Part 23

Sec. 223. Notwithstanding all which the Patient is not safe, except, during the Course of the Distemper, or immediately after it, he has had some considerable Evacuation; such as the Vomiting I have just mentioned; or a bilious Looseness; or considerable Discharges by Urine; or very plentiful Sweating. For when any of these Evacuations supervene, the Fever vanishes; the Patient resumes his Strength, and perfectly recovers. It happens sometimes too, and even without any of these perceivable Discharges, that insensible Perspiration expels the Relics of the poisonous Cause of this Disease, and the Patient recovers his Health. Yet it occurs too often, that this Venom not having been entirely expelled (or its internal Effects not having been thoroughly effaced) it is repelled upon the Lungs, where it produces a slight Inflammation. In Consequence of this the Oppression, the Cough, the Anguish, and Fever return, and the Patient's Situation becomes very dangerous. This Outrage is frequently less vehement, but it proves tedious and chronical, leaving a very obstinate Cough behind it, with many Resemblances of the Whooping-Cough. In 1758 there was an epidemic State of the Measles here extremely numerous, which affected great Numbers: Almost all who had it, and who were not very carefully and judiciously attended, were seized in Consequence of it with that Cough, which proved very violent and obstinate.

Sec. 224. However, notwithstanding this be the frequent Progress and Consequence of this Disease, when left entirely to itself, or erroneously treated, and more particularly when treated with a hot Regimen; yet when proper Care was taken to moderate the Fever at the Beginning, to dilute, and to keep up the Evacuations, such unhappy Consequences have been very rare.

Sec. 225. The proper Method of conducting this Distemper is much the same with that of the Small-Pocks.

1, If the Fever be high, the Pulse hard, the Load and Oppression heavy, and all the Symptoms violent, the Patient must be bled once or twice.

2, His Legs must be bathed, and he must take some Glysters: the Vehemence of the Symptoms must regulate the Number of each.

3, The Ptisans No. 3 or 4 must be taken, or a Tea of Elder and Lime-tree Flowers, to which a fifth Part Milk may be added.

4, The Vapour, the Steam of warm Water should also be employed, as very conducive to asswage the Cough; the Soreness of the Throat, and the Oppression the Patient labours under.

5, As soon as the Efflorescence, the Redness becomes pale, the Patient is to be purged with the Draught No. 23.

6, He is still to be kept strictly to his Regimen, for two Days after this Purge; after which he is to be put upon the Diet of those who are in a State of Recovery.

7, If during the Eruption such Symptoms supervene as occur [at the same Term] in the Small-Pocks, they are to be treated in the Manner already directed there.

Sec. 226. Whenever this Method has not been observed, and the Accidents described Sec. 223 supervene, the Distemper must be treated like an Inflammation in its first State, and all must be done as directed Sec. 225. If the Disease is not vehement, Bleeding may be omitted. If it is of some standing in gross Children, loaded with Humours, inactive, and pale, we must add to the Medicines already prescribed the Potion No. 8, and Blisters to the Legs.

Our Author very prudently limits this Discharge, and the Repetition of it, in this Disease (Sec. 225) as an erroneous Excess of it has sometimes prevailed. I have seen a very epidemical Season of the Measles, where Bleeding was not indicated in one third of the infected. And yet I have known such an Abuse of Bleeding in it, that being repeated more than once in a Case before Eruption (the Measles probably not being suspected) the Eruption was retarded several Days; and the Patient, a young Lady of Condition, remained exceeding low, faint and sickish; 'till after recruiting a very little, the Measles appeared, and she recovered. In a Youth of a lax Fibre, where the Measles had appeared, a seventh or eighth Bleeding was ordered on a Stitch in the Side, supervening from their too early Disappearance, and the Case seemed very doubtful. But Nature continued very obstinately favourable in this Youth, who at length, but very slowly, recovered. His Circulation remained so languid, his Strength, with his Juices, so exhausted, that he was many Weeks before he could sit upright in a Chair, being obliged to make Use of a Cord depending from the Ceiling, to raise himself erectly in his Seat. K.

Sec. 227. It often happens from the Distance of proper Advice, that the Relics, the Dregs as it were, of the Disease have been too little regarded, especially the Cough; in which Circumstance it forms a real Suppuration in the Lungs, attended with a slow Fever. I have seen many Children in Country Villages destroyed by this Neglect. Their Case is then of the same Nature with that described Sec. 68 and 82, and terminates in the same Manner in a Looseness, (attended with very little Pain) and sometimes a very foetid one, which carries off the Patient. In such Cases we must recur to the Remedies prescribed Sec. 74, Article 3, 4, 5; to the Powder No. 14; and to Milk and Exercise. But it is so very difficult to make Children take the Powder, that it may be sometimes necessary to trust to the Milk without it, which I have often seen in such Situations accomplish a very difficult Cure. I must advise the Reader at the same Time, that it has not so compleat an Effect, as when it is taken solely unjoined by any other Aliment; and that it is of the last Importance not to join it with any, which has the least Acidity or Sharpness. Persons in easy Circumstances may successfully take, at the same Time, Pfeffer, Seltzer, Peterstal, or some other light Waters, which are but moderately loaded with mineral Ingredients. These are also successfully employed in all the Cases, in which the Cure I have mentioned is necessary.

Bristol Water will be no bad Substitute for any of these, in such Cases. K.

Sec. 228. Sometimes there remains, after the Course of the Measles, a strong dry Cough, with great Heat in the Breast, and throughout the whole Body, with Thirst, an excessive Dryness of the Tongue, and of the whole Surface of the Body. I have cured Persons thus indisposed after this Distemper, by making them breathe in the Vapour of warm Water; by the repeated Use of warm Baths; and by allowing them to take nothing for several Days but Water and Milk.

Before I take leave of this Subject, I assure the Reader again, that the contagious Cause of the Measles is of an extremely sharp and acrid Nature. It appears to have some Resemblance to the bilious Humour, which produces the Erisipelas, or St. Anthony's Fire; and thence it demands our particular Attention and Vigilance; without which very troublesome and dangerous Consequences may be apprehended. I have seen, not very long since, a young Girl, who was in a very languid State after the Measles, which she had Undergone three Years before: It was at length attended with an Ulceration in her Neck, which was cured, and her Health finally restored by Sarsaparilla with Milk and Water.

Sec. 229. The Measles have been communicated by Inoculation in some Countries, where it is of a very malignant Disposition; and that Method might also be very advantageous in this. But what we have already observed, with Respect to the Inoculation of the Small-Pocks, viz. That it cannot be extended to the general Benefit of the People, without the Foundation of Hospitals for that very Purpose, is equally applicable to the Inoculation of the Measles.

The only Account I have read of this Practice, is in the learned Dr. Home's Medical Facts and Experiments, published in 1759, which admits, that but nine out of fifteen of the Subjects of this Practice took. Cotton dipt in the Blood of a Patient in the Measles was inserted into the Arms of twelve; and three received the Cotton into their Nostrils, after the Chinese Manner of infusing the Small-Pocks; but of these last not one took, and one of those who had taken, had the Measles again two Months after. We think the sharp hot Lymph distilling from the inflamed Eyes of Persons in this Disease, a likelier Vehicle to communicate it than the Blood, especially the dry Blood, which was sometimes tried; since the human Serum seems the Fluid more particularly affected by it; and this must have been evaporated when the Blood grew dry. A few practical Strictures on this Work, and particularly on this Practice described in it, appeared in the Monthly Review Vol. XXI. P. 68 to 75. K.

_Chapter XV._

Of the ardent or burning Fever.

_Sect._ 230.

The much greater Number of the Diseases I have hitherto considered, result from an Inflammation of the Blood, combined with the particular Inflammation of some Part, or occasioned by some Contagion or Poison, which must be evacuated. But when the Blood is solely and strongly inflamed, without an Attack on any particular Part, this Fever, which we term hot or burning, is the Consequence.

Sec. 231. The Signs which make it evident are, a Hardness and Fulness of the Pulse in a higher Degree than happens in any other Malady; an excessive Heat; great Thirst; with an extraordinary Dryness of the Eyes, Nostrils, Lips, of the Tongue, and of the Throat; a violent Head-ach; and sometimes a Raving at the Height of the Paroxysm, or Increase of the Fever, which rises considerably every Evening. The Respiration is also somewhat oppressed, but especially at the Return of this Paroxysm, with a Cough now and then; though without any Pain in the Breast, and without any Expectoration, or coughing up. The Body is costive; the Urine very high coloured, hot, and in a small Quantity. The Sick are also liable to start sometimes, but especially when they seem to sleep; for they have little sound refreshing Sleep, but rather a kind of Drowsiness, that makes them very little attentive to, or sensible of, whatever happens about them, or even of their own Condition. They have sometimes a little Sweat or Moisture; though commonly a very dry Skin; they are manifestly weak, and have either little or no Smell or Taste.

Sec. 232. This Disease, like all other inflammatory ones, is produced by the Causes which thicken the Blood, and increase its Motion; such as excessive Labour, violent Heat, Want of Sleep, the Abuse of Wine or other strong Liquors; the long Continuance of a dry Constitution of the Air, Excess of every kind, and heating inflaming Food.

Sec. 233. The Patient, under these Circumstances, ought, 1, immediately to be put upon a Regimen; to have the Food allowed him given only every eight Hours, and, in some Cases, only twice a Day: and indeed, when the Attack is extremely violent, Nourishment may be wholly omitted.

2, Bleeding should be performed and repeated, 'till the Hardness of the Pulse is sensibly abated. The first Discharge should be considerable, the second should be made four Hours after. If the Pulse is softened by the first, the second may be suspended, and not repeated before it becomes sufficiently hard again, to make us apprehensive of Danger: but should it continue strong and hard, the Bleeding may be repeated on the same Day to a third Time, which often happens to be all the Repetitions that are necessary.

3, The Glyster No. 5 should be given twice, or even thrice, daily.

4, His Legs are to be bathed twice a Day in warm Water: his Hands may be bathed in the same Water. Linen or Flanel Cloths dipt in warm Water may be applied over the Breast, and upon the Belly; and he should regularly drink the Almond Milk No. 4 and the Ptisan No. 7. The poorest Patients may content themselves with the last, but should drink very plentifully of it; and after the Bleeding properly repeated, fresh Air and the plentiful Continuance of small diluting Liquors generally establish the Health of the Patient.