INTERMITTING fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distingulsh an intermitting fever from any other and the proper medicine for it is now almost universally known.
THE several kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c.
CAUSES. - Agues are occasioned by effluvia from putrid stagnating water. This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the Fens of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be occasioned by eating too much stone fruit, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fatigue, depressing passions, and the like. When the inhabitants of a high country remove to a low one, they are generally seized with intermitting fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circulation in the capillary or small vessels, disposes the body to agues.
SYMPTOMS. - An intermitting fever generally begins with a pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and violent shaking. Afterwards the skin becomes moist, and a profuse sweat breaks out, which generally terminates the fit or paroxysm. Sometimes indeed the disease comes on suddenly, when the person thinks himself in perfect health; but it is more commonly preceded by listlessness, loss of appetite, and the symptoms mentioned above.
REGIMEN. - While the fit continues, the patient ought to drink freely of water-gruel, orange-whey, weak camomile tea; or, if his spirits be low, small wine-whey, sharpened with the juice of lemon. All his drink should be warm, as that will assist in bringing on the sweat, and consequently, shorten the paroxysm. Dr. Lind says that twenty or twenty-five drops of laudanum put into a cup of the patient's drink, and given about half an hour after the commencement of the hot fit, promotes the sweat, shortens the fit, relieves the head, and tends greatly to remove the disease.
BETWEEN the paroxysms the patient must be supported with food that is nourishing, but light and easy of digestion, as veal or chicken broths, sago gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch. He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass of small wine, in which gentian root, centaury, or some other bitter, has been infused.
AS the chief intentions of cure in an ague are to brace the solids, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But if he cannot bear that kind of exercise, he ought to take such as his strength will permit. Nothing tends more to prolong an intermitting fever than indulging a lazy indolent disposition.
INTERMITTING fevers, under proper regimen, will often go off without medicine; and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course; but when the patient's strength seems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This however should never be done till the disease be properly formed, that is to say, till the patient has had several fits of shaking and sweating.
MEDICINE. - The first thing to be done in the cure of an intermitting fever is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more efficacious. In this disease, the stomach is generally loaded with cold viscid phlegm, and frequently great quantities of bile are discharged by vomit; which plainly points out the necessity of such evacuations. Vomits are therefore to be administered before the patient takes any other medicine. A dose of ipecacuanha will generally answer this purpose very well. A scruple or half a dram of the powder will be sufficient for an adult, and for a younger person the dose must be less in proportion. After the vomit begins to operate, the patient ought to drink plentifully of weak camomile-tea. The vomit should be taken two or three hours before the return of fit, and may be repeated at the distance of two or three days. Vomits not only cleanse the stomach, but increase the perspiration, and all the other secretions, which render them of such importance, that they often cure intermitting fevers without the assistance of any other medicine.
PURGING medicines are likewise useful, and often necessary, in intermitting fevers. A smart purge has been known to cure an obstinate ague, after the Peruvian bark and other medicines had been used in vain. Vomits, however, are more suitable in this disease, and render purging less necessary; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bowels by a dose or two of Glauber's salt, jalap, or rhubarb.
BLEEDING may sometimes be proper at the beginning of an intermitting fever, when excessive heat, a delirium, &c. give reason to suspect an inflammation; but as the blood is seldom in an inflammatory state in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease.
AFTER proper evacuations, the patient may safely use the Peruvian bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder.
TWO ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses, as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile tea, water-gruel, or any other drink that is more agreeable to the patient. It has lately been observed, that the red bark is more powerful than that which has for some time been in common use. Its superior efficacy seems to arise from its being of a more perfect growth than the quill bark, and consequently more fully impregnated with the medical properties of the plant.
IN an ague which returns every day, one of the above doses may be taken every two hours during the interval of the fits. By this method the patient will be able to take five or six doses between each paroxysm. In a tertian, or third-day ague, it will be sufficient to take a dose every third hour during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person, a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms. In intermitting fevers of an obstinate nature, I have found it necessary to throw in the bark much faster. Indeed the benefits arising from this medicine depend chiefly upon a large quantity of it being administered in a short time. Several ounces of bark given in a few days, will do more than as many pounds taken in the course of some weeks. When this medicine is intended either to stop a mortification, or cure an obstinate ague, it ought to be thrown in as fast as the stomach can possibly bear it. Inattention to this circumstance has hurt the reputation of one of the best medicines of which we are in possession.
THE above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to patients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave it off, and begin again at some distance of time; by which means the disease gathers strength and often returns with as much violence as before. A relapse may always be prevented by the patient's continuing to take small doses of the medicine for some time after the symptoms disappear. This is both the most safe and effectual method of cure.
AN ounce of gentian root, calamus aromaticus, and orange-peel, of each half an once, with three or four handfuls of camomile flowers, and an handful of coriander-seed, all bruised together in a mortar, may be used in form of infusion or tea. About half an handful of these ingredients may be put into a tea-pot, and an English pint of boiling water poured on them. A cup of this infusion drank three or four times a day will greatly promote the cure. Such patients as cannot drink the watery infusion, may put two handfuls of the same ingredients into a bottle of white wine, and take a glass of it twice or thrice a day. If patients drink freely of the above, or any other proper infusion of bitters, a smaller quantity of bark than is generally used will be sufficient to cure an ague. There is reason to believe, that sundry of our own plants or barks, which are very bitter and astringent, would succeed in the cure of intermittent fevers, especially when assisted by aromatics. But as the Peruvian bark has been long approved in the cure of this disease, and is now to be obtained at a very reasonable rate, it is of less importance to search after new medicines. We cannot however omit taking notice, that the Peruvian bark is very often adulterated, and that it requires considerable skill to distinguish between the genuine and the false. This ought to make people very cautious of whom they purchase it.
THOSE who cannot swallow the bark in substance, may take it in decoction or infusion. An ounce of bark in powder may be infused in a bottle of white wine for four or five days, frequently shaking the bottle, afterwards let the powder subside, and pour off the clear liquor. A wine glass may be drank three or four times a-day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of the bark, and two drams of snake-root bruised, with an equal quantity of salt of wormwood, may be boiled in a quart of water, into an English pint. To the strained liquor may be added an equal quantity of red wine, and a glass of it taken frequently.
IN obstinate agues, the bark will be found much more efficacious when assisted by brandy, or other warm cordials, than taken alone. This I have had frequently occasion to observe in a country where intermittent fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aromatic. When the fits are very frequent and violent, in which case the fever often approaches towards an inflammatory nature, it will be safer to keep out the aromatics, and to add salt of tartar in their stead. But in an obstinate tertian or quartan, in the end of autumn or beginning of winter, warm and cordial medicines are absolutely necessary. In obstinate agues, when the patient is old, the habit phelgmatic, the season rainy, the situation damp, or the like, it will be necessary to mix with two ounces of the bark, half an ounce of Virginian snake-root, and a quarter of an ounce of ginger, or some other warm aromatic; but when the symptoms are of an inflammatory nature, half an ounce of salt of wormwood or salt of tartar may be added to the above quantity of bark.
AS autumnal and winter agues generally prove much more obstinate than those which attack the patient in spring or summer, it will be necessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an intermitting fever, in the beginning of winter, ought frequently, if the season proves rainy, to take a little medicine, although the disease may seem to cured, to prevent a relapse, till the return of the warm season. He ought likewise to take care not to be much abroad in wet weather, especially in cold easterly winds.
WHEN agues are not properly cured, they often degenerate into obstinate chronical diseases, as the dropsy, jaundice, &c. For this reason all possible care should be taken to have them radically cured, before the humours be vitiated, and constitution spoiled.
THOUGH nothing is more rational than the method of treating intermitting fevers, yet, by some strange infatuation, more charms and whimsical remedies are daily used for removing this than any other disease. There is hardly an old woman who is not in possession of a nostrum for stopping an ague; and it is amazing with what readiness their pretensions are believed. Those in distress eagerly grasp at any thing that promises sudden relief; but the shortest way is not always the best in the treatment of diseases. The only method to obtain a safe and lasting cure, is gradually to assist Nature in removing the cause of the disorder.
SOME indeed try bold, or rather fool-hardy experiments to cure agues, as drinking great quantities of strong liquor, jumping into a river, &c. These may sometimes have the desired effect, but must always be attended with danger. When there is any degree of inflammation, or the least tendency to it, such experiments may prove fatal. The only patient whom I remember to have lost in an intermittent fever, evidently killed himself by drinking strong liquor, which some person had persuaded him would prove an in infallible remedy.
MANY dirty things are extolled for the cure of intermitting fevers, as spiders, cobwebs, snuffings of candles, &c. Though these may sometimes succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose better. The only medicine that can be depended upon, for thoroughly curing an intermittent fever, is the Peruvian bark. It may always be used with safety: and I can honestly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly persisted in.
WHERE agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeable sharpness with the elixir or spirit of vitriol. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, the saline mixture - See Appendix, Saline mixture. - may be given with advantage to children.
WINE-WHEY is very proper drink for a child in an ague; to half an English pint of which may be put a tea-spoonful of the spirit or hartshorn. Exercise is likewise of considerable service; and when the disease proves obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourishing, and sometimes a little generous wine should be allowed.
TO children, and such as cannot swallow the bark, or when the stomach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm water, with the addition of half an ounce of sweet oil, and six or eight drops of laudanum, is the form recommended by Dr. Lind for an adult, and this to be repeated every fourth hour, or oftener, as the occasion shall require. For children the quantity of extract and laudanum must be proportionally lessened. Children have been cured of agues by making them wear a waistcoat with powdered bark quilted between the folds of it; by bathing them frequently in a strong decoction of the bark, and by rubbing the spine with strong spirits, or with a mixture of equal parts of laudanum and the saponaceous liniment.
WE have been the more full upon this disease, because it is very common, and because few patients in an ague apply to physicians unless in extremities. There are, however, many cases in which the disease is very irregular, being complicated with other diseases, or attended with symptoms which are both very dangerous, and very difficult to understand. All these we have purposely passed over, as they would only bewilder the generality of readers. When the disease is very irregular, or the symptoms dangerous, the patient ought immediately to apply to a physician, and strictly to follow his advice.
TO prevent agues, people must endeavour to avoid their causes. These have been already pointed out in the beginning of this section; we shall therefore only add one preventive medicine, which may be of use to such as are obliged to live in low marshy countries, or who are liable to frequent attacks of this disease.
TAKE an ounce of the best Peruvian bark; Virginian
snake-root, and orange-peel, of each half an ounce; bruise them
all together, and infuse for five or six days in a bottle of
brandy, Holland gin, or any good spirit; afterwards pour off
the clear liquor, and take a wine-glass of it twice or thrice
a-day. This indeed is recommending a dram; but the bitter ingredients
in a great measure take off the ill effects of the spirit. Those
who do not chuse it in brandy, may infuse it in wine; and such
as can bring themselves to chew the bark, will find that method
succeed very well. Gentian root, or calamus aromaticus, may also
be chewed by turns for the same purpose. All bitters seem to
be antidotes to agues, especially those that are warm and astringent.