PART I. Of the Causes by which Ordina­ry Fevers are often made grievous, and mortal.

I. WHAT^(a) CELSUS has insinuated, concerning Chronic Diseases, is, in some Respects, applicable to those that are called Acute, viz. That they are seldom mortal in their own Na­ture: [Page 2] ‘"And that, if a Phisitian's Advice, is followed from their Be­ginning, hardly any dye of them, unless through his Fault."’

II. FOR the first Attacks of Fe­vers, (even of such as are most dange­rous) are generally so light, that People are apt to persuade themselves, that they can easily get rid of them, with­out the Pain of Confinement, or a strict Regimen; and therefore many are seen walking abroad, for some Days, with the Sickness upon them▪ every Hour increasing. And when they are at length forced to lye down under the Burden, which they find them­selves unable to shake off, they often think they act a prudent Part in deli­vering themselves up to the Manage­ment [Page 3]of Persons, who (through a fa­tal, and too common Mistake) are deemed able, and honest enough to cure every slight, feverish Disorder.

III. AND in this Sense it is strictly true, that many ordinary Fevers have been made grievous, and mortal, which, if rightly handled in the Begining, would not have been attended with a­ny considerable Prejudice.

IV. THERE is likewise some Rea­son to suspect, that the commonly-re­ceived Opinion of the Nature of these Diseases has a tendency to retard, and sometimes absolutely to hinder their Cure. The Opinion I mean, is, ‘"that a Fever is excited by a Foulness, or Distemperature in the Blood, which [Page 4]is, for that Reason, called the Febrile Matter; that this Disorder itself is a kind of Instrument which Na­ture makes Use of to clear the Blood of that Foulness; that (as^(a) in the Depuration of Wine, and other fer­mentative Liquors) a certain num­ber of Days is necessary for carrying on, and completing this salutary Work, and therefore that we ought not to think of removing this Fe­brile Matter in the beginning of the Sickness, while it is yet Crude; nor until such Time, as by some parti­cular Signs, it shall be found so at­tenuated, and concocted, as to be fit for what is called a Critical Ex­pulsion out of the Body."’

V. THIS Opinion, I say, seems to be attended with no small Danger on ac­count, among other Things, of the De­lay, and inaction which it necessarily implys on the Part of the Phisitian. And I know not any^(a) Evacuation what­soever (bleeding itself not excepted) which, according to it, can with safety be advised in the Beginning of Fevers; or even until the Signs of Coction ap­pear in them. For, as before this Time, no Separation is made of the pretended morbid Humors from the sound, bleed­ing, and every other Evacuation that is then put in Practice, must indiscrimi­nately take away both; and perhaps, more of the Treasure of Life, than of the Cause of the Disease! And when the [Page 6]Signs of^(a) Coction have once appear­ed, every arteficial Evacuation is, gene­rally speaking, useless, if not hurtful. For, when Nature has of herself done so much towards a Cure in this, or any other Disorder, as to have brought about those Appearances by which the Coction of the Humours is said to be known, she seldom or never stands in need of the Assistance of Art to enable her to complete it.

VI. BUT the Truth is, that this Opi­nion had its rise in the very infancy of Phisick; when Phisitians were rather Observers than Assistants of Nature; which latter, however, they afterwards became in an eminent Degree, by [Page 7]Means chiefly of such Observation; and hence it was that few or no Mede­cines were then prescribed by them in these, or any other Disorders.

VII. IF what we are told concerning putrid Fevers, and the morbific Mat­ter in them be true, viz, that they con­sist as^(a) GALEN affirms, in a Change of the whole Body into Corruption; or, as modern Phisitians more cautiously express it, that they are caused by an Al­kalescence, or Degree of putrefaction in the Mass of Blood, the Case of those who are sick of them must be very de­plorable. For, to omit other Reasons, such a State of the Blood can be amen­ded by no other Medecines, but a suf­ficient Quantity of Acids intimately [Page 8]mixed, and blended with it; but this cannot be done by Acids given in the Usual way; for it is known by^(a) Ex­perience, that all acid Vegetables are very much altered in the Stomach and Guts; and that they are even made al­kalescent, before they are Received in­to the Blood; and it is highly probable, that no Mineral Acids can be admitted through the Mouths of the lacteal Vessels.

VIII. AND such shocking Ideas of any Distemper, when entertained by the Sick, are apt to make it, tho' light in its own Nature, both grie­vous, and mortal. For^(b) great anxi­ety of Mind has often produced dan­gerous, and malignant Fevers in Bo­dies, [Page 9]that were otherwise Sound. And^(a) Writers of good Credit Assure us that, in the Beginning of the Plague itself, Numbers have been seized with that Disease, and Dyed of it, who Contracted it rather through fear of so great an Evil, than by any Contagion.

IX. FROM the critical Evacuations in Fevers having, very often, a strong, fetid Smell, and other Signs of Corrup­tion in them, it has been generally concluded, that they must necessarily have been derived from an infected Source; and that the same morbid State of the whole Mass of Humours must, therefore, have given rise to these Distempers. But it may be as well in­fered that an harsh ill-scented Perspi­ration, [Page 10]to which many People enjoy­ing good Health are subject, can be thought to shew, that the Blood of such People is in a State of Putrefaction, or that their Bodies are infected with putrid Fevers,^(a) If a Vein be opened in these Diseases, while the most faetid Sweat is ouzing thro' the Pores of the Skin, there shall not be found the least, disagreeable Smell, or Taste in the Blood that is drawn. And there­fore all that can be concluded from the above-mentioned Evacuations, is, that as the Matter of them is always obstructed, or otherwise altered in the Emuncto­rys themselves,^(b) (which may happen many different Ways) they must, neces­sarily have something preternatural in [Page 11]them, without implying, at the same Time, any original Impurity, or Cor­ruption in the Mass of Blood, from whence they were derived.

X. ‘"The Humours that are critically cast forth in the Decline of Fevers, says the juditious (b) SYDENHAM on this Occasion, are no doubt vitious, although the Blood was before pure. But this is not more to be wondered at, than that some Part of our Food is made corrupt, and faetid, after having undergone a considerable change in the Body, and been separated from the rest."’

XI. UPON the whole, the Notion of a febrile Matter has not always been so universally entertained by Phisi­tians,^(a) [Page 12]as some would have us believe▪ for we learn from^(a) CELSUS that AES­CLEPIADES, who had many Follow­ers, seemed to shew no Regard to it in the Cure of Fevers. And many emi­nent Phisitians, says^(b) PROSPER AL­PINUS, have maintained that good, and profitable Evacuations have happened in these Diseases, before the Signs of Coc­tion appeared in them. As for pu­trid Fevers, TRALLIAN expresly^(c) assures us, that it was the Opinion of several among the Antients, that they do not arise from the Corruption of any other Humours, but those that are contained in the Stomach and Guts, and that the vital Juices cannot be the [Page 13]Subject of Putrefaction in these Cases. And^(a) SYDENHAM, among the Mo­derns, does not scruple to affirm, that Fevers happen more frequently, without the Concurrence of any vitious Parti­cles in the Blood, than otherwise.

XII. I must observe here, that it was a Point agreed upon by all the^(b) an­tient Phisitians, that DIARY Fevers are not excited by any peccant Matter in­herent in the Blood, or humors; and that they were accordingly cured by them, in a very short Time, and by the simplest Methods. But although these Fevers were formerly accounted harmless, (and in their own Nature in­deed they are so) yet we now often see [Page 14]them made griveous, and mortal, by Ignorance and Neglect. For it is my Design to shew hereafter, that the Fe­vers, which now-adays do so much Mischief among us, for the most Part arise from the same Causes, and are of the same Nature, with the DIARY in their Beginning.

XIII AND it may be no improper Introduction to this Design, to take Notice before-hand, of that dangerous Custom, (so prevalent of late, though contrary to the Sentiments of the best Phisitians,) of Bleeding, Purging, and Vomiting in the Beginning of all Fevers without Distinction. For although these Remedys, when administered with Judgment, are of the greatest Service to the sick; yet nothing is more cer­tain, than that an improper Application [Page 15]of any of them, may make Nature^(a) sink under a Disease, which, if left to herself, she might have easily over­come.

XIV.^(b) BLEEDING has been known to have kindled Fevers in Bo­dies, which, before they had under­gone that Operation, had not the least Disposition to them. And the Wri­tings both of antient and modern Phisi­tians, are full of the strictest Cautions against opening a Vein in some Fevers, which impudent Pretenders frequently undertake to cure by profuse Blood-letting.^(c) HYPPOCRATES was so far [Page 16]from Thinking Bleeding necessary in all Fevers, that he expresly forbids it in some other Disorders, on Account of their having Fevers joined with them.

XV. WHEN, in the Beginning of these Diseases, the Body is known to abound in Blood; when its Veins are turgid, and its Surface red, and inflam­ed, and when the Brain, or any other Viscus, is threatened or attacked by this fullness; and no spontaneous Hemorage ensues; then indeed large, and sometimes, repeated Bleeding, is not only safe, but necessary; but when, on the contrary, these Distempers happen to Persons already weakend by excessive Labour, too frequent Venery, or great Evacuations; or when, from being in­termitting, [Page 17]they become acute and con­tinual; in such Cases I say, Bleeding has been often found pernicious, and always will be so.

XVI^(a) THE giving of purgative Medicines, in the Beginning of Fevers, has been generally forbidden by Phisiti­ans, since the Days of HYPPOCRATES, down to our own Times. Yet nothing is more common, than to transgress this established Rule, on the most frivolous Pretences; and they who do so, never confider that, as such Medicines are always apt to increase the already too frequent^(b) Oscillations of the Solids, they bid much fairer to augment, than diminish these Disorders, and their [Page 18]Symptoms. There is no Question, but that sharp, indigested Humours in the Guts, often produce Fevers, which must cease as soon as these Causes have been removed; but it is equally certain, that this does not happen as often as it is pretended; and that when it does hap­pen, such Fevers do not require, or even admit of, CATHARTICS for their Cure. The following extraordinary Case, and the Observations naturally arising there­from, may serve to put this Matter in a clearer Light.

XVII IN the Year 1738, a Man, of about fifty, was brought to the CHA­RITABLE INFIRMARY on the INS­QUAY, DUBLIN, with a Tumor in his Groin, which in due Time, and by proper Applications, came to Suppu­ration. He had complained, for some [Page 19]Time before he was taken in there, of an Uneasiness, and Shooting Pain in the Part affected, but of no other Sick­ness. However, when this Tumor was opened, some Bones of a Chickens­neck were extracted from it; by which, and the Patients own Confession, it appeared, that he had some Weeks be­fore, hastily swallowed down these Bones unchewed; and that they had gradually^(a) forced themselves a Passage through the Intestine, and the Parts about it, into his Groin. This Man eate, and slept well, when I saw him; and he had done so from the very Beginning of his Complaint, as he himself avered. And, while in the INFIRMARY, he was free from every Feverish Symptom, [Page 20]except what the Suppuration of his Tumor naturally occasioned. Of this I was assured by Mr. FRANCIS DUA­NY, one of the Surgeons of that IN­FIRMARY, who had often visited him while he was there, and by whom I saw some of these Bones taken out intire, with great Dexterity. Mr. DUA­NY likewise informed me, that Mr. KELLY, in his Turn of Visiting, had also extracted, from this Person, some Bones of the same Kind.

XVIII. Now if an Irritation of the Intestines, which was so great, that it at length destroyed Part of their Sub­stance, did not produce any considerable Fever (which as I have said is indeed an extraordinary Case) may it not easily happen, that the so much feebler Stimu­lus [Page 21]of indigested Humours on these Parts, may be often hindred, by the MUCUS which defends them, from having any such Effect? And as in Case a Fever had ensued from that great Irritation, an Attempt to carry off these Bones by a Stimulating Purge, would in all probability, have increased the Evil,^(a) (it being the only safe Method in such Cases, as when Fragments of Glass, Needles, or Corrosive Poisons have been swallowed, to plye the Pati­ent with a sufficient Quantity of such Liquids only, as are fit to soften, relax, and lubricate his contracted Intestines) so, whenever sharp Cruditys in the Stomach, or Guts, have occasioned a Fever, and it is, therefore, necessary [Page 22]to empty these Parts, we should have Recourse to no other Remedys for that Purpose, but such as are lenient, and diluting, and as free as possible from any irritating Quality. Thus^(a) TRA­LIAN, in the Cure of such Fevers, does not once mention emetic, or pur­gative Medicines; but advises the Di­gesting, and Washing away of these Cruditys with plentiful Draughts of warm Water only. And a more ex­cellent Remedy, adds he, I know not for those who, being of an hot Tempe­rament, fall into DIARY Fevers from such a Cause.

XIX. In like Manner, when the Rigors, that commonly introduce Fe­vers, are caused, as they often are, by [Page 23]bilious Humors lying in the Stomach, and a Vomit is therefore wanting to Discharge them,^(a) CELSUS directs nothing else for that End, but warm Water, seasoned with a little Salt. And as the Caution of the Antients, in these Particulars, was wise, and worthy of Imi­tation, so is the Rashness of some modern Practitioners, as much to be dreaded and avoided. For there is, (much oftener than is vulgarly imagined) an^(b) Inflamati­on of the Stomach in these Disorders; and so very latent this Inflamation sometimes is, that it is with Difficul­ty discovered even by the most think­ing, and experienced!^(c) and Vomiting [Page 24]Medicines to an inflamed Stomach are certainly pernicious. It has been besides^(a) observed, that Vomits, when given in such Fevers as, in a particular Manner, attack the Head, have often produced fatal Symptoms in the Course of the Sickness, on Account of that Fullness, and Concussion of the Vessels of the Brain, which they always occasion.

XX. BUT if Bleeding, Purging, and Vomiting in the Beginning of all Fevers without Distinction, have often done Mischief, there is not less to be feared from the too dilatory Practice of those who, as we have already observed, have nothing else in View, in the Cure of these Distempers, but the gradual Correction, or distant Expulsion of [Page 25]some preconceived foulness of the Blood, or Humours. For while such are wait­ing for the imaginary Coction of a FEBRILE MATTER, they are fre­quently Suffering the real Cause of the Disease to take such deep Root in some of the noble Parts, that it cannot, per­haps, be afterwards removed from thence, by any Efforts of Nature, or Art.

PART II. Of the Sentiments of Antient, and Modern Phisitians con­cerning Ordinary Fevers, and the Methods to be used to prevent their becoming grie­vous, and mortal.

I. BY Ordinary Fevers I under­stand such, as happen to the Body, when otherwise sound, and in Health, from outward, or sen­sible Causes; as from the taking of Cold, excesses in Eating or Drinking, immoderate Exercise of Body or Mind, the Suppression of some usual Dis­charge, [Page 27]and the like. The Sentiments of antient and modern Phisitians con­cerning the Nature of these Fevers, and their Events, are briefly as follow.

II.^(a) ALL Fevers proceeding meer­ly from outward, or sensible Causes are, in their own Nature, simply DIARY; so called, from their commonly ending, or declining on the first Day; although they are sometimes prolonged to the second, or third.

III.^(b) DIARY Fevers are not ex­cited by any peccant Matter pre-existing in the Blood; yet they, for (the most Part,^(c) precede other Fevers; and [Page 28] ^(a) differ from them, chiefly by the mild­ness of their Symptoms, and Causes; insomuch, that the^(b) same Causes which, when light, produce only DI­ARY Fevers, will, when more violent, occasion such as are often dangerous, and fatal.

IV.^(c) DIARY Fevers are harm­less in their own Nature, and never be­come griveous, or mortal, until by Ig­norance, Mismanagement, or neglect, they have been first changed into such, as are known by the Name of putrid, hectic, malignant, or the like.

V.^(d) WHEN a DIARY Fever is made by improper Treatment, Igno­rance, [Page 29]or neglect, to exceed the Term of three Days, it degenerates into a Fe­ver of a worse Kind; as likewise when it seems to decline without Sweat, or some dewy moisture on the Skin.

VI. A DIARY Fever then chiefly Turns into that which is called putrid, when the proper Occasion of opening the Pores of the Skin has been neglec­ted.

VII. THAT DIARY Fevers are ca­pable of being changed into such as are very malignant, appears, among many other Instances, from the SWEATING-SICKNESS that prevailed in ENGLAND in 1486. For although this Sickness was called, and, in itself was no other but, the Brittish DIARY Fever, yet by [Page 30] ^(a) Mismanagement in stopping the Sweats, it became very griveous, and did great Mischief.^(b) SENNERTUS informs us, that scarce one Patient, out of an hundred, was recovered from it.

VIII. As the DIARY Fever often^(c) does Mischief before it is known, (and that chiefly because it is not known) it may not be amiss, to transcribe an History of it from FORESTUS, where­in he gives us the Rise, Progress, and Cure of it in his own Person.

IX.^(d) ‘"GOING to see a Patient, says he, that lay at some Distance from me, in a very cold and windy Season, [Page 31]the Pores of my Skin were closed by the Sharpness of the Weather, and I fell ill of a DIARY Fever. It seized me about Eleven o'Clock in the Mor­ning, not with a Shuddering, but with a Coldness that seemed to have pierced my Skin, and Muscles. But after I had placed myself by a Good Fire, I begun to be a little heated, without thirst; and my Pulse became quick­er, but was equal; about four in the Afternoon a Moisture came through my Skin, and I grew better. As I had taken no Nourishment through the whole Day, I then refreshed my­self with a little Ale, in which a small Quantity of Sugar, and Butter was boiled; and about six I went into a warm Bed, where covering myself up, I begun to Sweat. Neverthe­less, [Page 32]about two Hours after, having felt such a Pain in my Stomach, as had like to have made me faint, I took some Pearl-Sugar, by which Means I came again to myself, and my Pain and Anxiety vanished. Then I fell into a Sweet Sleep, in which I past the whole Night, and a copious, Vaporose Sweat exhaled from the lower Parts of my Body. In the Morning, when I found my­self intirely free from the Fever, I ordered the Sweat to be wiped off, having first used long, and gentle Friction, to open the Pores of my Skin."’

X. IT has been already observed, that DIARY Fevers differ from others [Page 33]only in Degree; and as the Proceeding from outward, or sensible Causes is so distinguishing a Mark of them, that^(a) FERNELIUS, and others tell us, even putrid Fevers, when occasioned by such Causes, are necessarily preceded by them, it follows that,^(b) whenever we find ourselves all at once seized, with any of the lighter Symptoms of a Fever, (as with a small Rigor or Cold­ness, to which an unusual Heat, Head­ach, Pain in the Stomach, or other Sickness, attended with a quick Pulse, succeeds,) and are, at the same Time, sensible that these Symptoms have ari­sen from some outward, or evident Cause, we may safely conclude that Fever to be simply DIARY, to which, [Page 34]however a proper Remedy should be immediately applyed, because when these Disorders, light as they are in their own Nature, have been neglected but a few Days, and the Symptoms above-mentioned have been all along felt, gradually increasing, it is to be feared, that they are no longer DIARY; but that they have degenerated into other Fevers, of much greater Danger, and Duration.

XI. THE Method of Cure used by^(a) GALEN, and the antient Phisitians in general, in DIARY Fevers was (be­sides a spare and regular Diet) no other, but that of relaxing the Surface of the Body, and opening the Perspiratory, or surdorific Pores. And although this [Page 35]was done chiefly by external Appli­cations, such as Baths of warm Water, Friction, and Unction; yet inward Means were sometimes found proper for the same End, according to the Nature, and Exigence of the particular Cause. ‘"Thus CASSIUS, the most in­genious Phisitian of our Age, says^(a) CELSUS, cured a Person of a Fever (which was got by Drinking too much Wine, and attended with great Thirst,) by giving him large Draughts of cold Water, and thereby putting him into a Sweat, and making him Sleep."’

XII. ‘"THE same Author^(b) in­forms us, that among the Antients, before the Days of HEROPHILUS, [Page 36]and ERASISTRATUS, and very soon after those of HYPPOCRATES, there was one PETRON, who, when he undertook to Cure any one of a Fe­ver, covered him up with a large Quan­tity of Cloaths, in order to excite a great Heat, and Thirst in him; and afterwards, when his Fever begun to be a little abated, he gave him cold Water to Drink, by which Means, if he made him Sweat, he thought he had extricated him from all Danger."’

XIII. NOR are the Objections com­monly raised against the Promoting of Sweat, in the Beginning of Fevers, of any Force here; for^(a) such Sudorifics only are, in this Case, forbidden by [Page 37]Phisitians, as are apt to stimulate the Fibres too much, and thereby increase the Causes of these distempers. Where­as those Things, which procure that Evacuation by Relaxing the Solids, and by Thining and Diluting the Humors, are allowed to do great Service, in the Beginning, and every other Period of these Diseases.

XIV. AND it is, no Doubt, from frequent, and successful Experience, grounded on this Maxim, that People are generally so fond of Sweating in the Be­ginning of all Fevers. And indeed this Method, when not abused by hot and inflaming Medecines (as it too often is) may be supported by the Authority of several eminent Phisitians.^(a) Doctor [Page 38]HARRIS observes that in the first Infults of Fevers, when the sensible, or insen­sible Perspiration is much obstructed, Sweats, whether natural, or procured by Art, are very beneficial. Doctor^(a) BRYAN ROBINSON has mentioned some Fevers, in which a constant, gentle Sweat in the Beginning, is of much use; and he says, that it often cures them in a little Time.

XV. I have frequently seen, says^(b) Doctor FREDERIC HOFFMAN, poor labouring People, (who had been seized with Fevers by being exposed to the Injurys of the Weather,) safely and speedily cured by Means of a Sweat, which was excited with warm Draughts of the decoction of SCABIOUSE and bles­sed [Page 39]THISTLE in equal Quantitys of Wine and Water. And^(a) another Au­thor assures us, that in Fevers from the same Cause, he has found nothing more successful than, after having first opened a Vein, to relax the Surface of the Bo­dy by a Sudorific Decoction. ‘"And my Success in this particular, adds he, has brought over several Phisi­tians to approve of my Method, who before never thought of giving Su­dorifics in such Cases."’

XVI. I must add, that even pesti­lential Fevers have been cured, by pro­moting Sweat, from their Beginning, as^(b) DIEMOERBROCK,^(c) BAR and others testify from their own Ex­perience. [Page 40]And SYDENHAM affirms that, after he had begun to follow that Method closely, in the pestilential Fe­ver of 1655 at LONDON, he did not lose one Patient out of all those he at­tended in that terrible Distemper.

XVII. BUT the Danger of using^(a) strong Sudorifics, in the Beginning of Fevers, cannot be too often, nor too strictly cautioned against. Of this Dan­ger^(b) Doctor HARRIS has given us a notable instance, in a very distin­guished Personage. He tells us that MARY, Queen of ENGLAND, had once acquainted him in Conversation, that she was accustomed, by the Advice of the famous Doctor LOWER, then sometime dead, to take, about bed­time, [Page 41]time, a pretty large Dose of the Trea­cle of Andromachus, in Order to pro­mote Sweat, as often as she found her­self inclined to a Fever. And although this Conversation happened two Years before the Appearance of the Small-pox, of which she dyed, and Doctor HAR­RIS had given her all the necessary pre­cautions against the Use of that Mede­cine, yet, so great was her Confidence in the Advice of her former Phisitian, that afterwards on the very Night, in which she fell ill of that Disease, she had Recourse to her Dose of Treacle, which not having its usual Effect of making her Sweat (althought it was re­peated next Morning in a double quan­tity) put her Humors into so great a Ferment, that, when the Small-pox, appeared, it was attended with a Spit­ting [Page 42]of Blood, purple Spots, and other such desperate Symptoms, that she dyed of it in a very few Days.

XVIII. FROM this Passage, howe­ver, it is manifest, that Doctor LOWER thought Sweating at the Beginning of Fevers the best Method to prevent their Increase; and that the Royal Patient had before experienced the good Effects of that Method.

XIX. THE famous^(a) BOER­HAAVE, after having warned us against the Use of hot, stimulating Things to remove that Coldness and Rigor, which are felt at the Beginning of Fevers, ac­quaints us, that if, instead of these, we have immediate Recourse to Draughts [Page 43]of warm Water, with which a little Nitre, Wine, and Honey are mixt; and to Bathing, Fomenting, and Wash­ing with the same, that Rigor and Coldness will happily Cease, and all the worst Symptoms of these Distempers be speedily prevented.

XX. DOCTOR^(a) BRYAN ROBIN­SON promotes Sweat in the Beginning of some Fevers, by Means that are not attended with any Danger. To grown Persons labouring under this Disease, he gives a Drachm of the testaceous Powders, in three or four Ounces of Cold Water, every third or fourth Hour; and to Children five or six Years old, he gives half the Quantity of Powders, in half the Quantity of [Page 44]Water; adding this Precaution, that Persons thus treated ought to be Bled and vomited, before they Begin the Use of the Powders, and he proposes this Method, not only in the Begin­ning of Colds and slight Fevers, but also in high inflammatory Fevers in young Bodies.

XXI. THE Sudorifics, says Doctor^(a) HARRIS, which are the Use in the Beginning of Fevers, ought to be mild and temperate; not dry, spirituous Things, taken from the Apothecaryes Shop, but liquid and simple, Such the Kitchen affords; Things, which by their Quantity, will yield Copious Matter to the Sweats, and call them [Page 45]forth, not by any innate Heat, but by externall, and acquired warmth.

XXII. IT was, no Doubt, by causing an easy and general Relaxation of the Surface of the Body, that Baths of warm Water antiently acquired the universal Character of being a certain Cure in DIARY Fevers. For Perspi­ration, from Bathing in warm Water, has been observed by^(a) KEIL, to arise to the Quantity of a pound, and an half in the Space of an Hour. And there is this further Advantage in perspi­ration thus caused, above that which is promoted by Exercise and Motion, that the large Evacuation in the former Case, does not lessen the usual Perspi­ration in the subsequent Hours, as it [Page 46]always does in the Latter.^(a) TRALLI­AN advises those who Labour under a Causus or burning Fever, to have them­selves bathed all over in warm Water. And^(b) PROSPER ALPINUS not only gives the same Advice, in Fevers that are called putrid, but he likewise in­forms us, that the best Phisitians among the Antients, made Use of this Reme­dy in almost all Kinds of Fevers.

XXIII. I shall conclude this Head with a Passage from CELSUS, relating chiefly to Diet, wherein are Directions to prevent the Increase of Fevers from their Beginning, given with such Ex­actness, and promised Certainty, that they very well deserve to be transcribed at Large.

‘"If any Signs of approaching ill­ness appear, says that^(a) Excellent Writer, the best of all Remedys are quiet, and abstinence. If the Per­son indisposed must Drink, let him Drink Water; and generally speak­ing, it will be sufficient for him to keep to that Drink for one Day; sometimes, if the Symptoms still re­main, it will be necessary to continue it for two. Next to abstinence, a very spare Diet is proper; with which Water must be drunk one Day, and Wine the next; and so on, until all Cause of Fear is re­moved. By these Means an heavy, and iminent Disease is often preven­ted. And many are deceived, who think to put of a Beginning Sickness, [Page 48]by Exercise, or Bathing, or Purging, or Vomiting, or Sweating, or the Use of Wine, on the first Day of its Appearance. Not that these Things have not sometimes a good Ef­fect; but because they are oftener attended with a bad one; while ab­stinence alone Cures without any Danger; for it may be lessened, or increased according to the Degree of the Sickness; insomuch, that, if the Symptoms be light, it will suf­fice to abstain from Wine only, the Disuse of which in this Case, will be, of more Service to the Sick, than lessening the Quantity of his Food can be. And although his Complaints should be somewhat greater, it will be enough to forbid him the Use of Flesh in his Diet, [Page 49]and to confine him to the Drinking of Water. Sometimes, indeed, it will be necessary to allow him less even of Bread than usual, and to tye him down to a moist Herb-diet. And should even the Signs of a violent Distemper treaten him, it will be sufficient to abstain intirely from Food, the Use of Wine, and all Motion of the Body. Nor is it at all to be doubted, that scarce any one hath fallen into an heavy Fit of Sick­ness, who has seriously, and in Time, taken those Methods to prevent it."’

XXIV. I must observe by the Way, that when CELSUS acquaints us, that many are deceived, who think to put off a Beginning Sickness by Bathing, or Sweating &c he ought to be pre­sumed [Page 50]to mean those Pople, who place their intire Confidence in such Me­thods, without having at the same Time, any Regard to abstinence and quiet.

Part III. Of the Production of the Symp­toms of Ordinary Fevers, as evidently deduced from Expe­rience and Observation.

ALTHOUGH^(a) it be ex­tremely difficult, to give an exact Definition of the Nature of Fevers, on Account of the great Variety of their Causes, and Symptoms; yet we are sure to find in all Bodies, affected with them, a SICKNESS, that is generally brought oh by a COLDNESS and SHUDDERING, to which a BURN­ING [Page 52]HEAT succeeds; and lastly a SWEAT breaks forth, by which an End is put to all the Symptoms.

AND it is plain, from^(a) the dry­ness, and Contraction of the external Parts of the Body, in the Beginning of these Distempers; from the Smallness of the Pulse, the Coldness of the Hands and Feet, and the Subsiding of the Vessels in them: from the Breathing difficult, and the Feeling of Blood, as it were, boil about the Praecordia; ‘"from all these Things, I say, happen­ing in the Beginning of Fevers, it is plain^(b) that the vital Fluids are, then, first driven, from the Surface, of the Body, into the internal, large [Page 53]Vessels, and towards the Heart; and that these Fluids are, afterwards, by the increased Contraction of the Heart, and Arterys, swiftly and for­ceably pushed outwards into the nar­rower Vessels; until such Time as, by the Removal of the Spasms, the usual Secretions return, and the Fever ceases."’

THIS retrograde Motion of the vital Fluids from the constringed Surface of the Body into its Center, has been long since discovered, and accurately descri­bed by^(a) HYPPOCRATES himself. For, treating of the Beginning of Fevers, he tells us, ‘"That the Blood, then, creeps over the whole Body, and runs together into its warmest Parts. [Page 54]— But, when, continues he, the Blood has FORSAKEN the EXTRE­MITYS, the Bowels and the Flesh tremble. For some Parts of the Bo­dy are replenished with a great Quan­tity of Blood, and others are left bloodless. And those Parts, which the Blood has forsaken, cannot rest through Cold, but are shaken; and those Parts, which are filled with a great Quantity of Blood, tremble on account of that fullness, and INFLA­MATIONS are excited in them."’

A remarkable Instance of the great Power of the constriction of the Surface, in repelling whatever is therein con­tained, into the larger Cavitys of the Body, we find in^(a) BAGLIVI, who [Page 55]informs us, that when he had opened a very strong Man (who had dyed of a Fever that begun with violent Rigors, succeeded by Convulsions,) almost all the Fat, which had layn towards his Skin was by the great Contrac­tions of the external Fibres, driven inwards to the Center; and that in such Quantity, and so dissolved, that his lax, and flaccid Intestines were found swimming in it.

FROM hence it follows, that the first apparent Symptom of a Fever is a Con­striction, Coldness, Rigor, or Trem­bling in the Surface of the Body, which, by driving the Blood in great Quanti­ty, from thence into the inner, and larger Vessels, and thereby preternatu­raly [Page 56]distending them, is the^(a) Cause of that Pain in the Head, Back, or Breast; of that Heat, Thirst, Anxiety, and Op­pression about the Heart, and all the other Griveances that commonly attend this Disease.^(b) Thus the greater the Coldness, or Rigor is, at the Beginning of Fevers, the more dangerous always are these Distempers; and the Cold­ness, which Ushers in the Plague, is generally greatest. Thus likewise what­ever Occasions a considerable, and last­ing Constriction of the Surface of the [Page 57]Body, as^(a) Bathing in Waters that are too hot, or astringent, is apt to produce Fevers of all Sorts. And, on the other Hand, whatever brings about an early Removal of this Rigor, or Constriction, and thereby promotes an easy, and universal Moisture of the Skin, will (as we have already shewn at large in the second Part of this ESSAY) speedi­ly prevent all the worst Symptoms of those Disorders.

THE Truth of this Reasoning is further confirmed, by the prognostic Signs that are observed, both in Bodies recovering from these Distempers, and in those that are dying of them. For as to the first, Experience and Obser­vation [Page 58]have always shewn us, that no Fevers are completely cured, until the Skin, from being dry, and contracted, becomes all over^(a) soft, relaxed, and moist. And as to the second, it is well known, that the Continuance, and Increase of the Contraction of the Skin in the decline of these Disorders, (which^(b) Cold Extremitys, the Temples col­lapsed, the Nose sharpened, the Eyes sunk, and the Drying up of Issues, and Ulcers plainly indicate) are but too of­ten the certain fore-runners of Death.

AND the Reason of these Prognostics is very evident, and naturally flows from the Idea we have given of Fevers. For, as the sick then only recover from [Page 59]them, when, by the Removal of the Spasms in the superficial Parts of the Body, a free Passage is again opened to the Humours that way, from the over­loaded VISCERA, (as in a complete and salutary CRISIS) so, by a too long Continuance, or great increase of these Spasms, and by the morbid Full­ness and Distension of the Parts with­in, consequent thereto, the Heart, and Brain must, at length, be intirely disabled from performing those Func­tions, on which the Lives of all Ani­mals do absolutely depend. For this Reason it is, that the sick are in^(a) great Danger in continual Fevers, when, after a Rigor or Shuddering, they do not grow warm. Hence like­wise those who dye of intermitting Fe­vers, [Page 60]commonly expire in the Cold Fit. And in all dead Bodies the right Ven­tricle of the Heart is found very much distended with Blood.

FROM what has been said, it follows that CRUDITY in Fevers, so much talked of, and so little understood, is in Truth nothing else, but an^(a) ir­regular, and devious Motion of the Vital Fluids, from the constringed Sur­face of the Body, into the VISCERA, causing such a Fullness, and Distensi­on in them, as are apt to produce the usual Symptoms of these Distempers; and that their CRISIS, therefore, con­sists, not in the Expulsion of any mor­bisic Matter out of the Body; but on­ly in the Removal of that Constriction [Page 61]of the Surface, and in an Opportunity, thereby, given to Nature to restore to the vital Juices their due, and regular Motion through all their usual Chan­nels. Wherefore the Evacuations, com­monly happening in this Period of Fe­vers, ought to be looked upon meerly as the Effects of that general Relaxation of the Solids, which then always ensues; and to be helpful to the sick, in no other manner, but by taking off that extraor­dinary Fullness in the Bowels, from whence all their Complaints arose.

AND, although, when these Diseases are left to themselves, and Art does not interfere with them, these Evacuations, for the most Part, happen on certain Days, which are therefore distinguished by the Name of CRITICAL; yet we [Page 62]often find the Matter otherwise, when proper Remedys have been administered from the Beginning, in order to put a Stop to them. For which Reason^(a) modern Phisitians pay not altogether so scrupulous a Regard to those Days, as the Antients have done; who were more employed in observing the Pro­gress, and Changes of Distempers, than in applying Medecines for their Cure. Thus we have already shewn, from the concurring Testimonys of the best Phisitians, that an End may be put to ordinary Fevers on the first, or second Day of their Appearance, though nei­ther of these Days was ever accounted CRITICAL.

IN this manner, may be explained [Page 63]both the Symptoms, and Events of or­dinary Fevers, as arising solely from a preternatural Change in the Solid Parts of the Body; and without having Re­course to hypothetical Conjectures of their being caused by any acrimonious Impuritys in the Blood itself. For it is highly probable, that no such Impuri­tys can be admitted through the ex­tremely small, and delicate Orifices of the lacteal Vessels; and that as well on Account of the great Irritability of these Orifices, (which the Contact of every thing that is acrimonious must immedi­ately close) as likewise, because these Vessels are formed only for the Recep­tion of such a Liquor as may contribute to the Nourishment, and Preservation of the Animal, or at least is not destruc­tive [Page 64]of it. Thus we says^(a) HE­QUET, that a sower Chyle is always refused by them, and cast out of the Body in loose Stools. Or, if any such Impuritys, wrapt up perhaps in smooch Chyle, should be suffered to pass through these Vessels into the Blood, Nature has provided various Outlets to discharge them by; and more Superfluitys of any Kind, than can be readily dis­charged by these Outlets, it is not rea­sonable to think she will receive.

IN the Progress of Fevers indeed, when, by Means of the Spasms in the Surface, Obstructions have been alrea­dy formed in the Bowels, and the usual Secretions have been stopt, the Blood may become too thick, or otherwise [Page 65]impure, as slow-moving, or stagnating Waters may be foul and corrupted;^(a) but as this happens only secunda­rily, and by accident, it ought to be considered, in these Distempers, meet­ly as a Symptom, but never as a Cause. Thus it hath been observed, that Fevers frequently happen to Bodies,^(b) whose Humours are pure; though these Hu­mours may be afterwards tainted in the Course of the Sickness. And it has been always remarked, that^(c) putrid Fevers themselves are most incident to Persons, of a found, laudable, and well-conditioned Blood.

THAT the Tenacity of the Blood, in these Diseases, is in Truth nothing [Page 66]more than the Effect of those Rigors at the Beginning of them, which slac­ken, and obstruct its Motion in the su­perficial Parts of the Body, appears, I think, from hence, that, if Blood be drawn during those Rigors, it shall be found so thick, and tenacious, as to pass with Difficulty through the Orifice that is made in the Vein; but it will be much thiner, and come out with greater Freedom, if it be drawn either sometime before those Rigors have been felt, or when they are abated.

AND, in general, the Appearances of Blood drawn in these, and other Distempers, are so various and uncer­tain, that a prudent Phisitian will hard­ly lay any Stress upon them in Chusing his Method of Cure.^(a) BAGLIVI [Page 67]has observed, that almost all those have been recovered from acute Diseases, whose Blood, when drawn, was cove­red with a White, and Chylous Crust; which, however, is vulgarly looked upon as a Mark of bad, and even corrupted Blood. And^(a) FREDERIC HOFF­MAN informs us, that he has often seen Blood, taken from scorbutical and hectical People, that was elegantly Red and fluid, while that which had been drawn from sound, and healthy Persons, was thick, black, and glutinous. And I have observed,^(b) continues he, Blood to flow from Arterys opened in a virulent Cancer, which was fluid, of a fine Red Colour, and in all Ap­pearance, [Page 68]without Fault.^(a) BAL­LONIUS affirms, ‘"that impure Blood has been taken from many, whose inward Parts appeared, after Death, to have been sound; and that pure Blood has been drawn from others, whose Lungs, and Bowels have been found to be rotten."’

ALL Attempts therefore to cure Fevers by directly attenuating the Blood; or by correcting, or expel­ling any morbific Matter supposed to be in it, must be vain, and fruit­less; inasmuch as they are levelled, not at the Causes, but meerly at the Effects of these Disorders. And in­deed, that the rectifying of the so­lid Parts of the Body, ought to be the Phisitian's chief Care, in these [Page 69]and other Diseases, seems reasonable from this Consideration, that the^(a) Operation of such Medecines, as have been found successful against the most dangerous and obstinate Distempers, is, in all Probability, confined to these Parts; and that they produce their most salutary Effects, in the^(b) Stomach and Guts, by affecting prin­cipally their nervous Coats, and other Parts of the Body by Consent only. We have already observed, that acid Medecines, which are allowed to be of great Use in Fevers, are intire­ly changed in the first Ways; or at least, soon after they have been receiv­ed into the Blood.

IT now remains to shew, by what Means that Rigor and Constriction of the Surface, from which, we have proved, all the other Symptoms of Fevers arise, are themselves produced; and these Means I take to be no o­ther, but those very Things which are commonly called the remote Cau­ses of these Disorders; viz. Cold tak­en, Excesses in Eating and Drinking, the Suppression of some usual Dis­charge, Trouble of Mind, and other Accidents of the like Nature, when great and sudden.

FOR, First; as to Gold taken, a Rigor and Constriction of the Surface, and a Fever thence ensuing, are such com­mon and obvious Effects of it, that all Proof on this Head is unnecessary.

Thus the^(a) antient Phisitians gene­rally attributed the Rise even of pu­trid Fevers, to no other Cause, but the Obstruction of the Pores of the Skin.

SECONDLY; Excesses in Eating and Drinking are apt to leave Crudities in the Stomach, which, by remaining there for a certain Time, grow acrid, and vellicate its nervous Coate; and from thence a Rigor or Constriction may be propagated, by Consent, to the Surface of the Body. Of this Consent of the Stomach with the Skin, we have a plain Proof, in those who are apt to shudder after having taken Things that are acrid or sower. And CEL­SUS, [Page 72]FERNELIUS, and ETMULLER plainly insinuate, that the Cause of those Horrors, which commonly in­troduce Fevers, often lies in the Stomach only.

THIRDLY; In the Suppression of every usual Discharge, especially when great and sudden, there is a morbid Fullness, in the Vessels, from whence the Discharge used to be made; and this Fullness, must neces­sarily occasion a Spasm, or Constricti­on in other Parts; but in none to such a Degree, as in those at the Sur­face and Extremities, by Reason of their great and general Consent with all the rest of the Body. Thus^(a) [Page 73]HYPPOCRATES has observed, that a dangerous Rigor ensues upon the untimely Suppression of the Purga­tions of Women in Child-bed, or af­ter a Miscarriage. And hence, on the other Hand, Baths of warm Wa­ter^(a), by relaxing the Skin, invit­ing the Humours thither, and open­ing the perspiratory Pores, are apt to remove Obstructions in the inner Vessels, and by that Means, often renew those Discharges from them, which had been supprest.

LASTLY, That Trouble of Mind occasions Fevers by affecting the Sur­face in the same Manner, appears [Page 74]from the Method of Cure, success­fully used by the antient Phisitians in the Beginning of Fevers so caus­ed, which was no other, but Fric­tion, Unction, and the warm Bath.

THUS have we assigned for the Production of those Rigors, that gene­rally usher in Fevers, Causes, which are plain and sufficient, and may be easily removed, together with their ill Effects, by a timely Application of^(a) proper Remedies. And we have excluded, from that Denomination, such Things only as, whatever may be thought of them, have been proved to be meerly Effects of these Distempers, hardly, if at all, to be come at by the Medecines usual in [Page 75]these Cases, and which, therefore, serve for no other Purpose, but to terrify the Sick, and mislead the Phisitian.