THEIR PROPER METHOD OF TREATMENT.

We now proceed to the more internal diseases; in which, the various steps that we intend to take of restoring health again, must be guided with the greatest caution, as the seat of the malady is hid from our external examination.

It is for this very reason I designed previously to prepare the reader with the two first lectures; particularly the second, I must beg the reader thoroughly to examine, and to understand; for on this will in a great measure depend the proper application of the various experienced remedies, which I here mean to unfold.

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Of Fevers in General

Hippocrates, the father of physic, was wont to say, “A fever is so universal, that no patient dies without it.” This is so true, that there is hardly an exception to it, even in the most momentary apoplexy itself.

To conceive this properly, we must observe, that every diminutive part in the animal fabric, like in a commonwealth, is endued with a sense of self-preservation; and the whole fabric is in so strict a conjunction with all its various particles, both solids and fluids, that nothing which may cause the least disturbance can pass unnoticed; but, let the injury be where it will, every individual particle, as a member of the whole animal state, feels the shock, and is immediately concerned for its own preservation.

This then is the cause of a fever in the general sense; and thence we shall be led to understand what this disturbance in its nature actually is; namely, an unnatural action of the solids upon the fluids.

Now as the fluids are the most yielding parts, that must submit to the pressing motion of the solids, we may without much difficulty, see one principle reason of its being set into a disturbed commotion, when the irritability of the nervous fibrillÆ are acted upon.

Again, when we consider that the blood is liable to become acrimonious, and thence by its stimulus apt to act upon the coats of its containing vessels, we see demonstratively plain, how the solids are subject to be excited to act upon the very blood that stimulates them.

Moreover, as motion must naturally produce heat, and heat motion, and motion expansion, and expansion rarefaction, we at once bring to view the principal laws of mechanism, that governs the human automaton in the various degrees of health as well as disease. However, let me not forget to whom I write, but haste to the point I am at.

A fever may proceed from many different causes, and may affect many different constitutions, and also produce many different effects; it is therefore just that a proper distinction should be made.

Indeed, it is a subject that cannot be too minutely handled; because it is scarce possible that there is a disease void of a fever in some degree or other.—But preciseness and utility is the object I have in view.

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Of Accidental Fevers.

How uncertain is human life! One moment in a perfect state of health, the next perhaps no more; or confined under the painful sensations both of body and mind!

Every accident is liable, and unavoidably must bring on a fever; and this, like fire, should be extinguished in its earliest commencement. But in that, as I have before observed, the constitution should principally be consulted.

I have in the lecture of accidents, at every opportunity, recommended bleeding, but always with a proviso, if requisite; and, as this is of more consequence than generally is supposed, I find it necessary here to expatiate farther on it.

In the first place, no man should be bled who has lost a considerable quantity of blood, unless indeed he was known in his state of health to be very strong and robust; and that the fever sets on with such fury, that the system requires absolutely to be reduced; for the solids and fluids have such a strict dependance amongst themselves, that they keep each other in an equipoise. If therefore the blood is of an acrimonious nature, and at the same time impoverished by lessening its quantity, the coats of the arteries and veins will be the more stimulated; thence the fever will naturally encrease, and generate more acrimony; which at length will destroy the patient. I have been an eye witness more than once, that the fever has actually increased upon every repeated bleeding, till the whole supply of life was spent; and all my persuasions have not been listened to till too late. Nay, a fever is sometimes absolutely necessary; and proves to some constitutions a remedy on its own account, provided it is properly treated, and kept within due bounds.

Secondly, If the constitution of the patient before the accident was but slender, and of a phlegmatic nature, bleeding should be very little or cautiously performed; for the blood of itself being but poor, must naturally be impoverished by being lessened; and whilst the tenseness of the fibres is lost, it is the more acted upon and rendered more acrimonious, and still unable to strengthen the tone of the irritated fibres; whence a relaxed body, together with a poor acrimonious blood, and all its evil tendencies must be the consequence.

Let it once for all be observed, that all the benefit we can possibly hope and expect from bleeding, is to lessen the whole system, to reduce the quantity of the fluids, and to relax the solids. This lessening of the system I must own is very often highly necessary; But, let us not fall into the ridiculous notion to suppose that bleeding will draw off the bad blood, and leave the good behind; far otherwise; the quantity of the blood is soon replenished, but the quality becomes impoverished.

The principle intention in fevers of whatever kind, should be to promote perspiration. This is the grand restorative of nature; and I cannot recommend it too much. Nature designed this evacuation in the formation of man; and by that, fevers were cured in time of yore, many ages before art contrived either lance or lancets.

But here let me not forget another great caution; namely, not to mistake profuse sweating for perspiration; for this is an extreme into which many have erroneously fallen. Nature frequently produces a sweat without force or compulsion; and if so, it should be favoured, but never brought on by stimulants, or strong forcing medicines.

Perspiration, sweat and urine, are the natural evacuations intended, for the purifying the system from animal acrimony; and when these excretions are in a just balance with the secretions of the fluids and motion in the system, without pain or fatigue; then nature is at peace with itself.

Lastly, I must observe, that the stomach is an organ which, by the nervous consent, carries on an immediate correspondence with every part in the human fabric; whence this viscera should likewise ever be consulted in fevers; that is, never to impose on it any aliment against its own inclination and appetite.

The want of appetite in a fever is a natural cause, and very often is in the patient’s favour; but the mistaken notion, that a patient must eat, even against his inclination, in order to recover strength, is not only highly absurd, but has been the destruction of many, who otherwise would have recovered, had they with patience waited the kind dictates of Nature.

Let the system be free from diseases, and the stomach will soon crave food, when there is a probability that the aliment may be converted into good blood; but whatever is forced into the stomach before that time, will instead of nourishing the body, only add fuel to the destructive fire, and encrease the already malignant blood.

Upon the principles of these observations, I shall lay down the rules that should be religiously observed in accidental fevers; and when they are well considered, we shall find that they will hold good also in all other kind of fevers, notwithstanding they arise from internal acrimony of the body; for the difference is barely this, whether the fire is kindled within or from without;—but to proceed.

Whatever then be the accident, a fall, a wound, a fracture, dislocation, bruise, &c. observe what the patient was before the accident.

If the patient was a stout hearty man, it naturally follows, that the fibres of his body were also in a rigid robust state; and the quantity and richness of the blood was in a due proportion; for this very reason, health being at such an acmÉ, a fever is the more to be feared, and ought studiously to be avoided.

If this patient has not lost any blood by the accident, by all means bleed him; but never exceed eight ounces at farthest; it is as much as the strongest man ought to lose at once.

In the next place, perspiration should be the principal object in view. To this end, let the patient immediately after bleeding go to rest, and take a dose of the Fever Powder (L); upon which let him drink plenty of Balm Tea (12); which will generally bring on a perspiration.

If however the fever increases, the pulse continues to beat hard and full, the head-ach, difficulty of breathing, a great draught and delirium should ensue, bleeding indeed may be repeated, provided it is within the same twenty-four hours; but if the symptoms come on beyond that time, then bleeding will seldom prevail, or do any good, but rather mischief; for by this time, the fever is generally agitated by acrimony, and the blood is of its own accord poor enough without being made more so by bleeding.

In the symptoms which I mentioned, regard should be had to the body being gently kept open, not by purges but by clysters; for purges in fevers are precarious, and liable to bring on heavy fluxes. If the patient under this high fever is costive, give him the following clyster.

No. XXIII

Take warm water one pint, or something more; in which scrape about one ounce of castile or hard soap, and let it perfectly dissolve; then add a spoonful of honey to it, and let it be as warm as that it may be easily borne to your cheek.

Let the patient keep this clyster within him as long as he can, till it comes away with a stool.

If the patient is sick at the stomach, a vomit of ipecacuanha (S) or No. XXVI, will be very proper, and nothing in such a case can be given more safety and better advantage; for it is not only the stomach that gets relieved, but the whole body is brought thereby into perspiration, by the universal strain it occasions. After the vomit, or after the clyster, give the following draught.

Take of fever powder (L) one scruple; common water or balm tea, one ounce or half a tea cup full; then take a lump of sugar, on which pour essential oil of peppermint (U) three drops; liquid laudanum (T) eight drops; sweet spirit of nitre (D) thirty drops; and mix them with a tea spoon.

This draught will not only promote perspiration, but it will comfort the stomach, and incline the patient to an agreeable rest; by which he will be greatly refreshed. If occasion requires, it may be repeated every six hours.

If rest comes of its own accord, the liquid laudanum (T) may be omitted; and if the stomach does not stand in need of any carminatives, the oil of peppermint (U) may also be omitted, &c. The constant drink when dry may be balm tea; in which, if it suits the palate of the patient, a slice of lemon may be put, and then sweetened with sugar.

The diet, as I have before observed, should be sparing; and the patient’s palate in this should principally be consulted. The following water gruel, or rather wine soup, or whatever other name it may acquire, I have often ordered to my patients at sea; and which has suited most stomachs, and proved an agreeable mess.

Take oatmeal, or pounded biscuit, a couple of spoonfuls; water, a quart; a small handful of raisins; a little allspice, a little mace, tied up in a fine rag; which boil together in a tin saucepan till consumed to a pint and a half; then add a gill of good wine, red or white, and sweeten it with sugar to suit the palate. You may put a little lemon peel in, to give it an agreeable flavour.

A little roasted fresh meat will hurt nobody; and broths most certainly are good, particularly if the body is costive; but when the body is inclined to looseness, I have known the best broth to produce a dangerous flux; and this should be taken notice of.

If the patient however who has met with the accident is of a puny weak constitution, or has lost a sufficient quantity of blood by the wounds, bleeding then is not so requisite as in the former case; though the treatment otherwise must be equally the same.

By this method of proceeding, there is little fear but that the patient will soon perfectly recover, even in the highest fever that may suddenly befall a man from an accident; provided the injury is not of a dangerous tendency. But as an acrimonious habit of body is liable on its own accord to diseases, it is easily imagined that an accident may become accessory, and heighten the malignity; hence often a fever of that kind is liable to degenerate into a malignant one, or even from the accident itself, when of a dangerous nature; and this I shall explain as I proceed. I shall therefore leave the accidental fever that proceeds from an external cause, and proceed to those which take their origin internally.

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SECT. III.

Of a Cold.

The fever now to be treated of is the most common amongst mankind; especially seamen, who are ever exposed, to have the perspiration obstructed. It however would save many from the grave, and almost as many from being food for the fish, was it a little more regarded than what it actually is.

The sound of a cold is so gentle, that custom has almost made it effeminacy to pay any regard to it; and yet, if we maturely examine, we shall find the most malignant, acute, and mortal diseases, first make their appearances by the symptoms of a cold,——But let us proceed to particulars. A cold is an obstruction of perspiration; which may become destructive to the animal oeconomy if neglected, in so much, that it may be considered as the first foundation of most diseases.

In my treatise on diseases of the lungs, I have enumerated the many causes of a cold to which mankind are liable, and their precautions to avoid them. To sea-faring men, I have one principal cause to mention whereby they make themselves subject to colds, and sow the seed of many dangerous diseases in their system, and that is their carelessness in shifting, after getting wet; in this respect, I have however a remedy to offer, which is as valuable and as efficacious to their preservation, as it is easily put in execution. The remedy is simply this:

A man who has been exposed on duty in the rain, and is become thorough wet, should not only shift himself in dry cloaths, but previously wash all over with sea water: if he carefully observes this, he will never get cold on that account. I have not only experienced this personally many times, but ever found it productive of salutary effects to those I have persuaded to it.——If we but make some observations on the accidental occurrences that happen at sea, we shall see the just foundation of this. When do we find a man who is continually washed by the sea to have a cold? while on the contrary a foul rainy day, will almost breed a general sickness.——These observations first brought me on the notion of washing the body with salt water, and having verified it by experiment, I soon saw the propriety of it; namely, that the fresh water being of a sluggish nature, and having a tendency to putrefaction, is not only apt to infuse a putrescency into the system, but from its slimy nature apt to clog up the pores, and thus obstruct perspiration; whilst on the contrary, salt water is not only antiseptic, but stimulates the pores of the skin to their secretory and excretory functions.——Nay so perfectly have I experienced this remedy, that I have persuaded the people to salute one another by way of play with buckets of sea water on a foul rainy day, and with pleasure I have experienced that they have all remained brisk and hearty after it, and evidently seen the difference, that on a similar day the sea water play being omitted, scarce one who has been thorough wet, escaped a cold in some degree or other.——I must not forget, that a draught of grog is likewise no bad preservative. But this is best taken when the watch is out, and that rest and sleep can be indulged upon it, as that will then be apt to throw them into a gentle perspiration; whilst however their watch is upon deck, the best warmth is that which is produced by exercise; except liquors is taken with the greatest moderation.

But when a cold has actually commenced, care should be taken immediately to have it subdued in time. The term cold however is a very vague expression, that includes a great many disorders, occasioned by an obstruction of perspiration, which all in turn shall be taken notice of: But as I am now on the subject of fevers, I shall confine myself to that at present, and consider the cold as it affects the body universally; namely headaches, a weakness in all the limbs; intermittent fevers, intermixed sometimes with flushes of heat, and at other times shivering, chilling, &c.

These are not only the symptoms of a cold, but of almost all inflammatory fevers; which in fact, the cold is a commencement of. Now all that nature requires is a perspiration; for thereby the imprisoned acrimony is expelled, and which nature is always engaged to throw off from the system.—To this intention, if the patient is rich of blood, bleeding should be performed; but with such caution, as I have before recommended. Next give the fever powder (I), together with a good quantity of balm tea, or if the constitution is of a phlegmatic habit, sage tea, or even sage punch ( No. V.) will not be improper; but care should be taken, that if there is much fever, all those things should be omitted, as it is liable to increase the fever. If there is a nausea at the stomach, give a vomit: take the following:

No. XXVI

Take Ipecacuanha (S), one scruple: sugar a little lump: water half a Tea cup full, and make it up into a draught.

This vomit should be well worked off with chamomile tea, or even common luke warm water; first letting the vomit operate, and then drinking plenty of the water after every operation. When this is over, the patient should keep his bed or hammock, and take either the fever powder (L), or the before mentioned draught, No. XXIV.

The catarrhal fever, and all the other symptoms of cold, viz. cold in the head, cough, hoarseness, &c. generally keep one another company, leave the patient generally at one time; and in fact, one method of cure, namely, promoting a perspiration, serves for all; for thereby the obstructions become removed, and nature is restored to its primitive tranquillity again.

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Of Intermitting fevers, and Agues.

There is scarce a disease that makes a patient more wretched, and unhappy, than the fever and ague. The causes of these kind of fevers is principally from a pituitous, or slimy blood, together with its being loaded with acrimony; and a flacidity of the moving fibres.

They are divided into various classes; though in fact all of one nature. When the ague with its succeeding fever comes on regularly every day, it is called quotidian, or every day’s ague; when every second day, tertian, or third day’s ague, and when every third day; a quartan, or fourth day’s ague. There are many other classes as subdivisions of these, but they are the mere speculations of physical pedants, who are ever sworn enemies to plain understanding, and delight in perplexities; which therefore, we shall neither spend paper nor time upon to recount.

Suffice it, let their paroxysms return at what stated period of time they will, either regularly or irregularly, they differ in nothing but this, that the farther the fits are distanced, the severer they generally are, when they come on; and the more regular, the more obstinate in their cure; though in this even there are exceptions.

It is surprizing to imagine, how many different opinions have been sent into the world concerning the returns of the periodical fits of the ague; and equally astonishing, how few with any probability of truth or reason.

I shall not here enter into an enquiry of this nature; certain it is, that at the stated times of these returning fits of the ague, there is an obstruction in some particular part of the system, that corresponds with the dated time of the circulation of fluids in such parts—which when disturbed, effects by the nervous consent, the whole animal structure.

The principal intention in all intermitting fevers, should be to correct the petuity and acrimony of the blood; to remove the obstructions; and to strengthen the solids.

With respect to the blood, it is an inevitable consequence, that when it is loaded with a vicidity and lentor, that it will ever occasion a depraved nutrition; and hence we see, that people labouring under agues, and intermittent fevers of any kind, have a depraved appetite, and many disagreeablenesses in the first passages.

The intermittent fever and ague approach with the following symptoms, viz. a heavy dull head-ach, a shivering chill all over the body, with a yawning, &c. pain in all the limbs attended with weariness, a nausea at the stomach, a depressed pulse; which after it has lasted for half an hour, changes into a burning heat, a throbbing head-ach, pain in the loins, and in every limb, a great draught, a full hard pulse, and which at last terminates in a profuse sweat; this seems to give the patient ease, for one, two, or three days; and then attacks the patient with the same symptom, increasing every time, and reduces the patient both in body and spirit.

The first thing to be done is to give a vomit, like No. XV. and XXVI. This is best taken at the approach of the cold fit, and worked well off with plenty of luke warm water. After the operation of the vomit is over, let the patient take the following draught.

No. XXVII

Take fever powder (L), thirty grains; calomel (N), one grain; elixir of vitriol (G), sixty, or seventy drops; essential oil of peppermint (U), four drops upon a little lump of sugar; to which add water, half a tea cup full.

This draught will not only promote perspiration, but help to dissolve the siziness in the blood; and may therefore be repeated every six hours, for a few days. But the patient should always be kept moderately warm upon it, that it may work by perspiration.—This simple method I have known put the patient to rights again, after a severe onset.

But sometimes this wretched disorder will require more powerful medicines to keep it in subjection. When the fibres are debilitated, and the blood still retains its viscid corruptive quality, the ague is apt to hang on the patient a long time, the succeeding fever apt to melt the patient down to a mere skeleton, and even destroy him. In this it is requisite to brace up the solids, and to infuse an astringency into the blood.

To this intent, the Peruvian bark is now frequently prescribed, and if judiciously administered it is an excellent medicine; but as it is liable however, to be improperly given, and then productive of irreparable mischief, I have purposely omitted it in this catalogue; nevertheless, I shall give in its stead a medicine, superior both in virtue, and by far more safe in the application; not only in this kind of complaint, but in scorbutic cases, as I shall hereafter take notice of. The medicine is this,

No. XXVIII

Take a quantity of rusty iron, the smaller the pieces are, the better, for the less quantity will do; pour on it good strong vinegar, sufficient to cover it; let them steep till the vinegar becomes of a deep brown colour, which it soon will, and at length acquire a consistence of a black elixir. The vessel should be either stone or glass; but what is yet better is an iron pot, which of itself will contribute to the medicine.

If the patient therefore, after the vomit, and the above draught, is attacked again with the fit of the ague, and succeeding fever, have immediate recourse to your elixir of iron.——Let him take after the fever is off, every three hours, a table spoonful of the elixir, and should it seem to come up again at first (which it sometimes will, particularly if the stomach is yet foul) give immediately another spoonful, and repeat this at least three times of the day.

A little gentle exercise upon taking the elixir is highly beneficial; and if it throws a gentle warmth over the body, and brings it into a gentle perspiration, you are sure of success.

The quantity of it should be adapted to the condition of the patient, and the strength of the stomach; if it sits easy, a larger quantity may be taken, and seldomer; and if it is more nauseous, a smaller dose and oftener.—Should the fits seem obstinate, the following electuary may be used; and is a powerful specific.

No. XXIX

Take stomach powder (M), two drachmes; nutmeg powdered, one drachm; powdered alum (17), half a drachm; essential oil of peppermint (U), twenty drops; calomel (N), ten grains; honey (E), one ounce: the whole well mixed.

Of this let the patient take every eight, or twelve hours, the bigness of a nutmeg, taking his elixir as before observed; and this will ever prove successful in the most obstinate case.

As patients of that kind at sea, have ever a taint of the scurvy in their composition, or at least have a tendency towards it, exercise and freshness of food, will prove one of the restorative means. The malt decoction should also be their drink, as well as in the scurvy.

To conclude, I shall only observe, that bleeding in agues must at all events be omitted, as being absolutely pernicious, as it cannot fail of impoverishing the blood; which is the principle source of the disorder. Also, in the intermitting time, exercise should be observed, and the diet should, when the stomach craves, be good. Sometimes indeed, the stomach is too ravenous and greedy; but that is a default which proceeds from the same cause as that which makes it loath its victuals; a vomit in either case is the most effectual medicine, and may be repeated as often as it is requisite, without the least fear of injury, particularly in this disease.

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Of Putrid and Malignant Fevers.

I Shall on this head restrain myself from saying more than what is absolutely requisite to the cure. It seldom happens to infect a ship’s crew at sea, unless the ship has carried it from some place where the disease was contagious.

Though notwithstanding, great sickness on board may give rise to it, if care is not taken to prevent it. I would therefore ever advise, in case of sickness, to steam the birth with vinegar; namely, taking a vessel with vinegar, in which put a hot iron, and thereby raise a steam, which is a powerful preservative.

A putrid fever may be generated from the contaminated atmosphere of a sick person, though it rarely is the case; yet prudence demands every precaution that is in our power.

The fever that I now speak of is of the malignant kind, and peculiar to the hotter climates.

The patient is seized first with a shivering chilliness, which is soon succeeded with a weak unequal fluttering pulse; the body is seized with a universal pain, together with a great debility; the mouth is hot and dry; the respiration depressed; and the mind labours under a heavy anxiety.—The fever continues, though not very high; and the pulse not very full;—a delirium or else a stupor ensues; the urine becomes deep coloured, and has an oily skim at top; and the patient is in so imminent a state of danger, that, unless a favourable crisis happens soon, twenty-four hours rapid progress is liable to put him beyond all help. The first and immediate remedy should be a vomit, No. XXVI, which is the grand step to be taken in all fevers; not so much for the sake of cleansing the stomach, as for the universal ease it gives to nature.

The next step is to correct the putrescent acrimony in the system; for which purpose make the following draught.

No. XXX

Take fever powder (L) one scruple; elixir of vitriol (G) thirty drops; sweet spirit of nitre (D) thirty drops; calomel (N) two grains; essential oil of peppermint (U) four drops; upon a lump of sugar; and half a tea cup full of water.

Let the patient take this draught every six hours; and after four have been taken, the calomel should be omitted. If the nerves seem to be affected, the essential oil of peppermint may be increased. If a delirium should come on, the liquid laudanum (T) from ten to twelve drops and upwards may be given in the draught.

I know many will think it odd, that I should give calomel in a fever; but all this is merely the effect of blind prejudice; a better medicine than calomel is not in all Nature, if judiciously applied; and so fortunate have I been in my success with this exalted medicine in contagious fevers, that I have preserved myself and my patients in the midst of Death’s spreading horror around us. But to proceed; if the patient continues to be dry on the surface of the skin, and perspiration seems backward, a blister betwixt the shoulders, the bigness of the palm of the hand^[15], will greatly facilitate the crisis or turn of the fever; but let it not be erroneously supposed, that a blister will draw off the bad humour, or that it does good by such an operation; for this notion has proved destructive to many patients. All the good a blister does is to spur on the animal function; by which sometimes the acrimony is thrown off from the system; but if thus irritating the system be overdone, or wrong applied, it is productive of many additional evils to the disease; causes spasms, strictures, and other acute disorders, that of themselves may become mortal. Therefore blisters should never be used but when the body is defective of perspiration, or when the debilitated system is defective in its excretory functions.

When the patient is rid of the fever, a general weakness will be left behind; this is best assisted with the elixir of iron; and now and then as a stomachic, a tea spoonful of Turlington’s balsam (W), or some few drops of oil of peppermint (U), as also the malt decoction, and fresh diet.

Malignant fevers are generally attended with eruptions on the skin, which is sometimes in favour of the patient, and therefore by no means to be hindered; but if there appears purple spots on the skin, and that they incline to turn black, it is rather a dangerous symptom, and indicates very little hope of the patient’s recovery.

The same method as above must be observed; which if medicine can avail, will afford benefit.

On the whole, I have this to observe, that all acute fevers are liable to become malignant and putrid; and in my practice I never found, that there was any real distinction to be made in the method of cure, whether the acrimony was generated in the habit by disease, or introduced by contagion; and if I may be allowed to judge by comparison, it must appear that my method is superior to the more general doctrine; because I have ever found it to be attended with much more success.