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 ofSwisserland: 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 theRhone, and in some other Situations that are exposed to much the same humid Air and Exhalations.§ 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 inSwisserland. 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.§ 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 kindof 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.§ 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.§ 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 Dispositionof 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.§ 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 ofit. These also deposite a white Sediment, which affords no bad Prognostic.§ 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.§ 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 arevery weak, expire in the Fit; though such an Event never happens but in the cold Fit.§ 258. Very happily Nature has afforded us a Medicine, that infallibly cures these Fevers: this is theKinkina, 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.67§ 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.§ 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;68he may take the Bark, that is the PowderNº. 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.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 theBark 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.§ 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 WaterNº. 3. These two Remedies generally bring the Patient into the State described§ 259: in which State he may take on a Day, when the Fever is entirely off, three or four Doses of the PowderNº. 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 fœtid, furred Mouth, a Loathing, Pains in the Loins, or in the Knees, much Anxiety, and bad Nights, he should be purged with the PowderNº. 21or the PotionNº. 23, before he takes the Bark.§ 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 PowderNº. 34or that of35is to be given (but see§ 241): and if, after the Operation of this, the Signs of Putridity continue, the Body is to be opened with repeated Doses of the PowderNº. 24; or, where the Patients are very robust, withNº. 21; and when the Fever becomes quite regular, with distinctRemissionsat least, the Bark is to be given as directed§ 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 mefrom averring it to be the only certain one; since nothing can be an equivalentSuccedaneumor 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.§ 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.§ 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 ofNº. 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.§ 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 theFever; 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.§ 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. UnderNº. 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, whichenterinto 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 theRegimendirected for him; and that, during the most rigid Severity of the Winter, he got every Day on Horseback, and took such aDegree of other Exercise in the open Air, as disposed him to perspire abundantly.§ 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§ 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, thePrescriptionNº. 44.I have also cured some Tertians and even Quartans, in 1751 and 1752, by giving them, every four Hours between the Fits, the PowderNº. 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, theirStomachs: 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.§ 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 evendangerous, it is prudent to abstain from them. Some Years since certain Powders were sold here, under the Name of theBerlinPowders; 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.§ 269. I have often known Peasants, who had laboured for several Months under intermitting Fevers; having made Use of many bad Medicines and Mixtures forthem, and observed no Manner of Regimen. Such I have happily treated by giving them the RemediesNº. 34, or35; and afterwards, for some Days, that ofNº. 38; at the End of which Time, I have ordered them the Bark (See§ 260) or other Febrifuges, as at§ 266,267; and then finally ordered them for some Days, to take Morsels of the poor Man's Treacle (See§ 247,Art.13) to strengthen and confirm their Digestions, which I have found very weak and irregular.§ 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 survivesthe 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§ 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 IpecacuanaNº. 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.§ 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§ 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.§ 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 someJuniper 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.70
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 ofSwisserland: 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 theRhone, and in some other Situations that are exposed to much the same humid Air and Exhalations.§ 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 inSwisserland. 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.§ 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 kindof 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.§ 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.§ 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 Dispositionof 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.§ 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 ofit. These also deposite a white Sediment, which affords no bad Prognostic.§ 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.§ 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 arevery weak, expire in the Fit; though such an Event never happens but in the cold Fit.§ 258. Very happily Nature has afforded us a Medicine, that infallibly cures these Fevers: this is theKinkina, 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.67§ 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.§ 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;68he may take the Bark, that is the PowderNº. 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.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 theBark 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.§ 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 WaterNº. 3. These two Remedies generally bring the Patient into the State described§ 259: in which State he may take on a Day, when the Fever is entirely off, three or four Doses of the PowderNº. 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 fœtid, furred Mouth, a Loathing, Pains in the Loins, or in the Knees, much Anxiety, and bad Nights, he should be purged with the PowderNº. 21or the PotionNº. 23, before he takes the Bark.§ 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 PowderNº. 34or that of35is to be given (but see§ 241): and if, after the Operation of this, the Signs of Putridity continue, the Body is to be opened with repeated Doses of the PowderNº. 24; or, where the Patients are very robust, withNº. 21; and when the Fever becomes quite regular, with distinctRemissionsat least, the Bark is to be given as directed§ 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 mefrom averring it to be the only certain one; since nothing can be an equivalentSuccedaneumor 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.§ 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.§ 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 ofNº. 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.§ 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 theFever; 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.§ 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. UnderNº. 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, whichenterinto 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 theRegimendirected for him; and that, during the most rigid Severity of the Winter, he got every Day on Horseback, and took such aDegree of other Exercise in the open Air, as disposed him to perspire abundantly.§ 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§ 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, thePrescriptionNº. 44.I have also cured some Tertians and even Quartans, in 1751 and 1752, by giving them, every four Hours between the Fits, the PowderNº. 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, theirStomachs: 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.§ 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 evendangerous, it is prudent to abstain from them. Some Years since certain Powders were sold here, under the Name of theBerlinPowders; 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.§ 269. I have often known Peasants, who had laboured for several Months under intermitting Fevers; having made Use of many bad Medicines and Mixtures forthem, and observed no Manner of Regimen. Such I have happily treated by giving them the RemediesNº. 34, or35; and afterwards, for some Days, that ofNº. 38; at the End of which Time, I have ordered them the Bark (See§ 260) or other Febrifuges, as at§ 266,267; and then finally ordered them for some Days, to take Morsels of the poor Man's Treacle (See§ 247,Art.13) to strengthen and confirm their Digestions, which I have found very weak and irregular.§ 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 survivesthe 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§ 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 IpecacuanaNº. 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.§ 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§ 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.§ 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 someJuniper 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.70
Of intermitting Fevers.
Sect.250.
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 ofSwisserland: 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 theRhone, and in some other Situations that are exposed to much the same humid Air and Exhalations.
§ 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 inSwisserland. 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.
§ 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 kindof 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.
§ 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.
§ 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 Dispositionof 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.
§ 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 ofit. These also deposite a white Sediment, which affords no bad Prognostic.
§ 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.
§ 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 arevery weak, expire in the Fit; though such an Event never happens but in the cold Fit.
§ 258. Very happily Nature has afforded us a Medicine, that infallibly cures these Fevers: this is theKinkina, 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.67
§ 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.
§ 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;68he may take the Bark, that is the PowderNº. 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.
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 theBark 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.
§ 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 WaterNº. 3. These two Remedies generally bring the Patient into the State described§ 259: in which State he may take on a Day, when the Fever is entirely off, three or four Doses of the PowderNº. 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 fœtid, furred Mouth, a Loathing, Pains in the Loins, or in the Knees, much Anxiety, and bad Nights, he should be purged with the PowderNº. 21or the PotionNº. 23, before he takes the Bark.
§ 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 PowderNº. 34or that of35is to be given (but see§ 241): and if, after the Operation of this, the Signs of Putridity continue, the Body is to be opened with repeated Doses of the PowderNº. 24; or, where the Patients are very robust, withNº. 21; and when the Fever becomes quite regular, with distinctRemissionsat least, the Bark is to be given as directed§ 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 mefrom averring it to be the only certain one; since nothing can be an equivalentSuccedaneumor 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.
§ 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.
§ 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 ofNº. 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.
§ 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 theFever; 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.
§ 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. UnderNº. 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, whichenterinto 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 theRegimendirected for him; and that, during the most rigid Severity of the Winter, he got every Day on Horseback, and took such aDegree of other Exercise in the open Air, as disposed him to perspire abundantly.
§ 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§ 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, thePrescriptionNº. 44.
I have also cured some Tertians and even Quartans, in 1751 and 1752, by giving them, every four Hours between the Fits, the PowderNº. 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, theirStomachs: 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.
§ 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 evendangerous, it is prudent to abstain from them. Some Years since certain Powders were sold here, under the Name of theBerlinPowders; 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.
§ 269. I have often known Peasants, who had laboured for several Months under intermitting Fevers; having made Use of many bad Medicines and Mixtures forthem, and observed no Manner of Regimen. Such I have happily treated by giving them the RemediesNº. 34, or35; and afterwards, for some Days, that ofNº. 38; at the End of which Time, I have ordered them the Bark (See§ 260) or other Febrifuges, as at§ 266,267; and then finally ordered them for some Days, to take Morsels of the poor Man's Treacle (See§ 247,Art.13) to strengthen and confirm their Digestions, which I have found very weak and irregular.
§ 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 survivesthe 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§ 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 IpecacuanaNº. 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.
§ 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§ 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.
§ 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 someJuniper 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.70