When the powers of the constitution are strong, a person affected with
a putrid fever ought to be bled in the commencement, provided there be
no crudities in the stomach. But when the powers are weak, or the age of
the patient is an objection, you must not bleed. After the evacuation by
bleeding, it will be proper to clear away the putrid matters by urine,
the belly, and sweating. And, if they have spontaneously been determined
towards the mouth of the stomach, they may be evacuated by emetics, but
otherwise you must not produce an unnatural irritation. Such things
ought also to be selected as will effect the afore-mentioned evacuations
without heating or drying, such as the juice of ptisan, honied water,
oxymel, apomel, and the root of parsley. When the belly is not opened,
an injection of mulse, with oil, may be given. The body is not to be
rarefied before evacuations; but, after evacuations, it may be rarefied
by means of an oil possessing a gentle heat, such as that of chamomile.
At this season, all the secretions are promoted by drinking of some
watery wine, and using a tepid bath of sweet water. When the strength
of the fever is an objection, you must neither use wine, the bath, nor
rarefying unctions; but, in such cases, drinking of cold water is the
most suitable remedy, if nothing prevent the use of it likewise. But if
all the powers are strong, the fever of a very hot nature, with clear
symptoms of concoction, cold water may be given boldly. But if he is
muscular, and the constitution of the air hot and dry, he will not be
hurt by being thrown into a cold bath. And if the fever is moderate,
and the strength good, with symptoms of concoction, baths, the drinking
of wine, and unctions of a rarefying nature will be beneficial to such
persons.
* * * * *
COMMENTARY. All subsequent writers on this subject are indebted to
Galen for laying down, in the most satisfactory terms, the principles
upon which the treatment of putrid fevers ought to be conducted. He
particularly recommends bleeding _ad deliquium_. When this evacuation
is neglected, the patient’s only chance of safety is from a spontaneous
hemorrhage or profuse perspiration. He is so confident in the remedial
powers of venesection, that he directs it to be performed as late as the
seventh day, and even later, if the strength of the patient permit. He
particularly directs us likewise to allow the patient to drink as much
as he chooses of the coldest water, which, he says, when seasonably
administered, is most efficacious in extinguishing the febrile heat.
This remedy, however, he says, is to be used with becoming caution. But,
upon the whole, he strenuously inculcates that the safety of the patient
depends upon the free use of phlebotomy and cold drink. When the fever
abates, he allows wine. Alexander, although sufficiently disposed to
differ from Galen, entirely concurs with him in opinion respecting the
treatment of putrid fevers, for which he particularly commends bleeding
and cold drink. When venesection is contraindicated by the weakness of
the patient, he is to be treated by a refrigerant and diluent regimen.
Aëtius and Oribasius follow Galen, and their treatment, therefore, agrees
perfectly with our author’s. Synesius and Constantinus Africanus agree in
recommending bleeding and cold drink. But when the patient is very weak,
they forbid us to have recourse to the former, and, in that case, direct
us to use gentle aperients, and medicines of a refrigerant and diluent
nature, such as prunes, jujubes, purslain, and the like.
Although Avicenna lays little claim to originality, his plan of treatment
in this case is deserving of attention, as being directed by the soundest
judgment. He begins with venesection, if the patient’s strength permit,
and then opens the belly gently, but cautions against violent purging. He
then gives first diuretics, and afterwards sudorifics. Unless when the
stomach is loaded with crudities, he approves very much of cold drink.
Though favorable to the seasonable practice of venesection, he forbids
it except at the commencement; and directs to proportion the loss of
blood to the strength of the patient. He also forbids interference with
the crisis by bleeding, purging, or giving gross food at that season.
Further, with regard to venesection, he does not approve of abstracting
much blood at once, which may occasion a dangerous prostration of
strength; but prefers taking a moderate quantity, and repeating the
operation, if necessary. The purgatives which he most commends are
tamarinds and myrobalans; but when these are not sufficiently strong, he
permits scammony, aloes, and colocynth to be given. He also directs us to
give camphor as a refrigerant. It is to be kept in mind that the Arabians
held the action of camphor to be frigorific, that is to say, narcotic.
He is most minute in his directions about the diet. For drink, he gives
barley-water, with a small proportion of wine or vinegar.
Haly Abbas lays down the rules of treatment with great precision. He
recommends venesection at the commencement, provided the fever be of a
sanguineous type; but, if the patient be debilitated, he is to be treated
with refrigerants.
Averrhoes treats of putrid fevers at great length, and with more than his
usual judgment; but, as he differs but little from Avicenna, we shall not
attempt to give an abstract of his practice. (Collig. vii, 9.) Rhases
gives a full account of the practice of the Greeks. When the extremities
are cold, and the pulse weak, he directs them to be rubbed, in order to
draw off the blood from the internal parts.
Alexander Aphrodisiensis inquires how it happens that wine, which is of a
hot nature, proves useful in fever. The amount of his speculations upon
this matter is this, that the wine acts by strengthening the powers of
the system. (Probl.)
All the ancient authorities disapprove of the bath, except in the decline
of the fever. See Ugulinus (de Balneis.) Rabbi Moyses says that the use
of it is to be regulated by three circumstances: 1st. That no rigor be
present. 2d. That no important member be affected. 3d. That there be no
crudities in the veins. These appear to be very judicious regulations.