Treating Fevers With Water (Aqua)

The application of water to the treatment of these disorders is one of the most important results of modern therapeutics - or rather of a revival of, and improvement upon, older ideas, for it is not wholly modern. Wright and Currie adopted it in 1786-1796, using cold effusion, i.e., dashing several buckets of water over the patient when stripped. The latter physician records an epidemic of typhus fever affecting 58 soldiers, most of them severely: 56 were treated by cold salt-water effusion, and all recovered; the other 2, considered too weak for this treatment, were the only fatal cases. He traced an evening exacerbation, and insisted on the importance of using the remedy during this access: or at least during a period of great heat, and not during a rigor, nor during a profuse perspiration ("Medical Reports on the Effects of Water," London, 1798). His method of treatment, although valuable and successful, was too harsh for ordinary use; but soon after his observations, Giannini, of Milan, advocated immersion in cold water for two to fifteen minutes in all forms of fever (especially intermittent, petechial, rheumatic, and scarlet fevers); he drew up very judicious rules for practice, and he had very good success, but he objected to the use of ice ("Della natura delle feb-bri," Milano, 1805). Frohlich (1822) was one of the first to regulate his practice of cold or tepid bathing by the thermometer. An account of his and many other earlier observations has been given by Fleury ("Traite d'Hydrotherapie," Paris, 1866). In our own time, Ziemssen has improved upon the older methods, by his process of gently lowering the patient (with a sheet) into a bath at a temperature of about 98° F., and then gradually cooling it by addition of cold water or ice to 80° or 72° F., or even lower, according to the effect produced; this should be noted by a thermometer (placed in the rectum if possible). When a distinct reduction of the fever heat is evident (it may be in five minutes or in thirty), the patient is dried, and laid again in bed, and the process may be repeated two to six times daily. A less complete mode of attaining a similar result is by cold compresses to the trunk, ice-bags to the spine and other parts, injections of iced water into the rectum, or the wet-sheet pack. All such applications, valuable as they are, must be carefully watched: they depress the circulation, sometimes extremely, and may need, after their use, stimulants internally, and hot cloths and bottles externally, in order to relieve too-cold extremities, blue lips, and tendency to collapse. The bath generally used in Germany has a temperature of about 70° F., or somewhat lower, and the patient is kept in it for about ten minutes, but very weak subjects only from five to seven minutes. Ziemssen now uses this bath, I believe, more frequently than the gradually cooled one, mostly mentioned with his name.

Treating Fevers With Hydrochloric Acid (Acidum Hydrochloricum)

In typhoid or "low" fever, hydrochloric acid had, at one time, a high reputation; it was said to moderate the pyrexia, to limit the alteration of the blood, and to directly influence the morbid process. We scarcely expect so much now, but still there is reason to think that a judicious use of this acid may favor the assimilation of food, if it do not exert antiseptic influence. According to the investigation of Manassein, with the gastric juice of fever patients, it is not pepsine that is deficient but acid, and this deficiency may be supplied for a time by the artificial acid, which then much aids the impaired digestion. It matters little whether we say with this observer, and with Chambers, that we supply deficient acid, or, with Richardson, that we neutralize by it super-abundant alkali formed during fever. Chambers records an emphatic opinion as to its value, after a fairly extensive use of it at St. Mary's Hospital, in "low" fever, apparently typhus and typhoid. The treatment by hydrochloric acid was more successful than by any other method, but we must add that he conjoined with the former, strict attention to nourishment, giving milk and beef-tea regularly every two hours, day and night (Medical Times, 1858; Medico Chirurgical Review, ii., 1863). Henderson has reported on its value during an epidemic at Shanghai (Medical Times, i., 1863). On the other hand, Dr. G. Johnson is satisfied with the far better progress made by his typhoid patients in King's College Hospital since he omitted wholly mineral acid from their treatment. He finds, especially, that diarrhoea is less troublesome, and considers that acids irritate the bowels, just as bread or meat would do (British MedicalJournal, i., 1875). I cannot think Dr. Johnson's reasoning very conclusive, though his facts are of course to be accepted. I think the acid sometimes useful, and if well diluted the doses required will not irritate the bowels. It may be given as a refrigerant drink in lemonade, or mixed with essence of meat so as to aid assimilation.

Treating Fevers With Nitric Acid (Acidum Nitricum)

Dr. Osborne has recorded a good experience of nitric acid in typhoid fever (Lancet, ii., 1862), and Dr. Bailey (U. S.) in intermittents- he prescribed it to relieve profuse sweating, and unexpectedly found a curative effect on the ague: of ninety cases, eighty made a rapid recovery. Dr. Hammond has corroborated his results (Ranking, 1862).

Treating Fevers With Dilute Phosphoric Acid (Acidum Phosphoricum Dilutum)

In any fever where the nervous system is specially depressed, phosphoric acid is indicated; it assuages thirst, and helps to remove exhaustion; its pleasant taste is one advantage over the other mineral acids.

Stromeyer, and others, recommend it in "eruptive fevers." The following is a convenient form: - R. Acidi phosphorici diluti, fl. 3 iij.; gly-cerini, fl. 3 j.; decocti hordei, Oij.: mix, and use when cold as a common drink.

Treating Fevers With Sulphuric Acid (Acidum Sulphuricum, Oil Of Vitriol)

In the diarrhoea of enteric fever, H. Kennedy, Murchison, and other authorities advocate the use of sulphuric acid (v. p. 197). We do not expect from it, as formerly, a power of shortening the morbid process; but it will allay thirst, and, to some extent, moderate the pyrexia and the undue secretion. In any enteric cases, the dose used should be small and well diluted: the aromatic, I find preferable to the simple form.

Treating Fevers With Antimony (Antimonium, Stibium)

At the commencement of an attack, when gastric disorder was very marked, an antimonial emetic was formerly much commended. Dr. Gregory often employed it in these circumstances, but he also pointed out the danger of inducing irritability of the stomach, and even inflammation. Dr. Graves and others have taught that such an emetic, given within thirty-six hours of the initial rigor, would often abort the fever, but this is difficult to prove, and is not generally accepted. Modern practice has rather taught us that nausea and vomiting are usually needless annoyances to the patient, though if induced in the early stages vomiting may certainly relieve headache and severe gastric congestion when dependent upon accumulated mucus and bile.

Dr. Graves originated, and highly praised also, the administration of antimony in fever (especially typhus) at a stage when cerebral complications are sometimes very severe, e.g., from the seventh to the ninth day. Thus, to a strong adult, suffering with complete insomnia, illusions of the senses, delirium, continued tremor and subsultus, "cerebral" respiration, very quick and weak pulse, sordes, and every symptom of the worst augury, 1/4 gr. of tartar emetic in water was given every hour: the patient vomited freely (though not directly) after each of the first four doses, then purging began, the general condition improved, and the man slept: after temporary omission of the medicine, 2 min. of "black drop" (opium) were given every two hours, and on the following day there was free perspiration, natural sleep, and a rational mind; ultimately a good recovery followed ("Clinical Lectures").

In other equally severe cases the same dose of antimony has been given from the first with 2 or 3 min. of laudanum, and the results have been such as to warrant much confidence in this method of treatment; it is necessary, however, to use it cautiously, and to bear in mind its weakening effect upon the cardiac muscle, which is already enfeebled from the effect of the disease (Murchison).