Part 10

IF the _SYMPTOM_ however proceeds from any _Inflammatory_, or _Acrimonious Quality_ of the URINE; it may be sufficiently helped by a proper, regular, cooling _Diet_: As, if it arises from any _undigested_, _crude Matter_; it may be assisted or reliev’d by a good _Draught_[77] of _warm_ generous _WINE_; which not only helps _Concoction_, but also facilitates and promotes _URINE_: But in case of absolute _Necessity_, after all, gentle PHLEBOTOMY ought to be carefully used.

CHAP. XXII. _Of COSTIVENESS._

THE _Belly_ discharges it self sometimes more _seldom_ or infrequently; sometimes with more _Pain_ and _Difficulty_; and sometimes in less _Quantity_ than is convenient for _Nature_.

THERE have been many _Instances_ given of this _Disorder_, by[78]Learned Men, where some PATIENTS have gone to _Stool_ but once in _Eight_, once in _Fourteen_, and once in _Twenty_ or more _Days_.

YEA,[79]_Dominicus Panarolus_ relates of a certain Friend of his, whose _Belly_ was so exsiccated, that he sometimes liv’d three _Months_ without going to _Stool_.

BUT what I mean by _Costiveness_, is not that Distemper, where there is a total Suppression, for that rather belongs to the _Iliack Passion_; but that only, where the _Excrements_ lodging longer than their due natural _Time_, perhaps three or four Days more or less, are at last voided hard and dry with some small Straining.

Which irregular _Accident_ may proceed from many different _Causes_. Although in the _pregnant Woman_, I take the following to be the most _Common_: That is to say, the _Calidity_ and _Siccity_ of the _LIVER_, or _SPLEEN_; occasion’d by the _Lusty Child’s_ attracting too much of the _Radical_ and Succid _Moisture_ of the _MOTHER_, and compressing the _Intestines_.

THIS _Symptom_ proves often of dangerous _Consequence_: For by the pressing _Force_, commonly us’d in such a _Case_ to ease the BELLY, some _Vessels_ or _Ligaments_ may be easily and readily _broken_. And not only so, but the retain’d _Fæces_ always affect the HEAD, and contaminate the BLOOD with noxious _Vapours_; and thereby impede or hinder the _Concoction_ of the _Ventricle_, and the Separation of the better and purer, from the grosser and impurer part of the _Chyle_: Whence proceed many other various _Disorders_ to the whole _Body_, from the long Retention of the _Excrements_.

THE _Cure_ consists in temperating the _Calidity_ of the _VISCERA_, and relaxing the _BELLY_ by proper _Diet_, _Dissolvents_, &c. And in _Case_ of any sudden _VOMITING_, which sometimes happens upon _Costiveness_, humectant and emollient _Clysters_ may be most properly and cautiously used, to restrain and prevent all such _Revulsions_.

CHAP. XXIII. _Of TENESMS._

A TENESMS is an irregular _Retention_ of NATURE, and nothing else but a continual _Desire_ or _Inclination_ of going to _STOOL_; attended with _Pain_, without voiding any thing but _Slime_, or an indigested MUCOSITY: And this is in the ANUS, what a _Strangury_ is in the BLADDER; being _Both_ a violent _Contraction_ of the FIBRES, or _Disorder_ of the SPHINCTER-MUSCLES.

WHICH tenacious _Symptom_ proceeds from a great Variety of _Causes_, occasionally provoking the _expulsive Faculty_ of the _strait Gut_, call’d the RECTUM, without a _Power_ to expel; such as may happen to be an unusual _Exulceration_, or _Constriction_ of, or an _Acid-Salt-Humour_ in the same INTESTINE: So likewise a _Stone_ in the Neck of the BLADDER, a _Tumour_ of the adjacent _Parts_, or seminal _Vessels_, a frigid _Intemperature_, the _Hemorrhoides_, a _Dysenteria_, _Dysuria_, _Ischuria_ or _Stranguria_, &c. may very shrewdly occasion the TENESMUS.

WHICH binding _SYMPTOM_ is of the same dangerous _Nature_ and[80]_Consequence_ with the preceding _Case_; both having an equal _Effect_ of Power, if not prevented, to expel and dislodge the INFANT. Which _Notion_ cannot be otherways better maintain’d; for the WOMB being situated upon the _Intestinum Rectum_, must suffer great _Commotions_ by continual _Needings_ and _Strainings_ in both Cases.

BUT the safest CURE, in short, in my humble Opinion, is to be perform’d by proper _Decoctions_, _Fomentations_, and absterging _Clysters_.

CHAP. XXIV. _Of the VARICES, or Vein-Tumours._

THIS _Symptom_ is nothing else, than a _Distention_ or _Dilatation_ of the HIP, THIGH, and LEG-VEINS: Which however chiefly appears about the HAM; and it happens most commonly to _Plethorick Women_, who walk much, or exercise themselves more freely upon any Occasion.

THE _Cause_ proceeds only from a _Plenty_, or _Superfluity_ of the suppressed BLOOD, more than the _Infant_ can consume: which being carry’d by the _Arteries_ to the _lower Parts_, is thence received by the _Crural_ and _Saphene_ or _Ankle-Veins_. Insomuch that the WOMB, being (by this time) both _Ponderous_ and _Bulky_, so presseth the ILIAC-VEINS, that it hinders the BLOOD in its _Course_, and obstructs its free _Motion_ and _Circulation_; whereby (of consequence) these _inferiour Veins_ must swell and distend themselves proportionably.

HOWEVER, the _Danger_ of the _SYMPTOM_ is not great; because after a safe _BIRTH_, when the super-abounding BLOOD and _Humours_ are evacuated, these preternatural _Tumours_ settle, and the VEINS return to their _Pristine State_.

WHEREFORE the only necessary _Relief_ of this Malady, consists chiefly in the _Woman’s_ abstaining from too much _Walking_, and all other extravagant _Exercises_; upon indulging her _inferiour Limbs_, by keeping them rais’d upon a _Couch_ or _Stool_, that the BLOOD may not settle too much to these _lower Parts_: Or (which is far better) let her prudently keep her _Bed_; in which _Posture_, the BLOOD can meet with no such _Difficulty_ in returning by these _Veins_ to the HEART, as it will find when it must ascend by the _Woman’s SITTING_ or _STANDING_ upright; so that consequently it must needs _circulate_ the more readily and with more _Ease_. Hence in short, it is, that from this more Free and Easy CIRCULATION in _Bed_, such _Women_ are always more easy, or better dispos’d, and far less _pain’d_ or troubled in the _Mornings_, than at _Nights_, in This Condition.

BUT if, after All, the _PATIENT’s_ Convenience will not permit such _Indulgences_, Then a proper _Swathe_ of three or four Fingers Breadth, is most adviseable; beginning to _swathe_ this _Varicose_, or _Swelling Part_, from the _Bottom upwards_, as far as the _Varices_ or _Tumours_ extend. But in Case of more _Plethorick Marks_, at last, in the _other Parts_ of the Body, _Phlebotomy_ may be most safely made Use of.

CHAP. XXV. _Of the INFLATIONS and TUMOURS of the LEGS._

THESE bloating _Symptoms_ not only happen to some _Women_ before, but also after _BIRTH_; especially when the LOCHIA, or Child-bed Cleansings, do not flow in a regular _Measure_ or sufficient _Quantity_.

THE _Cause_ of the present disorder’d _Case_, proceeds either from the Suppression of some _Aqueous Flux_ of the WOMB; or from some such _watery serous_ BLOOD descending to the LEGS; or from the Abundance of retain’d _Menstruous_ BLOOD, more than the INFANT can dispense with: which, being of no Service either to _MOTHER_ or _CHILD_, settles downwards to these aggriev’d _Parts_. But _these Things_ are to be considered with this Distinction and Difference, that if the _LIVER_ be debilitated, and the BLOOD becom’s _Pituitous_ or _Aqueous_, the _Woman_’s LEGS are so _Oedematous_ or _Tumid_, that when pressed with the Finger, it leaves the Impression of a _Dent_ and _Hollowness_: But if the BLOOD grows _corrupted_ and _bilous_, her LEGS are _inflam’d_, and sometimes occasionally _exulcerated_, as in _Scorbutick Cases_: And if none of _These_ happen, then a gross thick BLOOD only abounds, tending vitiously downwards. Upon which there are only some _Livid_ or _Blueish Marks_[81] to be discover’d with those _Tumours_, such as the _VARICES_ or _Swellings_ occasion in the preceeding _Case_.

IN fine, the _Woman_ troubled with these _Symptoms_, commonly bears a _Female_; as all _Women_, having sickly times of _GESTATION_, generally do. However yet, tho’ this swelling _Affection_ is very troublesome, its _Danger_ is not great; because it ordinarily ceases of it self with good Care after the _BIRTH_. Wherefore in this Condition a _CURE_ is not always to be attempted, lest the _Humours_ recoiling upwards, affect some _nobler Part_. Nevertheless, if the _SWELLING_ be too considerably Painful or Troublesome, proper _Digerents_ and _Discutients_ may be apply’d, and the LEGS fomented with a convenient _Lixivy_, _Decoction_, or _Cataplasm_.

CHAP. XXVI. _Of FISSURES or CHOPS of the BELLY._

THIS _Symptom_ only happens to _Women_ bearing their _first_ or _second CHILD_; whole _lower BELLIES_ have not yet been sufficiently _extended_ by frequent _CONCEPTION_.

THE _Cause_ proceeds only from the _natural Lenitude_ and _Constriction_ of the Skin of the _ABDOMEN_ or _lower Belly_; which (in proportion to the _Growth_ of the _INFANT_) must dilate and distend itself: So far as that towards the _latter Months_, it gives way to such a large degree, that it appears not otherways than as if the _SKIN_ was to be divided, and almost crack or break by its thin _Attenuation_.

HOWEVER it occasions also very often great _Pain_, as well as a _permanent wrinkled_ DEFORMITY of that _Part_. Wherefore _Laxative Liniments_, and proper _Unguents_, are pertinently to be made use of by way of _Precaution_, from the _fourth Month_, until the Time of Delivery.

CHAP. XXVII. _Of WATER-FLUXES._

THE _Water_ which is gather’d in the Time of _GESTATION_, between the _Membranes_ involving the _INFANT_, is at last upon the approaching _BIRTH_ effus’d: For the _CHILD_ having broke the AMNION, feels these _WATERS_ troublesome, and consequently obliges the CHORION also to give way. From whence proceeds naturally a _copious Effusion_ of the same WATERS.

BUT of this natural _Flooding_, I am not properly to treat in this Place; only of _that_ preposterous FLUX, which happens before the due time of _BIRTH_, the _immediate Cause_ of which proceeds from some _Procatarctick Accident_: Such as a _Perturbation of Mind_, an unlucky _Fall_, a _Leap_, a _Stroke_, or any other Violence.

THIS _Symptom_ happens _Two ways_, either by a _Disruption_, or _Dilatation_ of the _MEMBRANES_: the _first_ by _external_, the other commonly by _internal Causes_. In the _first Case_, the FLUX comes suddenly, irregularly, and in a great _Quantity_; in the _second_, by little and little, or by degrees, and less in _Quantity_.

THE _first Case_ is most dangerous, being the infallible _PROGNOSTICK_ of instant _Abortion_, if not timely and judiciously prevented. The _second Case_ is of the following bad _Consequence_, that this WATER, which has hitherto defended the INFANT from the _Rigidity_ of the circumjacent _Parts_, being at last (how leisurely soever) exhausted and spent; the CHILD is soon sensible of its _Loss_, and finding its wonted SEAT become uneasy, it thereupon being restless or discontented, endeavours to move and seek for a _Better_: By which means (if _Abortion_ does not presently ensue) it falls into a _preternatural Situation_, which (of course) occasions a _preternatural BIRTH_. But abstracting from _This_, the bare _Deficiency_ of the WATERS, for moistening the _Passages_ in time of _LABOUR_, is enough to effect the same Unhappiness.

HOWEVER, the _Cure_ of this _SYMPTOM_ depends chiefly upon a good _Regimen_ of _DIET_, and _external_, as well as _internal Corroboratives_.

IN short, having thus discuss’d the several _SYMPTOMS_ of the Nine _Months_, and such as are most common and familiar to the _Woman_ during her FOETURA, or the whole Time of her _CHILD-BEARING_; I shall proceed now in the next Place with all due _Method_ and peculiar _Regard_ for her GOOD.

CHAP. XXVIII. _Of Acute DISEASES incident to the CHILD-BEARING WOMAN._

IT sometimes, and more than too often, happens, that besides the common _SYMPTOMS_ of the _Months_, the _conceiv’d Woman_ is also suddenly taken with some _acute DISEASE_ or other; upon which I shall offer my sincere _Opinion_, and according to the best of my Judgment, give a brief _Account_ of _Those_ several _Maladies_, with their _Definition_ and _Cause_, _Nature_ and _Quality_, _Danger_ and CURE.

FIRST then, the great _Galen_ defines _acute DISEASES_ to be such, whose _Motion is swift_, attended with sudden and immediate _Danger_.

THE learned _Brassavole_ calls such _DISEASES Acute_, as come _suddenly_, continue a _short Time_, and have very severe or violent _SYMPTOMS_.

THE ingenious _Blancard_ calls those _DISEASES Acute_, which are _over in a little Time_, but not without _imminent Danger_. Now _Those_ are deem’d either _very Acute_, or _most Acute_; the _latter_ is meant when the _Distemper_ is over the 4th _Day_; but the _former_ is that which continues till the 7th _Day_: For the more _acute_ the _DISEASE_ is, the sooner follows its _Determination_, either for Life or Death. Again, a Disease is call’d _simply acute_, when it lasts 14 or 21 _Days_; or lastly, it is term’d _Acute ex decidentiâ_, which lasts 42 Days at least.

AND according to the diligent Dr. _Sydenham_[82], the _Despumation_ of _Acute DISEASES_ happens in 336 _Hours_; which he also justly applies to _intermitting FEVERS_, reckoning 5 Hours and a half for a _Paroxysm_: Because what we call DAYS in _Acute Fevers_, are so many PERIODS in _intermitting Fevers_: The only difference of _Those_ consisting in that the _one_ perfects its _Fermentation_ at _once_, which the _other_ accomplishes at reiterated _Times_, and divers _Turns_, by the same Duct of _Nature_. He farther still, observes that _Autumnal Quartan Fevers_ continue six Months; in which Time, if the Number of the recurrent _Paroxysms_ be summed up, they will exactly amount to the aforesaid 336 Hours, or 14 Days, which is the _Term_ or _End_ of the regular and _continual Fevers_ of that Season.

AND the wise HIPPOCRATES observes[83] that as an exquisite _continual Fever_ ceases within the 7th Day, so an exquisite _Tertian_ has seven _periodical Circuits_; because every _Access_ in the latter, makes up a _Day_ in the former Case. Hence it is manifest that all _Epidemick Diseases_ have their due and regular _Times_[84] of encreasing, continuing, and decreasing; and that These _Laws_ of _Nature_ are so constant and permanent, that however _Fevers_ differ in other Circumstances, they are equal as to the Duration of _Time_; counting according to the _Periods_ or Fits of the _intermitting_, and the continued Number of _Days_ of the never _intermitting Fever_.

GALEN[85] further explains _Acute DISEASES_, and calls them _Two-fold_: The _one_ attended with a continual FEVER; such as are _burning Fevers_, _Frenzies_, _Lethargies_, _Pleurisies_, _Squincies_, _Inflammations_, &c. The _other_ without any Fever, such as _Epilepsies_, _Apoplexies_, _Convulsions_, _Palsies_, _Contraction of LIMBS_, _JOINTS_, &c. Now the[86] _Accesses_ and _Crises_ of all _These_ proceed from the _Influence_ of the MOON; which in over-ruling terrestrial Things, surpasses all the other PLANETS and STARS, not so much because of her _Power_, as by her _Approximation_ or _Vicinity_.

THE _Cause_ of both the _one_ and the _other_ seems to be the _same_; tho’ it _affecteth differently_, according to the various _Regimen_ and _Disposition_ of the Woman: And it most probably proceeds either from the _vitious Humours_, which have abounded in the Body before _Conception_; or from such _Humours_ as have been congested afterwards by the _suppressed_ MENSES, or _Months_: Which being irritated by improper or depraved _Food_, by bad or negligent _Regimen_, either before or after _Conception_; those _Humours_ (like _Yest_ in _Ale_) ferment the BLOOD, to such a Degree, that (all on a sudden) the PATIENT is violently taken with one or other of those _Acute_ DISEASES, which are determined by a certain _Lunary_ CRISIS; that is to say, by a certain _Motion_ of NATURE, accelerated by the _Power_ of the MOON, to a gradual _Expulsion_ of the _peccant Matter_ thro’ the PORES of the Body. But this CRISIS, in short, happens always with most Ease and Safety upon the _New_ or _Full-Moon_, because the ambient _Air_ does not at that time so much affect the _Superficies_ of the Body, nor so violently repress the _Motion_ of the FLUIDS.

HOWEVER, this melancholy _Accident_ can never happen worse than to the _Conceiv’d Woman_; and the _farther_ she is gone in her Time, the more _Danger_ still. And that because of the _Scarcity_ or _Want_ of _pure_ BLOOD, which ought to be imbibed by the _Infant_, either in part or in whole, according to its Age and Strength: Or, because of the _Plenty_ of _vitious_ BLOOD, which tends to no other end, than to _imbecilitate_ the Woman, and render her _incapable_ of suffering the _Insults_ of such _acute_ DISEASES. For _Nature_ may (perhaps) be able to bear up against _one simple Effect_, but when it is joined and aggravated by _another_, the PATIENT is too often obliged to _succumb_, and yield herself up to be _overpower’d_ in the Struggle of Life.

BUT, after all yet, _acute_ DISEASES are not always _mortal_ to the _Conceived Woman_; for, as Experience teaches, SOME have the good Fortune to _escape_, tho’ indeed the Odds[87] are very great on the other Side. But of such sharp MALADIES, _those_ without any _Fever_ are reckoned most _dangerous_; because they are not only _Acute_, but also _most Acute_: And by _those_ the MOTHER is more immediately endangered than the INFANT; whereas by _those_ which come with a _Fever_, the tender INFANT is first and chiefly endangered, because of the MOTHER’s internal _Calidity_ and _Depravation_, which easily affects, and soon suffocates or stifles it in a short time.

HOWEVER, it is very observable, that a _Woman_[88], bearing a FEMALE, is more readily seized, and more easily freed or cured of _acute_ DISEASES, than _she_ who bears a MALE: And that because FEMALES are naturally more obnoxious to _Distempers_, proceeding from the _Retention_ of the MENSTRUA, and consequently more _favourably affected_, because of the _natural Affinity_ and _Familiarity_ of the Case.

AND this is the Reason that FEMALES, after the _first Months_, do bear and sustain more _Pains_ than the MALES; as daily Experience confirms, in that a _Female Miscarriage_[89] seldom happens after the _first Months_: whereas the _Male Abortion_ is most of all to be feared, after the TIME of _Motion_ or _Animation_, because the ACETABULA, or _Cavities_, being then more _siccid_, are the more easily broken by its _stronger Motion_.

IN Cases of _Acute_ DISEASES, the worst is, that the necessary _Helps_, which such incident _Distempers_ otherways absolutely require, are not always safe and convenient for the _Child-bearing Woman_: which Condition, (with respect to the CURE) renders the CASE one of the _nicest Points_ in the ART of _Physick_. Wherefore I would, with Submission, advise, that _none_ but the ablest and well-qualified _Physician_ should undertake either the _Care_ or the CURE of such a PATIENT. To whom I am not to prescribe _Rules_, and therefore I shall only refer him to his own more _Acute Judgment_, and the _Curious Solutions_ of (that most learned PHYSICIAN) _Daniel Senertus_[90], upon the _six following Questions_, thus stated by himself, _viz._

I. HOW _far slender Diet is convenient for the Child-bearing Woman_, _labouring under an acute Disease?_

II. HOW _far it is convenient to open a Vein or bleed this Woman upon such an Occasion?_

III. HOW _far it may be proper to purge her on the same Occasion?_

IV. WHETHER _Venæ-Sections or Purges are most dangerous in such a Case?_

V. WHETHER _it is practicable_ (_in such a dangerous Case_) _to excite Abortion_, _for the Woman’s Health and Recovery?_

VI. HOW _far Clysters_, _Diureticks_, _and Diaphoreticks are convenient on such Occasions?_

HAVING, thus, now, in fine, briefly hinted upon the _sundry_ HEADS of this _Chapter_, I shall, in the next Place, offer a few Words upon THAT, which (I think) is the most common Consequence of the foregoing EFFECTS, _viz._

CHAP. XXIX. _Of the DEBILITY and WEAKNESS of the_ Fœtus.

BESIDES all the enumerated SYMPTOMS, _Acute_ and _Chronical Distempers_, to which the _Child-bearing Woman_ is subject; it also happens over and above (too frequently) that the INFANT becomes _Weak_ and _Sick_ in the WOMB.

THE _Cause_ of which unhappy _Accident_ I take to be _fourfold_: As it proceeds, either from a _Debility_ and _Insufficiency_ of the _Parental_ SEED, or from a _Scarcity_ or _Want_ of requisite _Sustenance_, or from a certain _Depravation_ of that _Sustenance_, or from some immediate _Procatarctick Cause_ of the MOTHER; which may all be thus rationally distinguished, and severally accounted for; _viz._

THE _Cause_ certainly lies in the SEED, if the _Woman_ has continued always _healthy_, eating, drinking, and living regularly.

IT may be imputed to the _Scarcity_ of ALIMENT, if she has often laboured under _Diseases_, or been exposed to _Hunger_, _Want_, _Penury_, or any such like manifest retrenching CAUSE.

IT may be adjudged to a _Depravity_ of ALIMENT, when the _Woman_ (by a vitiated Constitution of Body) is subject to some certain _Distempers_; and, besides, in short, any _Procatarctick Cause_ is discoverable from the _Relation_ of the PATIENT.

BUT whatever the _Cause_ may be, the _Diagnostick Signs_ of this unhappy _Affection_, are commonly _One_ or _more_ of the following SIX; _viz._

1. THE turgid swell’d BREASTS of the _Pregnant Woman_, all on a sudden[91], fall and extenuate into a _Flabbiness_.

2.[92]THEY diffuse copiously a thin _Waterish Milk_, not half digested to its due Perfection.

3. THE _Menstrua_ return at an uncommon _Rate_, and in an irregular _Manner_.

4. THE _Woman_ personally is either very frequently _Sick_, or long expos’d to a lasting _Sickness_. Or,

5. SHE is either subject to a very frequent, or long continu’d _Looseness_, and constant _Diarrhæa_.

6. THE _Infant_ which used (as it ought) to _move briskly_, is now but very _seldom_, and more _faintly_ perceiv’d in _Motion_.

ON the other hand, the _Prognosticks_ of this CASE, are briefly _Two_: For either _Abortion_ follows, or (which is worse) the _Infant_ dies; if not timely prevented, by removing the _Efficient Cause_ of it, upon _comforting_ and _strengthening_ both the WOMAN and the CHILD.

IN a Word, the _Latter_ of these tragical _Events_ I shall refer to SECT. V. _Chap._ last. But the _Former_ leads me more immediately to consider it in the proper Method of my Discourse.

CHAP. XXX. _Of ABORTION._

WOMEN _miscarry_ so frequently, that if any curious Persons will diligently observe and examine that _Matter_, they will find the Number of MISCARRIAGES to exceed _That_ of _timely_ BIRTHS: Wherefore I have reason to think, that this _Head_ deserves to be handled more at large, and to be more particularly insisted upon, in the following manner.

THE _Modern Practisers_ in _MIDWIFERY_, distinguish MISCARRIAGES, by _four_ different _Appellations_; according to the _four_ different _Times_ of the _Constitution_ of the _CONCEPTION_. viz.