"J. C. aged 27, with black hair, and a ruddy complexion, was subject to cough from the age of puberty, and occasionally to spitting of blood. His maternal grandfather died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had long been threatened, in her 43d year, and immediately after she ceased to have children. In the severe winter of 1783-4, he was much afflicted with cough; and being exposed to intense cold, in the month of February he was seized with peripneumony. The disease was violent and dangerous, and after repeated bleedings as well as blisterings, which he supported with difficulty, in about six weeks he was able to leave his bed. At this time the cough was severe, and the expectoration difficult. A fixed pain remained on the left side, where an issue was inserted; regular hectic came on every day about an hour after noon, and every night heat and restlessness took place, succeeded towards morning by general perspiration.
The patient, having formerly been subject to ague, was struck with the resemblance of the febrile paroxysm, with what he had experienced under that disease, and was willing to flatter himself it might be of the same nature. He therefore took bark in the interval of fever, but with an increase of his cough, and this requiring venesection, the blood was found highly inflammatory. The vast quantity of blood which he had lost from time to time, produced a disposition to fainting, when he resumed the upright posture, and he was therefore obliged to remain almost constantly in a recumbent position. Attempting to ride out in a carriage, he was surprised to find that he could sit upright for a considerable time, while in motion, without inconvenience, though, on stopping the carriage, the disposition to fainting returned.
At this time, having prolonged his ride beyond the usual length, he one day got into an uneven road at the usual period of the recurrence of the hectic paroxysms, and that day he missed it altogether. This circumstance led him to ride out daily in a carriage at the time the febrile accession might be expected, and sometimes by this means it was prevented, sometimes deferred, and almost always mitigated.
This experience determined him to undertake a journey of some length, and Bristol being, as is usual in such cases, recommended, he set out on the 19th of April, and arrived there on the 2d of May. During the greater part of this journey (of 175 miles) his cough was severe, and being obliged to be bled three different times on the road, he was no longer able to sit upright, but at very short intervals, and was obliged to lie at length in the diagonal of a coach. The hectic paroxysms were not interrupted during the journey, but they were irregular and indistinct, and the salutary effects of exercise, or rather of gestation, were impressed on the patient's mind.
At Bristol he stayed a month, but reaped no benefit. The weather was dry and the roads dusty; the water insipid and inert. He attempted to ride on horseback on the downs, but was not able to bear the fatigue for a distance of more than a hundred yards. The necessity of frequent bleedings kept down his strength, and his hectic paroxysms continued, though less severe. At this time, suspecting that his cough was irritated by the west-winds bearing the vapour from the sea, he resolved to try the effects of an inland situation, and set off for Matlock in Derbyshire.
During the journey he did not find the improvement he expected, but the nightly perspirations began to diminish; and the extraordinary fatigue he experienced proceeded evidently from his travelling in a post-chaise, where he could not indulge in a recumbent position. The weather at Bristol had been hot, and the earth arid and dusty. At Matlock, during the month of June 1784, there was almost a perpetual drizzle, the soil was wet, and the air moist and cold. Here, however, the patient's cough began to abate, and at intervals he found an opportunity of riding more or less on horseback. From two or three hundred yards at a time, he got to ride a mile without stopping; and at length he was able to sit on horseback during a ride from Mason's Bath to the village of Matlock along the Derwent, and round on the opposite banks, by the works of Mr. Arkwright, back to the house whence he started, a distance of five miles. On dismounting, however, he was seized with diliquium, and soon after the strength he had recovered was lost by an attack of the hæmorrhoids of the most painful kind, and requiring much loss of blood from the parts affected.
On reflection, it appeared that the only benefit received by the patient was during motion, and continued motion could better be obtained in the course of a journey than during his residence at any particular place. This, and other circumstances of a private but painful nature, determined him to set out from Matlock on a journey to Scotland. The weather was now much improved, and during the journey he recruited his strength. Though as yet he could not sit upright at rest for half an hour together without a disposition to giddiness, dimness of sight, and deliquium, he was able to sit upright under the motion of a post-chaise during a journey of from 40 to 70 miles daily, and his appetite began to improve. Still his cough continued, and his hectic flushings, though the chills were much abated and very irregular.
The salutary effects of motion being now more striking than ever, he purchased a horse admirably adapted to a valetudinarian in Dumfriesshire, and being now able to sit on horseback for an hour together, he rode out several times a day. He fixed his residence for a few weeks at Moffat, a village at the foot of the mountains whence the Tweed, the Clyde, and the Annan, descend in different directions; a situation inland, dry, and healthy, and elevated about three hundred feet above the surface of the sea. Here his strength recovered daily, and he began to eat animal food, which for several months before he had not tasted. Persevering in exercise on horseback, he gradually increased the length of his rides, according to his strength, from four to twenty miles a day; and returning on horseback to Lancashire by the lakes of Cumberland, he arrived at Liverpool on the first of September, having rode the last day of his journey forty miles.
The two inferences of most importance to be drawn from this narrative, are, first, the extraordinary benefit derived from gestation in a carriage, and still more the mixture of gestation and exercise on horseback, in arresting or mitigating the hectic paroxysm; and secondly, that in the florid consumption, as Dr. Beddoes terms it, an elevated and inland air is in certain circumstances peculiarly salutary; while an atmosphere loaded with the spray of the sea is irritating and noxious. The benefit derived in this case from exercise on horseback, may lead us to doubt whether Sydenham's praise of this remedy be as much exaggerated as it has of late been supposed. Since the publication of Dr. C. Smyth on the effects of swinging in lowering the pulse in the hectic paroxysm, the subject of this narrative has repeated his experiments in a great variety of cases, and has confirmed them. He has also repeatedly seen the hectic paroxysm prevented, or cut short, by external ablution of the naked body with tepid water.
So much was his power of digestion impaired or vitiated by the immense evacuations, and the long continued debility he underwent, that after the cough was removed, and indeed for several years after the period mentioned, he never could eat animal food without heat and flushing, with frequent pulse and extreme drowsiness. If this drowsiness was encouraged, the fever ran high, and he awoke from disturbed sleep, wearied and depressed. If it was resolutely resisted by gentle exercise, it went off in about an hour, as well as the increased frequency of the pulse. This agitation was however such as to incapacitate him during the afternoon for study of any kind. The same effects did not follow a meal of milk and vegetables, but under this diet his strength did not recruit; whereas after the use of animal food it recovered rapidly, notwithstanding the inconvenience already mentioned. For this inconvenience he at last found a remedy in the use of coffee immediately after dinner, recommended to him by his friend Dr. Percival. At first this remedy operated like a charm, but by frequent use, and indeed by abuse, it no longer possesses its original efficacy.
Dr. Falconer, in his Dissertation on the Influence of the Passions and Affections of the Mind on Health and Disease, supposes that the cheerfulness which attends hectic fever, the ever-springing hope, which brightens the gloom of the consumptive patient, increases the diseased actions, and hastens his doom. And hence he is led to enquire, whether the influence of fear might not be substituted in such cases to that of hope with advantage to the patient? This question I shall not presume to answer, but it leads me to say something of the state of the mind in the case just related.
The patient, being a physician, was not ignorant of his danger, which, some melancholy circumstances served to impress on his mind. It has already been mentioned, that his mother and grandfather died of this disease. It may be added, that in the year preceding that on which he himself was attacked, a sister of his was carried off by consumption in her 17th year; that in the same winter in which he fell ill, two other sisters were seized with the same fatal disorder, to which one of them fell a victim during his residence at Bristol, and that the hope of bidding a last adieu to the other was the immediate cause of his journey to Scotland, a hope which, alas! was indulged in vain. The day on which he reached the end of his journey, her remains were committed to the dust! It may be conjectured from these circumstances, that whatever benefit may be derived from the apprehension of death, must in this case have been obtained. The expectation of this issue was indeed for some time so fixed that it ceased to produce much agitation; in conformity to that general law of our nature, by which almost all men submit with composure to a fate that is foreseen, and that appears inevitable. As however the progress of disease and debility seemed to be arrested, the hope and the love of life revived, and produced, from time to time, the observations and the exertions already mentioned.
Wine and beer were rigorously abstained from during six months of the above history; and all the blood which was taken was even to the last buffy." Feb. 3, 1795.
[8]. Febris scrophulosa. The hectic fever occasioned by ulcers of the lymphatic glands, when exposed to the air, does not differ from that attending pulmonary consumption, being accompanied with night-sweats and occasional diarrhœa.
M. M. The bark. Opium internally. Externally cerussa and bark in fine powder. Bandage. Sea-bathing. See Class [I. 2. 3. 21]. and [II. 1. 4. 13].
[9]. Febris ischiadica. A hectic fever from an open ulcer between the muscles of the pelvis, which differs not from the preceding. If the matter in this situation lodges till part of it, I suppose, becomes putrid, and aerates the other part; or till it becomes absorbed from some other circumstance; a similar hectic fever is produced, with night-sweats, or diarrhœa.
Mrs. ——, after a lying in, had pain on one side of her loins, which extended to the internal part of the thigh on the same side. No fluctuation of matter could be felt; she became hectic with copious night-sweats, and occasional diarrhœa, for four or five weeks; and recovered by, I suppose, the total absorption of the matter, and the reunion of the walls of the abscess. See Class [II. 1. 2. 18].
[10]. Febris Arthropuodica. Fever from the matter of diseased joints. Does the matter from suppurating bones, which generally has a very putrid smell, produce hectic fever, or typhus? See Class [II. 1. 4. 16].
[11]. Febris a pure contagioso. Fever from contagious pus. When the contagious matters have been produced on the external habit, and in process of time become absorbed, a fever is produced in consequence of this reabsorption; which differs with the previous irritability or inirritability, as well as with the sensibility of the patient.
[12]. Febris variolosa secundaria. Secondary fever of small-pox. In the distinct small-pox the fever is of the sensitive irritated or inflammatory kind; in the confluent small-pox it is of the sensitive inirritated kind, or typhus gravior. In both of them the swelling of the face, when the matter there begins to be absorbed, and of the hands, when the matter there begins to be absorbed, shew, that it stimulates the capillary vessels or glands, occasioning an increased secretion greater than the absorbents can take up, like the action of the cantharides in a blister; now as the application of a blister on the skin frequently occasions the strangury, which shews, that some part of the cantharides is absorbed; there is reason to conclude, that a part of the matter of small-pox is absorbed, and thus produces the secondary fever. See Class [II. 1. 3. 9]. And not simply by its stimulus on the surface of the ulcers beneath the scabs. The exsudation of a yellow fluid from beneath the confluent eruptions on the face before the height is spoken of in Class [II. 1. 3. 2].
The material thus absorbed in the secondary fever of small-pox differs from that of open ulcers, as it is only aerated through the elevated cuticle; and secondly, because there is not a constant supply of fresh matter, when that already in the pustules is exhausted, either by absorption, or by evaporation, or by its induration into a scab. Might not the covering the face assiduously and exactly with plasters, as with cerate of calamy, or with minium plaster, by precluding the air from the pustules, prevent their contracting a contagious, or acescent, or fever-producing power? and the secondary fever be thus prevented entirely. If the matter in those pustules on the face in the confluent small-pox were thus prevented from oxygenation, it is highly probable, both from this theory, and from the facts before mentioned, that the matter would not erode the skin beneath them, and by these means no marks or scars would succeed.
[13]. Febris carcinomatosa. Fever from the matter of cancer. In a late publication the pain is said to be relieved, and the fever cured, and the cancer eradicated, by the application of carbonic acid gas, or fixed air. See Class [II. 1. 4. 16].