Nine books of physick and chirurgery written by that great and learned physitian, Dr Sennertus. The first five being his Institutions of the whole body of physick: the other four of fevers and agues: with their differences, signs, and cures.

CHAP. XVI. Of Symptomatical Fevers.

BEsides these continued primary Fevers which have hitherto been explained, * 1.1 there are yet other continued Fevers called Symptomatical and accidental, which happen upon some other disease which hath gone before, and which follows as a Symptome the disease, and is taken away at the cure of the di∣sease, and so these Fevers follow other diseases which being ta∣ken away, they cease. Whence the Ancients, also as Galen teacheth, 4. Aphor. 73. said those only were fevourish, which were sick without an inflammation or other distemper, but those that did febricitate by reason of an inflammation of the side, lungs or any other part, they did not call them fevourish, but Pleure∣tick, Peripneumoniack, Hepatick, or other such like names.

But there is not only one sort of these Fevers, * 1.2 yet the princi∣pal and most usual is that which follows an inflamation of some internal part neer the heart, or which hath consent with the heart, when from blood powred into the inflamed part and pu∣trifying, vapours are communicated to the heart, and heat it; which in a Pleurisie, Peripneumony and Angina happens as we are commonly taught. But although it cannot be denied but that from the inflamation of these and other such like parts Symptomatical Fevers may arise, and that the Fevers ensuing the inflammations in accidental wounds do prove it; yet if we diligently consider it, all those Fevers which are commonly cal∣led Symptomatical are not such but primary.

For first putrefaction is kindled in the vena cava, whence a continued primary Fever is stirred up; * 1.3 but because nature is burthened with the weight of those peccant humours; she useth to force them as much as it could out of those greater vessels, and from a publique and Kingly seat as it were into lesser veins and smaller parts of the body, the blood with those vitious humours being diffused into those lesser parts causeth inflammation. And it is manifest by this, because a Fever for the most part precedes inflammation it doth not follow it, and oftentimes the matter passeth from one part to another, whence changes of diseases are made. Hence these Fevers are properly called by Platerus Co∣mitatae rather then Symptomatical, and such Febres Gomitatae are not only those which have an inflammation of any part ac∣companied with them, but also those, to which other evils are annexed, namely a Diarrhea, a Dysentery, Spots, Measles, the small Pox, wandring pains, the Gout of the joynts, or running Gout, Catarrhs. For all these evils do arise when na∣ture being oppressed with the weight of its burthen of peccant hu∣mours, it protrudes some part of them out of the vessels.

A Fever of this kind is also accompanied, which is an Erysipe∣las, * 1.4 called by the Germans Rose; for this Fever doth not pro∣ceed from an inflammation of an external part, but this evil ac∣companies the Fever; for when the thinner and hotter blood burneth in the vessels by what means soever, putrifies, and is corrupted, and acquires a vitious quality, which principally is caused by anger, and fear, nature being stimulated protrudes the same to some external part of the body, whence this evil in∣vadeth with a trembling and quaking, and whilest the matter striving to go outwards, ceaseth on the Glandules under the Arm-pits, and about the groin; some of the humour that is stirred up, sticks there, and pain and swellings are there percei∣ved, till at length it manifests it self in the leg or some other ex∣ternal part which may be known by the heat, pain, and rosie colour.

But we do not assent unto Platerus in that he says that all those Fevers are simple and pure continued, and are without any putrefaction.

The Urines, that we may pass by other things, do manifest∣ly shew putrefaction, which hath the same tokens of crudity and concoction as in other putred Fevers, and nature sometimes cri∣tically, sometimes Symptomatically, expells the matter offen∣sive to it; for it doth not only expel by insensible transpiration, and by a moist steam, which useth to be in Ephemeraes and Sy∣nochaes which are without putrefaction.

Some of these Fevers whether they arise from an inflammation of the parts, or whether they have that as a companion, * 1.5 are cal∣led Phlegmonides, which principally proceed from blood; but those which arise from Erysipelas or inflamation, are called Eru∣sipolatodes, and inflame fires. * 1.6

To these belong the Fever that leaves fire as it were behind it, which burneth so exceedingly, that all the interals are as it were burnt, but the external parts grow cold, and that during the whole course of the disease; and this Fever ariseth from an Eri∣sipelas or inflamation of any internal part, but principally of the stomack, and from blood and Spirits meeting in the part infla∣med.

The second kind of Symptomatical Fevers which is called Lenta, proceeds not from any inflamation of the bowels, * 1.7 but from some obstruction and hidden putrefaction, that is, from matter without the vessels, spread over the substance of any of the interals, or at least impacted, and putrifying in the capillar veins dispersed neer the substance of the interals, and hath its rise from the substance of the interal decaying; whence there is so great quantity as that when the matter is gotten into larger and wider vessels, vapours cannot be transmitted to the heart, and so a Febris Lenta is stirred up, which therefore is unequal and keeps no certain order.

This Fever is the gentlest of all, and molesteth not the sick with any grievous Symptome, so that the sick oftentimes thinks himself well. In the mean while the strength decayes, that the sick can scarce go forward, and the body is no ways refreshed by aliment, but wasteth by degrees, whence sometimes this Fever is accounted with an Hectick, and therefore when there is any suspition of this Fever, in the first place we must diligently search the Hypocondries and Hypogastries, to try whether any tumor be to be discerned in any of them; some signs of putrefaction also will appear in the urine, and discover themselves in the Pulse.

This Fever is more durable, and goes beyond the terms of o∣ther Fevers, and often endeth not in fourty days, nor is it gone until the humour fastened to the interal be consumed.

The third sort of Symptomatical Fevers is, * 1.8 that which ari∣seth from the putrefaction of any interal, from whence putred vapours through the veins inserted might be sent to the heart, heat that, and might stir up a continued Fever, whereby the body by degrees might be extenuated and wither. And this Fe∣ver is sometimes more violent, sometimes more mild, accord∣ing

as the putrefaction is more or less. This often happens in putrefaction of the lungs in such as are Phthisical; so 'tis found that the Caul or Kell, Mesentery, Womb, and other parts are corrupted, and thence a Fever kindled. In like manner from Fistulaes penetrating into the internal parts a Febris lenta being stirred up, it is observed, that some do consume and waste.

The fourth kind of Symptomatical Fevers is when either from corrupt milk, * 1.9 which often happens in Infants, or from blood pu∣trifying somewhere without the vessels, or from worms, putred vapours are communicated to the heart, that is heated, and a Fever irritated.

To these may be referred that Fever which ariseth from crudi∣ty, which is familiar amongst little children from their eating of sweet things, which hath with it a tumor and inflammation of the Hypocondries, which the Germans call Das Herngespam, from the abundance of crude humours collected in the stomack and neighbouring parts, which begin to putrefie and are turned into wind. * 1.10

Symptomatical Fevers properly so called, are known by this, that they come after diseases of private parts, and the first sort of these Fevers is known from hence, because it follows an inflam∣mation of some certain part: as on the contrary, Fevers called Comitatae, first appear and invade with rigor and trembling, to which afterwards a Fever happens.

But those Lentae or slow Fevers are known by their slow heat, wherewith notes of putrefaction in the urine and pulse appear, the sick are weak scarce able to go, the body wasteth by little and little, and the Fever is lengthened for the most part beyond four∣ty days; they are tormented by the use of purging. But when the cause of these Fevers is hidden, 'tis very hardly to be distin∣guished, and therefore the Hypocondries and other internal parts are to be observed with great diligence, and we are to enquire whether any tumor or pain be to be found there.

But those which arise from the putrefaction of any part are more easily known, nor indeed can the corruption of the part be hidden, unless it be ignoble.

So that Fever which proceeds from corrupt milk or blood is easily known by its signs; as also that which ariseth from crudi∣ty is manifest from their loathing things blowing up and swelling of the Hypocondries.

Although these Fevers in respect of themselves for the most part are not dangerous because they are mild, * 1.11 yet in regard of their causes on which they depend, we ought to doubt whether

they are dangerous or not, as also whether they are long or short; for those which follow an inflammation of any part are short; since that the inflammation it self cannot be long, but the dan∣ger of them depends on the inflammation.

The Febres Lentae are for the most part long, and often con∣tinue more then fourty days. And although not by their vio∣lence yet by their duration they debilitate the strength; they are cured also with difficulty, because their cause pertinaciously inheres in some interal.

Those Fevers are very dangerous and seldom curable which come from the corruption and putrefaction of any part; because the part can seldom be cured.

But those Fevers which proceed from corrupted mill: and blood, worms or crudity, are often acute and dangerous, and bring with them grievous Symptomes, as Epilepsies, Convul∣sions; yet they last not long, neither are they hard to be cured, but the cause being taken away they cease.

The way of cure ought to be aimed at by striking at the cause whereon it depends. * 1.12 If therefore a Symptomatical Fever de∣pend on an inflammation of any part, the cure is to be directed to the inflammation it self, which being cured, the Fever cea∣seth. And therefore most remedies which are convenient to asswage inflammations are here useful. Yet in regard of the part affected, the way of cure sometimes differs, the part affected is diligently to be weighed: Whereof it shall be spoken in the cure of particular affects.

The Febres Lentae since they proceed from extraordinary ob∣structions of the bowels, require opening, attenuating, and deterging medicines. And such are to be chosen as are appro∣priated to each part, and such as strengthen the tone of the inte∣rals, which for the most part is debilitated, yet by intervalls gentle purgation may be used. Neither are Diureticks to be o∣mitted in their season. Externally also if the part affected will bear it, Emollients and Discutients are to be applied.

If the Symptomatical Fever proceed from the corruption and putrefaction of any part, that cure is to be instituted which a∣greeth to Ulcers and Fistulaes of the internal parts.

If it be occasioned by corrupt milk or blood, Worms, or crude and corrupt meats we are to endeavour that those causes be taken away conveniently, either by vomit or cleansing and evacuating medicines, and together to resist putrefaction and fevourish heat.

In the cure of accompanied Fevers, we are to look no less to

the Fever then that conjunct disease or companion, and the me∣tion of nature is not to be impeded, * 1.13 least the peccant humour retained in the body should cause more danger; and therefore although it be not profitable to hinder an inflammation when 'tis beginning: Yet the humour that is the cause or that evil is also to be evacuated, which is most conveniently done for the most part by breathing of a vein, which together affords evacua∣tion and revulsion. Yet it shall be profitable also to empty the firft passages, since that oftentimes the matter is gather'd toge∣ther in them; and since the matter for the most part is thin, and often makes toward the extremties of the body, and is often full of malignity, 'tis conveniently expelled by sweat.

Notes

• * 1.1

  Symptoma∣tical Fe∣vers.
• * 1.2

  Differen∣ces.
• * 1.3

  Fevers ac∣companied.
• * 1.4

  Erysipelas or Rose.
• * 1.5

  Differen∣ces of Fe∣vers.
• * 1.6

  Phlegmo∣nides. Typhodes. Lipyriae.
• * 1.7

  Febre∣lentae.
• * 1.8

  Fevers from pu∣trefaction of interals.
• * 1.9

  From cor∣rupt milk. Putrified blood, Worms.
• * 1.10

  Diagn••∣stick signs:
• * 1.11

  The Pro∣gnostick.
• * 1.12

  The Cure.
• * 1.13

  The cure of accom∣panied Fe∣vers.