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. IV. Of the kinds of Intermitting Feavers, and first of a Tertian.

WE shall easily accommodate to our Hypothesis, delivered in the former Chapter, concerning the nature and beginning of Intermitting Feavers, all the Phaenomena which belong to it, and the reasons of them. But as those which are of this sort, do not observe the same space of Intermission, or of re∣turn, and their figures, as to the appearances of their signs and symptoms, do not alto∣gether happen after the same manner; therefore according to the diversities of these, and especially from the distance of the fits, the various species and differences of In∣termitting Feavers, are assigned. The chiefest division of them is, into Tertian, Quotidian, and Quartan: We shall here remark the chief things worthy of note concerning each of them.

It is called a Tertian Feaver, not which is accomplished at the distance of three days; but inclusively from the day in which one Fit begins, from thence the other re∣turns on the third. In the mean time, if the Fits be sometimes longer, viz. pro∣tracted almost to twenty four hours, and the Remissions anticipated also by their ac∣cessions, or comings of the Fits, the space is oftentimes less by a night and a day. This Disease is commonly distinguished into exquisite and spurious; The exquisite or exact Tertian Feaver is, which begins with a vehement shaking, to which succeeds a sharp and biting heat, which goes off in sweat, and its Fit is finished in twelve hours, and that the perfect intermission follows; In the spurious or bastard Tertian, the cold and heat are more remiss, but the Fit is often extended beyond twelve hours, yea often to eighteen or twenty. These differ as to the various disposition of the Blood, which is in the former more torrid and sharp; therefore perverts the alible Juice from Cru∣dity, towards an adustion, wherefore a more vehement Effervescency is stirred up; but as the matter more equally burns forth, it is sooner finished. In the latter, besides the adustion, the Blood abounds with too much serous humidity, wherefore, the nourishing Juice degenerates into a Crude matter, and therefore less apt to be overcome, and to burn forth; wherefore, its Fit is gentler, and more unequal, but is not finished but in a longer space.

The Essence therefore of a Tertian Feaver consists in this; That the Blood (like Beer brew'd with too high dry'd Mault) being too sharp, and torrid, does not right∣ly subdue, and ripen the alible Juice, which is taken in from crude things eaten, but very much perverts it into a nitrous-sulphurous matter; with which, when the mass of Blood is filled to a swelling up, like new Beer stop'd up in Bottles, it conceives an heat: From the flux of this nitrous matter, which blunts the heat, and vital spirits, and pulls the nervous parts, first the cold, with shaking is excited; then the vital spirit geting strength again, this matter growing hot in the Blood, begins to be subdued, and inkindled in the heart; from whose deflagration, an intense heat is diffused thorough the whole body; then its reliques being separated, and involved with serum, are sent away by sweat.

This torrid Constitution of the Blood, consists in this, That 'tis impregnated more than it ought, with particles of Sulphur and Salt; wherefore, the Procatartick causes, which dispose to this Disease, are an hot and bilous temperament, a youthful age, hot dyet, as an immoderate use of Wine and spiced Meats, but especially in the Spring, and autumnal feafons of the year, when the Blood (as all vegetables) is apt to flower, and to ferment of its own accord. By reason of these occasions, the liquor of the Blood, is want to be thorowly roasted, and to be changed into a cholerick temper: and when it departs from its natural Disposition, so much, that it perverts the nutri∣tious Juice, into a matter plainly Fermentative, the beginning of this Feaver is indu∣ced; which sometimes happens from this intemperance, being leasurely increased and brought to the height; but more frequently, an evident cause raises up this disposition

into act, and we ascribe the origine of this Disease to some notable Accident. Where∣fore, lying on the Ground, or taking cold after sweating, or transpiration being any ways hindred; also a Surfit, or a perturbation of the Stomach, from any thing inor∣dinately eaten; and lastly, What things soever stir up an immoderate heat in the Blood, bring the lurking disposition of this Disease into act: for that, from every such occasion, the nutritious Juice, being heaped in the Blood, and somewhat depraved, conceives a Flux, and departing from the rest of the Blood, ferments with a nitrous sharpness, then being inkindled and shaken by the Spirit, and vital heat, it induces the Fit, with a very strong burning.

A Tertian Feaver, is wont to be more frequent in the Spring, at which time, the Blood is livelier and richer, and therefore more fitted for this kind of Feaverish distem∣per. If this Feaver being taken, be ended within a moderate time, tis commonly said to be a Medicine, rather than a Disease; which is partly true, because, by this means, the impurities of the Blood burn out, the obstructions of the Viscera are dis∣charged, and in truth the whole body is ventilated, so that 'tis wholly freed from every Excrementitious matter, and the seminary of growing Diseases. But if this Disease be long protracted, it becomes the cause of many Sicknesses, and of a long want of Health. For from hence the mass of the Blood is very much deprived of the vital Spirit, and (like Wine too much fermented) in a manner grows lifeless: wherefore the Jaundice, Scurvy, or Cachexia, follow this Feaver, being long er'e it be cured For by its frequent Fits, the vital Spirit very much evaporates, and because it is but little restored by things eaten, the Blood therefore becomes weaker, and almost without life: In the mean time, the particles of Salt, and Sulphur, are carried forth more, and exalted; from whence, the Blood is made sharp, and salt, and so more unfit for Circu∣lation and Transpiration.

Moreover, This Disease being long protracted, oftentimes changes its Figure, and from a Tertian Feaver, becomes either a Quotidian, or sometimes a Quartan: then sometimes from either, it returns into a Tertian. The reason of this is, the dispositi∣on of the Blood being variously changed: which at first being sharp, and bilous, had perverted the nutritious Juice, by that means, that it arise to a fulness of swelling up on the third day; afterwards, by the frequent Deflagration, becoming less sharp, or in truth more waterish, it grows far weaker as to its Constitution, so that it doth very little, or not at all assimulate the nourishable humor, and ripen it, and by that means, the increase of the Fermentative matter is made sooner, and the Fits return daily: or else, the Blood from a sharp and bilous intemperance, (the constitution of the Heaven, or the year, bringing on this alteration) is changed into an austere, or saltish, and therefore more slowly perverts the nourishing Juice, and the increase of the Fea∣verish matter, gathering together more slowly, it doth not conceive the Fits till on the fourth day: but if either, by the means of Physick or Dyet, the temper of the Blood is reduced from either Dyscrasie, towards a bilous, the periods also are altered, and they resume the figure of a Tertian.

Certain symptoms are wont to come upon a Tertian Feaver, which are commonly esteemed for the Crises of this Disease; and in truth sometimes, these appearing, the Distemper either clearly ceases, or begins to abate of its wonted fierceness. But these kind of signs, are chiefly these three, viz. The Erysipelas, or an Eruption of pimples in the Lips, the yellow Jaundice, and an Inflamation, or swelling suddenly excited, in this or that part of the body: very often there happens after three or four Fits to the Sick, little ulcers, with a crusty scab, to break forth about the Lips, and altho there be no coming away of any matter, in all the body beside, yet from hence they presage, that the Feaver is about to depart, which sometimes the event proves true. But indeed sometimes, I have observed, that the hoped for effect has not succeeded, but that the Feaver pertinaciously, and for a long while hath afflicted them, when their Lips have been broken out. But as to what respects this Symptom, it seems to arise, for that the Blood having got a more free Diaphoresis, it not only thrusts forth adoors, the more thin, and smokie recrements, but also the more thick; and when the same, in other parts more easily exhale thorow the more open Pores, they stick in their passage about the Lips, by reason of the skin being more strictly bound together; and because the vaporous matter, abounds in particles of adust Salt, and Sulphur, being fixed in the skin, it there hinders Circulation, and therefore induces Pustles, and little Ulcers; per∣haps the more hot breath, which is breathed forth from the mouth, and nostrils, may contribute something to this Distemper, forasmuch as it scorches, and burns the

Blood, and Juices flowing thither: wherefore, it may be said, That this eruption of Pustles, denotes only a more full Diaphoresis in the whole, by which, the more thick, as well as the thin recrements of the adust Blood, evaporate forth of doors. For I have known in some, from a Tertian Feaver, little welks like the small Pox to break out in their whole body, that if by this more plentiful Ventilation, as it were a purg∣ing, the Blood be so freed, that it recovers its pristine disposition, the Feaver is cured: But if (as sometimes it happens) some recrements, tho more thick, break forth, yet others stay within, and still cherish the Feaverish disposition, those little Ulcers, argue only a greater taint of the Blood, and pertinacy of the Disease, therefore it may be ob∣served, when that scabs break out in the lips, if the Feaver does not presently abate, that it will be more grievous, and tedious for the future.

Sometimes the yellow Jaundice comes upon a Tertian Feaver, and cures it; (which Hippocrates has also taken notice of) the reason of which is, because, when the Blood has got a sharp or bilous disposition; that therefore it had perverted the alible Juice, and from thence had heaped together excrementitious matter, it is oftentimes freed by that Dyscrasie, when by a sudden Secretion, the recrements of adust Salt and Sulphur, are more plentiful purged forth. This the Choleduct vessels being irritated by Physick, or of their own accord, and so pouring out plentifully the Bile, from the Blood, do often perform: because Vomiting, Purging, and especially a Diarrhea or Lask, very much conduce to the cure of this Disease, yea sometimes, the Blood it self, putting forth of its own accord, thrusts forth the bilous recrements, as its off-scourings, and in the circulating puts them forth in the skin, and so inducing the yellow Jaundice, cures this Feaver.

When an Inflamation, (as sometimes tis wont) comes upon this Distemper, the Ague is commonly said to fall down into the part distempered with the Tumor. But that by such a breaking forth, this Disease is cured, 'tis no wonder; because the Blood by this means continually lays aside out of his bosom, the provision of the degenerate nutritious Juice, and transfers it to the distempered part; and therefore, the degene∣rate and fermentative matter in the mass of Blood, does not easily arise to a fulness of swelling up: wherefore, the Belly being perpetually loose, hath by degrees helped some, for that the Blood by this means, readily casts forth its burthen, now growing low, and not having a more full increase yielded to it: sometimes also, a Deafness suddenly arising, the Tertian Feaver has presently ceased, to wit, by reason of a con∣tinual translation of the Feaverish matter, from the bosom of the Blood, into the head.

If that the Tertian Feaver, within a short time, neither by the free accord of Na∣ture, declines by degrees, that it doth clearly cease within seven or ten periods, nor is cured by any of the aforesaid means, nor is removed by the help of Medicine, but that after ten or twelve Fits, the sick are still grievously afflicted, it will be a very hard task to cure it: because the Blood, from the continual heaping of the Feaverish mat∣ter, and by the frequent burnings, becomes at length so depraved, that it concocts no∣thing truly for the nourishment of the Body, and for the sustaining its strength; nei∣ther is it able to shake thorowly out of its bosom, the impurities and excrements, whereby the Disease may make a Crisis or separation, but in truth, the same growing in strength every day, the Blood, besides its Dyscrasie or evil disposition, begins to be hurt somewhat in its mixture; wherefore, more frequent Fits infest them, nor does a perfect Remission come between, but that the sick being very weak and languishing, are almost continually Feaverish, with thirst and heat: when it is come to this pass, unless they are succour'd by remedies from Art, or that the change of the Place, and Air, bring timely help, this Disease often ends in death.

As to its cure: the method of healing is commonly directed to this one scope, to wit, that the mine of the Disease may be extirpated, and that the Feaverish matter may be eradicated out of our Body, without any cherisher remaining, or fear of re∣lapsing; wherefore, Vomits, and Purges are diligently Instituted, which when pro∣fiting nothing to the cure, but that the Patients strength is very much broken, the sick are left by the Physicians, and the business is wholly committed to Nature. The In∣tentions (as it seems to me) ought to be of this sort: First, a restitution of the Blood, to its natural Temper. Secondly, a prevention of the depravation of the nourishing Juice, as much as may be. Thirdly, an Inhibition of the Feaverish Fermen∣tation, that the Fit may not be excited. And these Indications take place, not only in a Tertian Feaver, but in any other intermitting Feaver besides: which yet are to be

performed, not by the same ways and remedies, but by several, according to the diver∣sity of the Disease, of the condition of the sick, and of the symptoms chiefly urging. However in the curing of this Disease, there is more to be attributed to Nature, and to a good order of Dyet, or way of Living, than to Physick.

1. Concerning the first Intention, to wit, that the Blood may be reduced to its na∣tural Temper, Vomits, letting of Blood, and Purging are of great use: especially, if they be celebrated in the beginning of the Disease. Vomitories help, both for that they Purge the Ventricle, that the first Concoction may be better performed, and by that means the nourishing Chyme may be more purely supplyed, for matter of the Blood; but chiefly, for that by plentifully pressing forth the Bile, from the Choleduct passage, they empty the Galish bag, as by that means, the Bile is poured forth more full from the mass of Blood; and so the Blood is purified, from the recrements of adust Salt and Sulphur. The opening of a Vein cools and ventilates the Blood, as by that means, tis less torrified, or scorched, and is circulated more freely in the Vessels, without danger of burning. Also Purging, plentifully draws forth, and by provoking expresses, or squeeses out, the Bile, from the galish Vessels, and consequently from the mass of Blood. For this end, (to wit, the reduction of the Blood) Digestives bring help, the more temperate Vinegars, or Acetous things forasmuch as they fuse, and alter the Blood, and do attemper its fervor. Somtimes also, the change of ••he Soil, and Air, notably amends the evil constitution of the Blood, before all other Remedies whatsoever.

The second Intention, is excellently performed, by Dyet, and an exact manner of living; which in this Disease ought to be slender and sparing: wherefore it is commonly said, Starving is the best Remedy for this Disease: and it appears by common experi∣ence, that by a more spare eating, the coming of the Ague fit, is very often prolonged, beyond its wonted Custom. There are especially two things to be observed, concern∣ing Eating and Drinking: The first, that the food be slender, that nothing Sulphureous or Spirituous be given, for so the Conflagration of the Blood will be lessened; then secondly, that the Fit approaching, or urging, nothing of Aliment be taken, where∣fore, in fasting the Fit is lighter, and sooner finished.

As to the third thing proposed; the Inhibition of the Feaverish Fit, is instituted by Remedies, which stay the Fermentation of the Blood. But tho this Remedy seems Empirical, and unmethodical, and very failable to Physicians, yet I have found these Feavers to be very often cured by this means, when Medicines have profited nothing: What they are, and by what means, without the suspicion of Witchcraft, they afford help, for the curing this Disease, is before noted. We shall here only advertise you, that the use of these is most profitable after Physick, and opening a Vein, if there be need of it; and unless these be rightly performed before-hand, those other rarely stop the Fit. But Vomiting, Purging, and breathing a Vein, unless they be presently cele∣brated after the beginning, yield little help, yea, more often are wont to hinder: For whilst the Blood is strong in vital spirit, its evil disposition, may with easie labour be corrected, or amended: wherefore, if the Bile, about the beginning, be copiously drawn forth, or the Blood eventilated, it is reduced to its natural Complexion; but afterwards, in the progress of this Disease (the Spirit being now very much exhausted, and the Salt and Sulphur too much exalted) if these kind of Evacuations be admini∣stred, they do more debilitate the disposition of the Blood: and therefore it is clear by observation, that the Tertian Feaver, is rarely or never cured, by these Remedies late administred, and often passes into a Quotidian. I my self have known some, in the Spring time, being strong in very good health, from a more strong Emetick taken for prevention sake, causing a violence by the Evacuation, to have presently fallen into a Tertian Feaver; and others, for some time cured of this Feaver, when they had taken a strong Purge, for the carrying away of the remains of the Feaverish matter, upon it to have fallen into a Relapse. It may be readily said, that the mine of the Disease, be∣ing before at quiet, was stirred up, and brought into Act, after this manner by the Medicine: But if you consider this thing rightly, it may rather be said, that from the strong Medicine, the disposition of the Blood was very much hurt, and when at first it was prone to a bilous Dyscrasie, that it hardly did assimilate the alible Juice, from this evident cause, it forthwith degenerated, that it wholy perverted the Nutriment, into a Fermentative matter, and so conceived the Feaverish disposition. It is a common opinion, that a Tertian Feaver can scarce be cured, without a Vomit, wherefore some Medicasters, are wont under the pretext of the necessity, to give to all whatsoever,

labouring with this Disease (tho languishing and weak) an Emetick Medicine not without great danger of life: and those whom they judge wholy unfit for such a Me∣dicine, they leave as not easily cureable to Nature. But (as I have often found the contrary by experience) this sort of practice is evilly instituted; yea, I rather judge, for the cureing of a Tertian Feaver, that Vomits are rarely or never to be required, unless in a strong Body, and very easily prone to Vomiting, and when the Ventricle happens to be burthened, with excrementitious matter, but instead of it, that a gentle Purge, by which the load of the humors may be pleasantly brought away, may be of better use: because, a Purge in this case, doth the same thing as a Vomit, to wit, it evacuates the choleduct Vessels, that the Bile, being plentifully exhausted from the Blood, the Feaverish Dyscrasie is mended. But when the galish humor, being empti∣ed forth into the Ventricle, is cast out upwards, from thence there is great hurt brought to the stomach, and a mighty perturbation excited in the whole Body: But if that humour be inticed downwards by a gentle Purge, it is sent forth of doors, without any trouble. Then, if to a gentle Purge, once or twice repeated, be added a very slender dyet, without flesh it often answers the preservatory Indication, that there needs no other Remedies, for the taking away the cause of this Disease; but that these being rightly performed, shall render beneficial those things, which being either inwardly taken, or outwardly applyed, stop the Feaverish accession. By this sort of plain and easie institution of Medicine, viz. A Purge of the infusion of Senna, and Rhubarb, a slender dyet, and a Febrifuge or Ague-resisting Topick, laid either to the wrists, or the breast, I have known very often, and in a very short time, Tertian Feavers cured, with∣out the use of any other destroying Physick: yea, a thin dyet only, with Amulets timely administred, hath very happily cured Big-bellied women, and also very weak old men, whose strength could not bear Purging. I have so often made tryal of this method, with good success, that I doubt not, but that a Tertian Feaver, may as easily be cured, as any other Disease, if it be at the begining handled after this manner, viz. before the temper of the Blood be more hurt, by an evil manner of Dyet, or by Medicine untowardly administred. For the truth of this thing, I will relate this following History.

A certain noble young man, indued with a bilous Temper, had caught an inter∣mitting Tertian Feaver; upon the approach of the Fit, he Vomited forth much yel∣low and greenish Choler, then he was troubled most grievously, for many hours, with a great pain of the Heart, and most strong Heat and Thirst. On the day of the in∣termission there was taken from this person, with whom I was by chance, by my pre∣scription, eight ounces of Blood, and in the afternoon was given an Emollient Glyster, he also used a most slender Dyet, (viz. only made of Barly) He took every night going to sleep, this Opiate, viz. Conserve of Roses vitriolated half a dram, of Diascordium a scruple, also every morning of the Salt of Wormwood a scruple, in a spoonful of the Juice of Orange: but when these did not succeed (for the Fit returned somwhat more remiss, but with cruel Vomiting, as at first) besides, for that this sick person, ex∣treamly abhor'd a Vomitory Medicine, (because not long before this, from a very gentle Emetick, he had Vomited almost thirty times, until being distempered with the Cramp, and Convulsions, he was brought into great weakness, with hazard of his life) therefore, the day following the aforesaid Fit, I gave him a Potion of an infu∣sion of Senna, Rhubarb, and yellow Sanders, with Salt of Wormwood, in Spring∣water, by which he was Purged ten times, with ease: In the morning after, and three hours before he expected the Fit, I put to his wrists an Ague-resisting Medicine, and took from him six ounces of Blood, by which means, he mist his Feaverish Fit, and then being again Purged after the same manner, became perfectly well.

If that the Tertian Feaver, by reason of the evil Constitution of the sick, or be∣cause of errors in Dyet, or committed by Physick, hath more deeply rooted it self, that after a long sickness, the Fits still grow worse, and the sick extreamly languish, with want of Strength, Thirst, and almost continual Heat, want of Appetite, wake∣ings, weak Pulse, high colour'd Urine, and very full of Contents, the Curatory method ought to be a little otherways instituted; In this case, first it is to be endeavour'd, that the Dyscrasie of the Blood, may be taken away; wherefore, the sick are to be fed, with slender Aliments only, as Barly broth, or Grewel, with opening Roots boiled in it, (flesh-broth being wholly laid aside) the Belly is to be kept loose, (if need be) with the use of Emollient Clysters; besides (Purges being omitted) only digestive Medicines, which fuse the Blood, and bring away gently the serous Impurities by

Urine, also comforting Remedies, which corroborate the Viscera, and cherish the Spirits, are chiefly to be insisted on. To this end, Apozems are fitly to be prepared, of Herbs, and Roots gently Diuretic, also Opiats help very much, of temperate Conserves, with Sal Nitre, or the fixed Salt of Herbs, with shelly powders, and the Spirit of Vitriol mixed together. When the disposition of the Blood is somwhat mended, that the Urine is clearer, and less coloured, also sleep quieter, with a re∣mission of thirst, and heat following; then may be profitably administred, Reme∣dies to stop the Feaverish fit: wherefore Ague-resisting Amulets may be applyed to the Wrists or to the Soles of the Feet; also the powder of Peruvian Bark, or of somthing instead of it, or also of the Barks of the Ash-Tree, Tamarisk, or Gentian, with Salts mixed with them, and drunk in White-Wine: after the comings of the fits are taken away, and the sick being to get strength, and desire Food, and in some measure to digest it, gentle Purges may be of use: but let the sick still abstain, from a more plen∣tiful Diet, or participating of Flesh, and they will shortly after recover perfect Health, without any violent Purge or Phlebotomy.