A Treatise on Fever

by Southwood Smith

Of the Treatment of Fever.

We have seen that the first indication of disease in fever is traceable to the nervous system; that the nature of this primary affection of the nervous system is unknown; that it may possibly be the commencement of inflammation, modified by the nature of the nervous substance, in which the inflammatory action has its seat, and by the nature of the cause that excites it, namely, a peculiar poison: or, on the other hand, it may possibly be something distinct from inflammation, but having a peculiar tendency to excite it. In either case, the inflammation that is present in fever, is peculiar and specific, differing essentially from ordinary or simple inflammation. Whether the affection of the nervous system consist merely of inflammation of the nervous substance excited by a peculiar poison; or whether it consist of some unknown condition of the nervous system to which inflammation is superadded, and by which the character of that inflammation is modified, the great practical result is the same, namely, that febrile inflammation and ordinary inflammation are not identical, and that the difference between the two affections is such as to require a very considerable modification in the treatment appropriate to each.

The only morbid condition of fever, of which we have any knowledge, and over which the medical art has any control is that of inflammation. Although, as has been so often stated, inflammation be not the primary febrile affection, as far as regards the order of events, yet it is, at least, the primary affection, as far as regards the treatment, if it be not the sole affection that admits of treatment. The remedies proper for febrile inflammation do not differ from those which are adapted to ordinary inflammation; but they differ materially in the mode in which they ought to be applied, and the extent to which they ought to be carried. They can be understood neither in their mode nor measure, until the following questions are determined; namely, What is the precise object that should be aimed at in the treatment of fever? What is it which it is most important to do, and which it is in the power of the medical art to accomplish? An exact and true answer to these questions will afford an invaluable guide in practice: it will point out with clearness what is to be attempted; and it will put a stop to useless and pernicious aims.

It is in vain to hope to terminate fever by a stroke of art. The pursuit of a remedy, so long and so earnestly sought, endowed with the power of cutting short the disease, is to the physician what the search after the philosopher’s stone was to the alchymist, with this difference, that the alchymist, engaged in a vain pursuit, lost only his time and labour; but the physician, engaged in a pursuit equally hopeless, will often, in addition, lose his patient. Fever cannot be cured instantaneously; and to bring a fever patient under the influence of agents capable of exciting a powerful influence upon the system, in the expectation of at once removing fever, is pregnant with danger; and the expectation upon which such practice is adopted, must appear fallacious to whoever has studied the nature of the disease.

Fever cannot be cured instantaneously: it may be moderated; it may be gradually subdued; from being violent and dangerous, it may be rendered mild and safe: the physician may bring it to this condition; and this is all that he can accomplish. If it come under his care early, and he know with promptitude and decision at what to aim, he will rarely fail in his efforts to secure this object.

Since the various forms or types of fever differ in nothing but the degree of their intensity, in detailing the treatment, it will be necessary only to state first of all, the remedies which are appropriate to the disease; and, secondly, the modification of these remedies, which may be required by the different degrees of intensity in which it is commonly found to exist.

1. The common continued fever of this country, in its mildest form, requires little or no treatment. There is no affection of any organ intense enough to need the application of a powerful remedy. All the organs which constitute the febrile circle are deranged in their functions, but that derangement is so slight that a cure takes place spontaneously in the course of a few days. Confinement to the bed; the abstraction of stimuli; fever diet; a calomel purgative at night, consisting of one or two grains of calomel with six or ten of rhubarb, followed in the morning with half an ounce of castor oil; and these remedies repeated every day, or every alternate day, constitute the whole treatment which is required.

2. Whenever the fever passes beyond this, its mildest form, it becomes a serious disease. It is never for a moment to be trifled with; never for a moment to be neglected. Because it is moderate in the commencement, it is not to be presumed that it will continue moderate through its subsequent course: it may become most formidable; if the proper remedies are not applied early and vigorously, it generally does become truly alarming; the train only is apparent; the mine is concealed; the only safety for the patient is to prevent the train from being kindled; if that be once kindled, it may be no longer possible to save the patient from destruction.

When the mildest case of fever passes to a severer form, what is the event that happens? What is the change that takes place in the organs? The preceding pathology will, indeed, have been written in vain, if there can now be any doubt in the mind of the reader on that point. The great value of the facts there disclosed is, that they teach us what happens in organs which we cannot see, and declare to us by the external signs or symptoms, the internal actions that are going on. Out of the hundred cases which have now been recorded, and the history of which has been made known from its commencement to its termination, take any one, or fix upon any number, in which the symptoms from being slight became moderate, and from moderate severe, or, in which the symptoms were severe from the beginning, what is found after death? Inflammation, in general, rising in degree, and increasing in extent, or both, in proportion to the intensity of the febrile affection. If this, which may be justly considered as the law of the disease, be not absolutely constant and uniform, it may be safely affirmed, at least, that there are as few apparent exceptions to it, as to any general law that can be named.

The object to be aimed at in practice, then, is clear: it is to prevent, or to remove inflammation. Accomplish this, the fever will not be cured at once; it will still go on for some time; but it will come sooner to a close, and it will proceed mildly and safely to its termination. Fail to accomplish this, and the fever, however mild at first, will increase more and more in severity until it become truly formidable, and death take place at last, in consequence of the destruction of the organs by the process of inflammation.