inferred a disease since the blood also because it 's a fluent matter cannot justly deserve the name of a part but a cause of a disease or the vehicle of it Thirdly The bones cartilages and ligaments are not sensible of heat neither are they subject to receive any putrid heat because in a Fevor they are seldom or never observed to be taken with a putrefaction or rottenness how can then a Fevor be termed a preternatural heat of all the parts Likewise Fourthly Why ought the name of Fevor to be attributed to a fevorish heat more than to a shaking or fevorish coldness in the beginning of a paroxysm of a Fevor both the former and the later flowing equally as symptoms from a Fevor Fifthly An universal heat is erroneously ascribed to a Fevor for in a lipyrious Fevor a torrid heat doth torment the internal parts though the externals are cold moreover it oft happens that the hands and feet are stiff of cold and the entrails do in a manner glow with a burning heat Furthermore it may be observed that a Fevor doth sometimes only haunt one single part as the foot or hand Neither have I forgotten a certain Fevor whose heat extended no further than the head and face Hereunto add that those particular Fevors are not only inferred to be such because of the preternatural heat but also by reason of the preceeding cold shaking and ulcerous lassitude Sixthly those that swell so much with the Doctrine of Fermentation they do not altogether affirm that it is a preternatural heat that constitutes a Fevor since the forementioned heat doth take its rise from a heap of influent spirits striving to expel humours and such small bodies as are annoying which heat ought therefore rather to be judged natural than against nature In the second position we maintain that the heat that attends a Fevor is not always kindled in the heart as if the primar hearth were there which assertion is proved from the kinds of symptomatick Fevors for the Fevor that surprises a wounded patient or one that 's detained with an inflamation of an entrail as the Spleen Liver or Kidney certainly it 's not first kindled in the heart but in the part affected whence afterwards it 's dispersed throughout the whole structure Secondly If the heart were the only brand of fevorish heat the blood that passeth through its ventricles should retain a mark of being burnt and undergo some change of tincture when on the contrary thousands that have been bleeded in Fevors their blood that was extracted hath appeared to the eye to be of a pure scarlet and florid until the fourth and oft until the sixth and eighth day In the next paragraph I have thought fit to please my self with the examination of the vulgar opinion concerning the common seat of continual putrid Fevors intimating it to be the blood seething in the vessels and stained with putrefaction but how grosly this rabble of Physicians is mistaken may be extracted from what shall be proposed First If the sprout of a continual Fevor were ingraffed on the blood it would not be so refractory to cure but consisting of fluid and moveable elements by means of alteratives purgers diaphoreticks and emptying the vessels by opening a vein might in a short time be reduced to its former purity and temperament moreover through one nights seething of the blood nature doth oft expel those thin little bodies that float in it and the grosser it casts forth into pustules botches and other such tumors Secondly I cannot grant that what is stirred by motion and continual flowing as the blood is that it is easily taken with putrefaction for being full of vital spirits and living heat it 's held in a continual motion Thirdly Until the third fourth sixth eighth or tenth day computing from the beginning of the distemper according to the degree of the height of the Fevor the blood at the first phlebotomy is extracted pure and florid as I have observed in hundreds whence it 's evident that the primar matter of putrefaction and the seat thereof is erroneously placed in the blood though afterwards passing the entrails it be stained with a malignant quality loading it self thence with hot Miasms and Salts Fourthly pure phlegm or veiny gelly being watered with an immoderate quantity of a pale green and blew lymph or whey since it makes two thirds of the blood in the veins of those that are troubled with the Dropsie Green-sickness and other kinds of diseases why is not that blood which is so heterogeneous and so far remote from a temperature moisture abounding and the plurality of particles breeding putrefaction always forced into a fevorish heat And on the contrary why are hot and dry temperaments where choler is abounding constantly so inclinable to putrid Fevors whereas dryness doth so particularly resist putrefaction Summarily the blood according as I have asserted in the premises since upon no pretence it 's to be accounted among the parts of the body doth utterly exclude it self being capable to be a seat place or part affected If peradventure you doubt that I have hitherto receeded from the path of the received doctrine stating the heart or other entrail the seat in Fevors you have the liberty to take it from the fountain what is to be concluded concerning the matter Avicen fen 1. lib. 4. tract 2. cap. 43. dictates thus Dicamus quod Febris sanguinis est Febris putredinis Febris calefactionis ebullitionis that is Let us say that a Fevor of the blood is a Fevor of putrefaction and a Fevor of heat and ebullition Here is to be noted that the blood is inferred the subject matter and seat of a putrid Fevor Also Galen lib. 2. de Cris. cap. 12. Manentibus igitur in venis humoribus continuae ex ipsis Febres generantur that is The humors remaining in the veins continual Fevors are engendred out of them Likewise Aetius tetrab 2. Serm. 2. cap. 74. Putrescentes igitur humores aut intra vasa arctati continuas nunquam intermittentes usque ad perfectam morbi solutionem Febris efficiunt that is Wherefore humours putrefying or streightned within the vessels do cause continual Fevors and never intermitting until the perfect solution of the disease Here by the way observe though according to Galen Fevors are seated in the veins by their name Arteries are also described as lib. 1. de Crisib cap. 7. it 's by him more largely expressed Febres omnes sunt passiones venarum itaque in Febribus omnibus quoniam venosi sunt generis passiones nam arterias in hoc genere comprehendimus ad urinas praecipue attendere oportet the English is All Fevors are passions of the veins wherefore in all Fevors because they are passions of the veiny gender for we comprehend the arteries also in this gender we ought chiefly to heed the Urins On the other side they have destined the seat of intermittent Fevors to be without the vessels
the same manner if you pour some drops of those forementioned volatil liquors into a small quantity of blood though crude and phlegmatick you will digest it into laudable blood and preserve it warm and slorid but upon dropping some oyl of Vitriol into it it turns immediately into a curd the serum or whey is depressed downwards and assumes a purple red colour Spirit of Nitre doth pervert the redness into a whitish or ash colour but doth not precipitate the whey suffering it to swim a top Upon the further pursuit of the matter I dropt a drop into a large proportion of blood almost coagulated whereby almost in a moment the tye of the coagulative particles was dissolved and indued with a shining lustre not at all inferiour to the best digested blood Neither doth it only from this external use deserve to be termed so admirable but that in a short time being used inwardly as I have oft made trial it hath singularly digested the crude blood of Asthmaticks Scorbuticks and of worfer habits A consistency between thick and thin signifies a vigour of concoction chiefly to be ascribed to the volatil salt living in the vital Bitumen The causes of the thinness or tenuity of urine in those that are sick of a Fevor are the scarcity of volatil and sixt salts not being separated from the torrent floating through the great vessels also the drying away of the mucilage of the blood through the heat or its dissipation through the pores The thickness of urine is occasioned by the whey or serum imbibing too great a quantity of salt and thick mucilage Touching the matter of the hypostasis or settlement of the urine there hath hitherto but little certainly been stated among Authors though most are of opinion it proceeds from the superfluous humour of the third concoction To me the sediment appears to be a mucilage partly imbibed by the serum or whey within the vessels partly deterged from the slimy substance of the intern tunick of the ureters and bladder wherewith they are liquored to prevent their most exquisite sense be not hurt by the urine that flows by This mucilage if you examine the Chamber-pot shall be found to be a glutinous thick and slippery slime moreover that it 's dissolvable by heat and apt to be thickned by cold like phlegm may be observed in turbid urines which as long as they continue warm after they are made are clear and perspicuous but a little after growing cold are turned into turbid and dark being deprived of the energy of the particles of hot volatil salts that dissolved the slime for if you do but hold the urinal a moment to the heat of the fire or hold it in warm water they will resume their former shape of clearness Bubbles that oft swim a top the surface I judge ought not to be imputed to a slatuous but lixivious constitution of urine for ashes soap and other lixivious things being dissolved in water render it subject to turn frothy and bubbly with the least stirring The colour consistency and contents are chief universals whence a Physician may extract what preternaturals lye hidden in the body The colour discovers the active qualities of the salts the consistency the state of the serum or whey and the contents the quantity of the foresaid salts and other excrements that had performed their office a further and particular explication of all these relating to the kinds of Fevors shall be reserved to the sequel of the book Lastly it is to be noted that in the contents are included the enaeorema and hypostasis CHAP. IV. Concerning the true and Spurious Essence of a Fevor IN the first Chapter we had hinted at the definition of a Fevor what concerns its explication we have partly referred hither That a Fevor is a derivative from the nature of fire is abundantly suggested from its destructive manner of acting most fierce heat the tongue and roof of the mouth being crusted with a black smoak likewise from other symptoms thence proceeding as thirst dryness and roughness of the skin and inflammation of several parts Here the Reader is to assume that the vital Bitumen of the heart and the whole body being kindled into a fire is the disease or Fevor or rather that the fiery distemper of the heart and the whole body or part is the disease but not the preternatural heat being that's rather to be counted a symptom immediately flowing from the disease in no wise differing from the manner the heat emanates from the fire Wherefore the definition which is extant among Academick Authors as Fernelius Sennertus and others ought justly to be rejected To wit A Fevor is a heat against nature kindled in the heart and from thence by means of the spirits and blood diffused throughout the whole body and doing hurt to all the natural actions The objections against this definition I offer you in these positions First I assert that the essence of a Fevor doth in no wise consist in an universal heat nor secondly that the heat which attends a Fevor doth not altogether arise from sparks glittering in the heart The argument that confirms the former is taken from the genus of a Fevor which is stated a disease but a disease is said to be the constitution of a part hurt or injured which kind of saying doth not at all agree with a preternatural heat that depends on the burning fixt Bitumen of a part or oft on miasms or steems blown from the heart the receptacle of the fire to all or most parts of the body but those torrid miasms are not to be taken for the disease but causes that in process of time through their heat may occasion a disease Here may be offered a probable objection that a Fevor is the kindling or heat of the influent spirits of each single or more parts whose hurt is to be imputed immediately to the heat of the spirits whence a Fevor may justly be judged a heat Hereunto must be replied that the name of a part of the body can in no wise be given to the spirits because they flow continually neither are they in any manner permanent but are assigned for the animation and nutrition of the parts and for that reason their distemper ought not to be taken for a disease if notwithstanding the subversion of the temperament of a part should flow from a tumult of the influent spirits and that thence they should be incapable of performing their offices nevertheless because it 's a mediate affection and to be derived from the burning of the spirits it 's not to be taken for a disease but a cause Secondly If from the general opinion you have a mind to instance that the putrid heat of all the parts of the body is a Fevor to wit a continual putrid one supposing likewise that the said heat is risen out of the blood only being through its means conveyed to the sanguin parts I answer it ought not be
as appears here and there by the writings of Galen and Avicen Notwithstanding I can scarce apprehend the foundation of these seats wherefore I desire to be satisfied in this doubt whether continual Fevors are said to bud forth in the veins because the blood that leaps out upon phlebotomy doth appear hot to the touch and shews deep red being mixt with a blew milky or yellowish whey But this blood is not different from any other that 's extracted in an intermittent Fevor or any other disease And whether the difference of seats is expounded to be such because the blood within the vessels having an immediate commerce with the heart is capable to foment a strong heat whereas entrails that are more remote from the heart do only by fits profuse those putrid and fevorish steems and under that shape do occasion an intermittent heat Certainly not Moreover the entrails being tyed to the vessels are not less commodiously situated by means of these small chanels that tend directly to the heart to foment a fevorish heat than if the cause were engendred within the foresaid vessels or whether because the vessels are of a just capacity wherein they may receive such a quantity of fevorish matter as may suffice to nourish a Fevor without intermission whereas the entrails are stated to be streight and not provided with a hollowness to retain matter enough On the other hand the entrails according to what the thing requires ought to ingurgitate a larger quantity of matter which might suffice to protract an intermittent Fevor to some months and years as doth oft happen But to touch the knot of the difficulty the cause of the continuation intermission remission and intention of Fevors is not to be imputed so much to the quantity as the quality of the fevorish matter as hereafter shall be treated more at large In the precited definition the heart is idly stated the part primarily affected for thence would follow that the greater part of Fevors should be mortal because the composure of its temperament being once subverted is not easily restored Secondly Suppose an inflammation of the Liver or other entrail attended with a Fevor which do you think the part primarily affected the Heart or Liver CHAP. V. Concerning the fopperies of Fermentation ALmost every Barber and Plaster-spreader have got the knack to buzze every patient in the ear the song of fermentation and know how to fit the tone of it to every disease but chiefly to a Fevor illustrating the exposition thereof with this commentary that the blood fermenteth and the humors are in a fermentation likewise the ferment of the Heart Spleen Liver and it may be of the Fundament too if they go not orderly to stool is depravated moreover if a Corn of the Toe doth but ake the distempered ferment is the cause of it Summarily fitting the word ferment to every disease cause and symptom they conceive the case to be very well handled and thence tell the Patient they will expel the disease by correcting the serment and so as if they had done their business mighty well they send the Patient home swelled with hopes Concerning this abstruse Philosophy borrowed from certain theorems of the Wine-press and chymical notions Anthonius Guntherus Theobaldius Hoghelandius Felicianus Betera Conringius Martinus Kirger and others have prosessedly treated whose Treatises if you peruse you will find the word fermentation to serve in divers significations the one in a large sense gives the description of it not at all different from Peripatetical mixtion excepting that this performs its task by qualities the other by action and reaction But fermentation in a narrower signification as it relates to fluids is stated an effervescency of any liquor tending to concoction At present we will examine whether a Fevor be a fermentation or effervescency of the blood To the resolving of this we must resume from what hath been said in the foregoing Chapter that a Fevor as it is a disease of the body doth necessarily inhere in a part as its subject and foundation but the blood cannot perform the office of a part therefore neither a Fevor or fermentation can be properly attributed to it Secondly Neither can the blood fermenting be probably conceived to be the continent cause of a Fevor because its fluid mixture is absorbed in a few days whereas a Fevor is protracted to some weeks Suppose a fevorish Patient to contain four and twenty pints of blood in his vessels whereof a quarter of a pint is consumed every day by abstinence and dissipated away through the pores into vapors and some days a whole pint or at least three quarters are drawn off by phlebotomy for it 's very familiar amongst the French the first and second opening of a vein to extract a whole pint of blood and every bleeding afterward which is commonly every other day to take away two Porringers containing three ounces a piece by this computation the whole mass should be drawn off in two weeks or less and consequently the fermentation must be quieted and stopt and the Fevor expelled But on the contrary if you should extract blood forty times as I have oft observed in France they have done the height of the heat will not be half a degree abated but rather augmented Who would then maintain the blood boiling through fermentation to be the cause of a Fevor However this experiment is observed to be true if you take off the third part of any liquor that is a fermenting whether of Wine Beer or any other mixture it will immediately be taken off from working but ofttimes the blood is tapt off to the half and sometimes to the last fourth part without the least quieting of the fermentation if I may call it so Possibly you reply that according as the vessels are emptied by bleeding sweating and other torments they swell up again by the food and drink that 's daily taken On the contrary there is a thin Diet ordered to such as are in a Fevor neither do most in the whole course of a Fevor allow their stomach so much as whereout the sanguifick faculty may engender a pound of blood add hereunto that their appetite for fourteen or twenty days is quite dejected But you reply that they take as much food as answers what is consumed to this I return that the blood which is daily ingendred and newly admitted into the vessels either it 's pure or stained if the former then it ought to dilute and temperate the fermenting mass which it doth in no manner do if the later it is not to be doubted but that it hath contracted its stain from the concocting and depurating entrails whence follows that the primar and principal cause is not to be attributed to the blood but the entrails Thirdly It 's confirmed by experience that fermentation doth happen to any mixt liquor and soft compositions as paste or dow electuaries and others which is observed to be a mild working of
A THEORETICAL AND Chiefly Practical TREATISE OF FEVORS Wherein it 's made Evident that the Modern Practice of curing continual Fevors is dangerous and very unsuccessful Hereunto are added several Important Observations and Cures of Malignant Fevors not inserted in the former Impression Written in Latin by Gideon Harvey M. D. Physician in Ordinary to his Majesty Now rendered into English by I. T. and Surveyed by the Author LONDON Printed for William Thackeray at the Angel in Duck-Lane 1674. TO THE Physical Reader I Have long since observed that Physicians did not cure continual Fevors but rather did render them mortal Though if by good fortune any one hath been delivered of a Fevor it is only to be imputed to the strength of nature which if she had not been disturbed by improper means would have disintangled her self from the disease much sooner and with less danger The cause of this so unfortunate practice depends on a false supposition of fermentation whence since they desume erroneous indications the success must necessarily frustrate their expectation I confess I have made use of the term of fermentation in several Treatises and possibly in the illustration of Fevors but to this intent only that I might in some manner be complaisant to the received opinion of the times not in the least imagining the notion thereof necessary or contributing any whit to the knowledge or cure of Fevors Moreover the Reader is to take notice that at present I have not written or acted the part of a Professor in the Chair making a Methodical and Pedantick Lecture on the definition division next the causes then the Diagnostick and afterward the Prognostick signs of Fevors c. But it is my purpose to discourse succinctly of such things as are most necessary for a Practical Physician and of such other cases as I could call to mind since the time when I had seldom less in cure than two hundred Patients that lay sick of Fevors What concerns other theoretical notions and farther observations touching the several kinds of Fevors I shall hereafter propose them in distinct Sections in the mean time farewell Hatton Street near Holborn THE BOOK SELLER TO THE READER TAking my measures from the reception of the Latin Copies I judged I should do the publick service in causing this Treatise to be faithfully translated and that it might be attended with a greater welcom I have obtained the favor from the Author to make a superficial survey of the Translation and to insert the addition of very remarkable and important observations and cures which have rendred the Treatise at least a fourth part bigger than it was before in having procured this I doubt not but that you will easily believe I am your Friend and Servant W. T. A Theoretical and Practical TREATISE OF FEVORS CHAP. I. Of the Nature of Innate Heat IT is usual among Authors to derive the name they intend to impose upon the distempers of parts from the chiefest symptom whence the word Febris or Fevor being taken from fervor i. e. heat or from februa a sort of fiery sacrifices of the Antients or from the verb februo i. e. I cleanse likewise 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 in Greek a Fevor from 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 a fire seem to be applied to this distemper The word Fevor in English is certainly derived from fervor heat only leaving out the r and therefore ought to be written Fevor and not Fever unless you derive it from the French word fievre by omitting the i. Wherefore what this fervor or heat or 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fire signifie will best appear by conferring with them the words Calor warmth and Calidum heat being their opposits from warmth Calor and heat Calidum we have our strength and live but through Fervor a destructive heat and fire we lose our strength and end our days It will much conduce to our purpose I judge to premise the difference of these words Calidum heat denotes a hot essence or substance but Calor warmth signifieth only a quality separable from its subject or hot nature by our thoughts or concept and not really though 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 calidum or heat and 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 Calor warmth are by Hippocrates used in the same sense Neither are you to imagine that in feeling of Pulses of such as are ill of a Fevor it is not the quality of heat but fiery steems bodies really physical do strike your hand and ends of your fingers 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 fire is by Hippocrates expounded the Innate Heat of man but among the Latines generally a Fevor whence a Fevor may be commodiously defined A fire kindled out of the Innate heat of the body chiefly of the heart but secundarily Wherefore that the heart and its constitutive principle is the part for the most times hurt is evident from the fevorish affection and life the proper action of the heart being immediately opprest from the inordinate pulse a sudden decay of strength and the actions of the whole oeconomy being very considerably and all at once depravated and diminisht The experience of those that have put their finger into the ventricles of the heart the breast being suddenly opened of malefactors who by sentence have had their head cut off and have extracted it again thence very hot doth confirm that the Calidum or heat of the heart is a substance really burning about its chambers and thence diffusing flames through the articles to the circumference If on the other side the destructive nature of a burning heat be objected it 's not material considering the burning or flaming of brimstone or spirit of wine whose purity of flame will not burn those bodies it touches especially when through graduation of the air it may be moderated to any tone of heat or warmth Furthermore I state the Calidum Cordis or heat of the heart to be a Bitumen really ethereal and vital most exactly defecated or refined dispersing every where its most subtile and pure flames and feeding on the most pure and flowring particles of the blood But since it 's difficult to gain an universal assent that the nature of blood excercising so slender a commerce with the air and limited within the narrow bounds of the heart and arteries should be convertible into a flame and a perpetual warmth it may be rendred obvious by this only instance Namely almost all subterraneous waters that partake of a continual heat as the water of Aix la Chapelle Bathe and of other hot Baths since they source out of the deepest and most remote bosoms of the earth just in the same manner doth the indesatigable soring of vegetative or living blood leap very hot out of the bosom of the heart into the arteries like rivulets and certainly that which by natural Philosophers is asserted to be the cause of heat in those waters may easily be imposed upon me to believe the same to be the cause of heat in the blood
namely a Bitumen but not Sulphur being immediately extinguisht by water nor calx viva or lime there being no such fury of heat discoverable in the caverns of the earth as is requisite for its generation Wherefore in Bitumen only may be found a heat that is constant and scarce to be extinguisht for by water it 's apt to be kindled into a higher flame and to be nourisht by oyl and oylie bodies It is then in the heart where nature hath placed an abounding fountain of vital Bitumen on the purity and continuity of whose flame lise it self doth depend Neither must it be asserted that so great a proportion of this doth flow from the heart as to suffice to protract the life of it and of the whole structure for so many years but that it doth daily attract a bituminous nutriment from the streaming blood which being kindled into vital flames is by means of the pulse distributed into the rest of the small chanels of the body It must also be observed that all what we eat or drink the chyle and the blood do contain a certain proportion of Bitumen and as much hereof as there is abounding in them so much they are capable of being serviceable to the heart At present must be explained what and of what quality this Bitumen is namely a body grown out of a sulphureous oyl and a Colophony into a thick liquable and inflamable substance Such by distillation it 's also discovered to be in the analytick parts of the blood of a living creature to wit an oyl swimming a top the phlegm and a colophony with a part of fixed salt setled in the body of the glass-gourd withall a volatil salt passing the Alembick with the oyl which later namely the volatil salt it is that adds to the whole mixt body all its strength and power not unlike Gunpowder whose Nitro-salin particles being rendred volatil through virtue of the fire do assume so great a force that they strike any object whatsoever with the greatest alteration and the smartest blow imaginable when in the mean while the brimstone and the charcoal-dust only supply the place of a soporous matter From what hath been said the manner of the pulses may commodiously be extracted only conceiving that the Bitumen of the heart burning until the period of life and pour'd from the ascending vena cava into the left ventricle doth kindle the blood into a flame by vertue whereof the nitro-salin salt being blown into most volatile forcible particles is like Lightning or Gun-powder discharged out of a Gun propelled as it were by an elastick force into the Great and other Arteries CHAP. II. Concerning the differences of Pulses and their causes TO describe the difference and variety of the Waters of the Sea would prove a task less difficult than that of the pulsations of the Heart and Arteries which are subject to be altered by every passion wind and disease though Galen indeed counted them as if he had blown them out at his fingers ends among which notwithstanding scarce every third difference can be distinguisht by the feeling of a Spider Wherefore I shall only discourse of such which every one may almost discern in Fevors In the Pulse I use to mind first the strength or force next the swiftness of motion and thirdly the equality From the strength a pulse is called strong or weak hereunto are accounted a great pulse to wit full and strong and small namely empty and weak the causes of the strength of the pulse I state to be the abundance of volatil salt being vigorously and smartly discharged through the pulse of the blood and the strength of the fibres being well nourisht with the moisture of the brain On the contrary the defect of salt and emptiness of the fibres cause a weak pulse Here it 's worthy of your observance that the pulse in some sevorish Patients is found much stronger than it was in their state of health and what is more in some who were reduced to so low an ebb of strength that they were scarce able to keep death a day from their door I remember their pulse would beat the tops of ones fingers smartly which notwithstanding in my opinion ought not to be called a strong pulse but violent for the vital faculty being irritated by a corroding and reverberated kind of salt is forced into those violent pulsations whence falling at last into a very in all and most quick pulse is immediately attended with an Asphyxia or ceasing of pulsation It is an easie business to distinguish a violent pulse from a strong the former doth come full to the fingers the later empty Secondly I have oft met with a weak pulse in such as lay sick of Fevors that they seemed not to be able to hold out two days which notwithstanding have for a fortnight or twenty days strove very successfully with the disease This pulse proceeds from a thick and moist blood which by a continuated rarefaction and reiterated circulation being advanced to a higher degree of concoction doth revive the vital faculty whilst in the mean time there hath been sustained no great loss of volatil salt in those weak pulsations I have many times taken notice of this case in women that lay sick of Fevors wherefore it is warily pronounced by Hippocrates Aphor. 19. lib. 2. 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 i. e. The predictions of life and death in acute Fevors are not always certain and without doubt That we may avoid being mistaken we are to distinguish a pulse that 's really weak is empty and small and for the most part inequal in motion and weakness neither did it differ much from that degree since the beginning Under the motion of pulsation I take a slow and swift pulse likewise a thick and rare pulse A slow pulse is known by moving slowly from the systole or a contraction of the pulse to the diastole or a widening or dilatation of the pulse and again from the diastole to the systole A quick pulse is known by its quick pace from the systole to the diastole and so reciprocally A thick pulse to me is which is perceived by the finger by its frequent beatings or retreats a rare pulse contrariwise Here may be noted in my apprehension a pulse can scarce be discovered slow and thick at once when a slow pulse necessarily doth not return frequently or thick because it 's slow but according to the common maxim a thick and slow pulse may happen together because it is called thick in respect of the interval or rest between the systole and diastole namely which returns in a short space of time but a pulse may move slow from the systole to the diastole so that there is but a small interval between before it returns from the diastole to the systole and thence it 's termed thick But taking the matter into farther consideration there is scarce any such pulse as a thick or frequent one according
as it 's commonly described neither is there a rare pulse because there is no interval of rest between pulsation for conceiving that the pulse is like a reciprocal swelling and falling like the tide of the sea there can only be inferred a point of reflection namely as soon as it swells up the next moment it falls again and as soon as it 's fallen the next minute of time it swells again Moreover this rising or swelling is attended with an impulse from the heart by means of the constriction of its fibres whereby like waves besides the forementioned swelling or turgescency the blood is propelled through the pores of the body out of the arteries into the veins Wherefore that I might not beyond necessity burden my self in my practice with notions I scarce am used to take notice of any thing else in the motion of the pulse besides its swiftness and slowness neither do I stand much whether it be hard or hot or pricking since this rather relates to the altered qualities than the pulse Thirdly It is to be observed that those whose pulse being naturally full strikes quick their vital faculty is very weakly wherefore in women and children the arteries strike quick but full Fourthly In malignant Fevors the arteries do oft move slowly in such a manner that one might judge them free from all putrid heat but this doth not happen unless death be ready to follow within a day two or three The natural swiftness of pulsation not in sick people must be imputed partly to the abundance of volatil salt but such as is not close and compact for as soon as it arrives to the ventricles of the heart it 's apt to be flusht into too volatile particles and soon after the salt being so copious follows immediately from the other parts of the salt whence another pulse is ready at hand partly it 's to be imputed to a Bitumen that is easily inflamed which quickly kindles and is kindled whence happens the frequency of the pulse By the way a small question might here be moved whether the pulse beating quick in Fevors there passeth more blood through the heart than when one is in a state of health First It must be agreed upon whether in every dilatation the heart is filled full of blood and in every constriction it be quite emptied some defend the affirmative part which to me doth not at all seem plain for those whose pulse at one time beats full and at another empty it must necessarily be argued that at one time the pails of the heart must be swelled up with a greater quantity of blood and at another with a lesser and from the consequents it's evident that reciprocally in divers pulses there must be expelled a various proportion of humors Secondly Since it may be observed that a large diastole of the heart is sometimes the next moment followed by a short and weak systole as appears out of the swelled diastole of the arteries of the wrist or any other part there oft following a short and weak systole whence it 's deemed there is more received into the receptacle of the heart and less expelled so that oft a proportion that 's admitted by one diastole is expelled in three or four systoles To answer to the question we assert that the blood is not circulated nothing near so rapidly or quick in malignant Fevors as it is in the state of health because the pulsifick faculty of the heart is languishing neither is the systole of the arteries or heart made with so much force but in putrid Fevors the systole and diastole being violent the blood is transfused somewhat swifter than in a healthful state Here is to be observed by the way if a swift pulse be perceived to go slower a day before and the day after to grow swifter a malignity is to be suspected The third particular worthy of observation is the equality or inequality of the pulse in reference both to motion and strength Wherefore in respect hereof a pulse is said to be equal or inequal in motion to wit swiftness and slowness and in strength namely fortitude and weakness The equality which Authors are wont to apply to a thick and rare pulse likewise to the tone or musical rithme we pass by being rather apt to occasion confusion to the practising Physician To unequal in motion are accounted the dicrotus or anvile-pulse caprisant or goat-pulse intercedent and some others A strong pulsifick faculty and not depraved likewise a temperate mixture of the blood being well depurated from heterogeneous particles are both some causes of an equal pulsation On the contrary blood that 's unequally mixt with the vital Bitumen and several sorts of salts occasions an unequal pulse both in respect of motion and strength As for other differences proceeding from the force of passion and other procatarctick causes we refer to another place CHAP. III. Of what is generally to be observed in Urins SInce the Urine for a more certain presage must give place to the pulse we have thought fit to discourse of this after the other Through the abuse of pispot-gazers and some Physicians that imprudently pretend to tell wonders the doctrine of Urines among some is fallen into disgrace nevertheless since it makes an ample discovery of the diagnosticks and prognosticks of diseases it ought not to be dismembred from the art of Physick First we shall set down what Urine is afterwards what particulars are to be observed in it To me the Urine seems to be a liquor melted from the volatil and fixt salts likewise of some excrementitious phlegm dissolved in the serum or water of the blood which being throughly filled and impregnated with the foresaid contents through its weight tending downwards is posted to the kidneys thence as if it were distilled by descent it falls down by drops towards the bladder But that the nature of urine may be made more plain to you some particulars are to be taken from the constitution of the blood and proposed here Those volatil salts I conceive to be the principal efficient of concocting the blood adding to it a scarlet tincture sweetness homogeneity and fluidity in which shape the blood arriving to the pores of the parts that are to be nourisht doth desert the salts which return with the superfluous blood to the veins and lymphatick chanels that afterward disburden themselves into the emulgents That those salts do not only illustrate the blood with a tincture but likewise the urine shall be demonstrated by sight You shall find that spirit of sal armoniack scarce differing from spirit of Urine or spirit of Hartshorn or spirit of Soot a drop or two being dropt into whitish drabbish and undigested urine shall immediately concoct it into a golden or vitrinous colour and an excellent consistency But if you effuse an acid spirit that 's forced out of a fixed salt you shall see it turn more drabby more crude and of a heavier weight In
knee the use hereof in eight and twenty days did restore her to her former senses and perfectly freed her from that distraction so that she hath never been troubled with it since The malignant Fevor I formerly cured Mrs. Lamot of whose Husband is a Merchant in Thames street near Fishmongers Hall and some weeks after a violent Rhumatism following which was removed by two bleedings and a dose or two of Hydrotick Pills is a farther confirmation to me of the preceding observation which to illustrate by a greater number of instances I judge is needless and therefore shall proceed to recommend to you a remark of use so important that it may gain the Physitian repute and save the lives of many Patients The observation is such that it gives me occasion to admire so many preceding ages have so grosly erred in their practice and doth likewise detect the cause why malignant and indeed most Synochical Fevors prove so oft mortal It is an universal theorem that in these Northern Climates Fevors are terminated not critically but slowly and gradually by sweat and urine per Diaphoresin Diuresin Through the former viz. sweat the salin volatil and fuliginous matter is expelled through the latter namely urine the fixt salin and lixiviated matter is excern'd To accomplish this usually as I said before are prescribed Diaphoreticks as Aqua Epidemica Theriacalis Scordii Composita c. of one or more of these the measure of an ounce or two is mixed with the same proportion of Alexiterial simple waters and hereof two or three spoonfuls is to be given every second third or fourth hour according to the Capricio of the Physitian undoubtedly the effect doth not answer his expectation and no sweat appears upon this it may be double the quantity is to be used and yet not a drop of sweat is forced out then apologizes your Doctor for himself and tells you if the Patient could but be brought to sweat he would soon mend and further prognosticates if he doth not fall into a a sweat by to morrow or it may be next day he is a dead man and so Buenas Noches Now I will render it as evident to you as the light of the Sun that Mr. Doctor is the cause of this mans death that is to be understood 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 There being nothing more familiar among the fermentators than to explain their notions by theorems taken from the Brewhouse and Kitchin I shall make use of arguments desumed from the same Categories There is possibly a piece of meat to be prepared for to be eaten which to maturate or take away the crudity of it to mollifie or render it tender to dissolve and to purge it from its filth and impurity is to be boiled if you put to it salt wine or other ingredients and there be not a sufficient proportion of water or that the water boileth away too much especially if the meat be left dry it will not only harden but be burned smell of adustion or empyreum and soot and be entirely corrupted and spoiled whereas if it had been supplied with water the meat would have been softned concocted and depurated from its recrements and impurities which it casts forth into a scum The case is not different in the blood that boyelth up in the veins and arteries of fevorish Patients which being full of salin adust and other heterogeneou particles is by ebullition to be depurated of the said impurities if then the blood wanteth water or serum to dissolve those salin particles it must necessarily grow dry coagulate and be burnt up and consequently death must be the unavoidable issue Now observe that a Patient that hath been broyling under a continual Fevor for eight or ten days or longer his entrails scorcht and parcht his blood dried up and affected with an empyreum how impossible it is he should be put into a sweat by hot cordials though diaphoretick as Aqua Epidemica Theriacal lap Contrajerv to be given every third or fourth hour by spoonfuls or scruples These certainly must render the blood hotter and dryer and totally absorb the remaining moisture The infallible way to prescribe a remedy to Patients of this nature is to observe that for to cast one into a sweat you are to consider the subject the matter of sweat the efficient of sweat the several causes that hinder c. but chiefly the matter of sweat and the efficient The matter is the superfluous serosity of the blood The efficient is the spirits that expel the foresaid serosity to the circumference These two are nearest causes without both which at the same time no sweat can be procured for if we have only abundance of spirits and no abounding moisture the spirits will be provoked into a greater rage and force and consequently if there be any moisture remaining they will absorb that and so quite exsiccate the body this is that end which the Fermentators and the Putrid Physitians attain by their Cochleatim cordials The indication drawn hence doth direct that to procure sweat which as I said before is a common terminator of malign Fevours is to moisten the body well with appropriate Juleps or Apozems Which done give but two drams of any alexipharmacal water or five or six drops of spirit of Hartshâ—rn rectified and you shall certainly cause an abundant sweat In the next place consider though there be moisture sufficient to subminister matter for sweat as sometimes there is in malign Fevors there either may be a defect of spirits or the spirits may be opprest by the malignity and in a manner rendred languid or drowned by moisture too much abounding then in this case Putrid Physitians do commit a killing error in forcing the Patient to swallow down their acid Juleps and Apozems The indication desumed hence doth direct so subtil cordials as through their penetrability may insinuate into the most intime effuges of the body and disintangle the spirits from those malign particles that oppress them which done they will soon expel their malign enemies through the pores by sweat But since nothing can illustrate this point more than experience I will give you a most convincing instance I was not long since called out out of my bed to see the child of Mr. Harvey in Fetter lane end next Holborn who I was told lay a dying The child was two years and an half old or almost three I found she fetcht her breath with great difficulty her Pulse did beat convulsive vibrating and extreamly frequent as in like cases it usually beateth some two or three hours before death She was delirious not knowing any that were used to be about her her eyes were very hollow dim and very slow in motion her face was pale and cadaverous I examined how she had been the day before I was told that she had a high colour had been very burning and was very droughty and drousie She had been ill some four or five days After I had examined her mouth and belly I soon understood what it was viz. a malignant Fevor occasioned by the Small Pox which nature could not cast forth for want of moisture for hot cordials she had taken in abundance almost every half hour and would undoubtedly have been dead in three hours more had they gone on in that method I prescribed four or five drops of rectified spirits of Hartshom with a grain two or three of Bezoard mineral and a dram of Aq. Scordii comp to be given in a large draught of pure posset drink in less than two hours the Small Pox appeared and she was put into a tolerable sweat then caused two Epispasticks to be applied to the Wrists which had singularly performed their operation by extracting a great proportion of malignant serosity By next morning her senses were returned her aspect appeared florid and vivid her Fevor very much abated and all her malignant symptoms vanisht insomuch that within two or three days she was perfectly recovered Some other observations I must refer to the next opportunity in the mean time I wish Physitians would prefer experience before their opiniater notions FINIS