The Stomach is so irritable in the Beginning of this Disorder, as to reject the saline Draughts, Nitre, and such other Medicines. Nor will the Bark, which might be judged a very proper Medicine in the second Stage of the Disorder, lie upon the Stomach, but is thrown up immediately, in whatever Form it is given. However, a Gentleman who had practised long in the West Indies told me, that although the Patient could not retain it in his Stomach, yet that he had found great Service, after the Bowels were emptied, from the Bark used freely in Clysters.
Dr. Hillary disapproves of the Use of Blisters in the advanced State of these Fevers.
[75] Dr. Millar, one of the Physicians to the Army, told me in Germany, that he had given this antimonial Powder with great Success in the Remitting Fever, while the Eighth Regiment of Foot (to which he was formerly Surgeon) lay in England.—Dr. Pringle, in his fourth Edition of his Observations, Part iii. ch. iv. tells us, that having given a mild Purge immediately after Bleeding, he next Morning, when there was almost always a Remission, gave a Grain of the Tartar Emetic, with twelve Grains of Crabs-Eyes, and repeated the Dose in two Hours, if the first had little or no Effect; at any Rate, in four Hours. This Medicine not only vomited, but generally opened the Body, and raised a Sweat. By these Evacuations, the Fever was sometimes quite removed, but always became easier.—This Medicine he usually repeated the second or third Day; if not, he opened the Body with some mild Laxative, or a Clyster; and continued this Medicine, till the Fever went gradually off, or intermitted.—Dr. Pringle says, that Dr. Huck treated this Fever in a Method similar to this, both in North America and in the West Indies. In the Beginning he let Blood; and in the first Remission, gave four or five Grains of Ipecacuana, with Half a Grain of Tartar Emetic: This Medicine he repeated in two Hours, taking Care that the Patient should not drink before the second Dose; for by that Means the Medicine passed more readily into the Bowels, before it operated by vomiting. If, after two Hours more, the Operation either Way was small, he gave a third Dose; which commonly had a good Effect in carrying off the Bile; and then the Fever either went quite off, or intermitted so far as to admit the Bark. On the Continent he found no Difficulty after the Intermission; but in the Islands, unless he gave the Bark upon the first Intermission, though imperfect, the Fever was apt to assume a continual and dangerous Form. Dr. Huck never varied this Method, but upon a stronger Indication to purge, than to vomit. In which Case he made an eight Ounce Decoction, with Half an Ounce of Tamarinds, two Ounces of Manna, and two Grains of Emetic Tartar; and dividing this into four Parts, he gave one every Hour, till the Medicine operated by Stool.
[76] Dr. Hillary, in mentioning the Remitting Fever of the Island of Barbadoes, says: In those who were blooded, and took an Emetic afterwards, and then the saline Draughts, the Fever was generally carried quite off by a critical Sweat on the seventh or ninth Day; in some few it came to intermit regularly after that Time; and was soon cured by the cortex Peruviana, given with the saline Draughts, and seldom effectually without them; though these irregular ingeminated Fevers often remitted, and sometimes seemed to intermit; yet if the cortex Peruviana was given too soon in the Disease, before it intermitted regularly (as I have more than once seen, where it had been injudiciously given), it generally caused the Fever to become continual and malignant. Observat. on the epidemic Diseases of Barbadoes, p. 22.
[77] Mr. Cleghorn, after giving a very accurate Account of Tertian Fevers, as they appeared in their various Forms of true, of double, and triple Tertians, and of Semi-Tertians, in the Island of Minorca, tells us, that he first attempted the Cure by profuse Evacuations; but afterwards learnt from Experience, that they were unnecessary; and that Bleeding and Purging once or twice in the Beginning, was all that was in general requisite; and if on the fifth Day the third Revolution was not attended with more threatening Symptoms than the second, and the Patient bore it easily, he frequently trusted the whole Business to Nature; which commonly terminated the Fever about the fourth or fifth Revolution; and for the most part with an Increase of some natural Evacuation.—But if the Paroxysm on the fifth Day was the longest and most severe that happened, attended with any doubtful or dangerous Symptom, he ordered two Scruples of the Cortex to be given every two or three Hours; so that five or six Drachms may be taken before next Day at Noon; lest, if this Interval escaped, he should not have found a favourable Opportunity of giving a sufficient Quantity of the Medicine afterwards; as the Fits about this Period are wont to become double, subintrant, or continual.—This did not always put an immediate Stop to the Fever, but it invigorated the Powers of the Body, and prevented or removed the dangerous Symptoms. Having given the Bark on the fifth Day, if a Fit came on the sixth, and declined the same Evening, he gave some more Doses of the Bark to mitigate the Fit on the seventh; yet sometimes this Fit of the sixth united with that of the seventh, and the Patient had the Heat, Restlessness, Raving, and other Complaints, greatly augmented, and the Case seemed more desperate than ever; which, however, were more dangerous in Appearance than Reality, and went off with a profuse Sweat next Morning; after which he gave the Bark freely as before; and this either stopt the Fits, or made them so moderate, as that they yielded quickly to the same Sort of Management.—By this Method, when Assistance is called timely, Mr. Cleghorn says, the most formidable Intermitting and Remitting Tertians, may be certainly and speedily brought to a happy Conclusion about the End of the first Week, or Beginning of the second. See Observ. on the epidemic Diseases in Minorca, chap. iii. p. 187, &c.
OF THE
Intermitting Fever, or Ague.
This Disorder belongs to the same Tribe of Diseases as the Remitting Fever. We call it an Intermitting Fever, or Ague, when the Paroxysms are distinct, begin with a cold and hot Fit, and go off with a Sweat; and the Patient is cool, and free from the Fever in the Intervals between the Fits.
Many have been the Causes alledged to produce this Disorder. The great Quantity of Bile that is often thrown up in the Fit, has caused it to be ranked among the bilious Diseases; and the Seasons of the Year in which it is most frequent, and the low moist Situation of the Places where it is endemic, have made Practitioners suspect, that an obstructed Perspiration, and a Tendency in the Juices to the Putrescent, are the Cause of it.
But whatever Cause we may suppose to give Rise to the first feverish Fit, it is difficult from hence to account for the regular Returns of the Paroxysms and Intermissions: For my own Part, after considering Intermittents, which observed a regular Type in the Course of a Salivation[78]; their being so easily stopt by the Bark without any sensible Evacuation; their being sometimes put away by a Stimulus externally applied[79], or by a Fright, or sudden Plunge into cold Water[80]; their returning after slight Errors in Diet, and sometimes by the Operation of a Purge, or of Bleeding; their attacking sometimes only particular Parts, and many such Accidents in these Fevers, I must confess, that I am unable to form any Idea, either of their Origin, Seat, or Cause[81].
The Soldiers were subject to this Disorder, particularly in Spring, if they took the Field soon, and in Autumn: The Frequency of it was in a great Measure determined by the Nature of the Ground on which they were encamped, or the Situation of the Garrison or Town in which they were quartered; for the lower and moister the Camp or Garrison, and the more moist the Season, the more subject an Army is to Agues; and the drier the Situation of the Camp or Garrison, and the finer and drier the Weather is, the freer they are from Disorders of this Kind.