The remaining medical works of that famous and renowned physician Dr. Thomas Willis ...: Viz I. Of fermentation, II. Of feavours, III. Of urines, IV. Of the ascension of the bloud, V. Of musculary motion, VI. Of the anatomy of the brain, VII. Of the description and uses of the nerves, VIII. Of convulsive diseases : the first part, though last published, with large alphabetical tables for the whole, and an index ... : with eighteen copper plates / Englished by S.P. esq.

CHAP. X. Of the Symptoms, and Signs chiefly to be noted, in a Putrid Feaver.

THE Symptoms, coming upon a Putrid Feaver, altho they argue, the oeco∣nomy of the whole Body, to be for the most part depraved, and the disposi∣tion, and functions of some part, or Member hurt; yet, the accidents, which a Physician ought chiefly to consider, about the Diagnosis of this Disease, and its Prognosis to be rightly instituted, may be referred to three casses or common places; to wit, they have respect to the Viscera of Concoction, viz. the Ventricle, and In∣testines,

with their Appendixes: Or secondly, to the humours, flowing in the Ves∣sels, viz. the Blood in the Arteries and Veins, and the thin Liquor in the Nervous parts, together with the chief springs of either, viz. the Heart, and Brain; or lastly, these symptoms respect the habit of the Body, with the various constitution of the pores, and the extension or emarceration of the solid parts. They, who would ex∣actly observe, the course of this Disease, and would fitly draw out Curatory intentions, may take notice of these three heads of symptoms, and carefully consider, what altera∣tions may happen in these, as it were distinct Regions, according to the different times of the Feaver.

1. Troubles, and disorders, such as nauseousness, vomiting, want of Appetite, in∣digestion, a looseness, a scurfiness of the Mouth and Tongue, a bitter favour, are wont to infest about the Ventricle, and first passages, in the whole course of this Fea∣ver. These, for the most part, are attributed to the humors, first heaped together in the Stomach, and there putrifying: But besides, that the recrements of the Chyle, being throughly roasted, by too much heat, degenerate into an hurtful matter, very often, these kind of accidents happen, for that the Purgings, and the filth of the Blood, and Nervous Juice, whilst they grow hot, are carried inward, and being de∣posited in the membranes of the Viscera, provoke Convulsions, and also make a filthy heap of vitious, and very infestous humor. I have often observed, that about the beginning of the Feaver, the Blood growing hot, laid aside its recrements even in∣wardly, with a benefit to the sick, where, altho great molestations did arise about the first passages, yet the burning was therefore more mild, the Pulse moderate, and the Urine laudable, and these being after this manner in a Feaver, quickly grew well, with a slender diet, and the use of gentle evacuations. But if in this case I should admini∣ster a vehement Cathartic, for the extirpating the humours, that Natural Purging of the Blood being hindred, presently the Feaver became strong, with a red Urine, and troubled, a deep Pulse, Watchings, and other horrid symptoms: also, oftentimes after the state of the Disease, by this kind of interior Lustration or Purging, the adust mat∣ter, and excrementitious, is separated from the Blood. Hence, somtimes a Lask, somtimes a scurfie covering of the Mouth and Throat, follow: Wherefore, there is need of caution, about the accidents which happen in the first passages, lest that whilst we oppose them, we should pervert the motion of Nature; and lest whilst we fortifie these parts, against the course of the Morbific matter, we untowardly keep the same shut up, in the mass of Blood.

The Symptom chiefly to be considered, about the Bloody mass, are, an heat dif∣fused through the whole, a burning of the Praecordia, thirst, a disorder of the Pulse, a red urine, a spontaneous wearisomness, a loss of all strength, out of which rightly considered, these things following may be known, viz. what the manner of the heat is, or with what tenour the burning Blood flames forth; what times of remission, or of increase, its Effervescency observes, in the deflagration; whether it retains its Crasis, or mixture whole; for the burning of it, and circulation of it inkindled, what strength of the Heart will suffice, and what space the Vessels may require; so long as the Blood burns, what plenty of adust recrements it may heap up, by what means it may overcome, separate, or at lest endeavour to separate the same, and lastly, what way of a Crisis it endeavours, and with what success.

The accidents, which have a respect to the thin Liquor, with the Brain, and Ner∣vous Appendix, are, disorders concerning sleep and waking, a debility of the whole Body, a trembling, shivering, pains, Convulsive motions, Cramps of the Viscera, Stupifaction, Phrensie; and the observation of which suggests, what the temper, and constitution of that thin Liquor may be; by what means it waters, and influtes the Nervous parts, and performs its circutes through them; how the Animal Spirits execute the functions of the Viscera; what the state of the Brain may be, whether it remain free from the incursion of the Feaverish matter, or whether it be not in danger of being overwhelmed, by reason of its critical metastasis or translation.

Concerning the habit of the body may be observed, what may be the reason of sweating, and the manner of it; whether only by vaporous Effluvia? or by sweats? or also by little wealks! whether the flesh falls away on the sudden from its wonted bulk? Or whether it retains it self a long while? What the colour of the Face is! And the vigor or habit of the Eyes? from these well laid together, the course of the Feaver may be best of all measured; at what time it will come to its hight or stand∣ing? Whether Nature will prevail over the Disease or not; with what manner of se∣paration,

and with what success she will endeavor the expulsion of the Feaverish mat∣ter; also by these signs may be learned, by what degrees the Blood growing hot, and often congealed, doth tend towards Putrefaction, or Corruption; whether it does any thing concoct the alible Juice poured to it; or whether or not it presently casts forth of doors, all its provision by sweat, as often happens in the declination of this Disease.

By these symptoms and signs, a yet more plentiful Indication may be had, if first it be known, upon what causes the several species of them depend; and by what provi∣sion, they are wont to be raised up in our Body: wherefore I have thought it worth our labour to recount particularly the chief of these; and to explicate the reasons of them, and their ways of working. But the symptoms, chiefly to be observed in a pu∣trid Synochus, or continual fervor without intermissions, are, an heat in the whole Body, a spontaneous weariness, a burning of the Precordia, intolerable thirst, an ar∣dor, and scurfiness of the Tongue, or Jawes, a pain of the head and loins, pertinaci∣ous watchings, Phrensie, Convulsive motions, a Syncope, Heart-burning, Vomiting, Nauseousness, want of Appetite, a Loosness, a Flux, with which, not all at once, now with these, now with those, this Disease is wont to be beset.

1. Heat, which is felt sharp and biteing, in the whole Body, depends upon the too great effervency of the Blood, and the accension of it in the Heart: For the Sulphureous or oily part of the Blood, being exalted, and taking an heat, is inkindled in the heart, in a double proportion, more than it was wont; wherefore, it copiously diffuses, by its deflagration, effluvia of heat thorow the whole Body. When the Sulphur is less dis∣solved, and inkindled in the heart, as in the green sickness, or the white dropsical Dis∣ease, &c. Heat is wanting in the whole: but in a Feaver, when the Sulphur too much burns forth, Heat superabounds. For heat, depends not only upon the actual infla∣mation of the Sulphur, or the firing of it, but an intense heat is excited without fire, in many mixtures, where the particles of Sulphur are dissolved by corrosion, or are more thickly heaped together for want of ventilation; wherefore, when Iron is corroded by any acid mineral Spirit, or when Spirit of Nitre is poured on the butter of Antimony, a mighty heat with a fume is produced; in like manner when Dung, or Hay laid up wet, are kept from ventilation, grow highly hot: it is the same reason, why the Blood burns above measure in Feavers, to wit, the particles of the Sulphur, being too much exalted and made hot, are more thickly heaped together in the Vessels, and are more dissolved, and as it were inkindled by the ferment of the Heart; where∣fore, they every way diffuse heat, being loosned in the bond of the mixture, and eve∣ry where stretched forth or expansed.

2. A spontaneous weariness or lassitude, is felt in the whole Body: to wit, by rea∣son of the Vessels being distented with the boiling Blood, also the musculous flesh is very much stuffed with Blood, and a copious breath, that it is made less fit for motion, as they who are sick of an Anasarca, have their limbs very unwealdy by reason of the aboundance of serous humor: besides, in Feavers, by reason of the inflamation of the Blood, the Juice, which is sent for a supply to the nervous stock, departs from its due temper, that it becomes little fit, for the actuating the Body.

3. The burning of the Praecordia is made, by reason of the Blood being more co∣piously enkindled in the Chimny of the Heart, which from thence boiles forth into the Lungs, with great ardency; wherefore, by how much the neerer this Region is to that fire place of heat, it is pierced therefore with the greater burning.

4. An almost unquenchable Thirst is caused, both from the glowing heat in the Prae∣cordia, also by reason of the sharp and hot particles of the Feaverish matter, affixed to the ventricle, in the circulating of the Blood; which indeed, desire to be washed, even as salted and spiced meats, being plentifully eaten, or also strong, or sour things, rouled in the mouth, or throat; for this kind of distemper, calls for a more free swallowing down of Drink, as a member too much heated, the pouring on of cold water.

5. The ardor, and scurfiness of the Tongue, and Jawes, as also oftentimes an ac∣cretion of a certain white, or yellow, or black filth, happen without doubt, because of the heat, and soot, exhaled from the Ventricle, and Lungs, burning with heat: but the Tongue grows white, as often as that humidity, (with which it is naturally much im∣bued) is dried up, and parched, and so the exterior skin of the Tongue, is as it were roasted, by the burning heat, from hence also it becomes scurfie; which is also seen in healthful people, when it happens, that the Tongue is scorched by broth, or any other very hot suppings; in like manner, as when the Tongues of Animals are boiled, for the use of the Table, their skin becomes white and sharp or rugged. For whether the

spittle is drawn from the maxillary glandulas, (as the doctrine of the most ingenious Wharton hath first made known) or any other humor from the glandulas of the Jawes, or elsewhere; yet because, by the reason of the heat, and dryness, it grows too thick, and becomes clammy, also then the outward skin of the Tongue grows nevertheless white; but also it is covered with a certain filthy glew, to wit, because that humor, by reason of its thickness, may smear the Tongue, but cannot wet, or moisten it: but if it happens, that the Tongue is inwardly suffused, with a bilous humor, or outwardly tinged (as comes to pass by the use of Choler-abounding Vomits) then its hairy nap, being spongy, imbibing the yellow poyson, exhibits also the like colour. If that lastly, the heat be so strong, that it burns the Blood, and inkindles a fire, more ardent than usual, it follows, that from the fire place of the Heart, the breathing places through the Lungs, scarcely sufficing for the ventilating so great fire, soot or smoak is raised up, which being smitten to the furnace of the Pallat, strikes against the Tongue, as it were in a reverberatory, and infects it with blackness. But this same kind of blackness, (and as other filthinesses of the Tongue) is most conspicuous in its middle parts, because the more exterior compass, is cleansed by its frequent rubbing against the gums and palate.

6. Somtimes it happens in Feavers, and especially about their declinations, that the Tongue, palat, gums, yea the cavity of the whole mouth, and throat, are covered over with a certain viscous matter, as it were a whitish crust; which being often wiped off, presently new springs again, and unless by rubbing diligently, and washing the mouth, this crusty matter be frequently wiped away, the sick are in hazard of being choaked. This kind of distemper, is most often excited in Children newly born; for they are wont, for the most part, within fourteen days with an external growing hot, to be sprinkled thorow the whole skin, with broad and red spots; if that this suffusion of redness, do not freely break forth, or vanishes away sooner than it ought, for the most part, this whitish crust follows, in the parts of the mouth. This symptom, when it troubles Infants, after this manner, is wont to be ascribed to the fault of the Milk, to wit, that being to sharp, it induces the ulcerous distemper of the mouth. In those sick with Feavers, it is commonly attributed to thick vapors, and soottie, elevated from the ventricle: But to me it seems most likely, that in either, this distemper arises, from the impurities of the whole Blood, (and perhaps in some measure of the nervous Juice) deposited about these parts: for, as often as in the mass of either humor, any extraneous thing intimately mixed, is contained, that it is not to be dispersed by sweat, nor easily sent away by Urine, that, most often, is fixed, with the serous filth about the mouth; from whence Catarrhs, tumors, and troublesom spittings are caused: For when for the chewing of the meats, the salival humor in this place ought to be plenti∣fully suffused; nature very often endeavors to send forth of doors, what is superflu∣ous, or otherways troublesome, by these usual ways of excretion. Hence from Mer∣cury being taken, when both the Blood, and nervous Juice, are abundantly stuffed, with its most smally divided particles, and endeavor to thrust them forth, being in∣volved with serum, because they are not able to exterminate those mercurial little Bo∣dies, being intimately confused, neither by sweat, urine, or by any other ways, what is remaining, they endeavor to expel thorow the Arteries, and other passages, which supply the mouth with spittle, the same being involved with the serous Latex. Also in like manner, in Feavers, when from a long deflagration of the Blood, the adust matter is very much heaped together, of which no small part remaining, after the Crisis, is yet confounded with the Blood, and nervous Juice, being fixed either to the brain, or to some other place, from them it is at length supped up again, 'tis most probable, that this matter, is throughly roasted, by a long concoction, and so becomes almost like Glew, thick, wherefore, being not able to be dispersed, neither by spittle, or insensible transpiration, nor to be separated by the urinarie passages, but at length leisurely runs out, by the little Arteries, and other passages of the spittle, lying open into the Palat, as the most usual way of excretion, and forthwith by reason of its thickness grows into that glewiness. The same reason holds in Infants, whose Blood being made im∣pure, by filths contracted in the Womb, presently it endeavors to purifie it self, by that exterior putting forth, which if it do not rightly succeed, by reason of the thick∣ness of the matter, immediatly the viscous impurities, are exterminated by this way, as the more open. I have known some, in the declination of a Feaver, to whom, not only this kind of Crust of gummy matter, has hapned in the parts of the mouth, but a copious salivation, as if they had taken mercury, with a stinking of the breath,

also a swelling of the Tongue, and Gums, hath been raised up for many days.

7. The pain of the Head, in Feavers is excited, because of the Meninges of the Brain, being pulled or hauled with vapors, and with a sharp Blood, and hot; for the Blood being impetuously moved, by reason of the direction of the great Arterie, is carried in a greater plenty to the Head, than to the lower parts; because the passage, from the bosom of the Heart to the head, is strait, from the same, to the inferior mem∣bers, oblique, and as it were reflected; wherefore, as the membranes are very sensible, and that there the Blood is stopped, and reverberated, in its rapid course, it is no won∣der, if cruel headaches are excited in Feavers. Besides, this impetuous flowing of the Blood, wherewith (as it were by a certain Ramming) the membranes of the Head be∣ing distended, ake grievously; also somtime, Headaches arise, by reason of the ner∣vous Juice, (which is supplyed from the burning Blood) being too sharp, and prick∣ing: wherefore, when the membranes, and nervous parts, are watered, with the same, they being pulled by its acrimony, are moved into Pains and Convulsions.

8. In like manner also, the other distempers of the Head, as watchings, delirium, Phrensie, Convulsion, &c. arise, somtimes from the Blood being in a rage, and so stir∣ring up inordinate motions in the Brain, and somtimes also, from the nervous Juice be∣ing depraved, and therefore made improportionate, to the regiment of the Animal Spirits: But most often, these kind of symptoms are frequent in Feavers, by reason of the translation of the Feaverish matter, from the bosom of the Blood, into these parts. For the Blood, being full of the adust recrements, remaining after the deflagration, endeavors (like the flowring of new Wine) to subdue, and exclude them from its Company, by every manner of way; which, a Flux being arisen, when it cannot ex∣pel by Sweat, Urine, or bleeding, it oftentimes transfers, to the substance of the Brain, and there fixes them: and from hence chiefly, the aforsaid distempers, when they are fixed, and firmly rooted, draw their original, when as the lighter, and that are easily moved, often proceed from the afore-recited causes.

9. Convulsive motions, happen in Feavers, for divers causes: somtimes, because of the matter being heaped together in the first passages, which there haules the mem∣branous parts, with its notable pravity, and then, by the consent of the nervous stock, the Convulsion is presently Communicated to the beginning of the Nerves, in the Brain, and by that means draws aside now these, and now those parts: by which means, Worms abounding in the Viscera, sharp humors being stirred, and strong Me∣dicines, induce Convulsions: or secondly, when the Feaver, is a partaker of some malignity, so in the small Pox, Measels, or the Plague, frequently Convulsions happen; to wit, because the Blood is altered, from its benign and natural temper, into a destroy∣ing and venomous, by which the Nerves, and their beginnings, are pierced, and forced into Convulsions. Also, oftentimes without the suspition of malignity, in a putrid Feaver, Convulsive motions are induced, by reason of the translation of the Feave∣rish matter, to the Brain, as was but now intimated: so I have often observed, when the Disease is not presently cured with the Crisis, the sick ly by it, with a tedious sick∣ness, and are made obnoxious to tremblings, and Convulsive motions. Thirdly, and lastly, for the most part in every Feaver, which terminates in Death, Convulsive moti∣ons are the sad forerunners of it; which I think to happen, not only from the malig∣nity of the matter, with which the nervous stock is pulled and pierced, but because the Spirits, very much exhausted and debilitated, do not sufficiently blow up, and distend the Bodies of the Nerves, wherefore, being released from their wonted extension, and tonick motion, they are however by a more weak indeavor of the Spirits, agitated in∣to a disordered motion.

10. A syncope or swooning, is wont to be raised up several ways in Feavers, but chiefly for these three causes, to wit, either from the mouth of the Ventricle being distempered, which part, as it is interwoven with a manifold texture of Nerves, is very sensible, and because from the same branch of the sixth pare, little shoots of Nerves, are equally derived to the heart, and to the Ventricle, of the Orifice of the Ventricle, so implanted with Nerves, be distempered, with any great trouble, it is also Commu∣nicated to the heart, and either the motion is stopped in it, or at least an inordinate one is excited, whereby the equal Flux of the Spirits, and the Blood, is interrupted for a time. I knew one in an acute Feaver, taken with a frequent swooning, which distemper wholly ceased, after he had cast forth by Vomit, a long and smooth Worm. Secondly, a syncope also, is somtimes induced, because the invenomed matter is circu∣lated

with the Blood, which suddenly fixes, and extinguishes the vital Spirits, and con∣geals the Blood it self, that it is apt to stagnate in the heart, as usually happens in the Pest, small Pox, &c. of which we shall speak particularly hereafter. Thirdly, a syn∣cope is wont to happen, by reason of the more rare texture of the Spirits, which as they are very tender and subtil, are easily unbent, by any immoderate motion or pain: so I have known some, who being quiet in bed, have found themselves well enough, but being removed from one place to another, presently have swooned away.

11. The pain of the Heart happens in Feavers, when the Ventricle, and especially its Orifices, by reason of the manifold insertions of Nerves, being very sensible, are beset with a sharp and bitterish humor, or else with an acid, and corrosive; for hence a pain and trouble arises from the acrimony of the humor, after the same manner, as when the sphincter of the fundament is afflicted, in Cholloric dejections, with pain and molestation.

12. By reason of the same cause, Vomiting, and nauseousness are wont to be ex∣cited, to wit, by the Ventricles being beset, and irritated to a Convulsion, from an ex∣traneous matter, and not akin to it self: Such an excrementitious matter, may be ga∣thered together in the Ventricle, by three ways; for either the aliments, partly by rea∣son of a want of an acid ferment, by which they should be rightly Cooked, and partly by reason of the burning heat of the Ventricle, are roasted into such a Corruption; or Secondly, this kind of matter, is laid up in the Ventricle, from the Arteries, termi∣nating in its Cavity, as uses to happen in the small Pox, the Plague, and malignant Feavers; or Thirdly, meer Choler, being pressed forth from the Choleduct Vessels, into the empty intestine, by reason of an inverse motion, and as it were Convulsive, of that intestine, it is poured into the Ventricle, want of Appetite, also happens, by reason of the Ventricles abounding with vitious Juices, and because the acid ferment, is wholly perverted, by the scorching heat. These kind of distempers of the Ven∣tricle, and Viscera, somtimes arise from an excrementitious matter, (to wit, alimen∣tous, degenerated in the concoction) heaped together, a long while before the Feaver, in the first passages, which not seldom becomes, the occasional cause, of the Feaver it self: but somtimes, nauseousness, want of Appetite, Vomiting, pain of the Heart &c. are the immediate products of the Feaver; for when the day before the sickness, those distempered, have been well enough in their Stomack, as soon as the immoderate heat of the Blood was induced, whilst it boiled up above measure, both the Effluvia, and the recrements, being wonted to be evaporated outwardly, also the bilous humor, flowing out of the Choleduct Vessels, are poured into the Ventricle; by which, its Crasis is overthrown; also the Reliques of the Chyle, and other contents in the Vis∣cera, are egregiously depraved; from whence, the aforesaid Distempers draw their Original.

14. No less frequent a symptom in Feavers, is a Diarrhea, or Flux of the Belly, which somtime happens about the begining of the Disease, and arises (for the most part) either from the Bile, flowing forth of the Coleduct Vessels, into the Duodenum; or from the recrements of the Blood, and Nervous Juice, poured forth from the Ar∣teries, and the passage of the Pancreas, into the intestines. All the aforesaid humors, (but especially the Choleric) when they are supplied in abundance, often Ferment with the mass remaining of the Chyme, that the same swelling up with a spumous rarefa∣ction, irritates the intestines, and provokes to the motion of excretion: somtimes also, about the standing of the Disease, and in the declination of it, a Lask is exci∣ted; and so, either Nature being Conqueress, the more thick purgings of the Blood, are this way critically sifted forth; or being overcome, the Flux of the Belly, is the effect, and sign, of the Viscera wholly losing their strength, and firm tenour. It somtimes happens in a Feaver, that the Belly is always bound, that it is not at all loosned, but by Physick, and tho the sick take nothing but liquid things, for many days, the stools are still of a solid consistence, and hard, this seems for the most part to be done, when the Blood growing sharply and exceeding hot, like fire, consumes the humidities, wherever they flow, and draws to it self, out of the Bowels, the wa∣tery matter, by a Copious emission of vapours, and presently makes it to be evapo∣rated outwardly: wherefore, the thicker part, being left in the intestines, is made firm, from the scorching heat, as it were a Caput Mortuum, remaining after distillation.

A Dyssentery is a distemper, so frequent in continual Feavers, that some years it becomes Epidemical, and not more mild than the Plague, kills many: The cause of it is wont to be, not any humor produced within in the Viscera, that corrodes the in∣testines

with its Acrimony, (as some affirm) but a certain infection impressed on the Blood, and so intimately confused with it, that, under the form of a vapour, or a sincere humor, it cannot be pulled away from the Blood: wherefore, the thrusting forwards, towards the intestines, unlocks the little mouths of the Arteries, and makes there little Ulcers, and exudations or flowings forth of the Blood, like as when from the Feaverish Blood. Pustles and inflamations break forth outwardly, with a flowring towards the skin: But it is most likely, these dysenteric distempers, which accompany Malignant, or Epidemical Feavers, arise from a certain coagulation of the Blood, as shall be more fully declared hereafter.

And here also, among the symptoms of Feavers, might be recited, what are wont to appear outwardly, in the superficies of the Body, as are Spots, Whelks, Buboes, Carbuncles, &c. but because these belong after an especial manner to a Malignant Feaver, therefore we will forbear in this place, from the consideration of them, until we shall speak of the Plague, Small-pox, the Pestilential, and Malignant Feaver.

The Pulse and Urine shall conclude here the troop of symptoms and signs in a Pu∣trid Feaver, which are much heeded, for the finding out, both the state and the strength of the sick: For, as there are two things, by which our life is propped, viz. Heat inkindled in the Heart, and concoction to be made in the Viscera, and Vessels, because the Pulse and Urine, best show the alterations in either, induced in a Feaver, therefore from hence, a most certain judgment is taken of this Disease, about to end, in Death or Health. I think it is not needful, to speak of th••se at large, or to recount the several causes and differences of either: It will suffice for me to note here, the chiefest things of them, and what are worthy of consideration in the course of Fea∣vers. And first of all the Pulse is consulted, as it were a Thermometer or Weather-Glass, constituted by Nature, that from thence, the heat inkindled, in a Feaver might be meted; which if it should be more strong, stirs up a great ebullition or boiling up of the Blood, the Artery beats more strongly and quicker, so long as the Spirits are in strength; then they being a little exhausted, the more strong Pulse is remitted; which however is compensated with swiftness, and is made quick, and small. If the Feaver be gentler, and is troubled with a lesser burning, the Pulse also declines less, from its Natural condition, and the moderation of this, in the whole course of the Disease, denotes the truces of Nature. Neither doth the Pulse only, betray the forces of the Feaver, as of an Enemy, but shews also plainly the strength of Nature, and her ability of resisting. So long as the Pulse is laudable, the matter goes well, and it shews good hopes; but from the evil state of this, a bad omen is shewn, and a despair of Health. So without a frequent, and diligent examination of the Pulse a Physician connot make a right judgment or Prognostication, or safely prescribe Physick.

1. As to the first thing, it ought to be known (as much as may be) what every ones Pulse is, according to its Natural Constitution; for it is in these stronger, in those weaker: then it is to be considered, in every moment of the Feavers, by what degrees it is distant from its Natural state: for now it is somtimes more vehement, and argues the Feaver to grow stronger; now it is depressed, below its wont, and denotes the Spirits and Strength dejected.

Those whose Pulse in Health beats weakly and languishing, when taken with a Feaver, if they have a small and weak Pulse, it is not so evil a sign, that we should presently despair of their Health: In whom the Pulse is by Nature strong and vehe∣ment, if after the Crisis of the Disease, it hath scarce a moderate vigour, tho it be not wholly weak, it argues the condition of the sick to be suspected, and not safe.

If from the begining of the Feaver, before the Blood has flamed out, or if a Crisis being made, when part of the burthen is drawn away, or at another time, without an evident cause, the Pulse becomes weak, it portends evilly: but if after long watch∣ings, or great evacuations, the Pulse is made a little weaker, Health is not therefore to be despaired of, because the strength cast down by these means, or overwhelmed, may be restored, and the Spirits renewed.

When the Pulse is suddenly altered for the worse tho the sick seem to be better, as to the rest of the symptoms, you may forespeak the sad prognostication of Death; and so contrariwise, altho most horrid symptoms urge, and yet the Pulse is laudable, Health may be yet hoped for. If in a strong man, that hath a Feaver, the Pulse is very small, and creepingly, or becomes like the motion of Ants, death is at hand.

2. In the exhibiting of Medicines, cautions and rules of no small moment are taken; Purging and Vomiting are forbid, by the pulse being too quick and violent; also by being low and depressed; because, whilst the Blood is too fervent, evacuation helps little, because both what is hurtful is not separated, also for that by the pertur∣bation, the strength or spirits, are more debilitated. But when the spirits are broken, and strength cast down, Medicines cast them more down, and somtimes wholly over∣throws them. Wherefore, when a Physitian thinks of evacuation, upwards or down∣wards, he first examines the pulse, and goes about this work only, when Nature is strong and quiet; that she may at once be at leisure, for the operation of the Medicine, and may have sufficient strength.

Nor is there less need of circumspection, in sweating Medicines and Cordials: which, if administred in the Feaverish fit, do too much strengthen, the former violent motion of the Heart, and oftentimes break its strength; also, when the Pulse is very languid, if hot and strong Cordials are administred, (as when a small flame is troubled with a more strong blast of wind) life is easily extinguished; wherefore, tis a vulgar observation, that Cordials often accelerate death, for that by too much troubling the Blood, they sooner beat down strength.

There is yet the most need of the caution, and direction of the Pulse, in exhibiting narcoticks; for these, (because they perform their work by extinguishing, and fixing the too fierce vital spirits) if used in a weak or inconstant Pulse, either by diminishing the vital spirits, render them wholly insufficient for the Disease, or by suffocating them too much, cause a perpetual sleep: wherefore, in a languid, unequal, or formicating or creeping Pulse, opiats are to be shun'd, more than a mad Dog or a Snake.

An unequal, and intermitting Pulse, has a most evil report, from the writings of Physitians; yet, altho of an ill note, does not so certainly portend death, as a weak Pulse: for I have known many, to have recovered, tho by those kind of signs con∣demned to the Grave; because the inordination of the Spirits, and the Blood, may be more certainly and easily composed, or allayed, than their dejection restored.

2. The inspection of Urines in Feavers, before all other Diseases whatsoever, hath more of certainty, and is of greatest use: for from hence, the conditions of the sick, and of the Disease are best known, and the medical intentions, concerning what is to be done, are better directed; what observations, and rules, concerning this thing, are vulgarly set forth, are so many, that it would be almost an infinite labour and tedious∣ness, to recount them all: it will be sufficient here, to note the chief of them.

Concerning the Urines of persons in Feavers, there are chiefly to be considered, the colour, consistency, contents, and subsidency or setling. The colour of the Urine, shews the measure, or excess of heat in the Blood; which, as it is increased, and be∣comes more remiss; the Urine also is more, or less red; the cause of which is, the ebullition of the Blood or the effervescency induced from the Feaver, to the Blood; by reason of which, the particles of Salt, and Sulphur, implanted in the Blood, humors, and solid parts, are more dissolved, and incocted with the serum, and impart to it a red∣ness; even as, when Salt of Tartar, and common Sulphur being mixed one with an∣other, and boiled in water, impart a deep red colour to the Liquor.

The Urines of some, are highly red, when they are but a little, or lightly Feaverish: and on the contrary, the Urines of others, labouring with a Feaverish burning, are less coloured. Who abound with lively heat, and a very hot Blood, or are obnoxious to the Scurvy, phthifis, or hypochondriac distemper, when by taking cold, condensation, surfeit, or drinking of Wine, they are troubled by any little Feaver, they render a Urine strongly red: for that the particles of Salt and Sulphur, remain exalted in their Blood, and before half loosned; wherefore, there is a necessity, that the Feaver urg∣ing, they are more boiled in the serum; on the contrary, they who are indued with a cold temper, with a faint and weak Pulse, being taken with a Feaver, with a greater effervescency of the Blood, render their Urine less coloured.

The consistency, contents, and subsidency of Urines, being put as it were upon the same thrid, depend all of them, on the adust and recrementitious matter, which is remaining in the Blood, after the Feaverish deflagration: if there shall be plenty of this, the consistency of the Urine becomes somwhat thicker, and after it has stood, it is troubled by the cold: but if there be a lesser quantity of this, or otherways derived than to the Reins, (to wit, by sweat, or is called away by a critical translation, to this or that part) the consistency is made thinner, and the Liquor remains clear. Also the particles of this matter, do inlarge the contents of the Urine, which shew them∣selves

diversly, according as the nutricious Juice, is now somwhat cooked, and assi∣milated by the Blood, now altogether perverted, and carried into a putrifaction, some signs of concoction, and assimulation, shew themselves, in the Urines of Feaverish persons, now a laudable Hypostasis now some marks and rudiments of the same: A want of Hypostasis, and the confusion, and perturbation of the Urine, denote the concoction vitiated, But as this matter is more or less roasted, in the Blood, the con∣tents are now of a pale, now of a red colour, like oker. By reason, that the recre∣ments, confounded with the Blood, either the Spirit being strong, begin to be over∣come, and separated, or the same being depressed too much, they are less able to be se∣parated, also the contents of the Urine, are wont to be more or less, sooner or slower separated, from the rest of the Liquor, and to sink down towards the bottom.

As to the Prognosticks, to be taken from the Urine, we may take notice, that the colour of the Urine being somwhat more remiss, the consistency mean, the contents few, and the subsiding free or easily collected into a Cloud, portend good: on the contrary, a deep red, a thick and troubled consistency, thick and cloudy contents, which slowly or scarce at all sink to the bottom, denote a very great heat, plenty of adust matter, and its being brought under, and secretion, difficult or frustrated.

As to the Medicinal directions, the business depends on this, that we attend, by the frequent inspection of the Urine, the motion of Nature, and be helpful to the same; neither is it to be moved, by purge or sweat, but when a certain hypostasis of the Urine shews signs of concoction and separation. I thought it needless to say any more here concerning this matter, because those things are more largly handled elsewhere, in a proper place, which belong to Urines.