SECT. II.
Of Accidental Fevers.
How uncertain is human life! One moment in a perfect state of health, the next perhaps no more; or confined under the painful sensations both of body and mind!
Every accident is liable, and unavoidably must bring on a fever; and this, like fire, should be extinguished in its earliest commencement. But in that, as I have before observed, the constitution should principally be consulted.
I have in the lecture of accidents, at every opportunity, recommended bleeding, but always with a proviso, if requisite; and, as this is of more consequence than generally is supposed, I find it necessary here to expatiate farther on it.
In the first place, no man should be bled who has lost a considerable quantity of blood, unless indeed he was known in his state of health to be very strong and robust; and that the fever sets on with such fury, that the system requires absolutely to be reduced; for the solids and fluids have such a strict dependance amongst themselves, that they keep each other in an equipoise. If therefore the blood is of an acrimonious nature, and at the same time impoverished by lessening its quantity, the coats of the arteries and veins will be the more stimulated; thence the fever will naturally encrease, and generate more acrimony; which at length will destroy the patient. I have been an eye witness more than once, that the fever has actually increased upon every repeated bleeding, till the whole supply of life was spent; and all my persuasions have not been listened to till too late. Nay, a fever is sometimes absolutely necessary; and proves to some constitutions a remedy on its own account, provided it is properly treated, and kept within due bounds.
Secondly, If the constitution of the patient before the accident was but slender, and of a phlegmatic nature, bleeding should be very little or cautiously performed; for the blood of itself being but poor, must naturally be impoverished by being lessened; and whilst the tenseness of the fibres is lost, it is the more acted upon and rendered more acrimonious, and still unable to strengthen the tone of the irritated fibres; whence a relaxed body, together with a poor acrimonious blood, and all its evil tendencies must be the consequence.
Let it once for all be observed, that all the benefit we can possibly hope and expect from bleeding, is to lessen the whole system, to reduce the quantity of the fluids, and to relax the solids. This lessening of the system I must own is very often highly necessary; But, let us not fall into the ridiculous notion to suppose that bleeding will draw off the bad blood, and leave the good behind; far otherwise; the quantity of the blood is soon replenished, but the quality becomes impoverished.
The principle intention in fevers of whatever kind, should be to promote perspiration. This is the grand restorative of nature; and I cannot recommend it too much. Nature designed this evacuation in the formation of man; and by that, fevers were cured in time of yore, many ages before art contrived either lance or lancets.
But here let me not forget another great caution; namely, not to mistake profuse sweating for perspiration; for this is an extreme into which many have erroneously fallen. Nature frequently produces a sweat without force or compulsion; and if so, it should be favoured, but never brought on by stimulants, or strong forcing medicines.
Perspiration, sweat and urine, are the natural evacuations intended, for the purifying the system from animal acrimony; and when these excretions are in a just balance with the secretions of the fluids and motion in the system, without pain or fatigue; then nature is at peace with itself.
Lastly, I must observe, that the stomach is an organ which, by the nervous consent, carries on an immediate correspondence with every part in the human fabric; whence this viscera should likewise ever be consulted in fevers; that is, never to impose on it any aliment against its own inclination and appetite.
The want of appetite in a fever is a natural cause, and very often is in the patient’s favour; but the mistaken notion, that a patient must eat, even against his inclination, in order to recover strength, is not only highly absurd, but has been the destruction of many, who otherwise would have recovered, had they with patience waited the kind dictates of Nature.
Let the system be free from diseases, and the stomach will soon crave food, when there is a probability that the aliment may be converted into good blood; but whatever is forced into the stomach before that time, will instead of nourishing the body, only add fuel to the destructive fire, and encrease the already malignant blood.
Upon the principles of these observations, I shall lay down the rules that should be religiously observed in accidental fevers; and when they are well considered, we shall find that they will hold good also in all other kind of fevers, notwithstanding they arise from internal acrimony of the body; for the difference is barely this, whether the fire is kindled within or from without;—but to proceed.
Whatever then be the accident, a fall, a wound, a fracture, dislocation, bruise, &c. observe what the patient was before the accident.
If the patient was a stout hearty man, it naturally follows, that the fibres of his body were also in a rigid robust state; and the quantity and richness of the blood was in a due proportion; for this very reason, health being at such an acmé, a fever is the more to be feared, and ought studiously to be avoided.
If this patient has not lost any blood by the accident, by all means bleed him; but never exceed eight ounces at farthest; it is as much as the strongest man ought to lose at once.
In the next place, perspiration should be the principal object in view. To this end, let the patient immediately after bleeding go to rest, and take a dose of the Fever Powder (L); upon which let him drink plenty of Balm Tea (12); which will generally bring on a perspiration.
If however the fever increases, the pulse continues to beat hard and full, the head-ach, difficulty of breathing, a great draught and delirium should ensue, bleeding indeed may be repeated, provided it is within the same twenty-four hours; but if the symptoms come on beyond that time, then bleeding will seldom prevail, or do any good, but rather mischief; for by this time, the fever is generally agitated by acrimony, and the blood is of its own accord poor enough without being made more so by bleeding.
In the symptoms which I mentioned, regard should be had to the body being gently kept open, not by purges but by clysters; for purges in fevers are precarious, and liable to bring on heavy fluxes. If the patient under this high fever is costive, give him the following clyster.
No. XXIII
Take warm water one pint, or something more; in which scrape about one ounce of castile or hard soap, and let it perfectly dissolve; then add a spoonful of honey to it, and let it be as warm as that it may be easily borne to your cheek.
Let the patient keep this clyster within him as long as he can, till it comes away with a stool.
If the patient is sick at the stomach, a vomit of ipecacuanha (S) or No. [XXVI], will be very proper, and nothing in such a case can be given more safety and better advantage; for it is not only the stomach that gets relieved, but the whole body is brought thereby into perspiration, by the universal strain it occasions. After the vomit, or after the clyster, give the following draught.
No. XXIV
Take of fever powder (L) one scruple; common water or balm tea, one ounce or half a tea cup full; then take a lump of sugar, on which pour essential oil of peppermint (U) three drops; liquid laudanum (T) eight drops; sweet spirit of nitre (D) thirty drops; and mix them with a tea spoon.
This draught will not only promote perspiration, but it will comfort the stomach, and incline the patient to an agreeable rest; by which he will be greatly refreshed. If occasion requires, it may be repeated every six hours.
If rest comes of its own accord, the liquid laudanum (T) may be omitted; and if the stomach does not stand in need of any carminatives, the oil of peppermint (U) may also be omitted, &c. The constant drink when dry may be balm tea; in which, if it suits the palate of the patient, a slice of lemon may be put, and then sweetened with sugar.
The diet, as I have before observed, should be sparing; and the patient’s palate in this should principally be consulted. The following water gruel, or rather wine soup, or whatever other name it may acquire, I have often ordered to my patients at sea; and which has suited most stomachs, and proved an agreeable mess.
No. XXV
Take oatmeal, or pounded biscuit, a couple of spoonfuls; water, a quart; a small handful of raisins; a little allspice, a little mace, tied up in a fine rag; which boil together in a tin saucepan till consumed to a pint and a half; then add a gill of good wine, red or white, and sweeten it with sugar to suit the palate. You may put a little lemon peel in, to give it an agreeable flavour.
A little roasted fresh meat will hurt nobody; and broths most certainly are good, particularly if the body is costive; but when the body is inclined to looseness, I have known the best broth to produce a dangerous flux; and this should be taken notice of.
If the patient however who has met with the accident is of a puny weak constitution, or has lost a sufficient quantity of blood by the wounds, bleeding then is not so requisite as in the former case; though the treatment otherwise must be equally the same.
By this method of proceeding, there is little fear but that the patient will soon perfectly recover, even in the highest fever that may suddenly befall a man from an accident; provided the injury is not of a dangerous tendency. But as an acrimonious habit of body is liable on its own accord to diseases, it is easily imagined that an accident may become accessory, and heighten the malignity; hence often a fever of that kind is liable to degenerate into a malignant one, or even from the accident itself, when of a dangerous nature; and this I shall explain as I proceed. I shall therefore leave the accidental fever that proceeds from an external cause, and proceed to those which take their origin internally.