Part 27

Sec. 257. A few Fits of an Intermittent are not very injurious, and it happens sometimes, that they are attended with a favourable Alteration of the Habit in Point of Health; by their exterminating the Cause or Principle of some languid and tedious Disorder; though it is erroneous to consider them as salutary. If they prove tedious and obstinate, and the Fits are long and violent, they weaken the whole Body, impairing all its Functions, and particularly the Digestions: They make the Humours sharp and unbalmy, and introduce several other Maladies, such as the Jaundice, Dropsy, Asthma and slow wasting Fevers. Nay sometimes old Persons, and those who are very weak, expire in the Fit; though such an Event never happens but in the cold Fit.

Sec. 258. Very happily Nature has afforded us a Medicine, that infallibly cures these Fevers: this is the Kinkina, or Jesuits Bark; and as we are possessed of this certain Remedy, the only remaining Difficulty is to discover, if there be not some other Disease combined with these Fevers, which Disease might be aggravated by the Bark. Should any such exist, it must be removed by Medicines adapted to it, before the Bark is given.

This admirable Medicine was unknown in Europe, till about one hundred and twenty Years past; we are obliged to the Spaniards for it, who found it in the Province of Quito in Peru; the Countess of Chinchon being the first European who used it in America, whence it was brought to Spain, under the Name of the Countesses Powder. The Jesuits having soon dispensed and distributed it abroad, it became still more publick by the Name of the Jesuits Powder: and since it has been known by that of Kinkina or the Peruvian Bark. It met with great Opposition at first; some deeming it a Poison, while others considered it as a divine Remedy: so that the Prejudices of many being heightened by their Animosity, it was nearly a full Century, before its true Virtue and its Use were agreed to: and about twenty Years since the most unfavourable Prejudices against it pretty generally subsided. The Insufficience of other Medicines in several Cases; its great Efficaciousness; and the many and surprizing Cures which it did, and daily does effect; the Number of Distempers; the different kinds of Fevers, in which it proves the sovereign Remedy; its Effects in the most difficult chirurgical Cases; the Comfort, the Strength and Sprits it gives those who need and take it, have at length opened every Persons Eyes; so that it has almost unanimously obtained the first Reputation, among the most efficacious Medicines. The World is no longer amused with Apprehensions of its injuring the Stomach; of its fixing, or shutting up the Fever (as the Phrase has been) without curing it; that it shuts up the Wolf in the Sheepfold; that it throws those who take it into the Scurvy, the Asthma, the Dropsy, the Jaundice. On the contrary they are persuaded it prevents there very Diseases; and, that if it is ever hurtful, it is only when it is either adulterated, as most great Remedies have been; or has been wrongly prescribed, or improperly taken: or lastly when it meets with some latent, some unknown Particularities in a Constitution, which Physicians term an Idiosyncrasy, and which prevent or pervert its very general Effects. Tissot.

Sec. 259. In the vernal, or Spring-Fevers, if the Fits are not very severe; if the Patient is evidently well in their Intervals; if his Appetite, his Strength, and his Sleep continue as in Health, no Medicine should be given, nor any other Method be taken, but that of putting the Person, under such a gentle Intermittent, upon the Regimen directed for Persons in a State of Recovery. This is such a Regimen as pretty generally agrees with all the Subjects of these Fevers: for if they should be reduced to the Regimen proper in acute Diseases, they would be weakened to no Purpose, and perhaps be the worse for it. But at the same Time if we were not to retrench from the Quantity, nor somewhat to vary the Quality of their usual Food in a State of Health; as there is not the least Digestion made in the Stomach, during the whole Term of the Fit; and as the Stomach is always weakened a little by the Disease, crude and indigested Humours would be produced, which might afford a Fuel to the Disease. Not the least solid Food should be allowed, for at least two Hours before the usual Approach of the Fit.

Sec. 260. If the Fever extends beyond the sixth, or the seventh Fit; and the Patient seems to have no Occasion for a Purge; which may be learned by attending to the Chapter, which treats of Remedies to be taken by Way of Precaution; he may take the Bark, that is the Powder No. 14. If it is a Quotidian, a daily Fever, or a double Tertian, six Doses, containing three Quarters of an Ounce, should be taken between the two Fits; and as these Intermissions commonly consist of but ten or twelve, or at the most of fourteen or fifteen Hours, there should be an Interval of only one Hour and a half between each Dose. During this Interval the Sick may take two of his usual Refreshments or Suppings.

It happens very seldom that intermitting Fevers require no Purge towards their Cure, especially in Places, which are disposed to generate Putridity. There is always some material Cause essential to these Fevers, of which Nature disembarrasses herself more easily by Stools, than by any other Discharge: And as there is not the least Danger to be apprehended from a gentle Purge, such at those of No. 11 or 23, we think it would be prudent always to premise a Dose or two of either to the Bark. E. L.

Yet I have known many in whom no Purge was necessary, and have seen some rendered more obstinate and chronical by erroneous Purging. But a Vomit is very generally necessary before the Bark is given. K.

When the Fever is a Tertian, an Ounce should be given between the two Fits: which makes eight Doses, one of which is to be taken every three Hours.

In a Quartan I direct one Ounce and a half, to be taken in the same Manner. It is meer trifling to attempt preventing the Returns with smaller Doses. The frequent Failures of the Bark are owing to over small Doses. On such Occasions the Medicine is cried down, and censured as useless, when the Disappointment is solely the Fault of those who do not employ it properly. The last Dose is to be given two Hours before the usual Return of the Fit.

The Doses, just mentioned, frequently prevent the Return of the Fit; but whether it returns or not, after the Time of its usual Duration is past, repeat the same Quantity, in the same Number of Doses, and Intervals, which certainly keeps off another. For six Days following, half the same Quantity must be continued, in the Intervals that would have occurred between the Fits, if they had returned: and during all this Time the Patient should inure himself to as much Exercise, as he can well bear.

Sec. 261. Should the Fits be very strong, the Pain of the Head violent, the Visage red, the Pulse full and hard; if there is any Cough; if, even after the Fit is over, the Pulse still is perceivably hard; if the Urine is inflamed, hot and high-coloured, and the Tongue very dry, the Patient must be bled, and drink plentifully of Barley Water No. 3. These two Remedies generally bring the Patient into the State described Sec. 259: in which State he may take on a Day, when the Fever is entirely off, three or four Doses of the Powder No. 24, and then leave the Fever to pursue its own Course for the Space of a few Fits. But should it not then terminate of itself, the Bark must be recurred to.

If the Patient, even in the Interval of the Returns, has a foetid, furred Mouth, a Loathing, Pains in the Loins, or in the Knees, much Anxiety, and bad Nights, he should be purged with the Powder No. 21 or the Potion No. 23, before he takes the Bark.

Sec. 262. If Fevers in Autumn appear to be of the continual kind, and very like putrid Fevers, the Patients should drink abundantly of Barley Water; and if at the Expiration of two or three Days, there still appears to be a Load or Oppression at the Stomach, the Powder No. 34 or that of 35 is to be given (but see Sec. 241): and if, after the Operation of this, the Signs of Putridity continue, the Body is to be opened with repeated Doses of the Powder No. 24; or, where the Patients are very robust, with No. 21; and when the Fever becomes quite regular, with distinct Remissions at least, the Bark is to be given as directed Sec. 260.

But as autumnal Fevers are more obstinate; after having discontinued the Bark for eight Days; and notwithstanding there has been no Return of the Fever, it is proper to resume the Bark, and to give three Doses of it daily for the succeeding eight Days, more especially if it was a Quartan; in which Species I have ordered it to be repeated, every other eight Days, for six Times.

Many People may find it difficult to comply with this Method of Cure, which is unavoidably expensive, through the Price of the Bark. I thought however this ought not to prevent me from averring it to be the only certain one; since nothing can be an equivalent Succedaneum or Substitute to this Remedy, which is the only sure and safe one in all these Cases. The World had long been prepossessed with Prejudices to the contrary: it was supposed to be hurtful to the Stomach; to prevent which it has been usual to make the Sick eat something an Hour after it. Nevertheless, very far from injuring the Stomach, it is the best Medicine in the Universe to strengthen it; and it is a pernicious Custom, when a Patient is obliged to take it often, to eat an Hour after it. It had also been imagined to cause Obstructions, and that it subjected Patients to a Dropsy: but at present we are convinced, it is the obstinate and inveterate Duration of the Intermittent, that causes Obstructions, and paves the Way to a Dropsy. The Bark, in Consequence of its speedily curing the Fever, does not only prevent the former Disease; but when it continues, through an injudicious Omission of the Bark, a proper Use of it is serviceable in the Dropsy. In a Word, if there is any other Malady combined with the Fever, sometimes that indeed prevents the Success of the Bark, yet without rendering it hurtful. But whenever the intermitting Fever is simple and uncombined, it ever has, and ever will render the Patient all possible Service. In another Place I shall mention such Means and Methods as may in some Degree, though but imperfectly, be substituted instead of it.

After the Patient has begun with the Bark, he must take no purging Medicine, as that Evacuation would, with the greatest Probability, occasion a Return of the Fever.

Sec. 263. Bleeding is never, or extremely seldom indeed necessary in a Quartan Ague, which occurs in the Fall oftner than in the Spring; and with the Symptoms of Putridity rather than of Inflammation.

Sec. 264. The Patient ought, two Hours before the Invasion of the Fit, to drink a small Glass of warm Elder Flower Tea, sweetened with Honey, every Quarter of an Hour, and to walk about moderately; this disposes him to a very gentle Sweat, and thence renders the ensuing Coldness and the whole Fit milder. He is to continue the same Drink throughout the Duration of the cold Fit; and when the hot one approaches, he may either continue the same, or substitute that of No. 2, which is more cooling. It is not necessary however, in this State, to drink it warm, it is sufficient that it be not over cold. When the Sweat, at the Termination of the hot Fit, is concluded, the Patient should be well wiped and dried, and may get up. If the Fit was very long, he may be allowed a little Gruel, or some other such Nourishment during the Sweat.

Sec. 265. Sometimes the first, and a few successive Doses of the Bark purge the Patient. This is no otherwise an ill Consequence, than by its retarding the Cure; since, when it purges, it does not commonly prevent the Return of the Fever; so that these Doses may be considered as to no Purpose, and others should be repeated, which, ceasing to purge, do prevent it. Should the Looseness notwithstanding continue, the Bark must be discontinued for one entire Day, in order to give the Patient half a Quarter of an Ounce of Rhubarb: after which the Bark is to be resumed again, and if the Looseness still perseveres, fifteen Grains of Venice Treacle should be added to each Dose, but not otherwise. All other Medicines which are superadded, very generally serve only to increase the Bulk of the Dose, while they lessen its Virtue.

Sec. 266. Before our thorough Experience of the Bark, other bitter Medicines were used for the same Purpose: these indeed were not destitute of Virtue in such Cases, though they were considerably less available than the Bark. Under No. 43, some valuable Prescriptions of that kind may be seen, whose Efficacy I have often experienced: though at other Times I have been obliged to leave them off, and recur to the Bark more successfully. Filings of Iron, which enter into the third Prescription, are an excellent Febrifuge in particular Cases and Circumstances. In the Middle of the Winter 1753, I cured a Patient of a Quartan Ague with it, who would not be prevailed on to take the Bark. It must be confessed he was perfectly regular in observing the Regimen directed for him; and that, during the most rigid Severity of the Winter, he got every Day on Horseback, and took such a Degree of other Exercise in the open Air, as disposed him to perspire abundantly.

Sec. 267. Another very practicable easy Method, of which I have often availed my Patients, under tertian Fevers (but which succeeded with me only twice in Quartans) was to procure the Sufferer a very plentiful Sweat, at the very Time when the Fit was to return, in its usual Course. To effect this he is to drink, three or four Hours before it is expected, an Infusion of Elder Flowers sweetened with Honey, which I have already recommended Sec. 264; and one Hour before the usual Invasion of the Shivering, he is to go into Bed, and take, as hot as he can drink it, the Prescription No. 44.

I have also cured some Tertians and even Quartans, in 1751 and 1752, by giving them, every four Hours between the Fits, the Powder No. 45. But I must acknowledge that, besides its having often failed me, and its never succeeding so speedily as the Bark, I have found it weaken some Patients; it disorders, or disagrees with, their Stomachs: and in two Cases, where it had removed the Fever, I was obliged to call in the Bark for a thorough Establishment of the Patient's Health. Nevertheless, as these Medicines are very cheap and attainable, and often do succeed, I thought I could not properly omit them.

Sec. 268. A Multitude of other Remedies are cried up for the Cure of Fevers: though none of them are equally efficacious with those I have directed: and as many of them are even dangerous, it is prudent to abstain from them. Some Years since certain Powders were sold here, under the Name of the Berlin Powders; these are nothing but the Bark masqued or disguised (which has sometimes been publickly discovered) and have always been sold very dear: though the Bark well chosen, and freshly powdered when wanted, is greatly preferable.

Sec. 269. I have often known Peasants, who had laboured for several Months under intermitting Fevers; having made Use of many bad Medicines and Mixtures for them, and observed no Manner of Regimen. Such I have happily treated by giving them the Remedies No. 34, or 35; and afterwards, for some Days, that of No. 38; at the End of which Time, I have ordered them the Bark (See Sec. 260) or other Febrifuges, as at Sec. 266, 267; and then finally ordered them for some Days, to take Morsels of the poor Man's Treacle (See Sec. 247, Art. 13) to strengthen and confirm their Digestions, which I have found very weak and irregular.

Sec. 270. Some Intermittents are distinguished as pernicious or malignant, from every Fit's being attended with the most violent Symptoms. The Pulse is small and irregular, the Patient exceedingly dejected, and frequently swooning; afflicted with inexpressible Anguish, Convulsions, a deep Drowsiness, and continual Efforts to go to Stool, or make Urine, but ineffectually. This Disease is highly pressing and dangerous; the Patient may die in the third Fit, and rarely survives the sixth, if he is not very judiciously treated. Not a Moment should be lost, and there is no other Step to be taken, but that of giving the Bark continually, as directed Sec. 260, to prevent the succeeding Fits. These worst Kinds of Intermittents are often combined with a great Load of putrid Humours in the first Passages: and as often as such an aggravating Combination is very evident, we should immediately after the End of one Fit, give a Dose of Ipecacuana No. 35, and, when its Operation is finished, give the Bark. But I chuse to enter into very few Details on this Species of Intermittents, both as they occur but seldom, and as the Treatment of them is too difficult and important, to be submitted to the Conduct of any one but a Physician. My Intention has only been to represent them sufficiently, that they may be so distinguished when they do occur, as to apprize the People of their great Danger.

Sec. 271. The same Cause which produces these intermitting Fevers, frequently also occasions Disorders, which return periodically at the same Hour, without Shivering, without Heat, and often without any Quickness of the Pulse. Such Disorders generally preserve the Intermissons of quotidian or tertian Fevers, but much seldomer those of Quartans. I have seen violent Vomittings, and Reachings to vomit, with inexpressible Anxiety; the severest Oppressions, the most racking Cholics; dreadful Palpitations and excessive Tooth-achs: Pains in the Head, and very often an unaccountable Pain over one Eye, the Eyelid, Eyebrow and Temple, on the same Side of the Face; with a Redness of that Eye, and a continual, involuntary trickling of Tears. I have also seen such a prodigious Swelling of the affected Part, that the Eye projected, or stood out, above an Inch from the Head, covered by the Eyelid, which was also extremely inflated or puffed up. All these Maladies begin precisely at a certain Hour; last about the usual Time of a Fit; and terminating without any sensible Evacuation, return exactly at the same Hour, the next Day, or the next but one.

There is but one known Medicine that can effectually oppose this Sort, which is the Bark, given as directed Sec. 260. Nothing affords Relief in the Fit, and no other Medicine ever suspends or puts it off. But I have cured some of these Disorders with the Bark, and especially those affecting the Eyes, which happen oftner than the other Symptoms, after their Duration for many Weeks, and after the ineffectual Use of Bleeding, Purging, Baths, Waters, Blisters, and a great Number of other Medicines. If a sufficient Dose of it be given, the next Fit is very mild; the second is prevented; and I never saw a Relapse in these Cases, which sometimes happens after the Fits of common Intermittents seemed cured.

Sec. 272. In Situations where the Constitution of the Air renders these Fevers very common, the Inhabitants should frequently burn in their Rooms, at least in their lodging Rooms, some aromatic Wood or Herbs. They should daily chew some Juniper Berries, and drink a fermented Infusion of them. These two Remedies are very effectual to fortify the weakest Stomachs, to prevent Obstructions, and to promote Perspiration. And as these are the Causes which prolong these Fevers the most obstinately; nothing is a more certain Preservation from them than these cheap and obvious Assistances.