186 



FEVER. 



the repetition of the bleeding, but one namely, that 

 recourse must be had to it, whenever the system re- 

 acts with force, by which every symptom becomes 

 aggravated, rvt'ii if this occur several times in the 

 twenty-four hours. It is mainly owing to not taking 

 down the excess of action of the heart and arteries 

 when it occurs, that fatal disorganization takes place 

 so frequently; therefore, every paroxysm should be 

 carefully watched, that no one may pass without hav- 

 ing the force of the pulse abated, by the loss of blood ; 

 for it may be confidently said, that the system never 

 reacts forcibly in this disease, when it will not bear 

 the abstraction of blood, either generally or topically. 

 If topical bleeding be resorted to, it must be from 

 the epigastrium ; therefore, either leeching or cupping 

 must be the mode of abstraction. This state of the 

 system is rarely found, however, after the expiration 

 of eight-and-forty hours, unless the disease have been 

 vigorously treated by previous blood-letting. Should 

 this period have been lost, bleeding from the general 

 system can rarely be successful: topical bleeding 

 alone now promises relief ; and this may be tried at 

 almost any period of the disease, if the sensibility of 

 the epigastrium remain active. As regards the 

 feebleness of reaction, as just stated, we must not be 

 mistaken in its cause, in the beginning of this disease; 

 as it is almost sure to depend upon the depressed state 

 of the pulse. For after blood has been taken in an 

 appropriate quantity, the heat of the skin and activity 

 of the pulse will both increase ; but if stimulants be 

 used, both will be diminished. But it is always 

 proper, when reaction is feeble, the skin cooler than 

 natural, and the extremities perhaps cold, but cer- 

 tainly preternaturally cool, to use external stimuli 

 with a view of aiding the powers of the system in 

 their efforts to produce a warmth upon the surface. 

 Bottles or jugs of hot water, heated bricks, sinapisms, 

 Cayenne pepper, &c., should be applied to the feet 

 and legs, and used until a proper warmth be restored. 

 The bowels should be freely opened, but not violently 

 purged : for this purpose, eight or ten grains of calo- 

 mel should be given immediately after bleeding, fol- 

 lowed, in three hours, by a dose of castor oil, if it do 

 not operate previously to the expiration of this time. 

 During the whole disease, the bowels should be kept 

 open by the milder purgatives, but especially by oil, 

 or by injections; for purging is uniformly hurtful, 

 unless it be on the decline of the disease, and after 

 the liver has begun to secrete large quantities of bile, 

 which requires to be carried off. The mildest drinks 

 should be given during the whole attempt at cure, 

 and these cold, almost always; that is, unless cold 

 drinks be less acceptable to the stomach than tepid, 

 which is sometimes the case. Ice swallowed fre- 

 quently, in small portions at a time, is both acceptable 

 and useful, and should never be withheld when it can 

 be procured. All the drinks may be rendered cold 

 by this substance; and these should consist of gum- 

 arabic water, barley water, linseed tea, slippery-elm 

 bark tea, &c. Drinks should always be given in 

 small quantities at a time, lest the stomach reject 

 them. If there be much sickness of stomach, at- 

 tended by much tenderness upon pressure, the epi- 

 gastrium should be leeched or cupped ; and this 

 may be followed by a blister if the nausea or vomiting 

 continue. Should the headache be great after due 

 depletion from the arm, the temporal artery may be 

 opened, or leeches or cups be applied to the temples, 

 behind the ears, and to the back of the neck. Under 

 these circumstances, if the feet be cool or cold, they 

 should be placed in hot water, with which is mingled 

 a quantity of the flour of mustard, and the feet suffered 

 to remain in it for fifteen or twenty minutes. This 

 may be repeated, pro re nata. Fresh air should be 

 admitted freely into the room; the bedclothes ami 



body linen changed as often as practicable; %Iit 

 excluded, and noise prohibited. If there be much 

 determination to the head, cold applications should 

 be made to it, after reducing the quantity of hair, 

 should this be thick. Partial heat may be reduced 

 by sponging. Doctor Jackson, in his treatise on 

 fever, recommends large bleedings, in the first eight 

 hours of attack, even ad deliguium animi. This, in 

 robust constitutions, and when the disease commences 

 with high excitement, has been found very beneficial ; 

 but it rarely can be proper where the disease is of a 

 highly malignant character, as is almost always the 

 case where much indirect debility suddenly shows 

 itself, and, consequently, where the powers of the 

 system are inadequate to produce a quick and suffi- 

 ciently powerful reaction. In this case, however, 

 stimulation would be more quickly and certainly fatal 

 than bleeding, even indiscreetly urged; for, by the 

 former, you cannot fail to increase the inflammation 

 of the mucous membrane of the stomach, which will 

 necessarily augment the danger; while the latter 

 only diminishes the power of reaction; therefore, by 

 the first practice, the cause of the disease is increased ; 

 by the second, the effects of this cause are only aug- 

 mented. For the first, there may be no adequate 

 remedy; for the second, a remedy may be found: 

 hence, when, hi the early stage of yellow fever, re- 

 course is had to internal stimulants, the case is almost 

 uniformly fatal ; whereas, bleeding, even when inju- 

 diciously employed, only depresses the system, which 

 may recover by the aid of external stimuli ; and the 

 case is not as desperate as when stimuli have been 

 thrown into the stomach during the state of active 

 inflammation. In the case, however, under considera- 

 tion, it is only an abuse of the proper remedy; for, if 

 the abstraction of blood be judiciously made in this 

 state of the system, the system, instead of becoming 

 prostrate, will react promptly; for the pulse, in the 

 beginning of this disease, is in a state of depression, 

 as has already been explained, and not of absolute 

 weakness; for there have been instances of recovery, 

 as already stated, after spontaneous haemorrhages 

 from various parts of the body, but where the ab- 

 straction of blood from the general system by the 

 lancet would certainly have proved fatal. Does not 

 this flow of blood intimate to us the propriety of imi- 

 tating it, by the application of a leech or two to 

 various parts of the body ? One thing is very cer- 

 tain in the generality of cases of yellow fever, that 

 when bleeding, either general or topical, fails to 

 afford relief, stimulants never succeed: therefore, 

 when the time is past for both general and topical 

 bleeding, it is in vain to attempt the relief of the 

 patient by the exlu'bition of stimulants. By doing 

 little or nothing at this time, the recuperative powers 

 of the system, if left to themselves, may restore the 

 patient ; for all that art can do, at this time, is not 

 to thwart or prevent their efforts. We must, there- 

 fore, be rather the spectators of the conflict of the 

 system, than active agents against the disease ; tak- 

 ing care, however, constantly to remove, as much as 

 it may be in our power, any obstacle that may appear 

 to interfere with the general progress to recovery, as 

 an irregular condition of the bowels, of the stomach, 

 of the state of air, &c. &c. Nausea and vomiting 

 are troublesome conditions of the stomach, and its 

 relief shoidd be attempted by leeching, cupping, and 

 blistering, over its region, by Seltzer water, the effer- 

 vescing draught, lime water and milk, &c., but never, , 

 or but very rarely in the beginning of the disease, by 

 stimulants : after decided marks of debility, clove 

 tea, mint tea, or strong coffee, with mustard to the 

 epigastrium may be tried. When black vomit has 

 come on, the spirit of turpentine, with the oil of 

 cinnamon, in thirty drop doses, has been certainly of 



