The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 3. Of a Tertian Ague.

AN Ague, or Intermittent Tertian Feaver, is caused by an Excrementitious Chollerick Humor, contained in the first Region of the Body, and there putrefying.

A Tertian Ague is either Legitimate and Exquisite, or Illegitimate and bastard.

A Legitimate or Exquisite Tertian Ague, is terminated in twelve hours, and is caused by the pu∣trefaction of Natural Choller. But a bastard Tertian hath fits that last above twelve hours. But if it exceed twenty four hours, it is termed Tertiana extensa, a stretched Tertian. And it is caused ei∣ther by Preternatural Coller putrefying, or by Natural Choller mingled with other Humors, espe∣cially with flegm.

Also Tertian Agues are Simple, or Double, or Triple. A Simple Tertian, is that whose Fits come every other day. A Double Tertian is that whose Fits come every day. And although here∣in it differ not from a Quotidian or every day Ague, yet they are known one from the other by their proper Signs, shewing the abundance of Flegm or Choller in the Patient; of which Signs in their place. Somtimes notwithstanding in a double Tertian there are two fits in one day, the other day remaining free; and this some latter Physitians do call two Tertians, and make it to differ from a double Tertian. Which Distinction notwithstanding is of smal moment. A Triple Tertian is when there are three fits in the compass of two daies. This is a most rare and seldom seen sort of Feavers. Yet Galen propounds one single Example thereof, and I saw another in the yeer 1637. in a certain Gentleman, who once in sixteen hours had a fit of a Tertian Ague. And all the fits did every one of them terminate in the space of ten or twelve hours, by sweat. Now these divers Parox∣ysms are made by a different matter putresying in different places, so that each one hath as it were its peculiar Chimney where it is first kindled.

Now the Humors causing Tertian Agues, are collected chiefly in the first Region of the Body, viz. In the Liver, the bladder of Gall, the Stomach, the Mesentery, the Pancreas, or in the Veins of those Parts.

Their Causes, are all such things which ingender Excrementitious Choller, viz. An hot and dry distemper of the Spleen, youthful Age, Hot Constitution of the Air, Watchings, Cares, Anger, Fastings, use of hot Meats, over much Exercise. To these are added, for the breeding a bastard Ter∣tian, such Causes as engender Flegm and Melancholly. Hereupon, such as have hot Livers, and by Glutinous and bad Diet, do breed many Crudities, are subject to bastard Tertians, by reason of the mixture of Choller with crude Humors. And hence also it is, that in Summer time, crude Hu∣mors bred through weakness of the Natural Heat, by eating of Fruits, and over much drinking, being mixed with Choller, do breed bastard Tertians.

The Signs to know an Exquisite Tertian by, are these: That this Feaver alwaies begins with great shaking Fits, whereas in a Quotidian Feaver or Ague, there is only a light shivering or cold∣ness. After the cold shaking Fit, follows great Heat, sharp and biting, Intollerable Thirst, great and frequent breathing, want of Sleep, Head-ach, and somtimes Ravings. After the shaking fit, somtimes there follows a vomiting of Chollerick Humors, or a purging by Stool. The Urine is somtimes Yellow, Yellowish-Red, or Red. The Fits last not above twelve hours, and they are terminated by Sweat. Also the Causes fore-cited, breeding Choller, have preceded.

In a bastard Tertian, all the foregoing Signs are more remiss than they are in an Exquisite one, but more intense than in a Quotidian Ague. And according as there is more or less flegm mingled with the Choller, the Fits come neerer to those of an Exquisite Tertian, or of a Quotidian; but in re∣spect of the vehemency of the Symptoms, and the length of the Fit it self. So that the Paroxysms of a bastard Tertian may be lengthened out to sixteen, eighteen, or more hours. Although they may be somtimes shorter, because of the paucity of the Matter, and be terminated within the space of eight, ten, or twelve hours.

The Prognostick of this Disease, is taken out of Hippocrates, in Sect. 4. Aph. 59. Exquisite or exact Tertian Agues last but for seven fits at most. And in Aphor. 43. of the same Section, All Intermitting Feavers are void of danger. Which is to be understood only of such Tertians as are void of all malignity. For there are Malignant and Pestilent Tertians, which though they have e∣vident Intermissions; yet do they often kill the Patients. Furthermore, many things fall upon the Neck of a Tertian, which may breed danger, although the Feaver of it self be not dan∣gerous.

Haly writes, and common Experience shews, That if such as are sick of a Tertian Ague, have Ul∣cers, Scabs, or Pustles breaking out in their Lips, it is a token the Ague wil leave them. For it is a kind of Critical Evacuation in those parts.

A Loosness befalling one that hath a Tertian Ague, the matter being digested, ends the Disease. And this is the way by which alone Nature doth perfectly expel the Cause of these Feavers. For seeing the Original Cause of these Feavers is contained in the Gall-Bladder, or the Liver, or the Me∣sentery, and other Parts in the first Region of the Body; although that which steems and vapors therefrom in every fit, do get into the habit of the Body, and is purged away, either by Sweats, or by insensible Transpiration, or by Pushes and Pimples; yet the gross parts and setlings of the Humor abiding in their place, which unless by the benefit of Nature, or Medicaments it be purged away by stool, it is wont to be the Cause either of a long Ague, or of Obstructions, or of a Relapse, or of o∣ther stubborn Diseases.

Agues are wont to be of smal durance and little danger, if the habit of the whol Body be good, if the bowels be wel affected, if it be Spring or Summer, if the Patient eat little, and drink sparingly. And contrary wise, they are wont to be long and more rebellious, if there be an evil disposition of the Liver or Spleen if the Patient abound with flegmatick Humors or Melanchollick, if the Winter or Autumn be in their full force, if the Patients do eat much, or by much drinking do oppress their Na∣tural Heat.

The Cure, as in other Feavers, is to be directed to the Feaver, its Cause, and strength of the Pa∣tient. The Feaver calls for Coolers; the Cause requires Coolers likewise, and withal such things as digest and purge the Humor offending; the Patients strength calls for things that corroborate and vigorate the same.

And in the first place, A Cooling Diet must be appointed, and which moistens; it must be the very same in an exquisite Tertian, which we before prescribed in our Cure of Continual Feavers. But in a bastard and single Tertian, a fuller Diet somwhat, is to be enjoyned, especially if the Dis∣ease prove to be long; for then solid Meats are to be given on the wel-day, and five or six hours before the fit. But in a double Tertian, as in an exquisite Tertian, the Sick must be nourished only with broth, and other supping things.

This is a most pleasant Drink out of Forestus, for those which have a third day Ague.

Take Fountain Water two pints: Cinnamon half an ounce: Sugar three ounces: Let all be strained cold and raw, through an Hippocras Bag.

The Patient must not eat when the Fit is coming, according to that saying of Hippocrates, in Aphor. 11. Sect. 1. For Nature (as Galen shews in his Commentary on that place) by Conco∣cting of newly eaten Meat, is called away from Concoction of the Morbifick Humors. Add hereunto, That in the fit of an Ague, the whol body is filled with a filthy vapor, which doth mar, and for the most part corrupt that meat which is eaten neer the fit. But if the fit prove so long, or the Patients body so hot and dry, so lean and thinly woven together, with wide pores, that it is soon dissolved and dis∣sipated, and cannot hold out to the end of the fit; the Patient in such a case may be allowed to eat in the fit, and it wil be better to eat when the fit is in the state or height, than at any other time. How∣beit, in the beginning also, and in the augmentation, necessity compelling, Meat may be given. For so Galen in the tenth of his Method, Chap. 5. was compelled to give Meat even in the beginning of the fits, unto such as had this kind of Ague, being of a hot and dry temperature, unto whom fasting is ex∣treamly hurtful, lest they should fall into swooning fits. And in imitation of him, Amatus Lusita∣nus in the 68. Cure, of the fourth Century, to one that was full of, and vomited pure Choller, and by that means fell into swooning fits, he gave bread dipt in water, and sprinkled with Juyce of sown Grapes in the beginning of the Ague fit; by which means he hindered the aforesaid Symp∣tomes.

There is one thing yet further to be observed both in this, and all other Agues, That the Patient do neither eat, drink, nor sleep, before the fit. But it wil be good that the Patient go to stool, by means of a Clyster, provided the same be administred before the beginning of the fit.

Having therefore ordered a convenient Diet, we must forth with proceed to evacuate the Morbifick Matter, which seeing it sticks in the first Passages, it must be voided not only by Clyster, but by Pur∣ges and Vomitories.

Clysters in an exquisite Tertian, must be made of an Emollient and Cooling Decoction, with Cassia, Catholicum, Diaprunum simple, and purgative. But in a bastard Tertian, let the Decoction be of Emollient and Cutting simples, dissolving therein Diaphoenicon, Honey of Roses, &c.

Purgative Medicaments in an exquisite Tertian, must be the same which have been propounded in continual Feavers. But in a bastard Tertian, there must be added Agarick, Senna, Catholicum, Dia∣phoenicon, and others, such as the Judicious Physitian shall conceive most suitable to the constitution of the sick. And in every sort of Agues, Cream of Tartar may profitably be added to the Medica∣ments, because it opens Obstructions, is potently clensing, and yet cools withal. Purging Medi∣cines are to be given on the day of Intermission, and that in the morning, as commonly is used; if the time of Intermission fall within those hours: if not, the middle space between the two fits must be chosen. And at any hour of the day or night, we may give a Purge, provided it be far from the Fit, and the Stomach have digested what was last eaten.

But in a double Tertian, 'tis an hard matter to choose a convenient time to give a Purge, because many times, not above three or four hours do fal between two fits. Yea, And somtimes the fits are so long, that the one begins before the other be ended, which makes them be called Febres Subintran∣tes, encroaching or intruding Feavers. For then the speediness of the occasion or opportune time, requires the uttermost diligence of the Physitian. Now the more commodious hour of giving the Medicine, is thus to be chosen. In a double Tertian not encroaching, the Medicament must be given in the end of the Fit, at such a distance from the following Fit, that the working of the Physick may be over ere the other Fit come. But in an encroaching Ague, when the latter Fit interfers with the former, the Medicament must be given in the beginning of the declination, as soon as it begins never so little to remit. And in both Cases the Patient must drink Broth, three hours after the Medicament is taken; yet so, as that there must be remaining three hours from the Broth-taking before the next Fit begin. So that the Medicament, is to be given at least six hours before the next Fit.

As for Vomits, What was said of them in the Cure of Continual Feavers, may be here very com∣modionsly applyed; because the abundance of evil Humors conteined in the Stomach, Mesenterie, and Cavity of the Liver, which is wont to cause these Feavers, is brought away by Vomit; which somtimes cannot be moved by purging Medicines given again and again, as Fernelius hath well ob∣served. And therefore, If in the beginning of the Fit, the Patient be vexed with Vomitings, the Physitian shall do well to follow that motion of Nature. And seeing the gentlest sorts of Vomits, will not ordinarily serve the turn, we must proceed to the middle sort, such as is especially Asarum, of the pouder whereof, half adram, two scruples or one dram, is given in Broth, or some other con∣venient Liquor. Others give the Decoction thereof, which is made of three drams of Asarum Roots, boiled in Chicken Broth, or in Barley Broth made with Raisons. The Chymists do give white Vitriol prepared, and Salt of Vitriol, and also Aqua Benedicta, which is made of Crocus Metal∣lorum. Which, as other Medicaments made of Antimony, as they do somtimes happily rid away such morbifick Matter as is lodged in the first passages about the Stomach and Mesenterie, &c. So do they require a prudent and skilful Physitian to administer them; otherwise they are like a sharp Knife in the hand of an Infant, or like a Sword in the hand of a Mad-man.

The first passages of the Body, or first Region thereof, being purged, at least with one Purge, a Vein is to be opened in the Wel-Day. Yea verily, And if the Patient be Plethorick, the Urins red and thick, the Cure is well begun by Blood-letting, for the Purge will afterwards work the better.

If the Blood appear very Hot, Adust, or Putrid, Bloodletting must be repeated; which yet is left to the Judgment of the Physitian, according as he finds the Patients constitution.

After Purgation and Phlebotomie, we must endevor to prepare the Humors, by Juleps such as were set down in the Cure of Continual Feavers; the matter whereof must be varied, according as Flegm or Melancholly is mingled with Choller, as was observed in the place aforesaid.

In the mean time, whilst the Medicines aforesaid are making, the Feaverish heat is to be allaied with cooling Epithems applyed to the heart & Liver, such as were propounded in Continual Feavers, with this Caution, that they be never laid on, but in the height of the Hot-Fit, or rather when it first begins to abate.

To the Liver also and the Loins, Oyntment of Roses, or the cooling Oyntment of Galen may be applyed.

Also Emollient and cooling Clysters, will be very good at the end of the Fit, as well as in the beginning.

The matter being prepared certain daies, by the use of Juleps, Purgation must be again used, with Senna, Rhubarb, Catholicum, Syrup of Roses; adding thereto Agarick, if Flegm abound. And And if the Patient be strong; we may add Diaprunum Solutivum, Electuarium de Succo Rosa∣rum, or Diaphaenicon.

The Body being again purged, after the use of Juleps, if the Fits return and seem longer than they were before, it is a sign that gross Humors, and such as stick fast in the Body, do nourish the Fea∣ver, and breed Obstructions: In regard of which, clensing, opening and cutting things are to be used The Principal of which is Wormwood, which is exceedingly commended by Galen. In his 1. Book ad Glauconem Chap. 9. and Century, which in regard of the rare vertues it has in curing Agues, is called Febrifuga, that is to say Ague-Queller. But because these Herbs are hot, they may be qua∣lified by the Commixture of cooling things, after this manner.

Take Roots of Grass, Cichory, Asparagus, of each one ounce: Leaves of Agrimony, Sorrel, Ci∣cbory, Endive, of each one handful: vulgar Wormwood and Centaury, of each an handful: Boil all to a pint. In the strained Liquor dissolve three ounces of Syrup of Lemmons. Make all into a Julep for to be taken at three times in the morning.

The Juleps being finished, a Purgation must be again administred or a Vomitory, if Nature affect to discharge her self that way. For then, the signs of Concoction appearing, these Feavers are

somtimes happily Cured by Vomiting. And Galen in his first Book ad Glauconem Chap. 10. Writes that many are Cured of this kind of Ague only by a Vomit yea verily and daily experience shews, that Aqua Benedicta doth eradicate these Feavers or Agues for the most Part, unless some con∣tumacious obstructions of the Bowels do hinder. Many Experiments hereof are propounded by Martinus Rulandus in the Centuries of his Cures. But, it is, as was said before, a vehement Medicament, and not to be given without extream Caution. Some give an ounce of Aqua Be∣nedicta with the Infusion of half an ounce of Senna, and so it works more by Stool than by Vomit.

Others use Cambogia, others Mercurius Dulcis with Scammony. Which Medicaments, seeing they do potently Evacuate, do often Pluck these kind of Feavers away by the Roots, but they are to be given only to such as are strong of Constitution.

To these Medicaments exquisite Tertians and Bastard ones too, are wont to give place. But if the Agues do yet stubbornly resist (as it ofttimes fals out) Solemn Purgation must be made with an Apozem to be taken three daies, made of the Materials of the foresaid Juleps, adding thereto Senna, Rhubarb, Agarick, Syrup of Roses of Cichory with Rhubarb and such like. Yea verily and al∣though the Ague be gone before the use of this Apozem, if a Voluntary Loosness do not befal the Patient. For the solution of an Ague by Sweat or insensible Transpiration, as not to be trusted unto, gives suspition of a Relapse; because by them the thinner Part only of the Humor is Evacuated, the thicker being left behind: which can no other waies be Evacuated, save by Stool.

Before the Apozem aforesaid be used, if there be a Distension in the Parts under the short Ribs, let this following Emollient, attenuating and strengthening fomentation be applied.

Take Roots of Marsh-Mallows, Grass and Asparagus, of each one ounce: Roots of Enula Campana and the middle Bark of Tamarisk of each half an ounce: Leaves of Mallows, Violets, Agrimony, Maiden-Hair and Wormwood, of each an handfull: Lin-Seed and Faenu-Greek Seed, of each one ounce: Flowers of Chamomel, Melilot, Roses of each a pugil: Boyl all in three Parts of Water and one of white Wine, put in towards the conclusion, with two ounces of Vinegar: with this Decoction foment the Parts under the short Ribs Morning and Evening, for two daies before the use of the Apozem.

After Fomentation, anoint the said Parts with this following Oyntment.

Take Oyl of Lillies, Sweet Almonds and Tamarisk of each one ounce: Oyntment of Marsh-Mallows two ounces: and a little Wax. Make all into a Liniment.

If after al these remedies, the stubborn Ague do yet lengthen the time and keep its ground; and the Patients Face appear swoln, and palish, also their Lege swel towards night: they are to be plied with such Medicines as are commonly prescribed for obstructions of the Liver. Among the rest, Montanus doth very much commend the Decoction of Cichory and Germander in Broath; which he saies is admirable in long Feavers that are caused by obstructions.

Yet, it is to be noted; that the length of a Tertian Ague is some times caused by an hot and dry distemper of the Liver, whith perpetually produces a Chollerick Humor, the Cause of new Fits. Which is often observed in many, which being of a dry and meagre constitution of body and wholly Chollerick, have had a Tertian Ague three or four months together, especially in the more hot season of the yeer, without any tension of their Bowels, or any aboundance of Humours. To such as these, strong purgers, and strong aperitives or heaters do hurt. But such as these are to be plied with a cooling and moistening diet, with Juleps and Broaths of the same Nature. And the super∣fluous Humors are to be Purged away by little and little with Emollient and Refrigerating Clysters, with Cassia, Tamarinds, Catholicon and Syrup of Roses. But in this case especially great miracles are performed by a bath of Blood-warm Water, which doth extinguish the hot and dry distemper which is imprinted upon the Bowels. Let the Patient use these baths, on the Well-day, but without sweating.

Somtimes also the Length of Tertian Agues arises from the evil disposition of some of the Bowels, especially of the Liver and Melentery; which cannot be Cured by purgations though never so oft repeated, because that evil Quality remaining stil in the Liver, causes new Morbifick Matter daily to breed, which produces new Fits. Which evil Disposition or Quality of the Bowels, is taken a∣way by Diureticks, Sudorosicks and other resolving Medicaments.

With which faculties these following simples are endued viz. Wormwood, Centory, Carduu••, Roots of Dictamnus, of pimpernel, Tormentil &c. Of which are made Decoctions, Pouders, and such like, which must be given for divers daies together before the Fit.

A dram of Uenice Treacle is ordinarily given with white Wine, before the Fit, three times one after another.

Some give a walnut preserved in Sugar or Honey after the same manner.

When the Heat of Uenice Treacle is feared, it is at first given by it self, and a draught of Plantain-Water

is given after it. My Master Ʋarandaeus did often use this as a Specifick Medicine.

A Cup of Hippocras given before the Fit wil work the same effect, with which pleasant Medicine many have been Cured.

Yet must it carefully be observed, that these remedies must not be given, till the Patient hath been diligently Purged.

Zechius Frequently used these following Pils, which are most effectual for opening Obstructions, streng••hening the Liver, and taking away the distempers of the Bowels.

Take Treches of Rhubarb, of Eupatorium, and of Wormwood, of each half a dram: Pouder of Diarrhodon Abbatis one scruple: with Syrup of Wormwood make a Mass of Pils. Of which let the Patient take one dram in the morning three daies together, drinking after them a draught of Broath made with Cichory and Maiden-Hair.

Montanus was wont to give many daies together a scruple of Troches of Rubarb or of Worm∣wood, with Broath in which Barley, Parseley Roots, Cichory and Borrage have Boyled.

Let the Region of the Liver be anointed morning and evening before Meals, with a Liniment made of two ounces of Ceratum Santalinum, Juyce of Cichory half an ounce: Juyce of Wormwood two drams: and a little Vinegar of Roses.

In l••ke manner let the Region of the stomach be anointed with this Liniment.

Take Nard Oyl, Oyl of Wormwood and of Quinces of each half an ounce: Gallia Moschata one scruple: white Wax as much as shall be requisite. Make al into a Liniment.

Besides the Medicaments hitherto propounded, which respect a regular and Methodical Cure; there are many other specifick and Empirick Medicaments, both internal and external; both com∣mended by Practitioners, and frequently used by the common People; out of the almost infinite number whereof I shal here set down such as are the choicest. And among these Medicines may be reckoned, such things as were before propounded, to amend the evil Quality of the Liver and Me∣sentery which is wont to make long Agues: whereunto, these things following may profitably be added.

And in the first place, Spirit of Sulphur in a Legitimate Tertian, or one very neer Legitimate, after bleeding and Purging, being given with Purslain Water in the vigor of the Fit, doth power∣fully extinguish the heat of the Feaver; and if the Humor be thin, drives the same out by sweat, that there remaines no matter for a new Fit, and so is the Disease Somtimes pluckt up by the Roots. It is given from half a scruple to a scruple, with four ounces of Purslain Water.

And somtime the said spirit is mingled with Salt of Wormwood, which is also of great Efficacy in the Cure of Agues the Composition is thus.

Take Salt of Wormwood half a dram: Spirit of Sulphur a scruple: Carduus Water four ounces: Mix them. Let the Patient take it when the Fit Approaches and he covered with many Cloathes.

Some Affirm that the Juyce of Plantain Clarified and drunk to the Quantity of four ounces, an hour before the Fit, doth Cure a Tertian Ague. Some give it with Vineger and Saffron after this manner

Take of the Juyce of Plantain four ounces: Vinegar of Roses half an ounce: Saffron three grains: Mix them and give the Patient to drink, two hours before the Fit.

Manardus prefers a Decoction of Chamomel, or the distilled Water thereof, to the Quantity of four ounces, two hours before the Fit.

A Medicine commonly used, and often successful, is, a little Potion made of Rose-Water, Plantain Water and Aqua Vita of each a spoonful; given before the Fit.

These following are outwardly applied.

Take Leaves of Hyssop and Tansie cut smal, of each a pugil; Mirrh two drams: Mace, Nut∣megs, Cloves and Cinnamon, of each half a dram: Ʋenice Turpentine and Juyce of Tansey, of each one ounce: Mix all and spread them upon a Rose-Cake, fried in a frying Pan with Canary Wine, which being covered with a Linnen Cloath must be applied hot to the Region of the stomach, an hour before the Fit. Or,

Take Wormwood and Green Mint of each a pound: Crust of Bread toasted and steeped in Vine∣gar half a pound: pulp of Quinces, or Conserve of Quinces made with Honey two ounces: Mastich half an ounce: Mace and Nutmeg of each two drams: Let al be beaten and lustily wrought together, with Oyl of Quinces. Make hereof a Cataplasm to be applied before the Fit. It provokes sweat and takes away the Pains of the stomach. Or,

Take Nutmeg, Cloves, Cinnamon, of each three drams: Mirrh and Ginger of each two drams: Make al into a Pouder; mix it with Liquid Pitch and make thereof a Plaister for the stomach.

Also this following Cataplasm may profitably be applied to the Liver.

Take white Sanders and Red of each one dram: Barley Meal two drams: Aloes half an ounce: Flowers of Violets and Roses dried of each one dram: With Juyce of Wormwood and

Vinegar make a Cataplasm, to be applied to the Region of the Liver one hour before the Fit.

Neither are those Medicines wholly to be rejected which the common people are wont to apply un∣to the Wrists of such as have Agues. For not only the Opinion of People is hereby satisfied, who conceive that many are cured with these Remedies; but somwhat they may effect, by communica∣ting their vertues unto the Heart by those notable Arteries which are scituate in the Wrists. The chief of which kind of Medicines are these that follow.

Take Leaves of Plantane, Celondine the great, of each one handful: Cobwebs, Nettle Seeds, Soot from the Chimney, and common Salt, of each one dram: the strongest Vinegar as much as shall suffice. Make of all a Cataplasm to be applied to the Wrists a little before the fit, and to be repeated fresh three or four times.

Mous-Ear beaten with Salt and Vinegar, is by some accounted of great efficacy, being applied to the Wrists before the fit.

Of some, the smallest sort of Housleek or Mous-teat is commended, being used after the same manner.

Others commend the Leaves of Shepheards-purse beaten with Salt and Vinegar.

Platerus applies unto the Wrists the inner bark of the Nut-tree sleeped in Vinegar; which he saith, had been by him used with success.

Finally, Others apply such things as are apt to blister the Skin, as Garlick, Onions, Crow-foot, and the like; which are less safe than the former, and very troublesom to the Patient.