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. XX. Of an Intermitting Quartan.

THe third sort of intermitting Fevers which ariseth from a Melancholy humour putrifying in the meseraick veins, * 1.1 and seizeth on the fourth day also, whence it is called a Quartan.

The proximate cause of a Quartan Fever is a melancholy humour collected in the meseraick veins about the spleen and ad∣jacent Bowels, * 1.2 and there putrifying, and that somtimes natural by its own nature cold and dry, and somtimes it participates with some adustion; But the more remote causes are, all those things which conduce to the generation of black and melancholy hu∣mours, namely meats and drinks apt to generate this humour; amongst the which is vinegar, of the which Hypocrates 3. vich.

rat. in acut. t. 38. writeth, it attenuateth melancholy humours, raiseth them, and frames many visions in the mind: For Vine∣gar is a Leader or stirrer of Melancholy. The time is princi∣pally in Autumn, especially if a hot Summer have preceded.

This Fever is known by its quartane circuit, * 1.3 and signs of melancholy abounding in the body, and it invadeth with a cer∣tain unequal disturbance of the body, the which a cold shaking fit followeth, which at the first is little, or at leastwise instead thereof there is at the first refrigeration and horrour, in the pro∣gress of the disease the cold paroxism is alwaies greater, and at length most vehement with pain, causing the bones to knock to∣gether. The heat is kindled by degrees, neither is it burning, but somwhat milde. The pulse is thin and slow, and although in the vigour of the paroxism it become swift and frequent, yet in comparison of Tertians it is thin and slow. The Urines at first are thin and white, but in the progress of time higher co∣loured and thicker. Sweats in the beginning are not frequent, but in the progress of the disease plentiful.

And thus things are in a pure quartan, but in a bastard one tokens of some humour mixed do appear, and heat, thirst, watch∣ings, and other symptomes are more grievous.

This Fever continueth the longest of all other, * 1.4 and oftentimes is not only extended to some moneths, but years; and if it be not gone by the next solstice or aequinectial, after it was first ta∣ken, it lasteth for the most part till the next after, and for the most part goes away in the Spring. 'Tis safe and without dan∣ger, if it be legitimate, and without any disease of any of the bowels: But that which is joyned with black choler is more dan∣gerous, as also that which is with some grievous distemper of some of the intrals, and casteth the sick into a dropsie, the scurvie, or a consumption.

As concerning the cure, * 1.5 if this Fever proceed from a pure me∣lancholy humour, that since 'tis cold, dry, thick, 'tis to be moist∣ned and attenuated, or if it be also adust, it is in some measure to be cooled, afterwards to be purged with convenient medi∣cines.

The causes generating are to be removed, and in case other humours are mixed, regard must be had of them. The Fever it self indicates cooling and moistning; yet regard of the strength must be had, least by the duration of the disease that be impair∣ed, as also of the stomack, spleen, and liver, least they are of∣fended.

This Fever is to be handled gentl•• at the first, * 1.6 neither are

strong medicines to be used at the beginning of cure, sithence the melancholy humour may be exasperated by the use of them, and out of a simple Quartan, a double or treble may easily be raised, Galen 1. * 1.7 ad Glauc. cap. 11. yet there is least danger in Vomits.

The first passages of the Body therefore are first to be evacuated with clisters, lenitive medicines, and vomits also; afterwards in case blood abound therewith, a vein is to be opened; and in case it issue forth black and thick, the greater quantity is to be taken, that by this means both the plenty of blood may be diminished, and that part of the melancholy humour which is poured out in∣to the vena cava may be evacuated; but if the blood coming forth appear to be thin and yellow, 'tis forthwith to be stopped: And indeed where there is store of blood (the first passages being cleansed) a vein may be opened; but if this Fever begin with∣out store of blood, a vein is not to be breathed presently at the beginning, but when some of the peccant humour is drawn into the veins, and mingled with the blood: The Basilick or median vein either may be opened, most commend the opening of the Salvatella; yet they have not as yet rendered any sufficient rea∣son why that should be preferred before others.

The blood being evacuated, the peccant matter must be prepa∣red and concocted, * 1.8 and likewise that disposition of the body to generate vitious humours is to be corrected: And indeed, in case a Quartan Fever proceed only from natural melancholy, moist∣ning things are to be first used, but heating things should be more moderate; but if adust humours are mixed, there will be use of things moderately cooling, but in the progress of the disease, there will be need of cutting and attenuating medicines: If the pituitous humour be mixed therewith, in the beginning there will be need also of attenuating and cutting things, and it may be more safe to heat a little: Hence are to be administred, Bur∣rage, Bugloss, Violets, Maidenhair, Cichory, Fumitory, Cete∣rach, Hearts-tongue, Germander, Ground-pine, Carduus Bene∣dictus, the Roots of Marsh-mallows, Licoras, Chichory, the opening roots, Polipody, Gentian, Fern, the barks of Tamarisk, Capparum, Roots of Walnut Trees, Flowers and seed of Broom, of the Vine, Ash, Citron, juice of Apples, and compounds of these, and somtimes this or that may be chosen or mixed accor∣ding as the nature of the peccant humour requireth.

The concoction and evacuation of the matter must be by in∣tervals repealed, * 1.9 and when the matter is in some measure prepa∣red, purging medicines are to be prepared of Polipody, Epithy∣num, leaves of Senna, roots of Jalop, black Hellebore, lapidis

Lazuli, and compounds of these Syrup of Apples, Regis Sapor, Electuary called Diacatholicon, Confection of Hameck, with the compound powder of Senna and Diasenna, Tartarious pills, or pills evacuating melancholy of lapis Lazuli, Armoniack, be∣ginning with the more milde or gentle ones.

A Vomit also is convenient, by which oftentimes pertinaci∣ous Quartans are cured: So Galen of Treacle ad Pisonem, cap. * 1.10 15. the day before the fit, after Supper he gives a vomit, the next day after early, the juice or dilution of Wormwood, and two hours before the paroxism, Treacle; the gentler Vomits are of the decoction of Dill and Radish with Oxymel; the stronger are Asarabecca, and Gratiola, or Hedge-hysop; The strongest were made by the Ancients of black Hellebore; at this day such medi∣cines are made of Antimony.

If the Hemorrhodes can be opened, * 1.11 there will be much good expected thereby; seeing that the flowing of these, preserves and frees a man from many diseases arising from adust and melancho∣ly humours. The opening and preparing things before menti∣oned, may also cause Urine.

Moreover, * 1.12 for the discussing the reliques of the matter after purging, and that the matter is concocted, sudorifiques are to be exhibited an hour or two before the paroxism. Galen hath two medicines in use for this purpose; the one ex succo Cyraniaco, and Treacle, which is also in use at this day. 'Tis profitable to use the use of Gentian, Carduus benedictus, Antidotus Saxoni∣ca so called, and such like.

To these belong those medicines also which may help by a cer∣tain propriety, or hidden quality, * 1.13 whereof notwithstanding a rea∣son may be given for the most part; to wit, such as may dis∣cuss and consume the reliques of the humour, and strengthen the bowels: such are the juice of Wormwood, Vervain, Roots of Masterwort, Plantane. Others also commend other medicines, which for the most part provoke sweat likewise, and may safely be exhibited in due season.

But Opiates, and such like, * 1.14 which only have power to check the fit, are not alwaies safely to be administred, because they on∣ly stupifie the expulsive faculty, and dull it, and prohibite the endeavours of nature, and hinder the motion of the matter, and the humours offending being detained in the body, may cause other evils. Fruthermore above the wrists, and where the pul∣ses beat, may be applied those things which we have mentioned before amongst the Tertians.

In the mean time we should alwaies be careful of the interal••,

and endeavour that they may be strengthned, and that the spleen may not be obstructed, swell, or become scirrous and hardned, which often useth to come to pass.

Amongst other symptomes, * 1.15 for the most part cold shaking fits are most troublesome of the patient, which may be mitigated by the giving of Treacle or Mithridate before the paroxism, and a∣nointing of the spine of the back with oyl of Camomil, Dill, Costus, Rue, Pepper, Bayes, with Treacle and Mithridate.

Also there should be applied to those parts that principally che∣rish the Fever, * 1.16 and which are especially troubled with pain during the time of the fit, plaisters, somentations, and unguents, espe∣cially to the spleen, and those to be made of Marsh mallows, Ta∣marisk, Broom, Dill, Camomil, Armoniack, Bdellium.

As concerning diet, it should be meat of good concoction, and easie digestion, and no ways apt to generate melancholy hu∣mours, but rather such as may hinder the increase of them. The meat therefore should be moistning and heating in melancholy, and if an adust humour be mixed therewith, it should be som∣what cooling, yet so, that it may not be destitute or power and and force to attenuate that which is thick; the meats also mixed with Burrage, Bugloss, Fennel, Parsly, Capers, Cinamon, Saffron, and such like. Meats affording thick and viscous juices must wholly be refrained. If a Quartan arise of it self without any preceding disease, at first a little thinner diet is proper, then diet somwhat thicker is to be used, and at last towards the height, a little thinner is to be again administred: But if a Quartan suc∣ceed another disease, at first diet a little thicker is to be taken, and afterwards by degrees towards the height, somwhat to be detract∣ed from that: And in case the sick will endure it, let him fast that day his fit cometh, or at least six hours before the paroxism, let him eat nothing, according to Hypocrat. 1. Aphor. 11. and 19. For meats then given, afford not any nourishment to the body, but to the disease: And many Quartans, as also Terti∣ans are prolonged, not by their own nature, but by errors in diet, especially because the sick either in the fit, or newly before it comes, do not abstain from meat and drink.

Their drink should be white wine, thin, mature, and not au∣stere, or Beer that hath worked well, and is not flatulent; and the wine and beer may be mixed with herbs good against the me∣lancholy humour above-named.

Fevers which have longer periods, * 1.17 and return on the fifth or seventh day, or afterwards, since they all proceed from a melan∣choly humour, or melancholy declining into a black and adust

humour, or have a black humour mixed, as is manifest from the ••••••ation, and other symptomes, there is also the same reason of curing them as of Quartans: yet what the nature of the humour is, ought diligently to be observed.

Notes

• * 1.1

  A Quar∣tan.
• * 1.2

  The cause
• * 1.3

  Signs,
• * 1.4

  Progno∣sticks.
• * 1.5

  Indicati∣ons
• * 1.6

  Cure
• * 1.7

  Opening a vein.
• * 1.8

  Preparers.
• * 1.9

  Purging Medicines
• * 1.10

  Vomits
• * 1.11

  Hemor∣rhodes.
• * 1.12

  Sudori∣ficks.
• * 1.13

  Appropri∣ated medi∣cines.
• * 1.14

  Hindring the fits.
• * 1.15

  Mitigati∣of cold fits.
• * 1.16

  Topical things.
• * 1.17

  Quintan Fevers.