Anetus. Intermittent fever. GEN. II. few, spasms and twitchings of the tendons; aphthæ appeared occasionally; and one patient exhibited symptoms of violently acute rheumatism. The bark was universally successful; and, "I was as much pleased", says Dr. Reynolds," with its present efficacy, as I was in the year 1781 mortified by its extraordinary want of power. Half the quantity of it which I used on that occasion was sufficient on this." General remarks hereon. Sir George Baker's own account of 1780-1. In other words, idiosyncrasy and atmospheric temperament were both peculiarly visible, and gave a peculiar character, in the one instance to particular cases, and in the other to the general disease. In plethoric habits the head was greatly oppressed, with a tendency to delirium. In those of a nervous or irritable disposition, the intermittent was connected with spasms and twitchings of the tendons. And those disposed to rheu-. matism had acute arthritic pains. The state of the atmosphere, and general character of the season Dr. Reynolds has forgotten to notice: but we see evidently, and indeed he himself allows, that they gave a typhous impression to the epidemic; which, from the same, or from other causes, is also peculiarly distinguished by the easy victory it yielded to the use of the bark: as that of the preceding year was distinguished by its obstinate resistance to this medicine. If we ascend a year higher, or to 1780-1, we shall meet with an equal diversity of symptoms. "These fevers" (intermittents), says Sir George Baker, "were in general no other than the common ague; but in the more inland counties of England, they were often attended with peculiarities extraordinary and alarming. For the cold fit was accompanied by spasm and stiffness of the whole body; the jaws being fixed, the eyes staring, and the pulse very small and weak.-In many cases delirium, · was added to spasm, under both which symptoms the Symptoms patient laboured quite to the end of the paroxysm. And peculiarly though the senses returned when the fever subsided, yet a convulsive twitching of the extremities continued even severe. GEN. II. in the intermissions, to such a degree, that it was not possible to distinguish the motion of the artery at the Anetus. wrist. Intermittent fever. variable. Often raged in high grounds and not in low grounds. "This fever had every kind of variety; and, whether Peculiarly at its first accession it were a quotidian, a tertian, or a quartan, it was very apt to change from one type to another. Sometimes it returned two days successively, and missed the third, and sometimes it became continual. I am not informed that any died of this fever whilst it intermitted. It is, however, certain that many country people, whose illness had, at its beginning, put on the appearance of intermission, becoming delirious, sunk under it in four or five days. It is a remarkable fact, and very well attested, that in many places, WHILST THE INHABITANTS OF THE HIGH GROUNDS WERE HARASSED BY THIS FEVER, IN ITS WORST FORM, THOSE OF THE SUBJACENT VALLEYS WERE NOT AFFECTED BY IT. The people of Boston and of the neighbouring villages, in the midst of the Fens, were in general healthy, at a time when this fever was epidemic in the more elevated situations of Lincolnshire: and other examples of a like kind have already been noticed *. It is likewise singu- Among felar, and worthy of notice, that in many families the female servants were nearly exempted from a disease which very few male servants, especially the labourers males in the open air, escaped. But the distinguishing cha- Obstinate racter of this fever was its obstinate resistance to the Pe- resistance to the bark. ruvian bark; nor, indeed, was the prevalence of the disease more observable than the inefficacy of the remedy. Though the quantities of the bark usually given were exceeded, the fit was apt to return, rarely altered, either with respect to the time of invasion, or the intenseness of the symptoms; and just as if no means had been used to prevent it. A drachm of the bark in powder was frequently administered every second hour without avert> ing the fit."t * Sir Gilbert Blane, Select Dissertations, p. 111. 8vo. Lond. 1822. males in the house rather than abroad. GEN. II. Anetus. Intermit tent fever. Medical treatment. General remedies In casting our eyes over the great diversity of medicines that have been employed for the cure of intermittents, we shall find that, innumerable as they are, they may be arranged under two general heads, tonics and antispasmodics; as though, long before the time of Dr. character of Cullen, his two principles of the disease, debility and had been uniformly admitted and acted upon. The antispasmodics, consisting chiefly of stimulants, sedatives, and relaxants, have been confined to the term of the paroxysm, with a view to weaken and shorten it; what views and the tonics, consisting principally of bitters and asemployed. tringents, have been employed throughout the intervals with a view of fortifying the system against a recurrence of the attack. for inter mittents. Antispasmodics and tonics with Pungent antispasmodics of Bergius. spasm, In discussing the medical treatment of intermittent fevers, it will be sufficient to limit ourselves to these two indications. It was a favourite practice with Bergius to anticipate the cold fit, constituting the accession of the paroxysm, by pungent stimulants, in the hope that if he could successfully combat this first stage, he should gain a complete victory, not only over the individual paroxysm, but over all future incursions. His favourite medicines for this purpose were garlic, mustard-seeds, and capsicum, which in his day was described under the name of piper Indicum. And he boasts of having, in numerous instances, completely succeeded with each of these; though he admits that the mustard-seeds answered best in vernal intermittents, but did not in general prove sufficient for Indian prac- the autumnal quartans. The Indian practitioners, I may here observe, employ chakka or ginger, and sometimes the sison ammi for the same purpose, and Dr. Chisholm has occasionally succeeded with scallions*. Bergius, however, placed his chief reliance on the capsicum, six grains of which he was in the habit of giving, combined with two scruples of bay-berries in powder, "incipiente primo rigore"; and of repeating it every day, at the titioners: Chisholm. * Climate and Diseases of Tropical Countries, &c. 1822, p. 53. GEN. II. Anetus. same hour, for three or four times in succession. And he assures us that he has very frequently seen obstinate Intermitintermittents removed by this powder, and without any tent fever. relapse. Medical treatment. hands. The practice, however, has not been equally successful Ineffective in other hands; not even when capsicum has been given in other in a much larger quantity, or exchanged for ammonia, treacle-mustard (clypeola Jonthlaspi), or black or whitepepper, the latter of which is only the former denuded of its outward tunic, mixed up with brandy or hollands. They have all, indeed, sometimes answered, but the result is uncertain; and, as was long ago observed by the Baron Van Swieten, if the medicine do not succeed upon a full dose, and especially when combined with ardent spirit, it will often extend its influence to the hot fit, and greatly exacerbate it; and not unfrequently convert an intermittent into a continued fever. Upon the whole, therefore, this plan is not to be recommended, however varied. The least pernicious material is the ammonia, but then it is also the least effective. as an anti A large draught of cold water has been not unfre- Cold water quently had recourse to for the same purpose, and also, spasmodic. in a few instances, with success. The object is, by taking it about half an hour before the cold fit is expected, to excite a strong re-action and powerful glow over the entire system against the time when the cold fit returns, and thus to pre-occupy the ground; and, by disturbing the regularity of the type, to subdue the intermittent altogether. But this plan has, perhaps, more frequently failed than the preceding: and when the shivering or horripilation produced by the cold water has not been followed with a stimulant effect, as in delicate habits more especially, it has often continued so long as to run into the term of the febrile cold fit, and very considerably to increase its power. Ballonius relates a case in which it proved fatal*. The next division of antispasmodics which have been Opp. Tom. I. p. 193. directed against the paroxysm, and especially against the rigor with which it makes its onset, is sedatives: and of these the chief have been opiates, which, when, given in the form of laudanum in a dose of from thirty to forty drops at the commencement of the chill, has, in many 'cases of intermittents, been highly beneficial; diminishing the duration of the stage, and moderating its symptoms. Dr. Trotter says that he practised this plan with general advantage in an epidemic intermittent that attacked the Vengeance, one of the channel fleet under Lord Howe and adds that, "if the first dose of opium did not produce a sensible relief and exhilaration of spirits in half an hour, he repeated it, and never found it necessary to go beyond a second dose". Sir Gilbert Blane adverts to the same plan as pursued at Walcheren during the English expedition to that island, and with an equal success*. We have already seen, however, that there is some cause or other, probably the peculiar temperament of the atmosphere at the time, that baffles on one occasion the remedy that has best succeeded on another. And hence opium has often failed in other intermittents in every form, but especially when given in the cold fit. And owing to this diversity of effect Dr. Lind thought it most useful in the hot fit; and asserts that, if administered to the extent of twenty or five and twenty drops of laudanum half an hour after the beginning of the hot fit, it produced the advantage of shortening and moderating the heat, calmed the anxiety and head-ache which are usual concomitants, expedited the sweating stage, made the paroxysms more regular, and sometimes stopped the fever altogether. Other physicians have commenced with relaxants: and where these are selected, the antimonial preparations are to be preferred to ipecacuan. They tend more directly towards the surface, and, where it is useful to excite vomiting, which is often the case, they act sooner, and * Select Dissertations, &c. p. 105. Lond. 8vo. 1822. |