CHAPTER XI.

OF THE REMITTING FEVER.

THIS fever takes its name from a remission of the symptoms, which happens sometimes sooner, and sometimes later, but generally before the eighth day. The remission is generally preceded 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 the less.

CAUSES.—Remitting fevers prevail in low marshy countries abounding with wood and stagnating 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 frequent in close calm weather, especially after rainy seasons, great inundations, or 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 use 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 delirium 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 sometimes a little hard, but seldom full, and the blood, when let, rarely shows any signs of inflammation. Some patient’s are exceeding costive, and others are 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 greatly 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 we 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 a 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 and windows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, 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.

MEDICINE.—In order to cure this fever, we must endeavour to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation; but when that is not the case, bleeding is 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 continue.

The body ought to be 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 potent or drastic purges 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 a 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 to avoid this fever is, to use a wholesome and nourishing diet, to pay the most scrupulous attention 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 prevention of this and intermitting fevers.

To soldiers in camps, and in the various situations dangerous to health where their duty leads them, every precaution should be used to guard them against these fevers. Thoughtless and careless of their persons, our brave defenders despise disease as much as they do danger; and as disorders of this kind are more to be dreaded than the approach of an enemy, the proper means of prevention should be strictly enforced by the superior officers and medical attendants.