A Collection of Chirurgical Tracts

It has been likewise thought proper to preserve a small Treatise of curing Consumptions by a new Method, of administring Specific-Medicines, more especially such as proceed from Ulcers of the Lungs.

This excellent Piece was written by the late eminent Mr Thomas Nevett, of Fen-Church Street, Surgeon.

A NEW METHOD Of Curing CONSUMPTIONS BY Specific Medicines.

INTRODUCTION

I Remember a remarkable Passage in some Observations upon the Bermudus Berries, by a Doctor of Physic in the Country, addressed to the Hon. Robert Boyle, Esq; who professeth he had been for 50 Years an exact Observer of the Methodus Medendi; yet saith the Doctor for my part I firmly believe, that (Universal Evacuations being premised) the greatest Cures wrought in the World, are by the use of Specifical Medicines. The higher the Attainments of any have been in Understanding, the more freely have they acknowledged that the greatest part of those things they did know, was the least of those things they did not know; such Men account it not shameful to renounce an Errour, tho’ ever so ancient, when persuaded thereunto by Truth and plain Demonstration: There are other narrow Spirits (abundantly satisfied in their own Knowledge) who believe the Art of Physic hath been taught by our Ancestors, in such an absolutely perfect manner, as that nothing remains to the Industry and Diligence of Posterity; it being too much their Humour to undervalue every Medicine that they themselves are not Masters of, because they prefer their private Interest to the public Good: But in the mean time where is that cordial Love to Mankind, which is one of the Badges of true Christianity? Nay, where is the Exercise of Reason? For how can a Man give his Opinion against a thing that he never heard of before, or at least never experienced? I am sure, this unjustifiable Practice is the way to put a stop to all useful Knowledge and Improvements: It is therefore expected from the Ingenious and Candid Reader, that he should adhere to the Cause of Truth, by whomsoever it is pleaded, weigh every Invention, not in the deceitful Balance of Custom, but in the just and even Scales of Reason; approve what is agreeable, and reject what is contrary to it.

That I who am by Profession a Surgeon, should in such a polite and inquisitive Age, venture my Thoughts in public concerning a Physical Case, may be to some matter of Admiration, and to others of severe Censure; especially such as may think I have invaded their Province. As for the latter, I am persuaded nothing that I can say will remove their Prejudices; and for the former, I shall only tell them, that being alarmed by some of the Symptoms mentioned in the following Discourse, whereby I plainly perceived the Constitution of my own Body inclined to a Consumptive State, I strenuously applied my Mind to study the Nature of this Disease, and to find out, if possible, some noble Specific Medicines, which might indeed deserve that Name, and be able to oppose the growth of so fatal a Distemper, which hath insensibly flattered so many into the Chambers of Death. What I then laboured for, and searched after, I have since (by the Blessing of God) found, and with great Advantage experimented on my self and many others, and now think fit to disclose for the good of All, not doubting but if a more excellent Method and Medicine than hath hitherto been generally administered, or prescribed, be treasured up in the Hands of any Person whatsoever, he doth more faithfully perform the part of a just Steward, by a due Improvement, than a close Concealment of it. And on the same Account, I judge it more my Duty to serve my Native Country, than mind the Clamours of censorious Critics; not at all questioning but in a little time, the Efficacy of these Medicines will at once bring Health to the Patient, and Reputation to their Author: And the World will be convinced of the Power of these Remedies, by their Effects; tho’ ignorant Persons may be apt to contemn and neglect, till their Opinions be altered by Experience, and their Prejudices removed by Demonstration.

Of the Nature, Causes, and Symptoms of Consumptions

I. A Consumption, in general, is a wasting of all the solid parts of the Body, for want of a due Distribution, or Assimilation of the Nutritious Juices.

By some learned Men this is observed to be the Endemical Distemper of England; and indeed our Weekly-Bills at once declare both the Strength of the Disease, and the Weakness of the Medicines wherewith it’s Cure hath been hitherto attempted. Besides, that which seems to justify this Observation, is the pernicious Custom of the Inhabitants of this island, who immoderately and unseasonably indulge their Appetites with several sorts of Meats and Drinks, whereby the Tone of the Stomach is so vitiated, as that it cannot perfectly ferment and volatilize the Chyle, which is commonly the internal procatartic Cause of most Distempers among us, and consequently of Consumptions from those Distempers, from whence comes a Colliquation of the Chyle in Lienteries and Dysenteries, tormenting Cholic and Iliac Pains, hypocondriac Melancholly, hysteric Fits, scorbutic Twitches, troublesome Catarrhs, sluggish Passage of the Chyle thro’ the milky Veins, scrophulous Tumours and Inflammations of the mesenteric Glands, spasmodic Contractions or Convulsions of the Nerves, preternatural Fermentation of the Blood and Spirits, Cachexies, Atrophies, Obstructions, Fevers hectical, inflammatory and putrid, Exulcerations of the Lungs and Marasmus, with many other Diseases, whence come they originally and for the most part, but from the Weakness, ill Habit and Indisposition of the Stomach?

Now the proper Action of the Stomach is Chylification; for tho’ the Meat we take into our Mouths receives some Alteration there in Mastication, by the fermenting Juice that flows from the salivatory Glands, together with the acrimonious Particles, and fermentaceous Spirits of Liquors which we drink, yet it is not turned into a thick white Juice, ’till it hath passed down thro’ the Oesophagus, or Gullet, into the Stomach, where by the help of it’s Fibres it is closely embraced, and mixed with specific fermentaceous Juices, separated by it’s inner Coat, and impregnated by the Saliva, then by a convenient Heat there is made a mixture of all; for that the fermentaceous Particles entering into the Pores of the Meat, do pass thro’ agitate and eliquate it’s Particles, dissolving the whole Compages, in which the purer parts were intimately united with the Crass, and making them more fluid, so that they make another form of Mixture, and unite among themselves into the resemblance of a milky Cream, after which together with the thicker Mass with which they are yet involved, by the Constriction of the Stomach they pass down to the Guts, where by the Mixture of the Bile and Pancreatic Juice they are by another manner of Fermentation quite separated from the thicker Mass, and so are received by the Lacteal Vessels, as the thicker is ejected by Stool.

After the purer part of the Chyle hath been thus strained thro’ the narrow and oblique Pores of the milky Veins, by the continual and peristaltic Motion of the Intestines, it is yet farther attenuated and diluted with a very thin and clear Lympha from the Glands of the Mesentery to expedite its passage thro’ those numerous Meanders into the common Receptacle, from whence by the constant Supply of such like Lympha from the small Glands of the Thorax, it is safely conveyed thro’ the Ductus Chyliferus Thoracius, subclavian Vein, and the Vena Cava into the Heart.

The Chyle now mingled with the Blood, passeth with it thro’ the Arteries of the whole Body, and returns again with the Blood by the Veins to the Heart, undergoing many Circulations before it can be assimilated to the Blood; for every time the new infused Chyle passeth thro’ the Heart with the Blood, the Particles of the one are more intimately mixed with those of the other, in it’s Ventricles, and the Vital Spirit, and other active Principles of the Blood work upon the Chyle, which being full of Salt, Sulphur and Spirit, as soon as it’s Compages is loosned by it’s Fermentation with the Blood, the Principles having obtained the Liberty of Motion, do readily associate themselves, and are assimilated with such parts of the Blood as are of a like and suitable Nature.

After the Chyle hath been thus elaborated, it becomes fit as well to recruit the Mass of Blood, as to nourish the whole Body, seeing it consists of divers Principles and Parts of a different Nature; therefore, according to the various Use and Necessity of every part, and also that it may conform and fashion it self to the different Pores and Passages, it is severally appropriated; the most volatile and subtil part is separated in the Brain, and adapted to refresh the Animal Spirits, the glutinous to nourish the Body, and the sulphureous to revive the native Heat: And in it’s Passage with the Blood thro’ all the parts of the Body, all the Mass of Chyle that is capable of being turned into Blood is sanguified; the serous and saline part precipitated by the Kidneys, and evacuated by Sweats or insensible Transpirations, the bilious is deposited in the Liver, and the rest of its Excrements retire to the several Emunctories of the Body.

Thus it comes to pass by the wonderful Sagacity of Nature, such extraordinary Provision is made, that the purer part of the Chyle by these ways and means is more purified; and when it is thus purified and sublimed, it is more capable of reinforcing the Blood and Spirits, as also of corroborating the Tone of every particular Part: Whereas when the Chyle is sour and dispirited, the Blood necessarily becomes vappid, the animal Spirits which reside in the System of the Nerves are infected with a Morbid Disposition, and all parts of the Body begin to flag and waste. For indeed there is no other way to recruit the daily Expence of Blood and Spirits, but by a continual Influx of laudable Chyle into the Blood-Vessels, which Chyle is made by the Fermentative Juice of the Stomach, and this Fermentative Juice supplied from the Mass of Blood, so that there plainly appears to be a fixed Correspondence betwixt the Blood and the Chyle, and a necessary Dependance all the Humours in the Habit of the Body have on the Stomach; from whence it is reasonable to infer, That if the Chilifying Faculty of the Stomach be depraved, the Blood and Humours must necessarily sympathize therewith, and in a manner proportionable to the Distemper of this part.

II. The immediate Cause of a Consumption of the Lungs is store of sharp, malignant, waterish Humours, continually distilling upon the soft spungy Substance of the Lungs, stuffing, inflaming, impostumating, and exulcerating them, whereby their Action, which is Respiration, or a receiving-in and driving-out Air is depraved, as will more clearly appear by the following Description of these Parts. It will not be impertinent to our Discourse if we should usher in the Description of the Lungs, with a short Account of the Trachea, Aspera Arteria, or Wind-pipe.

III. The Trachea or Aspera Arteria is a long Pipe, consisting of Cartilages and Membranes, which beginning at the Throat or lower part of the Jaws, and lying upon the Gullet, descends into the Lungs, thro’ which it spreads into many Branchings, and is commonly divided into two parts, the Larynx and Bronchus; the Larynx is the upper part of the Wind-pipe, the Bronchus is all the Trachea besides the Larynx, as well before as after it arrives at the Lungs.

The Substance of the Lungs is soft, spongy and rare, curiously compacted of most thin and fine Membranes, continued with the Ramifications of the Trachea or Wind-pipe, which Membranes compose an infinite number of little, round and hollow Vesicles, or Bladders, so placed as that there is an open Passage from the Branches of the Aspera Arteria, out of one into another, and all terminate at the outer Membrane that investeth the whole Lungs: These little Bladders by help of their muscular Fibres contract themselves in Expiration, and are dilated in Inspiration, partly by the Pressure of the Atmosphere, and partly by the elastic Power of the Air, insinuating it self into these Vesicles thro’ the Windpipe and it’s several Branches: Their Lobes are two, the right and left, parted by the Mediastinum, each of which is divided into many lesser Lobules, according to the Ramifications of the Aspera Arteria; they have all sorts of Vessels that are common to them with other parts, as Arteries, Veins, Nerves, Lympheducts, but peculiar to themselves they have their Bronchia, or the Branches of the Wind-pipe, for bringing-in and carrying-out Air so necessary to Life, that we cannot Live without it: And when we consider their admirable Structure, (as well as the Structure of every individual part of our Body) how ought we to adore the infinite Wisdom of our Creator! Now when these small Vesicles or Bladders are replete with extravasated Serum, or purulent Matter, the natural Tone of the Lungs is so weakned, that we cannot enjoy the Benefit of free and full Respiration, hard, scirrhous Tumours and Tubercles are bred, attended with a dry and troublesome Cough, Oppression of the Breast, difficult and short Breathing, preternatural Heats, Exulcerations, and other deplorable Symptoms, according to the Degrees of Obstruction, and different Nature of the included Humours.

IV. The external Procatartic Cause of a Consumption of the Lungs is cold Particles of Air, constipating the Pores of the Body, whereby the Serum which ought to expedite the Motion, and temperate the Heat of the Blood is separated from it, and thrown upon the Glands of the Larynx, and the spungy Substance of the Lungs themselves: For as the Lympha helps the Motion of the Chyle, so the Serum accelerates the Circulation of the Blood, being carried about with it thro’ the smallest Capillary Vessels and remotest parts of the Body, lest it should be inflamed with a burning Heat, or stagnate by excessive Thickness; during which circular Motion they are both called by the same common Name, but when some Portion of Serum is separated from the Mass of Blood, and retreats to some one or more of the Emunctories; according to their various Dispositions, it derives a Name from those particular Parts on which it seizeth, as when it distils upon the Eyes, we call it Opthalmia, when upon the Nose Coryza, and when upon the Thorax it goes by the proper Name of a Catarrh.

Now forasmuch as there is nothing makes a Separation of the Blood more commonly than the want of usual Transpiration, so nothing more conduceth to the Preservation of Health, than that the Pores of the Body should continually let out the hot Streams and Vapours that arise from the Ebullition of the Blood; but when after taking Cold the Skin and Habit of the Body are on a sudden stopped up, that the sulphureous and waterish Excrements of the Blood cannot pass through the Pores, they are again resorbed into the Mass of Blood, from whence proceeds a feverish Disposition; unless they are carried off by Stool, or precipitated by the Kidneys, are sometimes translated to the Glandulous Parts of the Lungs, where by Degrees contracting more and more Heat and Sharpness they inflame and exulcerate these tender Parts.

Nevertheless tho’ a Consumption of the Lungs is sometimes thus caused by taking Cold, yet this comes to pass but seldom, unless in such Bodies whose Mass of Blood being rendered Cachectic, thro’ frequent Influxes of dispirited Chyle, is pre-disposed to receive, and unable to free it self from this New Influx of Catarrhous Rheum: For suppose Two Persons in like manner deprived of the Benefit of usual Transpiration, by some great Cold, which tho’ troublesome in the beginning, because of a violent and continual Distillation of Extravasated Serum upon the Glandulous Coat of the Wind-pipe, and other adjacent Glands, yet in the One of these it survives not the accidental feverish Disposition of the Blood, occasioned by the Stoppage of the Pores: For as soon as the Ferment ceaseth, the separated Humours, partly for want of a new Influx of Serum, and partly by the natural Heat of these Parts, are concocted into a thick sort of Phlegm, and coughed up; after the Expectoration of which separated Serum the glandulous Parts presently recover their natural Tone, without any Remains of a Tumour, Cough, Shortness of Breath, or other Inconvenience; but in the other this feverish Ferment, occasioned by taking Cold, is not transitory, but so habitually fixed by means of some previous Indisposition, as to encrease the Effervescence and Colliquation of the Blood and Spirits; from whence all the Glands which are seated in the upper part of the Larynx, as also the glandulous Coat of the Wind-pipe it self are overflown with a Deluge of hot distempered Humours, the Substance of the Lungs distended with hard Tumours, the Branches of the Wind-pipe comprest, and the Wind-pipe it self from these Swellings irritated to Cough, by a continual tickling, which promotes a frequent spewing out of hot sharp Humours all along the Aspera Arteria, till at length these Tubercles growing very large, begin to inflame and suppurate; immediately upon the breaking or opening of those Apostemes, sometimes such a Flood of corrupted Matter is poured out of their Baggs or Cavities, into the Branches of the Trachea, as compleatly suffocates and choaks the Patient; but at other times this Purulent Matter, mixt with streaks of Blood, and some thin Phlegm that is continually discharged from the glandulous Coat of the Wind-pipe, is coughed up by degrees, and then this deplorable Case requires Specific Medicines, to cleanse and heal these Ulcers.

V. Such kind of Consumptions whose Original is store of malignant acrimonious Humours, which are most apt to inflame and putrify, may be termed acute, when compared to others that proceed from Humours more mild and benign. There may be likewise some difference made by omitting Bleeding, and committing some egregious Errors in Diet, Exercise, Passions of the Mind, or any other of the Non-Naturals: However, all Consumptions of the Lungs ought to be reckoned in the Number of Chronical Distempers, because they are contracted and augmented by degrees, and no other way to be remedied; yet this doth not prove them incurable in their own Nature, for Reason and Experience both teach the contrary: And indeed I must confess, it was from the marvelous Success of these Remedies that I first imbibed this Notion, viz. Ulcers of the Lungs are in themselves curable. Sometimes a Fever or other acute Distemper may be jugulated, when either Nature or Art carries off the Morbific Matter by a sudden Crisis or plentiful Evacuation, but all hopes of dispatching a confirmed Consumption of the Lungs instantly are groundless, seeing many inveterate Obstructions must be removed, abundance of tough glutinous Humours attenuated and evacuated, the whole Mass of Blood and Spirits rectified, the Habit of the Body meliorated, and the Tone of several parts recovered, before we can eradicate this fixed Distemper.

What will be the Issue and Result of this Consumptive-Disease, may rationally be prognosticated from it’s several Stages or Degrees: For when the Mass of Blood by a continual Influx of sour dispirited Chyle is reduced to a sharp and hectical State, and the Serum which is separated from this corrupted Blood only stuffs the Bladders and Glandules which are dispersed thro’ the Body of the Lungs, this Distemper may be said to be in it’s Infancy or beginning, (and if sovereign Remedies were then presented, they might obtain an easy Conquest) but the Increase is attended with a greater Distention of the Glands and Bladders, as also an Inflammation of these Tubercles tending to suppuration: For when the Animal Spirits which are necessary to the natural Fermentation of the Blood are vitiated with unwholesome Particles of a foggy and thick Air, and the Humour which for a long time hath been contained in the Baggs or Cavities of the Lungs is over-heated by some extraordinary Ebullition or Fermentation of the Blood, with a total Suppression of Expectoration, the Cough becomes more violent, the Fever inflammatory, and all parts more tabid. In it’s further Progress or State all Symptoms advance apace towards their Extremity, Suppuration now succeeds the Inflammation of these Tubercles, for that the Purulent Matter is either breeding or already made, the Inflammatory Hectic is changed into a putrid Intermitting Fever, attended with an Universal Colliquation of the Nutritious Juices and plentiful Separation of them from the Mass of Blood by all ways of Evacuation that Nature affords; whence the Patients strength suddainly decays, and in a short time he is reduced to the highest State of a Marasmus, with an Hippocratic Face.

VI. Thus having demonstrated to the meanest Capacity the Power of this prevailing Evil, with it’s efficient and material Causes, Reason it self presently suggests nothing less than great and noble Medicines can tame a Distemper so formidable. It is no less obvious to the Understanding of every one that professeth any thing of Physic, that the sooner the Cure is begun the better, the more moderate the Patient is in the use of the Six Non-Naturals, the more likely to succeed; the Spring-time is the best Season, Universals are to be premised, extraordinary Symptoms and Circumstances peculiarly attended, and such like things must run through the whole Course of Practice.

No doubt but the Chalibeate Mineral Waters when impregnated with the Volatile Salts and Spirits of a serene Air, pleasant Society, delightful Recreations, Morning and Evening Walks, regular Diet, Freedom from Business, vexatious Thoughts, Exercise4, and the rest may be serviceable: But if the Jesuit were sentenced to perpetual Exile, I think the Consumptive have no reason excessively to lament, for I can tell them who hath a Febrifuge Antihectical, without a Grain of the Jesuit, more excellent far than the Peruvian Bark, because it makes a safe, not a treacherous Peace, and can give a Reason of it’s working so stupendiously, tho’ they who know not how a thing can be done, think it impossible to be done.

For my part, I do not believe any Medicine can work a Cure in the way of a Charm, yet they who either know or use no other (at least for the most part) than ordinary Medicines, cannot conceive how such wonderful Effects can be wrought, unless by Inchantment5.

The common Method of Cure is by Bleeding to abate the Effervescence or Colliquation of the Blood, and prevent the Tumour and Inflammation of the Lungs, by Vomits to relieve the Stomach opprest with store of ill Humours, and remove divers Obstructions of several Bowels and small Vessels, by Stomach-Purges gently to carry down the peccant Humours; and lastly by Diuretics and Diaphoretics with some mixture of an Opiate, plentifully to carry off the Colliquated Serum by Urine, or the Pores of the Skin, without raising a fresh Catarrh by a new Commotion of the Blood. After a due Administration of these universal Evacuations, (which in their respective Seasons are highly necessary) the frequent Use of Pectoral Apozems and Pulmonary Linctuses is next enjoined, to retund the Acrimony of the Humours which ouze out of the Wind-pipe, by their mucilaginous and incrassating Quality, and so mitigate the troublesome Cough. How far serviceable to this end and purpose the neatest Forms of such Dispensations that I ever yet saw may be, I will not dispute, only this I must take leave to say, because to me (as also to the unprejudiced I humbly conceive) it seems evident that such fulsom Ingredients of which they are compounded, are more apt to spoil a weak than recover a lost Stomach, and consequently not the fittest Medicines Consumptive Persons may have recourse to: For how many by woful Experience have found the constant and frequent use of such Anti-Stomachics led them from one Degree of this Malady to another, ’till their decaying Appetite hath been quite overthrown, (and consequently their hectic Heat inflamed) their Bodies so emaciated, as to render them uncapable of necessary Evacuations, and they themselves at last given over to a Milk Diet, Asses Milk, some Chalibeate Mineral Waters, or such like Liquids, to which the poor distressed Stomach ecchoes aloud, Miserable Comforters all! If therefore I can, as I have Reason to believe, with Medicines less offensive in Quantity, and more useful in Quality, restore the lost Appetite, and do the same, if not greater Service towards the Concocting and Expectorating that load of separated Serum with which the Pipes of the Lungs are stuffed, (which will easily be perceived by the Patient in a few Weeks with due Care and Management) I think I have gained a great Point, forasmuch as the Recovery of the Stomach may reasonably be looked upon as an Earnest of the Cure.