AN ESSAY On the preſent Epidemic Fever.

SINCE you were pleas'd to ſigni⯑fy your deſire of knowing what my ſentiments were concerning the preſent Epidemic Fever, and what my method of treating it, to your Candour I ſubmit the following obſer⯑vations.

I would remark to you in the firſt place, that notwithſtanding the many outcries we have had from all parts of the Country of the malignancy and con⯑tagious nature of the reigning Fever, there is nothing very particular or un⯑common in it, any more than that a par⯑ticular conſtitution of Air may be pro⯑ductive of a particular diſorder, and may induce what we call an Epidemic Diſ⯑eaſe.

But properly ſpeaking we know of but three contagious or infectious Diſ⯑eaſes, viz. the Plague, Small-Pox, and the Meaſles, all which, as far as we know, have Africa for their original, if at leaſt we except ſome few which are communicated by contact.

If we conſider the violent heats of the preſent ſummer after an exceſſive cold ſpring, we need not, I think, be at a loſs in accounting for the preſent [13]reigning Fever, ſince every one knows, who is ever ſo little vers'd or engag'd in obſervations of this kind, what an ef⯑fect an Eaſtern or Northern Air has in bracing up our fibres, and rendering them rigid and elaſtic, and how on the con⯑trary a Southern or South-weſtern Air, with exceſſive hot weather, relaxes them. The very great change from exceſſive cold to exceſſive hot weather, and by ſo ſuddena tranſition, could not but make a very great alteration in the temper of our bodies. Hypocrates, who liv'd two thouſand Years ago, and who was the moſt diligent obſerver of the cauſes and effects of diſeaſes either before or after him that liv'd in the World, told us, that the change of the ſeaſons was the principal Parent of diſeaſes; and no wonder, ſince we obſerve at different times and ſeaſons of the year, the dif⯑ference of the ſpring, weight, heat, cold, and moiſture of the Air. The blood and humours which were before by the ela⯑ſtic [14]force of the ſolids comminuted and render'd fit for their ſeveral ſecretions, are now by their ſunk and relax'd ſtate, become heavy and too abounding, and want that ſpur which is neceſſary to car⯑ry off the recrements, and prevent a tendency to a ſtagnation and putrefaction. The blood's viſcidity continually increa⯑ſing by the heat's exhaling the finer and more fluid parts of it, and the vis a tergo growing leſs and leſs by the re⯑laxation of the fibres, obſtructions muſt neceſſarily ariſe, and conſequently there muſt be brought on an inactive putrid ſtate of the fluids; from hence I think may be accounted for, the variety of ſymptoms, and the frequency of the pre⯑ſent Epidemic Fever, without having recourſe to any particular taint or in⯑fection communicated and brought to us from the Weſt Indies, as has been idly ſuggeſted.

From the ſame way of reaſoning we may account for the ſickneſs and mor⯑tality of our men in the Weſt Indies, having paſs'd from a Northern to a Southern Climate, from a cold to a hot air, and great moiſture, occaſion'd by their heavy rains at particular ſeaſons, which contribute exceedingly to the re⯑laxation of the fibres, and to the in⯑ducing that putrid and accumulated ſtate of the fluids which has been deſcribed: and if our Sailors were to bleed, and af⯑terwards bath in the ſea water, which they have ſuch good opportunities for, at their arrival in the Weſt Indies, it would contribute very much to the rai⯑ſing the elaſtic force of the ſolids, and preventing that viſcid, ſtagnating and putrid ſtate of the fluids.

Here I cannot but take notice, that if this way of reaſoning be juſt, how injurious the uſe of vinegar muſt be in [16]this ſtate of the blood, from the known properties of acids coagulating the maſs.

With humble deference to the Judg⯑ment of ſo learned a Body as that of the College of Phyſicians I would ſubmit it to them whether they were not a little too haſty in recommending the general uſe of vinegar to our men in the Weſt Indies, for tho' a tendency of bracing the fibres may be urged in its favour, yet its coagulating ſtagnating property muſt be injurious to a blood already too coagulated and ſtagnant, according to the foregoing Theory. And now I am upon the ſtory of vinegar, I cannot help taking notice of the uſe has been made of it ſince its recommendation from the College. Some are not contented with the great benefit they imagine they re⯑ceive from its internal uſe, but look up⯑on it as having ſomething of a charm with it to keep off and prevent infection, and the unfriendly taint of this Epide⯑mic fever; and for this reaſon they ſprinkle with vinegar walls, floors and [17]bed-poſts, which have contracted this taint; and which they have been told was a practice during the raging of the Plague in England.

Whether there be any thing in vine⯑gar oppoſite to the principles, nature, or effects of that direful and contagious diſeaſe, 'tis not my buſineſs at preſent to enquire into, but that it has any good effect either in promoting, or eſpecially in curing the preſent Epidemic Fever, I think is far from being demonſtrable.

Our Jayl, Bridewell and Work-houſe Fevers, of late ſo mortal, have not only the peculiar conſtitution of air already deſcribed for their cauſe, but to that we may add confinement, want of exerciſe, numbers and naſtineſs, and a want of proper and ſufficient nouriſhment and ſupport thro' the exceſſive dearth and ſcarcity of proviſions, all which have a prodigious tendency of ſinking the ſo⯑lids beneath their natural ſtandard, of producing a depauperated, viſcid, ſtag⯑nating [18]and corrupted ſtate of the blood and juices of the body.

If a great Man's definition of a Fever would in all caſes hold good, viz. aucta circulatio ſanguinis, perhaps acids and vinegar might be of ſome ſervice; but in the preſent Epidemic Fever is moſt commonly found, a depreſs'd pulſe, oc⯑caſioned, as I imagine, by too great a quantity of fluids in proportion to the ſtrength and elaſticity of the ſolids, from whence obſtructions ariſe, and from whence may be deduced and accounted for that variety of threatning and often⯑times fatal ſymptoms we meet with in this diſeaſe; and tho' no Epidemic does or ever did appear exactly in the ſame ſhape (very far from it) on account of different conſtitutions, different forma⯑tion of parts, mens different paſſions and different ways of living, &c. yet the ſame conſtitution of the air, the ſame properties of the air they in common breathe in, and the ſame properties of the food they in common feed on, will [19]produce in ſome meaſure the ſame ſort of diſeaſe, tho' differing in ſome, per⯑haps in ſeveral circumſtances, and this is what we call Epidemic, from [...] among the people.

I ſhall not undertake to give a very particular account, and enumerate all the ſeveral ſymptoms attending this Fever, ſince they appear different in different conſtitutions, ages, ſexes, &c. give me leave to point out a few, and which ſeem to be the principal ones. Moſt com⯑monly we find a low depreſs'd pulſe from a plenitude of fluids and want of proper force in the ſolids. No very great thirſt, or very foul tongue, an heavy pain of the head, an oppreſſion on the breaſt, the Urine pretty high colour'd, tho' ſometimes pale and without a ſedi⯑ment. No very great complaint of heat, a faintneſs, proſtration of ſtrength, ſweats, which give very little relief, becauſe not critical, a Diarrhoea, or a Delirium, I ſay, or a Delirium, becauſe if a Diarrhoea comes on towards the beginning of the [20]Fever, it prevents moſt commonly a De⯑lirium.

Theſe are the principal circumſtances which I have obſerved attending this Fever; and tho' a variety of appellati⯑ons have been given to it, but chiefly that of a malignant peſtilential, which I apprehend thoſe who give it that name, have ſcarce any fix'd and determinate meaning and Ideas of; yet the principal thing to be regarded is, what the diſ⯑eaſe itſelf is, and how it is to be treat⯑ed; and ſince we have laid it down as a great and prime Cauſe of this Fever, viz. the immoderate heats of the ſummer ſetting in after an unſeaſonable winter, and very cold ſpring, ſo affecting the ſo⯑lids of our bodies, whereby they were ſunk beneath their natural Standard, by which means there became an accumula⯑tion or too great a load of humours; hence the obſtructions, viſcoſities, ſtag⯑nations, putrefactions, and the direful train of ſymptoms obſervable in the pre⯑ſent [21]reigning diſeaſe we need not I think have recourſe to (tho' that can't be demonſtrably diſproved) a particular deleterious quality in the Air to account for them, ſince we know very little or nothing about this deleterious quality, or can find out any thing ſpecific or a⯑lexiterial to oppoſe and counteract it.

The method of cure then muſt in a great meaſure depend upon Evacuations of ſome kind or other, to remove the accumulation and load which oppreſs and overbalance the ſolids, to bring down and diminiſh the quantity of fluids that they may bear a proportion to the relaxed and ſunk ſtate of the ſolids; and then by proper gently ſtimulating and attenuating medicines to raiſe the force and elaſticity of the fibres to ſuch a pitch as ſhall be ſufficient to remove the remaining obſtructions, temper the viſcidity, put in action the ſtagnating and putrid Maſs, and diſpoſe the hu⯑mours [22]for their ſeveral excretions, and prevent the like ſtate ariſing.

It frequently happens in this Fever that nature ſets up a method of cure herſelf; ſo we ſhould take care how we counteract her, for inſtance, if we find a Diarrhoea coming on in the beginning, which we very often find, the Patient will need ſcarce any other evacuation, bleeding will be then unneceſſary, and 'twould be prepoſterous to endeavour by aſtringents to put a ſtop to it, it is an effort of nature to relieve herſelf, the blood throws off its enemy in plentiful ſtreams through the inteſtinal glands; and it has been obſerved, that when it has been ſtopt by a too officious hand adminiſtring aſtringents, or by any other accident, fatal have been the conſequen⯑ces; the patient has fallen into a Deliri⯑um thereupon, or into ſome other cir⯑cumſtances by which he has been carried off.

During this ſtruggle, this plentiful diſcharge, 'tis needleſs to remark, that Nature muſt be ſupported from time to time with ſome generous cardiacs.

Since this is a method that nature fre⯑quently takes to relieve herſelf, we may without abſurdity ask, why the Phyſi⯑cian neglects this Method; and though purging in Fevers has been look'd upon by ſome as prepoſterous, and going a⯑gainſt the rules both of nature and of art, as raiſing too great a commotion where there was but too great a ſtruggle before, yet I think that affair is not car⯑ried ſo far now as it has been formerly, and that in moſt kinds of Fevers ſome or other of them we ſee it neceſſary to uſe this evacuation, but nature in this, as in all other caſes, muſt be attended to, her motions narrowly watch'd, and carefully obſerv'd, that the Phyſician who is her ſervant, does not look one way whilſt ſhe points out another.

Bleeding is another method Nature takes to relieve herſelf, as we frequent⯑ly find by the plentiful Haemorages at the noſe in this diſeaſe. Opening a vein in that caſe is adviſable, becauſe relief will be the ſooner obtained, and in moſt of the caſes in this fever we find a ne⯑ceſſity of this diſcharge, to take off the Plethora, and bring the blood to an E⯑quilibrium with the Fibres: But it is not the leaſt part of the skill of the Phyſician to determine upon the quantity of blood which is to be taken off; and here I apprehend are many miſtakes made, here is the rock which many Pre⯑tenders to the art medical ſplit upon, and ſhipwreck the poor patient, though they themſelves, the more is the pity, eſcape; here if they draw blood with an undiſtinguiſhing hand, not diſcerning what proportion the ſtrength of the Fi⯑bre bears to the quantity of fluid in the veſſels, irretrievable miſtakes are com⯑mitted; and here I cannot but obſerve how many ignorant conceited Coxcombs [25]ride out under a ſhew of buſineſs with their lancet in their pocket, and make diſeaſes inſtead of curing them, drawing their weapon upon every occaſion, right or wrong, and upon every complaint ery out, E-gad I muſt have ſome of your blood, give the poor wretches a diſeaſe they never might have had, draining the body and the purſe, torment them in this world, and ſend them perhaps to another before their time, to keep them⯑ſelves the longer from that day of rec⯑koning where they muſt account for the quantity of innocent blood they have ſhed in this World.

The Evacuation by vomiting is often a very neceſſary one, eſpecially where a Nauſea or an inclination to vomit ap⯑pears, but it is not to be ventured upon at all hazards, or with all ſorts of Pa⯑tients, many circumſtances may forbid its uſe, and plainly contraindicate it, or it may be neceſſary previouſly to leſſen the quantity by bleeding, after which by the action of vomiting the ſtomach [26]is not only diſcharg'd of its diſagreeable load, but by the univerſal ſhock it gives to the ſolids, it raiſes their action, at⯑tenuates the fluids, drives through ob⯑ſtructions, and ſits and prepares the hu⯑mours in general for their ſeveral ſecre⯑tions.

Another Evacuation in the diſeaſe under conſideration is bliſtering, and which is frequently of very great uſe, not ſo much on account of the diſcharge, as its property of ſtimulating and adding to the force of the fibres, its tempering the viſcidities, and ſeparating the pre⯑ternatural cohaeſions; it makes a revul⯑ſion of the humours from a particular part, viz. from the brain, by which a Delirium or perhaps a Phrenzy, not un⯑common in this Fever, is either prevent⯑ed or taken off. But pointing out ge⯑ral rules for the uſe of bliſters will not do for particular caſes, nor is it ſafe up⯑on all occaſions to lay on bliſters before Evacuations of other kinds have pre⯑pared the humours in ſome meaſure and [27]pav'd the way to them; and I believe it has often been a caſe, whereby an un⯑skilful management of bliſters inſtead of relieving the brain, by the great ſtimu⯑lation upon the ſolids, the blood and humours have been thrown in upon its tender veſſels with ſuch a force, as they have not been able to bear, eſpecially if the bliſters have been accompanied as they often, I may ſay, almoſt always are, with other violently warm ſtimulating medicines.

The Evacuation by ſweating, I mean that artificially made, demands our con⯑ſideration in the next place, its being attempted at all adventures, and with⯑out good reaſon is often of the worſt conſequence to the Patient.

If the preſent Epidemic Fever has for its Cauſe an accumulation of fluids in too great proportion to the leſſen'd elaſtic force of the ſolids, and thoſe be⯑come an heavy ſizey putrid and inactive maſs, and peculiarly viſcid through the [28]great exhalations of their ſiner and more fluid parts by the extream heats of the ſeaſon, who is there but ſees how pre⯑poſterous it is to be flinging in violently hot ſudorifics, in this preſent ſtate of the fluids thus unprepar'd for them? Hence Petechiae, ſpots and eruptions of ſeveral kinds, if not before by nature made, are now by this method propell'd and di⯑ſtributed to the ſurface from a ſtagnating putrid maſs; hence the Deliria we fre⯑quently meet with among theſe Patients. But that ſuch medicines as theſe may not with ſafety be made uſe of in ſome time or other of the diſtemper cannot be aſ⯑ſerted, but it muſt be at a time that the fluids are properly prepared and fitted for this particular excretion.

So much for general viſible Evacuati⯑ons. It may be expected perhaps I ſhould give a detail of the materials or medicines which are to be made uſe of in the foregoing deſcribed caſes, but that was not in my intention, as thinking the giving Recipe's and ſtrings of medi⯑cines [29]can be of no uſe to the real Phy⯑ſician, ſo it might be of ill conſequence, and made an ill uſe of by the Pretender; I apprehend I have given ſuch hints, and made ſuch obſervations through the courſe of theſe Papers, as to lay down a foundation for a rational method of cure in the preſent Epidemic Fever. I muſt obſerve, as I hinted before, in the affair of bleeding, that a diſeaſe is often brought on a patient by an officious ill judging, ill-timing hand, rather than any preſent one removed, in like manner it falls out, that by the adminiſtration of many medicines improperly and un⯑skilfully apply'd, the diſeaſe is made a new one, and quite chang'd from what it was at firſt; and we need not wonder at the ill ſucceſs that is obſerved from the variety and great quantities of A⯑lexipharmacs (as they are termed) pour'd down the throat in an undiſtinguiſhing manner, perhaps more for the ſake of the Apothecary than the Patient, I ſay we need not be ſurpriz'd to ſee the Pa⯑tient [30]yield to the burthen, and fall a victim to the diſeaſe of Medicine.

Since we have pointed out a method of cure, and of relieving the Patient in this Epidemic Fever, it will not be diſ⯑pleaſing I imagine, to recommend a me⯑thod of prevention; and as we have proved, that health in a great meaſure depends upon a due balance, and juſt proportion between the ſolids and fluids of our bodies, that is, between the force or ſtrength of the former, and the quan⯑tity or quality of the latter, ſo 'tis our higheſt concern, and ought to be our principal Care, to endeavour as near as we can to keep to this ſtandard. Since the immoderate heats of the preſent ſeaſon, as we have reaſon to think, have ſo conſtituted the air, whereby it has a tendency of taking off that Equilibrium we have been deſcribing, and which is abſolutely neceſſary for health, by ſink⯑ing the ſolids, and increaſing the quan⯑tity of fluids, ſo it ſeems to be highly neceſſary, we ſhould leſſen this quantity, [31]and raiſe that force. And in theſe cir⯑cumſtances there ſeems to be no ſafer or ſpeedier method of prevention than pre⯑viouſly to empty the veſſels by loſing ſome blood, and then to uſe the cold bath, which has unſpeakably good ef⯑fects, in giving force to the fibres, where⯑by the blood is enabled to drive through all obſtructions, to ſcour the Glands, to attenuate the viſcidities, and prevent a ſtagnating putrid ſtate, the cauſe, nay the very eſſence of the diſeaſe itſelf.

Gentle exerciſe, ſuch as riding on horſeback, or in a Coach, or walking at proper ſeaſons, not to ſweat much, a temperate way of living, tho' not too low, but indulging now and then in a glaſs of ſome generous liquor, all con⯑tribute to keep up an Equilibrium, and prevent the reigning diſtemper. In a word, a due and regular uſe and appli⯑cation of the non-naturals is the moſt likely means to preſerve health, ſuch as calming the Paſſions and Affections of the mind, proportioning our exerciſe and [32]uſe of the Air to our ſtrength, and the Food we take in, not watching over much, but taking our uſual moderate hours of ſleep, and above all, taking care the natural Evacuations of every kind be not immoderate and to exceſs.