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.

A Description of an Epidemical Feaver, spreading about Autumn, in the Year 1657. taken in the middle of September.

WHilst we meditate the Description of a Feaver, at this time cruelly raging, it is fit, that following the example of Hippocrates, we first consider the fore∣going constitution of the Year, its intemperance and excess of qualities. For Epi∣demical Diseases, and commonly excited among the people, are from a common cause; such as the habit of the Year, and by that means contracted, a disposition of the Blood, by which many are alike affected. But that we may draw the matter from the beginning, the last Spring, and the time succeeding it, even to the end of the Summer, was all that half years space extremely dry and hot, but especially after the Summer solstice, the heats were so intense for many weeks following, that day and night there was none that did not complain of the heat of the Air, and were almost in a continual sweat, and were not able to breath freely: About the Calends of July, this Feaver, at first sporadical or particular, began to break forth in some places, that perhaps one or two were taken in the same City or Village: In many it imitated the likeness of an intermitting Tertian, viz. the Fits returned every other day; which yet infested the sick with a most intense heat, without any cold or shivering going be∣fore; Vomiting and Choleric Stools plentifully hapned to most, sweat succeeding but difficultly, and often interrupted, whereby the feaverish fit rarely ended in a remissi∣on, but that all the time between, the sick continued languishing and weak, with thirst and restlessness; in some, when the business began to grow better, after three or four fits, cold and shivering began the fits, and the Feaver became an exact inter∣mitting Tertian: But in most, the Feaver still grew worse, and presently became of an evil nature, and difficult Cure, with a depraved provision of symptoms; for when the sick were highly heated in their fits, and hardly sweated, they were wont to com∣mit errors, which daily increased the strength of the Disease, because by reason of the inpatience of the sick, and the unskilfulness of Servants, the sweat being inter∣rupted, which should have ended the fit of the Feaver, after one fit was scarce finish∣ed, another presently succeeded, and so the Disease was wont to have wandring and uncertain periods, without any intermission betweene and afterwards to pass into a kind of continual Feaver. The condition of which, sometimes being very dange∣rous, with an evil affection of the Brain and nervous stock, so that oftentimes a Le∣thargy, or Delirium, or not seldom cramps, and Convulsive motions, were excited: About the month of August, this Feaver began to spread far and near, among the peo∣ple, that in every Region and Village many were sick of it; but it was much more frequent in the Country, and smaller Villages, than in Cities or Towns. It was still like an intermitting Feaver, unless that it seemed more infestous than that is wont, and with more cruel fits, and shorter intermissions, and therefore was called

the new Disease: besides, it underwent the note of a certain malignity, and gave knowledg of its Contagion and Deadliness; insomuch, that it crept from house to house, infected with the same evil, most of the same Family, and especially those fa∣miliarly conversing with the sick; yea, old Men, and Men of ripe Age, it ordinari∣ly took away.

If you respect the nature and essence of the Disease, this Feaver properly should be referred to the rank of intermitting Feavers, for the fits returned at set times, also for the most part they began with cold and shivering, and oftenest with vomiting, and by and by a most intense heat proceeding, they were finished at last with a sweat. The Urine in most appeared of a flame colour, thin in the fits, with some hypostasis, without it more thick, and with a redish sediment; altho with a most copious sweat, and often iterated, the Disease was not cured, which might be expected in a conti∣nual Feaver; yea, the distemper continued exceeding long, for many days, some∣times months, tho much evacuation almost daily hapned by vomit and sweat: which we observe frequently in an intermitting Feaver, rarely to happen in a continual; out of the fit, at any time of the Disease a purge was profitably instituted, which in a Synochus before the sign of concoction, were a wicked thing to attempt; besides, that this Feaver was of the intermitting kind, it seems to appear from hence, because very many recovered of it, that scarce one of a thousand died, which I scarce ever knew in an Epidemical Synochus. About the first beginnings of this Disease, it appeared very like to an intermitting Tertian, altho afterwards in some, by reason of the vi∣tious provision of their body, and errors committed in Dyet, and sweating, it seem∣ed to change into a continual; for in whom the fits were not rightly concluded, nor ended in a remission, by reason of the morbific matter not being throughly dispersed, their Blood was continually hot: from whence it came to pass, that the fits sooner returned, and continued longer; till at length, by reason of the plenty of matter, and the languishment of Nature, the Blood being made weaker, endeavoured no longer to swell up, and to separate the feaverish matter at set hours, but to subdue it by little and little, with a continual effervency.

We are to inquire concerning the causes of this Disease, what may be the leading, evident, and conjunct cause, viz. by the means of which it spread so generally, and became Epidemical through all England; by what means, and for what occasion, it was wont to be excited in all men: and lastly, what kind of alteration of the Blood and humors, being induced, brought forth this kind of Feaver, with such a provisi∣on of symptoms, and conserved it in the Act.

I know it is easie to place wholly the cause of this so popular Disease in the malig∣nant constitution of the Air, to wit, that the Particles of the Air, in which we breath, were infected by a certain extraneous Infection, and not agreeable to our Na∣ture, the little bodies of which Infections being admitted within, did ferment with the Blood and humors, and so in most, brought in this Feaver, almost with the same appearance of symptoms. For who dares deduce the original of a Disease so ge∣nerally raging, from a less public fountain? or refer to any other place, the received causes of Diseases, than to that nest of Vital Air, on which every one seeds? But whilst I more attentively consider the thing, it seems to me, that its stem, and as it were its first beginnings, are to be sought a little deeper. To wit, that this Feaver is born not from the Contagion communicated by the Air, and immediately fixing its evil on men, but rather from a certain feaverish predisposition or nature, impressed somewhile before on our Bodies, because of the intemperance of the Year, which at length having gotten maturity, on the least occasion is brought into Act, and so breaks not forth into this Feaver, so much as it sifts it forth.

For when about the Calends of July, the Air was immoderately hot, with a most intense heat for many days, is easily altered our Blood towards an hot and bilous in∣temperance, by which (as 〈◊〉〈◊〉 ••ine growing more hot than it should do) the sweet part, and the spirituous was much consumed, in the mean time, the Saline and Sul∣phureous was too much carried forth, that by that means, the Liquor easily contra∣cted a rancor or sourness: We have in another place shewn, that this kind of dispo∣sition of the Blood, whereby indeed it turns from a sweet and spirituous temper, in∣to a bilous or choleric, is most apt for intermitting Feavers: Hence the alible juice, which is continually carried into the mass of Blood, is not rightly concocted nor as∣similated into Blood, but perverted as it were into an extraneous and fermentative matter: which arising to a fulness in the bosom of the Blood it self, and growing

turgid according to its increase at set periods, as we have already shewn, induces the fits of the intermitting Feaver: when therefore, from the great burning heat of this Summer, the Blood almost of all men, becoming more hot than usual, was very much scorched, it is no wonder, if from thence it should contract a great aptitude for intermitting Feavers. But why not whilst the fervor of the Heaven was yet urgent, but a little after, this Disease spread it self, the reason is, because this indisposition is not impressed on our Blood at once, or at one time, but by little and little, and not but of a long time; and therefore, Diseases like Fruits, are chiefly ripened in Autumn, after the foregoing heat of the Summer.

This aptitude or feaverish disposition, all do not contract alike; those whose Blood is of a more hot Nature, and abounds more in Sulphur, and for that cause is sooner scorched, also such who labour, or stay long in the heat of the Sun, and open Air, by reason of their Blood being more remarkably torrified, more easily fell into this Disease; wherefore, at first, it chiefly raged among Husbandmen in the Coun∣try: of these, who had acquired an aptitude to this Feaver, from the Blood being before scorched, some perhaps fell into this of their own accord, the feaverish dispo∣sition being leisurely carried forth to a maturity; others, by reason of a light occasi∣on or evident cause, which was wont otherways to stir up the feaverish burning, as from taking Cold, Surfeit, drinking of Wine, and the like; and others fell sick from the Contagion received of others, for as the effluvia constantly came away from the sick, when they pierced Bodies predisposed to the like distemper, they easily excited the hid powers into Act.

As to the third Proposition, to wit, that the conjunct cause of this Disease, and its formal Reason, may be known, we must put you in mind of those things, which we have elsewhere delivered concerning the nature of intermitting Feavers; for we sup∣pose the retorrid and bilous constitution of the Blood, as the basis of this Disease, by reason of which, the alible juice, being supplied daily, as it were in a certain measure, is not rightly concocted, but by the assation or scorching, becomes or goes into a fer∣mentative matter, not miscible with the Blood. When the Blood is filled to a full∣ness with this matter (which happens at set intervals of times, because the alible juice is supplied as it were by a set measure) it of its own accord conceives a swelling up, and the growing hot or effervescency being excited, for the carrying away of this matter, causes the feaverish fit: which so long indures, till this feaverish matter be∣ing inkindled, and as it were burnt in the heart, is wholly dissipated with sweat.

From these things premised, it is made plain, that in this distemper, we now dis∣course of, there are some things happen by a peculiar way, from the common kind of intermitting Feavers, and therefore it was noted, and that not undeservedly, with the appellation of a New Feaver; which are, First, That about the beginning of the Disease, fits did a long while afflict the sick, without cold or shaking, but with a most intense heat, thirst, and cruel vomiting; by which, the sweat hardly, and for the most part partial, and often interrupted, succeeded, whereby the fit was not finish∣ed but of a long time. The reason of which, may be only laid upon the very cho∣leric disposition of the Blood, and being above measure scorched: For this proceeding from the domineering Sulphur, wholly inhibits the wonted sourness of the Blood, which follows its turgency or swelling up, and is wont to stir up the cold or shiver∣ing; and by reason of this kind of temper of the Blood, too much roasting and as it were burning the alible juice, the Blood growing turgid, together with that juice, and being stirred up into motion, is inkindled more than it is wont in the heart, and by its deflagration, induces a most intense and troublesome heat, with thirst, to the sick. Cholerick vomitings, happen not only at the beginning, but in the middle of the fit, by reason of the abundance of choler, with which, the Choleduct Vessels being too much filled, infuse the intestines; which then, a Convulsion being stirred up, is easily emptied into the Ventricle: sweat hardly succeeds, because the bile abounds more than the serum, wherefore the feaverish matter being burnt, it is not easily sifted forth by sweat but be∣ing either mingled with the Blood, causes the long effervency, or being carried to∣wards the intestines, produces Vomiting, or a Flux. Secondly, This Feaver differs from the vulgar intermitting Feaver, because after the fit was ended, there was no full intermission, even to a remission, but the sick still remained languishing and thirsty; and as to appetite, sleep, and other accidents, very ill: which indeed hapned, because, by the intense heat of the fit, more of the Blood and feaverish matter is inkindled, than that its recrements remaining after its deflagration, are able presently to be dissi∣pated,

especially, because the sweat, by reason of the dryness of the matter, very hardly succeeds, nor is the feaverish matter enough diluted with the serous Latex, to be sifted forth; wherefore, the Blood by its Contagion, in the time of the fit, not being perfectly freed, grows hot still, neither the fit being ended, doth it get any full truce from the Disease: In the mean time, whilst the Blood is urged after this manner, with almost a continual effervency, it differs from a Synochus; because in this, the Sulphureous part of the Blood, being too much carried forth, and as it were inflamed, causes the Feaver by its deflagration; but the continual ebullition, which after this manner comes upon this intermitting Feaver, wholly depends upon the con∣fusion of the not miscible matter, and its hard secretion from the Blood. The Syno∣chus happens like Wine growing hot of its own accord, by reason of its richness, the other conceives its fury, like the same Wine, by reason of some heterogeneous thing poured to it: wherefore we remark, that whilst our Feaver is seen still to be continual, it is not cured by sweat or the Flux of the Belly, altho they frequently and copiously happen: because it depending upon the Blood being depauperated, rather than be∣ing inflamed, it continues long, and disposes the sick towards a Cachexie,

3. There is a third reason of difference, by which this Feaver may be distinguished from the common rank of intermitting Feavers, and it is this, that it is easily propa∣gated to others by Contagion; the reason of which is, because here very many bodies are predisposed after the same manner, towards the same distemper, which happens not at another time; wherefore, the meer effluvias from a diseased Body, are able to excite the like effect, in a very fit subject; even as some Beams of Flame enkindle Flame, in a very combustible matter: In the mean time all do not alike contract the Infection of this Feaver, but that some being less prepared or fitted for it, converse with the sick without harm.

4. There is another symptom occurs, not constant to this Feaver, but only hap∣ning in some places, that discriminates it not only from the common, but varies its own proper type; to wit, sometimes it happens, this Disease to be accompanied with a Dysenterick distemper; in some cholerick Vomits, and bilous Stools very much infest, and in others Bloody Stools follow, with cruel pains and torments of the Belly. The former I often observed in our Neigbourhood, and the reason of it may be deduced from the highly bilous temper of the Blood: For by reason of this, the adust matter, not to be dissipated by sweat, is copiously sifted into the Liver; then by reason of the choler-carrying Vessels, being filled to a flowing over, it is sent away to the Ventricle, and Intestines. The other Dysenterical distemper, was found only in some places, and there peculiar rather than common, it laid hold only of some sick. The origine of it may be referred to the peculiar dispositions of some Bodies, or viti∣ous provision, also to the site of the place, or condition of the Air; then the Disease is to be suspected, to be thence translated to others, not without the communication of a certain Infection.

There is to be had a double Prognostication concerning this Disease: First, of the Feaver in General, what end it shall have, and when; what it may threaten to the Land: whether it precede not (which is commonly feared) the Plague, or Pesti∣lential Sicknesses. Secondly, The signs ought to be laid down, whereby we are wont to presage health, or danger, in the various cases of the sick.

As to the First, Because we have shown that the Origine of this distemper is not to be fetched from the Contagion of the Air, or its being infected with any venomous Infection, nor from any malignant seeds of Vapours diffused through the Air, but only from the signal bilous temper or disposition of our Bodies, with the Blood be∣ing made adust and roasted extremely, by reason of the Summer heats, I think there is no reason of fear, that this Feaver should be carried forth into any thing worse, by the vice of the Air, or might at length grow to be Malignant or Pestilential. But rather (that the season of the Year being changed, and the alteration of our Blood assuredly to be expected) we might fear lest this Feaver, which now imitates the way of an intermitting Feaver, should afterwards pass into a Quartane, the Blood growing into a melancholy temper. Which thing indeed I observed to happen to some already, and I believe, that before the Autumn be fully passed over, will happen to many more.

As to the particular Prognostication, the chiefly notable signs, which occur in the course of this Feaver, and in a manner foretel its condition and event, are of this sort; if the Disease happens in a firm Body, well tempered, and easily perspirable;

if vomiting with ease succeeds, and that the Belly be loose: if the fit begins with a light shivering, and afterwards a moderate heat, with sweat concludes it, and that the intermission be with some tolerable remission; if the Pulse be strong, the Urine of a flame colour, clear, and with a laudable hypostasis, we may Predict that the Di∣sease will quickly end without any danger. But if this Feaver be excited in a fat Bo∣dy, and or a vitious habit, it with troublesome vomiting, an intolerable thirst, and fierce heat, long exercise the sick; if to the heat a difficult sweat, and partial, and often interrupted, and between frequent vomitings succeed, and that it ends not in a remission, we may declare, that this Disease may be long, and of a dangerous issue. But if the sick remain in strength, and the Urine shew signs of concoction, we need not despair of health; especially, if after four or five periods, the Disease, as it is wont to do, remits of its wonted fierceness. Thirdly we observe, if this Disease is excited in an old Body, or others broken with sicknesses, or debilitated; if besides horrid vomitings, there happen swoonings, faintings, Deliriums or Lethargic di∣stempers; if after many fits, the sick having lost their strength, the Disease remits nothing, but exerciseth the Blood, with a continual effervency, and that the Vital Spirits are much destroyed; if the appetite be lost, wakings pertinacious, and that they have Convulsive motions, with a weak Pulse, and Urine troubled, or thick, we judg the matter to be full of danger: yet is not the sick to be left as desperate, because the Disease is not hasty, and kills not suddenly, and out of hand; but is drawn out at length, and grants time and occasions to nature, of recollecting her self, and to the Physician, of giving Remedies.

The Therapeutic Indications, which have place in the Cure of this Feaver, are chiefly four. First, That the Blood being now scorched, and made too choloric, may be reduced to its due temper. Secondly, That the depravation of the nourisha∣ble juice, and its alteration into a fermentative matter, may be inhibited, or at least lessned. Thirdly, That about the declining of the Disease, the Blood depauperated by a frequent deflagration, and made more impure by the fusion or pouring into it the morbifick or adust matter, may be restored, and rendred as it should be volatile. Fourthly, That the symptoms, which chiefly infest in the course of the Disease, may be timely helped, by fit Remedies; that these intentions may be satisfied, I counsel that this following method be used.

About the beginning of the Disease, if the bilous or cholorie humor, flowing forth of the choler bearing Vessels, and being suffused into the Venticle, cause the sick to be prone to vomiting, let a more plentiful evacuation be procured, by a gentle Emetie in the time of the fit: The opening of a Vein, and Purging, ought not to be administred, unless between the fits: for whilst the Blood grows mainly hot, or is resolved into sweat, Nature ought not to be called back from the Work begun, nor her endeavours to be disturbed, by the prescriptions of Physicians; wherefore, after the 〈◊〉〈◊〉 being past, and the sweat throughly finished, a Purging may be instituted, by a gentle Cathartic, and the same afterwards sometimes repeated, on the like occasion: for by this method, not only the provision of the excrementitious matter, is brought away, from the first passages, but chiefly the choler-bearing Vessels being emptied, the choler is copiously drawn forth from the mass of Blood, and by that means the Blood is restored to its natural Crasis or disposition. The Letting of Blood, if it be indicated, should be performed presently after the beginning; for so its Liquor being too turgent or swelling up, is eventilated, whereby both the nutritious juice is less perverted, and the fit urging, it burns forth with a less heat, together with the mor∣bifick matter: but otherwise, if a Vein be opened after a long sickness, when the Blood being made poorer, and more watry, more of the morbific matter is heaped together, and does not rightly concoct, and sift it forth, it detracts much from the strength of Nature, and nothing from the power of the Disease. In the interval of the fits, when there is no place for opening a Vein, nor Purging, let the Belly be kept loose, by the constant use of Clysters; also digestive Remedies, of acetous or saline Liquors and Powders, are to be exhibited; of which sort are, Cream of Tartar fix∣ed Salts of Herbs, Tartar Vitriolate, Harts-horn burnt, Spirit of Vitriol, and Salt, &c. for these restore the lost, or sleepy ferments of the Viscera, purifie the Blood by fusing it, also separate the morbific matter, and as it were precipitate it: also, at this time, between, if pertinations waking infest the sick, and overthrow their strength, it may be lawful to administer anodyne, and gentle narcotic Remedies; but never in the fit: for then they greatly hinder the subduing, and sifting forth of the feaverish matter, and draw out in length the fit that would end sooner.

These things are to be done about the interstitia, or intervals of the fits; but whilst the fit is urgent, altho the sick then chiefly send for, and call upon Physiicans, yet at this time their prescripts are limited to a narrower space: If Vomiting (notwith∣standing an Emetic being given) still infest, it may be more freely provoked, either by simple Posset Drink, or with bitter Herbs boyled in it: But let the chiefest means of help be, in temperating the heat and thirst, which most grievously torments the sick in this Feaver: For whilst the Blood growing hot, with the morbific matter, and being inkindled in the Heart, leaps forth into the Lungs, stirs up there a cruel Infla∣mation, which requires a profusion of a cold humor as it were for the extinguishing the Flame; wherefore they greedily desire without any measure drink, for want of which the sick are almost killed with too great heat, and their Blood being almost wholly rarified into flame and fume, the thrid of Circulation is hardly continued; wherefore, drink ought to be wholly granted, to those in Feavers: which however, if it be taken in too large a quantity, it at first more disturbs the estuating Blood, and at length brings confusion to the feaverish matter, begun to be separated; that from thence, the Work of subaction and secretion is longer protacted, and the fit is made longer: also, besides, large drinking causes troubles in the Ventricle, and by disturb∣ing it, and often provoking Vomiting, hinders the breathing forth, and calls inward the sweat breaking forth, or perhaps already broke forth: wherefore, at first, the heat of the Feaver being inkindled, altho the sick be very thirsty, let them only sip a little, and abstain from drink as much as they can; afterwards, when the matter be∣ing burnt, and subdued, begins to be dissipated by sweat, they may be more freely indulged as to this, for so the sweating is greatly helped, and the fit is sooner finished: as to the nature of the Drink, let them take sometimes Posset Drink, sometimes Small Beer, or Barly Water, and sometimes simple Water, or sharpned with the juice of Lemons: In this case, the use of Sal Prunellae is deservedly praised, to be given in every Liquor; for this, with its nitrosity, wonderfully allays the raging Blood, and potently moves sweats, I have often observed, in the midst of a fit, the sick wont to fall into a swoon, or syncopy, to whom presently they give Cordials or hot Waters that much increase the violence of the Feaver, and bring forth more troubles than usu∣al, that the fit is more difficultly finished: But these faintings, for the most part, hap∣pen, either from a bilous humor suffused in the Ventricle, or by reason of the sweat suddenly breaking forth; and against these I always found the most present Remedy, that either a feather being put down the throat, Vomiting may be provoked, or that Liquor being plentifully drunk, a sweat may be again raised up: also, in the whole course of this Feaver, I am wont never to give any Cordials, or alexiteriums.

The Dyet in this Feaver ought to be only slender, and not nourishing, all sorts of Flesh, or any thing prepared of them, are wholly to be avoided; for as these abound with Sulphur, they give a more plentiful food (as Oyl poured on Flame) to the hot or enkindled Blood: besides, nothing spiritous, as strong Waters, strong Beer, or Wine, is to be yielded to; but Decoctions, or Broths of Oat-meal, or Barly, alter∣ed with cooling Herbs, are chiefly to be used; also Posset Drink, and small Beer, or Whey, is to be given them at their pleasure: for by this means, when a very slender and watry nourishing juice, is conveyed to the mass of Blood, the soluted Particles of Sulphur, burn forth sooner, and with the less tumult; also the recrements of the a∣dust matter, are more easily carried from the bosom of the Blood: but if on the con∣trary, a more rich or plentiful nourishment be administred, the effervency of the Blood is thereby very much augmented, and the Blood is more infected, by the confusion or pouring in of the adust matter.

After that the Blood being much burnt forth by frequent fits, and the Feaver being in its declination, remits of its fervor and fierceness, you must take heed, lest the sick at length growing well, fall not into a Cachexie, or Scorbutic Distemper: for the disposition of the Viscera being hurt, and the Blood very much depauperated, the alible juice, though not scorched so as at first, is not however rightly concocted, and ripened into perfect Blood: but by reason of the want of transpiration, the serous excrements, being imbued with a fixed salt, are greatly heaped together, and now fixed in the Bowels, now in the extreme parts, bring forth various Distempers. Wherefore in a long languishing of the sick, or otherwise for the sake of being sooner well, Remedies should be given them, which volatilise the Blood, or hinder the stuf∣fings of the Viscera, or if stuffed, may open them, and their ferments as if extinct, re∣store: for this use, those Remedies and Preparations chiefly help, which are com∣monly

called Digestives and Antiscorbuticks; with which being timely administred, I have known very many weak, pale, and as it were without Blood, suddenly to re∣cover a liveliness and vigor.