In other Respects, the Treatment of this Fever, when it degenerated into a continued Form, had nothing particular in it; nor differed from the common Practice of giving cooling Medicines when the Fever was high, and supporting Nature by the Use of Cordials and Wine, and the Application of Blisters, &c. when low; and promoting such Evacuations as Nature pointed out for a Crisis.
FOOTNOTES:
[70] I did not see the Delirium rise so high, nor the Paroxysms so severe, as in the Marsh Fever described by Dr. Pringle.
[71] Dr. Hillary says the Symptoms of this Fever in Barbadoes were much the same as those of the συνεχης, or continued Remitting Fever in England; except only that the Urine in this hot Climate never deposits any lateritious Sediment, nor very rarely in any intermitting or any other Fever, except when a Crisis happens that Way. Observations on the Diseases of Barbadoes, p. 23.
[72] Dr. Pringle takes Notice of this yellow Colour or Jaundice. He says, “some grow yellow, as in the Jaundice. This was found more frequent during the first Campaign than afterwards; it was an unfavourable, but not a mortal Symptom.” Observ. part iii. ch. 4.—Hippocrates mentions the Jaundice occurring in Fevers, Aphor. iv. § 62 & 64; and he reckons it a favourable Symptom in ardent Fevers, where it happens on the seventh Day. See Book on Crises’s, sect. 3.
[73] Does this Fever, when accompanied with this universal Yellowness of the Skin, approach to the Nature of the yellow Fever of the West Indies? As I had so few Cases of this Kind under my Care, I cannot determine any thing about it from my own Experience; but, from the Accounts of others, I should believe them to be very different Disorders.—In the yellow Fever of the West Indies, the Blood appears quite loose and dissolved, without the least Appearance of Size, even on the first Day; and the general Yellowness appears on the third or fourth, with Signs of a total Dissolution, and gangrenous Diathesis of the Blood: Whereas, in the Remitting Fever of Jamaica, Mr. Nasmith tells us, (See Dr. Lind’s first Paper on Fevers), there is always an inflammatory Diathesis of the Blood. The Yellowness in both depends on a Redundancy and Absorption of Bile; but in the yellow Fever of the West Indies, the Bile is in a much more putrescent State, and a great Part of the Cure depends on the early and speedy Evacuation of it.—In the yellow Fevers which appeared in Haslar Hospital, which are taken Notice of by Dr. Lind, in his Two Papers on Fevers, the Blood was in quite a different State from what it is in the Yellow Fever of the West Indies; the Blood drawn from two of these Patients became covered with a thick yellow Gluten, and the Serum was of the Consistence of a thin Syrup, and of a deep yellow Tinge, and tasted bitter; and in another who was bled two Days before his Death, it threw up the same thick yellow Gluten, tho’ the red Part below was quite loose.
[74] According to Dr. Hillary’s Account of the Yellow Fever in the West Indies, which is attended with bilious Vomiting, it bears bleeding once or twice, but not a third Time, before the third Day, but not at all after that Time; and after Bleeding a great Part of the Cure depends on carrying off as much of the putrid Bile as expeditiously and safely as possible, which he says is to be done by making the Patients drink freely of warm Water (sometimes mixed with a little simple Oxymel or Green Tea) so as to vomit seven or eight Times; and then to give a grain, or a Grain and a half of Opium, to procure Rest, and to settle the Stomach; to make the Patient take nothing for two Hours after; and then, if he has not had a Stool, to give a laxative Clyster; after six Hours Rest, to give a gentle Purge, to carry off as much as possible of the bilious corrupted Humours; and in the Course of the Disorder to repeat the Purge, as often as the Patient is attacked with an Anxiety, and a painful burning Heat about the Præcordia; which almost always depend on bilious corrupted Humours pent up within the Bowels; and to endeavour to support the Patient’s Strength, and stop the putrescent Diathesis of the Fluids by suitable Antiseptics, of which he found a watery Infusion of Snake Root, mixed with Madeira Wine and Syrup of Poppies, to answer the best of any Thing he tried, and to sit easiest on the Stomach; and to this he added the Use of Cordials, and of strong Wine Whey as the Patient became lower.
Dr. Hillary’s Purge was: ℞. Mannæ sescunc. vel unc. ij. Tamarind. cond. unc. i. Tartar vitriolat. gr. x. solve in seri lactis præparat. cum Vin. Maderiens. unc. vi. Colaturæ adde Tinct. Senæ unciam dimidiam. Divide in Partes quatuor, & capt. æger unam omni hora donec laxetur alvus.
His Infusion of Snake-Root was prepared in the following Manner:
℞. Rad. Serpent. Virgin. drachm. ij. Croci Angl. drachmam dimidiam, infunde per horam vase clauso in aq. bull. q. s. & dein unc. vi. Colaturæ, adde aq. Menth. simp. unc. ij. Vin. Maderiensis, unc. iv. Syrup. Croci vel Syr. e Mecon. unc. i. Elix. Vitriol. acid. q. s. ad gratum saporem M. capiat æger cochlear. ij. vel iij. omni hora vel secunda quaq; hora vel sæpius pro re nata.