In continued fevers with weak pulse the torpid stomach is affected primarily by previous exhaustion of its irritability by stimulus, as of contagious matter swallowed into it. The heart and arteries act feebly from deficient excitement of the power of association, owing to the torpor of the stomach, with which they are catenated; but the accumulation of the power of association, thus produced in organs subject to perpetual and energetic motion, is so great, as to affect the next link of the associate train; which consists of the capillaries of the skin or other glands; these therefore are exerted perpetually with great increase of action.
The continued fevers with strong pulse terminate by the reduction or exhaustion of the sensorial power by violent action of the whole system; which is followed either by return of health with the natural quantity of irritability, and of associability, or by a total destruction of them both, and consequent death.
In continued fevers with weak pulse the stomach remains torpid during the whole course of the fever; and at length by the recovery of its irritability and sensibility effects the cure of it. Which generally happens about the first, second, or third quarter of the lunar period, counted from the commencement of the disease, or continues a whole lunation, and sometimes more; which gave rise to what are termed critical days. See Sect. XXXVI. 4. on this subject. If the stomach does not recover from its torpor, the patient becomes emaciated, and dies exhausted by the continuance of the increased action of the capillaries and absorbents, and the want of nourishment.
The cure of continued fever with weak pulse consists first in weakening the undue action of the capillaries of the skin by ablution with cold water from 32 to 80 degrees of heat; or by exposing them to cool air. Secondly by invigorating the actions of the stomach, by decreasing them for a time, and thence accumulating the power of irritation, as by an emetic, or by iced water, or iced wine. Or by increase of stimulus, as by bark, wine, opium, and food, in small quantities frequently repeated. Or by renewing the action of the stomach by slight electric shocks. Or by fomenting it frequently with water heated to 96 or 100 degrees. Or lastly by exciting its power of association with other parts of the system, as by a blister; which succeeds best when the extremities are cool; or by swinging, as in vertigo rotatoria.
If by the stimulus of the Peruvian bark on the fibres of the stomach, they regain their due action, the heart and arteries also regain their due action; as their sensorial power of association is now excited, and expended as usual. And as there is then no accumulation of sensorial power in the heart and arteries, the capillaries cease to act with too great energy, and the fever is cured.
Thirdly. If the heart and arteries could be themselves stimulated into greater action, although the stomach remained torpid, they might probably by expending a greater quantity of the sensorial power of irritation, prevent an accumulation of the sensorial power of association, (for these may possibly be only different modes of action of the spirit of animation,) and thus the too great action of the capillaries might be prevented and the fever cease. This new mode of cure might possibly be accomplished, if the patient was to breathe a gallon or two of pure or diluted oxygene gas frequently in a day; which by passing through the moist membranes of the lungs and uniting with the blood might render it more stimulant, and thus excite the heart and arteries into greater action.
Fourthly. Greater energy might probably be given to the whole system, and particularly to those parts which act too feebly in fevers, as the stomach and the heart and arteries, if the action of the secerning vessels of the brain could be increased in energy; this is probably one effect of all those drugs, which when given in large quantity induce intoxication, as wine and opium. And when given with great caution in small quantities uniformly repeated, as from three drops to five of the tincture of opium, but not more, every six hours, I believe they supply an efficacious medicine in fevers with great arterial debility; and the more so, if the Peruvian bark be exhibited alternately every six hours along with them. There are other means of exciting the vessels of the brain into action; as first by decreasing the stimulus of heat by temporary cold fomentation; secondly, increasing the stimulus of heat by long continued warm fomentation; thirdly, by electricity, as very small shocks passed through it in all directions; and lastly by blisters on the head. All those require to be used with great caution, and especially where there exists an evident stupor, as the removing of that is I believe frequently injurious. See stupor, Class [I. 2. 5. 10].
The cure of fever with strong pulse consists in the repeated use of venesection, gentle cathartics, diluents; medicines producing sickness, as antimonials, digitalis; or the respiration of carbonated hydrogen; or by respiration of atmospheric air lowered by a mixture of hydrogen, azote, or carbonic acid gas, or by compressing the brain by whirling in a decumbent posture, as if lying across an horizontal mill-stone. See the former parts of this supplement for the methods of cure both of fevers with strong and weak pulse.
[10]. When any difficulty occurs in determining the weak pulse from the strong one, it may generally be assisted by counting its frequency. For when an adult patient lies horizontally in a cool room, and is not hurried or alarmed by the approach of his physician, nor stimulated by wine or opium, the strong pulse seldom exceeds 118 or 120 in a minute; and the weak pulse is generally not much below 130, and often much above that number. Secondly in sitting up in bed, or changing the horizontal to a perpendicular posture, the quickness of the weak pulse is liable immediately to increase 10 or 20 pulsations in a minute, which does not I believe occur in the strong pulse, when the patient has rested himself after the exertion of rising.
XVII. Conclusion.