Page images

the fame exposure to cold or moisture, as it would have done if no such disease had taken place.

. If a person has been subject to indigeftion, flatulency, or dir. position to acidity in the fomach and intellines, after the tertian has gone through its natural progress, these appearances in the intestinal canal no longer take place. Sometimes, habitual inflammation, or cutaneous eruptions, leave the patient during the course of a regular tertian, and do not afterwards return, although this more rarely happens than in other habitual difcafes. So epileply, hyttcric affection, and all other diseases which have become habi. tual, are in many intances removed. In many of thele cases, however, no alteration is made by a tertian, and it likewise happens, that such discafes are alleviatcd, although not catirely carried ofi.'

A little farther on, we meet with an observation that is far from holding out a bright prospect to the physician. The author tells us, (p. 18.) that he has never seen nor can himself conceive any cause why a simple paroxysm of fever thould go through its three stages, and terminaic in health, much less why a regular tertian should begin, grow gradually more perfect, continue for fome time in vigour, then gradually decay and go off; nor after so many conjectures which have been thrown away on this fubjeét, does he expect that the cause of this will be known in his time.'

In considering the treatment of this disease, the doctor goes at some length into the nature of food, and the proper modes of adminiftering it. On each of these he offers many useful hints, With refpect to the periods of taking food, however, he may, perhaps, by fome, be thought a little lingular, if not visionary.

We shall present the reader with his plan of proceeding.

P. 43.- To give an example in a regular tertian, whose paroxyims take place at ten in the morning, and where the intermiffions have become regular and perfect. On the day on which the patient is perfectly free from the disease ; breakfast in the morning may be, where the patient is accustomed to it, tca with milk and sugar, and bread with butter, not rendered empyreumatic with heat. The dinner, soup, fish, and meat, with fruits, all of such kinds as have been enumerated; but this variety only where the patient has been accustomed to it. The supper. may conlist of po. tatoes or rice, and milk, fago, or other things of the same kind, with a moderate quantity of wine.

• If the patient tould sleep during the night before the paroxysın, nothing but a bason of barley-water should be given at fix or eight in the morning. If instead of ten the paroxysm (hould not come on till twelve, or later, tea with bread and butter, or such other food may be given at eight in the morning. If the paroxysm fhould take place at ten, it will probably go off by eight in the evening; and the patient when he feels caly should eat fago, barley boiled down with a moderate quantity of wine, and bread with milk,, &c.

• When intermissions again become irregular, towards the end of the disease no folid animal food whatever should be employed,


but only such as are proper at the beginning of the disease, in more liberal quantity.

• To conclude, for the first fortnight food of easy digestion Ihould be ufed; afterwards more nourishing food, according to the perfection of the intermiffions; again food of calier digeition when they grow imperfect towards the end.'

This matter is still more clearly explained in the subsequent paflage.

p. 50.-" The only food proper, where the disease puts on the appearance of continued fever at the beginning, excepting that exacerbations do not take place in the evening, are folutions of farinaceous matter: where there are crises at the beginning, although very imperfect, tarinaccous matter in fubitance coagulated and boiled down again until fuft, should form the nourishment : if the crits at firit ihould be nearly perfect, the food during the firit, or even second week, fhould be farinaceous matter, and fruits; but in the second or third week, if the crisis should be come perfe1, or nearly so, milk not coagulated, and animal broth may be at first added, and sometimes folid animal food of easy digestion. When the crisis becomes perfect on the day on which the paroxysm does not take place, according to the state of the patieni, food should be exhibited nearly in the same manner as in health. No solid food of any kind, and of Auids only folutions of farinaceous matter, Mould be allowed for eight hours before the coming on of the paroxysm. After the paroxysm is over, farinaceous matter in a solid form, broths or milk may be made use of on the day of the paroxysm ; and finally, the itomach fhould be kept free from noxious matter by emetics.'

The remarks and cautions respecting the use of purgatives are certainly founded on juft observation.

The observations on tone, and the means of restoring it when loít, as well as those on exercise, and the manner of employing it, are philofophical and juft. We have long thought with the author, that many of the remedies administered with the view of reitoring strength were of little real advantage.

The directions for the exhibition of cinchona, and some other Temedies in the fever, may generally be consulted with adrantage by practitioners. In this part, we have noticed a few conclusions which are curious. The author says, (P. 128.) “ that the bark of the cinchona, and probably all the medicines that act in a similar manner, have no power of taking off a fever when present, but only a power of preventing the return; or if they have any action on a fever when present, they tend to prolong it, and prevent a perfect crisis from taking place.'

Another is, (P. 133,) that if the ciuchona be exhibited in such a manner as not to prevent the return of the paroxysms in the course of a few intermiffions, that its effect is generally lost, and that it never can be exhibited afterwards in any dose, or in any. manner so as to produce its effect in the manner it would have done if employed in a proper dose and mode from the first. Frequently its power of preventing the return of the paroxysın is totally loft, and therefore it is of the utmost importance to use it


at the beginning in such preparations and quantities as to be effectual.'

And at page 153, we are told, that 'there seems to be a great error in the view of remedies employed in fever; practitioners frequently making no distinction between those used to cure the disease itself, and those employed to remove accidents that have arisen in it, although such diitinctions are extremely necessary to be made. If, for example, in the course of a tertian, a pleurisy fhould happen to arise, taking away a quantity of blood would be a powerful remedy for the pleurisy, but although the pleurisy were removed, the intermittent tertian would go through its course just as if no blood had been taken away, excepting that the patient would be rendered weaker.'

How often the doctor has seen pleurisy take place in the course of a tertian fever, we are not here informed; we are disposed to believe, that it has not been very frequently.

This, like most of the author's tracts, contains niuch ingenious reasoning, and some novelty of remark.


Medical Reporis, on the Effets of Water, cold and warm, as a Remedy in Fever, and Febrile Diseases; whether applied to the Surface of the Body, or used as a Drink: with Observations on the Nature of Fever, and on the Effects of Opium, Alcohol, and Inanition. By James Currie, M. D. P. R. S. &c. 8vo. 314 pages. Price 6s. boards. Liverpool, M.Creery; London, Cadell and Davies. 1797.

The records of medicine contain various notices of the successful application of water to the surface of the body, in fever and febrile diseases; and of late, the practice has been frequently followed in hospitals and private houses. But it has neither been appreciated, nor reduced to rule. Our author refers the origin of his trials to a narrative by Dr. Wright, in the London Medical Journal for 1786. This gentleman, having been infected by febrile contagion, caused buckets of sea-water to be thrown over him. He found inttant relief; and, by continuance of the process for three days, the fever was stopped. Equally good effects were produced on the same occasion by the same method in another case.

Dr. Currie has imitated and improved this practice. His experience in low fever is ample; his cases fair; and we believe, that he will have earned the praise of ascertaining the full value of what had been studied with little care; and of reducing what was before altogether vague, to a certain rule. Here is the statement of that Tule.

P. 15.- The exacerbation usually occurs in the afternoon, or evening, the remission towards morning. These exacerbations are marked by increased Aushing, thirst, and restlessness. If the heat of the patient be, at such times, taken by the thermometer, it will be found to have risen one or two degrees in the central parts of the body, above the average heat of the fever, and ftill more on the extremities.-The safest and most advantageous time for using the aspersion or affusion of cold water, is when the exacerbation is at its beight, or immediately after its declination is begun ;


[ocr errors]

and this has led me almost always to direct it to be employed from fix to nine o'clock in the evening; but it may be safely used at any time of the day, vben i here is no sense of. chilliness present, when the beat of the surface is fteadily above what is natural, and when there is mo general or profuse perspiration. These particulars are of the utmost importance.

: 1. If the aspersion of cold water on the surface of the body be ofed during the cold stage of the paroxysm of fever, the respiration is nearly suspended; the pulse becomes fluttering, feeble, and of an incalculable frequency; the surface and extremities become doubly cold and shrivelled, and the patient seems to struggle with the pangs of inftant diffolucion. I have no doubt, from what I have observed, that in fuch circumstances, the repeated affufion of a few buckets of cold water would extinguish life. This remedy should therefore never be used when any considerable sense of chilliness is present, even though the thermometer, applied to the trunk of the body, should · indicate a degree of heat greater than usual.

• 2. Neither ought it to be used when the heat measured by the thermometer is less than, or even only equal to the natural heat, though the patient should feel no degree of chilliness. This is sometimes the case towards the last stages of fever, when the powers of life are too weak to sustain, or react under, fo powerful a stimulus.

* 3. It is also neceffary to abstain from the use of this remedy when the body is under profufe perspiration, and this caution is more important in proportion to the continuance of this perspiration. It ibe commencement of perspiration, especially if it has been brought on by violent exercise, the affufion of cold water on the naked body, or even immerîon in the cold bath, may be hazarded with little risque, and sometimes may be resorted to with great benefit. After the perspiration has continued some time and flowed freely, especially if the body has remained at reft, either the affusion or immerfion are attended with danger, even though the heat of the body at the moment of using them be greater than natural.- Perspiration is always a cooling process in itself, but in bed it is often prolonged by artificial means, and the body is prevented from cooling under it to the natural degree, by the load of heated clothes. When the heat has been thus artificially kept up, a practitioner, judging by the information of his thermometer only, may be led into error. In this situation, however, I have observed that the heat sinks rapidly on the exposure of the surface of the body even to the external air, and that the application of cold water, either by affufion or immersion, is accompanied by a loss of heat and a deficiency of re-action, which are altogether inconsistent with safety. Each of these points will be illustrated more fully in the sequel.

- Under these restrictions the cold affufion may be used at any period of a fever; but its effects will be more falutary in proportion as it is used more early.'

The internal use of cold water is governed by the same laws, and so is it's use in febrile disorders, as the small-pox, concerning which some facts occur in the present publication.

To the confiderations on fever succeeds an inquiry concerning the disease that arises from drinking cold liquids after severe exercise.




We are of opinion, that the author has successfully treated this im.
portant subject ;-no small merit, when we advert to the perplexity
in which it has been always involved. The fimple result is, that the
application of .coid to the surface or stomach is lefs dangerous, as the
body is more heated; when the body is losing, or has just lost it's
heat, it is more or less dangerous. Dr. C. thinks, that cold may be
more freely applied in continued fevers than in intermittents, and in
these than upon exercise, because, in the former cases, the body
• more firmly retains its heat.' Alle is we invite the reader to see well
explained in the original work.

Here Dr. C. chooses to interpole reflections on the cold bath ist
convulsion-and in insanity. He then proceeds to review the doctrines
of various authors respecting fever. He briefly recites the principles
of each theorist, and then gives theory to the dogs. • Dismissing
therefore, as far as is posible, all theories from the mind, let us briefly
consider the process of nature in fever, p. 145. How great, after
this resolution, was our furprize, to find a doctrine delivered which,
to our perception, has the very effigies, the very effect, the

very physiogromy of the mechanical doctine of Cullen !' let the reader judge.

P. 150.- Debility of a peculiar kind, is then the first operation of the poison producing fever---the neceffary confcquence, or as fome contend, the concomitant effect, is a spasm, or contraction of the arterics; but more especially of the extreme vessels, and the capillaries of the furface--hence follows an accumulation of blood on the heart and lungs--the re-action of those organs-the generation of morbid heat-and of morbid affociation. This strikes us the more, as the latest author before the present, on fever, after equally disclaiming theory, with equal seeming inconsistency, produces the fame, or a fimilar doctrine. We perceive, indeed, that Dr. C. thinks the experienced will object little to this view of fever. But must not all, that refuse asent to Dr. C., absolutely reject it? The explanation of the effect of cold water, deduced from these premiles, will easily be anticipated.

P. 161.- The sudden, general, and powerful stimulus given to the system, disolves the spasm on the extreme vessels of the surface, and of the various cavities of the body: the sudden and general evaporation carries off a large portion of the morbid heat accumulated under the skin; and the healthy action of the capillaries and exhalents being restored, the remaining fuperfluous heat pasies off hy sensible and insensible perspiration. The stimulus of morbid beat and of morbid fricture being removed, the inordinate action of the heart and arteries fubfides, and the harassed, and toil-worn patient sinks into that peaceful sleep which nature has provided as the solace of our pains and sorrows, and the restorer of our strength.'

Without doubt, the effect of cold will easily adapt itself to every posible hypothefis of fever, that shall be founded on the actions of the living solid. Whatever kind of action thall be fixed upon, no ingenuity will be found requisite to discover, that sudden cold destroys, or to a certain degree dillurbs, that action. The double effect in the above quotation seems not well imagined. The increase of heat is accompanied, if we rightly conceive the theory, with a relaxation of spasm. Indeed, it appears from Dr. C.'s own thermo


« PreviousContinue »