Part 28

I have seen several Cases in very marshy maritime Countries, with little good drinking Water, and far South of Swisserland, where intermitting Fevers, with Agues at different Intervals, are annually endemic, very popular, and often so obstinate as to return repeatedly, whenever the weekly precautionary Doses of the Bark have been omitted (through the Patient's nauseating the frequent Swallowing of it) so that the Disease has sometimes been extended beyond the Term of a full Year, and even far into a second, including the temporary Removals of it by the Bark. Nevertheless, in some such obstinate Intermittents, and particularly Quartans there, wherein the Bark alone has had but a short and imperfect Effect, I have known the following Composition, after a good Vomit, attended with speedy and final Success, viz. Take of fresh Sassafras Bark, of Virginia Snake-root, of Roch-Allom, of Nutmeg, of diaphoretic Antimony, and of Salt of Wormwood of each one Drachm. To these well rubbed together into fine Powder, add the Weight of the whole, of the best and freshest Bark; then drop in three Drops of the chemical Oil of Mint, and with Syrup of Cloves make it into the Consistence of an Electuary or Bolus, for 12 Doses for a grown Person, to be taken at the Distance of three or four Hours from each other, while the Patient is awake, according to the longer or shorter Intermission of the Fever.

I have also known, particularly in obstinate autumnal Agues there, an Infusion of two Ounces of the best Bark in fine Powder, or two Ounces and a half in gross Powder, in a Quart of the best Brandy, for three or four Days (a small Wine Glass to be taken by grown Persons at the Distance of from four to six Hours) effectually and speedily terminate such intermittent Agues, as had given but little Way to the Bark in Substance. This was certainly more suitable for those who were not of a light delicate Habit and Temperament, and who had not been remarkable for their Abstinence from strong Liquors: the inebriating Force of the Brandy being remarkably lessened, by the Addition and long Infusion of the Bark. These Facts which I saw, are the less to be wondered at, as in such inveterate, but perfectly clear and distinct Intermittents, both the State of the Fluids and Solids seem very opposite to their State in an acutely inflammatory Disease. K.

_Chapter XIX._

Of the Erisipelas, and the Bites of Animals.

_Sect._ 273.

The Erisipelas, commonly called in English, St. Anthony's Fire, and in Swisserland the Violet, is sometimes but a very slight Indisposition which appears on the Skin, without the Person's being sensible of any other Disorder; and it most commonly breaks out either in the Face, or on the Legs. The Skin becomes tense, or stiff, rough and red; but this Redness disappears on pressing the Spot with a Finger, and returns on removing it. The Patient feels in the Part affected a burning Heat, which makes him uneasy, and sometimes hinders him from sleeping. The Disorder increases for the Space of two or three Days; continues at its Height one or two, and then abates. Soon after this, that Part of the Skin that was affected, falls off in pretty large Scales, and the Disorder entirely terminates.

Sec. 274. But sometimes this Malady is considerably more severe, beginning with a violent Shivering, which is succeeded by a burning Heat, a vehement Head-ach, a Sickness at Heart, as it is commonly termed, or Reachings to vomit, which continue till the Erisipelas appears, which sometimes does not happen before the second, or even the third Day. The Fever then abates, and the Sickness goes off, though frequently a less Degree of Fever, and of Sickness or Loathing remain, during the whole Time, in which the Disease is in its increasing State. When the Eruption and Inflammation happen in the Face, the Head-ach continues, until the Decline, or going off, of the Disease. The Eyelid swells, the Eye is closed, and the Patient has not the least Ease or Tranquillity. It often passes from one Cheek to the other, and extends successively over the Forehead, the Neck, and the Nape of the Neck; under which Circumstance the Disease is of a more than ordinary Duration. Sometimes also when it exists in a very high Degree, the Fever continues, the Brain is obstructed and oppressed; the Patient raves; his Case becomes extremely dangerous; whence sometimes, if he is not very judiciously assisted, he dies, especially if of an advanced Age. A violent Erisipelas on the Neck brings on a Quinsey, which may prove very grievous, or even fatal.

When it attacks the Leg, the whole Leg swells up; and the Heat and Irritation from it is extended up to the Thigh.

Whenever this Tumour is considerable, the Part it seizes is covered with small Pustules filled with a clear watery Humour, resembling those which appear after a Burn, and drying afterwards and scaling off. I have sometimes observed, especially when this Distemper affected the Face, that the Humour, which issued from these little Pustules, was extremely thick or glewy, and formed a thick Scurf, or Scabs nearly resembling those of sucking Children: they have continued fast on the Face many Days before they fell off.

When the Disease may be termed violent, it sometimes continues eight, ten, twelve Days at the same Height; and is at last terminated by a very plentiful Sweat, that may sometimes be predicted by a Restlessness attended with Shiverings, and a little Anxiety of some Hours Duration. Throughout the Progress of the Disease, the whole Skin is very dry, and even the Inside of the Mouth.

Sec. 275. An Erisipelas rarely comes to Suppuration, and when it does, the Suppuration is always unkindly, and much disposed to degenerate into an Ulcer. Sometimes a malignant kind of Erisipelas is epidemical, seizing a great Number of Persons, and frequently terminating in Gangrenes.

Sec. 276. This Distemper often shifts its Situation; it sometimes retires suddenly; but the Patient is uneasy and disordered; he has a Propensity to vomit, with a sensible Anxiety and Heat: the Erisipelas appears again in a different Part, and he feels himself quite relieved from the preceding Symptoms. But if instead of re-appearing on some other Part of the Surface, the Humour is thrown upon the Brain, or the Breast, he dies within a few Hours; and these fatal Changes and Translations sometimes occur, without the least Reason or Colour for ascribing them either to any Error of the Patient, or of his Physician.

If the Humour has been transferred to the Brain, the Patient immediately becomes delirious, with a highly flushed Visage, and very quick sparkling Eyes: very soon after he proves downright frantic, and goes off in a Lethargy.

If the Lungs are attacked, the Oppression, Anxiety, and Heat are inexpressible.

Sec. 277. There are some Constitutions subject to a very frequent, and, as it were, to an habitual Erisipelas. If it often affects the Face, it is generally repeated on the same Side of it, and that Eye is, at length, considerably weakened by it.

Sec. 278. This Distemper results from two Causes; the one, an acrid sharp Humour, which is commonly bilious, diffused through the Mass of Blood; the other consists in that Humour's not being sufficiently discharged by Perspiration.

Sec. 279. When this Disease is of a gentle Nature, such as it is described Sec. 273, it will be sufficient to keep up a very free Perspiration, but without heating the Patient; and the best Method to answer this Purpose is putting him upon the Regimen so often already referred to, with a plentiful Use of Nitre in Elder Tea. Flesh, Eggs and Wine are prohibited of Course, allowing the Patient a little Pulse and ripe Fruits. He should drink Elder Flower Tea abundantly, and take half a Drachm of Nitre every three Hours; or, which amounts to the same Thing, let three Drachms of Nitre be dissolved in as much Infusion of Elder Flowers, as he can drink in twenty-four Hours. Nitre may be given too in a Bolus with Conserve of Elder-berries. These Medicines keep the Body open, and increase Urine and Perspiration.

Sec. 280. When the Distemper prevails in a severer Degree, if the Fever is very high, and the Pulse, at the same Time, strong or hard, it may be necessary to bleed once: but this should never be permitted in a large Quantity at a Time in this Disease; it being more adviseable, if a sufficient Quantity has not been taken at once, to bleed a second Time, and even a third, if the Fever should prove very high, as it often does, and that sometimes in so violent a Degree, as to render it extremely dangerous: and in some such Cases Nature has sometimes saved the Patients by effecting a large Hemorrhage, or Bleeding, to the Quantity of four or five Pounds. This Conduct a very intelligent and prudent Physician may presume to imitate; but I dare not advise the same Conduct to that Class of Physicians, for which only I write: it being safer for them to use repeated Bleedings in such Cases, than one in an excessive Quantity. These erisipelatous Fevers are often excited by a Person's being too long over-heated.

After Bleeding the Patient is to be restrained to his Regimen; Glysters are to be given until there is a sensible Abatement of the Fever; and he should drink the Barley Water freely, No. 3.

When the Fever is somewhat diminished, either the Purge No. 23 should be given, or a few Doses every Morning of Cream of Tartar No. 24. Purging is absolutely necessary to carry off the stagnant Bile, which is generally the first Cause of the violent Degrees of this Distemper. It may sometimes be really necessary too, if the Disease is very tedious; if the Loathing and Sickness at Stomach is obstinate; the Mouth ill-favoured, and the Tongue foul, (provided there be only a slight Fever, and no Fear of an Inflammation) to give the Medicines No. 34 or 35, which, in Consequence of the Agitation, the Shaking they occasion, remove these Impediments still better than Purges.

It commonly happens that this Disease is more favourable after these Evacuations; nevertheless it is sometimes necessary to repeat them the next Day, or the next but one; especially if the Malady affects the Head. Purging is the true Evacuation for curing it, whenever it attacks this Part. By carrying off the Cause of the Disease, they diminish it, and prevent its worst Effects.

Whenever, even after these Evacuations, the Fever still continues to be very severe, the Patient should take every two Hours, or occasionally, oftner, two Spoonfuls of the Prescription No. 10, added to a Glass of Ptisan.

It will be very useful, when this Disease is seated in the Head or Face, to bathe the Legs frequently in warm Water; and where it is violent there, also to apply Sinapisms to the Soles of the Feet. I have seen this Application, in about four Hours attract, or draw down an Erisipelas to the Legs, which had spread over the Nose, and both the Eyes. When the Distemper once begins to go off by Sweating, this should be promoted by Elder-flower Tea and Nitre (See Sec. 279) and the Sweating may be encouraged to Advantage for some Hours.

Sec. 281. The best Applications that can be made to the affected Part are 1st, The Herb Robert, a Kind of Geranium, or Crane's-Bill; or Chervil, or Parsley, or Elder Flowers: and if the Complaint be of a very mild Disposition, it may be sufficient to apply a very soft smooth Linen over it, which some People dust over with a little dry Meal.

2, If there is a very considerable Inflammation, and the Patient is so circumstanced as to be very tractable and regularly attended, Flanels wrung out of a strong Decoction of Elder-flowers and applied warm, afford him the speediest Ease and Relief. By this simple Application I have appeased the most violent Pains of a St. Anthony's Fire, which is the most cruel Species of an Erisipelas, and has some peculiar Marks or Symptoms extraordinary.

3, The Plaister of Smalt, and Smalt itself No. 46, are also very successfully employed in this Disease. This Powder, the farinaceous, or mealy ones, or others cried up for it, agree best when a thin watery Humour distills or weeps from the little Vesications attending it, which it is convenient to absorb by such Applications; without which Precaution it might gall, or even ulcerate the Part.

All other Plaisters, which are partly compounded of greasy, or of resinous Substances, are very dangerous: they often repel, or strike in the Erisipelas, occasioning it to ulcerate, or even to gangrene. If People who are naturally subject to this Disease should apply any such Plaister to their Skin, even in its soundest State, an Erisipelas is the speedy Consequence.

Sec. 282. Whenever the Humour occasioning the Distemper is repelled, and thrown upon the Brain, the Throat, the Lungs, or any internal Part, the Patient should be bled; Blisters must be applied to the Legs; and Elder Tea, with Nitre dissolved in it, should be plentifully drank.