[7] Dr. Huxham, tho’ he says “yet Bleeding to some Degree is most commonly requisite, nay necessary, in the strong and plethoric;” yet he afterwards makes the following Remark: “Besides, the Pulse in these Cases sinks oftentimes surprisingly after a second Bleeding, nay sometimes after the first, and that even where I thought I had sufficient Indications from the Pulse to draw Blood a second time.” See his Essay on Fevers, chap. viii. And Dr. Pringle observes, that in the second Stage of the Disorder large Bleedings have generally proved fatal, by sinking the Pulse, and bringing on a Delirium. Observations on the Diseases of the Army, part III. chap. vii. sect. V.
[8] Dr. Pringle advises giving a Vomit, by way of Prevention, on the first Appearance of the Symptoms, and at Night to force a Sweat, by giving a Drachm of Theriac with ten Grains Sal volat. Corn. cervi, and some Draughts of Vinegar-whey, and to repeat the same the following Night; and says, he has often seen those Symptoms removed which he apprehended to be Forerunners of this Fever received by Contagion; but previous to Vomits, or Sweats, if the Person be plethoric, it will be necessary to take away some Blood. Observ. part III. ch. vii. sect. 5. Dr. Lind, in his second Paper on Fevers, p. 66. says, “To all who are supposed to be infected by Fevers, during this Stage of Rigours, a gentle Vomit is immediately to be exhibited before the Fever be formed, and before the Fulness or Hardness of the Pulse renders its Operation dangerous. If the Vomit be delayed too long, and especially if Bleeding must precede it, the most certain and favourable Opportunity of procuring Safety for the Patient is past.—That he has found it equally serviceable in preventing Relapses, when it is given at the Return of the Shiverings.” A loose Stool, or two, should be procured by the Emetic or Clysters, and he advises Sweating immediately after, in the manner recommended by Dr. Pringle. At other times “he gave five Grains of Camphire every four Hours, with large Draughts of Vinegar-whey. Eight Persons in ten, he says, got quite well by this Treatment.”
I have never had sufficient Opportunities of trying this Method of Prevention, to determine any thing certain about it; but it may be worth while to practise it.
[9] Petrus a Castro, in his Account of a Petechial Fever, which was frequent at Verona, tells us, that the Sick had a great Thirst, and an Aversion to Meat, but all of them had the strongest Desire for Wine, and were perpetually asking for it, even those who at other Times used to be very temperate; and that this proceeded from an Instinct of Nature, which wanted something to support the Strength. De Feb. Malig. sect. iii. chap. 26. Dr. Huxham, in his Essay on Fevers, has the following very judicious Remark on the Use of Wine: “In this View, and in those above-mentioned, I cannot but recommend a generous red Wine as a most noble, natural sub-astringent Cordial, and perhaps Art can scarce supply a better. Of this I am confident, that sometimes at the State, and more frequently in the Decline of putrid Malignant Fevers, it is of the highest Service, especially when acidulated with Juice of Seville Orange or Lemon. It may be also impregnated with some Aromatics, as Cinnamon, Seville Orange Rhind, red Roses, or the like, as may be indicated, and a few Drops of Elix. Vitrioli may be added. Rhenish and French White Wines, diluted, make a most salutary Drink in several Kinds of Fevers, and generous Cyder is little inferior to either. The Asiatics, and other Nations, where pestilential Disorders are much more rife than with us, lay more Stress on the Juice of Lemons in these Fevers than on the most celebrated Alexipharmac.” Chap, viii. second Edit. p. 123, 4.
Acid and acescent Liquors have very justly been recommended and used by most late Practitioners, in this as well as in other malignant Diseases. Vinegar-whey, Barley-water acidulated with Lemon-juice, and such other Liquors, make good Drinks for the Sick; but we were obliged, for the most part, to use the vitriolic Acid for acidulating the Patient’s Drink, as it was the easiest procured and carried about with the Flying Hospital.
[10] If the preventive Method does not succeed, Dr. Lind advises to have recourse to Blisters; and says, that sixteen out of twenty will next Morning be free of the Fever. But adds, this is said, provided the Source of their Infection be not so highly poisonous as it was in the Garland Ship, or in other such violent Contagions. Dr. Pringle mentions his having applied Blisters early, but without relieving the Head, or preventing any of the usual Symptoms. I have often ordered Blisters pretty early in the Disorder; and though I have frequently found them of use in keeping up the Pulse, and relieving the Head, and other Symptoms, yet I never saw them have such an immediate Effect as Dr. Lind mentions.
[11] It is long since the Peruvian Bark has been used by Practitioners in Malignant Disorders, though I do not know that any body gave it in this Fever to the Amount of an Ounce per Day, before Dr. Haen and Dr. Hasenohrl. Dr. Ramazini mentions its having been tried in the Petechial Fever, in the Years 1692, 3, 4. And in a Treatise on the Plague in the Ucrane, published at Petersburgh, in the Year 1750, we are told, that in the French Translation of the Philosophical Transactions for the Year 1732, there is a Note to p. 264, telling, that Mr. Amyand informed the Academy of Surgery at Paris, that Mr. Rushworth, Surgeon, had wrote to Sir Hans Sloane, on the 23d of May 1723, that when he was Surgeon to a Ship, in the Year 1694, he had cured some Men ill of the Malignant Fever, attended with pestilential Buboes, by means of the Peruvian Bark. Dr. Huxham has recommended a Tincture of the Bark; and Dr. Pringle, a strong Decoction of it, with some of the Tincture, in these Malignant Fevers.
[12] The Peruvian Bark has not only been found useful in this Malignant Fever, but has likewise been recommended in the Plague. See Morton Oper. Append. secund. Exercitat. Hist. Febr. Ann. 1658, ad. an. 1691. complexa. In the Small Pox, see Medical Essays, vol. V. art. x. and has been found serviceable in the putrid Disorders of the West Indies, as taken Notice of by Dr. Hillary; and in the malignant ulcerous sore Throat in this Country, as Dr. Wall and others have observed. And in thirty-five Cases of the malignant ulcerous sore Throat, in which I gave it, joined with Cordials, and the Use of Acids, I did not lose one Patient. Nine of them were strong People, and had plethoric Symptoms, and were blooded in the Beginning; and seven of them were costive, and took a Dose of gentle laxative Physic before taking the Bark. The rest had no Symptoms which seemed to require these Evacuations. However, it ought to be observed, that this is a Disorder of the malignant kind; and that although some well-timed gentle Evacuations may be serviceable in the Beginning, before giving the Bark; yet too free, or even gentle Evacuations, injudiciously made, will sink the Patient, and infallibly do Mischief.
The free Use of the Bark has long been found serviceable in Mortifications and foul Sores, where the Juices tend too much to the Putrescent; and has been strongly recommended by Mr. Ranby, Serjeant Surgeon to his Majesty, in the Cure of Gunshot Wounds. See his Treatise on Gunshot Wounds.
[13] Dr. Huxham, in his Treatise on the ulcerous sore Throat, p. 54, &c. condemns the Use of the volatile alcaline Salts, in Fevers of the putrid, pestilential, or petechial kind, as being apt to heat too much, and to hasten the Dissolution and consequent Putrefaction of the Blood. However, I cannot help thinking that they are the best Remedies we can use on some particular Occasions, even in this Fever; for we have no Remedy which gives such a sudden and brisk Stimulus to the Fibres as they do. And I have known many Cases of Patients who were extremely low, and whose Pulse was scarce to be felt, and others who were apt to fail into fainting Fits, who have been preserved by large and repeated Doses of these Salts, and the free Use of Wine, and acescent Liquors, to correct their alcaline Acrimony in the Blood. Though as soon as such Patients had recovered from this low State, I laid these Medicines aside; because I cannot help agreeing with the Doctor in the Belief, that their continued Use will produce the Effects he mentions. For although it be true, that these Salts, when mixed with putrescent Liquors, or with dead animal Substances, resist Putrefaction, and, like ardent Spirits and Vinegar (the other Products of Fermentation) check and put a Stop to that very Process which produced them: Yet it is also true, that, when mixed with the Blood of living Animals, they stimulate the Vessels, and increase the Heat and Momentum of the Blood, and dissolve it; and therefore I cannot but disapprove the continuing their Use longer than is immediately necessary.