474

MEDICINE.

ness, I ailed nothingwhen I embarked. Tliis circumstance, how-ever, might perhaps dispose me more readily to receive the in-fection. Sept. 5th, 6lh, 7th: Small rigours now and then; apreternatural heat of the skin ; a dull pain in the forehead; thepulse small and quick ; a loss of appetite, hut no sickness at thestomach ; the tongue white and slimy: little or no thirst; the bellyregular; the urine pale and rather scanty; in the night restlesswith starling and delirium. Sept. 8th. Every symptom aggrava-ted ; with pains in the loins and lower limbs, and stiffness in thethighs and hams. I took a gentle vomit on the second day of thisillness, and next morning a decoction of tamarinds ; at bed-time anopiate joined with antimonial wine ; but this did not procure sleepor open the pores of the skin. No inflammatory symptoms beingpresent, a drachm of Peruvian bark was taken every hour for sixhours successively, and now and then a glass of port-w ine, but withno apparent benefit. When upon deck my pains were greatlvmitigated, and the colder the air the better. This circumstance,and the failure of every means I had tried, encouraged me to putin practice on myself, what I had often wished to try on others, infevers similar to mv own. Sept. 9. Having given the necessarydirections, about three o’clock in the afternoon I slipt off all myclothes, and threw a sea-cloak loosely about me till 1 got upondeck, when the cloak also was laid aside: three buckets of salt-water were then thrown at once upon me; the shock was great,but I felt immediate relief. The head-ache and other pains in-stantly abated, and a fine glow and diaphoresis succeeded ; towardsevening, however, the same febrile symptoms threatened a return,and I had again recourse to the same method as before, with thesame good effect. I now took food with an appetite, and for thefirst time had a sound night’s rest. Sept. 10. No fever, but alittle uneasiness on the hams and thighs : used the cold bath twice.Sept. 11. Every sympton vanished; but to prevent a relapse Iused the cold bath twice. Mr. Thomas Kirk, a voung gentleman,passenger in the same ship, fell sick of a fever on the 9th day ofAugust; his symptoms were nearly similar to mine, and havingtaken some medicines without experiencing relief, he was de-sirous of trying the cold bath ; with my approbation he did on the11th and 12th of September, and by this method was happily re-stored to health. He lives at this'time (Jan. 1766) near Liver-pool.” We have thus presented our readers with (his importantnarration of Dr. Wright, both as it furnishes a history of fever, asit details the mode in which the cold affusions should"be employ-ed, and as it was confessedly the means of introducing this mostvaluable remedy into general practice. We shall now add fromDr. Currie the more particular rules which ought to govern theuse ot the affusion or aspersion of cold water in fevers, and thenmake one or two observations on the nature of its operation. Thesafest and most advantageous lime, says Dr. Currie, “for using thecold water is, when the exacerbation is at its height, or imme-diately after its declination has begun ; and this has led me almostalways to direct it to be employed from six to nine in the evening;but it may be safely used at auv time of the day, when there is nosense of chilliness present, when the heat of the surface is steadilyabove what is natural, and when there is no general or profuseperspiration.— r l hese particulars are of the utmost importance: for,1st. If the affusion be used during the cold stage, the respiration isnearly suspended ; the pulse becomes fluttering, feeble, and ofincalculable frequency; the surface and the extremities becomedoubly cold and shrivelled, and the patient seems to struggle withthe pangs of instant dissolution. 1 have no doubt, from w hat Ihave observed, that in such circumstances the repeated affusionsof a few buckets of cold water would extinguish life. 'Phis reme-dy should therefore never be used when "any considerable senseof chilliness is present, even though the thermometer applied tothe trunk of the body, should indicate a degree of heat greaterthan usual. 2nd. Neither ought it to be used, when the heatmeasured by the thermometer is less than, or even only equal to,the natural heat, though the patient should feel no degree ofchilliness. I his is sometunes the case towards the last stages offever, when the powers ot life are too weak to sustain so powerfula stimulus. 3d. It is also necessary to abstain from the use of thisremedy under profuse sensible perspiration, and this caution ismore important in proportion to the continuance of tliis perspira-tion. Under these restrictions, our author adds, the cold affusionmay be used at any period of fever; but its effects are more salu-

tary in proportion as it is used early. When employed m tj ^advanced stages of fever, where the heat is reduced and the cte*bility great, some cordial should be given immediately alter. » IUthe best is warm wine.”

Observations. Cold water, as a remedy for fever, may be con-ceived to operate upon a twofold principle. In the earlier s ^ a S l ’ s ’and before the vital power is too much harassed and oppressedendure a violent shock, the copious and sudden affusion of c0 ‘ _water all over the naked body, appeal’s to effect its beneficial p» r 'poses in part by the abruptness of its agency; it in a mannerserc'ithe chain of diseased associations, and restores the healthy u”orderly movements of the frame. This operation, is not, ash®been suggested, mechanical: it is in some measure similar to u>‘produced bv the operation of an emetic, to which it is in c'veurespect greatly preferable, or to sudden mental agitation. Inlanguage of' the schools, it cuts short fever. W hen, however, “Ldiseased associations are more firmly established, and the vl ^power greatly oppressed by the disorder’s continuance, althougthe surface of the body retains its morbid heat, the water is toapplied, not in the way of sudden affusion, but by washing wm 1 *spunge, and this under the restrictions enjoined by Dr. Currie,we may safely say, while it is found genial to the patient’s feeling’’ought to be resorted to in every case of simple fever.

Cold air. The extraordinary melioration in the modern pr® *tice of medicine, as it relates lo the treatment of lever and lehr 1diseases, is not confined to the copious use ol affusion and ablution 1The terrors of our predecessors, in relation likewise to cold a|are fast departing ; and the importance of its free admission in Uapartments of the febrile sufferer especially, conies to be ^rally acknowledged and applied. It lias been stated by a ph)Scian, above all praise for fidelity of observation and justnessremark, that the corrupted air of sick rooms, from neglect of v*’ 1 ,tilation, lias been much more fatal even among the higher class<- ssociety, than the virulence of tire disease itself - Vereor lie quid ® 1a’groti non lam morbo suo perierint, quam halilibus putr'ib"j.quos discuti veluit pr.rpostera amicorum cura. The utility.cold-air in fever is referable to two principles : 1st. That ot !l11mediately lowering the heat of the surface, and thus taking oft 1,1oppression occasioned by such heat: and 2ndlyy from affordinglarger quantity of oxygen at each inspiralion. '1 lie first ot d ,e .

principles is sufficiently evident, and does not require any fill'd' ^illustration: if cold ablution prove beneficial chiefly by virtue 5diminishing the temperature of the body, it necessarily ioHn'jthat coldness in the circumambient atmosphere must he attenn.Lwith precisely similar effects ; but on the purity, as connected W 1diminished temperature of the atmosphere, it may not be in'? 1 ]per to embrace the present opportunity of offering one or two >marks. A given bulk of air at an inferior temperature, coni® 1more of the oxygenous principle than the same quantity at ® ^perior degree of heat; hence the greater refreshment which is e t. iperienced from the inhalation of a cold and dense, over that ?warm and rarefied atmosphere ; lienee, in part, the more vl g erous digestion and keen appetite of a healthy individual during hwinter," than the summer months; and finally, by tire reli c *febrile patient experiences from the inspiration of such air, 1 j.rendered evident, both that the heat of fever originates, a»‘ ,kept up, independently of those organs which modern clieinm^and physiology have supposed to be the sole organs for the sup? j|of lieatto the living system, from I his fact Dr. Reid infers, awe think w ith justice, that the constant equality of animal temp 0 ^,turn in a condition of health, lias more dependanct upon living ‘| ]Ctions in general than upon the chemical evolution of caloric ii' .lungs, according to the ingenious theory first suggested by ^Crawford, but since materially modified. j

Of refrigerants m fever. Resides, however, the employof cold wilier, ami the free admission of a cool and pure atf»pin re, other agents have been had recourse to, and witli cousin' ‘ble effect, in order to abate the inordinate heat of fever. l' ll vt >posses-ingthe faculty of cooling the system, certain medicines ft' •been distinguished by tire term refrigerants: refrigerants arc p 1 ' 111pally-chosen from the vegetable acids, and the different nt‘ usalts"; and so evident is their power in reducing animal teinp 1 ^,,lure, that they have properly been made to constitute a ' ('siderahle part of regimen in fever. Indeed nitre, and ° jjneutral salts, with the vegetable acids, have been receivc'U^e