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. 5. Of a Quartan Ague.

AQuartan Ague is that which hath its Fits returning every fourth day, and it is caused by Me∣lancholly putrefying in the first Region of the Body.

Now Melancholly is of two sorts; Natural, and Preternatural. The Natural is bred of the thic∣ker and more earthy part of our Nourishment, being cold and dry. The Preternatural, is caused by adustion of Choller, and is therefore hot and dry. Hence arise two sorts of Quartan Agues; for that which is bred of Natural Melancholly, is called a legitimate Quartan; that which is bred of Preterna∣tural Melancholly, is called a bastar Quartan. Howbeit, the bastard Quartan may also come of Na∣tural Melancholly, being mingled with some portion of Choller.

Again, A Quartan Ague is either Single, Double, or Triple. A Single Quartan is when one Fit alone comes every fourth day. A Double is when two Fits happen upon two daies one immediately after the other, and the third day is free. A Triple Quartan is when the Fits come every day, as they do in a Quotidian, and in a Double Tertian. Now these Double and Triple Quartans come of Me∣lancholly putrefying in divers parts of the Body.

The Signs to know this Ague by, are first, such things as argue that Melancholly abounds in the Patient. Unto which must be added the coming of the Fit upon the fourth day, which is the pecu∣liar sign. Also the form of the fit differing from the fits of other Agues, doth discover this Disease. For it begins with yawning and stretchings, together with heaviness of the whol Body; after which follows cold, and then shivering and shaking, in which the Patients seem to have their bones broken. Also the heat is kindled by little and little in a cold and thick Matter. The Pulse is seldomer and slower than in other Feavers. The Urines are at first white, thin, and watry; but in the progress they are more colored, and thicker. Now these signs appear in a legitimate Quartan. But in a ba∣stard Quartan, the vehemence of the Symptomes being greater, doth argue the Humor to be thinner and hotter. But a bastard Quartan is not distinguished from a legitimate, herein alone, in that in a bastard Quartan, the heat, thirst, watchings, and other Symptoms, are more vehement; but in that the legitimate begins of it self, without any Feaver foregoing; but a bastard Quartan succeeds other Feavers and Agues, by reason of the adustion of the Humor which caused those Diseases, by means of which adustion, it degenerates into Preternatural Melancholly.

A Double Quartan is easily known by the Course of the fits. And a Triple Quartan is distingui∣shed from a Double Tertian, and a Quotidian, not only by the Signs of Melancholly abounding, and by the form of the Fits; but also because it was first a Single, or a Double Quartan before it came to be a Triple Quartan. For very rarely, or never doth a Quartan Ague begin with a Triple; but a Simple or Double Quartan degenerates into a Triple.

As for what concerns the Prognostick; this kind of Ague is wont to be longest of all o∣thers; and that which begins in the fal of the leaf continues al Winter commonly, and goeth not away til the Spring come. Yea and some Quartans continue a yeer or yeers. Summer Quartans are the shortest. In al of them we must have a continual eye to the signs of concoction which signifie the solution of the disease to be at hand; and with these, for the patient to make black urine is a good token.

A legitimate Quartan is longer than a bastard Quartan because the former proceeds from a thic∣ker, the latter from a thinner Humor

This kind of Ague is wont to be very safe from danger, especially the legitimate, being accom∣panied with no grievous affection of any of the bowels. But the bastard Quartan is more dange∣rous. and if the Liver, Spleen, or any other part be grievously damnified, it degenerates into a Dropsie,

Aged persons above sixty years, being taken with a Quartan Ague, do for the most part dy of it: because their naturall heat is too weak to overcome so contumacious an Hu∣mor.

An intermitting Quartan, being changed into a continual, is for the most part deadly. Because that Feaver whose motion was outward, is changed into one whose motion is inward. Which mostly falls out in the Winter, the cold meeting with the humours which were but outward and beating them back into the innermost Closets of the Body. The which also come to pass by unseasonable use of sharp and vehement purges. For thereby of simple Quartans, double, triple, and continual are generated.

A Quartan Ague coming upon one that hath the falling sickness cures the same, according to Hippocrates in the 70 Aphorism of the 5 Section. Those that have Quartan Agues are not much troubled with Convulsions. And if having first Convulsions, a Quartan Ague follows, they are freed from their Convulsions, Now the reason which Galen in his Comment gives here∣of, is; because the thick matter which caused the Convulsions is by the long heat of this Ague, attenuated and digested. Also by the shaking of the Body in the cold Fits, the said Humor is more easily ejected. We must also add, that the evil Humors lurking in the Brain and other parts, as also in the veins, is transferred to the Hypochondria and more ignoble parts, where the Melancholly Quartanary Humors are seated, and so leaves the parts aforesaid.

A bloody flux coming upon a quartan Ague, tends to health, according to Hippocrates in the 48 Aphorism of the sixt section. To such as are splenetick a Dysenterie is good. Now in a quartan Ague, commonly the Spleen is misaffected, and a melancholly humor is common to a quartan Ague and a misaffected Spleen▪ but this must be understood of a short dysenterie, for a long one is wont to be mortal; as we have it in the 43. Aphorism of the said section. Such as being troubled with the Spleen have a flux of the Belly with pain, if it turn into a long Dysen∣terie or Bloody flux, they fall either into a Dropsie or a Lienterie, and dy.

To bleed at the nose in a quartan Ague, is a very bad sign. Because the Humor which causes a quartan is too thick and too cold to be voided that way; and because such bleeding is symp∣tomatical, and if it continue wil breed a dropsie; it must presently be stopped by opening the basilica vein, out of which the putrid blood may flow, because the pure blood comes from the Nose.

The quartan Ague hath a double cure according to the two kinds thereof. For the remedies used in a bastard quartan, must be far different from those which are used in a legitimate one.

And that we may begin with a Legitimate quartan: we must presently set our selves to van∣quish the cause thereof, not regarding the Feaver. And seeing the cause thereof is an humor cold and dry, thick and earthly; we must use medicaments that do heat, moisten, and atte∣nuate. Also the Peccant Humor must be at seasonable times evacuated, which notwith∣standing will require a long time to do; because of the extream contumacy of the Humor and length of the disease. But before these medicines be used, we must appoint the patient a convenient diet. Let the patient therefore use meats of good juyce, easy to digest, of thin substance, and moderately heating and moistening; as the flesh of young Animals and mountain Birds, new Egs soft boiled, Fishes that are taken in stony Rivers. In the state of the disease we may allow the pa∣tient Salt Fish, Capars, and Olives▪ Galen 1. ad Glauco. Grants likewise Pepper and Mustard. A∣mong Herbs Borrage is commended and Bugloss, Pimpernel and Spinach, Fennell and Parsly Roots, but especailly Turneps, which must be first boiled in water, and afterwads in fat broath which is very good for such as have the quartan. Crato in his Councels collected by Scholtzius, brags that he had cured many of the quartan Ague by the second broath of turneps seasoned with Butter and Sugar. Of fruits, Apples, and stewed Prunes, Raisons of the Sun, fat Figs, Al∣monds,

Dates, Pine-kernels are good. And finally, to Spice their Meats, let them use Cinnamon, Nutmeg, and Saffron.

Let the Patient abstain from Meats which are thick of substance and clammy and are long in pas∣sing through; such as the Flesh of Swine, Beef, Deer, Hares and Water fowl, from Pease and Beans, Colewort, Course Branny Bread, Cheese, Nuts, Walnuts and Chastnuts; from Flesh much Salted, or dried in the Smoak; from fruits, Raw Herbs, from Vinegar, Verjuice, because they are thought as al other sowr things to ferment Mellancholy and make it work

Let their drink be smal Ale or bear of moderate strength and meanly hopped neither new nor hard, Pure and wel Clarifiedwhite Wine or Cla••ret that is not strong, with Water in which the Bark of Tamarisk or the Leaves of Egrimony have been steeped, or a Decoction of Salsa Parilla, or Barley Water that hath Steel quenched in it.

Let them eat sparingly, no more than may barely preserve strength; for too larg feeding breeds crudities which makes the Disease of long continuance. But above al, they must be very spare in drinking, because nothing makes this Disease more rebellious and hard to Cure than over much drink and moist things, for they fil and Swel the spleen. Crato forbids al use of drink in the fit, which to forbear doth much as he saies help the Cure. On the fit-day, the Patient must eat six hours before the sit comes. And afterward nothing must be taken til the fit be over. Long sleep is good, because it moistens, but it must be forborn in the beginning of the Fit. On the daies of Intermission light exercise before Meat, is good; or in place thereof, frictions of the whol Body, after the Pati∣ent hath been at Stool. If thee Patient be costive, a Clyster or Suppository must be given. Final∣ly let the Patient be as cheerful as may be and avoid sadness

The Patients Diet being thus ordered; first a gentle Purgation must be administred, by a Clyster and a purging Medicament. the Clyster may be thus Made.

Take Roots of Bugloss two ounces: of the four Emollient Herbs, mercury and beetes of each one handful: Fat Damask Prunes five Pair: of the four larger cool Seeds and Annis Seed of each two drams: Epithymum three drams: Boyl all to a pint and an half: in the strained Liquor dissolve Catholicum one ounce: Oyl of Violets and Chamomel of each one ounce and an half: Red Sugar one ounce: Make of all a Clyster, which must be given the day before the following Potion, at a seasonable time.

Take Senna half an ounce: Annis Seed a dram: Leaves of Borrage and Fumitory of each one handful. Liquoris three drams: Boyl all to three ounces: in the strained Liquor dissolve Manna and Syrup of Roses of each one ounce: Make all into a potion.

Galen in I. ad Glauco. Ch: 11. Bids us give only gentle and benign Medicaments in the begin∣ning of this Ague, otherwise, it is to be seared, that if we use stronger Medicaments, of a simple Quartan, we shal make a double, a triple or a Continual Feaver.

After the first Purge aforsaid, Blood must be drawn from the Basilica Vena of the left Arm. Yet, if the Liver be affected, it may be drawn from the right Arm. And their Opinion is Ridiculous, who say that we must expect Concoction before we let Blood, because then the Blood will be more thin and apt to flow: for it is better digested and prepared, if first some Quantity thereof be taken away. Neither must we give eare to them which say, that Blood-letting is not to be allowed of in a Quarran Ague, unless redundancy of Blood do shew it self by the Swelling of the Veins and by other signs. For there is evermore at the beginning a Plethora ad Vires viz. Such a fullness of Blood as the Strength of the Patient cannot mannage, unless a Quartan do follow some other long Feaver. But that Precept of Galen formerly mentioned in I. ad Glauconem, is worthy of al Commendation, which saies that if the Blood which first comes away be Black and impure, that then the greater Quantity is to be taken away: but if it be Red and Pure, little must be taken, and the Patient must not be let Blood any more. The wel daies are fittest both for Bleeding and purging. Yet some let Blood upon the fit day, five or six hours before the Fit. which is not Ammis, because the Humors beginning then to be moued, are more easily drawn out. Zacutus Lusitanus saies, that it is very good to let Blood when the Moon is in the ful. For then, by reason of the Moons influence, that earthy Melancholick Humor doth Boyl and become more fluid and Apt to come away with bleeding. And he doth Testifie that many have by bleeding at that time been helped, and some perfectly cured, who could not by any other means receive Help. But Botallus contrary to the mind of Galen and al other Physitians, doth aver that frequent Blood-letting doth cure the Quar∣tan Ague, yea when it threatens a Dropsie; and he endeavours to confirm his Opinion by reasons and examples. Which notwithstanding is to be rejected as a Paradox, seeing the Refrigeration of the whol Body caused by much Beeding, makes the Morbisick matter more thick and contumaci∣ous.

The flux of the Hemorrhoids, is very good in Quartan Agues, and many are thereby Cured. For seeing the Hemorrhoid Veins are branches of the Mesaraick Veins, in which the matter of this Disease is conteined, when they are opened they Evacuate the immediate cause of this Disease. If

therefore a flux of the Hemorrhoids happens in such as have been accustomed thereunto, it must not be stopped. If it be too sparing, it must be furthered. As also if Nature seem to incline that way (which is known by itching of the Fundament, and by some drops of blood coming that way) the Blood must be made to come by application of Leeches.

But in such as have not been used to have their Hemorrhoid Veins opened, after bleeding in the Arm, it is good to let them blood in the Ankle Vein; by which oftentimes the Ague ceases; or at least that Bleeding, with other Remedies, will hasten the Cure; especially in Women whose Courses are stopt, or flow not sufficiently.

The opening of the Vein between the little Finger and the Ring Finger, called Vena Salvatella, is approved by the Antients, and many later Physitians, who said it cures the Quartan Ague. But ve∣ry many others reject this Conceit, as being founded upon no reason, because the foresaid Vein is a Branch issuing from the Arm Veins. Yet being commended by others with many Experiments, I conceive it ought not wholly to be neglected. Some hold, it ought to be opened in the Conjunction of the Moon with the Sun; others when the Moon inclines two hours before the Fit, at three several times, in three immediately succeeding Fits, which in some persons hath happened very well.

After these first Evacuations, we must bend our study to concoct and prepare the Humors, with certain Juleps, compounded after this, or some such manner:

Take Roots of Asparagus, Bruscus, Cichory, Bugloss steeped in white Wine, of each one ounce: Bark of Tamarisk half an ounce: Leaves of Borrage, Bugloss, Ceterach, Maiden-hair, Fumi∣tory, Germander, Ground-pine, of each one handful: Liquoris one ounce: the three Cordial Flow∣ers, of each one pugil. Boyl all to a pint and an half. In the strained Liquor dissolve Syrupus Bi∣zantinus, and Syrup of Maiden-hair, of each two ounces. Make thereof a Julep to be taken at four times, four mornings together. Which must also be continued many daies, for the Matter being contumacious, requires long preparation. Or if the Patient be nice, and squeezy, Broths must be made of part of the foresaid Simples, chusing such as are most grateful to the tast, whereunto, as also to the Juleps, Cream of Tartar may profitably be added.

With these Preparative Medicaments, between whiles, Purgatives must be given; so that every third or fourth day the Patient must take a Purge, with this Caution, That as long as the Matter is very crude, we use mild Purgatives: and when Concoction begins to go well forwards, we must then give such Purgers as are a little stronger. Now the Materials for these Purgations are very wel known, so we need not reckon them up.

It is somtimes good to prescribe an Apozem both Purgative and Preparative, for four or five Do∣ses, that a good part of the Morbifick Matter may be clensed away. Which Apozeme may be made of the Materials of the foresaid Juleps, adding Purgatives thereunto. But if the thickness and contu∣macy of the Humors, with the cold distemper of the Bowels, do seem to threaten that the Disease wil be long and bring a Dropsie, we must then fly to such Medicaments as do powerfully cut and di∣vide the said Humors; of which this following Apozeme may be compounded.

Take of the five opening Roots steeped in white Wine, of each one ounce: Enula Campana, Gentian, Aristolochia, and Asarum Roots, of each half an ounce: Leaves of Germander, Agri∣mony, Hops, Borrage, Ceterach, Wormwood, and Centaury, of each one handful: Liquoris, and Raisons stoned, of each one ounce: Senna one ounce and an half: Epithimum one ounce: Aga∣rick newly trochiscated three ounces: Ginger and Cloves, of each one dram: Boyl all to a pint and an half. In the strained Liquor dissolve Syrup of Cichory with Rhubarb five ounces: Troches of Capars, and Salt of Wormwood, and of Tamarisk, of each one dram. Make of all an Apozeme, for five Doses to be taken in the morning.

In this Chronick and lasting Disease, an obstinate Perseverance is necessary, that the perpetual vicissitude of Medicines may concoct and purge away the Cause thereof. For this is in a manner the only Cause why many that have Quartan Agues remain uncured, because after the use of a few Medi∣cines they grow weary, and wholly reject and disdain all the rest.

For a continual Use therefore, certain Purgatives are alwaies to be in a readiness. Which may be made in the form of a Magistral Syrup, or of Pils, or in any other form.

A Magistral Syrup may be made of the Materials of the Apozeme Aforesaid, adding a triple quan∣tity of the Purgative Ingredients.

Pils for frequent use may be thus compounded:

Take Aloes diligently steeped with the Juyce of Wormwood, half an ounce: Gum Ammoni∣ack dissolved in Vinegar, and afterward thickened, two drams: choyce Mirrh a dram and an half: Gummy, Turbith, and Agarick newly made into Cakes, of each two drams: Diagridium one dram: Salt of Wormwood and Tamarisk, of each two scruples: Saffron half a scruple. With Oxymel simple, make all into a Mass of Pill-stuff. Let the Dose be half a dram, or two scru∣ples, twice in a week.

If the Patient be of an hot Constitution, these following Pills may be used.

Take Polypody of the Oak half an ounce: Roots of Asarum, and seeds of Broom, of each one dram: Cristal of Tartar one dram and an half: Flowers of Bugloss and Borrage, of each half a pugil. Boyl all in a sufficient Quantity of Water, Of the Liquor strained, and very well clarified, take half a pint: Juyce of odoriferous Apples very well clarified four ounces. Infuse therein Sen∣na one ounce: Turbith and Agarick, of each three drams: Mace, Cloves, Cinnamon, and Epi∣thimum, of each one dram. Let them digest together three daies in Balneo Mariae, then strain and press them out. And add yet of Extract of Aloes made with Endive and Sorrel Water one ounce: Mirrh dissolved in Wine over the fire and strained two drams: Salt of Tartar one dram: Let all evaporate and thicken over a gentle fire, adding towards the conclusion, of the Pouders of Diarrho∣don Abbatis, and Laetificans Galeni, of each one scruple: Salt of Wormwood and Tamarisk, of each half a dram: Extract of Saffron half a scruple. Make a Mass of Pill-stuf for the use asore∣said.

Also a Purging Medicament very familiar, and most easie to prepare, but very profitable, may be made of three ounces of the Decoction of Wormwood, wherein two drams of Senna hath been infu∣sed, which must be taken now and then.

These Purging Medicines are wont to be given the day before the fit, because the Patients are then stronger than at other times. Yet many contend that they ought to be given before the fit, because the matter being agitated by the fit, is made more apt for Expulsion. This Opinion they underprop with the Authority of Hippocrates in his Book de Affectionibus, who would have a Medicine Pur∣ging downwards to be given at the beginning of the Fit. And although in Galens Judgment, that is none of Hippocrates his writings, but of his Son in Law Polypus; yet they conceive it ought not therefore to be of no Authority, seeing Polypus also was a very Learned Man, and frequent Experi∣ence confirms this Opinion; as the said Experience is set down by Arculanus, Genitilus, Amatus Lusitanus, and others, who have ordered that the Purging Medicament should be given four hours before the Fit. Which practice notwithstanding, hath need of much wariness and prudence in the Physitian, seeing the shaking fit intercepts the evacuation, and in the Ague Fit the Humors are mo∣ved with a motion quite contrary to that wherewith the Purge doth move them; by which means great disturbances may fall out in the Patients Body. Wherefore this course is not to be followed but in strong Bodies.

The Consent of Physitians is greater and more general touching the giving of Vomits in the be∣ginning of the Ague Fits, because Nature is at that time more prone to that kind of Evacuation. Neither is it to be doubted, that a Vomiting caused in the beginning of the Fit, and at the same time often repeated, doth make the Disease gentler and shorter. The Materials of Vomitories are set down in our Cure of a Tertian. But in a Quartan Ague, Asarum is preferred before the rest, one dram being given in Pouder, in white Wine, and three or four times repeated.

In the Intervals of purging, Clysters must frequently be given, which do accustom Nature to expel the hurtful Humors into the Guts, and do by little and little bring away some of the morbifick mat∣ter contained in the Meseraick Veins.

The Disease continuing (as for the most part it is long and lasting) we must somtimes rest, and abstain from Physick a month, or thereabouts; that Nature in the mean time may gather strength, be wearied with continual use of Medicaments, and may set her self to concoct the morbifick matter. And afterward we must return to our Preparatives and Purgatives.

Howbeit, in a long Ague, we must not alwaies use the same Medicaments; lest Nature be over much used thereunto, and the Patient become weary of them. Also because from more gentle Ape∣ritives and Purgatives, we must pass on to such as are stronger. Various sorts of Purgatives have been already propounded. And these following Aperitives besides the Apozems aforesaid, and the Juleps, may be used in the progress of the Disease, when the Signs of Digestion begin to ap∣pear.

Take White Wine three pints: Enula Campane Roots three ounces: Bark of Capar Roots half an ounce: Tops of common Wormwood dried one ounce: Infuse them three daies in Balneo Mariae. Reep all together without straining, and give of this Wine to the Patient two or three ounces in the morning, two hours before meat. And these following Pils may be used either alone, or with the said Wine.

Take Roots of Gentian two drams: round Birthwort Roots one dram and an half: Mugwort one dram: Briony dried three drams: Mirrh and Saffron, of each one dram: Asarum Roots two drams: Aloes one ounce: With Oxymel of Squils make all into a Mass of Pill-stuf. Let a dram be given every day by themselves, or a little before the taking of the Wine aforesaid.

To these Pils, Steel prepared may profitably be added, if the Patient be able to walk after the ta∣king of them. For the use of Steel in all Chronick Feavers is very profitable, because it potently o∣pens Contumacious Obstructions, which are wont to foster those Diseases.

Or to open and strengthen at once, the following Electuary may profitably be prescribed.

Take Conserve of Elecampane Roots, Conserve of Wormwood, and Maiden-hair, of each one ounce: Preserved Citron Peels▪ half an ounce: Confectio Alkermes three drams: Preserved Myrobalans, two: Pouder of Diarrhodon Abbatis two drams: Salt of Wormwood and Tama∣risk, of each one dram: Saffron two scruples. With Syrup of preserved Citrons, make all into an Opiate: of which let the Patient take the quantity of a Chestnut every morning, two hours before meat. Or if in the morning the Patient take some other Medicine, then may the Electuary be ta∣ken two hours before Supper.

To the same intent is commended as a most excellent Remedy, the Extract of Germander mixt with Salt of Tamarisk made into Pils.

Add hereunto, Discussers, and Diaphoreticks, which are very useful to discuss the reliques of the declining Disease, when signs of Concoction appear. For they do not only discuss the said reliques, but they do likewise correct that distemper which is bred by so long a Disease, and amend the ill ha∣bit of the Body; and strengthen the Stomach, Liver, and other Bowels, weakened by the length of the Disease. Among these Medicaments, Venice Treacle challengeth the first place, being by older and later Physitians commended to this Use. It is given one hour before the fit, one dram in weight, with Wine, or in a Decoction of Germander. Or if its heat be feared, it may be given with a Deco∣ction of Agrimony, or with the Juyce or Water of Plantane. This Medicine must be repeated be∣fore divers Fits one after another. It may also be given in the mornings for some daies together on the well-daies. But a little before the fit, it operates happily, because it hinders the encrease of cold, and doth more commodiously discuss the Humor, which is cause of the fit, now beginning to work in the Veins, and by this means it diminisheth the fit, and if the morbifick matter be little, takes it quite away. Here, notwithstanding, great Caution is to be used, lest Treacle, or other such hot Medicines, should be given when the Humors are yet crude; for they dissolve the putrid Humors, from whence ariseth a confusion in the Body, and an encrease of the Ague Fits; so that a single Quartan comes to degenerate into a Double, and Triple, yea, into a Continual Feaver. As it happened to Eudemus the Peripatetick, as Galen relates in Lib. de Praecog. ad Posth. Cap. 2. & 3. in whom was a single Quartan, the Physitians of Rome having given him Treacle unseasonably, was changed into a Tri∣ple. Howbeit, afterwards when the Signs of Concoction appeared, Galen gave him of the same Treacle, and cured him.

Among other Diaphoreticks, some commend the Roots of China, and Salsa parilla, whose first and second Decoction being given twenty daies together, doth somtimes cure contumacious Quartans. But they work more effectually, if with the Primary Decoction, Purgatives be ming∣led.

Other Remedies are also given before the Fit, which are accounted specifical, and appropriate to this Ague, and being given towards the declination, they do very often keep back the fits, and cure the Quartan. The chief of this sort, are these which follow:

Take Green Leaves of Plantane one handful: Green Sorrel half a handful: Vinegar and Treacle, of each three ounces. Distil them, and let the Patient take of the distilled Liquor three ounces, half an hour before the fit. Or,

Take Sugar-candy three drams: Ginger two drams: Camphire one dram. Make all into a Pouder. Give one dram in warm Water.

Ten Grains of Saffron in pouder, given with white Wine before the fit, doth much weaken the same.

Seed of wild Rue given before the Fit in white Wine, cures.

Heurnius assures us that with the following Troches, many have been cured, even in the Winter, with once taking.

Take Seeds of Rue, Parsley, Mirrh, and new Andromachus Treacle, of each one dram: Opium half a scruple: Make all up into little Cakes or Troches. And let the Patient take one of those Cakes in Water, before the fit. Narcoticks do indeed much abate the fits; but unless the greatest part of the morbifick Humor have been before abated, and the Obstructions much lessened, they may do hurt, because they may retain the vitious Humors in the Body, and breed Obstructions, and o∣ther worse Diseases. But given in a smal quantity, and mingled with things which open and cut, as in these Troches, they can do less hurt.

Also to restrain the Fit, gentle Purgers are profitably given an hour before it comes, which do revel the Humors, more by soliciting and provoking Nature, than by their purging. To which intent, such as these which follow are prescribed.

Take Senna, Polipody of the Oak, Time, Epithimum, of each one dram: Borrage flowers a pugil. Make a Decoction to three ounces. Give it an hour before the Fit.

Or,

Take Senna three drams: Turbith one dram: Cinnamon half a dram: Saffron and Ginger,

of each ten grains: Sugar, the weight of all the rest. Make of all a Pouder, divide it into three parts. Give the Patient one part before the fit, in white Wine.

Quercetanus in his Dispensatory, doth exceedingly commend Camillus his Pils of Sagape∣num; of which he gives only one at the beginning of the fit, for divers daies together; and a little af∣ter he anoints their Back-bone with a Liniment composed of Treacle, Aqua vitae, Oyl of Bays, or of Spike. And two or three hours after the Pils are taken, he gives Broth with opening Roots, Bor∣rage, Bugloss, Time, and an odoriferous Apple boyled in it.

Now those anointings of the Back-bone, are very good to mitigate the cold fit, and must often be used, although the foresaid Pils are not used. For they are frequently useful, when the shaking fits are vehement and importunate. And these Anointings are made, not only with the foresaid, but with very many other Medicaments; as with Oyl of Dill, Chamomel, Orice, Costus, Rue, the Pep∣pers, and other hot things, with Aqua vitae, Treacle, Cloves, Castoreum, Mustard seed, Pepper, and other things mixed therewith. Now these Liniments are more effectual, if the back-bone be a∣nointed therewith by the fire-side, an hour before the coming of the fit; and the sick party be pre∣sently thereupon conveighed to a hot bed, and hot Tiles sprinkled with odoriferous Wine, and wrapped in Linnen Cloths, be applied to the Soals of the Feet, and Palms of the Patients Hands.

While the aforesaid Medicaments are used, a special care must be had of the Spleen, because that part is alwaies affected in this Disease: And therefore those Medicaments which ordinarily are pre∣scribed for Obstructions of the Spleen, viz. Fomentations, Liniments, and Plaisters.

Yea verily, and somtimes a Bath of luke-warm Water, after many Evacuations have been celebra∣ted, is good, not only to mollifie the Spleen, but also to moisten the whol body, and to further the Coction of the morbifick matter. The bath may be used on the daies of intermission, giving dili∣gent heed that it be no other than luke-warm. For if it should be hotter, it is to be feared, lest the Humors being thereby dissolved, should run on a sudden into divers parts of the Body, and breed dangerous, very dangerous Imposthumes.

Finally, Such things as are wont to be laid to the Wrists, are not to be neglected, seeing Authors of good account do make some reckoning of them. For Rondeletius affirms, That he hath used this following Medicament, with great success.

Take Leaves of Elder, Sage, Doves-foot, Rue, of each half a handful: Marigolds a third part: a handful of Salt, and a little Wine. Beat all together, and apply to the Wrists before the Fit. Crato applies the Roots of Nettles being beaten and moistened or steeped in Vinegar, to the Arteries of the Wrists, and of the Feet. And Sennertus relates that a certain Citizen having had a Quartan Auge the whol Autumn and VVinter, and at last being afflicted with most sharp pains in his left shoulder, by the perswasion of a certain woman, he applied Crowfoot to his wrist, which raised a Push, and freed him both from his pain and Feaver.

A Bastard Quartan is cured with the same Medicines in a manner, which have been propounded for the Cure of a Tertian; adding to the Decoction of Juleps and Apozems, such things as do peculiarly regard Melancholly adust. Whereunto may be added al the more temperate, and less heating Medica∣ments, which have hitherto been propounded for a Legitimate Quartan.

In the beginning therefore it is good to use Borrage, Bugloss, Fumitory, Hops, Sorrel, Cichory, Ceterach, Scolopendria, Agrimony, and Odoriferous Apples. Whose Decoctions, distilled Wa∣ters, and somtimes their clarified Juyces may be prescribed in the form of a Julep, an Apozeme or Magistral Syrup.

But in the Progress of the Disease, it will be good to add unto the Simples afore∣said, the Bark of Capar Roots, of Tamarisk, Enula Campana, Polypodie, and Worm∣wood.

While the Patient useth these Preparatives, Purgatives are frequently to be interposed; which are to be given the Day before the Fit, and to be repeated twice a Week. To which Intent Various Forms may be prescribed. But for such as are Delicate, a Laxative Ptisan, Syrupus de Pomis Saporis, or the Broth of a Chicken, qualified with Borrage, Bugloss, Pim∣pernel, and three drams, or half an ounce of Senna, may profitably be given.

Blood-letting in the beginning must not be omitted, and so such quantity of blood must be taken away, as shal correspond unto the Quantity and Quality of Blood, and to the Age and Constitution of the Patient.

If the Disease prove long, when the fervor of the blood is abated, Vomits may profitably be ad∣ministred; especially to such Patients as are troubled with Stomach-sickness and Vomitings in the beginning of their Fits. Among Vomitories good for a Quartan, Asarum (as was said before) is the principal, being given to the quantity of a dram in white Wine, and divers times repeated, if the Disease shal not after once or twice giving, be discussed.

Hereunto ad fomentations and liniments applied to the parts under the short ribs, to cor∣rect the evil disposition of the bowels (which continually affords new matter for the fits) and to soften and make thin the fast, setled and impacted Humors: which may be prescribed after this manner.

Take Roots of Marsh-mallows, of Lillies, of Enula campana, Barks of capar Roots, and the middle rind of Tamarisk, of each one ounce; Leaves of Mallows, of Marsh-mallows, of Pellitory of the wall, of Borrage, Bugloss, Pimpernel, Wormwood of each one handfull; Lin-seed and Parsly seed, of each an half ounce; flowers of Chamomel, Melilot and Dill, of each one pugil: make a decoction in three parts of water, and one of white wine added towards the end. With which decoction foment the Hypochondria, twice a day, far from meals.

Take Ointment of Marsh-mallowes, one ounce and an half; Oyl of Lillies, Chamomel, Roses and Wormwood, of each an half ounce: make al into a Liniment, which must be used after the fomenta∣tion.

Or Oyls alone may profitably be applied to the same Parts, laid on with wool.

And finally a bath of warm water either alone or with emollient and qualifiing things boil∣ed therein, or of Barly and Almonds as is usual, will be very convenient to cure this dis∣ease. For it corrects the distemper of the bowels, rectifies the heat and dryness of black Choller, mollifie that which is hard, opens the passages and widens them, and digests crude Humors. Wherefore the frequent use thereof will be most convenient, using the caution before specified.

Now the operation thereof will be exceedingly advanced, if preparative Medicaments and such as open obstruction be given to the patient, upon entrance into the bath. Among which the chief is a decoction of Wormwood and Enula Campana, which is exceeding good to di∣gest all contumacious Humors. provided the over great heat of the Bowels, do not dis∣swade the use thereof. In which case it may be tempered by the mixture of other things fore re∣cited.

And while these things are doing, gentle purgations must be repeated, as we advised before. And when the disease doth indeed decline, those specified medicaments propounded in the Legiti∣mate Quartan, may here also be brought into use.

In the whol course of the disease we must be carefull of the Breast, least a Consump∣tion betide the same, for the Humor offending in this Disease is of a corroding quali∣ty