CHAP. I.
Of the Epidemic Constitution of the Year 1665. and 1666. at London.

THE foregoing Winter being extremely cold, and the Frost This Chapter is taken out of Dr. Syden­ham's Treatise of Acute Dis­eases. continuing without any Inter­mission till Spring, it thaw'd sud­denly at the end of March in the year 1665. and Peripneumonia's, Pleurisies, Quinseys, and such like inflammatory Diseases, made great Slaughter of a sudden. At the same time al­so a continual Epidemic Fever shew'd it self, 'twas [Page 2] very different from the Genius of the continual Fevers that Reign'd in the preceding Constitution, of which scarce any us'd to invade at that time of the year. The Pain of the Head was more vio­lent, and the vomiting more severe, than in the former; and the Diarrhaea, which was most com­monly prevented in the other Fever, by taking a Vomit, was now heighthned by the same, and yet the Vomiting did not cease. The external parts were dry as in the Fevers of the foregoing Con­stitution; but after bleeding the Patient could sweat, and the Symptoms were presently mitigated by it; and this might be done at any time of the Disease; whereas in the former Fever you could neither attempt it safely, nor indeed could easily obtain your desire, before the thirteenth or four­teenth day. The Bloud was like the Bloud of Pleutritics, and of those that have a Rheumatism, only it had not so white a Jelly upon it: These were at first the Diagnostic Phoenomena of this Disease; but in progress of the Year the Plague it self broke out, accompanied with a great Num­ber of Pathognomonic Symptoms, as Carbuncles, Bubo's, and the like. It increas'd daily more and more, and came to its heighth about the Autumnal Aequinox, at which time it destroy'd about 8000 in the space of a Week, notwithstanding that two Thirds, at least, of the Citizens betook themselves to the Country for fear of Infection: Afterwards it began to decrease, and by reason of the cold of Winter almost ceas'd, only here and there one had it all the Winter, and towards the following Spring, at the approach of which it totally va­nished; yet a Fever remained (tho not so Epede­mic) [Page 3] the whole following year, and even till the beginning of the Spring, 1667.

CHAP. II.
Of the Pestilential Fever and Plague of the Years 1665, 1666.

I Have heretofore hinted by the by, that some Fevers are vulgarly accounted Malignant, whereas the extream violence of the Symptoms, which seems to countenance this Opinion, proceeds not from any venomous disposition of the Disease, but from the ill Management of the Cure: For when we dont duly attend to the solution of the Disease destin'd by Nature, but rashly begin some other Method, we mightily disturb the Oeconomy of the whole Body, and turn all things topsie turvy: and on this Account the Disease, contrary to its wont, has a woful Aspect, is different from its self, and accompanied with irregular Symptoms; so that in­deed it seems of another kind: But a Fever truly ma­lignant does not happen every day, and wholly differs from other kinds of Fevers, that are so call'd, by reason of the irregularities of the Symp­toms; and is truly of the same Species with the Plague, only 'tis a degree below it; wherefore I will treat of the Rise and Cure of both in the same Chapter.

That such a disposition, or texture, happens to the Mass of Air, as occasions various Diseases at different times, is manifest to every one that but [Page 4] considers, that one and the same Disease de­stroys an infinit number of Men at some certain Seasons, and at another time seizes only here and there a Man, and goes no further; and this is ve­ry apparent in the Small-pox, especially in the Plague, the Argument of this Chapter.

But what that disposition of the Air is, from whence this Morbific Furniture proceeds, we know not; nor many other things about which the doat­ing and arrogant crowd of Philosophers trifle: What-ever it be, upon this account at least, the clemency and goodness of Almighty God is to be reverenced, because pestilential constitutions of the Air, producing the Plague (the greatest of all Miseries, and most destructive to Mankind) sel­domer happen, than those that cause less deadly Di­seases: So that the Plague rarely rages violently in our Britain oftner than once in the space of thirty or forty Years. Some here and there die of the Plague for some years after a notable Pestilence; and its wont to go off gradually, by reason the pestilential constitution of the Air continues still in part, and yet is not wholly changed to another more wholsom; and therefore it ought to be accounted only as the Gleanings of the last Harvest: And al­so the Fevers that reign a year or two after a dreadful Plague, are wont to be pestilential for the same reason: And tho some have not the Tokens of the Plague, yet are they much of the same Nature, and require the like method of Cure, as we shall make appear hereafter.

But besides the constitution of the Air, as a more common Cause, there ought to be also another Procatartic, to wit, the reception of the Infe­ction, [Page 5] either immediately by accompanying some plaguy Person, or mediately transmitted by a Fomes from some other place; for else if it should happen while there is such a disposition of the Air as we have mentioned, a dreadful Fire would pre­sently be kindled by a small Spark, and the whole Air through that tract of Earth would suddenly beinfected with the Plague, by reason of the Breath of the Sick, and Carcasses of the Dead; so that there would be no more need of a Fomes, or personal in­tercourse to propagate this dreadful Disease, but the very Air, passing in with the Breath, would be able to destroy a Man of it self, tho he were carefully re­mov'd from the infected, if he has a Body fur­nished with Humours, dispos'd to receive the In­fection. This Disease, when 'tis only sporadical, afflicts some few promiscuously, at any time, the Infection being as it were handed from one to another. But when there is also an Epidemic Con­stitution of the Air, it begins between Spring and Summer, that being a Season most fit to produce a Disease, whose Essence chiefly consists of an In­flammation, as we shall shew hereafter. Moreover it has its times of Increase, and Declination, like other kinds of natural things: It begins at the time we said; as the Year increases, it spreads; and as that declines, it decreases, till at length the Winter has chang'd the Air into a Diathesis, con­trary to this Disease.

For if the changes of the Seasons of the Year have no power over this Disease, but the pesti­lential Seeds beeing untamable by any Alteration of the Air, are transmitted from one to another in a perpetual Series, it could not be, but that [Page 6] when it has once entred into any popular City, it should still increase the Funerals more and more, till by a continued destruction no one at length would remain to whom it might impart its Infecti­on: But that the contrary often happens, is clear, from the number of the dead, which increas'd to some Thousands in one Week in August, but mightily decreas'd at the latter end of November, and almost ceas'd. And yet I don't deny, but that it may be, and which also some Authors have re­lated, that the Plague has broke out at other Sea­sons of the year, but 'tis rare, neither is such a Plague very raging; besides I very much suspect, that the disposition of the Air, tho it be pestilential, is not sufficient of it self to cause the Plague, but that being always in some place or other, its ei­ther conveighed by a Fomes, or by the coming of some plaguy Person from an infected place to ano­ther, and is not epidemical there, unless also the disposition of the Air incline to it: For otherwise, I don't understand how it comes to pass, that in the same tract of Heaven, when some one Town is grievously afflicted with the Plague, another not far distant, by warily prohibiting any Commerce with the infected place, should keep clear of it; as not long a-go, when the Plague rag'd cruelly almost over all Italy, it was shut out of the Con­fines of Tuscany, by the Care and Prudence of the Great Duke.

Its first approach is almost always accompanied with shaking and horror, like the Fits of intermit­tent Fevers, presently violent Vomitings, a pain a­bout the Region of the Heart as if'twere press'd, a burning Fever, with the usual concourse of Symp­toms, [Page 7] perpetually molest the Sick, till either Death it self, or a happy eruption of a Bubo, or Parotis, discharges the morbific matter, and so frees them from that deplorable condition. It does indeed now and then happen, but seldom, that it comes without any sense of a Fever before, and sud­denly destroys Men. The Purple Spots, which are the Forerunners of present Death, breaking out, as they are about their Business; but this sudden Death (which is to be noted) scarce ever hapens, but at the beginning of a dreadful Plague; and is never, when it remits, and is weakned, or in Years in which 'tis not epidemical. It sometimes also happens that Tumours appear, when neither a Fever, nor any other grievous Symptom went before; but I imagin that some little shaking or horror, tho less perceptible, always precedes. They that are after this manner, may safely walk about the Streets at pleasure, and do their Business, as if they were well, not regarding any Regimen.

As to the essence of this Disease, I dont pretend to define it exquisitly, and perchance, he would seem as impertinent to wise Men, who should ask me, what constitutes this, or that sort of Sick­ness, as I should, if I should ask him the same Question, concerning a Horse for instance, among Animals, or Betony among Plants: For Parent Na­ture accomplishes the Generation of all things, which any time she brings to Light from the Bo­som of Causes, by most certain Rules, only known to her self, and hides their Essence, Quiddities, and constitutive Differences, in the greatest obscurity. Hence every Species of Diseases, no less than of Animals, or Vegitables, is always allotted Affecti­ons [Page 8] peculiar to it self, and univocal, flowing from its Essence: And yet notwithstanding, that Que­stion will not be very considerable, to wit, How we should cure Diseases, when we are ignorant of their Causes? For as much as the Cure of most Di­seases is perform'd, not by the knowledge of the Causes, but by a convenient Method, approv'd by Experience. But to return to the business, be­cause we are wont to deduce the Rise of all simi­lar Deseases from a Fault of the first or second Qualities (which we can only do by reason of our great ignorance of things) 'tis probable, that the Plague is a peculiar Fever, of its own kind, proceeding from an Inflammation of the most spi­rituous Particles of the Bloud, for as much as they seem most adequate to its most subtle Nature: If it exert the greatest subtilty, with which 'tis en­dow'd, it suddenly dissipates the native Heat, and so kills the Patient, as is seen at the beginning, and state of an Epidemical Constitution. The Corps of those who are so suddenly destroyed, by the violence of this Disease, are every where dis­figured with Purple Spots, the Fibres of the Bloud being broken in pieces, by reason of the violence of the intestine Conflict, and the frame of it wholly dissolv'd: And this Tragedy may be acted by reason of the great subtilty of its Flame, even without any febrile ebullition of the Bloud, or sense before of any other Sickness, otherwise than it most commonly happens, where the Morbific Cause is less subtile, and the Weapon more obtuse with which it assaults Life; the manner of the difference may be thus bluntly represented: For Instance, If a Needle, or any other sharp thing, be put under [Page 9] a Pillow, and forceably press'd, it does not lift it up, as some things of a duller point would, but perforats it. But this kind of sudden Death sel­dom happens, and only, as we said before, at the beginning, or increase of the Plague: For most commonly, as in other Fevers, shaking and hor­ror first invades, and heat presently succeeds, which continues till the inflamed Particles of the Bloud are banished to the Emunctories, by the provident conduct of Nature, and there turn'd into Puss, after the manner of common Phlegmons. If the Inflammation be more remiss, its wont to produce those Fevers which are commonly call'd pestilenti­al, which often happen at the end of a pestilen­tial Constitution; and perhaps a year or two after, till that species of Fevers wholly disappears.

In my opinion, that Inflammation which is call'd an Erisypelas, is much like the Plague; for 'tis ac­counted by the best Physitians a continual Fever, arising from the thinner part of the Bloud, from which that Nature may free her self, she expels it to some external part of the Body, in which a Tumor, or rather broad red spots dispers'd (for a very visible Tumor does not often appear) arise, which they call an Erysipelas; but the Fever goes off critically by this Tumor, after it has afflicted the Sick a day or two. And moreover, some­times, there is wont to be Pain in the Glandules of the Arm-pit, or Groin, as in the Plague; and it begins also almost like it, with Horror, and a febrile heat following it: So that they who have not had this Disease before, think they are seiz'd with the Plague, till at length it shews its self in the Leg, or some other part: And indeed some [Page 10] Authors have imagin'd that there was somewhat of Malignity in this Distemper, and therefore have proceeded in the Cure with Sudorificks, and Alexipharmacs. This Flame soon goes out of its own accord, and does no further mischief, when by means of the ebullition, the torrid particles of the Bloud are cast out.

But the Plague far exceeds an Erysipelas; for by reason of the great tenuity of its substance, 'tis fitted to pass through the innermost recesses of the Body like Lightning, and suddenly destroys the Spirits of the Bloud, and dissolves its frame, be­fore oppress'd Nature can raise a febrile ebulliti­on, the wonted means by which she endeavours to remove whatever is offensive to the Bloud.

If any one be dissatisfied with my Opinion, to wit, that this Disease is occasioned by an Inflam­mation, let him consider, that not only the pre­sence of a Fever, but also many other things, favour this Opinion. For instance, the colour of the Bloud taken away, which is like that of Pleu­ritics, and of those that have a Rheumatism, the adust appearance of a Carbuncle, not unlike the impression of an actual Cautery, the Buboes, which are as much inclin'd to an Inflammation as other Tumors of any other sort, and they end in abcesses, as most inflammations are want to do; and also the Season of the year, in which an epidemic Plague most commonly breaks out, seems to confirm the same; for at the same time, viz. between Spring and Summer Pleurisies, Quinsies, and other Dis­eases that proceed from an Inflammation of the Bloud, are wont to be epidemical; and I never knew them more frequent than they were before [Page 11] the Rise of the London Plague. But 'tis of no im­portance, that that very year so dreadful, by reason of the destruction of many thousands, was otherwise most mild and healthy, and that all that escaped the Plague were better in health, and also that those who recover'd of it were after­wards freed from Cachexies, and other indispositi­ons usually occasioned by the reliques of former Diseases. And moreover, that the imposthumated Carbuncles (after the inflamed particles were car­ried off with the matter) were easily cur'd by Chirurgical means, and those too not very ex­quisit.

But perhaps, some one will ask, How it comes to pass, that hot Medicines, such as are almost all Alexipharmacs, should be us'd with good Success, both as to the cure of the Plague, as also for pre­servation from it, if it consists of an Inflammati­on? To whom I answer, That these things do good only by accident, to wit, by the benefit of Sweat that they produce, by which the inflamed particles of the Bloud are exterminated; but if they don't cause sweat when they are taken, as it very often happens, the flame of the Bloud, in­creas'd by their adventitious heat, soon proclaims openly the mischief of them. In a word, as to preservation, I know, that the use of hot Anti­dotes is also every where commended, but with what success is not yet prov'd: Indeed 'tis ra­ther probable, that Wine drunk too freely, and other strong preservatives taken daily at set hours have cast many into this Disease, who otherwise might not have had it.

[Page 12] As to the Cure of these Fevers, the Curative in­dications are first to be minded, which in general, are so to be directed, that either, exactly follow­ing the conduct of Nature, we assist her in exter­minating the Disease; or not trusting to the me­thod she is wont to use in conquering this intestine enemy, we substitute by Art, in the room of it, a contrary and more safe. But perhaps some one will say, that the cure of the Plague may be well enough performed by Alexipharmacs, great numbers of which may be found in practical Authors: but tru­ly 'tis very disputable, whether the help these Me­dicines afford, don't rather proceed from their ma­nifest qualities, by which, procuring Sweat plenti­fully, they prepare a way at the same time, for the exclusion of the Morbific matter, than from a cer­tain occult Virtue allotted them by Nature, to expel the Venom of the Pestilential Malignity. Neither may we only doubt of these, but also of the Alex­ipharmacs of other Diseases, viz. Whether they don't relieve the Sick, rather by stirring up some Evacuation, than by a Specific Virtue; for instance, in the French Pox; he that objects, that Mercury and Sarsaparilla are Alexipharmacs; for the Ve­nom in that Disease, must produce some examples of Cures, in which That did sometimes restore Health without Salivation or Stools, and this with­out Sweat; which I believe will be very difficult for him to do: But it seems probable to me, that the peculiar Remedy, and proper Alexipharmac of the Plague, yet lyes hid in Natures Bosom; nor can it be taken thence, but only by a Mechanic Reason.

[Page 13] But that we may a little more fully consider the former intention, which requires, that we should assist Nature after her own way and manner, in expelling the Morbific matter: 'tis to be noted, that in a true Plague, Nature performs her business by some abcess breaking out in the Emunctories, and so the matter is cast out, when she does not err, of her own accord; nor is violently forc'd out of the way; but in the Fever we call Pestilential, the same is perform'd by means of Sweat, through the whole superficies of the Body. Whence we may learn, that according to the various ways and order, which Nature discovers in both Diseases, a different method of Cure ought to be instituted; for if any one endeavours to expel the matter of a true Plague by Sweat, he proceeds in a method opposite to Nature's for as much as she attempts to do it by Imposthumes; and on the contrary, he that endea­vours to eliminate the matter of a Pestilential Fever, any other way than by Sweat, takes a course no way agreeable to her conduct and inclina­tion. But in the true Plague, 'tis not yet known by what fit and certain kind of Remedies, the ejection of the Morbific matter, that is, the erup­tion of the Imposthumes may be promoted. Per­haps some one may imagine, that a corroborating Diet, and Cordials, may conduce to it; but truly, I should very much doubt, lest they should increase the heat of the Patient, that is too much already. And as to Sweats, I am fully satisfied by experi­ence, that they signifie nothing in this case, tho I don't deny, but that after great Sweats, conti­nued for the space of three or four hours, and then suddenly stopt, the tumor shews its self; but [Page 14] I don't think, 'tis at all occasion'd by the Sweat; for as much as, when 'tis at height, there appears no sign of its eruption: when 'tis over indeed, it may follow, as it were by accident, to wit, when the Sweat has remov'd part of that burden, by which Nature was too much oppress'd, and the Body violently heated by Cordials, taken to raise it. But how fallacious and uncertain this ejection of the peccant matter, is by imposthumes, occa­sion'd by Sweat, the lamentable end of those testi­fies, who have bin treated after this manner, of which scarce one in three, (to speak within bounds) escape the danger of the Disease and Cure. But on the contrary, many on whom the Tumors broke out in the right manner, even when they were in­tent on their business, and without any sensible hurt of any natural, vital, or animal faculty, re­cover'd in a short time: except those, who unfor­tunately falling into the hands of a Quack, and composing themselves to Sweat, by his Advice, tho they were very well in Body and Mind, began from that very time to grow worse; and their sickness increasing, they sufficiently demonstrated the injury of this unlucky Counsel, by their own death. But the uncertain Judgment of this Disease by Tumors, is manifest; for that sometimes a Bubo, which comes out at first laudably, and with remission of the Symptoms, afterwards disappears of a sudden, and instead of it, Purple Spots, the certain tokens of Death succeed. The cause of the going in of the Tumour, seems of right to be at­tributed to those Sweats, which were design'd to promote its eruption; for as much as, they dissi­pated, other whither through the habit of the Body, [Page 15] the chief part of the matter, which should have serv'd to have kept up the Tumour. However it be, this at least plainly appears, that by the be­nignity of Almighty God, certain ways of casting out the Morbific matter, are appointed in other Diseases: but for this Scourge of hainous Iniqui­ty, only a very uncertain one. And perchance, the Cause and Original of this great destruction, may be as properly deduc'd from hence, as from Ma­lignity; for in the Gout, and other Diseases that have little suspition of Malignity, the striking in of the Morbific matter is full as destructive. From all which it manifestly follows, that the Physitian, who is oblig'd to follow exactly the conduct and inclination of Nature, ought here to renounce her guidance; the truth of which, because few have hitherto sufficiently understood, therefore the num­ber of those whom the Plague destroy'd, was not a little increas'd.

Wherefore, seeing 'tis not at all safe to fol­low the Foot-steps of Nature in exterminating this Disease, we must consider, in the next place, by what means we may satisfie that intention, which we call the second; namely, by instituting a so­lution of this Disease, contrary to that of Nature, and this I think, can only be done by these two ways, viz. either by Bleeding, or Sweat. As to the first, I am very sensible, that Bleeding is much abhorr'd by most in this Disease; but be­ing little concern'd at the prejudice of the Vul­gar, I will fairly discourse the Validity of the rea­sons in this Question. And first I appeal to those Phisitians that continued in Town when the late Plague rag'd, whether they ever observ'd, that [Page 16] large Bleeding, and often repeated, before any Tumour appear'd, was the cause of any ones Death that had the Plague: But 'tis no strange thing, that bleeding sparingly, or after the Tu­mour is come out, should be always hurtful; for when only a moderate quantity of Bloud is taken away, the administration of Affairs is forc'd out of Natures hand, who endeavour'd all she could to cause a Tumour; and yet in the mean while another Method is not substituted, that is power­ful enough to evacuate the morbific matter: And bleeding us'd, after the Tumour appears (for as much as it draws from the Circumference to the Centre) induces a motion quite contrary to that of Nature, which is from the Centre to the Circum­ference; and yet nothing is more commonly urg'd as a mighty Argument by those of the contrary opi­nion against bleeding in general in this Disease, than the injuries of Phlebotomy, administred after this perverse manner, as may be every where seen, in Diemerbroek, and other Writers of Observati­ons. As for my self, I can't assent to their Argu­ments, till I understand what they answer to the Question above propos'd: For very many Au­thors, and those of the best Note, have thought bleeding proper in the Plague; the chief of whom are Ludovicus Mercatus, Joannes Costaeus, Nicholaus Massa, Ludovicus Septalius, Trincavellius, Forestus, Mercurialis Altomarus, Paschalius, Andernachus, Pe­reda, Zacutus Lucitanus, Fonseca, and others: But there is but one that I know, who places the whole business of the Cure in as large a bleeding as we require, to wit, Leonardus Botallus, one of the most famous Phisitians of the former Age, [Page 17] whom I will quote, lest I should be thought singu­lar in this Practice; In a word, says he, I think there is no Plague in which this In his seventh Chapter, Of the Cure by bleeding. may not be better, than all other remedies, so it be us'd opportunely, and in a con­venient quantity, for I suppose 'tis found unprofitable sometimes; for that either 'tis us'd too late, or less is taken away than ought to be, or an error is committed in the using of it both ways. And a lit­tle afterwards, he adds, But in so great Timidity, and sparing Phlebotomy, how can it be that any one should judge exactly how much good or hurt it may do in the Plague? for if a Disease (for the Cure of which, the taking away of four pounds of blood was required, and but one pound be taken away) kill a man, it does not therefore destroy him because he was blooded, but because it was not done in a due manner nor perchance season­ably; but slothful wicked villains always endeavour to put the fault on that, not for that it did hurt, but be­cause they basely desire to have it disapprov'd by all: or if they don't do it wickedly they do it ignorantly, by a perverse custom; both certainly are pernicious, but that most of all. All which being about to confirm by experience, a little after he thus proceeds, These things being noted, no rational man can well dispraise bleeding in these Diseases, but rather wonderfully com­mend and extol it, and confidently use it, as a Divine help, which truly I have done for these fifteen years. Therefore in Pestilential Diseases, at the Seige of Ro­chel, and four years ago at the Mountains of Hai­nault, and for these two years at Paris, and the last year at Cambray, I found no remedy speedier and safer in all my Patients (which were innumerable) than large and seasonable bleeding.

[Page 18] And afterwards he delivers some observations, which for brevity sake I here omit, but will re­late a very rare case, and sutable to our purpose, of a business performed in England, many years ago. When among the other Calamities of the Civil War, that miserably afflicted this our Coun-try, the Plague also rag'd in many places, it chan­ced to be brought from another place, to the Castle of Dunstar in Somerset-shire: and some of the Souldiers dying suddenly, with an eruption of Spots, it seiz'd many others, at which time a Sur­geon, that had been a great Traveller, was a common Souldier there, who humbly beseech'd the Governour of the Castle to permit him to do all he could do for the relief of his fellow Souldiers, that were seiz'd with this dreadful Disease; and having obtain'd leave, he took away a prodigious quantity of Blood from every sick Person, at the first approach of the Disease, before there was any sign of a Tumour; he bleed them till they were even like to drop down, for he bled them all stand­ing, and in the open Air, neither had he any por­ringer to measure the blood; afterwards he order­red them to lye in their Tents, and though he gave no Medicine at all after bleeding, yet (which is very strange) of those very many, he treated af­ter this manner, not one died. Mr. Francis Wind­ham gave me this account, who was then Governor of the Castle, and is indeed a Gentleman, and remarkably honest, and is now living, so that any one may be satisfied, that doubts the truth of it.

I will mention what I have observ'd worth note, concerning this thing, when I come to treat, of those [Page 19] few remarks, I made by my own experience, while the late London Plague rag'd.

But tho' in my Judgment I approve of this practice, and have experimentally found the utili­ty of it long ago; yet the dissipation of the Pesti­lential ferment by Sweat pleases me better upon many accounts than the evacuation of it by bleed­ing: for as much as it does not weaken the patient so much, nor hazard the Physitians reputation: but this has also its inconveniencies; for first, many, especially young Men, of a hot constitution, sweat difficultly, and in such the more you endeavour to cause Sweat by strong Diaphoreticks, and by heap­ing on a great many Clothes, so much the more are they in danger of falling into a phrensie; or what is yet worse, after having been entertain'd a while with vain hopes, the Tokens are forc'd out instead of it. For the chief venom of this Dis­ease residing in the most spirituous part of the bloud (the motion of the grosser particles being on this account somewhat more languid, than is usual in other inflammations) that tender portion is driven into a greater fury, by the accession of this new heat, and at length violently breaks in pieces all the Fibers of the blood, distended beyond the bounds of their texture; which dissolution of the sanguineous Fibers, I take to be the cause of the Pestilential Tokens. For, first, they are intensly Red, and soon after Livid or Black, not unlike stripes inflicted by a violent blow on some muscu­lous part of the Body.

And then in those bodies which are easie to sweat, if it be stopt too soon, to wit, before the Morbific matter be wholly dissipated, the condi­tion [Page 20] of the Buboes is afterwards worse, which began to come out well at the latter end of the sweat. For that part of the matter being sub­stracted, which should serve to elevate them, ei­ther they soon strike in, or at least never come to true abcesses (as is wont to happen in the small Pox, when the sick has sweat violently at the be­ginning of the Disease) but the cruel Enemy be­ing again taken in, a commotion is stir'd up in the blood, by which means the Purple spots, the Tokens of suddain death are often driven out: in the manner we have describ'd above.

But that it may be more clearly evident by what means we may obviate these and the like difficul­ties, I will faithfully set down what has been done and observ'd by me, so far as I was able, in this Disease, beginning from the rise of the late Plague.

At the beginning of May, 1665. I visited a No­ble Lady, about one and twenty years of age, of a Sanguine complexion, besides the burning Fever, which began a little before, frequent Vomitings and other Febrile symptoms molested her. I be­gan the Cure with Phlebotomy, and the next day to prevent a Diarrhaea, (which as I noted at the beginning of this Treatise, was wont to come at the latter end of the Fever, when an Emetic was omitted, which the inclination to Vomiting at the beginning of the Disease requir'd) I order'd a Vo­mit that carried off the filth of her stomach very well: The day after, visiting her again, I under­stood she had a Diarrhaea, which being very un­usual for some years, did not a little perplex me; but from thence I gather'd that this was no com­mon Fever, (as was also apparent from the event) [Page 21] and therefore required another method of Cure, different from that I deliverd in another place, which I had us'd hitherto with continu'd success. Wherefore another elder Physitian being call'd in to assist me, bleeding was repeated by our joint consent; which the age and constitution of the Patient, and the inordinate ebullition of the blood seem'd to require; and also Cordials mode­rately cooling were prescrib'd, and Clysters were injected every other day. At the latter end of the Disease we order'd some of the stronger Alexi­pharmacs, because very unusual and irregular sym­ptoms invaded, commonly reckon'd the signs of great Malignity: but all doing no good, she dy­ed about the fourteenth day. I had various thoughts for some days after, about the odd di­sposition of this Fever; and at length remembring the violent heat which continued in the foresaid patient, even after repeated bleeding, that there was a redness in the Cheeks, and that some drops of blood flow'd from her Nostrils a little before her death, and that also the blood when 'twas cold in the porringers was not unlike that which is taken from Pleuritics; moreover that she had a Cough, and certain obscure pains in the vital parts: besides that that season of the year approach'd, which contains the end of Spring and beginning of Summer, and which is less dispos'd for the production of continual Fevers, (for these of their own accord, at this time, either turn to in­termittents, or suddenly change to Pleurisies, or other inflammations of the like kind); and lastly, that Pleurisies at that very time were very Epide­mical. All these things, I say, being duly weigh'd, [Page 22] I was of the opinion that this Fever, tho' 'twas destitute of the Pathognomonic signs of a Pleurisie or Peripneumonia, had the importance of a Sym­ptom, on the account of a certain Inflammation lurking about the vital parts, tho' there was no pain of the side, nor no considerable difficulty of breathing: To be short, at length I was persua­ded that I must wholly proceed, in the 'foresaid case, with the same method which I had often us'd, with excellent success, in a Pleurisie; and indeed it afterwards succeeded as well as cou'd be wish'd: for being call'd a little while after to a Man that was ill exactly after the same manner I began and finish'd the Cure by repeated bleed­ing, as is commended in a Pleurisie. About the latter end of May and the beginning of June, very many, desiring my assistance, were recover'd from this Fever (which was then very Epidemical) by the 'foresaid method. From this time that dread­ful Plague began to rage cruelly, which at length was so very mortal, that in the space of seven days it destroy'd so many thousands in this one City.

But whether the Fever, of which we have now Discours'd, deserve the name of the Plague, I dare not confidently affirm: but this I know experi­mentally, that all that were seiz'd with the true Plague at that time, and sometime after in my Neighbourhood, with all the Symptoms peculiar to it, had the same concourse of Symptoms both at the first coming of the Disease, and in the whole course of it. But when I was endanger'd by the near approach of the Plague to my own House, a [...] [...]ngth, by the persuasion of Friends, I accom­pani'd [Page 23] the vast numbers of those that left the Ci­ty, and remov'd my Family some Miles from thence; yet I return'd so very soon, and when the Plague continued so violent, that it cou'd not be, but by reason of the scarcity of better Physitians, I shou'd be call'd into the assistance of those that had the Plague. And not long after I visited ma­ny that had Fevers, which I perceiv'd (not with­out great admiration) were like that I manag'd so successfully before my departure; and there­fore confiding in my own experience, as a guide to be prefer'd before all idle precepts, I did not doubt to order bleeding again. I continu'd this course of bleeding plentifully (together with the use of a Ptisan and such like cooling diet) in many Pati­ents, with very great advantage, till at length missing my wonted success in the management of some, by reason of the frowardness of the standers by; who being possess'd with vain prejudices, wou'd not permit me to take away a due quantity of blood (to the great damage of the sick, from whom a sufficient quantity or none at all shou'd have been taken away, seeing the stress of the Cure depended on it) I perceiv'd a great obstruction to my designs, and therefore thought 'twould be of great use to find some other method of curing this Disease besides that of bleeding. I will instance in an injury I once did (but without guilt) not be­cause I let blood, but for that I was not permitted to take away so much as I desir'd; being sent for to a young Man of a sanguine complexion and strong constitution, whom a violent Fever had seiz'd two days before, with giddy pains of the Head, violent Vomitings and other such Symptoms, [Page 24] and finding upon inquiry that he had no sign of a Tumor, I presently order'd that blood should be taken away in a large quantity, the superficies of which, when 'twas cold, represented the corrupt­ed blood of Pleuritics; and I prescrib'd also a Pty­san with cooling Julaps and Broths; in the after­noon he bled a second time the same quantity, and likewise the next Morning, and towards the Eve­ning of this day I visited him, and found him much better; yet notwithstanding I perceiv'd his friends violently oppos'd the taking away any more blood: but I earnestly contended that it shou'd be again repeated, saying, he need be blooded but this time only, and then he wou'd be out of danger; but that if they shou'd continue obstinate, it had been better that no blood had been taken away, and that the Cure had been carried on by sweat, and in a word that the patient wou'd most certain­ly dye: The event confirm'd the Prognostication, for while we were disputing about the thing, we lost the opportunity of doing it; for the next day the Purple spots broke out, viz. the reliques of the peccant matter which ought to have been wholly evacuated (for as much as Phlebotomy so often repeated had taken away all hopes of an Ab­cess) by delay perverting the whole mass of blood, and breaking the texture of it by its great subtle­ty, and the Patient died in few hours. When therefore I had frequently met vvith such obstacles, I earnestly endeavour'd to find out (if possible) some method of Cure, that might be as effectual and not so displeasing: And having much and long deliberated the thing in my mind, at length I fell upon this method, which I found afterwards, [Page 25] to be perfect in all respects and always benefi­cial.

First, If the Tumor has not yet ap­pear'd, The Cure. I bleed moderately with re­spect to the strength and temperament of the sick, and afterwards the sweat is easily and soon rais'd; (whereas otherwise 'tis not only very difficultly procur'd in some bodies, but there is also danger lest the inflammation shou'd be heigthen'd by it, and so the Tokens forc'd out) and the benefit of the sweat immediately following, abundantly compen­sates the loss of blood, which how little soever it be wou'd otherwise be very injurious. After bleed­ing (which must be perform'd in bed, vvhen all things are in a readiness to promote sweat) vvith­out any manner of delay, I order the Patient to be cover'd quite over vvith clothes, and that a piece of Flannel be bound to the forepart of his Head, and indeed this covering of the Head, conduces more to the procuring sweat than any one vvou'd easily imagine. Afterwards if the Patient does not Vomit, I give these and the like Sudorifics.

Take of Venice Treacle ʒii, of the Electuary of the Egg ℈i, of compound powder of Crabs eyes, gr. xii, of Cochinell gr. viii, of Saffron gr. iv, with a suffi­cient quantity of the juice of Kermes make a Bolus, which let him take every sixth hour, drinking after it six spoonfuls of the following Julap.

Take Cardus-water compound, Scordium-water of each ℥iii, Treacle-water ℥ii, Syrup of July-flowers ℥ii, mingle them and make a Julap.

But if the Patient be troubl'd vvith vomiting, as he is very frequently in the Plague, and other Pesti­lential Fevers, I defer the giving of Sudorifics so [Page 26] long as 'till he begins to sweat, by means of the covering only, excepting that sometimes I put part of the sheet over the Face, to collect the vapors: for (which is indeed very well worth observation) when the rays of the Morbific matter extend themselves to the circumference of the Body, the Loosness and Vomiting, that were occasion'd by their being inwardly reflected and cast upon the Stomac and Bowels, cease presently of their own accord. So that how great soever the preceding subversion of the Stomac was, the Medicines that are taken afterwards are easily retain'd, and pro­cure sweat as well as can be wish'd.

I remember, that being once call'd by an Apo­thecary to visit his Brother, that was very ill of a Pestilential Fever, and speaking of giving him a Sudorific, he told me that he had taken various and strong Medicines to procure Sweat, but all in vain, for that he had Vomited them all up; to whom I answer'd, that he shou'd prepare the most loathsom and ungrateful of all, that before he had exhibited; and that I wou'd easily effect, that he shou'd not Vomit it up any more. The event con­firm'd what I promis'd, for when the Patient had Sweat a little, only by the weight of Clothes, he swallow'd and retain'd a large Bolus of Venice Treacle, by which means, Sweating plentifully, he recover'd.

But to return to the business, I order that the Sweat shou'd be continu'd, for the space of a natu­ral day, by Sage Posset-drink, or Mace-beer, now and then taken; and I strictly forbid that the Pa­tient shou'd be any way cleans'd; neither indeed do I permit that the Shirt, how moist or foul so­ever [Page 27] it be, shou'd be chang'd, within the space of Twenty four hours, from the end of the Sweat, which I wou'd have observ'd with the greatest cau­tion. But if the Sweat be circumscrib'd in a nar­rower compass of time, the violence of the Sym­ptoms soon returns, and the Health of the Pati­ent is left very uncertain, which a longer conti­nuance of the Sweat wou'd have put out of dan­ger.

And truly, I can't sufficiently wonder at Die­merbroek and others, as often as I consider upon how slight a pretence they are induc'd to break off the sweat, to wit, that they may preserve the strength of the sick. For, first, every one that is but very little conversant in the Cure of this Di­sease knows that the Patient while he Sweats is stronger than he vvas before. What use and ex­perience have taught in this case, I vvill not fear to defend and declare openly. Many that have been Sweated, by my Advice, for the space of Twenty four hours, have been so far from com­plaining of their being vveakn'd thereby, that they have profess'd that as much of the useless hu­mour was carried off by the Sweat, so much new strength they receiv'd: and towards the latter end I have oft, not without admiration, observ'd a Sweat break out more natural, genuine and copi­ous than the former, which was express'd by the force of the Medicine, and which brought much more relief, as if it were plainly and truly critical and eradicative of the whole Disease: moreover I don't perceive what inconvenience there wou'd be in refreshing the Patient, when the Sweat is at height, with comfortable Soop and Broath; and [Page 28] then that Objection concerning want of strength to bear long Sweats wou'd signifie nothing. Where­fore if any defection be perceiv'd, towards the latter end, I permit him to take a little Chicken Broath, the Yolk of an Egg or the like, which with Cordials and draughts commonly us'd, to keep up the Sweat, abundantly repair the strength. But there's no need of many Arguments in a thing so obvious: for 'tis manifest, that as long as the Patient Sweats he thinks himself in a good con­dition, and in the opinion of the standers by the worst is over, which openly proclaims the utility of this practice; but assoon as the Sweat is stopt, and the Body begins to dry, he falls ill again, and there is as it were a relapse.

I admonish that cold be carefully avoided, that the Clothes dry on the Body of their own accord, and that all Drinks are taken somewhat hot, and that the use of Sage Posset-drink be continued for the space of Twenty four hours after the Sweat. The next morning I give a common Purge, to wit, of the Infusion of Tamarinds, of the Leaves of Senna, of Rhubarb, with Manna, and Syrrup of Roses solutive. And with this method, the next year af­ter the Plague, I recover'd very many that were feiz'd with the Pestilential Fever; so that not one died of this Disease, that was under my Care, af­ter I began the use of the same.

But where the tumour has been out already, I have not hitherto dar'd to bleed, tho' in a Body [...]apt to Sweat, fearing lest the sudden Death of the Patient shou'd prevent the design'd Sweat, by reason of the Morbific matter flowing back to the empty Veins; yet perhaps Phlebotomy may be [Page 29] very safely administred, if Sweat be procur'd pre­sently after it, without any manner of delay, which being prolong'd to the space above requir'd, may be able to dissipate and consume by little and little the whole bulk of the humour, and with much less danger, than when a legitimate maturation of the Imposthume, (which is very uncertain and fallible in so very acute a Disease) is long waited for.

To conclude, if the Reader shall find that I have been any where mistaken about the Theory, I beg pardon; but as to practice, I declare that I have faithfully deliver'd all things, and that I ne­ver propos'd any thing before I had sufficiently try'd it. Truly when I come to dye, I trust, I shall have a chearful witness in my Breast, that I have not only with the greatest diligence and ho­nesty endeavour'd the recovery of the health of all, of what condition soever they have been, that have committed themselves to my care (of whom none was otherwise treated by me, than I desire to be manag'd if I should happen to have the same Diseases) but that also I have labour'd to the utmost of my power, that the Cure of Disea­seases (if by any means it might be) may be ad­minister'd with greater certainty after I am Dead, Esteeming any progress in this kind of Knowledg, how small so ever it be, tho' it teach no more than the Cure of the Tooth-ach, or of Corns, to be more valued than the vain pomp of nice Specula­tions, which perhaps are no more useful to a Phy­sitian, in the Cure of Diseases, than Skill in Mu­sick to a Carpenter in Building.

[Page 30] In the last place, I will add only this one short Note, lest perchance any one shou'd wrest my O­pinion by a sinister Interpretation, or at least not throughly understand it; to wit, that in the pre­ceding Discourse, I often use the word Nature, and attribute various effects to her, as if I would represent under this Title, some one thing sub­sisting of it self, and diffus'd every where through the whole Machin of the World, which being in­dow'd with Reason, governs all Bodies: such a thing as some of the Philosophers seem'd to think was the Soul of the World. But as I don't af­fect novelty of things, so neither of words: and therefore I use in these Pages, the Ancient word indeed, but in a sense (unless I am deceiv'd) both sober, and not only understood, but also us'd by the best Men. For as often as I mention Na­ture, I wou'd signifie a certain complex of Natural Causes, which tho' they are without Reason, and destitute of all Skill, yet are they govern'd by the best Counsel; whil'st all of them perform their Operations, and accomplish their effects. To wit, the supream Deity, by whose Power all things are produc'd, and on whose pleasure they depend, has so dispos'd all things by his infinite Wisdom, that they betake themselves to their appointed Functions in a certain order and method, doing nothing that's in vain, but that which is best and fittest for the whole Fabric of things, and their own private Natures; and so are mov'd, like En­gines, not by their own Skill but by that of the Artificer▪

CHAP. I. Of the continual Fever of the Year 1661. 1662. 63. 64.

FIRST, I observe that the inordinate com­motion of the Blood the Cause or Com­panion of this Fever, is stirr'd up by Na­ture, either that some Heterogenious matter con­tain'd in it and inimical to it shou'd be excluded, or that the Blood shou'd be chang'd into some new disposition.

And in this business the word Commotion pleases me best, because 'tis more large and general than [Page 32] either Fermentation or Ebullition, for it prevents the occasion of a vain Dispute about Terms, that per­haps words of that kind may seem to countenance; tho' they may admit of an Explication that is not incommodious, yet are thought a little improper and harsh by some: for tho' the Commotion of the Blood may be sometimes like the Fermentation, sometimes like the Ebullition of Vegetable Liquors, yet there are some that think it very much differs from both, and they produce one or two instan­ces of Fermentation. First, tho' Liquids fermen­ting are wont to obtain a vinous nature, so that Distillation will draw a hot Spirit from them, and easily degenerate into Vineger, which is indow'd with a notable sowerness, and by Distillation yeilds an Acid Spirit; yet they say that neither of these dispositions has hitherto been observed in the Blood.

And they take notice that in vinous Liquors the Fermentation and Depuration are finish'd at the same time, and as it were keep pace together; but the Depuration of the Blood in Fevers does not ac­company but follows its Aestuation, which they think is manifest even to sight, in a Febrile Pa­roxysm carried off by Sweat.

But as to Ebullition, the Analogy seems more difficult to them, and which experience disallows in many cases, where the fury of the Blood is not so outragious as that it may deserve the name of Ebullition: but however it be (for I will by no means ingage in these Controversies) seeing the terms of Ebullition and Fermentation have very much prevail'd among Modern Physitians, I shall not re­fuse to use them now and then, whil'st 'tis mani­fest [Page 33] from what has been said, that these words serve only in this Treatise for the more clear explication of what is to be discours'd of.

Certainly all kind of Fevers that are accompani­ed with Eruptions, manifest that this Febrile com­motion of the Blood, is stirr'd up for the Secreti­on of a certain Heterogeneous matter that is con­trary to nature: for that in these, by the help of Ebullition, an Excrement of an ill quality is cast forth to the skin that lay hid before in the Blood.

And 'tis not less probable in my Opinion, that the Febrile commotion of the Blood, shou'd often (not to say oftner) aim at no more than to be chang'd into a certain new state and disposition, and that a Man whose Blood continues pure and untainted may be seiz'd with a Fever, as by fre­quent observations we find it happens to healthy Bodies, in whom there is no Morbific furniture, ei­ther as to a Plethora or ill habit, no unhealthy disposition of the Air, which may administer oc­casion for a Fever, and yet notwithstanding by reason of some notable alteration of the Air pre­ceding, or change of Diet, or of the rest of the Non-naturals as they are term'd, such Men are likewise seiz'd with a Fever; and the reason is, because the Blood endeavours to gain a new state or condition, such as the Air and manner of Diet require; not that the irritation of vicious Parti­cles lodg'd in the Blood, cause the Fever, tho' I don't at all doubt but that the matter that is ordi­narily Excreted in the Despumation of the Blood, after the Febrile Commotion, is vicious, tho' the Blood before had a laudable Diathesis, which is [Page 34] no more to be wonder'd at than that some part of what we Eat shou'd turn to Corruption, and stink after it has been considerably alter'd in the Body and seperated from the rest.

Secondly, I reckon that the true and natural in­dications that arise in this Disease, shew that the Commotion of the Blood must be kept to that de­gree which is agreeable to Natures purpose, that it don't rise too high on the one Hand, from whence great Symptoms flow, nor be depress'd too low on the other; by which means the Protrusion of the Morbific matter may be hinder'd, or the endea­vours of the Blood Affecting a new condition, fru­strated; so that whether the Fever takes its rise from some Heterogeneous matter provoking it, or from the Blood affecting a new state; in either case the Indication is the same: these things being premis'd, I institute the method of Cure after this manner.

When I am call'd to Patients whose Blood of it self is weak (as 'tis most times in Children) or when it wants Spirits, as in old Age, and in young Men weaken'd by long Diseases, I forbear Phle­botomy; for if I shou'd bleed such, their Blood being already too weak, it wou'd be render'd al­together unfit to perform the business of Despu­mation, and by consequence the whole mass wou'd be perverted, and perchance the Life of the Pa­tient hazarded (as when the Fermentation of Beer or any new Liquor is unseasonably stopt, 'tis most commonly spoil'd) for Nature can no more associate with the Particles it has once begun to Exterminate, which tho' they were pure, whil'st they were equally mixt with the mass of [Page 35] Blood, yet now they are corrupt and apt to infect the other Humours. Indeed I know very well that those that are injured by bleeding are some­times restor'd by proper Cordials, so that the Blood is inabled to purifie it self, but 'tis better to prevent than Cure a Disease.

But when I have to do with those whose Blood is of a contrary Nature, such as is wont to be in young Men, of a Robust constitution and Sanguine complexion; I order bleeding in the first place, which can't be omitted here without hazard (be­side in some cases to be mention'd hereafter) for otherwise not only Phrensies, Pleurisies, and such like Inflammations may be fear'd, upon the account of too great Ebullition of the Blood, but also by reason of the superfluity, a Stagnation of the whole mass.

As to the quantity, I only take away so much Blood as I conceive will free the sick from those dangers, to which as we said, the immoderate Commotion of the same is obnoxious. Further­more, I regulate the Estuation by repeating Phle­botomy, or omitting it, by using or forbidding the use of hot Cordials; and lastly, by keeping the Body loose, or stoping it as I perceive that motion is high or low.

After bleeding (if it be necessary according to the cases above mention'd) I diligently inquire whether the Patient was inclin'd to vomiting, or nauseousness, at the beginning of the Fever, and if so, I presently prescribe a Vomit, unless the tender Age or some great Debility of the Sick forbid it. Truly a Vomit is so necessary, when an inclination to Vomiting has preceded, that [Page 36] unless that Humour be expell'd, it will occasion many difficult Symptoms, that will hinder the Phy­sitian in performing the Cure, and will very much endanger the Patient; a Diarrhaea is the chief and most usual of these, which most commonly fol­lows in the declination of the Fever, as often as Emetics are indicated and yet omitted; for in the progress of the Fever, when Nature has some­what subjugated the malign Humour in the Sto­mach, and thrust it forth to the Guts, they are so corroded by a perpetual Flux of a sharp Humour, from this fountain in the Stomach, that a Diarrhaea must needs follow. But I have observ'd that in Inflammatory Fevers, that are commonly call'd Ma­lignant, a loosness did not necessarily follow the omission of a Vomit, as in this Fever, tho' such a propensity to Vomiting preceded.

This kind of Diarrhaea is more dangerous, be­cause the Sick being sufficiently weakn'd before is more Enervated; besides (which is worst) it hap­pens at the declination of the Fever, at which time the Blood shou'd contract it self, and exert its faculty, for the compleating its Despumation, but is hinder'd by this evacuation.

But that you may not doubt that this Humour lodg'd in the Stomach, unless it be ejected by Vo­mit, will in a short time cause a Diarrhaea; by search we almost always find, that when a loosness accompanies this Fever, the Sick was inclin'd to Vomit at the beginning of the Disease, but a Vo­mit was not prescrib'd. Moreover you will ob­serve, that tho' the inclination to vomiting went off long ago, yet the Diarrhaea will cease for the most part upon taking a Vomit, if the Patient be [Page 37] able to bear it; but I have often observ'd, that when the Diarrhaea is once begun, Astringent Me­dicines signifie little or nothing, either inwardly taken or outwardly apply'd to stop it.

The Vomit I frequently use is this following,

Take of the Infusion of Crocus Metall. ʒvi, Oxy­mel of Squills and compound Syrup of Scabi­ous of each ℥ss. Mingle them and make a Vo­mit.

Which I order to be taken in the Afternoon, two Hours after a light Dinner; and that the Vomit may succeed the better, I appoint six or eight pints of Posset-drink to be provided, for these Me­dicines are dangerous, if they are not wash'd off; and therefore as often as the Patient Vomits or goes to Stool, he must presently take a draught of it, by which means the Gripes will be prevent­ed, and he will Vomit easier.

After a nice view of the matter ejected by Vo­mit, which was neither much nor very ill, I have often wonder'd how it comes to pass, that the sick shou'd be so much reliv'd by it; for assoon as the Vomit had done Working, the cruel Symptoms, to wit, the Nauseousness, Anxiety, Restlessness, Sighings and Blackness of the Tongue, &c. were commonly mitigated, which before tormented the Sick, and terrified the standers by, so that the re­mainder of the Disease was very tolerable.

Tis to be noted, that if the condition of the Patient require Bleeding and Vomiting, 'tis safest to bleed first, for otherwise whil'st the Vessels are distended with Blood, there is great danger lest [Page 38] by violent straining to Vomit, the Vessels of the Lungs shou'd be broken, and the Brain hurt, the Blood being impetuously pour'd in and out, and so the Patient may dye Apoplectic, of which I could produce some Examples if I thought it convenient; let it suffice that I warn you to use great caution in this case.

If any one shou'd ask at what time of the Fe­ver I would give a Vomit? I say at the very be­ginning, If I had my choice, for by this means the Sick may be defended from those horrid Sym­ptoms that take their rise from the filth of those Humours that lurk in the Stomach and neighbour­ing parts, and perhaps we may crush the Disease in its beginning, which othewise wou'd increase to the hazard of the Patient; and prove tedious, be­ing nourish'd by the foresaid Humours, which ei­ther by reason of their substance pass into the in­nermost parts of the Body, and are mingl'd with the Blood, or because they are too long detain'd in the Body they wax worse, and put on a vene­mous quality which they impart to the Blood, as it continually passes by their Neast; and of this (not to go far) the Cholera Morbus is a clear ex­ample, for it happens sometimes, that when the Vomiting is unseasonably stopt in that Disease, whether it be by an Opiat, or Astringent Medi­cines, a worse train of Symptoms follow; for the sharp and corrupted Humours being repell'd upon this account, whose exclusion ought to have been permitted a while till they were sufficiently eva­cuated, exert their fury and force upon the Blood, and kindle a Fever; which as tis wont to be ir­regular and accompanied with ill Symptoms, so it [Page 39] can scarce be Cur'd without an Emetic, tho' the Patient do not then Vomit.

But if we are call'd in late, (as we are often) so that we can't assist the Patient at the beginning of the Fever by prescribing a Vomit, yet I have thought it proper to order one at any time of the Disease, provided the Patient hath strength enough to bear the operation of it. Truly I have given an Emetic with good success, on the 12th day of the Fever, tho' the Patient had left off Vomiting before; and so I have stopt the loosness which hinder'd the Blood in finishing its Despu­mation; and I shou'd not doubt to prescribe one later unless the weakness of the Patient for­bid it.

The Evening after taking the Vomit, I always endeavour to quiet the tumult rais'd in the Hu­mours by the Emetic, and therefore I prescribe an Anodyne to be taken at Bed-time. For instance,

Take of Erratic Poppy-water ℥ii, of Aq. Mirab. ʒii, Syrup of white and Erratic Poppies of each ℥ss. Mingle them and make a draught.

But if there be no fear of raising the Ebullition for the future, either by reason of a great loss of Blood which was taken away in order to the Cure, or by frequent Vomiting and Stools occasi­on'd by the Emetic, or by a present Apurexy, or Debility of the Fever, or its declining state; then I boldly order a large dose of Diascordium, either by it self, or mixt with some Cordial Water in­stead of the Anodyne prescrib'd above, and 'tis indeed an excellent Medicine if it be given in a due quantity.

[Page 40] And now before I leave off discoursing of Eme­tics, I must acquaint you that 'tis by no means safe (at least in this Fever) to give Vomits of the infusion of Crocus Metallorum to Children, or to any under fourteen, no not in the least quantity; 'twere to be wish'd, that in the room of this we had some safer Medicine that were as efficacious, which may eradicate the Humour, that almost al­ways threatens a Diarrhaea, at the Declination of the Fever, at least that we had such a one as wou'd so change the corrosive matter, that it cou'd not cause a loosness; truly I have been often puzzel'd, when I have been call'd to Infants or Children in a Fever, and have beheld an indication which per­swaded the use of a Medicine that wou'd have Cu­red them, and yet I did not dare to prescribe it for fear of the ill consequence; but in grown peo­ple I have hitherto observ'd no injury to proceed from the use of an Emetic, provided it be admini­ster'd with the cautions above mention'd.

The fatigue of Vomiting being over, I further consider with my self, whether notwithstanding the preceding Evacuations, the Blood continues yet to rage so much, that 'tis still necessary to re­strain its Effervescence, or whether it be so very Languid that it wants to be heigthen'd; or lastly, whether the Fermentation being reduc'd to a due degree, may be left to it self without danger to the Patient: Of each of these I shall say some­thing.

First, Therefore if the Blood Ferments so vio­lently that we may yet reasonably suspect that the Patient is either obnoxious to a Phrensie, or any other troublesom Symptom proceeding from [Page 41] too great an Ebullition of the Blood; the day after taking the Vomit, I prescribe a Clyster. For instance,

Take of the common Decoction for a Clyster lbi, Syrup of Violets and brown Suggar, of each ℥ii. Mingle them and make a Clyster.

And I order it shou'd be repeated upon occasion, by which it often happens that the Blood being somewhat Ventilated and Cool, its Effervescence is sufficiently bridl'd, but sometimes 'tis necessary to repeat bleeding once and again, viz. in those of a very Sanguine complexion, and in the flower of their Age, or in others who have imprinted on their Blood a certain inflammatory disposition, by too frequent use of Wine. But for the most part there is no need of so great a Remedy (as is repeated Phlebotomy) and excepting the cases above men­tion'd, that Effervescence may be sufficiently sup­press'd by the help of Clysters; wherefore if the Blood Ferment too much, I order a Clyster to be injected every day, or every other day, as the case requires, and that it be done to the tenth day of the Disease or thereabouts; but if much Blood has been take away, or the Patient is Ag'd, I order no Clysters at that time, tho' the Blood be very hot; for in these cases as there is no fear that by the omission of Clysters the Ebullition be­gun shou'd proceed so far as that there shou'd be eminent danger from some violent Symptom: So its most certain that by the use of them the strength, and as I may say, tho' less properly, the Tone of the Blood is so much indeed relax'd, that especi­ally [Page 42] in old Men, (for Clysters are not used with so good success in old Men as in young) Nature is obstructed in her business; but if a Vein has been open'd, and not much Blood taken away, then as I said, I order Clysters to the tenth day more or less, and sometimes to the twelfth, especially for those I did not dare bleed; for there are some that are seiz'd with continual Fevers, after Autumnal in­termittents (whether they were Tertian or Quar­tan) by reason they were not purg'd after these Agues left them; and if you shou'd Bleed them there wou'd be danger lest that Sediment, which the foregoing Fermentation put off, shou'd be Re­sorb'd into the mass of Blood, and so shou'd oc­casion new Tumults; therefore in this case in­stead of Bleeding I use Clysters to the twelfth day, if the Patient be young and the Fermentati­on too high.

But on the contrary, whether Bleeding be us'd or omitted if the Effervescence be too Languid, and wants to be stirr'd up to assist Nature; in this case I suppose we must wholly abstain from the use of Clysters, even before the tenth day, and much rather if it be past: for to what purpose shou'd we endeavour any further to suppress the Fermen­tation which is too Languid already? but if after that time, to wit, in the declination of the Dis­ease we shou'd use Clysters, it wou'd indeed be as absurd, as if any one shou'd give too large vent to Beer when 'tis dying, for by means of this Evacuation Nature is hinder'd, so that she can't at­tend the separation of the Morbific matter with all her might; when therefore by means of fit Evacuations the Patient is out of danger as to [Page 43] those Symptoms which proceed from too great Ebullition, or the Disease is in its declination; the more I bind his Body, the farther he is out of danger, to wit the Febrile matter tending gently to its own Concoction. Wherefore if the fore­going Evacuations have induc'd as it were a Laxi­ty of the mass of Blood, or threaten the same, or if the Patient be freed from his Fever before the due time; or if the Fever has come to a full period, I do not only leave off the use of Clysters, but think that Cordials are to be allow'd, and pre­sently endeavour to stop the Belly.

But as to Cordials, for I have found by Experi­ence that the too early use of them has been very injurious, to wit (Bleeding having not been first us'd) there is danger lest the crude matter shou'd fall upon the Membranes of the Brain or the like, or on the Pleura; and therefore I always take care that Cordials be not given, when no Blood or but very little has been taken away, and there has been no other considerable Evacuation, or when the Pa­tient has not pass'd the vigour of his Age: for I can't see to what purpose his Blood that is rich enough of it self, shou'd be further Meliorated to his own ruine; but rich and opulent enough it is, neither wants it Restoratives, as long as conside­rable Evacuations have not vanquish'd its innate heat. Such Patients are sufficiently furnish'd with Cordials within themselves, and as to those which come from abroad, they are either needless or else are hurtful; wherefore I wou'd either wholly reject all, or at least admit of only the smallest. But if the Patient be weaken'd by profuse Evacuations, or be Ag'd, I use to give Cordials even at the be­ginning [Page 44] of the Fever, but on the twelfth day of the Disease, things then tending to Secretion, I suppose we ought freely to indulge the use of hot­ter Medicines, and indeed a little sooner, if there be no danger of driving the Febrile matter upon the principal parts. For at this time the more I heat, so much the more I accelerate Concoction; neither truly can I imagine what Physitians wou'd be at, who so often inculcate their Precepts con­cerning the administring of Remedies to promote the Concoction of the Febrile matter, which they often do, being call'd in at the beginning of the Disease; and yet at the same time notwithstand­ing they don't doubt to prescribe such kind of Medicines as attemperate the Fever; for indeed a Fever is Natures Instrument, by which she sepa­rates the impure parts from the pure: by this means utterly Imperceptible, she proceeds from the begin­ning to the highth of the Disease, but performs the business more manifestly at its declination, which may be discern'd by the Urine. The Con­coction of the Febrile matter denotes no more in­deed than the separation of the peccant matter from the good; now in the hastenning of it you must not busie your self with I know not what at­temperaters, but the Effervescence of the Fever is to be let alone, so long as the safety of the Patient will permit; but when it tends to the declination, Secretion being manifest, then we shou'd follow it with hotter Medicines to finish the business sooner and safer; and this is indeed to promote the Con­coction of the Febrile matter: whereas Evacuati­ons and Coolers cause delays and hinder the Cure, and drive away approaching Health, as I have of­ten observed.

[Page 45] If the Fermentation proceed well, the Despuma­tion will be finished about the fourteenth day, but if you use any Coolers too late, and so by their means suppress the Effervescence, 'tis not strange if the Fever continue till the twenty first day, and in fee­ble Bodies ill manag'd much longer.

Moreover this is worth Observation; that it sometimes happens that the Patient by the use of Clysters and other Catharticks unseasonably pre­scrib'd, about the declination of the Disease, seems a little reliev'd, and sometimes is wholly freed from his Fever; but after a day or two you will perceive not so much that the old Fever has recover'd strength as that a new one is broke out, viz. a shaking and horror presently invade, which heat and a Fever presently succeed, about to run the same course which was describ'd above, unless per­chance it change to an Intermittent. When the case is so, the Patient is to be treated as if he had no Fever before, and the same method is to be re­peated, for Despumation, which shou'd follow the Ebullition now begun, will not be finish'd in less than the time before mention'd, how tedious so­ever it wou'd be to the Patient, much weakn'd by the former Disease, to wait so long for health.

The Cordials I prescribe are such as these, which I will mention by and by; those that are more moderate I use at the beginning of the Dis­ease, when the heat is very violent, always pro­ceeding gradually to the use of hotter, according to the progress of the Disease and the degrees of Ebullition; always remembring that its lawful, if much Blood has been taken away, or if the Patient be Ag'd, to administer stronger Cordials than when [Page 46] Bleeding has not preceded, or when the Patient was in the flower of his Age.

Those Cordials, I call moderate, are made of distilled Waters, for instance, of Borage, Citron, Strawberries, Treacle, compound Scordium water, mingled with the Syrup of Baulm, of Fernelius, of Julyflowers, of the juice of Citron, &c. but the stronger of Gascoins Powder, Bezoar, con­fection of Hyacinth, Venice Treacle, &c.

These which follow are frequently us'd.

Take of the water of Borage, Citron, compound Scordium water, Black Cherries, each ℥ii, Cin­namon water with Barly ℥i, Pearls prepar'd ʒii, Crystalline Sugar a sufficient quantity, mingle them. Take four spoonfuls often in a day espe­cially in the Fits.

Take of the water of the whole Citron, of Straw­berries each ℥iii, of the cold Cordial water of Saxony ʒi, of Treacle water, of Syrup of Baulm, of Fernelius, of Julyflowers, and of the juice of Citron, each ℥ss, mingle them and make a Julap, of which take often.

Take of Gascoins powder, of the Oriental and Oc­cidental Bezoar-stone, of Contrayerva, each ℈i, one leaf of Gold, mingle them and make a very fine Powder. Take to the quantity of twelve grains when there is occasion, in the Syrup of the juice of Citron and Julyflowers, each ʒii, drink­ing upon it a few spoonfuls of the Julap pre­scrib'd

[Page 47] Take of Treacle water ℥iv, of the Seeds of Citron ʒii, beat them together and make an Emulsion: Add to the strain'd liquor a sufficient quantity of Pearl Sugar to make it grateful to the Taste. Take two spoonfuls three times a day.

I think 'tis needless to mention more forms, for they are innumerable or may be so, and they are to be varied in the course of the Disease, ac­cording to the various Seasons and Symptoms.

But if the Fermentation be neither too high nor too low, I leave it in that state and use no Re­medies, unless I am forc'd to do something by the importunity of the Sick or his Friends about him, that may please them, without obstructing my design.

And now I must tell you, that when I was cal­led to a poor Body who was not able to be at the charge of going through a long course of Phy­sick, I did nothing else after Bleeding and Pur­ging was over, (if they were indicated) but or­der them to keep their Beds, all the time of their Sickness, and to drink Oatmeal, and Barley Broath, &c. and that they should drink small Bear warm, moderately to quench their thirst. I took care that they shou'd have a Clyster of Milk and Sugar every day or every other day, till the tenth or eleventh day, and towards the end of the Fever, separation being now begun, if it were slow, I permitted them now and then stronger drink to help it instead of a Cordial, and so without any more a do, except that I use to give a gentle Purge at the end of the Disease, I cur'd them.

[Page 48] But to return to the business, if the method be­fore mention'd be carefully observ'd, I usually per­ceive about the fifteenth day, both from the Signs of a laudable separation in the Urine, as also from a manifest remission of all the Symptoms, that 'tis then seasonable to give a purging Poti­on which may carry off the Sediment, put off here and there by the foregoing Fermentation; and unless it is done timely there is danger lest it shou'd return into the mass of Blood, and so cause a relapse, or by its abode in the Natural parts upon which 'tis thrown, occasion hereafter a dreadful Minera of lasting ills in the Body, viz. Seperation being now finish'd the gross and impure Humours sent from the Arteries to the Blood, passing back into the Veins, easily hinder its re­turn, from whence various kinds of Obstructions and at length various Fermentations do arise.

But 'tis to be observ'd that Purging is not alto­gether so necessary, after Vernal Fevers as after Autumnal; and for this reason, because the Sedi­ment put off by Autumnals is more, and of a more Terrene and Malignant quality, and which is also to be noted in the Small Pox, and many other Diseases raging in the Spring, in which 'tis not so dangerous to omit Purging (which indeed I have observ'd) as in the case before menti­on'd.

And truly he wou'd not be much mistaken who shou'd affirm that more Diseases take their rise from hence, (to wit, from the omission of Pur­ging after Autumnal Diseases) than from any other cause whatever.

[Page 49] If the Patient be very weak, or if there be not a perfect Despumation, so that I can't boldly give a Purge on the fifteenth day, I defer it to the seventeenth, at which time I give the following or the like, according to the strength of the Pa­tient.

Take of Tamarinds ℥ss, of the Leaves of Sennna ʒii, Rubarb ʒiss, boyl them in a sufficient quan­tity of water, to three ounces of the strained Liquor; add Syrup of Roses, Solutive and Man­na, of each one ounce; mingle them and make a potion to be taken in the Morning.

Purging being over, I order the Patient to rise, who has been hitherto kept abed by my prescri­ption, and to return gradually to his accustom'd diet; for that which I have hitherto prescrib'd is in a manner the same with that which I have men­tion'd before, as Oaten and Barly broaths, and Panado made of Bread, and the Yolk of an Egg in water with Sugar, thin Chicken broath, small Beer; and sometimes when the Fever is high the juice of Orange newly express'd, and a little boyld to take off the Crudity mixt with it, &c. tho' Oatmeal broath is as good as any; but to deny small Bear to be taken now and then moderately, is a needless severity, and indeed very often hurt­ful.

It happens often (especially in old Men) that the Patient, tho' the Fever be Cur'd and the Bo­dy sufficiently purg'd, is notwithstanding very weak, and sometimes expectorates by Cough, and sometimes also hauks up a great quantity of [Page 50] clammy Phlegm, which Symptom does not only afrighten the Patient, but also imposes upon the Physitian, especially if he be unwary, and induces him to believe that this effect will make way for a Consumption, tho' I have observ'd that the thing is not so very dangerous. In this case I order the Patient to drink old Malago, or Muscadine with a Toast, which (corroborating the Crasis of the Blood, much weakned by the foregoing Fever, and by consequence unable to assimulate the juices of the meat lately eaten) takes off that Symptom in the space of few days, as I have often experienc'd.

By this method which I have propos'd, the sick will be secur'd from many affects and Symptoms which are wont to be attributed to Malignity; for nothing is more common with unskilful Physitians than to put the fault upon malignity: When by cooling Medicines, and the unseasonable use of Clysters, they have so relax'd the Crasis of the Blood, and so weakn'd Nature in performing the Despumation of it, that Faintings and other Sym­ptoms (which are indeed genuine effects of such impediments occasion'd by Art) happen. But if the Disease by its long continuance free it self from this aspersion, then what ever afterwards obstructs the Cure, is attributed to the Scur­vy; tho' in truth neither the Symptoms which hap­pen'd while the Disease was in its vigor, were the effects of Malignity, nor those which happen in its declination of the Scurvy, but both proceed from ill management, as I have often observ'd. Not that I or any other person who has been but lit­tle conversant in the History of Diseases can be ignorant, that there are Fevers which don't only [Page 51] consist of an Intemperies or putrid heat, but also of a malignant quality, whose most evident Sym­ptoms cannot but appear in the Sick; or that I de­ny that sometimes the Scurvy, and very many other Diseases may be complicated with a Fever, I say only that these affections are many times unde­servedly blam'd.

If the Fermentation proceed well, there will be a perfect Despumation of the Morbific matter within the time aforesaid; but if cooling Reme­dies or Clysters have been given too late, the Fe­ver will continue much longer, especially in very ancient Men ill manag'd by the Physitian. I have been sometimes call'd to such, after they have la­bour'd under a Fever forty days or more, and have try'd all things to induce Despumation to the Blood, but it was so much weaken'd, partly by old Age, and partly by Clysters and cooling Medi­cines, that I cou'd not attain my end either by Cordials or any other Corroborating Medicines; but either their Fever stood its ground, or if otherwise it seem'd to cease, the Patients strength was very low and in a manner gone.

But other Remedies being unsuccessfully us'd, I have been often forc'd to take this course, and in­deed with very good success, viz. I have apply'd the brisk heat of young People to the Sick. Nei­ther is there any reason why any one shou'd much wonder that the Patient is so mightily strengthen'd, and weak Nature reliev'd by this method, tho' it be unusual, as that it can deliver it self from the re­liques of the matter to be Eliminated, seeing 'tis easie to conceive a Transfusion of a great quanti­ty of vigorous Effluvias, from the sound and strong [Page 52] Body, into the wither'd one of the Sick, neither have I ever found that the repeated application of hot clothes cou'd at all do that which the now mention'd method has perform'd, where both the heat apply'd is more agreeable to the humane Bo­dy, and gentle, moist, equal and lasting; and tho' this way of immitting Balsamic Spirits into the Body of the Patient might seem absurd at the time when I prescrib'd it, yet it has been us'd by others with happy success; neither truly am I asham'd to mention this remedy, tho' perhaps some impertinent Men superciliously contemning all things Vulgar may ridicule me for it. For I think the Health and Good of my Neighbour is very much to be preferr'd before their vain Opinions.

He that prudently and with due consideration hath observ'd the method hitherto deliver'd, will free the Patient, if not from all, yet at least from most of those Symptoms which are either wont to accompany the Fever or to come after it, and which render the Physitian doubtful and at a loss in the course of the Cure, and often destroy his Patient, tho' the nature of the Disease does not seem deadly. But for as much as such accidents often happen, either because the Sick neglected to call the Physitian in time, or by reason of the un­skilfulness or carelessness of the Physitian. I think it not amiss to treat briefly of their pecu­liar Cure, but will only confine my self to those Symptoms, which tho' they might often have been prevented, if the foresaid method had been us'd, yet when they happen they require a different Cure proper to themselves.

[Page 53] And to begin from hence, if the Sick A Phrensie. either upon the account of taking hot Medicines unseasonably, or by being naturally of too hot a constitution fall into a Phrensie, or (which is next to it) if he does not sleep at all, often calls out or uses incoherent Speeches; if he looks and talks fierce, if he takes Medicines and common Drink greedily and as it were snatches it; and lastly has a suppression of Urine: In this case I say I bleed more freely than before, and use Cly­sters and cooling Medicines oftner, especially in the Spring; and tho' this Symptom do not appear in young People, and in those whose Blood is brisk, they admit of these Remedies without much hazard; and by the use of such Remedies I endea­vour to keep up the Patient, till the Disease has lasted a while, and then 'tis not very difficult to free him at once of the Symptom and the Disease too; and this may be done by giving some Narco­tick Medicine in a large dose; for tho' when the Fever is at the height those things that are of a Narcotic quality do no good, nor answer the Phy­sitians end, yet being given seasonably at the de­clination of the Disease are very beneficial; but before they can do no good, partly because they can't stop the force of Fermentation, tho' they are given in the largest dose; and partly, which truly is most considerable, because the Peccant matter at that time equally mixt with the Blood, and not yet tending to separation is restrained by such a Medicine, and so the despumation so much to be desir'd is hinder'd; but whether this be the reason of this Phaenomenon, or some other more obstruse, let those judge who have a mind and [Page 54] leasure to think of such things. But I declare that 'tis most certain, from a faithful and due col­lection of many observations, that Laudanum or any other Narcotics in the beginning, increase, or state of this Fever does no good for the quelling of this Symptom, but as it often happens does harm; but in the declination of the Disease, 'tis us'd successfully in a moderate Dose. I once us'd a Narcotic on the twelfth day of the Disease not in vain, but I never knew it given sooner with any success; but if the use of it be deferr'd till the fourteenth day, 'twill do the better, separati­on then being more perfect, neither indeed does this delay (tho' this dreadful Symptom does very much afrighten the by-standers) presently kill, for I have often observ'd, that it cou'd and was wont to bear a truce, till 'twas seasonable to use Narcotics, if care was taken that the Intemperies begun, was not heighthen'd too much by Cordials and hot Medicines; in which case the Patient dies suddenly. The Narcotics which I am wont to use, are either London Laudanum, from one Grain to one Grain and a half, or the following,

Take of Cowslip flowers Mi, boyle them in a suffi­cient quantity of Black-Cherry water, dissolve ℥ss, of Diacodium, and half a spoonful of juice of Lemons, in ℥iii of the strain'd Liquor, mingle them. Or take of Black-Cherry water ℥iss, Epidemic water ʒii, Liquid Laudanum Gutt. xvi, Syrup of July flowers ʒi, mingle them.

I will only add this, which I think is worth ob­servation, to wit, that if this Symptom will grant [Page 55] a truce so long, and the Fever continues a long space, so that the Patient may be safely purg'd before the taking of the Anodyne, 'twill prove more effectual, wherefore I us'd to order ℈ii, of the Pill Coch. major. dissolv'd in Betony water ten or twelve hours before the taking of the Narco­tic, neither is there any danger from the Tumult, which that hot Pill wou'd otherwise occasion; for the vertue of the following Narcotic, will appease those commotions and establish most gentle and sweet peace.

But if the watchings continue after the Fever is gone off, all the other Symptoms being likewise ceas'd, I have observ'd that a rag dipt in Rose­water, and apply'd cold to the fore part of the Head and Temples, is more beneficial than any Narcotic whatever.

It often happens that the Sick is vext with a Cough, through the whole course A Cough. of the Disease, to wit, the mass of Blood being in a commotion, and raging violently; all things now tending to Sedition, it comes to pass that the Humors let loose and flowing from the mass of Blood, by the vessels of the Lungs, or also by an Apertion of them, are cast upon the inner Mem­brane of the Aspera Arteria, to wit, the thinner, being of exquisite sense; and hence the Cough arises, which is first dry, because the matter being yet thin, frustrates the expulsive faculty, presently it grows thick, and is difficultly Expectorated, be­cause by degrees 'tis baked by the Febrile heat, and hence it comes to pass that the Patient is dis­cour ag'd by fear of choaking, because he wants strength to Cough up this viscid matter. In this [Page 56] case I rarely use any other Medicines than Oyl of Almonds fresh drawn, unless it happen (and some­time 'tis so) that the Patient has wholly an aver­sion to Oyl, and then we must use the common Pectorals; but I think Oyl of Almonds, if the Patient can bear it, is to be preferr'd before other Pectorals, for this reason chiefly, for that 'tis ne­cessary they are given in a larger quantity if we do any thing to the purpose; and by this means we overcharge the Stomach which was too weak before, and inclined to be nauseous; and some­times also we are hindred upon the same account, so that we can't mind those things which are to be dispatch'd at the same time; neither can I under­stand, nor learn by experience, why we shou'd ab­stain from the use of this Oyl (which we have now mention'd) in Fevers, to wit, because 'tis inflamable, and therefore to be fear'd lest it shou'd increase the Fever; for suppose it naturally hot, yet certainly its heat is not so great, but that the advantage of it upon another account may com­pensate for it, for 'tis manifestly more Pectoral than other things, and opens and Lubricates the passages and promotes Expectoration, by which (e­specially if it happen to be large) the Blood is both freed from a troublesom Humor, now con­veniently evacuated and also somewhat cool'd. And therefore I am not much concern'd when at any time I perceive this Symptom intervenes, for by it the Patient is not a little relieved. I only admonish that 'tis not safe to give it at first by whole spoonfuls, for there is danger lest it make the Stomach nauseous and cause a loosness, and therefore 'tis to be given sparingly and frequently [Page 57] Night and Day, by which, Expectoration being made, the Cough is not only lessen'd, but also which is of some moment, the Patients strength worn out, is somewhat renewed with a gentle nourishment.

Sometimes it happens that an Hae­morrhage An Haemor­rhage of the Nose. of the Nose supervenes, ei­ther for that too hot Medicines were given at the beginning of the Disease, or that the Ebullition was not sufficiently restrain'd, when the Patient was either in the flower of his Age, or the season of the Year further'd it: If it happen so, those things will do no great good, that are commonly us'd to stop the motion of the Blood, as Bleeding, Ligatures, Astringent and Agglun­tinative Medicines, or those things that attempe­rate the Acrimony of the Blood, and the like. For tho' these and other such things may be us'd according to the prudence and advice of Physiti­ans, yet the main business is to bridle the Ebulli­tion of the Blood, with some fit Medicine that may stop the force of it rushing upon every preci­pice. Indeed if the Symptom be consider'd apart, those things which we have mention'd before, espe­cially Bleeding, are proper enough; neither wou'd I doubt to use them, but truly they don't suffici­ently answer the cause of this Symptom, at least if you except Bleeding; and really 'tis as rational to endeavour with a Sword to put out Fire, as to take off this Symptom by the things above men­tion'd. Therefore having try'd in vain other things in this case, I us'd to prescribe some such thing as follows.

[Page 58] Take of Purslain and Erratic Poppy water of each ℥iss, of Diacodium ʒvi, Syrup of Cowslips ℥ss. mingle them for a draught.

I wou'd not have these things so understood, as if I wou'd presently stop every Haemorrhage, for 'tis often rather to be permitted, for it may much relieve the patient, partly by suppressing too great an Ebullition, and sometimes partly also by car­rying off the Disease critically; and indeed 'tis to little purpose to use the foresai'd remedy, for this Symptom before it has continued sometime, or be­fore a Vein has been open'd in the Arm. This is carefully to be noted, that this and all other im­moderate Haemorrhages have this peculiar to them­selves, that assoon as they are stopt, by what means soever it be, the Patient is in danger of a relapse, if some lenitive Purge be not given; and therefore we must Purge, tho' (with respect to the season of the Fever) it is wont and ought to be put off somewhat longer unless this Symptom hap­pen.

This Symptom for the most part hap­pens The Hickock. to old Men, after large Evacuati­ons, either by a Loosness, or especially by Vomit­ing, it very often portends that death is near at hand. I ingenuously confess, that I can't satisfie my self in my search after the Cause of the Hic­kocks; yet I have often observ'd they take their rise from a disturbance in the Stomach or neigh­bouring parts, rais'd by rough Medicines, for the quelling and reducing of which to pristine peace when the strength of Nature is not suffici­ent, there is great imminent Danger; and there­fore [Page 59] I have thought it reasonable to provide for it, that what Nature cou'd not do of her self, she shou'd do by the assistance of Art. Therefore ha­ving given a large dose, (to wit two Drams) of Diascordium, it has done the business, when I cou'd do not good with the Seeds of Dill, and other things that are cry'd up as Specifics.

If in the course of this Disease a loos­ness A Diarrhaea. arise, which (as we have noted a­bove) us'd to happen, when a Vomit was indica­ted at the beginning of the Disease, and was not taken. In this case I say a Vomit may be given at any time of the Disease, if the Strength does not Contraindicat, tho' the inclination to Vomiting be long since pass'd. But because I think I have Treat­ed sufficiently of this thing in the former Pages, I will only add this now, to wit, what is to be done if a loosness come, tho' a Vomit has been given, which indeed is very rare unless in an Inflamma­tory Fever, where a Vomit does not only hinder this Symptom, but sometimes occasion it, which must be observ'd; therefore when things are so I have found a Clyster of this kind more beneficial than any other Astringent whatever.

Take of the Bark of Pomegranates ℥ss, of Red Roses Pii, boyle them in a sufficient quantity of Cows Milk, dissolve ℥ss of Diascordium in half a pound of the strain'd Liquor, mingle them and make a Clyster.

I would not advise that a Clyster shou'd be in­jected in a greater quantity, for tho' it may be na­turally Astringent, yet there is danger lest it [Page 60] shou'd weary the Intestines by its bulk, and so provoke more the flux which we endeavour to stop.

But perhaps some one will object that it seems more proper, especially at the declination of the Disease, that the Diarrhaea if it happen, shou'd ra­ther be permitted than stopt, for as much as that Flux is sometimes critical, and carries off the Dis­ease: I answer, that I don't deny, but that some­times the Fever is carried off this way, but this so seldom happens that we may not depend upon it, and that account (in which having spoke generally of the Cure of all Fevers, we endeavoured to prove the necessity of the stopping this Flux) is also here much to the purpose; and now this is to be added, and in my Opinion 'tis worth observing, to wit, that for a genuine Depuration of the Blood, 'tis not only necessary that there be a Secretion of some parts by the Faeces, but it is requisite also that others like Flowers be separated, which is daily per­ceiv'd in other Rich and Heterogenious Liquors; wherefore if we too much indulge the Diarrhaea, the Depuration so much desir'd wou'd be only im­perfect, and perchance that which shou'd be cast out last wou'd be Secreted first. Truly I confess that separation by Flowers being made (which by the by is perform'd gradually and insensibly, and more commonly by large perspiration rather than by manifest sweat) the Diarrhaea if it shou'd chance to happen will not be very dangerous; but 'tis to be noted that then it happens upon no other ac­count, but because purging to carry off the Faeces was not opportunely prescrib'd, which Faeces in­deed by their continuance growing malignant, [Page 61] provoke now the Intestines to Excretion; to say nothing that that Liquid consistence of the Ex­crements, (for so they are most commonly) suf­ficiently indicates, that 'tis not to be accounted a critical Solution of the Disease.

And perchance the Iliac Passion may be reckon'd among the Symptoms that come The Iliac Passion. upon Fevers, because violent Vomitings, which are wont to appear at the beginning of Fe­vers, sometimes occasion it.

This dreadful Disease, being hitherto almost in the opinion of all mortal, takes its rise from the inverted, and preposterous motion of the In­testines. To wit, the Fibres of the Intestines, which ought to be contracted from the Superior to­wards the Inferiour, are drawn to the Superior; and whatsoever is contained in the Intestines, is not protruded to the Belly, but towards the Sto­mach, and is violently regurgitated to the mouth; so that Clysters, how sharp soever, become vomi­tive; and also Cathartics, taken by the mouth, are suddenly cast up by Vomit: And in my opini­on, the exquisit and intollerable pain coming up­on this Disease, is only occasioned by the foresaid preposterous motion of the Intestines. For whereas those Folds which the many circumvolutions of the Intestines make, are so form'd by Nature, that they should most fitly conduce to the carrying down of the Faeces, when they, I say, are forc'd to give way to a motion contrary to their Fi­bres, the aforesaid pain is occasion'd from thence, which is fixed to one part, and is like the bo­ring of an Auger, when either the Valve, which is placed at the beginning of the Colon, hinders the [Page 6] going back of the Excrements to the Ileon, or any other Membrane belonging to the Sinus, sustains alone the force of this preposterous Impulse.

We may assign a two-fold cause of this Inver­version, from whence that pain arises, viz. Ob­struction and Irritation.

First therefore, whatever violently obstructs the Intestines, so that nothing can pass down­wards, necessarily produces this contrary motion in them. Among these, Authors are wont to reck­on the Excrements harden'd, gross wind collected in a great quantity, and tying up as it were the Intestines, the constriction of them in a Rup­ture; and lastly, an Inflammation, and other great Tumours which stop up the internal Cavity of the Intestine. In the mean time we must not deny, that this contrary motion, owing its rise to these causes, is rather to be accounted the mo­tion of the things taken in, than of the Intestines: Neither is this an inversion of the whole duct of the Intestines, but only of those which are situated above the seat of that obstruction; wherefore I call an Iliac Passion proceeding hence, Spurious.

Secondly, I think that in the Iliac Passion the cause of the inversion of the peristaltic motion of the Intestines, is most commonly after this manner, viz. Sharp and malignant humours are cast upon the Stomach, and the Guts that are next to it, by the Blood raging on the account of the Fever begun of late, by which the motion of the Stomach is first inverted, and forc'd vio­lently to cast up what is contained in it; at length the small guts that are join'd to the Stomach be­ing weakned, yield to the violent motion of it, and [Page 63] with them at last the greater follow by consent, the Stomach vomiting, leading as it were the Dance. This I call the true Iliac Passion, and which is treated of now: The Method of curing, it has been hitherto in a manner unknown, whatever some boast of the use of Quick-silver and Bullets, which besides that they do little good, are oft very injurious. I have successfully us'd this method.

When it appears by Clysters cast up by the mouth, and other signs, that 'tis a true Iliac Pas­sion, I endeavour these three things: First, That the contrary motion of the Stomach, which causes the like motion of the Guts, may be hindred. Se­condly, That the Intestines being weakned by the sharp humour, may be corroborated. Third­ly, That the Stomach and Guts be freed from those Humours; and that I may answer these In­dications, I institute the Cure after this manner: First, I prescribe one Scruple of Salt of Wormwood in a spoonful of Juice of Lemons to be taken morn­ing and evening: But at other times of the day I order some spoonfuls of Mint-water without Su­gar, or any thing else to be taken twice in an hour, by the repeated use of which alone, the vomiting, and the pain arising from thence will soon vanish. At the same time I order a live Kitling to lie continually upon the naked Belly: But after the pain and vomiting has wholly ceas'd for the space of two or three days, I give one Dram of the Pill Coch. Maj. dissolved in Mint­water, which I also order to be us'd very often all the time of the working of the Pills, that I may the more certainly hinder the return of the vo­miting: Neither is the Kitling to be remov'd before the Patient has taken the Pills.

[Page 64] I have observ'd that 'tis to no purpose to give these Pills, or any other Cathartics, how strong soever, until the Stomach is strengthned, and reduced to its natural motion, and the Guts also to that which is proper to them: For otherwise all Ca­thartics taken inwardly would prove emetic, and so do more hurt than good; and therefore I don't use purging Medicines, until for some time I have us'd those Medicines which respect the Sto­mach.

I prescribe a very thin Diet, for I allow only some spoonfuls of Chicken broath to be taken twice or thrice a day; in the mean while I order the Pa­tient to keep his bed all the time of the Sickness, till the signs of perfect health appear; and when he is well I appoint him to persist in the use of the foresaid water, for a long time, and to keep his Belly warm with Flannels doubl'd, that there may not be a relapse, to which this Disease is more ob­noxious than any other.

My whole method of Curing this Disease, con­sists of these few things, which I trust will not be despis'd by any Judicious Person, by reason of its simplicity, and want of Rhetorick, and pomp of Medicines. And these are the Symptoms that are wont to happen in this Fever, there are some others which I will not now mention, partly because they are of less moment, and partly because they don't require a peculiar way of Cure, for the Fever be­ing well treated they go off of themselves. And so much for the continual Fever of this Constitution and of its Symptoms.

CHAP. II. Of the New Fever.

THO my old Age, worn out almost by long Sickness, may well require on that account a Writ of Ease, and a cessation from deep thought, the labour of the Brain; yet I cou'd not forbear, but I must be busi'd in the procuring the Health of others, tho even by the loss of my own; when my acquaintance inform'd me of the en­trance of a new Constitution, from whence pro­ceeded a new sort of Fever, much unlike those that reign'd of late.

We must remember that in Autumn 1677. Inter­mittent Fevers first advanc'd and increas'd dayly, and were Epidemic till they came to their state; afterwards they gradually decreas'd and so rarely appear'd the last Years of this Constitution, that they cou'd not be 'counted Epidemical; and on this account we must likewise take notice that the two last Years of the Constitution now going off, had two very severe Winters, especially the last save one, viz. the Year 1683, in which the season was so extreamly cold, that no Man living ever saw the like, as to the intense degree of cold, and the long time it held. For the Noble River of Thames was so froze that it easily sustain'd, like a solid pavement, Coaches running about upon it, and Shops well stock'd, in the manner of Streets, and great crowds of People. Tho the following Year 84, did not equal the preceding, either as to [Page 66] the extremity of cold or obstinate duration of it, yet it did not come much behind it as to either; but as soon as it thaw'd in February, in the Year 8 4/5. this Fever, began that I now treat of, which I take to be a new sort of Fever, and wholly diffe­rent from that which has prevail'd for these eight Years last past.

I can't certainly say whether the change of this Constitution is to be attributed to the alteration of the manifest qualities of the Air, which suc­ceeded for those two Winters; for I have observ'd that alterations as to the sensible qualities of Years how different soever, have not produc'd species of Epidemic Diseases; and that a certain series of Years (tho one Year has differ'd from another, as to outward appearance and temperament) have notwithstanding all agreed in the production of the same species of stationary Fevers; which when I had seriously consider'd, I was of the Opinion, as I have mention'd in another place, that the change of a Constitution chiefly depends on some secret and hidden alteration in the Bowels of the Earth passing through the whole Atmosphaere, or from some influence of the Coelestial Bodies. Tho 'tis to be noted here, that when the Depuratory Fever here­tofore went off, a very dry and violent Frost from the beginning of Winter 64, froze up all things, nor did it at all abate till the beginning of March, at which time, assoon as the Frost went off, and a Pestilential Fever, soon after the Plague be­gan to rage. But however this be, the Fever which we now Treat of, began at the time afore­said, to wit in Feb. 8^t. and was more spread through all the parts of England, and more Epi­demic [Page 67] in other places than here in London, the Year before and this Year.

When I was first call'd to this Fever, I verily believ'd 'twas not of that kind of Fevers which I call Stationary, but rather of the Family of In­tercurrents, which come promiscuously almost in all Years; to wit, that 'twas nothing else than that Bastard Peripneumonia, which I have hereto­fore describ'd in my Book of Acute Diseases, on­ly with this difference, that in this Fever the Sym­ptoms did not appear now and then, which were more Pathognomonic in the Peripneumonia; such are a violent Cough, a violent Head-ach in Cough­ing, cleaving as it were the Head, a Giddiness upon any motion, and a great difficulty in Breath­ing, all which did most commonly accompany the Bastard Peripneumonia. When therefore the Book­seller desir'd a new Edition of my Works at that time, I Publish'd my conjecture in the Postscript, in which I perceive I was mistaken; and truly I was led into this Error by the great and manifest agreement which was between this Fever and the foresaid Peripneumonia, which comes now and then every Winter; but the Summer coming on, which was wont to vanquish these Peripneumonic Fevers, and this notwithstanding continuing, I was soon convinc'd of my error, and was wholly persuaded that 'twas to be reduc'd to a new Constitution.

After as diligent a search as I cou'd make, the Symptoms I observ'd are, and were for the most part these, the Sick is Cold and Hot by turns, and often complains of Pain of his Head and Limbs; the Pulse are like the Pulse of those that are well; Blood taken away is most commonly like the [Page 68] Blood of Pleuritics; the Patient for the most part is troubl'd with a Cough, which together with other Symptoms accompanying a gentle Pe­ripneumonia goes off so much the sooner, by how much longer the Disease invades from Winter. A pain seizes the Neck and Jaws, sometimes at the beginning of the Disease, but 'tis less than in a Quinsey; tho the Fever be Continual, yet it has of­ten violent Exacerbations towards Evening, as if 'twere a double Tertian or Quotidian. The Pati­ent is much endanger'd by keeping his Bed con­tinually, tho he has but very little clothes on, for by that means the Fever being turn'd upon the Brain he soon falls into a Coma or Frensie; and to speak the truth, the inclination in this Disease to a Frensie is so great that it often creeps on of a sudden of its own accord, without any such occa­sion. But the Frensie does not rise with so great a fury in this Fever, as in that with which those that have the Small Pox and other Fevers are seiz'd; for the Sick rather doats, muttering now and then some odd words. Petechiae very often break out by reason of the unseasonable use of Cordials, and too a hot Regimen; and in young People of a hot con­stitution, Purple Spots the certain signs of a high Inflammation, as well in this as in any other kind of Acute Diseases; and sometimes Eruptions which they call Miliares, sprinkle themselves over the Superficies of the Body, and are not much unlike the Measles, only they are Redder, and when they go off they don't leave behind them those Branny Scales which are seen in the Measles; tho they come sometimes of their own accord, yet most commonly they are forc'd out by the [Page 69] heat of the Bed and Cordials. The Patients' Tongue is either moist or dry according to the Method which has been us'd; when its dry 'tis of a Duskish Colour in the middle, which is hemm'd round with a whitish Fringe; but when 'tis moist 'tis all White, cover'd also with a White and filthy Skin; for if the Patient be too much heated by the Method us'd, the Tongue is most common­ly Dusky and Dry, but if not 'tis Moist and White. The same is to be affirm'd of Sweat, which flows according to the different Method a­foresaid; for if the Patient be treated with too much Heat, 'tis in a manner Viscous, especially about the Head; and tho it flow freely, and from all parts, yet the Sick has little relief by it: so that 'tis manifest that such Sweats are only Sym­ptomatical; not Critical. Sweat forc'd by Art at the beginning of the Disease, us'd to put off the Morbific matter, if not on the Head, at least upon the Limbs. But when the Fever has possess'd the Head, and the Frensre has once prevail'd, then no signs of the Fever remain, only the Pulse is some­times quicker sometimes slower: but at length, when by ill management, the Spirits are driven into a Confusion, the Pulse is inordinate, with a Subsultus of the Members, and Death soon fol­lows.

As to the Cure, those Signs of the Peripneu­monia which accompanied this Fever last Year in February, in which it first began, made me believe presently after Winter, as I said before, that it ought to be reckon'd with the Family of Peripneu­monics; and therefore I presently betook my self to that Method which I have heretofore commend­ed [Page 70] in the Cure of the Bastard Peripneumonia, which indeed was very succesful to me, in those few, I was scarce able to take care of by reason of my Sickness, and to others who were pleas'd to try it upon my commendation. What ever it was that persuaded me to use this Method, I am now fully satisfied, having weigh'd the Phaenomena of the Di­sease, and the Temperateness of the last Year, which follow'd the two cold Winters (especially of the Winter, if it cou'd be call'd so, for it brought with it no considerable cold) I say 'tis manifest to me that this Fever is nothing else than a simple Inflammation of the Blood, and that therefore the Curative Indications are wholly to be directed to the suppressing of the said Inflam­mation by proper Remedies and Methods.

Therefore I proceed after this manner, first I order ten ounces of Blood to be taken from the Arm; and truly this Fever (how like soever the Blood be most commonly to that of Pleuritics) does not easily bear repeated Bleeding; but if a diffi­culty of Breathing, a lancing pain of the Head in Coughing and the like, signifie that this Disease tends to a Bastard Peripneumonia, then Bleeding and Purging are to be repeated, until all the Symptoms wholly vanish, as I have said in the Chapter of a Peripneumonia, and I desire this may be seriously minded.

In the Evening I apply a Blister to the Pole, and next Morning give this lenitive Portion.

Take of Tamarinds ℥ss, leaves of Senna ʒii, Rubarb ʒiss, boyl them in a sufficient quantity of water to ℥iii, in the strain'd Liquor, dissolve [Page 71] of Manna and Syrup of Roses Solutive each ℥i,, mingle them and make a Potion to be taken early in the Morning.

Which I order to be repeated every other day for thrice, and this or the like Paregoric to be taken at Bed-time after every Purge.

Take of Cowslip water ℥ii, of Diacodium ℥i, of juice of Lemons freshdrawn 2 spoonfuls, mingle them and make a draught.

viz. To prevent the Patients being Comatose, by reason of the confusion of the Animal Spirits, which Purges often occasion, by the Tumult they raise in the Blood and Humours of those that have Fevers; which Symptom is Cru'd by Hypnotic Medicines, tho they seem to promote it; for which reason not daring to give a Purge, in the Comatose Fe­ver of the Year 73. I persisted in the use of Cly­sters; for I knew very well that Purging Medicines, us'ed at that time, presently occasion'd a Coma, which perhaps wou'd have happen'd otherwise, if I had thought of giving a Paregonic after such a Purge. But when the Patient does not Purge, we must not give an Anodyne at bed-time, lest it hin­der the operation of the Cathartic, which is to be taken the next day (which is usual, tho it be taken late) but if it don't wholly stop it, it will render it less efficacious. 'Tis a Rule with me, in this and other Epidemic Fevers, not to Purge either in the beginning or state of the Disease, unless Bleeding hath first been us'd: which indeed by being either neglected or violated has occasion'd the Death of [Page 72] many, especially of Children, as I have in ano­ther place admonish'd by way of caution.

But we must take notice, that tho for the most part the 'foresaid Evacuations ought to be us'd in the Cure of this Fever, yet often the Sick, espe­cially if he be a young Man or Infant, presently recovers after Bleeding and being once Purg'd: and there is no occasion for more, the Fever being vanquish'd by the first; but on the contrary 'tis sometimes necessary that Purges shou'd be us'd oft­ner than we said before. For it sometimes hap­pens, tho rarely, that the Patient being freed by this Method, relapses in a few days after by rea­son of the Febrile matter growing Crude again; but 'tis presently Eliminated by the Purge repeat­ed the fourth time, tho this Fever seldom happens under this Method, unless it be occasion'd by Aph­thae, coming at the latter end of the preceding Fever, and now being at their heigth, recall it; which Fever is indeed only Symptomatical, and the Hickocks returning by intervals often follow it, which also remain for some days after the Fever is gone off; but at length vanish of their own accord, as the Patient gets strength, which is diligently to be noted; for as much as there is no danger from the Hickocks coming at the latter end of this Fever, unless many Medicines are over officiously and unprofitably cramm'd in, and then Death is instead of the Physitian; but both the Aphthae and Hickocks, or either of them, if they don't go off of their own accord, but continue a long while, may be easily Cur'd by the Peruvian Bark, viz. an ounce with a sufficient quantity of Erratic Poppies, either in the form of an Electu­ary, [Page 73] or Pills taken after the manner I set down heretofore in my Epistle to Dr. Brady, drinking upon it a draught of Posset-drink. Which Reme­dy I have found by experience in this case more certain than any other whatever, if its vertue be not spoyl'd (as commonly 'tis) by the Patient keeping his Bed continually.

I sometimes prescribe the following or the like, on the days the Purges are not taken.

Take of the Conserve of Wood-sorrel, of Cynosbal. aa ℥i, Conserve of Barberies ℥ss, Cream of Tartar ʒi, with a sufficient quantity of Syrup of Le­mons, make an Electuary, of which take the quantity of a Nutmeg thrice aday, drinking upon it four spoonfuls of the following Julap.

Take of the water of Purslain, Lettice and Cow­slips aa ℥iii, of Syrup of Lemons ℥iss, of Syrup of Violets ℥i, mingle them and make a Julap.

Or take of Fountain waters lbi, of Rose water, of the juice of Lemons, of White Sugar aa ℥iv, boyl them over a gentle fire, till all the scum be risen, take ℥iii at pleasure.

But in all these things I forbear the use of Spi­rit of Vitriol, tho it be very refrigerating, because 'tis not proper in any Diseases that are Cur'd by Purging, by reason 'tis so very Styptick, not to mention now the Mineral nature of this Spirit.

It often happens, especially towards the end of this Fever, that the Sick when he is mannag'd after this manner, Sweats now and then of his [Page 74] own accord in the Night, by which all the Sym­ptoms of the Disease are very much mitigated; but notwithstanding seeing we can't trust in such Sweats, we must by no means intermit the 'fore­said method, because if the Sick shou'd indulge those Sweats for a longer time, the Fever which the preceding Purges had in some sort subjugated wou'd again revive; for if the Sweat be protract­ed beyond that time, in which the Febrile par­ticles repair'd by due coction are wholly carried off, the Sweats that follow do nothing else but kindle the flame afresh; wherfore tho those Sweats which flowed Spontaneously were perchance critical, with respect to the casting out of the Febrile matter, which is fit for Expulsion, yet the others that fol­low them may be only Symptomatical, and so do more hurt than good. In a word, the gentle heat of the Bed at Nights opportunely favours such Sweats as flow of their own accord in the Night; wherefore the Sick shou'd have no more nor thicker clothes on, than he use to have when he was well, nor shou'd any hot Medicines be given. Let him only keep his Bed a little longer than he is wont, in the Morning following, and afterwards let him persist in the method of Cure above prescrib'd.

His diet is to be Oatmeal and Barly broaths, and now and then a roasted Apple, and after the second Purge Chicken broath. I order small Beer cold for his ordinary drink, and the white Decocti­on made of one ounce of Harts-horn calcind, and boyl'd in three pints of common water, and after­wards sweeten'd with white Sugar.

Tis not necessary, as I have mention'd in ano­ther place, after the taking of two Purges, to for­bid [Page 75] the Eating of Chickens, and the like of easie concoction; for this way of Cure by Purging in­dulges the same, which cou'd not be allow'd if we proceeded in another way; moreover after the last Purge, if the Fever has a little spent it self, and is not yet turn'd to an Ague, three or four spoonfuls of Canary Wine may be taken Night and Morning, and after Dinner for some Days, by which the Strength may be the sooner restor'd and the Febrile fits averted.

But for as much as this kind of Fever is more prone, than any other I ever yet saw, to assault the Head, neither can it be remov'd from thence with­out great difficulty: I seriously admonish my Pa­tients that they lye a Bed naked only a Nights, but if they are so very much weaken'd that they can't sit upright, I permit that they shou'd lye upon the Bed or Couch with their clothes on, with their Heads a little elevated; neither do I allow that they shou'd have any more fire in their Chambers than when they were well.

And as this Regimen is to be observ'd from the beginning, in all that are seiz'd with this Fever, (excepting Women taken on the first days of Childbed) so is it necessarily enjoin'd, when the Physitian is call'd to a Patient, who by reason of too hot a Regimen, has been seiz'd with a Phrensie, Petechiae or Purple spots, or any other signs of a violent inflammation; for in this case tho Blood be taken away, tho the Body be lightly cover'd, and whatever cooling Liquors are drunk, yet the Fever will not cease till the Patient keeps from bed adays, for as much as the heat of the Ambi­ent Air, kept in by the coverings, too much exagi­tates [Page 76] the Blood, and the lying posture of the Body forces the same with violence on the Head; but when the Phrensie hath once prevail'd, by reason of an ill Method, it can't presently be tamed, neither is it safe to endeavour the Cure by repeat­ing Bleeding and purging beyond the limits pre­scrib'd; but at length 'twill go off at its own time and of its own accord, by the help of the Method aforesaid. But nothing so much conduces to the removal of it as shaving the Head, and therefore I always order it without applying a Plaister, only a Cap so thick as may compensate the loss of the Hair, or at least defend the Head from external cold; by this means the Brain is very much cool'd and refresh'd, so that by degrees it may be able to overcome the hot impressions that occasion the Phrensie.

And what has been said of a Phrensie may like­wise be affirm'd of the Coma that comes upon this Fever, in which and in the said Phrensie the Febrile matter is carried up to the Head, and so if you except the whiteness of the Tongue there are no signs of a Fever; for the Patient seems to be wholly freed from it. In this Sympton as in the other, Cathartics, Sudorifics, Blisters, and the like, are not us'd only unsuccessfully, but do a great deal of hurt; for such Evacuation procure death, sooner than the Cure of this Symptom: wherefore after general Evacuations, by Bleeding and Purging, the business is to be committed to Nature and time, tho this Symptom terrifie the by-standers; for tho the Sick be stupid for a long time, yet he will re­cover his Health after many days, if he be not continually kept a Bed; but is taken out of it a [Page 77] days and laid upon a Couch, or on the Bed with his Clothes on; in the mean time his Head may be shav'd, and at the latter end of this Symptom three or four spoonfuls of Canary Wine may be given twice a day. But I have Treated largely of this in the fifth Section, and second Chapter, of my Book of Acute Diseases, where I discours'd of a certain notable Coma that accompanied that Con­stitution.

But as to the Fever the Physitian is not to be deterr'd, from making the 'foresaid Evacuations, if upon feeling the Pulse, he shou'd perceive a twitching of the Members or a Convulsive moti­on of the Body; for as much as in some kind of Diseases of the Nerves, both Bleeding and Pur­ging don't only not do hurt but are necessarily pre­scrib'd; of which I will produce an experiment I made in a certain kind of Convulsion, which is commonly call'd Chorea Sancti Viti, of which Dis­ease I have seen and Cur'd no less than Five by Bleeding and Purging prescrib'd by intervals; of which sort of Disease I will speak somewhat seeing it occurs opportunely, and clearly confirms the truth of what I now assert. Chorea Sancti Viti, is a sort of Convulsion which cheifly invades Boyes and Girles from ten Years of age to Puberity: First it shews it self by a certain Lameness, or rather instability of one of the Legs, which the Patient drags after him like a Fool, afterwards 'tis perceiv'd in the Hand of the same side, which he that has this Dis­ease can in no wise keep in the same posture for a moment, if it be brought to the Breast or any other part, but 'twill be distorted to another posi­tion or place by a certain Convulsion, do the Pa­tient [Page 78] what he can: if a cup of Drink be put in his Hand he represents a thousand gestures, like Juglers, before he brings it to his Mouth; for whereas he can't carry it to his Mouth in a right line, his Hand being drawn hither and thither by the Convulsion, he turns it often about for some time, till at length happily reaching his Lips he flings it suddenly into his Mouth, and drinks it greedily as if the poor wretch design'd only to make sport. For as much as this Disease seems to me to proceed from some Humour rushing in upon the Nerves, which provokes such preternatural motions; I think the Curative indications are first to be directed to the lessening those Humours by Bleeding and Purging, and then to the strength­ening the genus nervosum, in order to which I use this Method: I take seven ounces of Blood from the Arm, more or less according to the age of the Patient; the next day I prescribe half or some­thing more (according to the age, or the more or less disposition of the Body to bear Purging) of the common Purging Potion above describ'd, of Tamarinds, and Senna, &c. in the Evening I give the following draught.

Take of Black-Cherry water ℥i, of Langius's Epi­leptic water ʒiii, of old Venice Treacle ℈i, of liquid Laudanum Gutt. viii, make a draught.

I order the Purging Potion to be repeated thrice, once every other day, and a Paregoric draught the same nights; afterwards I prescribe Bleeding and Purging as before, and so Alternately I Bleed and Purge till the Patient has Bled three or four [Page 79] times, and after every Bleeding Purge so often as his strength will bear; only it must be diligently observ'd that there must be so much space between the Evacuations that the Patient receives no da­mage from thence; if the days Purging is not us'd, I prescribe as follows.

Take of Conserve of Roman Wormwood, of the Yellow rinde of Orranges aa ℥i, Conserve of Rosemary Flowers ℥ss, of old Venice Treacle and Nutmegs Candid aa ʒiii, of Ginger Candid ʒi, Syrup of the juice of Citrons a sufficient quantity, make an Electuary, of which take the quantity of a Nutmeg in the Morning, and at five of the Clock in the Evening; drinking upon it five spoonfuls of the following Wine.

Take of the Roots of Paeony, Elicampane, Master­wort, Angelica aa ℥i, of the Leaves of Rue, Sage, Betony, Germander, white Whore-Hound, and the tops of the lesser Centaury aa Mi, of Ju­niper Berries ʒvi, the rinds of two Oranges; let them be cut and infus'd cold, in six pints of Ca­nary wine; strain it as you use it.

Take of Rue water ℥iv, of Langius's Epileptic wa­ter, and compound Briony water aa ℥i, Syrup of Paeony ʒvi, mingle them and make a Julap, take four spoonfuls at bed-time, with eight drops of Spirit of Harts-horn. Let a Blaister of Gum Caranna be apply'd to the Soles of the Feet.

The more the Patient recovers, the less he drags his Foot, and the Hand is steddier, so that he can [Page 80] bring the cup to his Mouth more directly; which are certain signs how much better he is: but tho to perfect the Cure, I wou'd not advise that he shou'd be Bled more than three or four times, yet Cathartic, and Alterative Medicines are to be us'd till he is quite well. And because he that has once this Disease may easily relapse, I think it expedi­ent that he be Blooded and Purg'd for some days the next year about the same time, or a little be­fore the Disease first invaded. And truly I sup­pose that the Epilepsie of the adult, may go nigh to be Cur'd by this Method, if the Remedies prescri­bed were well proportion'd to their Age, tho by reason I have seldom met with this Disease, I have not yet try'd it; but this by the by.

It sometimes happens in Women subject to Hy­steric fits, that when the Cure has been managed by the 'foresaid Evacuations, the Fever continues after Bleeding and Purging, tho repeated; in this case the Fever that now prevails is plainly continu'd by the commotion of the Spirits occasion'd by the Evacuations; and therefore all other things being omitted, the Curative indications are only to be directed to the appeasing the fury of the Spirits, if there be no signs of a Peripneumonia, or Inflam­mation about the vital parts. In order to which a Paregoric, that is sufficient to cause sleep, ought to be prescrib'd every night; and also Hysteric Me­dicines properly so call'd, twice or thrice a day, such are Pills made of Galbanum, Assafetida, Castor and the like, and Julaps of the same nature, describ'd in my Treatise of Hysteric Fits. Moreover that meat and drink which is most agreeable to the appetite of the Patient ought to be allow'd to [Page 81] recover the strength, and to suppress the vapours, as they call them.

We have said already, that this Fever had both the last year, and especially this, a certain Exacer­bation dayly about night, not much unlike the fit of an intermittent Fever. Wherefore those Phy­sicians that had found by experience that all those Fevers which did any whit intermit (and oft those that did not intermit at all) through that series of years from 77 to the beginning of 85, were cer­tainly Cur'd by the Peruvian Bark, treated this Fever with the same Remedy: but tho 'twas rati­onal, yet most commonly 'twas not so successful as in the former years. For upon a diligent search I found that tho a great quantity of the Bark was given, yet it rarely Cur'd the Patient, and so ve­ry rarely, that I rather imputed the recovery of the Sick to some lucky event of the Disease, than to the vertue of the Bark, so that it wholly lost that Sanative vertue and certainty it had in the 'foresaid years. I mean the Fever we Treat of now, which is something like a Quotidian; but when there is the type of a genuine Tertian, or of one invading every other day, the Bark is as pre­valent now as ever; so that 'tis very manifest that this Fever was quite different from that of the former Constitution, for as much as the use of the Bark does now no good, and this is heighthen'd by Wine, Cordials, and other hot things; all which well enough agreed with the use of the Bark and also with that Fever.

Moreover we must take notice that this Fever raging all the Summer, especially that of this year, the Disease did often shew it self, not so much by the [Page 82] Pathognomonic signs of a Fever, to wit by restless­ness and inquietude, as by Gripes sometimes dry and sometimes loose, yet notwithstanding the Fever of this season lurk'd under this disguise, in which the inflammatory exhalations of the Blood were not as is usual protruded to the habit of the Body, but put off inwardly by the Mesenteric Arteries, upon the Viscera of the lower Belly, and sometimes upon the Stomach by the branches of the Coeliac Arte­ries, which exhalations are wont to provoke Vo­miting, especially presently after taking Drink or any more solid nourishment: yet tho this Fever lurk'd under the form of the 'foresaid Symptoms, yet 'twas to be Cur'd by the genuine Method we deliver'd above, in the same manner as if it had appear'd in its own Colours; to wit, by Bleeding and repeated Cathartics; only 'tis to be noted, that when the Fever does so much molest the Stomach, that it can't retain a Potion, then the Pill Coch. Major (of which 2 Scruples prescrib'd do always pass through the Body) may be substituted in the room of a gentle purging Potion; but the Pills must be taken at four in the Morning, that the Patient may sleep after them, and then an Hypnotic in a large dose is to be allow'd; to wit, a Grain and a half of Solid London Laudanum, with the like quan­tity of Mastic made into two Pills, to be taken the same Night; or eighteen or twenty drops of Liquid Laudanum in an Ounce of Cinnamon water hordeated or any other generous Vehicle, by which means the Stomach being both Corroborated, and not Irritated by the small quantity, may not cast up the Medicine: But if the Purging Potion and Diacodium can possibly be retain'd in the Stomach, [Page 83] they are wholly to be preferr'd before the 'fore­said Pills and Laudanum, for they perform their busi­ness without heating the Body so much as the Pills.

But seeing I have made mention of the Gripes, I will admonish my acqaintance with how much danger, as I have frequently observ'd, Mineral waters are wont to be prescrib'd in any Gripes whatever, or Loosness, or Vomiting, or any other Disease whatever, that takes its rise from a Fever, for as much as in so subtile and spiritual kind of Disease, as 'tis manifest a Fever is, Mineral Medi­cines do so confound all things, that instead of the Symptoms which were wont to accompany a Fever, they introduce accidents altogether irregu­lar, yet in the mean while don't at all assist to­wards the extirpation of the Fever, which I have long and often observ'd.

But this must be seriously minded, for as much as it may serve to deliver many from the Jaws of Death; to wit, that notwithstanding what we have said before, when the 'foresaid Gripes rise to a confirm'd Dissentery, in which besides the Gripes some Mucous matter together with Blood is ex­creted by Stool; 'tis manifestly very dangerous to treat the Disease with that tedious Method which orders evacuations first, and afterwards those things that attemperate the sharp Humours (to say nothing of Astringent Medicines of various kinds and forms, taken inwardly, and Clysters sometimes Astringent, sometimes Consolidating now and then injected) for I have found by expe­rience that a Dysentery is most certainly and most speedily Cur'd, if without any more ado the Flux be stopt presently with Laudanum; for this Disease [Page 84] is so very violent and fierce, that if you persist in Purging, when the Dysentery is confirm'd, there is great danger, lest it being heigthen'd by this means shou'd by reason of its incredible Ferment torment the Patient the ionger, do afterwards what you can, or perhaps kill him. Therefore be­ing call'd, I presently give about twenty two drops of Liquid Laudanum in Epidemic water, or in aq. Mirab. or the like, to be repeated twice in the space of twenty four hours, or oftner at set times, if the Dose prescrib'd to be us'd only Morning and Evening, be not sufficient to quell the Gripes and the Bloody Stools; the Excrements being a little thicken'd, or of a better consistence (which is the first sign of recovery) and the Symptoms being subdued, I suppose its safest for the Patient to continue a while in the use of the 'foresaid re­medy Morning and Evening, taking some drops dayly till there be no farther occasion. But 'tis to be noted that I order the Patient to keep his Bed longer after the use of a Paregoric, for any Erect posture soon disturbs the Head unless the Patient sleep long enough after it. As to Diet, if the Pa­tient has been accustom'd before to Wine, I allow him Canary, but well diluted with water, in which a crust of Bread has been boyld, which I order to be kept cold for this use in a stone bottle, that it may be in readiness when the Wine is to be attemperated; also the white decoction of burnt Harts-horn in Fountain water, drank freely is good; Barly or Chicken-broth, or a poach'd Egg, or any thing else of easie digestion may suf­fice for food on the first days; but afterwards we must rise by degrees to more generous liquors, [Page 85] and to a more plentiful and solid nourishment, lest too great a vacuity should produce again the same Disease the Patient recover'd of, or some other Sym­ptoms that are occasion'd by emptiness. But we must note this, that tho' Laudanum alone did subjugate Dysentries of this constitution, yet in those years in which they are epedimic, and exceed other Dis­eases, 'twill not be improper to use those evacu­ations first, which I have heretofore described in the Chapter of a Dysentery.

And as in that confirm'd Dysentery now spoke of, so in this case that follows, it can't be that the Cure should be presently expedited by that me­thod which is proper for the Fever, from whence it first took its rise. For instance, sometimes 'tis so that the Patient being seiz'd with a horror and ri­gor (heat and cold succeeding one another by turns, which are the certain signs of an imminent Fever) is of a sudden miserably afflicted with the Gripes, by reason of an eruption of the febrile matter; and whereas he ought to be purg'd and blooded as directed above: Presently he betakes himself to hot Medicines taken inwardly, and out­wardly apply'd, to the intent he may expel the Wind, which he supposes is the cause of his Mi­sery, till at length the pain increasing, and being as it were impacted into the Bowels by long con­tinuance, the peristaltic motion (by which accord­ing to the Law of Nature, all things shou'd be con­vey'd downwards) begins to be inverted, and all things tend upwards, and the Patient is grie­vously tormented, and provok'd to vomit, the Disease now ending in an Iliac Passion. In this case the Physician can proceed no further in the [Page 86] method of Cure, which the Fever, the antecedent cause of this Symptom, requir'd, than to order bleeding in the Arm for once: For how many, and whatsoever Catharties you prescribe, will pre­sently become emetic, and so the more promote the inverted motion of the Bowels; for as much as the strongest purging Medicines, or indeed the least part of them, can scarce pass the Guts, and cause a Stool. In this case I think 'tis most ad­visable, first to bleed in the Arm, and an hour or two after to inject a strong Clyster. I account the smoak of Tobacco, strongly blown up through a large Bladder into the Intestines by a Pipe invert­ed, to be the best and most efficacious Clyster I know, which may be repeated a little while after, unless the former, by giving a Stool, open the pas­sages downwards. But this Symptom being not wholly conquer'd by this Remedy, 'tis necessary that a Cathartic, somewhat stronger, be us'd, how difficult soever it be to make way.

Take of the Pill ex Duobus gr. XXXV. Mercurius Dulc. one Scruple, make four Pills with a sufficient quantity of Balsom of Peru, take them in a Spoon­ful of Syrup of Violets.

Drink no Liquor upon them, lest they should not be retain'd; but if the Patient should vomit this Remedy, we must proceed in this manner: Let him take presently 25 drops of Liquid Lau­danum in half an ounce of strong Cinnamon-wa­ter, and after a few hours let it be repeated; but when the vomiting and pain of the Belly are aba­ted by the use of these, then the foresaid Cathartic [Page 87] may be repeated again; for at this time 'twill be retained under the protection of the Laudanum, and will at length perform its business; but if the vomiting and pain should again return, by reason the vertue of the Anodyne is wholly decay'd, and the Purge should stop in the Body, in this case, all hopes from Stools being at present laid aside, we must return to the use of the Paregoric before describ'd, which must be repeated every fourth or sixth hour, till the Guts be wholly quiet, and the natural motion downwards be restor'd, at which time the Cathartic, which has hitherto been stopt in the Body, by reason of the contrary motion of the Guts, will now operate by Stool; tho' be­cause of the Narcotic so often repeated, a quite contrary effect might seem to follow, which I have just now experienced in a Gentlewoman tormented with a very severe Iliac Passion, who had after­wards Aphthae by reason of too long retension of the humours that occasion'd the Disease, and of sharp Purges; but they were easily cur'd by the use of the Peruvian Bark above describ'd, and by washing the mouth often with the following Gargarism.

Take of Verjuice lb ss. Syrup of Rasberr'ies ℥i, make a Gargarism.

But when these passages are open again as much as they should be, the Patient may forbear pur­ging for some days, till the Tumult rais'd of late in the Bowels be wholly ceas'd, which space of time may conveniently enough be allow'd for di­luting and attemperating the heat and acrimony [Page 88] of the humours, which being done, he must purge every other day as before, if the least footsteps of the Fever remain: But enough of this.

If a Child has this Fever, two Leaches must be apply'd behind each Ear, and a Blister to the Neck, and it must be purged with Beer, wherein Rubarb has been infus'd; if after purging the Fe­ver seem to remit, then the Julap must be given of the Cortex Peru, set down for Infants in the Chapter of an intermitting Fever.

Moreover 'tis to be noted, that Children are equally obnoxious to this kind of Fever with the Adult, and that therefore they are to be cured by the same method, only the quantity of Blood to be taken away, ought to be lessen'd, with re­spect to their Age, and purging ought to be ac­comodated to it, and perchance not so often to be us'd; for the Diseases of Infants, and young People will be often tam'd by the first or second Purge: Yet we must seriously consider, whether the Fever treated after this manner, certainly be­long to this Constitution, or to another kind, which ought seriously to be minded in those Fe­vers that seize infants in all constitutions of years; for 'tis commonly known, that Children are often seiz'd with Fevers, arising from their breeding Teeth, which are not easily distinguish'd from Fevers of another kind. I have been in great doubt a long time about the Cure of these, neither could I be certainly persuaded but of late, that any commit­ted to my Care, were recover'd so much by Art as by chance; till at length, being frequently admo­nish'd of the happy success of a Medicine, that is not very famous, yea indeed very contemptible, [Page 89] upon the account of the common use of it; I had also prescrib'd it, which answer'd my desire better than any I know; 'tis three or four drops of Spirit of Hartshorn, given in a spoonful or two of Black cherry-water, or of any other proper Julap, four or six times, once every fourth hour

There is another Symptom that very much in­fests Infants, which is very different from the Fe­vers, of various constitutions of the years, and from that last mentioned: 'Tis a sort of Hectic, that afflicts Children a long time, and those that are troubled with it, languish without any consi­derable heat, with a loss of Appetite, and a wasting every where, both of the Members and Trunk of the Body. I use this simple Method following. Take of choice Rubarb flic'd ʒii, let it be put into a glass Bottle, containing a Quart of Small Beer, well stopt, or any other Liquor the Child usually drinks of, which medicated Beer I order to be taken both in the day and night, and at meals; which being drank up, I order a quart more to be put upon the same Rubarb, which also be­ing drunk off, a quart more is to be put upon it as before, after which the Rubarb commonly loses its vertue, and the Child recovers; but lest the Beer first put on should be too much im­pregnated with the cathartic quality of the Ru­barb, and so purge too much, 'twill be better to add another pint presently after the first is drunk; but afterwards fresh Beer must not be added, till the whole Bottle be taken.

But to return to the Fever we now treat of, to wit, of the present Constitution; We must dili­gently observe, that in this sort of Fever (as in a [Page 88] [...] [Page 89] [...] [Page 90] Rheumatism, and many other Diseases, whose Cure is perform'd only by evacuations) if we ob­stinately insist on the foresaid evacuations, till all the Symptoms wholly cease, the Sick will often be destroy'd; for 'tis not very unusual that some slight Symptoms, as it were the reliques of the feeble Fever, remain a while after the Disease is gon off; yet there is no fear of a relapse from thence, they retiring gradually, as health returns; for these Symptoms are commonly nothing else but the true Progeny of those evacuations, by which the Physician endeavour'd to cure the Disease: If this at least be added, as partly the Cause, to wit, the emptiness, that the abstinence of the Sick from his wonted Meals and Drink has occasion'd: all which, when they fall upon Bodies weakned, and almost worn out by the Disease, raise Va­pours, as they say, as in Women; and for the same reason, on the account of the weakned, dis­jected, and broken System of the Animal Spirits: Wherefore having made these evacuations, that are sufficient for taking off the Disease, 'tis the Duty of a prudent Physician to forbear the un­seasonable administration of them, and to wait a while on Time, often the best and most successful Physician, for the taking off those light Sym­ptoms, which indeed, as I have often observ'd, go off at the latter end of such a Disease, with­out any more a-do, by a Paregorick taken at Bed-time two or three nights.

The method now deliver'd much excells all I have try'd in the cure of this Fever; and if at any time it does not take it off, yet it forces it to intermit, and then 'tis always cur'd by the Peruvi­an [Page 91] Bark: But whereas purging, order'd for the cure of this Fever, may perchance seem injurious to some, I affirm, that upon tryal, nothing so cer­tainly and so powerfully cools the Patient, as purging prescrib'd after bleeding, which must be always used first: For tho' a purging does for the present raise a greater tumult in the Blood, and other humours on the day 'tis taken, and in the operation, than was before, yet that injury will be sufficiently made up by the advantage that presently follows; for 'tis found by experience, that purging after bleeding quells a Fever sooner and better than any other Remedy whatever, both as it expels that filthy humour from the Bo­dy, by which, as the antecedent Cause, the Fe­ver was occasion'd; and if they were not pec­cant before, yet at length being heated, concocted, and thickned by the Fever, do much to render it more lasting: And also, as it makes way for an Anodyne, which performs its business safer, and much sooner, than if the peccant humours, which might otherwise hinder the force of the Paregoric, were not eliminated by purging.

But on the contrary, as that method which is busied in eliminating the febrile matter through the pores of the skin be less certain, so is it more troublesom and tedious; for by it the Disease is very often protracted many Weeks, and the Pa­tient is brought by this means to the brink of the Grave; and if he chance at length to escape Death, he is plagued with a croud of Medicines all the long course of the Disease, to take off those Symptoms, which the ill management of the Dis­ease brought on, when the Cure of it is attempted [Page 92] by the hottest method and medicines, which ac­cording to its own Genius wholly requires the coldest of both; and so while brain-sick men in­slave themselves to Rules of Art, falsly so call'd, and despise the judgment of their very Senses, in­forming them better, they learnedly convert a Dis­ease, of its own nature short and easie, into a la­sting and difficult one, confounding all things through tumult and fear, and raising, as they say, Waves in a Cup; upon which account there is no more need of them, than of a Pilate, who when he may sail in the open Sea, steers the Ship among Rocks and Shelves; from whence, tho' he may gain an opportunity of acquiring Fame by his great skill in preserving the Vessel in so great dan­ger, yet certainly he will be reckon'd an impru­dent man.

And for these Reasons I can, I trust, affirm upon good grounds, that the 'foresaid method of Cure, by bleeding and purging, is more powerful than any other, for the subduing of Fevers of most kinds; for tho'sweating, to speak properly, is na­tures own method, by which she casts out the fe­brile matter, and is more genuine and commodi­ous than the rest, when Nature left to it self, first digests the 'foresaid matter, and then when 'tis well concocted, gently expells it through the ha­bit of the Body; which happy event of Nature, of curing Fevers by sweating, when practical Physici­ans had often observ'd, the Dogmatical took occa­sion from hence of making this Rule, That all Fe­vers may, and ought to be cured by this method alone, and no other: But if we should grant this, yet Art, how much soever it may seem to imitate [Page 93] Nature, yet it can't arrogate to it self this privi­lege, that 'tis able to Cure Fevers certainly by Sweating. For first Art knows not by what means the peccant matter shou'd be fitly prepar'd to un­dergo Expulsion, and if it shou'd know this, yet it has no certain signs by which it may be admo­nish'd of the due preparation of it: so that also 'tis unavoidably ignorant of the fit time of pro­voking Sweat: and I suppose no one if he be not very obstinate, will deny that 'tis very dange­rous to raise Sweat rashly, before a due Concocti­on, for by forcing the crude matter upon the Brain, it adds Oyl to the Flame; and as I have hinted in another place, that that wholesom ad­vice of Hippocrates (to wit, that things Con­cocted, not Crude, are to be Medicated) does not seem to respect so much Purging, as Sweat for­ced by Art. For no one that is but indifferently ac­quainted with the practice of Physick can be ig­norant, how many are dangerously injur'd by old Women and Quacks, by this preposterous use of Sudorifics, for 'tis customary with these, if any one complains of Shivering, and a Pain of the Head and Bones, which are most commonly the forerunners of a Fever; presently to put them to Bed, and do all they can to force them to sweat: by which unseasonable endeavours they are so far from preventing the Fever, which perchance wou'd go off of its own accord, or by taking away some Blood; that on the contrary its the more heigth­en'd, and becomes a confirm'd and radicated Dis­ease. This is moreover to be noted, to say no more of old Women, that as those Sweats that come at the beginning of the Fever are wholly Symptoma­tical [Page 94] not Critical, so those that are forc'd at the beginning of the Fever by Diaphoretics, most commonly conduce no more to the Cure of it than the other Symptomatical Sweats that flow so early of their own accord are wont to do, that is, most commonly not all; and then as Art is ignorant of the due time for promoting Sweat, so likewise knows not how long it shou'd persevere in forcing them: for if Sweats are continued beyond the due time by which, to wit, the matter occasioning the Disease is wholly expell'd, a Consumption of those humid Particles, with which the Blood shou'd be di­luted and attemperated, will make the Fever con­tinue longer and heighten it. 'Tis manifest there­fore how uncertain this method is, whereas on the contrary 'tis in the Physicians power to moderate the other as he please, in which the Febrile mat­ter is Eliminated by Bleeding and Purging. More­over this is to be preferr'd before the other for this reason; to wit, that if the Physician shou'd miss his aim in Curing the Patient, yet he will not injure him, which is otherwise in the use of Diaphoretics, unless he recover; for the heat of one that is kept continually in Bed, to which he has addicted himself for some time, contrary to his custom (to say nothing of Cordials which are al­ways us'd in this way of Cure) confounds the E­conomy of Nature, and occasions Convulsions of the Members, and other irregular Symptoms, which can't therefore be describ'd, because they don't belong to the History of the Disease, (which is common in many Symptoms respecting all Dis­eases) but take their rise from the Confusion and Tumult that are unnecessarily occasion'd; by which [Page 95] Nature is often oppress'd when we carry on the Cure of the Disease by this Method; all which are commonly wont to be imputed to I know not what Malignity.

The invention of which Opinion concerning malignity, either as to the Nameor Notion of it, has been much more destructive to mankind than even that of Gunpowder: for as much as those Fevers are chiefly said to be Malignant, in which the inflammation is higher than in others; and therefore Physicians have betook themselves to Cordials and Alexipharmacs, to the end they may expel through the Pores of the Skin the Poyson they dream of, (for so it must be call'd, unless they had rather trifle about words, than propose seriously that which may be understood) upon which account they have prescrib'd the hottest Medicines and Method for those Diseases, which required above others the coldest Remedies and Regimen, which is manifest enough both in the Small Pox, (which is one of the hottest Diseases in Nature) and in the Cure of other Fevers: in­to which Error perchance they were led, by be­holding the Petechiae and purple spots, and other Phaenomena of the same kind, all which owe their rise in most Subjects to an Inflammation superin­duc'd upon the Blood of the Patient, too much fired by the Fever already; for as much as they rarely happen, except at the beginning of the Plague, and of those Flux-Small Pox that par­ticipate of the highest Inflammation: for in this kind of Disease the Livid Spots appear in va­rious parts of the Body, together with the Pustu­les, when they first come out, and the Patient will [Page 96] be troubled with an Excretion of Blood, either by the Urinary passages, or by the Lungs, with a Cough, when the Blood rages with such a violent motion and fury occasion'd by the Inflammation, that having broke through all, it rushes into the Cavities of the Body. And tho the Purple Spots in this Fever don't take their rise from such an in­tense heat of the Blood, as that is which causes such Haemorrhages, yet notwithstanding they are produced by the same Inflammation, tho in a less degree; and when there is not that Execretion of Blood they are easily taken off by a cooling Regi­men. But if they conjecture there is Malignity in the case, not only from the Purple Spots, but al­so because they have observ'd that the Symptoms of the Fever have been sometimes milder than may seem to agree with the Nature of it, and yet that the Patient was more weaken'd than cou'd be ex­pected in the time he has been ill: I answer, that all these things proceed only from hence, viz. for that Nature being as it were oppress'd and con­quer'd by the first assault of the Disease, is not able to raise regular Symptoms, and such as are agreeable to the greatness of the Disease, but all the Phaenomena are wholly irregular; for the Ani­mal Economy being disturb'd, and as it were de­jected, the Fever on that account is depress'd, which according to the genuine course of Na­ture us'd to be high. Of which, I remember, I saw a notable experiment many years ago, in a young Man to whom I was call'd; for tho he seem'd almost dying, yet the heat in the exter­nal parts of the Body felt so temperate upon touch­ing, that the standers by wou'd not believe me [Page 97] when I affirm'd that he had a Fever, which by rea­son of the oppression of the Blood (by whose bulk it was kept in and as it were choak'd) cou'd not extricate and shew it self openly: but that if they let him Blood they shou'd presently perceive the Fever high enough, a Vein being open'd and a pret­ty deal of Blood taken away, the Fever broke out, which was as violent as I ever saw any, and did not go off till bleeding had been us'd three or four times.

But if the A rguments I have brought are not so considerable as to prove the thing certainly to be, as I say, yet if I find by experience that this Fe­ver does not go off easily by Evacuations, made by Sweat, I have what I seek for: For no Man can tell by arguing, but by experience, what kind of Fever can and ought to be Cur'd by Sweats, and what by other Evacuations. And truly no wise Man, who has sufficiently weigh'd the nature of Men and things, can implicitly believe the Opini­on of any Man, how great soever he be, con­cerning those things that are meer Speculations, and can't be determin'd by any certain Experi­ment; for he ought to consider that the moments of reason are so very various and subtile, that when any one has propos'd a Speculation, so esta­blished by firm Reasons, that he forces the assent of all that are near him; presently another succeeds him, endow'd perchance with better Parts, who confutes that Opinion which was so fairly settl'd, and clearly proves by a stronger force of Argu­ment, that that was nothing but a fiction of the Brain, for as much as not the least Footsteps of it [Page 98] are to be found in Nature; and in the room of it substitutes a certain new Hypothesis more proba­ble than the former and more neatly contriv'd, yet this latter Fiction undergoes the same fate with the former, when some third person opposes, who as much exceeds the second in Ingenuity as he did the first; and so there will be no end till at length we come to him that is arriv'd at the top of hu­mane Ingenuity; and how difficult it is to find this Man, and to know him from others, any one will presently perceive who is not so very mad as to arrogate this praise to himself. For as we may conjecture that there are almost infinite Natures in the illustrious Orbs, here and there scatter'd throug the Firmament of the Universe, endow'd with far more excellent Intellects than weak Man; so we don't certainly know whether mankinds Brain, the Shop of the Thoughts, be not so form'd by Nature, that they can't find so well what is ab­solutely true, as what is most convenient and suit­able to their Natures. And so much may suffice to be spoken to those, who in Physick trust more to vain Speculations than to Experience, built upon the solid testimony of the Senses.

But if any one shou'd here object, and say, don't we see de facto that this Fever is very often Cur'd by a method quite contrary to this you deliver? I Answer, That the Cure of the Disease, which only the recovery of a Patient now and then wit­nesses for, wholly differs from the Cure of the same, by that Method of Practise which is confirm'd by more frequent recoveries of the Sick, and all other Practical Phanomena that happen in the Cure of it. [Page 99] For instance in the Small Pox, many who have been tormented with the cruel use of a hot Regimen, and Medicines have yet recover'd; and on the contrary they have done very well, whose Cure has been perform'd by a Method quite contrary. Now how shall we end this strife, which Method is to be preferr'd? Why truly by this means we shall cer­tainly judge: namely, if I have found in the for­mer Method, that the more I have heated the Pa­tient, the more I have rais'd and promoted the Fe­ver, restlessness, the Delirium, and other Sym­ptoms: and on the contrary, if it appears, that when he has been moderately cool'd, his tempera­ment is so much the more Sedate, and he is the less vex'd with the Fever and other Symptoms. Moreover that by keeping that due temper of the Muscular parts, which best suits with the increase and maturation of the Pistules, they are bigger and more fill'd than if the Patient were suffocated with too much heat. The case being thus put, I suppose 'tis manifest enough which Method of Pra­ctise we ought rather to follow. In like manner if I find in the Fever I now Treat of, that the more the Patient is heated, the more he is in­clin'd not only to a Phrensie, Purple Spots, Petechiae and the like; but that 'tis moreover on that account encompass'd with irregular and anomalous Symptoms of all sorts; and on the other Hand, if I observe another Patient treated by the Method we now propose, wholly freed from these Symptoms, Reason dictates that the latter Method of Practise, is much to be preferr'd be­fore the other, tho both Patients recover by such [Page 100] different means; but if more escape Death by this way than the other, the intricasie of the Contro­versie is so much the easier found out; but I must not judge of this, lest I should favour too much my own Opinion.