SPEC. II. BE. Typhus gravior. Putrid fever. Treatment. matory fever has, sometimes, a tendency from peculiarity GEN. IV. of constitution or accidental circumstances to run rapidly into typhus; typhus, in like manner, occasionally meets with incidents that suddenly reverse its character and incline it to an inflammatory type. A very stimulant plan of treatment has sometimes done this; but far more frequently a sudden change in the atmosphere, from hot, hazy, and relaxing weather, with scarcely a breath of air stirring abroad, to a dry, cool, and refreshing east or north-east breeze: and I have often found a like tonic effect produced upon a patient labouring under typhus in a low, damp, filthy, and suffocating lodging, upon his being removed into a large, cool, pure, and well-ventilated chamber, such as is now generally found in our fever institutions. In this case, bleeding, which I had not dared to risk, notwithstanding some symptoms of oppression, before the removal, has been practicable without any risk afterwards, and has laid the foundation of reconciled. speedy and effectual cure; and I am inclined to think Clash of that some part of the clash of opinion, which prevails pable of upon this subject in the present day, proceeds from a being conwant of due attention to the different states in which dif- siderably ferent or even the same patients are placed by this difference in the purity and temperature of the surrounding atmosphere; and that many hospital-physicians, who are the warmest advocates for sanguineous depletion in their own fresh, cool, airy wards, would hesitate upon its expediency if they were to attend their patients throughout in their own close, heated, and miserable habitations. illustration. It is not long since that I was consulted by a very Farther respectable practitioner in Hertfordshire, upon a plan of treating typhus, which was then raging with great violence among the poor of the town in which he resided. He had been a surgeon in the naval service of the East India Company: and having witnessed the benefit of early and copious bleeding in the yellow fever, had very generally followed it up in the contagion before him, and, as he frankly confessed to me, with a decidedly unfortunate result. My advice was, before he SPEC. II. 6 E. Typhus gravior. GEN. IV. thought of the lancet to take care of the ventilation; and then to subject it to the restrictions here laid down, and to let every case be its own interpreter. And a letter received from him a few weeks afterwards expresses his obligations for the advice, and the success that had resulted from it. Putrid fever. Upon this subject there is a passage in Dr. Hennen's Military Surgery so strikingly in point that I cannot avoid quoting it. After the famous battle of Vittoria, in July 1813, the sick and wounded of the British and Portuguese army were chiefly removed to a temporary hosHospital at pital established at Bilboa; where typhous miasm having Bilboa, in 1813. soon been produced by its ordinary causes, of a foul and lief." And he proceeds to state that from this time the practice of venesection, on the appearance of inflammatory symptoms in a wound or newly-healed stump, became general, and was the only remedy had recourse to whether as a cure or a preventive. GEN. IV. Putrid fever. Importance guided both by particular and general circum of being Of such importance is it for us to be guided by particular and general circumstances in the treatment, not merely of typhus, but of all diseases whatever: to let the rule have its exceptions, but not to mistake the exceptions for the rule. "The art of physic", says Sir stances. George Baker, "rarely admits of any perpetual precepts; and the best medicine may do harm if not adapted to the patient as well as to the disease."* almost immemorially; There is another remedy of very extensive use in the Cold water cure of typhus, far less disputable, and which is founded as a remedy, altogether upon the indication of equalizing, supporting, and restoring the sensorial power: and that is, the free application of cold water, and especially externally. This valuable medicament has been employed in some employed form or other almost immemorially. Hippocrates recommends it in malignant fevers generally in the form of epithems, or napkins wetted with cold water and applied repeatedly to the head or any other viscus as the cloths become warmt. Among the later Greeks, however, it does not appear to have been in very general use; and though it is highly prized by Celsus, in various debilities, and especially sensorial debility affecting the head, and combined with fever, in which, says he, "existat validissimè repentè aqua frigida infusa"‡, yet it does not seem to have constituted a fixed, or even a frequent practice in his day. In our own country it was successfully em- Early as an ployed by Dr. Willis, in various fevers, and especially external application in those accompanied with delirium; and was hence strongly England. recommended by Sir J. Floyer and Dr. Baynard: and was used on the continent, not merely in the form of epi • Med. Trans. III. 417. † Περὶ Νουσῶν, 11. p. 484. 50. though not very geneed in Greece rally adopt or Rome. GEN. IV. 6 E. Typhus SPEC. II. gravior. on the con tinent. Used internally as well as extern ally. thems*, and affusions, but occasionally in that of immersion, or cold bathing in a river adjoining the patient +. On the continent, indeed, it seems to have been employed at a much earlier period than in our own country, as we learn from Milot's Dissertation, "Ergo febris frigidis et humidis expugnenda?" printed at Paris in 1594; and Hernault's, on the same subject, "Ergo propria febrium medela refrigeratio?" printed in the same place in 1630. It was also used internally as well as externally, both in our own country as well as on the continent, especially in Spain and Naples, as is obvious from Dr. Hancock's Febrifugum magnum ‡, and Dr. Cyrillo's paper on the subject in the Philosophical Transactions. Snow-water. Even snow, or snow-water, under the name of aqua nivata, or aqua nive refrigerata, was also occasionally employed ; and, in the ardent fever, recommended by Paullini both externally and internally . Professor Hildenbrand of Vienna, during the extensive range of practice which the Austrian Army afforded him in the late war, employed sometimes the cold-bath, sometimes affusion of cold water, and sometimes a general friction Snow alone. of the surface with snow itself in the commencement of the fever ¶. And to prove how torpid to common impressions the body is under nervous fevers generally, and how little disposed to be injured by such applications, it is only necessary to advert to the case of a patient at Lucca, given by Dr. J. Benevuti, in another part of the Transactions just referred to. On the ninth and tenth day from the incursion of a malignant fever, he was Singular case from Benevuti. • Mursinna über Ruhr und Faulfieber. Loeffler, Beytrage, &c. † Eph. Nat. Cur. Dec. III. Ann. ш. Obs. 48, and Ann. v. vi. App. p. 128. Febrifugum magnum or common water the best cure for fevers. Lond. 1752. § Nouvelles Annales de Medicine, Iv. Cent. I. Obs. 66.-See also Nehemias (Abrah.) De tempore aquæ frigidæ in febribus ardentibus ad satietatem exhibendæ. 8vo. Venet. 1591.-Planchon, Journ. de Med. Tom. xxx. p. 127. Lamarque, id. Tom. LXVI. 460. LXVII. 68. ¶ Ueber den anstochenden Typhus, &c., ut suprà. GEN. IV. Putrid fever. Body tor action of thought to be in great danger. On the eleventh, he expressed a wish to go to sleep, and desired the attendants to withdraw. On their return, he was found to have left his bed; and three days afterwards was discovered in a hut in a vineyard, about two miles from the house, having but just recovered his senses, and as much won- pid to the dering how he came there as those who had traced him out. It appeared, on farther inquiry, that he had de- fluences. scended from his chamber by the window, in his shirt alone, and in a great perspiration; had walked all the way in the snow with which the ground was then covered, and had swallowed a large quantity of it to quench his thirst. Yet neither the cold air nor cold beverage affected him otherwise than beneficially. He continued well from this time *. external iu employed The use of cold water, however, as well external as Cold water internal, appears on many occasions to have been em- formerly ployed with too little caution, and hence one reason of incautiits falling into frequent disrepute. Even as early as ously. 1581, Masini thought it right to guard the profession against its abuse, by a work expressly devoted to this subject+; and numerous others occurred in succession through the ensuing century. day: by newed. In our own day, Dr. Wright of Jamaica is, perhaps, Practice of the present the first physician who revived the practice; but it is chiefly to the judgment and experience, the writings and whom rerecommendation of Dr. Currie of Liverpool, that cold water as an external application is indebted for the high and deserved degree of popularity it again possesses, and especially in typhus. It is now equally used in the form of sponging, ablution, and affusion, the last of which is the xaтánλuois of the Greek writers, though this term occasionally also imported immersion. All these are of essential use; yet the most sudden and decisive benefit has been observed to result from affusion; for which purpose the patient is to be supported on a stool in a low wide tub, and to Phil. Trans. VIII. 1768. † De Gelidi Potûs abusu. 4to. Cesen. In what forms em ployed. |