Зображення сторінки
PDF
ePub

however, withont topical inflammation, is in portion to the violence of the symptoms of this country a very rare occurrence, gene- increased excitement, strength, and former rally commences with short fits of cold and habits of life of the patient, and nature of heat alternating with each other, to which the prevailing epidemic; if, on the first succeed an intense burning heat, head-ach, blood-letting, the symptoms be consiaccompanied with throbbing of the temples, derably alleviated, and the pulse and heat or tinnitus aurium, pains in the back, loins, become nearly natural, it will not be ne. and joints, and the patient feels as if his body cessary to repeat it; if, on the contrary, had been severely bruised : the face is full the symptoms continne with but little or no and forid ; the eyes are inflamed and incaabatement, it will not only be advisable pable of bearing the light; the skin, mouth, but indispensably necessary to repeat the and throat are dry; the tongrie is covered operation, until we nearly reduce the pulse with a white crust; the thirst is intolerable; and heat to the natural standard; the bloodthe respiration is frequent, hurried, gene. letting will be the more efficacious, the rally oppressed, and attended with a dry more suddenly we abstract the blood ; an cough; there is anorexia, nausea, vomiting, emetic should then be administered, and in restlessness, and delirium; the urine is se. a few hours after its operation has ceased, a creted in small quantity, and is high co- cathartic should be exhibited, for which loured; the bowels are costive ; the pulse is purpose the phosphate or sulphate of soda, frequent, strong, and hard, scarcely ever, or the sulphate of magnesia, combined with however, exceeding 120 strokes in a mi- the infusion of senna, with a small propornute ; the blood, when drawn, is covered tion of the tartarised antimony, will be with a whitish or yellowish crust. In this the most efficacious ; calomel is a preconntry, after the symptoms have continued ferable medicine to the others; after the for some days, they begin generally to as- contents of the primæ viæ are sufficiently sume those of typhus, so that the whole evacuated, we should order the neatral disease is synochus.

salts, particularly the saline draughts every Causes. Suppression of the accustomed two or three hours, to each dose of which, evacuations ; cold by any means applied, as from twenty to thirty drops of antimonial exposure of the body to the cold air, when wine, with the same quantity of the spirit it is in a state of perspiration ; exposure to of nitre inay be conjoined with advantage ; the rays of the sun; intemperance in eating, cooling mucilaginous liquors acidulated but more particularly in drinking; topical with the vegetable acids, or cold water, inflammation; intense study; great fatigue; should be freely allowed, when the heat of the premature repulsion of eruptions ; per the surface of the body is steadily above the spiration suddenly checked, and violent natural standard. It is of the utmost con. passions of the mind.

sequence, throughout the whole course of Diagnosis. This fever will be readily this disease, that the alimentary canal should distinguished from the typhus mitior by the be kept clear of feculent matter; for which strength of the pnlse, the intense heat, great purpose the mildest laxatives should be emthirst, violent pains in the back and joints, ployed, or perhaps mucilaginons clysters high coloured urine, and by the less des would be preferable; all exercise, both of rangement of the mental functions. the body and mind, must be studionsly

Prognosis. It frequently terminates in avoided, the patient must be kept quiet and a favourable manner abont the seventh in a horizontal posture, the light should be as day, either by hemorrhage, a profuse much as possible excluded, there should be diaphoresis, or by the urine depositing a a free circulation of cool air through the copious lateritious sediment; the termi. apartment, the floor of which should be bation by diarrhea is a much more rare oc- frequently sprinkled with cold water, the currence. If the respiration be very labo- patient should be lightly covered with bed. rious, if the head-ache be very severe, at clothes, all excremental matters should be tended with delirium ferox, if the abdomi. speedily removed, and the patient should mal viscera be inuch affected, if the urine be have frequent changes of dry linen. If the pale or limpid, and the skin assames a yel- pain of the head be very violent, accomlow tinge before the seventh day, we panied with delirium, or, if the patient is may generally expect an unfavourable oppressed with coma, blood-letting, both issue.

general and topical, will be necessary, proTreatment. The removal of this disease vided the strength of the patient is not too must be attempted by blood-letting, in pro. much exhausted; catharties and laxative

Aa?

clysters must be ordered, the head should the morning, and returns in a more severe be slaved, and cooling applications, as manner every evening, and during the day vinegar and water, or a solution of the vola- he lies iv a confused state, or is constantly tile salt of hartshorn in vinegar, and the muttering to himself. All these symptoms like, must be employed; blistering the go on gradually increasing, followed by head, and fomenting the lower extremities tremor of the hands and tongue, muscæ vo. will also be of service. If the respiration litantes, picking of the bed-clothes, subsulshould be much oppressed, and attended tus tendinum, and convulsions, which gene. with a short, dry cough, we must immedi- rally close the scene. ately have recourse to blood-letting, both Causes. The depressing passions of fear, general and local ; "blisters should be ap- grief, and despair ; all excessive evacuaplied to the thorax, and we should direct a tions ; a relaxed habit of body; immoderate liberal use of mucilaginons diluents. Should venery; a sedentary and studious life; inthe abdominal viscera be attacked in the temperance in eating and drinking; fatigne; course of the disease, the same general the abstraction of the usual quantity of means of blood-letting and blistering must nourishing food; contagion, and pancity of be employed, together with laxatives or blood. fomentation of the lower extremities. In Diagnosis. The slow and insiduons apthis climate, after a short period, the symp- pearance of this fever will distinguish it toms generally begin to assume the typhoid from the typhus gravior: the rigors are form, therefore some degree of caution will less severe; there is a considerably less be indispensa bly necessary in the liberal degree of heat and thirst, and no bilious employment of evacuations, lest we should vomiting; there is also greater mildness in induce a degree of fatal debility.

the symptoms, even in the first stage; the Typhus.-Symptoms. An uneasy and pe- skin is pale, and has a bluish and sunk apculiar sensation in the stomach, sometimes pearance. attended with nausea and giddiness, fre- Prognosis. The favourable symptoms are, quently denotes the approach of this fe- an universal warm moisture of the skin; the

In many cases, however, it is scarcely tongue from being dry and foul becoming or not at all perceived, and the disease ge- moist; the pulse being rendered more slow nerally commences with lassitude, languor, and full after a gentle diaphoresis, or the some degree of debility, borripilatio or exhibition of cordials; the appearance of sense of creeping, impaired appetite, alter. an eruption about the lips and postrils ; a nate and irregular beats and chills, anxiety miliary eruption, neither preceded by, nor about the præcordia, and great dejection of accompanied with, profuse sweating ; deafspirits, accompanied with frequent sighing. ness; a temporary insanity; an increased After these symptoms have continued for a secretion of saliva without aphthæ ; a sponfew days, the patient is attacked with head. taneons but gentle diarrhæa. The unfaach, or an uneasiness and confusion of head; vourable symptoms are, a great degree of a deep-seated pain, or a sensation of cold. muscnlar debility; the early appearance ness is perceived, particularly in the occi- and obstinate continuance of delirium ; stuput; there is nausea, vomiting of insipid pidity and listlessness of the eyes on the first phlegm, and great prostration of streagth; days of the disease; a morbid sensibility of the heat of the body is but little increased; the surface, and of all the organs of sense ; there is little or no thirst; the tongue at profuse evacuations, attended with a weak the commencement of the disease is moist pulse; tremor of the hands and tongue ; and covered with a white crust; in the more feather - hunting ; a considerable degree advanced stages it becomes dry, brown, and of sighing, mumbling, and moaning; conclrapped ; the countenance is pale and sunk, stant watchfulness ; coma, accompanied the pulse is small, weak, and frequent, the with fulness of the vessels of the tunica adrespiration is oppressed, and attended with nata, and dilated pupils; a difficulty of great anxiety about the præcordia, the swallowing, attended with hiccup; an unurine is pale, and secreted in too great a conscious discharge of the urine and fæces. quantity. The uneasiness and confusion of Dr. Fordyce observes, in his third Essay on head increase with the debility, and prevent Fevers, p. 111, that, if the respiration and the patient from going to sleep; or, if he deglutition be free, the prognosis is seldom do, it does not refresli him, and on the bad, although the disease may be attended second or third night some degree of deli. with alarming symptomis. rium comes on, which, however, goes off in Treatment. The first step to be taken in this, as well as in most other febrile dis- Jessness : if the hands and feet be at that cases, is to clear the primæ viæ of their time parched, the effects of the opium or crude and acrid contents, by the early ex- other remedies will be promoted by moishibition of an emetic, which, by the con. tening them with cold or tepid vinegar. If cussion it gives to the whole system, dis- the head-ach be very distressing, blisters solves the morbid catenation, and fre. should be applied to the temples: should quently terminates the disease ; in a few subsultus tendimum supervene, either æther, hours after that has ceased to operate, a camphor, carbonate of ammonia, castor, or cathartic of calomel should be adminis. the musk, should be administered in large tered, mixed with a small quantity of con- doses alternately with bark : the diet should serve, honey, or mucilage, and it should be be light and nourishing; bottled porter and allowed to remain for a short time about wine should be allowed liberally, taking the fances, before it is swallowed; through- particular care that not the smallest degree out the whole course of the disease we must of intoxication ensues : sedative and antiprocure the regular expulsion of the fæces, spasmodic remedies may also be employed by means of the mildest laxatives, or by the externally by means of friction ; they have injection of clysters every evening; the skin in many instances produced the most happy on every part of the body successively should effects. be washed with cold water, or vinegar and Dr. Currie, in his ingenious and valuable water ; wine and opium should be admini- work, entitled “Medical Reports on the stered in small quantities, and repeated Effects of Water in Fevers and other Disevery three hours alternately; the applica- eases,” vol. i. p. 17, et seg. observes, when tion of small repeated blisters will be of speaking of the aspersion or affusion of cold considerable service; the administration of water, vinegar and water, or of a saturated oxygen gas will also prove an useful auxi- brine, “ that the safest and most advantaliary. The symptoms which forbid the use geous time for using either the aspersion or of bark are a hot and dry skin, and a affusion (the latter of which he prefers), is parched tongue; it must, therefore, be our when the exacerbation is at its height, object of practice to remove those symp- which is marked by increased flushing, toms as early as possible, which will in ge. thirst, and restlessness, or immediately afneral be accomplished by the administra- ter its declination is begun; and this has led tion of the saline draughts in a state of ef- me almost always to direct it to be emfervescence, every two, three, or four hours, ployed from six to nine o'clock in the evencombined with the infusion or tincture of ing; but it may be safely used at any time snake-root, with from twenty to thirty of the day, when there is no sense of chillidrops of æther in each draught; warm pe- ness present, when the heat of the surface diluvia should be ordered in the evenings, is steadily above what is natural, and when or the lower extremities should be foment there is no general or profuse sensible pered; whenever a general relaxation of the spiration. It is at the same time highly skin occurs, the bark, combined with a necessary to attend to the precautious which small portion of the confectio opiata, and a the employment of this valuable remedy few drops of the muriatic or sulphuric acid requires : 1. If the affusion of cold water on in each dose, should be given frequently, the surface of the body be used during the taking care at the same time not to oppress cold stage of the paroxysm of fever, the the stomach. A table-spoonful of yeast, respiration is nearly suspended, the pulse either diluted or in its pure state, has been becomes fluttering, feeble, and of an incalof late much employed, and with a consi- culable frequency; the surface and extrederable degree of success; it should be gi. mities become doubly cold and shrivelled, ven at least three or four times in the course and the patient seems to struggle with the of the day. At bed-time it will be proper paogs of instaut dissolution. I have no to give an opiate, particularly if the patient doubt, from what I have observed, that in is restless, and its effects will be promoted such circumstances the repeated affusion of by combining it with abont ten grains of a few buckets of cold water would extinthe castor or camphor, or from fifteen to guish life. This remedy should, therefore, twenty grains of the compound powder of never be used when any considerable sense ipecacuanha, or a drachm of Hoffman's of chilliness is present, even though the æther may be substituted, the last of which thermometer, applied to the trunk of the medicines, if it does not procure sleep, it body, should indicate a degree of heat do not, however, increase the heat or rest. greater than usnal. 2. Neither ought it to be used when the heat, measured by the water may be drank with the utmost free, thermometer, is less than, or even only dom. Frequent draughts of cold liquids at equal to, the natural heat, though the pa. this period are highly grateful; they gene, tient should feel no degree of chilliness. rally diminish the beat of the surface several This is sometimes the case towards the last degrees, and they lessen the frequency of stages of fever, when the powers of life are the pulse. When they are attended with too weak to sustain so powerful a stimulus. these salutary effects, sensible perspiration 3. It is also necessary to abstain from the and sleep commonly follow. Throughout use of this remedy, when the body is under the hot stage of the paroxysm, cold water profuse sensible perspiration, and this cau. may be safely drank, and more freely in tion is more important in proportion to the proportion as the heat is further advanced continuance of this perspiration. In the com above the natural standard. It may even mencement of sweating, especially if it has be drank in the beginning of the sweating been brought on by violent exercise, the stage, though more sparingly. Its cautious affusion of cold water on the naked body, use at this time will promote the flow of the or even immersion in the cold bath, may be sensible perspiration, which, after it has hazai ded with little risk, and sometimes commenced, seems often to be retarded by may be resorted to with great benefit. After a fres!: increase of animal heat. A draught the sweating has continued some time, and of cold water taken under such circumflowed freely, especially if the body has re- stances will often reduce the heat to the mained at rest, either the affusion or immer. standard at which perspiration flows more sion is attended with danger, even thongh freely, and thus bring the paroxysm to a the heat of the body at the moment of using speedier issue. 3. But, after the sensible it be greater than natural. Sweating is al. perspiration has become general and pro. ways a cooling process in itself, but in bed fuse, the use of cold drink is strictly to be it is often prolonged by artificial means, forbidden. At this time I have perceived, and the body is prevented from cooling un- in more than one instance, an inconsiderate der it to the natural degree, by the load of dranght of cold water produce a sudden heated clothes. When the heat has been chilliness both on the surface and at the thus artificially kept up, a practitioner stomach, with great sense of debility, and judging by the information of his thermo- much oppression and irregularity of respirameter only, may be led into error. In this tion. At such times, on applying the thersituation, however, I have observed, that mometer to the surface, the heat has been the heat sinks rapidly on the exposure of found suddenly and greatly rednced. The the surface of the body even to the exter- proper remedy is, to apply a bladder filled nal air, and that the application of cold wa- with water heated from 110° to 120° to the ter, either by affusion or immersion, is ac. pit of the stomach, and to administer small companied by a loss of heal and a de. and repeated doses of laudanum.” ficiency of re-action, which are altozether Dr. Cullen divides this disease into two inconsistent with safety.” Under these re- varieties : typhus mitior, or low nervous strictions, the cold affusion may be used at fever, being that we have now described ; any period of fever, but its effects will be and typhus gravior, jail, camp, or hospital more salutary in proportion as it is used fever, far more violent in its symptoms, more early. When employed in the ad. rapid in its progress, infectious in its effluvanced stages of fever, where the heat is vium, and fatal in its tendency. It becomes reduced and the debility great, some cor- the medical practitioner,' therefore, to be dial should be given impiediately after it, proportionably more hold and active: with and the best is warm wine. Dr. Currie, which general observation the same mode when speaking of the internal use of cold of treatment may for the most part be parwater, vol. i. p. 92, et seq. directs that sued. The stimulant plan must be pushed « 1. Cold water is not to be used as a drink to a much greater extent, and affusions of in the cold stage of the paroxysm of fever, cold water are here of more use than in the however urgent the thirst. Taken at such preceding variety, and of course ought to times, it increases the chilliness and torpor be employed with the most liberal and unof tlle surface and extremities, and produces hesitating attention: a sense of coldness in the stomach, augments Synochus.---Symptoms. This, as we have the oppression on the præcordia, and ren. already observed, is a fever compounded of ders the pulse more frequent and more fee. those that characterise the first stage of ble. 2. When the hot stage is fairly formed, synocha, or inflammatory fever, with which and the surface is dry and burping, cold it commences, and of those which constitute the middle and last stages of typhus or pu- same mode of treatment; and several we trid fever, into which it becomes converted have already noticed in the article DIETEby a sudden and oftentimes a very unex. TICS. Whatever be the organ affected, pected change. It is a common fever in with the very few exceptions we shall prethe large manufacturing towns of this coun. sently point out, the inflammation must be try; and great care is necessary, on its first attacked with applications both general and appearance, that it be not mistaken for, aud topical, and powerful in proportion to the consequently treated as, an inflammatory degree of inflammation. Venesection, ca. attack, by venesection, and a strict debili thartics of calomel, and laxative injections, tating plan. This is the general caution on may be safely recommended as a part of the its commencement, or while we are in general practice. Local bleeding by cupdoubt; in its further advance, the treatment ping, wherever it can be employed, and must be adapted to the different symptoms where it cannot, by leeches, should constiit exhibits, as more nearly approaching to tute an essential feature of the plan, and be the nature of the synocha or typhus, and repeated according to the urgency of the should be governed by the regulations al- symptoms. In most of these diseases beneready laid down for the treatment of these fit may also be obtained by frizid lotions, as diseases.

ver.

of common spring water, ice water, vinegar; Under this genus Dr. Cullen has ranged while the general syınptomatic fever, if hectic fever ; whilst he makes phthisis, of considerable, must be attacked by the prowhich he admits it to be only a symptom, cess of cure already laid down in the treatunder a gepus of another order, which he de- ment of fevers, and varied according to the nominates hæmorrhagiæ. It cannot, there- phænomena that arise. When the cause is fore, be considered as entitled to any notice obvious, as in many cases of ophthalmia, or in the present place, and we shall conse- inflammation of the intestines, we should quently transfer it to that to which it more be indefatigable till it be removed, since properly belongs.

without the accomplishment of this point

every thing else must be of no avail. These ORDER II. Phlegmasiæ. INFLAMMA

are general hints. Several of the diseases,

however, arranged under tbis order are conTopical inflammations, or phlegmasiæ, nected artificially alone, and not naturally, are a very numerous assemblage of diseases: and require a distinct treatment. We shall their chief characteristics are the general briefly notice a few of them. symptoms of fever, and a topical inflamma. Erythema. As in this arfection, notwithtion, attended with the lesion of some im- standing the inflammatory appearance, portant function; in which, usually after there is frequently a considerable degree blood-letting, the blood is found upon coa. of debility, we must not push the antiphlogulation to be covered with a buffy coat. gistic measures too far, particularly in debi

This order comprehends the following eigh- litated habits, and in those advanced in life, • teen genera :-1. Phlogosis, of which, upon for fear of inducing gangrene, but rather

the Cullenian system, there are two species; trust to wine, bark, combined with snake. P. phlegmon, and P. erythema, or cutane- root or camphor, and the sulphuric acid, toous erysipelas. 2. Ophthalmia, inflamma- gether with local applications. Should there, tion of the eyes. 3. Phrenitis, inflamma- notwithstanding all our efforts, be a tention of the brain. 4. Cynanche, the sore dency to gangrene, we should stimulate in a throat, or qninsy. 5. Pneumonia, inflam- still higher degree ; on the other hand, should mation of the lunge. 6. Carditis, of the there be any considerable danger of exciteheart. 7. Peritonitis, of the peritonæum. ment, which, however, is rarely the case, 8. Gastritis, of the stomach. 9. Enteritis, accompanied with a hard, full, and strong of the intestinal canal. 10. Hepatitis, of pulse, blood-letting, repeated according to the liver. 11. Splenitis, of the spleen. the violence of the symptoms, and effects 12. Nephritis, of the kiddies. 13. Cystitis, produced will be necessary; at the same of the urinary bladder. 14. Hysteritis, of time, it will be advisable to employ gentle the womb. 15. Rheumatismus, rheuma- cathartics: but the bark will usually be tism. 16. Odontalgia, inflammatory tooth- found the most efficacious remedy in every ach. 17. Podagra, gout. 18. Arthropuo- stage of this disease. sis, inflammation of the hip.

Cynanche, Quinsy. Of this genus the Cul. · By far the greater number of these are lenian system makes five species. 1. C. of the same natural family, and require the tonsilaris, common inflammatory sore throat.

TIONS.

« НазадПродовжити »