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.§ 243. The distinguishingCriterionor 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.§ 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.§ 245. The Symptoms of malignant Fevers are, as I have already observed, a total and suddenLoss 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, thewhole 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. Ablack 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.Hæmorrhagesalsohappensometimes 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.§ 246. The Duration andCrisisof 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.§ 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 eatsharp acid Fruits, such as tart juicy65Cherries, Gooseberries, small black Cherries; and those who can afford them, may be allowed Lemons, Oranges and Pomgranates.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 SpiritNº. 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 PowderNº. 35may 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, itwere 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 RhubarbNº. 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.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 PotionNº. 40, and repeat it regularly every three Hours; until it beinterrupted by giving one of the MedicinesNº. 38or39: 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 MorselNº. 41. If theDiarrhœa, 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, ofDiascordium; 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 Distemperis 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 MedicineNº. 14, and repeat the same the next Day, which may prevent theReturn of the Fever:66after which it may be sufficient to give daily only two Doses for a few Days.13, When the Sick continue entirely clear of a Fever, or any Return, they are to be put into theRegimenof 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 theTheriaca Pauperum, or poor Man's TreacleNº. 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 MedicineNº. 14, too much, may take three Doses of it daily for some Weeks, instead of the MedicineNº. 42, already directed.§ 248. It is necessary to eradicate a Prejudice that prevails among Country People, withRegard 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.§ 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 theirexact 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 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.§ 243. The distinguishingCriterionor 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.§ 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.§ 245. The Symptoms of malignant Fevers are, as I have already observed, a total and suddenLoss 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, thewhole 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. Ablack 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.Hæmorrhagesalsohappensometimes 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.§ 246. The Duration andCrisisof 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.§ 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 eatsharp acid Fruits, such as tart juicy65Cherries, Gooseberries, small black Cherries; and those who can afford them, may be allowed Lemons, Oranges and Pomgranates.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 SpiritNº. 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 PowderNº. 35may 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, itwere 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 RhubarbNº. 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.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 PotionNº. 40, and repeat it regularly every three Hours; until it beinterrupted by giving one of the MedicinesNº. 38or39: 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 MorselNº. 41. If theDiarrhœa, 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, ofDiascordium; 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 Distemperis 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 MedicineNº. 14, and repeat the same the next Day, which may prevent theReturn of the Fever:66after which it may be sufficient to give daily only two Doses for a few Days.13, When the Sick continue entirely clear of a Fever, or any Return, they are to be put into theRegimenof 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 theTheriaca Pauperum, or poor Man's TreacleNº. 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 MedicineNº. 14, too much, may take three Doses of it daily for some Weeks, instead of the MedicineNº. 42, already directed.§ 248. It is necessary to eradicate a Prejudice that prevails among Country People, withRegard 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.§ 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 theirexact Treatment here; since it consists in general of a Mixture of the Treatment of each Disease; though the Malignity commonly demands the greatest Attention.
Of malignant Fevers.
Sect.242.
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.
§ 243. The distinguishingCriterionor 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.
§ 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.
§ 245. The Symptoms of malignant Fevers are, as I have already observed, a total and suddenLoss 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, thewhole 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. Ablack 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.Hæmorrhagesalsohappensometimes 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.
§ 246. The Duration andCrisisof 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.
§ 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 eatsharp acid Fruits, such as tart juicy65Cherries, Gooseberries, small black Cherries; and those who can afford them, may be allowed Lemons, Oranges and Pomgranates.
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 SpiritNº. 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 PowderNº. 35may 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, itwere 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 RhubarbNº. 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.
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 PotionNº. 40, and repeat it regularly every three Hours; until it beinterrupted by giving one of the MedicinesNº. 38or39: 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 MorselNº. 41. If theDiarrhœa, 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, ofDiascordium; 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 Distemperis 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 MedicineNº. 14, and repeat the same the next Day, which may prevent theReturn of the Fever:66after which it may be sufficient to give daily only two Doses for a few Days.
13, When the Sick continue entirely clear of a Fever, or any Return, they are to be put into theRegimenof 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 theTheriaca Pauperum, or poor Man's TreacleNº. 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 MedicineNº. 14, too much, may take three Doses of it daily for some Weeks, instead of the MedicineNº. 42, already directed.
§ 248. It is necessary to eradicate a Prejudice that prevails among Country People, withRegard 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.
§ 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 theirexact Treatment here; since it consists in general of a Mixture of the Treatment of each Disease; though the Malignity commonly demands the greatest Attention.