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DOMESTIC MEDICINE

CHAP. XXI.

OF THE MILIARY FEVER.

THIS fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together.

THE whole body is sometimes covered with pustules; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption; but, when the skin is dry, the eruption is both more painful and dangerous.

SOMETIMES this is a primary disease; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ardent, putrid, or nervous fever, &c. In all these cases it is generally the effect of too hot a regimen or medicines.

THE miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is likewise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be seized with this disease in childbed, and often lose their lives by it.

CAUSES. - The miliary fever is sometimes occasioned by violent passions or affections of the mind; as excessive grief, anxiety, thoughtfulness, &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons, eating too freely of cold, crude, unripe fruits, as plums, cherries, cucumbers, melons, &c.

IMPURE waters, or provisions which have been spoiled by rainy seasons, long keeping, &c. may likewise cause miliary fevers. They may also be occasioned by the stoppage of any customary evacuation, as issues, setons, ulcers, the bleeding piles in men, or the menstrual flux in women.

THIS disease in childbed-women is sometimes the effect of great costiveness during pregnancy; it may likewise be occasioned by excessive use of green trash, and other unwholesome things, in which pregnant women are too apt to indulge. But its most general cause is indolence. Such women as lead a sedentary life, especially during pregnancy, and at the same time live grossly, can hardly escape this disease in childbed. Hence it proves extremely fatal to women of fashion, and likewise to those women in manufacturing towns, who, in order to assist their husbands, sit close within doors for almost the whole of their time. But among women who are active and laborious, who live in the country, and take sufficient exercise without doors, this disease is very little known.

SYMPTOMS - When this is a primary disease, it makes its attack, like most other eruptive fevers, with a slight shivering, which is succeeded by heat, loss of strength, faintishness, sighing, a low quick pulse, difficulty of breathing, with great anxiety and oppression of the breast. The patient is restless, and sometimes delirious; the tongue appears white, and the hands shake, with often a burning heat in the palms; and in childbed women the milk generally goes away, and the other discharges stop.

THE patient feels an itching or pricking pain under the skin, after which innumerable small pustules of a red or white colour begin to appear. Upon this the symptoms generally abate, the pulse becomes more full and soft, the skin grows moister, and the sweat, as the disease advances, begins to have a peculiar foetid smell; the great load on the breast, and oppression of the spirits, generally go off, and the customary evacuations gradually return. About the sixth or seventh day from the eruption, the pustules begin to dry and fall off, which occasions a very disagreeable itching of the skin.

IT is impossible to ascertain the exact time when the pustules will either appear or go off. They generally come out on the third or fourth day, when the eruption is critical, but when symptomatical, they may appear at any time of the disease.

SOMETIMES the pustules appear and vanish by turns. When that is the case, there is always danger; but when they go in all of a sudden, and do not appear again, the danger is very great.

IN child-bed women the pustules are commonly at first filled with clear water, afterwards they grow yellowish. Sometimes they are interspersed with pustules of a red colour. When these only appear, the disease goes by the name of a rash.

REGIMEN - In all eruptive fevers, of whatever kind, the chief point is to prevent the sudden disappearing of the pustules, and to promote their maturation. For this purpose the patient must be kept in such a temperature, as neither to push out the eruption too fast, nor to cause it to retreat prematurely. The diet and drink ought therefore to be in a moderate degree nourishing and cordial; but neither strong nor heating. The patient's chamber ought neither to be kept too hot nor cold, and he should not be too much covered with clothes. Above all, the mind is to be kept easy and chearful. Nothing so certainly makes an eruption go in as fear, or the apprehension of danger.

THE food must be weak; chicken broth with bread, panada, sago, or goat-gruel, &c. to a gill of which may be added a spoonful or two of wine, as the patient's strength requires, with a few grains of salt and a little sugar. Good apples roasted or boiled, with other ripe fruits of an opening and cooling nature, may be eat.

THE drink may be suited to the state of the patient's strength and spirits. If these be pretty high, the drink ought to be weak; as water-gruel, balm-tea, or the decoction mentioned below. Take two ounces of the shavings of hartshorn, and the same quantity of sarsaparilla, boil them in two English quarts of water. To the strained decoction add a little white sugar, and let the patient take it for his ordinary drink.

WHEN the patients spirits are low, and and the eruption does not rise sufficiently, his drink must be a little more generous; as wine-whey, or small negus, sharpened with the juice of orange or lemon, and made stronger or weaker as circumstances may require.

SOMETIMES the miliary fever approaches towards a putrid nature, in which case the patient's strength must be supported with generous cordials, joined with acids; and, if the degree of putrescence be great, the Peruvian bark must be administered. If the head be much affected, the body must be kept open by emollient clysters. In the commercium literarium for the year 1735, we have the history of an epidemical miliary fever, which raged at Strasburgh in the months of November, December, and January; from which we learn the necessity of a temperate regimen in this malady, and likewise that physicians are not always the first who discover the proper treatment of diseases. This fever made terrible havoc even among men of robust constitutions, and all medicine proved in vain. They were seized in an instant with shivering, yawning, stretching, and pains in the back, succeeded by a most intense heat; at the same time there was a great loss of strength and appetite. On the seventh or ninth day the miliary eruptions appeared, or spots like flea-bites, with great anxiety, a delirium, restlessness, and tossing in bed. Bleeding was fatal. While matters were in this unhappy situation, a midwife, of her own accord, gave to a patient, in the height of the disease, a clyster of rain-water and butter without salt, and for his ordinary drink a quart of spring water, half a pint of generous wine, the juice of a lemon, and six ounces of the whitest sugar, gently boiled till a scum arose, and this with great success; for the belly was soon loosened, the grievous symptoms vanished, and the patient was restored to his senses, and snatched from the jaws of death. This practice was imitated by others with the like happy effects.

MEDICINE. - If the food and drink be properly regulated, there will be little occasion for medicine in this disease. Should the eruption however not rise, or the spirits flag, it will not only be necessary to support the patient with cordials, but likewise to apply blistering plasters. The most proper cordial in this case is good wine, which may either be taken in the patient's food or drink; and if there be signs of putrescence, the bark and acids may be mixed with wine as directed in the putrid fever.

SOME recommend blistering through the whole course of this disease; and where nature flags, and the eruption comes and goes, it may be necessary to keep up a stimulus by a continual succession of small blistering plasters; but we would not recommend above one at a time. If however the pulse should sink remarkably, the pustules fill in, and the head be affected, it will be necessary to apply several blistering plasters to the most sensible parts, as the inside of the legs and thighs, &c.

BLEEDING is seldom necessary in this disease, and sometimes it does much hurt, as it weakens the patient and depresses his spirits. It is therefore never to be attempted unless by the advice of a physician. We mention this, because it has been customary to treat this disease in childbed-women by plentiful bleeding, and other evacuations, as if it were highly inflammatory. But this practice is generally very unsafe. Patients in this situation bear evacuations very ill. And indeed the disease seems often to be more of a putrid than of an inflammatory nature.

THOUGH this fever is often occasioned in chilldbed-wormen by too hot a regimen, yet it would be dangerous to leave that off all of a sudden, and have recourse to a very cool regimen, and large evacuations. We have reason to believe, that supporting the patient's spirits, and promoting the natural evacuations, is here much safer than to have recourse to artificial ones; as these, by sinking the spirits, seldom fail to increase the danger.

IF the disease proves tedious or the recovery slow, we would recommend the Peruvian bark, which may either be taken in substance, or infused in wine or water, as the patient inclines.

THE miliary fever, like other eruptive diseases, requires gentle purging, which should not be neglected, as soon as the fever is gone off, and the patient's strength will permit.

TO avoid this disease, a pure dry air, sufficient exercise, and wholesome food, are necessary. Pregnant women should guard against costiveness, and take daily as much exercise as they can bear, avoiding all green trashy fruits, and other unwholesome things; and when in childbed, they ought strictly to observe a cool regimen.

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