Fever, a general term for a' numerous and diversified class of diseases ; in which, after shivering, succeed increased heat and a quick, irregular pulse ; while several of the animal functions are impaired, and the muscular strength, particularly that of the joints, is remarkably diminished.
In most of the febrile actions tak-ingplace in the human body, Nature endeavours to remove some noxious foreign matter; and the evacuations which take place in fevers, are principally those by the pores of the skin, and the urinary passages, sometimes also by vomiting and diarrhoeas, less frequently by hemorrhages or fluxes of blood, and very seldom by cutaneous eruptions. - In the smallpox and bilious fevers, especially of scorbutic patients, a discharge of saliva occasionally intervenes, which, though it cannot be called critical, ought never to be sup-pressed.
In all fevers, there is either an increased, progressive motion of the blood, which is manifest from the quickness of the pulse ; or an acce'erated internal commotion of the fluids, which is obvious from the unusual degree of heat accompanying them : - in most instances, however, both symptoms occur in the same individual. Hence, the proximate cause of these complaints appears to be morbid matter, contained in the fluids, and thence stimulating the nerves.— qucntly, indeed, an irritability of the nervous system alone seems sufficiently to account for the production of a febrile disease, yet in these cases also the material cause has probably pre-existed, and been only excited by the additional stimulus. On the other hand, a fever may arise from any debilitating or exciting cause ; for instance, wounds, passions, acrid purgatives, etc. without any pre-disposition of the individual. Thus it may, in some measure, be explained, why rude and uncivilized nations are but seldom afflicted with febrile disorders ; because these affections are peculiar only to persons of a nervous and relaxed habit.
The following facts render it highly probable that the morbid matter of fevers is much disposed to putrefaction : 1. All remedies which are successfully administered in fevers, are of the antiseptic class ; such as salts, acids, camphor, Peruvian bark, etc. 2. Animal food is in almost every febrile case detrimental to the recovery of health. 3 The excrements are uniformly of a putrid nature. 4. All foul matters easily produce fevers ; for instance, putrid exhalations and ulcers. 5. The generation of heat is most remarkable in putrid fevers, and continues even for some time after death. - It is nevertheless rational to suppose, that no fever can arise, even though a disposition should pre-exist in the solid parts of the body, till the nervous system becomes affected by the stimulus of acrid or morbid particles ; and till a certain degree of acrimony has been generated in the fiuids.
The remote or pre-disposing causes of fever may be ascribed either to an improper mode of living:, with regard to the six non-na-turals, namely, Air ; Aliment 5 Exercise and Rest; the Passions and Affections of the Mind ; Wakefulness and Sleep; Repletion, and Evacuation : or they are to be attributed to a certain general influ-ence; such as famine, unwholesome provisions, an unusual and irregular temperature of the air, etc.
With respect to the more or less favourable prognosis in fevers, we shall only observe:
1. It is a favourable sign, if the efforts of nature are vigorous, and the evacuations do not take place till the febrile, or morbid matter is digested; an event which rarely occurs previously to the 4th day, but generally on the 5th, 7th, 9th, 11th, 13th, 15th, 17th, 19th, 21st, 27th, and 31st day: hence these have been called the critical days; and, if this natural order cannot, in the present artificial state of society, be traced with the same accuracy as in former ages, such irregularity proceeds from the more frequent complication of diseases. - When the spasmodic strictures begin to abate, and the secretions, as well as the excretions, assume their natural colour and consistence, we may then conclude that the fever is on the decline : if, for instance, instead of a small, con-tracted pulse, a parched skin, and thin urine, the circulation of the blood become more uniform, the pulse softer and fuller, the urine more oily, and the discharges by stool be neither of a green colour nor too thin, a favourable change may then be expected to take place on the next of those days, termed critical.
2. Where the powers of the body are insufficient to expel the febrile matter, the symptoms become more aggravated ; but there is no danger to be apprehended from them, unless there prevail too great debility. Thus, an intermitting puise, bleeding, vomiting, gid-diness, etc. are frequently the forerunners of the crisis; and the most violent fit of an ague is often the last, - not unlike continued fevers, when patients, during the last exacerbation, which terminates the disease, appear .to struggle with death. If, therefore, the pulse becomes natural and proportionate to the strength of the patient; if respiration is no longer impeded ; and a sound sleep succeeds the paroxysm, there is every prospect of a speedy recovery ; but, it these changes have occurred only in a slight degree, the crisis may then be considered as imperfect, and the fortunate issue of the disease depends on the vigour remaining in the constitution. Lastly,
3. Should, however, the skin continue in a dry and parched state ; breathing be short and interrupted ; the pulse become progressively quicker, and the excretions begin to emit a putrid, cadaverous stench, the worst consequences are then to be feared. It is also a dangerous sign, when the different symptoms bear no proportion to each other; for instance, if, notwithstanding a dry mouth and tongue, the patient be not thirsty ; if he evince a dislike to acids in a putrid fever, and his pulse be feeble during great heat and an increased circulation of the blood.
For the treatment and cure of fever, in general, it is impossible to lay down any precepts which are applicable to every individual: we shall, therefore, confine our observations to the following points :
1. The nature of the fever ought to be ascertained by professional men, who will accordingly endeavour to remove, if possible, the proximate cause. Thus, where bilious impurities abound, they are often most effectually evacuated by emetics; where a plethora or fulness of blood prevails in the constitution, bleeding is occasionally useful; where tire humours appear to be in an acrid state, it will be necessary to take diluent liquors, such as ptisan, gruel, etc. a tea cupful every half hour, and to abstain from all solid food, eggs, and even broth.
2. To promote the crisis, or assist the efforts of Nature by all proper means : thus, if the pulse become softer and fuller, diaphoretic or sweating remedies will then be necessary; but nothing ought to be more guarded against in fevers, than a precipitate and exces-sive use of medicines. This caution is so well founded, that the ancients cured the most obstinate and malignant fevers almost entirely by a strict attention to diet and regimen. Hence, the air in the patient's room ought to be pure, and never to exceed 70. of Fah-eenheit ; during the cold fit, additional covering may be allowed, but which should be instantly removed, as well as all feather-beds, when heat and perspiration commence. Both food and drink must be of a cooling and diluting nature; the latter, in particular, should be plentifully given, without overloading the stomach. All subacid, ripe fruit, particularly cherries, raspberries, strawberries, etc. are therefore of singular benefit in all inflam..
inflammatory and putrid fevers ; apples, pears, and plums being less juicy, are inferior to the fruit before mentioned, though some kinds of mellow and saccharine pears are equally proper. The juice of lemons and oranges, mixed with water, also affords a cooling and salutary beverage. In short, all those rules which we have stated under the head of Chronical Diseases, vol. i. p. 522, and foil, are, with a few modifications, also applicable in febrile complaints, especially after the crisis has taken place, when the patient may be considered in a state of convalescence. Although fevers are di-vided, by authors, into inflammatory, putrid, bilious, pituitous, heclic, and consumptive, eruptive, sporadic, epidemic, infectious, endemic, topical, vernal, autumnal, complicated, original and symptomatic, regular and irregular ; yet the following division is better calculated to answer practical purposes.
I. Intermittents, or Agues, which see.
II. Inflammatory fevers, or those which are attended with an inflammation of any internal part of the body; such as the breast, lungs, throat, etc. or of some external part, for instance, the Rose. For a description of the former kind, see Pleurisy, and Inflamma-tion. - Sometimes, however, there is no local affe6tion discoverable, though all the symptoms of an inflammatory disposition of the blood are evident, in which case the disorder is termed a simple inflammatory fever.
III. Putrid fevers, which are accompanied with certain symptoms of putridity, either in the first passages, or in the mass of the blood, or in both. - These malignant fevers are highly infectious and de-. structive 5 though they have lately been most successfully treated by large doses of fresh yeast, diluted with water ; a cheap and easy remedy, of which we propose to give a farther account, under its alphabetical head.
IV. Bilious fevers, are thus denominated from an undue secretion of the Bile, to which article we refer: - no time should be lost here in applying for proper advice, as they frequently terminate in putrid fevers, if mismanaged in the beginning. - See also Yellow Fever.
V. Nervous fevers, in which the whole nervous system is originally affected: these maladies are chiefly of modern origin, and have frequently been relieved by the proper use of the tepid bath. We cannot in this place expatiate upon their treatment, as they appear in a thousand different forms, and require the assistance of professional men, more than any other class of diseases.
VI. Hectic fevers are those which emaciate the body, and arise in consequence of the corruption of any particular organ or viscus in the system; for instance, obstruction, suppuration, or ulceration of the breast, lungs, liver, etc. See Hec-tic. - These fevers, however, are to be distinguished from the slow, consumptive, and cachectic febrile affections, which are followed by a general decline of the constitution, though there appears to be no organic injury, or local disorder, in any part of the system.
VII. Eruptive fevers are termed those, in which the skin or surface of the body discovers an eruption which consists either in vesicles, and pustules, such as the smallpox, scarlet fever, etc. or in spot somewhat elevated above the skin, and uneven to the touch, such as the measles ; or in mere stains or spots, marked only by a discoloured surface ; for example, in the petechial fever.
It would be superfluous to give farther explanations on the different kinds of fever, a subject which is but imperfectly understood in theory, though the generality of these maladies has, in consequence of many important discoveries in chemistry, been lately treated with greater success than our medical predecessors were entitled to ex-pc£t, from their deficient know-ledge of natural philosophy. Thus, an attempt has been made to reduce all fevers to one generic source, and to ascribe their origin to an undue proportion of azote, and a deficiency of oxygen, in the human system. Although we can-not approve of that uncommon fondness for generalization, which has been productive of incalculable mischief in medical practice, yet there appears to be some foundation for those eccentric opinions maintained by a foreign professor, Dr. Reich, of Erlang, in a treatise "On Fever;" a translation of which has just been published in English. Tin's ingenious practitioner has cured the most malignant putrid fevers, by the liberal use of mineral acids, and particularly the muriatic, or spirit of sea-salt. He acknowledges that acids have long been employed in fevers, though in very small quantities, and chiefly as auxiliaries, especially the vitriolic, and those of the vegetable kind; but the muriatic acid has seldom been used. In the year 17/3, indeed, Sir W. Fordyce highly recommended this acid to be given internally, in putrid and malignant fevers, and to be applied externally in the form of a liniment, or gargle, to the sloughs in the throat, frequently accompanying such fevers ; but his liniment consisted only of twenty drops of the concentrated acid to one ounce of honey of roses ; and his antiseptic febrifuge contained five drops of the acid mixed with two ounces of a strong decoction of Peruvian bark. In a subsequent pamphlet, concerning the virtues of the muriatic acid, which appeared in 1790, Sir William recommends it as the best remedy in all putrid disases of the worst kind; in petechial, camp, and jail-distempers, as well as the malignant sore-throat, so frequently fatal in this country; and afterwards in the small-pox and plague. The original discovery of this invaluable me-dicine appears to belong to ConSTANTINE RhODOCANACIDES, who in 1664 published a treatise on the internal and external use of this acid, the extraordinary power ot which he derived from the universality and approved value of common salt. Hence he recommended it to be mix d with food and drink to the amount, it necessary, of 100 drops in 24 hours, both as a preventive and remedy for the plague, and as a general antiseptic.
Dr. Reich observes, that the quantity of acids necessary to effect a cure of fevers, depends on circumstances, and can only be determined by experience. It is, however, more advisable to begin with small doses, and to repeat them frequently ; for instance, if a mixture be made of from one dram to half an ounce of the acid, eight ounces of water, a .d two of syrup, let the patient take a table-spoonful or more every hour, or two hours. But, in time of danger, from forty to an hundred drops, properly diluted, may bo given at once, and such doses often repeated. - As we propose to insert a few additional remarks on the use and efficacy of this ac d, under the head of Typhus, we shall conclude with observing, that we have prescribed large doses of this powerful remedy only in two cases of complicated bilious and nervous fevers, in which it at first produced alarming symptoms, such as diarrhoea, vomiting, etc. though it was eventually attended with success. In short, it is one of those medicines which may be safely administered by the experienced hand of the practitioner, but which is apt to be misapplied by dabblers and empirics.
Fever in horses, a disorder to which these creatures are subject from various causes. The symptoms are : great restlessness ; the animal's flanks beat; his eyes are red and inflamed; his breath is hot, and smells strong ; his appetite is lost ; he dungs little, but frequently; his urine is of a very high colour, is discharged seldom, and with great difficulty; he appears to be thirsty, yet drinks little, though frequently; and his pulse is uncommonly high.
The first remedy to be applied is bleeding, when two or three quarts of blood may be taken from the animal, if it be large, strong, and in good condition. A pint of the following drink is then to be given four times in the course of the day : Take of baum, sage, and chamomile flowers, each a handful ; of sliced liquorice-root 1/2 an ounce, nitre, 3 ounces : the whole is to be infused in 2 quarts of boiling water, and, as soon as it is cold, it is to be strained, the juice of 2 or three lemons squeezed in, and sweetened with honey; or, instead of the infusion above di-rected, an ounce of nitre, mixed with honey, may be given in the form of a ball, three times a day, and washed down with any small liquor.
The animal's diet ought to con-sist of scalded bran, allowed in small quantities ; or, if he refuse this, a little dry bran sprinkled with water may be substituted. It will also be necessary to put some picked hay into the rack, as horses will frequently eat it, when they relish no other food: their water should be scarcely lukewarm, and given them frequently, but in small quantities. Their clothing ought to be moderate, for too much weight on a horse is highly improper in fevers.
If, in the course of two days after this treatment, the animal's appetite begin to return, and he eat a little bran or hay, careful nursing will be sufficient to complete the cure; but, if he continue to loathe his food, it will be necessary to take away more blood, and to repeat the drenches. - The following clyster, consisting of 2 quarts of water gruel, fat broth, pot-liquor, a handful of common salt, 4 ounces of treacle, and a pint of linseed-oil, should be administered every day, while his excrements continue dry or knotty. Such clysters are more proper than those consisting of marsh-mallows, chamomile flowers, fennel-seed, and other purging ingredients.
An opening drink prepared of 4 ounces of Glauber's salts, or cream of tartar, and an equal quantity of lenitive electuary, dissolved in -barley-water, or any other liquor, should likewise be given every second day, when the clysters maybe omitted ; the nitre-balls, or the drink above mention-ed, being continued every day as usual, unless the clysters be administered. In the course of four or five days, the horse will begin to pick his food, if he be not beyond the power of medicine ; and, though his flanks will continue to heave for a fortnight, yet this may be effectually removed by walking him in the fresh air, and allowing him plenty of clean* litter in the stable.