CHAPTER V.

OF AN ACUTE CONTINUAL FEVER.

THIS fever is denominated acute, ardent, or inflammatory. It most commonly attacks the young, or persons about the prime and vigour of life, especially such as live high, abound with blood, and whose fibres are strong and elastic. It seizes people at all seasons of the year, but is most frequent in the spring and beginning of summer.

CAUSES.—An ardent fever may be occasioned by any thing that overheats the body, or produces plethora, as violent exercise, sleeping in the sun, drinking strong liquors, eating spiceries, a full diet with little exercise, &c. It may likewise be occasioned by whatever obstructs the perspiration, as lying on the damp ground drinking cold liquor when the body is hot, night watching, or the like.

SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which is soon succeeded by great heat, a frequent and full pulse, pain of the head, dry skin, redness of the eyes, a florid countenance, pains in the back, loins, &c. To these succeed difficulty of breathing, sickness with an inclination to vomit; the patient complains of great thirst, has no appetite for solid food, is restless, and his tongue generally appears black and rough.

A delirium, excessive restlessness, great oppression of the breast, with laborious respiration, starting of the tendons, hiccup, cold clammy sweats, and an involuntary discharge of urine, are very dangerous symptoms.

As this disease is always attended with danger, the best medical assistance ought to be obtained as soon as possible. A physician may be of use at the beginning, but his skill is often of no avail afterwards. Nothing can be more unaccountable than the conduct of those who have it in their power at the beginning of a fever to procure the best medical assistance, yet put it off till things come to an extremity. When the disease, by delay or wrong treatment, has become incurable, and has exhausted the strength of the patient, it is in vain to hope for relief from medicine. Physicians may indeed assist Nature; but their attempts must ever prove fruitless when she is no longer able to co-operate with their endeavours.

REGIMEN.—From the symptoms of this disease, it is evident, that the blood and other humours require to be diluted; that the perspiration, urine, saliva, and all the other secretions, are in too small quantity; that the vessels are rigid, and the heat of the whole body too great; all these clearly point out the necessity of a regimen calculated to dilute the blood, correct the acrimony of the humours, allay the excessive heat, remove the spasmodic stricture of the vessels, and promote the secretions.

These important purposes may be greatly promoted by drinking plentifully of diluting liquors; as water-gruel, or oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice of orange, jelly of currants, raspberries, and such like; orange-whey is likewise an excellent cooling drink. It is made by boiling among milk and water a bitter orange sliced, till the curd separates. If no orange can be had, a lemon, a little cream of tartar, or a few spoonsful of vinegar, will have the same effect. Two or three spoonsful of white wine may occasionally be added to the liquor when boiling.

If the patient be costive, an ounce of tamarinds, with two ounces of stoned raisins of the sun, and a couple of figs, may be boiled in three English pints of water to a quart. This makes a very pleasant drink, and may be used at discretion. The common pectoral decoction is likewise a very proper drink in this disease. A tea-cup full of it may be taken every two hours, or oftener, if the patient’s heat and thirst be very great.

The above liquids must all be drank a little warm. They may be used in smaller quantities at the beginning of a fever, but more freely afterwards, in order to assist in carrying off the disease by promoting the different secretions. We have mentioned a variety of drinks, that the patient may have it in his power to choose those which are most agreeable, and that when tired of one, he may have recourse to another.

The patient’s diet must be very spare and light. All sorts of flesh meats, and even chicken broths, are to be avoided. He may be allowed groat gruel, panada, or light bread boiled in water; to which may be added a few grains of common salt, and a little sugar, which will render it more palatable. He may eat roasted apples with a little sugar, toasted bread with jelly of currants, boiled prunes, &c.

It will greatly relieve the patient, especially in a hot season, to have fresh air frequently let into his chamber. This, however, must always be done in such a manner as not to endanger his catching cold.

It is too common in fevers to load the patient with bed-clothes, under the pretence of making him sweat, or defending him from the cold. This custom has many ill effects. It increases the heat of the body, fatigues the patient, and retards, instead of promoting, the perspiration.

Sitting upright in bed, if the patient is able to bear it, will often have a good effect. It relieves the head, by retarding the motion of the blood to the brain. But this posture ought never to be continued too long; and if the patient be inclined to sweat it will be more safe to let him lie, only raising his head a little with pillows.

Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rose-water, with a little nitre dissolved in it will greatly refresh the patient. This ought to be done frequently, especially if the weather is hot.

The patient’s mouth should be often washed with a mixture of water and honey, to which a little vinegar may be added, or with a decoction of figs in barley-water. His feet and hands ought likewise frequently to be bathed in lukewarm water; especially if the head is affected.

The patient should be kept as quiet and easy as possible. Company, noise, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that affects the senses, ought to be avoided. His attendants should be as few as possible, and they ought not to be too often changed. His inclinations ought rather to be soothed than contradicted; even the promise of what he craves will often satisfy him as mush as its reality.

MEDICINE.—In this and all other fevers, attended with a hard, full, quick pulse, bleeding is of the greatest importance. This operation ought always to be performed as soon as the symptoms of an inflammatory fever appear. The quantity of blood to be taken away, however, must be in proportion to the strength of the patient and the violence of the disease. If after the first bleeding the fever should rise, and the pulse become more frequent and hard, there will be a necessity for repeating it a second, and perhaps a third, or even a fourth, time, which may be done at the distance of twelve, eighteen, or twenty-four hours from each other, as the symptoms require. If the pulse continue soft, and the patient is tolerably easy after the first bleeding, it ought not to be repeated.

If the heat and fever be very great, forty or fifty drops of the dulcified or sweet spirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of simple syrup, or a bit of loaf sugar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or six hours will be sufficient.

If the patient be afflicted with reaching, or an inclination to vomit, it will be right to assist Nature’s attempts, by giving him weak camomile tea or lukewarm water to drink.

If the body is bound, a clyster of milk and water, with a little salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea-spoonful of magnesia alba, or cream of tartar, may be frequently put into his drink. He may likewise eat tamarinds, boiled prunes, roasted apples, and the like.

If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish sediment, there is reason to expect a favourable issue to the disease. But if instead of these symptoms, the patient’s spirits grow languid, his pulse sinks, and his breathing becomes difficult; with a stupor, trembling of the nerves, starting of the tendons, &c. there is reason to fear that the consequences will be fatal. In this case blistering plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion; poultices of wheat-bread, mustard, and vinegar, may likewise be applied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel, with wine in it, and such like.

A proper regimen is not only necessary during the fever, but likewise after the patient begins to recover. By neglecting this, many relapse, or fall into other diseases, and continue valetudinary for life. Though the body is weak after a fever, yet the diet for some time ought to be rather light than of too nourishing a nature. Too much food, drink, exercise, company, &c. are carefully to be avoided. The mind ought likewise to be kept easy, and the patient should not attempt to pursue study, or any business that requires intense thinking.

If the digestion is bad, or the patient is seized at times with feverish heats, an infusion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the remains of the fever.

When the patient’s strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a drachm of senna may be boiled for a few minutes in an English pint of water, and one ounce of manna dissolved in the decoction; afterwards it may be strained, and a tea-cup full drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening betwixt each dose.

Those who follow laborious employments ought not to return too soon to their labour, after a fever, but should keep easy till their strength and spirits are sufficiently recruited.

The most dangerous thing on recovering from a fever, is the indulgence in eating and drinking, in which the patient is too apt to exceed. The appetite is then unusually voracious, and requires the greatest self-command; else a relapse is most likely to ensue, as well as other still worse consequences, such as boils, ulcers, and settled swellings of the limbs. The diet ought to be light, principally of vegetables, not without, however, the total exclusion of animal food of easy digestion.

On the first appearance of fever, it is necessary to obtain the best medical advice. Many fall victims to their obstinacy in persisting to struggle against it, without even taking to their bed, which would in many cases stop an incipient fever; whereas, the struggling to keep on their legs, inevitably increases its force. Others, in the first symptom, employ hot and volatile sudorifics, smothering themselves up in bed, under a load of clothes, in a chamber where the air is excluded, in order to excite sweats. By these means the fever must certainly increase, whereby sweating, as well as every other evacuation, will be prevented. Diluting liquors, while they quench the patient’s thirst, and abate his pains, are the best means of promoting perspiration.

Fevers are in themselves too fatal: they require not to have their effects increased by the absurd management of the unhappy sufferers.