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DOMESTIC MEDICINE

CHAP. XXII.

OF THE REMITTING FEVER.

THIS fever takes its name from a remission of the symptoms, which happens sometimes sooner, and sometimes later, but commonly before the eighth day. The remission is generally preeceded by a gentle sweat, after which the patient seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometimes of longer, sometimes of shorter duration; the nearer however that the fever approaches to a regular intermittent, the danger is less.

CAUSES. - Remitting fevers prevail in low marshy countries abounding with wood and stagnated water; but they prove most fatal in places where great heat and moisture are combined, as in some parts of Africa, the province of Bengal in the East Indies, &c. where remitting fevers are generally of a putrid kind, and prove very fatal. They are most frequently in close calm weather, especially after rainy seasons, great inundations, and the like.

NO age, sex, or constitution is exempted from the attack of this fever; but it chiefly seizes persons of a relaxed habit, who live in low dirty habitations, breathe an impure stagnating air, take little exercise, and unwholesome diet.

SYMPTOMS. - The first symptoms of this fever are generally yawning, stretching, pain, and giddiness in the head, with alternate fits of heat and cold. Sometimes the patient is affected with a dilirium at the very first attack. There is a pain, and sometimes a swelling, about the region of the stomach, the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is sometimes a little hard, but seldom full, and the blood, when let, rarely shews any signs of inflammation. Some patients are exceedingly costive, and others afflicted with a very troublesome looseness.

IT is impossible to describe all the symptoms of this disease, as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be changed by the method of treatment, and by many other circumstances too tedious to mention. Sometimes the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them, at the same time, in the same person.

REGIMEN. - The regimen must be adapted to the prevailing symptoms. When there are any signs of inflammation, the diet must be slender, and the drink weak and diluting. But when nervous or putrid symptoms occur, it will be necessary to support the patient with food and liquors of a more generous nature, such as are recommended in the immediately preceding fevers. We must however be very cautious in the use of things of a heating quality as this fever is frequently changed into a continual by an hot regimen, and improper medicines.

WHATEVER the symptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if possible, should be large, and frequently ventilated by letting in fresh air at the doors or windows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His llnen, bed-clothes, &c. should be frequently changed, and all his excrements immediately removed. Though these things have been recommended before, we think it necessary to repeat them here, as they are of more importance to the sick than practitioners are apt to imagine. The ingenious Dr. Lind of Edinburgh, in his inaugural dissertation concerning the putrid remitting fever of Bengal, has the following observation: "Indusia, lodices, ac strangula, saepius sunt mutanda, ac aeri exponenda; foeces fordesque quam primum removendae; oportet etiam ut loca quibus aegri decumbunt sint salubria, et aceto conspersa; denique ut aegris cura quanta maxima prospiciatur. Compertum ego habeo, medicum haec sedulo observantem, quique ea exequi potest, multo magis aegris pro futurum, quam medicum peritiorem hisce commodis destitutum." - "The patient's shirt, bed-clothes, and bedding, ought frequently to be changed, and exposed the air, and all his excretions immediately removed; the bed-chamber should be well ventilated, and frequently sprinkled with vinegar; in short, every attention should be paid to the patient. I can affirm, that a physician who puts these in practice will much oftener succeed than one who is even more skillful, but has not opportunity of using these means."

MEDICINE. - In order ot cure this fever, we must endeavor to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation; but when this is not the case, bleeding ought by no means to be attempted, as it will weaken the patient, and prolong the disease. A vomit however will seldom be improper, and is generally of great service. Twenty or thirty grains of ipecacuanha will answer this purpose very well; but, where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be repeated once or twice at proper intervals, if the sickness or nausea continues.

THE body ought to kept open either by clysters or gentle laxatives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like; but all strong or drastic purgatives are to be carefully avoided.

BY this course the fever in a few days may generally be brought to a pretty regular or distinct intermission, in which case, the Peruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the bark, as we have already had occasion frequently to mention them.

THE most likely way avoid this fever is to use a wholesome and nourishing diet, to pay the most scrupulous regard to cleanliness, to keep the body warm, to take sufficient exercise, and in hot countries to avoid damp situations, night air, evening dews, and the like. In countries where it is endemical, the best preventive medicine which we can recommend, is the Peruvian bark, which may either be chewed or infused in brandy or wine &c. Some recommend smoking tobacco as very beneficial in marshy countries, both for the prevention of this and in intermitting fevers.

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