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
naturae quia aut curabit eam aut manifestabit eam that is when you do not know the disease leave it to nature because either she will cure it or discover it Also they would contribute far greater advantage to the ease of the sick by expecting with Hippocrates the crisis than by a thousand tricks to circumvent nature for if they can do no good let them do no harm at least But now it is I am at leisure particularly to set down the order of this lazy practice Those that reject glysters in the beginning of a Fevor because they should not blunt the edge of the ferment too much do not at all perform their duty in the right administring of things since the rubbish of the body that is lodged about the turnings and windings of the guts and the hidden places of the mesentery not being expelled doth either by profusing steems into the vessels very remarkably increase the heat or by putrid particles creeping into the blood is apt to kindle the Fevor This rubbish because it is incapable of being concocted and is lodged without the vessels does easily yield to a gentle laxative potion or purging glyster without any fear of increasing the heat But since people here are such immoderate devourers of flesh that the belly being the sink of the whole body must needs abound with sordid excrements is not a laxative purge or Cathartick glyster very necessary But it must be given in the first preceding days or afterwards the greatest part of that filth and dirt is carried away into the vessels by the rapid torrent of the blood and therefore all purging is to be set aside for hereby nature would else be drawn from its work with a great disturbance and that without the least benefit Neither is that I have proposed just now contrary to Hippocrates as you may observe Aphor. 10. â—â—b 4. In acutis passionibus eadem die si fiâ—i potest medicandum nam in his cunâ—ari malum est that is in all acute passions you must give physick the same day if possible for to tarry is hurtful also Aphor. 29. lib. 2. and in Aphor. 30. lib. 1. he gives the reason for it Circa initia omnia debiliora in statu omnia fortiora quae purgationem fieri impediunt that is about the beginning all things are at weakest and about the state at the strongest which hinder that a purge should be given Secondly all bodies that are inclinable to Fevors or are fevorish are for the most part in the beginning oppressed with a Plethora ad vires or a fulness of the vessels more than their strength can bear whereby the spirits are pincht and through too great a condensation grow vehemently hot the circulation grows slug and dull and is carried in a disorderly motion and the pores are stopt how urgent is the case then that some blood be taken away immediately thence the spirits will be able to bestir themselves the motion of the blood from irregular will become regular the passages of the skin will be more free and the heat will be moderated But since it is not seldom that a Fevor being subdued by the first bleeding though not to an absolute extinction of the fiery heat the sparks raising the flame again the blood doth swell up a new and run violently up and down reason doth like wise advise that the veins are 〈◊〉 be deplenisht the second time that we may arrive to the same effects But those that indeavour to venture the opening of a vein e third time do unpunisht make a playgame of a mans blood for there is not so great a benefit reaped this third bleeding as there was by the two former as I have found by a thousand trials but the spirits and forces of the sick are barbarously destroyed by taking away their due food and nourishment and quite ruining their base and foundation for they inhere in the blood as their foundation and subject and from it they draw life Moreover neither is the blood then so turgid and impetuous because besides the former substraction of blood the parts of the whole mass are attenuated melted and dispersed through a great many little caverns and holes that before were filled Likewise there is now a close engagement between the vital spirits and the febril corpuscles what these are shall be told you hereafter so that if either you disturb the spirits or exhaust and lessen them by bleeding the fevorish miasms must necessarily get the victory and produce death for their trophy Thousands are killed by the slaughter of the lancet That you may understand the case more plainly I will illustrate it to you by an example of one that lieth sick of a malignant Fevor whom should you bleed but a second time or sometimes but once you would certainly bring his life into danger for neither Pulse or Urin do signifie any great heat that should be the cause of the swelling of the blood neither are the pores stopt by an abundance of soot wherefore there must by no means any blood be taken away because it doth in no kind of manner nor through its abundance annoy the spirits If however against reason blood should be extracted the spirits will be so much wasted that they will be rendred too weak for the encounter Secondly since the vessels by opening of a vein are so swiftly deplenisht the malignant matter that stagnates in the capillar vessels or elsewhere lieth hidden in remote holes and secret places is thereby most impetuously drawn into the great vessels that lead to the principal parts where joyning with particles of their own nature do with a joint force fall upon the strong holds of life certainly this is a most clear demonstration We must here unty the knots of two particulars that were asserted above The first is the manner of computing the bleedings whence the first is to be counted whence the second and third The other is why there are but justly two bleedings set down At the first assault of symptoms that are derived from the spring of a Fevor that is not intermittent as Hippocrates here and there calls it by which name are meant both continual and continent Fevors the same day there ought some blood be taken away out of the right arm to quiet and suppress the febril matter that it may not be mixt with the mass flowing through the great vessels nor fiercely fall upon the spirits for as much as this should happen so much the quantity of the blood that is to be extracted ought to be moderated Moreover the measure of blood that is to be drawn away is to be taken from the degree of the swelling of the blood for if the degree of intumescence or swelling be at the degree of eight and if unto this degree doth answer the taking away of ten ounces of blood then if the intumescence be at the degree of four the substraction of five or six ounces will be
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