in _Germany_, that he had given this antimonial Powder with
great Success in the Remitting Fever, while the Eighth
Regiment of Foot (to which he was formerly Surgeon) lay in
_England_.--Dr. _Pringle_, in his fourth Edition of his
_Observations_, Part iii. ch. iv. tells us, that having given
a mild Purge immediately after Bleeding, he next Morning,
when there was almost always a Remission, gave a Grain of the
Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated
the Dose in two Hours, if the first had little or no Effect;
at any Rate, in four Hours. This Medicine not only vomited,
but generally opened the Body, and raised a Sweat. By these
Evacuations, the Fever was sometimes quite removed, but
always became easier.--This Medicine he usually repeated the
second or third Day; if not, he opened the Body with some
mild Laxative, or a Clyster; and continued this Medicine,
till the Fever went gradually off, or intermitted.--Dr.
_Pringle_ says, that Dr. _Huck_ treated this Fever in a
Method similar to this, both in _North America_ and in the
_West Indies_. In the Beginning he let Blood; and in the
first Remission, gave four or five Grains of Ipecacuana, with
Half a Grain of Tartar Emetic: This Medicine he repeated in
two Hours, taking Care that the Patient should not drink
before the second Dose; for by that Means the Medicine passed
more readily into the Bowels, before it operated by vomiting.
If, after two Hours more, the Operation either Way was small,
he gave a third Dose; which commonly had a good Effect in
carrying off the Bile; and then the Fever either went quite
off, or intermitted so far as to admit the Bark. On the
Continent he found no Difficulty after the Intermission; but
in the Islands, unless he gave the Bark upon the first
Intermission, though imperfect, the Fever was apt to assume a
continual and dangerous Form. Dr. _Huck_ never varied this
Method, but upon a stronger Indication to purge, than to
vomit. In which Case he made an eight Ounce Decoction, with
Half an Ounce of _Tamarinds_, two Ounces of _Manna_, and two
Grains of _Emetic Tartar_; and dividing this into four Parts,
he gave one every Hour, till the Medicine operated by Stool.
When the Fever came to remit, we were obliged, for the most part, to
continue the Use of the mild Diaphoretics, as before; for, although
the Disorder put on a remitting Form, the Bark had very little Effect
in stopping it[76], unless where the Fever changed into a regular
Quotidian or Tertian Ague.--In the Year 1761, very few of these Fevers
turned to regular Intermittents; but, in the Year 1762, the greater
Part of them terminated in regular Agues, and were cured by the
Bark[77].
[76] Dr. _Hillary_, in mentioning the Remitting Fever of the
Island of _Barbadoes_, says: In those who were blooded, and
took an Emetic afterwards, and then the saline Draughts, the
Fever was generally carried quite off by a critical Sweat on
the seventh or ninth Day; in some few it came to intermit
regularly after that Time; and was soon cured by the _cortex
Peruviana_, given with the saline Draughts, and seldom
effectually without them; though these irregular ingeminated
Fevers often remitted, and sometimes seemed to intermit; yet
if the _cortex Peruviana_ was given too soon in the Disease,
before it intermitted regularly (as I have more than once
seen, where it had been injudiciously given), it generally
caused the Fever to become continual and malignant.
_Observat. on the epidemic Diseases of Barbadoes_, p. 22.
[77] Mr. _Cleghorn_, after giving a very accurate Account of
Tertian Fevers, as they appeared in their various Forms of
true, of double, and triple Tertians, and of Semi-Tertians,
in the Island of _Minorca_, tells us, that he first attempted
the Cure by profuse Evacuations; but afterwards learnt from
Experience, that they were unnecessary; and that Bleeding and
Purging once or twice in the Beginning, was all that was in
general requisite; and if on the fifth Day the third
Revolution was not attended with more threatening Symptoms
than the second, and the Patient bore it easily, he
frequently trusted the whole Business to Nature; which
commonly terminated the Fever about the fourth or fifth
Revolution; and for the most part with an Increase of some
natural Evacuation.--But if the Paroxysm on the fifth Day was
the longest and most severe that happened, attended with any
doubtful or dangerous Symptom, he ordered two Scruples of the
Cortex to be given every two or three Hours; so that five or
six Drachms may be taken before next Day at Noon; lest, if
this Interval escaped, he should not have found a favourable
Opportunity of giving a sufficient Quantity of the Medicine
afterwards; as the Fits about this Period are wont to become
double, subintrant, or continual.--This did not always put an
immediate Stop to the Fever, but it invigorated the Powers of
the Body, and prevented or removed the dangerous Symptoms.
Having given the Bark on the fifth Day, if a Fit came on the
sixth, and declined the same Evening, he gave some more Doses
of the Bark to mitigate the Fit on the seventh; yet sometimes
this Fit of the sixth united with that of the seventh, and
the Patient had the Heat, Restlessness, Raving, and other
Complaints, greatly augmented, and the Case seemed more
desperate than ever; which, however, were more dangerous in
Appearance than Reality, and went off with a profuse Sweat
next Morning; after which he gave the Bark freely as before;
and this either stopt the Fits, or made them so moderate, as
that they yielded quickly to the same Sort of Management.--By
this Method, when Assistance is called timely, Mr. _Cleghorn_
says, the most formidable Intermitting and Remitting
Tertians, may be certainly and speedily brought to a happy
Conclusion about the End of the first Week, or Beginning of
the second. See _Observ. on the epidemic Diseases in
Minorca_, chap. iii. p. 187, &c.
In the Year 1761, we tried the Bark in various Forms in many Cases,
where the Patient had been blooded and purged in the Beginning, and
used the cooling Medicines; and where the Remissions were very clear:
Yet it had no Effect in removing the Disorder, except in two or three
Cases at _Munster_, where the Paroxysms assumed a tertian Form; for
the most part, it made the Patients more hot and feverish, and we were
obliged to leave off using it, as it was in Danger of changing the
remittent into a continued Fever. However, it was of Service after the
Fever came to a Crisis, and was going off; and Dr. _Pringle_ has very
justly observed, that it hastened the Recovery, and that those who
used it were less subject to Relapses than such as did not; and
therefore we commonly gave it in a convalescent State.--Before giving
the Bark, I always found it of Advantage to give a Dose of Rhubarb, or
of some other Purgative, or to mix some Rhubarb with the first Doses,
so as to procure the Patient some loose Stools.
When either the Fever went on without Intermission, or changed into a
continued Form, or the Patient continued hot and feverish through the
Day, with a Head-Ach, and other feverish Symptoms, nothing answered
better, after free Evacuations had been made, than to apply a large
Blister to the Back; and to make the Patient drink freely of cooling
diluting Liquors; which generally relieved the Head, and abated the
Violence of the other Symptoms.
When a Purging came on in the Course of this Disorder, if there was
much Fever, with a strong throbbing Pulse, Gripes and Pain of the
Bowels, some Blood was taken away; and immediately after the Patient
took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the
Evening after its Operation: But if there was little or no Fever, or
sharp Pain, Bleeding was omitted; and if the Patient complained of
Sickness, a few Grains of Ipecacuana were given previous to the Purge.
After this, if the Purging was moderate, and did not sink the Patient,
we did nothing to stop it; but if it was violent, we gave the
mindereri Draughts with Mithridate, and the Chalk Julep in the Day,
and an Opiate at going to Rest; and occasionally used the emollient
and anodyne Clyster; and, if necessary, repeated the Emetic and Purge.
The Hiccup seldom appeared in this Fever till the Patient was reduced
very low, and was commonly the Forerunner of Death. Some few, who had
a Purging and Vomiting, were taken with a Hiccup, attended with
Sickness, and Load at the Stomach, which seemed to depend on bilious
Humours lodged in the Stomach and Bowels. This induced me to give a
few Grains of the Ipecacuana; and to make the Patients drink an
Infusion of Camomile Flowers till they vomited freely, and afterwards
to take some mild Purge, or use laxative Clysters; after which they
found themselves easier, and an anodyne Draught, with twenty or
twenty-five Drops of the _tinctura thebaica_, put an End to the
Hiccup. Others required the Use of Cordial Draughts, mixed with
Opiates; and repeated Clysters and Fomentations, before they found
Relief.--The Application of a Blister removed the Hiccup in one,
after the above Remedies had proved ineffectual; as did the Musk Julep
with Opium, and the Application of an aromatic Plaister to the
Stomach, in another Patient.
Several of them complained of a burning Heat and Pain in making Water;
which commonly went off by drinking freely of the Gum Arabic
Decoction, with the dulcified Spirit of Nitre, and the Use of oily
Draughts; though in some it required the Assistance of Opiates, and of
Fomentations and Clysters, before it was got the better of.
The Symptom of Worms we were often obliged to neglect till the Fever
was over, and then we treated it as formerly mentioned.
The Deafness, though not near so frequent in this as the Malignant
Fever, was rather a favourable Symptom, and mostly went away of
itself; though in a few Cases, where it continued long, we applied
Blisters behind the Ears, or to the Neck, with Advantage.
Many, especially those who were brought low, complained, after the
Crisis of the Fever, of Restlessness, and Want of Sleep; which,
however, went off as their Strength returned: Where it fatigued them
much, and kept them low, we gave a Cordial anodyne Draught at Night;
and if that did not answer, commonly the Addition of a few Glasses of
Wine in the Afternoon had the desired Effect.
Others, in their convalescent State, complained of such a Giddiness,
and Lightness of the Head, that they could neither walk nor stand;
others, of a Dimness of the Eyes. These Symptoms, for the most part,
went off as the Patients gathered Strength: The Use of the Bark, with
now and then a Glass of Wine, hastened the Cure; and in two or three
Cases we were obliged to give a Dose or two of some gentle Physic, and
to apply a Blister, before the Patient got the better of them.
As the Sick were recovering, it was common for them to complain of
Pains of the Shoulders, Arms, and Legs, which also left them as they
recovered their Strength; where they did not, the saline Draughts, and
a low Diet, generally had a good Effect; and where it had not, we
treated them as rheumatic Complaints.
When the yellowish Colour of the Countenance remained after the Fever,
we kept the Patient on a low Diet; and his Body open by Means of the
saline Draughts, with a few Grains of Rhubarb, or by giving Half a
Drachm, or two Scruples of the Soap Pills with Rhubarb daily; which,
for the most part, removed the Yellowness soon. Two only had a
Jaundice remain after the Fever, and both were cured in a short Time.
In other Respects, the Treatment of this Fever, when it degenerated
into a continued Form, had nothing particular in it; nor differed from
the common Practice of giving cooling Medicines when the Fever was
high, and supporting Nature by the Use of Cordials and Wine, and the
Application of Blisters, &c. when low; and promoting such Evacuations
as Nature pointed out for a Crisis.
OF THE Intermitting Fever, or Ague.
This Disorder belongs to the same Tribe of Diseases as the Remitting
Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms
are distinct, begin with a cold and hot Fit, and go off with a Sweat;
and the Patient is cool, and free from the Fever in the Intervals
between the Fits.
Many have been the Causes alledged to produce this Disorder. The great
Quantity of Bile that is often thrown up in the Fit, has caused it to
be ranked among the bilious Diseases; and the Seasons of the Year in
which it is most frequent, and the low moist Situation of the Places
where it is endemic, have made Practitioners suspect, that an
obstructed Perspiration, and a Tendency in the Juices to the
Putrescent, are the Cause of it.
But whatever Cause we may suppose to give Rise to the first feverish
Fit, it is difficult from hence to account for the regular Returns of
the Paroxysms and Intermissions: For my own Part, after considering
Intermittents, which observed a regular _Type_ in the Course of a
Salivation[78]; their being so easily stopt by the Bark without any
sensible Evacuation; their being sometimes put away by a Stimulus
externally applied[79], or by a Fright, or sudden Plunge into cold
Water[80]; their returning after slight Errors in Diet, and sometimes
by the Operation of a Purge, or of Bleeding; their attacking sometimes
only particular Parts, and many such Accidents in these Fevers, I must
confess, that I am unable to form any Idea, either of their Origin,
Seat, or Cause[81].
[78] See _Van Swieten_, Vol. II. p. 537.
[79] A Gentleman told me, that he was once cured of an Ague
in the Country, by applying a Poultice of Garlic to his
Wrists, and letting it lie on till it inflamed and blistered
the Part.--I have seen Blisters cure an Ague.--In the
_Edinburgh Med. Essays_, Vol. II. Art. v. we have an Account
of Agues being cured by the Application of Poultices of
recent Erigerum (Groundsel) applied to the Stomach on the
Days free from the Paroxysm, which caused strong Vomiting.
[80] See an Account of an Ague being cured by the Patient
being pushed into a Pool of Water without any previous
Notice, and being much frightened, in _Mason's Account of
Agues_, p. 222.
[81] The common Account given of the Cause of Agues, and of
the regular Return of their Paroxysms, has been: That the
Ague takes its Rise from some Sort of Matter, bilious, or
whatever it may be, either mixed with the Blood, or lodged in
the Bowels, or in some other Part of the Body; that a great
Part of this Matter is thrown out of the Body, in the Time of
the Paroxysm; but that so much remains as serves by Way of a
Ferment to assimilate other Particles to its own Nature;
which, when collected in a certain Quantity, produce a new
Fit; and, according to the Time that it takes to produce this
Quantity, the Disorder assumes the Form of a Quotidian,
Tertian, or Quartan Ague.
The Soldiers were subject to this Disorder, particularly in Spring, if
they took the Field soon, and in Autumn: The Frequency of it was in a
great Measure determined by the Nature of the Ground on which they
were encamped, or the Situation of the Garrison or Town in which they
were quartered; for the lower and moister the Camp or Garrison, and
the more moist the Season, the more subject an Army is to Agues; and
the drier the Situation of the Camp or Garrison, and the finer and
drier the Weather is, the freer they are from Disorders of this Kind.
In Winter 1761, we had but very few Agues in the Hospitals; but on the
Return of the Troops from the Expedition into _Hesse-Cassel_, and
during the Spring, some (though not many) were attacked with Quotidian
and Tertian Agues, and but very few with Quartans.--In _July_ and
_August_ they were more frequent, and accompanied with more bilious
Symptoms. At _Bremen_, during the latter End of Autumn, and throughout
the Winter and Spring 1762, we had Agues of all Sorts, and many
inveterate Cases; and all this Spring, and during the Summer and
Autumn, the Ague was the epidemic Disorder all over _Westphalia_, as
well as among the Troops.
In Spring 1761, what Agues we had were mostly Tertian, some Quotidian,
and but two or three of the Quartan Kind. They were, for the most
part, mild, and yielded to the Bark.--Some of them began in the Form
of a continued Fever; but after Bleeding, and the Use of the cooling
Medicines for a few Days, they began to remit, and at last ended in
regular Quotidian or Tertian Agues: Others, at first, appeared in Form
of Remittent Fevers, attended with a strong throbbing Pulse; but
changed to regular Intermittents by pursuing the antiphlogistic Method
of Cure; and some from the Beginning assumed the Type of Quotidian or
Tertian Agues, but often attended with a good deal of Fever, for the
first two or three Days; and some had a slight Delirium in the Time of
the Paroxysms, and the Pulse was not quite settled in the Intervals.
In such Cases, where the Patient was strong, nothing answered so well
as to take away some Blood; and to give the saline Draughts with Nitre
till the Fever was moderated, before we gave the Bark.
In general, there is a Prejudice against bleeding in Agues, after they
become regular; but I have always observed, both in _England_ and in
_Germany_, that where Patients are strong and plethoric, and the
Fever in the Paroxysms rises high, or the Pulse remains quick in the
Intervals, that taking away more or less Blood, and giving the
antiphlogistic Medicines in the Beginning, eased the Patient,
moderated the Fever, and made it safer to give the Bark soon; and I
never saw the least Inconvenience from the Practice; but, on the
contrary, have seen several Intermittent Fevers change into continued
ones from the Neglect of this Evacuation; and have seen Cases where
the Bark, instead of stopping the Ague, rather increased the Fever,
till the Patient was blooded, and had pursued the antiphlogistic
Method for some Time; after which the Bark had its proper Effect, and
put an End to the Disorder.
As soon as these Agues became regular, and the Patient was quite cool,
and free from any Fever in the Intervals, we gave the Bark; which soon
put a Stop to the Paroxysms, without the least bad Consequences; but,
before giving the Bark, we always took Care to empty the first
Passages by the Use of Emetics and Purgatives, where there was no
Symptom to forbid their Use: In Cases where the Patient was weak, and
the Fits so violent as to make it necessary to stop the Ague, before
we had Time to administer Emetics or Purgatives, we added so much
Rhubarb to the first Doses of the Bark as procured the Patient some
loose Stools, as recommended by Dr. _Mead_[82]; which did not prevent
its stopping the Ague, at the same Time that it answered the End
proposed of carrying off any putrid Humours that might be lodged in
the Intestines.
[82] Mr. _Cleghorn_, while at _Minorca_, after Evacuations,
gave the Bark at the End of the third Period, as we observed
before; but where the Fever had been neglected till about the
third or fourth Period, or badly treated in the Beginning,
and the Bowels were inflamed or overcharged with corrupted
Gall, he was obliged to endeavour to palliate the most
pressing Complaints, and to watch Evening, Night, and Morning
for a Remission, and then immediately to fly to the Bark, as
the only Remedy that could avert the Danger. If the Patient
was strong, he gave Half an Ounce of the Bark, with six
Drachms of the _sal catharticum amarum_, divided into four
equal Parts, of which the Patient took one every two Hours;
the Effect of which was, that the next Fit was mitigated, and
an Intermission commonly ensued, in which the Bark was
repeated without the Purgative, to finish the Cure.--But
where the Patient was excessively feeble, and there was a
manifest Risk of his dying in next Fit, he gave Cordials with
the Bark, instead of the _sal catharticum_; and endeavoured
to throw in six or seven Drachms in the Space of ten or
twelve Hours; he having found by Experience, that if a
smaller Quantity is given, the Paroxysms come on earlier than
usual, and make all Attempts to preserve Life unsuccessful.
See his _Account of the epidemic Diseases of Minorca_, cap.
iii. 2d edit. p. 192.
In _England_, Vernal, Quotidian, and Tertian Agues, frequently go off
after Bleeding, and taking some Emetics and Purges, and the saline
Draughts, and cooling Medicines, for some Time, without the Use of the
Bark; but in _Germany_ very few yielded to this Treatment, and we were
obliged to give the Bark[83] before we could put a Stop to them.
[83] Sometimes, when Patients are reduced low by Agues, the
Stomach becomes so squeamish as to reject the Bark in every
Shape it can be given; in such Cases, when the Ague cannot be
stopped by other Means, it may be administered with great
Advantage in Clysters, of which the following is a very
remarkable Instance.--_William Hadderell_, a Lad seventeen
Years of Age, in the End of the Year 1761, was attacked with
a severe Tertian Ague, in which a Mortification came on his
left Foot, and one-half of it dropt off; notwithstanding, his
Ague continued to attack him every second Day, and the Sore
continued running on the 12th of _October_ 1763, when he was
admitted into _St. George_'s Hospital. He was reduced
extremely low; and the Sore of his Foot looked so bad, that
it was at first imagined he must lose his Leg. He was ordered
some Vomits, and a Purge, and cooling Medicines, and
afterwards to take the Bark freely; but his Stomach rejected
it, in whatever Form it was given. Other Means were then
tried to stop his Ague, but with no Effect, till the 7th of
_November_, that I ordered two Drachms of the Powder of the
Bark to be given him twice a Day in an emollient Clyster,
with Half a Drachm of the _tinctura thebaica_, which stopt
his Ague in three Days; and he had had no Return of it on the
28th of _January_ 1764, and had recruited his Health and
Strength, and the Sore of his Foot was greatly lessened. Dr.
_Harvey_ (who teaches Midwifery in _London_) told me, that he
has cured Children of Agues by Bark Clysters, after the Bark
Waistcoats, and other Means used, had proved unsuccessful.
In the End of _July_, and Beginning of _August_, the aguish Cases we
had at _Munster_ continued to be of the Quotidian or Tertian Kind. The
greatest Part of them began in the Form of continued Fevers, tending
more to the bilious Kind than the preceding Months, and many of the
Sick had bilious Vomitings in the cold Fits; and the Agues we had in
Spring, and during the Campaign 1762, were of the same Nature, and
required the same Treatment.
Those Cases, which began in the Form of continued Fevers, were
treated as such till they began to have regular Intermissions; they
then yielded to the Bark.
Some were attended with the Dysentery; and the Purging and Gripes were
most severe on the Days of the aguish Paroxysms. In such Cases, we
were frequently obliged at first to neglect the Ague, and to treat the
Disorder entirely as a Flux. Where there was much Fever, the Patient
strong, and the Pains in the Bowels acute, we ordered Bleeding; and
after it a gentle Emetic, and some Doses of the saline oily Purge, or
of Rhubarb; and gentle Opiates in the Evening, and other Medicines
proper in the Dysentery, till its Violence was abated, before we gave
the Bark: though in some Cases, where the aguish Paroxysms were very
severe, and helped to increase the Purging, and the Patient was in
Danger of sinking, we gave the Bark, notwithstanding the Flux still
continued; and the Method we followed was the same as that I formerly
mentioned, where it was complicated with the Malignant Fever; which
was to give the Bark, mixed with Diascord, and Opiates, or other
Medicines proper for the Dysentery, in the Intervals between the
Purges.
By this Treatment, very often both the Flux and Ague went off.
However, it ought to be observed, that unless the aguish Paroxysms
were severe, and in Danger of sinking the Patient, or that the
Disorder had continued for some Time, and the Paroxysms were distinct,
we seldom gave the Bark till the Violence of the Flux was abated: And
where-ever much Griping and Pain in the Bowels attended the Flux and
Ague, there Bleeding as well as Purgatives were necessary, before
exhibiting the Bark; which seldom or ever agreed with them, till there
was an evident _Apurexia_, or Absence of Fever in the Intervals
between the Fits. Where these Cautions were neglected, the Bark
generally made the Patients worse; and we were obliged to omit it,
till the Violence of the Purging was over.