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.

BOOK II. Of Putred Fevers. (Book 2)

CHAP. I. Of Putred Fevers in General.

WHereas there is a two-fold sort of Fevers, whose heat is inherent in the parts according to habi∣tude, whereof the one hath it's rise, and is con∣tinued by the kindling of the Spirits, and thin∣nest parts of the blood, without putred humours, the other hath it's original from vapours and putred humours; of the former kind 'tis already spoken; The next business is that we handle the putred Fevers.

That there are putred Fevers many things shew; * 1.1 For neither is it dissonant from the nature of humours, but that they may putrifie, since that may happen to every mixt body; and we see humours putrifie otherwise in mans body, as it happens in inflamations, wherein quitture is generated, as Galen in the 1 of the differences of Fevers, cap. 6. he compares the putrid∣ness whereby the humours putrifie in the brain, with that, by which Sanies is generated in the humours. And that they do actually putrify, sufficient reasons are given, which hereafter we shall propound, and the matter it self shews that humours do putrifie in the veins. For both blood which cometh forth from breathed veins, and those things which are evacuated by stoo••, Urine, sweat, sufficiently by their smell and otherwise, argue pu∣tridity of humours. And the way of cure proves the same, for 'tis not performed by things that alter, but evacuate humours, which is partly instituted by nature, partly by the Physician. For if humoral Fevers could be made without putrefaction, they might also be cured by altering things only. And indeed such Fevers are not only malignant as some think, but the same signs appear, and the same way of cure is exhibited to intermittent and continued, * 1.2 which are void of all malignity and pestilency.

Aristotlc. 4. Met. c. 1. defineth putrefaction to be the corrup∣tion of the proper and natural heat in every moist body, by rea∣son

of external ambient heat, but by Galen 11 Meth. med. c. 8. without doubt not so much regarding the common and adequate subject of putrefaction, as to mans body, subject to medicinal consideration. It is (says he) a change of the whole substance of the body putrifying to corruption, by reason of extrane∣ous heat; the ultimate end of putrefaction is the dissolution of the parts whereof the mixt body consists, and the corruption of the whole mixture.

That we may here pass by the tedious disputations which are extant amongst Philosophers and Physicians concerning putre∣faction, this is to be taken notice of, * 1.3 that putrefaction in re∣spect of the mixt body putrifying, the one, is according to the whole and perfect, * 1.4 whereby mixt bodies are plainly dissolved in∣to Elements, out of which they are bred: The other is in some part, and imperfect, whereby these which are full of moisture, * 1.5 putrify. For seeing the moisture wherewith it aboundeth can∣not wholly be drawn out, only some parts thereof, especially the thinner are. And such putrefaction, namely, according to parts, agrees to humors also; namely, when some particles of theirs are really corrupted, and they loose their form: Yet the whole hu∣mour must not necessarily loose it's form; thence it continues it's name, and those corrupted parts being evacuated, it returns to its former nature; unless the corruption have so far gone, that mutation is made into another kind. Which putrefaction, is pu∣trefaction indeed, and not alteration only. For although the whole be not corrupted, yet some parts thereof are really cor∣rupted.

Putrefaction in a body is caused by extraneous heat, * 1.6 and when the humours are no longer governed by the natural heat, but are destitute thereof, they are corrupted. Therefore all things whatsoever which may be an occasion to hinder the innate heat, so that it cannot in its due manner govern the humours, may be said to be the cause of putrefaction of the humours.

Putrefaction of humours though oftentimes it be caused by obstruction, and bowels, and prohibiting of free transpiration, since that, as Galen. 11. Meth. med. c. ••. writeth, things hot and moist, in a hot and moist place not being fanned and cooled by wine easily putrifie: Yet putrefaction may be occasioned with∣out this, by the meeting with putred things, and other causes, which debilitate the native heat, and bring in an extraneous heat.

First, certain humours by reason of some internal defect, * 1.7 of heir own accord tend to putrefaction, or at least are casily over∣come

come by small causes of putrefaction, and having gotten the least occasion fall into putrefaction: Such vice humours contract first from bad meats, of the which they are generated, whether they are such by nature, or any other wayes corrupted: More∣over by meats which are easily corrupted, such are fruits rare∣ripe. Thirdly, from the ill dressing of meats, or ill concoction, or when they are taken in excess, or at unseasonable hours, or after a preposterous manner. Fourthly, by the default of the parts appointed for concoction, by reason whereof even the best aliment may be corrupted. Lastly by reason of other causes which either impede concoction, or retain execrements, as also the preposterous use of the six Non-naturals. Therefore by how much the more of such humours are cumulated in the body, by so much the more easily they putrify. For nature doth not defend excrementitious humours so carefully as those which are fit to nourish the body; whence they are easily corrupted and putrify. Blood also out of the veins, being out of it's natural place, and of a hot and moist nature easily is corrupted. But al∣though such humours turn to putrefaction of their own accord, and being in a hot and moist place; yet it happens sooner if any other cause be added. Nay good humours also in a sound body if they are the cause in p••sse of putrefaction may become putted.

Amongst all these causes the first and chiefest is the hinderance of transpiration and ventilation, * 1.8 whether it happen by straitnes of the pores of the skin, or by obstruction of vessels & passages in the more inward parts of the body. For hot and moist things in a hot place unless they are ventilated, easily putrify. Narrowness of pores is occasioned either by constriction from cold, or astrin∣gent things, or driness, as staying under the Sun-beams; or by Obstructions, which either plenty or vicosity, or thickness of humours brings forth. Moreover the internal passages are stopped, either through store of blood over-flowing in the body, or plenty of it contracted up and down in many parts, or by the thickness and viscousness of humours.

Secondly, * 1.9 those things cause putrefaction, which can kindle preter-natural heat in humours, and call out the native heat; in which number is the Fever Ephemera, which for this cause is often changed into a putred in hot and moist bodies: Moreover the other causes heating, as hot air, a hot bath, too much ex∣ercise of body and mind * 1.10

Lastly, the meeting with putred things, seeing that which is touched by what is putred, is defiled and putrifieth

From all which it is manifest, that a putred Fever is short,

having it's rise from hot vapours stirr'd up by putred humours, and heating the heart, and thence the whole body against nature.

CHAP. II. Of the differences of putred Fevers.

ALthough there are many differences of Fevers, neverthe∣less those which are necessary to be known for the perfor∣mance of their cure, * 1.11 are taken either from the matter pu∣trifying, or the place putrified.

For first either solid parts putrify, or humours, or even the Spirits themselves; concerning which it is controverted as in it's own place shall be shewn. Humours that putrify are as well na∣tural as preter-natural: And those of every kind, blood, Phlegm, choller, melancholy; which both the variety of those things which are evacuated by stool, vomit and sweats, and the diffe∣rence of Symptomes which happen in Fevers doth shew, moreo∣ver the diversity of causes which went before it, whereof some generate this, some that humour, and moreover some afford matter for this, other for that humour. And the humours ei∣ther simply putrify, or a malignant venemous quality and conta∣gion is joyned with it. Furthermore the place wherein the hu∣mours putrefie is not alwayes the same; For sometimes the hu∣mours putrefie within the veins and arteries, sometimes without them. And that putrefaction which is within the vessels, is either equally in all the vessels, or in the greatest, or in certain parts of a vein.

Whence these differences of Fevers do arise. First, some Fe∣vers are simply putred, without any malignity or contagion, o∣thers malignant, postilent, contagious. Moreover some Fevers are continual, others intermittent, according as the putred va∣pour which is the cause containing of putred Fevers, or heat stir∣red up by putred humours either continually heats the heart, and from thence is diffused over all the body, or by certain inter∣valls.

Of either of which kinds of Fevers there are again many diffe∣rences; For either the putrefaction is kindled in the common vessels, and not in private passages, whence arise continued Fo∣vers, called Primary: Or the putredity comes by the inflam∣mation of some peculiar part, and from thence putred vapours are continually communicated to the heart, which Fevers are called Symptomatical.

Primary continued again are two-fold, for some have no aug∣mentation,

nor remission, which they call Fevers containing, or fiery Synochaes.

Others are continued, yet there is some increase of heat, and sometimes remisness, which are called Synochaes, and by the ge∣neral name of continual Fevers.

The continual for the time of their increase and decrease of heat, some are called tertian, others quotidian, others quartan, according as the heat is exasperated, dayly, each other day, or the fourth day likewise.

Intermitting also according to the time of their invading, some are called, tertian, others quotidian, others quartan. Nay it is observed that there are Fevers that have a longer distance between the Paroxismes.

CHAP. III. Of the signes of putred Fovers in general.

APutred Fever is known. * 1.12 1. From it's heat, which is more gnawing and acrid, then of any other Fever, and that in the increase and state. For in the beginning of fits, the heat doth not at the first touch of the Pulse discover it's acrimony, but if the hand be continued longer it may be percei∣ved, which proceeds from fuliginous vapours which exhale out of putred humours. 2. Because it begins without any manifest cause. Which indeed is a proper sign, but not an inseparable one, for as often as any Fever is kindled without any manifest cause, you may well determine it to be a putred Fever: Yet sometimes humours are so disposed to putrefaction, that upon any light occasion they'l become putred. 3. Urines in putred Fevers ei∣ther are crude or else at least afford but obscure notes of concocti∣on, unless an Ephemeral be degenerated into a putred Fever, o∣therwise there is no putred Fever wherein the Urine in the begin∣ning doth not appear crude or obscurely concocted. 4. The pulse is more changed then in other Fevers. 5. Putred Fevers begin with a cold shaking. Which is a proper, but not an inse∣parable sign. 'Tis a proper sign because neither Diaries nor Hecticks do ever begin with cold shaking; yet it is not insepera∣ble, because all putred Fevers do not begin with a cold fit, as a putred Synocha. 6. It is the property of putred Fevers to return by fits and Paroxismes; and no other Fever hath fits. Yet this is not an inseperable sign, because it doth not agree with all pu∣tred Fevers. 7. Lastly, if any sign be present which is proper to any sort of putred Fevers, 'tis a sign it may admit of the ge∣neral appellation of a putred Fever.

Concerning the event of putred Fevers in general not much can be spoken, * 1.13 since there is great variety and difference of pu∣tred Fevers, and the event various: Only this, that the event is best to be known by comparing the magnitude of the disease with the strength of the Patient; For if the patient be very strong, there is much hope of a good end of it, if the party be weak, there is great danger.

CHAP. IV. Of the cure of putred Fevers in general.

NOw seeing a putred Fever is cherished by the cause con∣taining, * 1.14 Indications in putred Fevers are taken some from the Fever it self, others from the cause thereof. Nor indeed ought vital indications to be neglected. First, a Fever as it is a Fever, indicates cooling things; Moreover as that heat of the whole depends on a hot putred vapour, as on the cause containing, the removal of that is also indicated; but because putred vapours depend on putred matter, they cannot be removed, unless the matter putrified be taken away; putrefaction cannot be taken away except its cause be removed, as we said before. First, all evident causes which are present are to be removed; the antecedent causes and whatsoever is in the body, either of su∣perfluous blood or peccant humours, they are to be prepared. and if occasion require, to be evacuated, streightness of passages if it be external or interal in the bowels, they are to be opened and free ventilation and respiration for the humours is to be pro∣cured, Putrefaction is to be resisted, and the putred humours are to be cooled and dryed; the generation of peccant humours, by ablation of their cause is to be prevented. Yet nevertheless seeing that these indications are often contrary, and that those medicines which are administred for the cause, may make the Fever worse, and the contrary. We must be careful how to perform these intentions. And for the most part, since the Fever comes last, the cause is to be taken away first, since the cause hath more power then the disease, and the cause of a putred Fever be∣ing taken away, the Fever of necessity ceaseth.

Yet if the greatness of the Fever inforce, 'tis necessary to have regard of the Fever first; and afterwards to the taking away of the cause; or certainly if we may first go to the taking away of the cause, we should be very careful that by those things by which we take away the cause, we increase not the Fever. But those

things are never to be used for the cure of the Fever, which in∣creaseth its cause, fince that for the most pare that is of greatest force.

CHAP. V. Of breathing of a vein.

NOw for the cure to be performed by these intentions, * 1.15 and first concerning Phlebotomy. Galen 11. meth. medendi. cap. 15. gives this rule. It is most wholesome he sayes in all Fevers to open a vein, not only in continued, but also in all others which the putrifying humour stirreth up, * 1.16 especially when neither age nor want of strength prohibites it. And he addeth this reason; For nature which rules our bodies being enlighthed, and unburthened of that by which as with a pack it was oppressed, what remains, it will overcome without difficulty, and therefore not being forgetful of its proper office, will both concoct what can be concocted, and cast out what may be emitted. Yet this precept of Galen is to be rightly understood and explained. For although there are many occasions for opening a vein, and Au∣thors cannot agree about the reason why Galen commands Phle∣botomy in putred Fevers: Yet 'tis clear he did it, that by evacu∣ation of the blood, nature might be enlightened and freed from the greatest part of her burthen, for when blood abounds, the opening of a vein, and purging of Cacochymy are the best reme∣dies; furthermore when it is a plethorick body, without doubt we should open a vein. In some measure the breathing of a vein, doth take away the cacochymy contained in the veins, and mixed with the blood, since the vein being opened, the vitious humours go out with the blood, especially because purgation which can take away foul humours out of the veins, is not so safe as the breathing of a vein to be appointed at the beginning of a Fever. For although Phlebotomy cannot take away all the ill humours out of the veins, yet nature is lessned some part of her burthen, and therefore can concoct and master the remain∣der the more easily, for it may be that the plenty of blood, which before the sickness was no trouble to the party, now being sick and weakened with a Fever, may become burthensom unto him. And although some good blood be emitted therewith, yet that hurts not the sick, but rather helps, as is said: As we also see by critical Hemorrhodes, that nature sends out no small quantity of good blood together. Yet nature for the most part useth to

drive no small part of peccant humours to the extream and sub∣cutaneous parts; thence and in the first place most commonly the worst blood comes first out. Whence it is manifest especially in continual Fevers, in those who abound with blood, or have peccant humours mixt with their blood, that bleeding is pro∣per, and that at the beginning, that nature may be unladed of part of her burthen, but if vitious humours are not intermingled with the blood in the greater veins, the breathing of a vein for e∣vacuation thereof is not to be used.

Cooling and fanning the blood is performed by lerting blood: but they are only to be done when bleeding will not cool it alone. * 1.17

We are not only to observe whether bleeding be needful, but also whether the party be strong enough to suffer it, when the strength of the vital faculty is principally to be required, so that the strength do not languish by too great store of blood suf∣focating the Spirits, Age, Habit of body, and condition of the ambient air shew the strength.

But how much blood is to be taken away, * 1.18 first by the plenty of blood, then by comparing the strength of the Patient with the greatness of the disease, will be manifest; for greater quantity requires larger emission, lesser, less; robustious bodies require larger breathings of veins, weaker require less. The strength varies according to temperament, habit of body, age, sex, sea∣son of the year, the condition of the Heavens, and the Region, as also in regard of certain Symptomes, which use to be accom∣panied with Fevers, as of watchings, pain, and such like.

As for the time for letting blood, * 1.19 'tis to be done when 'tis indicated, and no way prohibited; which is in the beginning, and by how much the more the disease hastens to increase, so much the sooner blood is to be taken away, * 1.20 but if the concocti∣ons are more dull and slow, Pulebotomy may be deferr'd longer.

Veins that are opened for evacuation are best in the middle of the arm; yet if the sick be weak, and that also revulsion is to be made from the head, the veins in the foot are to be opened to the greatest benefit of the sick.

CHAP. VI. Of Purging.

BUt because all putred Fevers have their original from foul humours: * 1.21 Now we are to consider by what means they may

be evacuated, but seeing those things which evacuate them are twofold, Lenitives and Purges, properly so called: Lenitives are safely to be administred in the beginning of all putred Fevers, because there are scarce any bodies wherein the stomack, guts, and Mesaraick veins contain not some of the peccant humours.

These evacuations are to be caused by Clysters, * 1.22 called loose∣ning medicines, and by vomit. The Clysters are made of Mallows, Marsh-mallows, Violets, Pellitory, Beares-breech, Mercury, common Oil, or mixt with Violets, brown Sugar, Cassia, * 1.23 Elect Lenitive, Diacatholicon Hiera, and such like.

Or those lenitive medicines may be given which are at this day in use: Syrrup of Roses solutive, of Violets solutive, Honey of Roses solutive, Tamarinds, Cassia, Manna, the lenitive Electuary simple, Cream of Tartar.

You must use such medicines at the times of remisness and in∣termittings, when the Fever least offendeth, whether it be car∣ly in the morning or in the evening.

Sometimes also in the beginning of Fevers you may admini∣ster a vomit; when great store of matter is contained in the sto∣mack and adjacent parts, whereof no concoction can be expect∣ed, the which useth to corrupt and putrifie in the body, and of∣tentimes that is easily vomited out, which with great difficulty is purged out. * 1.24

The Vomits are set down in the fifth Book of the Institutions part. 1. Sect. 1. cap. 12. Some give at this day the roots of A∣sarabecca, from half a drachm to a drachm. The Chymists use white Vitriol, Salt of Vitriol, Medicines prepared of Anti∣mony; which do not open only the first passages, but stir the whole body: These are to be used with much caution, and as Hippoc. * 1.25 1 Aphor. 24. Not without skilful advice.

Concerning Purgers at what time they are to be used, there is great controversie; for although vitious humours at any time during the desease, shew that they ought to be taken away; Yet they ought not to be evacuated at any time, but instead of an Oracle, Galen admonisheth four of preservation of health, c. 5. the Aphorisme of Hippocrates is to be had in esteem, 22. Sect. 1. Such as are concocted and ripe, ought to be purged and removed, not crude; neither in the beginnings, unless the matter trouble much, which seldom cometh to pass. But although some inter∣pret this Aphorism otherwise, yet if it be diligently considered, 'twill be manifest, that Hippocrates meant to speak only of pu∣tred Fevers, and of no other disease, and by crude humours in∣tends those that by reason of their putresection in putred Fevers

ought not to be purged, being unfit; by concocted he intends such as are fitting to be purged: The words crudity and concoction, being transsated from their proper signification of crudity and concoction to excrementitious humours.

Although there are certain other preparations of humours for purgation both in Fevers and out of Fevers: * 1.26 Yet the name of concoction belongs not to them, and we must distinguish be∣twixt concoction and preparation of humours. Concoction, whereof Hippocrates speaketh, is a reducing of the putred hu∣mours into a better condition, and less obnoxious to the body, and a separation of them from good blood, that they may the more profitably be evacuated out of the body; hence concoction belongs only to humours, which are contained in the Veins, and mixed with the blood, but those that are in other places, and not mixed with the blood, may be purged at any time. For these humours unless they are reduced to a certain mediocrity as they are capable of, and are seperated from laudable blood, the Physician in vain, and with much detriment to the sick, endea∣vours to expell them by purging. For neither will the humours follow the foregoing medicine, neither hath the Physician na∣ture for his assistant, since the matter is only stirr'd and trou∣bled, and various Symptomes arise; either the strength is weak∣ned by the vio••ence of a strong medicine, or the native heat is consumed and weakened.

Yet flatulent humours may be purged without concoction; * 1.27 For although these are not as yet concocted, yet because there is not only danger lest they should fall upon some principal part, but also because being thin, and already in motion, they easily follow their leading medicine; and the Physician hath nature to assist him, which alone sometimes expells such humours at the be∣ginning, to the great advantage of the sick. But by flatulent hu∣mours here, we are not to understand only those which hitherto are moved to no determinate part, but also those which although they rush into some part yet they are still moveable, and so dis∣posed, that they'l easily remove into another part, and according to their manner, are hitherto wandring, but have not any fixed seat any where.

Concoction, whereof we here speak, is the work of nature on∣ly, which when 'tis strong, gives what perfection they are ca∣pable of receiving, even to the vitious humours, as may be seen in the generation of quitture; and this concoction is made only in putred Fevers▪ For whilest the humours ferment in the veins, like new wine, and the good and bad are mixt together,

and cannot easily be seperated: They are called crude, but when the humours are appeased and cooled, and the good may easily be seperated from the evil, they are said to be concocted.

CHAP. VII. Of Concoction and Seperation of humours.

ALthough the concoction of humours be the work of na∣ture only. Yet a Physician may help her by his medi∣cines, which may either cherish and strengthen the na∣tive heat, or take away impediments which may hinder nature in concocting, * 1.28 and reduce the excess of qualities to mediocrity. And medicines of the latter of these two kinds are called Dige∣stives and Concoctives, namely, such as cool the hot humours, heat the cold, moisten the dry, attenuate the thick, incrassate the thin, and if there are any other excesses of qualities, redu∣ceth them to mediocrity.

So Cholerick humours because they are hot to be allayed; * 1.29 and tempered with cold medicines, and their tenuity if too much, to be reduced to mediocrity, and its power of inflaming to be prohibited. These perform this, Chichory, Endive, Sowthi∣stle, Garden-Endive, Sorrell, Burrage, Bugloss, Violets, Bar∣ley; the greater and lesser cooleing seeds, the juice of Lemmon Pomegranates, Goose-berries, Vinegar, Spirit of the salt of Vi∣triol, and medicines prepared of these.

Phlegmatick humours because they are thick and dull, * 1.30 require attenuating, and cutting medicines; such are the opening roots, Hysop, Bittony, Agrimony, Venus-hair, Vinegar, al∣so Spirit of Vitriol.

In a Melancholly humour, * 1.31 attenuating medicines are also useful, but such as moisten withal: Such as are Burrage, Bu∣gloss, Polypody, Caeterach or Spleen-wort, and such like.

But because in all these Fevers, * 1.32 corruption of humors is pre∣sent, those things which resist putrefaction are also necessary, such are Vinegar, Juice of Lemmon, Citron, Pomegranates, Sorrel, Spirit of Salt of Vitriol.

And those things which are spoken about concoction and cru∣dity of humours, principally take place in continued and a∣cute Fevers, which is manifest from Hippocrates, who 1. Ash. 24. adjoynes, In acute diseases seldom, and about the begin∣nings, purging is to be used, and that with diligent premedi∣tation, and 2 Aphor. 29. In the beginning of diseases if ought

be to he moved, move it; but when it flourishes 'tis best to be quiet, namely, if the matter swell big in acute diseases, present∣ly at the beginning 'tis to be evacuated, but if not, a concoction is to be expected, which nature alone performing, very often u∣seth to expell vitious humours, which if it be not done, the Physician useth to do it: The same crudity and concoction is required in intermitting Fevers, for since their causes are scitua∣ted in the Mesaraick veins, and the Mesaraick veins contain and elaborate blood of their own accord, if peccant humours be any where mingled with that blood, and begin to putrefie, cru∣dity is said to be present: But when those humours are so con∣quer'd by nature, that they may easily be seperated, concoction is performed.

Although in intermitting Fevers in every fit some of the pec∣cant matter be evacuated, yet notwithstanding the humour, which is the fuel of such Fevers, is not first taken away before the concoction be performed, and the bad are seperated from the good: That which in quartanes useth to be long in doing; For although each Paroxism some may be expelled, yet as Ga∣len. 2. of the difference of Fevers. cap. the last teacheth, super∣fluities in the part wherein the fewel feeding the Fever is contai∣ned being left behind, cause new fits, and purgation is appoin∣ted in vain before the humour be concocted and rendred fit to be purged, whereof shall be spoken amongst the intermitting Fe∣vers. * 1.33

But besides this concoction and preparation of humours, there is yet need of other things, which when the humours are con∣cocted, are to be exhibited: For considering purgation that it may be happily used, the passages ought to be open and the hu∣mours fluid, if the passages are obstructed, and thick sluggish humours be present, the wayes through which the humours ought to pass are to be opened, and the humours to be cut and taken away,

CHAP. VIII. Of Sudorificks and Diureticks.

BUt because nature for the most part expells the concocted matter by sweats, * 1.34 so that almost no Fever without them ceaseth and is well cured. The Physician ought to imitate nature, and the body being evacuated, to discuss the remaind∣ers by sweats: The Sudorifiques that at this day are in use, are,

Carduusbenedictus, Scabions, Fumetary, Tormentill, Zedo∣arie, Harts-horn, Elder, Bezoar-stone, Methridate, and such like, but no sudoriferous medicine ought to be administred, if any Crisis by stool, vomit, or Hemerrhodes at the nose be ex∣tant, lest nature should be disturbed in it's work. They are most conveniently exhibited at that time, when nature her self useth to remove humours, which happens either before any pa∣roxysm, or at the end thereof.

By Urine also sometimes part of the fevourish matter is evacu∣ated, * 1.35 and therefore Diureticks after other evacuations are to be appointed, and the most temperate amongst them are to be cho∣sen, which together attenuate the humours, and free the passa∣ges from obstructions, as Maiden-hair, Sparagus, Agrimony, &c. But those things which are cold, may timely be used also, since they correct the hot distemper of the humours and parts.

CHAP. IX. Of Diet in putred Fevers.

LAstly concerning dyet, * 1.36 and first, of meat and drink, not only regarding the use of them, for the comfort and re∣freshment of our strength, but in respect of what is to be permitted, and what prohibited; for when nature is most busi∣ed in concoction and evacuation of matter, she ought not to be called from that work to the concoction of meat, hence Hippo. 1. Aphor. 8. When the violence of the disease is great, dyet is to be used most sparingly, and ibid. Aphor. 11. In the Parox∣ism it self, food is to be taken away; for it affords mischief: and when by circuit the Fever returns in the fits we ought to abstain.

In the administration of dyet in Fevers, we are to observe, form, * 1.37 quantity, quality, and time. The form of dyet is three∣fold, thick, indifferent, and thin. Which of these are most proper for every one, is to be collected by comparing the strength of the sick with the morbifique cause; neither ought we to give more meat then the strength can concoct: and we ought to con∣sider whether the strength do more require food, or the disease forbid it, or the contrary: for by how much the busier nature is in oppugning the morbifique cause, by so much the less thre ought to be burthened with food: She is by so much the more busied in opposing the disease, by how much the paroxism is neerer at hand, hence Hippocrates 1. Aphor. 8. When the di∣sease is in it's vigour, then 'tis necessary to use the thinnest

food, and 1. Aph. 7. When the disease is peracute, there are extream labourings; and at height, the thinnest nutriment is to be taken. But when 'tis not at height, and that we may use more nourishing things, by so much is to varied from the thin∣nest of all, by how much the disease is remitted and abated, and ibid. 10. Those who expect the vigour forthwith to come, ought presently to take a little nourishment. They who expect it af∣terwards much, and should both in the vigour of it, and a little before it, abstain. But before-hand the sick should be more plen∣tifully nourished, that he might be the better able to endure the disease. But how dyet is to be moderated according to the strength, Hippocrates teacheth, 1 Aphor. 9. We ought to con∣jecture by the sick, whether he can hold out to the vigour of the disease by the prescribed dyet or not, or whether he will first faint, and being insufficient with such food, should dye before the disease depart and be overcome. And 1. Aphor. 13. Old men that are not decrepid easily endure to fast, according to these, middle aged men, young men less, children least of all; and amongst them especially such as are endued with the choicest and most acute wits: Custom also and course of life is to be con∣sidered in prescribing of dyet.

The quantity of meat also is to be considered by comparing of the disease with the strength of the sick: * 1.38 For since that we must never give more food then can be concocted at the time when nature is most busied in opposing the morbifique cause, the least quantity of food is to be taken, which is in the height thereof.

Concerning the quality of meat, * 1.39 since it is to be considered either as it is meat, or as it is medicinal meat, in the former respect those meats are to be chosen that are of easiest concoction, full of good juyce, facile to be distributed, and which hath the least excrements: But if it be considered as Medicinal, First, it ought to be contrary to the Fever, and therefore it should be cold and moist, 1. Aphor. 16. moreover it should be repugnant to the causes, and all excess of qualities in them.

The time for food is most proper when 'tis indicated, * 1.40 when the body requires nourishment, which is when the former meat is concocted, and no sign is present, which may prohibit the ta∣king of it, to wit, no combate betwixt nature and the disease; therefore during the fits, we ought to abstain. 1. Aphor. 11. un∣less the strength be much decayed and spent.

Care also is to be taken what drink is fittest in Fevers, for al∣though it be easier concocted then meat, * 1.41 and by it's cooling it

mitigates the heat, and the driness is hindred: Yet we are to be careful that nature be not burthened with it, and the concoction of matter hindred by it, and therefore in intermitting Fevers during the Paroxism, we should abstain from drink as neer as we can: But in continued Fevers, when heat, thirst, and debility of strength do require, you may give more drink; but sithence drink is to be considered, not as drink only, but as medicinal, hence it comes to pass, that at certain times, certain drinks are to be chosen. Drink considered as drink, ought to be given ac∣cording to the rules for meat: But as it is considered as altering, by how much the dry heat is more intense, by so much the more, hotter drinks are to be avoided, and the colder to be cho∣sen. Yet regard is to be taken of the cause, and oftentimes there will be need of attenuating and absterging drinks, and not of cooling only; and the matter being deeper fastened in the part, admits not cooling drink. The drinking of cold water is only useful in acute Fevers, 'tis never proper in intermittent. Fair water is often altered with barley, which is called a decoction, and barley-water. Instead of drink, Juleps are also exhibited, water mixed with Honey, Oxymel, Emulsions, Whey, strong beer, wine. But seeing certain drinks for certain Fevers are most convenient, we may more properly handle them severally amongst the different kinds of Fevers, of which sorts are peculiar for such a particular Fever then in general to treat thereof.

The air in all Fevers ought to be pure, cold rather then hot, yet so temper'd, * 1.42 that the drawing in thereof may rather allay the fevourish heat, then meeting with a naked body, cause it to shut its own pores, which hinders the discussion of vapours and sweats, and therefore the sick is to be covered with outward gar∣ments, but such as are light, that so the heat may be drawn to the outmost parts of the body.

Sleep ought to be moderate. Rest in putred Fevers is most advantagious: * 1.43 Excrements ought not to be retained beyond measure, but to be ejected in due time. The passions of the mind ought to be at peace, and sadness, and anger are to be avoi∣ded.

CHAP. X. Of the differences of putred Fevers.

HItherto we have spoken of putred Fevers in general, * 1.44 it re∣mains that now we speak of them particularly. First their differences are a little more cleerly to be explained. And they are taken chiefly from the matter putrifying, and the place of putrefaction.

As for the matter, Feversarise either from choller, or phlegm, * 1.45 blood or melancholly: To which not without reason is added a serous humour, especially that Ichor, which is very evil, easily obnoxious to putrefaction, * 1.46 and causeth the blood and other hu∣mours to putrefie more easily. Whence some are of opinion that Ephemeral Fevers, which commonly are said to arise from Spi∣rits kindled, do all proceed from the ebullition of the serous part of the venous or arterious blood: And much more a Synocha without putrefaction; although the vital Spirits being heat may first allure the heat to the serous humour. The same shew that all Synochaes or Fevers containing, as they are called, which have no periods, as well putred as not putred, do arise from the same aqueous and serous humour, whether putrefying or not putre∣fying; whereof the Tract of Fevers may be seen.

Those Fevers which proceed from blood do all keep a certain continuity and equality; and are neither exasperated daily, * 1.47 nor each other day, nor the fourth day, but those which do arise from Phlegmatick, chollerick, or melancholy humours, all have their periods, whether they are continued or intermittent.

Besides these there are other Fevers, * 1.48 which although they are exasperated, yet have no certain periods, such are those which a∣rise from inflammation, putrefaction, worms, corrupted milk; * 1.49 as in Infants, blood out of the Vessels, chyle, and blood im∣perfect, putrefying in the Mesaraicks.

The matter whereof putred vapours are bred in Fevers, * 1.50 is ei∣ther contained within the vessels or without. The vessels which carry the perfect blood, as the vena cava, and the arteries, or the more imperfect, as the Meseraick veins. * 1.51 Whilest blood pu∣trifies in the vena cava, there arise continued Fevers, whereof some are called Synochaes, or containing Fevers, others conti∣nued instead of a genus and periodick continued. If excremen∣titious humours putrefie in the Mesaraicks, intermittent Fevers are stirred up, but if imperfect blood putrifie in the Mesaraick

veins, continued Fevers are raised, but calm ones.

Putrifying matter without the veslels, * 1.52 sending putred va∣pours to the veins and arteries, kindles continued Fevers. Such are first Symptomatical, which proceed from inflammations of certain parts. Moreover calmer Fevers, which proceed from the stubborness of the guts and their obstructions. Thirdly, those that are caused by an Ulcer, Fistula, and all putrefaction. Fourthly, from corrupt milk, as in Infants, from blood putre∣fying without the vessels, also the matter of Catarrhs, whence they are called Catarrhal Fevers.

Lastly, there are Fevers called Comitatae, or Companions, which are occasioned from matter putrefying in the veins, * 1.53 part whereof when nature either expells out of the body, which hap∣pens in a Diarrhaea, Dysentery, and a Catarrh, or protrudeth into some part, which happens in the Meazles, Small Pox, Stragling pains, Quinsey, Peripneumonie, Phrensie, Erisi∣pelas, oftentimes. Another disease then accompanies the Fe∣ver.

CHAP. XI. Of a continued putred primary Fever, and first of a Synocha in particular.

NOw concerning putred Fevers in particular, * 1.54 and first we will handle a primary continued Fever: A primary con∣tinued Fever is that which comes not to apurexie before it be plainly taken away; and hath its rise from putred humours contained in the greater branches of the vena cava and arterie. For since that thence putred vapours are continually sent to the heart, a continued heat is also caused, thence until it fully be cured there is no absence of fire, neither doth it return by intervalls, with tremblings and shaking fits.

Primary continued Fevers are two-fold, Some without any remission or exacerbation of the heat, continue from the begin∣ning to the end: But there are others, wherein the heat before the Fever be throughly cured, doth never totally depart, yet at certain periods is increased. The former are called fiery Syno∣chaes, and Fevers containing; the other are called Synoches, or continued, instead of a genus.

The Fever Synocha putred, * 1.55 is a Fever, which without any slacking or increasing afflicteth from the beginning to the end, arising from putrefaction of the blood in the greater branches of

the vena cava. Although continued Fevers may arise out of vessels of determinate parts, yet such are Symptomatical: And if they are true Synochaes, which have their original from the default of any part, as from the womb offending: Yet that part only affords an occasion, the polluted, putredity being commu∣nicated, that the blood in the greater vessels might corrupt. But there are Fevers risen from determinate parts, for the most part continued Periodicks.

So sometimes peccant matter in the first passages collected in the first concoction, which useth to go to some of the humours, which at certain Periods are moved, and hath not as yet received its limits for motion, it useth then to corrupt the humours, and communicate putrefaction to the vena cava, which Fevers for the most part are malignant.

A putred Synocha hath its original for the most part from transpiration hindred, and want of ventilation of the blood, * 1.56 and hot fuliginous retentions, by reason of obstruction of veins, as well in the skin, as also in the internal parts. And the blood ap∣pointed to nourish the body putrifies in these Synochaes, and putrefying, continually sends hot vapours to the heart. For when preter-natural heat is so kindled in the veins, that nature can no longer rule it, it becomes putred and is corrupted. Nor is there any need that the putred blood should be turned into ano∣ther humour presently. For blood of its own nature is apt to putrefaction, and in inflamations we see it changed to quitture, not into choller; though nothing hinder it in the veins but that it might: And especially the Ichor or thin wate∣rish part of the blood is apt to turn to putrefaction, and by rea∣son of the Ichor the blood in the first place is corrupted, which happens, when the vapours which ought to transpire, are retai∣ned in the veins. Yet the whole blood doth not putrifie, but some parts thereof, which so long as they are not seperated from the good blood, crudity is said to be present, which afterwards by concoction are seperated from the good blood, which being done, Nature appoints evacuation, by which the blood returns to its former purity again.

A Synocha is three-fold, Acmastick, i. e. when it remains al∣wayes in the same state, namely, * 1.57 when so much of the humour daily putrifies as is discussed, this is called also Homotonos. Epacmastick or Anabaticos is when the heat continually increa∣seth, and more of the matter is kindled then can be discussed. Paraemastick is when there is more discussed then corrupted, and thence the heat alwayes decresseth. Furthermore it blood which

putrifies be temperate absolute, 'tis called a sanguinious Synoch a in particular: But if it be hotter, which useth to be called cho∣lerick, the disease is then called Synocha bilosa.

The Fever is known first by this, * 1.58 that it continues from the beginning to the end without any exasperation and mutation: Moreover because the Pulse is great, vehement, swift, frequent, unequal and inordinate. And in a Synocha proceeding from temperate blood the signs of Plethory are present: The blood to him that toucheth seems much and full of vapours, and is not so troublesome and sharp as in other Fevers, and other signes are present which are observed in a Synocha that is not putred. A putred Synocha is distinguished from a non-putred by certain signs. The heat in a putred is sharper then in a non-putred. In a putred the urine is red, thick and troubled, without any sedi∣ment, and crude, or a little concocted in the beginning; the Pulse affords signes of putrefaction, and all the Symptomes are greater then in a Fever that is not putred.

A Synochabilosa happens to those that are troubled with cho∣lerick blood, and the heat is sharper then in a Synocha proceeding from temperate blood, thirst is more troublesome, the urine thinner and sharper, and other signes which are usual in cholerick Fevers are discerned.

This Fever is the most simple amongst the putred, * 1.59 and easiest to be cured. And being pure, seldom passeth seven dayes, but the spurious is extended to the fourteenth day, and is terminated sooner or later, as the signes of concoction appear sooner or later. A white urine in a Synocha is evil. The least dangerous of all is that which is called Synochos Paracmasticos, next to that Ac∣masticos: But that is most dangerous which continually increa∣seth, and is called Epacmasticos, which easily degenerates into a disease called Causus. And by how much the fewer the evil Symptomes are, by so much the better hopes; the more they are, the more danger is shewn.

The whole cure consists in taking away the cause, * 1.60 and alter∣ing the fevourish heat. Blood therefore as abounding in plenty is to be lessened, the pores of the skin to be opened, the causes of obstructions being taken away. The fevourish heat is to be tem∣pered and allayed, if there be strength, as for the most part there is, thin diet is to be used.

Therefore a vein is forthwith to be opened in the right arm, a Clyster or lenitive medicine being given first, if occasion require, and to take away as much blood as the strength will permit. * 1.61 and you may more boldly take away blood in this, then in any o∣ther sort of Fever.

Blood being evacuated, * 1.62 that the concoction may be made more facile, we are to use those things which allay the heat, free from obstructions, and resist putrefaction; namely, the juice of Sorrel, Lemmons, Citrons, and Syrrups and Conserves prepa∣red of them, Syrrup of Sorrel simple, Oxymel simple, Oxysau∣harum simple, Spirit of Vitriol, and the four cold seeds with cooling waters are to be administred.

Principally we ought to endeavour that the pores of the skin may be freed from obstruction, which for the most part is the cause of this disease, which thing Oxymel and wine mingled with honey, and the honey dissolved, will conveniently perform, since they are easily carried to the outmost parts of the body, and attenuate dull thick humours, and simple Oxymel resists putre∣faction.

Concoction being perfected, the Ancients used to drink cold water, and gave so much of it to drink, as might not only extin∣guish the fevourish hear, but that the matter concocted might be evacuated by stool, vomit or sweats. But in our countries, sick people are not so accustomed to drink cold water, and many inconveniences are to be feared by the use thereof. So likewise swimming in cold water, which was usual with the Ancients, doth not agree with our bodies.

The concoction being perfected, nature useth for the most part critically to evacuate the corrupted matter, which if it be not done, it ought to be performed by the Physician with purging medicines.

Dyet in this Fever ought to be thin, * 1.63 because both that blood aboundeth, and the disease is short; It should be cooling and moistening, and also to have power of attenuating thick hu∣mours, and deterging viscid ones.

CHAP. XII. Of a Causus, or Burning Fever.

WHereas amongst continued Fevers there is often men∣tion made of a Causus, we are also here to say some∣thing of it: But a Causus is not any difference of a Fever, but rather a measure expressing the quality of fevourish heat. The word Causus is sometimes taken generally, and not so properly, sometimes specialiter, and more properly: Generally for any sort of Fever whose heat is vehement, in particular for a Fever which hath two Pathognomonicks, great heat, extream and

unextinguishable thirst. A Causus properly and in specie so called, is again twofold, legitimate and spurious: legitimate is that which hath alwayes, and that evidently, those two signes joyned with it: an illegitimate is that wherein those two signes are not so evident.

Whence it is manifest that burning Fevers, * 1.64 and such as pro∣perly and in specie are so called, are continued Fevers, and arise from choller. And so a Causus or burning Fever properly so cal∣led, is a Fever continued, Bilions, and indeed either Synocha bilosa, which we have newly handled, or a continued tertian, whereof we are to speak next.

The Pathognomonick signes as we said before, are two, ve∣hement and burning heat, and unquenchable thirst, although the sick shall drink; * 1.65 and the more legitimate the Causus is, by so much these signes are greater, yet the thirst is sometimes resisted if a little cough happen, which may draw humors from the neigh∣bouring parts.

Concurrent signes there are many, as a dry tongue, rough, black, watching, giddiness of the brain, difficulty of breathing, thick and great, and the sick continually blow, opening their mouth, that the hot spirits may the easier exhale.

These Fevers if they are pure, * 1.66 never continue long. For na∣ture cannot long endure such burning and vehement heat; and the Symptomes which accompany it with their vehemency. And for the most part they are terminated the seventh day, some∣times the ninth, eleventh, fourteenth: but the spurious are pro∣tracted longer, and all of them are dangerous according to Hip∣pocrates 4. Aphor. 43. Fevers of what kind soever that have no intermission by the third day, are the stronger, and fuller of dan∣ger. Yet some are more dangerous then others, according to the violence of the heat, and of the Symptomes, and force of the strength, and by how much the greater digression is made from the natural state, by so much the more dangerous is the Fever. Hence if an old man be troubled with a burning Fever, which seldom happens, 'tis deadly, as Galen hath it, 1. Aphor. 14. They lye down in no less danger who are exeedingly burnt in cold air: Who if they have not great strength, neither the signes of concoction appear, it can not be that they should escape, as the same Galen 11. Met. med. cap. 9. writeth. To whom if vehe∣ment Symptomes happen, by so much the more dangerous the disease shall be, whether they are Pathognomonick or superveni∣ent, yet if by the other signes, it be manifest to be a burning Fever, and that thirst be wanting, this also is dangerous, for

it shews the sick either to be in a Delirium, or that the desiring faculty of the stomack faileth.

Black urines are also evil, as also thin, crude, and such as have other ill tokens in them.

But it is good if the sick can easily endure his sickness, the Symptomes being not without vehemency, if he can easily fetch breath; if he complain of pain in no internal part, if he sleep; if he find benefit by his sleep; if the body be equally hot and soft, if the tongue be not too dry, if the urine be good. But if when the signes of concoction appear, and that there is much strength, in a critical day there happen large Hemorrhodes, or bleeding at the nose, without doubt the sick escapeth: For it is proper if there be any other of the pure burning Fevers, that they should be cured by bleeding. Yet sometimes they are determined by Sweats, looseness of the belly, vomits, and imposthums. But there are many Prognosticks of burning Fevers in Hippocrates in Prognosticis, Porrheticus, and Choacis praenotionibus, and there are many expounded in the Institutions, lib. 3. part. 3.

But by what means burning Fevers are to be cured, appears by what hath been spoken of a Synocha bilosa with putrefaction, and those things that shall be said of the cure of the continued Tertian shall make manifest.

CHAP. XIII. Of continued Periodick Fevers in general, and of a continued Tertian.

ANother kind of continued putred Fevers which they call in particular continued, comprehends those Fevers, * 1.67 which indeed continually remain, and have no remission before they are plainly dissolved, yet at certain periods they are exaspe∣rated, whence they are called continued periodick and proportio∣nated Fevers.

But as Fevers containing have their original from the blood appointed for nourishing the body; so continued Periodicks, * 1.68 as also intermittints proceed from an excrementitious humour and Cacochymie. Therefore continued Periodicks agree in this with Fevers containing, that both their causes are contained in the vena cava, but with intermittents in this that both proceed from excrementitious humours. But they differ from Fevers contai∣ning, in that they proceed from alimentary blood; these from an excrementitious humour: From intermittent because the

matter which is the cause of continued Periodicks is generated in the second concoction, and contained in the vena cava: But that matter which is the cause of intermitting Fevers is contai∣ned in the first concoction, or certainly in those parts which are about the liver, which are not appointed for perfect sanguifi∣cation. Namely, the matter of continued Periodick Fevers is generated in the Organs of the second concoction, if for any cause whatsoever it be not rightly performed. For then the pec∣cant humours generated in the second concoction are sent with the blood into the veins, which there stirreth up these continued periodick Fevers.

Which matter since it is not only confused with the blood, as in intermitting Fevers, * 1.69 but from the very first original is mixed therewith throughly. Nature also cannot expell it before con∣coction, and therefore the Fever from the beginning continually lasteth. Yet these Fevers have exasperations at set times, because that from the instruments of the second concoction, fresh mat∣ter which is the cause of these periods is afforded, and indeed for the most part from the liver: Whence also continued Terti∣ans are most frequent.

These Fevers are generally known because they never come to apurexie, * 1.70 yet at certain periods they are increased and remitted. Neither doth cold, trembling, nor shaking fits precede their ex∣asperation, neither doth sweat follow their remission.

There are three kinds of these Fevers.

For some are exasperated each other day, * 1.71 and proceed from Choller, and are called Tertians continued. Others every day which are caused by Phlegm, and are called continued quotidi∣ans. Others the fourth day, which arise from Melancholy, and are called Quartans continued.

First a tertian continued is a putred Fever, * 1.72 arising from blood with ill juyce and choller putrefying in the vena cava, indeed continued, but afflicting most the third day.

The causes of this Fever are all things which can increase store of cholerick Cacochymy in the veins, * 1.73 and being cumulated there of cholerick Cacochymy in the veins, and being cumulated there can introduce putrefaction; such as are before propounded.

This Fever is thus known, * 1.74 in that it is continued, and the third day it is exasperated. Yet there are present other signes and Symptomes of continued and burning Fevers.

But what is to be hoped concerning their event, * 1.75 is manifest from things which are spoken of the Prognosticks of burning Fevers.

Concerning the indications for cure, * 1.76 this Fever if it be pure,

since it is exceeding hot and burning, and the cause thereof hot and dry, it requires extraordinary cooling and moistening, and indeed more then any other Fever.

The humour it self indicates evacuation; but crudity for the most part forbids it: but if the Fever be spurious, regard is to∣gether to be had to the humour which is mixed with choller: if the Symptomes need it they are to be resisted likewise.

Therefore a vein is to be opened so that the strength will per∣mit it, by which means both some part of the peccant humour may be evacuated, * 1.77 and the blood cooled and revell'd from the more noble parts. And nature her self sometimes useth to make evacuation by the nose in the beginning of these Fevers, where∣by the Fever is wont to be abated; but the vein should be ope∣ned in the cubit forthwith in the beginning, or certainly in the augmentation, and blood is to be taken in such plenty as the strength of the patient requires.

But you are not to appoint purgation unless the matter be turged. * 1.78 Yet 'tis very necessary that the belly and first passages be evacuated before a vein be opened, but the medicines which perform that, ought to be cold and moist not hot; or if they are hot, they should be tempered with the mingling of cold.

Afterwards altering, namely, * 1.79 cooling and moistening medi∣cines are to be exhibited, both which prepare the humour ap∣pointed by nature for concoction, such as are, Syrrup of Sor∣rel simple, Oxymel simple, compound, Oxysauharum simple, Syrrup of Sorrel, Wood-sorrel, the juice of Lemmon, Pome∣granate, the accidity of Endive, Cichory, Violets, Goose∣berries, the four greater cold seeds, Purcelane, Lettice, th•• flowers of Water-lillies, Santalum, Water of barley, Sorrele Endive, Cichory, Strawberries, Water-lillies, Purcelane, spec. Diamargariti frigidi, and such like, to which for the re∣sisting of putrefaction and hindring inflamation may be added, Spirit of Vitriol and Salt, Nitre prepared is also commended: If Phlegm be mixed, opening and attenuating things are to be added; such as the roots of Fennel, Sparagus graminis, and medicines prepared of them,

In leek colour'd aeruginous choller, John Langius. l. 3. epist. 1. c. 4. commends Chrystal.

Topical medicines are also profitable to mitigate the heat, as Epithems, Oyles, and Unguents, made of cooling things, * 1.80 which should be applied to the heart, liver, or back. Yet you must be careful that you close not the pores of the skin thereby, and hinder transpiration, and therefore before the height they

are seldom used, unless it be when the heat is equally distributed through the whole body, and it is more commodious if they are applied hot then cold.

The matter being concocted, that nature might be strength∣ned, and stimulated to expulsion, and that the matter might be expelled either by stool or sweat, the Ancients used great quantities of cold drinks, as Galen teacheth 9. meth. cap. 5. and 4. de rat. vict. in acut. 12.

But if so be that after concoction nature do not institute eva∣cuation, * 1.81 it is to be done by the Physician, with Syrrup of Ro∣ses and Violets solutive, the pulp of Tamarindes, Manna, Ru∣barb, Trypheta Persica, such as have Scamony in them are not to be admitted; yet sometimes some of Electuarii rosati Mesua, de psyllio and of juice of Roses may be given.

For causing Urine in these Fevers an emulsion is profitable, prepared of the four great cold seeds, * 1.82 with the whey of Goats milk, or barly and strawberry water, or with a decoction of the roots of Parsley.

Sweats also ought to be provoked with medicines proper for that purpose, * 1.83 which hereafter shall be mentioned amongst malig∣nant Fevers.

Diet ought to be thin; but according as the height of the disease is neerer or farther off, * 1.84 it ought to be thicker or thinner. The meat and drink ought to be cooling and moistening, whence a Ptisan is profitable in these Fevers, the rest should be season∣ed with juice of Lemmon and Pomgranates: The drink should b•• barley water, or water boiled with the juice of Lemmon or Pomegranates, and suggar or small beer. The air should be cold, and if it be not so by nature, it should be prepared by art.

If Phlegm be mingled with choller, and the Fever be a con∣tinued Tertian or burning Notha, blood is to be taken away more sparingly: In the preparation of humours, those things are to be added which attenuate Phlegm. Agarick is to be mixed with the Purgers.

CHAP. XIV. Of a continued Quotidian.

A Continued Quotidian vulgarly called Latica, because it hath a certain hidden and obscure heat, * 1.85 is indeed a Fe∣ver continually lasting, yet having every day exasperati∣ons arising from indigested phlegmatick humours in the vena cava.

The cause of this Fever is Phlegm mixed with blood in the vena cava, and there putrifying, * 1.86 and therefore those fall into these Fevers which are of such an age and nature as that their bo∣dies are moister, as children and infants, as also old men and such as have grosser bodies, and are given to their bellies and to idleness, and dwell in moist places, but not young men and such as are cholerick.

The signs of continued periodick Fevers are also manifest in this Fever, only the violence is most about the evening. * 1.87 The heat first is gentle, a little afterwards more sharp, and some∣times seems to abate, and sometimes to increase, by reason of the thickness of the phlegm which purrisieth. The pulses are not so thick and frequent, the urine is not so fiery and red as in other Fevers but thicker, nor are the other Symptomes so vehe∣ment as in other Fevers.

Concerning the event. 1. * 1.88 This Fever by reason of the thick∣ness of the humour is long, and hard to be cured, and there∣fore dangerous. And by how much the thicker the phlegm is by so much the more violent and durable, so that it is not ended before the swetieth or sixtieth day, and the beginning is scarce past before the twentieth. 2. It continueth lesser time where many evacuations happen. That which is pure is also longer then that which is mixed with choller, and by how much the worser Symptomes are present, and the strength weaker, by so much the greater danger there is, which if they are not, health is to be hoped for. 3. By reason of the duration of the Fever, and weakness of the Liver, the sick for the most part fall into Cachexy and Dropsie.

As to the cure this Fever is more dangerous in respect of the cause, then of its heat; * 1.89 and therefore since it depends on phlegm that is to be heat, attenuated, cut, and afterwards being con∣cocted and prepared, evacuated, and regard is to be had of the strength, principally of the stomack and Liver.

Therefore in the beginning the stomack and first ways are to be opened and evacuated by Clisters and lenitive medicines, * 1.90 or else the matter inherent in the stomack is to be ejected by vomit. * 1.91

But although the cause of this Fever be cold, yet because it is mixed with blood and putrifieth, some blood may be taken a∣way by opening of a vein, in case that the urine be thick and red, and that the strength will bear it and the age, that nature may be eased of some part of her burthen.

Afterwards preparation & concoction of the matter is to be en∣deavored with attenuating things which do not heat much; * 1.92 there∣fore

in the beginning use Syrrup of Sorrel simple, with honey of roses, Oxymel simple, Syrrup of Hysop, Bittony, with the water or decoction of Maiden-hair, Sparagus, Grass, Fennel, Hysop, and medicines prepared of those plants; also Spirit of Vitriol and Salt.

When any signs of concoction have appeared you may exhi∣bite some gentle Purger of phlegm, * 1.93 of Agarick, the leaves of Senna and such like: Hence you must come to stronger prepa∣ring and purging things, and so the matter which cannot be e∣vacuated at once, is to be prepared, concocted, and evacuated at several times. And because a pure continued Quotidian sel∣dom happens, but that either choller or melancholy is intermix∣ed, we are to look to these humours also, and to adde Cichory, Burrage, * 1.94 Fumitory, Rubarb, and the leaves of Senna.

After the greatest part of the matter is evacuated, the re∣mainder is to be emitted by urine and sweat using such medicines as occasion the same.

But since that by reason of the duration of the disease the sto∣mack and liver are especially offended, * 1.95 things that corroborate these parts are to be administred, troches of Wo••mwood, of Rubarb, of Roses, with the powders of aromatici rosati and di∣axyaloes.

The Diet ought to be attenuating, * 1.96 cutting, and clensing, the meats therefore ought to be of good juice, easie of concoction, and affording little excrement. Fish are not proper in this Fe∣ver, the flesh should be seasoned with Parsley, Fennel, Time, Hysop, Savory, Rosemary, Cinamon. In the beginning nourish somewhat more plentifully, that the sick may endure to the height of the disease, but when 'tis neer the state abate ali∣ment by degrees. Yet if crudities be in the stomack and first passages by sparing dyet the three first days they may be abated and consumed, afterwards such a dyet as we have mentioned may be observed. In the beginning the sick should abstain from wine, and in its stead use water and honey; yet if by custom it be required, give it small and mixed with water. Small beer is also convenient, when concoction appears, wine is more safely administred, whereby the concoction is assisted, the stomack strengthened, and the humours driven out by urine.

Of the Fever Epiala.

THe Fever called the Epiala is referred to continued putred Fevers, * 1.97 which it self is indeed continued and quotidian,

yet differs from the other Quotidians in this, that the sick at the same time endure heat and cold, and the heat and cold to∣gether are dispersed through the smallest particles of the whole bo∣dy, as Galen teacheth de inaeq. intemperie. cap. 8. and 2. de diff. Febr. c. 6.

Galen in the place newly quoted, draws this Fever from acid and vitrious phlegm puttrefying; * 1.98 yet in his book of an unequal distemper, cap. 8. he addeth bitter choller, whence he infers that since heat and cold are perceived together in one place, it argues mixture of phlegm and choller; in another place he deter∣mines it to arise from vitreous phlegm, part whereof putrifying, exciteth heat, the other not putrifying causeth trembling and cold. Yet Platerus refers them to intermitting Fevers, and says that Epialaes are generated when intermitting Fevers hap∣pen together in one and the same day, and the cold of the one beginneth before the heat of the other be ended, or moreover when intermitting Fevers concur with continued, and the heat of the continued always remains, but the intermittent Fever coming, a trembling and cold fit is occasioned.

The cure of this Fever differs not much from the cure of other Fevers arising from phlegm, * 1.99 only that it requires stronger atte∣nuating and cutting medicines, because there is greater frigidi∣ty and crudity in this then in the rest; also though the humour it self seem to require stronger Purgers, yet the weak cannot bear them, and therefore evacuation by degrees is to be appoin∣ted.

Of the Syncopal Fever.

MOreover to these Fevers belongs a Syncopal Fever, com∣monly called a humorous Fever, * 1.100 in which there is more of pituitous and crude humours then in other Fe∣vers that are phlegmatick; and moreover a debility of the ori∣fice of the stomack is adjoyned, whence the sick easily fall into a Syncope, especially when the Fever begins.

This Fever is hard to be cured, since the sick by reason of their extreme weakness and danger of continual soundings, can∣not endure necessary evacuations, * 1.101 and especially if the pulse be weak, small and unequal, the Fever is exceeding dangerous.

But evacuations are most properly occasioned by frictions, as Galen teacheth in his twelfth of the method of curing, cap. 3. * 1.102 Clysters and Lenitives also with medicines opening the first passages only and causing no commotion of the other humours.

The first passages being opened and cleansed, we come to pre∣paring and evacuating humours, as in other Fevers petuitous, and medicines to prevent the sounding fits are also to be admini∣stred.

The meats should be not much, thin as to substance, easie of concoction, * 1.103 and generating as little phlegm as may be, and they are to be taken often. The drink should be wine which hath power to nourish, heat and attenuate, and doth not in∣crease phlegm. Hydromel is also good wherein Hysop hath been boiled.

CHAP. XV. Of a continued Quartane.

LAstly a continued Quartane is a Fever, * 1.104 whose heat is in∣deed continued, yet the fourth day 'tis exasperated, it pro∣ceeds from melancholy mixed with blood putrifying in the vena cava.

The cause is a melancholy humour putrefying in the vena ca∣va, * 1.105 hence all things that can generate melancholy and crowd it into the vena cava, and putresie, are the causes of this Fever.

It is known by its continued heat, * 1.106 raging the fourth day, without trembling fear or shaking fits going before, or sweats following afterwards, the pulse in the beginning is small and slow, afterwards great, full, and swifter then in an intermitting Fever, wherein 'tis most intended in the height.

This is the rarest of all Fevers, * 1.107 but dangerous and far more desperate then a continued Quartane, and debilitates nature ex∣ceedingly; it lasteth till the fourtieth day oftentimes, and be∣yond it.

Most part of the cure is the same with that of a continued Quartane, * 1.108 and because the humour, the cause of the Fever is contained in the vena cava, and there mixed with the blood in the beginning, those things that open the first passages being first exhibited, a vein is to be opened, afterwards phlegm is to be concocted and evacuated. Yet you should heat and attenuate more sparingly then in intermittent Fevers, but to moisten more and adde those things which may allay the heat of the putri∣fying humours, such as are in other cases convenient against choller.

The humour being prepared, purging is to be used, and a purge should be given the next day after the fit, which at first

should be given the next day after the fit; which at first should be gentle, but if nature order no Crisis, stronger may afterwards be given, Diureticks and Sudorifiques may also be given after concoction, but such as are not so hot, and those given in inter∣mittent Fevers; and when the strength is much debilitated confortatives are to be exhibited, prepared of Burrage, Bugloss, Balm, flowers of Rosemary, Gilliflowers, Confection of Al∣kerms, and such like.

Such Diet is to be appointed as in intermittent Quartanes, * 1.109 yet the diet should be thinner and cool more then in intermittent Fevers, since that the heat is greater and the height neerer the use of the smaller sort of wine, although it may be allowed, yet it must be taken more sparingly then in intermittents, and if the heat be greater, wholly abstain from wine.

CHAP. XVI. Of Symptomatical Fevers.

BEsides these continued primary Fevers which have hitherto been explained, * 1.110 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, * 1.111 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; * 1.112 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, * 1.113 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, * 1.114 are cal∣led Phlegmonides, which principally proceed from blood; but those which arise from Erysipelas or inflamation, are called Eru∣sipolatodes, and inflame fires. * 1.115

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, * 1.116 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, * 1.117 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, * 1.118 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. * 1.119

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, * 1.120 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. * 1.121 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, * 1.122 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.

CHAP. XVII. Of intermitting Fevers in general.

AFter continued Fevers, intermitting are to be explained. * 1.123 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, * 1.124 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, * 1.125 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: * 1.126 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, * 1.127 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, * 1.128 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, * 1.129 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, * 1.130 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, * 1.131 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; * 1.132 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, * 1.133 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, * 1.134 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, * 1.135 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; * 1.136 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; * 1.137 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: * 1.138 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, * 1.139 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, * 1.140 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, * 1.141 '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, * 1.142 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, * 1.143 which without doubt, that which they do, is performed by draw∣ing out, and evacuating of that Feverish corruption and pol∣lution.

CHAP. XVIII. Of Intermitting Fevers in particular, and first of an Inter∣mitting Tertian.

AFter we have handled intermitting Fevers in general, * 1.144 we will now go through them in particular; amongst them the most frequent is a Tertian intermitting, which ariseth from Choler putrifying in the meseraick veins.

But there is a certain difference of these Fevers; for first, * 1.145 Cho∣ler it self out of which these Fevers are generated, is not of the same kind; for somtimes the choler is like to that natural cho∣ler which afterwards is collected in the Galls bladder; somtimes it is preternatural green and aeruginous, such as somtimes by those that are Feverish, is evacuated by vomit or stool. Moreover, Choler either putrifies alone, or else hath some other humour mixt with it; Flegme or Melancholy that causeth a pure, this a bastard Tertian. They differ also in respect of duration; for if the fits are not extended beyond twelve hours, they are wont to be called pure tertians; but in case the Fit be extended above twelve hours, they are no more called exquisite and pure tertians, but either simply tertians, or spurious tertians; and when the pa∣roxism is extended above twenty four hours, they are called ex∣tense tertians; but this is occasioned either by the thinness or thickness, plenty or paucity of the humour. For by how much the Choler is thinner or lesser, by so much the sooner 'tis discus∣sed, but by how much the thicker, or more mixed with thick humours, or the more plentiful, by so much the longer the pa∣roxism continueth.

The causes of this Fever are all those things which can gene∣rate excrementitious choler, namely a hot and dry distemper; * 1.146 hot constitution of ayr, cating of hot meats, and drinking of hot drinks, using of hot medicines, watching, fasting, labour, and too much exercise: For although that in the Liver also yellow choler may be generated, yet it is very often generated by the er∣rour of the first concoction, and fault of the meseraick vein; therefore whether much choler be generated in the stomack by rea∣son

of meats, or by default of the stomack, and is carried to the meseraick veins with the chyle, and there is heaped up, and at length putrifieth, a Fever is kindled.

If the causes generating Flegme and Melancholy be annexed to those that generate choler, spurious tertians are bred.

This Fever presently invadeth, * 1.147 if it be pure, with a shaking fit, as it were pricking the flesh; afterwards when the cold fit ceaseth, presently much heat followeth, sharp and biting, and in its vigour is extended equally over the body, whence the sick draw their breath much, and are troubled with thirst. The pulses in the beginning of a fit are little, weak, slow, and thin; but the fit increasing, they become vehement, swift, frequent, and in some measure hard, and void of all inequalities besides Feverish. When the fit comes to the height, and the sick drinks, many vapours are sent through the skin, vomiting of choler followeth, which of∣tentimes useth to happen after the cold fit also, the belly is loosen∣ed, choler is pissed out, or somtimes more then these happen. Af∣terwards a sweating out of hot vapours ensueth over the whole body, and the pulse is swift, great, vehement, such as theirs use to be who are over-heated by exercise. The Urine is of a light red, or deep yellow, and afterwards hath a white cloud or suspen∣sion. The fit lasteth not above twelve hours, and the causes which generate melancholy, have either gone before, or are then present.

A bastard tertian is known from the causes which do not ge∣nerate pure choler, * 1.148 but to gather Flegm or Melancholy: The heat is not so sharp as in a pure tertian, but more mild, neither is it presently diffused over the whole body. Neither is this Fe∣ver dissolved by vomitting of yellow choler, or by sweat, but cer∣tain vapours go out in the declination, and if any sweats come forth, they either are not universal, or if they are universal, they cure not the Fever. The Urine is not so fiery as in a pure tertian, and the signs of concoction do not appear so soon in it. The pulse in the beginning is hard, and that hardness increaseth daylie, until the seventh paroxism, then by degrees it becomes softer, and the Urines also appear more concocted. The paro∣xism is often extended to eighteen hours and more: yet som∣times, to wit if the matter be less, and Nature strong, it is like∣wise terminated in twelve hours. It endeth not in seven fits, but often endureth till it comes to fourteen, and somtimes to twenty.

But these Fevers are least dangerous amongst all the putred ones 4. * 1.149 Aphor. 43. and such as are pure, do not long continue,

but at seven fits they are accounted at the height, 4. Aphor. 59. Somtimes they are terminated at the third or fourth fit; but spu∣rious tertians, as they are more frequent, so they continue long∣er: for although if the matter be little, and necessary medicines are timely exhibited, they somtimes cease at the fifth or seventh paroxism, yet for the most part they scarce end at fourteen fits, and are often lengthned out to the fortieth day; somtimes they continue six moneths, and end with some disease of the Liver or Spleen, or else are also ch••rished by them.

Although Tertians for the most part are not dangerous, yet somtimes they become pernitious. First, If any errour be com∣mitted by the sick, or the Physitian. Secondly, If the humour which Nature endeavours to expel, should fall upon any princi∣pal part. Thirdly, If the humour be exceeding thin, putred, or filthy. Fourthly, If a thin humour have a thick one mixed with it, and stir the same, and enflame it. Fifthly, If a thick humour poured out by heat, either fall down into some principal part, or cause a dangerous Catarrh, or Asthma, or the Gout, or draw the womb into consent. Sixthly, If the humour acquire a malignant quality.

But in the cure of this Fever, as also in others, * 1.150 regard must be had of the Fever, the cause and nature of it; the Fever indi∣cates cooling and moistning things, the same Choler also, as be∣ing the cause requireth, which also ought to be evacuated: yet if another humour be mixed with it, altering preparing and eva∣cuating medicines, which that humour requires, are to be mix∣ed; and because the abundance of the matter is in the meseraick veins, the vitious humour is to be purged out of them, and if need be, prepared before it infect the good blood: afterwards also it is to be altered, and the disposition of the part generating peccant humours to be corrected. Lastly, We must endeavour that the pollution and putrifaction may be discussed by Sudori∣fiques.

First therefore, the first passages are to be cleansed, * 1.151 either by Clysters, or lenitive Medicines exhibited of the Syrup of Roses solutive, Manna, Cassia, to which also we may add Rhubarb, Agarick, the leaves of Senna, according as the quality of the peccant humour requires. Vomits also convenient may be giv∣en, especially if the sick be troubled with pain in the heart, loath∣ing, and a desire to vomit: And since the matter consists in the meseraick veins, and that nature her self at the beginning of the paroxism strives to expel it either by vomit or stool, the Physician ought to be observant to it, and to eject the matter, if Nature

endeavour to expel it by stool or vomit; and because the matter for the most part in the first passages is either more abundant, or hath thick humours mixed therewith, there is need not only of lenitives, but those medicines also which we lately mentioned; nay somtimes of some of the Electuary of Fleawort or Fleabane, of the juice of Roses, Rosati Mesuae: Yet care must be taken that we do not draw the humours out of the veins into the first passages.

Concerning the opening of a vein, * 1.152 although Choler residing in the meseraick veins do not require it, yet if there be store of blood, and the peccant humour out of the first region of the bo∣dy have penetrated the vena cava, which may be discerned by the thickness and redness of the Urine, and if the party be strong, a vein may be breathed; and moreover note, that not at the first invading, but afterwards, Phlebotomy is to be used: Yet re∣gard of the Fever is to be had; for if it be a pure Tertian, which useth to be shorter, a vein is to be opened more timely, if it be required, because if it be referred till after the third fit, the dis∣ease comes to its height; but if it be a bastard tertian, you may defer it till after the third paroxism, namely, because more of the morbifique matter is then mixed with the blood in the vena ca∣va; but blood is to be taken away in less quantity in a pure Ter∣tian; because as in continued Fevers that is not the primary indicant, and the strength cannot bear the taking away of a great∣er quantity, blood may be taken away more safely, and in greater abundance in a spurious tertian: But the opening of a vein is most conveniently appointed during the intermission.

Afterwards those medicines are to be exhibited which both correct the qualities of the cholerick humour exceeding, * 1.153 whereby it is troublesome to nature, and also the vitious disposition in the part generating excrementitious humours, and such as are con∣trary to that pollution which remains after putrefaction; such are cooling and moistning things, which together have a power of purging the first ways, and of resisting putrifaction; such are Cichory, Sowthistle, Endive, Sorrel, Barley, the four great, and four small cold seeds, the juice of Citron or Limon, and medi∣cines prepared out of these, Syrup of Sorrel, Acetosa simplex, Oxysauharum, Syrup of Cichory, Endive de acitocitate citri, with waters and decoctions of the same, to which in spurious ter∣tians we may adde those things which are proper for Flegme and Melancholy, the roots of Fennel, grass, asparogus, asarabecca, polypodie, carduus benedictus, centurie the lesser, wormwood, scolopendrium, betony, the spirit of vitriol and salt is profitable, cream of Tartar, Tartar vitriolated.

But amongst those medicines there are some which by a certain peculiar force are said to oppugne Tertians; * 1.154 amongst which notwithstanding for the most part manifest causes may be rendred for it: such are Sowthistle, Camomil, Century the lesser, Plan∣tane, Divels bit.

Altering medicines being given, * 1.155 if the Fever be more pertina∣cious, somtimes purging and vomiting are convenient, which for the most part are to be administred on the intermitting day; but if it be advertised that the matter during the paroxism doth encline towards the stomack, or tend downwards, it is lawful even when the fit is present to administer vomits, or a gentle purge, yet so that before the beginning of the paroxism the ope∣ration may be past, in case a purge be given.

Amongst the vomits, Asarabecca and Broom are principally commended; amongst the purges, Rhubarb; to those that are stronger, the Electuary or Fleawort or Fleabane, Elect. Rosatem, Mesne, and of the juice of Roses may be given in spurious Terti∣ans; Agarick or Senna may be added, in whom it is also neces∣sary to repeat preparatives and purgations.

The body being sufficiently purged, * 1.156 the remainder is to be ta∣ken away by Diureticks: In a pure Tertian an Emulsion of the four great cold seeds is profitable, made with the whey of Goats milk, or the water of Barley, Strawberries, Cichory. In a spurious, a decoction of the roots of Grass, Sparagus, Fennel, Maidenhair, red Parsnips, Bindweed, flowers of Camomil and Wormwood are convenient.

But principally the Physitian ought to imitate nature, * 1.157 which at the end of the paroxisme useth to move sweats, and should dis∣cuss the Reliques of the vitious humours by fudoriferous medi∣cines given either before or after the paroxism; and indeed in pure Tertians, wherein nature usually causes sweat in the end of the fit, it often sufficeth that the sick drink only Barley water, or the water of Sorrel, or Carduus benedictus may be given with the Syrup of the juice of Citron or Limmon. In spurious, hotter medicines are to be used, such as hereafter shall be mentioned a∣mongst malignant Fevers, which being given some hours before the paroxism, often prevents or cures the same.

If the Fever be not cured with these remedies, * 1.158 and that there be any signe of viscous matter, and that the Liver and Spleen are likewise affected, regard thereunto must also be had; and since the Liver for the most part in bastard Tertians is obstructed by thick choler, or choler mixed with thick humours, which pol∣lutes the blood, those things which cleanse the body from choler

are to be used; to which purpose Wormwood is very good to be used, which hath a force of deterging choler, and bringing away the same by stool and urine, as also hath century the lesser, Tro∣ches also of Wormwood, of Rhubarb, Gentian and such like are also profitable; care also must be taken of the Spleen and Sto∣mack, if they are debilitated.

There are certain other medicines given somtimes, * 1.159 which are called Febrifuga, of which 'tis spoken in the fore-going chapter.

And besides these, * 1.160 there are yet others, which are externally ap∣plyed to the body to cure Fevers; namely, a plaister of cobwebs, with unguento populio, the leaves of Shepherds pouch, nettles, crowfoot, and other vesiccatories.

Concerning Diet, * 1.161 in a pure intermitting Tertian, the same diet useth to be kept for the most part as in a continued Tertian, they are to abstain from honey, sweet things, and all those things which ingender choler, wine is not to be drunk before concoction: but when the notes of concoction have appeared, you may use it, so it be thin and watry; meat is to be given when the paroxism is past, unless Syncope imminent perswade the contrary, Galen 10. Meth. Med. c. 5.

In bastard Tertians two things are principally to be observed concerning diet; first, that the disease by too plentiful a diet may not be increased. Secondly, that the strength by too slender a diet may not be debilitated, which should hold out most in a long disease; and therefore the magnitude of the disease, and the greatness of the strength are to be compared one with another; and in case the strength be greater, and the matter harder to be concocted, the thinner diet is to be used, but the larger diet, if the strength be weak, and the matter easier to be concocted. The drink should not only cool and moisten, but also cut, and there∣fore it may be mixed with Hysop and wilde Marjerom, and if water sweetned with honey be exhibited, Vinegar being there∣unto added, that Choler may be thereby corrected.

CHAP. XIX. Of a Quotidian Intermittent.

THe second sort of intermitting Fevers is that which pro∣ceeds from Flegm, * 1.162 which because it takes them every day, is called a quotidian. Fernelius writes that this is the rarest of all Fevers, and that which scarce happens once a∣mongst six hundred: Nay there are some who plainly deny it: and although many are affected every day, yet they are sick of a double Tertian, or treble Quartan.

The cause of this Fever sithence it is Flegm putrifying in the meseraick veins, all those things may be causes of this Fever, * 1.163 which conduce to the generation of Flegm, namely, weakness of the bowels, especially of the stomack, heat, cold and moist aliment, and too great plenty of them.

This Fever is known by the causes generating Flegm which went before, * 1.164 and also by the signs of Flegm abounding in the body, explained in lib. 3. of Institutions part. 2. cap. 2, This Fever chiefly comes to invade in the night, only with coldness of the extreme parts, and trembling: The heat after refrigeration slowly invades, so that somtimes heat, somtimes cold is percei∣ved; and the heat at the first doth not seem sharp, but habituous; yet if the hand put thereunto continue some time, it appears a little sharp, and when it is diffused over the whole body, it doth not burn much, so that the sick do not breath extraordinarily, neither are they very thirsty: The face is not very red, but for the most part yellowish, or a little puffed up; the eyes in the be∣ginning are white, thin, and crude; afterwards when the mat∣ter is concocted, they become thick, troubled, and oftentimes also red. In the first paroxisms also they sweat not, but in the progress of the disease they sweat a little; the Pulse also is ex∣ceeding little, thin, and more then in Quartans, but equally slow; the paroxism is extended to eighteen hours, and the inter∣val, which is six hours, is seldome pure and free; nay 'tis often extended to four and twenty hours.

But how long this Fever shall continue, * 1.165 may be conjectured by the signs of concoction appearing sooner or later in the Urine, and by the longitude and brevity of the paroxism; for if nature timely aim at some evacuation, it affords hopes of shortness of the disease: But this Fever as being that which ariseth from a pertinacious humour is long, and continueth unto forty days

three moneths or more, and is not without danger; and when the Stomack and Liver are much affected with it, the sick are of∣ten cast into a Dropsie and Cachexy.

The cure for the most part is the same with a Quotidian con∣tinued; * 1.166 for the pituitous humour is to be prepared and evacua∣ted, to wit, the first passages are to be opened with Clisters ac∣commodated to the pituitous humour; breathing a vein is scarce used, but a Vomit is more useful then in any other sort of Fever, because the stomack is principally affected, but 'tis to be occasi∣oned by seed of Radish, Orach, of Dill, flowers of Broom, in those that are strong, with Spurge, and others that are every where known.

The Flegmatick humour is to be prepared with convenient medicines; * 1.167 the opening roots, Hysop, wilde Marjoram, Betony, Mayden hair, Agrimony, Groundpine, Camomil, and other things convenient for Flegm, Syrup of Sorrel simple and com∣pound, Syrup of the two and of the five Roots, Honey of Roses, Syrup Byzant, simple and compound, of Hysop, Oxymel simple and compound with Squills, spirit of Salt and Vitriol.

The matter in the first place being prepared, * 1.168 it should be eva∣cuated with Agarick, Mechoachan, Turbith, Troches of Alhan∣dal, Elect. Indo Diaphaenico, Diacarthamo, pills of Hieca, with Agarick, and such like.

Sweat and Urine also should be provoked with medicines made of Fennel, * 1.169 Carduus Benedictus, Salsa Parilla, wood of Sassafras, Treacle, and Mithridate; and lastly the Bowels, but especially the Stomack and Liver are to be strengthned.

CHAP. XX. Of an Intermitting Quartan.

THe third sort of intermitting Fevers which ariseth from a Melancholy humour putrifying in the meseraick veins, * 1.170 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, * 1.171 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, * 1.172 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, * 1.173 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, * 1.174 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, * 1.175 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. * 1.176 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, * 1.177 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, * 1.178 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. * 1.179 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, * 1.180 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, * 1.181 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, * 1.182 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, * 1.183 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, * 1.184 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, * 1.185 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, * 1.186 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.

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

BEsides these simple Fevers hitherto mentioned, * 1.187 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, * 1.188 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: * 1.189 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, * 1.190 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; * 1.191 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, * 1.192 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, * 1.193 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; * 1.194 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: * 1.195 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, * 1.196 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; * 1.197 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, * 1.198 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.

* 1.199 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, * 1.200 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, * 1.201 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, * 1.202 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, * 1.203 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

  Putred Fevers.
• * 1.2

  What Pu∣trefaction is.
• * 1.3

  How ma∣nifold it is,
• * 1.4

  according to the who••
• * 1.5

  in some part.
• * 1.6

  The cause of putrefac∣tion.
• * 1.7

  Default of humours.
• * 1.8

  Transpi∣ration hindred.
• * 1.9

  Causae cali∣facientes.
• * 1.10

  Meetings with pu∣tre•• things.
• * 1.11

  The diffe∣rence of putred hu∣mors.
• * 1.12

  The Diag∣nosticks.
• * 1.13

  The Pro∣gnostick.
• * 1.14

  Indicati∣ons in pu∣tred Fe∣vers.
• * 1.15

  Letting blood.
• * 1.16

  Whether, when, and why to be done in a putred Fe∣ver.
• * 1.17

  Rules al∣lowing Phleboto∣my.
• * 1.18

  The quan∣tity that may be ta∣ken.
• * 1.19

  The time.
• * 1.20

  The place.
• * 1.21

  Purgation
• * 1.22

  Clysters.
• * 1.23

  Lenitives.
• * 1.24

  Vomits.
• * 1.25

  Purging medicines.
• * 1.26

  Concoction of humors.
• * 1.27

  Flatulent humours.
• * 1.28

  Digestive medicines.
• * 1.29

  Concocters of chole∣rick hu∣mours.
• * 1.30

  Phlegma∣tick.
• * 1.31

  Melancho∣ly.
• * 1.32

  Resisting of putre∣faction.
• * 1.33

  Preparing of humers.
• * 1.34

  Causing sweat.
• * 1.35

  Urine pro∣voked.
• * 1.36

  Dyet.
• * 1.37

  Form of Diet.
• * 1.38

  Quantity.
• * 1.39

  Quality.
• * 1.40

  Time.
• * 1.41

  Drink.
• * 1.42

  Air.
• * 1.43

  Sleep, rest. Excre∣ments, pas∣sions of the mind.
• * 1.44

  The diffe∣rences of putred Fe∣vers.
• * 1.45

  From the matter.
• * 1.46

  A serous humour.
• * 1.47

  From blood. Phlegm. Choller.
• * 1.48

  Melancho∣ly.
• * 1.49

  From other causes.
• * 1.50

  From the place.
• * 1.51

  within the vessels.
• * 1.52

  Without the vessels.
• * 1.53

  Fevers ac∣companied.
• * 1.54

  A primary continued Fever.
• * 1.55

  A Puered Synocha.
• * 1.56

  The cause.
• * 1.57

  Differen∣ces.
• * 1.58

  Diagno∣stick signs.
• * 1.59

  Progno∣sticks.
• * 1.60

  Indicati∣ous.
• * 1.61

  Breathing of a vein.
• * 1.62

  Medicines.
• * 1.63

  Diet.
• * 1.64

  Burning Fevers.
• * 1.65

  Diagno∣sticks.
• * 1.66

  Progno∣sticks.
• * 1.67

  Continus periodick Fevers.
• * 1.68

  their causes.
• * 1.69

  The reason of its con∣tinuity.
• * 1.70

  Signs.
• * 1.71

  Differen∣ces.
• * 1.72

  A Tertian continued.
• * 1.73

  The cause.
• * 1.74

  Signs.
• * 1.75

  Progno∣sticks.
• * 1.76

  Cure.
• * 1.77

  Opening a vein.
• * 1.78

  Lenitives.
• * 1.79

  Altera∣tives.
• * 1.80

  Topicks.
• * 1.81

  Purgation
• * 1.82

  Diureticks
• * 1.83

  Sydorificks
• * 1.84

  Dyet.
• * 1.85

  A continu∣ed Quoti∣dian.
• * 1.86

  Cause.
• * 1.87

  Signs.
• * 1.88

  Progno∣sticks.
• * 1.89

  Cure.
• * 1.90

  Lenitives.
• * 1.91

  Opening a vein.
• * 1.92

  Preparing and alter∣ing.
• * 1.93

  Purging.
• * 1.94

  Provoke urine and Sweat.
• * 1.95

  Strengthe∣ning Me∣dicines.
• * 1.96

  Dyet.
• * 1.97

  The Fever Epiala.
• * 1.98

  Cause.
• * 1.99

  The Cure.
• * 1.100

  Syncopal Fever.
• * 1.101

  The Pro∣gnostick.
• * 1.102

  Cure.
• * 1.103

  Diet.
• * 1.104

  A conti∣nued quar∣tan.
• * 1.105

  The cause.
• * 1.106

  the Diag∣nosticks.
• * 1.107

  ••••ogno∣sticks.
• * 1.108

  Cure.
• * 1.109

  Diet.
• * 1.110

  Symptoma∣tical Fe∣vers.
• * 1.111

  Differen∣ces.
• * 1.112

  Fevers ac∣companied.
• * 1.113

  Erysipelas or Rose.
• * 1.114

  Differen∣ces of Fe∣vers.
• * 1.115

  Phlegmo∣nides. Typhodes. Lipyriae.
• * 1.116

  Febre∣lentae.
• * 1.117

  Fevers from pu∣trefaction of interals.
• * 1.118

  From cor∣rupt milk. Putrified blood, Worms.
• * 1.119

  Diagn••∣stick signs:
• * 1.120

  The Pro∣gnostick.
• * 1.121

  The Cure.
• * 1.122

  The cure of accom∣panied Fe∣vers.
• * 1.123

  Intermit∣ting Fe∣vers.
• * 1.124

  their prox∣imate cause.
• * 1.125

  The fire place of Intermit∣ting Fe∣vers.
• * 1.126

  the cause of inter∣mitting Fevers conteined in the v••∣na cava.
• * 1.127

  Causes of the return of fits.
• * 1.128

  Cause of 〈◊〉〈◊〉.
• * 1.129

  Order of the fits
• * 1.130

  The cause of antici∣pation and coming late.
• * 1.131

  The cause of the length of Fits.
• * 1.132

  The more remote causes of intermit∣ting Fe∣vers.
• * 1.133

  Difference.
• * 1.134

  Of a quoti∣dian, whe∣ther any be.
• * 1.135

  Whether there are Quintan Fevers.
• * 1.136

  Diagno∣stick signs.
• * 1.137

  Progno∣sticks.
• * 1.138

  Indicati∣ons and Cure
• * 1.139

  Purging
• * 1.140

  Sweats
• * 1.141

  Letting blood.
• * 1.142

  Febrifuga.
• * 1.143

  Topical Medicines.
• * 1.144

  An inter∣mitting Tertian.
• * 1.145

  Its differ∣ence.
• * 1.146

  The causes genera∣ting, Choler signs of a true Ter∣tian.
• * 1.147

  A pure Tertian.
• * 1.148

  A spurious Tertian.
• * 1.149

  Progno∣sticks.
• * 1.150

  Indicati∣ons and Cure.
• * 1.151

  Purgers.
• * 1.152

  Opening a vein.
• * 1.153

  Prepara∣tives.
• * 1.154

  Specificks
• * 1.155

  Purgers.
• * 1.156

  Medicines causing of urine.
• * 1.157

  Sweats.
• * 1.158

  Corolora∣tives.
• * 1.159

  Febrifuga.
• * 1.160

  Topical Medicines.
• * 1.161

  Diet.
• * 1.162

  A Quoti∣dian Fever
• * 1.163

  The cause
• * 1.164

  Diagno∣stick signs.
• * 1.165

  Progno∣sticks.
• * 1.166

  The Cure
• * 1.167

  Preparers.
• * 1.168

  Purgers.
• * 1.169

  Movers of Urine and sweat.
• * 1.170

  A Quar∣tan.
• * 1.171

  The cause
• * 1.172

  Signs,
• * 1.173

  Progno∣sticks.
• * 1.174

  Indicati∣ons
• * 1.175

  Cure
• * 1.176

  Opening a vein.
• * 1.177

  Preparers.
• * 1.178

  Purging Medicines
• * 1.179

  Vomits
• * 1.180

  Hemor∣rhodes.
• * 1.181

  Sudori∣ficks.
• * 1.182

  Appropri∣ated medi∣cines.
• * 1.183

  Hindring the fits.
• * 1.184

  Mitigati∣of cold fits.
• * 1.185

  Topical things.
• * 1.186

  Quintan Fevers.
• * 1.187

  Fevers compound∣ed.
• * 1.188

  Confused
• * 1.189

  Implicite
• * 1.190

  Three ways of composi∣tion of Fevers.
• * 1.191

  Signs of compound Fevers.
• * 1.192

  Progno∣sticks.
• * 1.193

  Cure
• * 1.194

  A double Tertian.
• * 1.195

  A treble Tertian.
• * 1.196

  A double Quotidi∣an.
• * 1.197

  A double Quartan
• * 1.198

  A treble Quartan
• * 1.199

  Cure
• * 1.200

  Semiterti∣an.
• * 1.201

  Signs:
• * 1.202

  Progne∣sticks.
• * 1.203

  Cure.