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. XXI. Of Compound Fevers, and Semi-Tertians.

BEsides these simple Fevers hitherto mentioned, * 1.1 there are yet Compound Fevers, which is, when one Fever is complicate with another. They are divided into confused and expli∣cite.

They are commonly called confused, * 1.2 when two Fevers begin and end at the same time, so that they can scarcely be discerned; namely, when several humours confused amongst themselves, pu∣trifie in the same place, and each or every of them preserves its own proper nature; which nevertheless how it might be done, scarce seems possible: * 1.3 But implicite are those that are so joyned together, as that the nature and symptomes of either of them se∣verally and peculiarly may be known.

That complication happens many ways; for first, a non-putred is joyned with a putred, as a hectick with a putred; moreover a putred with a putred, and that several ways; for first, continued are mixed with continued, and intermittent with intermittent; and that either of the same sort, whence there are double Terti∣ans, double and treble Quartans; or different, but that is rarer, as a Tertian intermitting with a Quotidian intermitting, and a Tertian intermitting with a Quartan intermitting, continued Tertians with intermitting, when a Tertian intermitting with continued Quotidian, or an intermitting Quotidian with a con∣tinued Tertian is mixed, which Fevers are called Semi-Ter∣tians.

There are three ways of composition of Fevers, * 1.4 and three dif∣ferences of compounded Fevers; Subintrante, Coalternate, and Communicant.

Subintrante are, when the fit of the one Fever begins before the termination of the other: Coalternate, when one paroxism being-ended, by and by after a short interval, another begins a Communicant are such whereof the paroxisme of the one doth begin forthwith after the end of the other, there being no in∣terval.

Compound Fevers are known by the signs of simple Fevers,

and principally by the returns of cold tremblings and shakings af∣ter rest; * 1.5 and in case a cold fit happens, and sweat do not follow afterwards, or that one sweat happen after many fits. The pulse also if in a continued Fever it be often contracted, motion of new matter, and of a new paroxism, and so 'tis a token of a compound Fever.

But these Fevers are for the most part more dangerous then others, * 1.6 since that they more afflict the patient then simple, and a set time for their paroxisms is for the most part wanting, and especially in case the compound Fevers consist of several humours, and they are more difficult to be cured, seeing those things that are accommodated to one humour, are not fit for another.

But their cure depends on the manner of cure of their simples, * 1.7 and to every humour and Fever that is kindled, thereby are to be exhibited their opposite remedies.

But that we may say somthing of compound Fevers, we will add somwhat concerning a double and treble Tertian and Quar∣tian, and likewise of a Semitertian

A double or triple Tertian is caused by choler putrifying in two or three places in the meseraick veins; * 1.8 and indeed, if choler putrifie in two places, a double Tertian is made, which afflicteth either every day once, or in one day twice, that the next day af∣ter the sick may be free from the fit: * 1.9 But in case it putrifie in three places, a treble Tertian ariseth, which in the space of two days afflicts thrice, one day once, the other day twice. Nay cho∣ler may putrifie in four or five places, and more, and so many, or such Tertians then will ensue.

A double Quotidian is caused by Flegme putrifying in two places, * 1.10 and invadeth the sick twice in the space of four and twenty hours.

A double Quartan is caused by a melancholy humour putri∣fying in two places; * 1.11 and those that are troubled therewith, are one day free from a Fever, and the two next are troubled with it. But such as are troubled with a treble Quartan, are Feverish eve∣ry day; Nay, 'tis not impossible but that those that are trou∣bled with a compound Quartan, should be affected twice in one day.

And indeed a double Tertian is often such from the beginning, * 1.12 but a double or triple Quartan for the most part from the untime∣ly use of medicines, especially of hot sodorifiques, 'tis become such, because the crude matter is only stirred up, but not discussed, but dispersed over more parts.

* 1.13 A compound Tertian and Quartan is cured as other Tertians

and Quartans are: yet this is to be taken notice of, that the meats or medicines may be used at fit times in regard of the pa∣roxisme.

As for a Semitertian which by the Greeks is called a Semiter∣tian fire, 'tis compounded of a Tertian and a Quotidian, * 1.14 the one continued, the other intermittent, and indeed principally of an intermitting Tertian, and continued Quotidian, and hath its continuity from Flegm, its hoirour from intermitting, as commonly 'tis taught; whence these are also called horrid Fe∣vers. But although I should not deny that humours putrifie to∣gether in the vena cava, and the meseraick veins, and that from thence there may arise complicate Fevers, which have various exacerbations and mutations in their symptomes; yet it seems not absurd to call those Fevers also Semitertians, which by their nature are indeed intermitting Tertians, yet when 'tis joyned with an inflammation of any Intral, a symptomatical continu∣ed Fever is stirred up; for when the Feverish part of the matter is thrust out with the blood into the Guts, Stomack, Liver, and parts adjacent, an inflammation is caused, and thence a conti∣nued symptomatical Fever, which being complicate with an in∣termitting Tertian, constitutes a Semitertian, which in respect of the intermitting Fever is horrid, in regard of the sympto∣matical continued. That which Physitians observations teach us, by whom 'tis found out, by the dissected bodies of such as have died in Semitertians, that there are inflammations about the hollow parts of the Liver, as also in the Stomack, Guts, Mesentery, Kell or Cawl, Spleen; Whence 'tis easie to give a reason of a trembling or shaking fit in this Fever; for it happens somtimes ordinately, according to the nature of the intermit∣tent Fever; somtimes inordinately, when the inflammation seizeth on some new part, or when quitture or purulent matter is made; according to Hippocrates, 2. Aphorism. 4.7. Som∣times malignity happens to be joyned with these Fevers, and then for the most part they are popular, and there are many affected therewith.

This Fever is known, * 1.15 and if it be according as it is common∣ly described, compounded of a continued Quotidian, and an intermitting Tertian, by the signs of each Fever; for a conti∣nued Fever on the one humour, daylie brings a paroxism, but the other every third day, and so in one day there will be two fits, in the other but one. See Galen. 2. de diff. Febr. cap. 7. But if it proceed from an inflammation of any Intral adjoyned, signs of an inflammation are present, and together therewith

the intermittent Fever keeps it likeness; malignity, if it be pre∣sent, * 1.16 is known by its signs.

This Fever is altogether dangerous, both in regard of its con∣tinuity, and of its symptomes, as also of its inflammation or malignity.

The cure thereof depends either on the cure of an intermitting Tertian, * 1.17 or a continued Quotidian, or on the cure of a single or double intermitting Fever, and of an inflammation of In∣trals.

Notes

• * 1.1

  Fevers compound∣ed.
• * 1.2

  Confused
• * 1.3

  Implicite
• * 1.4

  Three ways of composi∣tion of Fevers.
• * 1.5

  Signs of compound Fevers.
• * 1.6

  Progno∣sticks.
• * 1.7

  Cure
• * 1.8

  A double Tertian.
• * 1.9

  A treble Tertian.
• * 1.10

  A double Quotidi∣an.
• * 1.11

  A double Quartan
• * 1.12

  A treble Quartan
• * 1.13

  Cure
• * 1.14

  Semiterti∣an.
• * 1.15

  Signs:
• * 1.16

  Progne∣sticks.
• * 1.17

  Cure.