The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XI. Of seavers, and the cures of these ••eavers which accompany Plegmons.

AMongst the Symptoms which most usually accompany Phlegmons, & afflict all the body of the patient, Feavers are the cheife; that is hot, and dry distem∣pers * 1.1 kindled in the heart, and thence by the Artery is sent over all the body; yet those which usually follow this kinde of Tumors are Ephemerae, that is, Diary, un∣putrid Synochi or putrid Synochi; Of whose nature and order of cure I will here briefly relate what I have learnt from my Masters, that is, Doctors of Physicke, as I have beene conversant with them in the practise of my Arte.

The Ephemera, or Diary [that is of one day] is, a hote and dry distemperature * 1.2 kindled in the vitall spirits. It hath that name, because by its owne nature it tarryes not above the space of one day or twenty foure houres, by reason it is kindled in a subtie easily dissipable matter.

The efficient causes of this Feaver are wearinesse, hunger, drunkennesse, anger, fury, sorrow, watching, great and peircing cold, Adustion, Bathes, and manner of living * 1.3 inclining more to heat than ordinary, applying, using or drinking of acride medi∣cines as Poysons, or of hot meats, and drinkes; to conclude, all the efficient causes common to all Feavers, putrifaction onely excepted which properly appertaines to putride feavers.

For a Bubo also, which is a Phlegmon of the Glandules, causes a Diary, as Hippocrates shewes. All feavers proceeding from the Tumors of the Glandules are evill, the * 1.4 Diary excepted. Which Aphorisme must be understood warily and with that distincti∣on which Galen gives in his commentary, where he saith; It is only to be understood of Tumors risen in the Glandules without occasion, that is, without any evident and manifest cause; for otherwise Feavers that thence take their originall, though not Diary, yet are not all evill, as we learne by Buboes in Children, and the venereous Buboes, which happen without inflammation, or corruption of the liver, for such commonly have no maligne Feaver accompanying them, which thing is worthy a Chirurgions observation.

The common signes of a Diary are, a moderate and vaporous heate feeling gentle to the hand, a pulse swift and frequent, sometimes great and strong, as when the * 1.5 Diary is caused by anger; sometimes litle, if the Feaver proceede from sorrow, hun∣ger, cold, crudity; for other respects equall and ordinary.

The most certaine signes are, if the Feaver come upon one not by litle and litle but sodainly and that from some externall and evident cause, no loathing of meat, no causelesse wearinesse, no deepe sleepe, yawning, great paine, restlesnesse, shaking nor cold going before, and lastly no other troublesome symptome preceeding. Wee here make no mention of the urine, because most frequently they resemble the vrines of sound bodyes; for in so short a time as Diaryes endure, there cannot so great a per∣turbation * 1.6 be raised in the blood that there may be signes thereof found in the vrine. A Diary is ended in one fit, which by the proper nature of this Feaver lasts but one

day, although sometimes, otherwise it is extended to three, or foure dayes space; and then it easily degenerates into a Putride, especially any error of the Patient, Phi••ition, or those which attend him concurring therewith, or if the externall things bee not rightly fitted.

This Feaver is terminated either by insensible transpiration, or by the moisture of the skin, or by a sweate naturall, gentle, and not ill smelling; to this Diary wee * 1.7 may referre the unputride Synochus, generated of blood not putrid, but onely heated beyond measure. For usually there arises a great heate over all the body, by meanes of the blood immoderatly heated; whence the veines become more tumide, the face appeares fiery, the Eyes red and burning, the breath hot, and to conclude, the whole habite of the body more full, by reason of that Ebullition of the blood, and the dif∣fusion of the vapours thence arising over all the body: Whence it is, that this kinde of Synochus may be called, a vapourous Feaver. To this Children are incident as also all sanguine bodyes, which have no ill humors. The cure of this and the Ephe∣mera or Diary is the same; because it may scarse seeme different from the Ephemera in any other thing, than that it may be prolonged for three or foure dayes. Where∣fore whatsoever we shall say for the cure of the Ephemera, may be all applyed to the Synochus, bloodletting excepted, which in an unputrid Synochus is very necessary.

Now the Cure of a Diary Feaver consists in the decent use of things not natu∣rall, * 1.8 contrary to the cause of the disease; wherefore bathes of warme and naturall water are very profitable; so that the Patient be not Plethoricke, nor stufft with excrements, nor obnoxious to catarrhes and defluxions, because a catarrhe is easily caused and augmented by the humors diffused and dissolved by the heate of a bath; therefore in this case we must eschew frictions, and annointing with warme oile, which things notwithstanding are thought very usefull in these kind of Feavers, espe∣cially when they have their originall from extreme labour, by astriction of the skin or a Bubo. Let this be a generall rule, that to every cause, whence this Feaver pro∣ceeded, you oppose the contrary for a remedy; as to labour, rest; to watching; sleep; to anger and sorrow, the gratefull society of friends, and all things replenished with pleasant good will; and to a Bubo, the proper cure thereof.

Wine moderately tempered with water according to the custome of the sicke pa∣tient, * 1.9 is good and profitable in all causes of this Feaver, except he be pained in his head, or that the Feaver drew its originall from anger, or a Bubo; for in this last case especially, the patient must abstaine wholy from wine, untill the inflammation come to the state, and begins to decline. This kinde of Feaver often troubles in∣fants; and then you must prescribe such medicines to their Nurses, as if they were sicke, that so by this meanes their milke may become medicinable. Also it will be good to put the Infant himselfe into a bath of naturall and warme water, and pre∣sently after the bath to anoint the ridge of the backe and brest with oile of Violets. But if a Phlegmon possesse any inward part, or otherwise by its nature be great, or seated neare any principall Bowell, so that it may continually send from it either a putrid matter or exhalation to the heart, and not onely affect it by a quality or pre∣ternaturall heate by the continuity of the parts, thence will arise the Putride Synochus, * 1.10 if the blood by contagion putrifying in the greater vessells, consists of on equall mixture of the foure humors. This Feaver is cheifly thus knowne, it hath no ex∣acerbations, or remissions, but much lesse intermissions; it is extended beyond the space of twenty foure houres, neither doth it then end in vomite, sweat, moisture, or by litle and litle by insensible transpiration, after the manner of intermitting Feavers, or Agues; but remaines constant, untill it leaves the Patient for altogether; it commonly happens not unlesse to these of a good temper and complexion, which abound with much blood, and that tempered by an equall mixture of the foure hu∣mors. It commonly endures not long, because the blood by power of some peculiar putrifaction degenerating into choler or Melancholy, will presently bring forth ano∣ther kinde of feaver, to wit a Tertian or continued Quartaine.

The cure of this Feaver (as I have heard of most learned Physitions) cheifly con∣sists in * 1.11 Bloodletting. For by letting of blood the fullnesse is diminished, & therfore the obstruction is taken away, and lastly the putrefaction. And seeing that in this kinde of

Feaver there is not onely a fault of the matter, by the putrefaction of the blood, but also of the Temper by excesse of heat; certainely Phlebotomy helps not only, as we said, the putrefaction, but also the hote distemper. For the blood in which all the heate of the creature is conteined, whilest it is taken way, the acrid and fuliginous excrements exhale and vanish away with it, which kept in, encreased the Feverish heate. Moreover, the veines, to shun emptinesse, which nature abhors, are filled with much cold aire instead of the hot blood which was drawne away, which fol∣lowes a cooling of the habite of the whole body; yea and many by meanes of Phle∣botomy have their bellyes loosed, and sweate, both which are much to be desired in this kinde of Feaver.

This moved the ancient Physitions, to write, that we must draw blood in this dis∣ease, even to the fainting of the Patient. * 1.12

Yet because thus, not a few have poured out their lives together with their blood, it will be better and safer to divide the evacuations, and draw so much blood at seve∣rall times, as the greatnesse of the disease shall require, and the strength of the Patient may beare.

When you have drawne blood, forthwith inject an emollient and refrigerative * 1.13 clyster; lest that the veines emptied by Phlebotomy may draw into them the impurity of the Guts; but these clysters which coole too much, rather bindethe belly, than loose it. The following day the Morbi••icke matter must be partly evacuated by a gentle purge, as a bole of Cassia, or Catholicon; then must you appoint Syrupes which have not onely a refrigerative quality, but also to resist pu∣trefaction, * 1.14 such as the Syrupe of Lemmons, Berberries, of the Iujce of Citrons, of Pomgranats, Sorrell and Vineger; let his diet be absolutely cooling and humecting and also slender; for the native heate much debilitated by drawing of a great quanti∣ty * 1.15 of blood cannot equall a full diet. Therefore it shall suffice to feed the Patient with chicken and veale brothes made with cooling herbes, as Sorrell, Lettuce and Purslaine. Let his drinke be Ba••ly water, Syrup of Violets mixed with some pretty quantity of boiled water, Iulepum Alexandrinum, especially if he be troubled with scouring, o•• laske. But the Physition must cheifly have regard to the fourth day, for if then there ap∣peare any signes of concoction in the excrements, the Crisis must be expected on the seventh day and that either by a loosenesse of the belly, or an aboundance of urine, by vomits, sweats, or bleeding. Therefore we must then doe nothing, but commit the whole businesse to nature. * 1.16

But for drinking cold water, which is so much commended by Galen in this kinde of Feaver, it is not to be suffered beforethere appeare signes of concoction; more∣over in the declining of the disease the use of wine will not be unprofitable to helpe forwards sweats.

Notes

• * 1.1

  The ••eaver of a Phlegmon. What a Feaver is.
• * 1.2

  What an Ephemera, or Diarye is.
• * 1.3

  The causes thereof.
• * 1.4

  Aphorism. 55. lib. 4.
• * 1.5

  The signes of a Diarie.
• * 1.6

  Why in a Dia∣rye the vrines like to these in health.
• * 1.7

  The unputride Synochus.
• * 1.8

  The cure of a Diary feaver.
• * 1.9

  The use of wine in a Dia∣rye.
• * 1.10

  How a pu∣tride Synochus is caused.
• * 1.11

  Phlebotomy necessary in a putride S••••••∣chu••.
• * 1.12

  What benefit we may reape by drawing blood even to fainting.
• * 1.13

  Why we must give a clyster presently after bloods letting.
• * 1.14

  What Syrupes profitable in this case.
• * 1.15

  Why a slender Diet must be used after let∣ting much blood.
• * 1.16

  When drin∣king of water is to be per∣mitted in a putride Syno∣chus.