Part 25

10, As the Organs of Digestion have been considerably weakened through the Course of this Fever, there is a Necessity for the Patient's conducting himself very prudently and regularly long after it, with Regard both to the Quantity and Quality of his Food. He should also use due Exercise as soon as his Strength will permit, without which he may be liable to fall into some chronical and languishing Disorder, productive of considerable Languor and Weakness. *

_Chapter XVII._

Of malignant Fevers.

_Sect._ 242.

Those Fevers are termed malignant, in which the Danger is more than the Symptoms would make us apprehensive of: they have frequently a fatal Event without appearing so very perilous; on which Account it has been well said of this Fever, that it is a Dog which bites without barking.

Sec. 243. The distinguishing Criterion or Mark of malignant Fevers is a total Loss of the Patient's Strength, immediately on their first Attack. They arise from a Corruption of the Humours, which is noxious to the very Source and Principle of Strength, the Impairing or Destruction of which is the Cause of the Feebleness of the Symptoms; by Reason none of the Organs are strong enough to exert an Opposition sufficiently vigorous, to subdue the Cause of the Distemper.

If, for Instance or Illustration, we were to suppose, that when two Armies were on the Point of engaging, one of them should be nearly deprived of all their Weapons, the Contest would not appear very violent, nor attended with great Noise or Tumult, though with a horrible Massacre. The Spectator, who, from being ignorant of one of the Armies being disarmed, would not be able to calculate the Carnage of the Battle, but in Proportion to its Noise and Tumult, must be extremely deceived in his Conception of it. The Number of the Slain would be astonishing, which might have been much less (though the Noise and Clangor of it had been greater) if each Army had been equally provided for the Combat.

Sec. 244. The Causes of this Disease are a long Use of animal Food or Flesh alone, without Pulse, Fruits or Acids; the continued Use of other bad Provisions, such as Bread made of damaged Corn or Grain, or very stale Meat. Eight Persons, who dined together on corrupt Fish, were all seized with a malignant Fever, which killed five of them, notwithstanding the Endeavours of the most able Physicians. These Fevers are also frequently the Consequence of a great Dearth or Famine; of too hot and moist an Air, or an Air, which highly partakes of these two Qualities; so that they happen to spread most in hot Years, in Places abounding with Marshes and standing Waters. They are also the Effect of a very close and stagnant Air, especially if many Persons are crouded together in it, this being a Cause that particularly tends to corrupt the Air. Tedious Grief and Vexation also contribute to generate these Fevers.

Sec. 245. The Symptoms of malignant Fevers are, as I have already observed, a total and sudden Loss of Strength, without any evident preceding Cause, sufficient to produce such a Privation of Strength: at the same Time there is also an utter Dejection of the Mind, which becomes almost insensible and inattentive to every Thing, and even to the Disease itself; a sudden Alteration in the Countenance, especially in the Eyes: some small Shiverings, which are varied throughout the Space of twenty-four Hours, with little Paroxysms or Vicissitudes of Heat; sometimes there is a great Head-ach and a Pain in the Loins; at other Times there is no perceivable Pain in any Part; a kind of Sinkings or Faintings, immediately from the Invasion of the Disease, which is always very unpromising; not the least refreshing Sleep; frequently a kind of half Sleep, or Drowsiness; a light and silent or inward Raving, which discovers itself in the unusual and astonished Look of the Patient, who seems profoundly employed in meditating on something, but really thinks of nothing, or not at all: Some Patients have, however, violent Ravings; most have a Sensation of Weight or Oppression, and at other Times of a Binding or Tightness about, or around, the Pit of the Stomach.

The sick Person seems to labour under great Anguish: he has sometimes slight convulsive Motions and Twitchings in his Face and his Hands, as well as in his Arms and Legs. His Senses seem torpid, or as it were benumbed. I have seen many who had lost, to all Appearance, the whole five, and yet some of them recover. It is not uncommon to meet with some, who neither see, understand, nor speak. Their Voices change, become weak, and are sometimes quite lost. Some of them have a fixed Pain in some Part of the Belly: this arises from a Stuffing or Obstruction, and often ends in a Gangrene, whence this Symptom is highly dangerous and perplexing.

The Tongue is sometimes very little altered from its Appearance in Health; at other Times covered over with a yellowish brown Humour; but it is more rarely dry in this Fever than in the others; and yet it sometimes does resemble a Tongue that has been long smoaked.

The Belly is sometimes very soft, and at other Times tense and hard. The Pulse is weak, sometimes pretty regular, but always more quick than in a natural State, and at some Times even very quick; and such I have always found it, when the Belly has been distended.

The Skin is often neither hot, dry, nor moist: it is frequently overspread with petechial or eruptive Spots (which are little Spots of a reddish livid Colour) especially on the Neck, about the Shoulders, and upon the Back. At other Times the Spots are larger and brown, like the Colour of Wheals from the Strokes of a Stick.

The Urine of the Sick is almost constantly crude, that is of a lighter Colour than ordinary. I have seen some, which could not be distinguished, merely by the Eye, from Milk. A black and stinking Purging sometimes attends this Fever, which is mortal, except the Sick be evidently relieved by the Discharge.

Some of the Patients are infested with livid Ulcers on the Inside of the Mouth, and on the Palate. At other Times Abscesses are formed in the Glands of the Groin, of the Arm-pit, in those between the Ears and the Jaw; or a Gangrene may appear in some Part, as on the Feet, the Hands, or the Back. The Strength proves entirely spent, the Brain is wholly confused: the miserable Patient stretched out on his Back, frequently expires under Convulsions, an enormous Sweat, and an oppressed Breast and Respiration. Haemorrhages also happen sometimes and are mortal, being almost unexceptionably such in this Fever. There is also in this, as in all other Fevers, an Aggravation of the Fever in the Evening.

Sec. 246. The Duration and Crisis of these malignant, as well as those of putrid Fevers, are very irregular. Sometimes the Sick die on the seventh or eighth Day, more commonly between the twelfth and the fifteenth, and not infrequently at the End of five or six Weeks. These different Durations result from the different Degree and Strength of the Disease. Some of these Fevers at their first Invasion are very slow; and during a few of the first Days, the Patient, though very weak, and with a very different Look and Manner, scarcely thinks himself sick.

The Term or Period of the Cure or the Recovery, is as uncertain as that of Death in this Distemper. Some are out of Danger at the End of fifteen Days, and even sooner; others not before the Expiration of several Weeks.

The Signs which portend a Recovery are, a little more Strength in the Pulse; a more concocted Urine; less Dejection and Discouragement; a less confused Brain; an equal kindly Heat; a pretty warm or hot Sweat in a moderate Quantity, without Inquietude or Anguish; the Revival of the different Senses that were extinguished, or greatly suspended in the Progress of the Disease; though the Deafness is not a very threatening Symptom, if the others amend while it endures.

This Malady commonly leaves the Patient in a very weak Condition; and a long Interval will ensue between the End of it, and their recovering their full Strength.

Sec. 247. It is, in the first place, of greater Importance in this Distemper than in any other, both for the Benefit of the Patients, and those who attend them, that the Air should be renewed and purified. Vinegar should often be evaporated from a hot Tile or Iron in the Chamber, and one Window kept almost constantly open.

2, The Diet should be light; and the Juice of Sorrel may be mixed with their Water; the Juice of Lemons may be added to Soups prepared from different Grains and Pulse; the Patient may eat sharp acid Fruits, such as tart juicy Cherries, Gooseberries, small black Cherries; and those who can afford them, may be allowed Lemons, Oranges and Pomgranates.

The French Word is Griettes, which Beyer englishes, the Agriot, the red or sour Cherry; and Chambaud, the sweeter large black Cherry or Mazzard--But as Dr. Tissot was recommending the Use of Acids, it is more probably the first of these: so that our Morellas, which make a pleasant Preserve, may be a good Substitute to them, supposing them not to be the same. Our Berbery Jam, and Jelly of Red Currants, may be also employed to answer the same Indication. K.

3, The Patient's Linen should be changed every two Days.

4, Bleeding is very rarely necessary, or even proper, in this Fever; the Exceptions to which are very few, and cannot be thoroughly ascertained, as fit and proper Exceptions to the Omission of Bleeding, without a Physician, or some other very skilful Person's seeing the Patient.

5, There is often very little Occasion for Glysters, which are sometimes dangerous in this Fever.

6, The Patient's common Drink should be Barley Water made acid with the Spirit No. 10, at the Rate of one Quarter of an Ounce to at least full three Pints of the Water, or acidulated agreeably to his Taste. He may also drink Lemonade.

7, It is necessary to open and evacuate the Bowels, where a great Quantity of corrupt Humours is generally lodged. The Powder No. 35 may be given for this Purpose, after the Operation of which the Patient generally finds himself better, at least for some Hours. It is of Importance not to omit this at the Beginning of the Disease; though if it has been omitted at first, it were best to give it even later, provided no particular Inflammation has supervened, and the Patient has still some Strength. I have given it, and with remarkable Success, on the twentieth Day.

8, Having by this Medicine expelled a considerable Portion of the bad Humours, which contribute to feed and keep up the Fever, the Patient should take every other Day, during the Continuance of the Disease, and sometimes even every Day, one Dose of the Cream of Tartar and Rhubarb No. 38. This Remedy evacuates the corrupt Humours, prevents the Corruption of the others; expells the Worms that are very common in these Fevers, which the Patient sometimes discharges upwards and downwards; and which frequently conduce to many of the odd and extraordinary Symptoms, that are observed in malignant Fevers. In short it strengthens the Bowels, and, without checking the necessary Evacuations, it moderates the Looseness, when it is hurtful.