symptoms of a fatal Consumption, he was carried off. But the Asthmatick Fits (which used to return often) I always took off with the use of Riverius' Mixture (when he once grew too weak to bleed) with very good Success, and with great Relief to the Patient, even to his dying day. Mr. Rand, a noted Apothecary of London, rubbed on many Years in the state of an Asthmatick Consumption (though he was emaciated and weak) with the plentiful use of Spirit of Hartshorn, of Pectoral, Chalybeate, and Balsamic Medicines, and a due management of himself in those six things, which we call not Natural. And although he was often in a Year subject to a light Peripneumonical Fever from a new Inflammation of the Tubercles of his Lungs, yet with Bleeding, and a due management, and the use of Pectoral Medicines, he as easily escaped: But the extraordinary benefit of Emetic Medicines I often found in him, whenever he seemed to be in very great danger from the increase of his Asthma, and from his loss of Appetite, and great Weakness following upon it. CHAP. IU. Of a Consumption proceeding from Melancholy, as also from an Hysterical and Hypochondriacal Affection. ANY one, that has been but a little concerned in the Practice of Physic, Hypochondriacal and Hysterical Persons are often Consumptive for a long time, and at last die of it. The Reason why it is so may easily observe, that those that are Hypochondriacal and Hysterical, do often live a long time in a Consumptive state, and at length being seized with those Symptoms of a Consumption of the Lungs, that accompany the last and fatal degree of it, they die. The reason of which thing may be easily gathered from the Principles which I have already mentioned. For in an Hypochondriacal and Hysterical Affection, the Brain, and the whole System of the Nerves are always distempered; and thereupon not only the Animal Spirits do degenerate into a Windy and unquiet Nature, but also the whole Mass of Blood, which ought to be duly actuated and invigorated by those Spirits, is turned into a crude and cachectical load. And indeed we have reason to wonder that a Consumption does not always follow, where there is such a destruction of the Tone of the Nerves, and from such a disposition of the Spirits and Blood. Moreover every one knows that some troublesome Passions of the Mind do for the most part precede, or at least accompany an Hysterical, and an Hypochondriacal Affection. From which (as I have already observed in the beginning of this Discourse) a Consumption is wont oftener to take its Original, than from Cold, or any other Occasion. Besides those that are Hysterical and Hypochondriacal from Fear and Anxious Thoughts, are very often subject to continual Suffocations, and Oppressions of their Breast (which are nothing but Spasmodick contractions of the Muscles of the Breast and Larynx, and of the tender Substance of the Lungs) whereupon their Tone being once weakened and destroyed, no Body can think it strange if there often follows a Consumption. This Consumption is for the most part Chronical, yet fatal. But this Consumption for the most part is Chronical, because it depends upon a morbid disposition of the Spirits, and Humours contracted by degrees: But yet for the most part it is Mortal, not only because they are seldom frighted at it by reason of the insensible Progress of it, until the Patient, that had been a long time sickly, falls at last into a deep Consumption; but also because the stock of Humours, upon which this kind of Consumption depends, is plainly not to be exhausted. How it is distinguished from other Consumptions. This Consumption may be distinguished from other Consumptions especially by an Oppression of the Breast, and an unusual Sadness of the Mind; as also by frequent Hysterical Choaking, Faintings, and other Nervous Symptoms. The Cure is almost the same as the general Method. But the Volatile Spirits and Cephalicks must be given more plentifully in this Consumption. The Cure is not to be altered much from the General Method. Yet I will subjoin some Observations concerning it. First, In this Consumption, because the great Weakness, and Obstruction of the Nerves require it, we must allow, if not even enjoin, a more liberal use of Spirit of Hartshorn, Spirit of Salt ammoniac, Tincture of Castor, Hysterical Water, and Compound Piony-water, and other things of that Nature, than we use to do in other Consumptions; the extraordinary Efficacy of which in relieving the Symptoms of this kind of Consumptive Persons, I have very often found by Experience; and indeed without these neither their Faintness, nor Choakings (which are Symptoms that are wont very frequently to affect these Patients) nor indeed the Cough itself (which in this Consumption does for the most part proceed from the Genus Nervosum) can be mitigated. Secondly, The Chalybeate Waters are very useful. Likewise the Mineral Waters are very useful in this case, and indeed without Chalybeate Medicines, those which are commonly called Pectoral and Antiphthisical, do no good. But they must be put upon the use of this kind of Medicines in time, before there appear any signs of an Ulcer of the Lungs, for fear the Patient should find more hurt than good from them, when Nature is once by degrees reduced to such a colliquative state. Thirdly, Neither a Milk Diet nor Purges are convenient. As a Milk Diet seldom is convenient for this kind of Consumptive Patients, so neither for the same Reasons (to wit, the weakness of their Nerves, and the preternatural sourness of their Stomaches) do Purges do any good, especially to Hysterical Women, unless they be very gentle, and given in due time. Fourthly, But gentle Vomits, Gentle Vomits are very beneficial. and such as are fitted to the strength of the Patient in the beginning of the Distemper, are wont to help this kind of Consumptive Persons to a wonder, by relieving the Brain and Nerves. Fifthly, Opiates are many times necessary. The use of Opium may not only be allowed by a Physician, but many times it appears plainly necessary, perhaps more in this, than in any other Consumption of the Lungs, by reason of the grievous Spasms of the Stomach, Intestines, and other parts, which are wont to happen to this kind of Consumptive Persons more than to any others from their pertinacious Watch, and other Symptoms, by reason of the windy and explosive state of the Animal Spirits, and the delirious activity and working of their Fancies. History 1. Mr. Richards, a Citizen of London, that lived in Southwark, a Man that was lean, and of a truly dry and cold Temperament (as the Ancients were pleased to speak) somewhat dull and Melancholy from his very childhood, before the fortieth Year of his Age fell into a Melancholy Delirium, from which he was perfectly freed by the long use of Chalybeate Medicines, gentle Purges, Antiscorbutics, and Cephalicks; the taking away of some Blood in time from the Jugular and Haemorrhoid Veins, contributing thereto. But although he was freed from his Melancholy, yet he continued lean, and something thoughtful, and many times too he was troubled with a little, dry Cough, which he had been subject to for a long time. But this he wholly neglected for several Years, till at length being frighted with the loss of his Appetite, with his Thirst, difficulty of Breathing, Weakness, colliquative Sweats, a violent Bloodyflux, attended with horrid Spasms, and other suchlike fatal Symptoms of a deplorable Consumption; and being moved with the present sense of his danger, he in vain desired my Assistance, because it was too late. There was one thing very remarkable in this Patient, and that was, that though he could not by reason of his great difficulty of Breathing bear the least Dose of Opium without apparent danger of his Life, yet from that time that the racking Pains of his Bloodyflux, or Spasms of his Bowels began to be violent, he seemed to be plainly freed from his Cough as well as his difficulty of Breathing, and indeed he breathed as if his Lungs had been perfectly found again, and bore the plentiful use of Opium without any inconvenience, until the Bloodyflux, with the racking Pains being once overcome with the long use of it, his difficulty of Breathing, together with the Cough that was as troublesome as before, returned, as if that Spasmodick Vellication of the Bowels had been presently changed into a constriction of the Lungs and Membranes of the Breast. But in the alternate Succession of the aforesaid Symptoms, one might easily see the Patient declining every day, and this Chronical Consumption, that had been neglected, hastening to its fatal end, of which I undertook only a palliative Cure. History 2. Mr. Prat, who lived in Pater-Noster-Row, being lean and Melancholic from his Childhood, of a cold and dry Constitution, and often subject to a Spasmodick pain of his Stomach; after he had been married a Year or two fell into a Consumption of his Lungs, but yet a slow and Chronical one, accompanied with a dry Cough, an Oppression and Constriction of his Lungs, as also a loss of Appetite; but yet without any remarkable degree of a Fever, or quickness of Pulse, by reason of the Natural coldness of his Constitution. For a Year or two he did not take care to eradicate the Disease, contenting himself with I know not what Receipts of some Old Women to help his Cough; till at length having some apprehension of the approaches of Death from the total loss of his Appetite, from a difficulty of Breathing, a Cough, Fever, and an universal Colliquation coming upon it, he begged my Advice, when it was too late, at the very beginning of the Winter. Because of his difficulty of Breathing, and his troublesome Cough, I sent him into the Country Air, and put him upon the use of Pectoral and Balsamic Medicines; whereupon he seemed for a Month or two to be better as to his Appetite, Cough, and Breathing. But being weary of the Country, he came up again to London: From which time all things grew worse, but above all his Cough and difficulty of Breathing were violent upon him, so that he was troubled almost with continual Watch. At length of a sudden, and without any evident cause, he was taken with dreadful Spasmodick Pains, like a Colic of the Stomach, his Body being at the same time locked up, so that every moment he seemed as if he were a dying with the violence of the pain. From which time he was perfectly freed from his Cough and difficulty of Breathing, fetching his Breath as well as if his Lungs were no ways affected. And therefore, the violent Symptom requiring it, I gave not only Opiates, but also cathartics, in a good quantity for several days; till at length with the use of Liniments, Fomentations, Clysters, Purges, and especially the frequent repetition of Opiates, those racking Spasms (which towards the latter end were inconstant, moving from one side to the other, and going from his Stomach to the Intestines, as being truly of a Hypochondriacal, or Spasmodick Nature) were plainly overcome. After this for some Weeks he continued free from the Spasmodick Constriction and straightness of his Lungs, and recovered something of an Appetite, and of his Strength; so that I myself began to have a great deal of hopes that he would quickly recover his Health, and thought him to be rather Hypochondriacal, than Consumptive; till at length the unexpected return of his difficulty of Breathing, Cough, and the other fatal Symptoms of a Consumption (of which he died at last) obliged me to alter my Opinion. History 3. Mrs. Walker, a Merchant's Wife of London, about the Thirtieth Year of her Age becoming Hypochondriacal and Hysterical from many preceding Cares, and Passions of her Mind, at length fell into a Hectic Fever, with a Cough, difficulty of Breathing, pain in her Side, and Looseness; which made her extremely weak, and brought her almost into the state of a Marasmus. But with the diligent use of Opiates, Hysterick Juleps, the Peruvian Bark, of Pectoral Antiscorbutic, and Chalybeate Medicines, and repeated Bleeding, she was restored even in the Wintertime to a state of Health, beyond the expectation of all her Friends. But two or three Years after, upon the Death of her only Daughter, and her Grief which was occasioned by it, she relapsed. From which she recovered again in the Spring with the timely use of Islington Waters, and the benefit of the Country Air. From which time she gave herself to the drinking of too much Brandy, and other Spirituous Liquors, to keep up her Spirits; with the liberal drinking of which, as she plainly lost her Appetite, so at length, that is, after a Year or two, she had a fatal return of her Consumption that Winter, together with a flaming Hectic Fever, a continual Cough, difficulty of Breathing, Looseness, and indeed an universal Colliquation. Neither would she ask my Advice until she was hardly able, by reason of her Weakness, to turn herself in her Bed. However with the use of the Peruvian Bark, and of Opiates, I plainly freed her from her Fever and Looseness. But yet the other Pulmonary Symptoms increasing every day, she was carried off by the Consumption returning this third time. CHAP. V. Of a Consumption caused by spitting of Blood. THAT common saying amongst Physicians, That Purulent Matter follows Blood, seems to have had its Original from hence, because an Aposteme of the Lungs, or a Pulmonary Consumption is wont to follow a spitting of Blood sooner and oftener than any other Distemper. Which whether it happens from the Crasis of the Blood being spoilt by too great a loss of it, or from a plentiful Flux of the Humours from the whole Habit of the Body into the tender Lungs, where they have a free passage; or from the Putrefaction of the clotted Blood, that remains in the Lungs after the spitting of Blood; or lastly, from some Ulcer following upon the erosion of the Vessels, I do not well know. A Consumption usually follows a spitting of Blood. A Physician must endeavour to prevent the one, as well as to cure the other. But this we may almost always observe, that where a spitting of Blood has preceded, a Consumption of the Lungs is wont to follow. And therefore a Prudent and Honest Physician, when he is called to one that spits Blood, ought not only to take care of his own Reputation, and the Honour of Physic, by making a Prognostic at first of the Consumption that is like to follow, but also as far as he is able by necessary Cautions, and proper Medicines, to prevent this fatal event of the spitting of Blood, as well as to Cure the present Distemper, at least not to do or attempt any thing in the Cure of it, that may make the Patient more subject to a Consumption. We must distinguish between an Accidental and an Habitual Haemoptoë. And here it is necessary to distinguish between an Accidental and Habitual Spitting of Blood. I call that Accidental, which proceeds merely from some Accident; as from Hollowing, or speaking too loud, Exercise, or a violent Cough, from the suppression of some usual Haemorrhage, from Chalky Stones, that are bred in the Lungs themselves, or from Pins, and any other things that slip down into them from without. That I call Habitual, which depends upon a vitiated, sharp, and fermenting Disposition of the Blood; so that the stock and fuel of the Disease always lurks within. An accidental Haemoptoë seldom ends in a Consumption. That Accidental spitting of Blood, as it seldom returns when it is cured after letting of Blood, a due ordering of their Diet, and the use of proper Medicines; so though the Bleeding has been profuse and plentiful, yet it seldom terminates in a Consumption; but the Patient being once by degrees freed, with a due management recovers his fresh Colour, and gets his Flesh, as if he had never been troubled with such a Flux, as it usually happens after an immoderate Flux of the Menses, and other Fluxes of that kind. But an Habitual spitting of Blood, as it depends upon an intestine motion of the Blood, that is in a Ferment, and upon the Acrimony of it, An Habitual Haemoptol● hot always a Fever joined with it. by which it opens the Vessels; so it has always a Fever joined with it, together with a quick Pulse, and an Urine that is something high-coloured, and is likewise wont to return after uncertain intervals; to wit, whenever the inconstant Feverish Fit returns, from the force of the Blood, that is in a violent Ferment, the tender Vessels of the Lungs being not able to endure this quick motion of the Blood, are wont one time after another to be opened, and then there follows a great expense of that red Liquor, which for the most part does not stop till the Feverish Orgasm, and the Intestine motion of the Blood depending thereupon, perfectly ceases, either with the help of Art, or of its own accord, at least with the lessening the quantity of the Liquor. And then too there is but a treacherous Truce, until the next time that the Vessels happen to be too much distended by the preternatural motion of the Blood in the next Fit. And often ends in a Consumption. And indeed this is that fatal spitting of Blood, which as it is hard to Cure, and often comes unexpectedly upon the Patient, so it has at first a Putrid, than a Hectic Fever joined with it, which is wont very often to terminate in an Incurable and Fatal Consumption. The Grand Antidote for this spitting of Blood is the Peruvian Bark, The Peruvian Bark is the great Remedy in this Haemoptoë. the extraordinary Virtue of which both to extinguish the present Feverish Effervescence of the Blood, and to prevent the return of it, I have always experienced with very great Success, whenever I have made use of it for this purpose. And as it quickly and safely stops the present spitting of Blood, An Haemoptoë cured this way does not end in a Consumption. and likewise prevents it for the future; so I never see a spitting of Blood that was cured this way, end in a Consumption. For the Flame being in this manner perfectly put out, and the Fever once overcome, the Blood uses presently to recover its Natural state, so that there cannot remain the least suspicion of a Consumption following upon it. For a Consumption, that uses to follow a spitting of Blood, does not seem to have its Original so much from the breaking or gaping of a small Vessel, as from the inordinate and Hectical state of the Blood. And therefore though a Consumption usually follows a spitting of Blood, when 'tis cured the common way, that is, by frequent Bleedings, Emplastic Medicines, Opiates, etc. which rather hinder the Eruption of Blood by force, than altar the internal state of the Blood: Yet no one will wonder if the Hectic Flame remaining within does at length throw the Patient into a Consumption; yet whenever the present Orgasm of the Blood is so overcome by repeated bleeding, the use of the Temperate Juices, of Astringent and Opiate Juleps and Electuaries, and other things of that Nature (which are to be found in another place in the Chapter of a Haemoptoë, or spitting of Blood) that we have an Opportunity to give the Bark totally to extinguish the Feverish flame, and to open the Obstructions, which otherwise might occasion a new Effervescence, we commonly make not only for the present a palliative but a truly, eradicative, and perfect Cure, without the least danger of the return of the spitting of Blood, or of a Consumption following upon it. For the flame being in this manner perfectly extinguished, the Blood is reduced to its Natural Motion and Crasis, whereupon the Appetite presently returns, the Lungs recover their Natural Motion and Temperament, and the loss of the Blood is by degrees repaired; until at length the Patient obtains, though by little and little, his former strong and lusty state, and it may be a better than he had before, without the least degree of a Hectic Heat, or the danger of a Consumption following upon his Bleeding. In this Consumption there are Tubercles in the Lungs. But if either through the Physicians neglect, or from the peculiar Constitution of the Patient, or from any other cause, it so happens, that a Consumption of the Lungs succeeds to a spitting of Blood, the whole Lungs, or at least one of the Lobes, being stuffed with hard Glandules scattered every where up and down in the form of Tubercles, is much swelled. And these Tubercles are wont sooner or later to turn to Apostems, and to be ulcerated, and from thence this Consumption has its Original, and Progress too. But according to the Magnitude and Number of these Tubercles, The Nature of which makes the Consumption various. and their disposition to a more quick or slower putrefaction, this Consumption is very various; sometimes slow, and Chronical; sometimes quick and Acute, yea, very Acute. For as I have seen some Persons that have been in a Consumption (who have been subject to a frequent spitting of Blood from the least occasion) live several Years with due care and management; doing likewise their business, though they have been sickly, with a Cough, and some degree of a difficulty of Breathing; to wit, whenever the Tubercles of the Lungs happen to be few, small, and not apt to putrefy; or whenever the spitting of Blood proceeds rather from Stones that are bred in the Lungs, or from some external Accident, than from an Intestine Hectical motion of a hot Fermenting Blood: So I have observed others that have been carried off with a quick Death within the space of a few Weeks; and that has been when great Haemorrhages have often returned upon the Patient from the Commotion of the Blood boiling vehemently, or when the Tubercles have partaked of some malignant Nature, and so have been quickly putrified. But whatever this Haemoptoïcal Consumption has been, whether Acute or Chronical, This Consumption is one of the most fatal. it has from the common Observation of Physicians been always reckoned amongst the number of the most Fatal and Incurable Consumptions. But the more Acute it is, the more dangerous it is wont to be. For as the spitting of Blood is the first occasion of this Consumption, so likewise it is very apt in the Progress of the Distemper to return often, either from the taking of the least Cold, or the committing any Error in their Diet, from Passions of the Mind, etc. And every new spitting of Blood bushes on the Consumption to a Fatal end. So that I have often seen this kind of Consumptive Persons in the very Haemoptoë, when it has returned upon them, spit out their very Lives in that stream of Blood which has come from them. And therefore in the Cure of this Consumption, Inciding and Lubricating Medicines are not good in the Cure. Cleansing, Inciding, and Lubricating Remedies must be avoided, or at least used very cautiously; as also hot and penetrating Liniments and Plasters, that are outwardly applied to the Breast, to promote Expectoration. But Incrassatin, etc. But we must (at least in the beginning of this Disease, and after every new spitting of Blood) rather insist upon the use of Alterative, Incrassating, Agglutinating, and Opiate Medicines; as also a Milk Diet, Solid or Liquid Laudanum, Syrup of Meconium, Syrup of Purslane, of Marsh-Mallows, of Ground-Ivy (the plentiful use of which in a Consumption from spitting of Blood I would recommend above all other things) Bole-Armenack, Coral, Dragons-Blood, Lapis Haematites, Gordonius Troches, Troches of Amber: Of which Electuaries may be made, and Compound Medicines in other forms for the Patient to take. Of which it will be proper to speak more largely in the Chapter of an Haemoptoë. But in the Progress of the Disease, when once there is not so much fear that the spitting of Blood will return, we may more safely answer the Indications of the Disease, with the cautious use of Lubricating and Expectorating Medicines. Likewise Balsamic Medicines are here of great use; as the Balsamic Syrup, Balsam of Tolu, Capivi, of Peru, Leucatellus Balsam, or Opobalsam, Balsam of Sulphur Terebinthinate, and Anisate, my Balsamic Pills, and other forms compounded of these Medicines, the manner of giving of which is to be learned from what has been already said in the General Method of Cure. Also Issues, and shaving of the Head are very Advantageous in this Consumption. But above all, I must, The best thing in the Cure of this Consumption is the Peruvian Bark. from the long Experience I have had of it, commend in this Acute and Dangerous Consumption from a spitting of Blood, the use of the Peruvian Bark, to be given in that form, which is most grateful to the Patient. By the frequent and sufficient repetition of which we may expect to temper the Feverish Heat, and to suppress the Intestine motion of the Blood, and so consequently to prevent the return of the Haemoptoë, and the Progress of the Consumption, more than with a Milk Diet, with Asse's Milk, or a Magazine of Pectoral Medicines. But in a Chronical and slow Consumption, In this Consumption when 'tis slow the Chalybeate Waters are proper. or rather a Consumptive state from a spitting of Blood, (where the heat of the Blood from the Intestine motion of it does not use to be so great) the Chalybeate Mineral Waters are of great use, if they are drank every day for a long time, but yet in a small quantity. They must be ordered to be taken thus in a little quantity, and to be drank leisurely every day, lest a too great and sudden distension of the tender Vessels of the Lungs, caused by drinking a great quantity of Water at a time, should bring a fresh spitting of Blood. But the small quantity of Water that is drank at a time must be made up by the length of the time that is every Year designed for the drinking of those Waters. By which means likewise the Blood perhaps is more tempered and altered, than by drinking a great quantity in a shorter space of time. History 1. One of the Masters in the Hospital of Bridewell, that had committed himself to my care a Year or two before, when he was sick of a Pestilential Fever, that went up and down attended with Swell in the Groin, and Carbuncles (from which Venom perhaps his Blood had not yet sufficiently purged itself) fell about the 35th. Year of his Age, and in the Year 1669. into a very great Haemoptoë, by which he had lost a great deal of Blood before he sent for me. But with Bleeding, Ligatures, Astringent Juleps and Electuaries, a Milk Diet, and a due Government in all things, the Flux was perfectly stopped. But yet he still continued Hectical, and was troubled with an ugly Cough. And therefore I ordered him to continue his Milk Diet, and to take a Dose of an Opiate Electuary every Night. And to prevent a Consumption, that was like to follow, I directed an Issue to be made in his Arm, his Head to be shaved, and the Cephalick Plaster to be laid upon it; and that the Patient should be sent into the Country, and into an open Air, and that he should use there the Temperating Juices; to wit, of Plantain and Nettles, at least twice a day, with several other things, which it is not necessary now to give a particular Account of. But notwithstanding all this, his Hectic Heat, and his Cough continually troubled him, and his spitting of Blood returned by uncertain periods, at least twice a Month, to wit, about the Full and the New of the Moon, from the heat and motion of the Blood being increased, the Patient continually wasting more and more with the Fever that followed him, till at length being brought into an universal Colliquative state with a Looseness, Sweats, a Dropsy, etc. and being troubled with a very great difficulty of Breathing, he ended his Life. For at that time I did not know the Virtue of the Peruvian Bark, to take off this Hectic Fever, from which that Fatal Colliquation did proceed. The Body being opened, I found the Lungs strangely swelled, and every where in all the Lobes full of Tubercles, some of which were crude, others ulcerated. History 2. Mr. Rooks in Cheapside, being about Forty Years old, from a multitude of Cares and hard Drinking seemed to be continually Hectical for Ten Years together, being stuffed in his Lungs, troubled with a Cough, and inclined to a Consumption: And from extraordinary Exercise, and excess in drinking of Spirituous Liquors, he fell into a very great spitting of Blood, accompanied with a difficulty of Breathing, and a pain in his Breast: And the poor Man had it returned upon him, and that considerably, every day, or every other day, for at least three Weeks, and that notwithstanding frequent Phlebotomy, the use of a Milk Diet, of the Tempering Juices, Astringent and Opiate Electuaries, and Juleps, and likewise of the Royal Styptic Water. But at length when I had observed not only by the quickness of his Pulse, and the high colour of his Urine, but also from his very Temper, that a remarkable Fever returning often by uncertain intervals always brought on his spitting of Blood, I gave him a Dram of the Peruvian Bark in a convenient Draught every four hours: To which I always took care there should be more or less Laudanum added, according as he could bear it. With the use of which I found his Fever taken off without any more to do, and without any return of his spitting of Blood, and that his Urine was come to its Natural colour. I ordered the repeating of the Cortex again and again at due intervals, and took care he should have Nourishment agreeable to his Appetite (which now was better than it was before he spit Blood) and that he should have the benefit of the Country Air. Whereupon (which is strange to be told) without any other help, he came to have a more firm and strong Habit of Body, his Lungs more free, his Breathing more easy, the heat of his Blood less, and his Cough too more moderate now for a Year and half, than he had found for several Years before his spitting of Blood; his Friends admiring at it, who expected he would certainly die of a Consumption in a little time after his spitting of Blood. Which was so much the more wonderful, because he continued as careless in the management of himself in the six non-natural things, as he used to be before his Haemoptoë, which neglect he at last paid for with the loss of his Life. For with the very great Errors he had lately committed, he fell into a new Consumption, and that a threatening and fatal one, which at length carried him off. His Body being opened after he was dead, we found the substance of the Liver compact and close, as if it had been parboiled, all the Lobes of the Lungs most filthily tinged with a black colour (which perhaps was occasioned by his continual smoking of Tobacco) and every where full of a world of Tubercles, of which some that were larger, were full of purulent Matter, others of a substance like Honey. But the greatest part of the lesser ones, which were disposed in Clusters, and like Grape-stones through all the substance of the Lungs, contained a Steatomatose's Matter in them. All the Glandules that were seated near the Windpipe were very black, and had in them a Liquor of a black, or dark colour, such as I have usually observed Scorbutical and Hypochondriacal Persons, that have been Consumptive, to hawk up out of their Throats in a Morning, especially those that have been used to smoak much Tobacco, or have lived in an Air that has been filled with the smoke of Coals. The Prescription for the Antipyretick Draught, which I ordered for Mr. Rooks, was this. Take of the Waters of Tormentil, of Plantain, of each an Ounce, Barley Cinnamon-water, Syrup of myrtles, of each half an Ounce, of distilled Vinegar half a Dram, of the Jesuits Powder a Dram. Mix them, and make a Draught, to be given every four hours, till he has taken eight Draughts. Once or twice a day I added a Grain of London Laudanum to the Draught. In the same manner I cured Mrs. Martin, an Old Woman, almost Seventy Years old; a Goldsmith in St. John's, Mr. Bloomer's Daughter, and a great many others, of a considerable, and (to all appearance) a fatal Haemoptoë. All which continue well, as yet, without any return of their spitting of Blood, or a Consumption following upon it, and are able to go about their Business, whose Histories perhaps it would be too long and tedious to give a particular Account of. History 3. Mr. Luff, the Son of that Reverend Divine which I have already mentioned, living in Milk-street, after he had married a Virgin that was Consumptive (and as I remember, died within a Year after she was married, with an universal Colliquation, and the other Symptoms of a fatal Consumption of the Lungs) a few Months after her Death fell into a Consumption (as I judged) by Contagion. To which fatal Disease an Haemoptoë prepared the way, with which he was suddenly taken at Exeter, and that in the Wintertime, and he lost a great deal of Blood. But as soon as his spitting of Blood was stopped by Phlebotomy, a Milk Diet, and Incrassating Medicines, and he had recovered his strength in some measure, being dismissed by his Country Physician, within a Fortnight (which was much sooner than was fit) he came back to London on Horseback, and presently sent for me. But alas! how much was he changed from what he was before! I found the poor Patient very Feverish, and always Coughing, and extremely wasted with a Colliquation, that was now begun, and troubled with a straightness and pains in his Breast. I found it to be a mixed Fever, partly Peripneumonick, from a new Inflammation of some of the Tubercles; partly Putrid, from the purulency of other Glandules, which had begun so soon to be ulcerated. I judged the Distemper to be a very Acute Consumption of the Lungs from a spitting of Blood, which as it was contracted by Infection, so it was rendered more hasty and violent by his ill Government in his Journey, and his return into our Air, that is filled with the smoke of Coals. The violence of the Pain, and Fever requiting it, I presently ordered a Vein to be opened, but I took away but a little Blood, because of the Consumption and Colliquation that was upon him. Then I endeavoured at least to stave off this hasty Ruin for some time with temperate Juleps and Opiates, and all sorts of convenient Pectoral Medicines, Blisters, and a due management in all things. But all these things were to no purpose; for within three or four Weeks he departed this Life, with all the Symptoms of a very Acute Consumption of the Lungs. CHAP. VI Of a Consumption caused by Stones bred in the Lungs, and by things slipped down into them from without, as also by the Stone in the Kidneys and Bladder. Chalky stones are often bred in the Lungs. I Have often observed Chalky Stones bred in the Lungs, which when they have been Angular, and disturbed with the shaking of the Lungs, are wont to tear the tender substance of those parts; from whence have arisen a violent and dry Cough, and a horrible pain in the Breast, like that in a Pleurisy and Peripneumony; sometimes also an Haemoptoë with a considerable Flux of Blood, and from thence Ulcers, with the usual Signs of a Consumption of the Lungs. Therefore when these horrid Pains happen with an Haemoptoë about the beginning of a Consumption, When we may judge a Consumption to be from them. we may justly suspect it to be a Consumption from Stones in the Lungs. Although we cannot pronounce any thing certain of this thing, till a Stone or two have been coughed up. For it often happens that these Stones passing by degrees through the Lungs, do at length get into the branches of the Windpipe, by which they are coughed up, and that seldom without a great flux of Blood. But if these Stones are smooth, and not such as may break or tear the substance of the Lungs, they do not dispose the Patient much to a Consumption (at least an Acute one;) nor indeed do they occasion any great mischief more than a dry Cough, that is somewhat troublesome, and something of an oppressing weight in the Breast, as I have observed in several long ago, in whose Lungs, after they have been dead, I have found many of these smooth Chalky Stones, and some of them pretty large, without the least Tubercle, or Ulcer occasioned by them: Where these Stones are sharp they cause a Consumption. But where these Stones have been Angular, and sharp, and apt to break and tear the Lungs, they have caused a Pain, a spitting of Blood, Ulcers, and a Consumption itself, as I have already hinted. In which case, as a pain does precede to, and accompany the spitting of Blood, so a spitting of Blood goes before, and accompanies the Ulcers and Consumption. What I have now said of Stones, The same is true of Nails, etc. is likewise true of Nails, Pins, and other things, that slip down into the Lungs as People laugh. For unless they are quickly coughed up again, they prick the Lungs, and cause a lancinating pain, from whence a spitting of Blood, Ulcers, and a Consumption are wont to proceed. Of which I shall add a remarkable History presently at the end of this Chapter. These Ulcers, as also the Consumption, The Ulcers they cause, cannot be cured before they are brought away. which is the effect of them (which we may likewise observe of Ulcers in the Kidneys and Bladder) can never be cured without fetching away the Stone, or Nail, or Pin, or whatever else it is of that Nature, that breeds the Ulcers. But these things, which causing a continual pricking in the ulcerated part, did by that means render the Cure of it impossible before, being once come away, though it be, as it usually is with a great Haemorrhage, yet the Ulcer, and Consumption of the Lungs, that proceed from them, do oftentimes admit of an easy and perfect Cure, because they have not their Original so much from a predisposed Habit of the Body, as from a mere accidental Distemper of one single part. Of which I shall relate one or two remarkable Histories at the end of this Chapter. The Cure of this Consumption. In the Cure of this kind of Ulcers, Opiate and Balsamic Medicines, with a Milk Diet, are of very great use; Opiates to obtund the sense of the torn and stimulated parts, and to keep them as quiet as is possible, whilst the Balsamicks exert their Healing Power. And with the continual use of Milk the Hectic heat of the Blood, contracted in this Consumptive state, is to be allayed. But although these sharp Stones can neither be made to lie quiet in that part of the Lungs which they occupy, with the plentiful use of Laudanum, nor brought away with the use of Lubricating Medicines, but cause an Incurable Consumption, and spitting of Blood, and that such a one as returns by uncertain Intervals with a lancinating pain: Yet this Consumption is in its own Nature slow, and very Chronical, as a Consumption from the Stone in the Kidneys and Bladder uses to be, and, generally speaking, every Consumption that depends merely upon an indisposition or Ulcer of some particular part, without an habitual disposition of the Blood contracted either by propagation from the Parents, or a long abuse of the six things called non-natural. But whenever a heap, or stock of predisposed Humours does conspire with some such fatal Cause, the Consumption which proceeds from thence, is not only fatal from the very beginning, but also quick and very Acute, so that it carries off the Patient within a few Months, and it may be Weeks. I shall add these few things concerning the variation of Cure in this kind of Consumption. First, Lubricating Medicines must be taken plentifully in the beginning of this Distemper; yea, and gentle Vomits; by which means we may endeavour to bring away the Stone, or any other things that have slipped down into the Lungs, before they are quite fixed there by their lodging long in the part, and before the Tone of the Lungs is much injured by them. Secondly, But if great and spasmodick pains are excited by the tearing of the Lungs, caused from the motion of these sharp bodies, we must expect a great spitting of Blood; and therefore instead of Lubricating Medicines we must give Laudanum, and that in good quantities, and often, whereby we may hinder the motion of the Stone for the present, abate the pain, and prevent the spitting of Blood. For in this case letting of Blood, outward Fomentations, and Liniments do no good (as they use to do in Pleuritic and Peripneumonick pains,) and this I found by Experience in one Mr. Foster, and in many others. 'Tis true indeed that a lingering and slow Consumption, attended with a difficulty of Breathing, and other suchlike Symptoms will follow from a Stone lying in this manner in the Lungs, which I have often observed in my Practice. But yet a lingering and uncertain Consumption is better than an Acute one, accompanied with horrid pains, that certainly and quickly terminates in Death. For if this kind of Consumptive People take such care of their Health as to live always in an open and Country Air, to keep from taking of Cold, from Drinking, and too much Exercise, and any other thing, that may disturb the Stones again, that are fixed, and lie quiet, they may live to a great Age, and do their Business well enough. Sometimes the Bleeding must be permitted a while. Thirdly, But if there follows a spitting of Blood from the tearing of the Lungs, it ought to be let alone for a while. For in this Flux, the Stones, or any other things that have slipped down into the Lungs, may be voided. But if the Haemoptoë is great and dangerous, we must open a Vein, and if it be necessary, repeat it; and we must give not only Opiate Medicines, but also Astringents in the form of Linctuses, Juleps, etc. the Lapis Haematites, the Royal Styptic Water; we must use a Milk Diet, and other things briefly mentioned before in the former Chapter, which I shall hereafter give a larger Account of in another Book, if I have an Opportunity to treat of an Haemoptoë. Balsamicks must be plentifully used. Fourthly, But if the Lungs happen to be torn, and to be ulcerated from the motion of the Stone (whether it be voided or not) we must make choice of Balsamic Medicines, and give them plentifully; of which I have given several forms in the General Method of Cure. A Milk Diet is not convenient, where there are Stones in the Lungs. Fifthly, we must not Order a Milk Diet in a Consumption proceeding from Stones in the Lungs, unless there is a great necessity; because it is apt to breed some new Chalky Stones: Whereby it comes to pass, that the Cure of one Consumption is wont to lay the Foundation of another. The Chalybeate Waters must be drank in little quantities. Sixthly, Likewise the Chalybeate Waters, though they may be good in this Consumption, must be drank in a little quantity at a time, for fear the Stone should be stirred again by the too great distension of the Vessels of the Lungs. Whereby it comes to pass, that the return of the pain, and of the spitting of Blood does often follow upon it. Seventhly, Sometimes there are several Stones. Sometimes there are several of these Stones in the Lungs; so that after one or two, or it may be a third has been voided, yet the Lungs are ulcerated by those which remain behind, and from thence there follows a Consumption. As I remember it happened to Mr. Plucknet, and some others. But a Consumption of the Lungs is wont to proceed not only from a Stone in the Lungs, The Stone, and Ulcers of the Kidneys and Bladder do often cause a Consumption. and an Ulcer there following upon it, but likewise very often from Ulcers, and a Calculous disposition of the Kidneys and Bladder; so that I have very often observed those that have had the Stone, to die of a Consumption. But this Consumption is always lingering, and Chronical; and is to be cured in the same manner as an ordinary Consumption, How this Consumption is to be cured. only we must avoid those Medicines that irritate the pains of the Stone, as my Balsamic Pills, etc. But the Chalybeate Waters, which ease those pains, must be often used. For I am apt to think that those who have the Stone, do not fall into a Consumption so often from the long and tormenting pain, as from a want of the due secretion of the Serum, and an alteration of the Ferment, which separates it in the Kidneys, following upon it. And therefore in the Cure of this kind of Consumption, we must have a regard not only to the Consumption, by using the Pectoral Medicines I have before mentioned, but also to the Disease, which is the cause of this Consumption; to wit, the Stone of the Kidneys and Bladder, by using such Medicines as may lubricate the Urinary Passages, and expel the Stone, or at least mitigate the pain. History 1. Mr. Plucknet, being Forty Years old, or thereabouts, a strong and lusty Man; but one that had for many Years lived irregularly in almost all the six non-natural things, yet found no other mischief from it besides a hesky and dry Cough, which he had now been used to for a long time without any great trouble; at length upon hard Riding, and taking of Cold by being very wet with the Rain, he fell into dreadful pains of his Breast, that were like the pains in a Pleurisy; upon which there came a great and long spitting of Blood, with a Fever, and a Cough almost continually troubling him. I could do no good with External Liniments and Expectorating Medicines, until I came at length to the use of Opiates. With which, though he got a little respite, and a treacherous Truce, yet he could get no perfect Cure. For as his Cough, so the Hectic Fever still continued, with which he every day by degrees pined away, and that notwithstanding the plentiful use of Balsamic and Pectoral Medicines, of Asse's Milk, etc. till at last in the space of a Year he appeared in a deplorable Consumptive state, with an universal Colliquation made by the Skin, by Stool, by his Lungs, etc. Which Consumption, that in its own proper Nature was lingering and Chronical, without doubt came to be so quick and hasty from a long predisposition of the Humours contracted by his irregular way of living. And the Fatal Day which concluded his Life, was not a little hastened, by reason he would not, though he took Medicines, submit to any Government during the use of them: Whereupon in this Consumptive state there being some new Stones moved three or four times in his Lungs with hard Riding, Drinking, and often taking of Cold, he found again and again a return of his dreadful Spasms, and a long and profuse spitting of Blood. Which continuing upon him, though he coughed up several Angular Stones, yet he was so much weakened by the Spasms, and lost so much Blood by his Haemoptoë, that he very quickly, to wit, in the space of a Year, or thereabouts, ran the whole course of this Distemper, even to the fatal period of it, as if his Consumtion had been in its own Nature plainly Acute. History 2. Mr. Foster, an Apothecary of London, who, setting aside a hesking and dry Cough he had, which yet was not very troublesome, enjoyed his Health very well for several Years, was suddenly taken, when he was about Thirty Years old, with Spasms in his Lungs, and dreadful pains caused thereby, as also a spitting of Blood from the disturbance and motion of some sharp Stones in the substance of his Lungs. For the relieving of which Symptoms we did very little good with Bleeding, external Liniments, and Pectoral Medicines given inwardly; so that with the loss of his Strength and Blood, caused by his spitting of Blood, and his pains returning almost every day, and by his want of Rest, and Fever that attended them, a continual Cough, etc. he was brought so low, and so much wasted, as if he would in a short time die of a Consumption. But with the long and plentiful use of Opium in the open Air at Highgate, whither he was now gone for the Recovery of his Health, he was at the same time freed from his spitting of Blood, and from his Pains, and so he continued; recovering his Strength thereupon every day, and being more and more freed from his Fever and Consumption, till at length he seemed as florid in his Looks, and as plump in his Flesh as he was before he spit Blood; and now for four or five Years past he has followed his business, and is in all things just as he was before his Distemper, but only having some degree of a difficulty of Breathing, and a dry Cough, he cannot bear the smoky Air of London so well as he used to do before, by reason of the stuffing of his Lungs, caused by the Stones that are fixed there, and his using a great deal of Laudanum. History 3. Almost the same thing happened to Mr. Smyth, an Apothecary in Aldermanburic, who from the moving of some Stones in the substance of his Lungs (several of which he had coughed up) fell into a spitting of Blood, which often returned, together with Spasmodick Pains, and from thence he seemed to be inclined to a Consumption of his Lungs. Which nevertheless after the voiding of the Stones, he was very easily freed from with the use of a Milk Diet, Opiates, and Balsamic Medicines; and now having had his Health very well for several Years, he goes about his business as he used to do. History 4. A Young Man, living near Cripplegate, that was strong, and every way sound in his Entrails, as he was doing something at his Trade of Whiteing, by which he got a convenient Livelihood, by chance with laughing hearty let three Nails, which he held in his Mouth for his use, go down through his Windpipe into his Lungs. Whereupon being seized with a most violent Cough and continual tickling, he fell into a very great spitting of Blood. From which Symptoms, I know not by what means, he got himself free. But this is most certain, that though those Nails never came up again, either of their own accord, or with the help of Art, yet the Young Man was very well for the space of several Months, following his Employment as before. Neither did he (as he told me) find himself any thing worse, but only from that time he used to be troubled with a dry and hesking Cough, and likewise with some Oppression. He was so well, that he thought himself fit for a Wife, and he did Marry one. But upon his Wedding-day, whether from his more liberal drinking of Wine, or from his dancing too much (with which the Nails, that before lay unmoved, and as it were buried in the substance of the Lungs, were stirred again) the poor Bridegroom in the Evening was taken with dreadful Spasms, and a most Acute pain in his Breast and Side, and withal a difficulty of Breathing, and a dry, but very troublesome Cough, so that he could scarcely lie in his Bed, or get the least sleep. Whereupon he began to be very Feverish, though his extreme Parts seemed to be cold from the violence of the Spasmodick pain. When they had tried all the Old Woman's, and Apothecary's little Receipts in vain, and without any benefit, at length I being very earnestly entreated, went about the third day of his illness to see him. I presently apprehended the Distemper to be plainly Peripneumonick, and therefore I ordered plentiful Bleeding, Fomentations, and Liniments externally, likewise Linctuses, and Pectoral Apozemes, and temperate Juleps of Antispasmodick Waters to be given inwardly. But these things doing no good, I ordered again and again some more Blood to be taken from him. And indeed I was forced for many days continually to insist upon the use of several internal and external Remedies before the poor Patient found the least ease of his pain: But at length when his pain was somewhat mitigated, yet I could hardly with my Skill promote any Expectoration of Phlegm; nor wholly remove the Fever, though it seemed changed from the Nature of an Acute and Peripneumonick, into a lingering and Hectic Fever. So that the Patient being now freed from the violence of the Symptoms, though he was always Feverish, yet he could sleep, and eat his Food better than before: But yet he grew every day weaker, and at length from an Universal Colliquation, he died plainly of a Consumption within the space of a Month or five Weeks. Indeed I wondered very much at the obstinateness of the Pain, and the difficulty of his Expectoration; and therefore, being directed by Hippocrates' Aphorism, I did foretell that a Consumption from an Empyema would follow. But I never did so much as dream of the Original cause, to wit, the Nails, which were slipped down into his Lungs, before the Patient's Life was past all hopes: Otherwise I should have given him good quantities of Laudanum from the first, and it may be with better Success. The Body being opened after he was dead, we found those three fatal Nails as it were buried together in one bed of Matter a little below the divarication of the branches of the Windpipe, and the Tone of the Lungs universally impaired by the Matter, which by degrees had crept all over them, and the very Membrane which covers the outside of the Lungs, corroded by the sharpness of the Matter; whereupon there came to be a continual dropping or distillation of the purulent Phlegm into the cavity of the Breast, out of which (to the best of my remembrance) I took out at least six-Pints of this purulent Liquor. Which when I saw, I no longer wondered at the obstinateness of the Pain, and the difficulty of his Expectoration, which accompanied that Peripneumony. Nor did it seem strange that a Peripneumony caused in this manner, should terminate in a Fatal, and such an Acute Consumption. CHAP. VII. Of a Consumption proceeding from the French Pox. The French Disease often brings on Atrophy. 'TIS certain every French Pox if it be Chronical, accompanied with a virulent Gonorrhoea, or many and large Ulcers, is always apt to bring the Patient by degrees into a Consumptive state by the continual substraction of the Nutritious Juice from the Habit of the Body, of which sort of Consumption I have before discoursed in the First Book. And likewise a Consumption of the Lungs. It is also as true, and I have often observed in my Practice, that a true Consumption of the Lungs has had its Original merely from the alteration of the Blood and Humours caused by the French Pox. And it is no wonder, when the whole Mass of Humours is so manifestly altered, and brought into a colliquative state by the Ferment of this Distemper (which is evident enough from the Malignant Swell, Gonorrhoea's, and Ulcers, that commonly accompany this Disease) if these kind of Venereal Swell and Ulcers happen sometimes also in the spongy and soft Substance of the Lungs; whereupon a true Pulmonary Consumption must necessarily follow. Indeed I have rather wondered that we ever meet with the French Disease, especially if it has been of a long standing, or ill cured, without an Ulcer in the Lungs, and a Consumption proceeding from it. But to speak the truth, I very seldom, if ever, observed a Consumption of the Lungs from the French Pox, Which is rare, unless the Lungs were obstructed before, or from ill management. unless it has been where the Lungs were obstructed, and disposed to a Consumption before; or at least where there has been a bad management, and ill-natured Medicines have been given by some Quacks; and the often taking of Cold in a Sweeting Course, or in a Salivation, has been joined with the French Pox. This Consumption (if it be treated in due time, and in a due manner) is as easily cured as any other. This Consumption is of an Asthmatick Nature. For (as far as I have observed) it is of an Asthmatick Nature, and is wont to be attended with tough Phlegm, and a difficulty of Breathing rather than a violent Cough; and therefore it is Chronical, and ascends slowly and by degrees to its highest degree; from whence it comes to pass, that I have sometimes observed some of these kind of Patients to live several Years in a Sickly and Consumptive state. Which perhaps may be partly from the continual use of the Decoction of Sarsa, and other things of that Nature; by which the Malignant Venom of the Humour, though it is not perfectly eradicated, is in some measure obtunded. For I do not doubt but the peculiar Nature of the French Pox is so Venomous, that unless the Malignity of the Humour happened to be corrected by the use of Calomelanos, a Decoction of the Woods, and other Medicines prepared by Art or Nature, every Consumption from a French Pox in its own proper Nature would be Acute. From a frequent Experience I do affirm, This Consumption is not to be cured without Antivenereal Medicines mixed with the Pectoral. that all Pectoral and Pulmonary Medicines, that are merely such, without mixing Antivenereal Medicines with them, will do nothing towards the perfect Cure of this Consumption. And therefore there is no better Method can be thought of, than to endeavour the healing of the Ulcers of the Lungs, and the restoring of the Crasis of the Blood, The best thing is a Salivation. which has been destroyed by the Venereal Ferment, by a Mercurial Salivation, before the Patient has been weakened by a long protraction of the Distemper, and so is unable to bear such a continual and profuse Evacuation. What is to be done if the Patient cannot bear that. But if the Patient, by reason of the extenuated Habit of his Body, does not seem to have strength enough for this Method of Cure, all the hope that remains must be from the use of a Restorative Milk Diet; and then from a strict and long use of a Decoction of Sarsa, and of my Balsamic Pills, giving likewise Purges with a moderate Dose of Calomelanos mixed with them. Of a Cure of this Nature I shall not think much here to give an extraordinary Instance. A History. A Young Girl about Twelve Years old, was persuaded by the Enticements of a Lascivious and Wicked Dancing Master, that was infected with the French Pox, to let him lie with her: Whereupon she likewise by Contagion was so peppered with the Venereal Venom, that notwithstanding one or two Salivations, which had been raised by some Empirics, and other Methods of Cure that had been tried in the space of four Years, after her Uuula was eaten away, and after other marks of the French Pox yet remaining, she fell into a Consumption of her Lungs, with a Hectic Fever, an Emaciation of her whole Body, a continual Cough, and a very great shortness of Breath, by reason of the toughness of the Phlegm stuffing her Pipes. Being called to her by Mr. Simons, a skilful and noted Surgeon of London, I ordered a Dose of Calomelanos with Diagrydium to be repeated once a Week; and on those days she did not Purge, to have three of my Balsamic Pills given her three times a day, and the following Decoction for her ordinary Drink. With the use of which, continued for the space of six or eight Weeks in the Springtime, she was perfectly, and without any relapse, freed from her Consumption, as well as from the Relics of the Pox. Take of the best Sarsaparilla six Ounces, of Chinaroots two Ounces, Sassafras-Chips, red Saunders, shave of Hartshorn, of Ivory, of each half an Ounce, of Raisins of the Sun stoned two Ounces, Jujubes, Sebestens, of each an Ounce and half, of Liquorice sliced half an Ounce: After a due Infusion, boil them in six Quarts of Spring-water to three Quarts, adding when they are almost boiled enough, Colts-foot, Maidenhair, spotted Lungwort, Sanicle, Ladies-Mantle, the Flowers of the great Daisy, of each two handfuls; then strain out the Liquor, and add three Ounces of the Balsamic Syrup. Mingle them, and make an Apozeme. CHAP. VIII. Of a Consumption proceeding from the Suppression of a virulent Gonorrhoea, of the Running of Old Ulcers, but especially Fistula's in the Fundament, and Scrofulous Ulcers, Issues, and the Whites. How this Consump ion is caused. I Have also observed in my Practice these kind of Consumptions; which are not caused (as it is commonly thought) by the translation of the Purulent Matter into the Lungs (which to me seems impossible;) but by the Pollution of the whole Mass of Blood by the violent keeping in of the Excrementitious Juice, which used to be continually thrown out by these Ulcers. From whence it comes to pass, that the Blood being in this manner fouled, does make it its business to cast off this extraneous and excrementitious Ferment, and to lodge it in the soft substance of the Lungs as it circulates through them, which many times according the Nature of the Matter is disposed to a speedy Putrefaction. And hereupon that Consumption of the Lungs, which I make it my business to treat of in this Chapter, though it be sometimes of a middle Nature, This Consumption is Acute. yet for the most part it is Acute; yea, many times according to the Nature and Disposition of the Ulcer of the Lungs, And most commonly Mortal. which causes it, very Acute, and almost always Incurable and Mortal, because it depends upon an inexhaustible stock of Matter lurking in the Habit of the Body. In the Cure of this kind of Consumption, The Cure. besides the General Method before prescribed, I shall add these few things particularly to be observed. First, The former, and accustomed Ulcers must as far as it is possible be revived; whereby the Humour may be diverted from the Lungs, and be evacuated by the usual and less dangerous vents, though it may seem troublesome. Secondly, But if this cannot be obtained (which indeed is very seldom done) then frequent Issues, yea, and Vesicatories, but especially applied near the place which Nature first assigned for the separation of this Humour, aught to supply this defect, by which we may make some compensation to oppressed Nature, and particularly derive the Matter from the Lungs. Thirdly, In the beginning of this Consumption, to wit, when the Glands of the Lungs begin to swell (which we may guests at by the Cough, difficulty of Breathing, and Feverish Heat) we must use Bleeding, and also repeat it if it be necessary. By which the stagnation of the Blood, which arises from the first reception of the Matter into the Lungs, and so the swelling of the part may be prevented, or at least abated. Fourthly, Amongst the more general Pectoral Medicines already described, I would commend the use of a Milk Diet, of Asse's Milk, the Chalybeate Mineral Waters (if they are drank in time) of a Pulmonary Decoction of Sarsa, for ordinary Drink, of the Gums, Balsams, and Wood-lice, but especially my Balsamic Pills. Fifthly, But we must always add to the Pectoral Medicines also those things which have a respect to the peculiar Nature of the Ulcer, or Original Distemper. A History. Mr. Simons, the Famous Surgeon before mentioned, had (as he told me himself) a Fistula in his Fundament continually weeping for the space of Twenty Years, which he did industriously preserve instead of an Issue, whilst he cured very many in other Persons, because it did seem neither very troublesome to him, nor at all dangerous. But by chance this accustomed Ulcer at length drying up of its own accord about the Sixtieth Year of his Age, he presently began to be affected with an Oppression at the Breast, and a dry and troublesome Cough. Which Symptoms for several Months he never minded, till being roused from this stupid Neglect by a manifest falling away in his Flesh, as well as a Hectic Fever; also by a frequent want of Appetite, Sickness, Weakness, and other Signs of a present and confirmed Consumption, he desired my Advice, but too late, when the poor Man had for some Weeks, and that in the Spring too, laboured under a great Colliquation, both by a Looseness and Sweats, brought upon him by a Putrid Intermitting Fever, and was confined to his Bed in a weak condition. I did endeavour at least to alleviate the Fever by the use of the Peruvian Bark; to abate his Looseness with Astringents and Opiates, to remove the cause of the Consumption with the White Drink, a Pulmonary Decoction of Sarsa, and Limewater, with all other sorts of Pectoral and Specific Medicines given in the form of Linctuses, Electuaries, etc. as also with a Milk Diet, (and so far as the Looseness would give me leave) to temper the heat of the Blood and Spirits with Asse's Milk; and to comfort and refresh his Spirits with Pearl Juleps, Jelly-Broths, and Jellies. But all was in vain; for this Excellent Person, being brought into the state of a Marasmus by this Colliquative Fever, yielded to Fate in the space of two or three Months. CHAP. IX. Of a Consumption proceeding from the Green-Sickness, and a Suppression of the Monthly Purgations in Women. THIS is most commonly the Original of Woman's Consumptions, Ab Obstruction of the Menses is commonly the Original of Consumptions in Women. and I have very seldom seen any Woman that was capable of the Monthly Purgations, either Virgin, married Woman, or Widow, who ever fell into a Consumption without an Obstruction of these Purgations coming upon it, either in the beginning, or at least in the progress of the Distemper. Sometimes 'tis the effect of a Consumption. 'Tis true indeed this Obstruction may arise in the progress of a Consumption from the impoverished state of the Blood, by reason of the want of new Nutritious Juice; and therefore is to be accounted an Effect rather than the Cause of this Disease. But many times the occasion of it. But many times it is the occasion of a Consumption, and that not only in Virgins and Widows, but even in married Women. For when there is an Obstruction of these Purgations caused by Passions of the Mind, taking of Cold, or using such Food as breeds a bad Juice, the Mass of Blood is apt to be fouled, and to be rendered cachectick by those Excrements, which used to be thrown out, but are now detained in it: By which Mass of Humours now gathered in the Blood the Lungs are wont to be stuffed, and thereupon a Cough, difficulty of Breathing, and the other ordinary Symptoms of a Consumption are wont to arise: From which being a long time neglected, a Consumption of a peculiar Nature, attended with prickings, and dreadful pains in the Sides does many times arise. In the beginning of this Distemper, Bleeding, What is to be done in the beginning of this Consumption. and moderate Purging with the Sacred Tincture, and other things of that Nature; and the use of Chalybeate Medicines, but especially my Chalybeate Electuary, which I may afterwards mention in the Chapter of a Chlorosis, etc. are convenient to provoke the Menses, and to correct the Cachectical state of the Blood: But if through the neglect of the timely use of these things, the Patient is already brought into a Consumptive state, it is not only in vain to try any of these things (because we cannot expect those Purgations in this impoverished state of the Blood) but also very prejudicial to the Patient to give them. For it is to no purpose to diminish the stock of Blood by opening a Vein; and with the use of Chalybeates it is more exagitated and grows hot. Therefore in this case the Patient must be put into the General Method of Cure used in a Consumption of the Lungs, and already described; and the Pains of the Sides must be eased with warm Liniments and Fomentations, mentioned in another place. But the Consumption being once cured, and the Body grown lusty again, the Uterine Vessels being replenished with Blood and Nutritious Juice, are wont to be opened of their own accord in a thin Country Air. But we must relieve this defect of Nature (if she is still deficient after the Patient is recovered) with the help of Art? For if the Obstruction still continues, the Patient will quickly grow Cachectical again, from whence we may justly expect a return of the Consumption. Therefore in this case let the Patient be kept in a thin Air, and shake off all Sadness and troublesome Cares; let her use Exercise, and due Frictions; as also bitter, Antiscorbutic, and Chalybeate Medicines, but especially the Vitriolic Mineral Waters, if it be a proper time of the Year for them. This Consumption, because it proceeds from a Cachexy, is for the most part Chronical, and not presently Mortal. But if it is not cured in the beginning, it is very difficult, if ever, to be cured; and indeed the Green-Sickness of Virgins has very often this Fatal Event; because the Symptoms of a Consumption and a Green-Sickness are so much alike, that the Common People seldom perceive when one comes to be joined to the other, till the Consumption is come almost to its Third and Fatal Degree. And from hence it is that I am wont always to suspect a Chronical Cough that attends a Chlorosis. A History. Mrs. Anderton, Madam Davison's Maid, a pretty Beautiful Young Woman, about the Seventeenth Year of her Age, from the Suppression of her Menses a long time neglected, fell into the Green-Sickness, with the usual Symptoms of it, a pale Look, Headache, shortness of Breath, Weakness, Lassitude, a slow Fever, etc. But at length when the Maid had advanced from an Oedematous to a Consumptive state, and the stuffing of her Lungs was turned to a troublesome, though dry Cough, it gave me occasion to suspect that a true Pulmonary Consumption had been the Product of the Chlorosis. And I was very much confirmed in this Opinion by those dreadful Pains in her left Side, with which the poor Creature had been almost continually racked to the highest degree for several days; which I could not ease so much by Bleeding, as by outward Fomentations and Liniments, and the internal use of Laudanum. Which sort of painful Spasms in the Sides I have observed almost always to have accompanied, or at least to have been the forerunners of a Consumption of the Lungs, whenever this Distemper has happened to have its Original from a Green Sickness, or a Melancholic and Thoughtful Mind. A long time before her Spasms first seized her, she was confined to her Bed, looking as if she had almost no Blood, and emaciated almost to the degree of a Marasmus, troubled with a Hectic Fever, continually languishing, and without any Appetite. And therefore though the violence of the Spasms at that time did Indicate it, yet her extenuated Habit, and the little stock of Blood which she had, as also her want of Strength, and the weakness of her Pulse did forbid Bleeding. However we bled her sparingly, again and again, and then those painful Spasms being taken off with the diligent use of Pectoral Remedies mixed with Antispasmodicks, but especially with repeated Doses of Laudanum added to Antihystericks; and with the outward application of Anodyne Liniments and Fomentations, I applied myself to the Cure of the Pulmonary Consumption with the General Method of Diet, and Medicines too, already described, with very good Success, and not without the great Applause of those that were about her. But the whole Cure was completed and finished by the Restitution of her Monthly Purgations, with the long use of Chalybeate Medicines in the form of an Electuary, Pills, Wine, Syrup, etc. which I always ordered to be mixed with her Pectoral Medicines. For after she began to be freed from her Consumptive state, and the Habit of her Body began to be restored, and the Vessels to be filled with good Blood, it was an easy thing to open their Obstructions with those very Medicines, which are wont to be tried without any Success, yea, with Prejudice to the Patient, when she is in a Consumptive, and emaciated state: And so the whole business being crowned by gaining of this Point, without any Relapse into a Consumption, my Patient has continued fresh and lusty for Fifteen Years or more to this very day, almost always enjoying her perfect Health, having been in that time a Virgin, a Wife, and a Widow. CHAP. X. Of a Consumption caused by a Peripneumony, and a Pleurisy. IT is well enough known to all those that have but a little Skill in Physic, A Consumption often proceeds from a Peripneumony and Pleurisy. that a Consumption is wont to arise likewise from these Distempers very often. And this happens sometimes from the Ignorance or Neglect of the Physician, sometimes from the perverseness and peculiar Nature of the Original Distemper, or a previous disposition in the Patient to a Consumption: Many times too the Patient himself, and his Friends that are about him, are to be blamed, who not observing the proper Directions of the Physician, in Bleeding so often as is necessary, in the seasonable and plentiful administration and taking of Pectoral Medicines, and in the other parts of a due management, do many times lay the Foundation of a Consumption, that follows afterwards. For a Consumption follows after a Peripneumony and a Pleurisy, for the Reasons following. First, The first Reason why it does so. When the Blood is left in a Colliquative state by these Distempers, which is wont to happen likewise for two causes; to wit, First, when the Patient has been Habitually predisposed to a Consumption by a propagation from the Parents, or by a long abuse of the six non-naturals; in which case the Blood and Lungs being heated and inflamed, are very difficultly brought to a due temper; for the Peripneumony and Pleurisy being once conquered, the putrid heat of the Blood degenerates into a Hectical, or Habitual heat, so that afterwards the Chyle can neither be perfectly united, nor amicably mixed with the Mass of Blood: And from this Colliquative state of the Blood a Consumption of the Lungs must necessarily follow. Secondly, and it may be this more frequently happens from the perverseness of the Patient, and the timorousness of his Friends, and those that are about him; and perhaps too from the Ignorance, or at least the Negligence of the Physician, when timely and plentiful Bleedings, which are not only necessary to relieve the Pain, but also absolutely requisite from the degree and exigence of the Fever, and the Inflammatory disposition of the Blood, are wholly omitted. For in this case there still remains a Hectic Heat in the Habit of the Patient, which disposes him to a sudden Consumption, after a due Concoction and Expectoration of the Matter, which was gathered in the Lungs. The second Reason want of due Expectoration. Secondly, When the Matter that is gathered in the Lungs is not at all concocted and expectorated, or not in a sufficient quantity, or at least not so soon as it ought to be. And this is wont to come to pass from several causes: As first, when the parts of the Lungs, that are inflamed, are the Vesicles, or Air-Glands, and thereupon the Matter, that is lodged in them, though it be concocted as it should be, yet being contained in its proper Cystises, does not find a passage out, notwithstanding the most diligent use of Expectorating Medicines. For though there is a greater quantity of purulent Matter concocted and gathered in the Glandules with the use of those things, and thereupon there follows an Aposteme of a great bigness; Which occasions an Aposteme. yet because the Matter does not find an immediate Vent, no Expectoration succeeds, and so the Lungs are not able to clear themselves; whereby it comes to pass, that after the Aposteme is broke, there remains a foul Ulcer in the Lungs, proportionate to the largeness of the Aposteme. And upon this breaking of the Aposteme, the Matter that is contained in it, Which when it break't, empties itself either outwardly, is wont to empty itself either outwardly or inwardly, according to the Situation of the suppurated part. For if the affected Glandules are placed near the branches of the Windpipe, when the Cystis is broke, the Matter easily finds a vent into the Windpipe: And many times the Patient is suddenly strangled, or ready to be choked with the violent gushing out of the Matter, And sometimes the Patient is suddenly choked; flowing out all together this way: Which I sometime since found in Mr. White's Son, whose case I shall give an Account of in the end of this Chapter. But if these Glandules are placed at that distance, Or inwardly. that the Matter cannot find a passage into the branches of the Windpipe itself, those parts do in progress of time swell to a great bigness, whereupon at length, when the Cystis breaks, the Matter diffusing itself every where through the whole substance of the Lungs, does perfectly destroy their Tone. Yea, sometimes I have observed the Lungs to be so much distended with it, that partly from their distension, and partly from the Acrimony of the Matter, that has insinuated itself into them (the outward Membrane, which invests the Lungs being once broken, or eroded) the matter has fallen continually, and plentifully out of the Lungs into the Cavity of the Breast: And thereupon in the dead Body, when it has been opened, though we found an Ulcer only in the upper part of the Lungs, and the Tone of the Lungs every where corrupted with the Matter passing through them, yet we met with several Pints of purulent Matter, which was fallen into the Cavity of the Breast through the broken Membrane, after the manner of an Empyema. And from hence it came to pass, that when the Physician had done all he could in prescribing, and the Patient had been as diligent in the taking of Expectorating Medicines, yet we did no good with them. The Expectoration is hindered by very profuse and unseasonable Bleedings. Secondly, When with unseasonable, and very profuse Bleedings the Blood is grown so cold, that the suppuration of the inflamed part is either hindered, or at least comes to be late. For every one, that understands any thing of Surgery or Physic, knows that Bleeding causes a suppuration to be slower than otherwise it would be. And that famous Aphorism of Hypocrates is no less true, That unless those that have a Pleurisy do expectorate in fourteen days, if they live so long, they will be Empyical upon the fortieth day; so great a quantity of true Matter being in that space of time collected in the Lungs, that by reason of the quantity, and Acrimony of it, it is apt to make its way through the broken and eroded Membrane of the Lungs into the very Cavity of the Breast. From the want of Pectoral Medicines. Thirdly, this also sometimes happens through the carelessness of the Physician, or else the perverseness of the Patient, from the neglect of the use of Expectorating Medicines in the beginning of a Pleurisy and Peripneumony. Fourthly, in fine, this often happens to Infants for want of Understanding, because they have not wit enough to raise and spit out the Purulent Phlegm which is lodged in their Lungs. This Consumption is always very Acute, This Consumption is always Acute. because it proceeds from an Acute Distemper preceding, by which not only the Patient has been very much weakened, but likewise the Mass of Blood has been left in a Colliquative state; yea, and very often there has happened to be a Collection of Matter made in the Lungs. So that this Consumption has scarcely gone by the Name of a Consumption, before the Patient has arrived plainly to the state of a Marasmus. The Cure of this Consumption, when 'tis from a Colliquative state of the Blood. If this Consumption has had its beginning from a Colliquative, and too hot a state of the Blood, caused by the preceding Distempers, we must not only continue the use of Expectorating, and other Antiphthisical Medicines, (which yet must be of those, that are more mild, and not very hot) but we ought also to prescribe Temperate Pearl Juleps to be taken plentifully to temper the heat of the Blood; as also Milk-water, Snail-water, yea, and the Chalybeate Waters, if it be a time of the Year proper for the use of them; but above all we must have recourse to Bleeding (however the Patient is weakened, and his Body brought into a Tabid state by his former Distemper) and that not once only, but frequently; and we must repeat it too (if it be necessary) not with too sparing a Hand. But if this Consumption proceeds from the breaking of the Glandulous Aposteme emptying itself by the Windpipe, The Cure, when 'tis from the breaking of an Aposteme. we must promote the Purgation of the Lungs by this Highway with the plentiful use of Expectorating Medicines. And if there is any fear that the Patient will be choked after the first breaking of the Abscess with the Matter rushing too fast, and in too great a quantity into the branches of the Windpipe, (which I remember happened to Mr. White's Son, and to some others) we must hasten the Expectoration by giving Oxymel of Squills, and other gentle Vomits; and then provoking them to Vomit by tickling the Tonsils and Uuula with a Feather dipped in Oil. Whereby it comes to pass, that a violent motion of the Stomach being excited in Vomiting, the Lungs also being agitated by it, can more easily free themselves from that glutinous Matter which sticks in them. The greatest part of the collected Matter being in this manner once evacuated, that which remains must be also brought away with the diligent use of Expectorating Medicines. Which being done, the Cure in progress of time may by degrees be perfected with a Milk Diet, Temperate Juleps, the Balsamic Medicines before described, and with the Chalybeate Waters drank in the Country in a wholesome Air. When a Paracentesis is to be made. But if by the continuation of the Hectic heat, a redness in the Cheeks coming every day, a difficulty of Breathing, without any considerable Cough attending them; but especially by a fullness and weight in one or both the Hypochondres, and a fluctuation of Matter in the Breast, perceived by its moving from one side to another, this Consumption seems to have been occasioned by some Matter, that has been gathered in the Glandulous Apostems of the Lungs, running through their outward Membrane, when it is eroded, or broken, into the Cavity of the Breast, after the manner of an Empyema; then I say the Matter that fluctuates in the Breast, and is continually dropping out of the Lungs, must be conveniently taken out at due intervals as the Patient can bear it, by a Paracentesis made in a convenient place near that Hypochondre where the greatest weight is felt. The rest of the Cure is to be performed with the plentiful use of Wood-lice, Balsamic Medicines, and of Temperate Juleps; as likewise with a Milk Diet, Decoctions of Sarsa, Chalybeate Remedies, but especially the Chalybeate Waters. But if by reason of the weakness of the Patient, When there is Matter in the Breast, and a Paracentesis will not be allowed, we must use Diuretics. or the timorousness of them that are about him, we may not be allowed to make a Paracentesis, we must endeavour to evacuate the Matter by a long and plentiful use of Diuretic Medicines, as Wood-lice, Salt of Amber, my Diuretic and Lubricating Apozeme, which I shall give an Account of presently in the next History, etc. which is sometimes done with good, though more uncertain Success (as I found in Mr. White's Son, whose Case I shall think it worth my while presently to subjoin. How the Cure must be completed. ) Afterwards the Cure must be completed with a Milk Diet, the use of Balsamic and Chalybeate Remedies, and likewise with Decoctions of Sarsa impregnated with Pectoral and Vulnerary Herbs, that are very temperate. But if this Consumption proceeds from the slowness of Expectoration, What is to be done when there is a slow Expectoration from the Blood being too much cooled, etc. caused by the Blood being too much cooled with unseasonable, or too liberal Bleeding, or by the neglect of Expectorating Medicines, we must enjoin the plentiful and frequent use of Lubricating and Balsamic Medicines, and especially such as are hot, and endowed with penetrating Particles; as Opobalsam, Balsam of Sulphur Terebinthinate and Anisate, linseed-oil fresh drawn without a fire, an Antiphthisical Mead, and other things of the same Nature. History 1. Mr. White, who lived in the Burrow of Southwark, his younger Son Samuel, about the Seventh Year of his Age, and in the Year 1670. fell into a true Pleurisy, with an Inflammatory Fever, a continual, but dry Cough, and a dreadful pain in his Side. After they had first tried several things for three days without any benefit, at length I was called, and ordered about six Ounces of Blood to be taken immediately from his left Arm, because his pain was chief in that Side, and the Parts to be externally anointed with an Anodyne Lineament, and likewise Expectorating Medicines to be given inwardly in a good quantity in the form of a Linctus and Apozem. They had a great deal of difficulty to make the Boy take internal Medicines. But the Pain, and his Fever being sufficient Reasons for the doing of it, I bled him once every day for five days successively, with the Advice and Consent of my Famous Colleague Dr. Micklethwait. And for the farther mitigating of the pain I ordered an Anodyne Fomentation in two Ox's Bladders to be alternately applied, with a Lineament, and Blistering Plasters to be put upon the Neck, and the inside of the Arms. But however neither the Pain, nor the Fever seemed to abate, till at length about the Ninth day of the Disease, Nature of her own accord went to work, and relieved herself by a bleeding at the Nose; and in this manner at the same hour of the day for three days one after another, did Nature, as if she were led by some Benignity, continually perform the Office of a Surgeon, and that with very good Success; for as the Pain, so likewise the Fever went almost quite off. But an Expectoration could not be procured by any Art through the whole course of the Distemper. Wherefore being moved by the Authority of Hypocrates, I declared my Opinion openly in the presence of his Friends, that an Empyema would follow afterwards within Forty days. And as I said, so it came to pass: For the poor emaciated Boy lay with a redness in his Cheeks, that returned every day, a moderate Hectic Fever, a continual dry Cough, and shortness of Breath, gradually wasting every day until the fortieth day of the Disease; the greatest part of the time likewise being drawn in on the left Side, he complained much of a gravative pain under the short Ribs of that Side. On the fortieth day I went to see him in the Morning, and found him eating of a little Fish or two, and more cheerful than ordinary. But for all that, remembering that Prognostic of Hypocrates concerning the fortieth day, I ordered an Emetic Mixture of Salt of Vitriol, and Oxymel of Squills to be in readiness, that it might be given him by Spoonfuls to make him Vomit, if upon the sudden rapture of the Aposteme he should be in danger of being choked with the too quick passing of the Matter into the branches of the Windpipe. I had scarce been gone an hour but the Patient waked out of his sleep almost strangled; and in that manner he continued for the space of four hours before they could find me, without even any sensible Respiration, or Pulse, with his Eyes set, and his Teeth and Hands Spasmodically shut, cold, and even dead. At last I came, and ordered that the Mixture (which I had before taken care should be in a readiness, though as yet by reason of the Fright they were in that were about him, who looked upon him to be dead, it was not yet gi-given) to be put down his Throat by Spoonfuls, his Mouth being opened by force, and his Tonsils to be tickled with a Feather dipped in Oil; with which being in a short time provoked to Vomit, he brought up not only crude Chyle out of his Stomach, but also near a Pint of Pus plainly fetid out of his Lungs; and thereupon with the use of a Cordial Julep both his Spasms and his Strangulation went off, the heat of the Extreme Parts too, and his Pulse came again, and at length after three hours he began to mutter some incoherent words; and after some quiet sleeps he came to himself: And so within 24 hours he was hungry, and asked for something to eat, to the great Amazement of his Friends, and those that were about him. But nevertheless he was not only weak, and confined to his Bed, but also emaciated, and Hectical, and lay continually Coughing, and fetching his Breath very short from the weight of that Matter in the Cavity of his Breast, which pressed upon his Diaphragm, as if he would in a short time die of a Consumption. By reason of the Acute Consumption which was upon him, and his Weakness, I dare not try to evacuate the Matter by cathartics, nor to let it out by a Paracentesis; because as they that were about him were against it, so indeed there appeared no protuberance in the Hypochondres, to show the right place where the aperture should be made. And therefore for the present I resolved to bring the business about by a long and slow Method, by ordering a Milk Diet to temper his Blood, and the frequent use of the following Apozeme, partly Pectoral, and partly Diuretic, with which (if it were possible) I might bring away the Matter by the Urinary passages without any loss of his strength: The form of the Apozeme was this which follows. Take the Seeds of Mallows, of Marsh-mallows, of each three Drams, the four greater cold Seeds, of each a Dram, of red Cicers an Ounce, of Winter-Cherries two Drams, the Leaves of Colts-foot, Maidenhair, of each a handful, seven Figgs, fifteen Sebestens, Liquorice sliced an Ounce, boil them in two Quarts of Spring-water to a Quart. To the Liquor when it is strained add of Syrup of Marsh-mallows an Ounce. Mingle them, and make an Apozeme. With this Management (and the addition of a Pearl Julep, and a Pectoral Linctus) his strength seemed to be much mended. But upon that there arose an Universal Dropsy, which increased so much, that the poor Patient seemed every day ready to die for want of Breath. But with the plentiful use of Salt of Amber, gentle Purges, and Chalybeate Electuaries (Balsamic and Pectoral Medicines being always mixed with them) he grew perfectly well of his Consumption and Dropsy both, with the help of the Spring, and Country Air, and is yet living, in health, strong, and lusty, following his Business of Merchandise. History 2. Mr. Gifford's Daughter in Fleet-Lane, about the Eighth Year of her Age was taken with an Inflammatory Fever, a Pain in her Side, and a troublesome and dry Cough. I being called after the Second or Third day of the Disease, judging by the Diagnostic Signs that the Patient had a Pleurisy, ordered a Vein to be opened once, and again, Liniments and Fomentations to be applied externally; and likewise Expectorating Medicines to be given her plentifully (which she took too sparingly:) I ordered likewise Blisters as it was necessary upon the account of her Fever, and the Affection of her Nerves, and Pearl Juleps made of Cephalick and Cordial Waters. After the use of these things, the Inflammatory Fever turned to a Hectic, and the Convulsive Pain of her Side into a Gravative Pain, and thereupon all the Symptoms appeared more mild. But because no Phlegm could by any Art be brought out of the Lungs by Coughing, I did much suspect that the Putrid Phlegm which had been concocted in the Lungs, had found some other way through the very substance of them into the Cavity of the Breast, and that my poor Patient would at last die of an Empyical Consumption, caused by the Pleurisy, for want of Expectoration. And indeed I was not much out in my Conjecture: For after the poor Girl had lain languishing for Twenty days after the end of the true Pleurisy, every day pining away with a continual Hectic Fever, a redness in her Cheeks often returning, the palms of her Hands very dry, with a dry and troublesome Cough, pertinacious Watch, shortness of Breath, and other expensive Symptoms; at last she began to complain of a gravative pain of her Side about the left Hypochondre, which increased so one day after another, that at last she could not be moved, nor set upright without crying out. But after the Thirtieth day of the Disease looking upon the Part affected, I found it swelled, and rising a little with a point. But yet I stayed till the fortieth day, and then Mr. Holier, a very Skilful Surgeon, being called in, we took out by degrees the putrid Phlegm by a Paracentesis made a little above the Diaphragm in the space of a Month: For by reason of the emaciated state of her Body she could not bear the taking away of much at a time. But for a Year or two the Wound was designedly kept open in the same part, like as an Issue. In the mean time making use of a Milk Diet, Balsamic Medicines, Wood-lice, and drinking freely and a long time a Vulnerary Decoction of Sarsa, etc. (with the help of the Country Air) interposing likewise at due intervals, and according to the strength of the Patient, Purges made of Calomelanos and Diagrydium, at length she recovered out of her Consumptive state, having got a good Colour, and Flesh, and so she continued for several Years without the least Symptom of her former Distemper, but only that she was somewhat drawn in with a crookedness on the Side that had been affected, to her dying day, when she was taken off by a Malignant Fever. CHAP. XI. Of a Consumption proceeding from the Gout, and from a Rheumatism. There is a Colliquation in a Gout and Rheumatism. IN a Gout and Rheumatism, especially that which is true, and Humorose (which is caused by a sharp Ferment supplied from the Nerves) there is such an evident Colliquation in the whole Mass of Blood, that no Body can reasonably think it strange, that a Consumption should arise from these Distempers (but especially when they are stubborn, and Chronical, and return often.) And hereupon it is an easy matter to observe, that a Rheumatic Pain, In Rheumatic Pains there is a Cough. coming from the taking of Cold, seldom if ever is wont to seize upon the Joints without a Pulmonary Cough. And as I have seen that great Man, the Lord Bridgman, Mr. Philip's, and Mr. Tib's, and many others, after frequent and long Fits of the Gout and Rheumatism, die at last of a Consumption or Asthma; so I have likewise observed, that sometimes an Acute and Fatal Consumption has followed upon the first Fit of a Rheumatism. This Consumption it sometimes Acute. This Consumption when it seizes them from the first Invasion of a Rheumatism, happens sometimes to be Acute, for this Reason; because it proceeds from a Colliquation of the Humours in an Acute Fit of a Humorose Rheumatism. And therefore because it partakes of the Nature of an ordinary Consumption, And must be treated with the general Method. it ought to be treated wholly in the General Method; that is, with the use of Lubricating, Incrassating, Opiate, and other Pectoral Medicines. And indeed it has been my Practice, and that with very good Success, to prescribe in every Rheumatic Fit the plentiful use of Pectoral, Lubricating, and Incrassating Apozemes and Linctuses, though there be no urgent Cough, nor difficulty of Breathing, not only to temper and soften the Blood, but likewise to prevent a Consumption, which uses often to be the effect of a Rheumatism. But whenever this Consumption proceeds from an old Gout, or a Rheumatism, When it comes from an old Gout, etc. 'tis Chronical. that has returned frequently, it is plainly Chronical, and does gradually in several Years create trouble to the Lungs, and the Parts that serve for Respiration. And indeed it is of an Asthmatick kind, And of an Asthmatick kind. attended rather with a difficulty of Breathing from the toughness of the Phlegm, than a pertinacious Cough. Because it seems to arise rather from a Stupor of the Nerves, than from a Colliquation of the Humours. But yet this Asthmatical Consumption to me seems to be of a peculiar Nature, But of a peculiar Nature. because it is not at all relieved by the choice of a good Air. For I have observed, that this kind of Consumptive Persons, though they be likewise Asthmatical, breath as well in a foggy and smoky Air, as in that which is thin and open. And from thence also it comes to pass, that Lubricating, and Expectorating Medicines do no good in this case, though Incrassating, and Opiate Medicines are fatally Mischievous. But there is more Relief to be expected from the frequent and plentiful giving of Spirit of Hartshorn, of Salt ammoniac, and Chemical Oil of Juniper, and other things of that Nature, that excite the Spirits, and comfort the Nerves, than from any Opiates, or Pectoral Medicines. As the Consumption proceeds, the Pains abate. The more this Asthmatical Consumption grows upon the Patient, the more the Rheumatic Pains and Swell are wont to abate. And a true and genuine Humorose Rheumatism, long before it becomes Mortal, degenerates into a Nervous Rheumatism, attended with pains running up and down, but with no evident Swelling. When a Rheumatic Consumption is incurable. This Rheumatic Consumption, proceeding from a Chronical Rheumatism, and happening to those that are Old, (so far as I understand) is plainly incurable. For it is a sign that Nature absolutely sinks, and is now overcome in the last Scene of a Rheumatism. Gentle Vomits are good Gentle Vomits repeated at due intervals (especially if the Patient bears them well, and they are not given when 'tis too late) do much towards the promoting of the Cure of this Consumption; because they open the Obstructions of the Brain and Nerves, and abate the Rheumatic pains, by taking off the stiffness, and Stupor of the Nervous parts; from whence it comes to pass, that a great part of the Procatartick Cause, or that which feeds the Distemper, is taken away. Bleeding does good in the beginning. Likewise Bleeding in the beginning of this Consumption (before the Habit of the Body is too much extenuated) does a great deal of good, not only by abating the Hectic heat, and the Rheumatic pains, but also by relieving the difficulty of Breathing. When the Distemper is improved, it is hurtful. But in the progress of the Distemper, when a great Emaciation has before seized the whole Habit of the Body, as I have often observed Nature to be more weakened, so their Respiration to be rendered more difficult with Bleeding. And indeed I do not at all doubt, but this Asthmatical Consumption does often proceed from Bleeding profusely, and the often repeating of it in the Fits of a Rheumatism; the Crasis of the Blood being thereby destroyed, and the whole Mass of it impoverished, as it uses to happen in all immoderate Haemorrhages. I have likewise very often by Experience found the extraordinary Virtue of the Peruvian Bark in extinguishing the Colliquative Hectic Flame, which has been kindled in the Blood, The Peruvian Bark does well. and is left there by its Rheumatic state, which Flame, unless it is taken away either by some Art, or by Nature, does most certainly prepare the way to this Pulmonary Consumption. I have observed likewise that Chalybeate Medicines do for the same Reason conduce very much in the beginning of this Distemper, So Chalybeate Medicines. at least to the gaining of some respite, if not to a perfect Cure; but especially the Chalybeate Waters, if it be not too late when they are drank, if they pass plentifully enough by Urine. The use also of Natural and Artificial Baths, And Baths. if they are used before the Habit of the Body is too much extenuated, is wont to promote the Cure of this Consumption very much at the beginning, by opening the Obstructions of the Nervous parts every where. A Milk Diet is likewise very beneficial at the first Invasion of this Distemper, And a Milk Diet at the beginning. by lessening the flame that is kindled in the Blood, and correcting the preternatural Acrimony of it. Though it must be confessed it does not so well agree with these Patients in the progress of the Distemper, when once there comes to be a difficulty of Breathing; because it uses to cause a greater toughness of the Phlegm, that is lodged in the branches of the Windpipe. And it may be this Conjecture is grounded upon very good Reason, to wit, that the using of Milk too much in a Rheumatism, does very much dispose the Patient to this Asthmatical Consumption. History 1. Mrs. Laurence, about the Five and Thirtieth Year of her Age, at which time too she was big with Child, fell into an Universal Rheumatism, and committed herself to the care of a certain Apothecary for several Months; till at length with a Cough, difficulty of Breathing, Hectic Fever, Emaciation, and other Symptoms of this kind, which she then had upon her, it was uncertain whether she would die of a Rheumatism, or of a Consumption; the Rheumatism (which before was a genuine one) being degenerated into a Nervous Rheumatism, attended with a rigidity, and a wand'ring pain in the Limbs, but with no Swelling. At which time, being the 25th. of October, 1686. I being sent for, ordered an Electuary with the following Julep to temper the Rheumatic and Hectic heat of the Blood and Spirits, and to allay the Hysterical Affections arising from thence. Take the Old Conserve of Red Roses, of Hips strained through a Sieve, of each an Ounce, Lavender-flowers powdered, Magistery of Coral, of each a Dram, of Syrup of Corals a sufficient quantity. Mix them, and make an Electuary, of which let her take the quantity of a Nutmeg every six hours. Take the Waters of Rue, Black-Cherries, of each four Ounces, of Barley Cinnamon-water three Ounces, the Compound Waters of Peony, of Briony, of each an Ounce and half, of prepared Pearl a Dram and half, of fine Sugar a sufficient quantity to sweeten them. Mingle them, and make a Julep, of which let her take four or five Spoonfuls after every Dose of the Electuary, and likewise at other times when she has a mind to it. To help the pains and stiffness of her Joints, I ordered that same Night Blistering-Plaisters to be applied to the inside of her Arms, near the Armpits; and I tried a gentle Evacuation by Stool with two Ounces of Tinctura Sacra, which she bore well. I ordered the following Paregorick Draught to be taken when she was to go to Rest. Take of Red Poppy-water three Ounces, Barley-Cinnamon-water an Ounce, of Compound Piony-water two Drams, Salt of Wormwood six Grains, Syrup of Meconium six Drams: Mix them, and make a Draught. October 28. I gave her the following Vomit. Take of the Infusion of Crocus Metallorum an Ounce, Syrup of Violets two Drams. Mix them, and let them be given for a Vomit about five a Clock in the Afternoon with due care and management; and (if it be necessary) let her take between her Vomiting a Scruple of Salt of Vitriol twice or thrice in a Draught of warm Posset-Ale. I ordered also the following Paregorick Draught to be taken when the Vomit had done working. Take of Mint-water half an Ounce, Dr. Stephen's Water three Drams, Barley-Cinnamon-water, the Cordial Milk-water, of each an Ounce, of Meconium six Drams. Mix them, and make a Draught. From the Vomit she found an Universal Relief, and that not only from the Symptoms of her Consumption, but also of her Rheumatism. And therefore after three days I ordered the repetition of the Vomit; and then I endeavoured to extinguish the Hectic flame, which had been kindled in the Blood by the Rheumatism, and thereby to take care of her Lungs, which had been injured by it, in the manner following. Take a sufficient quantity of the Ingredients of the Pectoral Decoction, of the Peruvian Bark an Ounce, Balsam of Tolu a Dram; boil them in a sufficient quantity of Spring-water to a pint and half; to the Liquor when it is strained add distilled Treacle-water, the Balsamic Syrup, of each an Ounce and half. Mix them, and make an Apozem, of which let her take four Ounces three times a day for six days together, taking always in the Night-draught fifteen drops of Helmont's Liquid Laudanum, if any Gripes, or Looseness, or want of Rest should trouble her. When she had done using the Apozeme, I ordered the Emetic Potion to be repeated, and afterwards, sc. Novemb. 13. I prescribed the following Pills. Take of the Peruvian Bark finely powdered an Ounce, Mucilage of Gum Tragacanth a sufficient quantity: Mix them, and make them into Pills of a middle size, to be gilded, of which let her take six Morning and Evening, from day to day. With the use of which she grew perfectly well, being plainly freed not only from the pains, and stiffness of her Limbs, but likewise from her Cough, difficulty of Breathing, Oppression, Fever, and all the other Symptoms of a Pulmonary Consumption. Her Appetite also returned, and at length she likewise recovered her Strength, and her Flesh, and still enjoys very good Health, without any return of her Rheumatism, or Consumption. History 2. Mrs. Covert, a Virgin, about the Eighteenth Year of her Age fell into a Continual Fever, which at length was followed by another that was Intermittent, which continued for the space of Eleven or Twelve Months. But this went away of its own accord, only a Humorose Rheumatism succeeded to it. But the Fever and Rheumatism in process of time being (I know not by what means) in some measure overcome, yet the poor Virgin remained continually Hectical, Coughing, Short breathed, very much Emaciated, and pale as if she had no Blood in her, presenting in a manner an Hippocratical Face. Moreover the Tendons of her Muscles were almost universally stiff by reason of a preternatural thickness and hardness in them, the Trophies of her former Rheumatism, so that all her Joints, not only the lesser ones of her Feet and Hands, but also the larger being plainly unable to do their Office, or at least doing it with a great deal of difficulty and pain, she continued almost always fixed to her Chair or Bed like an Image. She was likewise many times seized with wand'ring, and shifting, spasmodick, and dreadful pains up and down all about her Breast, and troubled with Hysterical Faintings, and Fits of a Fever often returning at uncertain times. To all these Symptoms there were joined a continual languishing Weakness, a want of Appetite, and a suppression of her Courses. The universal Habit of her Body too seemed to me to be very Scorbutical. A case verily (if any is so) very deplorable, which yet (with the Blessing of God) I did help by our Art in the following manner. Going to see this poor Virgin on the Thirtieth day of May 1683. to temper the Scorbutical sharpness of her Blood, and to ease in some measure her wand'ring Pains, which as they had continued a long time, so they did not a little wear out oppressed Nature, I ordered Calomelanos, Diagrydium, of each fourteen Grains, Syrup of Succory with Rhubarb a sufficient quantity. Mix them, and make a Bolus, to be taken in the Morning with due care. I likewise ordered two Scruples of Wood-lice prepared, and Crabs-eyes prepared, mixed together, to be given three times a day at Physical hours in a spoonful of the following Julep, drinking three or four spoonfuls of it after them. Take the Waters of Baum, Black-Cherries, the Cordial Milk-water, of each four Ounces, Barley Cinnamon-water, Epidemick-water, of each three Ounces, of Sugar of Pearl six Drams. Mix them, and make a Julep. I also ordered the following Bag to be hung in three Gallons of middling Ale for her ordinary Drink. Take the Roots of sharp pointed Dock, of Male-Piony, of each two Ounces, Garden and Sea Scurvygrass, of each three handfuls, Brook-lime, Water-cresses, Tun-hoof, Pine-tops, of each two handfuls, of Aniseeds an Ounce. Mix them, and make a Bag. On the Second of June, because the form of a Powder was not so grateful to her, and that I might promote the opening of Obstructions, instead of the Powder I substituted the following Electuary. Take the Conserves of Hips and Red Roses, of each half an Ounce, of Wood-lice prepared a Dram and half, Crabs-eyes prepared two Scruples, Salt of Steel twelve Grains, Syrup of Steel a sufficient quantity. Mix them, and make an Electuary, of which let her take the quantity of a Nutmeg every six hours, drinking a Draught of the Julep after it. I ordered likewise a Scruple of the Stomack-Pills with Gums to be taken the Night following. June 5th. because the form of an Electuary did not please her, I substituted a Chalybeate Syrup in the room of it for the same intention. And because she was not easy to work upon, I ordered instead of the former, the following Pills to be made up. For the Syrup, Take of the Chalybeate Wine a Quart, Tincture of Saffron, of Castor, of each an Ounce, of fine Sugar a sufficient quantity. Boyl them to the consistence of a Syrup. Let her take two spoonfuls of it in the Morning, and at five a Clock in the Afternoon on those days she does not Purge, by itself, or diluted with Carduus-water. For the Pills, Take the Stomack-Pills with Gums, Aloes Rosate, of each fifteen Grains, of Salt of Wormwood four Grains, Elixir Proprietatis a sufficient quantity. Mix them, and make them into four Pills, to be taken on the Morrow Night, without any strict Confinement. I likewise ordered the Tendons, that were indurated and contracted by reason of their thickness, so as to be painful, to be anointed twice a day with Oil of Amber, and Compound Spirit of Lavender, o● each equal quantities before a good Fire, and to put a Flannel upon them. Though the swelling of the Tendons seemed to be lessened, and her stiff Joints to be rendered something more fit for motion with the use of these things, yet the System of the Nerves seemed now and then to be grievously affected from her Hysterical Fainting Fits often returning. And therefore on the Ninth of June I ordered four or five Spoonfuls of the following Julep to be given her when she was faint. Take the Waters of Bawm, Black-Cherries, of each three Ounces, the Compound Waters of Bryony and Peony, of each an Ounce, of Tincture of Caster a Dram, Spirit of Salt ammoniac half a Dram, Compound Syrup of Peony ten Drams. Mix them, and make a Julep. I repeated the Bag of Antiscorbutic Ingredients, and ordered the Purging Pills to be taken every fourth Night. The Nerves having been relieved three or four times with the use of the Julep, that had been prescribed, I observed besides her continual Hectic Heat, sometimes also a Fit of a true Intermitting Fever, seizing her first with a chillness, and going off with profuse Sweats, though 'twas by uncertain intervals. And thereupon I did not without reason suspect that her loss of Appetite, her continual Hectic Fever, and Universal Weakness, did proceed from this Feverish Ferment lurking within, which had never yet been thrown out of the Mass of Blood; and which hitherto had so like a Proteus in various shapes deceived my sight. And therefore now I go, and encounter this Enemy with all the Power of the Peruvian Bark: For I promised myself (and my hopes were not frustrated, as the Event did afterwards prove) that when this Enemy was vanquished, the state of her Health would be very much restored upon it; however Baths, Fomentations, and other things of that kind would be of great use to extirpate fully the Trophies of the Gout, which were left in her knotted and weakened Joints. And therefore, June 13. I ordered the following Draught to be given, and to be repeated every four hours, for seven or eight times. Take Baum-water, Black-Cherry-water, of each an Ounce, Epidemick-water, Syrup of Clove-Gilly-flowers, of each two Drams, of the Peruvian Bark finely powdered a Dram; mix them, and make a Draught. I ordered likewise the following Julep to be taken by spoonfuls when she was faint. Take of Carduus-water six Ounces, Barley-Cinnamon-water four Ounces, strong Piony-water two Ounces, prepared Pearl a Dram and half, white Sugar five Drams. Mix them, and make a Julep. June 15. Take of the Peruvian Bark finely powdered five Drams, the Mucilage of Gum Tragacanth a sufficient quantity: Make them up into Pills of a middle size to be gilded, of which let her take six at four a Clock in the Afternoon, and when she goes to Rest from day to day, taking every Morning the Chalybeate Syrup before ordered. Let the Bag of Antiscorbutic Ingredients be likewise renewed. But though the Patient was perfectly freed from the Fever Fits, yet still her sickness at her Stomach, and want of Appetite continued, together with her Weakness, and the other Trophies of her inveterate Enemy. And therefore though I changed the form of the Medicine, yet I still pursued the Enemy, that was now plainly upon its flight, with the Bark, in the manner following. Take of the Ingredients of the Purging bitter Decoction a sufficient quantity, Salt of Wormwood half a Dram, the Peruvian Bark powdered half an Ounce: Infuse them in a due manner, and boil them in a sufficient quantity of Spring-water to twelve Ounces. Let her take four Ounces of the Liquor pressed out hard from the Ingredients, every Morning, and repeat it for three days together, continuing the use of the Chalybeate Syrup at Four a Clock in the Afternoon. June 27. I ordered the following Bolus to be taken every six hours, with four Ounces of the following Apozem, for three days together. Take of the Peruvian Bark finely powdered half a Dram, Syrup of Mugwort a sufficient quantity; mix them, and make a Bolus. Take of the Peruvian Bark powdered half an Ounce, infuse and boil it in Carduus-water and White-Wine, of each a sufficient quantity, to twelve Ounces. Strain it out for use. July 6. Because the Nervous Parts seemed still to be somewhat affected, I ordered her three of the following Pills to be taken three times a day at Physical hours, and to drink four Ounces of the Tincture of the Bark just before prescribed. Take of the Powder of the Peruvian Bark two Drams, Troches of Myrrh a Dram, Castor, Ens Veneris, of each two Scruples, the Mucilage of Gum Tragacanth a sufficient quantity. Mix them, and make them into Pills of a middle size, to be guilt. With this plentiful use of the Bark, though it was given in several forms, my Patient was in a wonderful manner recovered to a state of Health, so as to be every way well, and was perfectly freed from all the Symptoms of her Consumption and Rheumatism; but only that the Tendons and Joints, especially those of her Hands, continued stiff, and likewise something swelled, and she did not yet gather Flesh enough. And therefore when I had by way of Preparation taken care to Purge her with fifteen Grains of Extractum Rudii, and a Scruple of the Fetid Pill, I sent her down to the Bath to use those Waters, both outwardly by bathing, and inwardly by drinking them for six Weeks, ordering the Tendons, and Joints that were swelled at the end of every bathing, to be embrocated for a good while and freely with the Waters of the King's Bath, and the same Parts (when she was laid in her Bed, and disposed to sweat) to be a good while anointed with the following Lineament. Take Ointment of Marsh-mallows, Nerve Ointment, of each an Ounce, Oil of Scorpions, of white Lilies, of each half an Ounce, of Chemical Oil of Aniseeds three Drams: Mix them, and make a Lineament. And for fear she should be faint in the use of the Bath, she had the following Cordial in readiness, to be taken by spoonfuls at any time when she pleased. Take the Epidemick-Water, Dr. Stephens 's Water, of each half a Pint, of Syrup of Clove-Gillyflowers two Ounces. Mix them, and make a Cordial Julep. In the Month of September my Patient returned from the use of the Bath, having found a great deal of Benefit: But especially her Tendons and Joints, that were affected, were very much restored by it; to promote the Cure of which yet farther, I advised her to use one of our Bagnio's here at London twice or thrice a Week, together with the following Medicines. Sept. 4. 1683. Take of the best Sarsaparilla four Ounces, Chinaroots an Ounce and half, shave of Ivory, of Hartshorn, of each three Drams, of Raisins of the Sun stoned two Ounces, Liquorice sliced half an Ounce, after a due Infusion boil them in four quarts of Spring-water to two quarts. Let her take half a Pint of the Liquor strained thrice a day at Physical hours. Take Ceruse of Antimony, Wood-lice prepared, of each a Dram and half. Mix them together for six Papers, of which let her take one three times a day with every Draught of the Decoction before prescribed, but especially when she goes into the Bagnio. As soon as she had made an end of using the Bagnio, I endeavoured to promote a gentle Diaphoresis every Night with the use of the following Draught. Sept. 12. 1683. Take Carduus-water, distilled Treacle-water, of each an Ounce, of Ceruse of Antimony a Scruple, Syrup of Violets two Drams. Mix them, and make a Draught, to be repeated for Ten Nights together. With the use of which her Joints and Tendons received a great deal of benefit. But at length for fear the Patient's relapse into an Intermitting Fever at the end of the Year (of which I had a great and reasonable Suspicion) should frustrate the perfecting of her Cure, I advised her to repeat the use of the Peruvian Bark for several days, to be taken every fourth or fifth hour, in the form of the following Apozem. Sept. 20. 1683. Take of the Peruvian Bark powdered an Ounce, boil it in Carduus-water and White-wine, of each an equal quantity to a pint and half, and then let it be pressed out very hard. Lastly, For the getting of her Flesh again, and the farther tempering of her Hectic heat, I advised her to go into a strict Milk Diet, to be used for six Weeks in the Country Air. With the use of which she grew plump, and recovered her perfect Health, her Monthly Purgations then at length returning with a florid colour, which before this had been quite stopped for four Years, by reason of the emaciated and thin Habit of her Body. But the next Year, which was 1684 in the Month of June, because of some stiffness, which remained in the Tendons of her Wrists, and of one Foot, she went again to the Bath, and afterwards repeated the Milk Diet. From which time to this present she has enjoyed perfect Health; and likewise having been married, has had Children. With almost the same Method I happily cured Mr. Overton, living without Newgate, beyond the Expectation of all his Friends; who with a long Rheumatism was at length brought plainly into a Tabid state, with a difficulty of Breathing, a violent and perpetual Cough, a continual Hectic Fever, a spitting of Matter like Pus, and the other signs of a Fatal Consumption of the Lungs. Whose Case I here forbear to recite for Brevity's sake. History 3. Mrs. Lane, a Barber's Wife, whose Husband lived in Cow-Lane, being about Five and Thirty Years old, when she had lived in a Consumptive state, Emaciated, and Coughing, for several Years passed, fell in the Month of April, 1684. into a true Rheumatism, with violent Pains, and inflamed Swell, which yet were moving suddenly from one Joint to another; with a Fever likewise, that was evidently of a remitting kind, accompanying of it; which had the Type of a Tertian (which I have very often observed to be the Nature especially peculiar to a Rheumatic Fever.) In which case, whenever a new Fever-Fit seizes the Patient, the Rheumatic Pain and Swelling, which before were almost quieted, are wont to be renewed in the Parts that were before affected, or else by a Metastasis of the Matter (as the Ancients love to speak) to be translated to some other Joints. But the Fits were very long, lasting for the space of Twelve or Sixteen hours, and attended with a want of sleep, lightheadedness, great tumbling and tossing, heat, and a very Feverish Pulse. All which Symptoms used to be followed, and go off with great Sweats. But at the beginning of every Fit I observed that her Rheumatic Pains always grew more sharp in the Joints affected, or else seized some other Joints that were free before. So that a new Rheumatism seemed to come with every Fever-Fit. Being called in the time of her Fit, I endeavoured to satisfy the present Indications with Bleeding, Blisters, an Anodyne Draught, Tincture of Roses, a Pectoral Linctus, and a Pearl Julep. And indeed all the Symptoms going off at the end of the Fit, when I came to see my Patient the next day, I reckoned the Distemper was overcome, and removed with those things I had ordered, till at length by the return of the Fever, and Rheumatic Fit the next Night, I plainly understood how vainly I had hitherto flattered myself. And therefore according to the urgency of the Symptoms that indicated it, I bled her again, ordering the repetition of the Hypnotick Draught, and likewise the application of an Anodyne Cataplasm to the Joints, that were affected with extreme pain from the Rheumatism. But after I found the Type of the Fever and Rheumatism for two or three times, to be plainly a Tertian; and that notwithstanding the Method I had before prescribed, all things continually grew worse, the very System of the Nerves being now at length seized with Spasms, but especially in the time of the Fit; and her Mouth being likewise ulcerated with a Thrush, being led by a happy Conjecture, I betook myself in this deplorable case to the use of the Peruvian Bark; prescribing a Dram to be given every third or fourth hour, when her Fit was off. With the use of which in the space of Twenty Four hours, she was freed both from her Rheumatism and Fever, without any other Remedy, and was well after her manner, that is, Consumptively; but yet she was less oppressed in her Lungs, than she had been before she fell sick. But as soon as she got rid of her Pain and Fever, she wholly neglected her Chronical Consumption (which likewise seemed to be helped with the Bleedings, the use of the Bark, and the other Medicines before prescribed) refusing all sorts of Medicines; and thereupon after a Year or two she died of that Chronical Consumption of the Lungs. CHAP. XII. Of a Consumption proceeding from Fevers, especially such as are from Surfeits, Scarlate, and Intermitting Fevers; as also from the Smallpox and Measles. A Consumption often proceeds from these Acute Diseases. I Have very often seen a Consumption of the Lungs take its Original from these Acute Diseases. Neither indeed have we any reason to think it strange that a heat kindled in the Humours by a Putrid Fever is wont to degenerate so easily into a Hectic, or Habitual heat seated in the Spirits, and solid Parts of the Body. For when the Spirits and Humours in the Habit of the Body have been a long time fed, or nourished by the Blood too much inflamed and heated, they do not easily shake off that Preternatural Heat. And what wonder is it if from this Hectical and fixed Flame a Colliquation and Consumption are apt to follow? Especially from the Smallpox, etc. And this is wont to happen especially in the Smallpox, Measles, and in Scarlate, and Crapulous Fevers. Because in these Diseases there is so great a Colliquation of the Humours follows, caused by that sharp heat that attends them, that it can hardly be stopped afterwards; whereupon the new Chyle afterwards cannot be united, or assimilated to the Solid Parts. And from hence it comes to pass, that the Preternatural Heat of the Parts is not always quite extinguished by the critical eruption made in the former Diseases, but there still remains a Hectic heat in the Solid Parts, together with a dry Cough, with other signs of the Serous, and Colliquative state of the Blood (after the other Distempers are cured) which even presages a Consumption that is to follow. The most usual forerunner of this Consumption is a light Peripneumonick Affection, What is the usual forerunner of this Consumption. or Scrofulous Tubercles bred in the Lungs themselves; which are always wont to arise first in the declension of the former Diseases. From whence it comes to pass, that not only a Feverish Heat is kindled again, but it likewise returns attended with a Cough, difficulty of Breathing, want of Rest, a Thirst, want of Appetite; yea, and sometimes with a pain in the Breast, and other signs of an incipient Consumption. This Consumption for the most part is Acute. For this Consumption for the most part is quick, and Acute, because it comes upon Nature when she is already weakened by the former Distemper; neither can it be prevented, Bleeding is necessary as well to prevent as to Cure it. or cured any way without timely and repeated Bleedings, though the state of the Patient seems never so weak. And indeed the neglect of Bleeding, or doing of it too late, or too sparingly in the declension of the preceding or Original Disease, uses for the most part to be the occasion of this Consumption. But when we have bled the Patient as often, After which Expectorating and Balsamic Medicines must be used. and as much as we ought to do, the rest of the Cure is to be performed with the diligent use of Expectorating, and Balsamic Medicines, already described in the General Method; as also of a Milk Diet, and Temperate Juleps. What I have said of a Consumption coming after the Measles, Smallpox, as also Scarlate, and Crapulous Fevers, (all which Diseases are of one and the same kind, to wit, of a Serose, and Colliquative Nature) the same may likewise be affirmed with the same Reason of all Scorbutical and Chronical Fevers; as also, generally speaking, of any kind of Fevers, that have terminated without a fair and due Crisis. For the Feverish Ferment being in this manner rather depressed by force, than overcome, there succeeds a mild Hectical Heat to the former Putrid Flame, which will afterwards introduce a Consumption after it. And therefore even in the declension of these Fevers, In the declension of some Fevers we must bleed. what sort soever they are of, we ought to bleed, and then finish the rest of the Cure in the manner as I have hinted in this Paragraph. Malignant Fevers may bring a Consumption. And I do not doubt but that even Malignant and Pestilential Fevers, which are wont to have a Critical termination by Apostemes and Ulcers, may likewise bring a Consumption by throwing the Feverish Matter by the way of a Crisis upon the tender Substance of the Lungs, from whence Swell, and ill-natured Ulcers arising, are apt to bring a very Acute Consumption. But the Cure of it must be performed with the timely and diligent use of Expectorating, Absterging, and Balsamic Medicines before described; by which means we may as soon as is possible clear the Lungs. Observations concerning a Consumption from Intermitting Fevers. But here I have a mind to add some few things particularly of the Original of a Consumption proceeding from Intermitting Fevers. Scil. Observe. 1 First, That I have observed a Consumption to have its Original from no other Fever more frequently than from an Intermitting one. Which to me seems to happen for two Reasons. First, because this Fever either from its own peculiar Nature (because it has an inexhausted Source in the Habit of the Body) or from the neglect of giving Efficacious Medicines in time, and in a good quantity, is very Chronical, and many times though it is driven away, returns again; and from thence it comes to pass that at length a Hectical, and continual heat is brought upon the Spirits and Solid Parts by this Putrid Heat prevailing for a long time; and thereupon there must necessarily follow a Serous Colliquation of the Humours, together with a Cough, and the other Symptoms that accompany a Consumption. Secondly, because this sort of Patients, having no suspicion that this kind of Distemper will be Mortal, as they commonly make slight of it, so they are wont to neglect themselves, not only endeavouring to Cure themselves with I know not what Receipts of Old Women, (from whence it comes to pass, that under the pretence of Curing the Fever, they many times procure an Inflammatory and Venomous disposition to the Blood and Humours) but likewise very often exposing themselves carelessly to the cold Air, even in the time of the Fit, and getting one Cold after another, they at length suffer for their carelessness and ignorance, by a Consumption caused by the often taking of Cold, and the neglecting of it too in this distempered state of the Humours. Which Consumption is wont to go by the less infamous Name of a Catarrh with these poor Patients; till at length through their Negligence it becomes incurable. And therefore I would give this Advice to all Persons, that they do not from a false Opinion of the Innocent Nature of this Disease, trust to the Receipts of Quacks, and Old Women; but that they would immediately make it their business to Cure it perfectly, and in due time, with the plentiful use of the Peruvian Bark (the only mighty Antidote of this Distemper) and to prevent the return of the Fever by repeating the use of it. For a frequent relapse into this kind of Fever does threaten a Consumption as well as if it were plainly continual. I likewise advise these Patients out of the same good will to have a great care of taking of Cold so long as the Distemper continues, but especially in the time of the Fit. Observe. 2 Secondly, This Consumption is for the most part Chronical, and continues for the space of a Year, or more, before it comes to its helght, partaking in this respect of the Nature of the Original Disease, upon which it depends. Observe. 3 Thirdly, The Pathognomonick Sign of this Consumption is, that from the first beginning of the Disease there is a Feverish Paroxysm every day, or each day, or every third day, according to the peculiar Nature of the Original Distemper, always joined with the Hectic Fever, together with a Cough, difficulty of Breathing, and the other ordinary signs of a Pulmonary Consumption. Observe. 4 Fourthly, In the Cure of this Consumption the Peruvian Bark ought always to be mixed in good quantities with the Pectoral Medicines. For though I have freed several from a deplorable Consumption of this kind in three Weeks or a Month in the Springtime with an Ounce or two of the Peruvian Bark without any Pulmonary Medicine, and without a relapse (of a Cure of which kind I shall not think much to add an Instance or two by and by:) Yet I never myself cured any one of this sort of Consumptive Patients, nor do I remember one cured by any other even with the most diligent use of Antiphthisical Medicines without mixing the Bark with them. History 1. Mr. Thompson a Painter, living in St. Nicholas Lane near Lumbard-street, about the Year 1674. in the beginning of the Month of October, at Midnight, after the eating too freely of Salmon, and his Wife at the same hour were taken in their Beds with a Quotidian Ague, or as I think a Triple Quartane. The Wife was ill treated by an Apothecary with I know not what Medicines so long, that though she seemed freed from the stated Fits of the Fever before January, yet by reason of her Weakness she kept her Bed, and lay as if she were just ready to die. For her Pulse was very weak, and quick, she was troubled with frequent Swoonings, pertinacious Watch, almost a continual Sickness, and Vomitings, had large and Colliquative Sweats, a great Thirst, a plentiful Spitting, a continual Restlessness, and extraordinary Affections of her Nerves like Hysterical, and no Stomach. The poor sick Woman, that now expected to die every moment, earnestly wished for the return of her former Fever, so she were upon that Condition freed from her present Miseries. Having given her the bitter Decoction with Senna twice for that purpose, as I would have it, I brought her former Fever again with its true Periodick Fits. And then in the time between the Fits I ordered the Peruvian Bark in several forms to a good quantity, to wit, an Ounce and half. With the complete use of which she perfectly recovered without the least return of her Distemper, or the Symptoms of it. Neither did I order her any thing more besides Hysterick Juleps and Opiates, as the Symptoms required. But the Husband, because he was of a strong Habit of Body, and engaged in much Business, but especially because he observed his Wife to grow every day worse with the Medicines which were unskilfully given her by the Apothecary, looked out for no help for himself, either from a Physician or the Apothecary, expecting that the Spring being now approaching, his Distemper would go away of itself. And every day after his Fit was, off he did his Business both at home and abroad (his Fever in the mean time keeping its simple form with one and the same tenor in its stated Fits and Intermissions all this while.) But at length after his Wife was well, when he found himself every day to grow weaker and weaker with his Distemper, he was about to desire my help; but both the approaching of the Springtime, and a hurry of great Business diverted him from this Prudent Resolution. 'Tis true indeed, according to the Opinion he had before, about the beginning of the next Spring his Fever in its simple form left him of its own accord; but still he had no Stomach, his Strength was gone, the Habit of his Body lean and pale, his Pulse always quick and weak; he had a great Thirst, a shortness of Breath, a dry Cough, that troubled him continually both Day and Night, with all the other Symptoms of an Incipient Consumption. At length he comes to me, both he and his Wife imploring my help, and much lamenting his delay. Presently I well enough thought I had sufficient reason to believe that this Incipient Consumption was the true Offspring of his former Proteus-like Disease; and therefore I ordered almost nothing of common Antiphthisical or Pectoral Medicines, with the help of which I thought it almost impossible that the Patient, who was now almost brought into the state of a Marasmus, should be restored to his former Health. But I concluded that the whole Cure was to be performed with the use of the Peruvian Bark, by which means the Fever being once perfectly conquered, I rightly judged that the other Symptoms would go away of their own accord, as the Event itself did happily prove. And therefore I made it my business only to make the form of the Medicine as grateful as I could, lest I should have the Fancy of the Patient to strive with as well as his Disease. And therefore I ordered the Powder of the Peruvian Bark in the form of Tablets, in the manner following. Take of the Powder of the Peruvian Bark an Ounce and half, Sugar-candy dissolved in eight Ounces of Wormwood-water, thickened with the Mucilage of Gum Tragacanth. Mix them, and make them into Tablets, so that every one may weigh two Drams; let him eat one four times a day, drinking four Ounces of the clear Pectoral Decoction after it. When he had taken all the Tablets, presently that Hectic Fever (which as it was the Genuine Offspring of the Intermitting Fever, so it still partook of the Nature of its Parent) plainly went away, together with his Cough, difficulty of Breathing, and the other Company of Fatal Symptoms of a Consumption; but only that his Appetite was not yet perfectly restored, neither had he got his Flesh, by reason of the shortness of the time. And therefore, the time of the Year inclining me to it, I sent him presently into the Country Air; out of which after the space of two or three Weeks, he returned strong and plump, having got a good Colour, and a great Stomach, and enjoys very good Health to this very day. History 2. A certain Norway Merchant, that lived at Newington on the other side of the Thames, that Year when Mr. Talbor was very Famous for the liberal use of the Peruvian Bark in the Cure of Intermitting Fevers; and likewise that same Month, wherein I had recovered the same Merchant's Wife beyond the expectation of all those that were about her of a Remitting Fever, accompanied with very direful Symptoms with the use of the Peruvian Bark amongst other Remedies; when he himself was taken with a true and benign Tertian Ague: Leaving his Friend, and his known and familiar ordinary Physician, he went with the Crowd to Mr. Talbor, and having paid five Guinea's, he had an Ounce of the Bark for a great Secret; which when he had taken, he presently was well recovered. But there being no care taken by that Empiric to prevent the return of the Fever, after two, or at most three Weeks, the Distemper at length returned, of which he was freed again and again, with repeating the use of the Bark, but not without giving in hand the former extravagant Price every time it returned. The Gentleman being saving, chose rather to pass the remaining part of the Winter under the miserable Symptoms of this Fever, than to be always draining his Pocket in this manner, hoping in the mean time that his Distemper would at least leave him the next Spring of its own accord. But with the long continued course of this Fever (which perhaps the frequent taking of Cold in the time of the Fit, and the Old Woman's and Quacks Receipts, that were none of the wholsomest (all which he was wont to use very greedily, and without distinction) did promote.) I say, with the long continuance of this Ague, there seemed at the beginning of the Spring to be kindled a continual Hectic Heat in the intervals of the Fits of the Putrid Fever, attended with a great Cough, difficulty of Breathing, Colliquative Sweats, a continual Thirst, Nauseating, and other Symptoms of this kind. Whereupon before the end of June, at which time he desired my help, thinking he should soon die of a Consumption; he was so weak, and emaciated, that he had perfectly a Hippocratical Face, and when I first saw him I should plainly have thought him past Cure, if this Consumption had proceeded from any other cause than an Intermitting Fever. But yet I did rightly judge a Consumption arising in this manner, though to all outward appearance deplorable, to be curable, because it was in my Power, at least at this time of the Year, to give that great Antidote, the Peruvian Bark, in that manner as not only to take off the Intermitting Fever, but also to prevent the return of it. Whereupon I did not at all doubt but when the Fuel was once taken away, the Hectical Flame would soon be extinguished of its own accord, together with the whole Company of Pulmonary Symptoms depending thereon. Which Conjecture of mine was very quickly proved to be true by the happy Event. For the Fits of the Intermitting Fever being once taken away by giving an Ounce of the Peruvian Bark in the form of Pills, in the space of four or five days, the Hectic Fever also vanished of its own accord; likewise the Cough, with the other Pulmonary Symptoms was much lessened, and his Appetite much increased. But when the return of the Original Distemper was prevented by repeating the use of the same Bark, all the Symptoms of the Consumption vanished within the space of a Month, even without a Grain of Pectoral Medicines. And my Patient (as far as I know) to this very day looks well, and is lusty. History 3. Mr. Lane, a Vintner at the Sign of the Queen's Head in Southwark, a Man that was truly robust, and tall, about the middle of his Age, in the beginning of the Autumn, in the Year 1668. was seized with a violent Quartan Ague; he presently committed himself to the care of a Skilful Physician, who treated him with the usual Remedies, and in the old Method, to wit, with Bleeding, Vomiting, frequent Purging, Febrifuge Juleps, and tedious Deobstruent and Altering Apozems. But yet he grew every day worse; at length his Ague was doubled, yea, treble, so that he was no day free from his Fever; and about the end of December his Fits were so long, that almost presently after one was off another came on: He was so weak too, that he could scarcely rise out of his Bed; and his Stomach was so weak, that he hardly could eat so much as Water-gruel. He was continually, and extremely Thirsty, because he never seemed to be free from his Original Fever, or the Hectic, which was come upon it; and therefore being restless, he was continually tossing himself up and down in his Bed. And moreover there appeared Purple Scorbutical Spots, and those very large, every where almost all over his Body, but especially in his Breast and Limbs: His Legs and Thighs, as also his Belly and Breast, were very much swelled, like those that have the Dropsy. His Cough was troublesome, and continual, and his breathing difficult, and very unequal. So that the Patient at the first sight seemed to me to have not only an Intermittent Fever, but also a continual Hectic, arising from the former; and upon that to have fallen into a Pulmonary Consumption, and an Universal Dropsy. When it was so, that they plainly had no hopes of the Patient's Life, I was at last sent for by his Friends, not so much to Cure his Fever (which they judged to be incurable before the Spring Weather came) as to give him some help against his Consumption, Dropsy, and Scurvy, Distempers that raged so violently, that they seemed to threaten almost immediate Death. But the Patient himself loathing even Food itself, though the most delicious, much more Medicines, with the great quantity of which his Stomach had been long burdened, did with a great deal of difficulty consent that I should attempt his Cure with any kind of Medicines. But at length his Friends with much entreaty obtained this of him, that he would for three or four days take my Specific Pills made of the Peruvian Bark, only for a Trial. In which time having taken six Drams of the Powder, he presently escaped the next Fit. The next day, when I came to see my Patient, I found him plainly Triumphing over his Enemy, eating a potch'd Egg, and ready to ride out in a Coach, which was now at the Door, in order to follow his necessary Occasions. But which seemed much more wonderful to me, as all the Spots were disappeared, so likewise that Dropsical Swelling went away without even any sensible Evacuation. Also his difficulty of Breathing and Cough, with the other Symptoms of an incipient Consumption, seemed to be very much abated, and they decreased every day, till at last the Patient had by little and little recovered his former state of Health. 'Tis true indeed, this Fever after a Month returned in the form of a simple Quartan, and continued till he had had almost four Fits. But yet it went quite away without the use of any Remedies, or the former Symptoms following upon it; from which time the Patient enjoyed his Health very well, till at length after one Year, and some part of another, he died of a Bleeding at the Nose. CHAP. XIII. Of an Icterical, or Hepatick Consumption. THE Blood, as soon as it has here and there in its Circulation distributed the new Chylous Parts, and those that are fit for Nourishment, becomes plainly sharp, as if it were imbued with a Ferment, from the Saline and Acrious Particles, which by the Law of Nature it still contains in itself (to the end that from thence the Bile, and other necessary Ferments of the Body may be supplied, and every day renewed.) And therefore by the same Sagacity of Nature there is Provision made that after she has in this manner done what is sufficient for the necessary Ferments, the Acrious and superfluous remainders should as Excrements be forthwith thrust and thrown out by the pores of the Skin, by the Kidneys, the Glandules of the great Guts, and the other Avenues, or Emunctories of the Body; lest the Mass of Blood itself being burdened, and oppressed with this kind of Particles, and thereupon brought into a distempered state, should not be able to perform its Natural Office. From what I have now said it is evident to Reason how many ways a Jaundice is wont to occasion a Consumption. How a Jaundice causes a Consumption. For whether it be Accidental, as when it proceeds from an Obstruction of the Natural course of the Bile from the Gallbladder into the Cavity of the Duodenum, caused by a Stone, or the glutinousness of the parts of the Bile; or whether it be more Habitual, coming from a defective separation of the Bilious parts in the Liver, caused by a Schirrous hardness or an Exulceration of that part, there are two things, which must necessarily be the Effects of it; to wit, a want of Bile in the Intestines, and too great a congestion of it in the Blood. By the first of these, Nature for want of a due Menstruum in the Volatilization of the Chyle is hindered from the convenient separation of the Excrementious from the Chylous parts: From whence it comes to pass, that the Excrements of the Guts containing in them both parts, are voided of a white colour, together with a manifest faintness and weakness of the Patient, even from the very beginning of the Distemper. Because by this continual Substraction of the new Chyle there is caused by degrees an Universal Atrophy; which I have already hinted in the Appendix to the First Book. But by the latter the Mass of Blood itself is altered and distempered, as being too much saturated with Bilious Particles, that are sharp and pungent. Which discovers itself not only by an Universal Itching excited in the Habit of the Body, but also by a yellow Tincture coming upon all the Skin, and by the very red and yellowish colour of the Urine. From this Collection of sharp and bilious Particles in the blood (at least when it happens to be long, and Habitual) no Body must think it strange if even the very Mass of Blood is vitiated, and contracts a Hectical Heat; and any one may as easily observe how soon the Lungs, being from thence affected with a Hectical Heat, are apt to be stuffed, to swell, to be inflamed, and putrefy. So that the Jaundice, whenever it is Chronical and Habitual, by gradually spoiling the Crasis of the Blood, is wont likewise to bring a Chronical Consumption of the Lungs. Which also is not a little promoted by the Oppression of the Hypochondres, This Consumption is promoted by an Oppression of the H●pochondres. which continually creates a weight in them, caused by the preternatural thickness and compactness of the Liver; to wit, whenever the Jaundice is Chronical; and likewise from the Colic of the Stomach, or those dreadful Spasmodick Pains, which are wont to return often, from the Obstruction of the Gall-duct by a Stone, or the Glutinousness Viscidity of the Bile; or else from an Inflammation and Exulceration of the Liver itself, to wit, whenever this Distemper is Accidental, and more Acute. For as it is impossible but the Lungs must be much injured by the consent they have with the Liver that lies so near to them, and must likewise necessarily partake with it of the Spasmodick Contraction in the manner of Hysterical Suffocations; whereupon their tender Substance must needs be very much injured, and changed from their Natural Tone by that frequent Constriction; to wit, in an Accidental Jaundice: So likewise whenever it is Habitual, the Hypochondriacal Melancholy, which is wont always to accompany the Gravative Oppression caused by the Obstruction of the Liver, does dispose Persons to a Consumption of the Lungs it may be more than any other Passions of the Mind. A Consumption is seldom caused by an Accidental Jaundice. 'Tis true indeed that I have very seldom met with a Consumption of the Lungs proceeding from an Accidental Jaundice, whether this Disease has had its Original from the Obstruction of the Bile-duct, or from an Inflammation and Exulceration of the Liver itself: For by reason of the violent Colic, or Spasmodick Pain, and the Acute Inflammatory Fever, which are wont for the most part to accompany this Jaundice, the Patient very seldom happens to live so long, that the Blood can undergo so great an alteration from the Bilious Particles preternaturally heaped up in it, as to be disposed to form a Consumption of so Chronical a Nature. But before it is possible for the Blood to undergo such an alteration as is able to produce so great an Effect, either the Distemper is taken off from the Patient by Art, or the Patient is killed by the Distemper. But no Disease comes more frequently upon a Chronical Jaundice. But there is no Disease does come more frequently than a Consumption upon a Chronical and Habitual Jaundice, proceeding from a Schirrousness, or too great a Compactness and hardness of the Substance of the Liver; which Consumption for the most part is wont to terminate in a Fatal Dropsy. For as this is a Disease of several Years, because it is attended with no very great Symptom; so the Bile which is thereupon preternaturally heaped up in the Blood, though it is not in so great a quantity as in an Accidental Jaundice, yet by its long stay in, and frequent cohobations with it (if I may speak) it does more effectually alter the whole Mass, and disorder it; and it is no wonder if the tender Substance of the Lungs does at length get some fatal Mischief from it. The Evident or Procatarctick Causes of this Consumption, The Procatarctick causes of this Consumption. are, commonly frequent and long Debauches, and the more grievous Passions of the Mind succeeding alternately one another. By the first, the Substance of the Liver, and perhaps the Lungs too happens almost always to be too much heated and stuff● with superfluous Juice; and by the latter it happens to be spasmodically girt, or compressed. By both together the Liver (and it may be the Lungs too) is rendered too close or compact in its substance, if it does not also become Schirrous, or inflamed and ulcerated. And from hence there must necessarily follow too great a Collection of Bile in the Blood, and thereupon a Morbid alteration of it, an Oppression of the Hypochondres, a Melancholy, with the other signs just now mentioned, which tend to a Consumption of the Lungs. And hereupon I use to call this a Crapulous Consumption. For it is well known even to any one that has had but a little Experience in the Practice of Physic, how from anxious Care, and other troublesome Passions of the Mind, and much and accustomed drinking alternately succeeding one another, some happen often to pay dear for their ill-spent Life, by an untimely and miserable loss of it caused by this kind of Consumption; to which an Ascites, and sometimes an Anasarca is wont to be joined not long before they die. The Diagnostic Signs of this Consumption are to be taken from three Heads; to wit, The Diagnostic Signs of this Consumption are taken, 1. From the Urine. from the Urine, the Skin, and the Hypochondres. First, for the Urine, that is very little in quantity, very full of contents, and of a very red and yellowish colour like Mum. 'Tis true indeed the Urine of all Persons in a Consumption, by reason of the Fever, is high coloured, and but little in quantity, and likewise by reason of the present Colliquation full of Contents; and in this manner it is wont to appear in Putrid Intermitting Fevers. But in an Hepatick, or Icteritious Consumption all those appearances are always found in a much greater degree; and by how much the more the Substance of the Liver is obstructed, and the greater the Collection of the Bile in the Blood thereupon is, by so much the more intense they always are. For by the mixture of the Bile the Serous or Urinary part of the Blood, as it uses to be imbued with a very deep red and yellowish Tincture, so it is apt to be coagulated, and to precipitate its heterogeneous parts; from whence we may deduce the reason why the Urine of this sort of Consumptive Persons uses to be so little in quantity, and so full of Contents, as well as red and yellowish; also the colour of the Skin is yellowish. I do confess indeed that the Skin of all Persons that are in a Consumption, growing thick from the contraction of the Parts, so far as the Emaciation has prevailed, loses its wont lustre; but in this Consumption, besides the paleness, and that squalidness of the Countenance, there is a different and uncertain yellowness more manifest one day than another; 2. From the Skin. but especially about the Neck, Back, and some other parts of the Body, that are covered with a thicker Skin; though it is not so deep as it uses to be in an Accidental Jaundice, where there is a much greater quantity of Bile heaped up in the Blood by the total Obstruction of the Bile-duct, than where it is only imperfectly separated from the Blood by reason of the Obstruction of the Glands of the Liver. 3. From the Hypochondres Thirdly, there is always the sense of a gravative Oppression in the Hypochondres joined with a Melancholy proceeding from the Obstruction of the Liver, and the bulk of it being enlarged thereupon; which very often grows so hard, and is so much increased in its Magnitude, that from thence not only the right Hypochondre happens to be much distended and elevated, but likewise a Swelling, as it were hard and renitent, may be perceived in it, even by the external touch. This Consumption is always Chronical, This Consumption is always Chronical. and of several Years, because it proceeds from a slow and lingering cause. That which the Persons in this Consumption spit is likewise more viscid and plentiful, as it uses to be in every slow Consumption. As this Consumption gins with a want of Appetite, and a loathing of Food, It ends in an Ascites. so it almost always ends in a slow and painful Ascites; to wit, as soon as the Liver is grown so hard from the progress of the Disease, that the Lymphatic Vessels, which creep upon it, happen from their Constriction to be broken; to which also a frequent Bleeding at the Nose, proceeding from the circulation being hindered in other parts by the same Obstructions, uses almost always to be joined. And though this Consumption may be curable, when a Skilful Physician is sent for in time by a Patient, that will be Obedient to Rules, yet there is no Consumption more Fatal than this is, when once there comes a Dropsy upon it from the Rupture of the Lymphducts caused by the hardness of the Liver. Nor indeed can the miserable Patient have so much as an easy Death, by reason of the dreadful and continual Pains, his shortness of Breath, and the other Symptoms, that are wont to accompany this lingering Dropsy. The General Indications of Cure are only two; to wit, the restitution of the Lungs, The Indications of Cure. that are distempered, to a sound state; and the taking away of the cause, by which the Lungs happened to be ill affected. The first Indication we may satisfy with the use of Pulmonary Remedies, already mentioned in the Second Book in the General Method. But we must answer the second Indication with the help of Hepaticks, Diuretics, Chalybeates, and other suchlike Medicines, which by removing the Obstructions of the Liver, may restore the due and free secretion of the bilious Particles from the Mass of Blood, and promote the Excretion of the Bile into the Intestines by the Bile-duct; by which means the cause of the Atrophy, and likewise of this Symptomatical Consumption of the Lungs may be perfectly removed. But in what manner the General Method of the Cure of a Consumption is to be altered by the mixing of Hepaticks with Pulmonary Medicines (that we may satisfy both Indications) I had rather show by some Examples, than by the description of a new Method, lest I should seem to spin out this Discourse to too tedious a length. And therefore I will presently give a History or two relating particularly to this business, only premising first this general Observation, The Pectoral Medicines we use must be always Inciding, Abstersive, and Carminative. which it is convenient to have in our Eye through the whole Method of Cure in this Consumption; and that is that for Pectoral Medicines we must always make choice of those that are Inciding, Abstersive, and Carminative; plainly avoid Incrassating things, and use Mucilaginous Medicines, mixed with other altering Medicines moderately; being directed thus to do, not only by the toughness of the Phlegm (which this kind of Consumptive Patients with all that they can do can hardly expectorate or hawk up;) but also by the obstructed state of the Liver itself; where indeed in this case the first Seeds of this Consumption are lurking: And from thence it comes to pass, that though this Consumption, when it is but beginning, may sometimes admit of a perfect Cure only with the use of Inciding and Chalybeate Medicines, which by removing the Obstructions of the Liver, and consequently by taking away the Procatartick cause of the Disease, do likewise sufficiently provide for the Lungs, which have not yet received so much Mischief, but it may go off, and vanish of its own accord after there is no more Fuel supplied from a distempered Liver. But this Consumption is never cured with Pectoral Medicines alone. We must abstain from Incrassating Medicines. Yet I never saw this kind of Consumption cured by Pulmonary Medicines alone; but I have always observed that it has been very much, and quickly confirmed even to a fatal degree with the plentiful use of Incrassating Medicines, and of all those things, which increase the Obstructions of the Liver. And therefore as common Milk, and all things made of it, yea, and Asse's Milk itself, much more a strict Milk Diet, is not convenient in the Cure of this Consumption. So likewise for the same Reason it is best to abstain from all use of Laudanum and any sort of Opiates, unless there is a great necessity to give them. How the Patient is to govern himself. The Patient must carefully avoid Sadness, which does always promote the constriction of the parts of the Liver. He must likewise live in a thin and open Air, and there use moderate Exercise every day, all which do very much help to remove the Obstructions of the Liver. But above all things the long use of bitter, and Chalybeate Medicines does promote this Cure; and especially the Chalybeate Waters, if the Obstructions are not come to that height as to hinder the passing off of the Waters by Urine. But if it be so, we must Religiously abstain from the use of them, lest the Distemper be quickly rendered incurable, by bringing a Dropsy sooner than it would otherwise have happened. History 1. Mr. Dell, about the Twentieth Year of his Age, when he had for several Years before been troubled with a difficulty of Breathing, an Asthmatick Cough, together with other signs of a Chronical Consumption of the Lungs, and had been affected with somewhat a yellowish Tincture in his Skin, and had his Urine of the same colour, with other signs of an obstructed Liver, fell at length into an Inflammatory Fever, accompanied with dreadful pains of his Breast, a Thirst, want of Rest, and likewise a little Tincture of Blood in what he spit, and other signs of the Inflammation of the Tubercles of the Lungs, and he desired my help. Presently by looking on his Urine, which was of a very red yellowish colour, and likewise full of Contents like Mum; as also from a light yellowness of his Skin (though I had never seen the Young Man before this, that I know of) I rightly guest that the Peripneumonick Fever came by some Accident upon the Patient, that was before in the state of an Icteritious or Hepatick Consumption. And therefore the first day, which was the 9th. of Nou. 1688. I ordered Ten Ounces of Blood to be presently taken away from the right Arm, and four Ounces of the following Apozeme to be given with a Spoonful of a Linctus very often. Take Oil of sweet Almonds, Syrup of Hedge-Mustard, of each two Ounces, of white Sugar-candy two Drams; mix them exactly, and make a Linctus. Take of the Pectoral Decoction depurated a Quart, Tincture of Saffron, the Syrup of the five opening Roots, of each an Ounce and half; mingle them, and make an Apozeme. To ease the pain of his Breast and Side, I ordered the following Fomentation to be applied hot to the Parts affected, when the Pain was great, being first put into an Ox's Bladder, so that the Bladder should be but half full. Take Parsley-Roots, Fennel-Roots, Linseed, Fenugreek-seeds, of each two Ounces, the Flowers of Camomile, of Melilote, of each two handfuls; boil them in a sufficient quantity of Spring-water for a Fomentation. I took care that when the Bladder was removed, a Flannel should be rubbed warm with the following Lineament, and put upon the Parts affected. Take of the Ointment of Marsh-mallows half an Ounce, Oil of white Lilies, Oil of Bricks, of each three Drams; mix them, and make a Lineament. To comfort his Spirits I ordered the following Cordial Julep to be taken by Spoonfuls at any time. Take Baum-water, Black-Cherry-water, of each three Ounces, of Epidemick-water two Ounces, of Syrup of Clove-gillyflowers ten Drams; mix them, and make a Julep. Nou. 10. His Fever being yet very high, and his Pain very violent, I again ordered Eight Ounces of Blood to be taken from the same Arm, at which he had been bled before; and because of his great Thirst fifteen Grains of the finest Salt of Nitre, and half a Dram of white Sugar mixed together, to be dissolved in every draught of Beer that he took; likewise a Clyster of Milk and Sugar, with Camomile-flowers boiled in the Milk to be given, if he had not a Stool of his own accord; and (if the Pain required it) a Plaster of equal quantities of Paracelsus and De Minio Plasters to be spread upon Leather, and to be applied to the Parts affected; likewise when he was to go to Rest (if his Pain were still very great) fifteen Drops of Helmont's Liquid Laudanum, to be given in a little Draught of the Julep, and an Ounce of Stone-Horse dung to be infused cold in the Pectoral Apozeme. With the use of which things he seemed to be something better, his Fever being now very much abated; but then having made a diligent inspection of his Urine, Skin, and Stools, I was more certain of the Obstruction of his Liver. And therefore in the stead of the former Apozeme, I ordered that which follows with a Linctus, to be taken to the quantity of four Ounces every four hours. Take a sufficient quantity of the Ingredients of the Pectoral Decoction, the Roots of Parsley, Fennel, Succory, Grass, of each two Ounces, the Roots of Turmerick, the inner Bark of the Barberry-tree, of each an Ounce, the shave of Hartshorn, of Ivory, of each half an Ounce, of Currans two Ounces, of Saffron tied up in a Cloth half a Dram; boil them in a sufficient quantity of Spring-water to a Quart, adding when they have done boiling half a Pint of the best White-wine: To the Liquor when it is strained add of the Magisterial Water of Earthworms three Ounces, the Syrup of the five Opening Roots, the Traumatick Decoction, of each two Ounces; mix them, and make an Apozem. I likewise ordered two Ounces and a half of Tinctura Sacra to be given when he went to Rest, with which he had two Stools the next Morning with relief. And therefore Nou. 11th. I ordered the use of the Apozem to be continued, the Tincture to be repeated when he went to Rest, and two Quarts of the Purging Mineral Water's boiled to three Pints, and turned with half a Pint of Milk, to be given to drink the next Morning; and in the room of the former Julep I substituted the following to be drank plentifully. Take Parsley-water, Fennel-water, of each four Ounces, the Magisterial Water of Earthworms, Syrup of the five Opening Roots, of each two Ounces. Mix them, and make a Julep. Nou. 13. With this Method all the Symptoms began to be abated, and he did not make such a Jaundice Urine as he did before. And thereupon I ordered a continuation of the Apozeme, Linctus, and Julep, which were last prescribed, and the repetition of the Tinctura Sacra when he went to Rest; and likewise for the farther opening of the Obstructions of the Liver, three of the following Pills to be given every four hours in a Spoonful of the Linctus, with a Draught of the Apozeme. Take the Powder of Wood-lice prepared, Goose-dung, of each a Dram, of Saffron half a Scruple, of the Syrup of the five Opening Roots a sufficient quantity. Mix them, and make them into Pills of a moderate size, to be gilded. Nou. 14. After I had taken this care for the relief of his obstructed Liver with good Success, I began, as the thing required, to take more particular care of his Lungs, which had suffered very much from the defect of this Entrail, because his Chronical Cough, as also his difficulty of Breathing proceeding from the toughness of the Phlegm, with which the branches of the Windpipe were stuffed, did continually put me in mind of this part of my business; but especially when both were now not a little increased by a Peripneumonick Affection he had so lately had. And therefore besides the continuing of the use of the Abstersive Linctus, and the Apozem made of Pectorals, hepatics, and Diuretics, and likewise of the Julep, and the repeating of the Tinctura Sacra when he went to Rest; I ordered three of the following Pills to be taken in a Spoonful of the Linctus three times a day with a Draught of the Apozeme. Take of Wood-lice prepared three Drams; of Gum Ammoniack depurated a Dram and half, Flowers of Benjamin a Dram, Extract of Saffron, Balsam of Peru, of each half a Scruple, of Balsam of Sulphur Terebinthinate a sufficient quantity; mix them, and make them into Pills of a middle size, to be gilded. Nou. 15. I ordered him to insist upon the same things, and after Midnight to repeat the Tinctura Sacra, and the Purging Waters next Morning. In which manner he proceeded by my Order to the Nineteeths day, but only in the stead of the Tincture I substituted half a Dram of the Stomack-Pills with Gums, because of the loathing of that Medicine, which he began now to have from the long use of it. Nou. 19 I ordered the repeating of the Stomack-Pills, and the Purging Waters every third day for three times, and that he should persist in the use of the Linctus, Apozeme, and Balsamic Pills for eight days. Decemb. 10. He came to me into my Study, strong, fresh-coloured, and lusty, and much more free from the unhealthful Symptoms of his Lungs and Liver, than he had been for many Years past. But that this Chronical Mischief might be perfectly eradicated, I ordered a Pint of the Tinctura Sacra, that he might take six or seven Spoonfuls every fourth Night, and that he should take during the use of that four Ounces of the Pectoral and Hepatick Apozeme before described, three times a day at Physical hours on the intermediate days. Moreover I seriously advised him to use a Diet-drink made of Antiscorbutic, Hepatick, and Pectoral Ingredients steeped in Beer, and Sadler's Chalybeate Waters at Islington the Spring and Summer following. History 2. Mr. Maddox, a Man at least Fifty Years old, Gouty, and Hypochondriacal; from long Cares, and troublesome Passions of his Mind, and from the hard drinking of Spirituous Liquors, which he had used himself to, fell by degrees into a want of Appetite, a disposition to Vomiting, a stuffing of his Lungs, together with a Cough; and likewise an Obstruction of his Liver, and a Consumption of his whole Body. But I being called on the third day of August in the Year 1688. found him labouring under a Costiveness of his Belly, and a Spasmodick, and very dreadful pain of his Back and Side, for several days, not without the manifest signs of a Fever, and a Languor upon him, which now were come to that height, that they plainly despaired even of his very Life. At first I thought the pain arose from a Stone-Colick, and thereupon I ordered Ten Ounces of Blood to be taken from his Arm (being induced to do it not only by the present Fever, but likewise for fear of an Inflammation of the Intestines that might follow by reason of the violent pain) I ordered the Parts affected to be anointed warm with the Ointment of Marsh-mallows, Oil of white Lilies, and Oil of Bricks mixed together, and Pills of half a Dram of Extractum Rudii, and a Grain and half of London Laudanum, to be given him in his Bed, that he might get some sleep; likewise a temperate Cordial Julep to be given him often to drink to comfort him. And I ordered that if there were occasion a Stool should be procured after eight hours with a Clyster of Milk and Sugar with Camomile-flowers boiled in the Milk; but when the Purge had once done working, they were to give him Twenty Drops of Liquid Laudanum in a small Draught of the Cordial at the time he should go to Rest. But these things having no effect either to give him any Stools, or the easing of his Pain, on the 6th. of August I prescribed a Mucilaginous and Lubricating Apozeme to be drank often, and for three Nights together half a Dram of the Stomack-Pills with Gums, and a Grain and a half of London Laudanum, and the next Mornings two Quarts of the Purging Mineral Waters. Aug. 17. I ordered the repetition of the Pills when he went to Rest, and likewise of the Waters the next Morning; and that he should drink the Waters boiled, dissolving an Ounce and half of the choicest Manna in the last Draught. But for all this the Spasmodick pain of his Back, and his Costiveness continued. And thereupon, Aug. 18. I ordered four Spoonfuls of Elixir Salutis, and Thirty Drops of Liquid Laudanum to be given when he went to Rest; and that he should take three Ounces of the following Apozeme warm every three hours, until he had had some good large Stools. Take of Senna half an Ounce, Coriander-seed prepared, Salt of Tartar, of each two Scruples, boil them in a Pint and half of the Purging Mineral Waters to a Pint, dissolving in them when they are strained, two Ounces of the best Manna. With the use of which he at length began to have too many Stools, that is, more than he could bear; but without any relief of his Pain, which was so violent, that it could hardly be quieted even with the use of Laudanum itself, though by degrees I went as high as Forty, Fifty, Sixty Drops, which yet I was forced to repeat every Night. Aug. 21. Being called a second time to go see him, by the little yellowish colour of his Skin I understood well enough that the first Original of all this mischief was not in the Kidneys, but had lain in his obstructed Liver; and that neither the progress of his Consumption could be prevented, nor that horrid Pain, that moved up and down between his Back, Sides, and Belly, could be removed unless we had a due respect first to this part. And I did not make any matter that the pain was felt in the lower parts of the Belly, just by the Region of the Kidneys and Bladder, and a great way below the seat of the Liver, because I had often observed this same thing before in those that had the Jaundice, whom I had often heard complaining and crying out by reason of the violent pain which they felt in the lower parts of the Belly, when in truth the cause was remote in the right Hypochondre. Which appearance it is no hard matter to Account for; to wit, that as the substance of the Liver, according to my Hypothesis and Observation, by reason of its preternatural closeness and density, is almost deprived of Sense; so likewise for the same reason it affords a very difficult passage to the Blood, Lympha, and other Juices, that passed through it; so that the Vessels, which tend hither from the lower parts of the Belly, must necessarily be distended beyond their Natural Tone, and be rendered varicous; and thereupon suffer a great deal, till at length with the use of Hepatick and Deobstruent Medicines the Substance of the Liver had recovered its lose and Natural Tone. From this Hypothesis for three weeks I ordered two Ounces and a half of Tinctura Sacra to be given every Night when he went to Rest (to which being forced, I allowed Thirty, Forty, and at length Fifty Drops of Liquid Laudanum to be always added by reason of the violence of the pain.) I likewise ordered the Purging Apozem, with the addition of an Ounce and half of Syrup of Buckthorn, to be repeated every fourth Morning, and four Ounces of the following Diuretic Apozem to be given every four hours on the days between. Take the Roots of Succory, Grass, Parsley, Fennel, of each two Ounces, the Roots of Turmerick, the inner Bark of the Barbery-tree, of each an Ounce, shave of Hartshorn, of Ivory, of each half an Ounce, of Currans two Ounces, of Saffron tied up in a Linen Cloth, and often squeezed, half a Scruple, of Aniseeds half a Dram; boil them in a sufficient quantity of Spring-water to a Quart, adding when they are almost boiled enough half a Pint of White-wine. Add to the Liquor, when 'tis strained, of the Magisterial Water of Earthworms three Ounces, the Juice of two Lemons, of the Syrup of the five opening Roots three Ounces. Mix them, and make an Apozem. I advised him likewise to take an Ounce and half of the Steel Wine sweetened with a little brown Sugar every Morning. After Eight or Ten days were now past, as his Pain began to abate, so he likewise began to go to Stool more easily. And therefore first I left out the Syrup of Buckthorn from the Purging Apozem. And at length, Aug. 30. in the room of the Purging Apozem I substituted six Pints of the Purging Waters crude, with which he now went to Stool well enough, and therefore I took care they should be repeated every third Morning. Sept. 6. Because of his Faintness, caused by his frequent Purging (from that time he began to have so many Stools) I ordered the omission of the Purging Waters for the future, and prescribed the following Cordial Julep to be given often. Take of Dr. Stephens 's Water two Ounces, of the Epidemick-water an Ounce, of Black-Cherry-water four Ounces, of Syrup of Clove-gillyslowers ten Drams. Mix them, and make a Julep. Sept. 12. When now at length my Patient began plainly to loathe the Tinctura Sacra by reason of the long use of it, instead of that, and the Laudanum mixed with it, I substituted the Stomack-Pills with Gums, Cynogloss-Pill, of each twelve Grains, to be made into three Pills, which I ordered to be repeated every Night. And because I now perceived by the plenty, and less high colour of his Urine, that the Obstructions of his Liver were in some measure opened, I ordered four of the following Pills to be taken every Morning for the farther promoting of Urine. Take of the Powder of Wood-lice half a Dram, of Salt of Amber very well cleared from the Oil fifteen Grains, of Syrup of Marsh-mallows a sufficient quantity; mix them, and make them into Pills of a middle size, to be gilded. Sept. 18. When by the Tincture of his Urine being brought almost to its Natural colour, I rightly conjectured that the Liver was in a manner restored to its Natural Tone, I advised my Patient that he should try to open the Obstructions that remained, and to precipitate the Relics of the Morbific Matter by Urine with the use of Sadler's Chalybeate Waters at Islington. But when after the trial of a day or two, I was well enough satisfied that the obstructed parts were not yet opened so much as to give the Water's liberty to pass freely by the Kidneys, because the Serum of the Blood being held by the bilious Particles, and too much saturated with them, and as it were coagulated, by reason of the preternatural viscousness contracted thereupon, could not yet be readily strained through the Pores of the Glandules of the Kidneys, I altered my mind, and instead of the Waters, I prescribed the following Julep to be drank often and plentifully, and two Drams of the following Chalybeate Electuary to be given every Morning, expecting from the former of them a more plentiful flux of Urine, and from the latter a farther opening of the Obstructions; whilst at the same time I persisted to make the Tone of his Stomach more firm, and his Body more soluble by repeating the Tinctura Sacra every third Night. Neither did the Event deceive my Expectation. The Julep was this: Take Parsley water, Fennel-water, of each a Pint, the Magisterial Water of Earthworms, the Syrup of the five opening Roots, of each six Ounces. Mix them. The Electuary was this: Take of the filings of Steel prepared two Drams, Saffron, Mace, of each a Scruple, Conserve of Hips, of the Flowers of Succory, of each an Ounce and half, of Syrup of Citron-peel a sufficient quantity. Mix them, and make an Electuary. With the use of these things my Patient plainly recovered, being freed not only from his Pains, and his disposition to Vomit, but likewise from the stuffing of his Lungs, which he used to have, from his Cough and difficulty of Breathing; as also from the yellowish Tincture of his Skin, and from all the other signs both of the Obstructions of his Liver, and the Distemper of his Lungs. For he got a very good Appetite again, with which he soon was freed from his Consumptive as well as his Jaundice state, and continues hitherto well, and strong. However when I dismissed him, that I might quite pluck up the Roots of this Chronical Mischief, which had been a long time fixed, Sept. 24. 1688. I wrote him this last Bill for his use, which, being now almost well, he was not so conformable to, as he used to be to the former, because perhaps he did not think it so necessary. Take of Tinctura Sacra a Pint: Let him take six or seven Spoonfuls every third Night. Take of Extractum Ecphracticum without Aloes an Ounce and half; make it into Pills of a middle size, to be gilded, of which let him take three twice a day every day, sc. in the Morning, and at four of the Clock in the Afternoon. History 3. Mr. Dent, living in White-cross-street, used to desire my Help and Advice for several Years, whenever he, or any of his Family were sick; a Man truly Honest, but somewhat Melancholy, and thereupon given to drink hard at Nights, and that very late, sitting long at it to exhilerate his oppressed mind. With which he fell into a gross, and as it were a callous Habit of Body. But at length about the Fiftieth Year of his Age he used to complain by long and uncertain intervals of a Vertiginous Affection of his Head: And after three or four of these Fits (one or two of which came near to an Apoplexy) being advised, and earnestly entreated by his most dear and observant Wife, at length he consented to commit this business to my care; a Man that abhorred Physic as much as any one. But with the taking away of Blood from the Jugular Vein, and the application of a large Blistering Plaster to his Neck, and likewise the giving of him a gentle Vomit, and after that a Purge or two, together with Cephalick Juleps between while; being once freed from the present Symptoms, he plainly refused Chalybeates, and other Medicines, that were proper to open the Obstructions in the Viscera, with which we might take care of his Health for the future. From which neglect it happened that in the space of a Year or two he had a relapse again and again. But at length a certain Chemical Empiric, that could boast sufficiently, having given him I know not what Chalybeate Arcanum, without any preceding Evacuation, it happened so that the Disease was quickly translated from his Brain to his Lungs and Diaphragm in the Nature of a dry Asthma; so that he, who was wont to complain of a Giddiness before, did now much more lament his perpetual Strangulation or Choking, which indeed was visible enough in the Face of the Patient to the very Spectators, because not only he had now plainly lost the Natural fresh colour of his Face with his Skin growing thick; but likewise his Cheeks, and very Lips instead of their wont Rosy hue were basely tinged with a nasty black and blue colour, looking something pale, as if the Patient had hung in a Halter a good while: Also his Eyes, and almost all his Skin were lightly tinged with a Jaundice colour, his Urine also looking yellow after the manner of those that have the Jaundice; and as it was very little in quantity, so likewise always very full of contents, or settle. There was also almost a perpetual Cough, but yet not so very violent, because it proceeded from a tough Phlegm. But his Stomach was quite gone, and he had also a great Thirst, with other Symptoms of a Hectic Fever. And in this miserable and lamentable state he continued almost for the space of two Years, desiring the Care and Assistance sometimes of one, sometimes of another Physician, but not long observant of the Directions and Advice of any, till at length about three Months before he died, when he was plainly worn away with a Marasmus from an Universal Colliquation, made by a plentiful spitting of Putrid Phlegm, vast Sweats, a Looseness, and very troublesome Dropsical Swell of his Legs and Belly, he again, though 'twas now too late, with Tears and Entreaties committed himself to my care, and was extremely troubled that being tired with Medicines in the beginning of his Distemper, he had so soon withdrawn himself from my Care and Advice, when he had found a great deal of benefit from Bleeding, the repeated use of Riverius' Mixture, and other gentle Emetics, and Purges, of my Balsamic Pills, of Inciding and Absterging Linctuses, and Pectoral Apozems, change of Air, and other suchlike things, though he was not yet recovered to a perfect state of Health; seeing that now by reason of his Tabid Disposition, and Universal Colliquation, he was altogether unable to bear those Evacuations, that were necessary. Nevertheless so far as I was able, I gave my helping Hand to this miserable Patient; and first, I endeavoured to lessen the Dropsical Swelling by Purging off the Humour with the following Cathartick Bolus. Take the Conserve of the Flowers of Succory, Powder of Rhubarb, of each a Scruple, of Rosin of Jalap half a Scruple, Salt of Wormwood five Grains, Syrup of Succory with Rhubarb a sufficient quantity. Mix them, and make a Bolus. He bore the working of the first Bolus very well; but yet by reason of my Patient's Weakness, and his Fever, I was afraid to repeat that Bolus so often as the Dropsy required it. I likewise in vain endeavoured to promote a flux of Urine with a Diuretic Julep of Parsley-water, Fennel-water, the Magisterial Water of Earthworms, the Syrup of the five Opening Roots, Salt of Amber, etc. With the use of which the Fever seemed to be something increased, which at length I took off, at least for some time, with the use of the Peruvian Bark. But when I found his Appetite was not restored by it, I did not expect so much from that Medicine. And therefore I endeavoured to open the Obstructions of his Liver (in which I did rightly suspect the Original mischief of his Distemper to lie) with the plentiful use of my Hepatick, and Diuretic Apozem before mentioned, and the most convenient Chalybeate Medicines; as also to take care of his Lungs with my Balsamic Pills, Linctuses, and Pectoral Apozemes. With the use of which he seemed to breathe better, and to be less Feverish, and also to have his Skin and Urine less tinged with a yellow colour. But his Colliquation still persisting, and his Dropsy increasing upon him, and when we were in the midst of the Winter too, I plainly despaired of his Recovery; and therefore I sent him, as he himself desired, into the Country, and an open Air, that he might there at least have an easy Death, so far as his Symptoms would admit of it: Where in the space of a Month or five Weeks, being wasted by that Universal Colliquation, he went out by degrees like a Candle; complaining more than of any other Symptoms of this, to wit, a dreadful, and as it were a Spasmodick Pain, reaching from the right Hypochondre through a great part of the Belly; which indeed I could neither remove nor mitigate, either with Liniments, or Anodyne Fomentations, or any other way: Which kind of Symptom I have almost always found in other suchlike Patients; which thing it was a very easy matter to account for from the Body being opened after he was dead. For the Sternum being taken off, and the Breast opened, we first saw the Lungs, very much enlarged in their bigness, and now changed in their colour, from that which was Natural to a black, or cineritious colour, sticking almost every where very firmly to the sides of the Breast, and in all the Lobes full of Tubercles, in some places maturated, but in others crude. From whence it is evident enough, that this was a true Consumption of the Lungs, though a Symptomatical one. Also the Liver itself, as it appeared much larger than it ought to be, (by which means pressing the Diaphragm underneath, without doubt it did not a little promote that continual Suffocation with which the Patient was troubled, let him be in what Air he would) so likewise the substance of it appeared more hard and compact than usual, and what it should be, as if it had been plainly parboiled; and the branches also of the Vena Portae running from the Hypogastrium to the Liver, were every where distended beyond their Natural Tone, and varicous. From all which it is as easy to deduce the cause of this Chronical Icteritious disposition, which hear first gave the occasion of the Consumption, and of that horrid Pain, which reached from the Hypochondre through the Belly; which I observed not only this Patient, but also Mr. Maddox before mentioned, Mrs. James, Mr. Freestone in Bucklersbury, and almost all others that have been ill in this manner, to complain of with great cries so earnestly and continually, as if they had been troubled with no other Symptom. But in some this pain rather occupies the Region of the Kidneys and Loins, being like a Nephritick pain, or a Scorbutical pain of the Loins, as it happened to Mr. Maddox, and Mr. Freestone: But in others it is seated in the forepart of the Belly, and especially the Hypogastrium, in the form of a true Colic; in which manner the Patient of whom we are now speaking, was affected. From this as it were kind of compactness and hardness of the Substance of the Liver so preternaturally swelled, and from the remarkable varication of the branches of the Vena Portae following thereupon as the Aetiology of this Chronical Icteritious Disposition, by which my Patient was first disposed to a Consumption, does appear plain enough to Reason, and in a manner to Sense too: So no less evident is the Original of that horrid pain, which occupied the parts of the Belly, and perhaps too of that Remarkable Ascites, by which without doubt the fatal day of his Death was much hastened. As for that Chronical Icteritious Disposition, no one can think it strange, when this great Instrument of the separation of the Bile is quite deprived of its Natural laxity, if by the constriction and compression of its Substance following thereupon it is rendered unfit for the performance of its Function; to wit, the secretion of the bilious parts from the Blood, and the excerning of them into the Bile-duct, and Gallbladder for great uses, for which they are appointed by Nature: From whence there must necessarily follow too great a congestion, or heaping up of Bile in the Blood itself, and thereupon also a yellowish Tincture of the Skin, an Urine very high-coloured, yellow, and full of Contents, somewhat a whitish colour of their Stools, together with a Faintness, Weakness, and the other usual Symptoms of a Jaundice. And it may be from this compression of the Substance of the Liver, and the varication of the Vena Portae caused thereby, it happened that the Lymphatic Vessels which arise from the Liver, or the conglobate Glands seated in the Sinus of it, just at the entrance of the Vena Portae, were broken; from whence also it is easy to give the reason of that Dropsical Swelling, which came upon this Patient about the end of his Icteritious Consumption, as it uses to happen to almost all others that are affected in that manner. Finally, as for that horrid pain, which is wont to accompany this Distemper, we must observe that every Jaundice, of what sort soever it is, whether Accidental or Habitual, has always this kind of Spasmodick pain joined with it; but with this difference, that as an Accidental Jaundice proceeds merely from an Obstruction of the Porus Bilarius, or the Ductus Communis, caused by a stone, or the glutinousness of the Bile; so it causes a very Acute Disease attended with a dangerous Fever, and dreadful Spasmodick pains, even so great as to make them swoon; which pain indeed is wont nevertheless to be circumscribed by the Region of the Stomach, and by the Shoulderblades, like a Colic of the Stomach: Because these Parts that are near are wont to have very painful Spasms by the consent they have with that tender Dust, which at this time is distended much beyond is Natural Tone by the Bile, or by Stones: When on the contrary, in an Habitual Jaundice, though there is always felt from the very beginning of the Disease a certain dull and gravative pain in the Region of the Liver (as I remember it happened often to Mrs. James, and some others;) to wit, as soon as the substance of this Entrail gins to be deprived of its Natural laxity, and to be too compact. Yet there is no Acute and Spasmodick pain like the former but only in the parts of the Belly below the Navel, in the manner of a true Colic; or in the Region of the Loins in the form of a Nephritick pain, and that not long before they die, that is not long before the Liver itself happens at length to be constringed to such a degree from the compression of its Substance being much increased, that the Blood can very difficultly if at all pass through it out of the Vena Portae: Whereupon who can wonder if the very Vessels being once distended beyond their Natural Tone by the pressure of the subsequent Blood, do by degrees grow very large, if it is not prevented by an immoderate flux of the internal Haemorrhoids (to which this sort of Patients are very subject) or by some other Rupture, or else opening of the Vessels. So Vessalius, in the 15th. Chapter of the Fifth Book, observed in one that had the Jaundice, and was carried off with the flowing of the Haemorrhoids, the Liver very much swelled, and the branch of the Vena Portae all along the Dust of the Intestinum Rectum enlarged so as to be an Inch in Diameter. Likewise Guarinonius in 584th. Consultation affirms, That in Hypochondriacal Persons he himself has often found the obstructed Veins of the Mesentery so much dilated, that they looked more like Intestines than Veins. 'Tis true indeed, this pain is not perceived in the Vessels themselves, that are preternaturally distended or swelled; for the Veins and Arteries (as Galen, in the xij. Chapt. of his First Book of the use of the Parts, affirms) have no sense if they are cut, or burnt, or tied hard with strings. To which Opinion I very readily assent, as being persuaded of the truth of it from the frequent Observation of Varices, which I remember to have often happened in Cancrous Breasts, and in the Legs of Women with Child: All which seemed to be affected with a very obtuse or no pain from these Varices, though they were grown never so big; which pain too always seemed to me to proceed rather from a preternatural distension of the external Skin, and a pressing upon the Muscular flesh under them caused by the larger Varices, than from the sense of the Vessels themselves, that were so varicous. And it may be that dreadful pain in the lower part of the Belly, which is wont to accompany an Icterical Consumption, of which we are now speaking, may be thought to be caused in the same manner. For as soon as the substance of the Liver happens to be so constringed and thickened, that being now deprived of its Natural laxity, it does very difficultly, if at all admit the passage of the Blood through it; the Vena Portae, and the branches of it, which bring the Blood back to this part, must necessarily at length be much swelled, and rendered varicous by the continual drift of fresh Blood, by reason of the stop that is here put to it. Which being so, though the Veins themselves, according to Galen's Opinion, are not affected with any dolorifick sense, yet none ought to think it strange that from a distension, and a Solutio continui made in the Membranes, through which these varicous Vessels creep, there proceeds this dreadful and spasmodick pain, which can be removed only with the use of Chalybeate and Diuretic Medicines, endued with subtle and penetrating parts; and that a long and constant use of them, which may be sufficient to open the Obstructions of the Liver. Which Obstructions being once removed, and thereupon the Varices going down of their own accord, the Membranes, through which they creep, may by knitting together again be quickly freed from this Spasmodick Pain. And in vain, even for the abating of the pain, are outward and warm applications made, to wit, of Fomentations, and Anodyne Liniments, which are wont to be of very great use in Pleuritic, Colic, and other Spasmodick Pains, because the Blood contained in the Varices is more agitated and heated by external warmth; whereupon a greater varication or preternatural distension of the Vessels with an increase of the pain must necessarily follow. But I have observed that Oxycrate, the Cerote of Saunders, Ointment of Roses, and other suchlike Styptic and cooling things, and those applied cold, have much better answered the end. But above all things, Opium given inwardly, as it is the last, so it is likewise the only, at least the greatest Relief and Refuge for this pain. This too is given in vain if it be in a little quantity. For no Doses will truly answer our end, unless it be so great as may be able to cause some kind of numbness or insensibility in the distended Membranes as well as in the other parts of the Body. Which I have often found in Mr. Maddox, and other Patients in the like case; whose Pains I could not so much as abate, even with Laudanum itself, till I began to prescribe three or four Grains every time. 'Tis true indeed the Original Disease, and these Symptomatical Pains proceeding from it, do afford different Indications. For as much as these Pains are abated by Opiates, so much the Obstruction, or Constriction of the Substance of the Liver, which gave the first occasion of the pain, is increased and confirmed. And indeed what is done by Chalybeates in the Daytime, is in some measure undone by Opiates in the Night. However, forasmuch as the Vital Indication requires it, oppressed and languishing Nature must be supported with necessary Opiates. For they being now almost ready to expire with the continual Fatigue of these Spasms, there cannot be room to use either Chalybeates, or any other kind of convenient Medicines. And therefore in this case, though the use of Opium, which is very necessary (and which ought to be compensated with the more diligent, and longer use of Deobstruent and Attenuating Medicines) may be permitted at due intervals by a Prudent Physician, yet we must not give even the least Grain of Laudanum without urgent necessity, because the Original Distemper does plainly contraindicate the use of it. History 4. The Wife of Mr. Prestbury, that lived in blackfriars, who was now some Months gone with Child, really an honest Woman, but somewhat anxious and thoughtful, at length from Cares, and various Passions of her Mind fell into the Jaundice from a deficient secretion of the Bile, caused by as it were a kind of Schirrous hardness and closeness of the Substance of the Liver itself. But from the long neglecting of her Jaundice she became not only tabid and emaciated by the long substraction of the Nutritious Juice; but likewise began to want an Appetite, to have a Thirst, and something of a Hectic heat, to be troubled with a difficulty of Breathing, a Cough, and other signs of an incipient Consumption of the Lungs; insomuch that even I myself thought she would in a short time die of a Consumption, unless there could be some help given her to open the Obstructions of her Liver time enough: And therefore when for fear of a Miscarriage, I dare order neither Tinctura Sacra, nor the Purging Mineral Waters, nor any other Purging Medicine, on the third day of May this present Year I ordered four Ounces of the Aperitive Apozem already described to be given her every sixth hour for ten days together, adding likewise twice a day an Ounce of the Chalyheate Wine to the Draught. But when by reason of some Natural Antipathy which she had against Saffron, she could neither bear that, not Turmerick-Roots, nor it may be some other things that were Ingredients in these Medicines, but as soon as they were taken she threw them up again, and that not without signs of a sudden Miscarriage. May 25. I set myself to answer the former Indications by some new Prescript made for the same intentions in the manner following. Take the Powder of Wood-lice, Goose-dung, of each two Drams, of Salt of Steel a Scruple, Syrup of the five Opening Roots a sufficient quantity: Mix them, and make them into Pills of a middle size to be gilded, of which let her take three thrice a day at Physical hours, and drink four Ounces of the following Apozeme after every Dose. Take the Roots of Succory, Grass, Parsley, Fennel, Asparagus, of each two Ounces, of the inner Bark of the Barberry-tree an Ounce, shave of Hartshorn, Ivory, of each half an Ounce, of Currans two Ounces, boil them in a sufficient quantity of Spring-water to a Pint and half, adding when they are almost boiled half a Pint of White-wine. To the Liquor when it is strained add the Magisterial Water of Earthworms, Syrup of Hedg-Mustard, of each three Ounces, the Juice of one Lemon. Mix them, and make an Apozeme. Take Parsley-water, Fennel-water, of each four Ounces, the Magisterial Water of Earthworms, strong Piony-water, of each an Ounce, of the Syrup of the five Opening Roots an Ounce and half. Mix them, and make a Julep, of which let her take four or five spoonfuls when she is faint. With the long use of which (the Country Air likewise contributing something) she became plainly freed not only from her Jaundice, but also from her Consumption, and the Morbid Symptoms of her Lungs, and that without one Grain of Pectoral Medicines; and now at length having recovered her wont Temper and Appetite, she is very well. CHAP. XIV. Of a Consumption of the Lungs proceeding from Internal Ulcers of the Viscera, and Membranous Parts. I Have, as well from Reason as Experience, proved in the First Book, that there is a Flame kindled in the solid Parts, from the long and plentiful substraction of the Nutritious Juice caused by old and large Ulcers, which are wont to discharge continually a great quantity of gleety Matter in what part soever of the Body they happen to be seated, whether inward or outward, and thereupon the Patient is rendered Tabid. I have likewise sufficiently shown in the 8th. Chapter of this Book, that a Consumption of the Lungs is very often occasioned from the healing of this kind of Ulcers, but especially if they have been customary, and of a long continuance, or else Malignant, or Fistulous. A true Consumption of the Lungs often proceed from Internal Ulcers. But because I have observed, not only that Patients being brought into the state of an Universal Atrophy, have at length been rendered Tabid, but have likewise many times from thence been affected with a Consumption of the Lungs from the beginning by a long continuance of Ulcers bred in the Viscera, and Internal Membranous Parts, but especially in those, that are reckoned the more Noble, and of greater use; such as the Liver, Kidneys, Testicles, Ovaries, the Womb, and the Vagina Uteri, the Urinary Bladder, Stomach, Intestines, etc. from long substraction of the Nutritious Juice, as frequently as from the healing of them; I shall think fit in this place to add also, though briefly, the Observations, which my Practice has offered to me, concerning the peculiar Nature of this kind of Consumption. Neither has any one reason to think it strange; This is not strange upon several Considerations. that this kind of Ulcers, especially if they have been Chronical, can occasion a true Consumption of the Lungs: I say, no one has reason to think it strange, that seriously considers with himself how great and continual an expense there is of the Nutritious Juice, that is wont to be discharged by this kind of Ulcers; and how great an impoverishment of the whole Mass of Blood, together with an Acrimony following upon it, from this substraction of the Chyle that is designed for the reparation of it; and how great a wasting, or Atrophy of the Parts proceeding from thence; thereupon how great an excandescence or intestine motion of the Blood and Spirits, and finally, how great a Flame there is, with a fixed heat in the whole Habit of the Body, together with an Universal Colliquation of the Nutritious Juice from the Mass of Blood (to which by reason of its preternatural Heat and Acrimony it could not be perfectly united) made by every Avenue, where it has the liberty of passing. But to be Ingenious, and to speak the whole truth, I have been ready to wonder rather that in this Universal Flame and Colliquation, the Lungs (whose Substance is Naturally so Tender, Vesiculous, and Spongy, and thereupon as it is apt to be very soon affected with a Hectical Heat, so it is also ready to be as soon corrupted by the purulent Particles, which are translated thither by the Circulation of the Blood, and in every considerable Colliquation more susceptive of the Humours, than any other part) can ever be long free from a touch of a Consumption. A Consumption from Ulcers in parts remote from the heart ends in an Ulcer of the Lungs. And indeed to speak the truth of this case, whenever these Ulcers happen to be bred in the Bladder, Womb, Vagina Uteri, the Ovaries, or Kidneys, or other Entrails, or Membranous Parts, that are remote from the Heart, and so of less note, as I have always observed the Consumption that is caused by them, to be more Chronical; so I have observed that a little before Death it certainly terminates in a true Consumption of the Lungs, proceeding by degrees from a stuffing of the Lungs to Tubercles, and those such as at length become ripe, and ulcerate, together with a troublesome Cough, a shortness of Breath, an universal Colliquation, and the other signs of this Fatal Disease. In a Consumption from Ulcers in the Liver, etc. Death prevents this. But yet in a more Acute and hasty Consumption, proceeding from an Exulceration of the Liver, Stomach, and other Entrails, or Membranous Parts seated nearer to the Heart itself, I have found in the Bodies of such Persons, that have been opened when they have been dead, the Lungs not so much exulcerated, as discoloured, stuffed, and sticking to the sides of the Cavity of the Breast; and at length (that is, when they have been very ill affected) full of crude Tubercles: Because by reason they died quickly, there was not time enough for the Lungs to receive any deep impressions from this Phthisical Malignity; the Patient being taken off by a quick Death from the Original Consumption before the Tubercles of the Lungs could be ripened, or the Consumption of the Lungs could be advanced beyond its first or second degree. But in this very Acute Consumption I have found plainly the same, if not more violent Symptoms, than in a true Pulmonary Consumption that has been Mortal; the same fierce and troublesome Cough, the same difficulty of Breathing, though they proceeded merely from a stuffing of the Lungs, and crude Tubercles bred in them; but first an Inflammatory Fever, and afterwards a Putrid and Intermitting Fever, attended with an Universal Colliquation, Lightheadedness, and other more direful and fatal Symptoms than in an Original Consumption of the Lungs; I speak of those which arise from an Inflammation and Exulceration of the Viscera, or Membranous Parts, that are very Noble. So that it is a very hard matter to distinguish this Consumption from an Original Consumption of the Lungs, unless it be by the more intense degree of the Symptoms, and by some Pathognomonick signs, which discover the Part that is primarily affected. Every Pulmonary Consumption of this sort is very hard to Cure, These Consumptions are very hard to Cure. because it springs from a certain Fountain, that is for ever running. For the Internal Ulcers, which gave the first Occasion to this Consumption, can very seldom be perfectly cured, as lying beyond the Sphere of Surgery. And not to be cured without healing the Original Ulcer. And indeed to Cure this Consumption perfectly, without healing of the Ulcers, from from which it takes its Original, is the same thing as to take away an Effect whilst the Cause of that Effect remains. It is true indeed that so often as these Ulcers happen to be small and benign, and are likewise placed in the Kidneys, Bladder, Testicles, Ovaries, the Vagina Uteri, or in other Membranous Parts and Entrails, that are more remote from the Heart; as the Ulcers themselves (which here assume the Nature of a Cause) do sometimes admit of a perfect Cure, so likewise the Pulmonary Consumption itself, which depends upon them, may as well be cured. But this Consumption, whether it be capable of a Cure or not, does nevertheless almost always assume the Nature of a Chronical Disease in some measure. And from hence I have found some of this sort of Patients for several Months, When this Consumption is Chronical. yea, and sometime several Years languishing with a Consumption, pining away by degrees, and dissolved by Colliquations; but especially when the source of the Disease has been in one of the Kidneys, the Bladder, or Vagina Uteri, that have been ulcerated. A Consumption proceeding from an Ulcer of the Ovaries in Women, or the Testicles in Men, I have observed to have been of a middle Nature, but for the most part to carry off the Patient within the space of a Year: But that which arises from an Exulceration of the Womb itself, When Acute. the Stomach, Liver, or other Entrails, or Membranous Parts of the greatest note, I have observed to put an end to the Patient's Life in the space of a very few Months, or even Weeks, after the manner of a very Acute Consumption; because it has been immediately attended, first, with an extraordinary Inflammatory Fever, and after that with a Putrid Intermitting Fever, and an universal Colliquation, together with a want of Rest, Lightheadedness, Spasms, and other direful Symptoms of the Nerves. But yet by reason of the sudden Destruction brought on from the Nature of the Original Disease, I have found by inspecting into Bodies after they have been dead, that the Lungs have not been so much affected, as they used to be in other Consumptions, that are more Chronical; to wit, where by reason that the Original Distemper has suffered the Patient to live long enough, the Lungs have happened not only to be stuffed, but likewise to have Tubercles bred in them, and those Tubercles at length have happened to turn to Apostems. But, generally speaking, The more Acute it is, the harder to Cure. as every Consumption of this kind is very hard to Cure, so it is so much the harder as it is more Acute, because it has its Original from more considerable Ulcers. Neither indeed does it ever admit of a perfect Cure without the healing of the Ulcers whatever they are, and in whatsoever Entrail or Membranous Part those Ulcers are bred, which gave the first occasion to this Disease. From what I have now said, it is plain enough even to Reason what are the Indications of Cure in this kind of Consumptions, which likewise the happy Success of our Practice is wont daily to present to our very sight; that is, whenever the Distemper does in its own Nature admit of a Cure. The Indications of Cure And they must respect the Original Disease as well as the Lungs themselves, first, by promoting as much as we can the healing of the Ulcers, in what part soever of the Body they have been bred, with the plentiful use of Balsamic and Vulnerary Medicines; which indeed ought to be of the milder sort, lest by increasing the Feverish Flame, that is already kindled in the Blood, they should do more hurt than good. Secondly, by taking timely care of the Lungs with the use of Pulmonary Remedies, to wit, Opiate and Expectorating Medicines given alternately; by which the mischief which they have got, may be taken off, or at least as little as may be promoted by the Original Distemper. Thirdly, by mixing always with the Pectoral and Balsamic Medicines those things which may restore and confirm the Tone of the Part, which was first of all affected, and which have a particular respect to it; as Uterines', Hepaticks, Diuretics, and other suchlike Medicines, as the case may require. Fourthly, by tempering the Hectic heat, which is already kindled in the Blood and Spirits, with a strict Milk Diet, the Chalybeate Mineral Waters, Vulnerary Decoctions of Sarsa, Limewater, and other things of the like Nature (so far as the present state of the Patient can bear them;) as also by taking off the Putrid Intermitting Fever with the plentiful use of the Peruvian Bark, and with repeating of it often enough at due intervals: And lastly, by relieving with the most diligent application the most urgent Symptoms, and those which weaken the Patient most, whether they arise from the Original Ulcer, or from the Lungs. As for Example. The Method of Cure. If the Original Ulcer is so benign and small, that there appear any hopes of a perfect Cure, and it has not continued so long, that the Patient is brought very weak with it; and if it is not seated in so Noble a Part, as to make us fear the sudden destruction of the Person from an Acute Consumption, it is plainly convenient in the very beginning of the Cure to endeavour the healing of the Original Ulcer, by giving Calomelanos plentifully, and that not only mixed with Purges, and therefore at due intervals, but likewise by itself in Doses repeated quickly one after the other, with a design to raise a Salivation; by which (if the Patient has strength enough to bear so great an Evacuation, and it be convenient in other respects) we shall take much better Measures, as for the healing of the Ulcer, so likewise for the preventing of the Consumption, which is like to follow, than by any other Apparatus of Medicines. But if that be contraindicated by the Patient's Weakness, the intense degree of the Fever, and the very Acute Nature of the Consumption, at least as Antimonial, so Mercurial Medicines may be so disposed at due intervals in the Method of Cure, that they may successfully exert their extraordinary Healing Virtue without any expensive Evacuation excited thereby. As for Example: Let the Patient take every Night xv. or xx. Grains of Antimonium Diaphoreticum in a little bit of Old Conserve of Red Roses mixed with Leucatellus' Balsam. And every third or fourth Morning a Scruple, or half a Dram of Mercurius Dulcis in a spoonful of Milk. Let him also drink a Vulnerary Decoction of Sarsa, described in another place, for his ordinary Drink, adding always at the time when he takes it, of the Balsamic Syrup so much as will serve to make a Draught of it grateful to the Patient's Palate. My Balsamic Pills are likewise very good in this case, being ordered so that the Patient may take three of them every day at Physical hours; drinking after them four or six Ounces of the Traumatick Decoction, and the Pectoral Decoction mixed in equal quantities. Here likewise it is very convenient to temper the Hectical heat of the Blood with a Milk Diet ordered in the strictest manner, or else (if other things do not contradict, and it is a proper time of the Year for it) with a long use of the Chalybeate Mineral Waters, the Virtue of which, especially in curing a Consumption proceeding from an Exulceration of the Kidneys and Bladder, I have often tried with good Success. Neither is it of less use, as well to temper the Acrimony, and heat of the Blood, as to carry down the load of Purulent and Heterogeneous Particles heaped up in the Mass of Blood, to give at Physical hours an Emulsion made of fifty or sixty Wood-lice, and four Ounces of the Vulnerary Decoction of Sarsa sweetened with the Balsamic Syrup; or with two Ounces of the Pectoral Decoction, and as much of the Traumatick Decoction. The Peruvian Bark is likewise of very great Efficacy in this case to relieve the Putrid Intermitting Fever, caused by the mixture of the Purulent and Heterogeneous Particles, that are sent into the Mass of Blood from the Original Ulcer. Which we must repeat often at due intervals for this end, thereby to obtain some respite, as well to support and relieve languishing Nature, as for the use of Balsamic Medicines, and other things of that Nature, which respect the Original Distemper. History 1. Mr. Nest, a Presbyterian Minister of London, and my very good Friend, whilst he lived at Oxford was suddenly taken about the Eight and Twentieth Year of his Age with a dreadful Colic with taking a great deal of Pains in Ringing; caused without doubt by the motion of a Stone out of the Gallbladder into the Dust, which goes towards the Intestines. From which he was freed I know not by what means; yet he continued free from the return of any such kind of Fit till he was almost Forty Years old, and the Year 1670. From which time almost for the full space of Ten Years, to wit, to his dying day, he used oftentimes in a Year to be taken with, and to be a long time ill of this dreadful Distemper, with a violent pain in his Side, a high Fever, and other usual Symptoms from any violent Motion, the taking of Cold, a draught of Sack, or any other the least occasion. But when I was first called to go see him, mistaking the Distemper for a Pleurisy, I endeavoured in vain to free him from his painful Spasms with repeated Bleeding, a Fomentation, and Anodyne Liniments, as also with Pectoral Medicines; till at length upon a more attentive Inspection, and Observation, as well of his high-coloured and yellowish Urine, as of his whitish Stools, and of his Skin being lightly tinged with a Jaundice colour, I reasonably altered my Opinion, and upon that I took off the Racking Fit with the repeated use of the Tinctura Sacra, given with Liquid Laudanum at the time of going to Rest, and of the Purging Mineral Waters boiled, and turned with Milk, given him to take the following Mornings. And in this manner I used afterwards to take it off easily, and that in a little time. But though his Fits were by this means brought to be shorter, yet with the frequent return of them (because so long as this Spasmodick Constriction continued upon the Bile-duct, which was at the same time plugged up with a Stone, the usual Excretion, or Passage of the Bile into the Intestines being thereby hindered, and so the Nutritious part of the Aliment being driven down into the thick Guts with the Excrements, there was very little if any thing supplied for the reparation of the Blood.) I say, with the frequent return of these Fits, the Patient did by degrees continually waste away from the detraction of the due Nutritious Juice, having likewise Tremble come upon him, and Spasms in the Nervous Parts frequently recurring. Which I now observing, to prevent the sudden Destruction of Nature, amongst other things I ordered the use of Chalybeate Medicines, but especially the Vitriolic Waters every Year, from which I hoped there would follow the opening of the Obstructions, and the restitution of the Tone of the Liver, which was much spoiled. But at length, to wit, about the Year 1680. my Patient being taken with a most violent Colic, together with an Inflammatory Fever, though he was treated with Bleeding, and a due Regimen, yet at last his Fever turning into a Putrid Intermitting Fever, which was a Quotidian, notwithstanding the use of the Peruvian Bark, Pectoral Medicines, and Temperate Juleps, and likewise the application of Blisters, and the giving of other things, which either I or my Famous Colleague Dr. Pagett thought might be most Efficacious, this Excellent Person within the space of six Weeks died deeply Consumptive, being delirious in his Fever-Fits, and always miserably troubled with an Asthmatick Cough, in the same manner as those that are affected with a true Pulmonary Consumption, and likewise worn to nothing with an universal Colliquation. The Body being opened when he was dead, we found the Gallbladder very much distended like a Purse with Stones of a different Magnitude without even the least drop of Bile in it. Likewise in the Concave part of the Liver, just at the entrance of the Vena Portae was found a large Aposteme, which contained in it almost a Pint of true Pus. But for all his great Cough, and difficulty of Breathing, we did not find the Lungs affected with any Tubercles, at least that were maturated, though we found them tinged with several colours, and stuffed, and adhering to the sides of the Breast. Whereupon the Colic of his Stomach, which frequently returned, seemed to me to have its Original from the moving of the Stones out of the Gallbladder: The Universal, and Habitual Consumption from the frequent Obstruction of the Bile caused by that Colic; the fatal Fever, which was first Inflammatory, and afterwards Putrid and Intermitting, together with the universal Colliquation, and Marasmus following upon it from the Inflammation and Exulceration of the Liver; finally, the Cough and difficulty of Breathing from a more light Symptomatical Affection of the Lungs; but such as by reason of the hasty and acute Nature of the Original Disease (however that dreadful Cough seemed to be Asthmatical) was not advanced beyond the first degree of a Pulmonary Consumption. History 2. The Wife of Mr. Greaves, living in Paster-Noster-Row, who, when she was a Virgin used to be very Cachectical, a few Months after she was married, and before the Twentieth Year of her Age, began to be Melancholy, and to have Oppressions at her Breast: Her Belly likewise swelled, but yet more on one side than on the other: Her Appetite was plainly lost, her Thirst increased, and a Consumption together with a Hectic Fever at length prevailed so much upon her, that having at length wholly given over the vain hopes of being with Child, I was sent for, though too late, to visit this miserable Patient: Whom I found in a Tabid state, and afflicted every day with a Putrid Intermitting Fever, which moreover was accompanied with the Gripes, vast Colliquative Sweats, a Dropsical Swelling of the Legs as well as of the Belly, a perpetual Catarrhous Cough, a shortness of Breath, and the other usual Symptoms of a Fatal Consumption of the Lungs. With which the Patient being at length brought into the state of a Marasmus in the space of six Weeks or somewhat more, notwithstanding the plentiful use of Pulmonary and Uterine Medicines, of the Peruvian Bark, Laudanum, Pearl Juleps, Vesicatories, and other Remedies respecting the Original Disease as well as the various Symptoms proceeding from it, and she wasting away by degrees, went off plainly in the same manner, as those use to do, who die of a Consumption of the Lungs. The Body being opened after she was dead, we found the Lungs, contrary to our Expectation, not very much affected with the Stigmes of a Consumption. For though we found them stuffed, adhering to the Ribs, and tinged with several Colours, yet (so far as I remember) there were no Tubercles, either crude or ripe, found in them: But the Substance of one Ovary was plainly eaten away and consumed by an Exulceration; and the outward Membrane in a wonderful manner distended with a Dropsical Humour, so that we took out of it, which now took up the greatest part of the Belly, several Pints of Water somewhat purulent, together with a great quantity of little Bones, and small Fibres, or (as I judged) threads which had made up the Glandulous Substance that looked like yellow Hair. From whence it seemed plain to me that that Mortal Fever, accompanied with the fatal Colliquation (though this Consumption was Pulmonary only Secondarily and Symptomatically; and the Cough (and in some measure the difficulty of Breathing too) had their rise from the stuffing and adhesion of the Lungs) had its Original from the Inflammation and Exulceration of the Ovary itself. By which Colliquative Fever, as also by the substraction of the Nutritious Juice by the large Dropsical Swelling of the Ovary such a quick Consumption, and so grievous a difficulty of Breathing were caused, that her Life being thereby brought all of a sudden into extreme danger, there was not time enough given for that Consumption which was impressed upon the Lungs to be advanced beyond the first degree of a Pulmonary Consumption, though there seemed to be all the usual Symptoms of a Fatal Consumption of the Lungs. History 3. A certain Merchant of London before the Fortieth Year of his Age (when he had now lived almost two Years somewhat sickly, and with little and uncertain Appetite, which perhaps he procured to himself by his immoderate use of Wine and Women) at length asked my Advice about a Swelling, and a painful Inflammation arising from thence, with which the right Testicle had been now affected for almost the space of three Months, and that (as he told me) occasioned by some Contusion he had got in Riding. Indeed that Swelling to me seemed to be a kind of Sarcocele. The Testicle swelled to the bigness of ones fist. There was likewise no small Inflammation upon the Scrotum itself, as well as upon the Testicle. But with repeated Bleedings, the application of Cataplasms made of Barley-meal and Oxycrate (the Parts affected being likewise kept up with a Truss to prevent the flux of Humours into the place) frequent Purging with Calomelanos and Confectio Hamech, and also drinking plentifully of Emulsions of the four greater cold Seeds made with Barleywater, and of a Decoction of Sarsa and China ordered for his common Drink, the painful Inflammation plainly vanished. But the Swelling still continued, though without any pain, and the bigness of it was uncertain, being sometimes greater, sometimes less, and easily yielding to a pressure of ones fingers; so that at length the Judgement of two very skilful Surgeons being taken, and that Swelling being supposed to be a Hydrocele, it was justly thought fit to open it. But when it was solemnly opened with an Incision-Knife, there came out scarce any Water, and no Matter. Also the whole Substance of the Testicle seemed to have been eaten away, and perished for some time, but the Investing Coats were hard and incrassated, so that the Testicle being once opened looked like an empty Eggshell, or rather a Pomegranate-shell, when the Meat, or that which was contained in it, is taken out. From the Fistulous state of this Swelling it came to pass that the Surgeons being deceived, and taking it, because it yielded to the pressure of their Fingers, for a Hydrocele, opened it by Incision, though indeed after they had once opened it, it soon appeared to be in truth a Venereal Fistula, proceeding from some virulent and old Gonorrhoea, that had been ill cured. But from that Wound there arose a large Ulcer, which every day ran a great quantity of Ichorous, or gleety Matter. Which though many times it deluded us for several times with the vain hopes of Curing it, having ordered the Sarsa Drink now again for his ordinary Drink, when at the same time he was purged with the bitter Decoction repeated at due intervals, that is, so often as there was occasion, and every Night he had a Paregorick Draught given him with Syrup of Diacodium. But yet from an unexpected flux of the Humours, (which (as I always told the Surgeons) it was impossible to prevent without castration or cutting out of the Fistulous Testicle) the Ulcer very often broke out again; so that the Patient being quickly brought into a Tabid and Hectic state by the contival and plentiful substraction of the Nutritious Juice through the Wound, and the expenses arising from it, which Nature was not able to bear, as he began to have a great Thirst, so likewise to lose his Stomach, and at length to be afflicted with a troublesome Cough, a shortness of Breath, and the other usual Symptoms of the Lungs when they are distempered; continually wasting away more and more with the sudden Ruin of Nature, which was much promoted by the Fits of a Putrid Intermitting Fever coming upon all; which returned every day at a stated hour with a Chillness, Heat, and Sweats succeeding one another; till at length the Patient being brought to the utmost degree of a Marasmus, was forced to yield to Fate. With the repeated use of the Peruvian Bark I very often took off his Putrid Fever, which nevertheless (the cause of it still remaining in the Wound) returned as often, after the interval of a Week or two. Likewise the Hectic heat, which was kindled in his Blood, was much mitigated with the use of a Milk Diet, of Ass' Milk, and by the benefit of the open Country Air; though it could never be perfectly extinguished, because the Procatartick Cause of it, to wit, the Malignant and Incurable Ulcer was plainly too much for the Art of Surgery. Whereupon at last, the ulcerated part being gangrened, after he had lain six Months, he was reduced to a very Skeleton, and carried off not only with an Universal Consumption, but also a true Consumption of the Lungs, though it was a Symptomatical one. History 4. Mr. Nye, the Son of Philip Nye, the Famous Nonconformist Minister (as they are called) when he had now about the Thirtieth Year of his Age been troubled almost continually for the space of a Year with a Swelling, that grew in his Stomach, a Cardialgia, and Vomiting, (from which Symptoms he could not be freed neither by the frequent use of Calomelanos, the Purging Mineral Waters, Chalybeates, Wood-lice, the Decoctions of Sarsa, prepared Coral, Pearl, Crabs-eyes prepared, nor of other Medicines of all sorts, ordered even by the most learned and skilful Physicians) at length the Swell beginning to be inflamed and ulcerated, he being presently taken with an Inflammatory Fever, which was afterwards succeeded by a Putrid Intermitting Fever, he not only ran apace into a Consumptive state with an Universal Colliquation, but also being troubled with a pertinacious Cough, a difficulty of Breathing, and all the other Symptoms of a very Acute Consumption of the Lungs; at length he sent for me, though 'twas to no purpose. For I found him Sick in Bed, in the last degree of a Symptomatical Consumption of the Lungs, which as it was in its own Nature fatal, so likewise very quick. And therefore when I had once given him my helping Hand as much as I could for the Relief of the urgent Symptoms, I presently took my leave of him, having first made a Prognostic of his Death. Neither indeed did this miserable Patient continue many days. But not having the liberty of opening the Body after he was dead, though there were all the Symptoms of a Pulmonary Consumption, yet as it did not appear to me as an Eye-witness, so I cannot confidently affirm how much the Lungs themselves had happened to be affected and injured thereby. History 5. A certain Old Gentlewoman, a Lawyer's Wife, that lived in Shoe-Lane, when (as she told me) she had for the space of Twenty Years been hardly able to sleep half an hour at a time by reason of a violent and continual pain in making of Water; with which, and with other direful Symptoms accompanying of it she having been very much and continually weakened (and that notwithstanding she had taken the Advice of the most able Physicians) and thereupon being brought at length into a plain Consumptive and Hectic state, and being continually confined to her Bed by reason of her Weakness, she sent for me not long before she died; now when by reason of the loss of her Appetite, she had for a long time abhorred Food as well as Physick When I came I found her really an extraordinary Woman, that adorned her Old Age with Fortitude and Prudence beyond what is common to that Sex; but yet (as I guest even at the first sight by her extreme Emaciation, Cough, Fever, and difficulty of Breathing) I found her lying very miserably in the last degree of a Consumption. Because she was obliged almost perpetually to conflict not only with the usual Symptoms of a Pulmonary Consumption, and a Hectic Fever, but also with a frequent and dreadful Spasmodick Colic of her Stomach, from the motion of some Stones out of the Gallbladder, as likewise with a continual pain in making of Water, caused by a Stone, and an Ulcer of the Kidneys. From whence it came to pass, that her Urine when 'twas first made, was whitish, and afterwards had a very great, a fetid, and truly purulent Sediment. But upon looking on the Urine, I presently found there was a pretty large Ulcer caused by a Stone in the Kidney affected, and I did think that a Pulmonary Consumption had been brought on Symptomatically by that Ulcer. Nature having been now for some time weakened, oppressed, and sinking under so many, and such great Evils, it happened likewise that her Brain, and the whole Genus Nervosum were so remarkably and continually affected, that laying aside all her other Complaints of her Consumption, Ulcer, and Stone, she desired only this, that I would do something to help her against her Swoonings, and Faintness, which often returned, as also against delirousness, and the cold and hot Vapours, (as she called them) which did continually both Night and Day alternately succeed each other, which seemed to be more troublesome to her than all the other miserable Symptoms. Presently I did all I could to relieve those troublesome Symptoms with the use of Spirit of Hartshorn, of Salt ammoniac, Tincture of Castor, Antihysterick Juleps, and other things of that Nature. Neither indeed did I plainly neglect her distempered Lungs, and her ulcerated Kidneys, (where the first Original of this Distemper lay) but I took care of these too, with the use of Emulsions, Balsamic and Pectoral Medicies', that is, so far as the extenuated Habit of her Body, and of her bad Stomach would bear. But yet all these things were now ordered to no purpose. For as the Ulcer of her Kidney was now for a long time become plainly incurable; so likewise the Secundary Affections of the Lungs and Genus Nervosum, which were the Effects of it, seemed to be rather the Trophies of conquered and yielding Nature, than either accidental Oppressions, or any accidental Diseases, that Art could overcome. But a little before she died, when Death seemed to be near at hand, this Virago desired me very earnestly, and indeed made me promise that I would take care that her Body should be opened after she was dead, that for the good of the Living, she might, when she was dead, be serviceable to that Art of Physic, from which she received no Benefit whilst she lived. The Husband having given leave (though with much ado) that the Body should be examined after she was dead, she was opened very Solemnly, several Eminent Physicians being present. The first thing that was Remarkable was, that though all the Limbs, and the Face of this Tabid Woman were emaciated, yet the Adipose Membrane of the Belly was strangely thick with Fat, as it commonly happens to Calculous Persons, it may be from a slower motion of the Blood through the Neighbouring Parts, and a smaller secretion of the Serum by the Kidneys than there ought to be; but we found the outward Membrane of the left Kidney sticking firmly to it, as being something swelled from its Distemper. But the Substance of it being opened it looked like a Honeycomb, being every where full of Stones and Cavities, or certain little Cells, out of which some Stones had been formerly extruded, but without the least Exulceration. But the right Kidney we found like a Purse not only full of Stones and Matter, but likewise very much distended, the whole Substance also, which had been contained within the investing Membranes, having been before by degrees corrupted and consumed, and likewise the Membranes themselves being filled with abundance of Stones and Serous Pus, such as we likewise found in the Bladder, and such as she used commonly to void with her Urine. From which the cause of that Chronical Dysury and Consumption, with which she had been so long afflicted, was very evident. Also the Emulgent Veins, which carried back the Blood from the Kidneys, by reason of the mighty Calculous disposition of the Blood, with which this Miserable Old Woman was affected, were (which was very strange) like stony Pipes covered on the inside with a plain calculous Crust. Moreover we found the Gallbladder full of Stones, from the motion of which that Colic of her Stomach, accompanied with dreadful Spasms, with which she was often troubled, did without doubt take its Original. Yet we did not find that the Lungs themselves were any where exulcerated, but almost every where full of crude Tubercles, and Chalky Stones. From which the cause of her continual Cough, shortness of Breath, and the other Pulmonary Affections did appear to our very sight. Yet I do not at all doubt but that in progress of time those Tubercles might have ripened; and by that means this Incipient Consumption of the Lungs might have gone on to a Confirmed and Deplorable Consumption, if an untimely Death, procured by other causes, had not prevented it. FINIS. A General TABLE Of all the DISEASES and their CURE, illustrated with variety of Cases and Observations. A. OF an Abscess of the Loins, an Example. pag. 30 Agglutinating Medicines pag. 135 What Air is good in a Consumption pag. 152 Anatomical Cases of an Asthmatical Consumption pag. 215 Of a Consumption from a Dropsy pag. 49 Of a Consumption from an Haemoptoë pag. 232 Item pag. 233 Of an Icterical Consumption pag. 327 Of a Consumption from a Loseness pag. 38 Of a Consumption from Nails in the Lungs pag. 247 Of a Scrofulous Consumption pag. 200 Of a Consumption from Internal Ulcers pag. 348 Item pag. 351 Item pag. 357 Antiscorbutics to be used in a Scorbutical Consumption pag. 204 Asse's Milk is proper in Consumptions pag. 22 Rules to be observed 〈◊〉 the use of Asse's Milk pag. 163 Asse's Milk not convenient in an Icterical Consumption pag. 315 Of an Asthmatical Consumption pag. 212 The Cure pag. 214 A History pag. 215 An Atrophy, or Nervous Consumption pag. 4 The Cure pag. 6 History 1. pag. 8 History 2. pag. 10 B. BAlsamicks proper in a Consumption from Apostems pag. 27 Balsamicks proper in an Original Consumption of the Lungs pag. 133. 151. 159. 180 Balsamicks useful in a Scrofulous Consumption pag. 196 In a Consumption from stopping of Ulcers pag. 255 In a Consumption from a Peripneumony pag. 269 In a Consumption from Stones in the Lungs pag. 240 Item pag. 242 In a Consumption from Internal Ulcers pag. 345 The Author's Balsamic Pills pag. 151 The Peruvian Bark is good in a Consumption from Bleeding at the Nose pag. 17 The Bark is good in a Consumption from Intermitting Fevers pag. 298 Is an Antidote against an Habitual Haemoptoë pag. 227 Is good in an Hamoptoïcal Consumption pag. 231 Is to be given in the Putrid Fever pag. 179 And to be repeated pag. 181 The Bath Waters are proper in a Consumption from a Diabetes pag. 41 Bleeding necessary in the beginning of a Consumption pag. 138 Bleeding necessary in the Peripneumonick Fever pag. 175 Bleeding necessary in a Consumption from Fevers pag. 295 Bleeding when necessary in a Scrofulous Consumption pag. 197 From Bleeding at the Nose a Consumption pag. 14 The Cure Ibid. A History pag. 17 A Broth to be used in a Consumption pag. 165 C. THE Cure of the Catarrh in the beginning of a Consumption pag. 138 Carminative Medicines to be used in a Consumption pag. 134 From the Celiack Passion a Consumption pag. 57 History 1. pag. 59 History 2. pag. 60 Cephalicks proper in an Atrophy pag. 6 Cephalicks proper in a Consumption from Melancholy pag. 218 Chalybeate Waters proper in a Consumption from Apostems pag. 29 In a Consumption from Bleeding pag. 17 In a Consumption from a Diabetes pag. 41 In a Consumption from a Dropsy pag. 48 In a Consumption from a Dysentery pag. 38 In a Consumption from a Gonorrhoea pag. 22 In a Consumption from stopping a Gonorrhoea, etc. pag. 255 In a Consumption from the Gout, etc. pag. 279 In a Consumption from the Green-Sickness pag. 260 In a Haemoptoical Consumption pag. 231 Chalybeate Waters proper in an Icterical Consumption pag. 315 In an Original Consumption of the Lungs pag. 160 In a Consumption from a Peripneumony, etc. pag. 269 In a Scorbutical Consumption pag. 205 In a Scrofulous Consumption pag. 200 In a Consumption from giving of Suck pag. 34 In a Consumption from Sweats pag. 54 In a Consumption from Internal Ulcers pag. 347 Rules to be observed in the use of the Chalybeate Waters pag. 161 Item pag. 231 Chirurgical Remedies in a Pulmonary Consumption pag. 137 Of the Colliquation in a Consumption pag. 105 How to moderate the Colliquative Sweats pag. 186 Of a Confirmed Consumption of the Lungs, the Signs pag. 100 A dry Cough the first Sign of a Pulmonary Consumption pag. 82 How distinguished from a Catarrh pag. 84 How to relieve the Cough in a Pulmonary Consumption pag. 184 D. THE Decoction of Sarsa good in a Consumption from Apostems pag. 24 In a Consumption from the French Pox pag. 283 In an Original Consumption of the Lungs pag. 133, 134 In a Consumption from the drying of Old Sores pag. 287 A Prescription for a Decoction of Sarsa pag. 25 A Pectoral Decoction of Sarsa pag. 153. 253 The several Degrees of a Pulmonary Consumption pag. 69 From a Diabetes a Consumption pag. 41 The Cure Ibid. History 1. pag. 42 History 2. Ibid. History 3. pag. 43 The Diagnostic Signs of an Asthmatical Consumption pag. 212 Of Consumption from Melancholy pag. 218 Of an Original Consumption pag. 82 Of a Scrofulous Consumption pag. 195 Of a Consumption from Stones, etc. pag. 238 Diaphoreticks good in a Consumption pag. 143 What Diaphoreticks are good in a Consumption pag. 133 Rules about the use of Diaphoreticks pag. 144 What Diet is convenient in a Pulmonary Consumption pag. 153 The Differences of an Original Pulmonary Consumption pag. 117 Diversion good in a Consumption from Bleeding pag. 16 Diversion good in a Nervous Consumption pag. 8 Diversion good in a Scorbutical Consumption pag. 206 The Diuretics proper in a Pulmonary Consumption pag. 132 Diuretics good in a Consumption from a Dropsy pag. 48 From a Dropsy a Consumption pag. 47 The Cure pag. 48 A History pag. 49 A Dysury from an Ulcer in the Kidney pag. 357 E. FRom an Empyema a Consumption, and the Cure pag. 268 History 1. pag. 270 History 2. pag. 273 Evacuations proper in an Original Pulmonary Consumption pag. 128 All Evacuations, when to be avoided pag. 22. 34. 131 F. A Fever one sign of a Consumption pag. 98 From Fevers a Consumption pag. 294 The Cure pag. 295 Observation 1. pag. 299 Observation 2. pag. 302 Observation 3. pag. 304 From Fistula's a Consumption pag. 254 A Fistula in one of the Testicles pag. 353 From the French Disease a Consumption pag. 250 The Cure pag. 251 An Observation pag. 252 G. GArgarisms to be used in the Thrush pag. 190 From a Gonorrhoea a Consumption pag. 19 The Signs pag. 20 The Cure pag. 21 From the stopping of a Gonorrhoea a Consumption pag. 254 The Cure pag. 255 From the Gout a Consumption 276 The Cure pag. 277 From the Green-Sickness a Consumption pag. 258 The Cure pag. 259 An Observation pag. 260 H. A Hectic Fever one Sign of a Consumption Pag. 94 A Hectic Fever when the Sign of a confirmed Consumption Pag. 158 When the Hectic Fever is considerable, what is to be done Pag. 163 The Hiccough how to relieve Pag. 189 From an Hypochondriacal Affection a Consumption Pag. 217 From an Hysterical Affection a Consumption Ibid. The Cure Pag. 218 Of an Hysterical Consumption, an Observation Pag. 223 Hysterick Passions the sign of Nurse's Consumptions Pag. 33 I. AN Icterical Consumption Pag. 307 Diagnostic Signs Pag. 311 Prognostic Signs Pag. 313 The Cure Ibid. Observation 1. Pag. 316 Observation 2. Pag. 321 Observation 3. Pag. 327 Observation 4. Pag. 338 Jellies to be used in a Consumption Pag. 166 A Jelly-Broth Ibid. Inciding Medicines Pag. 134 Inciding Medicines good in an Asthmatical Consumption Pag. 214 Incrassating Medicines Pag. 135 Incrassating Medicines good in the beginning of a Consumption Pag. 146 Incrassating Medicines good in an Haemoptoical Consumption Pag. 230 Incrassating Medicines hurtful in an Asthmatick Consumption pag. 214 In a Consumption from the Gout pag. 277 In an Icterical Consumption pag. 314 Indications for preventing a Consumption pag. 75 Indications of Cure in a Pulmonary Consumption pag. 127 Inflammatory Fever a sign of a confirmed Consumption pag. 100 The Inflammatory Fever described pag. 174 The Cure pag. 175 From Intermitting Fevers a Consumption pag. 296 The Cure pag. 298 Observation 1. pag. 299 Observation 2. pag. 332 Observation 3. pag. 344 Issues convenient in an Original Pulmonary Consumption pag. 81 Issues when convenient in a Consumption from Ulcers pag. 28 Issues convenient in a Consumption from Sweats pag. 54 In a Consumption from stopping of Ulcers pag. 255 Juleps to be used in a Pulmonary Consumption pag. 167. 169. 173. 177 A Julep for the Colliquative Sweats pag. 187 K. FRom the King's-Evil a Consumption. Vide A Scrofulous Consumption L. FRom a Lientery a Consumption pag. 57 A Limewater good in a Consumption from Apostems pag. 25 For a Limewater a Prescription pag. 26 From a Looseness a Consumption pag. 37 The Cure Ibid. An Observation pag. 38 Of the Looseness in a confirmed Consumption pag. 109 A Looseness in a Pulmonary Consumption how to relieve pag. 183 The Lubricating Medicines that are proper in a Consumption of the Lungs pag. 134. 146 Lubricating Medicines when proper in a Consumption from a Peripneumony pag. 269 Lubricating Medicines good in a Consumption from Stones in the Lungs pag. 241 Lubricating Medicines do no good in a Consumption from the Gout pag. 277 Not to be used in Haemoptoical Consumptions pag. 230 Of the Lungs an Original Consumption pag. 62 The Causes pag. 64 The Degrees, and Presaging Signs pag. 69 The Diagnostic Signs pag. 82 The signs that it is confirmed. Vide confirmed Consumption Indications of Cure. Vide Indications. Method of Cure in the first degree pag. 138 Method of Cure in the second degree pag. 155 Method of Cure in the third degree pag. 171 Symptoms how to relieve pag. 182 Of the Lungs Symptomatical Consumptions pag. 191 M. THE Matter spit in a Pulmonary Consumpt. pag. 115 True Matter, or Pus, how to be known pag. 116 A Mead when proper pag. 170 From the Measles a Consumption pag. 294 The Cure pag. 295 From Melancholy a Consumption pag. 217 The Prognostics pag. 218 The Cure Ibid. Observation 1. pag. 220 Observation 2. pag. 221 A Milk-diet good in a Consumption from Apostems pag. 29 In a Consumption from Bleeding pag. 17 In a Consumption from a Diabetes pag. 41 In a Consumption from a Dysentery pag. 37 In a Consumption from a Gonorrhoea pag. 22 In a Consumption from a Looseness pag. 37 In an Original Consumption of the Lungs pag. 127 In a Consumption from Salivation pag. 46 In a Consumption from giving of Suck pag. 34 In a Consumption from Sweats pag. 55 In a Consumption from Internal Ulcers pag. 347 Concerning a Milk-diet, some Observations pag. 163 A Milk-diet not proper in an Asthmatick Consumption pag. 214 Nor in a Consumption from a Dropsy pag. 49 Nor in an Icterical Consumption pag. 315 Nor in a Consumption from Melancholy pag. 219 Nor in a Scorbutical Consumption pag. 206 Nor in a Scrofulous Consumption pag. 197 Nor in a Consumption from Stones pag. 242 A Milk-Water pag. 168 Mucilaginous Medicines to be used in an Icterical Consumption pag. 314 N. FRom Nails, etc. a Consumption pag. 239 The Cure pag. 240 An Observation pag. 247 The Nerves to be relieved in a Consumption from Melancholy pag. 218 A Nervous Consumption. Vide Atrophy. O. OPiates convenient in a Consumption from a Looseness pag. 38 In an Original Consumption of the Lungs pag. 136 Opiates convenient after a Vomit pag. 140 After a Purge pag. 142 With Diaphoreticks pag. 144 At other times pag. 150 Opiates to be given to abate the Cough pag. 185 Opiates easily born in the Symptomick Looseness pag. 183 Must be given in the Symptomatick Looseness. Ib. Opiates when cautiously to be given pag. 173 Opiates good in a Consumption from Melancholy pag. 219 Opiates good in a Consumption from spitting of Blood pag. 230 In a Consumption from Stones, etc. pag. 240 Opiates dangerous in an Asthmatick Consumption pag. 214 Opiates hurtful in a Consumption from the Gout pag. 277 In an Icterical Consumption pag. 315 In a Scorbutical Consumption pag. 204 An Oppression of the Breast in a Consumption pag. 96 Oily Medicines. Vide Lubricating Medicines. P. PAins racking the Bowels to relieve pag. 183 Pains of the Sides how to relieve pag. 178 Pains in a Consumption from the Green-Sickness pag. 259 Pains in an Icterical Consumption pag. 313 Pains in a Consumption from Stones pag. 238 A Paracentesis when to be made pag. 268 From Parents a Consumption derived pag. 66 Passions troublesome cause a Nervous Consumption pag. 8 Passions the cause of a Pulmonary Consumption pag. 92 Passions attend a Consumption from Bleeding pag. 16 Confirm a Consumption pag. 21 Troublesome Passions must be avoided pag. 154 Of Pectoral Medicines the several sorts pag. 74. 133 Pectorals must be given plentifully. The Peripneumonick Fever in a Consumption pag. 100 174 The Cure pag. 175 Salt Phlegm sign of a Consumptive disposition pag. 71 From a Pleurisy a Consumption pag. 263 The Cure pag. 267 Observation 1. pag. 270 Observation 2. pag. 273 A Pleurisy ill cured causes Tubercles in the Lungs pag. 91 From the French-Pox a Consumption pag. 250 The Cure pag. 251 An Observation pag. 252 From the Small- Pox a Consumption pag. 294 The Cure pag. 295 The Prevention of a Consumption pag. 74 Prognostics in an Original Consumption of the Lungs pag. 122 Pulmonary Medicines. Vide Pectoral Medicines Of the Pulse in the Hectic Fever, Observations pag. 113 In the Inflammatory Fever Ibid. In the Putrid Fever pag. 114 Purging proper in a Consumption pag. 128 The Purgers proper in a Pulmonary Consumption pag. 131 Purging-Waters when convenient in a Scorbutical Consumption pag. 205 Purging when not convenient pag. 158 The Putrid Fever in a Consumption of the Lungs described pag. 103. 179 The Cure pag. 179 R. A Raucedo presages a Consumption pag. 95 From a Rheumatism a Consumption pag. 276 The Cure pag. 276. 278 Observation 1. pag. 280 Observation 2. pag. 283 Observation 3. pag. 291 From a Chronical Rheumatism a Consumption incurable pag. 278 S. FRom a Salivation a Consumption pag. 45 The Cure pag. 46 An Observation Ibid. Salivation proper in a Consumption from the French Disease pag. 252 Salivation proper in a Consumption from Internal Ulcers pag. 346 A Salt Scurvy pag. 202 From Scarlate Fevers a Consumption pag. 294 The Cure pag. 295 A Scrofulous Consumption pag. 194 The Cure where there are hot swell pag. 197 The Cure where they are of a middle nature pag. 199 The Cure where there is no Putrid Fever pag. 200 An Observation Ibid. From the Scurvy a Consumption pag. 202 The Signs pag. 203 The Cure pag. 204 An Observation pag. 207 Shaving of the Head good in a Consumption from Apostemes pag. 28 Shaving of the Head good in a Pulmonary Consumption pag. 81. 137 Shellfish, when proper pag. 165 Shortness of Breath follows upon the Tubercles pag. 96 Signs of an Incipient Consumption pag. 82 The Skin how it shows a Consumptive disposition pag. 70 A Snail-Water pag. 168 From Spitting of Blood a Consumption pag. 225 The Cure pag. 230 Observation 1. pag. 232 Observation 2. pag. 233 Observation 3. pag. 236 Steel Medicines good in an Atrophy pag. 6 In a Consumption from Melancholy pag. 219 Steel Medicines good in a Scorbutical Consumption pag. 205 Stomachicks good in a Nervous Consumption pag. 6 From Stones in the Lungs a Consumption pag. 238 The Cure pag. 240 Observation 1. pag. 244 Observation 2. pag. 245 Observation 3. pag. 246 From Stones in the Kidneys and Bladder a Consumption pag. 243 The Cure Ibid. From giving of Suck a Consumption pag. 32 The Cure pag. 34 An Observation pag. 35 Giving of Suck sometimes Cures a Consumption pag. 32 The Suppression of Evacuations one cause of a Consumption pag. 70 From a Suppression of women's Courses a Consumption pag. 258 The Cure pag. 259 From Surfeits a Consumption pag. 294 The Cure pag. 295 From Sweats a Consumption pag. 52 Observation 1. pag. 53 Observation 2. pag. 54 Observation 3. pag. 56 Colliquative Sweats in a Consumption pag. 107 The Colliquative Sweats how to moderate pag. 186 The Symptoms of a Consumption to be relieved pag. 182 Symptomatical Consumptions of the Lungs pag. 191 T. TAblets of the Peruvian Bark pag. 301 From breeding of Teeth a Diabetes and Consumption pag. 43 A Thirstiness attends a Consumption pag. 94 Much Thoughtfulness presages a Consumption pag. 70 Tobacco hurtful in a Scorbutical Consumption. p. 206 A Thrush happens in the end of a Consumption p. 111 The Thrush how to be relieved p. 189 Tubercles in the second degree of a Consumption p. 156 An Account of the Tubercles in a Pulmonary Consumption p. 88 V. Vesicatories' proper in an Original Consumption of the Lungs p. 145. 178 In a Consumption from the stopping of Ulcers, etc. p. 255 A Voice squeaking and shrill shows a Consumptive disposition p. 70 A disposition to Vomit, when the Sign of a Consumption p. 94 A Vomiting in the end of a Consumption to relieve p. 188 Vomits good in an Original Consumption of the Lungs p. 132 In a Consumption from the Gout and Rheumatism p. 278 In a Consumption from Melancholy p. 219 Vomits to be given to help Expectoration p. 268 Observations of the Urine in a Consumption p. 114 From Iternal Ulcers a Consumption p. 340 Indications of Cure p. 345 Method of Cure p. 346 Observation 1. p. 348 Observation 2. p. 351 Observation 3. p. 353 Observation 4. p. 356 Observation 5. p. 357 From large Ulcers a Consumption p. 23 The Cure p. 24 W. WAsting of the Flesh a sign of a Consumption pag. 99 From the Whites a Consumption pag. 19 The Presaging Signs pag. 20 The Cure pag. 21 Wine hurtful in a Consumption from Bleeding pag. 16 In a Consumption from a Diabetes pag. 42 In a Consumption from a Gonorrhoea pag. 22 In a Pulmonary Consumption pag. 153 Y. IN Young Persons a Consumption is Acute, and hard to Cure pag. 124 FINIS.