_Of Accidental Fevers._
How uncertain is human life! One moment in a perfect state of health,
the next perhaps no more; or confined under the painful sensations both
of body and mind!
Every accident is liable, and unavoidably must bring on a fever; and
this, like fire, should be extinguished in its earliest commencement.
But in that, as I have before observed, the constitution should
principally be consulted.
I have in the lecture of accidents, at every opportunity, recommended
bleeding, but always with a proviso, _if requisite_; and, as this is of
more consequence than generally is supposed, I find it necessary here to
expatiate farther on it.
In the first place, no man should be bled who has lost a considerable
quantity of blood, unless indeed he was known in his state of health to
be very strong and robust; and that the fever sets on with such fury,
that the system requires absolutely to be reduced; for the solids and
fluids have such a strict dependance amongst themselves, that they keep
each other in an equipoise. If therefore the blood is of an acrimonious
nature, and at the same time impoverished by lessening its quantity, the
coats of the arteries and veins will be the more stimulated; thence the
fever will naturally encrease, and generate more acrimony; which at
length will destroy the patient. I have been an eye witness more than
once, that the fever has actually increased upon every repeated
bleeding, till the whole supply of life was spent; and all my
persuasions have not been listened to till too late. Nay, a fever is
sometimes absolutely necessary; and proves to some constitutions a
remedy on its own account, provided it is properly treated, and kept
within due bounds.
Secondly, If the constitution of the patient before the accident was but
slender, and of a phlegmatic nature, bleeding should be very little or
cautiously performed; for the blood of itself being but poor, must
naturally be impoverished by being lessened; and whilst the tenseness of
the fibres is lost, it is the more acted upon and rendered more
acrimonious, and still unable to strengthen the tone of the irritated
fibres; whence a relaxed body, together with a poor acrimonious blood,
and all its evil tendencies must be the consequence.
Let it once for all be observed, that all the benefit we can possibly
hope and expect from bleeding, is to lessen the whole system, to reduce
the quantity of the fluids, and to relax the solids. This lessening of
the system I must own is very often highly necessary; But, let us not
fall into the ridiculous notion to suppose that bleeding will draw off
the bad blood, and leave the good behind; far otherwise; the quantity of
the blood is soon replenished, but the quality becomes impoverished.
The principle intention in fevers of whatever kind, should be to promote
perspiration. This is the grand restorative of nature; and I cannot
recommend it too much. Nature designed this evacuation in the formation
of man; and by that, fevers were cured in time of yore, many ages before
art contrived either lance or lancets.
But here let me not forget another great caution; namely, not to mistake
profuse sweating for perspiration; for this is an extreme into which
many have erroneously fallen. Nature frequently produces a sweat without
force or compulsion; and if so, it should be favoured, but never brought
on by stimulants, or strong forcing medicines.
Perspiration, sweat and urine, are the natural evacuations intended, for
the purifying the system from animal acrimony; and when these excretions
are in a just balance with the secretions of the fluids and motion in
the system, without pain or fatigue; then nature is at peace with
itself.
Lastly, I must observe, that the stomach is an organ which, by the
nervous consent, carries on an immediate correspondence with every part
in the human fabric; whence this viscera should likewise ever be
consulted in fevers; that is, never to impose on it any aliment against
its own inclination and appetite.
The want of appetite in a fever is a natural cause, and very often is in
the patient’s favour; but the mistaken notion, that a patient must eat,
even against his inclination, in order to recover strength, is not only
highly absurd, but has been the destruction of many, who otherwise would
have recovered, had they with patience waited the kind dictates of
Nature.
Let the system be free from diseases, and the stomach will soon crave
food, when there is a probability that the aliment may be converted into
good blood; but whatever is forced into the stomach before that time,
will instead of nourishing the body, only add fuel to the destructive
fire, and encrease the already malignant blood.
Upon the principles of these observations, I shall lay down the rules
that should be religiously observed in accidental fevers; and when they
are well considered, we shall find that they will hold good also in all
other kind of fevers, notwithstanding they arise from internal acrimony
of the body; for the difference is barely this, whether the fire is
kindled within or from without;—but to proceed.
Whatever then be the accident, a fall, a wound, a fracture, dislocation,
bruise, &c. observe what the patient was before the accident.
If the patient was a stout hearty man, it naturally follows, that the
fibres of his body were also in a rigid robust state; and the quantity
and richness of the blood was in a due proportion; for this very reason,
health being at such an _acmé_, a fever is the more to be feared, and
ought studiously to be avoided.
If this patient has not lost any blood by the accident, by all means
bleed him; but never exceed eight ounces at farthest; it is as much as
the strongest man ought to lose at once.
In the next place, perspiration should be the principal object in view.
To this end, let the patient immediately after bleeding go to rest, and
take a dose of the _Fever Powder_ (L); upon which let him drink plenty
of _Balm Tea_ (12); which will generally bring on a perspiration.
If however the fever increases, the pulse continues to beat hard and
full, the head-ach, difficulty of breathing, a great draught and
delirium should ensue, bleeding indeed may be repeated, provided it is
within the same twenty-four hours; but if the symptoms come on beyond
that time, then bleeding will seldom prevail, or do any good, but rather
mischief; for by this time, the fever is generally agitated by acrimony,
and the blood is of its own accord poor enough without being made more
so by bleeding.
In the symptoms which I mentioned, regard should be had to the body
being gently kept open, not by purges but by clysters; for purges in
fevers are precarious, and liable to bring on heavy fluxes. If the
patient under this high fever is costive, give him the following
clyster.