7. Cooling medicines, external and internal. The good effects of cold water applied to the body in fevers has long been known. Dr. Jackson observes that it was first introduced at Rome in the infancy of the Methodic sect, and attained afterwards a high degree of celebrity. Its reputation was highly raised by a cure performed on the emperor Augustus; but soon after sunk by the death of Marcellus, the presumptive heir to the empire, to whom it had been improperly prescribed. It was soon after prescribed again, and greatly used by Galen; and after him was in still greater favour with the Arabian physicians; but, since the revival of literature, has been much neglected till of late. In the fever of Jamaica, after the fatal symptoms were removed, Dr. Jackson says, that the tone and vigour of the system was best restored by cold bathing, “which (says he) I am induced to consider as the most important remedy in the cure of the fevers of the West Indies, and perhaps in the cure of the fevers of all hot climates. Though it might not absolutely cut short the course of the disease, yet it seldom failed to change the fatal tendency of its nature.” Even in the last stage of the yellow fever, where the patient seems at the utmost extremity, our author tells us that he has alternately employed warm and cold bathing with the greatest success. He has even wrapped the body in a blanket soaked in water in which a large portion of salt had been dissolved, or which had been steeped in brandy or rum, enjoining the liberal use of wine, or more powerful cordials. Dr. Wright also mentions the cold bath with approbation; but, as it cannot be very generally depended upon, its use ought never to supersede that of other remedies, especially mercury; and indeed this may be said of every thing else; for though by the use of the remedies already mentioned the disease has sometimes been subdued, yet the success has never been so great but that every one under an attack of the yellow fever must be considered as in very considerable danger.
In the use of cooling medicines, taken internally, we must have a particular regard to the state of the stomach, which is excessively irritable; and it is surprising that this irritability is of such a nature that, though it will certainly reject the mildest drinks or medicines, it may yet retain others seemingly much more acrid, as has already been observed in the case of Dr. Sayres’s patients. As long ago as the time of Diemerbroeck a solution of common salt in vinegar was recommended in the plague. Since that time it has been found extremely useful in the dysentery; and, as in this disease the bowels are likewise in an extremely irritable state, it would seem from analogy that the same medicine might be useful also in the yellow fever. Dr. Wright of Jamaica (who attests the efficacy of the medicine in dysentery, belly-ach, remittent fever, and putrid sore throat) gives the following improved method of preparing it: “Take of lime or lemon juice three ounces; of marine salt as much as the acid can dissolve; of any simple distilled cordial water one pint; and of loaf sugar a sufficient quantity to sweeten it. The dose of this mixture must be proportioned to the age and sex of the patient, and to the violence of the disease. A wine glassful may be given to adults every two, four or six hours.”
8. Medicines proper for relieving the most urgent symptoms of the disease. The most distressing symptoms attending the yellow fever are, head-ach, vomiting, pain in the stomach, and pains in the back, loins and limbs. Blisters were tried by Dr. Chisholm to mitigate the pain in the head. “I have (says he) blistered the whole head, and the inside of each thigh, at once, in several cases, without producing the least change in that or any other symptom. I have had recourse to this remedy to lessen pain, to remove irritability of the stomach, and to raise the vital powers in the low, comatose stage, but always except in two cases without success.” In one a blister to the scrobiculus cordis completely removed the irritability; the other case is related in the next section. Another practitioner found a blister applied to the forehead of remarkable use in four cases; but Dr. Chisholm supposes them to have been of the less violent kind. Others have also found them occasionally useful; so that, though dependence cannot be placed upon these remedies, it seems improper to reject them entirely. But the most effectual method of allaying the irritability of the stomach was by the exhibition of vitriolic æther. Dr. Chisholm adopted the medicine on the recommendation of M. Poissonier, and found it to answer the character given of it by him. Dr. Chisholm gave about a teaspoonful in half a glassful of cool water, after which the patient continued undisturbed about two hours, when the dose was repeated. Sometimes, though seldom, the stomach was thus enabled to bear the bark, but otherwise the æther was given every three hours. If the stomach retained the bark after the first dose, æther was then given only once in five or six hours. Æther, says he, given in the manner I have mentioned, is extremely grateful to the patient; it occasions an agreeable warmth along the oesophagus, and gently stimulates the stomach. This effect, however, does not continue long; but the frequent production of it at length gives it permanency. It appears to act as a tonic, an antiseptic, and an agreeable stimulant; a warm glow overspreads the surface; and thirst, nausea and oppression, often have fled before it.
These are the remedies most approved, and which may with most reason be expected to succeed in the cure of the disease, where it is within the power of medicine. But there are certain cases in which medicines of the ordinary kind cannot act. Sometimes, at the very beginning of the disease, all the three stages of it seem to commence at once, or to be mingled in such a manner that medicines have not time to exert their force. Again, in the last stage, Dr. Jackson compares the attempts to overcome the torpor of the system by medicine, to that of attempting to revive a dead corpse. “I have, however (says he) seen instances of such unexpected recoveries from the most hopeless state in fevers, that I seldom totally despair as long as life remains.” It is evident, however, that the remedies employed must be different, according to the different times of the disease. In the beginning it is probable that by bleeding to an extreme degree, so that the greater part of the mass of blood was taken away, the disease might be subdued at once, and the patient recover, as has been already mentioned of the plague, p. [363]. But the idea of death seems to be so firmly connected in the human mind with the loss of a great quantity of blood, that very little hopes can be entertained of any good being done in this way. It seems indeed owing to this invincible association of ideas that the enemies of Dr. Rush have found means to load him so much and so undeservedly with reproach. Another method, less exceptionable, though probably also less efficacious, is by injections into the veins. But what are we to inject? Here, to the disgrace of experimenters, let it be recorded, that such has been their innate propensity to cruelty, that though we know a number of substances which, injected into the veins of an animal, will certainly kill it, yet we scarce know one which can be injected with even a probability of doing good. In the Medical Extracts indeed we find it related that at Guadaloupe a physician had cured the most inveterate diseases by injecting certain remedies into the veins. But what these remedies were we know not. In the same paragraph indeed it is said that alarming symptoms from the bite of a viper were removed by injecting diluted spirit of hartshorn into the blood. As the bite of a viper is attended with a dissolution of the blood, and yellowness of the skin, we may thence derive some faint hope that such an injection might also be useful in desperate cases of the yellow fever; but, till further experiments are made, we can say nothing more on the subject.
Lastly, when the disease has proceeded so far that the blood flows out from all parts of the body, and it is evident that the patient must die were it only from the loss of that fluid, then, if ever, the once celebrated remedy of the transfusion of blood may be of use. An account of this remedy has been given in the former part of this work. It must be evident that human blood ought to be preferred to that of a brute creature; but the danger incurred by one who should lose a quantity of blood so near to a person capable of giving the febrile infection must certainly be very great. Nevertheless, there are cases in which the death of a beloved object inspires more horror than the thoughts of any personal danger, or even death itself, to the person who beholds it. In such cases no doubt there are many that would run all risks; and, should any case prove successful, no doubt the person who had the courage to make the experiment would find ample recompense in saving a person he loved from death, and in establishing a truth of such importance to the world in general.[207]
SECTION IV.
Remarkable Cases.
SO many cases have been enumerated in the course of this work, that little more remains to be done in that way. The following are given, not merely on account of their singularity, or to give instances of surprising and unexpected recovery, but to elucidate some points of doctrine hinted at before, and not sufficiently explained.
1. Spontaneous burning. In the former part of this treatise several extraordinary instances of this kind are given; but a doubt was suggested whether the fire was produced internally, or externally. The following account, from the Medical Extracts, determines the matter. The circumstance took place in England, in the year 1613. One Hitchill, a carpenter, came home from his work as usual, without being sensible of any indisposition, and went to bed. In the night time, or early in the morning, his wife awaked and found him dead by her side. His body was so hot that it could not be touched, and he continued burning internally for three days. No flame appeared on the outside, only an hot steam issued from his body; and we are not told what was the ultimate effect of the fire, or whether his body was consumed to ashes or not. In the same work we are told of a woman who was found dead in her room in the morning, and consumed to ashes, her very bones being calcined to whiteness. The floor on which she lay was very little burned. This last case, however, is not so directly in point as the former, which seems decisive with regard to the internal origin of the fire.
2. M. D’Obsonville’s case of the plague. In the former part of this treatise it has been said that heat destroyed the plague; but, on the authority of the Russian physicians, that the disease could not be treated in hot rooms. The following case, however, shows that even exposure to a burning sun in a desert, to the cold air of night, and to the most injurious usage, cannot always render fatal an attack even of the most dreadful distemper in the world. M. D’Obsonville had undertaken a journey over land to the East Indies, in order to execute an important commission from the French government, in 1761, the very time when the plague raged violently in the east. He describes his case in the following words: “I felt the first symptoms of the plague two small days journey from Aleppo, when I had entered the desert; and at night, when going to rest, complained of a general uneasiness and heaviness of the head. In the morning the fever was known to be inflammatory; and from that time I had no longer any sleep. The third, the fever and head-ach became more violent, two buboes began to rise on my left side, my tongue was swelled, and of a brown violet colour. The fourth and fifth days, sores began to appear on my loins, the spine of my back, and the scrotum; some of which were as large as the palm of my hand, and their colour at first was a red purple. I was obliged, however, to rise, like other passengers, at two in the morning, and travel on horseback till eleven. Unable to swallow any thing but a little water, abandoned by my Christian servant, who durst not come near me, and attended by an Arab, that I could not understand, the violence even of my illness, and a little fortitude, had hitherto contributed to support me; but my weakness increased hourly, and I could no longer sit my horse, when an Armenian lady, named Tcheremani, determined to ride him herself, and with the utmost humanity gave up her camel to me, on which was a kind of litter. On the sixth day the symptoms all appeared aggravated; at one moment my pulse beat with an astonishing quickness, and fire seemed to run through my veins; and the next, my blood was intercepted in its course, a moisture covered my forehead, and I felt myself fainting, though without being delirious, or losing my senses.”