OF DISEASES.
CHAP. XII.
OF THE KNOWLEDGE AND CURE OF DISEASES.
The knowledge of diseases does not depend so much upon scientific
principles as many imagine. It is chiefly the result of experience and
observation. By attending the sick, and carefully observing the various
occurrences in diseases, a great degree of accuracy may be acquired,
both in distinguishing their symptoms, and in the application of
medicines. Hence sensible nurses, and other persons who wait upon the
sick, often discover a disease sooner than those who have been bred to
physic. We do not however mean to insinuate that a medical education is
of no use: it is doubtless of the greatest importance; but it never can
supply the place of observation and experience.
Every disease may be considered as an assemblage of symptoms, and must
be distinguished by those which are most obvious and permanent. Instead
therefore of giving a classical arrangement of diseases, according to
the systematic method, it will be more suitable, in a performance of
this nature, to give a full and accurate description of each particular
disease as it occurs; and, where any of the symptoms of one disease have
a near resemblance to those of another, to take notice of that
circumstance, and at the same time to point out the peculiar or
characteristic symptoms by which it may be distinguished. By a due
attention to these, the investigation of diseases will be found to be a
less difficult matter than most people would at first be ready to
imagine.
A proper attention to the patient’s age, sex, temper of mind,
constitution, and manner of life, will likewise greatly assist, both in
the investigation and treatment of diseases.
In childhood the fibres are lax and soft, the nerves extremely
irritable, and the fluids thin; whereas in old age the fibres are rigid,
the nerves become almost insensible, and many of the vessels
imperviable. These and other peculiarities render the diseases of the
young and aged very different, and of course they must require a
different method of treatment.
Females are liable to many diseases which do not afflict the other sex:
besides, the nervous system being more irritable in them than in men,
their diseases require to be treated with greater caution. They are less
able to bear large evacuations; and all stimulating medicines ought to
be administered to them with a sparing hand.
Particular constitutions not only dispose persons to peculiar diseases,
but likewise render it necessary to treat these diseases in a peculiar
manner. A delicate person, for example, with weak nerves, who lives
mostly within doors, must not be treated, under any disease, precisely
in the same manner as one who is hardy and robust, and who is much
exposed to the open air.
The temper of mind ought to be carefully attended to in diseases. Fear,
anxiety, and a fretful temper, both occasion and aggravate diseases. In
vain do we apply medicines to the body to remove maladies which proceed
from the mind. When it is affected, the best medicine is to sooth the
passions, to divert the mind from anxious thought, and to keep the
patient as easy and cheerful as possible.
Attention ought likewise to be paid to the climate, or place where the
patient lives, the air he breathes, his diet, &c. Such as live in low
marshy situations are subject to many diseases which are unknown to the
inhabitants of high countries. Those who breathe the impure air of
cities, have many maladies to which the more happy rustics are entire
strangers. Persons who feed grossly, and indulge in strong liquors, are
liable to diseases which do not affect the temperate and abstemious, &c.
It has already been observed, that the different occupations and
situations in life dispose men to peculiar diseases. It is therefore
necessary to inquire into the patient’s occupation, manner of life, &c.
This will not only assist us in finding out the disease, but will
likewise direct us in the treatment of it. It would be very imprudent to
treat the laborious and the sedentary precisely in the same manner, even
supposing them to labour under the same disease.
It will likewise be proper to inquire, whether the disease be
constitutional or accidental; whether it has been of long or short
duration; whether it proceeds from any great and sudden alteration in
the diet, manner of life, &c. The state of the patient’s body, and of
the other evacuations, ought also to be inquired into; and likewise
whether he can with ease perform all the vital and animal functions, as
breathing, digestion, &c.
Lastly, it will be proper to inquire what diseases the patient has
formerly been liable to, and what medicines were most beneficial to him;
if he has a strong aversion to any particular drug, &c.
As many of the indications of cure may be answered by diet alone, it is
always the first thing to be attended to in the treatment of diseases.
Those who know no better, imagine that every thing which goes by the
name of a medicine possesses some wonderful power or secret charm, and
think, if the patient swallows enough of drugs, that he must do well.
This mistake has many ill consequences; it makes people trust to drugs,
and neglect their own endeavours; besides, it discourages all attempts
to relieve the sick where medicines cannot be obtained.
Medicines are no doubt useful in their place; and, when administered
with prudence, they may do much good; but when they are put in place of
every thing else, or administered at random, which is not seldom the
case, they must do mischief. We would therefore wish to call the
attention of mankind from the pursuit of secret medicines, to such
things as they are acquainted with. The proper regulation of these may
often do much good, and there is little danger of their ever doing hurt.
Every disease weakens the digestive powers. The diet ought therefore, in
all diseases, to be light and of easy digestion. It would be as prudent
for a person with a broken leg to attempt to walk, as for one in a fever
to eat the same kind of food, and in the same quantity, as when he was
in perfect health. Even abstinence alone will often cure a fever,
especially when it has been occasioned by excess in eating or drinking.
In all fevers attended with inflammation, as pleurisies, peripneumonies,
&c. thin gruels, wheys, watery infusions of mucilaginous plants, roots,
&c. are not only proper for the patients food, but they are likewise the
best medicines which can be administered.
In fevers of a slow, nervous, or putrid kind, where there are no
symptoms of inflammation, and where the patient must be supported with
cordials, that intention can always be more effectually answered by
nourishing diet and generous wines, than by any medicines yet known.
Nor is a proper attention to diet of less importance in chronic than in
acute diseases. Persons afflicted with low spirits, wind, weak nerves,
and other hypochondriacal affections, generally find more benefit from
the use of solid food and generous liquors, than from all the cordial
and carminitive medicines which can be administered to them.
The scurvy, that most obstinate malady, will sooner yield to a proper
vegetable diet, than to all the boasted antiscorbutic remedies of the
shops.
In consumptions, when the humours are vitiated, and the stomach so much
weakened as to be unable to digest the solid fibres of animals, or even
to assimilate the juices of vegetables, a diet consisting chiefly of
_milk_ will not only support the patient, but will often cure the
disease after every other medicine has failed.
Nor is an attention to other things of less importance than to diet. The
strange infatuation which has long induced people to shut up the sick
from all communication with the external air, has done great mischief.
Not only in fevers, but in many other diseases, the patient will receive
more benefit from having the fresh air prudently admitted into his
chamber, than from all the medicines which can be given him.
Exercise may likewise in many cases be considered as a medicine.
Sailing, or riding on horseback, for example, will be of more service in
the cure of consumptions, glandular obstructions, &c. than any medicine
yet known. In diseases which proceed from a relaxed state of the solids,
the cold bath, and other parts of the gymnastic regimen, will be found
equally beneficial.
Few things are of greater importance in the cure of diseases than
cleanliness. When a patient is suffered to lie in dirty clothes,
whatever perspires from his body is again resorbed, or taken up into it,
which serves to nourish the disease and increase the danger. Many
diseases may be cured by cleanliness alone; most of them may be
mitigated by it, and in all of them it is highly necessary both for the
patient and those who attend him.
Many other observations, were it necessary, might be adduced to prove
the importance of a proper regimen in diseases. Regimen will often cure
diseases without medicine, but medicine will seldom succeed where a
proper regimen is neglected. For this reason, in the treatment of
diseases, we have always given the first place to regimen. Those who are
ignorant of medicine may confine themselves to it only. For others who
have more knowledge, we have recommended some of the most simple but
approved forms of medicine in every disease. These however are never to
be administered but by people of better understanding; nor even by them
without the greatest precaution.
CHAP. XIII.
OF FEVERS IN GENERAL.
As more than one half of mankind is said to perish by fevers, it is of
importance to be acquainted with their causes. The most general causes
of fevers are, _infection, errors in diet, unwholesome air, violent
emotions of the mind, excess or suppression of usual evacuations,
external or internal injuries, and extreme degrees of heat or cold_. As
most of these have already been treated of at considerable length, and
their effects shewn, we shall not now resume the consideration of them,
but shall only recommend it to all, as they would wish to avoid fevers
and other fatal diseases, to pay the most punctual attention to these
articles.
Fevers are not only the most frequent of all diseases, but they are
likewise the most complex. In the most simple species of fever there is
always a combination of several different symptoms. The distinguishing
symptoms of fever are, _increased heat_, _frequency of pulse_, _loss of
appetite_, _general debility_, _pain in the head_, and _a difficulty in
performing some of the vital or animal functions_. The other symptoms
usually attendant on fevers are, nausea, thirst, anxiety, delirium,
weariness, wasting of the flesh, want of sleep, or the sleep disturbed
and not refreshing.
When the fever comes on gradually, the patient generally complains first
of languor or listlessness, soreness of the flesh, or the bones, as the
country people express it, heaviness of the head, loss of appetite,
sickness, with clamminess of the mouth; after some time come on
excessive heat, violent thirst, restlessness, &c.
When the fever attacks suddenly, it always begins with an uneasy
sensation of excessive cold, accompanied with debility and loss of
appetite; frequently the cold is attended with shivering, oppression
about the heart, and sickness at stomach, or vomiting.
Fevers are divided into continual, remitting, intermitting, and such as
are attended with cutaneous eruption or topical inflammation, as the
small-pox, erysipelas, &c. By a continual fever is meant that which
never leaves the patient during the whole course of the disease, or
which shews no remarkable increase or abatement in the symptoms. This
kind of fever is likewise divided into acute, slow, and malignant. The
fever is called _acute_ when its progress is quick, and the symptoms
violent; but when these are more gentle, it is generally denominated
_slow_. When livid or petechial spots shew a putrid state of the
humours, the fever is called _malignant_, _putrid_, or _petechial_.
A remitting fever differs from a continual only in a degree. It has
frequent increases and decreases, or exacerbations and remissions, but
never wholly leaves the patient during the course of the disease.
Intermitting fevers or agues are those which, during the time that the
patient may be said to be ill, have evident intervals or remissions of
the symptoms.
As a fever is only an effort of Nature to free herself from an offending
cause, it is the business of those who have the care of the sick to
observe with diligence which way Nature points, and to endeavour to
assist her operations. Our bodies are so framed, as to have a constant
tendency to expel or throw off whatever is injurious to health. This is
generally done by urine, sweat, stool, expectoration, vomit, or some
other evacuation.
There is reason to believe, if the efforts of Nature, at the beginning
of a fever, were duly attended to and promoted, it would seldom continue
long; but when her attempts are either neglected or counteracted, it is
no wonder if the disease proves fatal. There are daily instances of
persons who, after catching cold, have all the symptoms of a beginning
fever; but by keeping warm, drinking diluting liquors, bathing their
feet in warm water, &c. the symptoms in a few hours disappear, and the
danger is prevented.
When fevers of a putrid kind threaten, the best method of obviating
their effects is by repeated vomits.
Our design is not to enter into a critical inquiry into the nature and
immediate causes of fevers, but to mark their most obvious symptoms, and
to point out the proper treatment of the patient with respect to his
diet, drink, air, &c. in the different stages of the disease. In these
articles the inclinations of the patient will in a great measure direct
our conduct.
Almost every person in a fever complains of great thirst, and calls out
for drink, especially of a cooling nature. This at once points out the
use of _water_, and other cooling liquors. What is so likely to abate
the heat, attenuate the humours, remove spasms and obstructions, promote
perspiration, increase the quantity of urine, and in short produce every
salutary effect in an ardent or inflammatory fever, as drinking
plentifully of water, thin gruel, or any other weak liquor, of which
water is the basis? The necessity of diluting liquors is pointed out by
the dry tongue, the parched skin, and the burning heat, as well as by
the unquenchable thirst of the patient.
Many cooling liquors, which are extremely grateful to patients in a
fever, may be prepared from fruits, as decoctions of tamarinds,
apple-tea, orange-whey, and the like. Mucilaginous liquors might also be
prepared from marsh-mallow roots, linseed, lime-tree buds, and other
mild vegetables. These liquors, especially when acidulated, are highly
agreeable to the patient, and should never be denied him.
At the beginning of a fever the patient generally complains of great
lassitude or weariness, and has no inclination to move. This evidently
shews the propriety of keeping him easy, and if possible in bed. Lying
in bed relaxes the spasms, abates the violence of the circulation, and
gives Nature an opportunity of exerting all her force to overcome the
disease. The bed alone would often remove a fever at the beginning; but
when the patient struggles with the disease, instead of driving it off,
he only fixes it the deeper, and renders it more dangerous. This
observation is too often verified in travellers, who happen when on a
journey to be seized with a fever. Their anxiety to get home induces
them to travel with the fever upon them, which conduct seldom fails to
render it fatal.
In fevers the mind as well as the body should be kept easy. Company is
seldom agreeable to the sick. Indeed every thing that disturbs the
imagination increases the disease; for which reason every person in a
fever ought to be kept perfectly quiet, and neither allowed to see nor
hear any thing that may in the least affect or discompose his mind.
Though the patient in a fever has the greatest inclination for drink,
yet he seldom has any appetite for solid food; hence the impropriety of
urging him to take victuals is evident. Much solid food in a fever is
every way hurtful. It oppresses nature, and, instead of nourishing the
patient, serves only to feed the disease. What food the patient takes
should be in small quantity, light, and of easy digestion. It ought to
be chiefly of the vegetable kind, as panada, roasted apples, gruels, and
such like.
Poor people, when any of their family are taken ill, run directly to
their rich neighbours for cordials, and pour wine, spirits, &c. into the
patient, who perhaps never had been accustomed to taste such liquors
when in health. If there be any degree of fever, this conduct must
increase it, and if there be none, this is the ready way to raise one.
Stuffing the patient with sweetmeats and other delicacies is likewise
very pernicious. These are always harder to digest than common food, and
cannot fail to hurt the stomach.
Nothing is more desired by a patient in a fever than fresh air. It not
only removes his anxiety, but cools the blood, revives the spirits, and
proves every way beneficial. Many patients are in a manner stifled to
death in fevers for want of fresh air; yet such is the unaccountable
infatuation of most people, that the moment they think a person in a
fever, they imagine he should be kept in a close chamber, into which not
one particle of fresh air must be admitted. Instead of this, there ought
to be a constant stream of fresh air into a sick person’s chamber, so as
to keep it moderately cool. Indeed its degree of warmth ought never to
be greater than is agreeable to one in perfect health.
Nothing spoils the air of a sick person’s chamber, or hurts the patient
more, than a number of people breathing in it. When the blood is
inflamed, or the humours in a putrid state, air that has been breathed
repeatedly will greatly increase the disease. Such air not only loses
its spring, and becomes unfit for the purpose of respiration, but
acquires a noxious quality, which renders it in a manner poisonous to
the sick.
In fevers, when the patient’s spirits are low and depressed, he is not
only to be supported with cordials, but every method should be taken to
cheer and comfort his mind. Many, from a mistaken zeal, when they think
a person in danger, instead of solacing his mind with the hopes and
consolations of religion, fright him with the views of hell and
damnation. It would be unsuitable here to dwell upon the impropriety and
dangerous consequences of this conduct; it often hurts the body, and
there is reason to believe seldom benefits the soul.
Among common people, the very name of a fever generally suggests the
necessity of bleeding. This notion seems to have taken its rise from
most fevers in this country having been formerly of an inflammatory
nature; but true inflammatory fevers are now seldom to be met with.
Sedentary occupations, and a different manner of living, have so changed
the state of diseases in Britain, that there is now hardly one fever in
ten where the lancet is necessary. In most low, nervous, and putrid
fevers, which are now so common, bleeding is really hurtful, as it
weakens the patient, sinks his spirits, &c. We would recommend this
general rule, never to bleed at the beginning of a fever, unless there
be evident signs of inflammation. Bleeding is an excellent medicine when
necessary, but should never be wantonly performed.
It is likewise a common notion, that sweating is always necessary in the
beginning of a fever. When the fever proceeds from an obstructed
perspiration, this notion is not ill-founded. If the patient only lies
in bed, bathes his feet and legs in warm water, and drinks freely of
water-gruel, or any other weak diluting liquor, he will seldom fail to
perspire freely. The warmth of the bed, and the diluting drink, will
relax the universal spasm, which generally affects the skin at the
beginning of a fever; it will open the pores, and promote the
perspiration, by means of which the fever may often be carried off. But
instead of this, the common practice is to heap clothes upon the
patient, and to give him things of a hot nature, as spirits, spiceries,
&c. which fire his blood, increase the spasms, and render the disease
more dangerous.
In all fevers a proper attention should be paid to the patient’s
longings. These are the calls of Nature, and often point out what may be
of real use. Patients are not indeed to be indulged in every thing that
the sickly appetite may crave; but it is generally right to let them
have a little of what they eagerly desire, though it may not seem
altogether proper. What the patient longs for, his stomach will
generally digest; and such things have sometimes a very happy effect.
When a patient is recovering from a fever, great care is necessary to
prevent a relapse. Many persons, by too soon imagining themselves well,
have lost their lives, or contracted other diseases of an obstinate
nature. As the body after a fever is weak and delicate, it is necessary
to guard against catching cold. Moderate exercise in the open air will
be of use, but great fatigue is by all means to be avoided; agreeable
company will also have a good effect. The diet must be light, but
nourishing. It should be taken frequently, but in small quantities. It
is dangerous at such a time to eat as much as the stomach may crave.
CHAP. XIV.
OF INTERMITTING FEVERS, OR AGUES.
Intermitting fevers afford the best opportunity both of observing the
nature of a fever, and also the effects of medicine. No person can be at
a loss to distinguish an intermitting fever from any other, and the
proper medicine for it is now almost universally known.
The several kinds of intermitting fevers take their names from the
period in which the fit returns, as quotidian, tertian, quartan, &c.
CAUSES.——Agues are occasioned by effluvia from putrid stagnating water.
This is evident from their abounding in rainy seasons, and being most
frequent in countries where the soil is marshy, as in Holland, the Fens
of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be
occasioned by eating too much stone fruit, by a poor watery diet, damp
houses, evening dews, lying upon the damp ground, watching, fatigue,
depressing passions, and the like. When the inhabitants of a high
country remove to a low one, they are generally seized with intermitting
fevers, and to such the disease is most apt to prove fatal. In a word,
whatever relaxes the solids, diminishes the perspiration, or obstructs
the circulation in the capillary or small vessels, disposes the body to
agues.
SYMPTOMS.——An intermitting fever generally begins with a pain of the
head and loins, weariness of the limbs, coldness of the extremities,
stretching, yawning, with sometimes great sickness and vomiting; to
which succeed shivering and violent shaking. Afterwards the skin becomes
moist, and a profuse sweat breaks out, which generally terminates the
fit or paroxysm. Sometimes indeed the disease comes on suddenly, when
the person thinks himself in perfect health; but it is more commonly
preceded by listlessness, loss of appetite, and the symptoms mentioned
above.
REGIMEN.——While the fit continues, the patient ought to drink freely of
water-gruel, orange-whey, weak camomile-tea; or, if his spirits be low,
small wine-whey, sharpened with the juice of lemon. All his drink should
be warm, as that will assist in bringing on the sweat, and consequently
shorten the paroxysm[58].
Between the paroxysms the patient must be supported with food that is
nourishing, but light and easy of digestion, as veal or chicken-broths,
sago, gruel with a little wine, light puddings, and such like. His drink
may be small negus, acidulated with the juice of lemons or oranges, and
sometimes a little weak punch. He may likewise drink infusions of bitter
herbs, as camomile, wormwood, or water-trefoil, and may now and then
take a glass of small wine, in which gentian root, centaury, or some
other bitter, has been infused.
As the chief intentions of cure in an ague are to brace the solids, and
promote perspiration, the patient ought to take as much exercise between
the fits as he can bear. If he be able to go abroad, riding on
horseback, or in a carriage, will be of great service. But if he cannot
bear that kind of exercise, he ought to take such as his strength will
permit. Nothing tends more to prolong an intermitting fever, than
indulging a lazy indolent disposition.
Intermitting fevers, under a proper regimen, will often go off without
medicine; and when the disease is mild, in an open dry country, there is
seldom any danger from allowing it to take its course; but when the
patient’s strength seems to decline, or the paroxysms are so violent
that his life is in danger, medicine ought immediately to be
administered. This however should never be done till the disease be
properly formed, that is to say, till the patient has had several fits
of shaking and sweating.
MEDICINE.——The first thing to be done in the cure of an intermitting
fever, is to cleanse the stomach and bowels. This not only renders the
application of other medicines more safe, but likewise more efficacious.
In this disease, the stomach is generally loaded with cold viscid
phlegm, and frequently great quantities of bile are discharged by vomit;
which plainly points out the necessity of such evacuations. Vomits are
therefore to be administered before the patient takes any other
medicine. A dose of ipecacuanha will generally answer this purpose very
well. A scruple or half a dram of the powder will be sufficient for an
adult, and for a younger person the dose must be less in proportion.
After the vomit begins to operate, the patient ought to drink
plentifully of weak camomile-tea. The vomit should be taken two or three
hours before the return of the fit, and may be repeated at the distance
of two or three days. Vomits not only cleanse the stomach, but increase
the perspiration, and all the other secretions, which render them of
such importance, that they often cure intermitting fevers without the
assistance of any other medicine.
Purging medicines are likewise useful and often necessary in
intermitting fevers. A smart purge has been known to cure an obstinate
ague, after the Peruvian bark and other medicines had been used in vain.
Vomits however are more suitable in this disease, and render purging
less necessary; but if the patient be afraid to take a vomit, he ought
in this case to cleanse the bowels by a dose or two of Glauber’s salt,
jalap, or rhubarb.
Bleeding may sometimes be proper at the beginning of an intermitting
fever, when excessive heat, a delirium, &c. give reason to suspect an
inflammation; but as the blood is seldom in an inflammatory slate in
intermitting fevers, this operation is rarely necessary. When frequently
repeated, it tends to prolong the disease.
After proper evacuations the patient may safely use the Peruvian bark,
which may be taken in any way that is most agreeable to him. No
preparation of the bark seems to answer better than the most simple form
in which it can be given, viz. in powder.
Two ounces of the best Peruvian bark, finely powdered, may be divided
into twenty-four doses. These may either be made into boluses as they
are used, with a little syrup of lemon, or mixed in a glass of red wine,
a cup of camomile-tea, water-gruel, or any other drink that is more
agreeable to the patient[59].
In an ague which returns every day, one of the above doses may be taken
every two hours during the interval of the fits. By this method the
patient will be able to take five or six doses between each paroxysm. In
a tertian or third-day ague it will be sufficient to take a dose every
third hour during the interval, and in a quartan every fourth. If the
patient cannot take so large a dose of the bark, he may divide each of
the powders into two parts, and take one every hour, &c. For a young
person a smaller quantity of this medicine will be sufficient, and the
dose must be adapted to the age, constitution, and violence of the
symptoms[60].
The above quantity of bark will frequently cure an ague; the patient,
however, ought not to leave off taking the medicine as soon as the
paroxysms are stopped, but should continue to use it till there is
reason to believe the disease is entirely overcome. Most of the failures
in the cure of this disease are owing to patients not continuing to use
the medicine long enough. They are generally directed to take it till
the fits are stopped, then to leave it off, and begin again at some
distance of time; by which means the disease gathers strength, and often
returns with as much violence as before. A relapse may always be
prevented by the patient’s continuing to take small doses of the
medicine for some time after the symptoms disappear. This is both the
most safe and effectual method of cure.
An ounce of gentian root, calamus aromaticus, and orange-peel, of each
half an ounce, with three or four handfuls of camomile-flowers, and an
handful of coriander-seed, all bruised together in a mortar, may be used
in form of infusion or tea. About half an handful of these ingredients
may be put into a tea-pot, and an English pint of boiling water poured
on them. A cup of this infusion drank three or four times a day will
greatly promote the cure. Such patients as cannot drink the watery
infusion, may put two handfuls of the same ingredients into a bottle of
white wine, and take a glass of it twice or thrice a day. If patients
drink freely of the above, or any other proper infusion of bitters, a
smaller quantity of bark than is generally used, will be sufficient to
cure an ague[61].
Those who cannot swallow the bark in substance, may take it in decoction
or infusion. An ounce of bark in powder may be infused in a bottle of
white wine for four or five days, frequently shaking the bottle,
afterwards let the powder subside, and pour off the clear liquor. A wine
glass may be drank three or four times a day, or oftener, as there is
occasion. If a decoction be more agreeable, an ounce of the bark, and
two drams of snake-root bruised, with an equal quantity of salt of
wormwood, may be boiled in a quart of water, into an English pint. To
the strained liquor may be added an equal quantity of red wine, and a
glass of it taken frequently.
In obstinate agues, the bark will be found much more efficacious when
assisted by brandy, or other warm cordials, than taken alone. This I
have had frequently occasion to observe in a country where intermittent
fevers were endemical. The bark seldom succeeded unless assisted by
snake-root, ginger, canella alba, or some other warm aromatic. When the
fits are very frequent and violent, in which case the fever often
approaches towards an inflammatory nature, it will be safer to keep out
the aromatics, and to add salt of tartar in their stead. But in an
obstinate tertian or quartan, in the end of autumn or beginning of
winter, warm and cordial medicines are absolutely necessary[62].
As autumnal and winter agues generally prove much more obstinate than
those which attack the patient in spring or summer, it will be necessary
to continue the use of medicines longer in the former than in the
latter. A person who is seized with an intermitting fever in the
beginning of winter, ought frequently, if the season proves rainy, to
take a little medicine, although the disease may seem to be cured, to
prevent a relapse, till the return of the warm season. He ought likewise
to take care not to be much abroad in wet weather, especially in cold
easterly winds.
When agues are not properly cured, they often degenerate into obstinate
chronical diseases, as the dropsy, jaundice, &c. For this reason all
possible care should be taken to have them radically cured, before the
constitution has been too much weakened.
Though nothing is more rational than the method of treating intermitting
fevers, yet, by some strange infatuation, more charms and whimsical
remedies are daily used for removing this than any other disease. There
is hardly an old woman who is not in possession of a nostrum for
stopping an ague; and it is amazing with what readiness their
pretensions are believed. Those in distress eagerly grasp at any thing
that promises sudden relief; but the shortest way is not always the best
in the treatment of diseases. The only method to obtain a safe and
lasting cure, is gradually to assist Nature in removing the cause of the
disorder.
Some indeed try bold, or rather fool-hardy experiments to cure agues, as
drinking great quantities of strong liquors, jumping into a river, &c.
These may sometimes have the desired effect, but must always be attended
with danger[63]. When there is any degree of inflammation, or the least
tendency to it, such experiments may prove fatal. The only patient whom
I remember to have lost in an intermittent fever, evidently killed
himself by drinking strong liquor, which some person had persuaded him
would prove an infallible remedy.
Many dirty things are extolled for the cure of intermitting fevers, as
spiders, cobwebs, snuffings of candles, &c. Though these may sometimes
succeed, yet their very nastiness is sufficient to set them aside,
especially when cleanly medicines will answer the purpose better. The
only medicine that can be depended upon, for thoroughly curing an
intermittent fever, is the Peruvian bark. It may always be used with
safety: and I can honestly declare, that in all my practice I never knew
it fail, when combined with the medicines mentioned above, and duly
persisted in.
Where agues are endemical, even children are often afflicted with that
disease. Such patients are very difficult to cure, as they can seldom be
prevailed upon to take the bark, or any other disagreeable medicine. One
method of rendering this medicine more palatable, is to make it into a
mixture with distilled waters and syrup, and afterwards to give it an
agreeable sharpness with the elixir or spirit of vitriol. This both
improves the medicine, and takes off the nauseous taste. In cases where
the bark cannot be administered, the _saline mixture_ may be given with
advantage to children[64].
Wine-whey is a very proper drink for a child in an ague; to half an
English pint of which may be put a tea-spoonful of the spirit of
hartshorn. Exercise is likewise of considerable service; and when the
disease proves obstinate, the child ought, if possible, to be removed to
a warm dry air. The food ought to be nourishing, and sometimes a little
generous wine should be allowed.
To children, and such as cannot swallow the bark, or when the stomach
will not bear it, it may be given by clyster. Half an ounce of the
extract of bark, dissolved in four ounces of warm water, with the
addition of half an ounce of sweet oil, and six or eight drops of
laudanum, in the form recommended by Dr. Lind for an adult, and this to
be repeated every fourth hour, or oftener, as the occasion shall
require. For children the quantity of extract and laudanum must be
proportionally lessened. Children have been cured of agues by making
them wear a waistcoat with powdered bark quilted between the folds of
it; by bathing them frequently in a strong decoction of the bark, and by
rubbing the spine with strong spirits, or with a mixture of equal parts
of laudanum and the saponaceous liniment.
We have been the more full upon this disease, because it is very common,
and because few patients in an ague apply to physicians unless in
extremities. There are, however, many cases in which the disease is very
irregular, being complicated with other diseases, or attended with
symptoms which are both very dangerous and very difficult to understand.
All these we have purposely passed over, as they would only bewilder the
generality of readers. When the disease is very irregular, or the
symptoms dangerous, the patient ought immediately to apply to a
physician, and strictly to follow his advice.
To prevent agues, people must endeavour to avoid their causes. These
have been already pointed out in the beginning of this section; we shall
therefore only add one preventive medicine, which may be of use to such
as are obliged to live in low marshy countries, or who are liable to
frequent attacks of this disease.
Take an ounce of the best Peruvian bark; Virginian snake-root, and
orange-peel, of each half an ounce; bruise them all together, and infuse
for five or six days in a bottle of brandy, Holland gin, or any good
spirit; afterwards pour off the clear liquor; and take a wine glass of
it twice or thrice a day. This indeed is recommending a dram; but the
bitter ingredients in a great measure take off the ill effects of the
spirit. Those who do not chuse it in brandy, may infuse it in wine; and
such as can bring themselves to chew the bark, will find that method
succeed very well. Gentian root, or calamus aromaticus, may also be
chewed by turns for the same purpose. All bitters seem to be antidotes
to agues, especially those that are warm and astringent.
CHAP. XV.
OF AN ACUTE CONTINUAL FEVER.
This fever is denominated acute, ardent, or inflammatory. It most
commonly attacks the young, or persons about the prime or vigour of
life, especially such as live high, abound with blood, and whose fibres
are strong and elastic. It seizes people at all seasons of the year; but
is most frequent in the spring and beginning of summer.
CAUSES.——An ardent fever may be occasioned by any thing that overheats
the body, or produces plethora, as violent exercise, sleeping in the
sun, drinking strong liquors, eating spiceries, a full diet, with little
exercise, &c. It may likewise be occasioned by whatever obstructs the
perspiration, as lying on the damp ground, drinking cold liquor when the
body is hot, night-watching, or the like.
SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which
is soon succeeded by great heat, a frequent and full pulse, pain of the
head, dry skin, redness of the eyes, a florid countenance, pains in the
back, loins, &c. To these succeed difficulty of breathing, sickness,
with an inclination to vomit. The patient complains of great thirst, has
no appetite for solid food, is restless, and his tongue generally
appears black and rough.
A delirium, excessive restlessness, great oppression of the breast, with
laborious respiration, starting of the tendons, hiccup, cold clammy
sweats, and an involuntary discharge of urine, are very dangerous
symptoms.
As this disease is always attended with danger, the best medical
assistance ought to be procured as soon as possible. A physician may be
of use at the beginning, but his skill is often of no avail afterwards.
Nothing can be more unaccountable than the conduct of those who have it
in their power, at the beginning of a fever, to procure the best medical
assistance, yet put it off till things come to an extremity. When the
disease, by delay or wrong treatment, has become incurable, and has
exhausted the strength of the patient, it is in vain to hope for relief
from medicine. Physicians may indeed assist Nature; but their attempts
must ever prove fruitless, when she is no longer able to co-operate with
their endeavours.
REGIMEN.—From the symptoms of this disease, it is evident, that the
blood and other humours require to be diluted; that the perspiration,
urine, saliva, and all the other secretions, are in too small quantity;
that the vessels are rigid, and the heat of the whole body too great:
all these clearly point out the necessity of a regimen calculated to
dilute the blood, correct the acrimony of the humours, allay the
excessive heat, remove the spasmodic stricture of the vessels, and
promote the secretions.
These important purposes may be greatly promoted by drinking plentifully
of diluting liquors; as water-gruel, or oatmeal-tea, clear whey,
barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice
of orange, jelly of currants, raspberries, and such like: orange-whey is
likewise an excellent cooling drink. It is made by boiling among milk
and water a bitter orange sliced, till the curd separates. If no orange
can be had, a lemon, a little cream of tartar, or a few spoonfuls of
vinegar, will have the same effect. Two or three spoonfuls of white wine
may occasionally be added to the liquor when boiling.
If the patient be costive, an ounce of tamarinds, with two ounces of
stoned raisins of the sun, and a couple of figs, may be boiled in three
English pints of water to a quart. This makes a very pleasant drink, and
may be used at discretion. The common pectoral decoction is likewise a
very proper drink in this disease. A tea-cupful of it may be taken every
two hours, or oftener, if the patient’s heat and thirst be very
great[65].
The above liquids must all be drank a little warm. They may be used in
smaller quantities at the beginning of a fever, but more freely
afterwards, in order to assist in carrying off the disease by promoting
the different excretions. We have mentioned a variety of drinks, that
the patient may have it in his power to chuse those which are most
agreeable; and that when tired of one, he may have recourse to another.
The patient’s diet must be very spare and light. All sorts of
flesh-meats, and even chicken-broths, are to be avoided. He may be
allowed groat-gruel, panado, or light bread boiled in water; to which
may be added a few grains of common salt, and a little sugar, which will
render it more palatable. He may eat roasted apples with a little sugar,
toasted bread with jelly of currants, boiled prunes, &c.
It will greatly relieve the patient, especially in an hot season, to
have fresh air frequently let into his chamber. This, however, must
always be done in such a manner as not to endanger his catching cold.
It is too common in fevers to load the patient with bed-clothes, under
the pretence of making him sweat, or defending him from the cold. This
custom has many ill effects. It increases the heat of the body, fatigues
the patient, and retards, instead of promoting, the perspiration.
Sitting upright in bed, if the patient is able to bear it, will often
have a good effect. It relieves the head, by retarding the motion of the
blood to the brain. But this posture ought never to be continued too
long: and if the patient is inclined to sweat, it will be more safe to
let him lie, only raising his head a little with pillows.
Sprinkling the chamber with vinegar, juice of lemon, or vinegar and
rose-water, with a little nitre dissolved in it, will greatly refresh
the patient. This ought to be done frequently, especially if the weather
is hot.
The patient’s mouth should be often washed with a mixture of water and
honey, to which a little vinegar may be added, or with a decoction of
figs in barley-water. His feet and hands ought likewise frequently to be
bathed in lukewarm water; especially if the head is affected.
The patient should be kept as quiet and easy as possible. Company,
noise, and every thing that disturbs the mind, is hurtful. Even too much
light, or any thing that affects the senses, ought to be avoided. His
attendants should be as few as possible, and they ought not to be too
often changed. His inclinations ought rather to be soothed than
contradicted; even the promise of what he craves will often satisfy him
as much as its reality.
MEDICINE.——In this and all other fevers, attended with a hard, full,
quick pulse, bleeding is of the greatest importance. This operation
ought always to be performed as soon as the symptoms of an inflammatory
fever appear. The quantity of blood to be taken away, however, must be
in proportion to the strength of the patient and the violence of the
disease. If after the first bleeding the fever should increase, and the
pulse become more frequent and hard, there will be a necessity for
repeating it a second, and perhaps a third, or even a fourth time, which
may be done at the distance of twelve, eighteen, or twenty-four hours
from each other, as the symptoms require. If the pulse continues soft,
and the patient is tolerably easy after the first bleeding, it ought not
to be repeated.
If the heat and fever be very great, forty or fifty drops of the
dulcified or sweet spirit of nitre may be made into a draught, with an
ounce of rose-water, two ounces of common water, and half an ounce of
simple syrup, or a bit of loaf-sugar. This draught may be given to the
patient every three or four hours while the fever is violent; afterwards
once in five or six hours will be sufficient.
If the patient be afflicted with retching, or an inclination to vomit,
it will be right to assist Nature’s attempts, by giving him weak
camomile-tea, or lukewarm water to drink.
If the body is bound, a clyster of milk and water with a little salt,
and a spoonful of sweet oil or fresh butter in it, ought daily to be
administered. Should this not have the desired effect, a tea-spoonful of
magnesia alba, or cream of tartar, may be frequently put into his drink.
He may likewise eat tamarinds, boiled prunes, roasted apples, and the
like.
If about the tenth, eleventh, or twelfth day, the pulse becomes more
soft, the tongue moister, and the urine begins to let fall a reddish
settlement, there is reason to expect a favourable issue to the disease.
But if, instead of these symptoms, the patient’s spirits grow languid,
his pulse sinks, and his breathing becomes difficult; with a stupor,
trembling of the nerves, starting of the tendons, &c. there is reason to
fear that the consequences will be fatal. In this case blistering
plasters must be applied to the head, ancles, inside of the legs or
thighs, as there may be occasion; poultices of wheat-bread, mustard, and
vinegar, may likewise be applied to the soles of the feet, and the
patient must be supported with cordials, as strong wine-whey, negus,
sago-gruel with wine in it, and such like.
A proper regimen is not only necessary during the fever, but likewise
after the patient begins to recover. By neglecting this, many relapse,
or fall into other diseases, and continue valetudinary for life. Though
the body is weak after a fever, yet the diet for some time ought to be
rather light than of too nourishing a nature. Too much food, drink,
exercise, company, &c. are carefully to be avoided. The mind ought
likewise to be kept easy, and the patient should not attempt to pursue
study, or any business that requires intense thinking.
If the digestion is bad, or the patient is seized at times with feverish
heats, an infusion of Peruvian bark in cold water will be of use. It
will strengthen the stomach, and help to subdue the remains of the
fever.
When the patient’s strength is pretty well recovered, he ought to take
some gentle laxative. An ounce of tamarinds and a dram of sena may be
boiled for a few minutes in an English pint of water, and an ounce of
manna dissolved in the decoction; afterwards it may be strained, and a
tea-cupful drank every hour till it operates. This dose may be repeated
twice or thrice, five or six days intervening between each dose.
Those who follow laborious employments ought not to return too soon to
their labour after a fever, but should keep easy till their strength and
spirits are sufficiently recruited.
CHAP. XVI.
OF THE PLEURISY.
The true pleurisy is an inflammation of that membrane called the
_pleura_, which lines the inside of the breast. It is distinguished into
the moist and dry. In the former the patient spits freely; in the
latter, little or none at all. There is likewise a species of this
disease, which is called the _spurious_ or _bastard pleurisy_, in which
the pain is more external, and chiefly affects the muscles between the
ribs. The pleurisy prevails among labouring people, especially such as
work without doors, and are of a sanguine constitution. It is most
frequent in the spring season.
CAUSES.——The pleurisy may be occasioned by whatever obstructs the
perspiration; as cold northerly winds; drinking cold liquors when the
body is hot; sleeping without doors on the damp ground; wet clothes;
plunging the body into cold water, or exposing it to the cold air, when
covered with sweat, &c. It may likewise be occasioned by drinking strong
liquors; by the stoppage of usual evacuations; as old ulcers, issues,
sweating of the feet or hands, &c. the sudden striking in of any
eruption, as the itch, the measles, or the small-pox. Those who have
been accustomed to bleed at a certain season of the year are apt, if
they neglect it, to be seized with a pleurisy. Keeping the body too warm
by means of fire, clothes, &c. renders it more liable to this disease. A
pleurisy may likewise be occasioned by violent exercise, as running,
wrestling, leaping, or by supporting great weight, blows on the breast,
&c. A bad conformation of the body renders persons more liable to this
disease, as a narrow chest, a straitness of the arteries of the pleura,
&c.
SYMPTOMS.—This, like most other fevers, generally begins with chillness
and shivering, which are followed by heat, thirst, and restlessness. To
these succeeds a violent pricking pain in one of the sides among the
ribs. Sometimes the pain extends towards the back bone, sometimes
towards the fore-part of the breast, and at other times towards the
shoulder blades. The pain is generally most violent when the patient
draws his breath.
The pulse in this disease is commonly quick and hard, the urine
high-coloured; and if blood be let, it is covered with a tough crust, or
buffy coat. The patient’s spittle is at first thin, but afterwards it
becomes grosser, and is often streaked with blood.
REGIMEN.——Nature generally endeavours to carry off this disease by a
critical discharge of blood from some part of the body, by
expectoration, sweat, loose stools, thick urine, or the like. We ought
therefore to second her intentions by lessening the force of the
circulation, relaxing the vessels, diluting the humours, and promoting
expectoration.
For these purposes the diet, as in the former disease, ought to be cool,
slender, and diluting. The patient must avoid all food that is viscid,
hard of digestion, or that affords much nourishment; as flesh, butter,
cheese, eggs, milk, and also every thing that is of a heating nature.
His drink may be whey, or an infusion of pectoral and balsamic
vegetables[66].
Barley-water, with a little honey or jelly of currants mixed with it, is
likewise a very proper drink in this disease. It is made by boiling an
ounce of pearl-barley in three English pints of water to two, which must
afterwards be strained. The decoction of figs, raisins, barley,
recommended in the preceding disease, is here likewise very proper.
These and other diluting liquors are not to be drank in large quantities
at a time, but the patient ought to keep continually sipping them, so as
to render his mouth and throat always moist. All his food and drink
should be taken a little warm.
The patient should be kept quiet, cool, and every way easy, as directed
under the foregoing disease. His feet and hands ought daily to be bathed
in lukewarm water; and he may sometimes sit up in bed for a short space,
in order to relieve his head.
MEDICINE.——Almost every person knows, when a fever is attended with a
violent pain of the side, and a quick hard pulse, that bleeding is
necessary. When these symptoms come on, the sooner this operation is
performed the better; and the quantity at first must be pretty large,
provided the patient is able to bear it. A large quantity of blood let
at once, in the beginning of a pleurisy, has a much better effect than
repeated small bleedings. A man may lose twelve or fourteen ounces of
blood as soon as it is certainly known that he is seized with a
pleurisy. For a younger person, or one of a delicate constitution, the
quantity must be less.
If, after the first bleeding, the stitch, with the other violent
symptoms, should still continue, it will be necessary, at the distance
of twelve or eighteen hours, to let eight or nine ounces more. If the
symptoms do not then abate, and the blood shews a strong buffy coat, a
third or even a fourth bleeding may be requisite. If the pain of the
side abates, the pulse becomes softer, or the patient begins to spit
freely, bleeding ought not to be repeated. This operation is seldom
necessary after the third or fourth day of the fever, and ought not then
to be performed, unless in the most urgent circumstances.
The blood may be many ways attenuated without bleeding. There are
likewise many things that may be done to ease the pain of the side
without this operation, as fomenting, blistering, &c. Fomentations may
be made by boiling a handful of the flowers of elder, camomile, and
common mallows, or any other soft vegetables, in a proper quantity of
water. The herbs may be either put into a flannel bag, and applied warm
to the side, or flannels may be dipped in the decoction, afterwards
wrung out, and applied to the part affected, with as much warmth as the
patient can easily bear. As the clothes grow cool, they must be changed,
and great care taken that the patient do not catch cold. A bladder may
be filled with warm milk and water, and applied to the side, if the
above method of fomenting be found inconvenient. Fomentations not only
ease the pain, but relax the vessels, and prevent the stagnation of the
blood and other humours. The side may likewise be frequently rubbed with
a little of the volatile liniment[67].
Topical bleeding has often a very good effect in this disease. It may
either be performed by applying a number of leeches to the part
affected, or by cupping, which is both a more certain and expeditious
method than the other.
Leaves of various plants might likewise be applied to the patient’s side
with advantage. I have often seen great benefit from young
cabbage-leaves applied warm to the side in a pleurisy. These not only
relax the parts, but likewise draw off a little moisture, and may
prevent the necessity of blistering-plasters; which however, when other
things fail, must be applied.
If the stitch continues after repeated bleedings, fomentations, &c. a
blistering-plaster must be applied over the part affected, and suffered
to remain for two days. This not only procures a discharge from the
side, but takes off the spasm, and by that means assists in removing the
cause of the disease. To prevent a strangury when the blistering-plaster
is on, the patient may drink freely of the Arabic emulsion[68].
If the patient is costive, a clyster of thin water-gruel, or of
barley-water, in which a handful of mallows, or any other emollient
vegetable has been boiled, may be daily administered. This will not only
empty the bowels, but have the effect of a warm fomentation applied to
the inferior viscera, which will help to make a derivation from the
breast.
The expectoration of spitting may be promoted by sharp, oily, and
mucilaginous medicines. For this purpose an ounce of the oxymel, or the
vinegar of squills, may be added to six ounces of the pectoral
decoction, and two table-spoonfuls of it taken every two hours.
Should the squill disagree with the stomach, the oily emulsion may be
administered[69]; or, in place of it, two ounces of the oil of sweet
almonds, or oil of olives, and two ounces of the syrup of violets, may
be mixed with as much sugar-candy powdered, as will make an electuary of
the consistence of honey. The patient may take a tea-spoonful of this
frequently, when the cough is troublesome. Should oily medicines prove
nauseous, which is sometimes the case, two table-spoonfuls of the
solution of gum ammoniac in barley-water may be given three or four
times a-day[70].
If the patient does not perspire, but has a burning heat upon his skin,
and passes very little water, some small doses of purified nitre and
camphire will be of use. Two drams of the former may be rubbed with five
or six grains of the latter in a mortar, and the whole divided into six
doses, one of which may be taken every five or six hours, in a little of
the patient’s ordinary drink.
We shall only mention one medicine more, which some reckon almost a
specific in the pleurisy, _viz._ the decoction of the seneka
rattle-snake root[71]. After bleeding and other evacuations have been
premised, the patient may take two, three, or four table-spoonfuls of
this decoction, according as his stomach will bear it, three or four
times a-day. If it should occasion vomiting, two or three ounces of
simple cinnamon-water may be mixed with the quantity of decoction here
directed, or it may be taken in smaller doses. As this medicine promotes
perspiration and urine, and likewise keeps the body easy, it may be of
some service in a pleurisy, or any other inflammation of the breast.
No one will imagine that these medicines are all to be used at the same
time. We have mentioned different things, on purpose that people may
have it in their power to chuse; and likewise, that when one cannot be
obtained, they may make use of another. Different medicines are no doubt
necessary in the different periods of a disorder; and where one fails of
success, or disagrees with the patient, it will be proper to try
another.
What is called the crisis, or height of the fever, is sometimes attended
with very alarming symptoms, as difficulty of breathing, an irregular
pulse, convulsive motions, &c. These are apt to frighten the attendants,
and induce them to do improper things, as bleeding the patient, giving
him strong stimulating medicines, or the like. But they are only the
struggles of Nature to overcome the disease, in which she ought to be
assisted by plenty of diluting drink, which is then peculiarly
necessary. If the patient’s strength however be much exhausted by the
disease, it will be necessary at this time to support him with frequent
small draughts of wine-whey, negus, or the like.
When the pain and fever are gone, it will be proper, after the patient
has recovered sufficient strength, to give him some gentle purges, as
those directed towards the end of the acute continual fever. He ought
likewise to use a light diet, of easy digestion, and his drink should be
butter-milk, whey, and other things of a cleansing nature.
Of the BASTARD PLEURISY.
That species of pleurisy which is called the _bastard_ or _spurious_,
generally goes off by keeping warm for a few days, drinking plenty of
diluting liquors, and observing a cooling regimen.
It is known by a dry cough, a quick pulse, and a difficulty of lying on
the affected side, which last does not always happen in the true
pleurisy. Sometimes indeed this disease proves obstinate, and requires
bleeding, with cupping, and scarifications of the part affected. These,
together with the use of nitrous and other cooling medicines, seldom
fail to effect a cure.
Of the PARAPHRENITIS.
The _paraphrenitis_, or inflammation of the diaphragm, is so nearly
connected with the pleurisy, and resembles it so much in the manner of
treatment, that it is scarce necessary to consider it as a separate
disease.
It is attended with a very acute fever, and an extreme pain in the part
affected, which is generally augmented by coughing, sneezing, drawing in
the breath, taking food, going to stool, making water, &c. Hence the
patient breathes quick, and draws in his bowels to prevent the motion of
the diaphragm; is restless, anxious, has a dry cough, a hiccup, and
often a delirium. A convulsive laugh, or rather a kind of involuntary
grin, is no uncommon symptom of this disease.
Every method must be taken to prevent a suppuration, as it is impossible
to save the patient’s life when this happens. The regimen and medicine
are in all respects the same as in the pleurisy. We shall only add, that
in this disease emollient clysters are peculiarly useful, as they relax
the bowels, and by that means make a derivation from the part affected.
CHAP. XVII.
OF A PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS.
As this disease affects an organ which is absolutely necessary to life,
it must always be attended with danger. Persons who abound with thick
blood, whose fibres are tense and rigid, who feed upon gross aliment,
and drink strong viscid liquors, are most liable to a peripneumony. It
is generally fatal to those who have a flat breast, or narrow chest, and
to such as are afflicted with an asthma, especially in the decline of
life. Sometimes the inflammation reaches to one lobe of the lungs only,
at other times the whole of the organ is affected; in which case the
disease can hardly fail to prove fatal.
When the disease proceeds from a viscid pituitous matter obstructing the
vessels of the lungs, it is called a _spurious_ or _bastard
peripneumony_. When it arises from a thin acrid defluxion on the lungs,
it is denominated a _catarrhal peripneumony_, &c.
CAUSES.——An inflammation of the lungs is sometimes a primary disease,
and sometimes it is the consequence of other diseases, as a quinsey, a
pleurisy, &c. It proceeds from the same causes as the pleurisy, _viz._
an obstructed perspiration from cold, wet clothes, &c. or from an
increased circulation of the blood by violent exercise, the use of
spiceries, ardent spirits, and such like. The pleurisy and peripneumony
are often complicated; in which case the disease is called a
_pleuro-peripneumony_.
SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an
inflammation of the lungs; only in the latter the pulse is more soft,
and the pain less acute; but the difficulty of breathing, and oppression
of the breast, are generally greater.
REGIMEN.——As the regimen and medicine are in all respects the same in
the true peripneumony as in the pleurisy, we shall not here repeat them,
but refer the reader to the treatment of that disease. It may not
however be improper to add, that the aliment ought to be more slender
and thin in this than in any other inflammatory disease. The learned Dr.
Arbuthnot asserts, that even common whey is sufficient to support the
patient, and that decoctions of barley, and infusions of fennel roots in
warm water with milk, are the most proper both for drink and
nourishment. He likewise recommends the steam of warm water taken in by
the breath, which serves as a kind of internal fomentation, and helps to
attenuate the impacted humours. If the patient has loose stools, but is
not weakened by them, they are not to be stopped, but rather promoted by
the use of emollient clysters.
It has already been observed, that the _spurious_ or _bastard_
peripneumony is occasioned by a viscid pituitous matter obstructing the
vessels of the lungs. It commonly attacks the old, infirm, and
phlegmatic, in winter and wet seasons.
The patient at the beginning is cold and hot by turns, has a small quick
pulse, feels sense of weight upon his breast, breathes with difficulty,
and sometimes complains of a pain and giddiness of his head. His urine
is usually pale, and his colour very little changed.
The diet in this, as well as in the true peripneumony, must be very
slender, as weak broths, sharpened with the juice of orange or lemon,
and such like. His drink may be thin water-gruel sweetened with honey,
or a decoction of the roots of fennel, liquorice, and quick grass. An
ounce of each of these may be boiled in three English pints of water to
a quart, and sharpened with a little currant-jelly, or the like.
Bleeding and purging are generally proper at the beginning of this
disease; but if the patient’s spittle is pretty thick, or well
concocted, neither of them are necessary. It will be sufficient to
assist the expectoration by some of the sharp medicines recommended for
that purpose in the pleurisy, as the solution of gum ammoniac with
oxymel of squills, &c. Blistering plasters have generally a good effect,
and ought to be applied pretty early.
If the patient does not spit, he must be bled according as his strength
will permit, and have a gentle purge administered. Afterwards his body
may be kept open by clysters, and the expectoration promoted, by taking
every four hours two table-spoonfuls of the solution mentioned above.
When an inflammation of the breast does not yield to bleeding,
blistering, and other evacuations, it commonly ends in a suppuration,
which is more or less dangerous, according to the part where it is
situated. When this happens in the pleura, it sometimes breaks
outwardly, and the matter is discharged by the wound.
When the suppuration happens within the substance or body of the lungs,
the matter may be discharged by expectoration; but if the matter floats
in the cavity of the breast, between the pleura and the lungs, it can
only be discharged by an incision made betwixt the ribs.
If the patient’s strength does not return after the inflammation is to
all appearance removed; if his pulse continues quick though soft, his
breathing difficult and oppressed; if he has cold shiverings at times,
his cheeks flushed, his lips dry; and if he complains of thirst, and
want of appetite, there is reason to fear a suppuration, and that a
phthisis or consumption of the lungs will ensue. We shall therefore next
proceed to consider the proper treatment of that disease.
CHAP. XVIII.
OF CONSUMPTIONS.
A consumption is a wasting or decay of the whole body from an ulcer,
tubercles, or concretions of the lungs, an empyema, a nervous atrophy,
or a cachexy.
Dr. Arbuthnot observes, that in his time consumptions made up above
one-tenth part of the bills of mortality in and about London. There is
reason to believe they have rather increased since, and we know from
experience, that they are not less fatal in some other towns of England
than in London.
Young persons, between the age of fifteen and thirty, of a slender make,
long neck, high shoulders, and flat breasts, are most liable to this
disease.
Consumptions prevail more in England than in any other part of the
world, owing perhaps to the great use of animal food and malt liquors,
the general application to sedentary employments, and the great quantity
of pit-coal which is there burnt; to which we may add the perpetual
changes in the atmosphere, or variableness of the weather.
CAUSES.——It has already been observed, that an inflammation of the
breast often ends in an imposthume: consequently whatever disposes
people to this disease, must likewise be considered as a cause of
consumption.
Other diseases, by vitiating the habit, may likewise occasion
consumptions; as the scurvy, the scrophula, or king’s evil, the venereal
disease, the asthma, small-pox, measles, &c.
As this disease is seldom cured, we shall endeavour the more
particularly to point out its causes, in order that people may be
enabled to avoid it. These are:
——Confined or unwholesome air. When this fluid is impregnated with the
fumes of metals or minerals, it proves extremely hurtful to the lungs,
and often corrodes the tender vessels of that necessary organ.
——Violent passions, exertions, or affections of the mind; as grief,
disappointment, anxiety, or close application to the study of abstruse
arts or sciences.
——Great evacuations; as sweating, diarrhœas, diabetes, excessive venery,
the fluor albus, an over-discharge of the menstrual flux, giving suck
too long, &c.
——The sudden stoppage of customary evacuations; as the bleeding piles,
sweating of the feet, bleeding at the nose, the menses, issues, ulcers,
or eruptions of any kind.
——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of
a phthisis occasioned by a small bone sticking in the _bronchæ_. It was
afterwards vomited along with a considerable quantity of purulent
matter, and the patient, by a proper regimen, and the use of the
Peruvian bark, recovered.
——Making a sudden transition from a hot to a very cold climate, change
of apparel, or whatever greatly lessens the perspiration.
——Frequent and excessive debaucheries. Late watching, and drinking
strong liquors, which generally go together, can hardly fail to destroy
the lungs. Hence the _bon companion_ generally falls a sacrifice to this
disease.
——Infection. Consumptions are likewise caught by sleeping with the
diseased; for which reason this should be carefully avoided. It cannot
be of great benefit to the sick, and must hurt those in health.
——Occupations in life. Those artificers who sit much, and are constantly
leaning forward, or pressing upon the stomach and breast, as cutlers,
taylors, shoemakers, seamstresses, &c. often die of consumptions. They
likewise prove fatal to singers, and all who have occasion to make
frequent and violent exertions of the lungs.
——Cold. More consumptive patients date the beginning of their disorders
from wet feet, damp beds, night air, wet clothes, or catching cold after
the body had been heated, than from all other causes.
Sharp, saline, and aromatic aliments, which heat and inflame the blood,
are likewise frequently the cause of consumptions.
We shall only add, that this disease is often owing to an hereditary
taint, or a scrophulous habit; in which case it is generally incurable.
SYMPTOMS.——This disease generally begins with a dry cough, which often
continues for some months. If a disposition to vomit after eating be
excited by it, there is still greater reason to fear an approaching
consumption. The patient complains of a more than usual degree of heat,
a pain and oppression of the breast, especially after motion; his
spittle is of a saltish taste, and sometimes mixed with blood. He is apt
to be sad; his appetite is bad, and his thirst great. There is generally
a quick, soft, small pulse; though sometimes the pulse is pretty full,
and rather hard. These are the common symptoms of a beginning
consumption.
Afterwards the patient begins to spit a greenish, white, or bloody
matter. His body is extenuated by the hectic fever, and colliquative
sweats, which mutually succeed one another, _viz._ the one towards
night, and the other in the morning. A looseness, and an excessive
discharge of urine, are often troublesome symptoms at this time, and
greatly weaken the patient. There is a burning heat in the palms of the
hands, and the face generally flushes after eating; the fingers become
remarkably small, the nails are bent inwards, and the hairs fall off.
At last the swelling of the feet and legs, the total loss of strength,
the sinking of the eyes, the difficulty of swallowing, and the coldness
of the extremities, shew the immediate approach of death, which however
the patient seldom believes to be so near. Such is the usual progress of
this fatal disease, which, if not early checked, commonly sets all
medicine at defiance.
REGIMEN.——On the first appearance of a consumption, if the patient lives
in a large town, or any place where the air is confined, he ought
immediately to quit it, and to make choice of a situation in the
country, where the air is pure and free. Here he must not remain
inactive, but take every day as much exercise as he can bear.
The best method of taking exercise is to ride on horseback, as this
gives the body a great deal of motion without much fatigue. Such as
cannot bear this kind of exercise, must make use of a carriage. A long
journey, as it amuses the mind by a continual change of objects, is
greatly preferable to riding the same ground over and over. Care however
must be taken to avoid catching cold from wet clothes, damp beds, or the
like. The patient ought always to finish his ride in the morning, or at
least before dinner; otherwise it will oftener do harm than good.
It is pity those who attend the sick seldom recommend riding in this
disease, till the patient is either unable to bear it, or the malady has
become incurable. Patients are likewise apt to trifle with everything
that is in their own power. They cannot see how one of the common
actions of life should prove a remedy in an obstinate disease, and
therefore they reject it, while they greedily hunt after relief from
medicine, merely because they do not understand it.
Those who have strength and courage to undertake a pretty long voyage,
may expect great advantage from it. This, to my knowledge, has
frequently cured a consumption after the patient was, to all appearance,
far advanced in that disease, and where medicine had proved ineffectual.
Hence it is reasonable to conclude, that if a voyage were undertaken in
due time, it would seldom fail to perform a cure[72].
Such as try this method of cure ought to carry as much fresh provisions
along with them as will serve for the whole time they are at sea. As
milk is not easily obtained in this situation, they ought to live upon
fruits, and the broth of chickens, or other young animals which can be
kept alive on board. It is scarce necessary to add, that such voyages
should be undertaken, if possible, in the mildest season, and that they
ought to be towards a warmer climate[73].
Those who have not courage for a long voyage may travel into a more
southern climate, as the south of France, Spain, or Portugal; and if
they find the air of these countries agree with them, they should
continue there, at least till their health be confirmed.
Next to proper air and exercise, we would recommend a due attention to
diet. The patient should eat nothing that is either heating or hard of
digestion, and his drink must be of a soft and cooling nature. All the
diet ought to be calculated to lessen the acrimony of the humours, and
to nourish and support the patient. For this purpose he must keep
chiefly to the use of vegetables and milk. Milk alone is of more value
in this disease than the whole _materia medica_.
Asses milk is commonly reckoned preferable to any other; but it cannot
always be obtained; besides, it is generally taken in a very small
quantity; whereas, to produce any effects, it ought to make a
considerable part of the patient’s diet. It is hardly to be expected,
that a gill or two of asses milk, drank in the space of twenty-four
hours, should be able to produce any considerable change in the humours
of an adult; and when people do not perceive its effects soon, they lose
hope, and so leave it off. Hence it happens that this medicine, however
valuable, very seldom performs a cure. The reason is obvious; it is
commonly used too late, is taken in too small quantities, and is not
duly persisted in.
I have known very extraordinary effects from asses milk in obstinate
coughs, which threatened a consumption of the lungs; and do verily
believe, if used at this period, that it would seldom fail; But if it be
delayed till an ulcer is formed, which is generally the case, how can it
be expected to succeed?
Asses milk ought to be drank, if possible, in its natural warmth, and,
by a grown person, in the quantity of half an English pint at a time.
Instead of taking this quantity night and morning only, the patient
ought to take it four times, or at least thrice a-day, and to eat a
little light bread along with it, so as to make it a kind of meal.
If the milk should happen to purge, it may be mixed with old conserve of
roses. When that cannot be obtained, the powder of crabs claws may be
used in its stead. Asses milk is usually ordered to be drank warm in
bed; but as it generally throws the patient in a sweat when taken in
this way, it would perhaps be better to give it after he rises.
Some extraordinary cures in consumptive cases have been performed by
women’s milk. Could this be obtained in sufficient quantity, we would
recommend it in preference to any other. It is better if the patient can
suck it from the breast, than to drink it afterwards. I knew a man who
was reduced to such a degree of weakness in a consumption, as not to be
able to turn himself in bed. His wife was at that time giving suck, and
the child happening to die, he sucked her breasts, not with a view to
reap any advantage from the milk, but to make her easy. Finding himself
however greatly benefited by it, he continued to suck her till he became
perfectly well, and is at present a strong and healthy man.
Some prefer butter-milk to any other, and it is indeed a very valuable
medicine, if the stomach be able to bear it. It does not agree with
every person at first; and is therefore often laid aside without a
sufficient trial. It should at first be taken sparingly, and the
quantity gradually increased, until it comes to be almost the sole food.
I never knew it succeed unless where the patient almost lived upon it.
Cows milk is most readily obtained of any, and though it be not so
easily digested as that of asses or mares, it may be rendered lighter by
adding to it an equal quantity of barley-water, or allowing it to stand
for some hours, and afterwards taking off the cream. If it should
notwithstanding prove heavy on the stomach, a small quantity of brandy
or rum, with a little sugar, may be added, which will render it both
more light and nourishing.
It is not to be wondered, that milk should for some time disagree with a
stomach that has not been accustomed to digest any thing but flesh and
strong liquors, which is the case with many of those who fall into
consumptions. We do not however advise those have been accustomed to
animal food and strong liquors, to leave them off all at once. This
might be dangerous. It will be necessary for such to eat a little once
a-day of the flesh of some young animal, or rather to use the broth made
of chickens, veal, lamb, or such like. They ought likewise to drink a
little wine made into negus, or diluted with twice or thrice its
quantity of water, and to make it gradually weaker till they can leave
it off altogether.
These must be used only as preparatives to a diet consisting chiefly of
milk and vegetables, which the sooner the patient can be brought to
bear, the better. Rice and milk, or barley and milk, boiled with a
little sugar, is very proper food. Ripe fruits roasted, baked, or
boiled, are likewise proper, as goose or currant berry tarts, apples
roasted, or boiled in milk, &c. The jellies, conserves, and preserves,
&c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly
of currants, conserve of roses, preserved plums, cherries, &c.
Wholesome air, proper exercise, and a diet consisting chiefly of these
and other vegetables, with milk, is the only course that can be depended
on in a beginning consumption. If the patient has strength and
sufficient resolution to persist in this course, he will seldom be
disappointed of a cure.
In a populous town in England[74], where consumptions are very common, I
have frequently seen consumptive patients, who had been sent to the
country with orders to ride, and live upon milk and vegetables, return
in a few months quite plump, and free from any complaint. This indeed
was not always the case, especially when the disease was hereditary, or
far advanced; but it was the only method in which success was to be
expected: where it failed, I never knew medicine succeed.
If the patient’s strength and spirits flag, he must be supported by
strong broths, jellies, and such like. Some recommend shell-fish in this
disorder, and with some reason, as they are nourishing and
restorative[75]. All the food and drink ought however to be taken in
small quantities, lest an overcharge of fresh chyle should oppress the
lungs, and too much accelerate the circulation of the blood.
The patient’s mind ought to be kept as easy and cheerful as possible.
Consumptions are often occasioned, and always aggravated, by a
melancholy cast of mind; for which reason music, cheerful company, and
every thing that inspires mirth, are highly beneficial. The patient
ought seldom to be left alone, as brooding over his calamities is sure
to render them worse.
MEDICINE.——Though the cure of this disease depends chiefly upon regimen
and the patient’s own endeavours, yet we shall mention a few things
which may be of service in relieving some of the more violent symptoms.
In the first stage of a consumption, the cough may sometimes be appeased
by bleeding; and the expectoration may be promoted by the following
medicines. Take fresh squills, gum-ammoniac, and powdered cardamum
seeds, of each a quarter of an ounce; beat them together in a mortar,
and if the mass proves too hard for pills, a little of any kind of syrup
may be added to it. This may be formed into pills of a moderate size,
and four or five of them taken twice or thrice a-day, according as the
patient’s stomach will bear them.
The _lac ammoniacum_, or milk of gum-ammoniac, as it is called, is
likewise a proper medicine in this stage of the disease. It may be used
as directed in the pleurisy.
A mixture made of equal parts of lemon-juice, fine honey, and syrup of
poppies, may likewise be used. Four ounces of each of these may be
simmered together in a sauce-pan, over a gentle fire, and a
table-spoonful of it taken at any time when the cough is troublesome.
It is common in this stage of the disease to load the patient’s stomach
with oily and balsamic medicines. These, instead of removing the cause
of the disease, tend rather to increase it, by heating the blood, while
they pall the appetite, relax the solids, and prove every way hurtful to
the patient. Whatever is used for removing the cough, besides riding and
other proper regimen, ought to be medicines of a sharp and cleaning
nature; as oxymel, syrup of lemon, &c.
Acids seem to have peculiarly good effects in this disease; they both
tend to quench the patient’s thirst and to cool the blood. The vegetable
acids, as apples, oranges, lemons, &c. appear to be the most proper. I
have known patients suck the juice of several lemons every day with
manifest advantage, and would for this reason recommend acid vegetables
to be taken in as great quantity as the stomach will bear them.
For the patient’s drink, we would recommend infusions of the bitter
plants, as ground-ivy, the lesser centaury, camomile flowers, or
water-trefoil. These infusions may be drank at pleasure. They strengthen
the stomach, promote digestion, rectify the blood, and at the same time
answer all the purposes of dilution, and quench thirst much better than
things that are luscious or sweet. But if the patient spits blood, he
ought to use, for his ordinary drink, infusions or decoctions of the
vulnerary roots, plants, &c.[76]
There are many other mucilaginous plants and seeds, of a healing and
agglutinating nature, from which decoctions or infusions may be prepared
with the same intention; as the orches, the quince-seed, coltsfoot,
linseed, sasaparilla, &c. It is not necessary to mention the different
ways in which these may be prepared. Simple infusion or boiling is all
that is necessary, and the dose may be at discretion.
The conserve of roses is here peculiarly proper. It may either be put
into the decoction above prescribed, or eaten by itself. No benefit is
to be expected from trifling doses of this medicine. I never knew it of
any service, unless where three or four ounces at least were used daily
for a considerable time. In this way I have seen it produce very happy
effects, and would recommend it wherever there is a discharge of blood
from the lungs.
When the spitting up of gross matter, oppression of the breast, and the
hectic symptoms, shew that an imposthume is formed in the lungs, we
would recommend the Peruvian bark, that being the only drug which has
any chance to counteract the general tendency which the humours then
have to putrefaction.
An ounce of the bark in powder may be divided into eighteen or twenty
doses, of which one may be taken every three hours through the day, in a
little syrup, or a cup of horehound tea.
If the bark should happen to purge, it may be made into an electuary,
with the conserve of roses, thus: Take old conserve of roses a quarter
of a pound, Peruvian bark in powder an ounce, syrup of orange or lemon,
as much as will make it of the consistence of honey. This quantity will
serve the patient four or five days, and may be repeated as there is
occasion.
Such as cannot take the bark in substance, may infuse it in cold water.
This seems to be the best menstruum for extracting the virtues of that
drug. Half an ounce of bark in powder may be infused for twenty-four
hours in half an English pint of water. Afterwards let it be passed
through a fine strainer, and an ordinary tea-cupful of it taken three or
four times a-day.
We would not recommend the bark while there are any symptoms of an
inflammation of the breast; but when it is certainly known that matter
is collected there, it is one of the best medicines which can be used.
Few patients indeed have resolution enough to give the bark a fair trial
at this period of the disease, otherwise we have reason to believe that
some benefit might be reaped from it.
When it is evident that there is an imposthume in the breast, and the
matter can neither be spit up nor carried off by absorption, the patient
must endeavour to make it break inwardly, by drawing in the steams of
warm water or vinegar with his breath, coughing, laughing, or bawling
aloud, &c. When it happens to burst within the lungs, the matter may be
discharged by the mouth. Sometimes indeed the bursting of the vomica
occasions immediate death, by suffocating the patient. When the quantity
of matter is great, and the patient’s strength exhausted, this is
commonly the case. At any rate the patient is ready to fall into a
swoon, and should have volatile salts or spirits held to his nose.
If the matter discharged be thick, and the cough and breathing become
easier, there may be some hopes of a cure. The diet at this time ought
to be light, but restorative, as chicken-broths, sago-gruel, rice-milk,
&c. the drink, butter-milk, or whey, sweetened with honey. This is
likewise a proper time for using the Peruvian bark, which may be taken
as directed above.
If the vomica or imposthume should discharge itself into the cavity of
the breast, betwixt the pleura and the lungs, there is no way of getting
the matter out but by an incision, as has already been observed. As this
operation must always be performed by a surgeon, it is not necessary
here to describe it. We shall only add, that it is not so dreadful as
people are apt to imagine, and that it is the only chance the patient in
this case has for his life.
A nervous consumption is a wasting or decay of the whole body, without
any considerable degree of fever, cough, or difficulty of breathing. It
is attended with indigestion, weakness, and want of appetite, &c.
Those who are of a fretful temper, who indulge in spirituous liquors, or
who breathe an unwholesome air, are most liable to this disease.
We would chiefly recommend, for the cure of a nervous consumption, a
light and nourishing diet, plenty of exercise in a free open air, and
the use of such bitters as brace and strengthen the stomach; as the
Peruvian bark, gentian root, camomile, horehound, &c. These may be
infused in water or wine, and a glass of it drank frequently.
It will greatly assist the digestion, and promote the cure of this
disease, to take twice-a-day twenty or thirty drops of the elixir of
vitriol in a glass of wine or water. The chalybeate wine is likewise an
excellent medicine in this case. It strengthens the solids, and
powerfully assists Nature in the preparation of good blood[77].
Agreeable amusements, cheerful company, and riding about, are however
preferable to all medicines in this disease. For which reason, when the
patient can afford it, we would recommend a long journey of pleasure, as
the most likely means to restore his health.
What is called a _symptomatic consumption_ cannot be cured without first
removing the disease by which it is occasioned. Thus, when a consumption
proceeds from, the scrophula or king’s evil, from the scurvy, the
asthma, the venereal disease, &c. a due attention must be paid to the
malady from whence it arises, and the regimen and medicine directed
accordingly.
When _excessive evacuations_ of any kind occasion a consumption, they
must not only be restrained, but the patient’s strength must be restored
by gentle exercise, nourishing diet, and generous cordials. Young and
delicate mothers often fall into consumptions, by giving suck too long.
As soon as they perceive their strength and appetite begin to fail, they
ought immediately to wean the child, or provide another nurse, otherwise
they cannot expect a cure.
Before we quit this subject, we would earnestly recommend it to all, as
they wish to avoid consumptions, to take as much exercise without doors
as they can, to avoid unwholesome air, and to study sobriety.
Consumptions owe their present increase not a little to the fashion of
sitting up late, eating hot suppers, and spending every evening over a
bowl of hot punch or other strong liquors. These liquors, when too
freely used, not only hurt the digestion, and spoil the appetite, but
heat and inflame the blood, and set the whole constitution on fire.
CHAP. XIX.
OF THE SLOW OR NERVOUS FEVER.
Nervous fevers have increased greatly of late years in this island,
owing doubtless to our different manner of living, and the increase of
sedentary employments; as they commonly attack persons of a weak relaxed
habit, who neglect exercise, eat little solid food, study hard, or
indulge in spirituous liquors.
CAUSES.——Nervous fevers may be occasioned by whatever depresses the
spirits, or impoverishes the blood; as grief, fear, anxiety, want of
sleep, intense thought, living on poor watery diet, unripe fruits,
cucumbers, melons, mushrooms, &c. They may likewise be occasioned by
damp, confined, or unwholesome air. Hence they are very common in rainy
seasons, and prove most fatal to those who live in dirty low houses,
crowded streets, hospitals, jails, or such-like places.
Persons whose constitutions have been broken by excessive venery,
frequent salivations, too free an use of purgative medicines, or any
other excessive evacuations, are most liable to this disease.
Keeping on wet clothes, lying on the damp ground, excessive fatigue, and
whatever obstructs the perspiration, or causes a spasmodic stricture of
the solids, may likewise occasion nervous fevers. We shall only add,
frequent and great irregularities in diet. Too great abstinence, as well
as excess, is hurtful. Nothing tends so much to preserve the body in a
sound state as a regular diet; nor can any thing contribute more to
occasion fevers of the worst kind than its opposite.
SYMPTOMS.——Low spirits, want of appetite, weakness, weariness after
motion, watchfulness, deep sighing, and dejection of mind, are generally
the forerunners of this disease. These are succeeded by a quick low
pulse, a dry tongue without any considerable thirst, chillness and
flushing in turns, &c.
After some time the patient complains of a giddiness and pain of the
head, has a nausea, with reachings and vomiting; the pulse is quick, and
sometimes intermitting; the urine pale, resembling dead small-beer, and
the breathing is difficult, with oppression of the breast, and slight
alienations of mind.
If towards the ninth, tenth, or twelfth day, the tongue becomes more
moist, with a plentiful spitting, a gentle purging, or a moisture upon
the skin; or if a suppuration happens in one or both ears, or large
pustules break out about the lips and nose, there is reason to hope for
a favourable crisis.
But if there is an excessive looseness, or wasting sweats, with frequent
fainting fits; if the tongue, when put out, trembles excessively, and
the extremities feel cold, with a fluttering or slow creeping pulse; if
there is a starting of the tendons, an almost total loss of sight and
hearing, and an involuntary discharge by stool and urine, there is great
reason to fear that death is approaching.
REGIMEN.——It is very necessary in this disease to keep the patient cool
and quiet. The least motion would fatigue him, and will be apt to
occasion weariness, and even faintings. His mind ought not only to be
kept easy, but soothed and comforted with the hopes of a speedy
recovery. Nothing is more hurtful in low fevers of this kind than
presenting to the patient’s imagination gloomy or frightful ideas. These
of themselves often occasion nervous fevers, and it is not to be doubted
but they will likewise aggravate them.
The patient must not be kept too low. His strength and spirits ought to
be supported by nourishing diet and generous cordials. For this purpose
his gruel, panado, or whatever food he takes, must be mixed with wine
according as the symptoms may require. Pretty strong wine-whey, or small
negus, sharpened with the juice of orange or lemon, will be proper for
his ordinary drink. Mustard-whey is likewise a very proper drink in this
fever, and may be rendered an excellent cordial medicine by the addition
of a proper quantity of white-wine[78].
Wine in this disease, if it could be obtained genuine, is almost the
only medicine that would be necessary. Good wine possesses all the
virtues of the cordial medicines, while it is free from many of their
bad qualities. I say good wine; for however common this article of
luxury is now become, it is rarely to be obtained genuine, especially by
the poor, who are obliged to purchase it in small quantities.
I have often seen patients in low nervous fevers where the pulse could
hardly be felt, with a constant delirium, coldness of the extremities,
and almost every other mortal symptom, recover by using in whey, gruel,
and negus, a bottle or two of strong wine every day. Good old sound
claret is the best, and may be made into negus, or given by itself, as
circumstances require.
In a word, the great aim in this disease is to support the patient’s
strength, by giving him frequently small quantities of the above, or
other drinks of a warm and cordial nature. He is not however to be
overheated either with liquor or clothes; and his food ought to be
light, and given in small quantities.
MEDICINE.——Where a nausea, load, and sickness at stomach, prevail at the
beginning of the fever, it will be necessary to give the patient a
gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or
a few spoonfuls of the vomiting julep[79], will generally answer this
purpose very well. This may be repeated any time before the third or
fourth day, if the above symptoms continue. Vomits not only clean the
stomach, but, by the general shock which they give, promote the
perspiration, and have many other excellent effects in slow fevers,
where there are no signs of inflammation, and nature wants rousing.
Such as dare not venture upon a vomit, may clean the bowels by a small
dose of Turkey rhubarb, or an infusion of senna and manna.
In all fevers, the great point is to regulate the symptoms, so as to
prevent them from going to either extreme. Thus, in fevers of the
inflammatory kind, where the force of the circulation is too great, or
the blood dense, and the fibres too rigid, bleeding and other
evacuations are necessary. But in nervous fevers, where nature flags,
where the blood is vapid and poor, and the solids relaxed, the lancet
must be spared, and wine, with other cordials, plentifully administered.
It is the more necessary to caution people against bleeding in this
disease, as there is generally at the beginning an universal stricture
upon the vessels, and sometimes an oppression and difficulty of
breathing, which suggest the idea of a plethora, or too great a quantity
of blood. I have known even some of the faculty deceived by their own
feelings in this respect, so far as to insist upon being bled, when it
was evident from the consequences that the operation was improper.
Though bleeding is generally improper in this disease, yet blistering is
highly necessary. Blistering-plasters may be applied at all times of the
fever with great advantage. If the patient is delirious, he ought to be
blistered on the neck or head, and it will be the safest course, when
the insensibility continues, as soon as the discharge occasioned by one
blistering-plaster abates, to apply another to some other part of the
body, and by that means keep up a continual succession of them till he
be out of danger.
I have been more sensible of the advantage of blistering in this than in
any other disease. Blistering-plasters not only stimulate the solids to
action, but likewise occasion a continual discharge, which may in some
measure supply the want of critical evacuations, which seldom happen in
this kind of fever. They are most proper, however, either towards the
beginning, or after some degree of stupor has come on, in which last
case it will always be proper to blister the head.
If the patient is costive through the course of the disease, it will be
necessary to procure a stool, by giving him every other day a clyster of
milk and water, with a little sugar, to which may be added a spoonful of
common salt, if the above does not operate.
Should a violent looseness come on, it may be checked by small
quantities of Venice treacle, or giving the patient for his ordinary
drink the white decoction[80].
A miliary eruption sometimes breaks out about the ninth or tenth day. As
eruptions are often critical, great care should be taken not to retard
Nature’s operation in this particular. The eruption ought neither to be
checked by bleeding nor other evacuations, nor pushed out by a hot
regimen; but the patient should be supported by gentle cordials, as
wine-whey, small negus, sago-gruel with a little wine in it, and such
like. He ought not to be kept too warm; yet a kindly breathing sweat
should by no means be checked.
Though blistering and the use of cordial liquors are the chief things to
be depended on in this kind of fever; yet, for those who may chuse to
use them, we shall mention one or two of the forms of medicine which are
commonly prescribed in it[81].
In desperate cases, where the hiccup and starting of the tendons have
already come on, we have sometimes seen extraordinary effects from large
doses of musk frequently repeated. Musk is doubtless an antispasmodic,
and may be given to the quantity of a scruple three or four times a-day,
or oftener if necessary. Sometimes it may be proper to add to the musk a
few grains of camphire, and salt of hartshorn, as these tend to promote
perspiration and the discharge of urine. Thus fifteen grains of musk,
with three grains of camphire, and six grains of salt of hartshorn, may
be made into a bolus with a little syrup, and given as above.
If the fever should happen to intermit, which it frequently does towards
the decline, or if the patient’s strength should be wasted with
colliquative sweats, &c. it will be necessary to give him the Peruvian
bark. Half a drachm, or a whole drachm, if the stomach will bear it, of
the bark in fine powder, may be given four or five times a-day in a
glass of red port or claret. Should the bark in substance not sit easy
on the stomach, an ounce of it in powder may be infused in a bottle of
Lisbon or Rhenish wine for two or three days, afterwards it may be
strained, and a glass of it taken frequently[82].
Some give the bark in this and other fevers, where there are no symptoms
of inflammation, without any regard to the remission or intermission of
the fever. How far future observations may tend to establish this
practice, we will not pretend to say; but we have reason to believe that
the bark is a very universal febrifuge, and that it may be administered
with advantage in most fevers where bleeding is not necessary, or where
there are no symptoms of topical inflammation.
CHAP. XX.
OF THE MALIGNANT, PUTRID, OR SPOTTED FEVER.
This may be called the _pestilential fever_ of Europe, as in many of its
symptoms it bears a great resemblance to that dreadful disease the
plague. Persons of a lax habit, a melancholy disposition, and those
whose vigour has been wasted by long fasting, watching, hard labour,
excessive venery, frequent salivations, &c. are most liable to it.
CAUSES.——This fever is occasioned by foul air, from a number of people
being confined in a narrow place, not properly ventilated; from putrid
animal and vegetable effluvia, &c. Hence it prevails in camps, jails,
hospitals and infirmaries, especially where such places are too much
crowded, and cleanliness is neglected.
A close constitution of the air, with long rainy or foggy weather,
likewise occasions putrid fevers. They often succeed great inundations
in low and marshy countries, especially when these are preceded or
followed by a hot and sultry season.
Living too much upon animal food, without a proper mixture of
vegetables, or eating fish or flesh that has been kept too long, are
likewise apt to occasion this kind of fever. Hence sailors on long
voyages, and the inhabitants of besieged cities, are very often visited
with putrid fevers.
Corn that has been greatly damaged by rainy seasons, or long keeping,
and water which has become putrid by stagnation, &c. may likewise
occasion this fever.
Dead carcases tainting the air, especially in hot seasons, are very apt
to occasion putrid diseases. Hence this kind of fever often prevails in
countries which are the scenes of war and bloodshed. This shews the
propriety of removing burying grounds, slaughterhouses, &c. at a proper
distance from great towns.
Want of cleanliness is a very general cause of putrid fevers. Hence they
prevail amongst the poor inhabitants of large towns, who breathe a
confined unwholesome air, and neglect cleanliness. Such mechanics as
carry on dirty employments, and are constantly confined within doors,
are likewise very liable to this disease.
We shall only add, that putrid, malignant, or spotted fevers, are highly
infectious, and are therefore often communicated by contagion. For which
reason all persons ought to keep at a distance from those affected with
such diseases, unless their attendance is absolutely necessary.
SYMPTOMS.——The malignant fever is generally preceded by a remarkable
weakness or loss of strength, without any apparent cause. This is
sometimes so great, that the patient can scarce walk, or even sit
upright, without being in danger of fainting away. His mind too is
greatly dejected; he sighs, and is full of dreadful apprehensions.
There is a nausea, and sometimes a vomiting of bile; a violent pain of
the head, with a strong pulsation or throbbing of the temporal arteries;
the eyes often appear red and inflamed, with a pain at the bottom of the
orbit; there is a noise in the ears, the breathing is laborious, and
often interrupted with a sigh; the patient complains of a pain about the
region of the stomach, and in his back and loins; his tongue is at first
white, but afterwards it appears black and chaped; and his teeth are
covered with a black crust. He sometimes passes worms both upwards and
downwards, is affected with tremors or shaking, and often becomes
delirious.
If blood is let, it appears dissolved, or with a very small degree of
cohesion, and soon becomes putrid; the stools smell extremely fœtid, and
are sometimes of a greenish, black, or reddish cast. Spots of a pale
purple, dun, or black colour, often appear upon the skin, and sometimes
there are violent hæmorrhages, or discharges of blood from the mouth,
eyes, nose, &c.
Putrid fevers may be distinguished from the inflammatory, by the
smallness of the pulse, the great dejection of mind, the dissolved state
of the blood, the petechiæ, or purple spots, and the putrid smell of the
excrements. They may likewise be distinguished from the low or nervous
fever by the heat and thirst being greater, the urine of a higher
colour, and the loss of strength, dejection of mind, and all the other
symptoms more violent.
It sometimes happens, however, that the inflammatory, nervous, and
putrid symptoms are so blended together, as to render it very difficult
to determine to which class the fever belongs. In this case the greatest
caution and skill are requisite. Attention must be paid to those
symptoms which are most prevalent, and both the regimen and medicines
adapted to them.
Inflammatory and nervous fevers may be converted into malignant and
putrid, by too hot a regimen or improper medicines.
The duration of putrid fevers is extremely uncertain; sometimes they
terminate between the seventh and fourteenth day, and at other times
they are prolonged for five or six weeks. Their duration depends greatly
upon the constitution of the patient, and the manner of treating the
disease.
The most favourable symptoms are, a gentle looseness after the fourth or
fifth day, with a warm mild sweat. These, when continued for a
considerable time, often carry off the fever, and should never be
imprudently stopped. Small miliary pustules appearing between the
petechiæ or purple spots are likewise favourable, as also hot scabby
eruptions about the mouth and nose. It is a good sign when the pulse
rises upon the use of wine, or other cordials, and the nervous symptoms
abate; deafness coming on towards the decline of the fever, is likewise
often a favourable symptom[83], as are abscesses in the groin or parotid
glands.
Among the unfavourable symptoms may be reckoned an excessive looseness,
with a hard swelled belly; large black or livid blotches breaking out
upon the skin; apthæ in the mouth; cold clammy sweats; blindness; change
of the voice; a wild flaring of the eyes; difficulty of swallowing;
inability to put out the tongue; and a constant inclination to uncover
the breast. When the sweat and saliva are tinged with blood, and the
urine is black, or deposits a black sooty sediment, the patient is in
great danger. Starting of the tendons, and fœtid, ichorous, involuntary
stools, attended with coldness of the extremities, are generally the
forerunners of death.
REGIMEN.——In the treatment of this disease we ought to endeavour as far
as possible to counteract the putrid tendency of the humours; to support
the patient’s strength and spirits; and to assist Nature in expelling
the cause of this disease, by gently promoting perspiration and the
other evacuations.
It has been observed, that putrid fevers are often occasioned by
unwholesome air, and of course they must be aggravated by it. Care
should therefore be taken to prevent the air from stagnating in the
patient’s chamber, to keep it cool, and renew it frequently, by opening
the doors or windows of some adjacent apartment. The breath and
perspiration of persons in perfect health soon render the air of a small
apartment noxious; but this will sooner happen from the perspiration and
breath of a person whose whole mass of humours are in a putrid state.
Besides the frequent admission of fresh air, we would recommend the use
of vinegar, verjuice, juice of lemon, Seville orange, or any kind of
vegetable acid that can be most readily obtained. These ought frequently
to be sprinkled upon the floor, the bed, and every part of the room.
They may also be evaporated with a hot iron, or by boiling, &c. The
fresh skins of lemons or oranges ought likewise to be laid in different
parts of the room, and they should be frequently held to the patient’s
nose. The use of acids in this manner would not only prove very
refreshing to the patient, but would likewise tend to prevent the
infection from spreading among those who attend him. Strong scented
herbs, as rue, tansy, rosemary, wormwood, &c. may likewise be laid in
different parts of the house, and smelled to by those who go near the
patient.
The patient must not only be kept cool, but likewise quiet and easy. The
least noise will affect his head, and the smallest fatigue will be apt
to make him faint.
Few things are of greater importance in this disease than acids, which
ought to be mixed with all the patient’s food as well as drink. Orange,
lemon, or vinegar whey, are all very proper, and may be drank by turns,
according to the patient’s inclination. They may be rendered cordial by
the addition of wine in such quantity as the patient’s strength seems to
require. When he is very low, he may drink negus, with only one half
water, and sharpened with the juice of orange or lemon. In some cases a
glass of wine may now and then be allowed. The most proper wine is
Rhenish; but if the body be open, red port or claret is to be preferred.
When the body is bound, a tea-spoonful of the cream of tartar may be put
into a cup of the patient’s drink, as there is occasion; or he may drink
a decoction of tamarinds, which will both quench his thirst, and promote
a discharge by stool.
If camomile-tea will sit upon his stomach, it is a very proper drink in
this disease. It may be sharpened by adding to every cup of the tea ten
or fifteen drops of the elixir of vitriol.
The food must be light, as panado or groat-gruel, to which a little wine
may be added, if the patient be weak and low; and they ought all to be
sharpened with the juice of orange, the jelly of currants, or the like.
The patient ought likewise to eat freely of ripe fruits, as roasted
apples, currant or gooseberry tarts, preserved cherries, or plums, &c.
Taking a little food or drink frequently, not only supports the spirits,
but counteracts the putrid tendency of the humours; for which reason the
patient ought frequently to be sipping small quantities of some of the
acid liquors mentioned above, or any that may be more agreeable to his
palate, or more readily obtained.
If he is delirious, his feet and hands ought to be frequently fomented
with a strong infusion of camomile flowers. This, or an infusion of the
bark, to such as can afford it, cannot fail to have a good effect.
Fomentations of this kind not only relieve the head, by relaxing the
vessels in the extremities, but as their contents are absorbed, and
taken into the system, they may assist in preventing the putrescency of
the humours.
MEDICINE.——If a vomit be given at the beginning of this fever, it will
hardly fail to have a good effect; but if the fever has gone on for some
days, and the symptoms are violent, vomits are not quite so safe. The
body however is always to be kept gently open by clysters, or mild
laxative medicines.
Bleeding is seldom necessary in putrid fevers. If there be signs of an
inflammation, it may sometimes be permitted at the first onset; but the
repetition of it generally proves hurtful.
Blistering plasters are never to be used unless in the greatest
extremities. If the petechiæ or spots should suddenly disappear, the
patient’s pulse sink remarkably, and a delirium, with other bad
symptoms, come on, blistering may be permitted. In this case the
blistering plasters are to be applied to the head, and inside of the
legs or thighs. But as they are sometimes apt to occasion a gangrene, we
would rather recommend warm cataplasms or poultices of mustard and
vinegar to be applied to the feet, having recourse to blisters only in
the utmost extremities.
It is common in the beginning of this fever to give the emetic tartar in
small doses, repeated every second or third hour, till it shall either
vomit, purge, or throw the patient into a sweat. This practice is very
proper, provided it be not pushed so far as to weaken the patient.
A very ridiculous notion has long prevailed, of expelling the poisonous
matter of malignant diseases by trifling doses of cordial or
alexipharmic medicines. In consequence of this notion, the
contrayerva-root, the cordial confection, the mithridate, &c. have been
extolled as infallible remedies. There is reason however to believe,
that these seldom do much good. Where cordials are necessary, we know
none that is superior to good wine; and therefore again recommend it
both as the safest and best. Wine, with acids and antiseptics, are the
only things to be relied on in the cure of malignant fevers.
In the most dangerous species of this disease, when it is attended with
purple, livid, or black spots, the Peruvian bark must be administered. I
have seen it, when joined with acids, prove successful, even in cases
where the petechiæ had the most threatening aspect. But, to answer this
purpose, it must not only be given in large doses, but duly persisted
in.
The best method of administering the bark is certainly in substance. An
ounce of it in powder may be mixed with half an English pint of water,
and the same quantity of red wine, and sharpened with the elixir or the
spirit of vitriol, which will both make it sit easier on the stomach,
and render it more beneficial. Two or three ounces of the syrup of lemon
may be added, and two table-spoonfuls of the mixture taken every two
hours, or oftener, if the stomach is able to bear it.
Those who cannot take the bark in substance may infuse it in wine, as
recommended in the preceding disease.
If there be a violent looseness, the bark must be boiled in red wine
with a little cinnamon, and sharpened with the elixir of vitriol, as
above. Nothing can be more beneficial in this kind of looseness than
plenty of acids, and such things as promote a gentle perspiration.
If the patient be troubled with vomiting, a dram of the salt of
wormwood, dissolved in an ounce and half of fresh lemon-juice, and made
into a draught with an ounce of simple cinnamon water, and a bit of
sugar, may be given and repeated as often as it is necessary.
If swellings of the glands appear, their suppuration is to be promoted
by the application of poultices, ripening cataplasms, &c. And as soon as
there is any appearance of matter in them, they ought to be laid open,
and the poultices continued.
I have known large ulcerous sores break out in various parts of the
body, in the decline of this fever, of a livid gangrenous appearance,
and a most putrid cadaverous smell. These gradually healed, and the
patient recovered, by the plentiful use of Peruvian bark and wine,
sharpened with the spirits of vitriol.
For preventing putrid fevers we would recommend a strict regard to
cleanliness; a dry situation; sufficient exercise in the open air;
wholesome food, and a moderate use of generous liquors. Infection ought
above all things to be avoided. No constitution is proof against it. I
have known persons seized with a putrid fever, by only making a single
visit to a patient in it; others have caught it by lodging for one night
in a town where it prevailed; and some by attending the funerals of such
as died of it[84].
When a putrid fever seizes any person in a family, the greatest
attention is necessary to prevent the disease from spreading. The sick
ought to be placed in a large apartment, as remote from the rest of the
family as possible; he ought likewise to be kept extremely clean, and
should have fresh air frequently let into his chamber; whatever comes
from him should be immediately removed, his linen should be frequently
changed, and those in health ought to avoid all unnecessary
communication with him.
Any one who is apprehensive of having caught the infection, ought
immediately to take a vomit, and to work it off by drinking plentifully
of camomile-tea. This may be repeated in a day or two, if the
apprehensions still continue, or any unfavourable symptoms appear.
The person ought likewise to take an infusion of the bark and camomile
flowers for his ordinary drink; and before he goes to bed, he may drink
an English pint of pretty strong negus, or a few glasses of generous
wine. I have been frequently obliged to follow this course, when
malignant fevers prevailed, and have likewise recommended it to others
with constant success.
People generally fly to bleeding and purging as antidotes against
infection; but these are so far from securing them, that they often, by
debilitating the body, increase the danger.
Those who wait upon the sick in putrid fevers, ought always to have a
piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to
smell to while near the patient. They ought likewise to wash their
hands, and, if possible, to change their clothes, before they go into
company.
CHAP. XXI.
OF THE MILIARY FEVER.
This fever takes its name from the small pustules or bladders which
appear on the skin, resembling, in shape and size, the seeds of millet.
The pustules are either red or white, and sometimes both are mixed
together.
The whole body is sometimes covered with pustules; but they are
generally more numerous where the sweat is most abundant, as on the
breast, the back, &c. A gentle sweat, or moisture on the skin, greatly
promotes the eruption; but, when the skin is dry, the eruption is both
more painful and dangerous.
Sometimes this is a primary disease; but it is much oftener only a
symptom of some other malady, as the small-pox, measles, ardent, putrid,
or nervous fever, &c. In all these cases it is generally the effect of
too hot a regimen or medicines.
The miliary fever chiefly attacks the idle and the phlegmatic, or
persons of a relaxed habit. The young and the aged are more liable to it
than those in the vigour and prime of life. It is likewise more incident
to women than men, especially the delicate and the indolent, who,
neglecting exercise, keep continually within doors, and live upon weak
watery diet. Such females are extremely liable to be seized with this
disease in child-bed, and often lose their lives by it.
CAUSES.——The miliary fever is sometimes occasioned by violent passions
or affections of the mind; as excessive grief, anxiety, thoughtfulness,
&c. It may likewise be occasioned by excessive watching, great
evacuations, a weak watery diet, rainy seasons, eating too freely of
cold, crude, unripe fruits, as plums, cherries, cucumbers, melons; &c.
Impure waters, or provisions which have been spoiled by rainy seasons,
long keeping, &c. may likewise cause miliary fevers. They may also be
occasioned by the stoppage of any customary evacuation, as issues,
setons, ulcers, the bleeding piles in men, or the menstrual flux in
women, &c.
This disease in child-bed-women is sometimes the effect of great
costiveness during pregnancy; it may likewise be occasioned by their
excessive use of green trash, and other unwholesome things, in which
pregnant women are too apt to indulge. But its most general cause is
indolence. Such women as lead a sedentary life, especially during
pregnancy, and at the same time live grossly, can hardly escape this
disease in child-bed. Hence it proves extremely fatal to women of
fashion, and likewise to those women in manufacturing towns, who, in
order to assist their husbands, sit close within doors for almost the
whole of their time. But among women who are active and laborious, who
live in the country, and take sufficient exercise without doors, this
disease is very little known.
SYMPTOMS.——When this is a primary disease, it makes its attack, like
most other eruptive fevers, with a slight shivering, which is succeeded
by heat, loss of strength, faintishness, sighing, a low quick pulse,
difficulty of breathing, with great anxiety and oppression of the
breast. The patient is restless, and sometimes delirious; the tongue
appears white, and the hands shake, with often a burning heat in the
palms; and in child-bed-women the milk generally goes away, and the
other discharges stop.
The patient feels an itching or pricking pain under the skin, after
which innumerable small pustules of a red or white colour begin to
appear. Upon this the symptoms generally abate, the pulse becomes more
full and soft, the skin grows moister, and the sweat, as the disease
advances, begins to have a peculiar fœtid smell; the great load on the
breast, and oppression of the spirits, generally go off, and the
customary evacuations gradually return. About the sixth or seventh day
from the eruption, the pustules begin to dry and fall off, which
occasions a very disagreeable itching in the skin.
It is impossible to ascertain the exact time when the pustules will
either appear or go off. They generally come out on the third or fourth
day, when the eruption is critical; but, when symptomatic, they may
appear at any time of the disease.
Sometimes the pustules appear and vanish by turns. When that is the
case, there is always danger; but when they go in all of a sudden, and
do not appear again, the danger is very great.
In child-bed-women the pustules are commonly at first filled with clear
water, afterwards they grow yellowish. Sometimes they are interspersed
with pustules of a red colour. When these only appear the disease goes
by the name of a _rash_.
REGIMEN.——In all eruptive fevers, of whatever kind, the chief point is
to prevent the sudden disappearing of the pustules, and to promote their
maturation. For this purpose the patient must be kept in such a
temperature, as neither to push out the eruption too fast, nor to cause
it to retreat prematurely. The diet and drink ought therefore to be in a
moderate degree nourishing and cordial; but neither strong nor heating.
The patient’s chamber ought neither to be kept too hot nor cold; and he
should not be too much covered with clothes. Above all, the mind is to
be kept easy and cheerful. Nothing so certainly makes an eruption go in
as fear, or the apprehension of danger.
The food must be weak chicken-broth with bread, panado, sago, or groat
gruel, &c. to a gill of which may be added a spoonful or two of wine, as
the patient’s strength requires, with a few grains of salt and a little
sugar. Good apples roasted or boiled, with other ripe fruits of an
opening cooling nature, may be eaten.
The drink may be suited to the state of the patient’s strength and
spirits. If these be pretty high, the drink ought to be weak; as
water-gruel, balm-tea, or the decoction mentioned below[85].
When the patient’s spirits are low, and the eruption does not rise
sufficiently, his drink must be a little more generous; as wine-whey, or
small negus, sharpened with the juice of orange or lemon, and made
stronger or weaker as circumstances may require.
Sometimes the miliary fever approaches towards a putrid nature, in which
case the patient’s strength must be supported with generous cordials,
joined with acids; and, if the degree of putrescence be great, the
Peruvian bark must be administered. If the head be much affected, the
body must be kept open by emollient clysters[86].
MEDICINE.——If the food and drink be properly regulated, there will be
little occasion for medicine in this disease. Should the eruption
however not rise, or the spirits flag, it will not only be necessary to
support the patient with cordials, but likewise to apply blistering
plasters. The most proper cordial, in this case, is good wine, which may
either be taken in the patient’s food or drink; and if there be signs of
putrescence, the bark and acids may be mixed with wine, as directed in
the putrid fever.
Some recommend blistering through the whole course of this disease; and
where Nature flags, and the eruption comes and goes, it may be necessary
to keep up a stimulus, by a continual succession of small blistering
plasters; but we would not recommend above one at a time. If however the
pulse should sink remarkably, the pustules fall in, and the head be
affected, it will be necessary to apply several blistering plasters to
the most sensible parts, as the inside of the legs and thighs, &c.
Bleeding is seldom necessary in this disease, and sometimes it does much
hurt, as it weakens the patient, and depresses his spirits. It is
therefore never to be attempted unless by the advice of a physician. We
mention this, because it has been customary to treat this disease in
child-bed-women by plentiful bleeding, and other evacuations, as if it
were highly inflammatory. But this practice is generally very unsafe.
Patients in this situation bear evacuations very ill. And indeed the
disease seems often to be more of a putrid than of an inflammatory
nature.
Though this fever is often occasioned in child-bed-women by too hot a
regimen, yet it would be dangerous to leave that off all of a sudden,
and have recourse to a very cool regimen, and large evacuations. We have
reason to believe, that supporting the patient’s spirits, and promoting
the natural evacuations, is here much safer than to have recourse to
artificial ones, as these, by sinking the spirits, seldom fail to
increase the danger.
If the disease proves tedious, or the recovery slow, we would recommend
the Peruvian bark, which may either be taken in substance, or infused in
wine or water, as the patient inclines.
The miliary fever, like other eruptive diseases, requires gentle
purging, which should not be neglected, as soon as the fever is gone
off, and the patient’s strength will permit.
To prevent this disease, a pure dry air, sufficient exercise, and
wholesome food, are necessary. Pregnant women should guard against
costiveness, and take daily as much exercise as they can bear, avoiding
all green trashy fruits, and other unwholesome things; and when in
child-bed, they ought strictly to observe a cool regimen.
CHAP. XXII.
OF THE REMITTING FEVER.
This fever takes its name from a remission of the symptoms, which
happens sometimes sooner, and sometimes later, but generally before the
eighth day. The remission is commonly preceded by a gentle sweat, after
which the patient seems greatly relieved, but in a few hours the fever
returns. These remissions return at very irregular periods, and are
sometimes of longer, sometimes of shorter duration; the nearer however
that the fever approaches to a regular intermittent, the danger is the
less.