Part 11

_Unicum remedium est, nec opinantem in piscinam non ante ei provisam projicere, et, si natandi scientiam non habet, modo mersum bibere pati, modo attollere; si habet, interdum deprimere, ut invitus quoque aqua satietur: sic enim simul et sitis, et aquæ metus tollitur. Lib. v. cap. 27._

But to avoid being tedious, I will proceed to the method I would have pursued in an accident of that terrible kind.

If you by the before description find that the dog who gave the wound is actually mad, then without a moment’s delay let the piece bit, be cut fairly out; if that is not practicable, apply immediately the ointment made of _mercurial ointment_ and _precipitate_, No. XXI. Over which apply _mercurial plaister_. Give one of the pills No. X. every morning and night, and continue this course for a whole month. Let the plaister remain on the place a good while after the sore is healed up.

This method I pursued with a gentleman, and a little boy in New-York, who both were bit by the same dog, without provocation, the dog having never attempted the like before; upon which he was immediately shot, and was found to have all the signs of madness.——The accident happened at noon, and I was immediately sent for; but not being in the way, my assistant dressed it with basilicon, and laid over it a compress with _spirit of wine and Camphor_, supposing it of no consequence, as the wound was but very small. But on my hearing of it in the evening, I went that moment to their assistance, removed the dressing and applied what I have before mentioned.

I was not mistaken, for the sore and all around, after some time grew angry, and had an unfavourable appearance; but with diligent attendance gradually became better.—— The little boy was bit deeper than the gentleman; His wounds were on both sides of the _tendo achillis_: But the gentleman’s wound was a little above the _maleolus externus_ on the right leg, inclining to the _tendo achillis_.

It was in the month of July—I ordered bathing every morning and night, which suited the season. In the mean time, during three months, I gave one grain of calomel every morning and night; and every thing succeeded to our wishes.

But to return; should the mercurial medicines go to the mouth, a gentle cathartic will divert this, for I am an utter enemy to salivation. If however these remedies are administered too late, so that, notwithstanding all those applications, the patient should grow melancholy, have a difficulty in breathing, and a sore throat; but especially a pain in the sore, or bitten part, recourse should be had to frequent cold bathing, or rather plunging; mercurials should be continued, and every method pursued as will be advised in the putrid malignant fevers.

Should the patient however be seized with madness, care should be taken that those about him have no wounds where the least of his spittle may be introduced; and that the deplorable patient is rendered incapable to make any wounds or mischief on himself, or those who attend him; as he will be apt to snap and bite about him like a dog. He should be sewed up in a hammock, to which his arms should also be confined: in this method he may, by help of a tackle, be plunged up and down in the sea, but not his head under water. This is far superior to the unnatural and cruel way of smothering with beds, where the patient has no chance at all left.

The subject is melancholy; but, willing to contribute all the relief in my power to the distressed, I have been insensibly led on; and summed up all that might promise success. Innumerable are the remedies delivered to us, but few prove successful if the case be real.

Of all, I never knew any meet with better success than where mercury was concerned; and as I have been so fortunate as to have experienced the exalted virtue of that great medicine, in this and other deplorable cases, I stand so much upon the firmer grounds, to recommend it beyond any other medicine that I am acquainted with at present.

To conclude, I think it requisite to observe, that, dreadful as the bite of a mad dog is, when the poison has infected the unfortunate patient, yet this unlucky accident happens much seldomer, than mankind from the dread of the misfortune, are apt to apprehend it does. Many nostrums are published as specifics, and their virtue artfully confirmed, with cases of being bit by dogs, that had however not the least symptom of madness; and thence cures enumerated, that could have no foundation on reality; by which artifices much mischief has been done in real cases. Due observance should therefore be had to the state of the dog that has given the wound, and the circumstances attending; that either the patient may not be brought into unnecessary pain, or that proper and substantial remedies may not be neglected.

LECTURE V.

OF

FEVERS AND INFLAMMATORY DISEASES,

AND

THEIR PROPER METHOD OF TREATMENT.

We now proceed to the more internal diseases; in which, the various steps that we intend to take of restoring health again, must be guided with the greatest caution, as the seat of the malady is hid from our external examination.

It is for this very reason I designed previously to prepare the reader with the two first lectures; particularly the second, I must beg the reader thoroughly to examine, and to understand; for on this will in a great measure depend the proper application of the various experienced remedies, which I here mean to unfold.

SECT. I.

_Of Fevers in General_

Hippocrates, the father of physic, was wont to say, “A fever is so universal, that no patient dies without it.” This is so true, that there is hardly an exception to it, even in the most momentary apoplexy itself.

To conceive this properly, we must observe, that every diminutive part in the animal fabric, like in a commonwealth, is endued with a sense of self-preservation; and the whole fabric is in so strict a conjunction with all its various particles, both solids and fluids, that nothing which may cause the least disturbance can pass unnoticed; but, let the injury be where it will, every individual particle, as a member of the whole animal state, feels the shock, and is immediately concerned for its own preservation.

This then is the cause of a fever in the general sense; and thence we shall be led to understand what this disturbance in its nature actually is; namely, an unnatural action of the solids upon the fluids.

Now as the fluids are the most yielding parts, that must submit to the pressing motion of the solids, we may without much difficulty, see one principle reason of its being set into a disturbed commotion, when the irritability of the nervous fibrillæ are acted upon.

Again, when we consider that the blood is liable to become acrimonious, and thence by its stimulus apt to act upon the coats of its containing vessels, we see demonstratively plain, how the solids are subject to be excited to act upon the very blood that stimulates them.

Moreover, as motion must naturally produce heat, and heat motion, and motion expansion, and expansion rarefaction, we at once bring to view the principal laws of mechanism, that governs the human automaton in the various degrees of health as well as disease. However, let me not forget to whom I write, but haste to the point I am at.

A fever may proceed from many different causes, and may affect many different constitutions, and also produce many different effects; it is therefore just that a proper distinction should be made.

Indeed, it is a subject that cannot be too minutely handled; because it is scarce possible that there is a disease void of a fever in some degree or other.—But preciseness and utility is the object I have in view.

SECT. II.

_Of Accidental Fevers._

How uncertain is human life! One moment in a perfect state of health, the next perhaps no more; or confined under the painful sensations both of body and mind!

Every accident is liable, and unavoidably must bring on a fever; and this, like fire, should be extinguished in its earliest commencement. But in that, as I have before observed, the constitution should principally be consulted.

I have in the lecture of accidents, at every opportunity, recommended bleeding, but always with a proviso, _if requisite_; and, as this is of more consequence than generally is supposed, I find it necessary here to expatiate farther on it.

In the first place, no man should be bled who has lost a considerable quantity of blood, unless indeed he was known in his state of health to be very strong and robust; and that the fever sets on with such fury, that the system requires absolutely to be reduced; for the solids and fluids have such a strict dependance amongst themselves, that they keep each other in an equipoise. If therefore the blood is of an acrimonious nature, and at the same time impoverished by lessening its quantity, the coats of the arteries and veins will be the more stimulated; thence the fever will naturally encrease, and generate more acrimony; which at length will destroy the patient. I have been an eye witness more than once, that the fever has actually increased upon every repeated bleeding, till the whole supply of life was spent; and all my persuasions have not been listened to till too late. Nay, a fever is sometimes absolutely necessary; and proves to some constitutions a remedy on its own account, provided it is properly treated, and kept within due bounds.

Secondly, If the constitution of the patient before the accident was but slender, and of a phlegmatic nature, bleeding should be very little or cautiously performed; for the blood of itself being but poor, must naturally be impoverished by being lessened; and whilst the tenseness of the fibres is lost, it is the more acted upon and rendered more acrimonious, and still unable to strengthen the tone of the irritated fibres; whence a relaxed body, together with a poor acrimonious blood, and all its evil tendencies must be the consequence.

Let it once for all be observed, that all the benefit we can possibly hope and expect from bleeding, is to lessen the whole system, to reduce the quantity of the fluids, and to relax the solids. This lessening of the system I must own is very often highly necessary; But, let us not fall into the ridiculous notion to suppose that bleeding will draw off the bad blood, and leave the good behind; far otherwise; the quantity of the blood is soon replenished, but the quality becomes impoverished.

The principle intention in fevers of whatever kind, should be to promote perspiration. This is the grand restorative of nature; and I cannot recommend it too much. Nature designed this evacuation in the formation of man; and by that, fevers were cured in time of yore, many ages before art contrived either lance or lancets.

But here let me not forget another great caution; namely, not to mistake profuse sweating for perspiration; for this is an extreme into which many have erroneously fallen. Nature frequently produces a sweat without force or compulsion; and if so, it should be favoured, but never brought on by stimulants, or strong forcing medicines.

Perspiration, sweat and urine, are the natural evacuations intended, for the purifying the system from animal acrimony; and when these excretions are in a just balance with the secretions of the fluids and motion in the system, without pain or fatigue; then nature is at peace with itself.

Lastly, I must observe, that the stomach is an organ which, by the nervous consent, carries on an immediate correspondence with every part in the human fabric; whence this viscera should likewise ever be consulted in fevers; that is, never to impose on it any aliment against its own inclination and appetite.

The want of appetite in a fever is a natural cause, and very often is in the patient’s favour; but the mistaken notion, that a patient must eat, even against his inclination, in order to recover strength, is not only highly absurd, but has been the destruction of many, who otherwise would have recovered, had they with patience waited the kind dictates of Nature.

Let the system be free from diseases, and the stomach will soon crave food, when there is a probability that the aliment may be converted into good blood; but whatever is forced into the stomach before that time, will instead of nourishing the body, only add fuel to the destructive fire, and encrease the already malignant blood.

Upon the principles of these observations, I shall lay down the rules that should be religiously observed in accidental fevers; and when they are well considered, we shall find that they will hold good also in all other kind of fevers, notwithstanding they arise from internal acrimony of the body; for the difference is barely this, whether the fire is kindled within or from without;—but to proceed.

Whatever then be the accident, a fall, a wound, a fracture, dislocation, bruise, &c. observe what the patient was before the accident.

If the patient was a stout hearty man, it naturally follows, that the fibres of his body were also in a rigid robust state; and the quantity and richness of the blood was in a due proportion; for this very reason, health being at such an _acmé_, a fever is the more to be feared, and ought studiously to be avoided.

If this patient has not lost any blood by the accident, by all means bleed him; but never exceed eight ounces at farthest; it is as much as the strongest man ought to lose at once.

In the next place, perspiration should be the principal object in view. To this end, let the patient immediately after bleeding go to rest, and take a dose of the _Fever Powder_ (L); upon which let him drink plenty of _Balm Tea_ (12); which will generally bring on a perspiration.

If however the fever increases, the pulse continues to beat hard and full, the head-ach, difficulty of breathing, a great draught and delirium should ensue, bleeding indeed may be repeated, provided it is within the same twenty-four hours; but if the symptoms come on beyond that time, then bleeding will seldom prevail, or do any good, but rather mischief; for by this time, the fever is generally agitated by acrimony, and the blood is of its own accord poor enough without being made more so by bleeding.

In the symptoms which I mentioned, regard should be had to the body being gently kept open, not by purges but by clysters; for purges in fevers are precarious, and liable to bring on heavy fluxes. If the patient under this high fever is costive, give him the following clyster.

No. XXIII

_Take warm water one pint, or something more; in which scrape about one ounce of castile or hard soap, and let it perfectly dissolve; then add a spoonful of honey to it, and let it be as warm as that it may be easily borne to your cheek._

Let the patient keep this clyster within him as long as he can, till it comes away with a stool.

If the patient is sick at the stomach, a vomit of _ipecacuanha_ (S) or No. XXVI, will be very proper, and nothing in such a case can be given more safety and better advantage; for it is not only the stomach that gets relieved, but the whole body is brought thereby into perspiration, by the universal strain it occasions. After the vomit, or after the clyster, give the following draught.

No. XXIV

_Take of fever powder_ (L) _one scruple; common water or balm tea, one ounce or half a tea cup full; then take a lump of sugar, on which pour essential oil of peppermint_ (U) _three drops; liquid laudanum_ (T) _eight drops; sweet spirit of nitre_ (D) _thirty drops; and mix them with a tea spoon._

This draught will not only promote perspiration, but it will comfort the stomach, and incline the patient to an agreeable rest; by which he will be greatly refreshed. If occasion requires, it may be repeated every six hours.

If rest comes of its own accord, the _liquid laudanum_ (T) may be omitted; and if the stomach does not stand in need of any carminatives, the _oil of peppermint_ (U) may also be omitted, &c. The constant drink when dry may be balm tea; in which, if it suits the palate of the patient, a slice of lemon may be put, and then sweetened with sugar.

The diet, as I have before observed, should be sparing; and the patient’s palate in this should principally be consulted. The following water gruel, or rather wine soup, or whatever other name it may acquire, I have often ordered to my patients at sea; and which has suited most stomachs, and proved an agreeable mess.

No. XXV

_Take oatmeal, or pounded biscuit, a couple of spoonfuls; water, a quart; a small handful of raisins; a little allspice, a little mace, tied up in a fine rag; which boil together in a tin saucepan till consumed to a pint and a half; then add a gill of good wine, red or white, and sweeten it with sugar to suit the palate. You may put a little lemon peel in, to give it an agreeable flavour._

A little roasted fresh meat will hurt nobody; and broths most certainly are good, particularly if the body is costive; but when the body is inclined to looseness, I have known the best broth to produce a dangerous flux; and this should be taken notice of.

If the patient however who has met with the accident is of a puny weak constitution, or has lost a sufficient quantity of blood by the wounds, bleeding then is not so requisite as in the former case; though the treatment otherwise must be equally the same.

By this method of proceeding, there is little fear but that the patient will soon perfectly recover, even in the highest fever that may suddenly befall a man from an accident; provided the injury is not of a dangerous tendency. But as an acrimonious habit of body is liable on its own accord to diseases, it is easily imagined that an accident may become accessory, and heighten the malignity; hence often a fever of that kind is liable to degenerate into a malignant one, or even from the accident itself, when of a dangerous nature; and this I shall explain as I proceed. I shall therefore leave the accidental fever that proceeds from an external cause, and proceed to those which take their origin internally.

SECT. III.

_Of a Cold_.

The fever now to be treated of is the most common amongst mankind; especially seamen, who are ever exposed, to have the perspiration obstructed. It however would save many from the grave, and almost as many from being food for the fish, was it a little more regarded than what it actually is.

The sound of a cold is so gentle, that custom has almost made it effeminacy to pay any regard to it; and yet, if we maturely examine, we shall find the most malignant, acute, and mortal diseases, first make their appearances by the symptoms of a cold,——But let us proceed to particulars. A cold is an obstruction of perspiration; which may become destructive to the animal œconomy if neglected, in so much, that it may be considered as the first foundation of most diseases.

In my treatise on diseases of the lungs, I have enumerated the many causes of a cold to which mankind are liable, and their precautions to avoid them. To sea-faring men, I have one principal cause to mention whereby they make themselves subject to colds, and sow the seed of many dangerous diseases in their system, and that is their carelessness in shifting, after getting wet; in this respect, I have however a remedy to offer, which is as valuable and as efficacious to their preservation, as it is easily put in execution. The remedy is simply this:

A man who has been exposed on duty in the rain, and is become thorough wet, should not only shift himself in dry cloaths, but previously wash all over with sea water: if he carefully observes this, he will never get cold on that account. I have not only experienced this personally many times, but ever found it productive of salutary effects to those I have persuaded to it.——If we but make some observations on the accidental occurrences that happen at sea, we shall see the just foundation of this. When do we find a man who is continually washed by the sea to have a cold? while on the contrary a foul rainy day, will almost breed a general sickness.——These observations first brought me on the notion of washing the body with salt water, and having verified it by experiment, I soon saw the propriety of it; namely, that the fresh water being of a sluggish nature, and having a tendency to putrefaction, is not only apt to infuse a putrescency into the system, but from its slimy nature apt to clog up the pores, and thus obstruct perspiration; whilst on the contrary, salt water is not only antiseptic, but stimulates the pores of the skin to their secretory and excretory functions.——Nay so perfectly have I experienced this remedy, that I have persuaded the people to salute one another by way of play with buckets of sea water on a foul rainy day, and with pleasure I have experienced that they have all remained brisk and hearty after it, and evidently seen the difference, that on a similar day the sea water play being omitted, scarce one who has been thorough wet, escaped a cold in some degree or other.——I must not forget, that a draught of grog is likewise no bad preservative. But this is best taken when the watch is out, and that rest and sleep can be indulged upon it, as that will then be apt to throw them into a gentle perspiration; whilst however their watch is upon deck, the best warmth is that which is produced by exercise; except liquors is taken with the greatest moderation.

But when a cold has actually commenced, care should be taken immediately to have it subdued in time. The term cold however is a very vague expression, that includes a great many disorders, occasioned by an obstruction of perspiration, which all in turn shall be taken notice of: But as I am now on the subject of fevers, I shall confine myself to that at present, and consider the cold as it affects the body universally; namely headaches, a weakness in all the limbs; intermittent fevers, intermixed sometimes with flushes of heat, and at other times shivering, chilling, &c.

These are not only the symptoms of a cold, but of almost all inflammatory fevers; which in fact, the cold is a commencement of. Now all that nature requires is a perspiration; for thereby the imprisoned acrimony is expelled, and which nature is always engaged to throw off from the system.—To this intention, if the patient is rich of blood, bleeding should be performed; but with such caution, as I have before recommended. Next give the _fever powder_ (I), together with a good quantity of balm tea, or if the constitution is of a phlegmatic habit, sage tea, or even sage punch ( No. V.) will not be improper; but care should be taken, that if there is much fever, all those things should be omitted, as it is liable to increase the fever. If there is a nausea at the stomach, give a vomit: take the following:

No. XXVI

_Take Ipecacuanha_ (S), _one scruple: sugar a little lump: water half a Tea cup full, and make it up into a draught._

This vomit should be well worked off with chamomile tea, or even common luke warm water; first letting the vomit operate, and then drinking plenty of the water after every operation. When this is over, the patient should keep his bed or hammock, and take either the _fever powder_ (L), or the before mentioned draught, No. XXIV.