Praxis medicinæ reformata: = or, The practice of physick reformed Being an epitome of the whole art: wherein is briefly shewed, the true causes, signs, prognosticks, and cure, of most diseases. Published for the benefit of all persons. By Robert Johnson, Med. Professor.

CHAP. VII. Of intermitting Fevers.

AN intermitting Fever is that which re∣turns after intervalls, sometimes longer, sometimes shorter in divers Fits; whence accor∣ding to the divers space of every access or fit; the same gets also divers Names, for if a new Fit return daily, answering the precedent in proportion, it is called a Quotidian.

If it comes every other day, it is called a Tertian.

If the fit return after two days intermissi∣on, it is called a Quartan, and so forward, although Quintans, Sextans, &c. are seldom observ'd.

And here you may note, that intermit∣ting Fevers do but seldom return in the ex∣act * 1.1 intervall of natural days of twenty four hours; but return quicker or slower, for the most part; wherefore then they are said to anticipate the expected time for some hours, which is disliked, or to come later, which is commended by some.

Although it matters not, whether the fits anticipate, or come later; if so be that their continuance, and the grievousness of Symptoms (daily accompanying) be di∣minish'd.

There is great diversity among Authours concerning the Causes of intermitting Fe∣vers, which I shall not insist on; but in a few words will set down the true Causes of them.

The causes then, are either external, or * 1.2 internal.

The external Cause of Agues is a stop of the usual necessary discharge of fermenting humours; the porous skin (being shut by external sudden cold) denies passage to the constant discharge of the sweatty humours,

which happens most commonly about Au∣tumn; and likewise when any comes sud∣denly out of a hot Climate, into a cold Re∣gion; for the sweatty Vapours being detain'd by the Constipation of the skin, or shutting of the Pores, the same condense, and thence become sour, which chills the external parts, and causeth the shaking, or shivering cold fit, at the first invasion of this disturbing Foreigner; after which the inflaming Fer∣ment of Choler (being exasperated) doth act its part, and (having gain'd Dominion) it doth rarefie the Bloud by degrees; whence the Pulse becomes greater and stronger) which is increas'd by an irritation of the Acrimony of Choler, and the rarefaction of the Bloud at the Heart; for the heat and burning in the Heart, and thence in the whole Body, is increas'd by Choler succes∣sively over-ruling.

The internal Cause of Agues or intermit∣ting Fevers, is an obstruction of one or more of the lateral ducts or branches of the Pancreas or Sweet-bread, by reason of viscous Phlegm; which being separated from the Bloud by the Glandules of the Pancreas, is there collected by degrees; whence it is sent (in too large a quantity) to the main duct or pipe thereof, which detaineth the Juice of the Pancreas contrary to nature, which

ought continually to flow into the small Gut called Duodenum.

The Juice of the Pancreas, which is natu∣rally sourish, being compelled to stand still in its passage, quickly grows more acrimo∣nious, or acid; because the Volatile Spirit (which is naturally conjoin'd to it, to temper it) doth gradually fly away; by which this Juice (becoming more sharp and acid) ac∣quires a putrefactive Ferment; whence at length it makes way through the obstructing Phlegm, and is effused into the Duodenum, where meeting with Choler, it stirs up a vitious effervescency, or preternatural Fer∣ment, from whence comes the Ague fit, with all its Symptoms; as in the beginning Horrour, Chilness, Cold, Shaking, &c. then presently follows Reachings, Yawning, and Vomiting, &c.

At length acrimonious and flatulent Va∣pours (raised by the aforesaid vitious Effer∣vescency) are carried through the Lacteal veins, and Thoracick passage, and so through the Vena cava ascendens, (in what form soever) to the right Ventricle of the Heart; and by its Acrimony, alters and troubles the vital Effervescency, and by over stirring the Heart, causeth a more frequent Pulse; and many times produceth grievous Symptoms, as great Heat and Thirst, difficulty of brea∣thing, Heart-ach, Raving, Swouning, and

all other Symptoms, that happen in all in∣termitting Fevers.

The nature of viscous Phlegm is such, * 1.3 that though it be pierced through by the Juice of the Pancreas too acid and acrimoni∣ous, yet it doth presently run together and unite again, and so repairs and renues the obstruction that was in part opened; and the Juice of the Pancreas being stopped as be∣fore, grows sour by standing still as afore∣said, so that it forceth through the Phlegm that stopped its natural passage, and so pro∣duceth, a new fit; sooner or later, as the Phlegm (obstructing the lateral passage of the Pancreas) is pierced through by the fore∣mention'd Juice.

For if the obstructing Phlegm be not very glutinous, and the Juice of the Pancreas be plentifull and acid, a new fit of an in∣termitting Fever will return in the space of twenty four hours, and therefore 'tis called a Quotidian * 1.4

But if the Phlegm be very viscous and plen∣tifull, and the Juice of the Pancreas be little in quantity, and also tart and obtuse; so much the slower will the new fit of the intermitting Fever be produced; so that it is sometimes three, sometimes four days, be∣fore the returning of the fit; from whence it is called a Quartan, or Quintan, &c.

So likewise as oft as the obstructing

Phlegm, and the Juice of the Pancreas are in a medium, viz. The Phlegm more glutinous and plentifull, than in the Quo∣tidian, but not so much as the Quartan; as likewise the Juice of the Pancreas is more in quantity, and more acid than in the Qutartan, but not so plentifull and acid, as in a Quoti∣dian) so oft new fits of intermitting Fevers will return almost every other day, from whence they may be called Tertians, which much differ in their Symptoms beyond what other intermitting Fevers do, although none of them return in the exact intervall of the Days or Hours before mention'd, but return quicker or slower for the most part.

The Cure of all intermitting Fevers will * 1.5 be perform'd.

1. First, if the glutinous coagulated Phlegm, (which is the cause of the obstruction) be cut and dissolv'd, and wholly carried out of the Body.

2. If the increas'd Acidity, and Acrimony of the Juice of the Pancreas, be temper'd and corrected.

3. If its vitious Effervescency with Choler, &c. In the small Gut, behindred and amended.

Phlegm obstructing will be cut most com∣modiously with Aromaticks, and any Vola∣tile Salt.

This Volatile Aromatick Julep may serve for Example.

Take the Waters of Carduus, Parsley, Fen∣nel, Fumitery, Succory, Treacle, Cinamon, * 1.6 of each one ounce; Syrup of Carduus, the five opening Roots, of each an ounce and half; Powder of Crabs-eyes, Tartar vitrio∣lated, of each one drachm; Salt of Amber, Antimony Diaphoretick, of each half a drachm; Laudanum opiat. ten grains; Oil of Cloves six drops; mix it.

Take a spoonfull of this Volatile Medi∣cine, often in a day throughout the whole Cure, using some exercise, that thereby the whole Body may grow warm, and the force of the medicine being disperst over all the Body, may come at last to the lateral passages of the Pancreas, and dissolve the obstruction.

Three or four hours before the coming of the fit, you may give three or four spoon∣fulls of the aforesaid Cordial, which will not onely cause a breathing sweat, but will temper and correct the increas'd Acidity and Acrimony of the Juice of the Pancreas, and hinder, and amend its vitious Effervescency with Choler, &c. in the small gut, which will conduce much to a Cure.

Three hours before the return of the next fit, administer an antimonial Emetick, which is in this case proper before all others; for by the help thereof, not onely Choler aboun∣ding, but also phlegm obstructing, will be

expell'd to the small gut, and thence to the Stomach, and at length by the mouth; and the straining to vomit doth many times pro∣cure a stool or two, which is very beneficial.

But if the sick be a Female, or vomiting be prejudicial, or not approv'd of; then such things as cut and purge phlegm downwards, may be administred, for example.

Take of pil. faetidae one drachm; Mercur. * 1.7 dulcis, Powders of Troches Alhandal, Scam∣mony prepar'd, Tartar vitriolated, of each half a Scruple, Salts of Amber and Worm-wood, of each one Scruple; Spirit of Salt Armoniack, Oil of Amber, of each ten drops, with Syrup of Buckthorn; make it into a Mass for Pills.

Take four or five of these Pills, four hours before the coming of the fit; which will both cut, and purge the viscous Phlegm out of the Body, and also educe other peccant humours.

After purging or vomiting, let the sick often take the following Powder in a glass of generous Wine, or in two or three spoon∣fulls of the Cordial Diaphoretick before men∣tion'd, to provoke sweat as is there directed.

Take Volatile Salt of Harts-horn, Salts of * 1.8 Amber, Worm-wood and Carduus, Tartar vitriolated, of each ten grains; Sugar of Pearls the weight of them all, mix them for two doses.

You may take a dose of it two or three hours before the access of the fit; which will wonderfully conduce to dissolve the ob∣struction, and cause a breathing sweat.

Let these evacuations be as often reiterated as occasion requires.

If the intermitting Fever hath continu'd long, or the sick hath a Plethorick body, let a vein be opened.

By these few forms the young Practitioner may easily invent other effectual Medicines, in some things to be varied as the distemper requires.

Notes

• * 1.1

  Observa∣tion.
• * 1.2

  Causes.
• * 1.3

  The cause of the Re∣turn of the fit.
• * 1.4

  Quotidian.
• * 1.5

  Cure.
• * 1.6

  Cordial Iulep.
• * 1.7

  Purging Pills.
• * 1.8

  Powder.