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. XVII. Of intermitting Fevers in general.

AFter continued Fevers, intermitting are to be explained. * 1.1 But although the Ancients did extend the name of inter∣mitting Fevers more largely, and attributed the same to all Fevers which admit of some change of heat, and are some∣times exasperated, sometimes remitted, and so to continued periodicks: yet afterwards use brought it to pass that those Fe∣vers only were called intermittent, which sometimes cease and come to that apurexy or want of fire.

The proximate cause of an intermitting Fever is a putred va∣pour, * 1.2 elevated from the putrefaction of excrementitious hu∣mours, not continually as in continued Fevers, but by certain intervalls sent to the heart, and heating the same contrary to na∣ture.

But how it comes to pass, * 1.3 that the putred vapour is not conti∣nually sent to the heart but at certain times is very obscure. For the explanation whereof since the knowledge of the place wherein putrefaction ariseth, doth not a little conduce, and whence the putred vapours are communicated to the heart, which Galen calls the Furnace and Chimney in his 2. of the differences of Fevers, cap. the last, and in his 15. of the method of curing. cap. the fourth, that therefore is first to be explained. But since 'tis beyond the bounds of our Breviary of Institutions to reckon up the various and different opinions of Physicians concerning it, we will here set down that opinion which we think truest. The Chimney or Furnace and place wherein the matter the cause of intermitting Fevers is generated, are the Mesaraick

veins, wherein the matter which sufficeth to irritate each single Paroxism, is generated during the time of its interval. And that many things which happen about intermitting Fevers do prove; namely Loathing, Vomitting, Dolor of the heart, Extension and pain of the Midriffe, Intumescence about the Ventricle, Bitterness about the mouth, Belching, and such like; for in the beginning of intermitting Fevers pure choller is often ejected by vomit in great abundance, which out of the more remote veins could not be evacuated in that manner, and about the cava of the Liver. Fernelius says he hath found the quantity of a pound by weight after the death of a Patient.

This choler being cast out the Fever is often cured, which is a sign that it is the cause of the Fever, and that it is collected in those first ways or passages. Which Fomentations also used to the Hypocondries at the beginning of a Paroxysm shews by the mitigation of the trembling and shaking.

This matter is gather'd together in the Mesaraick veins a long time before it brings forth a Fever, but when it begins to putre∣fie, grow hot, and be changed, its heat being diffused over the whole body it exciteth a Fever; which when it is dispersed, the fevourish heat and Paroxism ceaseth, and the Fever leaveth so long as till new matter which in like manner putrifieth in its due time, is generated.

But although the matter which is the cause of intermitting Fevers be generated in the Mesaraick veins and first passages: * 1.4 Yet the whole doth not reside and continue included in them, but is sent to the vena cava and arteries, both during the fit and out of the same. Nor is it here necessary to seek for occult and blind passages, through which the putred vapours should be sent to the heart during the Paroxism, since there are manifest passages enough; for the branches of the Gate-vein are inserted into the substance of the Liver, and the mouths of these have communion with the vena cava, and the arteries going from the heart are joyned in the stomack, guts, spleen and other parts to the Mesaraick veins. Yet 'tis probable that the fevourish mat∣ter may be communicated to the veins not principally and only in the Paroxism, but moreover some part thereof by that pas∣sage which is from the Meseraick veins to the Liver continually may be carried to them; whence both by Galen. 1. de cris. cap. 7. and other Physicians a Fever is called a passion of a venemous nature. And that is first manifest from the urines, which shew evident notes of crudity and concoction in Intermittents. Hence also it comes to pass that urines during the Paroxisms are lauda∣ble

and like to theirs who are well, since that the peccant humor is then protruded by nature out of the veins towards the circum∣ference of the body, and so the blood in the veins is become pu∣rer, which again in the intervals of fits is polluted by the vitious humour proceeding from the chimney of the Fever. The same is manifest out of those things which happen at the beginning of a fit, and at that time which the Greeks call Episemasian; for then spontaneous lassitudes, stretching, compression of pulses, and other things happen which indicate that the matter which is to stir the Fever begins to be moved and as it were to swell in those common vessels, veins and arteries.

That vitious humour accumulated partly in the Mesaraick veins, partly in the vena cava when in time it putrifieth, nature stimulated and irritated oftentimes strives several ways, first by vomit and stool, afterwards by sweats and urine sensibly to eva∣cuate the same, as also through the pores of the skin, and by in∣sensible transpiration it may discuss the same being resolved into vapours and steam. For since that peccant humour is not exact∣ly mingled with the blood but confusedly, nature may easily se∣perate the same from the good blood, and may shake it off each single fit; which being discussed, since putred vapours cannot any more be communicated to the heart, the Fever also ceaseth and apurexie ensueth.

But because that as long as the Fever continueth some seeds and sparks are left in the granary and chimney, * 1.5 and seeing that there is imbecillity in the part, 'tis necessary that the humour flowing to it, although it be good, should be defiled with that pollution and excrement which was left as it were with leaven, and through the debility of the part be corrupted, and so new matter of a future Paroxism be generated. And these fits conti∣nue, and so often return, until that those seeds, that putrefacti∣on, and those sparks are fully taken away from thence, and the weakness of that part restored. Yet it seems probable that the whole matter which is the cause of a Fever doth not putrifie to∣gether in the first Paroxism, but that part which is apt to putre∣faction, in the other fits the rest, until the whole be putrified and consumed.

By these things it is manifest both where the matter that is the cause of putred Fevers is generated, * 1.6 how it causeth a fit, by what ways it is evacuated, and how the matter which is the cause of a new Paroxism is generated, and so the cause of Paroxisms and the recourse of intermitting Fevers is explained. But what the reason is why these Fevers return at set times, some sooner, some

later, is now another question, and that most intricate, which is easier to ask then answer? But that we may here forbear to re∣cite the opinions of others, which are very many, we will men∣tion only that which seems most probable to us, so far as in this humane dimness of our understanding in so obscure a business we are able to discover. And first, that Fevers keep such certain periods, experience doth manifest; whereby it appeareth, that some Fevers return the third, some the fourth day, and that oftentimes it observes not only the same hour, but minute of in∣vasion although the fits may somtimes anticipate, somtimes re∣tard for certain reasons. But the cause why paroxisms return at certain times, we conceive is to be sought from the diversity of humours: For those effects, as Valleriola saith, in any one sort of things, which perpetually agree to the things, and are made in the like manner, into what body, and at what time soever they happen to come, these are to be referred to the proper substance of that of the which they are made; but to make return through certain days, and to irritate accessions, both agrees perpetually to humors and the recourses in this manner, alwaies at equal in∣tervals (unless a perverting of the order of periods happen from else-where) are made: Therefore it shall be from such or such a nature of humours that the recourse shall be made in the same sort; namely, the causes of periods and intermitting Fevers, are excrementitious humours. Choler, Melancholy; Flegme; and those Fevers which return the third day, proceed from a Chole∣rick humour; those on the fourth from Melancholy; those that come every day, so that they are not double Tertians, proceed from Flegme.

Yet the cause of periods cannot be drawn simply from hu∣mours, but as they acquire a peculiar quality from putrefaction or corruption, by reason whereof at a certain time, they wax hot and begin to be moved. For sithence this effect is definite and determinate, which carries it self alike in all individuals, 'tis necessary that it have a certain definite and determinate cause in all individuals that are alike; which since that neither dispo∣sition of parts, nor quantity of humours (for we see that although the store of matter decreaseth, and the fits are become shorter, nevertheless they do return at their usual time) nor manifest quality of humour, thickness, viscidity, tenuity, or some such like, which useth to vary, can be a quality; we must needs fly to a peculiar and proper quality and nature of a humour; which also when it is changed, the form of the Fever it self is changed; for when Choler is turned into Melancholy, the Fe∣ver

which used to come the third day, cometh on the fourth; and this quality also may afterwards remain in the humour, when the putrefaction ceaseth, and the Fever depending thereon. Whence, as Fornelius in his to of Fevers witnesseth, the tor∣ments of the Cholick, Pains of the Joynts, and such like dis∣eases arising after long continued Tertians and Quartans, do likewise keep certain periods, by reason of that disposition which they have received from the corruption or putrefaction of the humours.

Yet if any one be willing to determine that the said occult pro∣priety is derived, * 1.7 not from corruption only, but that celestial causes do also concur to its generation, I will not much contend with him; for we see that principally about the Solstices and Aequinoctials, such Fevers, especially the most durable of them, do begin and end.

But although Fevers keep certain periods, yet there is a cer∣tain difference in them also; for somtimes the fit returns just at the expected time: somtimes the following paroxisme returns sooner then the former; which form is called proleptick: som∣times the following fit comes later then the former, and that form is called Hysterick; and indeed somtimes through the whole course of the disease, such a form is observed, and often∣times from the beginning of a Fever, until the end of the same the paroxismes anticipate, or come after the expected time: but somtimes in some there is anticipation, in some post pofition, otherwise the fits comes at the same time.

For the most part they say, * 1.8 that anticipation happens when the humours by some error in diet are augmented, or are moved by medicines, anger, exercise, and such like causes. But the fits return flower, when the matter is diminished, or thickned: Which indeed when the accustomary paroxisme is changed, that it may be so, as we do not deny; so when the Fever keeps al∣ways some certain form, either proleptick or hysterick, the cause rather seems to be taken from the diversity of the humour; for although Choler, according to its manner, being corrupted, is the cause of a Tertian, Melancholy of a Quartan; yet Choler and Melancholy, according to the diversity of Bodies and Tem∣peraments, do oftentimes vary somthing; Hence also it happens, that although that putred leaven, or occult quality introduced by choler, be the cause of the circuit of a Tertian, Melancholy being brought in of a Quartan: yet according to the difference of a humour, it may happen so, that the effervescence, or ferven∣cy of humours, may come sooner or later by some hours.

Concerning the longitude or brevity of some Paroxisms that depends on the paucity or plenty of matter, * 1.9 disposition of the humours and body: For a plentiful quantity of humours is the cause of a longer fit then a small; so a thick humour causeth a longer then a thin, since it cannot be so soon discussed as a thin. If the strength of the body be great, which can more easily dis∣cuss what is offensive, then theirs who are weak; the shorter fit followeth: Also a thinner constitution of body, as being more apt for the discussing of the matter, is the cause of a shorter fit; a thicker, of a longer. And when all the causes which occasion a short paroxism concur, a very short fit is raised: But when all those that produce a long are present, the paroxism is extream long. When certain causes are present which make a short fit, and some are wanting of them, an indifferent betwixt both hap∣pens.

And so much of the nature, place, and motion of the proxi∣mate cause, which exciteth intermittent Fevers; * 1.10 But the more remote causes, and those things which conduce to the generation and corruption of that matter in the Meseraick veins, are meat and drink of evil juice, but yeilding matter for peccant humours answering to their own nature; and an ill disposition of stomack, whereof meats turn into choler, or become sour, an intemperate constitution of Ayr; for although divers humours are generated in different bodies naturally, yet if there be great vehemency of manifest causes, even in bodies of different constitutions, they may produce the same humours and diseases depending on them.

As for the difference of intermitting Fevers, * 1.11 they proceed from the diversity of humours; for there are so many sorts of inter∣mitting Fevers, as there are of humours by which they are pro∣duced; for there are according to the vulgar opinion, three sorts of excrementitious humours, Choler, Flegme, and Melancholy, and so three kinds of intermitting Fevers, Bilious, Pituitous, and Melancholy; which differences we usually call a Tertian in∣termittent, a quotidian intermittent, and a quartane intermit∣tent. And in case those humours are sincere, pure Fevers are generated; if they are mixed, spurious. And that Fever which proceeds from pure Choler, is called a pure Tertian, but that which ariseth from yellow Choler mixt with some other humour, is called a Bastard Tertian.

But concerning a quotidian intermittent, * 1.12 the matter is not so plain: For Fernelius accounts this the rarest of all other, and scarce one of them happens amongst six hundred; and that those intermittent Fevers which daylie afflict, for the most part he rather

accounts them double Tertians: But Platerus flatly denies a Quotidian Fever, and wholly agreeth with Galen 8. Meth. med. cap. 5. where he appoints only a twofold crudity; the one ni∣trous, the other acid: and they only seem to afford matter for two sorts of Fevers, Cholerick and Melancholy. For although Flegme also, according to preheminency, and most principally, be called a crude humour; yet since it is exceeding cold, it can scarcely putrifie and excite a Fever.

But whether there are more circuits of Fevers, * 1.13 and whether besides Tertians, Quartans, and if there be any such thing as Quotidians, there are also other Fevers which are extended be∣yond the fifth circuit, is doubtful. Galen saw no such: Never∣theless Hypocrates, and other Physitians, observed Fevers which returned the fifth, sixth, seventh, eighth, ninth day: But what the cause of this course is, is very obscure. Some seek the cause of such fits out of the diverse constitution of Choler and Melan∣choly; and Andreas Caesalpinus Art. Med. lib. 2. cap. 15. re∣fers Quintans to Choler, Septanes to Melancholy; and deter∣mines such flower returns of Fits to be a kind of renewing of one or more simple accessions; and the Quintan to be a kind of Ter∣tian, wherein the third day is without a paroxism; and a Se∣ptan to be a sort of Quartan, renewing the accession of the fourth day. But most derive the reason of these circuits from the vari∣ous mixture of Melancholy humours with others. But although it be probable that all these Fevers, as keeping longer periods, pro∣ceed from a Melancholy humour; yet a mixture of that humour seems not necessary: Because no humour can be appointed to be mixed with a Melancholy, which can be a cause of a slower peri∣od then it self: for those humours, both Cholerick and Melan∣choly, are not alwaies of the same sort; and moreover, the cor∣ruption also which they suffer, is not alwaies the same; so that it is no wonder that the effect also varies, which proceeding from them is not alwaies the same: And as in epidemical diseases, som∣times rare and wonderful corruptions of humours happen, so in Intermittents, that some such thing may likewise happen, is not altogether absurd.

Intermitting Fevers are easily known; * 1.14 for they come to Apu∣rexie, and at certain times; and indeed, as Galen 1. ad Glaucan. cap. 5.2. de crisib. cap. 3. & 2. de diff. Febr. cap. 3. teacheth, they return with shaking, horror, or cold, For although that somtimes Fevers do occur which seem intermittent, and invade without any rigour, trembling, or cold; yet really they are not such, but only slow and obscure continued ones; or in case they

are really intermittent, they are not pure; whose Idea Galen propounds but spurious.

But these Fevers are less dangerous then continued; * 1.15 and sel∣dome, unless the strength be decayed, or in regard of age, or some other cause, or some errour committed in diet, are mor∣tal, sithence it may be convenient during the apurexie to gather strength, and administer necessary medicines.

Concerning the cure of these Fevers in general: * 1.16 Since their cause is collected and generated in the meseraick veins, there pu∣trifies, and thence is diffused over all the body, and at length is discussed by insensible transpiration or sweats: But the cause of the recourse of the Fever, as Galen teacheth, 2. de Febr. cap. the last is a twofold vitious disposition in a body, the one a certain pollution or putrifaction left after the former paroxisme; the other imbecility of the member or part, generating excrementi∣tious humours; what therefore is to be done in each sort of Fe∣ver, easily appears from hence.

For sithence the beginning of generation and corruption of humours producing a Fever, is in the first passages, * 1.17 we are to endeavour to purge out that peccant humour, before it corrupts the rest of the blood, and brings weakness, and a vitious dispo∣sition to the parts; but we must proceed warily in those evacua∣tions, since there is not the same reason of all intermitting Fe∣vers: For when that vitious and excrementious humour, the cause of a Fever, in the meseraicks is mixed with blood, crudity also, and concoction, according to their manner are necessary; whereby the vitious humours may be separated from the good, and rendred fit for evacuation: and that often happens in a short time in Fevers full of Choler, and the cholerick humour is other∣wise apt enough to motion: But in a Quartan the humour is more stubborn, and moreover according to Galen 1. ad Glau. cap. 11. no strong medicine is easily to be admitted at the be∣ginning.

And Sudorifiques are not at all (or altogether) to be used, * 1.18 un∣less evacuations have preceded; for if many vitious and excre∣mentitious humours do hitherto abide in the first ways, it may easily come to pass that by reason of hydroticks untimely exhi∣bited, they may be detruded thence to the more noble parts, and may become the cause of various and grievous evils, and such as may bring more danger then the Fever it self.

As for breathing of a vein, * 1.19 'tis not indicated from the prima∣ry cause of intermitting Fevers, which is generated in the mese∣raick veins, where the greatest part abideth: Yet because that

somtimes blood also abounds, which may easily be corrupted and polluted by the vitious humours, and so if it be too plentiful, cannot be well governed by nature when it is weakned by a Fe∣ver; and in the progress of the disease, from thence some of the peccant matter passeth into the vena cava, and is mixed with the blood, it is somtimes needful to open a vein, which nevertheless is not to be appointed presently in the beginning, before the eva∣cuation of the primary passages.

If the Fever be not cured by these evacuations, we are to en∣deavour that the causes of the returns of fits may be taken away, and moreover two things remain to be done; namely, that that disposition and weakness of the part generating vitious humours, may be taken away, which is performed by altering medicines, which together correct the fault of the humour, and discuss that pollution, and those seeds which were left out of the putrifacti∣on of humours: and indeed that paroxisms depend on that pol∣lution, and that when it is taken away the Fever ceaseth, ap∣peareth from hence, That whilst that is driven by nature to the circumference of the body, out of the veins, and that Pustules are raised about the lips, nose, and other parts of the face, the Fever ceaseth

Wann der Mundt oder die Nase auss schiaget.

But 'tis principally taken away by Sudorifiques; yet there are also certain other medicines known both to Physitians and to the vulgar, * 1.20 which take away feverish fits, and therefore are called Fe∣brilia, Puretagoga, and such as specifically cause, and are called The flight of a Fever, or Febrifuga, which nevertheless cause no sweat, but without doubt some other way take away that seed, and by consequence the paroxism, such as commonly are accoun∣ted the powder of burnt shells of Cockles or Snails or of the Pearl bearing shels, or mother of pearl calcined, of River Crabs, and prin∣cipally their eyes, which are so called prepared, and such like: But how they perform this, is not explained by Authors. That I may speak my own opinion, such like medicines seem by a certain precipitation to take away that force of heating and stirring up a paroxism which is in the humours, to which Opiats seem to be∣long: yet such like cannot be given safely, unless the vitious humours, and those things which may afford the reason of the antecedent cause be first taken away; for otherwise those things which may be expell'd by nature when it is irritated in a paro∣xisme, are left in the body, and afterwards may become the cause of a Chachexie, Dropsie, Jaundies, Cholick pains, and of other gri••vous evils.

Externally also are applied certain medicines to cure intermit∣ting Fevers, of Cobwebs, oyl of Spiders, and certain vesicatories, * 1.21 which without doubt, that which they do, is performed by draw∣ing out, and evacuating of that Feverish corruption and pol∣lution.

Notes

• * 1.1

  Intermit∣ting Fe∣vers.
• * 1.2

  their prox∣imate cause.
• * 1.3

  The fire place of Intermit∣ting Fe∣vers.
• * 1.4

  the cause of inter∣mitting Fevers conteined in the v••∣na cava.
• * 1.5

  Causes of the return of fits.
• * 1.6

  Cause of 〈◊〉〈◊〉.
• * 1.7

  Order of the fits
• * 1.8

  The cause of antici∣pation and coming late.
• * 1.9

  The cause of the length of Fits.
• * 1.10

  The more remote causes of intermit∣ting Fe∣vers.
• * 1.11

  Difference.
• * 1.12

  Of a quoti∣dian, whe∣ther any be.
• * 1.13

  Whether there are Quintan Fevers.
• * 1.14

  Diagno∣stick signs.
• * 1.15

  Progno∣sticks.
• * 1.16

  Indicati∣ons and Cure
• * 1.17

  Purging
• * 1.18

  Sweats
• * 1.19

  Letting blood.
• * 1.20

  Febrifuga.
• * 1.21

  Topical Medicines.