The London practice of physick, or, The whole practical part of Physick contained in the works of Dr. Willis faithfully made English, and printed together for the publick good.

THE PRACTISE OF PHYSICK, CONTAINED In Dr. Willis's Tract of Fevers. (Book 6)

CHAP. I. The Anatomy of the Blood; its Resolution into five Principles: its Comparison with VVine and Milk.

A Fever is only a fermentation, or an immoderate effervescence brought on the Blood and Spirits; now that this feverish effervescence may be explicated as it ought, these three things are to be considered. First, what that Liquor is which Ferments, whether it be only the Blood, or other Humours besides. Secondly, of what prin∣ciples, and of what proportion of the same that Liquor consists in its mixture. Thirdly, and lastly, with what kind of motion and turge∣scency of these Parts or Particles of which the Blood is compos'd, the Feverish effervescence is raised.

1. That the Blood boyles violently, and makes an effort in a Fever, it is evident enough, and we may Conjecture that that Juice with which the Brain and Nervous Parts are irrigated, is often also in the sault; for since this Liquor is carried by a constant motion and a cer∣tain circulation from the Blood into the Genus Nervosum, and thence by the Lymphick Vessels into the Blood, its probable, if by reason of a Taint contracted by the Blood, that Humour is deprav'd in its Crasis,

or is perverted from its regular motion, that thence the shivering and the pain, the convulsions, delirium, frenzy, and many other symptoms of the Genus nervosum, usual in Fevers, arise.

After the Blood and Nervous juyce there are two other Liquors which are to be considered, as being apt to ferment, viz. the Chime or Nutri∣tive juyce alwayes coming to the Blood, and the Serous Latex perpe∣tually parting from it; which, tho first and last are Liquors sever'd from the Blood, and distinct from it, yet whilst mixt with it, they ought to be lookt upon as Parts received into it, or belonging to its Accomplishment: and as long as both these are circulated with the Blood in the Vessels, they participate of the Effervescencies of the pri∣mogenious Cruor, and often begin the same on occasion, or encrease them being begun.

2. As to the Principles of which the mass of Blood consists in its mix∣ture, and what Proportion they have in it; We do not allow of the Opinion of the Ancients, That the Mass of Blood consists of the four Humours, viz Blood, Flegm, Choler, and Melancholy; and that according to the Eminency of this or that Humour, the divers Tem∣peraments are form'd, and that by reason of their fermentings or Exor∣bitances, in a manner, all Diseases arise: nor has this Opinion been so ge∣nerally used for solving the Phenomena of Diseases, since the Circula∣tion of the Blood, and its other Affects, before unknown, came to light: and since those Humours consist of other Principles, viz. Cho∣ler of Salt and Sulphur, with a mixture of Spirit and Water, and Melancholy of the same, with an addition of Earth; and since the Blood is immediately composed of these kind of Principles, and is wont to be sensibly resolved into them, I have rather chosen, omit∣ting the vulgar Acceptation of the Humours, to make use of these known Principles of the Chymists for explicating the nature and affects of the Blood: therefore there are in the Blood, as in all other Liquors apt to ferments, a great deal of Water and Spirit, a small Proportion of Salt and Sulphur, and somewhat of Earth. I shall briefly run over these Principles, and endeavour to shew after what manner they constitute the Consistency, Properties, and Affects of the Blood.

1. The Spirits (which without Dispute have the first place) are the subtle, and most volatile part of the Blood: their Particles being always expanded, and endeavouring to fly away, exagitate the gros∣ser Corpuscles of the rest in which they are involv'd, and keep them always in a motion of Fermentation; by the Effervescence and even Expansion of these in the Vessels, the liquor of the Blood continually boyls, and the rest of the Principles are kept in an orderly Motion, and in an exact Mixture: if any thing that is heterogeneous, or unapt for mixture, comes into the Mass of Blood, presently the Spirits, being troubled in their Motion, make an Effort, exagitate the Blood, and

make it boyl vehemently, till that which is extraneous and immisci∣ble with it, be either subdued, or reduced, or driven forth.

2. From the Dissolution of Sulphur in the Blood, it is likely that the ruddy Tincture of the Blood arises. For sulphureous Bodies, above all others, give the highest saturated redness to a solving Menstruum; and if at any time by reason of too much Crudity, the Sulphur is not dissolv'd, the Blood becomes pale and Watery, that it scarce gives a redness to Linnen. The mass of Blood impregnated with Sulphur to∣gether with Spirits, is very fermentative, and when the sulphureous part is raised, and abounds too much in the Blood, it perverts its Crasis from its due state, that thereby the Blood being deprav'd or rendred bilous, does not rightly concoct the nutritive Juice, or being wholly inflamed, falls into heats and burnings, such as arise in a con∣tinual Fever. For the Sulphur being too much exalted, and growing more turgid than it ought, raises mighty Effervescensies in the Blood; and those whose Blood is plentifully impregnated with Sulphur, are ve∣ry obnoxious to Fevers: by reason of the Particles of this incocted in the Nutritive Juice, and thence applyed to the solid parts, Fatness, Softness and Tenderness happen to our Body.

3. We discover Salt in the Blood by the Taste, which is there highly volatiz'd by circulation, and if at any time in the Blood, by reason of an ill digestion, the saline Particles are not duely exalted, but conti∣nue crude and for the greatest part fixt, thereby the Blood becomes thick and unapt for circulation, so that obstructions are engendred in the Viscera and solid parts, and serous Crudities are every where heapt together: but if the Spirit being depress'd or fainting, the Salt is ex∣alted too much, and comes to a flowing, an acetous and austere dispo∣sition is brought on the Blood, such as is observ'd in scorbutical Per∣sons, and in such as are troubled with a quartan Ague: also from the Salt by this means variously coagulated, the Gout, Kings-evil, the Ne∣phritis, the Leprosie, and a great many Cronick Diseases arise. When the Salt is exalted in a due measure, the saline Particles re∣strain the wild efforts of the Spirits, and especially of the Sulphur; wherefore those who have the Blood well saturated with a volatile Salt, are least subject to Fevers, and so also those who are often let Blood, are more apt to Fevers.

4. By the earthy Particles in the Blood, its too great volatilisation is stay'd, and its over quick accension is hindred: Moreover, from the terrestrial Particles of the Blood and nutritive Juice, the balk and in∣crease happens to the Body.

5. On the watery part of the Blood its fluidity depends, for hereby its stagnation is hindred and the Blood is circulated in the Veins with∣out growing thick; also its too great conflagration and adustion is qualified, and its heat is allayed.

What we have said even now concerning the Principles of the Blood, and the Affects to be drawn from thence, will appear more clear, if we consider a little the Blood according to its sensible Particles; and com∣pare it with the Liquours which are frequently in use among us. Now those Liquours which have the greatest Analogy with the Blood are Wine and Milk; as to its wayes of Fermentation and Effervescence, it is most aptly compar'd to Wine; as to its Consistency, Coagulation, and Separation of the parts from each other, it is compar'd to Milk.

First therefore we may observe concerning Wine, that as long as it is included in a Vessel, its subtle and spirituous Parts continually ex∣agitate and refringe the more gross, and render them apt for an exact mixture; that which is heterogeneous and unapt to be subdued, is se∣ver'd by effervescence: mean while the depurated Liquour gently fer∣menting, is in perpetual motion, whereby all the parts expand them∣selves every way, and pass by a constant circumgiration from the top to the bottom, and again from the bottom to the top; by the particu∣lar fretting and refraction a great many effluvia's of Attoms part from the Liquour, which if they are kept in by a Vessel close stopt, the Li∣quour ferments too much, and often makes the Vessel flye in pieces. So the Blood within the Veins is prest on by a constant circulation: the vital Spirit subtilises, refringes, and presently subdues the grosser Particles: drives forth that which is heterogeneous and immiscible: mean while from the refraction, and working of the Parts and Cor∣puscles, the Effluvia of heat constantly flow forth, and evaporate by the Pores: upon the closing of which, if transpiration be hindred, presently by reason of the too great effervescence of the Blood a Fever is kind∣led.

Secondly, we observe concerning Wines, that they grow turgid if any thing that is extraneous and of a fermentative Nature be mixt with them: nay, that sometimes they are troubled more than usually of their own accord: for when by a long digestion the sulphureous part of the Wine is exalted too much, it falls into an effervescence greater than it ought, and (unless it be presently appeas'd) it perverts the cra∣sis of the Liquour by its Turgescency; the same thing altogether seems to be in the feverish Effervescence rais'd in the Blood, which is wont to be introduc'd for those kinds of causes.

The third observation, or comparison of the Blood with Wine is this: Wines (as many other Liquours) have their times of Crudity, Maturation, and decay, the same thing being to be observ'd in the Blood. [concerning which sec Dr. Willis as large.]

So far of the comparison of the Blood with wine, what follows, its similitude with Milk consists in the diversity of its parts and their part∣ing from each other, which is chiefly seen in it when it is let out of the Veins, and grows cold in a Vessel, For when the heat and vital Spirit, which preserve all in a mixture, are fled away, the remaining

parts depart from each other, and there is made a separation of the thin from the thick, of the Serum from the fibrous Blood, &c.

After having considered the Blood, we may observe, that the nu∣tritive Juice, supply'd from the Blood, and sever'd from its mass for the nutrition of the solid parts, sometimes by reason of its depravation and irregular motion causes many symptoms in Fevers: This nutritive Juice which is supply'd from the mass of Blood, by a certain circulati∣on, after it has past the nervous parts, what remains of it being effaete and Poor as it were, is sent again by the Lymphick Vessels to the Blood.

CHAP. II. Of the Motion and Effervescencies of the Blood.

WE must next enquire concerning the Bloods motion both natu∣ral (viz. by the help of what ferments; and by what fort of turgescency of the parts, it is circulated in a continual motion through the Vessels) and preternatural, viz. for what causes, and by the efforts of what parts, sometimes it boyles above measure in its Vessels, and falls into feverish Effervescencies.

Concerning the natural Motion of the Blood, we do not here en∣quire concerning its circulation: viz. by what knid of structure of the Heart and Vessels, as it were in a Water Engine, it is carried round in a constant course, but concerning its Fermentation, viz. by what kind of mixture of the Parts, and their mutual Action on each other (like Wine fermenting in a Vessel) it continually boyles: and this kind of motion depends both on the Heterogeneity of the parts of the Blood it self, and on the various ferments, which are inspir'd into the mass of Blood from the Viscera.

As to the first, those things which have altogether the like Particles, do not ferment, wherefore neither distill'd Waters, chymical Oyles, Spirits of Wine, or other simple Liquours are stir'd at all, but the Blood, consisting of various Elements of a contrary nature, and working on each other continually, ferments, and his all its Particles in a perpe∣tual Motion.

It is an Argument that Ferments are requir'd for Sanguification, because, when they fail by nature, they are supply'd by Art with good success: for fixt Salts, Alchalies, Extracts, Digestives, and especially Chalybeat Remedies give help only in this respect, that they re∣store

a new the ebullition of the Blood either weak or almost extinct.

As to what concerns natural Ferments, certainly many may be form'd and stor'd up in divers Parts, or Viscera: for any Humour in which the Particles of Salt, Sulphur, or Spirit, being very much exalted, are contain'd, indues the nature of a Ferment: After that manner Yest and Leaven come to be such, with which new Beer, and a mass of Bread are excellently fermented: In like manner, an acetous Humour in the Stomack, participating of an exalted Salt, helps there Concoction: and in the Spleen, the Dreggs of the Blood, by reason of the Salt and Earth exalted in them, turn to a ferment.

How great a Vigour comes to the Blood from the Womb and geni∣tal Parts, appears hence, because from the Privation or Discrasie of these in Virgins a Green-sickness, in Men a want of Beard, a weak Voice, and an amission of Virility follow, but the cheif ferment which ferves for Sanguification is lodged in the Heart; for here is the greatest scat of heat, in which the more crude Particles of the Chyme are kind∣led as it were, and acquire a volatility.

Therefore the Motion and heat in the Blood, depend chiefly on two things, viz. partly on its proper Crasis and Constitution, whereby be∣ing plentifully compos'd of the active Principles of Spirit, Salt, and Sul∣phur, it grows turgid of its own accord in its Vessels (as Wine in a Hogs-head) and partly on the ferment implanted in the Heart, which very much rarifles the Liquour, passing through its Sinus's, and forces it to spring forth with a frothy Effervescency.

Let thus much suffize concerning the natural Motion, Heat, and Fermentation of the Blood, in the even tenour of which the state of our Health consists: to speak now of its preternatural, or over great Effervescency, on which the Types, and Fits of Fevers depend. I call an over-great or preternatural Fermentation, when the Blood (like a Pot boyling over the Fire) boyles above measure, and being rarified with a frothy Turgescency, swells the Vessels, raises a quick Pulse, and, like a sulphureous Liquour taking fire, diffuses on all sides a burning heat.

This kind of Motion or Fermentation of the Blood is excellently il∣lustrated by the example of fermenting Wines: for Wines, besides the gentle and even fermentation, whereby they are first depurated, at certain times boyl so mightily, that they work over the Vessels: and if they are close stopt, they make them flye in pieces; after this manner, being put upon an effort as it were, unless they are presently drawn off from the Tartar, or their Lees into another vessel, they cease not to boyl, till the Spirit, being very much spent, and the Sulphur or Salt too much exalted, they either become over-fretted, or degenerate in∣to Vinegar.

Such an Effervescency is wont to be raised chiefly for two Causes; first, when any thing extraneous and immiscible is put into the Vessel:

(so some drops of Tallow or of Fat dropt into the vessel, produce this Motion) or secondly, when Wines having too much Lees or Tar∣tar (by reason of the sulphureous parts exalted above measure) fall into an Effervescence of their own accord, and boyl vehemently: for in whatsoever substance Sulphur abounds, and its Particles being loos∣ned from their mixture, joyn with one another, and are kept close together, there such immoderate Effervescencies are procur'd.

After the like (tho not wholly the same) manner as Wines fer∣ment, the Ebullition of the Blood is caused, viz. either some extrane∣ous and heterogeneous thing is mixt with the Blood, which, in regard it is not assimilated, is wont to cause a perturbation and Effervescence, till the heterogeneous thing be either subdued, or sent forth, and the confused and troubled Particles of the Blood, are clear'd again, and take to their former position and site in mixture. Or secondly, the Blood is troubled above measure, because some Principle or Element which composesit, (viz. the Spirit or Sulphur) is rais'd beyond the natural Temper, and becomes exorbitant, whereby the Particles of this, or that not agreeing with the rest, are loosned from their mixture, being loos'd make an effort more then they ought, exagitate the Li∣quour of the Blood, and cause an effervescence, which is not appeas'd, till the Blood, being inflam'd as it were, has burnt a long time with a feverish blast. But there is this difference betwixt these two boyl∣ings of the Blood, that the Effervescence which depends on the mix∣ture of an extraneous thing with the Blood, is for the most part short, or comming by Fits; which when the heterogeneous thing is separated or subdued, ceases of its own accord, and the troubled and disordered parts of the Blood readily return to their natural Site or Crasis: but the Ebullition which arises from the disordering of the exorbitant Spirit or Sulphur, is continual: to wit, here the whole mass of Blood is so open'd, and loosn'd from the strict bond of mixture, that taking a fire like an oily Lpquour, it does not cease to rage and flame till the Particles of the Spirit or Sulphur, or of the combustible matter are for the greatest part consum'd.

There remains yet a third preternatural way of effervescency, in which the Blood undergoes an alteration, which does not happen to Wine, but very frequently to Milk: viz. sometimes a coagulation of that liquor is induc'd by a morbifick cause, so that it substance is sus'd, and separates into parts, and there is a secretion made of that which is thick and earthy from the thin; by reason of which the Blood is not meetly circulated in the Vessels, but its congeal'd portions, being apt to be fix'd in the extreme Parts, or to stagnate in the Heart, interrupt its even motion, and greatly hinder it. For restoring of which, effervescencies greater than usual are rais'd in the Blood; to wit, such as every where occur in the Pleurisie, Plague, Small Pox, and malignant Diseases.

CHAP. III. Of Intermitting Fevers.

AFever may be describ'd after this manner, That it is a disor∣derly motion of the Blood, and its over great boyling, with a heat and thirst, and other symptoms besides, with which the natural oeconomy is variously troubled. As we observ'd before concerning the effer∣vescence of the Blood, so we may now concerning the Fever, that its access is either short, and coming by sits; which therefore is called intermittent: or great, and drawn in length, which is call'd a continual Fever: We shall speak first of the intermittent.

Concerning this Fever, we shall first enquire in general what kind of effervescence of the Blood it is which causes its Fit, and whence it is rais'd. Secondly, Wherefore the Fit consists of a coldness, with a shivering, and a sweat ensuing. Thirdly, What is the cause of the intermission, and of the set times of return. Fourthly and lastly, we shall subjoyn certain irregularities of Intermittent Fevers.

As to the first, We must suppose, that for an Intermittent Fever, some heterogeneous thing is mix'd with the Blood, whose Particles, in regard they are not assimilated, make so long an ebullition of the same, till either being subdued, they are rendred miscible, or being subtilis'd, they are sent forth: wherefore, such matter being subdued or sent forth, the fit ceases; and when this matter springs a fresh, it causes a new Ebullition, and consequently a new Fit happens.

Now that which causes an exactly periodical Effervescence of the Blood, must of necessity be some thing which against each of the set returns or accesses of the Fever is engendred in our Body in a set measure, and alwayes in an even proportion, and is communicated to the mass of Blood: wherewith, when the Blood is saturated to a fulness, presently it grows turgid, and falls into an Effervescence: now what∣soever others may think, I judge this thing to be the nutritive Juice, supplyed from the matter of things eaten and convey'd to the Blood in weight and measure, which, in regard it is not assimilated through defect of Sanguification, being heap'd together to a fulness in the Ves∣sels, it causes a Turgescency in the Blood for its expulsion.

I have observed before a three-fold State concerning the Particles of the Blood, viz. of Crudity, Maturity and Decay, that is to say, the nutritive Juice supplyed from the daily Food, comes crude, being mixt with the Blood, and circulated for some time, it is assimilated, and maturated into a perfect humour; afterward waxing stale, it runs into

parts, and is separated, while the Blood is continually renewed after this even manner, and its losses are repair'd, it ferments quietly, and is circulated within the Vessels without tumult or immoderate Efferves∣cence; but if the supply of the nutritive Juice be not maturated as be∣fore, nor turns into Blood by a perfect digestion; its Particles mixt with the Blood, continue in its mass as some heterogeneous thing, and not exactly agreeing; with which, when it is saturated to a fulness, presently the Blood grows turgid, and falls into a feverish Effervescence, where∣by the fresh supply of this depraved Juice is either subdued or sent forth.

If it be askt for what cause the nutritive Juice, being mixt with the Blood, is not assimilated, but degenerates into a heterogeneous and fermentative matter: I judge that this is done for the most part, not through the fault of the Aliments, or of the Viscera, but of the Blood it self. For the Blood, even as Wines, sometimes falls from its na∣tive and genuine Disposition, into a sharp, acid, or austere nature, and because the Blood sanguifies, it happens that when that is fallen from its due temper, it easily perverts the store of nutritive Juice, where∣with it ought to be repaired.

Secondly, as to the shivering and cold preceding the heat in this af∣fect, doubtless the true and genuine cause of those is the flowing and turgescencie of the nervous Juice degenerated into a nitrous Matter, wherewith the Spirits and heat being charged, are obunded, and the nervous Bodies being irritated are put into a Trembling: but after∣ward when these nitrous Particles, being in part protruded to the Su∣perficies of the Body, the Blood is somewhat freed from their cum∣brance and oppression, the animal spirits recollect and begin to dis∣play themselves, and then a most intense heat ensues, because both the mass of Blood being opened by reason of its Effervescence with the febrile matter, and its mixture being loosned, the sulphureous Parti∣cles are freely kindled in the Heart: and because (the Pores of the Skin being possest by the same matter protruded toward the circum∣ference of the Body) the vapory Effluvia are inwardly restrained, which much exagitate and heat the Blood: and which heat continues still in it till the fermentative Matter being wholly burnt, and fully subdued and subtiliz'd together with the adust Recrements remaining after the Deflagration, and joyning with the Serum, they evaporate by Sweat or insensible Transpiration.

Thirdly, from what is said it will be easy to shew the Causes of the Intermission, and of the Set Returns, viz. the Intermission follows, because the Morbifick Matter is all clear'd at one fit, and so till a new be brought in place, an intermission follows of necessity. Now a new matter begins to be engendred from the time that the last Fit ceas'd, and when the Blood is filled again to a Turgescency, it boyles and comes to a flowing.

As to the Set Returns of the Fits, these happen, because for the most part the nutritive Juice is supplied from the Viscera to the Blood passing in the Veins in an even measure and quantity, tho sometimes, if the Persons who have intermittent Fevers gorge themselves too much, or are very abstemious, the Fits happen sooner or later than usual.

If it be ask'd, wherefore the Set Returns of Fevers are not of one kind, and of the same distance, but that some come every day, some every third or fourth day; the cause is the different constitution of the Blood, whereby it is perverted from its due temper into a sharp, sometimes an acid, or austere disposition. According to this differ∣ing Dyscrasy, the nutritive Juice, fresh brought, falls more or less from its maturation, and is perverted into a matter sooner or later apt to Ferment.

The Procatarctick Causes of this Disease plainly shew its Origine from the temper of the Blood being chang'd. For intermitting Fevers are chiefly rife in that Season, and those places, in which the Blood receives the greatest alteration from the Air.

The same thing is made out by the Cure of intermittent Fevers, whether it be natural and critical; or artificial, and be perform'd by the help of Medicines: As to the first, Intermittent Fevers are wont to be terminated after a two-fold manner: the first is, when the tem∣per of the Blood is altered by the Fits themselves, and it is brought to its natural state; the other way is, when the change of the Air or Place of abode brings a mighty alteration of the Blood, for so Fevers begun about the Equinoxes, are terminated about the Solstices; also the Diseas'd travelling into another Country often recover.

As to the Cure to be perform'd with Medicines, it is undertaken either Empirically or Dogmatically; and in this Disease Empyrical Re∣medies, taken from Mountebanks or old Women, are more esteem'd, and often effect more than the Prescripts of Physicians given according to an exact method of Curing.

The Empyrical Remedies which are said to cure intermittent Fe∣vers, are such as without any evacuation keep off the invading Fit: and are either taken inwardly, or are outwardly apply'd where the Pulses chiefly beat, viz. they are bound for the most part to the Regi∣on of the Heart, or to the Hand-wrists, or to the Soles of the Feet: now it is worthy to be enquired into, after what manner these work, and by what means they stop the feverish accesses. It is manifest in the first place, that the vertue and action of these things which are outwardly applyed, are communicated to the Blood and Spirits immediately; and in regard they drive off the Fit by way of preventi∣on without the evacuation of any humour or matter, of necessity the reason of this effect must consist only in this, that by the use of these kinds of Medicines the Turgescency and Fermentation of the Blood

with the Febrile matter are stopt, that is to say, from the Medicine bound about the Vessels, certain Corpuscles or Effluvia are communicated to the Blood, which greatly fix, and constringe its Particles, or also by fusing and exagitating precipitate them as it were: after both wayes the spontaneous Effervescence of the Blood is hindred: like as when cold Water is put into a boyling Pot; or as when Vinegar or Allum is put into new and working Beer, presently the fermentation ceases, and the Liquour acquires a new tast and consistency, and is as fit for drinking as if it had been ripened a long time. Now that these Febrifuges operate after this manner, it seems plain enough, because those that are of chiefest note excell in a styptick and astringent, or also in a precipitating Virtue: hence Sea-salt, Nitre, Sal Gemm, the Juice of Plantain, Shepherds pouch, all astringent Herbs bruised with Vinegar, and the like things bound to the Wrists; the roots of Yarrow, Tormentill, also Camphire hung about the Neck, are said to remove this Disease: Moreover the things that are taken inwardly are of the like sort, the Juice of Plantain, red Rose-water, Allum, in as much as they fix and constringe the Blood; a Decoction of Pepper, Sal Armoniack, or of Wormwood, Spirit of Vitriol, also a sudden Passion of Anger or Fear, in as much as by fusing and exagitating the Blood, they pre∣cipitate it, often hinder the feverish access: like as a concussion and exagitation of any Liquour, or an infusion of astringent things in it hinder a spontaneous Effervescence or Effort. It is usual with some Empiricks for the cure of intermittent Fevers, to make a hard Ball of Flax or Paper rowled up, and to bind it so colse to the Wrist where the Pulses beat, that the circulation of the Blood in that place is in some manner stopt, and by this means the invading fit of the Fever is driven away. I have certainly known many cured after this man∣ner of a long continued Disease: the reason of which seems to be, that whilst the Blood is stayed in its Motion in any part, it stirrs more vi∣olently in the rest, and so from that trouble raised in the whole Blood, the spontaneous Effervescence of its Liquour, which was to follow a while after, is stopt: and upon the Fits being put off twice or thrice, Nature takes to the digestion of the matter, and to its ancient regu∣larity.

The dogmatical cure for the most part is undertaken by Vomits and Catharticks, also by letting Blood: with which the Diseased are mise∣rably tormented, and the Disease is seldom brought to an end, tho sometimes Tertian Fevers are taken away by a Vomit given a little be∣fore the Fit, which happens, because by this means the Blood is pretty fully cleansed of its bilous Humour: tho its worthy observation that Vomits do no good in a Quartan Ague, and seldom in a Tertian, un∣less they are given presently at the beginning, when the febrile Dis∣position is yet light, and not fully confirmed.

Concerning intermitting Fevers in general, there remain yet to be explained certain irregularities, of them, in which they alter from the common way: first therefore, the fits are wont sometimes to be with∣out cold or shivering: an intermittent. Fever was rise this Autumn, whose accesses troubled the diseased only with heat, and that very in∣tense, in many there was a violent vomiting, but no cold or sweat; after four or five returns had hapned, as the fit invaded, the diseased were wont to be a little chill'd, and afterward plainly to have the cold fit, and, as it went off, to sweat: the reason of this was, because by the hot summer the Constitution of the Blood was become sharp and very much burnt: wherefore the Particles of the crude Juice mixt with it were presently scorcht and burnt, that they did not wax cold first with a sourness (like new beer) and then afterward burn out: but a Tur∣gescency being raised, the whole (like dry Wood laid on the fire) presently burnt out in a light flame; but afterward, the Liquour of the Blood, after having burnt for some fits, became less torrified; that the depraved nutritive Juice was not presently scorcht, but passed into a nitrous Matter, and fermenting with a sourness; which first growing turgid, brought a sence of coldness on the whole Body.

There remains yet a great doubt concerning the distances of the returns, which sometimes seem to be double in the same Fever, that the first access answers to the third, and both happily in the Morning: and again, the second to the fourth, and both happen in the Evening, and so on: wherefore such a Fever is wont to be called a double tertian or quartan: It seems to me, that in this case sometimes it happens that the Fever is simple, and of one kind, and that the Types are a like, and all agreeing with each other; but that the errour chiefly arises, because the intervals of the returns are not computed by hours, but by dayes: for since the intervals of the beginnings of the Fits are not distant from each twenty four hours exactly, but either sixteen or thir∣ty hours in a quotidian, and in a tertian not forty eight hours, but forty or fifty six, more or less, or thereabout, it will come to pass that the alternate fits will happen before, and the rest after noon: to which also may be added, that the uneven way of living which the diseased use, may oftentimes produce great unevennesses of the returns, that sometimes the fit comes twice a day, as I have often observed in cache∣ctical Persons, and such as have used a disorderly dyet: nevertheless it often happens that intermittent Fevers have returns of fits which neither observe the same distance, nor keep wholly to the same sort of form: I have frequently noted in a quartan Fever, that besides the set accesses, returning about the same hour, the fourth day, certain er∣ring and uncertain fits troubled the Diseased, that sometimes, the day preceeding the wonted fit, sometimes following it, another fit also (tho slight) was raised anew, carrying exactly the Type of an inter∣mittent Fever, with a shivering, a heat and sweat: and nevertheless

the primary access returned at the usual time: this for the most part is wont to happen either by a diet ill ordered, especially by surfeiting and drinking of Wine, or by the ill administration of Physick: the rea∣son of which, I take it, consists in this, that by these errours in diet more matter is heapt together, than can be clear'd off at one fit.

CHAP. IV. Of the kinds of intermittent Fevers, and first, of a Tertian.

WE call a Tertian Fever, not that which happens at three days distance; but inclusively from the day in which one fit be∣gins, on the third thence, another returns: mean while, sometimes if the fits are long, viz. protracted to twenty four hours, and withall come before the usual time of their accesses, the space of intermission is often less then twenty four hours.

The essence of a Tertian Fever consists in this, that the Blood (like Beer made of over-dryed Malt) being too sharp and burnt, does not soon subdue and ripen the nutritive Juice, which is brought into it crude, from things eaten, but perverts a great deal of it into a Nitro∣sulphureous matter, wherewith, when the mass of Blood is saturated to a Turgescency, like new Beer put in Bottles, it falls a fermenting: from the flowing of that nitrous matter, which obtunds the heat and vital Spirits, and twitches the nervous Parts, first a cold is caused with a shivering: afterward, the vital Spirit prevailing again, this mat∣ter fermenting in the Blood, begins to be mastered and to be kindled in the Heart, by the burning of whilch, an intense heat is diffus'd through∣out the whole Body: afterward its relicks being severed, and mixing with the Serum, are sent forth by sweat.

This burnt disposition of the Blood consists in this, that it is im∣pregnated more than it ought with Particles of Salt and Sulphur: Wherefore the procatarctick Causes which dispose to this disease are a hot and bilous Temperament, Youth, a very hot Diet, as an immo∣derate use of Wine and peppered meats; but especially the Vernal and Autumnal Seasons of the Year; tho most comonly some evident Cause besides is requir'd for putting this Disposition in act, and we ascribe the origine of this Disease to some notable accident: Where∣fore a lying on the Ground, or taking cold after sweating, or transpira∣tion

any way hindred, also surfeiting or a troubling of the Stomack by disorderly eating, and whatsoever things cause an immoderate effer∣vescence of the Blood, bring into act the latent disposition of this Di∣sease: for on every such occasion the nutritive Juice heapt together in the Blood, and somewhat deprav'd, falls a flowing, and separating from the rest of the Blood, ferments it with a nitrous sourness, after∣ward being kindled and exagitated with the vital Spirit and Heat, it brings the fit with a very intense burning.

A Tertian Fever is wont to be most common in the Spring, at which time the Blood is most vigorous and in best plight. A Fever hapning, if it continues not long, is commonly said rather to be Physick, than a Disease, which in part is true, because by this means the impurities of the Blood are consumed, the obstructions of the Viscera are opened, and indeed the whole body is ventilated, so that it is wholly freed from any ex∣crementitious matter, and from the seminaries of growing Diseases: but if this Disease be drawn out in length, it is the cause of many Di∣stempers, and of a long sickness: for hereby the mass of Blood is very much deprived of the vital Spirit; and (like Wine too much ferment∣ed) in some manner looses its strength, wherefore a Jaundise, Scur∣vy, or Cachexia follow upon this Fever, when it is long a curing: for by the frequent fits, the vital spirit very much evaporates, which in regard it is little restored by things eaten, the Blood becomes thereby watery, and almost without strength: mean while, the Particles of the Salt and Sulphur are raised and exalted more, whence the Blood is made sharp and salt; and so more unapt for Circulation and a Pneu∣matosis.

Moreover this Disease, protracted in length, often changes its form, and from a Tertian, becomes either a quotidian, or sometiems a quar∣tan; and afterward, sometimes it returns from both to a Tertian: the reason of this is, the various change of the Disposition of the Blood; for when from being sharp and bilous, as it is in a Tertian, it comes to be less sharp, but more watery, and weaker in its Crasis, the in∣creases of the fermentative matter are more quick, and the accesses return daily, but when it turns austere and pontick, the increases of the matter being more slow, the fit comes but on the fourth day.

Certain Symptoms are wont to happen upon a Tertian Fever, which are vulgarly accounted for the Crises of this Disease; and in truth, sometimes those appearing, the affect either clearly ceases, or begins to remit of its wonted fierceness: those Symptoms are chiefly these three, viz. a breaking forth of the Lips, a Jundise, and a Phlegmon sud∣denly raised in any part of the Body; tho I have sometimes observed, that notwithstanding such breaking forth of the Lips, the Fever has continued obstinate for a long time. wherefore I think it must be said, that that eruption of Pimples denotes only a fuller Diaphoresis in the whole, whereby the gross, as well as the subtle recrements of

that adust Blood, evaporate forth; for I have known in some, that in a Tertian Fever pushes have broke out all over their Body, as tho they had the small Pox; and if by this free ventilation, as by a purging, the Blood is so freed, that it recovers its ancient Crasis, the Fever is come to a Crisis; but if (as it sometimes happents) some re∣crements, tho the more gross, break forth, and others remain within, and still foment the feverish Disposition, those sores argue only a grea∣ter taint of the Blood, and an obstinacy of the Disease: therefore it is to be observed, if upon sore Lips the Fever does not remit, it will prove of long continuance and severe.

Sometimes a Jaundise happens upon a tertian Fever, and puts an end to it, the reason is, because when the Blood has gottne a sharp or bilous Disposition, that thereby it perverts the nutritive Juice, and so heaps together an excrementitious matter, it is often freed from that Discrasy, when by a sudden excretion the recrements of the adust Salt and Sulphur, are freely purged: the Gall-vessels being irritated by a Medicine or spontaneously, and so plentifully clearing forth the Cho∣er from the Blood, often perform this: for vomiting, purging, and especially a Diarrhaea conduce very much to the cure of this Disease, nay sometimes the Blood alone, exerting it self of its own accord, throws off its bilous Recrements as its refuse, and deposes it in the Skin in cir∣culating, and so the Jaundise cures the Fever.

When a Phlegmon (as it sometimes is wont) happens upon this affect, it is commonly said, that the Ague is fallen into the place swoll'n. Now it seems not strange that the Disease is determined by such an abscess: because the Blood by this means continually severs from its body the store of the degenerated nutritive Juice, and conveys it to the Part affect∣ed: wherefore a Belly continually loose has freed some by degrees: be∣cause by this means the Blood has presently cast forth its unprofitable Burthen, still growing upon it, nor has allowed it a full increase: and sometimes also, a deafness hapning on a sudden, the tertian Fever has presently ceas'd, viz. by reason of the continual Metastasis of the febrile matter from the mass of Blood to the Head.

But if a tertian Fever neither declines by degrees of its own accord within a short time, so as to cease wholly within seven or ten returns, nor is brought to a Crisis by any of the ways above-mentioned, nor is remov'd by the help of Physick; but after ten or twelve fits continues still sorely to afflict the Diseased, it will prove a very difficult thing to cure it: for the Blood, by the continual he aping together of the febrile Matter, and by its frequent being inflam'd, becomes at length so depraved, that it concocts nothing rightly for nourishing the Bo∣dy and supporting its strength: nor is it able wholly to shake off the impurities and Excrements from its mass, that it may make a Crisis of the Disease; but the same daily prevailing, the Blood, besides its dyscrasie, begins to be somewhat injur'd in its mixture, wherefore

the Flts return more frequently; nor does a perfect intermission come between, but the Diseased being very weak and faint, are in a man∣ner always feverish, with a thirst and heat. When the thing is brought to this pass, unless Art affords a Remedy, or the change of the place of aboad, or the revolution of the Year bring relief, this Affect often is terminated in Death.

As to the Cure, the Method of healing commonly is directed to this only scope, viz. that the Minera of the Disease be extirpated, and that the febrile Matter be eradicated out of our Body without any remaining fomes or fear of a Relapse; wherefore we diligently insist on Vomits and Purges, whcih, when they do little towards a Cure, but the strength of the Diseased is very much broken, they are left by the Physicians, and the whole business is committed to Na∣ture. The Intentions (as it seems to me) ought to be these; First, the restoring of the Blood to its natural temper, Secondly, the pre∣vention (as much as may be) of the depravation of the nutritive Juyce. Thirdly, the stopping of the feverish fermentation for keep∣ing off the Fit. And these Indications have place not only in a Tertian Fever, but in every intermittent Fever besides: which nevertheless are not to be perform'd by the same wayes or Remedies, but by one sort and another, according to the diversity of the Disease, the con∣dition of the sick, and the symptoms chiefly pressing: howsoever, in the Cure of this Disease, there is more to be imputed to Nature, and to a well regulated form of Diet, than to Pharmacy.

1. Concerning the first Intention, viz. that the Blood may be re∣duc'd to its natural temper, Vomits, bleeding, and purging are of great Use; especially if they are used in the beginning of the Disease. Vo∣mits do good, inasmuch as they purge the Stomach, that the first con∣coction may be better perform'd, and that thereby a purer nutritive Chyme may be supplied for the Matter of the Blood, and chiefly, in∣asmuch as by forcing the Choler plentifully from the meatus cholede∣chus, they empty the Gall-bladder, that thereby the Choler may be more copioussy clear'd from the Blood, and so the Blood may be cleans'd from the recrements of the adust Sulphur and Salt. Opening a Vein cools and ventilates the Blood, that thereby it is less torrified or parch'd, and is circulated more freely in the Vessels without dan∣ger of being burnt. Purging also draws plentifully the Choler from the Gall-vessels, and consequently from the mass of Blood, and by ir∣ritation them, forces it forth. For this end, (viz. the reducement of the Blood, Digestives conduce, being sharp qualifiers, inasmuch as tey fuse and alter the Blood, and allay its fervour. Sometimes also the change of the place of abode, and of the Air, egregiously corrects the evil constitution of the Blood above any other Remedies.

The second Intention is excellently perform'd by a Diet, and an ex∣act form of Food, which in this Disease ought to be thin and spare:

wherefore Hunger is commonly said to be the best Remedy of this Disease; and we find by common Experience, that by a spare feed∣ing the feverish access is most commonly put off beyond it usual time. There are two things chiefly to be observ'd concerning Dyet; first, that the Aliments be thin, let nothing be given sulphu∣reous or spirituous; for so the conflagration of the Blood is lessened: then secondly, that when the Fit is a coming, or has seized, no Food be taken; wherefore in fasting Persons the Fit is more mild and is sooner over.

What was propos'd in the third palce: a stopping of the feverish access, is undertaken by Remedies which stop the fermentation of the Blood; and tho this Remedy be look'd upon by Physicians as Em∣pyrical, Immethodical, and Deceitful, yet I have found by experi∣ence, that these Fevers have been oftentimes cured this way, when Medicines did nothing at all: tho you must observe, that the use of these after bleeding and purging (if there be need of them) will do most good, and unless these are duely premitted, those others sel∣dom stop the Fit: and Vomiting, Purging, and Blooding, unless they are used presently and at the beginning, do little good, nay, are oft∣ner wont to do hurt; wherefore if the Choler about the beginning be plentifully cleansed forth, or the Blood be ventilated by breathing a Vein, it is reduced to its due Crasis; but afterward, in the progress of this Disease, (the Spirit being very much exhausted, and the Salt and Sulphur being too much exalted) if these evacuations are us'd, they weaken the Crasis of the Blood more; and therefore it is found by observation, that a Tertian Fever is seldom or never cur'd, and of∣ten passes into a Quotidian, where these Medicines are us'd very late. I have known my self in the Spring-time that certain Persons enjoying a good entire health, have fallen presently into a Tertian Fever, af∣ter having taken a Vomit for prevention-sake, which caused a violent evacuation; and that others, who have been cur'd for some time of this Fever, have presently undergone a relapse upon taking a strong Purge for carrying off the remainder of the febrile matter: it may readily be said, that the Minera of the Disease lying quiet before, is rous'd up by this means by the Medicine, and brought into act; but if you consider this thing rightly, it seems rather to be said, that by a strong Purge the Crasis of the Blood is very much injur'd, and where∣as before it was prone to a bilous Discrasy, so that it assimilated with difficulty the nutritive Juyce, upon this evident cause it presently de∣generates more, and that it forthwith perverts the Nutriment into a fermentative matter, and so incurrs the feverish disposition. An Opi∣nion has vulgarly prevail'd, that a Tertian Fever can scarce be cured without a Vomit; wherefore some Medicasters are wont, under the pretext of necessity, to give an Emetick Medicine to any Persons what∣soever troubled with this Disease (tho weak and infirm) not without

great danger of Life; and those whom they judge wholly unable to bear this Remedy, they leave to Nature, as not easily curable. But (as I am well satisfied by having often try'd the contrary) that this kind of Practise is ill founded: and I rather think that Vomits are seldom or never requir'd for the Cure of a Tertian Fever, unless it be in a ro∣bust Body, and readily inclin'd to vomit, and when it happens that the Stomach is loaded with an excrementitious matter; but instead of this, that a gentle Purge may be more properly us'd; for a Purge in this case does the same thing as a Vomit, to wit, it evacuates the Ves∣sels containing the Choler, that this being plentifully exhausted from the blood, the feverish Dyscrasy may be corrected. Now when the Humour of the Gall, emptied in the Stomach, is drawn forth upward, a great offence is thereby brought on the Stomach, and a mighty per∣turbation is raised in the whole body: but if by a gentle Cathartick that Humour is allur'd downward, it is sent forth without any trouble. Moreover, if to a gentle Purge repeated once or twice, a very thin Diet, and without any meat, be added, it will often answer the Pre∣servatory indication, that there will not be need of other Remedies for removing the cause of the Disease, but these things being duely premitted, let those things be used, which either inwardly taken or outwardly applyed stop the access of the Fever. By this plain and ea∣sie form of Physick, viz. by purging with an infusion of Senna and Rhu∣barb, a thin diet, and a topical febrifuge applyed to the Brest or Wrists, I have oftentimes known tertian Fevers cured in a short time, without the use of any other offensive Medicine. Nay, a thin diet alone, with Periapts seasonably applyed, has cur'd very successfully a Woman with Child, aged Persons, and such as were very weak, whose strength would not bear purging.

I have so frequently experienc'd the wished success of that method, that I do not doubt, but a tertian Fever, if it be mannag'd this way from the beginning, to wit, before the temper of the Blood be more injured by an ill form of diet, or by Physick ill administred, it will be caured as easily as any other Disease: for proof of this I shall give the following relation.

A certain noble Youth, of a cholerick Temperament, was seised with an intermittent tertian Fever; as the fit came on him he vomit∣ed very much yellow and grenish Choler, afterward for many hours he was sorely troubled with a most intense Heart-burning, a heat and a drought. The day of intermission, on which it was my chance to be pre∣sent, eight ounces of Blood were drawn by my order from this Person, and in the Afternoon an emollient Clyster was injected: he used also, a very thin diet, (viz. only of Barly Meats) he took every Night going to rest this Opiate, viz. Conserve of Roses vitriolated half a dram, Dia∣scordium a scruple, and every Morning a Scruple of Salt of Worm-wood, in a spoonful of the Juice of Oranges: but these things not succeed∣ing (for the fit returned somewhat more remiss, but with

a violent vomiting as before) and likewise in regard this sick Person greatly dreaded a Vomit (because upon taking a very gentle Emetick not long before he had vomited about thirty times, even till being seiz'd with a Cramp and Convulsions, he was brought to a great failure of strength with danger of Life) therefore, the day following the said fit, I gave him a potion of the infusion of Senna, Rhubard, and yellow Saunders with Salt of Wormwood in Fountain Water, by which he purg'd ten times with relief: the next Morning, three hours before he ex∣pected the fit, I applyed febrifuge Epithems to his Wrists, and blooded him again to six onnces, from which time he had no fit of his Fever, and afterward, being purg'd again after the same manner, he grew per∣fectly well.

But if a Tertian Fever, by reason of the evil constitution of the di∣seased, or by reason of errours committed in diet, or Physick, has laid its roots deep, that after a long continued affect the fits still grow worse and worse, and the diseased mightily languish, their strength being dejected, with a thirst, and burning almost continual, a loss of Appetite, Watchins, a weak Pulse, a ruddy Urine, and very full of contents, somewhat a differing method of Cure ought to be ordered: in this case first it must be endeavour'd that the Discrasy of the Blood be removed: wherefore let the diseased feed only on thin diet, as Barly or Oat Meats, with the opening Roots boyled in them, wholly forbear∣ing Meat Broaths; let the Belly be kept soluble (if it be needful) by the use of emollient Clysters; Moreover (Catharticks being omitted) it seems that we ought only to insist on digestive Medicines, which fuse the Blood, and gently lead forth the serous Impurities by Urine; and comforting Remedies, which strengthen the Viscera, and refresh the Spirits: for this end apozemes of diuretick Herbs and Roots, neatly pre∣pared, also Opiats of temperate Conserves with Sal Nitre, or the fixt Salt of Herbs, and with testateous Powders, and Spirit of Vitriol mixt with them, excellently conduce, when the Crasis of the Blood is somewhat amended, that the Urine is clearer and less colured, also the sleep quieter, with an abatement of Thirst and Heat; then Remedies may be profitably given for stopping the fit of the Fever: Wherefore let febrifuge Epithems be applyed to the Wirsts, and to the Soles of the Feet; also let the Powder of the Peruvian Bark, or of its Succedaneum, or also of the Bark of an Ash, of Tamarisk, or of Gentian, be given in White-wine with the mixture of Salts: After that the accesses are taken away, and the diseased begin to gather Strength, to have a Stomack, and in some measure to concoct what they take, gentle Purges will be of use, but let the diseased still abstain from seeding on Flesh or rich fare, and it is not to be doubted, but he will soon recover his perfect Health with∣out violent purging or blooding.

CHAP. V. Of the Intermittent Quotidian Fever or Ague.

NExt after a tertian Fever, by reason of their Affinity and the likeness of the Fit, follows a Quotidian. viz. whose access is wont to return every day. It is the Opinion of some that this Fever is only a double Tertian, and that it arises from the matter being disperst, and getting possession of a two-fold focus; to which never∣theless I do not agree, and I judge that its rise is to be attributed to a peculiar Discrasy of the Blood: in this the symptoms of Heat and Cold are more remiss; but the access holds longer, and is often wont to continue eighteen or twenty hours: this Fever for the most part follows upon a Tertian, for when the vital Spirit is much spent by a frequent Deflagration of the Blood, and (the feverish Disposition still remaining) the Blood is become weaker, it less concocts, or brings to perfection the nutritive Juice, and perverts it in a manner wholly into a fermentative matter: wherefore it is sooner brought to an increase, and is heapt together to a plenitude of Turgescency in half the time as before: but because the matter heapt together partakes as well of cru∣dity as adustion, therefore the heat of the fermentation is more re∣miss and more uneven, and (like green Wood laid on the fire) it burns more flowly; wherefore the fit is of a longer continuance.

Sometimes it happens that a Qutidian Fever arises first without a foregoing Tertian, viz. when a feverish affect seises a Body that is ca∣cochimical, and filled with evil Juices: for then the Blood, being poor in Spirits, perverts the nutritive Juice in a greater store, and heaps it together in a shorter time to a plenitude of Turgescency: and that which at first is a Quotidian often changes its Type, and becomes a Tertian: even as a Tertian often passes into a Quotidian, there being a great vicinity betwixt these Fevers, and their Causes; and a little change of the Constitution of the Blood makes a transition of the one into the other. An intermittent Quotidian Fever is not so easily cur'd as a Tertian: for whether that comes first simply, or follows upon an∣other intermittent; however it is raised drom a stronger cause, and ar∣gues a greater Discrasy of the Blood, which does not presently yield to Remedies: Moreover, this Fever if it be of Long eontinuance, or comes upon another Cronick Disease, besides the vice of the Blood, it has most commonly joyned with it infirmities of the Viscera: to wit, the Blood being vitiated, easily fastens its Impurities, heapt toge∣ther by degrees on the Viscera, as it passes through their Involutions.

(Hence in a quotidian Fever; a loading of the Ventricle, a tension of the Hypochondres, obstructions, or Tumours sometimes of the Liver, sometimes of the Spleen, or of the Mesentery, are joyn'd) tho these kinds of Affects are not the cause of the Fever (as is vulgarly thought) but only its products. Wherefore in this Fever, besides the simple Method of Cure which is indicated in a Tertian, many other Intents or Coindicants come in consideration, viz. We must use all our Endeavours that the Ventricle be purged of its load of Humours, that the stuffings of the Viscera be clear'd, that their Infirmities be strengthned, and together with these, that the Discrasy of the Blood be amended, and the feverish accesses stopt, so that by reason of these various kinds of Intentions, we must proceed by a longer way to the Cure. In this case Vomits, (if the Strength will bear them) will be of use above the rest; also Purges, with which the assiduous increase of the excrementitious Matter may be sent forth, must be often repeated; besides these, digestive Remedies and deobstruents which restore the Ferments of the Visce∣ra and of the Blood, and correct their Discrasies are frequently to be used. Wherefore, fixt Salts of Herbs, their extracts, the acid Spirits of Minerals, and sometimes Preparations of Steel do excellent∣ly well. Concerning these means there is a difficult task, since, because of the manifold evils, many things are to be done together, whereas, by reason of the assiduity of the feverish fit, the Diseased can use only a few. In affects thus complicated, tho the way of Method requires first a removal of Impediments, and then to cure the Disease, yet I have known this kind of Fever cured often without method, and empirically, in a cacochymical Body, attended with many other af∣fects; to wit, after a light provision for the whole, febrifuge Remedies outwardly apply'd have first taken away the feverish access, that af∣terward, time, and occasions of curing, might be the better afforded for the other affects. I lately went to see a Lady of Quality, who having long had a cachectical habit of Body, and being weak and fee∣ble, a month after Child-birth, was seized with an intermittent Quo∣tidian; after fix or seven accesses of which, her strength was so cast down, that she was not able to rise from her bed, or scarce to be rais'd up in it; nor could she take ever so little food, tho very thin, but it caus'd great disturbances in her Stomach: Moreover, the Region of the Stomach, and of the left hypochondre, was all beset with a hard Tumour, and violently paining: By reason of the strength being ex∣tremely cast down, there was no place here for evacuation besides the use of Clysters; and the Stomach being mighty weak, refus'd all other Remedies, unless they were pleasing, and in a small quantity. In this difficult case, and pent up within narrow limits of Curing, I advis'd these few things, viz. that she should take twice a day this mixture; viz. Magistral water of Earth-worms two ounces, Elixir Prprietatis

six drops: moreover, I ordered a fomentation to be apply'd to the Stomach, of the Leaves of Pontick Wormwood, Centory, Southern∣wood boyl'd in White-wine with the roots of Gentian, the Vessel covered; and that after the somentation, a toast dipt in the same Liquor should be worn on the Stomach; besides, I had febrifuge Epithems bound to her Wrists; and by these Remedies alone, on the third day she mist her Fit, and continued free from the same afterward, and then by the use of Chalibeat Remedies, she grew perfectly well within a short time.

CHAP. VI. Of the Quartan Fever or Ague.

IN a Quartan Fever, the time for the return of the Fit is longer than in the rest, it being extended to the fourth day inclusively; and it's wont to be of longer continuance, and more difficultly cured: for this Disease is protracted for many Months, and often Years, and seldom or searce at all yields to Medicines.

The Fit for the most part begins with cold, and a shaking, which are followed with a pretty troublesome heat, but more remiss than in a Tertian, Sweat for the most part concludes the access. If the Dis∣ease sticks long, it brings the Scorbutick or hypochondriack affect, and involves men in an unhealthy habit of body.

The Causes which dispose to this Disesse are, first, the constitution of the Air, and of the Season; for the time of Autumn is always pro∣per for this affect, that you shall seldom observe a Quartan Fever to arise but about the Fall: also in certain places, especially about the Sea-coast, this affect is wont to be endemious, seizing any that live there, or come thither as strangers; for this also makes a declining age, also a melancholy temperament, and which, by reason of an ill form of Diet, is obnoxious to the hypochondriack affect; moreover, Fevers of another kind, that are of a long continuance, and Chronick Diseases, often pass into a Quartan Fever.

These things being confidered, it seems that it must be said, that a Quartan Fever, even as other Intermittents, depends on the vitious disposition of the Blood; for the nutritive Juyce, conveyed by de∣grees into the Vessels, is perverted into a fermentative Matter, and the effervescency of this heapt together to a plenitude of turgescency, makes the Fit of a Quartan Fever. But since in this Fever there are

some things peculiar from the rest, we must enquire what sort of dyscrasie of the Blood there is in this Disease distinct from the rest, and after what manner it raises the most observable Symptoms.

I say therefore, that in this Disease the Liquor of the Blood has pass'd from its sweet, spirituous, and balsamick nature, to be acid and somewhat austere, like Wine turning sour. That is to say, there is a scarcity of Spirits, and the earthly or tartarous part (which consists chiefly of Earth and Salt) is exalted too much, and being raised to a flowing, brings a sourness to the mass of Blood: the Blood degene∣rated after this manner from its native Disposition, does not duely concoct, and assimilate to it self the nutritive Juice, but perverts it in∣to an extraneous matter, wherewith, when it is saturated to a sulness in the Vessels, and the nervous parts are irrigated with the Juice thence arising, there follows a flowing, and as it were a spontaeous Es∣fervescence of this Matter, whereby the feverish access is wont to be caused with a shaking, and a heat, as in a Tertian.

In a Quartan Fever the returns have longer Intervals, because the Discrasy of the Blood being toward an acid, and therefore less smart and hot, it perverts the nutritive Juice without a contest and tumult; wherefore somewhat of it is assimilated, and the depravation of the rest does not recede so far from its natural state as in a Tertian: and hence its heaping together to a plenitude is slower, and it rises to a Turgesency in about as much time again and a half as in a Tertian.

The reason why this Disease is of so difficult a cure, and so obsti∣nately infests the Diseased, is the melancholy Constitution of the Blood, which is nor easily removed, and yields scarce to any Medicines; for there being in it a scarcity and defect of Spirits, and the Salt and Tar∣tar being too much exalted (as when Wines turn sour) it is extream hard to restore it, and it is in a manner of the same labour and diffi∣culty as to renew the vinous Spirit and Vigour in Vinegar; because for restoring the Blood depraved after that manner, there is need that its whole mass be volatiz'd, and that it spiritualises as it were a∣new. Wherefore in this case evacuatives do not the least good, nay by depauperating the Blood more without remedying it, they often impair the Strength: but there is need of those things which may ex∣alt and volatise that which is fixt: and may promote a Pneumatosis in the whole mass of Blood: thence it is that in this disease the change of the Air and of the Soil most commonly give relief before any other Remedies whatsoever. For Quartan Fevers arising about Autumn are often cured by the following Spring, which doubtless happens be∣cause the changed quality of the Air is wont to alter the evil habit of the Blood for the better: and for the same reason, the change also of the place of aboad most commonly cures this Affect when it will not yield to any Medicine.

The Autumnal Season is most proper to produce this severish ha∣bit of the Blood, because when very much of Spirit and Sulphur has past away by the Summer heat, and that which remains begins to be prest upon by the Cold, the Liquor of the Blood (as Wine turning sour after too much Effervesence) easily degenerates into a pontick and sharpish Nature: this also is provur'd by the Air of the Sea infecting the Blood with saline Vapours, which fix the Spirits. Moreover, the affinity of this Disease which the Scurvy and the Hypochondrial affect plainly shews that the evil Disposition of the Blood is in fault, where∣by it is become salt and earthy with a defect of a Pneumatosis.

The last year, towards the end of the Summer, which had been very hot, an Epidemick Fever arose: then Autumn coming on, when that Disease ceased, a Quartan Fever began to be very rife, so that in many places well near the fourth part of man-kind was seis'd with the same, and those of all Ages and Temperaments, which plainly shew'd that this affect did not take its rise from a melancholy Humour heapt together through the fault of the Spleen, (as some have thought) but from the Discrasy of the Blood caused through the distemperature of the Year.

Tho many Physical Apparatus's were ordered against this evil, yet ve∣ry few were cured within the compass of the Autumn: In some, about the first beginnings of their Sickness, before the Disease had taken root, Vomits gave relief: tho, in most, Medicines purging any ways, tho repeated a hundred times, did not the least good at all: those in whom the evil was deeply rooted, received not any relief from the most exactly devised Remedies used throughout the whole Autumn; when at this time I saw the vulgar Methods of Physick put in practise in vain. To a certain noble Virgin who desired a sudden Cure to be performed by any manner of means, I propos'd, that if she would undergo a Salivation for some dayes by a mineral Medicine, she might thence hope a speedy conquest of her Disease: she readily agreeing to this, I gave her a gentle and very safe Medicine, by which only a gen∣tle spitting was raised, and that ended within twelve dayes; from the time the salivation began, she presently mist her fits; but at the times they were wont to come she found a disturbance in her whole Body, with an oppression of the Heart, and a danger of Fainting, but afterward, the spitting being ended, she seem'd throughly recovered; and when after two Months time she had again certain slight accesses of this Disease, an Emetick Powder being given her twice or thrice she was perfectly cured without a relapse.

After the Winter Solstice this Disease was not so violent, but began to grow mild, in some, of its own own accord, and to be more easily overcome in most others by the use of Medicines, for at this time the discrasy of the Blood, contracted by the Summer heat, is wont to be re∣moved by degrees by the cold of Winter, and the inveterascent mass

of the Blood to depose its old taint, and to return towards its natural state: but those who were of a melancholy Temperament, or had the Viscera, and especially the Spleen ill affected, or those that used an ill form of diet, received no change from this Tropick, but held their Disease to the next period of the Year, to wit, to the Vernal Equinox, and then in a great many this affect was seen to be overcome, the Blood either being renewed of it self, or its Distemperature being more easily amended by the use of Medicines; but in the mean time many aged, cachochymical, and otherwise weakly Persons, died every where of this Disease, in this whole tract of time; and some there were, who having past the Summer Solstice, had not yet shaken it off: now, tho many were troubled with this, as it were, Epidemious Fever almost for a whole Year, yet none that I knew of contracted it first in the Spring, and very few recovered of it during the Autumn, that I cannot doubt but the Discrasy of the Blood was really the cause of it, and that its cure consisted in its change.

The Remedies which oftentimes gave relief (at least as far as it agreed with our observation) were such as stopt the fit of the Fever: for the evil habit of the Blood being somewhat amended upon the change of the Season of the Year, in case the habitual usance of the fits be broken off, Nature recollects her self, and easily recovers her ancient state of Health by her own endeavour. And this kind of intent (viz. the stopping of the Fits) tho it be sometimes performed by Vomits given a little before the access (for these often stop the fe∣verish Motion of the Blood, by raising another contrary to it) yet this indication is far more certainly, and indeed more successfully performed by the use of those kinds of Medicines, which do not at all evacuate from the Viscera, but cause in the Blood a certain fixation, or precipitation of the feverish Matter for a time. Wherefore those, whom I undertook to cure as the Spring came on, and thence forwards, I managed with this Method (and in many with good success) a pro∣vision being made for the whole by a Medicine, sometimes Vomiting, sometimes Purging three hours before the fit, I was wont to order Epithemes to be applyed to the Wrists, and withal a febrifuge Powder to be taken in Sack, and the diseased to be kept in Bed in a gentle sweat: It seldom happen'd but at the first or second time the access of the Fe∣ver was stopt after this manner, and afterward the same Remedy be∣ing sometimes repeated, at length the Disease wholly ceased: this kind of Practise (besides what I have found by experience) seems to be made good by the use of the Powder of a certain Bark lately brought from the Indies; which is said most certainly to cure this Dis∣ease, whereas the Virtue or operation of this, without any Evacu∣ation, consists only in this, that it stops the invading fits of Fe∣vers.

Concerning that Peruvian Bark, because of late it begins to be in daily use, these few things which occur to common observation are to be said, the vulgar way of giving it is to infuse two drams of this, being made into a Powder, in White-wine or Sack for two Hours, the Ves∣sel being close covered, and then as the fit approaches to let the Disea∣sed, lying in Bed, drink the Liquour with the Powder. This Drink often removes the imminent access, tho many times that coming after its usual manner, it prevents the next ensuing, howsoever, whe∣ther the fit be stopt at the first, or at the second, or third time of re∣turn, and the Disease seem to be cured, yet it oftentimes it wont to return within twenty or thirty dayes: and then this Powder being given again, the Invasion of the Disease is again put off for the space of about the same time; and after this manner I have known many troubled with a Quartan, to have undergone only a few accesses of it during the whole Autumn and Winter, and so to have held the Enemy foreguarded till the Spring coming on, by the help of the Season of the Year, and of other Medicines, the Disposition of the Blood was altered for the better, and so that affect vanisht by degrees: those who by this means procured frequent times of truce, of the Quartan, being cheerful and sprightly, liv'd prompt for all business, whereas other∣wise being enervated and pale, they were brought to a Languour, and a vitious habit of Body; scarce one of a hundred tryed this Remedy without effect, nay, if it be taken in a half quantity, or less, viz. to the weight of half a dram or a dram, it oftentimes takes away the accesses, and suspends the same only for a shorter space, nor is it matter whe∣ther it be taken in White-wine or Sack, but with respect to the Tempera∣ments of the Diseased; for in a hot Temperament it may conveniently be taken in a distilled Water or Whey; also its clear infusion, the thick substance thrown away, produces the like effect but of shorter conti∣nuance. I have ordered this Powder to be given to some made into Pills with Mucilage of Tragacanth, with the like henefit to the Diseased; af∣ter what manner soever it be taken, it cause no manifest Evacuation, unless it be in such as are apt to cast, and loath all Physick, and it takes away the fit in a manner in all; nor is it only given with bene∣fit in a Quartan Fever, but in other kinds of intermittents, viz. in all where there interceeds a time of cessation of the Fever: It is com∣monly ordered, that a gentle Purge be given before the use of this; but in some who have been very weak, and kept their Beds, this Powder taken alone without a previous Purge, has procur'd laudable effects: mean while I must ingeniously consess, that I have not yet seen an intermittent Fever throughly cured by once giving this Powder, nay, not only fits of a Quartan Fever, but of a Tertian and Quotidian, easie to be wholly overcome by other Remedies, seeming to be dri∣ven away with this, constantly returned after a short time; for this reason those, who, when there is no case of Necessity suppress intermittent

Fevers only for a short while by this Medicine, they being easie to be cured other wayes, seem to proceed deceitfully in Physick, nor more to the purpose, than those who heal over a hollow Ulcer which will presently break forth again: Indeed in some cases the use of this may be proper enough, viz. when by the too great assiduity of fits, the strength of the Diseased is very much spent, times of truce may be provured by this means, whereby Nature may recollect her self, and afterward more powerfully oppose her Enemy; also this Powder is con∣veniently given, that the Quartan Fever may be past over with less tediousness during the Autumn and Winter. But those who desire to be long vacant from the Incursions of that Fever, are advised to take this Powder in a great quantity and often, viz. two drams for three fits one after the other, whether the acccesses return or not, by this means they continue free the longer, but still keep the latent Enemy within them, tho laid asleep.

If it be enquired concerning the nature of this Bark, and of its Ver∣tue in suppressing the fits of intermittent Fevers, we must not dis∣semble, but it is a difficult thing to explicate the causes of these kinds of Effects, and of the wayes of operating; because we cannot find the like efficacy in any subject besides: and a general rule is not well adapted to a singular experiment, however, by a diligent conferring the Phoenomena, we shall make an orderly deduction of certain Positions, which is they do not attain the truth of this matter, at least wise may make some step towards it.

In the first place it may be observed, that this Medicine inwardly taken chiefly exercises its force and energy on the mass of Blood: for it does not at all irritate the Viscera, nor does it cause any exertion or trouble to them; Moreover, until its vertue be communicated to the Blood, its antipyretick sorce is not at all exerted, wherefore the fit immediately ensuing is not always prevented, but the second or third after its being taken: and for this reason, that it may affect the Blood the sooner, it is usual, that together with the Powder a Liquour strongly impreguated with the same be given, for so its Particles are more readily conveyed into the mass of Blood.

Secondly, the vertue of that Bark conveyed itno the Blood continues for some time in it, and that shorter or longer, according as a greater or lesser portion of the Medicine is inwardly taken; for the Particles of this mixt with the Cruor, are circulated a long time with it, and the more ther are of them, the more they affect its mass, and pro∣duce a more lasting affect; for tho Aliments, and certain other things taken inwardly, in as much as they are presently subdued by the na∣tural heat, assimilated or cast forth, cease to operate; yet some Medicines taken into the Body, because they are not easily subdued, nor by a sudden irritation are presently sent forth, continue very active

for many dayes, and keep the Blood and Jucies a long time in this or that course of Fermentation; this may be observed of certain Medi∣cines, also of Poysons, and many Antidotes; whereof one only gi∣ving is wont to affect our Bodies for many daies, and the same repeat∣ed for a longer time: for it is usual after Cathartick Medicines, if at any time they do nto operate by Vomit or Seige, that Pimples and Pushes break forth outwardly, after many Weeks. Moreover, if after Toxicum being drank Death be escap'd, every man knows that its viru∣lency lurches for a very long time in the Blood and Juices. In like manner also this Powder, and haply a great many other things inward∣ly taken, continue still to act on the Spirits and Humours how much so∣ever they seem lulled a sleep.

Thirdly, tho that Medicine acts immediately on the Blood and Hu∣mours, yet it does not throughly take away the feverish Discrasy seat∣ed in them, for as soon as its force is spent, and all its Particles are past off from the mixture of the Blood, the affect, suppressed only for a time, breaks forth anew, and takes to its accesses after its wonted manner: but for as much as nature during this time of cessation is be∣come more strong, therefore after the relaps, the fits are wont to re∣turn (not as before) but on the third or fourth day, according to the first Type of the Disease.

Fourthly, it is to be observed, that this Remedie does not stop the accesses of Fevers, as vulgar sebrisuges, by fixing or also by susing, the Blood; for then always the imminent fit, and not the second, or third to follow after would be prevented.

Which things being considered, that we may subjoyn some things, as a Corallary, concerning the way of operating, whereby this Medicine seems to Work, we say, that its likely that when the Par∣ticles proceeding from the same taken inwardly, are mixt with the Blood, they force it into a certain new Fermentation, wherewith whilst the Particles of the Blood are continually agitated, they are wholly hindred from heaping together an excrementitious matter, and from falling into feverish Turgescencies: for, as after the biting of a Mad-dog, or the stinging of venemous Animals, the Blood it self, and nervous Juyce are long poyson'd; yet Alexipharmicks taken hinder them from falling prefently into great Irregularities, by keep∣ing their Uquours in another Fermentation, the use of which if so long continued, till the virulent Corpuscles are wholly past away, no dreadful svmptom is fear'd from that taint contracted; but if the strength of the Remedie, given in too small a quantity, be first spent, presently the Povson springs forth anew, and the ancient venom which seemed to be driven away, is again brought into act: after the like manner, when the Blood having gotten a vitious habit perverts the nu∣tritive Juvce, and for the better expelling it when heapt together to a fulness, falls into feverish Turgesencies, that Peruvian Bark reduc'd

to a Powder, and given, by the commerce of its Particles so exagi∣tates, and alters the Blood, tho affected with a Discrasy, by stirring a new fermentation, that it in some measure concocts the nutritive Juice, and continually evaporates its recrements, so that they are not heapt together for a matter of the fit, as before, but when the Parti∣cles of this Remedy are wholly exhal'd from the community with the Blood, and all the vertue is spent, the evil Disposition of the Blood before contracted breaks forth again, and therefore the fits of the Fe∣ver return after their wonted manner: haply sometimes it falls only that whilst by the use of that Powder the accesses are supprest, that Discrasy of the Blood, by reason of the change of the Season of the Year, or by help of some other Remedy, or of nature her self, is amended by degrees, and so at length the Fever disappears of its own accord: tho I have known this to have hapned but seldom, that you may expect the feverish fits to return in a manner with the like cer∣tainty, as they are supprest by that Powder.

As to the sensible qualities with which this Bark is endowed, it is manifest that it excells in a bitterness, with a certain stipticity, that by the taste it is discovered to carry in a manner the like savour as is usually found in most Alexipharmicks, such as the root of Gentian, Serpen∣tary, Contrayerva, &c. For things which are actually bitter are mighty powerful in suppressing the sorces of preternatural Ferments: nay, and the Root of Gentian, which excellently resembles this Bark, was for∣merly of famous use for curing quartan Fevers: and now, tho this Pe∣ruvian Powder be the only Alexiterion yet found for the quartan Fever, which stops the fits of it and of others (tho only for a time) yet it is not to be doubted, but there are other Medicines in nature, equally febrisuges; and it may be hop'd, that being led by the example of this new invention, we may be stirred up to search into the Vertues of Herbs yet unknown to us: thus while we insist on the tryal of Fparticu∣lars, and joyn Empirical Physick with the Rational, it is not to be doubted but the Cures of the quartan and of other Herculean Diseases will go on more prosperously: which I the more freely ensure for in this age, or at leastwise in the succeeding, because being guided by the Analogy of that Bark, I my self not long since, running through many things, lighted on a Medicine of no contemptible use for sub∣duing Fevers: which also I give to all poor People, as a Succedaneum, with good success.

CHAP. VII. Of continual Fevers.

AContinual Fever is that whereof the access is prolonged to many dayes without any cessation: it has its times of remission and exacerbation, but none of intermission; the burning some∣times is more remiss, sometimes more intense, but the Diseased are still in a Fever, till the Disease be wholly solv'd by a Crisis, or an in∣sensible recovery.

Now there are three degrees or manners of Effervescency by which the Species of continual Fevers are determined: from the subtle por∣tion of the boyling Blood, or from the Ebullition of the Spirits arises the Ephemera, also the Synocus of one or many dayes: from the sulphu∣reous or oily part of the Blood too much heated and kindled, is rai∣sed the putrid Fever; thirdly, on a venemous Miasm infecting the Blood, and congealing its Liquour, malignant Fevers depend: in each of these, from the depravation or rather corruption of the nutritive Juice, fresh heapt together in the Blood, various Paroxisms, Inequalities, and critical Motions arise.

If it be askt after what manner the Effervescency of the Blood in a continual Fever differs from that other which makes intermittents; I say, that the Effervescence of the Blood in the latter depends only on the mingling of some fermentative Matter with the Blood, which will not duely mix with it, and on its heaping together to a plenitude of Tur∣gescency: by reason of the Effervescency of this with the Blood in the Vessels, and its deflagration in the Heart, the fit is caused, its difflation is followed by an Apyrexia, so that in the intervals of the fits neither the Spirits nor the Sulphur make an effort, but the Liquour circulates evenly and without tumult in the Vessels, the bond of mixture being entirely preserved; on the contrary, in a continual Fever, the Disor∣ders of the Spirit or Sulphur, or of both of them together cause the ebulli∣tion of the Blood by their proper Effervescence, without the mixture of another thing: Wherefore, for a cessation of the hurning heat, besides the difflation of the excrementitious matter, a deflagration of the kindled Blood, and its reduction to a due Crasis, are required.

The Constitution of the Blood in a continual Fever, is as that of Wines when they ferment by too rich Lees; that is to say, they are strong with Spirit, and grow turgid with an exalted Sulphur, and therefore of their own accord without the mixture of another thing, they fall into a heat and boyl violently: In an intermittent Fever the Blood is stirr'd

after such a Manner as Wines when they fall a fermenting by reason of something which is not missible being put into them: Moreover, in this Fever the Disposition of the Blood is like that of Wines, when in their declining state they become over fretted, ropy, or also sour; in which the Spirit is deprest, while the Salt or Sulphur, or both together, are above the rest, and affect the whole Liquour with their disorder: an intermittent Fever for the most part is without danger, because the parts that compose the Blood, tho they have changed a little their Crasis, however keep their bond of mixture; and whilst they are at liberty, circulate evenly in the Vessels; and pervert the nutritive Juice into a matter not altogether preternatural, but rather infesting with its Plenitude and Turgescency. In a continual Fever, besides the dis∣temperature, the mixture of the Blood, and the texture of the Liquor are somewhat dissolv'd, that its corruption easily follows, wherefore this Disease is often terminated in death; and the nutritive Juyce is depraved to a matter wholly vitious, and altogether offensive to Na∣ture.

CHAP. VIII. Of the Ephemera Fever.

I Have said that the least degree of Effervescence which brings a con∣tinual Fever is placed in the subtle and spirituous Portion of the Blood, being too much agitated and heated: for this, like Spirit of wine, boyls on any light occasion, and gets a heat, being irritated either by too much Motion of the Body, or Perturbation of Mind; from an ambient heat, as that of the Sun, or of a Stove; by hot things inwardly taken, as drinking of Wine, eating of peppered Meats, and the like: for the Spirits of the Blood easily wax very hot of their own accord, and being violently moved, are not presently appeased, but exagitate, variously confound, and force to a rapid and disorderly Motion other Particles of the Blood: also by this Motion of the Spi∣rits, the Sulphur, or the oily part of the Blood is more boyled, a little more dissolved, and somewhat more freely kindled in the Heart, whence an intense heat is raised in the whole Body, but for as much as the Sulphur is heated and inflamed only by minute Parts, and not through∣out the whole, that fervour of the Spirits is soon allayed and ceases; Wherefore the Fever which is raised after this manner, is terminated

for the most part within twenty four hours, and therefore is called an Ephemera. And if by reason of a greater heat of the spirituous Blood, it be prorogued longer, it seldom exceeds three dayes, and it is called an Ephemera of many dayes, or a Synochus not putrid: but if it happens to be extended beyond this time, this Fever readily passes in∣to a putrid, to wit, from the long continued ebullition of the spiritu∣ous Blood, at length the grosser Particles of the Sulphur fall a burning, and involve the whole mass of Blood in this Effervescence.

An Ephemera Fever and a simple Synochus seldom begin without an evident Cause; besides the things before-mentioned, immoderate La∣bour, Watchings, a sudden Passion of the Mind, a constriction of the Pores, Surfeiting, also a Bubo or Wound, in Child-bearing Women an increase of milk are wont to bring these; the procatarctick causes which dispose to them are, a hot temper of Body, an Athletick habit, a Sedentary Life, and a Disuse of Exercise.

The first beginnings of this Disease depend on the presence of an Evident Cause; for either the Corpuscles of an extraneous heat mixt with Blood, make it boyl like Water on the Fire or a Fever is brought by motion, or by reason of Transpiration being letted, even as when Wines being heated, or stopt close in a Vessel, are set in a strong working: after what manner soever the inflammation be first rais'd, presently the Spirits make an effort, and moving hither and thi∣ther, force the Blood to boyl, and to inlarge it self in a greater space, with a frothy rarefaction: wherefore the Vessels are stretcht, and the membranous Parts are vellicated; hence a Pain, especially in the Head and Loyns, a spontaneous lassitude, and an inflation as it were of the whole Body ensue. But if with the Spirit of the Blood some sulphury Part withall be somewhat kindled, a smart heat is diffus'd through the whole, the Pulse becomes high and quick, the Urine ruddy; also Thirst, Watchings, and many other offensive Symptoms arise.

Concerning the Solution or Crisis of an Ephemera Fever, and of a Synochus not putrid, there are three things chiefly requisite, viz. a re∣moval of the evident Cause; secondly, a severing or difflation of the depraved or excrementitious matter from the Mass of Blood; thirdly, an appeasing of the parts of the Blood, and their restitution to a natu∣ral and even motion and site. According as these things happen, some∣times sooner, sometimes slower, and with more difficulty, this Disease is ended in a shorter or longer time.

1. The Evident Cause, which for the most part is extrinsecal, is ea∣sily remov'd, and Diseased Persons, as soon as ever they perceive them∣selves injur'd by any thing, are wont to avoid the presence of, or con∣tinuance with that thing: no Person being in a Fever upon drinking Wine, continues still to drink it; when any Person grows more hot

than usual by the heat of a Bath or of the Sun, it is irksome to him to continue in it longer.

2. As to the excrementitious matter which ought to be separated and blown off from the Blood, this is either brought from without, as when by surfeiting, drinking of Wine, standing in the Sun, or bath∣ing in hot Water, the Blood is infected with hot and fermentative effluvia's or Corpuscles, or that matter is ingendred inwardly, as when upon the deflagration of the Blood its Liquor is stuff't with adust Re∣crements or Particles; both these Matters must be separated and blown off from the Blood, and be sent forth either by Sweat, or insensible Transpiration, before the Fever is appeas'd: wherefore, when the Pores are clos'd, and Transpiration is hindred, the Ephe∣mera Fever continues a longer time, and passes from a simple Syno∣chus into a putrid Fever.

3. The Evident Cause being remov'd, and this degenerated Mat∣ter blown off, for a cessation of the burning heat there is required an appeasing of the Parts of the Blood, and a reducement of them to or∣der. for a rapid and disorderly motion begun in the Blood is not pre∣sently stopt, but ought to be allay'd by degrees: also the divers Parti∣cles of the Blood disorder'd after this manner, and being driven this way and that, by reason of the feverish effervescence, do not presently take to their former order of site and position, but it is necessary that they be extricated by degrees, and restored to their due mixture by little and little.

Tho this Disease, after the removal of the Evident Cause, ceases for the most part of its own accord, yet some Physical Remedies are ad∣vantageously applied to Use, especially where there is danger lest the Ephemera Fever passes into a putrid. The chief Intentions must be to allay the fervour of the Blood, and to procure a free Transpiration, to which chiefly conduce blooding, a very thin Diet, or rather absti∣nence, cooling Drinks, a withdrawing the excrements of the Belly by Clysters; but above the rest, Sleep and Rest do most good, which if wanting, they must be seasonably procur'd by Opiats and Ano∣dines.

A renowned young man, about twenty years of age, of an athletick habit of Body, by an immoderate drinking of strong Wine fell into a feverish distemper, with a drought, heat, and a mighty trouble of the Praecordia; being blooded, he drank a vast quantity of fountain-water, and thereupon a copious sweat presently ensuing, he soon recovered.

An ingenious young man, of a sedentary Life, and withall very much addicted to the study of Learning, when of late he had exercis'd him∣self above measure in the Summer Sun, began to complain of a Head∣ach, a want of Appetite, a trouble of the Praecordia, and a feverish distemperature over the whole Body. To whom (in regard he loath∣ed all Physick) I ordered a total Abstinence, unless it were from

small Beer and Barley-meats: On the second day, and again more on the third, the Symptoms remitted by little and little; at length, on the fourth, he became free from his Fever without any Medicine.

CHAP. IX. Of the Putrid Fever.

A Putrid Fever is when the oily or sulphureous part of the Blood, being too much heated, grows turgid above measure, and is brought as it were to flame; and therefore, from its likeness to humid things putrifying which contract a fervour, this kind of ebul∣lition of the Blood, because it causes an immoderate Heat, is called a Putrid Fever: Which name it ought properly enough to retain, be∣cause in this Fever the Composition of the Blood (as it usually hap∣pens in Liquors putrifying) is very much dissolv'd; and so that its Principles are in a manner wholly severed from each other by the ferment of the Heart, and the active Particles being loosened from the mixture, break forth as it were into a flame. Wherefore the Li∣quor of the Blood being after this manner rarified, and as it were kindled in the Heart, is carried thence with a most rapid motion through the Vessels, and with its deflagration sends a great many efflu∣via's of heat from it; hence the whole mass of Blood, (like water set on the fire) continually boyling, stretches the Vessels, vellicates the Brain and nervous Parts, raises Cramps and Pains in them, very much consumes the Vital Spirits by its effervescency, destroys the ferments of the Viscera, hinders the functions of concoction and distribution, often depraves the nutritive Juice sent into the Genus Nervosum, that thereby very great disorders of the animal Spirits ensue; nay, it per∣verts in a manner the whole oeconomy of Nature.

The Procatarctick Causes which dispose to this Disease, are, a hot and moist temperament, an Athletick habit of Body, Youth, the Spring or Summer season, a plenteous and rich Feeding; moreover, an assiduous drinking of rich Wines, a sedentary and idle Life, a Body cacochymical and filled with evil Juyces: but above the rest, it is ob∣served, that a frequent letting blood renders men apt to a Fever; wherefore it is commonly said, that those who have been let blood once, unless the same be done yearly, are prone to a Fever. The reason is, that by a frequent letting blood the Sulphur is more copi∣ously heapt together within the mass of Blood, the Salt in the mean

while (which ought to moderate and keep it from growing exorbi∣tant) being by this means withdrawn.

The Evident Causes which draw the latent disposition of this Fever into act, are of the same kind as those which bring an Ephemera Fe∣ver, and a Synochus Simplex: in this rank we place chiefly perspiration letted, and surfeiting. By reason of the effluvia being restrain'd, the mass of Blood, being increas'd in its bulk, grows turgid, and being inspir'd anew with a certain ferment, as it were, falls a burning, and boyls violently; thereupon presently the Pores are more obstructed by the stuffing of the effluvia: and the texture of the Liquour being dissolved, the particles of the abounding Sulphur in the Blood get free from the mixture, and are inflam'd by the fermentation of the Heart, as tho Fire were applied to them, and so they kindle a very intense Fever. And by surfeiting, both an immoderate fermentation is caused in the Blood, and also a nitro-sulphureous matter fit for burning, and being enkindled, is conveyed as a fuel into the inflam'd Blood.

In this Fever four states of time are to be observed, by which, as by so many Stages, its course is performed; and they are these, the begin∣ning, the Increase, the height, and the declining state: these are wont to be pass'd over in some sooner, in some slower, and in a longer time. The beginning ought to be computed from the time that the Blood be∣gins to grow hot, and its Sulphur to fall a burning, till the burning Heats and inflammations are diffus'd throughout the whole mass of Blood. The increase is, from the time that the Blood, being heated and kindled throughout, has burnt for some space, and its mass is loaded with Recrements, or adust Particles, which also increase the Fermentation. The height of the Disease is, when (after the Blood has burnt enough, and its inflammation is remitted) the long trou∣bled Blood, as a noble Champion, its adversary somewhat giving ground, recollecting all its Forces, endeavours a subduing and sepa∣ration of that adust matter wherewith it is saturated to a fulness, and a driving of it forth, a Crisis being attempted once or oftener. The declining state follows after the Crisis, in which the Blood, the in∣flammation growing weak, becomes less hot, and either the vital Spi∣rit still prevailing, it subdues and purges forth by degrees what there is remaining of that adust and extraneous matter, till it be restored to its ancient vigour: or the same Spirit being too much deprest, the Liquour of the Blood is still tainted with adust Recrements, and there∣fore becomes troubled and depauperated; that it neither assimilates the nutritive Juyce, nor continues fit for Circulation, nor for accensi∣on in the Heart, for sustaining the lamp of Life.

When therefore any one is seized with a Putrid Fever, for the most part a cold stiffness or a shivering accompanies the first invasion, which is followed by a Heat which is unequal, and not as yet intense; be∣cause

the Blood being yet full of crude Juyces, is kindled only by parts, and therefore it burns a little and then ceases, and then begins again, like a flame burning wet straw: in this state the Disease conti∣nues for some dayes, the Urine becomes more ruddy than usual, by reason of the Salt and Sulphur more dissolved, and incocted with the Serum: it retains still its Hypostasis, because the coction and assimilation are not altogether depraved: it has a sediment greater than it ought, which nevertheless is easily separated, and subsides of its own accord: at this time you may let Blood, and give a Vomit or a Purge, so it be done without any great Perturbation of the Blood: It often happens upon the seasonable administrations of these kinds of Evacuations, that the greater increases of the Disease are prevented, and that the Fever is killed as it were in ovo: the limits of this stage are variously deter∣mined according to the temperament of the Diseased, and other acci∣dents of the Disease. Sometimes within a day or two the first Rudi∣ments of this Disease are laid; sometimes the beginning of the Disease is extended to more, if it happens in a Body well in Flesh, full of Spirit, and of a hot Blood and Juyce, in the time of Youth, and in a very hot Season, in case the Disposition to a Fever be great, and a strong evident cause supervenes, the severish Effervescence once begun, soon pervades the whole Blood, and on the second or third day, the root being laid, the Disease arises to its increase: but if the feverish Indisposition begins in a body that is not hot, a Phlegmatick or me∣lancholy temperament, in old age, or in a cold Season, it has a lon∣ger Proaemium, and scarce passes the limits of this first stage before the sixth or seventh day.

The increase of this Disease is computed from the time that the burning of the Fever has got possession of the whole mass of Blood: that is, the Sulphur or the oily part of the Blood, being long heated, and boyling vehemently by parts, at length like Hay laid together wet, af∣ter a long incalescence, bursts forth all together into a flame: through the violent boyling of the Blood, at this time the Diseased complain of an intollerable thirst; Moreover, a head-ach, obstinate watchings, often also Deliriums, a Phrensy, and convulsive Motions molest them: they loath all Food, or cast it forth by Vomit, or if happily it be re∣tain'd, being parcht by the too much heat, it turns to a febrile matter; there is also a bitterness in the Mouth, an ungrateful savour, a rough∣ness of the Tongue, a vehement and quick Pulse, a Urine very rud∣dy, for the most part troubled, filled with contents, without an Hy∣postasis or laudable sediment: the Blood at this time being in a man∣ner wholly kindled, it engenders by its deflagration a mighty quanti∣ty of adust matter, like the ashes remaining after a Fire: whereby both the Serum, being mightily fill'd, yields a Urine that is thick and full of Contents: and the Blood being loaded with it to a Turgescency, is irritated into critical Motions, wherewith that febrile mater (if it

may be) being subdued and separated, may be sent forth: and this brings the height of the Fever, in which judgment is given betwixt Nature and the Disease, the contest being brought as it were to a tryal, and therefore the evacuation which thereupon ensues is called a Crisis.

Therefore the height of a putrid Fever, is that time of the Disease, in which Nature attempts the expulsion of the adust matter remaining after the deflagration of the Blood: to this are requir'd first, that the Blood for the greatest part has past burning, for in the midst of it, Nature is not at leisure for a Crisis, nor ever attempted it prospe∣rously, nor is it procur'd by Art with good success. Secondly, that the Spirit first in some manner subdue this adust matter of the Blood, and separate it from that which is good, and render it fit for expulsion. Thirdly, that this matter be heapt together in so great a plenty, that by its Turgescency it irritates Nature to a critical Expulsion: when either of those things is wanting, the Crisis for the most part is of no effect and not to be relied on, and seldom puts an end to the Disease.

A Crisis in a continual Fever is in a manner the same as the fit of intermittents; for as in these, when the mass of Blood is saturated to a fulness of Turgescency with the Particles of the nutritive Juice depra∣ved, and unfit for Maturation, there happens a flowing, secretion, and expulsion of that matter; so in a continual Fever, after the deflagra∣tion of the Blood and nutritive Juice, a great many Corpuseles of adust matter are heapt together, with which the Blood being opprest, when it is a little free from burning, it subdues and separates them by de∣grees, and then, a flowing being raised, endeavours to send them forth. Wherefore as the fits of intermittents do not happen but at a set time, and after so many hours, so also critical Motions happen from the fourth day to the fourth, or haply from the seventh to the seventh, for in such a kind of space the Blood burns off, and by its burning makes a heap of adust matter, as it were of Ashes, which being offen∣sive to Nature, causes critical Motions by its irritation.

Therefore, as to what some say, that the Crises depend altogether on the Influences of the Moon and Stars, and that they follow their Quartile, or opposite Aspects, or their Conjunctions, it is not true: be∣cause critical Evacuations are determined only by the heaping together and Turgescency of the adust matter, whose Particles, if they can easily be separated from the Blood, and the Pores of the Skin are open enough, being involved in the Serum they are sent forth by sweat: and this is the best way of a Crisis, which if it succeeds well, it often at one bout puts a perfect end to the Disease, without fear of a relaps: to this next succeeds that crisis which is attempted by an haemorrhagie, for this matter, as an Efflorescence arising with the Blood (if by reason of an unfree perspiration it be not sent forth by sweat) it is conveyed in∣to some part remote from the Heart, and is frequently sent into the

Head by an impetuous sally of the Blood, where, if there be an open passage from the Sinus's spreading into the Nostrils, the morbifick matter springs forth together with a portion of the Blood: but other∣wise often sticking in the Brain, it brings a Delirium, Frensy, or other sore, and lasting Diseases of the Head: and it is to be observed, that in almost any continual Fevers, if at any time they come to an imperfect or dif∣ficult crisis, so that the Blood is corrupted for a long time with a feverish matter or adust Recrements: thereby the nervous Juyce (as it seems) comming to be tainted, obstinate Affects, viz. Watchings, also De∣liriums, Tremblings, Conlvulsive Motions, and long sticking Weaknesses of the nervous Parts follow. There are other wayes of Crisis's in which Nature endeavours to expell the febrile matter, not at once and en∣tirely, but by little and little, and by parts; sometimes by Urine, sometimes by Vomit, or Seige, sometimes by Pushes, or Buboes; which way soever it be done, that it may be with good success, it is requir'd that the deflagration of the Blood preceeds it, and that the adust matter be concocted, and rendred apt for separa∣tion.

Therefore the Height of the Disease is not one and simple, nor al∣ways happens after the same manner, but with a various diversity of Symptoms, and with a tendency to events far differing: now a pru∣dent Physician must give his Prognostick, in what space of time the Disease will come to its height, and what event it will have.

If the Fever from the beginning be vehement, and on a sudden per∣vades the whole mass of Blood with a burning, if with the fierceness of Symptoms it presses in a constant and even manner without remis∣sion, for the most part the Blood will so much burn off within four dayes, that the adust matter which is to make a Crisis, rises by that time to a plenitude of Turgescency: but if the beginnings are slow, and the accension of the Blood be often interrupted, the Fever will come to its height about the seventh day: if it begins yet more remis∣ly, the height of the Disease is wont to be protracted to the eleventh or fourteenth: mean while it is to be noted, that as the fits of inter∣mittent Fevers return at set times, so do critical Motions in such as are continual, (and for the most part they observe the fourth day) for tho a perfect Crisis be prorogued to the fourteenth, or seventeenth, or haply to the twentieth day, because all things requir'd to a full determi∣nation of the Disease do not concur: yet in the middle space light mo∣tions happen, with which the febrile matter, rising by degrees to an in∣crease is a little emptied, and cut off as it were by parts, till Nature is able to set upon a more full discussion of it: and since upon the Blood's burning a mighty store of adust matter is heapt together in the Vessels within four dayes, Nature, unless it be otherwise disturbed, every fourth day being provok'd with the store of matter, endeavours to shake off a part of its burthen with a certain Turgescency: wherefore, for the

most part, on the fourth, seventh, eleventh, and fourteenth dayes, critical Motions happen, not through a direction of the Planets, but through a necessity of Nature.

As to the event, whether the Crisis will be good or no, certain fore-knowledges are taken from the Strength of the Diseased, the Pulse, Urine, and other signs, and the concourse of Symptoms: if the burn∣ing of the Fever pressing, the diseased holds his strength in some mea∣sure, has a strong and even Pulse, if the Urine be of a middle Con∣sistency, with some Hypostasis, a Separation of Contents, and an easie subsiding, if the Disease makes its progress without violent Vo∣miting, Watchings, a Phrensy, convulsive Motions, and the Suspi∣scion of Malignity, the height of it may be expected to be laudable, with a good Crisis: if the contrary to these things happen, viz. that the strength be presently cast down, and the Diseased be subject to a frequent Fainting, Convulsions, or a Delirium, with a weak intermit∣tent or uneven Pulse, if obstinate Watchings, an intolerable Thirst, and a Vomiting continually molest the Diseased, if the Urine be thick and troubled, without an Hypostasis or a subsiding of the parts, if whilst the burning still presses, Nature be stimilated to critical evacuati∣ons, the extremity or height of the Disease will be dangerous, nor is any good to be hop'd of the Crisis.

Concerning the Crisis of a putrid Fever, I shall here subjoyn a par∣ticular prognostick, in which, tho the things that appear at the begin∣ing promise a wished for event, a very sad one is at hand: I have often∣times observed in a putrid Fever, which begins slowly and with a small burning, if the Urine be ruddy, and, when it is made, be presently troubled, and opake, which is neither precipitated by the cold, nor deposes a sediment of its own accord, and if at the same time the Diseased lye for many Nights without Sleep, tho they are quiet, and without tossing, their state is very dangerous; and there will be a greater suspicion, if in the mean time they are not prest with an intense Fever, nor with a Thirst, and a Heat very troublesome: for those that are affected after this manner, about the height of the Disease, for the most part fall into Deliriums, convulsive Motions, and often into a Mania, from which they are in a short time precipitated into Death, and when these Symptoms appear, the Urine is altered from being thick and ruddy, to be thin and pale, Melancholy Persons are most obnoxious to these kinds of Fevers, to wit, in which the Exorbitan∣cies of the Sulphur are little restrained by the Salt and earthy Dregs troubled together with it; and all which being raised by little and lit∣tle break forth afterward with a greater destruction.

When the Disease is come to the height, either the thing is brought to a stress at one conflict, and thence forward there is a manifest ten∣dency to Health with a Declination, or to Death: or there are frequent

Bickerings betwixt Nature and the Disease, and critical Motions are often attempted before the Victory falls to either fide.

As to the first, if with a good fore-running of Signs and Symptoms, after that the Blood has burnt enough, and its burning has remitted, the adust matter being evenly subdued and subtiliz'd, rises with a full increase to a Motion of Turgescency, and Nature being free from any impediment or depression, is of strength sufficient for a conflict, the feverish matter is exterminated for the most part at one motion of Ef∣florescence, and the Blood being become free from its Contagion and Fellowship, recovers in a short time its ancient Vigour.

2. But if Nature be irritated to a critical Motion, before the Blood has perfectly burnt off, or that adust matter be prepar'd for excretion, tho, as to the rest, affaires are in an indifferent state, yet none but an imperfect Crisis follows hence, whereby somewhat of the Burthen, or Load wherewith the Blood is opprest is diminisht; but in its stead presently another springs afresh from a new burning, and at set times afterward (haply in the space of four or seven dayes) as the fits of intermittents, critical Motions return haply the second or third time before that, the conflict being divided, the advantage plainly inclines to this or that side.

3. But when an ill apparatus of Signs and Symptoms preceeding, the burning of the Blood still pressing, without any concoction or subduing of the feverish Matter, a critical Motion is stirred up, Na∣ture is sometimes overthrown at the first conflict: nor does she reco∣ver her self again, but yielding her self conquered by the Disease, is precipitated into Death: nor are things in much a better state, when a Crisis at first being imperfect and of no effect, comes without any relief of the Diseased, and afterward the next to this happens to be worse, and then by another or haply another conflict the Disease pre∣vails, till the strength being wholly broken and prostrated, there is no hope left of recovery. So much of the height or Crisis of the Dis∣ease.

By the Word Declination I understand the Condition of the Disea∣sed and of the Disease, which follows the height of it, whether it tends to a Recovery or to Death: whether the Fever, or the Life it self of the Diseased at this time declines.

As to the times of the declining state, it will be necessary for us to enquire what the temper of the Blood is, and what alterations it un∣dergoes, as often as a progress is made from a good Crisis, or an evil, to a Recovery, or Death.

The vice or depauperation which the Blood contracts from a fe∣verish effervescence, consists in these things; the Spirit very much evaporates and is lost; the sulphureous Part is too much scorcht, and is much spent by the deflagration, and after its burning, an adust mat∣ter is left, as a caput mortuum, with whose Particles the mass of Blood

is loaded and weak'ned, mean while the Saline and Earthy Parts are too much exalted; even as it is wont to happen in Wine or Beer too much fermented. The Blood being tainted after this manner, ill assimilates the stock of nutritive Juyce; nay, and not duely ferment∣ing, or being inflam'd in the Heart by reason of the scorching, or de∣fect of the Sulphur, it ill distributes the Vital Spirit; mean while, by reason of the adust Matter, and the Salt too much exalted, it boyls more than it ought, and destroys it self more.

1. After a good Crisis, the Spirit, tho become weak, still bears the sway; wherefore it subdues by degrees, and expells what there is re∣maining of feverish matter, and concocts and assimilates the nutri∣tive Juyce, (so a thin juyce be administred); whence the mass of Blood is refresh'd with a genuine Spirit and Sulphur.

2. After an evil Crisis the thing is otherwise, the Liquour of the Blood (like Wine too much fermented) wholly loses its strength; its Spirit is greatly diminisht, what there is remaining of it for the most part is involv'd, and as it were overwhelm'd with Particles of adust matter: whence a continual Effervescence remains still in the Blood, tho without coction, or assimilation of the nutritive Juyce, or a separation of that which is useless from what is good: the benign Sulphur and Food of the vital Flame is much consum'd, so that the Blood is kindled in the Heart less than it ought: mean while, through adust Recrements, and raised to too great a height with Salt and Earth, it continually boyles in the Vessels, with a Drought and a Heat, and because it is daily depauperated upon the continual spending of the benign Spirit and Sulphur, and is more tainted with the Salt and earthy Faeculencies too much exalted, its Liquour in a short time grows vapid, and becomes unfit for circulation and accension in the Heart for upholding the vital Fire; wherefore Life must necessarily fail.

3. After an imperfect and doubtful Crisis, when the Diseased being broken by a long continued Weakness, recover not but after a long time, the case stands thus: the Spirituous and Sulphureous parts of the Blood are very much consum'd by their long burning; the remaining Liquour being not purg'd from the adust Recrements and Feculencies is rendred very impure; and there remaining still somewhat of Oyle for the vital Flame, and the Spirits not ceasing wholly from working upon the febrile Matter, the Blood is still circulated, and (tho in a small measure) is kindled in the Heart: nay, and the Spirits recover themselves by little and little, and begin to set upon the matter re∣maining after the Fever, and at length wholly subdue it, and restore a sprightly Fermentation de Novo in the Heart.

CHAP. IX. Of the most observable Symptoms and Signs in a Putrid Fever.

THE accidents which a Physician ought chiefly to consider in giving a true Diagnostick and Prognostick of this Disease, may be reduced to three Classes, as it were, or common Places; that is to say, they have regard to the Viscera of Concoction, viz. the Ventricle and Intestines with their Appendixes; or second∣ly, to the Humours flowing in the Vessels; to wit, the Blood in the Arteries and Veins, and the thin Liquor in the nervous Parts, together with the first sources of both, viz. the Heart and Brain: or lastly, those Symptoms regard the habit of the Body, with the various con∣stitution of the Pores, and the firmness or pining away of the solid Parts; those who will exactly observe the course of the Disease, and aptly draw the Curative Intentions, must mind these three heads of Symptoms, and diligently observe what alterations happen in these distinct Regions, as it were, according to the differing times of the Fever.

1. Concerning the Ventricle and first Passages, in the whole course of this Fever, tedious affects and Disorders; as a Nauseousness, a Vo∣miting, loss of Appetite, Indegestion, a Diarrhoea, a roughness of the Tongue and Mouth, a bitter savour are wont to molest them; these things for the most part are attributed to the Humours, first heap'd to∣gether in the Stomach and there putrifying; but besides that, the Re∣crements of the Chyle being burnt with too much heat, degenerate into an offensive matter; often those kinds of accidents happen, because the off-scourings and filth of the Blood and nervous Juyce, whilst they ferment, are carried inwards, and being depos'd within the Mem∣branes of the Viscera, cause Contractions, and make a filthy heap of a vitious and very infesting Humour: I have often observ'd, that about the beginnings of Fevers, the Blood vehemently boyling, still depos'd its recrments in wardly, to the benefit of the Diseas'd, where, tho some tedious affects hapned about the first Passages, yet the efferves∣cence was thereby more mild, the Pulse moderate, and the Urine laudable; and after this manner those that were ill of a Fever, with a thin Diet and the use of gentle carriers forth of Excrements, recovered in a short time; but if in this case I gave a violent Cathartick for ex∣tirpating the Humours, that natural purging of the Blood being letted, presently the Fever became intense, with a ruddy and troubled Urine,

a high Pulse, Watchings, and other horrid Symptoms; also often af∣ter the height of the Disease, the adust and excrementitious matter is sever'd from the Blood, by this kind of inward lustration, hence some∣times a loosness, sometimes crusty breakings forth of the Mouth and Throat happen: wherefore concerning the accidents which happen in the first passages, there is need of caution, lest while we obviate those, we pervert the Motion of Nature: and lest whilst we fortifie these Parts against the incursion of the morbific Matter, we perversly keep the same shut up in the mass of Blood.

The Symptoms chiefly to be considered in reference to the Mass of Blood, are a heat diffus'd through the whole, a great trouble of the Prae∣cordia, a ruddy Urine, a spontaneous Lassitude, a Swooning, from which, being duely considered, these following things may become known: viz. what the degree of heat is, or according to what tenor the inflamed Blood burns, what times of remission or exacerbation its effervescence observes whilst it burns; whether it retains its Crasis, or its mixture entire: what strength of the Heart suffises, and what space the Vessels afford for its burning, and the circulation of it, being kind∣led, in what store the Blood, whilst it boyles, heaps together adust Re∣crements, after what manner it subdues and severs them, or at least∣wise endeavours to sever them, in fine, what way of Crisis it endeavours, and with what success.

The Accidents which regard the thin Liquour, with the Brain and the nervous Appendix, are disorders about Sleep and Watching. a Weakness of the whole Body, a Trembling, a Tetanus, Pains, convul∣sive Motions, Contractions of the Viscera, a Stupor, a Phrensy, and the Observation of which will suggest to us, what is the Temper and Constitution of that thin Liquour; after what manner it irrigates and influences the Nervous parts, and circulates through them; how the animal Spirits perform the Functions of the Viscera; what is the state of the Brain; whether it continues free from the incursion of the fe∣verish matter: whether it be not in danger of being overwhelm'd by reason of its critical Metastasis.

Concerning the Habit of the Body, we must consider the manner of its Perspiration, and the degree of it, whether it be only by vapory Effluvia, or by Sweat, or also by Pushes; whether the flesh falls on a sudden from its wonted bulk, or whether it retains it a long time? what is the colour of the Face, and the Vigour, or dulness of the Eyes? from these things being duly compared together, we excellently measure the Course of the Fever, at what time it will come to the height, whether Nature will prevail over the Disease or not? with what way of Excretion, and with what success it endeavours the ex∣pulsion of the febrile matter, by these signs also we are taught by what degrees the Blood fermenting, and often being coagulated, tends towards a Putrefaction, or Corruption: whether it any wayes concocts

the nutritive Juyce mixt with it; or whether or no it does not forth∣with cast forth its whole store by Sweat, as it often happens in the de∣clining state of this Disease.

From the foresaid Symptoms and Signs a fuller instruction yet is had; if it be first known, on what causes each kind of them depends, and in what orderly course they are wont to be raised in our Body. Wherefore I have thought it expedient, particularly to set down the chief of these, and to explicate the Reasons of them, and their ways of coming to pass: Now in a putrid Synochus, or continual Fever, the Symptoms chiefly to be observed are, a heat in the whole Body, a spontaneous Lassitude, a great trouble of the Praecordia, an intolerable Thirst, a burning and roughness of the Tongue and Jaws, a pain of the Head and Loyns, obstinate Watchings, a Phrensy, convulsive Motions, a Swooning, a Cardialgia, a Vomiting, Nausecousness, loss of Appetite, a Loosness, a Dysentery, with which, not all of them toge∣ther, but sometimes these, sometimes the others, this Disease is wont to be attended: Amongst the signs, the Pulse and Urine give the great∣est light. I shall observe a few things concerning each.

1. The heat, which is perceiv'd in the whole Body to be sharp and piercing, depends on the too great Effervescence of the Blood, and its accension in the Heart: for the Sulphureous or Oily part of the Blood, being exalted and falling a burning, is kindled at least in a dou∣ble portion more than its wont in the Heart: When the Sulphur is not duely dissolved in the Blood, and kindled in the Heart, as in the longing Disease of Maids, the Leucophlegmatia, &c. The heat fails in the whole.

2. A spontaneous Lassitude is felt in the whole Body, to wit, by rea∣son of the Vessels being extended with the boyling Blood, also the muscular Flesh is much siuft with Blood, and a copious Vapour, so that it is not fit for Motion: as those who are troubled with an Ana∣sarca have their Limbs less free, by reason of the Redundancy of the serous Humour: Moreover in Fevers, by reason of the inflammation of the Blood, the Juyce, which is suppsyed to the genus Nervosum, falls from its due Temper, so that it is less fit for actuating Bodies.

3. The great trouble of the Pracordia happens, by reason of the Blood being copiously kindled in the focus of the Heart, which boyles thence with a great inflammation into the Lungs; wherefore the nearer this Region is to that Focus of heat, by so much it is affected with a greater burning.

4. The almost unexstinguishable Thirst is caused both by reason of the growing inflammation in the Praecordia, and by reason of the sharp and hot Particles of the febrile matter fixt in the Ventricle by the Blood in circulating; which require to be washt off even as salt and pepper'd Food eaten in a plenty, or as sharp things kept sometime in the Mouth or Throat: for this kind of affect suggests a free taking in of Drink, as a Member too hot does a pouring of cold Water on it.

5. The burning and roughness of the Tongue and Throat, and of∣ten also the growing of a certain white, yellow, or black Lee upon it, doubtless happen by reason of the Heat and Fumes breathing from the Ventricle and Lungs strongly burning; and the Tongue grows white as often as that Moisture (wherewith it is naturally much imbued) grows dry, the Saliva then growing too thick and viscous: but if it happens that the Tongue be inwardly fill'd or outwardly ting'd with a bilous Humour (as it comes to pass in Vomitings of Choler) then its Villi, in regard they are spongeous, imbibing the yellow matter, pre∣sent also a like Colour: and if the Heat becomes so intense that it burns the Blood, and kindles a Fire more ardent than usual, it follows, that Fumes are raifed from the Focus of the Heart, through the breathing Pipes of the Lungs, they scarce sufficing for ventilating so great a Blast; which coming to the Roof of the Palate, strike the Tongue as it were by Reverberation, and tinge it with a blackness.

6. Sometimes in Fevers (and especially about the time of their de∣clining) it happens, that the Tongue, Palate, Gums, nay, the Cavity of the whole Mouth and Throat, are covered with a Viscous Matter, resembling some whitish Crust; which being often cleans'd, presently a new succeeds; and unless by diligently rubbing and washing the Mouth, this crusty Mtter be frequently clear'd, the Diseas'd often in∣cur danger of Suffocation: that kind of Affect very often happens to Infants newly born; for they are wont, for the most part, within fourteen days an outward Efflorescence, to be bedeck'd with large and red Spots all their Skin over; and if this over-spreading of Red∣ness does not break forth freely, or disappears sooner than it ought, for the most part, that whitish Crust ensues in the Parts of the Mouth. This Symptom, when after this manner it molests Infants, is wont to be ascribed to the fault of the Milk; in feverish Persons the same is vulgarly attributed to thick and fuliginous Vapours rais'd from the Stomach: but it seems more likely to me, that in both, this Affect arises from the Impurities of the whole Blood, (and haply, in some measure of the nervous Juice) depos'd about these parts; for, as often as in the Mass of both Humours, somewhat extraneous inwardly mixt with them, is contain'd which is neither to be blown off by Sweat, nor is easily sent away by Urine, that very often is fix'd about the Mouth with a serous Filth; whence catarrhous Affects, Tumours, and troublesome Spittings, are rais'd: for in regard, for the Mastica∣tion of Food, the salival Humour ought to be plentifully discharg'd in this Place, Nature often endeavours to send forth here what is su∣perfluous, or otherwise troublesome, by these open and accustomed ways of Excretion: hence, after Mercury is given, when both the Blood and nervous Juice are abundantly fill'd with its Particles most minutely divided, and endeavour to send them forth involv'd in the Serum, because they are not able to exterminate these mercurial Cor∣puscles,

inwardly mix'd with them, neither by Sweat, Urine, or other way; what remains, they strive to expell the same, mixt with the Se∣rous Latex, by the Arteries and other Ducturs's, which convey the Spittle to the Mouth. In like manuer also in Fevers, when after a long Deflagration of the Blood, the adust Matter is much heapt toge∣ther, whereof a good part, remaining after the Crisis, is still mixt with the Blood and nervous Juice; or being fix'd on the Brain, or other place, is again drank up by the same; it's probable that that matter, by long Coction, is so parch'd, and grown thikc almost like Glew; wherefore it is neither to be blown off by Sweat nor insensible Transpiration, nor is fit to be separated by the urinary Passages, but at length distills forth by degrees from the little Arteries, and other Ductus's of the Saliva, which open themselves into the Mouth, (as being the usual way of Excretion) and presently, by reason of its thick∣ness, it settles into that clammy Humour. The same Reason holds concerning Infants, whose Blood being rendred impure, from the Filth contracted in the Womb, presently, by making an outward Ef∣florescence, it endeavours to purge it self; which, if by reason of the Thickness of the Matter, it does not succeed well, presently the vis∣cous Impurities are exterminated this way, as the more open. I knew a certain Person in the Declination of a Fever, who had not only an Incrustation of this kind of a clammy Humour in the Parts of the Mouth, but a copious Salivation, as tho he had taken Mercury, was raised in him for many Days, with a stinking Breath, and a swel∣ling of the Tongue and Gums.

7. A Head-ach is raised in Fevers by reason of the Meninges of the Brain being twitcht by Vapours, and by a sharp and boyling Blood; for, the Blood being violently moved, it is carryed in a greater Plen∣ry, to the Head by reason of the streight Direction of the great Arte∣ry, than to the inferiour Parts, to which it is carryed obliquely. And sometimes Head-achs arise by reason of the nervous Juice (which is supplyed from the boyling Blood) being too sharp and pungent; wherefore, when the Membranes and nervous Parts are irrigated with the same, being twitcht by its Acrimony, they are cast into Pains and Contractions.

8. In like manner also, the other Affects of the Head, as Watch∣ings, a Delirium, a Frenzy, Conyulsions, &c. sometime arise from the Blood making an Fffort, and so raising disorderly Motions in the Brain; sometimes also from the nervous Juice degenerated, and therefore become disproportionate for the Governance of the animal Spirits: but most commonly these kinds of Symptoms are rife in Fc∣vers by reason of a Metastasis of the febrile Matter from the stock of Blood into these Parts; for the Blood being full of adust Recrements remaining after Deflagration, endeavours (like working Wine) whol∣ly to subdue them, and to exclude them from its Society, which

when, a flowing hapning, it is not able to expell by Sweat, Urine, or an Hoemorrhagie, it often conveys them into the substance of the Brain, and there fixes them: and hence chiefly the foresaid Affects, when they are fixt and firmly rooted, take their Rise; but, when they are light, and easily moveable, they often proceed from the Cau∣ses before mentioned.

9. Convulsive Motions happen in Fevers for divers Causes; some∣times by reason of a Matter heapt together in the first Passages, which, by reason of its mighty Pravity, twitches there the membranous Parts, and afterward, by the Consent of the Genus nervosum, presently a Convulsion is communicated to the Origine of the Nerves in the Brain; and thence is retorted sometimes into these Parts, sometimes into others: after which manner, Worms gnawing in the Entrails, sharp Humours moved, and venemous Medicines, cause Convulsions; or secondly, when a Fever partakes of some Malignity: so Convulsi∣ons srequently happen in the Small Pox, Meazles, or Plague; to wit, because the Blood is altered from its benign and natural temper to a venemous Nature, whereby the Nerves, and their Origines, are put upon Motions and Contractions: often also, without a suspicion of Malignity, in a Putrid Fever, convulsive Motions are caused by rea∣son of a Metastasis of the febrile Matter to the Brain, as it was hinted even now; so I have often observ'd, when a Disease is not presently solv'd by a Crisis, the Diseased lye ill of a long Sickness, and become obnoxious to convulsive and trembling Motlons. Thirdly, for the most part, in every Fever, convulsive Motions are the sad Fore-warners of Death; which I think to happen not only through the malignity of the matter, whereby the Genus Nervosum is twitcht and troubled, but because the Spirits being very much exhausted and weakned, do not sufficiently influence and extend the Bodies of the Nerves; where∣fore being relaxt from their wonted Tension and tonick Motion through the weaker effort of the Spirits, they are still put upon a dis∣orderly motion.

10. Swooning is wont to be caused many ways in Fevers, but chief∣ly for three Causes; viz. Either throught the Mouth of the Stomach being affected, which part being interwoven with sundry Plexus's of Nerves, is very sensible; and because from the same branch of the sixth Pair, branches of Nerves are derived to the Heart and Ventri∣cle, if the Orifice of the Ventricle, so beset with Nerves, be affected with great Pain, the offence also is communicated to the heart, and in this the Motion is either stopt, or at leastwise a disorderly one is raised, whereby the even afflux of the Blood and Spirits is interrupted for a time. I knew a certain Person, in an acute Fever, seiz'd with a srequent swooning; which Affect, nevertheless, wholly ceased after that he had cast up, by Vomit, a long and round Worm. Secondly, a swooning also is sometime caused, because a venemous Matter is cir∣culated

culated with the Blood, which fixes and extinguishes the vital Spi∣rits on a sudden, and congeals the Blood it self, that it is apt to stag∣nate in the Heart, as it is usual in the Plague, Small Pox, &c. of which we shall speak particularly beneath. Thirdly, A Swooning is wont to happen by reason of the fine Texture of the Spirits, which being very thin and subtle, easily yield to a Fainting upon any immo∣derate Motion or Pain: so I have known some, who lying still in their bed were well enough, but being moved to any side, presently fainted.

11. A Cardialgia happens in Fevers, when the Ventricle, and es∣pecially its Orifices, being very sensible by reason of the manifold Insertions of Nerves, are beset with a sharp and betterish, or also with an acid and corrosive Humour; for hence a Pain arises from the Acri∣mony of the Humour, after the like manner as when the Sphincter of the Anus is affected with a tedious Pain in bilous Dejections.

12. For the like Cause, a Vomiting and a Nauseousness are wont to be raised; to wit, the Ventricle being beset and irritated to a Con∣traction by a matter which is extraneous and not agreeing with it self. Such an excrementitious matter is heapt together in the Ventri∣cle, after three manners: for, either the Aliments, partly through de∣fect of an acid Ferment, wherewith they ought to be duely concoct∣ed; partly by reason of the burning Heat of the Ventricle, are parcht into such a Mass of Corruption: or secondly, this kind of Matter is deposed into the cavity of the Ventricle, from Arteries terminated in it, as it usually happens in the Small Pox, Plague, and malignant Fe∣vers: or thirdly, meer Choler exprest from the Meatus Choledochus into the Intestinum jejunum, by reason of an inverted, and, as it were, convulsive Motion of the Intestine, is cast up into the Stomach. The loss of Appetite also happens by reason of the Ventricle being filled with vitious Juices, and because the acid Ferment is wholly perverted by the scorching Heat. These kinds of Affects of the Ventricle and Viscera, sometimes arise from an excrementitious matter, (viz. the Alimentary degenerated whilst it was concocting) heapt together in the first Passages a long time before the Fever, which often is the occasional Cause of the Fever it self: but sometimes the Nauseousness, Loss of Appetite, Vomiting, Cardialgia, &c. are the immediate Products of the Fever; for, when the day before the falling sick the Affected had a Stomach good enough, assoon as the immoderate Effervescence is brought on the Blood, whilst that boyls above measure, both the Effluvia and Recrements wont to be evaporated outwardly, and the bilous Humour flowing from the Vasa Choledocha, are pour'd into the Stomach, with which its Crasis is perverted; and the Relicks of the Chyle, and other Contents in the Viscera, are mightily depraved, whence the foresaid Affects draw their Origine.

13. Nor is a Loosness a less frequent symptom in Fevers, which some∣times happens about the beginning of the Disease, and arises (for the most part) either from the Choler flowing from the Vasa Choledoca, into the Duodennm, or from the Recrements of the Blood and Ner∣vous Juyce pour'd from the Arteries and Ductus of the Pancreas into the Intestines: Sometimes also about the height of the Disease, and in its declining state a loosness is raised: and so either Nature being con∣queress, the grosser off scourings of the Blood are this way Criti∣cally voided, or the same being overcome, the loosness is an effect and sign of the Viscera being wholly dissolv'd in their strength and firm tone. Sometimes it happens in a Fever that the Belly is alwayes bound, and unless irritated by a Medicine it discharges nothing, and tho the Diseased have taken only liquid things for many dayes, the stools are alwayes of a solid and hardish consistency: and this seems for the most part to be done, when the Blood burning greatly with a smart heat, consumes the moisture lying in any part like Fire; and by a copious emission of stems draws the watery matter from the Vis∣cera into it self, and presently causes it to evaporate outwardly; where∣fore the grosser part left in the Intestines, is thickned by the parching heat, as the Caput Mortuum remaining after distillation.

14. The bloody Flux is an affect so frequent in continual Fevers, that in certain years it becomes Epidemious, and being as bad as a Plague, it kills many; the cause useally is not a humour produ'd inward∣ly in the Viscera, which corrodes the Intestines with its Acrimony, (as some assert) but some Miasm past into the Blood, and so in wardly mixt with it, that it cannot be forc'd from the Blood under the form of a Vapour or sincere Humour: wherefore being driven toward the In∣testines, it opens the Mouths of the Arteries, and causes little Ulcers and Distillations of Blood there, as when from a feverish Blood taking toward the Skin, Pushes and inflamed Swellings break forth outward∣ly; and it is likely that those affects of the bloody Flux which accom∣pany malignant or epidemious Fevers may airse from a certain coau∣lation of the Blood.

The pulse and Urine bring up the rear of the Symptoms and Signs in a putrid Fever, which are chiefly to be minded for knowing both the state of the Disease, and the strength of the Diseased; for there being two things by which our Life is supported, viz. Heat kindled in the heart, and Coction to be perform'd in the Viscera and Vessels, because the Pulse and Urine excellently shew the alterations caused in both by the Fever, therefore hence a most certain Judgment is taken of the affect whether it will terminate in Death or a Recovery. First, we consult the Pulse as a Thermometer constituted by Nature for mea∣suring the heat kindled in a Fever: which if it be intense, and raises a great ebullition of the Blood, the Artery has a vehement and quick beat, as long as the Spirits hold a good Vigour; afterward the same

being somewhat exhausted, the strong Pulse remits, which neverthe∣less is recompens'd by quickness, and becomes quick and small. If the Fever be mild, and be attended by a less burning, the Pulse also declines less from its natural state; and in the whole course of the Disease the moderation of this denotes a truce of Nature, nor does the Pulse only discover the strength of the Fever, as it were of the Enemy, but plainly shews also the sktrength of Nature, and its ability of resisting: as long as the Pulse is laudable, things are in safety, and it gives very good hope: but from the evil state of this a very ill omen is given, and a despair of doing well. So that without a srequent and diligent exami∣ning of the Pulse, the Physician can neither make a due prognostick, nor safely order a Medicine.

1. As to the first: he ought to know (as far as he may) what sort of Pulse a Person has according to his natural Constitution, for in some it is strong, in others weak; again in each change of Fevers he must weigh by what degrees it differs from its natural state; for one while it is more vehement than it ought, and argues the Fever to be in∣tended: another while it's deprest lower than usual, and denotes the Spirits and Strength to be dejected.

Those whose Artery has a weak and languid beat in their state of Health, when they are taken with a Fever it is not so very ill with them to have a small and weak Pulse, that we must presently despair of their well doing: those who have naturally a strong and vehement Pulse, if after the Crisis of the Disease it scarce holds a mean Vigour, tho it be not altogether weak, it argures the state of the diseased to be suspected, and not safe.

If at the beginning of a Fever, before the Blood has much burnt, or if after a Crisis, when part of the burthen is diminisht, or if at another time the Pulse becomes weak without an evident cause, it fore-bodes ill: but if after long Watchings, or after a great Evacuation, the Pulse becomes somewhat weaker, we may not therefore despair of a Reco∣very: because Strength dejected or impair'd by these means may be again restor'd, and the Spirits may be refresht.

When the Pulse on a sudden is altered for the worse, tho the Disea∣sed as to the rest of the Symptoms seems to himself to be better, you may give a sad prognostick of Death, and on the contary, tho hor∣rid Symptoms are pressing, if notwithstanding the Pulse be laudable, we may still hope for a Recovery. If in a robust man, being in a Fever, the Pulse becomes very small and formicating, Death is near at hand.

2. In giving Medicines, Cautions and Rules of no small moment are taken from the Pulse: Purging and Vomiting are prohibited by an over quick and violent Pulse, also by a low and deprest one: for when the Blood boyles too much, an evacuation does little good, both be∣cause that which is offensive is not separated, and also for that by

that Perturbation the strength is more debilitated. And when the Spirits are broken, and the Strength dejected, a Purge casts them do wn more, and sometimes wholly resosves them. Wherefore when a Phy∣sician thinks of an evacuation upward or downward, first let him try the Pulse, and let him set upon this work only when Nature is strong and in a calm; that it may both be at leisure for the Operation of the Medicine, and have Strength enough to bear it.

Nor is there need of less Circumspection in Diaphoreticks and Car∣diacks; which if they are given in the feverish fit, they too much in∣tend the motion of the Heart, which before was violent, and very of∣ten break its strength: and when the Pulse is very faint, if hot and strong Cordials are given, Life is easily extinguisht, (as when a small Flame is prest with a strong blast of Wind) wherefore its a vulgar ob∣servation that Cordials often accelerate Death, for that by too much exagitating the Blood, they sooner consume the Strength.

There is yet need of the greatest Caution and Direction of the Pulse in giving Narcoticks; for those (because they perform their Opera∣tion by exstinguishing and fixing the over fierce vital Spirits) if they are used in a weak or wavering Pulse, either by diminishing the vi∣tal Spirits they render them wholly insufficient for the Disease; or by suffocating them too much they bring a perpetual sleep: wherefore in a languid, unequal, or formicating Pulse let Opiates be shun'd of all things.

The uneven and intermittent Pulse have an ill name in the writings of Physicians: yet tho they are lookt upon as ill, they do not so certain∣ly portend Death as a weake Pulse: for I have known many with those kinds of signs to have escapt, who were condemn'd to the Grave: for the disorder of the Blood and Spirits may much more certainly and easily be restrain'd or appeas'd, than their dejection be restored.

2. The inspection of Urines in Fevers has more of certainty than in any other Diseases, and is of very great use: for hence the states of the sick Person and of the Disease are excellently known, and the phy∣sical Intentions concerning things to be done are hence best directed: some of the chief Observations and Rules concerning this matter are as follows.

Concerning the Urines of Persons in Fevers, the things chiefly to be observed are the Colour, Consistency, Contents, and setling; the co∣lour of the urine shews the degree or excess of heat in the Blood, which as it is increast, or is more remiss, the Urine also is more or less ruddy.

Nevertheless the Urines of some are mighty ruddy, when they are but lightly feverish: and on the contrary, the Urines of others troubled with the burning heat of a Fever are less coloured. Those who abound with a vigorous heat, and a very hot Blood, or are obnoxious to the Scurvy, Ptysick, or the Hypocondriack affect, when upon taking cold,

or through a Fulness, Surfeiting, or drinking Wine, they are set up∣on by any small Fever, they make an intensly ruddy Urine, because the Particles of the Salt and Sulphur are exalted, and half dissolved in their Blood before; wherefore, of necessity, when the Fever pres∣ses, they are more incocted in the Serum: on the contrary, those who having a cold Temperament, and a weak Pulse, are taken with a Fe∣ver, tho they have a greater Effervescence of the Blood, void a Urine less coloured.

The Consistency, Contents, and Setling of Ʋrines, being places, as it were, in the same Rank, depend altogether on the adust and re∣crementitions Matter, which remains in the Blood after the burning of the Fever: if there be a plenty of this, the Consistency of the Urine becomes somewhat thick; and after it has stood, it is troubled by the Cold: if either the quantity of this be less, or it be derived elsewhere than to the Reins, (to wit, if it be withdrawn by Sweat, or by a critical Metastasis into this or that part) the Consistency becomes more thin, and the Liquor remains clear. And the Particles of this matter furnish the Contents of the Urine, which are diversly disposed according as the nutritive Juyce is one while somewhat concocted and assimilated by the Blood, another while is wholly perverted, and turns to a mass of Corruption. Some signs of Coction and Assimilati∣turns to a mass of Corruption. Some signs of Coction and Assimilati∣on are given in the Urines of Persons in Fevers, sometimes by a lau∣dable Hypostasis, sometimes by certain Rudiments and Foot-steps of the same. A Privation of an Hypostasis, and a confusion and troubled state of the Parts of the Urine, denote Coction to be vitiated: and as this matter is more or less parched in the Blood, the Contents are sometimes pale, sometimes of a yellowish Colour like oker. Accor∣ding as the Recrements mixt with the Blood, either the Spirit pre∣vailing, begin to be subdued and separated; or the same being too much deprest, are less able to be separated, also the Contents of the Urine are wont, more or less, sooner or later, to be separated from the rest of the Urine, and to subside towards the bottom.

As to the Prognosticks to be taken from the Urine, we observe, That somewhat a remiss Colour of the Urine, a mean Consistency, a sew Contents subsiding of their own accord, or readily gathering to∣gether into a little Cloud, portend Good: on the contrary, an intense Redness, a thick and troubled Consistency, gross and opake Contents, which slowly, or scarce at all, subside towards the bottom, denote a great Effervescency, a plenty of adust Matter, and its subduing and separation to be difficult, or frustrated.

As to Physical Directions, the thing consists in this; that by a fre∣quent Inspection of Urines we attend to the Motion of Nature, and readily follow it; nor must we move by Purging or Sweat, but when some Hypostasis shews signs of Coction and Separation in the Urine.

CHAP. X. Of the Signs and Cure of the putrid Synochus, or continual Fever.

BEsides what is said before of the putrid Synochus in general, there are moreover certain Varieties, or Irregularities (not to say Species) of this Disease, by which this Fever somewhat de∣clines from this common Rule; and by reason of certain accidental Affects, gets new Names and Distinctions.

First therefore, a putrid Synochus is wont to be divided into a symp∣tomatick and an essential one. That is said to be symptomatick which draws its Origine from some other Affect or Disease first raised in the Body; so that the Fever is only the symptome coming upon that other Affect, as that is accounted which depends on a Squinancy, Plurisie, Wound, Ʋlcer, &c. in or near some principal Part; of which we think somewhat otherwise; to wit, that in Truth there is no Putrid Fever which is merely symptomatical; occasionally perchance it may arise from some other Affect; but it is founded immediately in the sulphu∣reous part of the Blood too much heated, and as it were kindled: for, without a Procatarxis or precedent Indisposition of the Blood, the foresaid Affects seldom, or scarce at all, bring a putrid Fever.

As to the Squinancy, Plurisie, and the like, I say that those are Products of the Fever, or Affects following it, but not Causes of it; for most commonly an evident Cause has preceeded, which has pro∣duc'd the feverish Effervescence of the Blood, as a taking of Cold, an Evacuation restrain'd, &c. afterward, tho the Diseas'd are not forth∣with openly feverish, nevertheless, a greater Ebullition of the Blood than usual is raised; as we may easily gather from the Urine, Pulse, and Restlesness of the whole Body. After some Days, (sometimes sooner, sometimes later) an Inflammation is produced in this or that part; whereof a probable Reason enough is thus assigned: The Blood by reason of the Effluvia retained (which are like a Ferment) is in∣creas'd in bulk, and swells its Vessels more than usually; and when through defect of Ventilation, it is straitned in the space of its Circu∣lation, it readily finding a way, springs forth of the Arteries; and be∣ing extravasated, upon the course of Circulation its being interrupt∣ted, it is raised into a Tumour; and because by that kind of Tumour a Heat and Pain in the Part are made more intense, the Blood is more troubled in its motion, and so the Fever, first kindled, is more aggra∣vated.

Moreover, in these kinds of Fevers we may observe a certain apt∣ness of the Blood to coagulate, whereby it becomes less fluxile, and so apt to be congeal'd in the lesser Vessels: even as we find in Milk when it begins to turn sour, for then it cannot be boyl'd nor warm'd on the Fire without coagulating: in like manner we have reason to suspect in the Blood also a certain Diposition to turn sharp, by reason of which it is obnoxious to coagulation; for it plain enough appears, that in the Phrensy, Peripneumonia, Squinancy, and the like Disea∣ses, an Inflammation or Extravasation of the Blood does not always depend on the exuberancy of the Blood, and the plenitude of the Ves∣sels: for often with a weak Pulse, and a subsiding of the Vessels, the Blood is stopt in its Motion, and being extravasated in the side or else where, causes an acute pain.

It only remains for us to enquire whether the Fever which accom∣panies these affects, be to be accounted of the number of those which are called putrid, or not; To this we reply, that oftentimes they are simple Synochi, in which only the subtle and more spirituous part of the Blood is inflamed, and therefore, if after a copious taking away of Blood, or the Vessels being emptyed by sweat, the extravasated, Blood be restor'd to Circulation, presently the Effervescence is restrain'd, and the Fever in a short time is appeas'd: Nevertheless sometimes when a Predisposition happens, as in a Plethora, or mighty Cacochymia, a putrld Fever is kindled together with these kinds of affects wholly from the same occasion.

Among Symptomatick Fevers they place that which is vulgarly call'd Febris Lenta, those that are troubled with this grow hotter than they ought, especially after Meats, or any Motion, or Exercise, the Urine for the most part is ruddly, the Spirits are weak, and the Strength de∣jected; as to Appetite and Sleep they find themselves indifferently well, they are without a Cough, or much Spitting: but daily (like consumptive Persons) they pine away, and without any manifest cause: the fault for the most part is ascribed to Obstructions in some one of the Viscera (suppose the Liver, Spleen, or mesentery) by whose default, the Food is not well concocted, nor duely dispen'd: but it seems to me that this kind of affect is immediately founded in the evil Disposition of the Blood, whereby it inclines to an over-salt and sharp Temper, and therefore is rendred less apt for Nutrition, and an even Circula∣tion.

But the Fever which most deserves to be called Symptomatical, is that which is raised in Ptysical Persons from an Ulcer or Consumption of the Lungs: for the Blood, whilst it wholly passes through the Lungs in its circulation, often imprints on this entral the Ideas of many Di∣seases; and on the contrary, from the Lungs being ill affected, it re∣ceives the same. Whatsoever impure is contain'd in the Mass of Blood is cast forth of the extremities of the Arteries, as the flowrings

of new Wine: Wherefore, when Nature being become weak, is not able to convey its Recrements to the superficies of the Body, it deposes the same in the Lungs by a nearer way of purging it self. Hence a mighty Cacochymia, and many Cronick Diseases frequently end in a Ptysick. In like manner, when the flesh of the Lungs con∣sumes, or abounding with an ulcerous Ichor, is become half rotten, the blood passing through it is infected with the purulent matter, or the consumptive filth, and consequently is put upon a continual Effer∣vescence, by reason of that immiscible Substance being confounded with it, wherefore it brings an assiduous Fever, and wholly perverts the nutritive Juyce: the like reason holds concerning Fevers caused from an Ulcer, or Absess often hapning in other parts: for those even as the consumptive Constitution of the Lungs, often bring the Ptyfick, or hectick Fever: a full consideration of these things belongs not to this Place, wherefore let us return to the putrid Fever properly so call'd, or essential Fever.

The essential putrid Synochus is wont to be divided into the putrid (such is above describ'd) inot the Causus or most sharp burning Fe∣ver, and moreover into the quotidian, tertian, and quartan. The pu∣trid Synochus even now describ'd ought to be the Rule or Square of the rest, according to the Type of which, for the most part Fevers which are of this kind are compounded, as to the rest even now mention∣ed, I shall briefly set them down according as they vary their Spe∣cies.

A Causus or burning Fever is that which performs its course with a great burning, an intollerable Thirst, and other Symptoms shewing a mighty Inflammation of the Blood: its formal Nature wherein it's dif∣ferent from the rest, consists in this, that the temper of the Blood in those that are affected with it, is hotter, that is, it more abounds with a combustible Sulphur; therefore when it rages, it is kindled in a grea∣ter plenty, and by its burning diffuses Effluvia's of a most intense heat throughout the whole Body; its Motion is acute, and soon comes to its height, it is attended with more horrible Symptoms than others, it has a difficult Crisis, and its event is very dangerous.

Now as to what regards those periods or paroxisms in which a putrid Fever now and then at a set time is wont to have a sharp fit, and (in∣termitting, as it were) sometimes every day, sometimes every other, or fourth day resumes its febrile accension as it were: the reason of this which seems to me most likely, is as follows. In a continual Fever there are two chief things (as we have hinted above) which for the most part cause the Effervescence of the Blood, viz. an exaltation and ac∣sion of the sulphureous part in the Blood; and then consequently a heaping together of the adust matter remaining after the deflagration of the Blood, to a Turgescency: on the former, the continuity of the Fever, on the other its height and critical Perturbations depend: to

these sometimes a third thing is added, to wit, a fulness and turges∣cency of a crude Juice from Aliments fresh gathered together, which at set intervals of times causes a greater effervescence in a continual Fever (as in the fits of Intermittents.)

Concerning the Cure of putrid Fevers of what kind soever, there are four general intentions, on which the whole stress of the Business lies. First, that the Blood (if it may be) be freed from its burning, and that the Flame or Fire kindled in its sulphury part be wholly supprest, which often happens to be done about the first beginnings of this Di∣sease. Secondly, that when the Blood, being set a burning, cannot presently be extinguisht, it may go on with it at least mildly, and with as little dammage as may be. Thirdly, that the burning being over, the Liquour of the Blood may be clear'd of the Recrements of the burnt and adust Matter, and be restor'd to its natural Vigour and Crasis. Fourthly, that the Symptoms chiefly pressing be seasonably obviated, without the removal of which the attempts both of Nature and Physick will be in Vain.

As to the particular Remedies, with which those intentions are ans∣wer'd, there are various Prescripts, and Forms of Medicines every where in use, not only amongst Physicians, but likewise old Women and Empricks; from which nevertheless, in regard they are us'd like a Sword in a blind Mans Hands, without differences, and an exact Me∣thod of Healing, more dammage than benefit often accrues to the Di∣seased. It will not be needfull for me to repeat in this Place the Forms of Purgers. Cardiacks, or other Medicines neatly enough delivered in many Authors. I shall briefly set down some of the chief Indications, and Physical Cautions which ought to be observed in the course of this Fever, according to the various Seasons, and divers Symptoms of it.

1. About the first Invasion of this Disease, you must endeavour that the Fever be forthwith supprest, and that the inflammation of the over-heat∣ed Sulphur may be stopt; to which breathing a Vein chiefly conduces; for by this means the Blood is ventilated, and the hot Particles too much crowded together, and even ready to fall a burning, are dissipated from each other, as when Hay, being apt to take on Fire, if it be expos'd to the open Air, its kindling is prevented: Moreover, let a thin diet be ordered: in which nothing spirituous or sulphureous ought to be us'd: let the Viscera and first Passages be freed from the Load of Excremen∣tious Matter; Wherefore Clysters will be of necessary use, sometimes also Vomits, and gentle Purges, which being now and then given sea∣sonably and with judgment, the Fever presently at the beginning, its Fuel for accension beig withdrawn, is extinguisht. But if notwith∣standing this Method the burning gets Ground, and daily more and more lays hold on the sulphureous Particles of the Blood: let it be pro∣cur'd

(as far as may be) that the deflagration goes on gently without any great Commotion.

2. Wherefore, when the Fever is in its Increase, if the Blood boyls too much, and very much extends the Vessels with a strong and ve∣hement Pulse, if Watchings, a Frenzy, or Head-ach, violently press, bleed a second time, and let as free a Transpiration (as may be) be procur'd: wherefore, let the Diseas'd, for the most part, lye in Bed, let the Diet be sare, of very thin Food; also, let the Drink be small, and plentiful, that the burning Blood may be freely diluted with Se∣rum. Clysters are given with Safety, and indeed, with good Effect; but let Medicines, whether Catharticks or Diureticks, and which too much exagitate the Blood, be avoided with the same Industry as Blasts of Wind are where Houses are on fire; nay, rather Opiates and Anodines, which fix and constipate the Blood and Spirits, are to be used: also, Juleps and Decoctions, which cool the burning Bow∣els, qualifie the Blood, and refresh the Spirits, are frequently to be given. Acetous Liquors of Vegetables or Minerals, also Nitre puri∣fied, because they restrain the burning of the Blood, and quench Thirst, agree well: let hot and spirituous Waters, cordial and Bezoar∣tick Powders (so the Disease be without Malignity) be let alone. In case the Blood circulates unevenly, and be carried more violently to∣ward the Head than the Feet, Epithemes of the warm Flesh, or In∣wards of Animals, applyed to the Feet, do well.

3. When the Fever is at its height, let the motion of Nature be diligently minded, whether it be about to make a Crisis or not; wherefore, nothing is to be attempted rashly by a Physician: breath∣ing a Vein, or strong Purging, are wholly forbidden: but aftenward, when the burning of the Fever is in some measure remitted after the Deflagration of the Blood, and signs of Concoction appear in the Urine, in case the Motion of Nature be sluggish, a Sweat or gentle Purge may be procured, which, nevertheless, are performed better, and with more Safety, by a Physician, when Nature before, by a cri∣tical motion, has set upon a seclusion of the morbifick matter. But if all things are crude, and in a Perturbation, the Urine be still troubled without a Sediment or a Separation of Parts, if the Strength be faint, the Pulse weak, if no Crisis, or only a fruitless one, has preceded, any Evacuation, either by Sweat, or Purging, is not attempted with∣out manifest Danger of Life: but we must expect longer, that the Spirits of the Blood may recover themselves, and in some measure subdue the recrementitious and adust Matter, and afterward, by de∣grees, separate them; mean while, let the Strength be refresh'd with temperate Cordials, let the immoderate Effervescence of the Blood (if it be so) be stopt; and let its due Fermentation be upheld, which, in truth, is excellently performed by Coral, Pearl, and those kinds of Powders, which are dissolv'd by the Ferments of the Viscera, and

afterward ferment with the Blood, and greatly restore its weak and wavering Motion. Mean while (whilst Nature labours) let all Ob∣stacles and Impediments be removed, and especially let the store of Excrements heapt together in the first Passages, be withdrawn by the frequent Use of Clysters.

4. After what way or method the Symptoms chiefly pressing ought to be handled, it is not an easie thing to prescribe by certain Rules; because the very same sometimes require to be forthwith restrain'd and appeas'd, sometimes to be moved on faster: and those that have somewhat greater in them, haply ar another time are to be left whol∣ly to Nature. This, in some, may be obviated with asswaging and le∣nifying Remedies, but in others with a rough and irritating Physick: mean while, it is a Precept to be stood to in all, that we religiously follow the Footsteps of Nature: which, if it acts amiss, its Disorder is to be reduced; if rightly, but too vehemently, it is to be cheekt; and if rightly, but slower or weaker than it ought, it must be our bu∣siness to encourage and aid its Effort by physical means.

5. In the declining state of a Fever, when after a perfect Crisis, Na∣ture has gotten the upper-hand of the Disease, things are in Safety; nor is there much left for a Pyhsician to do: it only remains, to pro∣pose an exact form of Diet, that the Diseased may soon recover their Strength without fear of a Relapse: also it is good to clear the Re∣mainder of the febrile matter by a gentle Purge. Concerning the Diet, Men very often incur a Relapse, to wit, by an over-hasty eating of Flesh or strong Food, the Diseased fall back into the Fever; for since the Viscera are weak, and do not easily concoct Food, (unless it be very thin) and since the Crasis of the Blood is so weak what it does not assimilate a strong nutritive Juice, if any thing disproportionate be brought to either, the oeconomy of Nature is again perverted, and all things run amiss. Wherefore, let such as are upon Recovery frobear a long time from Flesh, and let them not use it till their Urine is become like that of sound Persons, and is no longer troubled by the Cold: and indeed, then it will be better to begin with diluted Broth of Flesh, and afterward by Degrees to rise to stronger Aliments.

6 When, after an imperfect Crisits, the thing hangs in doubt, and is not yet come to a Determination, then the Physician has a hard Task: let a diligent Eye be had to the motion and strength of Nature, whether it begins to prevail over the Disease, or yields to the same: if there are signs of Concoction, and the Strength holds good, a gen∣tle Evacuation, and only per Epicrasin, is to be put in practise: mean while, let the chiefly pressing Symproms be obviated by fit Remedies, let all Impediments be removed; let the Strength be upheld, as much as may-be, by Cordials, and a true method of Diet.

7. When after an evil or no Crisis all things grow worse, and when the Physician, in a manner, despairs of the Cure of the Disease, he may declare the event of it to be suspected, and greatly to be feared: nevertheless, we must not so yield to a bare Prognostick that Fear shall put us by of all things else; but still, as much as lies in the Art of Physick, let Care be taken for a Recovery, tho the Case be desperate; let Remedies be used to the Symptoms that are most dangerous; let the Spirits of the Blood, almost extinct, be reinvigorated with Cor∣dials. When we despair of a Recovery, let Life be drawn out in length as long as it may be, at leastwise let an easie Death be pro∣cur'd.

I shall now briefly give you some few Examples having regard to each Species of the foresaid Fever.

A noble Matron, about fifty Years of Age, of a thin habit of Body, a low Stature, and a fresh coloured Countenance, having cloathed her self thinner than usual on the fifteenth day of June, by reason of the Summer-heat, in the Evening was taken ill, and upon it, was seised with a Nauseousness, and an Oppression of the Stomach: she had wandring Pains troubling her sometimes in the Shoulder-blade, some∣times in the Back, being very thirsty, tho without any immoderate Heat. On the second and third day she found her self almost after the same manner. On the fourth day, after a Vomit given her, viz. un ounce of the Infusion of Crocus Metallorum, she vomited four times a yellow Choler, and purging thrice by Stool, she seemed to receive ease: the following night she slept somewhat better; but the next day, the Fever being kindled throughout the Body, she complain'd of a Thrist, a burning of the Praecordia, and of a Pain sometimes in the Side, sometimes in the Back, presently eight Ounces of Blood were taken from her; her Urine was of a very saturated Redness, opake, and troubled, without an Hypostasis, or subsiding of the Contents; the Pulse was uneven, and often intermitting: the following Night was without Rest. On the sixth day of the Disease, early in the Morning, a small Sweat arose, whereupon the Heat became somewhat more mild, which grew more intense again in the Evening. On the seventh day there was a very sharp Heat, with a Thirst, Burning, a disorderly and intermittent Pulse also a mighty Restlessness of the whole Body. On the eighth, the Symptoms were somewhat more remiss; also in the Urine there were some Tokens of an Hypostasis: she took on that day, Whey with the Leaves of Meadow-sweet boyl'd in it; she sweated freely; the Fever came to a Crisis. All the time of her Sickness her Diet was only small Ale, Whey, Barley and Oat Broaths; Clysters were frequently us'd; Drink and cooling Juleps were given her at her Pleasure.

About the beginning of the Summer, Anno 1656. a worthy Man, of an athletick habit of Body, without any manifest Cause (unless that

being very much addicted to Study, he used no Exercise besides) fell ill: first he complain'd of a Nauseousness and a want of Appetite, with a violent Head-ach. On the second day he was affected with a cold Shivering, sometimes with a heat coming upon him by Turns; and likewise with a Thirst, and burning of the Praecordia, with a rough∣ness of the Tongue, and an ingrateful Savour: on that Day he took ten Drams of an Emetick Liquor, after which he vomited seven times, and threw up a mighty quantity of yellow Choler, and had four Stools: the Night following was restleAss, and in a manner without Sleep; at which time, the Diseased, the heat being increast, grew more intensly feverish. On the third Day, when the foresaid Symptoms increast, ten ounces of Blood were taken from him: his Urine was reddy and thick, with a copious Sediment; the Pulse was quick and vehement; in the Night he sweated a little, with a short, but troubled, Sleep: the Morning following the seemed somewhat relieved; but in the Evening all things grew worse again, with Watchings, and a most intense Heat and Drought. On the fifth day, after a light Sweat, the burning somewhat remitted; which, nevertheless, return'd again with its wonted Fierceness a little before the Evening; the Night again was without Sleep, with an almost continual tossing of the Body: in the Morning, upon a gentle Sweat, he found a little Relief; in the Evening again there was an Exacerbation of all things; the night also was very restless. About the beginning of the Day following a Sweat happened as before, and somewhat more plentifully: this day there was a manifest Change toward a Recovery; the Heat and Thirst aba∣ted by degrees; the Urine was less ruddy, with somewhat of an Hy∣postasis: afterward, for three days, the Fever leisurely declin'd; yet he had every Night a certain Fit, tho more remiss than before. On the eleventh Day he sweated more freely, and came to a perfect Crisis. During the whole time of the sickness he used a very spare Diet, as desiring no Food but small Ale, and Whey made with it: he took now and then cooling Drinks, and Juleps of a Decoction of Barley, and distill'd Waters; every day, if he had not a Motion to Stool of his own Accord, an emollient Clyster was injected: he used no Medi∣cine beside, viz. either Cathartick or Cardiack; but the Fever being over, he was twice purg'd, and afterward soon grew well.

A young Student, about twenty five Years of Age, of a pale Coun∣tenance, and a melancholy Temperament, without a manifest Cause, in August, 1656. began to be sick: first he complain'd of a feverish Di∣stemper, with a Thirst, a spontaneous Lassitude, and a want of Ap∣petite. On the second day he was troubled also with a Pain in the right side, and a Distension of both Hypocondres, also with an almost continual Vomiting, Watchings, and a violent Head-ach. On the third day, a Physician being called, presently twelve Ounces of Blood were taken away: in the Evening he grew hotter and deliri∣ous;

afterward a Sweat, tho small, hapning, he was better the next Morning. On the fourth day, he presently threw up again whatso∣ever was given him, and was troubled with an almost continual stri∣ving to vomit; the giving of a Vomitory being propos'd by the Phy∣sician, both the sick Person, and his Friends, refused to admit of it, being taught by Experience of the Danger of it before: a Clyster be∣ing given him, he had six Stools, and seem'd to be somewhat relie∣ved, and the Night following he slept a little. On the fifth day again there was a frequent Vomiting, with a continual Thirst; he burned inwardly; but the sense of that immoderate Heat was not per∣ceivable outwardly to the Touch, because the Recrements of the boyl∣ing Blood, which ought to have breath'd forth through the skin, seemed to stagnate within, and so float the Viscera; therefore in the Evening, for provoking a Sweat, this Bolus was given, Conserve of Ro∣ses vitriolated a dram, Gascoins Powder a Scruple, Laudanum dissolv'd in Bawm Water a Grain: That Night he slept indifferently, and a co∣pious Sweat ensuing, the Symptoms seem'd to be mitigated: never∣theless, on the sixth day all things grew bad again; a Heat through∣out the whole Body, a Thirst, and a burning of the Praecordia prest violently. On the seventh and eighth days the Pulse was uneven and disorderly: for the most part, he spoke delirous, and if he was stirr'd in his Bed he fell frequently into a fainting Fit. On the ninth Day the same Symptoms continued; moreover, he was troubled with a Contraction of the Tendons, in the Wrists, and with Convulsive Mo∣tions of other Parts, so that we despaired, in a manner, of his well∣doing. That Morning, because Nature seemed to yield her self over∣come, it concerned us to do what Art could afford; wherefore, in∣tending a copious Sweat as the last Refuge, I gave him at one taking, a Dram of Spirit of Hart-born in a little Draught of a Cordial Julep; from thenceforward, for four Hours, being very restless and raving, he could scarce be kept in Bed; but afterward, Sleep stealing upon him, he sweated very much, and his Case was soon brought to be out of danger: the following Night, in order to continue the Sweat, I ordered a Dose of the Powder of Contrayerva to be given him every six Hours. The Fever, and the Affects of the Genus Nervosum, ceas'd in a short time, and the sick Person recovered.

A Woman about thirty Years of Age, of a robust Body, and a melancholy Temperament (as we might guess from her very austere way of Behaviour) in the third Month after Child-birth, as she gave her Infant suck in the Night, the Cloaths falling from her, took Cold, and shortly upon it fell into a cold Shivering; a Heat, greater than usual, followed it, which afterward (a gentle Sweat arising) soon re∣mitted. On the second and third days she was very thirsty, and had no Appetite, tho without any immoderate Burning, that she scarce yet believed her self in a Fever; every Night she lay quiet, but

wholly without Sleep, the Urine was intensly ruddly, and somewhat thick and opake through the multitude of contents, which neverthe∣less being not disturbed by the cold, continued still after the same man∣ner without an flypostasis or subfiding of the parts: on the fourth day, the heat was, kindled throughout the whole, wherefore a Physician being then first called, about twelve ounces of Blood were taken from the Arm: after the letting Blood, and the Belly being co∣piously emptyed the same day by a Clyster given, in the Evening she fell into a Sweat, by which Nevertheless being not relieved, she past the Night without Sleep as before, tho an Anodyne Medicine were given her: on the fifth day, after a Clyster injected she had three stools, and found ease: the Urine still continued the same, ruddy and troubled: when it was prescribed her to have Blood taken from the Vein running under the Knee, the Diseased earnestly refused it, thinking herself upon a Recovery: the Night following, after that she had lain with∣out Sleep, and restless for a long time, at length she fell into a sore fit, such as is vulgarly said to be Hysterical, and in the first place she was affected with a certain Numness or a Sense of pricking, which seised the extream parts of the Body, especially the Feet, Leggs and Thighs, and withall with a Flatus violently distending the Intestines, Ventri∣cle and Hypochondres: she selt in the lower part of her Belly a cer∣tain great and heavy things, as it were, to rise up gently, which when it was risen to the Heart, and thence to the Brain, presently the Di∣seased failed in her Understanding, and for all the Night afterward lay delirous and talkt light-headed: on the sixth day, after the Belly's be∣ing loosned by a Clyster she came to her self again, was very sound in her Mind, and seemed to be indifferently well: but in the Evening, as she was moved in her bed, she began to feel an invasion of such a kind of fit, as before, to wit, in her whole Body she had a sense of Pricking, as tho she were stung with Nettles: and withall in her Bel∣ly she felt a Ball, as it were, which creeping upwards distended the in∣testines and Ventricle, so that store of Flatus'd and Belchings were thence caused: for relief she desired cold Water might be given her to drink, moreover Remedies usual in Hysterick Affects, as Castoreum, a smell of Assafetida, Fumes of Feathers burnt, Ligatures, and Frictions of the Legs and Thighs, and the like things were used, by which she seemed for the present free from the said affect, and was wholly cleared from it for four hours; but as she lay on her Back in the Bed, settling her self to sleep, on a sudden she complained that the same Symptoms pervaded her whole Body together, and presently upon it fell into a Delirium, all the night without sleep, howling and crying, she talkt light-headed; on the day following, she lay with her Eyes open, without Motion or Speech; in the Evening again, as the Fever increast, the Diseased grew raving, that she could scarce be kept in her Bed; and so for three dayes, sometimes she lay delirous, orying and

howling, sometimes stupid as it were without Motion or Speech, but still she was troubled with convulsive Motions about the Tendons of the Muscles; on the tenth day she feteht her Breath deep and short, with a weak, and as it were formicating Pulse, in the middle of the night she dyed.

A Learned Young Man, of a thin habit, and a pale Countenance, in the beginning of the Spring, not being conscious of any errour in Diet, began to complain of a Lassitude and a Debility in walking, also of a Drowsiness of his Head, and a Sleepiness: on the second day he was withall tormented with a Thirst, a loss of Appetite, and a burn∣ing of the Praecordia; on the third day, a Physician being called, he took a Vomitory, after which when he had thrice vomited, and had voided five times by Seige hot and bilous Excrements, he became somewhat more cheerful, and the following Night slept indifferently well: on the fourth day he bled a little at Nose: afterward the Thirst and Heat were very much increas'd: the Urine was ruddly, with a copious Sediment and somewhat of an Hypostasis: but because after signs of Concoction in the Urine there appear'd an effort of Nature, opprest as it were, for voiding something without a sufficient Evacua∣tion, therefore seven ounces of Blood were taken away, and thereup∣on he seemed to be very much relieved: Nevertheless, in the Evening all things grew worse, and thence forward for three dayes the Fever seemed still to be rendred more intense, on the seventh day he com∣plained of a great Drowsiuess in his Head, and of a Dimness in his Eyes: in the After-noon a very large Haemorrhagie happened, that through the vast loss of Blood the strength of the Diseased was almost wholly spent, and there was an extream need of physical aid for stop∣ping the Blood: for this purpose, when Blooding in the Arm, Ligatures, Evithems applyed both to the Head and the lower part of the Belly, and a great many other Remedies (the instantancous occasion of Cure pres∣sing for it) prescribed by all Persons, were tryed in Vain; at length, by the persuasion of a Woman being there by chance, a red hot Iron was held to the Nose as it dropt, and on a sudden, upon the receiving of the Fume of the burnt Blood into the Nostrills, its Flux was stopt: I have known this Remedy used since in many others with good suc∣cess: by that copious Haemorhagy the contrinual Fever came to a Crisis; tho an intermittent Quotidian followed it, which after∣ward was soon cur'd according to the Merhod above delivered.

A Matron sixty years of Age, lying a certain night in Sheets not well dryed, began to be ill: first she was affected with a suffocating Catarth, that through the serous Mass of filth distilling on the Larynx, she could soarce breath, much less fleep: the next day after she had a Nauseous∣ness and a want of Appetite, with somewhat of a Thirst and an Excess of Heat: on the third day an acute Pain seized her fide, with a Cough and an increase of the Fever, the Urine was ruddy, and clear, with a

laudable Hypostasis; the Pulse was uneven and intermitting. A Phy∣fician being called, ten Ounces of Blood were taken away; also, on that day a Clyster being giv'n, she purg'd freely: about night the Pain vanish'd, and she slept indifferently: the Urine then was ruddy, troubled, and filled with Contents. On the fourth day the Fever was somewhat more increast; in the Evening the Cough was very troublesome, being followed with an acute Pain in the same Side as before; the Urine was again with an Hypostasis: the Pain, upon letting Blood again, soon ceas'd. On the fifth Day the Fever was some∣what more remiss; yet the Night was restless with a Heat and a Tos∣sing of the Body, but without Pain: the next Morning she sweated freely, and was relieved: afterward, by a thin Diet used for some Days, and being once pnrged, she recovered without a Relapse. It is worthy to be observ'd, that the Pain pressing, the Urine was clear, and with an Hypostasis; nor was it troubled by the Cold: which nevertheless, the same being appeased, presently grew thick and more ruddy, and fill'd with Contents.

A robust Young-man, and well in Flesh, about the Summer Solstice, after immoderate Exercises, and then a sudden Cold coming upon the Heat, fell ill. First, he was affected with a loss of Appetite, a Nauseousness, a violent Pain of the Head, also with a Thirst, and a Heat more intense than usual. On the second day, an acute Pain in the Right-side, with a Cough and a difficult Respiration, seized him; Blood presently being plentifully drawn from the Arm of the same Side, that Pain somewhat remitted; which nevertheless, returned more violently in the Evening, with a Cough and a spitting Blood; the night past without sleep, and very restless. On the third day Blood was taken away again; and moreover, Liniments and Fomen∣tations were applyed to the Side pained; Antipleuritick Powders, Ju∣leps, and Decoctions, were inwardly taken: about night, the Pain, in a manner, wholly ceas'd; presently after, the Diseased was affected with a violent Head-ach, and a Vertigo. On the fourth day he bled two ounces of Blood at the Nose; after which, that Affect of the Head clearly ceased; but in the Evening the Pain returned in the Side first affected, with a greater Fierceness: mean while the Pulse was low and weak; that when it was consulted concerning letting Blood, there was danger lest the dejected Strength would not admit of such a Reme∣dy; wherefore, Blood being taken only in a small quantity, it was prescribed, that a Fomentation and Cataplasmes should be diligently applyed to the Side; moreover, that twenty Drops of Spirit of Harts∣horn should be given in a Spoonful of a Cordial Julep, and that the same should be still repeated every six Hours: he sweated plentifully that Night, and the Pain very much abated; the Spittle was but little, sprinkled with Blood, which wholly ceas'd within a Day, the Pain al∣so vanishing by Degrees: the Diseased took twice a day a Scruple of

the same Spirit of Harts-horn, and perfectly recovered within a few Days, without a Relapse.

CHAP. XI. Of the Malignant or Pestilential Fever in general.

BEsides the Continual Fever, such as above describ'd, and which arises by reason of some Principle in the Blood exalted too much, and disproportionate with the rest; there is another Species of it, which is raised by reason of the Blood being tainted with some venemous Miasm, and thereupon ready to incur various Coagulations and Corruptions; in which, not only the Spirit and the Sulphur, as in a Putrid Fever, make an exorbitant Effort, and force the Blood to boyl immoderately, but withal, the mixture of the Blood is forthwith dissolved, and its Liquor runs into parts; and so that horrible Symptoms, with a manifest danger of Life, are caused in this kind of Affect. Under this Rank we comprehend Malignant and Pestilential Fevers, the Plague, the Small Pox, and Measles; concerning which, it remains for us to treat at present.

By the unanimous Consent of all, the Force and Power of these Diseases are plac'd in a venemous Matter; because, upon a Pestilen∣tial Affect, even as upon drinking Poyson, we find that the Strength is suddenly cast down, and that Life is soon destroyed: and therefore, for explicating the nature of the Pestilence, it will not be amiss, first to enquire concerning Poyson in general, and after what manner it affects our Bodies; and then to shew what sort of Venom is disperst in the Plague and contagious Diseases: which being premitted, we shall speak in particular of the Affects even now mentioned.

We may justly give the name of Poyson to whatsoever sticking in our Body, violently and after a secret manner, injures the Temper and Actions of any part, or of the whole, destroys the Spi∣rits, or perverts their Motions, dissolves the mixture of the Liquors, causes Coagulations and Corruptions, subverts the Ferments and Fun∣ctions of the Viscera, and so on a sudden, and privily, endanger Life. There is a vast store of these in Nature, which are often engendred within our Bodies, and abundantly supply'd outwardly from the Earth, Air, and Water, and from the distinct Families of Minerals, Vegetables, and Animals.

As there is a great variety of Poysons, so there is no less a diversity of them, as to the Subjects, and the ways of their hurting; for, tho a great many poysonous things are said to be contrary to us, as to the whole Substance, so that they set upon any thing, and like a Funeral Flame, with a caustick Force reduce it, as it were, into Ash∣es: yet some of these, being endowed with a peculiar Force of of∣fending, rather hurt one Part or Substance than another. The Sub∣jects on which the Taint of the Venom fixes it self first of all, and most immediately, are two-fold, to wit, the Animal Spirits, or the spirituous and subtle Liquor passiing in the Brain and 'Genus Ner∣vosum, and the Blood flowing in the Heart and Vessels. When a dis∣proportionate Object presents it self to one of them alone, or to both together, so that thereupon the Crasis of the Liquors or of the con∣taining Parts, is subverted, whereby Functions necessary for perform∣ing the Offices of Life and Sense, are letted and this is done after a secret manner, and as it were on a sudden, these kinds of Effects we ascribe to Poyson.

The nervous Bodies, with the animal Spirit, are not set upon whol∣ly after the same manner by all sorts of Poysons; for sometimes they are assail'd with a Stupor, sometimes with Cramps and convulsive mo∣tions, and those of divers Kinds and Conditions. The Bite of the Tarantula causes a Dancing; the force transmitted from a Tortoise by a Spear, or the Cords of a Net, stupifies the hand of the Fisher; the Roots of Wild Parsnips, or the Seeds of Dranel, eaten, make Men tun mad; Opium, Mandrake, Henbane, and the like, cause a deep, and sometimes a mortal Sleep. These, and a great many other things, without any mighty Perturbation of the Blood, or Injury brought on the Heart, fast'n chiefly their Venom on the Animal Faculty or Spi∣rit.

There are also some Poysons which chiefly insinuate their Malignity into the mass of Blood; wherefore, after using some Medicines, a yel∣low or black Jaundice, sometimes a Leprosie, leprous Affects, or Swellings of the whole Body, are produc'd; Vapours rising from sub∣terraneous Vaults, also from Charcoals newly kindled, often suffoca∣ting the Vital Spirits, congeal the Blood withall, and stop its Motion; so that the Flame of Life cannot be continued in the Heart. Every Man may see how great a Corruption is communicated to the Mass of Blood from the pestilential Miasm, by the Spots and Pushes which are the infamous Marks, as it were, of the blasted Blood.

If the Injury first inflicted on either, viz. the ceconomy of the Heart or Brain be light, for the most part it is brought to an end with∣out any great Offence of either; wherefore, Convulsive Motions, a Stupor, Lethargy, Melancholy, Paralytick Affects, often begin with a landable Pulse, and without an immoderate Effervescence of the Blood; and afterward, if the Affect does not wax strong, they come

to an end, and cease by little and little. There are other Poysons which often deprave the Blood, and corrupt its Mixture by dissolving it, the animal Functions in the mean time continuing whole and sound; but if the Ferment of the Poyson be stronger, and lays deep∣er Roots, presently the Venom is disperst from the one into the Pro∣vince of the other; for when the nervous Parts are fill'd with a viru∣lent Juice, a Portion of the Venom, brought back with the nervous Latex, by the lymphatick Vessels into the Veins, is readily conveyed into the Mass of Blood, and defiles it with the Corruption prevailing in it: also from the Blood greatly infected with Venom, the Juice wherewith the Nerves are irrigated in a short time becomes tained; Hence, Persons that are mad are feverish, and such as are seiz'd with a pestilential Fever very often are assailed with a Delirium or Frenzy. Concerning these things, we must consider what kind of Alteration or Impression of Injury it is which is inflicted by Poyson on the Animal Spirits with the Brain and nervous Appendix; also what on the Blood, with the Heart and the Vessels annex'd to it.

As to the first, we observe, that that subtle Liquor, or the Animal Spirits, with which the nervous Bodies are influenced, and by the Expansion of which, Sense and Motion perform reciprocal Actions, are easily perverted from their Continuity, and even Expansion; for, the Nerves being of a sost Texture, and the Spirits wherewith they are fill'd being of a very subtle Substance, they are not able to endure any sorts of Objects that are strong or vehement; wherefore, when any violent or disproportionate Thing assails them by Surprise, they are often forc'd from their Expansion and Excursion, to a Flight and a Retreat, and often into Irregularities of motions; wherefore, sudden Passions of the Mind distract them, and stir them to Twitch∣ing and Convulsions: when the nutritive Juice wherewith they are supply'd is sent to them too sharp, acid, or austere, they undergo sometimes Resolutions, sometimes Shrinkings: and if some Object more contrary (such as we affirm Poyson to be) presents it self, whose Particles are of such a fierce Nature, or of such a Configuration, that they violently ferment with the nervous Liquor, they strongly drive the subtle or spirituous Part of it this way and that, or wholly drive it away; and either by their styptick Force they fix the rest of the Liquor, or force it by an Ebullition into disorderly Motions; Hence necessarily arise the evil Affects of the Brain and nervous Parts, viz. sometimes a Convulsion, a Trembling, a Shivering, sometimes a Stupor, or Resolutions, and other severe Symptoms. The Things which infect with Venom the nervous Juice after this manner, some∣times are gross, and only inflict their Injury when they are applyed in a very corporeal Substance; sometimes they are subtle, and being resolv'd into a Vapour, or even to a Breath, they disperse the Ferment of the Poyson from a little Point throughont the whole Genus Nervo∣sum.

Sometimes the Poyson of an ill Thing eaten first begins its Tragedy in the Stomach, but oftner by a bare Contact on the Surface of the Body, it leaves the virulent Miasm, which soon and readily de∣files, with its Ferment, the Spirits dispers'd through the whole. A Taint inflicted on the Extremities of the Nerves, any where, whether inwardly or outwardly, it dispers'd to a distance by their ready Con∣veyance, presently many Sprouts of the same Branch being brought to communicate of the Evil. Often, a light Touch of a venemous Thing by the Finger, or the extream part of any Member, presently conveys the Taint received to the Brain, and thence it is retorted on the whole Body, and the most remote Members: the Reason of this is, that the Particles both of the nervous Juice, and of some venemous Miasm, are so active and quick of Motion, that either of them pass most swiftly through the whole Mass of the others, as Rays of Light through a Diaphanous Medium.

2. As often as the Blood gets Mischief by a venemous Thing, the Venom sticking in it, either is dull and of less Activity, which does not presently discover it self, nor breaks forth into terrible Symptoms, till after a long time, when it is brought to a Ripeness by a tacit Fer∣mentation, and has first infected the whole Mass of Blood; as we may observe in some Poysons, which are said to kill at a distance, and not but after some Months or Years: or the Poysons inspired into the Blood are imbued with a much sharper Sting, that the Taint con∣tractef by their Contagion presently breaks forth into terrible Symp∣toms; and thereupon follows sometimes a feverish Effervescence, with a Vomiting, a Thirst, and a burning of the Praecordia; sometimes a puffing up of the whole, a discolouring of the Skin, often an Erup∣tion of Pushes and Buboes; frequently also a sudden falling of the Strength, so that a sudden Death steals on without any Stir, and al∣most unperceiv'd: where it is to be noted by the By, if the Spirits of the Blood provok'd by the Enemy, are able to set upon him and to contend for the Victory, from this Conflict a feverish Ebullition is rais'd in the Blood; but, if the Particles of the Poyson far exceed them in Strength, presently the Mase of Blood is corrupted, that it can neither be circulated in the Vessels, nor be duely kindled in the Heart.

If it be farther enquired, what Changes in its Substance, or Consi∣stency, the Blood infected with Poyson undergoes, that thereby it is rendred unfit for the Support of Life; I answer after this manner, Some Poysons fuse the Blood, and precipitate its Serosity, as those Medicines which being destructive either by Purging, or by causing a Flux of Urine, or by a puffing up of the whole, or by a Discolourati∣on, or an Eruption of Pushes, make a very great Separation of the Serous Latex: mean while, a great ebullition is caused in the mass of Blood, whereby the Vital Spirits are greatly spent; the Particles of

the Salt and Sulphur, by the too much Contion, are exalted, and of∣ten so scorch'd, that a Jaundise, either yellow or black, is caused.

There are Poysons of another kind far more dangerous, which con∣geal the Blood, and corrupt its mixture by destroying it, viz. first they bring a Coagulation on the Mass of Blood, and then a Corrupti∣on; for, when the Spirits of the Blood, put to flight by the Contagi∣on of the Poyson, are dissipated, the even mixture of the Liquor is dissolved; wherefore, the grosser Particles mutually lock with each other, and (like Milk upon Rennets being put into it, or turning soure of its own accord) they are coagulated together; hence the Blood grows clotted in the Vessels, that it is not readily circulated in them: the coagulated Portions of it being convey'd inwardly into the Sinus's of the Hearts, are there apt to stagnate, and so they cause frequent Faintings and Swoonings: being carried outward, and stuck in the Skin in circulating, sometimes, when cast on every side in a plentiful manner, they cause an over-spreading of Blackness throughout the whole; sometimes being disperst more spartingly, they cause only Spots, or black and blew Marks, and the rest of the Phoenomena of Malignity: now the Coagulation of the Blood soon disposes it to Pu∣trefaction or Corruption, as it is to be seen in extravasated Blood, which soon turns black, and is wont to putrefie; for the Spirit being exhal'd the remaining Particles of the Salt and Sulphur in the Blood begin to separate from each other, and to dissolve the Bond of Mix∣ture, whence Putrefaction ensues.

These things being thus premitted concerning Poyson in general, the method of Healing requires that we set upon the Tract of Fevers, which draw their Origine wholly from a venemous and malignant Miasm: and since among these, the Plague is undoubtedly the chief, I shall be∣gin with the Consideration of that, and shall speak afterward, in order, of Malignant Fevers, the Measles, and Small-Pox. But before I give its Definition, I shall enquire briefly concerning the Pestilential Venom, of what Nature and Disposition it is; also whence it arises; and lastly, after what manner it is propagated by Contagion in others.

The Essence of the Pestilential Fever is founded in a vapory and spiritual Miasm, from which Effluvia's diffused on every side so pow∣erfully display themselves, that from the least Seminary they soon propagate a fertile Harvest of Death and Destruction. By reason of its mighty Activity, this Miasm deserves to be called, a certain Quin∣tescence, as it were, of Poyson: its very nimble and subtle Particles penetrate all Bodies, and inspire them with their Ferment; for, whe∣ther being dispers'd through the Air, or stored up in some Fomes, if they come to hit upon a Homane Body, tho it be lightly, and as it were, with a Glance, they readily penetrate it, soon infect the Ani∣mal Spirits and those of the Blood, and thereby overspread all the Members with a Venemous Contagion.

When a pestilential Breath or Vapour has assailed any one, and that Venom has first seiz'd the Animal Spirits, or those of the Blood, or both of them together; from the subtle and thin Substance of these the Taint is soon derived into the grosser Matter, for in a short time it ferments the whole Mass of Blood, or nervous Juice, and the excre∣mentitious Homours in any place abounding; and thence is drawn in∣to the solid Parts, and fixes the Evil in them. If this Contagion first seises the Animal Parts, presently the Injury is communicated to the Brain, and the Genus Nervosum, and esecially to the Ventricle; it forthwith poysons the Homour lodging in these, dissolves its mixture, perverts its regular Motion, and renders it wholly disagreeing and of∣fensive to the tender substance of the containing Parts: thence forth∣with Cramps, and Convulsive Motions, violent Vomitings, a Cardialgia, also a Frenzy, Delirium, or obstinate Watchings, are raised about the first Invasion of the Disease; whereas in the mean while, the Taint being not yet disperst through the Blood, the Diseased are not in a Fever, nor infested with a disorderly, Pulse, or a Swooning, or an ap∣pearance of Tokens; which Symptoms, nevertheless, assoon as the Blood is infected, shew themselves afterward. If at any time the Spirits of the Blood are first seised with the venemous Miasm, either breathed in with the Air, or attracted by the Pores, by and by its ferment is disperst throughout the whole mass of Blood, the infected portions presently begin to be loosned from their even mixture, to se∣parate into parts, and to be coagulated, and the same being conveyed into the Sinus's of the Heart, to stagnate there, and to cause a Swoon∣ing, Faintings, and often a sudden Death: also being carried outward∣ly, and fixt about the Skin, they are wont to cause Bubo's, Pushes, and the other marks of a Venenosity, mean while the Diseased are present enough to themselves, and are not assail'd with a Delirium or convul∣sive Motions: but if from a stronger cause an Injury be inflicted on both Parts at once, the course of the Disease is carried on with a more horri∣ble appearance of Symptoms, and with a Phrensy infesting together.

As to what regards its rise; when the Plague first arises in any Region or Tract of the Earth (whatsoevre others may think) we place the first and chief natural Seminary of this Poyson in the Air, for it seems consonant to reason, that from the same Fountain from whence the Food of common Life is derived, the beginnings also of Death, which is no less diffused, should be taken: the same necessity lies upon us for breathing the Air, as for Fish of living in the Waters; where∣sore, as the common Destruction of Fish dying in Multitudes is as∣cribed to Waters being infected with Poyson, so nothing but a Taint of the Air, breathed by all, can kill Men that dye without a manifest Cause, by an epidemick Destruction.

For the Air, which we necessarily breath in for the Support of Life, consists of thick Steams and Vapours, which continually are breathed

from the Earth; to which the exhalations of Salts and Sulphurs being mixed, they make here a thick Fog, as it were, of Atomous Corpus∣cles. The Motions of these being both very swift and restless, are of a manifold and very differing Figure; wherefore some of them con∣tinually encounter others, and according to their various Configurati∣ons, they close with these and are mutually combined, and are driv'n and fly from others: on this the Reasons of every Sympathy and Anti∣pathy chiefly depend; from the divers Agitations of these kinds of Atomes near the Surface of the Earth, this or that Tract of the Air undergoes divers Alterations, with which Bodies, especially those that are living, are variously affected, for the inward Motion of the Particles of each Animal depends very much on the motion and temper of the Particles of the Air: Since these continually exagitate those, stir them up when they are drowsie, repair the Losses of those that fly away, exa∣gitate the vital Flame with their Nitrosity, and supply it with a nitro∣sulphureous Food, and eventilate it being kindled by the continual Courses of Accesses and Recesses: as long as an apt Contemperation happens for the Motion and Configuration in both, Animals enjoy a perfect Life and Health; but if the Corpuscles flying in the Air are of such a kind of Figure and Power, that they are manifestly contrary to the Spirits implanted in Animals, they loosen the mixtures of these from the rest of the Elements with which they are bound, and per∣vert their Motions: hence the Crases of things are destroyed, Life is overthrown, and that being scarce extinct, the Bodies incur Putrefa∣ction; hence the Tops of Trees or Corn being struck with a Blast wither on a sudden; hence the Murrain oftentimes reigns amongst Cattel, which kills whole Herds together. For this kind of Cause the Seeds of the Pestilence first exert themelves, and threaten a uni∣versal Slaughter of Mankind; for even as venemous Corpuscles gather∣ed together in the Bowels of the Earth, or on its Surface, produce Ar∣senical Mixts, or venemous Herbs; so these being resolved into a Va∣pour, and gathered thick together in the Air, create pernicious Blasts, from which malignant and pestilential Diseases arise: and it seems to me not improbable, that the things which first give a seminary of the Pestilence to any peculiar Tract of the Air, are the venemous Effluvia of Salts and Sulphurs grown exorbitant, and breath'd forth of the Bow∣els of the Earth; which sometimes, being first long included in the Earth, are exhal'd by degrees; sometimes, by reason of Tremblings of Openings of the Earth, break forth together; of which kind also there are generally breath'd from the Tents of Souldiers filled with Nastiness, by reason of dead Carcasses lying unburied, or from places fill'd with staguating and stinking Mud. And Corupscles exhaled after this manner, by a long Putrefaction, acquire to themselves won∣derful Powers and Discongruencies, that thereby they are disagreeing and heterogeneous to all others whatsoever; and so being received in∣to

to the Air, they ferment it (like a mass of Liquor) and pervert it from a'wholsome and benign into a pernicious and curst Nature.

Some Bodies easily receive the malignant Tincture of a pestilential Air, others not so readily; those who have a very great Cacochymia by reason of an ill Dyet, and those who by reason of a Plethora have a Blood filled with an inflamable Sulphur, a light Blast of a venemous Air fastens the pestilential Venom on them, especially if they lye un∣der a Fear and Sadness, which convey inwardly the lightest Parts of Contagion, as it were by a certain Infusion. On the contrary, those who have the Viscera clean, and the Mass of Blood well tempered, and those who carry a strong and undaunted Mind, do not so eafily receive this Infection; and sometimes being receiv'd they expell it again.

So far of the Pestilence and its Communication, according to its first Being, and the Source of the infected Air thence drawn; it remains for us to speak of its Propagation by Contagion, as it is often commu∣nicated from some Men to others, as it were ex traduce.

By Contagion we understand that Force, or Action, whereby any Affect being in one Body stirs up the like to it in another; but since this happens either immediately by Contact, as if any one lying in the same Bed with another Man seiz'd with the Plague, gets the same Dis∣ease; or mediately, and at a distance, as if it happens that the Conta∣gion be convey'd from one House to others at a distance; and so if the Plague assails any Person handling a Garment or Houshold-stuff of an infected House, after some Days, or Months, or haply Years: tghere∣fore, that the nature of a Contagion, and the divers manners of it, may be plainly known, let us examine first, What that things is which flows from an infected Body: secondly, How it is fisposed in the me∣dium through which it passes: thirdly, After what manner it engen∣ders an Affect like it self in another Body.

1. That from every Body, though of a fixt Nature, Effluvia's of Atoms constantly flow, which make, as it were, a mist or cloudy Cir∣cle about them, and invest them, as it were, like the Down of a Peach, it is so receiv'd a thing among the soundest Philosophers, that there is nothing more; and the more active Particles any thing consists of, by so much it sends from it Corpuscles of a more notable Vertue, and Energy: hence the Effluvia which part from Electrick Bodies, are albe to move other Bodies from their Places; from Sulphurs Emana∣tions pass, which fill the whole Neighbourhood with Odours: since therefore the pestilential Venom, as is said before, tho in a small Bulk, is of a mighty Efficacy and Operation, wheresoever it is fixt, certain Emanations necessarily proceed from the Bodies imbued with it, which carry the nature of the same Poyson and Malignity, and diffuse it on every side according to its Sphere of Activity: but since these Corpus∣cles which retain the Contagion of the Pestilence, when they flow from

one body, are not presently received by another, let us inquire how they are disposed in respect of their passing through the Medium.

Where presently occurrs the difference of them from most others, in regard that the Effluvia, which generally evaporate, do not long retain the Nature of the body whence they flow, but either vanish in the tenuated Air, or closing with other bodies, are assimilated with them: but those Particles which part from a pestilential Miasm, are not easily absorb'd by the Air, or other Body, so that they wholly pe∣rish; but among various Consusions of Atomes, and Dashings against other bodies, they preserve themselves entire: for this Poyson being ina manner masterless, and insuperable by others, continues still the same; and tho it consists of a very small heap of Atomes, it does not presently vanish, but taints with its Ferment the next Corpuscles to it, and so acquires to it self new Stores, and gets Strength as it goes; whence it lies long hid in every Fomes, and after a long time, when it has lighted on a fit Subject, it exerts it self, and communicating the Infection of its Venom to the other, it resuscitates a-new the Disease of the Plague, which before seemed to be driv'n away, and tho from a very small Seminary, it disperses its mortal Povson far and near.

For the Plague discloses such most certain Signs of its Contagion, that some Authors affirm it to subsist among Mortals only by this means, and that it not where arises a-new, but is preserv'd only by a Fomes, and that it is now and then conveyed from one Region into another. Histories tell us, that the Seeds of it have lain dormant for many Years in a Garment or Bed-Cloaths, that upon the same after∣ward being stirr'd, they have shewn themselves, and have brought the Disease of the Pestilence, arising a-fresh, with a mighty Destruction of Mankind: when by reason of a Fomes the Pestilence is propagated to a distance after this manner; the venemous Corpuscles which remain in the Miasm, being stirred, presently spring forth, and display their Venom on every side, as it were by a certain Irradiation: if they any where light on a humane Body, they presently seise the Spirits, and are conveyed inward by their Vehicle, and then easily enough infect the Blood, and all other Homours flowing in the Vessels with their Ferment, and in a short time cause Coagulations and a Putrefaction in them. And after this manner, by most subtle Effiuvia, there is made a certain Transmigration, as it were, of the pestilential Disease, ev'n as when a graft cut from some Tree, and laid aside for some time, and afterward inserted in another Trunk, is able, though from a very small Bud, to produce a Tree of the same Kind and Nature.

CHAP. XII. Of the Plague.

THE Plague may be described after this manner, That it is an Epidemious Disease, contagious, very destructive to Mankind, taking its Rise from a venemous Miasm first received by the Air, afterward propagated by Contagion, which setting upon Men after a hidden and secret manner, causes Extinctions of the Spirits, Coagulations of the Blood, Syderations and Mortifications of it, and of the solid Parts, and brings the Diseased in danger of Life, with an Appearance of Pushes, Bu∣bo's, or Carbuncles, and with the addition of other horrible Symptoms.

There are a great many Signs occurring to us, which fore-shew that the Pestilence will happen in a short time, to wit, if the Year does not keep its Temperament, but has immoderate and very unseasonable excesses of Heat or Cold, Drought or Moisture: if the Measles or Small Pox are every where very rise, if Phlegmons, or Bubo's accom∣pany reigning Fevers; from a preceeding Famines a most certain Pre∣sage is taken of an ensuing Plague; for the like Constitution of the Year which for the most part brings a Dearth of Provisions, by reason of the Corn being blighted, is apt also to produce a Plague; also the evil sort of Dyet, which such as are prest with Hunger make use of, eating all kinds of unwholsome things without choice, disposes their Bodies more readily to receive the Contagion. Moreover Earth-quakes, and fresh-opened Grotto's and Caverns upon the cleaving of the Earth, by reason of the Eruptions of a malignant and venemous Air, have often given Beginnings to Plagues. Again, as there is need of great Dili∣gence in taking a fore-view as it were, from a Watch-Tower, of an imminent Plague, so we ought to be no less sagacious in observing the same as if first arises, and cast its first Darts; for often, being too sollici∣tous, we dread even vulgar Fevers, if haply they end in Death, for this Contagion; and sometimes being too secure, contemning the Pe∣stilence by reason of its Symptoms resembling those of a common Fe∣ver, we find our Dangers but too late: wherefore, for the fuller know∣ledge of this Disease, we shall set down its Signs and Symptoms both common and pathognomick.

Besides the Signs above delivered, which by a certain Demonstra∣tion, a Priori, give a Suspicion of an ensuing Plague; there are others whose concurrence with it plainly shew its Presence in a Body diseas'd: of these some are common to a Plague with a putrid Fever, some are more proper to this Affect; for the Impression of the Plague oftentimes stirs up an Effervescence of the Blood, and has a Fever so

frequently joyn'd with it, that by some, in the Definition of the Plague, the Fever is put as a Genus; wherefore, by reason of the Ebullition of the Blood, and the Injury brought on the Viscera, pre∣sently an Incalescence with a spontaneous Lassitude, a Thirst, a burn∣ing of the Praecordia, Vomitings often violent, a Cardialgia, Gripes in the Bowels, a Roughness or Blackness of the Tongue, a Swooning, and a sudden Fall of the Strength, ensue. Tho vulgar Fevers are of∣tentimes attended with these kinds of Symptoms, yet if at the same time a Plague be rife in the Neighbourhood, and a fear of the same seises the Minds of Men, hence a greater Suspicion of this Evil is gi∣ven; and especially, because, when a Plague reigns, all other Disea∣ses leave their own Nature and pass into that: wherefore, if to the Affects even now mentioned, there be added a Communication of the same Disease to many, and many dye of it, so that it generally becomes mortal and spreads it self; and if besides, Buboes, Carbuncles, Push∣es, or others Marks of a pestiferous Contagion appear, the thing is put without doubt, and we hence proclaim a Pestilence, with no less Confidence, than we do a Fire when we see a Flame burst forth through the Roofs of Houses: but because a mention is here made of Buboes, Carbuncles, and other Symptoms, it remains for us to give briefly the Causes of them, and the ways of their being produc'd; they are these, a Carbuncle, Bubo, Pushes, Wheals, and malignant Pu∣stules.

Concerning these, we say in general, that they are all Products of the Blood, and nervous Juice, struck with a pestiferous Venom, and coagulated by Parts in their Circulation, and variously affected with Purtrefaction; for the Spirits residing in both Liquors, especially in the Blood, are no sooner touched with the breath of a malignant Contagion, but a Coagulation is caused in the remaining Liquor, even as when Milk turns sour, or has an acid Juice mixt with it: wherefore, Portions of it being greatly tainted with Venom, soon grow clotty, and like extravasated Blood, fall into a Corruption with a Blackness; whence presently they stop the Motion of the rest of the Blood in the Heart and Vessels, and coagulate it more by reason of their Ferment. Now whatsoever is gathered together into Clots by Coagulation, un∣less it be presently cast forth, brings Death in a short time, by stop∣ping the Circulation of the Blood; and being driven outward to the Circumference of the Body, is stopt in motion in the narrow Involu∣tions of the Vessels; and either being wholly destitute of Spirit, as tho it were Planet-stricken, it produces black or blew Marks by its Mortification, or by reason of the Salt and Sulphur exalted by the pestilential Ferment, and affecting new things, it grows, into Tumours of various kinds.

A Carbuncle is a fiery Tumour, with very smart and burning Pustules about it, infesting the Diseased with an acute Pain; which arising in

various places indifferently, does not suppurate, but spreading largely round about, burns the Flesh, and at length throws off lobes of it be∣ing corrupted, and leaves a hollow Ulcer, as tho burnt by an Eschro∣tick.

The Generation of Carbuncles seems to be after this manner; when venemous Miasms light on a Blood parch'd with Heat before, its congeal'd Portions are fixed in the Superficies of the Body; and at that place, because the motion of the Blood is a little letted, first a little Tumour is made, which afterward, the malignant Venom pre∣sently spreading it self farther, being increast by little and little, creeps into the Neighbourhood, Suppuration does not follow, because the matter extravasated, and stagnating, is not concoted and digested with a gentle heat, but by reason of the Particles of the Sulphur, grown exorbitant together with the Salt exalted, being heap'd toge∣ther into these Tumours, and by reason of the Stagnation being forth∣with dissolved from mixture, an Adustion is caus'd, as if a Cautery were applied to the part: the pieces and lobes of Flesh, eaten as tho covered with an Eschar, fall away, because the corrosive Venom sticking to the Muscles, does not corrode them only in their Sursace, but through their whole Substance; wherefore, before the whole Flesh is consumed, the Membranes in which it is involved being eaten away, some pieces fall from the rest as tho cut from it: often one, of∣ten more Carbuncles arise; sometimes they are alone, sometimes they have a Bubo accompanying them.

A pestilential Bubo arises only in glandulous parts; toward the bulk of which, not only the Blood congeal'd by the Venom, and car∣ried thither by the Arteries, but also the nervous Juice there heaped together, and to be carried back into the Veins, contribute. Because this Tumour happens from Juices less parch'd, and in a colder part, therefore it partakes of Suppuration; for, the Matter heaped together by degrees when (the vital Spirit departing by reason of Stagnation) it has lost the Form of Blood, through the Particles of the Salt and Sulphur being exhaled, and kept in the Tumor, is converted into a Pus by long Concoction. Now that these Tumours only happen in the Glands, the Reason is, not that the Fewel of the Diseass is con∣veyed to these parts by a certain Appointment of Nature, but as the Particles of the virulent Miasm abound every where in the Blood and nervous Juice, they are heaped together there more readily, as in a common place of Retreat, where both the Blood conveyed to the Extremities of the little Arteries, is with difficulty and not so readily re∣ceived and carried back by the Veins, and withall, where the nutri∣tive Juyce, to be carried back from the Nerves into the Veins, is deposed. That both done about the Glands, it is mani∣fest, both by Experie natomical Experiments; where∣fore, since both Homo Seeds of the pestilential Con∣tagion

met together in these Parts, a seat of Malignity is here made by reason of the Virulency deposed here by both.

Pushes, Wheales, and Purple Spots, in respect of the Venenosity, are of the same Batch with the Tumours even now described; but in these the Products of the Virulency are less in bulk, tho with a greater dan∣ger, by reason of the Seeds of the Venom being more dispersed: small Portions of coagulated Blood sticking in the Skin, make these lesser Phoenomena; wherefore, some of these, rais'd into Bladders, suppu∣rate; others, by reason of a certain Mortification or Syderation of the corrupted Blood, turn into Purple Marks and Spots.

Tho the Plague, by reason of Destruction wherewith it threat∣ens the Diseased, both secretly, and very much on a sudden, scarce affords Place or Time for a Prognostick; and tho by reason of the oc∣cult ways of doing Mischief, this Disease carries all things suspected in it; yet it is manifest, by frequent Observation, that some Signs ap∣pear in the Course of it, from which we are wont to divine a Recove∣ry or Death. The Case is full of Danger if the Contagion suddently passes into an universal Sickness, and makes violent Invasions; if an Haemorrrhagy, or only a small Pain happen in the beginning of the Disease; if the Urine be thick, and troubled, the Pulse unequal and weak; if a Convulsion or Frenzy présently follow; if the Vomitings, or Stools, are livid, black, or very stinking; if the Pushes at first red, afterward turn black and blue; if the Carbuncles are numerous, if the Buboes first arising, disappear; if the Strength be cast down on a sud∣den; if the Countenance looks dismal, or turns black and blue; if with a cold Stiffness of the extream Parts there be a burning of the Viscera, especially if these or most of them happen in a Body very cacochymical, or in an unwholsome Season. On the contrary, the be lighter, and lefs dangerous; if the Disease happens in a sound and robust Body with a Fortitude of Mind; if Remedies are seasonably ad∣ministred before the Disease has seised the whole Mass of the Blood; also, if the Course of the Disease goes on with a constancy of the Strength, a Vigour and Evenness of the Pulse, a Suppuration of Bu∣boes, and a large Discharge of Pus, and with the absence of horrible Symptoms: mean while, tho we may hope here all good, yet it is not free for us to be secure, because sometimes, with a laudable Ap∣pearance of Signs, Ambushes are privily laid for Life; and, as srom a reconciled Enemy, we suffer most severely, when we seem'd to have escap'd his raging Threats.

In the Cures of most Diseases, the chiefest Work is committed to Nature, to whose Failure Physick gives a helping hand: and the Of∣fice and Science of a Physician chiefly consists in this, To wait fit Oc∣casions of giving Aid to her, when she is at a Fault. But the Plague has this peculiar, that the Cure of it is not to be left to Nature, but we

must fight against it always with Remedies taken from Art; nor must we be here sollicitous of a more seasonable, and as it were, a milder Time: but we must get Medicines assoon as may be, and insist on them at all Hours, and almost Minutes. But, because when a Plague reigns there is need of no less care for driving away the Contagion, than that the Contagion receiv'd, be cured: therefore a Physician has a double Task; to wit, both that he take care for the Prevention of this Disease, and for its Cure.

Prophylactick Cautions either regard the Publick, and belong to the Magistrate, or private Persons; by which it is taught what must be done by each Man when a Plague is feared.

The publick care, in a time of the Plague, chiefly consists in these things; That Divine Worship be duely observed; that all Matters maintaining Putrefaction be taken away; that Filth, Dunghils, and all stinking Things, be removed from the Streets, and every occasion of Contagion be most diligently avoided; that Commerce with insect∣ed Places be forbidden; and that a wholsome kind of Diet be con∣stantly kept to by the Citizens; let the Poor, who have not a plen∣ty or choice of Provisions, be fed at publick Charges. If the Plague be already grown rife, let the venemous Force of the Air be corrected as much as may be, which will excellently be purg'd by a frequent burning of sulphureous things: let the insected be separated from such as are sound, and let these keep from their Carkasses or Houshold-stuff Lastly, let skilfull and meet Physicians and Attendants be gotten to sup∣ply the Wants both of those that are in Health, and of the Diseased.

The Rule of a private Prophylaxis is wont to be concluded in these three things; viz. Diet, Pharmacy, and Chirurgery: The Deit regards the six non-natural things, amongst which, those of chiefest Note are the Air, and the Passions of the Mind: as to the rest, the Precept of Hippicrates suffices, viz. that Labour, Meat, Drink, Sleep, and Venus, all keep a mean: let the Pestilential Air either be avoided by remo∣ving into another place, or let it be corrected by sulphureous things duely kindled, or let it be refresh'd in breathing by Fumes and odori∣ferous things frequently help to the Nostrils: As to the Passions of the Mind, Fear and Sadness, whilst a Pestilence reigns, are as a se∣cond Plague; for, by these the seeds of the venemous Contagion, which lye on the Superficies of the Body, as it were in the outmost Margin of the Vortex, are violently drawn inward, and deliver'd to the Heart; wherefore, a cheerful and confident Mind is better than the most exquisite Antidote. I have known many, who were wont to say in the Words of Helmont, That by fortifying the Archeus with Wine and Coufidence, and using no other Alexipharmicks, they past their Time among infected Persons without any injury by Contagion; and those who liv'd otherwise, imbib'd the Seeds of the Pestilence, as tho de∣riv'd from the Stars.

Among Chirurgical Things to be used for Preservation, Blooding, Cauteries, and Amulets, are usually recommended: where there is a Plethora with a great Turgescency of the Blood, or when by a long Usance Persons have accustom'd themselves to be let Blood, opening a Vein agrees with them; for, by how much the less the Blood boyls, and is circulated in the Vessels without trouble, by so much the slower is it infected with the venemous Contagion. Issues made by Cauteries are so much approved of by the Suffrages almost of all Men, for Pre∣servation against the Plague, that their use is Generally receiv'd among the Vulgar; for these constantly drain the assiduous encrease of the excrementitious matter: and if any Miasms of the Pestilence are in∣wardly admitted, they cast them forth by their open passage.

Amulets, hung about the Neck, or worn about the Arm-Wrists, are thought to have a wondersul Force against the Pestilence: of these the most excellent are accounted by some, which consist of Arsenick, Quicksilver, the Powder of Toads, and other venemous Things: that the same do good in some Cases, besides the Observations of Physicians, this Reason seems somewhat to convince; the Effluvia, or atomous Corpuscles which sometimes flowing from certain Bodies, sometimes set∣tling on others, fly about the whole Region of the Air; these being di∣versly figur'd, some of them excellently close with others; but if they jut against Corpuscles of another Form, they enter a Conflict with them, and subvert them; hence the Particles of the pestilent Miasm, which are contrary to our Spirits, excellently agree with those Corpuscles of the Poyson coming to them, and readily close with them: where∣fore Amulets made of Poyson do this; to wit, they gather into them∣selves the Seeds of the Pestilence coming against us, by reason of a Simiiitude of Parts; nay, and by drawing the same from our Body to their Embraces, they in some sort free the Infected from the Malig∣nity.

The Pharmaceutick Prophylaxis has a double Scope; first, That the assiduous Increase of the excrementitious Matter, or Humours, be re∣mov'd by a gentle Furge as often as there is need: secondly, That by Alexipharmicks daily taken, the Spirits and our Bodies be fortified against the Incursion of the Venom: by the former, the Food and Fewel which increase the Putrefaction caused by the Venom, are withdrawn; by the other, the first kindling of the pestiferous Conta∣gion, as it were of a suneral Flame, is hindred: for Alexipharmicks seem to give help against the Contagion of the Pestilence under this two-sold Respect; both because the Mass of Blood, and the Viscera fill'd with the particles of these, also the Spirits being first possest by the same, do not easily admit the Fellowship of the venemous Miasm, and for that the Blood being quick in its Motion by the gentle Instiga∣tion of these Particles, is freed from Coagulation.

So far of Preservation: it remains now for us to treat of the Cure of the Pestilence; the Doctrine whereof is either general, and comprises the Remedies which are taken for this end from Diet, Chirurgery, and Pharmacy; or special, which delivers the use, and cautious con∣cerning the giving of those Remedies, and after what manner we must obviate Symptoms variously emerging.

The Diet comprehends the use of the six non-natural things, tho the chief Care and physical Cautions are concerning the Food; the primary Indications of this have not place together, and at the same time, but ought to be supply'd as occasion requires, now one, now another, and according to the Exigency of Nature. In respect of the Malignity and the Dejection of the Strength, Aliments are required, which greatly refresh the Spirits, and afford a plentiful Nourishment: in respect of the feverish Distemper, a Dyet seems to be required which is thin, cooling, and qualifying of the Blood. Let a Physician take care of both; but let him direct his Remedies rather against the Malignity than against the Fever.

The Aids which belong to Chirurgery are Bleeding, which ought to be used seldom, and with great Caution in this Disease, because the Blood being too much exhausted, and the Vessels falling, a Sweat is not so easily procur'd; the place of this is better supplyed by Cup∣ping-Glasses with a Scarification; for this, and Vesicatories are aptly used for drawing forth the Venom. Moreover, against Buboes, Car∣buncles, and malignant Ulcers produc'd by them, Cataplasms, Fo∣mentations, Plaisters, Liniments, and many other things, to be ap∣ply'd outwardly, are taken from Chirurgery, with which some poy∣sonous things, as Drawers of Venom, are prescribed to be mix'd by some: wherefore, Preparations of Arsenick, viz. its Oyl, and Balsam, are recommended in this Case, as of excellent Use and Efficacy.

Medicines, in order to the Cure of the Plague, are either Evacua∣tives or Alexipharmicks. The Intention of the first is, that the Se∣rous Latex in the Blood, and the excrementitious Humours, which abound in the Viscera, be sent forth; and together with them, a great many Particles of the venemous Miasm every where dispers'd in the Body. Now these things are perform'd by Vomitories and Purges, whose use is rare, and only in the beginning of the Disease; also by Diaphoreticks, which at all times, as long as the Strength is able to bear them, are indicated in the Plague: for these evacuate more fully, and withal from the whole Body, and also by exagitating the Blood, they free it from Congelation, and in regard they move from the Cen∣ter to the Circumference, they drive the venemous Ferments, and al∣so the Corruptions of the Blood and Humours far from the Heart, and repell the Enemy from the Fort: but Vomitories and Purges evacuate less generally, and often by concentrating the malignant Matter, draw it inward, and fix it in the Viscera. Now these Medicines, whether

they work by Purging, or Sweat, ought to be such as have Particles of the same kind with the venemous Miasm, rather than with our Blood or Spirits; for such a Medicine will pass through the various Involutions of our Body with its entire Force, and by reason of the Similitude of both, will certainly lay hold on the virulent matter of the Disease, and through a mutual Adhaesion of Parts, Nature being irritated, will carry it forth with it self: wherefore Medicines, whether Catharticks or Sudorificks, are most recommended, which are pre∣par'd of Mercury, Antimony, Gold, Sulphur, Vitriol, Arsenick, and the like; which, in regard they are not subdued, or overcome by our Heat, become excellent Remedies against the Venom of the Pestilen∣tial Contagion; for, these do not only powerfully evacuate superflu∣ous things, but for as much as they exert, and display on every side in our Body very strong and masterless Particles, they dissipate, and hinder from Maturation, the Ferments of the Venom gliding every way. And since the Remedies themselves, being insuperable by Na∣ture, must of necessity be sent away by the open passages of the Body, they carry forth together with them whatsoever is extraneous and ho∣stile.

As to Alexipharmicks, which are said to resist the Venom of this Disease without a sensible Evacuation, they are for the most part such whose Particles are neither very agreeing with Nature, that they turn to an Aliment, nor are so contrary to it, that they stimulate an Excretion. The same being inwardly taken, and refracted to most minute Parts, they, by their Corpuscles, inspire as it were with a new Ferment, the Blood and Juices flowing in the Vessels and Visce∣ra, and by moving them gently, and keeping them in an even mix∣ture, they free them from Coagulation and Putrefaction: by the same gentle Agitation they dissipate from each other, and hinder from ma∣turation the Particles of the Venom beginning to be gathered thick to∣gether. Lastly, by praeoccupying the Blood and Spirits, they defend them from the Ingressions of the pestilent Character: of these Reme∣dies some Simples are recommended, as Rue, Scordium, &c. but those are esteem'd far better, which are more compounded; wherefore Treacle, Mithridate, and Diascordium, whereof some consist of at least fifty Simples, are accounted Medicines so compleat in all Respects. that it is esteem'd a Crime to omit, in the making of them, ev'n one Plant; the Reason haply is, That many things being put together make a Mass, whose diversifyed Particles, being exalted by a long Digesti∣on, cause a greater Fermentation in our Blood and Humours.

Having thus set down the Remedies with which we ought to be provided for curing the Plague, we should speak next of its method of Cure, to wit, what is to be done in the first place, and what next in order; but that all things are so precipitated in this Disease, that there is no room for Deliberalion, nor will a Physician be frequently

present with the Diseas'd for fear of Contagion: wherefore there is no need here of many Praescripts, or a long Series of Indications. This thing is to be done quick, and must be comprehended in a few words: when therefore a Pestilence reigning, any one is infected with this Disease, God's help being implored, we must presently flye to Re∣medies. If the Plague happens in a Body that is not well purg'd, and prone to Vomit, presently let a Vomitory be taken; the Operation of which being ended, presently Diaphoreticks being giv'n, let a Sweat be procured, and let the same be continued as the Strength will bear; afterward let it be often repeated: moreover, Alexipharmicks must be used almost every moment, till the Venom be wholly sent forth by the eruption of Pushes, Carbuncles, or Buboes; nevertheless, in the mean while, let respective and proper Remedies be oppos'd to the Symptoms chiefly pressing; but especially for the cure of Buboes and Carbuncles, let fit Aids be taken from Chirurgery. The whole stress of the Business relyes on these two chief Intentions, that the pe∣stiferous Venom be by all means expelled from within, outward; and then that the Return of it, being expulsed, be with an equal Di∣ligence prevented.

It is not an easie thing for us, in the Plague, to give Examples and Histories of Persons diseased, with exact Diaries of Symptoms; for these kinds of Sicknesses do not happen every Year, nor when they are rise is it free for every Physician, who minds his own Health, to visit the Sick with a curious Eye, or to stay long with them, that he may diligently observe every Accident, and carefully weigh the Rea∣sons of them; which Task, nevertheless, the Famous Diemerbroch has so accurately performed, that since him, others may lawfully surcease from this Work. When heretofore in this City, viz. Anno 1645. a Plague (tho not exceeding great) was rise, Mr. Henry Sayer, a Physi∣cian very learned, and fortunate in Practise, boldly went to visit all sorts of sick Persons, both poor and rich, many others refusing this Undertaking: he daily gave them Medicines, touching Buboes and virulent Ulcers with his own Hand; and so by a dliligent, tho dange∣rous, means, cured many of the Diseased. To fortifie himself against the Contagion, before he went to infected Houses, he only was wont to drink a good Draught of Generous Wine, and after he had gone his Circuit, to repeat the same Antidote. After that he had taken Care a long time of the Sick in this City, without receiving any Injury, as though he were Plague-free, he was sent for to Wallingford Castle, where this Contagion violently raged, as ā second Aesculapius, to the Governour of that place; and there, in a short space, having dar'd to lye in the same Bed with a certain Officer seised with the Plague, whose Society he very much delighted in, he took the Infection of the same Disease: nor could then those Arts prove of Use to their Ma∣ster, which had been beneficial to all others, not without a mighty

loss in the Art of Physick, did he perish by that Disease. To others seised with the Pestilence, he was wont to order this method of Cure; If he was called before Pushes or Buboes appeared outwardly, for the most part he gave Vomitories, the Praescripts of which were of the Infusion of Crocus Metallorum, sometimes with white Vitriol, and sometimes with Roman; the Vomiting being over, he caused them to be cast into a Sweat, by giving presently Diaphoreticks; and after∣ward, some Intervals being allowed for the restoring of the Strength, he ordered the Sweating to be continued even to the Declination of the Disease: but if he was called to Persons affected after the Tokens appeared, Vomiting being omitted, he insisted only on Sudorificks.

CHAP. XIII. Of pestilential and malignant Fevers in Specie, and other Epidemick Fevers.

AFter having explicated the Nature of the Plague, according to the Order of our Tract, we ought to proceed to those Affects which seem nearest to carry its Nature; as are chiefly the Fevers called Pestilential and Malignant: for it is vulgarly known, that Fevers sometimes reign among the People, which for the Vehe∣mency of Symptoms, the mighty Slaughter among the Diseased, and the force of the Contagion, scarce yield to the Pestilence; tho because they imitate the Types of Putrids, nor do not so certainly kill the Affected, or infect others, as the Plague, they do not deserve the name of Plague, but in a milder Appellation, of a Pestilential Fever. Be∣sides these, there are Fevers of another kind, whose Destruction and Contagion are more remiss; yet because they are more dangerous than Putrids, and contain somewhat of Divine in them, as Hippocrates calls it, they are called, in a lower Expression than the others, Malignant Fevers.

These Fevers differ doth from the Plague, and from each other, ac∣cording to the Degrees and Vehemency of the Contagion and Destru∣ction; so that the Plague is a Disease contagious, and destructive to Mankind in the highest Degree: A Pestilential Fever is that which ge∣nerally reigns with a less Diffusion of its Miasm, and with a less Mor∣tality: when an Infection is only suspected, and only a treacherous or unsafe Crisis happens, above the Events of vulgar Fevers, it is said to

be a Malignant Fever: They may be describ'd yet more fully, thus:

When a Fever vulgarly reighs, which for the variety of Symptoms carries the Nature of a Putrid so called, viz. which has a Thirst, Burning, Lassitude, restless Pain, a Roughness of the Tongue, Watch∣ings, a Frenzy, Vomiting, loss of Appetite, Fainting, Swooning, a Cardialgia, and the concourse of other terrible Accidents joyn'd with it; if moreover, there be added to it Spots either like small Flea∣bites, or broad and black and blue like the Impressions of Stripes; we esteem this Disease of an ill Nature: again, if it does not discover it self after the wonted way of Fevers, but the Strength of the Sick falls without a manifest Cause, and Death often happens on a sudden, and unsuspected, contrary to the Prognostick of the Physician, there grows still a greater suspicion of Malignity: but if most of the Sick dye, and those that converse with the Diseased take the Infection of the same Disease, so that oftentimes the same runs through whole Parishes and Cities, it is called, above the Appellation of a Malignant, a Pestilenti∣al Fever; of which, a farther Proof is made if it generally rages in most with some common Symptom, as with a Quinsey, a Dysentery, or if a mortal Sweat, such as heretofore was famously known in Eng∣land, accompanies these kinds of Fevers.

But if a Fever arises, which affects many together living in the same Region for the most part after the same manner, which nevertheless in its Course observes the laws of a vulgar Putrid, and comes to a Crisis almost after the same manner, (but that in some, troubled with a mighty Cacochymia, it discovers certain signs of Malignity by an ap∣pearance of Spots or Buboes, sometimes by a mortal Crisis, and a Contagion spreading to others) this is not called a petilent, but only a Malignant Fever.

If it be enquired in which Classis of the Fevers above treated off, Pestilent and Malignant Fevers are placed, we put them only in the Rank of Continual Fevers, and exempt Intermittents from them, be∣cause by Intervals these grant such firm Truces to Nature, and likewise observe regularly and exactly their Periods, which will not consist with a venemous Diathesis: we exempt also Hecticks from Malignity, because otherwise they would not protract Death so long, but, parta∣king of Venom, would kill sooner. Of Continual Fevers, tho we do not look upon Simple Sinochi, as free, yet we assert them to be seldom touch'd with this Taint; but most commonly, the Fever which gives marks of a pestilent Nature or Malignity, is such as imitates the Type of that we call a Putrid Fever: for since in these Fevers, besides the Phoenomena of a Virulency, we observe a continued Effervescence of the Blood, which, as in Putrids, passes through the Stages of a Be∣ginning, Increase, Height, and Declination, we justly conclude, that the sulphureous part of the Blood here, is heated, and kindled, and by

its burning brings the Fever: wherefore, in these kinds of Fevers two things are chiefly to be noted, to wit, the Effervescence of the Blood, and a Malignity joyn'd with it, of which sometimes this, sometimes that, excells, and in both there is a great Latitude, and there are many Degrees of Intension, according as the Fever becomes more or less acute, or malignant.

The Effervescence happens after the same manner, as it is said before of putrid Fevers, to wit, the sulphureous part of the Blood, growing hot above measure, by its fervour, takes to a Flame, as it were; whilst it burns it heaps together a vast Store of adust Matter in the Blood; on the subduing and exclusion of which, after the wonted manner of Fevers, the height and Crisis depend but besides, the Blood being infected with a certain venemous Miasm, begins, in burning, by reason of the malignant Ferment, to be coagulated, and to putrifie by Parts: wherefore, besides the usual Symptoms of a vulgar Fever, by Rea∣son of certain Portions of the Blood being congealed, or mortified, a Fainting and Dejection of the Spirits, also Appearances of Spots and Marks ensue. Moreover, the Venemous Effluvia, which part from the Diseas'd, by the force of the Contagion, are able to stir up the like Affect in others: wherefore, by reason of the Destruction and Conta∣gion, and the various Degrees of the same, it is call'd a Pestilential or Malignant Fever.

When the Blood, boyling over vehemently, is infected also with a malignant and venemous Ferment, not only Coagulations of its own Mass, with a Disposition to a Putrefaction are caus'd, but the nervous Liquor also readily contracts this Taint; whence being rendred dispro∣portionate to the Brain, and for the oeconomy of the animal Spirits, it stirs up great Irregularities in them: wherefore, not only Spots and Pushes, but oftentimes a Delirium, Frenzy, drowsie Affects, Tremblings of the Limbs, Cramps, and convulsive Motions, happen upon these Fevers. We often observe, that in certain Years malig∣nant Fevers are rife, which without an appearance of Marks, shew their Virulency chiefly about the Genus Nervosum; for in some, pre∣sently from the Beginning, a Sleepiness, with a mighty Drowsiness of the Head, in others obstinate Watchings, a Disturbance of Mind, with a Trembling, and convulsive Motions: but in most, either no Crisis, or a deceitful one; and instead of it, a Translation of the se∣brile matter to the Brain has followed. It has been farther observ'd, that these Fevers have past by Contagion into others, and that many have died of them; so that they deserve to be call'd Malignant.

Now these kinds of Fevers sometimes are first begun by a vene∣mous Miasm; and the Blood being blasted with the Particles of the Poyson, naturally falls into an over-vehement boyling, and is infla∣med; as when any one, by a Contagion, or by breathing a malignant Air, falls into a malignant Fever, without an evident Cause, or Prae∣disposition:

and sometimes a feverish Distemper arises from its own cause; and afterward the Seeds of the Malignity, either lying hid within the Body, exert themselves in the Blood boyling over vehe∣mently, or come from elsewhere from a contaminated Air, as a Few∣el to a Flame first kindled: for it is manifest by frequent Observation, that during the time an Epidemick Fever reigns, others, after what manner soever they arise, pass into it.

Malignant Fevers, as also Pestilential, for the most part are Popular, and seise many together; but sometimes they are peculiar and spora∣dical, that haply they seise only one or two in a whole Country. In such a case we may imagine, that they proceed, not from an Infected Air, or Epidemick Cause, but from a morbid Disposition of the Bo∣dy; for I have often observ'd, that when, Spring or Fall, a pretty common Fever has reign'd in some City, or Village, of which a great many Sick escap'd; haply some one, on whom an evil Praedisposition, and a strong evident Cause, brought the Fever, lay seis'd with more dreadful Symytoms, and great Notes of Malignity: in which Case, that Malignity is not to be said a common Fever, but only a sporadical and accidental one.

Tho the greatest Difference whereby these kinds of Fevers are distin∣guished betwixt themselves, and from others, consists in their Morta∣lity and Contagion; yet sometimes they are mark'd by some peculiar Symptom, from which both the note of Malignity, and the name they are called by, are taken for that time: hence in some Years an epi∣demick Fever reighs, which causes in most that are affected with it, a Quinsey, at another time a Peripneumonia, Plurisie, Dysentery, or some other Affect, and that often dangerous and contagious: so that not only the Seeds of Diseases deriv'd from Parents ex traduce, disclose their Fruits, by a certain Destiny, as it were, in the same Part or Member; but also such as are received from a venemous Miasm generally reign∣ing, produce in all Persons Affects of the same manner and form: which nevertheless I judge to happen, not because the Seeds of the venemous Miasm regard this or that Region of the Body by some peculiar Ver∣tue: but they affect thus the Mass of Blood after the same manner in all, forasmuch as, for washing off that taint, a Crisis must of necessity be attempted after the same manner in all; for when without Malig∣nity, the Blood is apt to be extravasated by reason of Coagulation, or haply for other Causes, the usual Places in which the Portions of the same extravagated are wont to be fix'd, are, the Throat, Pleura, Lungs, and Intestines: wherefore it's no Wonder when a Congelation, and therefore an Extravasation of the Blood is procur'd from a malignant Cause, if the Disease lodges it self in the usual seat of Nature.

As to the Signs of these kinds of Fevers, besides by the Contagion and Mortality, the Malignity of the Fever is shewn by a sudden Deje∣ction of the Strength, a weak and uneven Pulse, an evil Affect of the

Brain and nervous Parts caus'd on a sudden, violent Vomitings, a blackness of the Tongue, an over-spreding of Blackness over the whole Body, but especially by an appearance of Spots, Buboes, and other Marks.

For the Cure of Fevers, both Pestilential and Malignant, there is need of a greater Judgment and Circumspection than in any others whatsoever; for there being two primary Indicants, to wit, the Ma∣lignity and the Feverish Distemperature, and since we can scarce provide for the one without the Detriment of the other, it will not be easie to judge which we must obviate first, and chiefly take care off: in respect of the Fever, Purging, Bleeding, and cooling things, chiefly conduce; but whilst these things are used, the Malignity, for the most part, is increased, and they being neglected, it diffuses it self farther. Against the Malignity, Alexipharmicks, and Diaphoreticks are required; but these greatly intend the Fever, exagitate, as by a blowing of Bellows, the Blood and Spirits kindled before, and put them in a manner all in a Flame: wherefore there is need here of a great Quickness of Understanding, that these things be duely compared betwixt each other, and that the curative Intentions be there directed where most danger shews it self; tho so, that while one is taken care of the other be not neglected: but in these Cases, besides the private Judgment of each Physician, Experience furnishes us with the chief method of healing; for, when these Fevers first grow rise, almost eve∣ry particular Person trys particular Remedies; and from their Successes compar'd together, it is easily learnt, what kind of Method we must insist on, till at last, by a frequent Tryal, as it were by the Foot-steps of Passengers, a common, and Road-way as it were is made to the Cure of these kinds of Affects, being fortified with various Observations and Precepts.

Besides these kinds of Fevers, which assail many together, and by reason of their Contagion, Mortality, and conspicuous Marks of Viru∣lency, deserve to be called Pestilential, or Malignant; there are found some other Epidemick or Popular Fevers, which almost every Year, either Spring or Fall, grow very rise in certain Countries, of which a great many of the Inhabitants are wont to fall sick, and not a few, es∣pecially of the more elderly People, to dye: in which, nevertheless, no Signs of a pestilent or malignant Nature appear; nor does the Disease seem so much by Contagion to pass from some incontinently to others, as to seise many together by reason of a Predisposition communicated almost to all. Now these kinds of Affects depend chiefly on a forego∣ing Constitution of the Year; for if a Season very intemperate, by reason of excesses of Cold or Heat, Drought or Moisture, has prece∣ded, and has so continued a long time, it changes our Blood, for the most part, from its due Temper, whereby it is apt afterward to fall into severish Effervescencies; and hence a Fever, sometimes of this,

sometimes of that Type and Idea, is produced, which presently becomes epidemical, because it draws its Origine from a common Cause, where∣by the Bodies, in a manner, of all Men, are affected together. Now such Fevers, in as much as they depend on the Blood, getting a Dis∣position, sometimes sharp, sometimes austere, or of another kind, ac∣cording to the Temper of the Year, for the most part they are of the number of Intermittents, tho they are wont to be mark'd with a pe∣culiar Apparatus of Symptoms, according to the peculiar Constitution of each Year. We cannot comprehend these under a certain com∣mon Rule, or formal Consideration, which aptly answers to each of the Particulars of this Nature, because they vary yearly according to a great many Accidents: tho however, of these kinds of Fevers reign∣ing of late Years in this Country, we shall give the Descriptions taken at that time; and shall set them down as a Conclusion at the end of this Work.

It remains for us still to add to the number of Malignant Fevers, certain other private Fevers, partaking of no Contagion, as are those especially, which are wont to happen to Women in Child-bed, by reason of their difficult Labour, or for that the Lochia are detain'd; for it is manifest enough, by common Observation, that these are very dangerous, and often mortal: for if the Parts of the Womb being injured, or upon the admission of Cold, or haply for some other Cause, the Lochia are stopt, and the Humour which ought to have been voided forth, comes to be mingled with the Mass of Blood, it fouly defiles it with a certain venemous mixture, as it were, that thereby presently a Fever is raised, which for the most part is at∣tended with an ill Company of Symptoms, viz. a Heat, and violent Drought, a Vomiting, a Cardialgia, and Watchings, and generally comes either to no Crisis, or a very difficult one; because, unless the flowing of the Lochia after their wonted way be again restor'd, after the Blood has undergone an Effervescence for some Days, the Taint is wont to be communicated to the Brain, and the Genus Nervosum; whence presently a Delirium, Frenzy, Convulsions, and other very ill Affects for the most part are caused, which often terminate in Death. But these kinds of Fevers deserve a peculiar Consideration; which we resolve to have more fully beneath, in a Discourse appro∣priated to this purpose: mean while we must give some Instances or Examples of the Fevers above treated of, viz. of the Pestilential and Malignant.

The pestilential Fever, of late Years, has reign'd more rarely in these Parts, than the Plague it self. I shall give you briefly the Descripti∣on of the only one of this kind which has occur'd to our Observation. Anno 1643. when in the beginning of the Spring the Earl of Essex besieg'd Reading, kept by the King's Garrison, in both Armies a very Epidemick Disease began to arise; tho however, he pursuing his work

till the Besieged were forced to a Surrender, The Affect so prevail'd, that in a short while afterward there was a Cessation on both sides, and thenceforward, for many Months, there was a Conflict, not with the Enemy, but with the Disease. Essex withdrawing his Forces, seated himself at—, and the adjacent Places, where, in a short time, he lost a great Part of his Men: and the King returned to Ox∣ford; where the Souldiers first keeping themselves in the open Field, and afterward being disposed off in Towns and Villages, he underwent a loss not much inferiour; for his Foot (whom it chiefly seised) being lodg'd a great many of them together in streightned Lodgings, when they had filled all Places with Nastiness and Filth, and stinking Odours (that they seem'd to have defil'd even the Air it self,) fell sick many of them together, and as it were in Files: at length the Fever, reaching farther than the Souldiery, assailed every where the weak Multitude, to wit, the Persons of the Houses where the Souldiers lodged, and others, tho many of them at first (the Contagion being yet but mild upon them) escaped, yet lying a long time in a very languishing Condition. About the Summer Solstice, this Fever began to psread it self with a worse Attendance of Symptoms, and to seise a great many Husband-men, and others living in the Country: and afterward it reigned in this our City, and the whole Neighbourhood, for at least ten Miles round about; mean while, those who liv'd in other Countries far from hence, as tho they were beyond the Sphere of the Contagion, continued free from harm. But here that Disease grew so general, that the greatest part of Mankind was infected with it: whatsoever House it entred, presently it set upon the whole, that there were scarce enough remaining in Health to attend those that were ill; such as came to them from elsewhere, or Hirelings called to attend the Diseased, were presently seised with the same Infection: that at length, for fear of the Contagion, such as lay sick of this Fe∣ver, were shunn'd by those that were in Health, in a manner, as Per∣sons troubled with the Plague.

Nor did a small Mortality or Destruction of Mankind attend this Disease; for a great many old Men, Cachectical, Ptysical, or otherwise unhealthy Persons, fell under this Fate: also not a few Children, Youths, and such as were full grown. I remember, that in certain Villages, all the elderly People, in a manner, were carried off this Year, that there scarce remained alive any for unpholding the Cu∣stoms and Priviledges of the Parish, by the Traditions rcceiv'd from their Ancestors.

When this Fever first began it carried somewhat the Type of a pu∣trid Synochus, but it came with difficalty to a Crisis, and when it seemed to be solv'd by a Swear, or a Loosness, it was wont presently to wax worse again: but for the most part after a Deflagration of the Blood, continued for six or seven days, this remitting, and in∣stead

of a Crisis, the adust Matter being convey'd to the Brain, the Diseased lying a long time, sometimes raving mad, oftner with a Drowsiness and a great Weakness, and sometimes with convulsive Motions, scarce escaped at length with Life. About the middle of the Summer, beside the Contagion, and the frequent Mortality, this Disease discovered its malignant and pestilential Force, by open Signs, viz. by the Eruption of Pushes and Spots; for about this time, without any great burning of a Fever, the Pulse in many grew un∣even, weak, and very disorderly; also, without a manifest spending of the Spirits, the Strength presently became languid, and very much dejected; in others, lying ill after the like manner, Pimples some∣times small and red, sometimes large and livid, appear'd; in many, Buboes (as in the Plgaue) about the glandulous Parts; some of these, without any great Conflict of the Spirits, or feverish Excandescence raised in the Blood, died without noise and on a sudden: mean while, others, growing presently raving mad, as long as they continued in Life, underwent horrible Distractions of the Animal Spirits. Such as escap'd from this Disease, recovered not but after a long time, and that without a laudable Crisis (unless by a Sweat procured by Art) the Brain at length, and the Genus Nervosum being affected, and they be∣ing seized with a Dullness of the Senses, Tremblings, a Vertigo, a Weakness of the Members, and-convulsive motions. During the Dog∣days this Disease still infesting, began to be handled not as a Fever, but as a milder sort of Plague, and to be overcome only by Alexiphar∣mick Remedies; Bleeding was always thought fatal to it: Vomitories and Purges were used now and then, tho not so frequently; but the chiefest method of Cure was placed in Alexipharmicks, and a Sweant seasonably procured. For this purpose, besides the Prescripts of Phy∣sicians taken from Apothecaries Shops, certain Empirical Remedies deserv'd no small Praise: then first in this Country, the Countess of Kent's Powder began to be of great Fame; and another ash-coloured Powder was not of the least note, which a certain Courtier, coming by chance to this City, gave to many with good Success, and sold it others, who approved of its use, at a great rate. The Diseased were wont, upon drinking half a Dram of this in any Liquor, to fall into a most copious Sweat, and so to be freed from the Virulency of the Disease: that Diaphortick (the Preparation whereof I learnt after∣ward from the Authors Sisters Son) was only the Powder of Toads, cleansed with Salt, and afterward washed with good Wine, and light∣ly calcin'd in an earthen Pot. Autumn coming on, this Disease re∣mitted by Degrees of its wonted Fierceness, that fewer fell sick, and a great many of them recovered; till upon the access of Winter, a state of Health was again entirely setled in this City, and in the ad∣jacent Country.

Let us here consider the Rise, Progress, and lastly, the End of this Fever, which at first was only belonging to the Army, and at length became pestilential and epidemick: that the Disease first began in the Souldiers Camp, it seems that it ought not only to be imputed to their Nastiness and stinking Smells, but in some measure, to the common Fault of the Air; for, since these Fevers do not happen yearly, their Origine will be somewhat ascribed to the peculiar Constitution of the Year: for a light Distemperature of the Air being thereby contracted, tho it does not ill affect such as use a wholsome way of living, yet in an Atmy, where, to the general Procatarxis, evident Causes, viz. a great many Errors in the six non-natural things, are joyn'd, those kinds of Sicknesses must of necessity be more easily rais'd. Now the Vernal Constitution of this Year was very moist, being almost conti∣nually attended with wet Showers; to which afterward a hot Sum∣mer succeeding, both rendred still more depraved the Miasms of the feverish Contagion reigning here before, and more disposed all Bo∣dies to receive them: wherefore, that this Distemper became in a manner peculiar to this Country, and epidemick at this time, it was long of its Seminary, arising in the first place from the Army lying round about: but in as much as becoming afterward pestilential and very epidemick, it infected the greatest part of Mankind here living, and killed not a few; the cause was, the ill Affect of the Air, which being unwholsome through the Distemperature of the year, became moreover so vicious at length, by the continual breathing forth of stinking Vapors from the Souldiers Camps, and the Cohabitation of the Diseased, that the Miasms of this Fever, disperst in it, were greatly exalted, and rise almost to the Virulency of a Pestilence. Diemerbro∣chius relates, That from such a kind of Camp-Fever, rais'd in the Summer, in the Town of Aquitane, afterward another malignant and pestilential, and at length the Plague it self grew: and that this our Fever at last stood in competition with the Plague it self, besides the great force of the Contagion, and the great Mortality, the very ill Af∣fects of the Blood and nervous Liquor, presently caused in all from the same, did declare; for the Strength dejected on a sudden, the weak, intermittent, and formication Pulse, the Eruption of Pushes and Bu∣boes, argued the Coagulation, and corruptive Disposition of the Blood. Moreover, a Delirium, Mania, Frenzy, Deadness, Sleepy∣ness, Vertigo, Tremblings, convulsive Motions, and other Affects of the Head of divers kinds, shew'd a mighty Annoyance of the Head and Genus Nervosum.

For setting forth the Type, or Idea of the Malignant Fever to the Life, there are a great many Observations or Stories of Sick Persons ready at hand: Of many Examples of this Disease, I shall here insert only a few, which some years since happened in the House of a Vene∣rable Person, after a manner to be lamented, and not without some Admiration.

About the Winter Solstice, Anno 1655. a Boy about seven years of Age, being ill without a manifest cause, was affected with a great Pain in his Head, a Sleepyness, and a mighty Heaviness; there was withall a Fever, tho not intense, with an indifferent Burning, which nevertheless, by unconstant Fits, had its time of being intended some∣times once, sometimes twice within the space of twenty four Hours. Presently, from the Beginning of the Disease, he slept almost continually, he was wont also to cry out in his Sleep, to talk idly, and oftentimes to leap out of Bed; being stirred up, and sometimes awaking of his own accord, he was straitway present to himself, and always desired Drink: his Urine was ruddy, and fill'd with Contents; the Pulse was uneven, and strong enough; the Contractions of the Tendons in the Wrists were light: in the Neck, and other Parts of the Body, certain red Spots, like Flea-bites, appeared. On the first days, a gentle Purge was ordered, and a frequent easing of the Belly by the use of Clysters: Cordial Juleps with Alexipharmicks were daily taken: Vesicatories were applyed to the Neck, and other Plaisters to the Soles of the Feet. On the sixth day, a little Blood dropt from the Nose. On the seventh the Fever very much remitted without a manifest Crisis, the Heat, being only mild, was perceivable by the Touch, and the Urine was pale and thin, without any Sediment; nevertheless, a Sleepyness, and Heaviness of the Head prest far more severely, so that the Urine, and Excrements of the Belly, flowed from him insensibly: however, being call'd upon by Name, he knew the Standers by, and answered to things asked. Those Affects, notwithstanding Remedies, daily grew worse and worse. About the fourteenth Day the Diseased became so stupid, that he could neither understand, nor speak, yet he still swallowed down things put into his Mouth, tho unminded by him, and his Pulse was laudable enough: about this time he had a Looseness, naturally happening to him, for four Days; which at length ceasing, a whitish and chalky Crust, as it were, began to cover the whole Cavity of his Mouth and Throat, which being cleansed off often in a Day, presently a new one arose. When he had been troubled after this manner for four Days, he was better as to his Understanding and Sensation; so that he could know Friends, give a Nod to what was said, and do some things he was ordered: but as the sensitive Faculty began to be restored, so the Evil increased as to the Organs of the Speech, and Swallowing: doubtless the Matter being fallen from the Brain into the Beginnings and Ductus's of the Nerves. The Heaviness and Stupidity were follow∣ed by a Palsie in the Tongue and Throat; which Affect grew so much in a short space, that afterward the Diseased was not able to swallow at all, but things put into his Mouth presently came forth again, nor did any thing descend into his Stomach; when, besides the Violence of the Disease, there was danger, lest he should dye through Hun∣ger, an Instrument was made of a flexible Whale-bone, and a Lawn

Button fix'd to the end of it; and this being thrust into the Throat, opened for a time its Closure, that a Passage was made for Food giv'n; after the use of this a Day or two he could swallow again, and after∣ward take in Food enough; and within a few days he began to speak, to discern every thing, and growing wonderfully hungry, to desire all day long Food of all kinds, and most greedily to devour all things giv'n him: mean while, through his long-continued Sickness, and the nervous Parts being sorely injur'd, he grew so lean, that at length the Skin scarce sticking to the Bones, he exactly resembled a living Skele∣ton; tho afterward by the diligent, indefatigable, and prudent Care of his Mother, as to his Dyet, he recovered a perfect Health, and continues still well.

At the Time that this Boy was about the height of his Sickness, his Brother, about two years elder, fell sick almost after the same manner, on the first day of January. First, he was affected with a Dullness, and a heaviness of the Head. On the third day growing fe∣verish, he had a Sleepiness and Stupidity: he began in his Sleep to talk light-headed, and upon his Awake, scarce to be present to him∣self. After four or five Days these Symptoms increased; he could understand little, nor speak without tripping of his Tongue, and scarce arciculately: his Urine was thick, and opake, without an Hypo∣stasis, or subsiding of the Contents: red and small Spots like Flea-bites appear'd, as in his Brother: the Excrements, as well of the Belly as of the Bladder, pass'd from him insensibly; but the Pulse held still strong and even: the Hypochondres were extended, and blown up with a Swelling of the Abdomen. About the eighth day a little Blood dropt from his Nose: On the eleventh day of the Sickness he fell into a Looseness, whereby he had seven Stools, of a bilous, thin, and very stinking matter, within five Hours; whence there was some hope, that the Condition of the Diseas'd would change for the better; tho the next day after, the Loosness ceasing, a Pain, and Gripes, violently tormented him in his Belly, that crying and howling, he complain'd most sorely Day and Night: the Hypochondres and Abdomen were swollen, and very much distended like a Drum. Not receiving any thing of ease by any Remedies tryed by the most exquisite Endea∣vours of many Physicians, he died on the fourteenth day, convulst in these Tortures.

A little after the Death of this, viz. on the 15th. of January, his El∣dest Brother, about eleven years of Age, a very hopeful Lad, began to be feverish, being affected with a Dullness, and a Heaviness of the Head, as the former, tho less intense: but in his Blood, which was of a hot Temperament, a greater Effervescence and trouble appear'd, that on the first six days, besides a Heat and Thirst, he was molested with a continual Effort of Excretion, sometimes by Sweat, sometimes by a Loosness; his Urine was ruddy and troubled; certain red Spots,

as in the others, brake forth. On the seventh day an Haemorrhagie happened to five ounces, which ceasing, a mighty Dullness followed, that for all that day, and the following Night, he was scarce able to open his Eyes. On the eighth day a very copious Haemorrhagie of the Nostrils happened again, that there was danger of pouring forth his Soul together with the Blood; the Blood sprang forth so copiously from the left-Nostril, that, being received into a Bason, it made vast Bubbles by its fall: when he had lost above two Pounds of Blood, and being all in a cold Sweat, began to lose his Strength; Reme∣dies being at length applyed, the Flux was stop'd with great difficul∣ty; the Haemorrhagie being appeased, the Lad slept a sound Sleep, and became sleepy all that Night; tho often waking, he was present enough to himself, and had a quick Sense and Understanding: being asked concerning his Health, he said he was pretty well; the Urine which before was ruddy, and troubled, appeared then pale, thin, and with a laudable Hypostasis, that the Diseased (especially because free from Thirst and an immoderate Heat) seemed to be come to a perfect Crisis, and free from the Fever. The Morning following, the ninth day of the Fever, he continued still dull; but being stirred up, he seemed without a Distemperature, and to be chearful in a state of Convalescence, only that he began a little to faulter in his Speech: in the Evening, when things were not suspected, the Fever being kindled again, he fell on a sudden into a Lethargy, that he was scarce able to be awaked from his Sleep, and being pull'd up, hardly to know any one, or to speak articulately: Tho so great a loss of Blood had preceded, his Pulse was again quick, high, and strong, and his Urine was ruddy; after deriving and revulsing Remedies used all that Night, this noble Youth seemed somewhat in a better state; so that the next Morning he kept himself longer from Sleep, began to turn his Eyes this way and that, and to raise himself a little, tho without Speech, or Knowledge of the Standers by; before Noon, his Eyes being clos'd again, he wholly lost the use of every Animal Faculty, and lay, as it were, Apoplectical for three Days, with a high and vehement Pulse, a Palpitation of the Heart, and a short and broken Respiration: the Pulse at length growing less by degrees, he died on the tenth day of the Fever.

On the 18th. of February, his little Sister, having a feverish Di∣stemperature and a Thirst, began to complain of a Pain, and Gripes in the Belly, a trembling in the Hands, and a painful Tension in the Muscles of the Neck. On the last day of February, being more openly feverish, she was not able to keep out of Bed; moreover, she was affected with a running Heat, sometimes in the Hands, sometimes a∣bout the lower Parts; she became also drowsie and sleepy; awaking from her Sleep she did not forthwith come to her self. On the first of March she was gently Purged with an Expression of Rhubarb, which

gave her ease; the Urine was thick and ruddy, also red Spots like Flea-bites (as in the rest) were plain to be seen. We gave her after∣ward frequently for four days, to wit, every six hours, Ten Drops of Spirit of Harts-horn, in a Spoonful of a Cordial Julep: the foresaid Symptoms afterward remitted by degrees, and this sick Person reco∣vered her Health, tho slowly, without a manifest Crisis.

About the same time a Brother of these, the youngest of all, fell sick almost after the same manner; who nevertheless, through a Loos∣ness naturally happening, voiding bilous and green Excrements for many days, more easily recovered. Also in the same Family, a great many other Domesticks, and some Strangers, who came there as At∣tendants, fell ill of the same Disease, the Taint, as it were being pro∣pagated by Contagion: all of which, notwithstanding, escaped at length with a difficult and long Convalescence, without any Crisis re∣gularly made.

That this Fever was malignant, it seems to be manifest, from the Contagion, Mortality, the appearance of Spots like Flea-bites, and many other Tokens; tho that infecting Miasm, whereby it passed from one to another, was torpid and less efficacious: for betwixt the Sicknesses of each, many Days, and often Weeks, interceded, that the Infection of this Disease, tho acute, and its Propagation in many, were scarce ended within four Months space in the same House: the Fever about the first Beginnings seem'd mild and gentle, not very ter∣rible by its Burning: but the Matter heap'd together after the Defla∣gration of the Blood, presently became masterless, and difficult to be exterminated, also offensive to the Brain and Genus Nervosum; where∣fore in each, the Beginnings of the Disease were known rather by a Drowsiness and a Sleepyness, than by a Sweat and Burning: also the Crisis, tho attempted various ways, to wit, by a Sweat, a Loosness, and an Haemorrhagie, did not succced well; but for the most part, the Blood growing turgid by a critical Motion, was forc'd to transfer the febrile Matter from its own Precincts into the mansion Places of the Animal Spirits; nor did it self, notwithstanding, become purified after this manner; but about the height of the Fever, both Humours (to wit, the Blood and the nervous Juice) being vitiated together, and sorely blasted with an impure Mixture, made the Event of the Disease either fatal, or very dangerous.

CHAP. XIV. Of the Small-Pox and Measles.

IN the rank of pestilential and malignant Fevers we place next the Small Pox and the Measles, which in Truth are mixt Affects, both according to, and against our Nature: As to their Origine, they have a seminary Connate to us; but as to the Affects, they produce praeternatural Symptoms, and venemous, as the Plague it self; so that they constitute a certain peculiar sort of Fevers, which belong to all Mankind, and only to them, and that but once. If haply any one lives free from them all his Life, or some one falls often into those Affects, these are rare, and unusual Events of Nature, which do not derogate to common Observation: but it may pass for a Truth, that all, and only Mankind are obnoxious to the Measles and Small Pox, and that they are usually freed of them at one Bout. We shall speak of the Measles by themselves.

1. As to the Small Pox; The natural Praedisposition which inclines Mankind to it seems to be a certain Taint, or Impurity of the Blood, conceiv'd in the Womb with the first Rudiments of the Foetus. All Authors, in a manner, will have this ascrib'd to the menstruous Blood: which Opinion does not seem altogether improbable; be∣cause in the Womb of a Woman (otherwise than in most other Ani∣mals) a certain Ferment is engendred, which being communicated to the Mass of Blood, gives it a Vigour and Pneumatosis, and after∣ward procures, at set Periods of Times, a Turgescency, and an Ex∣cretion of the superfluous Blood; and at the time of Conception, when the Menses wholly cease, a great deal of this Ferment is commu∣nicated to the Foetus; and its Particles, being heterogeneous to all the rest whatsoever, are disorderly confounded with the Mass of Blood and Humours, as some extraneous thing; in which being involved, and being separated from each other, they lye hid a long time; tho af∣terward at some time being stirr'd by an evident cause, they ferment with the Blood, and cause in it an Ebullition, and afterward a Coa∣gulation; from which most of the Symptoms of this Disease arise.

2. The Evident Cause which stirs these Fermentative Seeds, and oftentimes brings them into Act, is said to be threefold; viz. Conta∣gion receiv'd from elsewhere, the Disposition of the Air, and an im∣moderate Perturbation of the Blood and Humours: Persons related soon infect each other; also those that are fearful, and mightily dread this Disease, fall more readily into it: for, by Fear the Particles of the

Miasm are convey'd from the Surface of the Body inward: at the time that the Contagion is rife, and the Small Pox is Epidemick, all other Diseases in a manner degenerate into this.

3. As to the Conjunct Cause of this Disease, to wit, what is the for∣mal Reason of it, or its way of coming to pass, the thing seems a little more intricate: It is vulgarly wont to be compared to the Effervescence of new Wine, or of Ale, when they are depurated in a Vessel, be∣ing put in a Fermentation by the mixture of some heterogeneous Sub∣stance; but if the thing be narrowly considered, a great difference will here appear: for, the Miasm of the Small Pox is as a Ferment, but corruptive, and forces the Flood to ferment, not towards a Per∣fection, but a Depravation; for when the venemous Particles of this Miasm light on a capable Subject, they presently stir up Corpuscles like themselves, and innate to us; with which being joyn'd, they pervade the whole Mass of Blood, and make it grow mighty turgid, and boyl, and after some Effervescence, to separate into Parts, and to be coagulated: to wit, the dispers'd Seeds of the Venom dissolve the Mixture of the Blood, presently subvert the more pure Spirits, and afterward gather to themselves the more gross Particles of it, and con∣geal them, as it were, by their Adhaesion. The Portions so coagula∣ted, together with the Seeds of the Venom mingled with them, being left by the rest of the Blood in its Circulation in the Extremities of the Vessels, are fix'd on the Skin: after which manner, if Nature being strong enough, sends off the whole Venom with the congeal'd Blood, the rest of the Mass of the Blood, tho depauperated, is never∣theless good, and capable of continuing Life; but, if the Blood being too much coagulated, cannot be cleansed after this manner; or if the Portions of the Blood closing with the Venom, do not fully break forth, they either restagnate inward again, and wholly corrupt the Liquor of the Blood, or fixing themselves on the Viscera, and espe∣cially the Heart, they destroy their Crasis and Strength.

The Portions of the Blood congeal'd with the Venom, about the fourth day (sometimes sooner, sometimes later) begin to break forth; for the Coagulation is caused not presently, but after some time that the Venom displays it self, and by its Effervescence ferments the Blood: first light Portions of the Blood being desil'd, and those but few in number, are fix'd in the Skin like Flea-bites; soon after these, more appear, and those which brake forth first, by the access of new mat∣ter, and by the continual Appulse of the congealed Blood, grow big∣ger, and are rais'd into a Tumour; afterward these Pushes, which at first are red, being encreased by degrees, at length turn white, to wit, the Blood extravasated with the Venom, by reason of the Heat and Stagnation, is chang'd into a Pus. About the seventh day after the Eruption, the white Tumours turn to a dry Scab; for the more subtle Part of the Matter being evaporated, the rest grows hard, which at

length, the Scarf Skin being eaten off and broken, falls from the Skin.

When the Miasm of the Small Pox is once gotten into the Spirits and Mass of Blood, it is very seldom that it can be destroy'd or clear'd off by Medicines or Bleeding, but the latent Disposition will break forth into Act; wherefore, first it diffuses it self gently, and inspires the Mass of Blood, as it were, with a Ferment: hence an Ebullition and Ef∣fervescence are produced in the whole Body, the Vessels are extend∣ed, the Viscera are irritated, the Membranes are twitch'd, till the Seeds of the Contagion, by fusing and coagulating the Blood, at length being involv'd in its congeal'd Portions, are thrust forth. The Essence of this Disease will be the better known, if I set down the Signs and and Symptoms which are observ'd in the whole Course of it, and give you in order the Reasons of them, and the Causes on which they de∣pend. Now these are either such as indicate the Disease present, or such as fore-shew the height of it, and its event.

As to the Diagnostick of this Affect, whereby it may be known whether any one, at first falling sick, will have the Small Pox or not. There must be considered at that time, the force of the Contagion, and the Concourse of the Symptoms first appearing; for, if by reason of the malignant Constitution of the Air, this Disease generally reigns, no one is then seised with a Fever without a suspicion of the Small Pox, especially if the Person never had it before: but if this Disease be more rare, and there be no Fear of Contagion, yet its unexpected Invasion in a short time discovers it self by these kinds of Signs and Symp∣toms.

1. There is an inconstant Fever, coming at random, sometimes intense, sometimes more remiss, observing no set form of Increase, or coming to a height, so that the Diseas'd one while are mighty hot, by and by, without an evident Cause, they are without any Fever; the Cause of which is, That the sermentative Seeds are not agitated with an even motion, but like Fire half extinct, one while they have an extraordinary Flash, another while they lye quiet, and dye, as it were, till the Burning spreading it self, the Flame breaks forth every where.

2. A Pain in the Head and Loins is so peculiar a sign in this Affect, that it alone, in a continual Fever, signifies an imminent Small Pox; the Cause of which, is vulgarly imputed to the great Vessels being ve∣ry much extended by the Effervescence of the Blood; tho it does not appear why the same Pain should not be as well caused in other Parts by reason of the like Extension of the Vessels, and why those kinds of Pains are rife in the Small Pox, rather than in the Causon, or other Fevers, where the Blood boyls more. Again, you may observe, that mighty Pains are pressing, sometimes in the Head, sometimes in the Brains, when, the Blood not being turgid, the Vessels are not enlarg'd,

viz. in the beginning of the Disease, when the Feverish Distempera∣ture is not yet conspicuous: while the Diseas'd are yet walking abroad, and have a good Stomach, the imminent Small Pox first discovers it self by these Pains; wherefore, it seems that the Cause of these kinds of Pains subsists rather in the Genus Nervosum; to wit, that those Pains arise in the Brain, and spinal Marrow, by reason of the Membranes and Nervous Parts being twitch'd by the Particles of the Venom; for it is likely that the innate Seeds of the Small Pox are chiefly stored up in the Spermatick Parts, and that the first Contagion of the Miasm for the most part seises the Animal Spirits: hence the first Efferves∣cence is raised in the Juice wherewith the Brain and nervous Parts, but especially the spinal Marrow, are irrigated; and thence the taint is communicated to the Mass of Blood: wherefore, in the beginning of this Disease, the Head and Loins are press'd with a violent Pain; afterward, the Venom being convey'd into the Blood, the feverish Effervescence is rais'd in the whole.

3. A great Irksomness and Restlessness, and sometimes a Swooning, infest the Diseased, to wit, by reason of the Motion of the Blood be∣ing troubled, and its even mixture being begun to be dissolv'd by the venemous Ferment, the Blood being hence apt to stagnate, and to be letted in its Circulation, causes the Affects even now mentioned.

4. A violent Vomiting, even when the Stomach is free from an im∣pure Mass of Humours, very often accompanies this Affect; the Reason of which is, because the Fermentative seeds being put in motion, are deposed in the little Arteries which open into the Tunicles of the Ventricle, upon each Appulse of the Blood, and raise a Vomiting even as the Particles of Antimony swallowed down: but afterward, assoon as a Sweat being procur'd, the Venom is driven outward, this Symptom ceases, and the Diseased are well in their Stomach, without any purging forth of offensive matter.

5. To these may be added the Symptoms, which, according to the various Dispositions of Bodies, happen after a various manner, as are, a great Sleepyness, Frights in the Sleep, Deliriums, Tremblings, and Convulsions, a Sneezing, Heat, Redness, a sense of pricking in the whole Body, involuntary Weeping, a sparkling and itching of the Eyes, a swelling of the Face, a Vehemency of Symptoms from the beginning that the Disease seems presently to have reached its height, &c.

2. As to the Prognostick of this Disease, it is indicated either to be safe, or mortal, or doubtful, by supervenient Signs.

1. Things seem to be in safety when this Affect has benign Circum∣stances; to wit, when it happens in a good Constitution of the Air, and of the Year, at a time that the Small Pox is not Malignant and Pestilent; also there is less danger if it happens in Childhood, or In∣fancy, if in a sanguine Temperament, and a good habit of Body, if it

chances in a Family to whose Predecessors the Small Pox has not been mortal: moreover, if in the whole Course of the Disease laudable Symptoms happen; if at the first Invasion there be a gentle Fever without a violent Vomiting, a Swooning, a Delirium, or other horri∣•••••• ••••••ts; if, about the fourth day, the Fever with the most pressing ••••••••ms are appeased, and then some red Spots begin to appear; 〈◊〉〈◊〉 second day of their coming forth, a great many more of those red Spots are conspicuous, which afterward grow by degrees into Pushes, and are ripened into a Pus; if about the tenth day, more or less, after the Eruption, the white Pushes begin to grow hard, and af∣terward to fall off by little and little; if after the time of their first breaking forth the Small Pox are soft, separate from each other, few, round, raised at the Top, possessing only the Skin, and not the in∣ward Part, we may presume the case of the Diseased to be in a good State.

2. The Phoenomena, which, in the Small Pox signifie the Case to be suspected and full of Danger, are these; if there be a Malignant Constitution of the Air, that this Disease is become pestilent, and many have died of it; if Persons well grown in Years are seised with it, if it chances in a cold and melancholick Temperament, or in a foul and cacochymical Body, where the Blood is neither readily circu∣lated, nor Perspiration duely perform'd; or if the Hypochondres or Praecordia are obstructed, any Viscera infirm, or affected with an Ul∣cer; or if the Habit of the Body be too gross, the Small Pox does not happen without great danger of Life: Nor is it less to be fear'd, when presently at the beginning a mighty Fever, a violent Vomiting, a Swooning, a Dejection of the Strength, a Frenzy, or Delirium, assail Persons, and give not over when the Small Pox are fully broken forth; for these things signifie an over-great Perturbation in the Blood and Humours, as also a Confusion and Contumacy of the mortifying Mat∣ter, which can neither be subdued, nor easily separated, or evenly ex∣truded from the Mass of Blood; if there be an Irksomness, and a great Restlessness, with a disorderly Effervescence, and Ebullition of the Humours; or if a mighty Thirst, and a difficuly of Breathing, also a Loosness, or Dysentery, they shew that Transpiration is letted, and that the Malignant Humours restagnate toward the inward Parts. The Small Pox breaking forth slowly, argue the Crudity and Unruliness of the Matter, and the Impotency of Nature: much more, when double and confluent, do they shew that there is an excess in quantity, and a Confusion, also a disorderly and irregular Expulsion of that matter, since it is not cast forth at determinate Pores or places of Vent, but indifferently on every side. Small Pox which are hard signifie the Incoctibility of the said Matter, and if flat, the weak Expulsion of it, and they are by so much the worse if black Spots appear in the midst of them; or if such Spots as are familiar in a Purple or Pestilential

Fever, are mix'd with the Small Pox, they shew a mighty Malignity and Corruption of the Blood, such indeed, as is found in the Plague. Finally, black, livid, or green Small Pox, threaten ill; because, besides the Coagulations of the Blood, they argue its Mortifications and Cor∣ruptions, as in a Gangrene, or pestilent Carbuncle: if when th•• 〈◊〉〈◊〉 Pox are come forth, they presently wither, and the swelling of 〈…〉〈…〉 remits, it indicates the Recess of the malignant Matter, or of th•• 〈◊〉〈◊〉 congeal'd with the Venom, and its Restagnation toward the Inward Parts; whence unless, upon raising a free Diaphoresis, it be again sent forth, a sudden Death for the most part ensues: for hence the Blood being more coagulated, falls into Corruption, and is apt to be letted in its Motion, and to stagnate in the Heart and Vessels. If after the Eruption of the Small Pox, a Loosness, or Haemorrhagie supervenes, it foreshews ill, because by this means the Venom, driv'n outward, is again call'd in; tho I have observ'd, that these Symptoms have some∣times hapned with a great Relief to the Diseas'd; to wit, Nature being before loaded and opprest, is eas'd by this means, part of the Burthen, as it were, being withdrawn, wherefore she sets upon the Work of Transpiration, and more readily dispatches the Expulsion of the of∣fensive matter.

As to what concerns the Cure, since the Course of this Disease has three Seasons, like so many Stages as it were, distinct from each other: the curative Intentions ought also to be accommodated to each of these; wherefore, the Therapeutick Method concerning the Small Pox, teaches first what is to be done as long as the Blood boyls inwardly, and ferments by the Motion of the Fermentative Matter, and the Small Pox do not yet appear; which Period for the most part is wont to be ended in four or five Days. Secondly, what form of Diet and Physick ought to be ordered, from the time of the Eruption of the Small Pox to the height of the Disease, to wit, till the Pushes are come to their height, and being fully suppurated, begin to wither. Thirdly, and lastly, what we ought to observe in the Declination of the Disease, till the Small Pox, being dryed, fall clean off.

1. As to the first, the Intention must be, that we remove all Im∣pediments of Nature, whereby the Blood being defiled with the Fer∣ment of the Small Pox, and apt to be coagulated, may retain still its even Motion in the Heart and Vessels, without Stagnation, and that fermenting, it may expell forth the Portions congeal'd with the Venom: mean while, a Caution must be had, that the work of Fer∣mentation, or Effervescence, be neither any ways check'd, nor too much irritated; for by this the Mass of Blood is forc'd into congeal'd Portions more than it ought, and by the other it is restrain'd too much in motion, nor are the venemous Particles sent away forth with the congealed Blood. Nature is wont to be hindred from the work of Secretion and Expulsion, by a too great heap of Excrements

in the Viscera, or by an over-abounding of Blood in the Vessels; where∣fore presently, at the first Invasion of the Disease, we must endeavour that an Evacuation by Vomit, or Seige, if need be, be seasonably pro∣cur'd: we must use only mild and gentle Medicines, that is, which do not irritate, or trouble the Humours; wherefore, at this time, sometimes Emeticks, Purges, or Clysters, these one while another while those have place; opening a Vein also, if there be a Plenitude, is used with good Success. During this Effervescence of the Blood, let a thin, and moderately cooling Diet, be ordered; to wit, of Oat and Barley Meats, Posset-drink, Small-Ale, and the like; let Flesh, and Broaths made of it, be avoided, with which the Blood, by rea∣son of their too great store of sulphureous Fuel, is too much kindled; also cold and all acid things, do hurt, for these congeal the Blood more, and contract the Mouths of the Vessels by Astriction, that the Small Pox do not break forth freely: also let hot and cordial things be cautiously giv'n, for by these the Blood and Humours are too much stirred, and put in Confusion.

2. When the Small Pox begin to appear, there are three things which we order constantly to be done to all Sick Persons; to wit, that a mild and gentle Diaphoresis be always continued in the Mass of Blood; also that the Throat and Eyes be preserved from the too great Eruption of the Small Pox; that the Blood gently boyling may push forth the Small Pox, Decoctions of Figs, of the Flowers of Ma∣rigolds, and of the Shavings of Ivory, in Posset-Drink, are vulgarly prescribed, and their use has grown rife for a long time, almost among all Persons, For the same intent, we are wont to give mode∣rate Cordials divers times in a day, but let such as are hot and strong be diligently avoided: Purging and Bleeding are here censur'd, and tho the Pretext of necessity may press for them, Physicians scarce dare use them for fear of incurring a Blame. For a Guard to the Parts of the Gullet and Throat, we are wont to fasten outwardly a Chin-stay with Saffron sewen in, and dipt in Womans Milk; for these, by opening the Pores, draw the Venom from the inward part of the Throat, outward: also, for this Purpose we give Gargarisms, and things to wash the Mouth, which by their restrictive Force repress the Small Pox ready to break forth inwardly. We fortifie the Eyes from the Incursions of the Small Pox by Epithemes of Rose-water, Womans Milk, Saffron, and the like, frequently iterated: Besides these, certain horrible Symptoms are sometimes pressing, which we must seasonable obviate with fit Remedies: sometimes there are Watchings, a Frenzy, Hae∣morrhagies, Vomitings, Loosnesses, Fallings in of the Small Pox. A prudent Physician knows how to provide against all these, and any others whatsoever, as occasion requires; in which, nevertheless, there is need of great Caution, lest while we take care of small things, the great Work of Nature be disturb'd through the over-great disquieting

of Physick: for, during all this time, there is one continued Crisis; wherefore, nothing is to be mov'd rashly. There is required a very great Care and Circumspection both in the Phyfician and Attendants, when this Disease is in its height; to wit, That when the Small Pox are fully broken forth, and raised to their greatest height, they do not hinder Transpiration; for then the Diseased are in danger of having their Fever renewed, and of the Restagnation of the Malignant Matter in ward, of which, while we endeavour to prevent either, we often cause the other.

3. When the Disease is in its Declination, and the Small Pox begin to wither away, and to grow hard, the Case for the most part is out of danger, nor has a Physician much to do: let the Diseas'd, tho grow∣ing very hungry, still be content with a thin Dyet, without Meat: if the Pox are slow in falling off, we are wont to hasten their Fall with Liniments and Epithemes, by which they are prevented from Pitting much. After that the Diseased, the Small Pox being wholly fall'n away, is able to arise from his Bed, and to walk in his Chamber: a Purge being repeated twice or thrice, let the Filth, and excrementiti∣ous Matter left in the Viscera, and Blood, be carried off, and afterward he may be permitted a more free Dyet.

The Measle are so allied to the Small Pox, that amongst most Au∣thors, they have not deserved to be treated of apart from them; but the Affects of both are deliver'd after the like Manner and Method together. The Essence and Cure differ as to more or less, or at least∣wise accidentally; because in the Measles the Pushes are not so much raised in height, nor are they suppurated: wherefore the Disease ends sooner, and with less danger. This Affect is wont oftentimes to reign among Children, but seldom seises such as are grown in Years, or old People; also those who have had the Small Pox before, are not after∣ward so obnoxious to the Measles, but in most they are allied Affects; to wit, the Taint contracted from the Womb disposes Men alone, all Men, and that but once to the Measles: A malignant Constitution of the Air, and sometimes Surfeiting, but most commonly Contagion, are wont to draw into Act the latent Disposition. There are Marks of Malignity, and the Disease often becomes Epidemical, with a Mortali∣ty, and Contagion.

To give you the thing in short; it seems that the Measles are a cer∣tain light Efflorescence of an extraneous Ferment, contracted from the Womb; whereby some Particles, being stirr'd to motion, cause the Blood to boyl gently, and to be a little coagulated: wherefore, the Pimples thence brought forth, are blown off by Evaporation, with∣out a breaking of the Skin. But the Small Pox are a more full and strong Agitation of the same Ferment, and in all its Particles, which causing a greater Ebullition and Coagulation of the Blood, produces a great many more Pushes, and those greater in bulk, and not dissol∣vabe

without Suppuration. When the Small Pox precede, there follows not only an Immunity afterward from the same Affect, but for the most part from the Measles also. The Measles, because they con∣sume only a few Particles of the Ferment, leave still a Disposition to the Small Pox; wherefore, old Persons, or such as are grown in years, are not so readily infected with the Measles, because having been be∣fore infected with the Small Pox, they are freed from the Contagion; or their Spirits being robust, easily resist the light Miasm of this Af∣fect.

Of the great number of Stories and Observations relating to Persons troubled with the Small Pox, I shall in this place propose only a few Cases, and those remarkable for certain Irregularities.

It is usuall thing to treat all Persons, affected with the Small Pox, with the like, or wholly the same method of Healing, and form of Diet; wherefore, a Physician is seldom call'd to the Vulgar, but the Business is wholly committed to certain Women-Tenders, who boast that they know this Practice beyound all others; and those are wont to boyl Marygold Flowers, and Shavings of Harts-horn, and sometimes Figs in the Broaths, and any other Liquors to be taken by the Diseas'd, and to give at Night a Bolus of Diascordium: such as do not recover by such a Management, are declared not to be neglected, but that they are incurable through the Violence of the Disease. But that this kind of Practise does not equally agree to all, nor is to be us'd to all indif∣ferently, the two following Relations plainly shew.

A Young-man about twenty Years of Age, of a thin Body, and hot Temperament, began to be severish in the beginning of the Spring: in the first days violent Vomitings, an Oppression of the Heart, fre∣quent Changes of a burning and cold Shivering, a Pain in the Loins, a Perturbation of the Fancy, and Watchings, infested him: On the third day the Small Pox appearing, those Symptoms remitted, tho the Fever still continued with a Thirst and Heat. To this Person, not on∣ly the Decoctions usual in this Disease, but Juleps also, neatly prepar'd not so much as sip of them without great loathing: as often as he took at Night Diascordium, or any other temperate Cordial, tho in a small quantity, for continuing a Transpiration, he passed the Night follow∣ing without Sleep, and with a great tossing of the Body, and in the Morning he had an Haemorrhagie, which hapning once, and then a second time through this occasion, after that the Small Pox were fully broken forth, the well-doing of the Diseas'd was mightily endan∣ger'd; wherefore, when I had found by Experience, that the Blood of this Person was apt to boyl immoderately upon a light Irritation, I ordered this Method, according as the Occasion required: All Physick whatsoever being laid aside, for quenching Thirst he took small Ale, and a simple Almond Drink at Pleasure: His Food, because he refus'd

all Oat and Barley Broaths, was only Apples boyl'd to a Tenderness, and then season'd with Sugar and Rose-water, which he ate at some certain times in the Day. Nature, content with this thin Dyet, and seeming to be disturbed by any other whatsoever, perform'd her work successfully, that the Diseased recovered without any sore Symptom afterward, the Small Pox ripening by Degress, and then falling off of their own accord.

In the midst of Autumn of the last Year, a noble Youth, having a sharp Blood, and being obnoxious to a frequent Bleeding at the Nose, fell sick of the Small Pox; his Blood naturally boyled immoderately, that the Pushes brake forth extream thick all over his Body: in this Person, Whey with Marygold Flowers, and other things usually boyl'd in it, also Juleps, or nay Cordials (tho temperate) gently promoting a Transpiration, did most certainly raise a Flux of Blood; wherefore I ordered him a like way of Diet as to the Diseased before mention'd, by which indeed he was better: however, in the very height of the Disease, (when, the Small Pox being fully broke forth, the Fever is wont to be renewed in all Persons by reason of a difficult Transpirati∣on) this sick Person fell into a copious Haemorrhagie; that after a large Profusion of Blood the Small Pox began to be flaccid; after that a great many Remedies for stopping Blood were tryed in vain: at length, upon hanging a Bag about his Neck (in which was a Toad dryed in the Sun and pounded) he first of all, and immediately, found ease; for the Haemorrhagie being hereby presently appeased, and not returning afterward, (he constantly wearing thenceforward this Epitheme in his Bosom) our sick Person using always a most thin and cooling Dyet, grew perfectly well: that it may really seem to be manifest hence, that tho the Blood in this Affect be mighty apt to coagulate, yet as long as the Vital Spirits are strong and robust enough, and have a go∣verning Power, relying on their own Strengty, by a certain prudent Discretion as it were, they excellently separate and send forth the congealed Portions of the Blood; and this Work is mightily disturbed when the same Spirits are to much irritated, and forc'd into a Con∣fusion by hot Cordials or a hot Dyet. But in the Plague it happens otherwise; for, in this, if delay be granted, the Spirits themselves are presently destroyed by the Venom: wherefore, here we must pre∣sently fight with open War; whereas, in the Small Pox a Physician ra∣ther restores things by protracting time.

Concerning letting Blood just upon the coming forth of the Small Pox, it is greatly doubted. Formerly, among our Country-men, this thing was stil'd sacred, nor was Blooding wont to be admitted under any pretext of Necessity: but of late it is proved by Experience, that it is altogether useful and necessary to let Blood in some Cases; which Evacuation, nevertheless, if it be used indifferently in any Constitution, or be done in too large a quantity, when there is need of it, great Da∣mages often ensue thereby.

Some years since, I went to see a Young-woman of Quality, of a florid Countenance, and a hot Temperament, who was fall'n very fe∣verish after the fourth Month of her being with Child: she was press'd with a violent Vomiting, a fierce Pain in the Loins, and also with a most intense Heat and Drought: her Pulse was very quick, with a strong and vehement Vibration: tho the Small Pox no where reign'd in that place, nevertheless, those Symptoms of that Affect gave us no small suspicion of them. Be it how it would, the very immoderate Effervescence of the Blood indicated, that some ought to be taken away: wherefore, I presently took about six Ounces; thereupon the Heat somewhat remitted, tho the Vomiting still continued, with the violent Pain in the Loins. At the time of her going to rest, I gave her a Cordial Bolus with half a Grain of our Laudanum, whence a qui∣et Sleep, with a mild Sweat, and an appeasing of all Symptoms, en∣sued. The next Morning the Small Pox brake forth, which, tho the Diseassed had very thick, yet without any dangerous Illness, or fear of Abortion, she recover'd, and perfectly compleated her Child. bearing.

In the last Autumn, a robust Man, of an Athletick Habit of Body, tho of a pale Countenance, and a cold Temperament, fell into a Fe∣ver. On the second day he was tormented with a Heat and a Drought, and a most violent Pain in the Loins; when, it was ordered that he should be let Blood in a small Quantity: a Quack Chirurgion being called, he took from him almost a pound and a half; a little after, the Diseased began to fall all into a cold Sweat, and his Strength fail∣ing on a sudden, to be seised with a Shivering, a weak and uneven Pulse, and a frequent Fainting: being called at this time, I ordered him temperate Cordials to be taken frequently: then upon the resto∣ring of his Pulse and Spirits the Fever was renewed, which afterward held the Diseased for many Days, nay Weeks, after a very irregular manner; for he was wont, for three or four days, to be very hot, also to be infested with Thirst, Watchings, a Head-ach, and other Symp∣toms, afterward to fall into a copious, and as it were, critical Sweat, all over his whole Body, by which indeed, in half a days time, he found himself better, tho afterward the Fever renewing again, fre∣quently heaped together a new Matter, still to be blown off by a second, and afterward by a third Crisis. After that he had lay'n thus irregular∣ly feverish for at least twenty days, at length the Small Pox broke forth here and there in each part of the Body, and then the Fever first be∣gan wholly to remit; tho within a few days, by reason of Errors com∣mitted in Diet, a great many Pushes subsided again, a few only being brought to a Ripeness: however, in the place of the subsiding Small Pox, a mighty Bubo grew behind the right Ear; which being suppu∣rated and broken within a short time, a great store of Pus flowed forth for many days; and so at length, the Taints of the Blood hardly

to be blown off other ways, were sent forth by degrees, and the Dis∣eased perfectly recovered his Health.

CHAP. XV. Of Fevers of Women in Child-bed.

VUlgar Experience abundantly testifies, that the Fevers of Wo∣men in Child-bed are very dangerous, above the Nature of our common Fevers: also it clearly appears from the Signs and Symptoms of them, duely considered, that the same very much differ as to their Essences, from a Synochus both simple and putrid: wherefore I have thought it not amiss, after malignant Fevers, to treat of the acute Diseases of Women in Child-bed, as being very much al∣lied to them by reason of their Mortality. But before I shall set up∣on the Explication of the Affects themselves, we must consider their Subjects, to wit, the Bodies of Women that bring forth Children af∣ter what manner they are predisposed, and with what Apparatus they become obnoxious to those kinds of Diseases.

Concerning this, it first occurs, That to undergo a Flux of menstru∣ous Blood belongs to Humane Kind, and that alway to Women; con∣cerning the Nature and Origine of which, it does not concern us here to enquire; but it may suffice to note, that in them the Particles of the Blood to be voided periodically, are very fermentative, which if they are retain'd in the Body beyond the usual Custom of Nature, they oftentimes become the Cause of many Sicknesses; still excepting, if the Woman has conceived with Child; for all the time of Child-bearing the Menses stop without any great damage: and mean while, for the Nourishment of the Foetus, Milk, or a nourishable Humour, is deposed in a great Plenty about the Placenta of the Womb: but, after Delivery, that long Suppression of the Menses is recompenc'd by a copious flowing of the Lochia, and the Milk, within three days space, leaving wholly the Womb, flies plentifully into the Breasts; at which time, Child-bearing Women are wont to be set upon by a small Fever: and if the Milk be driven from the Breasts, it restagnates again towards the Womb, and is voided forth together with the Lochia under the form of a whitish Humour. Mean while, after Delivery, the Womb it self undergoes various Affects, for often its Tone is injur'd, its Unity is dissolv'd, and a great many other Accidents are caused, which ren∣der Women in Child-bed subject to a dangerous Condition: where∣fore,

that their acute Diseases may be duely explicated, we must chiefly consider these three things; to wit, first concerning the Nourishment of the Foetus, or of the Generation of Milk, both in the Womb, and in the Breast, and of its Metastasis from either of them into the other. Secondly, of the Purgation of the Maternal Blood, or of the flowing of the Lochia after the Menses being long supprest. Thridly, or the State of the Womb after Delivery, and of its Influence on other parts of the Body. And these things being premitted, we shall speak of the Fevers of Women in Child-bed; to wit, both the Lacteal, and that called Putrid, which, by reason of its Mortality, deserves to be call'd Malignant.

First, the Milk and nutritive Humour, heap'd together in the Ute∣rine Parts for the Nourishment of the Foetus, are by Nature alike, tho they differ somewhat in Consistency: the Milk indeed is the thicker, because, being to be received in the Mouth, it ought to be digested in the Stomach, and afterwards its more tender Portion to be convey'd into the Mass of Blood. The other nourishable Humour is more thin, and like to distill'd Water of Milk, because it's immediately infused into the Blood of the Embryo, by the umbelical Vessels, without a previous Digestion. Both Juyces are thought to consist of the Chyle fresh made in the Mothers Stomach: that which is deposed in the Breast is grosser and whiter, by reason of the course Strainer, and its Coction in the greater Glands; it happens on the contrary in the Womb, where the straining is closer, and the Glands are very small. Now it is greatly disputed among Authors, by what Ductus's that Hu∣mour is conveyed both into the Breast, and into the Placenta of the Womb. Some say that the Milk is engendred only from the Blood freely concocted in the Glands, which nevertheless does not seem pro∣bable, by reason of the immense Spendings of Milk which does not con∣sist with the Blood. Others affirm, That the Chyle, or Lacteal Hu∣mour, is conveyed immediately into both Receptacles from the Viscera of Concoction through occult Passages, without any Alteration. But till those Ductus's appear, it seems more likely to me, that from the Food taken into the Mothers Stomach, a Portion of the Chyle thence made is presently absorbed into the Veins, which having gotten the Vehicle of the Blood, and being brought by the Arteries into the Glands destinated here and there for receiving it before it is assimilated, and being separated, is depos'd again from the Mass of Blood.

Secondly, as to what regards the Menses, supprest during the time of being with Child, and the Lochia plentifully flowing after Child∣birth; we say, That after the Foetus is conceived, the Menses are stopt by Divine Appointment, because their flowing often brings Abor∣tion; and in regard the Vessels are emptied by a continual Exsudati∣on of the nutritive Juyce into the Parts of the Womb, the Mass of Blood does not easily arise into Turgescencies to be appeased by a

monthly flowing. For the same reason, the Menses for the most part are stop'd as long as Women give suck to Infants: in some happily, endowed with a hot Blood, the Menses flow both in the Time of their being with Child, and giving Suck; but that is wont to happen but rarely, and not without damage: tho in the mean time the Menses, stopt while Women are with Child, because far less of the nutritive Humour at that Time is imployed for Milk, deprave the Blood much more than the same are wont when restrained during the Time of gving Suck: nay, from those being long supprest in the first State, a venemous Taint, as it were, is communicated to the Mass of Blood; which, unless it be purg'd off, presently after Child-birth, by a long flowing of the Lo∣chia, it produces sore and very malignant Affects; wherefore, to give my Opinion of the flowing Lochia, I say, that that Haemorrhagie immediately proceeds from those Vessels being broken by which the Placenta sticks to the Womb, and that by this way the Blood and excrementitious Humours, partly heap'd together about the Womb during the Time of being with Child, and partly flowing from the whole Mass of Blood, are evacuated; to wit, whilst the Womb, first swoll'n in a Bulk, falls presently after Delivery, and is contracted into a less space, the Blood is copiously express'd from the Vessels that are open in it. And more∣over, in as much as during the Suppression of the Menses, the Mass of Blood is imbued with very fermentative Particles, assoon as after Child-birth the Mouths of the Vessels are open, presently, as tho a large flowing of the Menses were at hand, the whole Blood ferments, even as new Wine in a Bottle opened, and endeavours to purge from it self the extream fermentative Particles, by a flowing of the Lochia, as it were, by an Efflorescence; and therefore, besides the Blood, which in the first days, by reason of the Vessels being newly opened, often flows forth pure; afterwards very discoloured Ichors, to wit, livid, or green, and those very stinking, are voided forth. This kind of flowing is wont to continue for fourteen days at least, nay, in some, for a month; and if by reason of any Errors it be stopt before the Mass of Blood be cleansed enough by such an Efflorescence, presently a very dangerous Fever, with a horrible Apparatus of Symptoms, is wont to be caused.

The third Consideration, previous to the Doctrine of the Fevers of Women in Child-bed, chiefly concerns the Womb it self; to wit, how it's affected after child-birth, and what kind of Influence it has over other Parts of the Body. As to the first, there are two Accidents chiefly on which the acute Diseases of Women in Child-bed much depend; first, the setling of the Womb, or the Reducement of it to its natural Site and Magnitude from the Bulk of Ingravidation: second∣ly, A Solution of its Unity within its Cavity, by reason of the Conne∣xion of the Placenta being broken. When the Foetus is deposed with its Envellopings, presently the sides of the Womb it self, before great∣ly inlarged, fall together, and contract themselves by degrees into a

narrower space, by the help of the Fibres: By reason of this kind of Contraction the Blood and Ichors are copiously exprest from the Ves∣sels and Pores of the Womb, and are voided forth with the Lochia; but sometimes it happens, by reason of preternatural things contain'd in the Womb, as are a part of the Secondine, a Mola, Clots of Blood, &c. even tho after a laborious Delivery, a Contusion, or great Dila∣seration happen, that the Womb does not duely contract it self, but the Motion of the Fibres being inverted, ascends upwards, and is rai∣sed into a Lump; also the Membranes being affected with a Twitch∣ing, it is still assail'd with Tortures, as tho the Throws of Child-birth were in being; which kind of Affects, if they continue for some time, by reason of the Orifice of the Womb being constringed with a Con∣vulsive Motion, the Lochia also are often stop'd: hence severe Symp∣toms ensue; and oftentimes it happens, that a Fever either thereby is first raised, or being induc'd by some other cause, is rendred far more dangerous. Secondly, as to the Unity dissolv'd by the Placenta being broken, it happens either at the due Time of Delivery, or when it is precipitated and over-hasty; and then the Secondine is thrown out en∣tire, or being broken, part of it being left behind, it comes away as it were at halfs. If a Child-birth happens at the just time, and the Foetus falls away entire, and without Violence, from the Cavity of the Womb, with its Envellopings, as ripe fruit from a Tree, the Mouths of the Vessels are somewhat opened, that the Lochia flow moderately; and hence no severe Symptom is feared. But if the Foetus, not yet ripe for Delivery, be torn away as it were by force, tho the Placenta, with the Membrances are torn away entirely, yet the Vessels being broken, a great Haemorrhagie, and at length the Mouths of the Vessels gleeting forth a stinking Ichor, an ulcerous Disposition ensues. And if part of the Secundine or the whole, sticks to the sides of the Womb after Deli∣very, and there putrifies, they gleet forth very stinking Ichors, and cause mischievous Affects: oftentimes the Orifice of the Womb is shut, and retains within Clots of Blood, and pieces of Membranes, or Flesh; which putrifying through Hear, Poyson the Blood, and Humours flowing thither by Circulation from the whole Body, and by a'trouble∣some Irritation stir the Parts of the Womb, which are very sensible, into Contractions.

Since therefore, after Child-birth an Injury is brought on the Womb after the foresaid Manners, the same is soon communicated to the other Parts, not without a Disturbance to the whole Body; which is usually done in a double Respect; for first, this happens, because the Lochia, hindred from being voided forth, presently restagnate into the Mass of Blood, and defile it with a sort of virulent Miasm. Moreover, from the Contents putrifying in the Womb, either the Substance it self of the Ichor, or the Particles departing from the cadaverous thing, are mix'd with the Blood and nervons Juice, passing through them, and in

a short time infect their whole Liquours, Secondly, Histerick affects are extended far and near by reason of the mighty accord there is be∣twixt the Womb and the Brain, with the Fibres and Membranes of the whole Body, by the means of the Conveyance of the Nerves: for when the extremities of the Nerves plac'd about the Uterine Parts are driven into Cramps and Convulsions by reason of the presence of the offensive Humour, the Convulsions there entred upon, presently being conveyed upward by the Efforts and Coarctations of the Nerves, creep toward the Brain: and so it happens that the Viscera are suc∣cessively pust up, and violently convuls'd, and at length that the Brain it self is struck with it, and that its Functions are overwhelmed as it were: hence, upon convulsive Motions began about the Womb, a puf∣fing up of the Belly and Hypochondres, a rumbling there, 'a Vomit∣ing, a Belching, a straightness of the Praecordia, and a difficult Breath∣ing, a sense of Choaking, and often a Stupor, and a loss of Speech, or at least some of these are caused: nor does the Tragedy wholly cease so, but the Brain being also offended by the continuation of the affect, the Injury is retorted thence on the other Parts, that often the whole Genus Nervosum is forc'd into Irregularities of Motions: for what is vulgarly said to be done by Vapours, and the affect, which creeping from below upward is called an ascent of Vapours, is nothing else, but the parts of the Membranes and Nervous ductus's forc'd successively in∣to Contractions. Moreover, in these kinds of Affects the injur'd acti∣on does not always begin, or is first felt in that Region or Place, where the Injury is inflicted, nor do the Passions which are said to be hy∣sterical only proceed from the Womb; for sometimes the disturbance is brought immediately on the Brain, but the Cramps and Contractions begin in the extream parts, and sometimes the extremities of the Nerves are twitched somewhere in the Viscera, suppose the Stomach, Spleen, Reins, no less than in the Womb; in which Irregularities arising, are continued in the neighbouring Parts, and thence into the Brain: from which again Convulsions are reflected unto other Parts, and often into the whole Body: that the thing is so in Women in Child-bed, and others that have Fevers, I have often observed: to wit, some by reason of the Womb being ill affected, and others by reason of the febrile matter fixt in the Brain by a critical metastasis fall into Passions in a manner hysterical: and these things being duely con∣sidered concerning the Apparatus previous to the Fevers of Women, in Child-bed, we need not stay here longer, only it may be observed that the Bodies of Women in Child-bed (especially those which are weak and of a tender Constitution) are very much debilitated after a laborious and difficult delivery, so that by reason of this sole occasion they easily fall into feverish distempers, and being caused this or an∣other way, they bear them ill; now next let us speak of the Fevers themselves, with which Women in Child-bed are wont to be troubled:

of which affects three kinds as it were are vulgarly instanced. viz. the Lacteal Fever, the Putrid, or of that kind which is mark'd by some borrowed Symptoms, as especially the Pleurisie, the Quinsie, or the Small Pox, of which we shall speak in order.

The Lacteal Faver.

I Am of Opinion that the milky Chyme made of the Aliments in the Viscera, and thence mixt with the Blood for a Nutritive Juyce, is again presently separated, for the greatest part, from its Mass, by the help of the Glands in the Womb, or in the Breasts, even as the Serum is in the Reins; that it might afford Nourshment to the Foetus either in the Mothers Belly, or carried in her Arms. During the time of being with Child, tho the greatest part of it be derived to the Womb, yet in the last Months, a little of it is depos'd in the Breasts, but about the third or fourth day after Child-birth, the Milk is carried to the breasts more plentifully, and as it were with a certain Impetus, that it soon fills them to a Tension, and begins to load them. At this time Women delivered (tho not all, yet most) are wont to be affected with a feverish Distemperature, a Thirst, Heat, and Restlessness of the whole Body: they complain of a sad Pain in the Back and Shoulders, of a fulness of the breasts, and a burning, and, unless the Mild be dili∣gently drawn from thence, being heapt together too much, it often causes an In flammation with a following Abscess in the breasts: This Fever, so the Lochia pass as they ought, seldom last above three days, but about that time, a copious sweat spontaneously arising, is wont to be appeas'd: yet this Distemperature raised by the coming of the milk, is somewhat intended, and stays longer, if at any time the Milk being freeely entred into the Breasts, be not drawn away, but be again repell'd thence; for upon its departure, even as upon its com∣ing, a perturbation is wont to happen in the whole body, with a Thirst and Heat, whcih also more certainly comes to pass, if that happens to be violently driven away with repelling Topicks: but being driven from the breast by their help, or departing thence of its own accord, it is voided with the Lochia in the form of a whitish Humour, and a Sweat, or a full perspiration exterminates the reliques of the Disease. But if by this kind of distemperature, being caused by reason of the com∣motion of the Milk, the Lochia are stopt, or errours in dyet are commit∣ted, or some evident cause happens. so that the effervescence of the blood be intended, often the Lacteal Fever, joyning to it worse Symptoms, turns to a Putrid or Malignat.

The Cure of this Fever is committed wholly to Nuture, and as long as the Lochia are as they ought, it passes off for the most part well enough without any physical Help: for after an effervescence of the Blood, carryed on for three or four dayes, either a copious Sweat, or a free Transpirations, resolves this Affect: to wit, either the Parti∣cles of the lacteal Humour, degenerated in assimilating, or the adust Recrements remaining after the Deflagration of the Blood, or both of them together administring a Fuel to the Fever, are subdued by degrees, and evaporated forth, which being sent forth, the Blood being become free from its extraneous mixture, soon recovers its former state, tho in the mean while some vulgar Rules concerning the admission of the Milk, or thedriving away of the same from the breasts, are wont to be observed. If the Milk springs into the breasts in too great a plenty, then to prevent their Inflammation, and an immoderate effervescence of the Blood, let the dyet be thinn and spare, viz. of Broth wthout Flesh, and in a small quantity: also let the breasts be emptyed by a fre∣quent sucking: if it be not convenient for the Mother to give the In∣fant suck, it is usual on the first, or third day after delivery, to cover over all the brests with gently astringent Cere-Cloths, as withthe red Lead Plaister, &c. For so the spungy Substance of the Glands is some∣what constring'd, whereby they do not so readily receive the lacteous Humour flowing thither, tho this kind of Remedy ought to be cauti∣ously us'd, lest if the Milk be wholly excluded, or be driven away from the breasts too much in a croud, presently restagnating into the Blood, it causes a disorder of the same; as a forerunner of a putrid or malignant Fever: of which we must speak next.

The Putrid Fevers of Women in Child-bed.

WOmen in Child-bed, throught the taint of their ill affected Body, as tho they were struck with the Contagion of a pestilential Air, are found to be extreamly obnoxious to a putrid or rather malignant Fever, tho all do not equally receive tha taint of this Disease; for poor Women, Hirelings, Rusticks, and others us'd to hard Labours, also Viragoes, and Whores, who are clandestinely delivered, bring forth without great difficulty, and in a short time after, rising from their Bed, return to their wonted Labours: but Women that are rich, tender and beautiful, and many living a se∣dentary Life, asa tho they partak'd of the Divine Curse after a more severe manner, bring forth in Pain, and presently after their delivery lye in an uneasie and dangerous condition: the reason of which seems to lye in this, that those that use much exercise, continually exagitate, and eventilate the Blood, and therefore after the Menses are stopt, heap

together fewer Miasms for the matter of the Disease; Moreover, labour∣ing and active Women, having the nervous Parts more firm, are less subject to convulsive Mothions, and the affects vulgarly called hysterical: on the contrary, in nice Women, and such as live idly, during the time of their being with Child the mass of Blood becomes impure and fer∣mentative: moreover, because they have the Brain and the System of the Nerves thender and weak, upon any light occasion they undergoe Distractions of the animal Spirits, and disorderly Motions of the nervous Parts: and here it is to be noted by the by, that Women before Men, and some of that Sex before others, are troubled with the Affects called hysterical, not so much by reason of the fault of the Womb it self, but by reason of the weaker Constitutions of the Brain and Genus Ner∣vosum: for in Perons so affected, Passions of Anger, Fear, Sadnes; also all vehement or strong Objects easily pervert the Crases or Functi∣ons of those parts, which when they have been once injur'd, day af∣terward in a manner always accustom them selves to the same Irregula∣rities. But to return whence we made a digression: the Fever even now mentioned is wont to infest Women in Child-bed, at various thimes, and for diver Occasions; sometimes it arises presently after delivery, especially if it has been difficult and laborious, sometimes the second, third, or fourth Week; tho the later it begins, the safer it it is wont to be; the Type of that effect passes after this manner: after a previous indisposition an open feverishness for the most part with a cold and a shivering makes the first invasion, which presently is follow∣ed by a heat, afterward a sweat ensues for a day haply or two, there are various reciprocations of Fits of heat and cold: afterward, the Blood being kindled throughtout, the Lochia, unlefs supprest before, either flow a little, or wholly stop. If the Disease be acute, and of a quick motion, on the third, or fouth day it comes to its height, then there is an intense heat, with a very troublesome drought, a ve∣hement and quick Pulse, there are obstinate Watchings, a great rest∣lessness of the whole Body, so that the Diseased continually toss them∣selves this way and that in their Bed, the Urine is thick and ruddy, and other severe symptoms are rife: whilst the Fever is thus in its height, a Crisis is not to be expected; for I have never seen this Di∣sease resoled by a critical sweat; nay, the case is very dangerous, so that after the Blood has boyl'd for some time, the adust matter pre∣sently being convey'd into the Brain, dangerous and very sore Irregu∣larities of it, and of the Genus Nervosum straitway ensue, for convul∣sive Motions of the Tendons, wonderful distentions about the Viscera, and puffings up, resembling hysterick Passions, oftentimes are raised: Moreover, sometimes a Phrensy, a Delirium, often a Stupor and a Speechlessness also follow; almost in all the strength is suddenly cast down without a manifest Cause, tyhe Pusse becomes weak and uneven, and the Diseased are often precipitated into Death: if any haply es∣cape,

either the flowing of the Lochia being restor'd, or a Diarrhoea superventing, they recover with much adoe after a long lying ill: I have known purple Spots to have appear'd in some; indeed in most the symptoms which regard either the Blood or the nervous Juyce, argue no small malignity.

The Procatarctick Causes of this Fever, on which the malignity and mighty danger of this Disease depend, are chiefly two; viz. first, an evil dispostion of the Blood, after a long suppression of the Menses: secondly (after delivery) the evil affects of the Womb from the dangerous labours of Women (which make out the Divine maledi∣ction:) after the Menses being long supprest, the Blood does not on∣ly grow turgid, and its sulphureous parts being rais'd too much, are rendred more apt for Inflammation, but moreover, the mass of Blood is imbued with very fermentaive Particles, so that (as is hinted be∣fore) being struck as it were with a venemous Miasm, as it ferments, it forthwith is dispos'd toward a putrefaction and corruptive irre∣gularities, and besides, it may presently poyson the nervous Liquour, and render it offensive to the Brain and the whole Genus Nervosum: this kind of taint communicated to the blood, ought to be purg'd forth by a copious flowing of the Lochia; but if after delivery the Womb be out of order, their is not only a stoppage of the Lochia, and so the Reparation of the whole blood is hindred, but besides, stinking Ichors are thence transmitted to the blood, and greatly infect it. Also by rea∣son of convulfive motions begun about the Womb, and thence conti∣nued to the other Parts, Irregularities are rais'd in the Blood and Juyces, whcih often conspire to the production or exasperation of a Fever.

The evident Causes which either cause an actual effervescence in the Blood, having gotten a Dyscrasy, or trouble the whole Body with the Distempers of the Womb are divers; for these make a painful deli∣very, a solution of unity about the Womb, a contusion, a retention of preternatural things, an ulcerous disposition, and a great many other Accidents, which are caus'd throught some necessity; but the occasions in the power of Patients, and easie to be avoided, which are wont to raise this Fever, are chiefly two; viz. an ill form of Dyet, and a taking Cold. It's a usual thing to give to weak Women after Child-birth, on the first and second day, the Flesh of Animals, or their Gelly-broths, and other Food very disproportionate to their Constitutions; whence presently an indigestion and great disquietings arise in the Viscera, and feverish turgescencies in the Blood, by reason of a nutritive Juyced richer than it ought. Befides Errours commit∣ted in Dyet, often an Injury is Caus'd, for that their Bodies, which are very tender, and by reason of the Labours of Child-birth, and the Ex∣clusion of the Foetus, are all full of open Pores, are too unwarily ex∣pos'd to the open Air: for most, being impatient of their Bed, put on

their Cloaths, and rise from it within a day or two, or sooner than they ought: thereby presently the Pores of the Skin being presently stopt, and the Air getting into the Uterine Parts, tanspiration is check'd, and often the Lochia are suddenly stop'd, either of which suffices to raise a feverish effervescence.

The conjunct Cause, or formal Reason of this Distemper, compre∣hends chiefly these three things; to wit, there are present, first a mighty Dyscrasie of the Blood, that growing very hot from a Fever occasionally rais'd, it does not burn evenly, nor does is subdue by degreeds the adust Recrements, and purge them forth critically; more∣over, the boyling Blood is presently loos'ned in its Mixture, and its Texture being loos'ned, it declines toward Corruption; hence when it has a little abated of its Heat, the Spirits, being cast from their Go∣vernance, are driv'n into Confusion: mean while, the sulphureous Particles become masterless and exorbitant; wherefore the Strength fails without a manifest Cause, the Pulse becomes weak and disorderly. Tho from the Deflagration of the Blood a great many adust Recrements are heap'd together, yet nothing is duely concocted or separated; but Nature being greatlyopprest, altho the Diseased continually sweat, they often receive no ease thereby: but the Febrile Matter, which ought to be purged forth, being conveyed into the Head and Genus Nervosum, causes there very sore Perturbations of the animal oeconomy. Second∣ly, The Tragedy of this Disease, for a good part of it, is ascribed to the nervous Juyce forthwith turning sharp, and therefore rendred dis∣proportionate to the Brain and its Appendix; for this being defiled with a Taint contracted from the Blood, does not gently irrigate and mildly inspire its Subjects, but (as when an Infusion of Vitriol is pour'd on a Worm) mightily vellicates, and irrtates into Contrqactions, and as it were into Motions of Trepidatons and Leapings those tender Parts, and sometimes wholly overthrows their Functions: hence Con∣tractions, severe Convulsions, a Delirium, Watchings, sometimes a Stupor, and sleepy Affects, happen to Women after Delivery. Ihird∣ly, whilst these things are done, often a third Troop of Symptoms in∣fest the Diseased; to wit, for that the Womb, being some way hurt, moves it self disorderly, and is struck with a Contraction in these or those Parts; thence presently by the Membranes nad nervous Ductus's convulsive Motions pervade the whole Region of the Abdomen, where∣fore the Viscera and Hypochondres are blowen up, Belchings and vio∣lent Vomitings are raised; afterward the Affect creeping upward, and possessing the nervous Parts of the Thorax, a difficult and uneven Breathing, a Palpitation of the Heart, a sense of Choaking in the Throat, by reaon of the Muscles there drawn together, and other Symptoms are raised throughout the whole, upon the same Injuries being communicated to the Brain.

The Fevers of Women afte Delivery, are scarce ever free from danger, tho sometimes it happens for them to be cur'd about the first beginnings, by a thin Diet, and upon restoring the flowing of the Lo∣chia: but if the feverish Distemper has laid deep Roots, that the Blood be wholly kindled, and boyls immoderately, we can give but an ill Prognostick; and there will be a greater Cause of Danger, if be∣sides a Heat diffus'd through the whole, the Diseased are seised with a frequent Shivering, if they are affected with a great Restlessness, and Watchings, with sudden Concussions of their Bodies, or Contra∣ctions of the Tendons: if on the third or fourth Day they complain of a ringing of the Ears, with a great Repletion of the Head, you may presently gather, that a great Evil is at hand, to wit, a Mertastasis of the febrile and offensive Matter into the Brain; nor is less to be feared if there lyes an Oppression and Load on the Praecordia that the Disea∣sed cannot freely breath, nor draw their Breath deep, nor form the bottom of the Thorax; but only from the upper part of it, and that short and with a Blowing, so that in the mean while the Diseased are forc'd to fit upright, and to move themselves this way and that, after a restless manner; for this argues the Blood to stagnate about the Heart and Lungs, also that it is apt to grow clotty, and to be coagula∣ted: and if worse yet Affects of the Brain and Genus Nervosum ensue, and the Pulse becomes weak and uneven, you may declare the Case to be desperate: but if (as if sometimes falls out, tho rarely) after a Fever is kindled, and threatens severely, either a flowing of the Lochia, or a Diarrhoea happens with Relief, some Hope may be admitted.

Concerning the Cures of these kinds of Fevers, a Physician has a ve∣ry hard Task; because, among the Vulgar, all Medicines to Women in Child-bed are accounted not only useless, but likewise very hurtful; wherefore, Physicians are selfom called, but when there is no place left for Medicines, and the occasion for a useful Assitstance is wholly past: and if they are present about the first beginnings of the Disease, it will not be an easie thing to procure Health to the Diseased by vul∣gar Remedies; and whatsoever they try, unless it gives Help, is af∣firmed by old Women, and those that are about them, as pernicious, and the only Cause of their Death: that in reality, there is wont to accrue to us about the Cure of no Disease, less benefit and more Dis∣grace than of this.

Now the method of Cure (even as in contagious Diseases) is twofold; to wit, Prophylactick and Therapeutick: the former of these delivers Precepts and Cautions, with which Women in Child-bed are preserved from the Incursion of Fevers; the other suggests curative Intentions, with which the Diseased (if it may be) recover again their Health.

1. Tho this Fever, however malignant it be, is not accus'd of Con∣tagion, and there be no fear in those that lye in, of a venemous Miasm being received from without; nevertheless, all Women in Child-bed

have an innate Minera of Virulency, and ought to have a care of the mischief of this, as a Fomes of a mighty Malignity; wherefore they have need of an exact Governance, that after Child-birth the Impuri∣ties of the Blood and Humours may be duely purg'd without the danger of a Fever; and that the evil Affects of the Womb be healed; and that the Strength, broken and debilitated by Child-birth, may be duely restored. For these ends, these three things are to be chiefly inculcated in the Praescripts of Physicians: First, I think it necessary that a most exact form of Diet be ordered Women in Child-bed; to wit, that at least for a Week they wholly feed on Oat Broths, sometimes prepar'd with Ale, sometimes of Water mixed with White-wine; because they are much emptied, therefore they may sup often of them; but let no∣thing of a solid or strong Food be given; for I have diligently observ'd that an over-hasty eating of Flesh, or of a rich Food, has oftentimes brought these Fevers. For, Women in Child-bed ought to be ma∣naged not only as Persons sorely woulded, but as having gotten a fe∣verish Indisposition from a troubled Crasis and Distemperature of the Blood; for in them, the Blood being for a long time too much exalt∣ed and inspired with an impure Miasm, presently upon the Access of any sulphureous Fuel, takes a light Flame. The second Care, after Diet, must be, that the Pores be not clos'd, or the Lochia stopt, upon the unwary Admission of an outward Cold; for upon the lightest oc∣casion, the way of the Transpiration being chang'd, the Blood, before fermenting, falls into Disorders, also the Womb being touch'd with the breath of the Air, contracts it self, and closes the Mouths of the Ves∣sels, that the Lochia do not flow: wherefore in any wise Women ought to be kept in Bed five days after Child-bearing. I know its the vulgar way to take Women out of Bed the third day, but I have known many to have fall'n into Fevers thereby; and in truth, if we will have Child-bearing Women secure from danger, the safest way will be, to keep them in Bed longer. There remains a third Scope concerning Preservation, that in Women in Child-bed, by giving somewhat gently to stir the Blood, we continue a flowing of the Lo∣chia: for this end Midwives are wont (if at any time after a difficult Child-birth that Evil be fear'd) to give Sperma coeti, Powder of Irish Slate, or Saffron steep'd with White-wine: moreover, to pre∣pare Broths, that they may fuse the Blood more, of Water mixed with White or Rhenish Wine, in which, or also in Whey, they boyl Mary gold-flowers, Penny Royal, or Mugwort. There are a great many other kinds of Administrations in use for Women in Child-bed, which I willingly pass by, as being valgarly known.

The Cure of the Fever following Child-birth far differs from the Method used in Putrids: for in that it is not to be expected that the Blood being struck with a Febrile Burning, should burn on by degrees and then should subdue the adust Recrements heap'd together by de∣grees

in its Bosom, and should separate the same by a Crisis; but ra∣ther (as is best done in a malignant) assoon as the Blood boyls immo∣derately, it is good to exagitate it, and to send forth its haeterogene∣ous and impure Mixtures by Remedies gently promoting Sweat; wherefore it is usual among the Vulgar (and that not amiss) to give presently Sudorificks to Women in Child-bed that are feverish: by this means the Blood being eventilated, its Effervescence is appeased; also by reason of its Agitation, the Lochia, apt to be restrained, are stimulated to a flowing. It is much disputed among Authors whence the Beginnings of these kinds of Fevers ought to be computed; to wit, Whether from the Birth it self, or from the first Sense of the Fever∣ishness: but it little matters whether it be concluded this way or that; for, since this Fever does not justly observe the wonted Stages of Pu∣trids, nor is to have a Crisis, nor at all admits the use of a Cathartick Remedy, there is no cause for us to be any ways sollicitous concerning its Period or Mensuration as to days: but it will be only useful for us to distinguish concerning its curative Indications, of what things are to be done in the Beginning, Encrease, and End of this Disease; what also we ought to attempt while the Strength holds somewhat good; and what in the same being depressed and greatly dejected.

When therefore any Woman brought to Bed is first affected with this Fever (whose Invasion is distinguished from the Lacteal, because it begins for the most part with a cold Shivering) presently we must en∣deavour that the Fewel be plentifully withdrawn from the burning Blood; and, as I have advised above, let the Flesh of Animals, or Broths made of the same, be wholly forbidden: for these fix the Blood, and constipate it too much, and hinder its purging, which is very necessary both by the Lochia, and by cutaneous Transpiration: and rather, tho the Fever be pressing, let Decoctions, Powders, and Confections, be given of moderately hot things: of this kind (as I said before) are the Decoctions, or distilled Waters of the Flowers of Marygolds, of the Leaves of Penny-royal, of Mugwort, of the Roots of Scorzonera, also bezoartick Powders, Spirit of Harts-horn, the fixed Salts of Herbs, &c. If the Lochia are stopt, we must try all ways to move them to flow again; for promoting these, Frictions conduce, and Ligatures about the Thighs and Legs, also in the Soles of the Feet, sometimes cupping Glasses, or Vesicatories about the Thighs, or Hips, also in the Soles of the Feet; sometimes also Blooding in the Ancle is good: mean while, let a Fomentation of an hysterick Decoction be applyed about the Share, or let a Weathers Caul, taken forth warm, be laid on the lower Part of the Belly: it has been found by Experi∣ence, that Pessaries, and uterine Injections, have sometime done good; if the Belly be costive, let it be gently loos'ned by the Violet Suppository, or an emollient Clyster. We must beware of a too strong Irritation, because it is known, that in Child-bed the Strength is sud∣denly

cast down, with a Swooning, by a copious Purging, even as in a Malignant Fever. If at any time, with a Suppression of the Lochia, there be a mighty Perturbation of the Blood with a Vomiting, a Thirst, and Watchings, I have often known Laudanum mix'd with Saffron given with good Success. Instead of a cooling Julep, this kind of Mixture may be proper: viz. Take Water of Penny-royal, and of Bawm, of each three ounces, Histerick-water two ounces, Syrup of Mug∣wort an ounce and a half, Tincture of Saffron two drams, Castoreum tyed in a Rag and hung in the Glass a Scruple. Mix them. Let three or four Spoonfuls of this be taken divers times in a day.

2. If, notwithstanding the use of these kinds of Remedies, the Fe∣ver still grows worse, and is increased by degrees with a worse Appa∣ratus of Symptoms, so that besides the Disorders of the Blood, the Brain and nervous Parts begin to be affected, Medicines, tho a great many of them of every kind are tryed, oftentimes can do nothing: nay, in this ease, the Indications are in a manner coincident with those that are to be made use of in the Plague it self; for, the Lochia being a good while supprest, they cannot easily, or searce at all, be brought again in a great Confusion of the Blood and Humours: therefore it is good quickly to raise a Sweat; to wit, That the Corruptions made in the Blood and nervous Juice, and restagnating from the Womb, may in some sort be sent forth by Sweat and insensible Transpiration: wherefore here Bezoartck Powders and Confections, Spirit of Harts-horn or of Soot, Tinctures of Coral or of Pearl, conduce. I have sometimes seen, that by the help of these kinds of Medicines, in a desperate Case, somewhat of Hope has shewn it self, the Pulse and other Symp∣toms promising a little better; tho the Cure has seldom succeeded: but when that use of Cordials was remitted, the Diseased fell head∣long into Death, with a weak Pulse, and a Loosness forthwith ari∣sing.

3. When still the case of the Diseased grows worse and worse, that the Fever being increased, the Pulse is weak and uneven, and frequent Shiverings, and convulsive Motions infest the whose Body, with a Delirium, or a Stupor; then let the Physician, first giving a Progno∣stick of Death, insist on fewer Remedies, and those, in a manner, on∣ly Cardiack: and let him wholly abstain from Blooding, Scarifying, Vesicatories, or the use of Cupping Glasses; for such Administrations bring only an ill-will and Disgrace, that thereby we are accounted by Women hard-hearted and cruel.

The Symptomatick Fevers of Women in Child-bed.

THE acute Diseases of Women brought to bed do not only follow the Type of the foresaid Fever, but are sometimes at∣tended with some notable Symptom; to wit, the Quinsey, Plurisie, Peripneumonia, Dysentery, Small Pox, or of some other kind; and then they are call'd by the Names of those Affects. It is not proper to repeat in this Place what belongs to the Natures and Essences of each of them at large, but I shall briefly set down what those Diseases, complicated with the Affects of Women in Child-bed, have peculiar to them, as to their Causes or Cures.

We judge that all those Symptoms proceed from a certain Coagula∣tion of the Blood, and afterward its Extravasation: now while the Blood is extravasated in one part, every natural nad critical Effiux of it is restrain'd in another; wherefore there is danger, lest while the Blood begins to be coagulated either in a particular and usual Focus of Congelation, or universally in its whole Mass, presently the flowing of the Lochia be stopt; which in reality happens for the most part, and therefore those Affects are most commonly mortal to Women in Child-bed: nevertheless, the Cause of their Death, for the most part, happens with some difference, to wit, in the Small Pox, the flowing Lochia call inward the Malignity began to be sent forth outwardly, and wholly poison with their Taint the Mass Blood and the Heart it self; and therefore in the Small Pox those uterine Purgations ought to be stopt: but in the Pleurisie, Quinsey, and the rest, when the Stimulus of the Disease, fix'd here or there in a particular Place calls to it self, and wholly derives from the Womb the Impurities of the Blood which ought to be voided by the Lochia, thereby it increases the Taint of the BLood: the Lochia restrain'd in the Small Pox might be sent forth by a more general way of Excretion, with the venemous Particles of the Disease; with indeed does not succeed in the rest by reason of the small and more spare way of Excretion.

Among these, the Quinsey, Plurisie, and Peripneumonia, by reason both of the great likeness of their Cause, and the Analogy of their Cure, may be considered together. When a Woman in Child-bed is affected with either of these, it is to be judg'd, that besides the Mi∣asms heaped together during the time of Ingravidation, there happens a certain acid disposition of the Blood, by the means of with, whilst it feverishly boyls, certain Particles of it being imbued with a sharp∣ness, fall into a Congelation in this or that place, like Milk turning sour and consequently coagulated: the Blood letted there, and hindred in its Circulation, hinders the Passage of the rest; now the Blood, being obstructed in its Motion, butts against its dam, and so being heaped

together round about, and driven out of its Vessels, grows into a Tu∣mour; thence presently whatsoever haeterogeneous and separable is contained in its Mass, is deposed in the Part affected as in a Sink: wherefore, the Corruptions of the Blood, which ought to be purg'd forth by the Womb, are deriv'd thence toward the Seat of this Dis∣ease; which since they cannot be purged forth sufficiently this way, both the Liquor of the Blood is more notoriously corrupted, and a Crisis of that particular Affect, to wit, of the Quinsey, Plurisie, or some other, is rendred more difficult.

For the Cure of these kinds of complicated Diseases, presently from the very first beginning it must be endeavoured, that the Blood fixt any where and begun to be extravasated, be restor'd to Circulation, and do not make an Impostume, because it is very rarely that Wo∣men in Child-bed, seised with those symptomatick Fevers, are cured by an Abscess or spitting forth of the Matter; wherefore, inward Re∣medies, which fuse the Blood and free it from Coagulation, are to be used; of which kind are chiefly Diaphoreticks filled with a volatile Salt, as Spirit of Harts-horn, of Soot, of Urine, and the Salts them∣selves: also testaceous and bezoartick Powders, Sal Prunella, Deco∣ctions and Juleps of Vegetables promoting the menses or the Urine; in all which those things ought to be mixt, which by Experience are found to be appropriated to uterine Affects: moreover, discussing Re∣medies, which drive away and expell the Matter stinking in the Part affected (of which kind are Liniments, Fomentations, and Cata∣plasms) are carefully to be applyed to it. Mean while, let the violent Motion, and immoderate Effervescence of the Blood be removed far from thence, and let its Excretions of Filth be conveyed still to the lower Parts, by what ways we may: for this end, Frictions, Ligatures, Epispasticks, and (if need be) cupping Glasses, may be applyed to the Feet or Legs: in case the Affect growing very much worse, blooding be indicated; unless there be a great Plethora in the whole Body, and a very acute Inflammation in the Part affected, it will be best to breath a Vein in the Foot, or to open the haemorroid Vessels with Leeches: but if necessity presses for it to be done in the Arm, after Blooding there, let another Bleeding (if it may be admitted) follow in the Leg: nevertheless, we must give a Hint, that opening a Vein ought to be very cautiously ordered in these Cases: for unless it gives Relief (which I have seldom known to happen) presently the Pulse be∣ing rendred more weak, the State of the Diseased becomes worse.

A Dysentery takes its Rise in a manner from the like Cause, as the foresaid Affects; but because in this, the extravasated Blood is pre∣sently poured forth, nor being restrain'd in the Body creates a mis∣chief there, and is still more corrupted: and since this way of Excre∣tion is performed near the uterine Efflux, and does not derive it after∣ward another way, hence less danger is feared from this Disease than

from the others before mentioned; tho oftentimes this Affect is mor∣tal to Women in Child-bed, and that the rather, because by a Dysen∣tery things that qualifie and gently astringe the Blood are indicated: and these are found too apt to stop the flowing of the Lochia: where∣fore in this case, till Women delivered are in a manner purg'd enough by a long flowing, let the Cure of the other Disease be omitted, and let the fierceness of Symptoms be restrain'd only by lenifying things.

The Indications of the Small Pox do not only differ from those ev'n now above described, but are attended by some Contrary to them∣selves; for they require the Flowings of the Lochia to be alittle stopr, (as is said before;) tho withal, that the Efflorescence of the Blood, and a gentle Sweat, be continued: for since in this Disease there is a double venemous Ferment, and the corrupted Particles of the Blood are carried forth two ways, Care is tob e taken that the less and nar∣rower Passage do not draw to it self all the Matter, or more than it can let forth: therefore, lest the Lochia too copiously flowing draw inward∣ly the Venom, which is apt to make an outward Efflorescence, the form of Dyet must be somewhat chang'd; and in the first place let things be boyled in the Broths of the Diseased, which have an Alexi∣pharmick together with an astringent Vertue (as the Roots of Tormen∣til and of Bistort,) also it is good to give at due Intervals of time, Pow∣ders, Juleps, and Opiates, endowed with such a kind of Vertue: moreover, in this Case let it by no means be allowed Women to feed on Flesh and Broths made of it, or to rise from bed; but a quiet both Mind and Body being procured by what means we may, and a Diet being ordered of those things which do not exagitate the Blood, let the business in a manner wholly be committed to God and Nature.

It were an easie thing to illustrate wlth Stories and Observations what is said above concerning the acure Diseases of Women in Child-bed; ut the Examples which may be brought in this kind, are for the most part deplorable and of an ill Event; for those Fevers generally are ter∣minated in Death. Now to describe these kinds of Sicknesses will nei∣ther confirm the Endeavour of a Physician, nor at all recommend the method of Physick used in them; however, since the Knowledge of these makes for the better Diagnostick of that Disease, I shall here propose certain singular Cases and Varieties of Symptoms of Women after Delivery; in which, tho Forms and ways of curing seldom occur, at leastwise you will have certain Rules of Precaution of no con∣temptible use.

A renowned Woman about twenty fix years of Age, was delivered of a sixth Child with great difficulty, and not without danger of Life. On the second day, she are a whole Chicken. On the third, being taken up from her Bed, she sate for four hours in a Chair. The night following she was ill, at which time the Milk sprang into her Breasts; which ne∣vertheless

soon disappeared upon the Application of the Diachylum Plaister. The next Morning she complained of a Lassitude, and a Pain like a Soreness of her whole Body, also of a Vomiting, a Nauseousness, and a Plenitude about the Ventricle and Hypochondres: a very trou∣blesome Night followed. On the fifth day she was more openly se∣verish, and felt sometimes a Shivering, sometimes a Burning all about her. She nauseated all things, had an Oppression of the Stomach, moreover, being restless, and without Sleep, the Lochia flowed but lit∣tle, but a whitish Humour (vulgarly call'd a flowing of Milk) flow'd from her. In the Evening she had a heaviness about the Fore-head and Temples, as tho she were sleepy, and began to sleep a little: af∣ter an hour and a half, awaking with a troubled Fancy, she complain'd of her Head being increas'd as it were to a mighty Bulk, also of her Jaws being closed that she could not open her Teeth, and of her Fifts being closely contracted; moreover, in her whole Body she seemed to perceive a pungitive sort of a Stupor: the Ventricle and Hypochon∣dres continued still distended and puffed up. To this Person Frictions, Ligatures, cupping Glasses, and other Remedies, both inwardly and outwardly, were applied for recalling the Lochia, and deriving the Recrements of the Blood from the Head: the weak and disorderly Pulse did not admit Blooding: Powders and Juleps for gently moving a Sweat, and fusing the Blood and nervous Juice, and hindring them from Restagnations, were diligently given. Moreover, Fomentations sometimes of linnen Cloths dipt in an emollient Decoction, sometimes of the tepid Viscera of Anirnals were applied to the lower Part of the Belly; mean while, stinking things (as is wont to be done to Persons troubled with hysterick Fits) were held to the Nostrils, for hindring the impetuous flowing of the Blood and Spirits to the Head. Now these things and others being carefully plyed for many Hours, she seem∣ed to perceive some ease, tho she still dreaded of closing her Eyes, or preparing her self for Sleep; for, her Eye lids being closed, a thou∣sand Phantasms came into her Head, with a noise, and a ringing in her whole Head. She passed the Night almost without Sleep; assoon as she began to slumber, presently being frighted, and being opprest in the Praecordia, she awaked. On the sixth day, about Noon, she had a cold Shivering, with a strong Concussion of the whole Body; to which, as in the Fit of an Intermittent Fever, presently a Heat, afterward a copious Sweat succeeded, tho no Relief hapned to the sick Person thereby: for presently after the Sweat, the feverish Heat renewed, and convulsive Affects more infested her. The Night following, when al∣so the other Symptoms grew worse, a Palsie was raised first in the Tongue, and then presently in the Throat, that she could not speak, and scarce at all swallow. On the seventh day, about the same Hour, a cold Shivering again, with a Heat and a Sweating, scised her, and thence∣forward the Pulse was far weaker and uneven; also a difficult Respira∣ion,

with short Breath, seised her; she knew not the Standers by. On the eighth day she dyed.

Many Occasions concured to the Death of this Woman, predispos'd to a Fever by reason of her Ingravidation, they greatly increasing the Malignity of the Disease; for, the hurting of the Womb through the difficult Delivery, the sudden striking of the Milk from the Breasts, the eating of Flesh, and the too quick rising from Bed, all concurred, as tho conspiring together, for a greater Mischief. The Blood taken with a feverish Burning began Disorders: it drew the Lochia, and haply other Corruptions of the Womb, into it self, and thence acquir'd a greater Taint and a wholly venemons Disposition; the Membranes of the Vis∣cera, whether upon their being fill'd with a degenerate nervous Juyce, or upon Contractions being communciated to them from the Womb, were struck with convulsive Motions: for those kinds of Inflammations and Distensions about the Abdomen, are really the Effects of Convul∣sions: for tho the direct Fibres contracting that Member, often com∣press it, yet when the Fibres both streight and transverse, and others placed in a various Site, are convulsed together in the Membrane com∣passing about the Cavity, part of it swells like a blown Bladder, into the Vacuity of which the Air secundarily passes it self. So far it is from what is ulgarly said, viz. That the Air, or Flatus's first heap'd together there, are the Cause of the Distension. In our Sick Person the Blood growing hot, and soon being full of an adust and malignant matter, presently, it being incapable of being subdued, and separated by Sweat, endeavoured to fix it in the Brain; the first discharge of that Matter on the Head, by reason of the Animal Spirits being half overwhelmed, brought the Sense of the Heads being very much increast in bulk; which happens after the like manner, as when the Foot, being seised with a Stupor, seems to be felt much greater than it self: now that af∣ter some ease, by slumbering, and closing the Eyes, the Affect return'd anew, the Reason is, because Watching, and the stirring of the Senses, in some sort shake off and remove from them the Matter besetting the Brain and Nerves; which nevertheless, being seated near, and in a Readiness, Sleep stealing on, is as it were imbib'd by them, and throughly enters their Bodies together with the nutritive Juice. Now the Blood, tho it had copiously discharged the Recrements on the Brain, yet it became not free it self; but being still full of an impure Load, fell as it were upon a critical Efflorescence, and with a Shiver∣ing, followed by a Heat and a Sweat (as is usual in a great Excretion) it tryed again and again to shake off its Burthen; tho all it could do by that Effort was, that the Matter sticking to the Brain got deeper Root in it, and fixing it self in certain Sprouts of the Nerves, it took away Speech, and Swallowing, and then afterward Sensation; and the Mass of the Blood being deprav'd more and more by degrees, at length it became unable for supporting Life.

A Renowned Woman, Married a little under Twenty, being with Child, and during the time of her Ingravidation having used but little Diet, and almost no Exercise, underwent in her Travail Pains and Throws, but with Intermission and a frequent Respite, for twelve Hours, and brought forth a Son; the Foetus came away with the Se∣cundine, and all things were well about the Womb. On the first and second days she was indifferently well, but on the third, after a light Shivering, she began to complain of a Thirst and a Heat; which a Loosness followed, so that she had four Stools that day; the Night passed in a manner without Sleep, the feverish Distemper continued afterward for two days after the same manner; she daily had three or four Stools, the Lochia as yet flowing moderately. On the sixth day, when by the Perswasion of Women she had taken somewhat for mode∣rating her Loosness, the Purgings of the Womb were in a manner wholly stopt: at which time, the Fever became more intense, and Symptoms resembling Hysterical arose; for, in the Praecordia she had great and frequent Oppressions, and had a sense of Choaking in the Throat. On the seventh day, there was a more intense Heat, and a difficult and more painful Breathing; and then by a Physician's Order, at that time first call'd, three ounces of Blood were drawn from the Foor, after which, for four Hours, she was better; for a quiet Sleep, with a copi∣ous Sweat, ensued, the Lochia, tho in a small quantity, appear'd again: in the Evening all things grew worse, the Strength being very much resolv'd, the Pulse became weaker, and uneven; she complain'd also of a Noise and a ringing of the Ears, with a Plenitude of the Head, moreover she had Leapings of the Tendons in her Wrists, also sudden Convulsions of the whole Body, and still the Loosness troubled her. To this Person Cordials and other Remedies and kinds of Administrati∣ons diligently used by the Prescripts of many Physicians, did not the least good; the pulse growing weaker, and the Strength decreasing by degrees, on the ninth day after Delivery she died.

This Fever depended very much on the vicious Disposition of the Body, as on the procatarctick Cause; for I have often observed, that it falls out ill with Women in Child-bed, who when they are with Child, unwholsomly seed on fruits and any sorts of food, and living without Motion and Exercise, indulge themselves only to Idleness and Rest: the Blood, by reason of the previous Cachexia, without any evident Occasion, fell a burning as it were of its own accord; now whilst it boyled, deposing its Recrements and Impurities still inward, it brought the Loosness: nor did its Mass become more pure from that almost continued Excretion, but its Mixture or Crasis being still more depra∣ved, at length the Blood fell wholly from its genuine Nature, and be∣came uncapable of fermenting in the Heart: the Loosness naturally hap'ning was ill stopt, especially by the use of AsTringents; for I have often observed, that these things are not attempted without danger:

for a Loosness has cured some that were ill, and in that Lady, and in many others (as we have sufficiently found by Experience) tho it did not take away the Fever, yet it freed them from the more severe Af∣ects of the Brain and Genus Nervosum; whence this Diseased was whol∣ly without a Delirium, nor was she seised with convulsive Motions, till she was brought almost to the last.

A worthy Matron about thirty six Years of Age, going with Child the seventeenth time, was very sad, and perplex'd with Thoughts that she should dye in Child-bed upon her Delivery: but (as it pleased God) she was very well delivered of a Son, and was chearful for three days after. On the fourth day, having eaten more of a Chicken than she ought, a little before Night she fell into a feverish Distemper, with a Vomiting, and the Lochia were stop'd: all the night she lay without Sleep and restless; the next Morning, within an Hours space she had four Stools, and seem'd to be reliev'd; about Noon (at which time I came) she complained again of a Heat and a Drought, also of a Palpi∣tation of the Heart, and of the Ascent of a certain heavy thing in her Throat; the Pulse was quick and small, the Urine was ruddy, the Lo∣chia scarce appeared. I ordered that Cordial Juleps, and things mo∣ving a Uterine Purgation, should be given to this Person; moreover, That Fomentations should be applyed to the lower part of the Belly, also that the Legs and Feet should be often rubbed with warm Cloaths: at the time for Sleep, I gave her a Grain of Laudanum, with half a Scruple of Saffron powdred in a Spoonful of Treacle Water. She slept qui∣etly, and the Lochia flowed plentifully, afterward, using a thin Diet, and things gently promoting a uterine Flux for a few days, she per∣fectly recovered.

A Noble Woman, Young, and Handsome, had a good easie Deli∣verance of a second Daughter, and for six days being well as to the Lo∣chia and other Accidents, she was wholly free from the Suspicion of any Distemper; she daily are Flesh, and being taken forth of Bed she lived chearfully in her chamber. On the seventh day, without a ma∣nifest Cause, she had a Shivering, with a Fever, and the Lochia were lessened, tho not supprest. To the tenth day after her Delivery, be∣ing only gently feverish, and the Purgings of the Womb still flowing, she liv'd free from any severe Symptom; but then, tho very feverish, she seemed more chearful than usual, and more confident of her doing well; in the night she slept little or scarce at all; the morning follow∣ing (at which time I first visited her) she was manifestly delirous, the Lochia were stopt, and the whole Body was in a Shivering, the Ten∣dons in the Wrists were convulsed, so that her Pulse was scarce to be distinguished; which in the mean while was weak, uneven, and very quick. I declar'd, That this Person, unless the Hand of God unex∣pectedly delivered her, must dye in a short time; however, six Grains of Oriental Bezoar being given in a Spoonful of a Cordial Julep, and

causing a copious Sweat with a better Pulse, and afterward other Cor∣dials given at due Intervals, gave some hope of doing well, tho doubt∣ful, and not to be relyed on. After four Hours after I came, being in a languishing Condition, she had a very large Stool, then presently her Strength wholly fell, and within an hour and a half she died.

A Woman of Quality, scarce exceeding twenty Years of Age, of a florid Countenance, and a thin Body, the Lochia flowing immoderate∣ly after Child-birth, used certain astringent Remedies by the Advice of the Attendants, whereby they were wholly stopt: but a Loosness fol∣lowed; which increasing for three days, the Women gave her other Remedies to stop the Loosness, nor were they frustrated of Success; mean while they brought a dangerous Fever, and Affects as it were hysterical in the place of the former; for the unfortunate Woman in Child-bed was affected with a Thirst, and a Heat, with Watchings, afterward with a frequent Swooning, and cold Sweats. Being called at this time, I ordered Cordial Remedies, and things to promote ute∣rine Purgations to be drank, and likewise a Clyster to be injected; the Loosness of the Belly being again procur'd, the Lochia also came down, and the Diseas'd being freed from the foresaid Symptoms, and the more severe Disease, viz. the Nurses Remedies, soon recovered from her Fever.

Here let it be observed by the By, that it's very dangerous either to stop, or to alter, or to thwart any Motion raised by Nature, tho anomalous.

A Woman of Note, about twenty years of Age, of a full and well-flesh'd Habit of Body, aborted twice within a Years space; when af∣terward she had conceived with Child, by her Physician's Order, once a Month drinking plentifully of Whey, she raised a Vomiting, whereby she was wont to cast up a great deal of thick and clammy Flegm; al∣so during the time of her being with Child she was let Bood five times. The time of Child-bearing being over, she brought forth a Boy with great Difficulty: the Secundine came away entirely, and she purged egregiously. On the second day, as she raised her self on her Feet in her Bed, that the Cloaths might be put in order, she took Cold; and thenceforward the bloody Lochia were wholly stopt, and only a little serous Water flowed forth. On the third day she began to complain of an acute Pain in the right-side; the Women present applyed to it Bags of Camomile made warm with Bricks: nevertheless, the Affect was very much increast with a bloody Spittle. On the fourth day after Delivery a most acute Pain, with a most difficult and very painful Breathing, seised her. By the Order of a Physician then coming from the Neighbourhood, six ounces of Blood were drawn from the Basili∣ca, and she suddenly found Relief, and was better for ten Hours. At Midnight a pricking Pain returned with the wonted fierceness: at other Physicians being called to consult, they all concluded that it was necessary to bleed again in the Arm of the Side affected. Blood being

drawn to four ounces, the Pain remitted, and the Diseased breathed better: afterward Diaphoreticks being giv'n, she fell into a copious Sweat, with a quiet Sleep; but the Pulse became more quick and weaker: also Contractions of the Tendons appear'd in the Wrists. Presently afterward she talked light-headed, and within twenty four Hours after Blood was drawn the last time, she died.

That this Lady, upon the Lochia being supprest, together with a Fe∣ver, fell into a pleurisie, the Cause in some measure seems to be the Bleeding so often used during the time of her going with Child; for by this means the Blood, accustomed to be breathed by the Arm, after∣ward fermenting, leaving the Womb, ran towards the wonted way of being let forth; where not finding a Passage, it fixed it self in the neighbouring side as in the next seat of Extravasation. Moreover, be∣sides the usual state of a Pleurisie, no small Malignity was added to this Disease; for the Blood being freed from Extravasation, presently began to be corrupted in its Crasis, and on the third Day of the Fever was so far deprav'd, that it was not able to ferment longer in the Heart, and so to continue Life.

Not long since, the Wife of a certain Smith was brought to Bed at the time that her Children were sick of the Small Pox in the same House, and her self, as it seems, took the Contagion of the Disease; for, on the second day after Delivery Pushes began to break forth with a feverish Incalescence, and a Pain in the Loins; which for three days, the Lochia flowing moderately, rise up as they ought to good Wheals; and tho a uterine Purgation happened copiously at this time, she had the Small Pox very thick in her whole Body; nor were they only on the Surface of the Skin, but they likewise so filled the Cavity of the Mouth and Throat, that she was scarce able to speak or to swallow. On the sixth day, after being delivered, the Lochia flow'd immoderately, whereby presently the Small Pox falling, a Swooning, frequent Convulsi∣ons, and other Symptoms of an ill nature, assail'd the Diseased, which threatned Death in a short time. Being called, I prescribed half a dram of this Powder to be taken constantly every three Hours in a Spoonful of the following Julep; viz.

Take Roots of Tormentil powdred two drams, the best Bole-armoniack one dram, Species of Hyacynth half a dram, make a Powder.

Take Water of Scordium compound, of Dragonwort, of Meadow sweet, of each three ounces, Acetum Theriacale an ounce, Syrup of Corals two ounces, burnt Harts-horn half a dram, make a Julep.

Moreover, I ordered that in her Broth, and in all things she drank, the Roots of Tormentil should be boyled; by these Remedies the ute∣rine Purgation was wholly stopt, and the Small Pox without any severe Symptom, being ripened by degrees, fell away.

This Case was really difficult, and was managed with a great deal of Danger; viz It was dangerous either for the Lochia or Small Pox

to be kept in, and nevertheless, the full Eruption of either hindred the Motion of the other: as long as both proceeded moderately, the Bu∣smess being left to the Guidance of Nature, went on indifferently well; but when the one prevailing, the Assistance of Art was required, it was necessary to check the Lochia, and to put forward the Small Pox.

CHAP. XVI. Of Epidemick Fevers.

I Had design'd to have put an end here to our Dissertation concering Fevers, it being my Intent rather to write a Commentary than an entire Tract: but in regard certain Epidemick Fevers are often rise, which observe no Laws, nor can be reduced to a certain Rule of Doctrine; but being wholly anomalous, vary yearly, and therefore, as often as some one of them spreads it self, presently it is called the New Disease: therefore I have thought it necessary, because general Precepts are not to be given concerning these Fevers, to subjoyn par∣ticular Relations of some of this kind: for from the various Apparatus of Symptoms whereby they are wont to be marked, the Nature, and the whole formal Reason of these kinds of Affects, will somewhat ap∣pear. Since therefore of late Years, within a little Tract of Time, three Popular Diseases have reigned in these Countries, I shall give here, as a conclusion to this Work, the particular Descriptions of them made formerly in the Tiems that those Fevers reigned.

A Description of an Epidemick Fever Reign∣ing in Autumn, Anno 1657. made in the middle of September.

WE, designing a Description of a Fever violently reigning at this time, it is fit, that being led by the Example of Hippocrates, we first consider the foregoing Constitution of the Year, and its Distempera∣tures, and Excesses of the Qualities; for the Cause of an Epidemick Dis∣ease, raised generally among People, must be common. We must note what the State of the Year was, and the Disposition of our Body thence contracted, whereby many were affected together. Now to take the thing stom its Origine, The foregoing Spring, and the Time thencefor∣ward to the end of the Summer, to wit, all this half years space was

mighty hot and dry: but especially after the Summer Solstice the Heats were so intense for many Weeks together, that Night and Day every one complained of the Heat of the Air, and almost of a conti∣nual Sweat wherewith they were all bedewed; and that they could not breath freely. About the end of July, this Fever being first sporadi∣cal, began to break forth in certain Places, that one haply, or two, in a Town, or Village, were seized with it: in most it carried the Type of an intermittent Tertian, to wit, the Fits returned every other Day; which nevertheless, without any fore-running Cold or Shiver∣ing, infested the Diseased with a most intense Heat; Vomitings and bilous Stools happen'd plentifully in most, a Sweat succeeding, but dif∣ficult, and often interrupted, whereby the feverish Access seldom went off with an Apvrexia: but all the time of Intermission the Dis∣eased continued languid and weak, with a Thirst, and a Restlessness; in some, when they began to amend, after three or four Fits, a cold and a Shivering began the Access, and the Fever became exactly an intermittent Tertian; but in most the Disease still grew worse, and presently became obstinate, and of a difficult Solution, with an ill Apparatus of Symptoms; for the Diseased being mighty hot in their Fits, and sweating with Difficulty, Errors were wont to be commit∣ted, which daily intended the Strength of the Disease: for through the Impatience of the Diseased, and the Unskilfullness of the Attendants, the Sweat, which ought to have ended the feverish Access, being in∣terrupted, scarce one Fit was ended, but another presently succeeded, and thereby the Disease was wont to have erring and uncertain Peri∣ods, without an Intercession of an Apyrexia, and afterward it was wont to pass into a continual Fever as it were; the State whereof was sometimes very dangerous, with an ill Affect of the Brain, and Genus Nervosum, that not unfrequently a Lethargy or Delirium, and often Cramps and convulsive Motions were raised. In the Month of August this Fever began to reign far and near among the People, that in every Part and Village, many lay ill of it; tho it was far more common in the country and little Villages, than in the Confines of Cities and Towns. It still carried the Type of an intermittent Fever, only that through the Violence of Symptoms, and the Shortness of Intermissi∣on, it seemed more tedious than ordinary, and therefore was general∣ly call'd the New Disease. Moreover, it was censur'd of some Malig∣nity, and gave Proofs certain enough of its Contagion and Mortality; in as much as it crept from House to House, and infected many of the same Family with the same corrupted Taint, and especially such as conversed familiarly with the Sick: moreover, in many Places it car∣ried off old Persons, and such as were come to a Ripeness in Years.

If you consider the Nature and Essence of the Affect, this Fever must be placed properly in the number of Intermittents: for the Fits

return at set times; also for the most part they begin with a Cold and a Shivering, and very often with a Vomiting, and presently going on with a most intense Heat, at length they are ended in a Sweat. The Urine in most appears of a Flame Colour; clear in the Fit, with some Hypostasis, out of it thick, with somewhat a ruddy Sediment: the Disease comes not to a Crisis by a Sweat, tho very plentiful, and of∣ten repeated, which might be expected in a continual Fever: but the Affect holds on for many Days, and sometimes Months, to a very long time, tho there happens a very great Evacuation by Vomiting, and Sweating almost daily; which we observe to fall out often in an In∣termittent Fever, seldom in a continual: out of the Fit, at any time of the Disease, Purging is conveniently ordered, which it were a Crime to attempt in a Synochus before the Signs of Concoction. More∣over, that this Fever is of the kind of Intermittents, it hence appears, because most recover of it, that scarce the thousandth part of the Dis∣eased dies; which I think is scarce heard of an Epidemick Synochus. About the first beginnings of this Disease, it appears very like an In∣termittent Tertian, tho it may seem in some, by reason of a vicious Predisposition of the Body, and of Errors committed in Diet, and Transpiration, to have pass'd into a continual: for in those in whom the Fits do not come to a due Determination, nor end in an Apyrexia, by reason of the morbifick Matter being not perfectly blown off, in those the Blood continually boyls; whence it comes to pass, that the Accesses return quicker, and infest longer; till at length, by reason of the store of the Matter, and the languishing of Nature, the Blood be∣coming weak, is not able to grow turgid any longer, and to separate the Febrile Matter at set Hours, but endeavours to subdue it by little and little, and by a continual Effervescence.

Some haply may wholly place the Cause of this so Popular a Disease in a malignant Constitution of the Air, to wit, that the Particles of the Air breath'd in were infected with a certain extraneous Miasm, the Corpuscles of which Miasm being inwardly admitted, fermented with the Blood and Humours, and so caused this Fever in a great ma∣ny with the same Appearance of Symptoms. But I do not think that this Fever arose from a certain Contagion communicated from the Air, and immediately fixing the Taint in Men, but rather from a cer∣tain febrile Diathesis or Predisposition communicated to our Bodies by degrees before, through the Distemperature of the Year; which at length having gotten a Maturity, is brought into Act on a light oc∣casion; and it cannot be said so much to burst forth into this Fever, as to grow into it.

For when about the Beginning of July the Air wax'd immoderately hot, through a most intense Scorching for many days, it easily altered our Blood, towards a hot and bilous Distemperature; to wit, because (as in Wine fermenting more than it ought) the sweet and spirituous

Part is very much spent, mean while the saline and sulphureous is too much exalted, that thereby the Liquor readily contracts a Musti∣ness or a Sharpness: now we have seen elsewhere, that this kind of Diathesis of the Blood, whereby from a sweet and spirituous Tempe∣rament, by reason of its too great Scorching, it inclines to a bilous, is very apt for Intermittent Fevers. Hence the nutritive Juice, which is continually conveyed into the Mass of Blood, is not duely concoct∣ed, nor assimilated into Blood, but is perverted into an extraneous, as it were, and fermentative Matter; which arising to a Fullness with∣in the Blood, and growing turgid at set Periods, according to its In∣creases, brings the Fits of an Intermittent Fever. Since therefore from the scorching Heat of this Summer, the Blood almost of all Men growing hotter than it ought, was very much parch'd, it's no Wonder if thereby it contracted a very great Aptness to Intermittent Fevers: but why this Disease grew not rife during the great Heat, but rather afterward, the Reason is, because this Indisposition is not imprinted in our Blood at one bout, but by degrees, and not till after a long time; and therefore the Fruit, as it were, of the Disease after the foregoing Heat of the Summer, were chiefly brought to a Ripeness in Autumn. All do not equally contract this Aptness or Disposition to a Fever; those whose Blood being hot by Nature most abound with Sulphur, and thereby is sooner parch'd, and those who being given to Labours or staying much in the Sun, endur'd most of the Summer Heat, by reason of their Blood being more egregiously scorch'd, ea∣sily fell into this Disease: wherefore it first reigned among the Hus∣bandmen, and chiefly in the Country: of those who had acquired an Aptness to this Fever from their Blood being scorched, haply some fell into it naturally, the feverish Diathesis being raised by degrees to a Maturity, others by reason of a light Occasion, or an evident Cause, which is otherwise wont to raise a feverish Effervescence, as upon ta∣king Cold, Surfeiting, drinking Wine, and the like; and others fell sick by reason of a Contagion received from others; for Effluvia con∣stantly flow from the Sick, which when they light on Bodies predis∣posed to the like Affect, readily raise into Act the latent Powers.

That the Conjunct Cause of this Disease, and its formal Reason may be known, you must call to Mind what is said elsewhere concern∣ing the Nature of Intermittent Fevers; to wit, we suppose that the Basis, as it were, of this Affect, is a burnt and bilous Constitution of the Blood; by reason of which, the nutritive Juice, daily supply'd as it were by Measure, is not duely concocted, but through its being scorch'd turns into a fermentative Matter, and not miscible with the Blood. When the Blood is saturated with this Matter to a Fullness, (which happens at set Intervals of Times, because the nutritive Juice is supply'd in a set Measure as it were) it naturally falls into a Tur∣gescency, and the Effervescency raised for the Expulsion of this Mat∣ter,

brings the feverish Fit; which lasts so long, till this febrile Matter, kindled in the Heart, and as it were burnt, is wholly blown off with the Sweat.

From these things premitted, it is plain, that there are some things which in this Affect, whereof we treat, happen after a peculiar man∣ner from the common kind of Intermittents, and therefore it is not unfitly call'd by the Name of a new Fever; such as are, first, that about the beginnings of the Disease, the Fits begin without a Cold or a Shivering, but long afflict the Diseased with a Vomiting, a Thirst, and a most intense Heat, to which a Swear for the most part with dif∣ficulty, and partial, and often interrupted, ensues, whereby the Access is not ended but in a long time: the reason of which eught to be sole∣ly plac'd in the very bilous and excessively parched Disposition of the Blood; for, this proceeding from the prevailing Sulphur, wholly hin∣ders the wonted Sourness of the Blood, which follows its Turgescency, and is wont to raise the Shivering or Cold; and by reason of this kind of Temperature of the Blood, scorching too much and as it were burning the nutritive Juice, the Blood growing turgid together with that Juice, and stirr'd to motion, is kindled more than usually in the Heart, and by its Deflagration, it causes a most intense Heat with a Drought, which are most tedious to the Diseas'd. Bilous Vomitings happen not only at the Beginning, but even in the middle of the Fit, by reason of the Redundancy of the Choler wherewith the Vasa Coledo∣cha, being oftentimes too much fill'd, they pour it into the Intestines; which afterward, a Contraction being raised in the Viscera, is easily sent into the Stomach: the Sweat follows with difficulty, because the Choler abounds more than the Serum; wherefore the burnt Febrile Matter is not easily separated by a Sweat, but, either being mixt with the Blood, brings a long continued Effervescence, or being convey'd towards the Intestines, produces a Vomiting or a Loosness. Secondly, this Fever differs from a vulgar Intermittent, because, after a Fit end∣ed, there is not given a full Intermission, so far as an Apyrexia, but the Diseas'd continue still languid and dry, being ill disposed as to their Appetite, Sleep, and other Accidents: which really happens, because by the intense Heat of the Fever, more of the Blood and fe∣brile Matter is kindled, than that the Recrements remaining after its Deflagration can be soon blown oft, especially because a Sweat, by reason of the Drought of the Matter, with great difficulty ensues; nor is the febrile Matter, to be voided forth, sufficiently diluted with a Serous Latex: wherefore, the Blood being not perfectly freed from its Contagion at the time of the Fit, ferments still, nor the Access be∣ing ended, has it a full Truce from the Disease. Mean while that the Blood is press'd after this manner with an almost continual Effer∣vescence, it differs from a Synochus: because in this the sulphureous Part of the Blood being too much exalted, is inflam'd as it were, and

makes the Fever by its Deflagration: but the continual Ebullition which happens to this Intermittent Fever, depends wholly on the Confusion of the Matter not miscible, and the difficult Secretion of it from the Blood. A Synochus happens as Wine naturally fermenting by reason of its Richness; the other like the same Wine when it falls a working by reason of some haeterogeneous thing mixt with it: wherefore we observe, that when our Fever has pass'd into a continual, yet it comes not to a Determination, neither by a Sweat, nor by a Loosness, tho happening in a plentiful manner and frequently, because depending on the Blood depauperated, rather than being inflam'd, it continues a very long time, and disposes the Diseased towards a Cache∣xia.

The third way of difference, wherein this Fever differs from the common Rank of Intermittents, is plac'd in this, that it is oftentimes readily propagated by Contagion into others; the reason of which is, because here a great many Bodies are predispos'd after the same man∣ner to the same Affect; which at another time does not happen: wherefore the mere Effluvia from a morbid Body are able to stir up the like Affect in a Subject easily capable; even as certain Rays of a Flame kindle a Flame in a Matter which is very combustible: mean while, all do not contract the taint of this Fever alike; but some not prepar'd for it converse with the Diseas'd without hurt.

There is another Symptom which does not constantly attend this Fever, but only happening in some Places, which distinguishes it not only from a common Fever, but changes its own proper Type, to wit, it sometimes happens that dyssenterick Affects accompany this Dis∣ease; in some bilous Vomitings and Seiges are very troublesome, as in the cholerick Disease, and in others bloody Stools happen with a vio∣lent Pain and Gripes of the Belly. I have often observ'd the former in this our Neighbourhood; and the reason of it may be deduced from a mighty bilous Temperature; for by reason of this, the adust Matter, not to be blown off by Sweat, is copiously separated in the Liver: af∣terward by reason of the Vasa Choledocha being over-fill'd, it is sent to the Ventricle and Intestines: the other Affect of the Dysentery is found only in some Places, and there being sporadical rather than common, it has seised only some sick Persons. The Origine of it can be ascrib'd only to the peculiar Crasis or vicious Predispositions of some Bodies, also to the Scituations of Places, or the nature of the Air. Moreover, it may be suspected that the Disease is now and then conveyed to others, not without the Communication of a certain Miasm.

Concerning this Disease, there ought to be a double Prognostick; first of the Fever it self, in general, what kind of end it will have, and when; what it does threaten to our Land; whether it be not a Fore-runner of the Plague, or Pestilential Diseases, (as it is vulgarly feared.) Se∣condly, We ought to give the Signs by which we are wont to

presage a Well-doing or Danger in the various Cases of the Dis∣eased.

As to the first, because we have shewn that the Origine of this Af∣fect is not to be taken from the Air infected with a Contagion, or ve∣nemous Miasm, nor from a malignant Seminium of Vapours diffus'd through the Air; but only from a mighty bilous Temperature or Dia∣thesis of our Bodies, with a Blood which is adust and mightily scorch'd by reason of the Summer Heats: I think there is no cause of Fear here, whereby we may dread that this Fever, being rais'd to a worse state through the fault of the Air, may grow at length to be Malignant or Pestilential; but rather (what the Change of the Season of the Year, and the Alteration of our Blood may make us expect) we ought to fear lest this Fever, which at first imitates the Type of a Tertian, may pass into a Quartan: which I observe has already happened to some; and think it is greatly to be fear'd, lest hereafter, Autumn drawing to an end, it may happen in many.

As to the particular Prognostick, the Signs which happen in the course of this Fever most remarkable, and which in some manner foretell its Issue and Event, are these: If the Disease happens in a sound Body, well-temper'd, and easily perspirable, if a Vomiting with a well-bearing ensues, and the Belly be loose; if the Fit begins with a light Shivering, and after a moderate Heat ends in a Sweat, and the Interval of it be with an Apyrexia, or a well-bearing; if the Pulse be strong, the Urine of a flame colour, clear, with a laudable Hyposta∣sis, we predict that the Disease will end in a short time without dan∣ger: but if this Fever be raised in a fat Body, and of a vicious Habit; if with a troublesome Vomiting, an exorbitant Heat, and an intolera∣ble Thirst, long torment the Diseased; if the Heat be succeeded by a difficult, partial, often interrupted Sweat, and interlac'd with frequent Vomitings, and does not end in an Apyrexia, we declare this Disease to be long, and liable to Danger: but if the Diseased holds his Strength, and the Urine shews signs of Concoction, we do not despair of well∣doing; especially if after four or five Returns, the Disease, as it is usu∣al, remits of its wonted fierceness. Thirdly, we observe, if this Dis∣ease happens in a Body which is cold, or broken with other Diseases, or weaken'd; if besides horrible Vomitings, and a violent Heat, a fre∣quent Fainting, Swoonings, Deliriums, or Lethargick Affects happen; if after many Accesses, the Strength of the Diseas'd falling, the Disease remits nothing, but a continual Effervescence troubles the Blood, and very much dissipates the vital Spirits; if a dejected Appetite, obsti∣nate Watchings, convulsive Motions, with a weak Pulse, a troubled or thick Urine happen, we declare the Case to be full of Danger: but it is protracted to a good length, and it gives Time and Occasions for Nature to recollect her self, and to the Physician for giving Re∣medies.

The Therapeutick Indications which have place in the Cure of this Fever, are chiefly four. First, that the Blood being becom burnt, and too bilous, be reduc'd to its due temper. Secondly, that the deprava∣tion of the Nutritive Juyce, and its alteration into a fermentative mat∣ter, be stopt, or at leastwise, be lessen'd. Thirdly, that about the de∣clination of the Disease the Blood being depauperated by a frequent Deflagration, and rendred impure by the mixture of the morbifick or adust matter be restored, and be rendred volatile as it ought. Fourth∣ly, that we obviate with Remedies the Symptoms which are chiefly infesting in the Course of the Disease. To answer these Intentions, I advise the following Method to be used.

About the first beginnings of the Disease, if a bilous Humour flow∣ing from the Vasa Choledocha, and sent into the Ventricle, the Disea∣sed be inclin'd to Vomit, when the Fit is at hand let a plentiful Eva∣cuation of the same be raised by a gentle Emetick: Blooding and Pur∣ging ought not to be used but during the Interval of Fits; for while the Blood violently ferments, or is resolved into a Sweat, Nature ought not to be diverted from its Works begun, nor its Attempts be distur∣bed by the Prescripts of Physicians; wherefore after the Access is over, and the Sweat entirely ended, let a Purging be ordered by a gentle Cathartick, and let the same afterward be sometimes repeated on the like occasion: for by this Method, not only the store of the excremen∣titious Matter is withdrawn from the first Passages, but especially the Choler-Vessels being emptied, the Bile is plentifully drawn from the Mass of Blood, and thereby the Blood is restor'd toward its natural Crasis. Let Blooding, if it be indicated, be put in Practise, from the beginning; for so its Liquor growing too turgid, is eventilated, where∣by it both less perverts the nutritive Juice, and when the Fit presses, it burns with a more mild Blast together with the morbifick Matter: but otherwise, if after a long Sickness a Vein be opened, when the Blood being depauperated and rendred watery, has heaped together more of morbifick Matter, and does not duely concoct it, and purge it forth, much is drawn from the Strength of Nature, from the Power of the Disease nothing. In the Interval of the Accesses, when Blooding nor Purging may not be admitted, let the Belly be kept soluble by a con∣stant use of Clysters; also let digestive Remedies of acetous or saline Liquors and Powders be giv'n, such as Cream of Tartar, the fixt Salts of Herbs, Tartar Vitriolate, burnt Harts-horn, Spirit of Vitriol and of Salt, &c. for these restore the Ferments of the Viscera lost or grown sluggish, depurate the Blood by fusing it; also separate, and as it were, precipitate the morbifick Matter: also at this time, if obstinate Watch∣ings chance to prove infesting, and impair the Strength of the Diseased, we may interlace Anodyne and gently Narcotick Remedies, but by no means give them in the Access, for then they greatly hinder the sub∣duing, and secretion of the febrile Matter, and prolong the Fit which would sooner end.

So far concerning what is to be done in the Intervals of the Fits; but in the Fit, tho the Diseased then chiefly send for and call upon Physicians, yet their Prescripts at this time are limited within a nar∣row Scope: if a Vomiting (tho an Emetick be giv'n before) be still infesting, let it be freely promoted by Posset-Drink, either simple, or with bitter Herbs boyled in it; but let the chief way of the Cure be in qualifying the Heat and Drought, which are wont to torture severely the Diseased in this Fever; for whilst the Blood, fermenting with the morbifick Matter, and being kindled in the Heart, springs into the Lungs, it raises there a most violent Inflammation, which requires a pouring on of cold Water as it were for extinguishing a Flame: where∣fore they desire to be pouring in Drink without measure; without which the Diseased faint through the too much burning, and in a manner all their Blood, being rarefied as it were into a Flame and a Smoak, does not easily continue the thread of Circulation; wherefore, Drink by all means ought to be granted to those that are in the Fever: which nevertheless, if it be pour'd in in too great a quantity, first it exagitates more the boyling Blood, and again brings a Confusion of the febrile Matter began to be separated, that thereby the Work of subduing and Secretion is longer protracted, and the Fit is made longer; moreover, a great pouring in of Drink proves offensive to the Stomach, and by troubling it, and often by raising a Vomit, hinders Transpiration, and calls in a Sweat breaking forth, or haply already broken forth: wherefore, when the Heat of the Fever is first kindled, let the Diseased, tho very dry, drink only by sipping, and, what they may, let them refrain it; afterward when the burnt and subdued Mat∣ter begins to be sent off by Sweat, let them more freely gratifie them∣selves with it; for so the Sweating is greatly promoted, and the Fit is sooner over: as to the nature of the Drink, sometimes let Posset Drink, sometimes small Ale, or Barley Water be given; sometimes Fountain Water, either alone, or sharpen'd a little with the Juice of Limons: in this case, the use of Sal Prunella is justly commended, gi∣ven in any Liquor; for this, by its Nitrosity, wonderfully restrains the boyling Blood, and powerfully moves Sweat. I have often observ'd in the middle of the Fit, that the Diseas'd have fall'n into a Fainting or a Swoon, where the Cordials and hot Liquors, which are wont presently to be pour'd in, very much increase the Violence of the Fe∣ver, and cause greater Troubles than usual, that the Fit is more diffi∣cultly ended: but these Swoonings, for the most part, happen either from the bilous Humour sent into the Ventricle, or by reason of a Sweat broken off abruptly, and against these I have always found the most present Remedy; that either a Feather being put in the Throat, a Vo∣mit be promoted, or that a thin Liquor being drank in a plentiful Measure, the Sweat be again rais'd: and in the whole Course of this Fever, I am wont to give no Cordials or Alexipharmicks.

A Diet in this Fever only thin, and not rich, ought to be ordered: let all Food prepar'd of the Flesh of Animals be wholly shunn'd; for these abounding with Sulphur, plentifully afford a Fuel to the boyling or kindled Blood, as Oyl pour'd on a Flame: moreover, let nothing spirituous, as hot Waters, strong Ale, or Wine, be allowed; but let Oat or Barley Decoctions or Broths, altered with cooling Herbs, be chiefly used; also let Posset Drink, small Ale, or Whey, be drank by the Diseased at Pleasure: for since by this Means a very thin and wa∣tery nutritive Juyce is conveyed to the Mass of Blood, the resolved Particles of the Sulphur are burnt off sooner, and with less Tumult; also the Recrements of the adust Matter are more readily sent forth from the Mass of Blood: but if on the contrary, a rich and plentiful Nourishment be used, the Effervescence of the Blood is thereby much encreas'd, and the Blood is more infected with the Mixture of an adust Matter.

When after frequent Fits, the Blood being much burnt off, and the Fever, being in its declining State, has remitted of its Fervour and Fierceness, Care must be taken, that the Diseased, while upon their Recovery, do not fall into a Cachexia, or Scorbutick Affect; for the Crasis of the Viscera being injured, and the Blood being very much depauperated, the nutritive Juice, tho it be not scorch'd as before, yet is not duely concocted, and maturated into a perfect Blood: but through defect of a Pneumatosis, serous Excrements, imbued with a fixt Salt, are very much heap'd together; and sometimes being fixt in the Viscera, sometimes in the extream Parts, bring forth various Affects. Wherefore in a long continued languor of the Diseased, or otherwise, in order to a quicker Recovery, let Remedies be given which volatize the Blood, and either hinder the Stuffings of the Vis∣cera, or remove them being made, and restore their Ferments being almost extinct; for this Use chiefly conduce the Remedies and Pre∣parations, which are vulgarly call'd Digestives and Antiscorbuticks; by which being seasonably administred, I have known many weak, pale, and bloodless Persons as it were, to have soon recover'd a spright∣ly Strength and Vigour.

A Description, made the last Day of May, of a Catarrhous Epidemick Fever happening in the middle of the Spring, An. 1658.

AN immoderate Heat of the Summer before was followed in the Winter with a Frost equally intense, so that no Man living has scarce remembred a year like this for an Excess both of Heat and Cold. From the fifth of December almost to the Vernal Equinox, the Earth

was cover'd with Snow; and from the North Winds continually blowing, all things, set in the open Air, waxed stiff with Cold: and afterward, from the beginning of the Spring almost to the first day of June, the same Wind still blowing, the Season was more like Win∣ter than Spring, only that sometimes haply it was interlac'd with a day or two of hot Weather. During the Winter, amongst our Peo∣ple here (save that the Quartan Ague contracted in the Autumn infest∣ed some) the State was indifferently healthful, free from any popular Disease. In the beginning of the Spring an intermittent Tertian Fever (as it's usual in every other year) seised some. About the end of April, on a sudden an Affect shew'd it self, which being sent as it were by a certain Blast from the Stars, seis'd a great many; that in some certain Towns, in a Weeks space, above a thousand Men lay ill at once. The Pathognomick Symptom of this Disease, which first seised the Disea∣sed, was a troublesome Cough, with a copious Spitting, and a Catarrh falling on the Palate, Throat, and Nostrils; there is also a feverish Distemperature, which for the most part is joyn'd with a Heat and a Drought, a want of Appetite, a spontaneous Lassitude, and a great Pain in the Back and Loins: which Fever nevertheless in some was more remiss, that they walk'd abroad, and during all the time of their Sickness followed the usual Offices of Life, complaining in the mean time of a want of Strength and a Weakness, of a loathing of food, of a Cough and a Catarrh. Now in some a hot Distemperature very much reigned, that being confined to their Bed, they were troubled with a Burning and a mighty Drought, with Watchings, a Hoarseness, and an almost continual Cough; sometimes a Bleeding at Nose, in some a Spitting Blood, and often bloody Stools, happened upon this Affect. Those who being of an infirm Body, and stricken in Years, were seised with this Disease, many of them died; but in a manner all of those that were strong and of a sound Constitution recover'd: those who yielding to this Disease perished, they died for the most part by reason of their Strength being wasted by Degrees, and a Mass of serous Filth being heaped together in the Breast, with the Fevers being in∣creased, and a difficult Breathing, like Persons troubled with a Hectick Fever. Concerning this Disease, we must enquire what kind of Pro∣catarctick Cause it had, that it should rise on a sudden in the Spring, and that within a Months time almost the third Part of Mankind should be affected with it. Afterward, the Signs and Symptoms being dili∣gently compared together, the formal Reason of this Disease, also the ways of its Crisis and Cure, ought to be assigned.

That the North Wind is most apt for producing Catarrhs, besides the Testimony of Historians, common Experience makes good: but why Catarrhs did not spread themselves so much sporadically during all the Tract of the Winter and Spring, but that this Affect should reign epidemically only for the space of one Month, and then joyn'd

with a Fever, the reason is not so plain. I know that many draw the Cause from the uneven Distemperature of the Air, for that Season; which tho for the most part cold, yet sometimes, the Northwind remitting, for a Day or two was very hot; wherefore, on this Occasion, as upon taking Cold after being hot, many Men might fall sick: this kind of evident Cause might suffice haply for affecting some with this Sickness; but for causing an Affect arising so on a sudden, and generally reigning, besides such an occasion, a great Procatarxis or Predisposition was re∣quir'd: for it ought to be supposed, that all Men in a manner, were ready prepared for receiving this Disease, otherwise no evident Cause would exercise its force so powerfully on a great many: wherefore it is likely that this Disease drew its Origine from the Distemperature, and very great Irregularity of the Year: and as the intermittent Au∣tumnal Fever above described was the Product of a preceeding immo∣derate Heat, so this catarrhal Fever wholly depended on the Tract of the Year hapning to be too cold; for the Blood being already burnt from the over-hot Summer, and inclin'd to the Fever above described, then Autumn coming on being made more sharp, and apt to a Quartan Fever, afterward by reason of the intense Cold of the Winter being little eventilated, and hindred from its due Perspiration, it held still a Dyscrasie, and was ready to suffer by it as occasion might be given. Wherefore, in regard the Blood in the middle of the Spring (as the Juyce of Vegetables) being become more sprightly, and having begun to spring and display it self, by reason of its Thickness still continued, was straitned in circulating, it was prone to feverish Effervescencies; and in regard the Serous Latex abounding in the Blood, was not able to evaporate forth by reason of the Pores being still closed with the Cold, restagnating inwardly and falling chiefly on the Lungs (where somewhat succedaneous is performed to outward Perspiration) it rais'd so frequent and troublesome a Cough.

Therefore the Rise and formal Reason of this Disease are chiefly founded in two things; to wit, that there happened together a great∣er Effervescence of the Blood than ordinary, caused by the Spring Sea∣son, and withall a Density, or a great Constriction of the Pores caused by the preceeding Tract of Time which was too cold; that thereby there was not a free space granted the Blood springing in the Vessels: the Case was the same, as if Wine beginning to ferment, were put into Vessels close stopt; for by this means both the Vessels and the Wine are in danger of being destroyed.

Wherefore, to draw the thing in short; that this Disease arising in the middle of the Spring, presently spreading very far, seiz'd a great many, the cause was not a blast of a malignant Air, whereby the Diseased were affected as tho struck by a Sideration, as some will have it, but that at this time the Blood being inspired by the Consti∣tution of the Spring, and so apt to display it self and ferment, was strait∣ned

in its Motion, and the Efluvia being inwardly restrained, it could not be enough ventilated. Every years tho temperate, it is usu∣al in the Spring and Fall for certain Diseases to reign epidemically, to wit, because at this time, the blood being renewed, displays it self as it were anew, and therefore intermittent Fevers, and sometimes the Small Pox grow every where rife at this time; wherefore it is no won∣der, after a very uneven Constitution of the Year, and differing from the natural, when in this Spring the Blood boiling strongly within the Vessels, by reason of a letted Transpiration, was not able to be circu∣lated freely, and to be enough eventilated, if thence great Diforders follow, and a very epidemick Affect be raised from this very general Cause.

As to the Symptoms joyned to this Disease, the feverish distemperature and the things depending of it, the burning of the Praecordia, the Thirst, spontaneous Lassitude, the great pain in the Head, Loyns or Limbs, were caused by the Bloods boiling too much, and not being enough eventilated. Hence in many the thinner part of the Blood be∣ing heated, and the remaining Liquour being only troubled, a Syno∣chus simple, or of many dayes was caused: but in some having a vi∣tious Diathesis of the Blood, or an ill habit of the Body, this kind of Fever being arisen through the same cause, soon passed into a very dangerous, and often mortal putrid.

The Cough accompanying this Fever with the Catarrh, draws its origine from the serous humour heapt together along time in the Blood, by reason of Transpiration being letted, and afterward an effer∣vescence arrising, distilling in a great plenty from the little Arteries gaping inwardly: for when the Pores are constringed, the superfluous Serosities in the Blood, wont to evaporate outwardly, are poured on the Lungs by a nearer way of purifying the Blood: Wherefore upon taking cold, (as its vulgarly said) that is upon Transpiration being outwardly letted, a Cough for the most part is raised: and in the Pro∣catarxis for this affect, a redundancy of Serum in the Mass of Blood had almost the first Place, for from the long continued cold stopping the burning of the Blood, or the encrease of Cholor, and hindring the Transpiration of the watery Latex, of necessity a great deal of serous Humour was heapt together in the Blood; wherefore, when the Blood, displaying it self in the Spring, fell into an Effervescence, the overflowing of the Serum, and its discharge on the inward Parts was wont to bring first a Cough, as a proper Symptom of this Disease: and in whom the Blood, being much diluted by the mixture of Serum, were very obnoxious to the Cough and rheumatick affect, those came more lightly off with the Feverish Distemper.

The Prognostick of this affect, as to private Persons, for the most part is easy, that presently from its first invasion it discovers the event. For if this Sickness be raised in a robust Body and sound before, and

the feverish Distemperature be moderate, and without any severe and dreadful Symptom, the Case is free from Danger, and the affect is reputed of so light Moment, that commonly it is only called a Cold taken, and for the most part neither a Physician nor Remedies are sought after, unless some that are very common, and of an easy Pre∣paration are used. But if this Affect happens in a weak and unhealthy Body, with an ill Apparatus, and either the Fever be raised to a pu∣trid, or the Cough growing strong, causes a difficult Breathing, and a kind of consumptive Constitution, the event of the Disease is very much suspected, and often is terminated in Death. The common Prognostick, which is taken hence concerning the future state of the Year, contains nothing very much to be feared, or threatens mighty ill; by reason of the uneven Intemperies of the Year, as great excesses of Heat, and afterward the Cold, we may fear Diseases arising from the discrasy of the Blood; but from the present state, we neither suspect the Air mightily depraved, nor infected with venemous Breaths, that we may hence ground a Judgment of a Plague, or malignant in∣termittent Disease.

As to the Method of Cure, when this Disease seises lightly, its cure for the most part is left to Nature: for this Fever being only a simple Synochus, is wont to be determined within a few dayes by a Sweat. Wherefore after a copious Sweat for the most part about the third or fourth day, the heat and Drought, the lassitude and great Pains are ap∣peased: then the Cough, protracted longer, afterward remits by little and little, and at length the Diseased recover by degrees. If at any time this Disease has taken deeper root, there is need of fit Remedies and an exact Method of Cure; let the Fever growing strong be cured according to the Rules to be observed in a putrid, tho with this diffe∣rence, that because a letted Transpiration, and the discharge of the serous Humour on the Lungs are chiefly in the fault, therefore let Diapho∣reticks, and the Remedies called Thoraciks be of frequent use; for these restrain the great flowing of the Serum from the Vessels inward, and either by opening the Pores, convey it outward, or by precipi∣tating it from the Mass of Blood, send it away by the urinary Passages: therefore let the Method of cure for this Disease raised to a worse state, regard both the feverish Distemperature, for curing which you may di∣rect according to the Intentions used in a putrid Fever: and the Rheumatick Affect, Which nevertheless must be the second Indicant, and does not admit any evaporating Remedies indifferently, or such as are usual against a Cough, but only of that kind, which does not intend the Fever. Let the Forms of these and the fit times of heal∣ing, be taken from the Precepts every where delivered for the cure of the putrid Fever, and of the Cough: the Aides which now by a fre∣quent Experience are vulgarly said to have given a chief relief in this Disease, are a Diaphoresis, or a procuring of a Sweat, and a letting

Blood; for the Vessels being emptied this or that way, both the im∣moderate Effervescence of the Blood, and the redundancy of it are moderated.

A Description, made the first day of September, of an Epidemick Fever, arising about the beginning of Autumn, An. 1658.

THE Vernal Fever even now described, scarce lasted above six Weeks, that it plainly seemed only a light Effervescence of the Blood, which growing turgid in the Spring, and withall being strait∣ned in its room for want of Ventilation, boiled violently like new Wine stopt in Bottles, and afterward ceased of its own accord: but thenceforward, as the Year did not recover its due Temper, so neither did our Blood, and so a second fewel was soon heaped together for a new Fever, for after the Summer Solstice, the North-wind still blow∣ing, the Season continued cold a long time; so that the Husbandman feared that the Fruits and standing Corn would scarce be brought to a Maturiy this Year: but after this, a little before the beginning of August, a most intense heat followed for many dayes; and in the Dog Dayes the Air was mighty parching, that it was very tedious to be in the open Field. By reason of those Excesses of Heat and Cold, the Temperature of this Year was very uneven: wherefore of Necessity our Blood must be sometimes fixed, and as it were congealed, some∣times too much parcht, and therefore preverted from its natural Cra∣sis, to be burnt, or atrabilarious: also the Pores of the Skin were very much altered from their due Constitution, that thereby insensible Trans∣piration was not performed after its wonted manner.

From the time the foregoing Fever ceased there was a healthy state, and free from any popular Disease, almost to the end of the Dog-dayes: but afterward, a few, first in Country Houses and Villages fell sick here and there: but afterward about the end of the Month of August, a new Fever rising on a sudden, began to be rife throughout whole Countries, on every side in our Neighbourhood; this, also the other, which reigned the Autumn before, chiefly raged in Country Villages, and Boroughs; fewer of the Inhabitants of Cities, and the greater Towns in the mean while falling ill of it. At the same time in other Countries far remote from hence, nay almost throughout all England, an Epidemick Fever was said to reign, and in certain other Places a far greater mortality was talked of, than here with us. Haply the Idea of this Fever now reigning, and its Apparatus of Symptoms is not in all Places alike in all things, or is it markt wholly with the same Phaenomena and Accidents, I shall set down succinctly,

and briefly, whatsoever I have learned by my own Observation, or by the Communication of others, concerning its Nature as it was in our Neighbourhood.

About the first beginnings of this Disease, its Type was erring and very uncertain; for in some there was a continual Effervescence, in others it was intermittent, and renewed with set Fits; but in a great many of the Diseased it happen'd as a pathognomick Symptom at this time to be ill in the Brain and Genus Nervosim, that presently from the beginnings of this Fever almost all complain'd of their Head being very bad, for some were infested with a violent Head-ach, others with a hardness of Hearing, and a ringing in the Ears; but to most, either a Drowsiness, and a great Sleepiness, with a vertiginous Affect, or obstinate Watchings, with a Delirium, and Distractions of the Animal Spirits, were wont to happen. I have observed in some, that on the first or second Days of being sick, broad and red Spots, like the Mea∣sles, broke forth by little and little in the whole Body, which vanish∣ing in a short time after, presently the Fever became more intense, and especially the Affects of the Head far more severe: thenceforward a Drowsiness of the Senses, and a Sleepiness seised some for many days, that they lay a long time without Speech, or Knowledge of their Friends, like Persons ready to dye. I have known some to have been cast hence into a Lethargy, others into an Apoplexy, some to have fall'n into Deliriums and a Frenzy. Many of the younger and stronger of these Men escaped (tho not without a long continued Weakness and a doubtful Recovery) mean while, the old Persons, and those who were otherwise weak and sickly, dyed in all Parts: as for such who lay ill of a continual Fever as it were with these Marks of Malignity, they were but few, and only in some Houses sporadically: but the Sickness which, most generally reigning in our Neighbourhood, assail'd most, and still severely rages, seems to imitate the Type of an intermittent Fever; viz. of a Tertian or of a Quotidian: for either each Day, or (which I have more frequently observed) every other day, the Dis∣eased have Fits, which with a Cold, a Heat, and a Sweat succeeding in order, infest them a long time and severely: and these kinds of Ac∣cesses, and the whole course of the Disease, are wont to be mark'd with a various Concourse of Symptoms and Accidents, according to the different Age and Temperament of the Diseased: and this is com∣mon to most (I had almost said to all) that fall sick to be troubled with Cephalick Affects together with this Fever.

When therefore any one is affected with this Disease (whether the Sickness be raised from an evident Cause or from Contagion, or with∣out a manifest Occasion) a Pain in the Head, and often in the Loins, with a Drought, a want of Appetite, a spontaneous Lassitude, and a Heat, tho not intense, discover its coming: if it happens in a young Body, of a florid Blood, and hot Temperament, about its Beginnings

the Fits are without a Cold, or a Shivering, but they prove very trou∣blesome with a long and sharp Burning. The Sick are often troubled with a Vomiting, and for the most part they have a violent Pain in the Head; a Sweat happens with difficulty, which often being partial, and soon interrupted, seldom ends the Fit; but when they cease to sweat, they burn again, that the Access is scarce ended in some with∣in eighteen or thirty four Hours. Mean while, by the Bloods very much boyling the Fancy is troubled, that often a Delirium, a talking light-headed, Watchings, and a great Restlessness, are raised during the Fit; and the same being ended, during the time of the Interval, still a troublesome Drought, a remiss Heat, a failing of the Strength, and a great Weakness of the Spirits, with a Head-ach and a vertigi∣nous Affect, molest them: they are scarce to be found, who, as in a common Tertian, are indifferently well in the Intervals of the Acces∣ses. About the Beginnings of the Disease, the sharp Fits of the Fever are somewhat more mild, which afterward grow worse every time by little and little, and at length begin with a Cold or a Shivering; to which nevertheless after a long and very troublesome Burning, a Sweat with difficulty succeeds in most, so that the Fit is seldom ended in a due Temperature. Within six or seven Returns, the Strength of the Diseased is very much consumed, that being become lan∣guishing and weak, they have a hard Task to strive with the Disease; for unless Nature be aided by Art, the Fever, still prevails; and seldom or never within a short time is either solv'd by a Crisis, or remits by little and little, but brings the affected by a long Siege to the greatest straits, to wit, persisting so long, till the Blood being become very effaete, or rendred watery, by its frequent Deflagration, is altogether unmeet to boyl too much of its own ac∣cord in its Vessels, or to be freely kindled in the Heart; and then it becomes often so vapid, and poor of Spirits, that being insufficient for continuing the Lamp of Life, it brings Death. But sometimes the mass of Blood, depraved and depaupered by this Disease, is able to continue (tho with difficulty) the Vital fire hlaf extinct, and to refresh it again by little and little, and in a long time, with Spirit and Vi∣gour, tho in the mean while after the height of this Disease, when the Blood being rendred weak, and withall impure, is not able to ex∣pell forth the febrile Matter, or the adust Recrements by a critical Motion, it conveys the same to the Brain; and therefore abut the increase of this Fever, a Drowsiness, and a Stupidity of the Spirits, a Sleepiness, a Vertigo, a ringing of the Ears, Tremblings and Con∣vulsive Motions, with a great Suppression of the whole animal Facul∣ty are oftentimes caused,

Those, who being of a cold Temperament, or grown in Years, are seized with this Disease, tho they have not so acute a Fever, yet are wont to lye in a greater danger of Life: for in these, besides the Dis∣position

of the Blood not easily reducible; also in the Fits, what is heaped together extraneous and not miscible, is hardly subdued, and with difficulty separated from the mass of Bood: wherefore, both the Blood is still more notably depraved in its Crasis, and in every of the Fits is more infected with an impure mixture: Moreover, the Nervous Liquour is greatly perverted from its due Temper, and is exceedingly defiled with adust Recrements continually poured on the Brain: when therefore old, melancholy, or otherwise unhealthy Persons, fall into this Fever, from the first Invasion they presently become torpid, and for the most Part Vertiginous: in the Fits, tho the heat be not vehe∣ment and sharp, yet they lye restless, and tossing very much, often talk absurdly and idlely: after a long Incalescence, either no Sweat, or only a partial one, and often interrupted, ensues, whereby the fit is not fully solved: but all during the Intervals the Diseased being very dry, continue to be ill disposed, with a drought of the Mouth, a rough∣ness of the Tongue, and an overspreading of a viscous Lee: after some fits, their Strength being mightily dejected, either they are con∣fined to their Bed altogether, or rising a little in the day time, they are scarce able to stand, or to creep about from Place to Place: mean while they are troubled with a Fainting, a difficult Breathing, a Dead∣ness of the Senses, and a great Weakness of the whole Genus Nervo∣sum. The Urine is intensly red in a great many, of a more saturated Colour, and a thicker Consistency than in a common Tertian; the Pulse, as long as the Strength is not wholly cast down, for the most part is strong and even; afterward, when the Diseased grow very faint, it is weak, uneven, and often intermittent, to which also Contractions of the Tendons, and convulsive Motions in the Wrists, being iovn'd, for the most part give an occasion for a Prognostick of Dearth. Those who being weak'ned by degrees decline toward Death, for some time be∣fore they dye, lye for the most part without speech, or the Knowledge of the Standers by, as Persons stupid: it seldom happens in this Fever, that any one about to dye, being of a good Memory and Understand∣ing, disposes things of his Family, or bids his Friends farewell: and those who happen to escape from a mighty Weakness, and almost from a desperate Condition, do not recover by a sudden and mani∣fest Crisis, but wavering a long time, lye torpid and enervated, that not without a doubrful and difficult Contest, Nature at length, with much adoe, prevails over the Disease, and then they recover their Strength by Degrees by a slow and long-continued Convalescence.

If the nature and formal reason of the Epidemick Fever even now described be inquired into, we say that this (as that of the foregoing Year) is properly an Intermittent, for that which generally reigns, carries this kind of Type; tho some continual Fevers here and there are scattered with them; of which also we shall presently give a short Touch. It will not be needful for us to derive the Seminary of this from the Air infected with some Miasm, but rather to fetch the ante∣cedent

Cause of it from the undue Constitution of the Year, and the Indisposition of our Blood acquir'd thereby; for Spring and Fall inter∣mittent Fevers yearly reign, to wit, because our Blood, as the Juyce of Vegetables, is wont to be moved, and to display it self at these times more sprightly than ordinary: wherefore, if the Mass of Blood, by rea∣son of the foregoing Season of the Winter or Summer be altered from its ••ue Temper, and has contracted a sharp or atrabilarious Diathesis of another kind; its Dyscrasies, began before, are chiefly maturated about the Equinoxes; to wit, when the Blood, more freely ferment∣ing (in case it falls from its natural Crasis) does not so readily sangui∣fie, but will be apt to pervert the nutritive Juyce, mix'd with it, in∣to an extraneous and febrile Matter. Since therefore this Year very much declined from its due Constitution (that not only the prece∣ding Dog days, but the two Solstices and Equinoxes before were alto∣gether intemperate) is no Wonder if intermittent Fevers, more fre∣quent than usual, and those attended with some unusual Symptoms, reign in Autumn. That therefore an Epidemick intermittent Fever reigns at this Time, I think it ought not to be attributed to the Fault of the present Air, but to the Irregularities of the foregoing Season: but on what Causes and Occasions certain peculiar Symptoms, and distinct from the common Rule of Intermittents, arise in this Fever, it is worthy to be inquired into. I have said above, that the Appara∣tus whereby this Fever became destructive to Mankind, consisted chiefly in two things; to wit, the Temper of the Year one while migh∣ty cold, afterward happening to be very hot, both variously perverted the Crasis of our Blood, and affected the Pores of the Skin with an undue Constitution. According to the Reasons taken from both, I shall briefly explicate the Accidents of this Disease, and assign the Causes of its Phoenomina.

1. First, we observe that the Type of this Fever was various; to wit, in some with a continual Effervescence, in others with an Erupti∣on of Spots, but in most intermitting, and like a Tertian, and some∣times (tho rarely) like a Quotidian, renewing its Fits either each or eve∣ry other day: we assign the Cause of this Diversity, because in this Year the morbid Procatarxis was greater and stronger, than only to produce an intermittent Fever generally usual in Autumn: wherefore in some (haply of a more deprav'd Habit of Body) it raised Fevers somewhat malignant; and in those to whom it brought Intermittents according to the wonted Custom of the Season, it distinguished them by some peculiar Appearance of Symptoms.

2. Persons after being seis'd with the Epidemick Fever at this time (whether it be continual or intermittent) forthwith undergo ill Affects of the Head; to wit, they are wont to be infested sometimes with a violent Head-ach, sometimes with a Stupor, or a too great Distracti∣on of the Animal Spirits; the Reason of this is, that the nervous Juyce, as well as the Blood, through the Distemperature of the Year,

is very much altered from its due Crisis, to wit, from its sweet and spirituous Nature, and has become sometimes dull and almost vapid, sometimes too sharp and pungitive. Moreover, the Mass of Blood also has greatly contributed to this Evil; for whilst it ferments the vapory Effluvia, which ought to be blown away outwardly, by reason of the Pores being constring'd, are sent to the Membranes of the Head and the Brain: and by reason of this closing of the Pores communicated al∣most to all, a Sweat happens with Difficulty, and that but partial, and often interrupted in the Fits. Hence also in the height of the Disease, a perfect Crisis, or a spontaneous Solution of it, seldom, or scarce at all, happens: but instead of it, if the thing be committed to Nature, an adust Matter, or Recrements heap'd together in the Blood, are con∣veyed to the Brain, and there raise Affects sometimes of the Coma, sometimes of the Frenzy, and those lasting and obstinate.

3. That the Fits sometimes begin without a Cold, or a Shivering, and are protracted in length with a troublesome Heat, and a difficult, partial, and often-interrupted Sweating; afterward, that the same be∣ing ended, the Diseased grow hot again, so that the Accesses are not ended but after a long Evaporation of a dry Breath, the Cause is the too sharp and bilous Disposition of the Blood, whereby, being fill'd with a burnt Salt and Sulphur, rather than with a Serous Latex, when it grows turgid, it presently takes to a light Flame, without a previous flowing of the nitrous Matter: and therefore by reason of its want of Serum, and the Pores being shut, its Deflagration is continued a long time, in a manner only with a dry Exhalation, and scarce ends at length in an Apyrexia: and therefore the Intervals of the Fits are very troublesome with a Heat and Drought, a Head-ach, a Vertigo, and other Affects; to wit, because the febrile Matter heap'd together in the Blood, is not wholly discussed every Fit, but part of it being left after the Access, as extraneous and not miscible, brings almost a continual Effervescence.

4. It is to be observ'd, that those that are affected with this Fever presently fall from their Strength and the wonted firm State of their Bo∣dies, that after a Fit or two, being out of Breath and very weak, they are scarce able to stand or walk without a Staff; whereas it is usual for such as are seised with a common intermittent Fever, to be sprightly and chearful enough during the Intervals of the Accesses: The Reason of the Difference is; because, in this Fever, both the Mass of Blood is more depraved with the impure Mixture of a degenerate Juice, and especially because the same is more perverted from its natural Crasis, and therefore when out of the Fits it does not boyl, yet it does not ferment duely and evenly in the Sinus's of the Heart: wherefore, when by a quick Motion, or any Agitation of the Body, the Blood is vehe∣mently pressed forward into the Sinus's of the Heart, because it is not all presently kindled there, and springs forth, by its Stagnation, it brings an oppression of the Heart, and great Faintings of the animal Spirits.

By reason of this kind of Dyscrasie of the Blood, to wit, whereby it is unfit for Fermentation, or a due Accension in the Heart, some Cattel also, and especially Horses, in the Spring of Fall, become short-wind∣ed, and very unfit for a swift Motion.

5. It remains for us to enquire, lastly, concerning this Fever, where∣fore it reigns chiefly in Parishes, little Villages, and in the Country, when Cities and great Towns have little of it. It might seem that this Affect might be raised from marshy and other noxious Vapours, plentifully heap'd together in this or that Tract of the Air; but it is more rational to say, That the Inhabitants of those Kinds of Places ha∣ving been more exposed to the Winter Colds and Summer Heats, con∣tracted a greater Dyscrasie of the Blood, and so a more apt Disposition to this Fever: for those that live in the Country scarce go out of their Houses, but are exposed to the Rays of the Sun, or to the Fervour of the heated Air. Moreover, Husband-men, and those in the Country, being used to hard Labours (among whom this Fever chiefly reign'd) through their Toyls and immoderate Exercises in the Fields, and withall using an ill and course Dyet, sooner acquire an adust and burnt Disposition of the Blood, and therefore more apt to this Disease, than Citizens and Towns-men, who enjoying Rest and a wholsome Dy∣et, most commonly live in Houses together, or in Streets cooled by the shadow of Houses. The truth of this Assertion is confirm'd, for that not only the Epidemick Fever now reigning, but the other also of the Autumn before, rais'd through a Dyscrasie of the Blood, was chiefly rife among Husbandmen and the Inhabitants of the Country; but that popular Fever which arose in the middle of the Spring, de∣pending chiefly on a letted Transpiration, infested most Citizens and Towns-people: mean while, those in the Country usually procuring a more free Transpiration by Exercise and Labours, liv'd more free from it.

The general Prognostick of this Disease only seems to threaten, that in a manner the like ill consequence will attend it, as followed the Epidemick Fever of the foregoing Year; to wit, (by a Guess taken from the Distemperature of the Blood rather than from the Taint of the Air) we may dread an imminent Quartan Fever again, but not a Plague. As to the particular Observations in it, to give you in short the Signs which promise Death or Well-doing; they chiefly regard the Temerature and Governance either of the Blood with the vital Spirit, or also of the nervous Juice with the Animal Spirit. If from the Pulse, Urine, Actions not injur'd, and the Appearance of other Symptoms, it be plainly indicated, that the Blood, as to its feverish Disposition, be not greatly perverted from its natural Crasis, that in the Fits it burns only moderately, and that in every Conflict it easily subdues the load of the febrile Matter, and wholly shakes it off from its Fellowship, that after some Accesses the Mass of the same Blood is somewhat restor'd toward its due Temper, that it less perverts the nutritive Juyce, and sends forth that which is extraneous and not miscible, with a more mild

Turgescency; and in the mean while, if the other spirituous Liquor duely influences and irrigates the Brain and nervous Bodies, that Sleep, Watchings, Sensation and Motion are perform'd well, or at leastwise indifferently, we may hope all good things of the Diseased. But if it shall appear from the same kinds of Signs, that the Blood in this Fever has gotten a Crasis far remote from the natural, if it perverts much of the nutritive Juyce, and afterward from its extraneous and incon∣gruous mixture the Liquor of the Blood be greatly troubled, and the Spirits are driven into Confusion; if in the Fits the Blood burns too intensly, and for a long time, and does not duely subdue the febrile Matter, or send it wholly forth, but its impure Mixture is still more infected, (and in every feverish Access more and more) and withall, the Spirits being continually consum'd, is become poor, we may declare the Life of the Diseased to be in a dangerous Condition. If, besides these, the nervous Juyce be faulty, that being altered from its due Temper, or being dull, and vapid as it were, it does not actuate the Brain and Genus Nervosum, or being more sharp than it ought, it con∣tinually irritates the same into Cramps and Distractions; and if besides vapory Effluvia continually departing from the Blood, or adust Recre∣ments, wont to be voided forth by a critical Sweat, are convey'd to the Head, and there cause Lethargical or Maniacal Affects, the well∣doing of the Diseas'd stands very ticklish, and we may fear a very fatal Event.

Concerning the method of Cure of this Disease, three chief curative Intents come under Consideration: First, A speedy Reducement of the Blood and nervous Juyce to their natural Crasis, (as much as may be) or at leastwise a Prevention of a too great Depravation of them: Secondly, A due Management of the Diseased as to their Fits, which ought to procure; first, that less of degenerate Juyce be heap'd to∣gether for a Matter of the Fit; secondly, that the store of that which is heap'd together be wholly blown off every Access, that the Diseased may be better in the Intervals: Thirdly, That the Body being altered for the better, the Fits be stopt with antifebrifuge Remedies: the third Intent regards the Symptoms chiefly pressing, which must be sea∣sonably obviated, whereby Nature being not hindred, may reduce whatsoever intemperate is contain'd in the Viscera, may subdue and clear forth what is extraneous, and may soon recover its former Strength and Vigour.

First therefore, for the Reducement and Correction of the Blood and nervous Juyce, divers kinds of Evacuations, about the beginning of the Sickness, are wont to be us'd in this Disease with good Success. It is maifest by modern Practise, that Vomitories are very much more useful in this Affect, than in a common Tertian; wherefore in a robust Body, and prone to Vomit, about the beginning of the second or third Fit an Emetick Medicine is wont to be given. The Operation of this seems to do more good in this Fever, both in as much as it plentifully

evacuates the filth from the Ventricle, and the yellow Choler from the Vasa Choledocha, and because it copiously expresses the Serous Latex from the Emunctories of the Genus Nervosum, plac'd about the Pancras and Intestines, and draws it forth by stirring them: wherefore we observe, after a Vomit given, the Diseased are better as to the Af∣fects of the Head. Let Purging (where Vomiting is not proper) be or∣dered the day following the Fit, as a Succedaneum to the other: also tho a Vomit be premitted, it may do well after a Fit or two; but let it be perform'd only with a mild and gentle Medicine, which does not trouble or exagitate the Blood. It is usual with us in these Fevers, all Aloetick or diagridiated Medicines laid aside, to give only the Infusion or Powder of Sena, Rhubarb, and yellow Saunders, with Tartar and Salt of Wormwood: and to use this kind of Purging a little after the beginning the Disease; but at other times, to make the Belly soluble by a fre∣quent use of Clysters. That Blooding in this Disease is very good, fre∣quent Experience has sufficiently taught us; for since, by reason of the Pores being more clos'd than usual in all, the Blood boyling in a Fe∣ver wants a Ventilation, letting Blood supplies the Place of a more free Transpiration, and prevents the Effluvia restrained from being so rea∣dily discharged on the Brain and Genus Nervosum. But this Remedy is chiefly indicated by a very hot Blood and a hot Temperament; nor ought it to be used indifferently by old Persons, such as are flegmatick, and others very weak, unless haply it be in a small Quantity, that the Mass of Blood may be somewhat eventilated, and that the Translati∣on of the febrile Matter into the Brain may be stopped. If it be proper to open a Vein, let it be done about the beginning of the Fever, or at leastwise before the fourth or fifth Access; to wit, before the Blood be rendred very effaete by a frequent Deflagration, and too impure by the Mixture of an adust Matter: for if Blooding be used when the Blood is mightily vitiated, the vital Spirits, and the Strength of the Diseased are thereby more debillitated; nor is there any thing withdrawn from the Power of the Disease, or its Cause. There remains another Eva∣cuation famous in this Fever; to wit, by Blistering Plaisters applyed to many Parts of the Body: these are so vulgarly observed to give Re∣lief, that such as are against them, and have a great Aversion for such a Remedy, being led by the Example of others growing better there∣by, easily admit of it. After what manner they separate the skarfe Skin from the Skin, and raise it as it were into a Bladder full of Water; whether they fetch the watery and limpid Humour from the Arteries, or out of the Nerves, this is not the Place to enquire: but, that they are used with benefit in this Disease, besides Experience, this Reason seems somewhat to convince; to wit, because a large Discharge of this kind of serous Humour does in some sort recompence the Defect of a free Transpiration. Moreover, this kind of Remedy opens as it were the Doors and Gates at which the Blood and nervous Juice may pre∣sently void forth the extraneous Matter mixt with them by a nearer

way of Purging; wherefore in the Plague and malignant Affects, Vesi∣catories are esteemed very profitable. Also it is manifest by common Observation, that in this and other Fevers, hapning in the same Season, they prevent the severe Affects of the Head, and are wont to relieve them being caus'd before wherefore in Men that are flegmatick, aged, and of a cold Temperament, Epispastic. Plaisters may be apply'd about the first Invasion of this Disease for Preservation; and in any others, troubled with a Drowsiness, a Vertigo, or a violent Head-ach, they are wont to be advantagiously used for the Cure of those Affects. But in very hot Constitutions, where with a Defect of Serum, the Blood is too much burnt; and if those that are in Fevers with an intollerable Burning are obnoxious to Watchings or a Frenzy, Vesicatories do not seem fit to be used.

For correcting the Crasis of the Blood, and the Tone of the Viscera, qualifying and digestive Remedies have place, in intermediate times, when the Sick have rested a little from the Evacuations ev'n now men∣tion'd, being such as fuse the Liquor of the Blood, and separate its Foe∣culencies, and drive them towards the Emunctories as it were by pre∣cipitating them; for those kinds of Intents are wont to be giv'n cool∣ing Juleps and Decoctions, acidulated with Spirit of Vitriol, of Salt, with Tamarinds, the Juyce of Oranges, or of Limons, whereof neat Forms e∣nough are vulgarly to be sound: and for this end conduce acetous, saline, and testaceous Powders, viz. such as are prepared of Tartar, Sul∣phur, the fixt Salts of Herbs, of burnt Harts-horn, also of the Claws or Eyes of Crabs. For Example, Take Cream of Tartar three drams, Salt of Wormwood a dram and half: the Dose is half a dram in an aperient Decocti∣on, twice a day, out of the Fit. Or, Take Cream of Tartar two drams, Pow∣der of Crabs-eyes a dram, Nitre purified half a dram, mix them, let it be giv'n after the same manner. Or, Take burnt Harts-horn two drams, Spi∣rit of Vitriol as much as the Powder will receive by imbibing: the dose is a Scruple. It is of excellent use when those that are in the Fever are troubled with Worms. These kinds of Remedies promote the Secreti∣on of the febrile Matter, and restore the almost lost Ferments of the Blood and Viscera.

The second Intent, to wit, the due Management of the Diseas'd in the Fits, comprehends many things: first, a neat Form of Dyet ought to be ordered, that a large heaping together of the degenerate Juyce for a Matter for the Fit may be hindred: wherefore, let the Diseased feed only on a thin Food; let them wholly abstain from Flesh, or Broth made of it, from Eggs, generous Wine, and all rich Fare; be∣ing content only with Barley or Oat Broths, Panada, Whey, and small Ale: in regard a more plentiful Dyet is not concocted, or assimilated, but it oppresses the Stomach, and being mixt with the Blood it trou∣bles its Liquour, and forces it to boyl vehemently, as the Fit comes on, and during the while it lasts, unless it be for quenching Thirst, let no Food be taken: but for qualifying the Heat and Drought, cooling Ju∣leps

and Decoctions, and especially small Ale and Whey, ought to be allowed. Secondly, a little before the feverish Access is expected, let a gentle Medicine be given, which either may keep off the Fit by pre∣venting it, or may render it easie by procuring an easie Sweat. For this Use, the febrifuge Potion of the Learned Riverius does well, made of Carduus Water, with Oyl of Sulphur and Salt of Wormwood: Or, take Cream of Tartar, Salt of Wormwood, Nettle Seeds, of each a Scruple: let it be given in a Decoction of the Roots of Sorrel. When the Fever begins to decline, and the Fits are a little more remiss. Febrifuge Epi∣themes outwardly apply'd often stop the febrile Accesses; tho in the mean while, as long as the Fits return, let the Diseased be so managed, that every Access, the feverish Matter heap'd together in the Blood may be wholly blown off: wherefore, when a Sweat happens with dif∣ficulty, let it be a little raised with temperate Medicines; also let the Diseas'd be kept in Bed with a gentle Sweat for many hours, nor let them be permitted to rise too soon: for I have often observ'd, that the Diseased have still grown worse, because being impatient of lying in Bed, they put on their Cloaths before the watery Effluvia were exhal'd enough.

Thirdly, as to the Symptoms, and particular Accidents, with which the Diseased are wont to be troubled in this Fever, a great many of them are sufficiently provided against with the Remedies and Method of Cure hitherto deliver'd; against the Thirst, Burning, the Roughness of the Mouth and Tongue, Vomitings, the Loosness, a Swooning, or danger of Fainting, the Prescripts commonly used in other Fevers may aptly enough be transferr'd hither. But the Things which in this Dis∣ease seem to require a peculiar Method of Healing, are chiefly the Af∣fects of the Head and Brain, with the Genus Nervosum; by which, un∣less seasonably obviated, the Diseased are soon brought into a great danger of Life: Concerning these kinds of Evils of the Head, the In∣dications are of two kinds. If it appears by a Drowsiness, a Sleepiness, a Vertigo, or a Head-ach, that the nervous Juyce is too dull, and as it were vapid, and therefore that it does not vigorously enough actuate the Brain and nervous Bodies, besides the Remedies above deliver'd, and especially the Vesicatories, Medicines full of a volatile Salt, excel∣lently conduce in this Case; wherefore Spirit of Harts-horn, of Blood, also the Salts of the same are of excellent Use: but, if the nervous Li∣quor be too sharp, or the Effluvia, sent from the boyling Blood, drive the Animal Spirits into Distractions, those kinds of Remedies of vola∣tile Salt are given with benefit in somewhat a less quantity. Moreover, a frequent Letting Blood, and Medicines allaying its fervour, do good, as Emulsions, Whey, pure Water plentifully drank: let Opiates be used in this Fever with great Caution; for the Frenzy appeas'd by them is oftentimes chang'd into a Lethargy, or a deep Stupor.

FINIS.