Employed as a remedy, there is no degree of burning heat which the animal economy is capable of producing, no intensity of vascular action, and no violence of pain that can resist its continued application. Sooner or later, usually in from ten to twenty minutes, the heat, though most intense, disappears, the skin becomes cold, the face pallid, the features shrunk, while the pulse is reduced to a mere thread, and the pain of the head, however violent and intolerable, entirely ceases. After the patient has been wiped dry, which he should be as rapidly as possible, and placed in bed, the symptoms may soon return in all their violence; the same process will again remove them, and as often as the former recur the latter must be repeated. Three or four repetitions will commonly suffice to subdue the most intense cerebral affection. In the case of Dr. Dill, the relief it brought was instantaneous and most complete. From a state of intense suffering it rendered him perfectly easy, and from a state of imminent danger, safe. I had no anxiety about him from the moment he came out of his tub, although it was necessary to pass him through the same ordeal three times; but he himself having tried this remedy on his sister, having in her case witnessed its efficacy, and now felt it in his own, was extremely desirous that it should be repeated as soon as he was conscious of any return of pain. In consequence of its application, together with the copious depletion that preceded it, at the period when under ordinary treatment, the most exquisite typhoid symptoms would have been present, he was convalescent.[[36]] If we consider how powerful the abstraction of caloric must be by every fresh current of water that falls upon the head, to what a mere thread the minute external blood-vessels must be constringed, and consequently to what an extent the internal must be affected, we shall not wonder at its efficacy. Powerful as the cold affusion is when exhibited in its ordinary mode, yet the impression it makes upon the brain, compared with the effect produced by this remedy, may be said to be what the application of six leeches to the temples is to the abstraction of thirty ounces of blood.
Cold applications to the head, and evaporating or iced lotions, are useful in mild cases; they may keep up the effect produced by this in the more severe, but to hope to control the latter by their aid alone, is to expect to coerce a giant, by twisting around his arms a spider’s thread.
II. Of the Modification of Treatment in Thoracic Affection.
Fortunately, there is a remedy nearly as powerful and efficacious in intense thoracic affection, as blood-letting and the cold dash are in the cerebral. In the severe bronchial affection of fever, blood-letting is of little avail. It seems to have scarcely any control over the peculiar affection of the lining membrane of the bronchial tubes, or even over the inflammation of the substance of the lung, which so often accompanies the intense form of thoracic disease. It weakens the patient, without making a decided impression upon the disease. Laennec states that the pathology of pneumonia could scarcely be learnt under his practice; for that he treated the disease, not by blood-letting, but by tartar emetic; and that all his patients recovered. I thought this one of the exaggerated statements in which medical writers sometimes delight to indulge; but it immediately occurred to me that this remedy might prove exceedingly efficacious in the bronchitis of fever. Its efficacy has surpassed my expectation. It seldom fails if exhibited with promptitude and decision. The mode in which it is most efficiently administered, is in doses of two grains, dissolved in an ounce of water, and repeated every second, third, fourth, or sixth hour, according to the severity of the case.
In the slight bronchial affection, which is so constantly present in fever, nothing is required but the mucilage of gum-arabic, or a little of the almond emulsion now and then, with the tincture of hyosciamus, or two or three grains of the compound powder of ipecacuanha, to allay the irritation of the cough. The inflammation of the mucous membrane, when slight, spontaneously subsides.
III. Of the Modification of the Treatment in Abdominal Affection.
No remedy at all comparable in efficacy to the preceding has yet been discovered for the inflammation of the mucous membrane of the intestines, which forms so constant and formidable a part of the organic affection of fever. General bleeding has but little influence over the disease. If employed early and with due activity, it will prevent the affection from occurring, but, when once it has supervened, large bleedings are out of the question, and even small and repeated bleedings are not as effectual as leeches. In severe cases, the abdomen should be covered with leeches, and they should be re-applied daily, until the pain and tenderness are gone, or, at least, have become slight, for it is often impossible entirely to remove the tenderness. The abdomen should be covered with a poultice as soon as the leeches fall off. Afterwards, the application of a linen rag, moistened constantly with the oleum terebinthinæ, keeps up the effect produced by the leeches, and, when the affection is slight, may supersede their use altogether.
When the purging is considerable, five grains of the hydrargyrum cum cretâ, with five of the pulvis ipecacuanhæ compositus, given every night or every night and morning, often checks it; if this remedy fail, a stronger opiate may be exhibited, and sometimes an anodyne enema may be administered with great advantage. If there be constipation, one or two drachms of castor oil is the proper laxative. Active or irritating purgatives are highly injurious.
When blood is mixed with the stools or there is considerable hæmorrhage from the intestines, every thing that can irritate the mucous membrane must be carefully avoided. The mineral acids sometimes appear to check the discharge. The infusion of roses rendered stronger by the addition of a few drops of the sulphuric acid, is a convenient mode of administering such medicines, and the efficacy of the draught is sometimes improved by the addition of a drachm of the tincture of hyosciamus. It is not uncommon for copious discharges of blood to alternate with constipation. In this case the mildest laxative must be administered with caution. The powers of life are sometimes so prostrate, that three or four stools, excited by purgative medicines, are sufficient to exhaust them. A tea-spoonful of castor oil, repeated at intervals of six hours, is all that should be attempted. Now and then a stimulant has a greater effect in checking the hæmorrhage than an astringent, and then the oleum terebinthinæ is the best remedy.