As this disease affects an organ which is absolutely necessary to life, it must always be attended with danger. Persons who abound with thick blood, whose fibres are tense and rigid, who feed upon gross aliment, and drink strong viscid liquors, are most liable to a peripneumony. It is generally fatal to those who have a flat breast, or narrow chest, and to such as are afflicted with an asthma, especially in the decline of life. Sometimes the inflammation reaches to one lobe of the lungs only, at other times the whole of the organ is affected; in which case the disease can hardly fail to prove fatal.
When the disease proceeds from a viscid pituitous matter obstructing the vessels of the lungs, it is called a spurious or bastard peripneumony. When it arises from a thin acrid defluxion on the lungs, it is denominated a catarrhal peripneumony, &c.
CAUSES.——An inflammation of the lungs is sometimes a primary disease, and sometimes it is the consequence of other diseases, as a quinsey, a pleurisy, &c. It proceeds from the same causes as the pleurisy, viz. an obstructed perspiration from cold, wet clothes, &c. or from an increased circulation of the blood by violent exercise, the use of spiceries, ardent spirits, and such like. The pleurisy and peripneumony are often complicated; in which case the disease is called a pleuro-peripneumony.
SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an inflammation of the lungs; only in the latter the pulse is more soft, and the pain less acute; but the difficulty of breathing, and oppression of the breast, are generally greater.
REGIMEN.——As the regimen and medicine are in all respects the same in the true peripneumony as in the pleurisy, we shall not here repeat them, but refer the reader to the treatment of that disease. It may not however be improper to add, that the aliment ought to be more slender and thin in this than in any other inflammatory disease. The learned Dr. Arbuthnot asserts, that even common whey is sufficient to support the patient, and that decoctions of barley, and infusions of fennel roots in warm water with milk, are the most proper both for drink and nourishment. He likewise recommends the steam of warm water taken in by the breath, which serves as a kind of internal fomentation, and helps to attenuate the impacted humours. If the patient has loose stools, but is not weakened by them, they are not to be stopped, but rather promoted by the use of emollient clysters.
It has already been observed, that the spurious or bastard peripneumony is occasioned by a viscid pituitous matter obstructing the vessels of the lungs. It commonly attacks the old, infirm, and phlegmatic, in winter and wet seasons.
The patient at the beginning is cold and hot by turns, has a small quick pulse, feels sense of weight upon his breast, breathes with difficulty, and sometimes complains of a pain and giddiness of his head. His urine is usually pale, and his colour very little changed.
The diet in this, as well as in the true peripneumony, must be very slender, as weak broths, sharpened with the juice of orange or lemon, and such like. His drink may be thin water-gruel sweetened with honey, or a decoction of the roots of fennel, liquorice, and quick grass. An ounce of each of these may be boiled in three English pints of water to a quart, and sharpened with a little currant-jelly, or the like.
Bleeding and purging are generally proper at the beginning of this disease; but if the patient’s spittle is pretty thick, or well concocted, neither of them are necessary. It will be sufficient to assist the expectoration by some of the sharp medicines recommended for that purpose in the pleurisy, as the solution of gum ammoniac with oxymel of squills, &c. Blistering plasters have generally a good effect, and ought to be applied pretty early.
If the patient does not spit, he must be bled according as his strength will permit, and have a gentle purge administered. Afterwards his body may be kept open by clysters, and the expectoration promoted, by taking every four hours two table-spoonfuls of the solution mentioned above.
When an inflammation of the breast does not yield to bleeding, blistering, and other evacuations, it commonly ends in a suppuration, which is more or less dangerous, according to the part where it is situated. When this happens in the pleura, it sometimes breaks outwardly, and the matter is discharged by the wound.
When the suppuration happens within the substance or body of the lungs, the matter may be discharged by expectoration; but if the matter floats in the cavity of the breast, between the pleura and the lungs, it can only be discharged by an incision made betwixt the ribs.
If the patient’s strength does not return after the inflammation is to all appearance removed; if his pulse continues quick though soft, his breathing difficult and oppressed; if he has cold shiverings at times, his cheeks flushed, his lips dry; and if he complains of thirst, and want of appetite, there is reason to fear a suppuration, and that a phthisis or consumption of the lungs will ensue. We shall therefore next proceed to consider the proper treatment of that disease.
A consumption is a wasting or decay of the whole body from an ulcer, tubercles, or concretions of the lungs, an empyema, a nervous atrophy, or a cachexy.
Dr. Arbuthnot observes, that in his time consumptions made up above one-tenth part of the bills of mortality in and about London. There is reason to believe they have rather increased since, and we know from experience, that they are not less fatal in some other towns of England than in London.
Young persons, between the age of fifteen and thirty, of a slender make, long neck, high shoulders, and flat breasts, are most liable to this disease.
Consumptions prevail more in England than in any other part of the world, owing perhaps to the great use of animal food and malt liquors, the general application to sedentary employments, and the great quantity of pit-coal which is there burnt; to which we may add the perpetual changes in the atmosphere, or variableness of the weather.
CAUSES.——It has already been observed, that an inflammation of the breast often ends in an imposthume: consequently whatever disposes people to this disease, must likewise be considered as a cause of consumption.
Other diseases, by vitiating the habit, may likewise occasion consumptions; as the scurvy, the scrophula, or king’s evil, the venereal disease, the asthma, small-pox, measles, &c.
As this disease is seldom cured, we shall endeavour the more particularly to point out its causes, in order that people may be enabled to avoid it. These are:
——Confined or unwholesome air. When this fluid is impregnated with the fumes of metals or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender vessels of that necessary organ.
——Violent passions, exertions, or affections of the mind; as grief, disappointment, anxiety, or close application to the study of abstruse arts or sciences.
——Great evacuations; as sweating, diarrhœas, diabetes, excessive venery, the fluor albus, an over-discharge of the menstrual flux, giving suck too long, &c.
——The sudden stoppage of customary evacuations; as the bleeding piles, sweating of the feet, bleeding at the nose, the menses, issues, ulcers, or eruptions of any kind.
——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of a phthisis occasioned by a small bone sticking in the bronchæ. It was afterwards vomited along with a considerable quantity of purulent matter, and the patient, by a proper regimen, and the use of the Peruvian bark, recovered.
——Making a sudden transition from a hot to a very cold climate, change of apparel, or whatever greatly lessens the perspiration.
——Frequent and excessive debaucheries. Late watching, and drinking strong liquors, which generally go together, can hardly fail to destroy the lungs. Hence the bon companion generally falls a sacrifice to this disease.
——Infection. Consumptions are likewise caught by sleeping with the diseased; for which reason this should be carefully avoided. It cannot be of great benefit to the sick, and must hurt those in health.
——Occupations in life. Those artificers who sit much, and are constantly leaning forward, or pressing upon the stomach and breast, as cutlers, taylors, shoemakers, seamstresses, &c. often die of consumptions. They likewise prove fatal to singers, and all who have occasion to make frequent and violent exertions of the lungs.
——Cold. More consumptive patients date the beginning of their disorders from wet feet, damp beds, night air, wet clothes, or catching cold after the body had been heated, than from all other causes.
Sharp, saline, and aromatic aliments, which heat and inflame the blood, are likewise frequently the cause of consumptions.
We shall only add, that this disease is often owing to an hereditary taint, or a scrophulous habit; in which case it is generally incurable.
SYMPTOMS.——This disease generally begins with a dry cough, which often continues for some months. If a disposition to vomit after eating be excited by it, there is still greater reason to fear an approaching consumption. The patient complains of a more than usual degree of heat, a pain and oppression of the breast, especially after motion; his spittle is of a saltish taste, and sometimes mixed with blood. He is apt to be sad; his appetite is bad, and his thirst great. There is generally a quick, soft, small pulse; though sometimes the pulse is pretty full, and rather hard. These are the common symptoms of a beginning consumption.
Afterwards the patient begins to spit a greenish, white, or bloody matter. His body is extenuated by the hectic fever, and colliquative sweats, which mutually succeed one another, viz. the one towards night, and the other in the morning. A looseness, and an excessive discharge of urine, are often troublesome symptoms at this time, and greatly weaken the patient. There is a burning heat in the palms of the hands, and the face generally flushes after eating; the fingers become remarkably small, the nails are bent inwards, and the hairs fall off.
At last the swelling of the feet and legs, the total loss of strength, the sinking of the eyes, the difficulty of swallowing, and the coldness of the extremities, shew the immediate approach of death, which however the patient seldom believes to be so near. Such is the usual progress of this fatal disease, which, if not early checked, commonly sets all medicine at defiance.
REGIMEN.——On the first appearance of a consumption, if the patient lives in a large town, or any place where the air is confined, he ought immediately to quit it, and to make choice of a situation in the country, where the air is pure and free. Here he must not remain inactive, but take every day as much exercise as he can bear.
The best method of taking exercise is to ride on horseback, as this gives the body a great deal of motion without much fatigue. Such as cannot bear this kind of exercise, must make use of a carriage. A long journey, as it amuses the mind by a continual change of objects, is greatly preferable to riding the same ground over and over. Care however must be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought always to finish his ride in the morning, or at least before dinner; otherwise it will oftener do harm than good.
It is pity those who attend the sick seldom recommend riding in this disease, till the patient is either unable to bear it, or the malady has become incurable. Patients are likewise apt to trifle with everything that is in their own power. They cannot see how one of the common actions of life should prove a remedy in an obstinate disease, and therefore they reject it, while they greedily hunt after relief from medicine, merely because they do not understand it.
Those who have strength and courage to undertake a pretty long voyage, may expect great advantage from it. This, to my knowledge, has frequently cured a consumption after the patient was, to all appearance, far advanced in that disease, and where medicine had proved ineffectual. Hence it is reasonable to conclude, that if a voyage were undertaken in due time, it would seldom fail to perform a cure[72].
Such as try this method of cure ought to carry as much fresh provisions along with them as will serve for the whole time they are at sea. As milk is not easily obtained in this situation, they ought to live upon fruits, and the broth of chickens, or other young animals which can be kept alive on board. It is scarce necessary to add, that such voyages should be undertaken, if possible, in the mildest season, and that they ought to be towards a warmer climate[73].
Those who have not courage for a long voyage may travel into a more southern climate, as the south of France, Spain, or Portugal; and if they find the air of these countries agree with them, they should continue there, at least till their health be confirmed.
Next to proper air and exercise, we would recommend a due attention to diet. The patient should eat nothing that is either heating or hard of digestion, and his drink must be of a soft and cooling nature. All the diet ought to be calculated to lessen the acrimony of the humours, and to nourish and support the patient. For this purpose he must keep chiefly to the use of vegetables and milk. Milk alone is of more value in this disease than the whole materia medica.
Asses milk is commonly reckoned preferable to any other; but it cannot always be obtained; besides, it is generally taken in a very small quantity; whereas, to produce any effects, it ought to make a considerable part of the patient’s diet. It is hardly to be expected, that a gill or two of asses milk, drank in the space of twenty-four hours, should be able to produce any considerable change in the humours of an adult; and when people do not perceive its effects soon, they lose hope, and so leave it off. Hence it happens that this medicine, however valuable, very seldom performs a cure. The reason is obvious; it is commonly used too late, is taken in too small quantities, and is not duly persisted in.
I have known very extraordinary effects from asses milk in obstinate coughs, which threatened a consumption of the lungs; and do verily believe, if used at this period, that it would seldom fail; But if it be delayed till an ulcer is formed, which is generally the case, how can it be expected to succeed?
Asses milk ought to be drank, if possible, in its natural warmth, and, by a grown person, in the quantity of half an English pint at a time. Instead of taking this quantity night and morning only, the patient ought to take it four times, or at least thrice a-day, and to eat a little light bread along with it, so as to make it a kind of meal.
If the milk should happen to purge, it may be mixed with old conserve of roses. When that cannot be obtained, the powder of crabs claws may be used in its stead. Asses milk is usually ordered to be drank warm in bed; but as it generally throws the patient in a sweat when taken in this way, it would perhaps be better to give it after he rises.
Some extraordinary cures in consumptive cases have been performed by women’s milk. Could this be obtained in sufficient quantity, we would recommend it in preference to any other. It is better if the patient can suck it from the breast, than to drink it afterwards. I knew a man who was reduced to such a degree of weakness in a consumption, as not to be able to turn himself in bed. His wife was at that time giving suck, and the child happening to die, he sucked her breasts, not with a view to reap any advantage from the milk, but to make her easy. Finding himself however greatly benefited by it, he continued to suck her till he became perfectly well, and is at present a strong and healthy man.
Some prefer butter-milk to any other, and it is indeed a very valuable medicine, if the stomach be able to bear it. It does not agree with every person at first; and is therefore often laid aside without a sufficient trial. It should at first be taken sparingly, and the quantity gradually increased, until it comes to be almost the sole food. I never knew it succeed unless where the patient almost lived upon it.
Cows milk is most readily obtained of any, and though it be not so easily digested as that of asses or mares, it may be rendered lighter by adding to it an equal quantity of barley-water, or allowing it to stand for some hours, and afterwards taking off the cream. If it should notwithstanding prove heavy on the stomach, a small quantity of brandy or rum, with a little sugar, may be added, which will render it both more light and nourishing.
It is not to be wondered, that milk should for some time disagree with a stomach that has not been accustomed to digest any thing but flesh and strong liquors, which is the case with many of those who fall into consumptions. We do not however advise those have been accustomed to animal food and strong liquors, to leave them off all at once. This might be dangerous. It will be necessary for such to eat a little once a-day of the flesh of some young animal, or rather to use the broth made of chickens, veal, lamb, or such like. They ought likewise to drink a little wine made into negus, or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether.
These must be used only as preparatives to a diet consisting chiefly of milk and vegetables, which the sooner the patient can be brought to bear, the better. Rice and milk, or barley and milk, boiled with a little sugar, is very proper food. Ripe fruits roasted, baked, or boiled, are likewise proper, as goose or currant berry tarts, apples roasted, or boiled in milk, &c. The jellies, conserves, and preserves, &c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly of currants, conserve of roses, preserved plums, cherries, &c.
Wholesome air, proper exercise, and a diet consisting chiefly of these and other vegetables, with milk, is the only course that can be depended on in a beginning consumption. If the patient has strength and sufficient resolution to persist in this course, he will seldom be disappointed of a cure.
In a populous town in England[74], where consumptions are very common, I have frequently seen consumptive patients, who had been sent to the country with orders to ride, and live upon milk and vegetables, return in a few months quite plump, and free from any complaint. This indeed was not always the case, especially when the disease was hereditary, or far advanced; but it was the only method in which success was to be expected: where it failed, I never knew medicine succeed.
If the patient’s strength and spirits flag, he must be supported by strong broths, jellies, and such like. Some recommend shell-fish in this disorder, and with some reason, as they are nourishing and restorative[75]. All the food and drink ought however to be taken in small quantities, lest an overcharge of fresh chyle should oppress the lungs, and too much accelerate the circulation of the blood.
The patient’s mind ought to be kept as easy and cheerful as possible. Consumptions are often occasioned, and always aggravated, by a melancholy cast of mind; for which reason music, cheerful company, and every thing that inspires mirth, are highly beneficial. The patient ought seldom to be left alone, as brooding over his calamities is sure to render them worse.
MEDICINE.——Though the cure of this disease depends chiefly upon regimen and the patient’s own endeavours, yet we shall mention a few things which may be of service in relieving some of the more violent symptoms.
In the first stage of a consumption, the cough may sometimes be appeased by bleeding; and the expectoration may be promoted by the following medicines. Take fresh squills, gum-ammoniac, and powdered cardamum seeds, of each a quarter of an ounce; beat them together in a mortar, and if the mass proves too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a-day, according as the patient’s stomach will bear them.
The lac ammoniacum, or milk of gum-ammoniac, as it is called, is likewise a proper medicine in this stage of the disease. It may be used as directed in the pleurisy.
A mixture made of equal parts of lemon-juice, fine honey, and syrup of poppies, may likewise be used. Four ounces of each of these may be simmered together in a sauce-pan, over a gentle fire, and a table-spoonful of it taken at any time when the cough is troublesome.
It is common in this stage of the disease to load the patient’s stomach with oily and balsamic medicines. These, instead of removing the cause of the disease, tend rather to increase it, by heating the blood, while they pall the appetite, relax the solids, and prove every way hurtful to the patient. Whatever is used for removing the cough, besides riding and other proper regimen, ought to be medicines of a sharp and cleaning nature; as oxymel, syrup of lemon, &c.
Acids seem to have peculiarly good effects in this disease; they both tend to quench the patient’s thirst and to cool the blood. The vegetable acids, as apples, oranges, lemons, &c. appear to be the most proper. I have known patients suck the juice of several lemons every day with manifest advantage, and would for this reason recommend acid vegetables to be taken in as great quantity as the stomach will bear them.
For the patient’s drink, we would recommend infusions of the bitter plants, as ground-ivy, the lesser centaury, camomile flowers, or water-trefoil. These infusions may be drank at pleasure. They strengthen the stomach, promote digestion, rectify the blood, and at the same time answer all the purposes of dilution, and quench thirst much better than things that are luscious or sweet. But if the patient spits blood, he ought to use, for his ordinary drink, infusions or decoctions of the vulnerary roots, plants, &c.[76]
There are many other mucilaginous plants and seeds, of a healing and agglutinating nature, from which decoctions or infusions may be prepared with the same intention; as the orches, the quince-seed, coltsfoot, linseed, sasaparilla, &c. It is not necessary to mention the different ways in which these may be prepared. Simple infusion or boiling is all that is necessary, and the dose may be at discretion.
The conserve of roses is here peculiarly proper. It may either be put into the decoction above prescribed, or eaten by itself. No benefit is to be expected from trifling doses of this medicine. I never knew it of any service, unless where three or four ounces at least were used daily for a considerable time. In this way I have seen it produce very happy effects, and would recommend it wherever there is a discharge of blood from the lungs.
When the spitting up of gross matter, oppression of the breast, and the hectic symptoms, shew that an imposthume is formed in the lungs, we would recommend the Peruvian bark, that being the only drug which has any chance to counteract the general tendency which the humours then have to putrefaction.
An ounce of the bark in powder may be divided into eighteen or twenty doses, of which one may be taken every three hours through the day, in a little syrup, or a cup of horehound tea.
If the bark should happen to purge, it may be made into an electuary, with the conserve of roses, thus: Take old conserve of roses a quarter of a pound, Peruvian bark in powder an ounce, syrup of orange or lemon, as much as will make it of the consistence of honey. This quantity will serve the patient four or five days, and may be repeated as there is occasion.
Such as cannot take the bark in substance, may infuse it in cold water. This seems to be the best menstruum for extracting the virtues of that drug. Half an ounce of bark in powder may be infused for twenty-four hours in half an English pint of water. Afterwards let it be passed through a fine strainer, and an ordinary tea-cupful of it taken three or four times a-day.
We would not recommend the bark while there are any symptoms of an inflammation of the breast; but when it is certainly known that matter is collected there, it is one of the best medicines which can be used. Few patients indeed have resolution enough to give the bark a fair trial at this period of the disease, otherwise we have reason to believe that some benefit might be reaped from it.
When it is evident that there is an imposthume in the breast, and the matter can neither be spit up nor carried off by absorption, the patient must endeavour to make it break inwardly, by drawing in the steams of warm water or vinegar with his breath, coughing, laughing, or bawling aloud, &c. When it happens to burst within the lungs, the matter may be discharged by the mouth. Sometimes indeed the bursting of the vomica occasions immediate death, by suffocating the patient. When the quantity of matter is great, and the patient’s strength exhausted, this is commonly the case. At any rate the patient is ready to fall into a swoon, and should have volatile salts or spirits held to his nose.
If the matter discharged be thick, and the cough and breathing become easier, there may be some hopes of a cure. The diet at this time ought to be light, but restorative, as chicken-broths, sago-gruel, rice-milk, &c. the drink, butter-milk, or whey, sweetened with honey. This is likewise a proper time for using the Peruvian bark, which may be taken as directed above.
If the vomica or imposthume should discharge itself into the cavity of the breast, betwixt the pleura and the lungs, there is no way of getting the matter out but by an incision, as has already been observed. As this operation must always be performed by a surgeon, it is not necessary here to describe it. We shall only add, that it is not so dreadful as people are apt to imagine, and that it is the only chance the patient in this case has for his life.
A nervous consumption is a wasting or decay of the whole body, without any considerable degree of fever, cough, or difficulty of breathing. It is attended with indigestion, weakness, and want of appetite, &c.
Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease.
We would chiefly recommend, for the cure of a nervous consumption, a light and nourishing diet, plenty of exercise in a free open air, and the use of such bitters as brace and strengthen the stomach; as the Peruvian bark, gentian root, camomile, horehound, &c. These may be infused in water or wine, and a glass of it drank frequently.
It will greatly assist the digestion, and promote the cure of this disease, to take twice-a-day twenty or thirty drops of the elixir of vitriol in a glass of wine or water. The chalybeate wine is likewise an excellent medicine in this case. It strengthens the solids, and powerfully assists Nature in the preparation of good blood[77].
Agreeable amusements, cheerful company, and riding about, are however preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recommend a long journey of pleasure, as the most likely means to restore his health.
What is called a symptomatic consumption cannot be cured without first removing the disease by which it is occasioned. Thus, when a consumption proceeds from, the scrophula or king’s evil, from the scurvy, the asthma, the venereal disease, &c. a due attention must be paid to the malady from whence it arises, and the regimen and medicine directed accordingly.
When excessive evacuations of any kind occasion a consumption, they must not only be restrained, but the patient’s strength must be restored by gentle exercise, nourishing diet, and generous cordials. Young and delicate mothers often fall into consumptions, by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immediately to wean the child, or provide another nurse, otherwise they cannot expect a cure.
Before we quit this subject, we would earnestly recommend it to all, as they wish to avoid consumptions, to take as much exercise without doors as they can, to avoid unwholesome air, and to study sobriety. Consumptions owe their present increase not a little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of hot punch or other strong liquors. These liquors, when too freely used, not only hurt the digestion, and spoil the appetite, but heat and inflame the blood, and set the whole constitution on fire.
Nervous fevers have increased greatly of late years in this island, owing doubtless to our different manner of living, and the increase of sedentary employments; as they commonly attack persons of a weak relaxed habit, who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors.
CAUSES.——Nervous fevers may be occasioned by whatever depresses the spirits, or impoverishes the blood; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, unripe fruits, cucumbers, melons, mushrooms, &c. They may likewise be occasioned by damp, confined, or unwholesome air. Hence they are very common in rainy seasons, and prove most fatal to those who live in dirty low houses, crowded streets, hospitals, jails, or such-like places.
Persons whose constitutions have been broken by excessive venery, frequent salivations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease.
Keeping on wet clothes, lying on the damp ground, excessive fatigue, and whatever obstructs the perspiration, or causes a spasmodic stricture of the solids, may likewise occasion nervous fevers. We shall only add, frequent and great irregularities in diet. Too great abstinence, as well as excess, is hurtful. Nothing tends so much to preserve the body in a sound state as a regular diet; nor can any thing contribute more to occasion fevers of the worst kind than its opposite.
SYMPTOMS.——Low spirits, want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue without any considerable thirst, chillness and flushing in turns, &c.
After some time the patient complains of a giddiness and pain of the head, has a nausea, with reachings and vomiting; the pulse is quick, and sometimes intermitting; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienations of mind.
If towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moisture upon the skin; or if a suppuration happens in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favourable crisis.
But if there is an excessive looseness, or wasting sweats, with frequent fainting fits; if the tongue, when put out, trembles excessively, and the extremities feel cold, with a fluttering or slow creeping pulse; if there is a starting of the tendons, an almost total loss of sight and hearing, and an involuntary discharge by stool and urine, there is great reason to fear that death is approaching.
REGIMEN.——It is very necessary in this disease to keep the patient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not only to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient’s imagination gloomy or frightful ideas. These of themselves often occasion nervous fevers, and it is not to be doubted but they will likewise aggravate them.
The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panado, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or small negus, sharpened with the juice of orange or lemon, will be proper for his ordinary drink. Mustard-whey is likewise a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a proper quantity of white-wine[78].
Wine in this disease, if it could be obtained genuine, is almost the only medicine that would be necessary. Good wine possesses all the virtues of the cordial medicines, while it is free from many of their bad qualities. I say good wine; for however common this article of luxury is now become, it is rarely to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities.
I have often seen patients in low nervous fevers where the pulse could hardly be felt, with a constant delirium, coldness of the extremities, and almost every other mortal symptom, recover by using in whey, gruel, and negus, a bottle or two of strong wine every day. Good old sound claret is the best, and may be made into negus, or given by itself, as circumstances require.
In a word, the great aim in this disease is to support the patient’s strength, by giving him frequently small quantities of the above, or other drinks of a warm and cordial nature. He is not however to be overheated either with liquor or clothes; and his food ought to be light, and given in small quantities.
MEDICINE.——Where a nausea, load, and sickness at stomach, prevail at the beginning of the fever, it will be necessary to give the patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few spoonfuls of the vomiting julep[79], will generally answer this purpose very well. This may be repeated any time before the third or fourth day, if the above symptoms continue. Vomits not only clean the stomach, but, by the general shock which they give, promote the perspiration, and have many other excellent effects in slow fevers, where there are no signs of inflammation, and nature wants rousing.
Such as dare not venture upon a vomit, may clean the bowels by a small dose of Turkey rhubarb, or an infusion of senna and manna.
In all fevers, the great point is to regulate the symptoms, so as to prevent them from going to either extreme. Thus, in fevers of the inflammatory kind, where the force of the circulation is too great, or the blood dense, and the fibres too rigid, bleeding and other evacuations are necessary. But in nervous fevers, where nature flags, where the blood is vapid and poor, and the solids relaxed, the lancet must be spared, and wine, with other cordials, plentifully administered.
It is the more necessary to caution people against bleeding in this disease, as there is generally at the beginning an universal stricture upon the vessels, and sometimes an oppression and difficulty of breathing, which suggest the idea of a plethora, or too great a quantity of blood. I have known even some of the faculty deceived by their own feelings in this respect, so far as to insist upon being bled, when it was evident from the consequences that the operation was improper.
Though bleeding is generally improper in this disease, yet blistering is highly necessary. Blistering-plasters may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be blistered on the neck or head, and it will be the safest course, when the insensibility continues, as soon as the discharge occasioned by one blistering-plaster abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of danger.
I have been more sensible of the advantage of blistering in this than in any other disease. Blistering-plasters not only stimulate the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacuations, which seldom happen in this kind of fever. They are most proper, however, either towards the beginning, or after some degree of stupor has come on, in which last case it will always be proper to blister the head.
If the patient is costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoonful of common salt, if the above does not operate.
Should a violent looseness come on, it may be checked by small quantities of Venice treacle, or giving the patient for his ordinary drink the white decoction[80].
A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature’s operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen; but the patient should be supported by gentle cordials, as wine-whey, small negus, sago-gruel with a little wine in it, and such like. He ought not to be kept too warm; yet a kindly breathing sweat should by no means be checked.
Though blistering and the use of cordial liquors are the chief things to be depended on in this kind of fever; yet, for those who may chuse to use them, we shall mention one or two of the forms of medicine which are commonly prescribed in it[81].
In desperate cases, where the hiccup and starting of the tendons have already come on, we have sometimes seen extraordinary effects from large doses of musk frequently repeated. Musk is doubtless an antispasmodic, and may be given to the quantity of a scruple three or four times a-day, or oftener if necessary. Sometimes it may be proper to add to the musk a few grains of camphire, and salt of hartshorn, as these tend to promote perspiration and the discharge of urine. Thus fifteen grains of musk, with three grains of camphire, and six grains of salt of hartshorn, may be made into a bolus with a little syrup, and given as above.
If the fever should happen to intermit, which it frequently does towards the decline, or if the patient’s strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the stomach will bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. Should the bark in substance not sit easy on the stomach, an ounce of it in powder may be infused in a bottle of Lisbon or Rhenish wine for two or three days, afterwards it may be strained, and a glass of it taken frequently[82].
Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remission or intermission of the fever. How far future observations may tend to establish this practice, we will not pretend to say; but we have reason to believe that the bark is a very universal febrifuge, and that it may be administered with advantage in most fevers where bleeding is not necessary, or where there are no symptoms of topical inflammation.
This may be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful disease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been wasted by long fasting, watching, hard labour, excessive venery, frequent salivations, &c. are most liable to it.
CAUSES.——This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly ventilated; from putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails, hospitals and infirmaries, especially where such places are too much crowded, and cleanliness is neglected.
A close constitution of the air, with long rainy or foggy weather, likewise occasions putrid fevers. They often succeed great inundations in low and marshy countries, especially when these are preceded or followed by a hot and sultry season.
Living too much upon animal food, without a proper mixture of vegetables, or eating fish or flesh that has been kept too long, are likewise apt to occasion this kind of fever. Hence sailors on long voyages, and the inhabitants of besieged cities, are very often visited with putrid fevers.
Corn that has been greatly damaged by rainy seasons, or long keeping, and water which has become putrid by stagnation, &c. may likewise occasion this fever.
Dead carcases tainting the air, especially in hot seasons, are very apt to occasion putrid diseases. Hence this kind of fever often prevails in countries which are the scenes of war and bloodshed. This shews the propriety of removing burying grounds, slaughterhouses, &c. at a proper distance from great towns.
Want of cleanliness is a very general cause of putrid fevers. Hence they prevail amongst the poor inhabitants of large towns, who breathe a confined unwholesome air, and neglect cleanliness. Such mechanics as carry on dirty employments, and are constantly confined within doors, are likewise very liable to this disease.
We shall only add, that putrid, malignant, or spotted fevers, are highly infectious, and are therefore often communicated by contagion. For which reason all persons ought to keep at a distance from those affected with such diseases, unless their attendance is absolutely necessary.
SYMPTOMS.——The malignant fever is generally preceded by a remarkable weakness or loss of strength, without any apparent cause. This is sometimes so great, that the patient can scarce walk, or even sit upright, without being in danger of fainting away. His mind too is greatly dejected; he sighs, and is full of dreadful apprehensions.
There is a nausea, and sometimes a vomiting of bile; a violent pain of the head, with a strong pulsation or throbbing of the temporal arteries; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noise in the ears, the breathing is laborious, and often interrupted with a sigh; the patient complains of a pain about the region of the stomach, and in his back and loins; his tongue is at first white, but afterwards it appears black and chaped; and his teeth are covered with a black crust. He sometimes passes worms both upwards and downwards, is affected with tremors or shaking, and often becomes delirious.
If blood is let, it appears dissolved, or with a very small degree of cohesion, and soon becomes putrid; the stools smell extremely fœtid, and are sometimes of a greenish, black, or reddish cast. Spots of a pale purple, dun, or black colour, often appear upon the skin, and sometimes there are violent hæmorrhages, or discharges of blood from the mouth, eyes, nose, &c.
Putrid fevers may be distinguished from the inflammatory, by the smallness of the pulse, the great dejection of mind, the dissolved state of the blood, the petechiæ, or purple spots, and the putrid smell of the excrements. They may likewise be distinguished from the low or nervous fever by the heat and thirst being greater, the urine of a higher colour, and the loss of strength, dejection of mind, and all the other symptoms more violent.
It sometimes happens, however, that the inflammatory, nervous, and putrid symptoms are so blended together, as to render it very difficult to determine to which class the fever belongs. In this case the greatest caution and skill are requisite. Attention must be paid to those symptoms which are most prevalent, and both the regimen and medicines adapted to them.
Inflammatory and nervous fevers may be converted into malignant and putrid, by too hot a regimen or improper medicines.
The duration of putrid fevers is extremely uncertain; sometimes they terminate between the seventh and fourteenth day, and at other times they are prolonged for five or six weeks. Their duration depends greatly upon the constitution of the patient, and the manner of treating the disease.
The most favourable symptoms are, a gentle looseness after the fourth or fifth day, with a warm mild sweat. These, when continued for a considerable time, often carry off the fever, and should never be imprudently stopped. Small miliary pustules appearing between the petechiæ or purple spots are likewise favourable, as also hot scabby eruptions about the mouth and nose. It is a good sign when the pulse rises upon the use of wine, or other cordials, and the nervous symptoms abate; deafness coming on towards the decline of the fever, is likewise often a favourable symptom[83], as are abscesses in the groin or parotid glands.
Among the unfavourable symptoms may be reckoned an excessive looseness, with a hard swelled belly; large black or livid blotches breaking out upon the skin; apthæ in the mouth; cold clammy sweats; blindness; change of the voice; a wild flaring of the eyes; difficulty of swallowing; inability to put out the tongue; and a constant inclination to uncover the breast. When the sweat and saliva are tinged with blood, and the urine is black, or deposits a black sooty sediment, the patient is in great danger. Starting of the tendons, and fœtid, ichorous, involuntary stools, attended with coldness of the extremities, are generally the forerunners of death.
REGIMEN.——In the treatment of this disease we ought to endeavour as far as possible to counteract the putrid tendency of the humours; to support the patient’s strength and spirits; and to assist Nature in expelling the cause of this disease, by gently promoting perspiration and the other evacuations.
It has been observed, that putrid fevers are often occasioned by unwholesome air, and of course they must be aggravated by it. Care should therefore be taken to prevent the air from stagnating in the patient’s chamber, to keep it cool, and renew it frequently, by opening the doors or windows of some adjacent apartment. The breath and perspiration of persons in perfect health soon render the air of a small apartment noxious; but this will sooner happen from the perspiration and breath of a person whose whole mass of humours are in a putrid state.
Besides the frequent admission of fresh air, we would recommend the use of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be most readily obtained. These ought frequently to be sprinkled upon the floor, the bed, and every part of the room. They may also be evaporated with a hot iron, or by boiling, &c. The fresh skins of lemons or oranges ought likewise to be laid in different parts of the room, and they should be frequently held to the patient’s nose. The use of acids in this manner would not only prove very refreshing to the patient, but would likewise tend to prevent the infection from spreading among those who attend him. Strong scented herbs, as rue, tansy, rosemary, wormwood, &c. may likewise be laid in different parts of the house, and smelled to by those who go near the patient.
The patient must not only be kept cool, but likewise quiet and easy. The least noise will affect his head, and the smallest fatigue will be apt to make him faint.
Few things are of greater importance in this disease than acids, which ought to be mixed with all the patient’s food as well as drink. Orange, lemon, or vinegar whey, are all very proper, and may be drank by turns, according to the patient’s inclination. They may be rendered cordial by the addition of wine in such quantity as the patient’s strength seems to require. When he is very low, he may drink negus, with only one half water, and sharpened with the juice of orange or lemon. In some cases a glass of wine may now and then be allowed. The most proper wine is Rhenish; but if the body be open, red port or claret is to be preferred.
When the body is bound, a tea-spoonful of the cream of tartar may be put into a cup of the patient’s drink, as there is occasion; or he may drink a decoction of tamarinds, which will both quench his thirst, and promote a discharge by stool.
If camomile-tea will sit upon his stomach, it is a very proper drink in this disease. It may be sharpened by adding to every cup of the tea ten or fifteen drops of the elixir of vitriol.
The food must be light, as panado or groat-gruel, to which a little wine may be added, if the patient be weak and low; and they ought all to be sharpened with the juice of orange, the jelly of currants, or the like. The patient ought likewise to eat freely of ripe fruits, as roasted apples, currant or gooseberry tarts, preserved cherries, or plums, &c.
Taking a little food or drink frequently, not only supports the spirits, but counteracts the putrid tendency of the humours; for which reason the patient ought frequently to be sipping small quantities of some of the acid liquors mentioned above, or any that may be more agreeable to his palate, or more readily obtained.
If he is delirious, his feet and hands ought to be frequently fomented with a strong infusion of camomile flowers. This, or an infusion of the bark, to such as can afford it, cannot fail to have a good effect. Fomentations of this kind not only relieve the head, by relaxing the vessels in the extremities, but as their contents are absorbed, and taken into the system, they may assist in preventing the putrescency of the humours.
MEDICINE.——If a vomit be given at the beginning of this fever, it will hardly fail to have a good effect; but if the fever has gone on for some days, and the symptoms are violent, vomits are not quite so safe. The body however is always to be kept gently open by clysters, or mild laxative medicines.
Bleeding is seldom necessary in putrid fevers. If there be signs of an inflammation, it may sometimes be permitted at the first onset; but the repetition of it generally proves hurtful.
Blistering plasters are never to be used unless in the greatest extremities. If the petechiæ or spots should suddenly disappear, the patient’s pulse sink remarkably, and a delirium, with other bad symptoms, come on, blistering may be permitted. In this case the blistering plasters are to be applied to the head, and inside of the legs or thighs. But as they are sometimes apt to occasion a gangrene, we would rather recommend warm cataplasms or poultices of mustard and vinegar to be applied to the feet, having recourse to blisters only in the utmost extremities.
It is common in the beginning of this fever to give the emetic tartar in small doses, repeated every second or third hour, till it shall either vomit, purge, or throw the patient into a sweat. This practice is very proper, provided it be not pushed so far as to weaken the patient.
A very ridiculous notion has long prevailed, of expelling the poisonous matter of malignant diseases by trifling doses of cordial or alexipharmic medicines. In consequence of this notion, the contrayerva-root, the cordial confection, the mithridate, &c. have been extolled as infallible remedies. There is reason however to believe, that these seldom do much good. Where cordials are necessary, we know none that is superior to good wine; and therefore again recommend it both as the safest and best. Wine, with acids and antiseptics, are the only things to be relied on in the cure of malignant fevers.
In the most dangerous species of this disease, when it is attended with purple, livid, or black spots, the Peruvian bark must be administered. I have seen it, when joined with acids, prove successful, even in cases where the petechiæ had the most threatening aspect. But, to answer this purpose, it must not only be given in large doses, but duly persisted in.
The best method of administering the bark is certainly in substance. An ounce of it in powder may be mixed with half an English pint of water, and the same quantity of red wine, and sharpened with the elixir or the spirit of vitriol, which will both make it sit easier on the stomach, and render it more beneficial. Two or three ounces of the syrup of lemon may be added, and two table-spoonfuls of the mixture taken every two hours, or oftener, if the stomach is able to bear it.
Those who cannot take the bark in substance may infuse it in wine, as recommended in the preceding disease.
If there be a violent looseness, the bark must be boiled in red wine with a little cinnamon, and sharpened with the elixir of vitriol, as above. Nothing can be more beneficial in this kind of looseness than plenty of acids, and such things as promote a gentle perspiration.
If the patient be troubled with vomiting, a dram of the salt of wormwood, dissolved in an ounce and half of fresh lemon-juice, and made into a draught with an ounce of simple cinnamon water, and a bit of sugar, may be given and repeated as often as it is necessary.
If swellings of the glands appear, their suppuration is to be promoted by the application of poultices, ripening cataplasms, &c. And as soon as there is any appearance of matter in them, they ought to be laid open, and the poultices continued.
I have known large ulcerous sores break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a most putrid cadaverous smell. These gradually healed, and the patient recovered, by the plentiful use of Peruvian bark and wine, sharpened with the spirits of vitriol.
For preventing putrid fevers we would recommend a strict regard to cleanliness; a dry situation; sufficient exercise in the open air; wholesome food, and a moderate use of generous liquors. Infection ought above all things to be avoided. No constitution is proof against it. I have known persons seized with a putrid fever, by only making a single visit to a patient in it; others have caught it by lodging for one night in a town where it prevailed; and some by attending the funerals of such as died of it[84].
When a putrid fever seizes any person in a family, the greatest attention is necessary to prevent the disease from spreading. The sick ought to be placed in a large apartment, as remote from the rest of the family as possible; he ought likewise to be kept extremely clean, and should have fresh air frequently let into his chamber; whatever comes from him should be immediately removed, his linen should be frequently changed, and those in health ought to avoid all unnecessary communication with him.
Any one who is apprehensive of having caught the infection, ought immediately to take a vomit, and to work it off by drinking plentifully of camomile-tea. This may be repeated in a day or two, if the apprehensions still continue, or any unfavourable symptoms appear.
The person ought likewise to take an infusion of the bark and camomile flowers for his ordinary drink; and before he goes to bed, he may drink an English pint of pretty strong negus, or a few glasses of generous wine. I have been frequently obliged to follow this course, when malignant fevers prevailed, and have likewise recommended it to others with constant success.
People generally fly to bleeding and purging as antidotes against infection; but these are so far from securing them, that they often, by debilitating the body, increase the danger.
Those who wait upon the sick in putrid fevers, ought always to have a piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to smell to while near the patient. They ought likewise to wash their hands, and, if possible, to change their clothes, before they go into company.