even than this, severe as it is, under the name of the intensest form of fever. And of this, the same may be said as was stated of the mildest, that there is little or nothing to be done. As far as regards the treatment, the two extremes of fever, the mildest and the most intense, meet, for in the first no remedies are required, and in the second, none are of any avail. In these latter cases, there is no remedy and no combination of remedies yet known, capable of affording effectual aid. The abstraction of the smallest quantity of blood is fatal: the application of the cold bath is out of the question; the warm bath is inert; the vapour-bath affords rather more prospect of benefit; but the proper remedies, if any exist, remain to be discovered.
When a person has swallowed a certain quantity of laudanum, there are remedies which are capable of counteracting the poison and of saving the patient. When he has swallowed a larger dose, provided it amount to a certain quantity, no remedies will avail, excepting the application of the stomach-pump. Unless the poison be promptly expelled from the system, adopt with the utmost vigour the best-concerted expedients which the medical art can supply, the patient will die. A person afflicted with the intensest form of fever, is in the condition of a person who has swallowed this large dose of poison. When a pump is invented, capable of extracting his poison from the brain, he may be saved.
V. Of the Treatment of Scarlet Fever.
Little modification is required in the treatment of scarlet fever. The most important difference between continued fever without and with an eruption, is the greater predominance of nervous affection in the former and of inflammatory affection in the latter. Accordingly, in scarlatina there is not only a greater tendency to inflammation than in ordinary fever, but the inflammation which is set up in the febrile circle of organs approximates more to the character of pure inflammation. There is greater vascular action, with less nervous and sensorial depression. The consequence is, that blood-letting may be carried to a greater extent, and will be attended with still more decided and more certain efficacy than in ordinary fever. After a decided impression has been made upon the vascular excitement by general bleeding, the application of ten or twelve leeches to the throat is of sovereign efficacy. If scarlatina be treated in this manner on the second day, or sometimes even on the third, though it commence with exceedingly severe symptoms, yet the patient will be convalescent in the course of three or four days.
It is not probable that much advantage would be derived from the detail of numerous cases to illustrate the modification of treatment, and the circumstances under which particular remedies should be chosen. A few are subjoined as specimens of the ordinary extent to which bleeding may be carried, and of the usual conditions under which wine may be exhibited, and of the results, when favourable, produced by each remedy.
Case CXI.
Mary Ann Hunt, æt. 24, servant. Admitted on the 14th day of fever: attack commenced with shivering, succeeded by heat, nausea, and head-ache; until last night, has had no stool for five days. At present, no pain of head or chest; much pain of limbs; sleeps well; severe pain over the epigastrium, increased considerably by coughing and by pressure; tongue thickly coated with a whitish-yellow fur, through which the papillæ appear large and prominent; much thirst; no appetite; no stool to-day; skin warm; catamenia regular; pulse 135, of good strength.
V.S. ad ℥xxvj. Haust. Sennæ Sal. quam primum. Acid. Mist. pro potu. Mist. Acet. Amm. C. 6tâ q. h.
15th. Pain of limbs quite gone; that of epigastrium also entirely removed; no tenderness on the fullest pressure; tongue more clean; less thirst; several stools; slept well; skin cool; pulse 84, soft. Blood in both basons very buffy. Cont. med.
16th. Continues quite free from pain; tongue nearly clean; two stools; skin cool, moist; pulse 88. Pt. med.