CHAP. I.
Of the Agues of the Year 1661, 62, 63, 64.

IN the first place that we may make at least some guess about the Nature and Genius of Agues, it's to be noted that these three Sea­sons ought to be considered in the Fits. 1. The time of Shaking. 2. Of Ebullition. 3. Of De­spumation. As to the Shaking, (to speak briefly of these things) I think it arises hence: Because the febrile matter not as yet turgent, was after a sort assimilated by the mass of Blood; and be­ing at length not only useless, but become an [Page 2] Enemy to Nature, does in a manner exagitate and provoke it; whence it comes to pass that be­ing stirr'd up by a certain natural sense, and as it were endeavouring to escape, it raises a shive­ring and shaking in the Body, a true witness of its aversion; just as purging Potions taken by squeamish Persons, or Poisons taken unawares, use presently to cause a shivering, and other Sym­ptoms of that nature. Nature therefore being ir­ritated in this manner (that I may now come to the time of Ebullition) that she may the more easily keep this Enemy from her Throat, falls upon Fermentation, namely, the usual Engine which 'tis accustom'd to make use of in Fevers, and some other acute Diseases, when it endeavours to free the Blood from intestine Enemies: For the disjoyn'd parts of this peccant Matter, which were equally mixt with the Blood, do by the benefit of this Effervescence, begin in some sort to be gather'd together, and so may the more easily be wrought upon, so as to become fit for Despumation. And truly that this may be, seems very probable on this account; be­cause they which die of Agues, if they die in the Fit, go off at first with the Shaking; for if they reach the hot Fit, they escape, at least for that time: And the Patient is worst at the time of Shaking and Ebullition, which being over, De­spumation follows, and then all the Symptoms first abate, and at length wholly cease. By the name of Despumation I would have nothing else understood, than the expulsion or separation of the febrile matter, now brought under, and as it were conquer'd; and what is separated has the [Page 3] nature partly of Yeast, and partly of Lees, as we may observe in other Liquors.

These things being premised, let us consider how it comes to pass that the Fit returns, seeing that the Patient at present seems to be in a good condition: Truly the Febrile matter is not yet wholly gone, but as young Bees grow up lea­surely at set times, so this latent matter, accord­ing to the nature of the Fits, shews it self again, and creates Nature a new trouble, running over the same course, which we have shewed before. But now if any one should ask me the reason why the hidden Fomes, being not sufficiently subdued by the foregoing Effervescence, and therefore not expell'd with the rest of the peccant matter, and so about to occasion new troubles, should not proceed alike in all Agues (for sometimes it re­quires one day, sometimes three before it comes to maturity, and makes a new Fit;) I say, if any one should trouble me about this thing, I would plainly confess I knew not. Nor indeed has any other, that I know of, done so considera­bly in this matter, that he may be reckoned to have sufficiently explicated this hidden work of Nature. I do not covet the name of a Philoso­pher, and I admonish those that think they have deserv'd that Title, and perchance think me blame­able on this account, because I have not endea­voured to dive into the Secrets of Nature, to try their Faculties in other Works of Nature, which are every where to be seen, before they censure others: For I would willingly know why a Horse comes to his perfection in the space of Seven Years, and a Man at Twenty One? Why [Page 4] among Plants, some flower in May, and some in June; to say nothing of many other things. And if the most learn'd Men are not asham'd to confess openly their Ignorance of these things, I don't see why I should be blam'd, if I forbear reasoning about a thing fully as difficult, and perhaps altogether inexplicable. Truly I am perswaded that the Progress of Nature is as re­gular and certain in this case, as in any other. For the matter of a Quartern and Tertian Ague is as subject to Natures Laws, and is govern'd by them, as well as any other Bodies whatever.

All Agues in general begin with a shivering and shaking, to which Heat presently succeeds, and then Sweat; the Patient most commonly vomits both in the cold and hot Fit, is very sick, dry and thirsty, and his Tongue is dry, and the like; all which Symptoms go off by degrees as the Sweat comes on; and when 'tis very plentiful, the Fit seems to be at an end; and he that was just now sick, seems to be very well, until the Fit returns at its wonted time; namely, a Quotidian once every natural day, a Tertian every other day, a Quartern every third day, reckoning from the beginning of one Fit to the beginning of the next; tho' often the two last are doubled, so that a Tertian invades daily; The Quartern for two whole days, the third being free from a Fit; and sometimes also it comes for three days toge­ther, when 'tis a triple Quartern, the Ague ta­king its Name from the shape it first assum'd; which doubling of the Fits, sometime proceeds from the excess and too great activity of the fe­brile matter; in which case the adventitious Fit [Page 5] comes before the first, sometimes also from the loss of Strength, the Patient being much infee­bled, and the vigour of the Fit broken, either by cooling too much, or by evacuations above measure: In this case the adventitious Fit follows the first, and does not last so long. In the for­mer instance, the turgency or fury of the matter does not wait for the return of the slow period due to it, and finishes its Despumation some­what sooner: In the later the Blood being not vigorous enough to put off the Febrile matter at once, presently substitutes another afresh, where­by it may expel the Relicks of it. And perhaps from these two Causes opposing one another, de­pends as well the Anticipation of the Fits, as the slow access of them, in an ordinary and regular Ague; of which either frequently happens in Agues that run through all the Night and Day, ei­ther by coming before the usual time of the Fit, or after it.

Of Agues some belong to the Spring, and others to the Autumn; for though some come be­twixt these two Seasons, yet because they are not so frequent, they may be reduc'd to the two former (to those namely which they are nearest:) I shall therefore comprehend them under these two kinds. The Seasons to which they are for the most part to be particularly referr'd, are the Months of January and August; tho some­times they come sooner, and sometimes later, as there is a greater or lesser disposition in the Air to produce them, and by consequence they are more or less Epidemical: Of which we have a clear Instance in the Agues of the Year 1661. at [Page 6] which time I remember, there was a Woman my Neighbour, that had the first Fit of a Quartern on St. John's day, and many others were taken very early with Agues about that time, which af­terwards were very Epidemical; which is an Ar­gument, that there was a great disposition of the Air at that time to those Diseases, and moreover they were more numerous as the year increas'd.

And indeed this distinction of Agues is so ne­cessary, that unless in our practice we take no­tice carefully of it, we can neither make our prognostick aright, how long they will last, nor keep our Patient's Bodies under a right Regimen, with respect to the different nature both of the Seasons and Agues. It is true indeed, the Agues of each Season have their Nature not altogether unlike, whether you consider the manner of their first coming, which first begins with shivering, by and by bursts out into Heat, and at last ends in a Sweat: Or the difference of their Types, in respect whereof there are some Tertians both Spring and Fall; yet I do not doubt but they are very different in their nature or Essence.

And that I may speak first of Vernal Agues, they are all either Quotidians or Tertians, and they come either sooner or later, according to the various disposition of the Season; for in the Winter time the Spirits are concentrated, and in their recess gather Strength to themselves, which being now brisk, the heat of the approaching Sun draws out, and being mixt with the viscid humours, (yet they are not so viscid as those the heat of the foregoing Autumn has boyl'd and [Page 7] rosted) which Nature, during Winter, had ga­ther'd in the Mass of Blood, while they endea­vour to fly away, are as it were intangled, and so cause the vernal Ebullition. After the very same manner as Vessels full of Beer, and set long in a cold Sellar, if they be set near the Fire, pre­sently begin to work, and the Liquor is apt to fly. The Blood being in this manner affected, endeavours the purging of it self, and by the help of Volatil Spirits does the business soon enough; unless it chance to be too full of viscid Juices, which may hinder the Fermentation be­gun; and tho this happen, yet the vernal Effer­vescence is seldom continual and constant, but is usually parted into several Fits: For the Blood being now turgid with these rich Spirits, Nature falls to her Work, as it were in hast, and makes a Secretion of some parts by particular Parox­isms, after the manner of perfect Solution, be­fore she finishes universal Separation. And this seems no improper reason, why in Spring time, (especially that part of it which is nearest Summer) we meet with few continual Fevers, unless the Constitution chance to be Epidemic: For the Fermentations that then arise, are either quickly laid, or hasten to an intermission. Or lastly, the parts of the Humours being more prone to Separation, are too hastily, and with some violence translated to another place, from whence presently Quinseys, Peripneumonies, Plu­risies, and Diseases of that kind do proceed, shewing their heads especially at the latter end of Spring.

I have taken notice▪ that vernal Agues have [Page 8] been seldom lasting, and always beneficial; so that the oldest Man, or any weak Person can scarce be kill'd, even by the over-officiousness and destructive nicety of the most unskilful, if he be but honest. Yet I have seen Vernal Tertians protracted to the time in which Autumnal Agues use to invade, by reason of bleeding and pur­ging unduly us'd, together with a Regimen disa­greeable to the Disease; but that Season being very contrary to the nature of it, presently ex­tinguishes it; the Patient in the mean while being almost ruined by the frequent doublings of the Fits, and the longer duration of them, so that he seems to be in a great deal of danger; yet so far as I have seen, he has always recover'd; neither could I ever perceive those grievous Sym­ptoms in those that recover of this Disease, which follow long Autumnal Agues, as shall be menti­on'd by and by; I mean, a deadly inflammati­on of the Almonds of the Ears, an hard Belly, hydropical Swellings, and the like. But I have more than once observ'd, that when the sick have been extreamly weakned by the length of the Disease, and doublings of the fits, together with mischievous Evacuations repeated, they have fallen into a Mania, when they first began to recover, which gradually went off as their strength increas'd.

But Autumnal Agues are very different; for first, a Tertian, tho' it sometimes soon goes off, and is not accompanied with more Symptoms than Vernal Tertians us'd to be, in those years it is not Epidemical, and ceases sound People; yet when 'tis Epidemical, and falls on those that are [Page 9] in Years, and of an ill habit of Body; it is dan­gerous, and tyrannizes two or three months, and perchance till the beginning of the following Spring. But Quarterns are much more danger­ous and obstinate, than those we treated last of; for when they seize ancient People, they some­times kill them, after they have endured a few Fits, in which case the Patient most commonly dies in the cold Fit: But if the Patient be not very old, there is not that danger of his be­ing dispatch'd at first, yet he will hardly re­cover till the next year, and that time approach­es, wherein he was first seized; and sometimes also it leaves some dreadful mark behind it, which can't be obliterated by any thing but Death alone. A Quartern sometimes varies its Type, and occasions many Symptoms: For instance, the Scurvy, a hard Belly, the Dropsie and the like. But younger People are able to bear this Disease, and sometimes get rid of it about the Winter Solstice, yet it holds them most commonly till the approach of the Vernal Equinox, and some­times till the next Autumn, when they have been blooded and purg'd. I have seen Infants bear up to Admiration for the space of six Months, and have also recover'd.

'Tis here to be noted, That of what Age or Temperament soever he be that is seized with a Quartern, if ever he had it before, tho it be long ago, it will not last long upon him the second time, but will go off of its own accord after a few Fits; which is worth notice.

As to the Cure of Vernal Agues, though I al­ways thought they were to be left to them­selves [Page 10] without doing any thing; because I never knew any one die of them: And on the contrary, that those that endeavoured to cure them, espe­cially by Evacuations, did only make them more obstinate and lasting. Yet if the sick importu­nately desire the assistance of a Physician, they may be successfully treated by various methods, as I have frequently observ'd.

Sometimes a Vomit given seasonably, so that it might have done working before the Fit, has succeeded well; especially if a moderate Dose of Diacodium, or of any other Narcotic, has been given after the Operation of it, just before the Fit comes.

Sometimes Health is restored by Diaphoreticks, which promote the Sweat coming at the end of the Fit, the Patient being well cover'd with Cloaths, which is to be continued as long as he can bear it: And this does the business often in Spring Agues, especially in Quotidians; for the Humours being not very thick at this time, the Disease goes quite off, which otherwise would return again; but this never happens in Au­tumn. I have sometimes cur'd Tertians, by Clysters given three or four days of the well days.

But if by reason of bleeding too freely us'd, (to which the Season of the year easily inclines the unwary) or through the foregoing weakness of the Patient, the Spirits that should suddenly betake themselves to Despumation, are some­what impoverished, so that they can't well per­form it, it may chance that these Vernal Agues, notwithstanding all that can be done, may vie [Page 11] in length with the Autumnal, tho they are not wont to last so long; for either they go off of themselves, or are easily cur'd with gentle Re­medies. But Autumnal Agues are not so easily removed, and therefore I shall say something of them: If the Autumnal Constitution be Epide­mical, they us'd to invade about June; if not, they tarry til August, and the beginning of Sep­tember; but they rarely occur in the Months next following.

When a great many of them invade together, you may observe that they come for the most part in the same day, and at the same hour of the day; the Fits coming sometimes sooner, some­times later in the same way and manner, unless it chance that that order by perverted, or chang'd by Medicines that have a faculty of hastning or retarding them in some Bodies.

We must take notice that 'tis difficult at the beginning of Agues (especially of those that are Epidemical in the Autumn) to distinguish rightly the Type, in the first days of their Invasion, for they are at first accompanied with a continual Fever; neither is it easie for some time after­wards, (unless you diligently observe) to per­ceive any thing more than a kind of remission of the Disease, but by degrees it ends in a perfect intermission and type exactly agreeable to the Season of the year.

In respect of their Types, they are either Tertians or Quarterns; and it may be well said of Quarterns, that they are the genuine Off­spring of Autumn. Indeed they are so allied to one another, that they often change from one [Page 12] to the other, and sometimes presently again as they were. But Vernal Tertians never assume the shape of Quarterns, for they are as different as possibly can be imagined. Moreover I never observ'd a Quotidian in this Season, unless any one will have a double Tertian, or a treble Quartern in acurate speaking so call'd.

I suppose these Agues take their rise for the most part in the manner we shall now briefly mention, viz. according to the progress of the year, the Blood is proportionably exalted, (just as Vegetables by their growth and decay shew the course of the year) till it comes to its height and utmost vigour; and then again keeping pace with the declining Season of the year, it declines also, and more especially when push'd down by some accidental Cause, as by immoderate loss of Blood, by taking cold, by crude and excrementitious Meats, by the unsea­sonable use of bathing, and the like. And when the Blood is in this ebbing state, it easily re­ceives every morbifick impression, that any Con­stitution of the Air will make upon it, which is Epidemical at this time for Agues, and the Ebul­lition presently begun tends hither; which sei­zing the Blood sometimes very degenerate, the Fever arising from thence, uses to be untoward, and full of malignant and dreadful Symptoms; however this comes to pass, the Blood being spoil'd of great part of its Spirits, and much burnt by the foregoing Summer, performs its Ebullition but by slow Motions, and requires a very long Period for its Despumation.

Now that it may manifestly appear how diffi­cultly these Agues admit a Cure, (I mean Autumnal) we must consider in this place, that the difference between them and continual Fevers in this Season consists especially in this, That continual Fevers constantly carry on the Effervescence in one and the same order, when once 'tis begun, and Agues per­form the same at several turns and divers times: In the mean time Fermentation is perform'd in both by Nature's Guidance in the space of 336 hours, or thereabouts: For the mass of Blood in an Humane Body is not usually purg'd soon­er or later than so, if you leave the business to Nature; just as Cyder, Wine and Beer, have each of them their peculiar Period wherein they are depurated: And tho in Agues the Blood sometimes (as it happens in a Quartern) endea­vours its Despumation in the space of six months, and at length perfects it; yet if you calculate right, there is not more time spent in performing it, than what naturally uses to be spent in conti­nual Fevers; for fourteen times 24 hours, or fourteen natural days, make 336 hours, allowing namely five hours and an half to every Fit of a Quartern, you will have in a Quartern the va­lue of 14 days, that is, 336 hours: Now if any one should say a Quartern, for example, (for the like account is to be understood of other Agues) sometimes runs out beyond the space of six Months before it finishes its Period; I answer, That the same thing is usually seen in continual Fevers of this Constitution, which are often pro­tracted beyond fourteen days; and in either case, if you have a care that the Effervescence (espe­cially [Page 14] towards the end of Fevers) go on well and in good order, and be kept up brisk, De­spumation will be finished within the space of the time aforesaid, that is, in fourteen days, or 336 hours; but if at that time, that is, to­wards the declination of the Fever, you unsea­sonably hinder the Effervescence, either by Me­dicines that cool the Fermentation, or by use of Clysters, and give a check to it, no wonder if they last long, because the order of Nature is disturb'd; for by this means the Tone of the Blood is in a manner relaxed, so that it can't betake it self to Despumation with effect; yea, and sometimes in weak and spent Bodies the same happens spontaneously, unless you assist Nature languishing in them by the help of Cordials, that it may be sufficient for the Despumation of the Blood.

But 'tis to be noted here, that those things which we have deliver'd above concerning the space and continuation of the Fermentation, are only to be understood of those Fevers that have arriv'd at a setled state and habit: For I know very well that there are some Fevers both con­tinual and intermittent, which are of a transient and uncertain nature, and do not reach the de­stin'd period in their Effervescencies: Of this kind are those that sometimes take their rise from some small Error in the six Nonnaturals, as they are term'd; as from a disorder in eating and drinking, or of the Air, and the like; they that are seized with these Diseases often soon reco­ver; and the same sometimes happens in young Men, whose Blood is pure, and stock'd with [Page 15] many Spirits; for their Fevers depending on a Spiritual and thin Matter that easily flies away, soon finish their Fermentation; and having swift­ly run their race, vanish away. For this is princi­pally necessary to fermentation, that the Matter to be fermented, whether it be Blood or Wine, or any other kind of Liquor, should be so clam­my and tenacious, as to be able to detain the intangl'd Spirits in such a manner, as that they may be stirr'd and mov'd in the Mass of Liquor, even as Birds catch'd in Bird-lime, and Flies in Hony, may indeed struggle and buz, but can't fly away: But by the by, the foresaid Liquors ought not to be so tenacious, as to overwhelm and wholly oppress the Spirits, so that they can't move at all.

These Things being laid down, (which in my Opinion are rational enough, however they seem to others) 'tis no wonder if I propose no other Method of Cure, than that which seems proper to perfect the despumation in continual Fevers, for that they don't at all differ from them, if you consider the order in which Nature is wont to expel the matter of them, namely by effer­vescence contain'd in a certain Period; tho I confess, with respect to the kind of them, and the propriety of their Nature, they differ from continual Fevers, and very much among them­selves. Therefore we must take an indication, either by cautiously and solicitously observing the method, whereby Nature uses to rid her self of this Disease, that we may quicken Fermenta­tion when arisen, and so recover our Patients; or by searching into the Specific Cause, we must [Page 16] do our endeavour to meet with the Disease, by effectual and specific Remedies: Indications must be taken from one of these two. I have at one time or other gon both ways to work, and I can modestly say, not without great Care and in­tention of Mind; but yet I am not arriv'd to that Happiness, as to be able to remove Autumnal Agues, by any certain Practice or method of Cure, before they have finished the stated Fermentations (of which we have spoke before) how trouble­some soever this may seem to those that have Agues, who are so long against their will com­pell'd to wait for their Health; but indeed if a Man can be found, who knows not only sud­denly to stop the career of these Agues, but wholly to break it off, either by using some cer­tain method, or some Specific or other; I think him oblig'd in Conscience to discover a thing so much to be desir'd by Man-kind; and if he does not do it, I count him neither a good Citizen, nor a prudent Man; for 'tis not the part of a good Citizen, to keep that to himself, which may be so great a Benefit to Man-kind; neither is it the part of a prudent Man, to deprive himself of that Blessing he may reasonably expect from Heaven, if he makes it his business to promote the publick Good; and indeed Virtue and Wis­dom are more esteem'd by Good Men, than either Riches or Honour.

But tho' it be difficult to cure these Autumnal Agues, yet I will set down what I have found most successful in the treating of them.

I have long ago found by frequent Experience, that 'tis very hazardous The Cure of Autumnal Agues. to endeavour the Cure of Autumnal Agues by Purging, (unless we proceed in the way to be mention'd by and by,) but espe­cially by Bleeding; for in Tertians (especially if the Constitution be very epidemical) if Bleed­ing don't instantly take away the Disease, 'tis prolong'd thereby, even in Young People, and in those that are of a strong Constitution; but in Old People after they have been a long while tormented with the Ague, Death succeeds, and the deadly inflammation of the Almonds, as we have said, is often the fore-runner of it. More­over, Bleeding hastens those other Symptoms, which we said accompanied Autumnal Agues at their later end, or follow'd presently after them. But Bleeding is so very injurious in Quartans, that by reason of it, they continue upon Young People a Year, whereas otherwise they would go off in half the time; and whereas Ancient People may be rid of them within a Year, if they don't Bleed, there is danger if they do, of their con­tinuance beyond the appointed time, and of their being destroy'd by it: That which has been said of Bleeding, may easily suit with Purging; only 'tis not so very dangerous, except it be often repeated.

I begin with Autumnal Tertian intermittents after this manner, The Patient being put to Bed, and well cover'd with Cloths, I force Sweat with Sage Posset-Drink, about four Hours before the Fit comes, and as soon as the Sweat begins, I presently order that he take ℈ ij of the Pill. Coch. [Page 18] Maj. dissolv'd in one Ounce of the following Mixture;

When he has taken these Things, let the Sweat be carried on 'till some hours be pass'd, from that time in which the Fits should come, taking great care of those interruptions of Sweat, which perchance Stools may cause by reason of the Purge. This Medicine has oftner succeeded well with me in the Cure of Tertians, than the common decoction of the Roots of Gentian, and the Tops of Centaury, and the like with a little Senna and Agaric, which aims at the same thing; for seeing it stirs up those two contrary Motions at the same time of Sweating, and going to Stool, it has the same effect as the other, by con­founding and interrupting the ordinary course of the Fit, and indeed is more effectual, and full as safe: And truly I have Cur'd a great many Autumnal Tertian intermittents with this Me­thod, neither in these Years could find a better.

In a double Tertian which hath varied its type by reason the Sick was weakn'd by Evacuations, or any other way, the Sweat must be rais'd in like manner, and at the same distance of time from the Fit that is to come, either by the Medicine before commended, (but the Pill. Coch. must be omitted, for 'tis neither safe, nor to any purpose to weaken the Sick more by Purging, when he has been weaken'd by it already; and so [Page 19] by it to help on the doublings of the Fits) or by some other powerful Sudorific, which may be also repeated in the genuine Fit next following. When the Patient is extreamly weaken'd by the doublings of the Fits, I prescribe the following Electuary,

Of which let him take the quantity of a small Nut Morning and Evening, drinking upon it six Spoonfuls of the following Julap;

Or instead of this, I give some simple Epide­mic Water, sweetn'd with Sugar. I forbid the use of Clysters, and allow the Sick to eat Oatmeal, and Chicken Broath, and the like.

As to the Cure of Quartans, there is no one I suppose who is indifferently skill'd in this Art, is ignorant, how little success all the Me­thods have hiterto had, which were design'd for the taking off this Scandal of Physicians, if he except the Jesuits Power, and which indeed oftner makes a Truce with the Disease, than conquers it; for when it has lurk'd a Fort-night or three [Page 20] Weeks, to the great advantage of the Patient, who having been dreadfully handled by it, has a little breathing time, it begins again afresh, tormenting him as bad as ever; and for the most part how often soever the Medicine be repeated, it requires a long time before it can be vanquish'd; yet I will relate what I have ob­serv'd concerning the Method of giving it.

But great care must be taken, that the Bark be not given too soon, namely, before the Dis­ease has somewhat wasted it self, (unless the weakness of the Patient requires it should be given sooner) for 'tis not only to be fear'd, that it should be render'd ineffectual by the too early use of it; but also lest it should endanger the Patients Life, if a Stop should suddenly be put to the Blood, whilst 'tis endeavouring its despu­mation, with all its might. In the next place no part of the Febrile Matter is to be drawn away by Purging, much less by Bleeding, that the Bark may perform its Business the better; for by either of them, the OEconomy of the Body is weaken'd, and so the Fits may more readily and certainly return; the Virtue of the Powder vanishing at once. It seems to me more benefi­cial to tincture the Blood leasurely with the afore­said Medicine, and a good while before the Fit, than to endeavour at once to hinder the Fit just approaching; for by this means the Remedy has more time to perform its Business throughly, and then the Patient is freed from the danger, that might happen by a sudden and unseasonable stop, by which we endeavour to oppress the Fit that is now about to exert it self with all its [Page 21] might. Lastly, The Powder is to be repeated in such short intervals of time, that the vertue of the former Dose be not wholly spent, before the other be given; for by the frequent repetition, a good habit of Body will be recover'd, and the Disease wholly vanquished. And for these rea­sons I like this Method more than any other;

Let the Patient take the quantity of a Large Nutmeg, Morning and Evening daily, of those days the Genuine Fit does not come, till he has taken all the Confection, and let it be repeated once a Fortnight for Thrice.

And perhaps the Bark may be as successfully us'd in Tertians, as well Vernal as Autumnal; but to speak the truth, and not to boast absurd­ly of Art, if the Patient seiz'd with any of these Agues, be either an Infant or Young, it's best (as far as I yet understand) to use no Medicine at all, nor to change the Air or Diet; for I ne­ver found hitherto any ill from hence, if the business be wholly left to Nature, which I have often observ'd with admiration, especially in In­fants; for the Blood having perform'd its depu­ration, these Agues go off of themselves. But on the contrary, if a strict course of Diet be or­dered, or Purging Medicines given, (for they us'd to be prescrib'd forsooth, to open obstru­ctions, and to carry off the Humours lodg'd in the first Passages;) or if especially Bleeding be us'd in an Epidemical Constitution, it comes to [Page 22] pass that the Disease is much prolonged, and the Patient is expos'd to a Thousand dangerous Symptoms. But if the Patient be Ancient, there is great danger in both Diseases, (I mean Au­tumnal Tertians and Quartans) not only of their Diuturnity, but even of Death itself. There­fore here the Physician ought to act so, as that if he cann't take off the Disease, neither by the Bark, nor any other Method, he may at least succour Nature, and give her such assistance, as may enable her to perform her own work. For certainly in weak Bodies, unless the Fermenta­tion be kept up by the help of Cordials and a strengthening Diet, as with Wormwood-wine, and the like, it will happen that the Patient will be weakened and molested with uncertain and fruitless Fits; and the Disease continue so long, that Nature being very languid, and seiz'd with a grievous Fit, cann't reach the time of E­bullition; so he dyes in the cold Fit: And this often happens in Old Men that have been wea­ken'd by a long course of Cathartics; and sometimes it happens, that they dye in the sha­king of the First Fits, whereas they might have been sustained at least for some time by some strong Cordial.

When the Blood has pass'd the time that is re­quir'd for the perfecting its despumation, 'tis necessary that Ancient Patients should remove at that time to another Air very different, or which is better, into some warmer Region; or at least should leave the Place where they were first seiz'd with the Disease. Truly 'tis ve­ry strange how much the change of Air prevails [Page 23] for the total Extirpation of this Disease; but the change of Air before this point of time is not only not necessary, but inconvenient for the recovery of Health; for though any one should remove into a hot and Southerly Region, yet 'tis necessary that the Blood setled in this Mor­bid Motion, should finish its depuration; and 'twill be in vain to expect any benefit from an unusual and new Air, till the motion of the Blood proceeding and growing perfect, is capable of recovering Health. Therefore a considerable al­teration of the Air, is then to be appointed when the Sick can first be freed from the Fit. For instance, In a Quartan which first began in Au­tumn, the Air is not to be chang'd till the be­ginning of February; but if the Patient will not or cann't conveniently change his Habitation, he ought at this time to use some strong Medi­cine, so powerful, as may be able at once to promote the Languid Depuration, and if it may, to perfect it. I would prescribe as fol­lows:

Give it Two Hours before the Fit; I have used this with good success in the Declination of such Diseases; though I confess, that hot things given sooner, have either doubled the Fit, or changed it into a continual Fever, as was long ago observed by Galen: The same may be given with caution to young People in this Disease, [Page 24] but I have long ago found them injurious to Children.

Before I leave this Argument, I must admonish that those things which have been spoken of the duration of Autumnal intermittents, and of the time requisite for the despumation of the Blood, are so to be understood, that we respect now only that which Nature is wont to perform by the as­sistance only of common Medicines; for we have by no means designedly discoursed so of these things to discourage Learned and Diligent Phy­sicians from searching for better Methods of Cure, and more effectual Remedies, by which they may hasten the cure of Diseases of this kind; for truly I am so far from thinking so, that I don't despair of finding one day such a method or remedy.

The Disease being removed, care must be ta­ken that the Patient be purged, for 'tis incredi­ble how many Diseases are occasioned by the o­mission of Purging after Autumnal Agues; and I wonder this is taken so little notice of, and no more provided for by Physicians; for whenever I have seen either of these Diseases happen to People somewhat in Years, and Purging was neglected, I could certainly foretell that some dangerous Disease would befall them, though they had not the least thought of it, being as it were perfectly recover'd.

But care must be taken that the Patient be not purged before the Disease is wholly van­quished; for though the Natural Parts seem by this means to be freed from the Filth, which the Ague had cast upon them, yet fresh matter [Page 25] will suddenly spring up, the Fever returning by reason of the force of Cathartics, and the Agita­tion of the Humours, and supplying the same. And so all we gain by Purging, is the rendering the Disease more stubborn: and we find this dai­ly, by examples of those who yielding to that Theory which places all the hope of Cure in o­pening Obstructions, and in evacuating the Me­lancholy humour, which is vulgarly accounted the cause of this Disease, are miserably pu­nished with Purging repeated in the declination of the Disease. And truly whatever that hu­mour be, which is evacuated by them, 'tis most apparent to me, that the Fever is more rooted thereby, and more obstinately maintains its ground for being provok'd. Wherefore I by no means give a Purge before that time, in which the Perceptible Fits are quite gone, and also that alteration how little soever it be that is felt of those days in which the Fit ought to come, and moreover till a Month be past. After which, I prescribe some Lenitive Potion, and I order it should be repeated once a Week, for Two or Three Months following; and after every Purge, an Anodyne at Bed-time, the Medicine having done working, to the end I may hinder the com­ing of the Fit afresh, which perhaps might o­therwise be occasion'd by the tumult that gentlest Cathartics raise.

Therefore I Purge at such a distance of time, that the Patient may be free'd from the fear of a Relapse, which indeed may easily be oc­casioned by the agitation of the Humours, and too frequent Bleeding; but when this danger [Page 26] is passed, the following Apozem may be fre­quently used.

And now at length, that we may treat of those Symptoms which accompany Agues in their Declination, we must take notice, that very few compared with Autumnal, belong to Vernal A­gues; for that they are not so lasting, and be­cause they don't consist of such Terrene and Ma­lignant Humours.

A Dropsy now and then accurring, is the chiefest, in which the Legs swell first, and then the Belly, which takes its rise A Dropsy. from the Blood, wasting a great many Spirits by reason of frequent Fermentations, which the diuturnity of the Disease occasions, es­pecially in Old People; so that being extreamly [Page 27] weakened, it cann't any more assimulate the Juices taken in with the nourishment, of which a crude and indigested heap is at length put off upon the Legs, and when they are distended so, that they can receive no more, upon the Belly also, and so it becomes a true Dropsy. But this Dis­ease seldom befalls Young Men, unless it has been foolishly brought upon them by Cathar­tics frequently repeated in the course of the Ague.

But a Dropsy coming from the cause above mentioned, is easily cur'd at first by Cathartics, and opening Medicines; neither am I concerned at the event, when I hear of this Disease proceed­ing from hence, for then I think all will go well. I have cured some with the Apozem above pre­scribed, without the mixture of any thing more appropriated to the Dropsy.

But truly I have observed, that 'tis in vain to endeavour the cure of a Dropsy of this kind, by Purging Medicines, while the Ague continues; for by this means the Ague is more firmly root­ed, and besides the Dropsy will not be taken off; therefore we must wait till the Ague is cured, and then we may successfully undertake the busi­ness.

But indeed if this Symptom be so very violent, that the cure of it cann't be deferr'd, till the re­cess of the Ague permits the use of Cathartics, it must be wholly managed with the infusion of Horse-Radish Roots, the tops of Wormwood, and of the lesser Centaury, of Juniper Berries, Broom-Ashes, and the like made in Wine, which not only resists this Symptom, by restoring the [Page 28] Feeble Blood, but also helps Nature just about to triumph over the Disease.

Infants are sometimes Hectic after Autumnal Feavers, both continual and inter­mittent, their Bellies are puft up, The Rickets. swell'd, and hard, and they have often a Cough, and other Symptoms which ac­company Consumptive People, which plainly re­semble the Rickets; I would have these to be treated after the following manner. Let the Purging Potion be prepared which I have pre­scribed to be taken at the end of continual Fe­vers, of which let the Infant take One or Two Spoonfuls more or less according to its age, in the Morning, for Nine days, omitting a Day or Two if there be occasion, the Purge being so moderated, either by increasing or decreasing the Dose, that it don't exceed Five or Six Stools a day. After Purging, let the Belly be anointed with some Aperitive Liniment for some days: I use the following,

Let them boil to the Consumption of the Jui­ces, add of the Ointment of Marsh-mallows, and of Fresh Butter each one Ounce, of Gum Am­moniacum dissolv'd in Vinegar ℥ss, of Yellow Wax a sufficient quantity, make a Liniment. Truly I have cured a great many Children of the true Rickets with this Method.

But as I said before, great care must be taken that we don't enter upon Purging, till the Ague be quite gone; for though by this means some part of the Humour cast upon the Natural Parts may probably seem to be evacuated, yet some­times a fresh quantity of ill matter is supplied by the Fever, which does not only render Purging ineffectual, but makes the Disease more lasting, for the Reasons above mentioned.

'Tis worth noting, that when these Autumnal Agues have a long time molested the tender A­ged, there is no hope of Recovery, till the Re­gion of the Belly, especially about the Spleen, begins to be hardened and to swell, for the A­gue goes gradually off in like manner as this Symptom comes on; neither perhaps can you any other way better prognosticate the going off of the Disease in a short time, than by the taking notice of this Symptom, and of the Swelling of the Legs which is sometimes seen in the a­dult.

The Swelling of the Belly which happens to Infants after these Agues in those Years, the con­stitution of the Air is epidemically determined to the propagation of Autumnal Intermittents, feels to the Finger touching it, as if the Bowels contained some matter hardened to a Scirrhus; whereas that which comes in other Years, in like appearance affects the touch so as if there were only a Tensity of the Hypocondries by Wind un­der them. And which is worth observation, the true Rickets don't often occur, unless in those Years, in which Autumnal Intermittents prevail.

The Pain and Inflammation of the Tonsils after either continual or intermittent Fevers, first with a difficulty of swallowing, and afterwards also with Hoarseness, and Hollow Eyes, and a Hippocratical Face, certainly betoken that Death is at hand, all hope of recovery being plainly frustrated; and I have observed that too large Evacuations in Patients almost worn out with the Disease, and also the long continuance of it, have mutually contributed to the Production of this fatal Symptom.

There are many other accidents which used to follow upon these Diseases, by rea­son of Purging not used at all, or A certain kind of Mad­ness. not rightly used, which at present we will say nothing of, seeing the way of cure in all, is almost the same; namely, the Purging off of the Sediment deposited by the preceding effervescence, for that it has occa­sioned these ills by its continuance. But it may be convenient here to discourse of a kind of Symptom no way contemptible, which will yield neither to Purging, nor to any other Evacuation, especially to Bleeding, but is heightened by them. 'Tis a certain peculiar Madness of its own kind, which follows long Agues, especially Quartans. The common Methods of Cure are no way be­neficial in this case, for by strong Evacuations, the Patient becomes a Changling, and continues so all his life long; I have oftentimes wondered that Authors have made no mention of this, see­ing I have taken notice of it several times. Whereas other sorts of Madness are most com­monly cured by Copious Evacuations, both by [Page 31] Bleeding and Purging, this can bear neither; for when the Patient is in a manner recovered, if a Clyster only of Sugar and Milk be but once given, 'twill presently begin again afresh: And if we proceed with Purging repeated and Bleed­ing, such Evacuations may indeed quell the fury of the Disease, but they will certainly make the Patient a Fool, and render him wholly incurable; and 'tis not to be wondered at, if it be consi­dered, that the other kind of Madness is occasion­ed by the too vivid and exalted crasis of the Blood, but that this proceeds from the weakness of the same, becoming vapid by too long a Fermenta­tion carried on by the Feaver; so that the Spirits are quite incapable of performing the Animal Functions.

I use to treat this Disease in this manner; I prescribe a large Dose of some generous Cordial to be taken Thrice a Day: For instance, Venice Treacle, the Electuary of the Egg, the Countesses Powder, Sir Walter Rawleigh's Powder, or the like, in Epidemic or Treacle Water, or in some other Cordial. Medicines may be also given in any other form; the Patient is likewise to be comforted with strengthening and generous Li­quors, he must keep within, and lye much a Bed; the Belly by this means will be bound, so that a Fever may be feared by some, especially by rea­son of Hot Medicines taken; but there is really no danger of it, for the Spirits worn out by the foregoing disease, are not able to kindle a new Fever. After some Weeks, the Patient will grow better by little and little, at which time Cordials may be omitted for some days, but [Page 32] the Strengthening Diet must be constantly used, and the use of Cordials must be again repeated after a short intermission, and continued till he is quite well.

The foresaid Method has sometimes cured Madness that has not come upon these Agues in those of a cold and infirm temperament. Last Year I was called to Salisbury, to consult with the Learned and Sagacious Physician, Dr. Thomas my very good Friend, about a Gentlewoman who was distempered in Mind, and she was perfectly cured by the Remedies above prescribed, though she was then with Child.

But the common Madness which used to befall Brisk People, without any Fever going before, is indeed of another kind, and therefore to be treated with a quite contrary Method, as to Evacuations, though in this sort also those things that corroborate the Brain, and the Animal Spi­rits are not to be omitted: I will add the cure of this by the by to the foresaid kind, though it don't properly belong to this place, lest any one should be deceived by the likeness of Dis­eases.

In Young People of a Sanguine Constitution, let Eight or Nine Ounces of Blood be taken from the Arm Twice or Thrice, Three Days being between each Bleeding; afterwards Bleed once in the Neck; Bleeding oftner, rather makes the Patient a Changling than Cures him: Then let the Patient take ʒss or ℈ii of the Pill ex duobus once a Week, according as it works of a set day. For instance, if the Patient takes the Pills first of a Monday, let the same be repeated exactly the [Page 33] same day, and not oftner, in the following weeks for a long time, till he is perfectly recover'd. By this Method the humours which in this Dis­ease used to seize the Head, fall by degrees up­on the lower parts, their course being turned.

When the Patient don't Purge, let him take of the following Electuary, or another Me­dicine of the same vertue through the whole course.

Let him take the quantity of a Nutmeg, and drink a small draught of Canary after it, in which Cowslip Flowers have been infused cold.

CHAP. II.
Of the Agues of the Year 1678.

IN the Year 1678, the constitution of the Air did so favour Agues, that they became a­gain Epidemical; whereas they had in a manner wholly left the City for the Space of Thirteen Years, from 1664, and they will not continue as they are, but will increase till the disposition of the Air comes to its height on which they depend; for though there were few of them in the Spring, yet they did so rage a­bove all other Diseases at the latter end of Sum­mer and in Autumn, that they were alone Epi­demical: But in the Winter they gave way to the Small Pox, and to other Epidemical Disea­ses, till a Fit Season for Agues returned.

But now that I may deliver what I have care­fully observed concerning the nature and causes of these Agues, it must be first noted, that though Quartan Agues were heretofore most frequent, now they were either Tertians or Quotidians (unless any one will call the last Double Tertians;) and likewise that though these Tertians and Quotidians sometimes inva­ding with shaking and shivering, and then Heat first following, and presently Sweat, end in a perfect Apyrexy, and return again afresh after a stated Period; yet they did not keep this or­der above Three or Four Fits, especially if the [Page 35] Patient was kept a Bed, and took hot Cordials, which add Oyl to the Fire, as they say; for then the Disease was so heightened, even contrary to its nature, that instead of an intermission, there was only a remission, and coming daily nearer to the species of continual Fevers, at length ha­ving seiz'd the Head, destroyed many.

As to the cure, it has now been well known to me for many Years, how dangerous a thing it is in Tertians and Quotidians (which when they are new, and have put on no Type, are still next door to continual Fevers) to attempt the removal of them by Sudorificks; for though 'tis very well known, that as soon as Sweat breaks out, restlessness and other Symptoms vanish im­mediately, and an Apyrexy succeeds, and there­fore of consequence it must be indulged a little, at least not hindered when the Fit is going off; yet 'tis very evident, that if Sweat be forced more than it should, the Fever which inter­mitted, will prove continual, and the Patient's life is in a hazardous condition; this Man is sa­ved, and the other perishes; the reason is this, unless my conjecture fails me, namely, that this profuse Sweat, when it exceeds the degree of the Febrile matter, exalted so far by the heat of the Fit, as that part of it answering to one Paroxysm, may be exterminated, wastes the rest of it, inflaming the Blood. Therefore whilst I considered with my self the ineffectualness of this method, and of other Evacuations, that is, of Bleeding and Purging, both of which by re­laxing the tone of the Blood, protract the Dis­ease, the Peruvian Bark gave me the most cer­tain [Page 36] hope; concerning which, I can safely say, notwithstanding the prejudice as well of the Vul­gar, as of some of the Learned, I never saw nor could rationally so much as suspect any mis­chief befall the Sick from the use of it; only that they who have used it a long while, and several times (as I shall in the Chapter of a Rheu­matism) are sometimes subject to a Rheumatical Scurvy; but this very rarely happens on this ac­count, and when it does happen, it is easily cured by the Remedies there described. And indeed if I were as well assured of the duration of its effects, as I am of its innocence, I should make no scruple to give it the first place among all Medicines thet are yet extant; for 'tis not only found to be of excellent vertue in this Dis­ease, but also in the Diseases of the Womb and Stomach so little reason has any man to com­plain of the unwholsomness of it.

But the said Bark has got an ill name for these Reasons especially, if I am not mistaken; First, Because all these horrible Symptoms that attend an Ague, when it has tormented a Man a long time, are imputed to the Bark, when indeed he has not at all tasted of it, or taken it but once. Secondly, Because many reckon, seeing it drives away the Disease by an occult vertue, and not by sensible evacuation, that the matter causing the Disease which should have been driven out, lies shut up by the Astringent vertue of the Bark, like an Enemy within the Walls, ready to give new disturbance, and that the Patient is not quite escaped, when he still drags his Chain. But these Men don't consider that the Sweats which [Page 37] end the Fit, have cast off all that was gathered in the Lucid intervals of it, there remaining on­ly the Seminary of the Disease to be ripened in time; and that the Bark pursuing the flying Fit at the Heels, (when all the Provision or Suste­nance of the Disease which should have been sent in, is intercepted,) can't be said to retain that in the Blood, which can't be found there unless as in Embrio; and therefore must not be held guil­ty, either of those Fits, or obstructions which are commonly objected.

But by what means do we find that the Bark drives away Agues by its Astringent faculty? He that would prove this, must of necessity first pro­duce other Astringents endued with the like vertue; truly I have tryed the strongest of them, and I could never yet obtain my end: Yea, it cures some who after the taking of it, go as often to Stool, as if they had taken a strong Purge. But when all is said, 'tis the truest wis­dom for every one to contain himself within his due bounds; but if any one will deceive himself, and think he is endued with other faculties than what are subservient either to Natural Theology, that is, That due veneration may be given to God the Architect and Moderator of all things, with the profoundest prostration of Mind (which of right he deserves;) or to Moral Philosophy, (that he may exercise vertue, and accommodate his manners, both to the publick and private good of Humane Society.) Or Lastly, to the Art Me­dical, Mathematical, or to some Mechanic Trade, (which are beneficial to Mankind,) let this Man first draw an Hypothesis from the Na­tural [Page 38] Philosophy School, by which he can expli­cate but only one specific difference of things in nature. For example, let him render a reason why all Grass is every where found to be green, and never otherwise, and the like; if he can do this, I will with all my heart subscribe to his judgment; but if not, I will not fear to say, that all a Physicians care and industry should be be­stowed in searching out the History of Diseases, and in using those Remedies which Experience being his Guide and Mistriss, are able to cure them; yet ever observing that Method of cure, which right reason founded, not on speculative imaginations, but upon the right and natural way of thinking, shall dictate. I will therefore briefly declare what I have learned by Practice concerning the Method wherein we must give the Bark.

The Peruvian Bark, which is vulgarly called the Jesuits Powder, about Twenty Five Years agoe, if I remember well, first became Famous at London for curing of Agues, and especially Quartans; and indeed for very good reason, see­ing these Diseases were seldom cur'd before, by any other Medicine or Method; wherefore they were called Opprobria Medicorum, and truly were a reproach to Physicians. But not very long after, it was damn'd for Two Reasons, and those no small ones, and so was wholly disus'd; First, because it being given a few Hours before the Fit, ac­cording to the received custom of that time, sometimes kill'd the Patient. Thus I remember it happened to a Citizen of London, one Alder­man Ʋnderwood, and to one Captain Potter an [Page 39] Apothecary in Black-Friers. This Tragical Effect of the Powder, tho very rare, did yet deser­vedly withdraw the best Physicians from the use of it. Secondly, Because tho the Patient was rid of his Fit by it, which would otherwise have come, and it seldom fail'd; yet within fourteen days he relaps'd, that is, when the Disease was new, and had not spent it self by length of time. Most Men being sway'd by these Reasons, did utterly cast off the hope they had conceiv'd formerly of this Powder, neither did they value the keeping off a Fit for a few days at such a rate, that upon such a Score they would endanger their Lives by taking the Powder. But for several Years since seriously considering with my self, and revolving in my Mind, that the Vertue of this Bark was not common; I was confident Agues could better be cur'd by no other Medicine than by this Herculian one, if what care and diligence was necessary were taken. Therefore I contriv'd a long time with my self, how I might prevent the danger impending from the Powder, and the relapse which fol­low'd in a few days, which were the two incon­veniences to be avoided, and by the help of it to promote the Patient to a degree of perfect Health.

First of all, I suppos'd the Danger that was threaten'd, did not so much proceed from the Bark, as from the unseasonable giving it to the Patient: For when great store of Febrile Matter is gather'd in the Body on the intermission days, the foresaid Powder if it be taken immediately before the Fit, hinders the Morbific Matter from [Page 40] being eliminated in Natures Method, that is, by the force of the Fit, which therefore being con­trary to all reason shut up, usually brings the Pa­tient into danger of his Life. Now I reckon'd I could keep off this Mischief, and also put a stop to the breeding of Febrile Matter a new, if as soon as one Fit is off I should presently give the Powder, that the following might be stopt; and if on the intermission days, at set times, now and then I repeated the same till a new Fit were coming, and so I might gradually, and therefore safely, throughly tinge the Mass of Blood, with the Salutiferous Vertue of the Bark.

Secondly, Since the Relapse which usually hap­pen'd within fourteen days, did appear to me to arise from thence, that the Blood was not suf­ficiently saturated with the Vertue of the Fe­brifuge, which how efficacious soever, yet was not sufficient; therefore I guess'd nothing would be so good for preventing the Fit, as a method of repeating the Powder, even when the Disease was conquer'd for the present, always at just Intervals, that is, before the Vertue of the preceeding Dose were wholly spent.

My Mind therefore sway'd by the weight of these Reasons, dictated to me the method that I now use, being call'd to one ill of a Quartan Ague, suppose of a Monday; if the Fit were to come on the same day, I meddle not, but only put him in hopes that he shall be free from the next, and therefore the two intermission days, that is, Tuesday and Wednesday, I give the Bark after this manner;

Of which let him take one every fourth hour, beginning immediately after the Fit, drinking a Glass of Wine after it: Or if the Patient like Pills better,

Of which let him take six every fourth hour: But one Ounce of the Powder may be mingl'd with a Quart of Claret, with the same success, and less trouble, and eight or nine Spoonfuls may be given at the same distance of time we mention'd before. On Thursday, at which time the Fit is fear'd, I order nothing, because usually none comes; the Reliques of the Febrile Matter being despumated and ejected out of the Blood by the usual Sweats, which compleated the preceding Fit, and the gathering a new Minera, Fomes, or Matter being prevented by the repeated use of the Powder, of the days between the Fits.

And however, lest the Disease should return, which was one of the foresaid inconveniences on the seventh day after the Patient had taken his last Dose, I certainly give him the same quantity of the said Powder, that is, one Ounce divided into twelve parts, in the same method I gave the [Page 42] former; but tho' the Bark once in this manner repeated, often makes an end of the Disease; yet the Patient is not wholly out of harms-way, unless he vouchsaf's to observe his Physician, when he prescribes him the same method, at the same distance of time, a third or a fourth time, especially when the Blood has been weak­en'd with some preceding Evacuation, or the Patient has unadvisedly expos'd himself to the cold Air.

But tho' this Medicine have no purgative Ver­tue in it, yet through the peculiar Temper and Idiosyncrasie of some Bodies, it sometimes hap­pens that the Patient is violently purg'd after the taking of it, as if he had taken a strong Ca­thartic; in this case 'tis altogether necessary to give Laudanum with it, that it may not be able to perform this Operation so plainly contrary both to its own Nature, and to the Disease, that the Powder be not carried off too soon by Stools, before it has perform'd its Business; Therefore in this case I order ten Drops of Laudanum to be dropt into Wine, and to be taken after every other Dose of the Powder, if the Loosness continue.

I take the same method in other Agues, whe­ther Tertians or Quotidians; for upon the end­ing of the Fit, I immediately fall upon both, and I follow and press them as much as their Nature will bear by the repetition of the Medi­cine, in the but now mention'd interstices of the Fit; yet with this difference, that whereas a Quar­tan can very rarely be got off under an Ounce, divided into Doses; the other may be so subdued [Page 43] with six Drams, that they will grant some Truce at least.

But tho Tertians and Quotidians, after a Fit or two may seem to intermit; yet oftentimes they afterwards turn into a kind of continual Fever, (as I have noted before) and come only to a Remission, even on those days they pro­mis'd an intermission; especially when the Pa­tient has been kept too hot in Bed, or has been punish'd with Medicines to carry off his Ague by Sweat; in this case taking an opportunity from the Remission, be it never so little, for that is all is left me, I give the Powder just after the Fit, as near as I can guess, viz. every fourth hour, as I said, making no matter of the Fit; because otherwise in too short an Interval, the alexiteric Virtue of the Bark can't be com­municated to the Blood.

And tho' the Agues which are now rife a­mong us, after one or two Fits incline to con­tinual Fevers, yet since they must be referr'd to intermittents, I make no scruple to give the Bark, even in those that are most contiunal of this kind, which being repeated in the manner aforesaid, will certainly bring the Patient to an Apyrexy, if the constant heat of the Bed, and the unseasonable use of Cordials, have not made it a contiunal Fever; in which case I have more than once observ'd the Bark will do no good. I never found that Wine in which the Bark is given (which one might well suspect) did any harm to one in an Ague; but on the contrary Heat, Thirst, and other Symptons of the Ague, did presently vanish after taking a sufficient quantity [Page 44] of this remedy, notwithstanding the Wine. But here 'tis to be noted, that the nearer the Ague comes to a continual Fever, either of its own accord, or by reason of too hot a Regimen, so much the more need is there of a greater quan­tity of the Bark; so that sometimes I have found it necessary to give an Ounce and an half, and sometimes two Ounces before the Disease would go off.

And whereas there are some that can't bear this Bark in Form, neither of a Powder, nor of an Electuary, nor yet of Pills, I give them an infusion made in cold; that is, I infuse for some while two Ounces of the Bark grosly pow­der'd in a Quart of Rhenish Wine, this Liquor being several times pass'd through Hippocrates's Steeve, is of a clear Colour, and not so offensive, but that it may please the most deli­cate Palate; four Ounces of the said Infusion, having stood several days, seem to contain the Vertue of one Dram of the Bark given in Powder, which, because 'tis neither ingrateful, nor bur­dens the Stomach, may be taken twice as often as any Form of that Medicine, namely, till the Fits are gon.

And sometimes it happens that when this Dis­ease is ill form'd, and is not come to a regular Type, the Patient by reason of Vomiting almost continually, can't retain the Bark in the Stomach, in what form soever it be given; in this case the Vomiting is first to be stopt before the Bark be given; to which end I order that he take a Scruple of Salt of Worm-wood, in a Spoonful of the fresh Juice of Lemons, six or eight times [Page 45] in the space of two hours, and afterwards six­teen Drops of Liquid Laudanum in one Spoon­ful of strong Cinnamon-Water, and soon after if the Vomiting cease, let him begin the use of the Jesuits Powder.

For Children whose tender Age can searce bear, that this Remedy be taken in any other form, at least in such a quantity as may be sufficient to cure the Disease, I used to prescribe the follow­ing Julap;

Let them take a Spoonful or two according to their Age every fourth hour till the Fits go off; drop into every other Dose, if there be a Loose­ness, one or two Drops of Liquid Laudanum.

It must be observ'd moreover, that because the short Interstices between the Fits in Tertians and Quotidians, don't allow time sufficient fully to faturate the Blood with the Febrifuge Vertue of the Bark, it can't be expected that the Patient should certainly miss the next Fit after his ta­king it, as it usually happens in a Quartan; for in these the Medicine often will not per­form the promis'd Cure under two days.

And we must take notice, that if the Patient, notwithstanding the abundant Caution above de­liver'd, do nevertheless relapse, which seldomer happens in a Quartan, than in Tertians or Quo­tidians; yet 'twill be the part of a Prudent Phy­sician [Page 46] not to insist too pertinaciously upon the method of giving the Bark at the said inter­vals; but according to his Judgment, to attempt the Cure by some other means, to which above the rest the bitter Decoction is generally held greatly to conduce.

As to Diet and other Regiment, the Patient must neither be kept from Meat nor Drink, of what kind soever it be, which gratifie his Sto­mach, hortary Fruits and cold Liquors only ex­cepted, for they weaken the Mass of Blood, and are apt to occasion the return of the Ague. Let him therefore eat Flesh of easie Concoction, and of good Juice; and let him use a little Wine for his ordinary Drink, by which alone I have sometimes restor'd sick Persons, even those whose Bodies being weaken'd with the frequent return of the Ague, have eluded the Virtue of the Bark.

Nor ought the Patient unadvisedly to commit himself to the Cold Air, 'till the Blood hath ob­tain'd its pristine Vigor again.

But 'tis to be noted here, that when hereto­fore treating of Agues, we admonish'd that the Patient was to be well purg'd after the Disease went off; this is to be understood only of those Agues that either went off of their own accord, or were cur'd by some other Medicine or Me­thod, and not by the Peruvian Bark; for when the Cure was perform'd by this Remedy of which we now speak, there was no need of purging, nor indeed would it bear it; so power­fully does the said Bark resist the Fits, and that ill disposition which they bring upon the Body; [Page 47] therefore all sorts of Evacuations are by all means to be avoided; for the gentlest Purge, yea a Clyster of Milk and Sugar will certainly put the Patient in danger of the return of the Disease, and perchance of Death it self.

And here 'tis to be remembred that a certain great Sympton sometimes came upon these Agues the first Years of this Constitution, namely, their Fits did not come with shaking and shiver­ing, and afterwards the Fever following; but the Sick had plainly the Symptoms of an Apo­plexy, tho indeed 'twere nothing else how like soever to this Disease, than the Fever falling on the Head, as was sufficiently evident by other signs, as well as by the Colour of the Urin, which in Agues is most commonly of a deep red, as is the Urin of People in the Jaundies, tho not quite so red, and likewise puts off a Sediment almost like Brick Dust; in this case tho all Eva­cuations of every kind seem to be indicated for the revulsion of the Humors from the Brain, as is wont to be done in a true Apoplexy, yet they are wholly to be omitted, for that they are very prejudicial in the Agues, the Original Cause of this Sympton; and moreover, hasten Death, as I have known; but on the contrary, we must wait till the Fit go off of its own ac­cord, at which time the Bark is presently to be given, if it could not be taken before, and must be carefully repeated in the Intervals that are free from the Fits of this kind, 'till the Patient be quite well.

Sometimes it happens, tho very rarely, that Old Men that have had this Disease a long time, [Page 48] and have been unskilfully punish'd with Bleeding and Purging, fall into a Diabetes when the Fe­ver is perfectly Cur'd; for their Blood weaken'd on this account, being wholly disabled for the assimilating the Juices brought to it, they are put off crude and unconcocted by the Urinary Passages; and so by reason of a prodigious quantity of Urin voided as often as they make it, the Strength is by degrees wasted, and the sub­stance of the Body as it were wash'd away. In this case as well as in every Diabetes, by what means soever occasion'd; the curative Indica­tions are wholly to be directed to the invigora­ting and strengthening the Blood, and likewise to stop the preternatural Flux of the Urin.

Let him take the quantity of a large Nutmeg in the Morning, and at five in the Evening, and at Bed-time for the space of a Month, drinking upon it six Spoonfuls of the following infusion;

Let him be fed with Meats of easie Digestion, as with Veal, Mutton and the like; let him for­bear the eating of Herbs, and all Fruits whatever, and let him drink Spanish Wine at every Meal.

That lasting and obstinate Disease, the Whites in Women, is cur'd almost the same way, and by the same Remedies, as is the Diabetes just now mention'd; for the Curative Indications are in both the same, how different soever these Diseases may seem to be; but in the Cure of the Whites, Bleeding must be us'd once, and Purging thrice, before corroborating Medicines are prescrib'd: But in the whole Process after­wards they must be no more us'd; for all sorts of Evacuations render the Vertue of cor­roborating Medicines in effectual: But this by the by.

But lastly, Tho the Bark much excels all other Medicines in the Cure of these Agues, yet in ver­nal Tertians if the Patient be of a Sanguine Constitution, and in the Flower of his Age, I have observ'd the Cure has been perform'd by the following Remedies; for instance, Let the Patient be Blooded in the Arm of his well day, and some hours after in the same day, give a Vomit of [Page 50] the Infusion of Crocus Metallorum, and so order the time that the Vomit may have done work­ing, before the Invasion of the following Fit, and presently after 'tis off, let him enter upon the use of the following;

And there is another Method of curing these Tertians in Poor People who are not able to bear the Charge of a long Process.

CHAP. III.
Of a Pleurisie.

THIS Disease that is as frequent as any other, comes at any time, but especially betwixt Spring and Summer; for at that time the Blood heated by the nearness of the Sun, rushes violently into Effervescencies and inordinate Motions; it chiefly seises those that are of a Sanguine Temperament, and often Country People and those that are accustom'd to much Labour; it most commonly begins with a shaking and shivering; and then heat, drouth, and restlessness, and other Symptoms follow of a Fever, sufficiently known; after a few hours (tho sometimes 'tis much longer before this Symptom comes) the Patient is taken with a violent pricking Pain in one of his Sides, about the Ribs, which sometimes reaches towards the Shoulder Blades, sometimes towards the Back-Bone, and sometimes towards the Breast; he Coughs frequently, which occasions great Pain by reason of the disturbance of the inflam'd Parts, so that sometimes he holds his Breath to prevent Coughing. The Matter which is spit up at the beginning of the Disease, is little, and thin, and often sprinkl'd with Particles of Blood; but in the Process of the Disease 'tis more and more concocted, and also mixt with Blood; the Fever in the mean while keeps the same pace, and is [Page 52] helpt on by those Symptons that proceed from it; and the said Fever with all its ill Train, (namely, the Cough, the spitting of Blood, the Pain, and the like) is gradually lessen'd accord­ing to the degree of the free expectoration of the Morbific Matter. But the Matter occasion­ing this Disease, does not always in the Process of it attain the Concoction that is due to ex­pectoration; for it often happens that the Mat­ter which is spit up, is yet little, and thin, as at the beginning of the Disease, and consequent­ly the Fever, and other Symptoms don't at all remit till they have destroy'd the Patient; and in the mean while he is sometimes bound in his Body, and sometimes too loose, the Stools being frequent and very liquid; it sometimes happens when the Disease is very high, and Bleeding has not been us'd, the Patient is not able to Cough, but labouring under a great difficulty of Breath­ing, is in a manner suffocated by the violence of the Inflammation, which is sometimes so very great, that he can't expand his Breast large enough for respiration without exquisite Pain. And sometimes after a violent Inflammation, and when Bleeding has been omitted, which ought to have been done at the beginning of the Dis­ease, an Impostume is presently occasion'd, and the Cavity of the Breast is fill'd with Matter; in which case tho the Original Fever either wholly ceases, or is at least lessen'd, yet the Pati­ent is not out of danger; for an Empyema, or a Hectic Fever following, the poor Wretch dies Consumptive.

But now, tho a Pleurisie commonly takes its [Page 53] rise from the proper and specific Inflammation of the Blood, which is wont to produce it when 'tis an Original Disease, yet it comes sometimes accidentally upon other Fevers of what kind so­ever they be, from a precipitation of the Febrile Matter upon the Pleura, or intercostal Muscles, and it happens for the most part at the very beginning of the Fever, the Febrile Matter be­ing as yet crude, and not subdued by a fit Ebul­lition, and so not prepar'd for a due Separa­tion by a more convenient way: But this incon­venience most commonly arises from an unsea­sonable and preposterous use of hot Medicines, such as are wont to be given by Gentle-Wo­men; but their Charity would be better be­stow'd in feeding the Poor, than Physicking them; and they do so Forsooth with design (if they have any at all) to force Sweat at the be­ginning of the Fever, little imagining the ill consequence of it; for Nature being disturb'd by this means, is forc'd to expel the Humour, as yet crude, by any way; and so sometimes the Febrile Matter is impetuously cast upon the Meninges of the Brain, and then a Phrensie is occasion'd; and sometimes upon the Membrane covering the Ribs, and from thence a Pleurisie arises, especially when the Age and Tempera­ment of the Patient, and the Season of the Year betwixt Spring and Summer contribute to it; for certainly at that Season Fevers are prone to turn to Plurisies.

The colour of the Blood taken away by Bleeding, seems to shew, that a Pleurisie takes [Page 54] its rise from such a kind of precipitation as we have mentioned; for the Blood (at least that which is taken away the Second time,) when 'tis cold enough, is like melted Suet, and the Super­ficies like true Pus, and yet in this 'tis very dif­ferent from it, for 'tis clolely knit with Fibres like the other Blood; neither will it run like Pus, for that part of another colour when 'tis torn from the rest, is like a tough Skin, and full of Fibres, and perhaps nothing else than the Sanguiferous Fibres, who having put off their Red and Natural Tegument by precipitation, grow into this whitish Membrane, by reason of the Cold of the Ambient Air. But 'tis to be no­ted by the by, that if the Blood don't flow. Ho­rizontally with a right Stream from the opened Vein, but runs down upon the Skin perpendicu­larly, 'tis often of another colour, how quick soever it runs. But I confess I don't know the reason of it, neither is the Sick so much eased by this kind of Bleeding, as by the other just now mentioned; yea, when Blood is taken a­way after this manner, if the Orifice be too small, or if any thing else obstruct the free Pas­sage, so that it can't come out with a full Stream, 'tis not like the Blood of those that have a Pleu­risie, neither is the Patient so much eased. I have likewise observed, that if the Blood fresh drawn, in what manner soever it flow, be stirr'd, the Superficies will be of a Red and Florid co­lour, as in any other Diseases.

But however the Blood be, this Disease though it has an ill name, and is more dangerous of itself than any other, yet if it be well managed, [Page 55] 'tis easily cured, and indeed as certainly as o­ther Diseases.

Having diligently consider'd all the various Phoenomena of this Disease, I count it nothing else than a Fever arising from a proper and pe­culiar Inflammation of the Blood, by which Na­ture puts off the Peccant matter upon the Pleu­ra, and sometimes upon the Lungs, and so it becomes a Peripneumonia, which I think differs only from the former in degree, and according to the greater intention and larger extent of the same cause.

Therefore I propose this Method for the cure of it, namely, that the Inflammation of the Blood be suppressed, and that the The Cure. inflamed Particles of it which have vio­lently rushed upon the Membrane covering the Ribs, and inflamed the whole, be duly evacuated. Wherefore depending most upon Bleeding, I order so soon as I am called, that Ten Ounces of Blood or thereabouts be taken away from the Arm of the Side affected, and afterwards I pre­scribe the following Potion to be taken presently after Bleeding.

At the same time I prescribe the following E­mulsion;

I also order Pectorals to be taken frequently; for instance,

As to Diet, I forbid the use of all Flesh and all Broaths of it, though never so thin; I ad­vise that the Patient be fed with Oaten and Bar­ley Broaths, and Panado; and let him drink of a Ptisan made of Barley-water, with Sorrel Roots and Liquorish and the like, and sometimes small Beer.

Moreover I prescribe the following Ointment,

With which anoint the affected Side Morning and Evening, applying upon it a Cabbage-Leaf. I also order he should persist in the use of the [Page 57] said Remedies, through the whole course of the Disease.

Of the same day I am first called, if the Pain be very violent, I take away again the same quantity of Blood, or else the day following, and so the Third day, and after this manner, Four times one day after another, (unless the Patient be well before,) when the pain and other Symptoms rage violently; but if the Disease be­ing more moderate and less dangerous, permit me to proceed more gently, or if the Patient being weak, cann't well bear Bleeding repeated so often, I don't repeat it again after it has been twice used, till a day or Two be passed between each Bleeding; in which case I always consider the things that contraindicate, namely, on this side, the violence of the Disease, on the other side, the weakness of the Patient: And though in curing Diseases, I would always proceed as I thought convenient, so as to order the ta­king away more or less Blood according to the occasion, yet I have seldom observed that a confirm'd Pleurisie has bin cured in grown Peo­ple, with less than the loss of Forty Ounces of Blood, or thereabouts; though in Children, once or twice Bleeding is most commonly sufficient: Nor does the Diarrhaea which sometimes comes upon this Disease, hinder the foresaid repeated Bleeding, which indeed may be soon stopp'd by this very method, without any astringent Me­dicines.

But I either wholly omit Clysters, or I take care that they be injected at as great a distance as may be betwixt the Bleedings; and [Page 58] they should be only made of Milk and Sugar.

All the time of the Disease, I take care that the Patient be not over-heated; and therefore I give leave that he be taken every day out of his Bed, and that he keep up some Hours, according to his strength, which is of so great moment in this kind of Disease, that if the Patient be kept continually a Bed, neither this so large E­vacuation of Blood, nor other remedies how cooling soever, will sometimes do any good for the taking off the said Symptoms.

Presently after the last Bleeding, unless per­chance it happens before that all the Symptoms abate, and that the Patient (who has been kept hitherto for some days from all Spiritous Li­quors and strong nourishment,) soon recovers his strength, it will be convenient to give a gentle Purge.

But now if any one should say, that proceeding in this way, we scarce touch upon expectoration, so far are we from discoursing largely of the ways by which 'tis to be promoted through the various seasons of the Disease; he is to know that these things were not unwarily passed over, but after good consideration designedly neglected. For I always thought, that they were in very great danger, who committed the cure of this Disease to expectoration; for to say nothing of the tediousness of this Method, by which Nature is busied in ejecting the Morbific matter; 'tis moreover very hazardous, for it often happens, that part of the Morbific matter being con­cocted and perhaps spit up, the rest remains crude, the best Maturating and Expectorating [Page 59] Medicines having been used in vain; for some­times the expectoration goes on very well, and sometimes is wholly suppressed; the Patient in the mean while being in Jeopardy on every hand, and for any power I have over Expectoration, (which indeed is none at all,) may be adjudged for Life or Death. Whereas on the contrary, by Bleeding, the Morbific Matter is in my Power, and the Orifice of the Vein may supply the use of the Aspera Arteria; for I confidently assert, that this Disease, which if it be treated by the Method, we have spoken against, is deser­vedly reckoned among the most dangerous, may be as certainly and as safely cured by the Method I have now prescribed, as any other Disease what­ever; neither could I ever find the least in­jury befall any one by so large an Evacuation of Blood, though unskilful People think other­wise.

I have indeed often endeavoured to find out some other method that might be able to do the business, without so great a loss of Blood, name­ly, either by destroying the Humour, or by E­vacuating it by the promotion of Expectoration; but I never yet could find any equal to the pra­ctice above mentioned; by the benefit of which (notwithstanding the dreadful Prognostication of Hippocrates concerning a dry Pleurisie,) I free the Patient from the violence of the Disease, not waiting for Expectoration by Bleeding, and so cure him.

But forasmuch as the Cure of this Disease al­most wholly consists in Bleeding repeated, which being performed in Places far distant from Popu­lous [Page 60] Towns, by unskilful Surgeons and Farriers, Poor People are often in danger of losing their Arms, and their Lives are hazarded by the prick­ing of a Tendon; I thought fit to add here the cure of such Punctures when they chance to hap­pen. They whose Tendons are prick'd, do not presently perceive a Pain, but Twelve Hours af­ter Bleeding, they complain of it, not so much in the Orifice lately made, as in the Parts tend­ing to the Arm-pits, where at length the Pain fixes, and is chiefly perceived, when the Arm is extended; but the hurt part has no great swel­ling, that scarce exceeding the bigness of a Ha­zel Nut; an Ichor continually distills from the Orifice, which indeed is chiefly reckoned the sign of a Puncture of a Tendon. I have known it cured after this manner,

CHAP. IV.
Of a Peripneumonia.

A Peripneumonia is thus defin'd, 'Tis an Inflammation of the Lungs, with an a­cute Fever, a Cough, and a difficulty of Breathing. They that have this Disease per­ceive a great Inflammation in the Breast, with a Swelling of the Lungs, and sometimes a prick­ing Pain; they labour for breath, and Breath short, or as Hippocrates says, they draw it deep. The Fever is accompanied with great Thirst, Watchings, and a troublesome Cough, and the Spittle Bloody, or streak'd with Blood; from which it manifestly appears, that this Disease is occasion'd by reason the Blood boiling Fevourish­ly, does not easily pass through the lesser Vessels of the Lungs, but sticking in their Passages, causes first an Obstruction, and then being more extra­vasated, an Inflammation with Heat, a Cough, and colour'd Spittle. Moreover as the Blood so stagnating, puffs up the Passages of the Lungs, and compresses them, there is a difficulty of Re­spiration, and as it disturbs and stretches the Nervous Fibres, it often causes Pain.

But if it be ask'd how an Inflammation should come in the Lungs, they being wholly without Flesh, and how it differs from that which is wont to be in the Muscular Parts? I must an­swer, That tho the foresaid Parts differ as to [Page 62] their Texture, yet the reason of the Disease is in all the same: For small Sanguiferous Vessels do every where alike embrace, bind, and vari­ously twine all the Tracheal Passages in the Lungs, and Carnous Fibres in the Muscles, and the little Fibres and Nervous Threads in the En­trails: And that which produces a Phlegmon, is the Blood it self, which while it ferments vio­lently, and is hindred in its Passages every where, especially in the Lungs, where the Vessels are branch'd into very fine Twigs woven to one another, first occasions an Obstruction, and con­sequently an Inflammation.

Wherefore the Formal Reason and Conjunct Cause of a Peripneumonia consists in the Febrile Effervescence of the Blood, together with the Stoppage of it in the narrow Passages of the Lungs, which occasions an Obstruction, and an Inflammation there; unless it happens so, this Dis­ease does not come: For in most other Fevers, as in the Burning Fever, tho the Blood boil, never so much, inflaming the whole Breast; and tho it be very clammy, and stick very much in the Passages of the Lungs; as in the Disease call'd a Pica, in the Green-Sickness, and the Dropsie of the Breast, yet it don't occasion a Peripneu­monia, for both these must concur to the pro­ducing of it; but when there is a Disposition to both, sometimes this, sometimes that first ex­erts its self, and is in some sort the Cause, or at least the Occasion of the other; for sometimes the Blood growing feverish, causes an obstru­ction of the Lungs, and sometimes also a Fever is stirr'd up in it, by reason of its being ob­structed [Page 63] in the Lungs; yet for the producing this Disease the Blood ought to be dispos'd for Effer­vescence, and for the obstructing the Vessels of the Lungs.

Tho it be not easie to say what this disposi­tion of the Blood is that inlcines to a Peripneu­monia, yet the reason of it does somewhat ap­pear from Bleeding, always us'd in this Disease with good success; for the Blood taken away from those that have this Disease, and also in a Pleurisie, hath a little white Film, or otherwise discolour'd, growing on it when 'tis cold, instead of a Scarlet Cream, which is also very tough and clammy, whence we may conjecture, that the Mass of Blood being too much bound up, so that in Circulation it can't put off its Excrements, is too much thicken'd and clammy, and by con­sequence too prone to Effervescence, and to stop narrow Passages, especially of the Lungs.

But if it be farther inquir'd from whence pro­ceeds this Disposition of the Blood, by which it becomes clammy like ropy Wine; the gene­ral reason hereof is this, That the grosser parts of the Blood are not sufficiently wrought upon by the more Fine, so as to be equally mixt and temper'd, that the good may at length betake themselves to their proper Functions, and that the superfluous should perpertually be discharged by their proper ways. But on the contrary, the sul­phureous Particles of the Blood, combin'd with the saline and earthy too much exalted, intangle all the rest; so that containing within it self all its Impurities, it grows clammy as Glue, and for this reason occasions a Peripneumoic Disposition.

For 'tis very evident that the Blood growing clammy in this manner, is prone to obstruct the narrow Passages of the Vessels, (which are very small in the Lungs) and so are apt for Febrile Effervescences; for retaining obstinately within themselves all their impurities, they are so much swell'd when they are full of them, that an Ob­struction and an Inflammation of them is necessa­rily begun or increas'd.

Moreover, to the Procatartic Cause of this Disease, a fault of the Lungs is frequently join'd, and determines the general indisposition of the Blood to seize this part. For when the Breast is sound and firm, it frequently discharges the clammy Blood growing Hot, which being fixt to the Pleura, or about the Habit of the Body, a Pleurisie or a Rheumatisim is rather occasion'd than a Peripneumonia. But when the Lungs are weak, or subject to a Cough, or when they are hurt by spitting of Blood, or by any other Dis­ease of the Beast, they are easily obstructed and inflam'd by the boiling Blood, when 'tis too much bound up, and of a clammy consistence.

Hitherto we have treated of the Conjunct and Procatartic Causes of a Peripneumonia: As to the evident Causes, what ever suddenly perverts or restrains free transpiration, belongs to these; as especially excess of Heat and Cold; immode­rate drinking of Wine or Strong-Waters; vehe­ment Exercise; the drinking of some Waters, especailly Ice-Water. Moreover, sometimes a Malignant Disposition of the Air, brings this Disease upon many, and makes it epidemical.

Authors in Physick do every where observe (and 'tis a Vulgar Observation) that a Peri­pneumonia frequently follows, or comes upon a Pleurisie. And nothing is more usual than a bloody and thick Spittle, and as it were purulent in a Pleurisie. So that there is a great Dispute on this account, by what passages or ways the Matter spit up should pass from the Pleura to the Lungs. Some think that falling into the Cavity of the Breast, it is suck'd into the Lungs as through a Spunge; and others suppose that 'tis carried thither through the Membranes grown to them, by which the Lungs often adhere to the Pleura; but both ways seem very improbable, if not impossible. For first, 'tis manifest that the Lungs don't suck in that which is contain'd in the Cavity of the Breast; for that in a Dropsie, or Wounds of the Breast, the Lungs being un­hurt, neither Matter nor Blood is at all dischar­ged by Coughing, tho frequently great plenty of either Humour is there, which soon flows out of its own accord, when incision is made into the Breast. That sometimes Membranes growing to the Lungs, knit themelves to the Pleura, is clearly manifest by Anatomical Ob­servations; yea, by this way of Communication, I have sometimes known the Purulent Matter translated to the Side, and there eritical evacu­ated by an Issue made by Art or Nature. But such Membranes of the Lungs join'd to the Pleu­ra do seldom pre-exist; and in a Pleurisie, which is a very acute Disease, they can't like a Mush-Room sprout out in two or three Days. Moreover, tho sometimes those obscure Passages [Page 66] may be ready at hand, which perchance by some admirable instinct of Nature, may discharge something out of the Lungs, towards the out­ward parts of the Breast; yet it seems against the OEconomy of Nature that they should de­rive any Corruption outwardly bred, to this most noble part, which is indeed the Fountain both of Life and Heat.

Now that I may propose my Opinion concern­ing this matter, I am inclin'd to believe that a Peripneumonia and Pleurisie are sometimes sin­gular and separate Diseases, and sometimes bred together, and coexisting at first, and sometimes also that they follow one another: For the Pro­catartic Cause being stirr'd up into Act, the Blood growing clammy and boiling also, ob­structs in some place the lesser Vessels, and the Nest of the Disease is sometimes fixt on the Pleu­ra, or in the Lungs separately, sometimes in each of them together, and sometimes first in one, and then in another; but for the most part the Pleura being first heal'd, the same Morbific Cause presently invades also the Vessels of the Lungs. Moreover I have seen great variety of Translations of this Disease; First, That it has seiz'd one Side, and then another, and having left that presently, the Lungs; and afterwards they being freed, the Brain also; and that it has frequently pass'd from thence to the former places.

And for the reason aforesaid, a Peripneu­monia also frequently succeeds a Quinsy, and sometimes other Diseases. For when the Blood growing clammy, and boiling, continues a [Page 67] Fever in the whole; it transfers the Obstru­ction and Inflammation variously hither and thither. And from hence that observation will be clearly understood of a Palsy, or a deadly Hemiplegia following sometimes a Peripneu­monia, which has so much puzl'd Interpreters; for the clammy Blood which even now obstruct­ed the Vessels of the Lungs, stuffing some of the Carotid Arteries, hinders the Generation of Animal Spirits in this or that Region of the Head, and by consequence their Influx into their respective Nervous Parts. From what has been said the chief differences of a Peripneu­monia are made plain, namely, that 'tis either a simple Disease, or join'd with a Pleurisie, Quinsie, or some other Disease; and then 'tis either primary or secundary. Moreover 'tis usually distinguish'd as to the Fever, and state of Breathing, to wit, according as this is more or less prejudicial; and as that is more intense or remiss, this Disease is also denominated more or less acute.

As to the Prognosticks of this Disease, com­mon Experience does attest that 'tis a very dan­gerous Disease; for many either die of it, or very difficultly recover Health, and this is manifest from its Etiology; for a Wound with a great extravasation or stagnation of Blood made in the Lungs, is very difficultly cured, and the affected place is never restored to its pristine State. The prognostic Signs which are of chief­est note, are taken from appearance of the Symptoms, and from the nature of Things eva­cuated, and from the degrees of Strength.

A Peripneumonia coming upon a Pleurisie or Quinsie, most commonly is worse than when it comes of it self, or succeeds either of them. But if upon this Disease, after what manner soever begun, an acute Fever presently follows, with great Thirst, Watchings, and an Orthop­noea; 'tis ill, and yet much worse if a Deli­rium, or Phrensie, or Convulsive Motions, or an Hemiplegia come upon it. Moreover, the Patient is as much indanger'd if he be very short Breath'd, if he be troubled with Vomiting, or frequent Swonding away, a weak Pulse, or could Sweats. For while these Symptoms are urgent, the Obstruction of the Blood in the Lungs is not at all remov'd, nothing is digested or spit up; but the circulation of the Blood be­ing more and more obstructed, and its accen­sion by respiration hinder'd, the Animal Spirits are much disorder'd and decayed, so that at length the Strength is quite spent, and the Vi­tal Flame extinguish'd.

As to the Prognosticks from Things evacu­ated, we observe a Peripneumonia to be dan­gerous, when nothing is spit up; next to this, when the Spittle is thin, and Crude, mixt with Blood; its far better when the Spittle is yellow and thick, streak'd with a little Blood. The Urin being yellow from the beginning, and of a good Consistence, with a Cloud in the midst, shews that almost all the Impurities are lodg'd in the place affected; when from that state 'tis chang'd into a thick and turbid Urin, it shews that the Morbific Matter is resorb'd from that part into the Blood. But if such [Page 69] kind of Urin be suddenly changed into a thin one, than a Delirium, or Death it self is at hand. Much Sweat, and plenty of Urin, a Di­arrhaea, Bleeding at Nose; the Flux of the Courses, or of the Hemorrhoids are good Signs in this Disease; yea, any of these Evacuations happening seasonably, do frequently discharge the Disease.

The Condition of Strength is ever of great moment in making a due Prognostic in this Disease; for oftentimes when there be dreadful Symptoms, as a violent Fever, a difficulty of Breathing, with a Cough, Watchings, and other ill Signs; if the Pulse be as yet strong, and the Animal Spirits vigorous, there is more hope of the Patient, than when these Things are moresedate, if the Pulse be weak, and the Spirits torpid and oppress'd.

The first indication of cure in a Peri­pneumonia, is, that the Blood impacted The Cure. in the Vessels of the Lungs, and causing an Obstruction and Inflammation, may be dis­cuss'd from thence, and restor'd to its pristine Circulation. But if it can't be done, the se­cond Indication will be, that the Matter be duly digested or suppurated, and presently spit up.

While the former Indication prevails, the in­tentions of Healing may be these following. First, That the more plentiful afflux of Bood, to the part affected, be prevented, or some way hinder'd. Secondly, We must endeavour that the Blood stagnating or extravasated in the Lungs, be re­sorb'd again by the Veins into the rest of the [Page 70] Mass, and restor'd to circulation: And that it may be the better done, the Blood ought thirdly to be freed from its clamminess, whereby its fluidity is hindred. Fourthly, We must take care of the most urgent Symptoms, viz. the Fever, Cough, Watchings, and difficulty of Breathing. But if notwithstanding all these Things, the other indication shall come into use, it will be requisite to prescribe maturating and expectorating Medicines, vulgarly so call'd, to­gether with these just mention'd.

That we may answer the first and second in­tention together, Bleeding is for the most part requisite in every Peripneumonia; yea, sometimes it ought to be frequently repeated; for the Vessels being emptied of Blood, don't only withdraw the nourishment of the Disease, but do often resorbe the Matter impacted in the part affected. Wherefore if Strength re­main, and the Pulse be strong enough, large Bleeding is convenient at the very beginning: But otherwise let it be us'd in a small quan­tity, which, however may be repeated as occa­sion offers it self. We noted above that Blood drawn in a Peripneumonia, and also in a Pleurisie, after its cold, contains in its Super­ficies a small viscous and discolour'd Film. Moreover, we may observe one while the Blood entirely, another while only part of it is sub­ject to this Change. For when the Blood is received in three or four Dishes, sometimes in all, but oftner in the second and third Dish, 'tis apparently bad, and in the first and last good enough. Wherefore it is commonly or­dered, [Page 71] that the Blood is always to run so long, 'till that which is so depraved, begins to come forth; and if there be sufficient strength, the flowing out is to be continued till it runs good again: Indeed as frequent experience does ap­prove of this practice, so doth reason itself; for in this Disease seeing the whole Mass of Blood does not presently acquire that clamminess, the depraved Portions are chiefly accumulated about the place of the Obstruction, and adhere on e­very side in the lesser Vessels; wherefore the Blood first flowing out by Phlebotomy, is often good: afterwards the Vessels being emptied, re­ceive the other Morbific stagnating before, and restore it to circulation; and when Portions of it plac'd near, troop together to the Orifice of the Vein, they slow out together; and after that the entire Mass of bad Blood hath flowed out, the residue more pure doth succed. Wherefore in this case let incision be ever made with a large Orifice, and let the Blood be drawn out with a large and continued Stream. For otherwise if in the midst of Bleeding, the bad Blood is­suing out, the Orifice (as the manner of some is, that the Spirits should not faint) [...] closed with the Finger; when 'tis opened again, the pure Blood will flow next, but the bad sliding by, if there be any remaining, will not presently return to that Orifice. Beside Phlebotomy, many other Remedies, namely whatever does repress the turgency of Blood, and empty the passages there­of, whereby the Morbific matter may be resorb'd are here to be used. Wherefore a very thin Diet is prescribed, for the most part meerly of [Page 72] Barley and Oats. And though Catharticks are altogether prohibited because they disquiet the Blood, and hurry it impetuously upon the part affected; yet Clysters which gently loosen the Belly, and draw the impurities of the Blood to­wards the Belly, ought to be daily used. More­over Julaps and temperating Apozems which re­strain the Fervor of the Blood, and evacuate the superfluous serosities of it, and gently open the passages of the Breast, are used with good suc­cess.

The third intention of healing which respects the taking off of the clamminess or obstructing viscosity of the Blood, is wholly to be perform'd by remedies, which unloose the frame thereof too much bound, and dissolve the combination of the Salts. And truly the Remedies of this kind, which in this respect Reason and Analogy would dictate, are now receiv'd into use by long expe­rience. For testaceous Powders, the Tooth of a Boar, the Jaws of a Pike, and other things en­dew'd with an Alkali Salt, also Sal Prunellae, are prescribed for the most part by all Practitio­ners as well ancient as modern. I have fre­quently▪ [...]nown the Spirit of Sal Armoniac and Hartshorn, to have yielded notable relief in this Disease; and the infusion of Horse-dung, by reason of its volatile Salt, is of great use, though it be a common remedy.

As to the Symptoms and their cure, very ma­ny Remedies appropriated to these, fall in toge­ther with the former; for against the Fever, the same Julaps and Apozems which appease the Heat of the Blood, and withal recreate the ani­mal [Page 73] Spirits, are of most common use; to which, besides in respect of the Cough and difficulty of Breathing, temperate Pectoral Remedies are ad­ded. The greatest difficulty is, what ought to be exhibited against want of sleep, when 'tis very urgent; for Opiats, because they further the dif­ficulty of Breathing in this Disease, are scarce safely taken, yea, sometimes they are very per­nicious. Wherefore Laudanum, and the strong preparations of Opium, are to be shun'd in a Pe­ripneumonia, worse than a Dog or Snake. Ne­vertheless Anodines and gentle Hypnoticks, as Water and Syrup of Red Poppies, are not only allowed, but accounted Specific Remedies in this Disease, and in a Pleurisie. And sometimes it will be expedient to use Diacodiats as long as Strength endures, and as long as the Pulse is strong enough. For the pain of the Breast, if at any time it be troublesom, 'tis necessa­ry to apply Liniments, Fomentations, and Ca­taplasms.

The second curative indication which intends the digestion of the matter impacted in the Lungs (if it can't be discuss'd or resorb'd) and to throw it up by Spittle, requires ordinary maturating and expectorating Medicines that are temperate, such as asswage Thirst, and ap­pease the Feverish Heat. The more select Re­ceipts, and chiefly accommodated to this Disease shall be now mentioned.

CHAP. V.
Of a Bastard Peripneumonia.

A Fever accompanied with many Peripneu­monic Symptoms, invades yearly about the beginning of Winter, but oftner at the end of it; it chiefly seizes those that are of a gross Habit of Body, and middle ag'd, or (which oftner happens) those that are older, and too much addicted to Spirituous Liquors, especially to Brandy: For when the Blood in such Men has been burden'd with Flegmatick Humours, heapt up in the Winter, and stir'd into a new Motion by the approaching Spring, a Cough is presently occasion'd by this means, by which the said Flegmatick Humours rush upon the Lungs; at which time if the Patient chance to live irregularly, and continues to drink freely such Spirituous Liquors; the Mat­ter growing almost thick, which occasion'd the Cough, stops the passages of the Lungs, and the Fever consumes the Mass of Blood: At the beginning of the Fever, the Patient is some­times hot and sometimes cold, is giddy, and complains of a launcing Pain of his Head; when the Cough is violent, he vomits up all Liquid Things when he Coughs, and sometimes when he does not; the Urin is turbid and very red; the Blood taken away is like that of Pleuri­ticks; [Page 84] he is often short Breath'd; if he be de­sir'd to cough, his Head-akes just as if it were cleft in pieces, (for so the Patient terms it) there is a Pain of the whole Breast, or at least a pressure of the Lungs, which is perceived by the Standers by when the Patient Coughs the Lungs not sufficiently dilating themselves, the Vital Passages are as it seems shut up by the Swelling, and the Circulation on that account is so intercepted, and the Blood so stopt, that there are no Signs of a Fever, tho this may also happen by reason of the plenty of the Flegmatic Matter, by which their Blood is so burden'd, that it can't rise to a perfect Ebulli­tion, especially in gross Bodies.

In curing this Fever, I count I am oblig'd to take away that Blood by The Cure. Phlebotomy, which occasions the suffo­cation and inflammation of the Lungs, and to ventilate and open the Lungs with pectoral Re­medies, and to mitigate the Heat of the whole Body with a cooling Diet: But whereas on the one hand, the Heap of Flegmatic Matter con­tain'd in the Veins daily supplying Matter for the Inflammation of the Lungs may seem to indicate Bleeding often repeated; yet on the other Hand I found by the best Observation I could make, that Bleeding often repeated, has succeeded very ill in Feverish People of a gross Habit of Body, especially if they have passed the flower of their Age, and therefore I forbore the repetition of it; and instead of it, us'd frequent Purging, which is well enough sub­stituted [Page 85] for it in those that abhor large and often repeated Bleeding.

Therefore I proceeded after this manner: I order'd that the Patient should be blooded in the Arm lying a Bed, and that he should not rise till two or three hours after; for all Blood­letting somewhat weakning and disordering the whole Body, may by this means the easier be born; for the Patient lying a Bed can better bear the taking away of ten Ounces, than of six or seven when he is up; the next day I give the following Potion in the Morning;

The next day I us'd to bleed a second time; and the next day save one, I order the purg­ing Potion above prescrib'd, to be repeated, and to be given every other day till the Pa­tient is quite well; when the Patient don't Purge, I advise him to use a pectoral De­coction, and Oyl of Sweet Almonds, and the like.

I Forbid the Patient the use of Flesh, and of the Broath of it, but especially of all Spi­rituous Liquors; in the stead of which, I allow him for his Ordinary Drink a Ptisan of Barly and Liquorish, and small Beer, if he desire it.

And indeed the Bastard Peripneumonia, oc­casion'd by a great deal of Phlegmatick Filth heapt up in the Blood and by reason of the Analogy of the Winter cast upon the Lungs, is to be cur'd by that Method wherein re­peated Bleeding is not only indicated, but also purging, otherwise than a true Peripneumonia, which I suppose is plainly of the same kind with a Pleurisie, and that it only differs from it in this, viz. That a Peripneumonia does more universally affect the Lungs. Both Dis­eases are cur'd by the same Method, namely, by Bleeding chiefly, and by cooling Medicines.

Tho this Bastard Peripneumonia is somewhat like a dry Asthma, both as to the difficulty of Breathing, and some other Symptoms, yet 'tis sufficiently distinguish'd from it; for in this there are manifest Signs of a Fever and In­flammation, which never appear in that; tho in this kind they are much less and obscurer, than those which accompany a true Peripneu­monia.

But we must carefully observe, that 'tis by no means safe to forbid the drinking of Spirit Wine, and such Liquors all of a suddain, when the Patient has been a while addicted to them, but they must be left off gradually, for there is danger of a Dropsie from a hasty and abrupt change, which ought to be observ'd in all Diseases that come on this occasion. And see­ing there has been mention made of Spirits of Wine; I will say by the by, that indeed 'twere to be wish'd they were either wholly prohi­bited, [Page 87] or at least us'd for refreshing the Spirits, and not for extinguishing them, or that the internal use of them were wholly abdicated, and that they should be only us'd by Surgeons in Fomentations to digest Ulcers, or to be ap­ply'd to Burns, in which last case they are bet­ter than any other Medicine yet found out, for they defend the under Skin from putre­faction, and so soon perform the Cure, (not waiting for Digestion, which requires a con­siderable time) if a Rag dipt in Spirit of Wine be presently apply'd to the part hurt with Scalding-water, Gun-powder, or the like, and moisten'd with the aforesaid Spirit now and then, till the pain from the Fire be quite gon, and afterwards only twice a day.

CHAP. VI.
A Quinsey.

IT comes at any time of the Year, especial­ly between Spring and Summer; it chiefly seizes Young Men, and such as are of a Sanguine Constitution, and Red-Hair'd People (which I have often observ'd) more than any other; they shiver and shake presently at the beginning of the Disease, a Fever follows, and a little after a pain and inflammation of the Jaws; and if the Patient be not seasonably re­liev'd presently, he can neither Swallow, nor draw his Breath through his Nostrils, so that he is under the apprehension of Strangling, by reason the Jaws are stopt by the Inflammation, and tumor of the Uvula, Almonds, and Larinx, and is indeed in a manner suffocated. There is great danger in this Disease, for it some­times destroys a Man in a few hours, namely, when a great deal of the Febrile Matter is cast upon the foresaid Parts, and when the voilence of the Disease is not timely prevented by the use of proper Remedies.

In order to the cure, I presently take away Blood plentifully from the Arm, The Cure. and presently afterwards from the Veins under the Tongue, and then I order that the inflam'd Parts should be touch'd with Hony of [Page 89] Roses made very sharp with Spirit of Sulphur, and that the following Gargarism should be used, not after the common way, but that it should be kept in the mouth without any agi­tation 'till it wax hot, and then that it should be spit out, and that it should be repeated now and then.

I likewise order that the Patient take daily of the Emulsion prescribed in the Cure of a Pleurisie, or the like.

The next Morning I bleed again, unless the Fever and difficulty of Swallowing somewhat abate, and defer Purging 'till the next day; but if both these are lessened, I presently give a lenitive Purge, which I have found ve­ry necessary by manifold experience above all other things after Bleeding. If the Fe­ver and other Symptoms are like to be trou­blesome after Purging, they are to be quelled by Bleeding repeated as before, and by apply­ing a large and strong Blister to the Neck; a cooling and emollient Clyster is to be injected every Morning, except when the Patient Purges, through the whole Course of this Disease. The use of Flesh of all kinds, and their Broaths are to be forbid, and the Patient is to be Dieted with Oatmeal and Barley Broaths, and Roasted [Page 90] Apples, and the like; let him use a Ptisan of Barley or Small Beer; let him keep up some Hours every day, for the warmth of the Bed heightens the Fever, and other Symptoms, which I endeavour to cure by this Method. But 'tis to be noted, that such a Quinsey which is only a Symptom of a Fever, I call Stationary, is to be cured by that method which is requisite for the Fever, and so is either to be taken off by Sweat and Transpiration, or by any other Me­thod of Cure which is necessary for the Primary Fever on which it depends. Which is worth ob­servation.

CHAP. VII.
Cholera Morbus, Vomiting and Loosness, in 1669.

THis Disease was more Epidemical in the Year 1669, than I ever knew it in any other Year. It comes as certainly at the latter end of Summer, and at the approach of Autumn, as Swallows at the beginning of Spring, and as Cuckows at the heat of the fol­lowing Season. That Disease which is occasio­ned by a Surfeit, comes at any time; the Symp­toms are indeed alike, and the Cure the same, yet 'tis of another kind. The Disease is easily known, for there are violent Vomitings, and an evacuation of Ill Humours with great difficulty and trouble by Stool; there is a violent pain and inflation of the Belly and Guts, a Heart­burning, Drouth, a quick Pulse, with heat and Anxiety, and often small and unequal, with great nauseousness, and sometimes a Colliqua­tive Sweat, Contractions of the Arms and Legs, Fainting, a Coldness of the Extream Parts, and such like Symptoms, which greatly terrify the By-Standers, and kill the Patient in Twenty Four Hours. There is also a dry Cholera from a Flatuous Spirit breaking out above and be­low without Vomiting or Loosness, which I never saw but once, and that was at the begin­ning [Page 92] of this Autumn, at which time the former kind was very frequent.

I have found by diligent application of mind, and by manifold experience, that if on the one hand I should endeavour to expel these sharp Humours that are the Fewel of the Dis­ease by Catharticks, I should do just as he that endeavours to quench Fire with Oyl, see­ing the operation of the most gentle Cathar­tick would but give farther disturbance, and raise new Tumults: And on the other hand, should I at the very first restrain the primary effort with Narcotick Medicines, and other astrin­gents, whilst I hindred natural Evacuation, and detained the humour against nature, the Pa­tient would undoubtedly be destroyed by an intestine War, his Enemy being inclosed in his Bowels: For these Reasons therefore I thought I must go the middle way, that I might partly evacuate and partly dilute the Humour. I found out this Method several Years agoe, and have long experienced it, and have by it many times reduced this Disease to good order.

A Young Chicken is Boiled in about Three Gallons of Spring Water, so that the Liquor hath scarce any Relish of the Chick; the Pa­tient is ordered to drink several large Draughts of this a little warm; at the same time a good quantity will serve for several Clysters, to be given successively, until all the Broath be con­sumed and rendred upwards and downwards, an Ounce of the Syrups of Lettice, Violets, Purslain, Water-Lilly, may be now and then mixt with the Draughts and Clysters; though [Page 93] the Broth may do very well without any such Addition. So the Stomach being often loaded with a considerable quantity of the Liquor, and as I may say turn'd, and the Injection of Cly­sters being reiterated, the sharp Humours are either cast out, or their Acrimony being taken off, they are reduced to a due temper, the filth being cast up by these means, which require Three or Four Hours: Some Paregoric Medicine perfects the Cure; I use this often.

Instead of which, any Shop Narcotick may be made use of. And this way of diluting the Humours is much safer, and more expedite, than that which is commonly taken to stop this most dangerous Disease; viz. either by Evacuaters or Astringents; because the tumult is heightened by Evacuaters, and all things are put in a hurly burly by them; and the other on the contrary detain an Enemy in the Bowels, and of a Stranger do plainly make him an In­habitant. To say nothing of the tedious trou­ble created to the Patient, when the Disease is protracted, whereby at length the Bad Homours creep into the Mass of Blood, and easily kindle a Malignant Fever.

But 'tis to be diligently noted, that if the Physician be not called till the Vomiting and Loosness have continued many Hours, suppose Ten or Twelve, and the Patient is worn out, [Page 94] so that the Extream parts wax cold; I say in this case all other Remedies being omitted, he must immediately fly to Laudanum, the Sacred Anchor in this Disease, which is not on­ly to be given when the Symptoms are ur­gent, but also after the Vomiting and Loos­ness go off, and to be repeated Morning and Evening daily, till the Patient has recovered his Strength and Health.

Though this Disease be Epidemical, yet it very seldom lasts longer than August, in which it first began; on which account I have been induced to contemplate that most elegant and subtle Artifice, which nature uses in the pro­duction of Epidemick Diseases; for though the same causes wholly remain, so that many should be seised with this Disease as well in September as August, by reason of eating too much Fruit, yet we see the same effect does not follow. And he that has carefully col­lected the Phaenomena of a Legitimate Cho­lera, of which only we treat at present, will confess that that Disease which invades at any other time of the Year, though coming upon the same occasion, and accompanied with some of the same Symptoms, is quite diffe­rent from this now spoken of; just as if there were some secret and peculiar thing in the Air of this peculiar Month, able to impress on the Blood, or on the Ferment of the Sto­mach, some such specifick alteration adapted only to this Disease.