Part 26

9, If the Skin be dry, with a Looseness, and that by checking it, we design to increase Perspiration, instead of the Rhubarb, the Cream of Tartar may be blended with the Ipecacuana, No. 39, which, being given in small and frequent Doses, restrains the Purging, and promotes Perspiration. This Medicine, as the former, is to be taken in the Morning; two Hours after, the Sick must begin with the Potion No. 40, and repeat it regularly every three Hours; until it be interrupted by giving one of the Medicines No. 38 or 39: After which the Potion is to be repeated again, as already directed, till the Patient grows considerably better.

10, If the Strength of the Sick be very considerably depressed, and he is in great Dejection and Anguish, he should take, with every Draught of the Potion, the Bolus, or Morsel No. 41. If the Diarrhoea, the Purging is violent, there should be added, once or twice a Day to the Bolus, the Weight of twenty Grains, or the Size of a very small Bean, of Diascordium; or if that is not readily to be got, as much Venice Treacle.

11, Whenever, notwithstanding all this Assistance, the Patient continues in a State of Weakness and Insensibility, two large Blisters should be applied to the fleshy Insides of the Legs, or a large one to the Nape of the Neck: and sometimes, if there be a great Drowsiness, with a manifest Embarrassment of the Brain, they may be applied with great Success over the whole Head. Their Suppuration and Discharge is to be promoted abundantly; and, if they dry up within a few Days, others are to be applied, and their Evacuation is to be kept up for a considerable Time.

12, As soon as the Distemper is sufficiently abated, for the Patient to remain some Hours with very little or no Fever, we must avail ourselves of this Interval, to give him six, or at least five Doses of the Medicine No. 14, and repeat the same the next Day, which may prevent the Return of the Fever: after which it may be sufficient to give daily only two Doses for a few Days.

Observation and Experience have demonstrated the Advantage of the Bark, to obviate a Gangrene, and prevent the Putrefaction of animal Substances. We therefore conclude it may be usefully employed in malignant Fevers, as soon as the previous and necessary Evacuations shall have taken Place. E. L.--Provided there be very clear and regular Remissions at least. K.

13, When the Sick continue entirely clear of a Fever, or any Return, they are to be put into the Regimen of Persons in a State of Recovery. But if his Strength returns very slowly, or not at all; in Order to the speedier Establishment and Confirmation of it, he may take three Doses a Day of the Theriaca Pauperum, or poor Man's Treacle No. 42, the first of them fasting, and the other twelve Hours after. It were to be wished indeed, this Medicine was introduced into all the Apothecaries Shops, as an excellent Stomachic, in which Respect it is much preferable to Venice Treacle, which is an absurd Composition, dear and often dangerous. It is true it does not dispose the Patients to Sleep; but when we would procure them Sleep, there are better Medicines than the Treacle to answer that Purpose. Such as may not think the Expence of the Medicine No. 14, too much, may take three Doses of it daily for some Weeks, instead of the Medicine No. 42, already directed.

Sec. 248. It is necessary to eradicate a Prejudice that prevails among Country People, with Regard to the Treatment of these Fevers; not only because it is false and ridiculous, but even dangerous too. They imagine that the Application of Animals can draw out the Poison of the Disease; in Consequence of which they apply Poultry, or Pigeons, Cats or sucking Pigs to the Feet, or upon the Head of the Patient, having first split the living Animals open. Some Hours after they remove their strange Applications, corrupted, and stinking very offensively; and then ascribe such Corruption and horrid Stink to the Poison they suppose their Application to be charged with; and which they suppose to be the Cause of this Fever. But in this supposed Extraction of Poison, they are grosly mistaken, since the Flesh does not stink in Consequence of any such Extraction, but from its being corrupted through Moisture and Heat: and they contract no other Smell but what they would have got, if they had been put in any other Place, as well as on the Patient's Body, that was equally hot and moist. Very far from drawing out the Poison, they augment the Corruption of the Disease; and it would be sufficient to communicate it to a sound Person, if he was to suffer many of these animal Bodies, thus absurdly and uselessly butchered, to be applied to various Parts of his Body in Bed; and to lie still a long Time with their putrified Carcases fastened about him, and corrupting whatever Air he breathed there.

With the same Intention they fasten a living Sheep to the Bed's-foot for several Hours; which, though not equally dangerous, is in some Measure hurtful, since the more Animals there are in a Chamber, the Air of it is proportionably corrupted, or altered at least from its natural Simplicity, by their Respiration and Exhalations: but admitting this to be less pernicious, it is equally absurd. It is certain indeed, the Animals who are kept very near the sick Person breathe in the poisonous, or noxious Vapours which exhale from his Body, and may be incommoded with them, as well as his Attendants: But it is ridiculous to suppose their being kept near the Sick causes such Poison to come out of their Bodies. On the very contrary, in contributing still further to the Corruption of the Air, they increase the Disease. They draw a false Consequence, and no Wonder, from a false Principle; saying, if the Sheep dies, the Sick will recover. Now, most frequently the Sheep does not die; notwithstanding which the Sick sometimes recover; and sometimes they both die.

Sec. 249. The Cause of Malignant Fevers is, not infrequently, combined with other Diseases, whose Danger it extremely increases. It is blended for Instance, with the Poison of the Small-Pocks, or of the Measles. This may be known by the Union of those Symptoms, which carry the Marks of Malignity, with the Symptoms of the other Diseases. Such combined Cases are extremely dangerous; they demand the utmost Attention of the Physician; nor is it possible to prescribe their exact Treatment here; since it consists in general of a Mixture of the Treatment of each Disease; though the Malignity commonly demands the greatest Attention.

_Chapter XVIII._

Of intermitting Fevers.

_Sect._ 250.

Intermitting Fevers, commonly called here, Fevers and Agues, are those, which after an Invasion and Continuance for some Hours, abate very perceivably, as well as all the Symptoms attending them, and then entirely cease; nevertheless, not without some periodical or stated Return of them.

They were very frequent with us some Years since; and indeed might even be called epidemical: but for the five or six last Years, they have been much less frequent throughout the greater Part of Swisserland: notwithstanding they still continue in no small Number in all Places, where the Inhabitants breathe the Air that prevails in all the marshy Borders of the Rhone, and in some other Situations that are exposed to much the same humid Air and Exhalations.

Sec. 251. There are several Kinds of intermitting Fevers, which take their different Names from the Interval or different Space of Time, in which the Fits return.

If the Paroxysm or Fit returns every Day, it is either a true Quotidian, or a double Tertian Fever: The first of these may be distinguished from the last by this Circumstance, that in the Quotidian, or one Day Fever, the Fits are long; and correspond pretty regularly to each other in Degree and Duration. This however is less frequent in Swisserland. In the double Tertian, the Fits are shorter, and one is alternately light, and the other more severe.

In the simple Tertian, or third Day's Fever, the Fits return every other Day; so that three Days include one Paroxysm, and the Return of another.

In a Quartan, the Fit returns every fourth Day, including the Day of the first and that of the second Attack: so that the Patient enjoys two clear Days between the two sick ones.

The other kinds of Intermittents are much rarer. I have seen however one true Quintan, or fifth Day Ague, the Patient having three clear Days between two Fits; and one regularly weekly Ague, as it may be called, the Visitation of every Return happening every Sunday.

Sec. 252. The first Attack of an intermittent Fever often happens, when the Patient thought himself in perfect Health. Sometimes however it is preceded by a Sensation of Cold and a kind of Numbness, which continue some Days before the manifest Invasion of the Fit. It begins with frequent Yawnings, a Lassitude, or Sensation of Weariness, with a general Weakness, with Coldness, Shivering and Shaking: There is also a Paleness of the extreme Parts of the Body, attended with Loathings, and sometimes an actual Vomiting. The Pulse is quick, weak, and small, and there is a considerable Degree of Thirst.

At the End of an Hour or two, and but seldom so long as three or four Hours, a Heat succeeds, which increases insensibly, and becomes violent at its Height. At this Period the whole Body grows red, the Anxiety of the Patient abates; the Pulse is very strong and large, and his Thirst proves excessive. He complains of a violent Head-ach, and of a Pain in all his Limbs, but of a different sort of Pain from that he was sensible of, while his Coldness continued. Finally, having endured this hot State, four, five or six Hours, he falls into a general Sweat for a few more: upon which all the Symptoms already mentioned abate, and sometimes Sleep supervenes.

At the Conclusion of this Nap the Patient often wakes without any sensible Fever; complaining only of Lassitude and Weakness. Sometimes his Pulse returns entirely to its natural State between the two Fits; though it often continues a little quicker than in perfect Health; and does not recover its first Distinctness and Slowness, till some Days after the last Fit.

One Symptom, which most particularly characterises these several Species of intermitting Fevers, is the Quality of the Urines which the Sick pass after the Fit. They are of a reddish Colour, and let fall a Sediment, or Settling, which exactly resembles Brick-dust. They are sometimes frothy too, and a Pellicle, or thin filmy Skin, appears on the Top, and adheres to the Sides of the Glass that contains them.

Sec. 253. The Duration of each Fit is of no fixed Time or Extent, being various according to the particular sort of Intermittents, and through many other Circumstances. Sometimes they return precisely at the very same Hour; at other Times they come one, two, or three Hours sooner, and in other Instances as much later than the former. It has been imagined that those Fevers, whose Paroxysms returned sooner than usual, were sooner finally terminated: but there seems to be no general Rule in this Case.

Sec. 254. Intermitting Fevers are distinguished into those of Spring and Autumn. The former generally prevail from February to June: the latter are those which reign from July to January. Their essential Nature and Characters are the very same, as they are not different Distempers; though the various Circumstances attending them deserve our Consideration. These Circumstances depend on the Season itself, and the Constitution of the Patients, during such Seasons. The Spring Intermittents are sometimes blended with an inflammatory Disposition, as that is the Disposition of Bodies in that Season; but as the Weather then advances daily into an improving State, the Spring Fevers are commonly of a shorter Duration. The autumnal Fevers are frequently combined and aggravated with a Principle of Putrefaction; and as the Air of that Season rather degenerates, they are more tedious and obstinate.

Sec. 255. The autumnal Fevers seldom begin quite so early as July, but much oftner in August: and the Duration to which they are often extended, has increased the Terror which the People entertain of Fevers that begin in that Month. But that Prejudice which ascribes their Danger to the Influence of August, is a very absurd Error; since it is better they should set in then than in the following Months; because they are obstinate in Proportion to the Tardiness, the Slowness of their Approach. They sometimes appear at first considerably in the Form of putrid Fevers, not assuming that of Intermittents till some Days after their Appearance: but very happily there is little or no Danger in mistaking them for putrid Fevers, or in treating them like such. The Brick-coloured Sediment, and particularly the Pellicle or Film on the Surface of the Urine, are very common in autumnal Intermittents, and are often wanting in the Urine of putrid Fevers. In these latter, it is generally less high coloured, and leaning rather to a yellow, a kind of Cloudiness is suspended in the Middle of it. These also deposite a white Sediment, which affords no bad Prognostic.

Sec. 256. Generally speaking, intermitting Fevers are not mortal; often terminating in Health of their own Accord (without the Use of any Medicine) after some Fits. In this last Respect Intermittents in the Spring differ considerably from those in the Fall, which continue a long Time, and sometimes even until Spring, if they are not removed by Art, or if they have been improperly treated.

Quartan Fevers are always more obstinate and inveterate than Tertians; the former sometimes persevering in certain Constitutions for whole Years. When these Sorts of Fevers occur in boggy marshy Countries, they are not only very chronical or tedious, but Persons infested with them are liable to frequent Relapses.