INTERMITTENT FEVERS.

93

52. Pain and inflammation of the tonsils, following fevers,

either continued or intermittent, accompanied with distress and
difficulty of swallowing, and followed by hoarseness, sinking
under the eyes, and the fades Hippocratica, are certain signs
of imminent death. They cut off all hope of recovery. I
have observed that the protraction of the fever, and excessive
evacuations on the part of the patient, already prostrated by
the disease, have generally lent a hand towards the production
of this fatal symptom.
53. There are many accidents which are wont to follow
these diseases, either from purging having been neglected, or
from its having been resorted to at the wrong time. I will waive
mention of them, however, for the present, the principles of
the cure being the same for all. It consists in the repurgation
of the sediment deposited by the previous effervescence, which,
by its retention, supplies the pabulum to these evils. One sort
of symptom, however, and that an important one, it may be
proper to mention in this place ; it yields neither to purges
nor evacuants of any kind, least of all to bloodletting. In
defiance of these, it even takes strength from their adminis-
1
tration. form of mania peculiar, and sui generis.
It is a It

occasionally follows long agues, especially if they be quartan ;

it stands beyond the reach of all the usual remedies. From
the exhibition of strong evacuants, it degenerates into fatuity,
and ends only with the life of the patient.
54. I have often wondered that no notice has been taken
by authors of this symptom, as I have observed it not unfre-
quently. The other forms of madness are mostly cured by
means of copious evacuations, bloodletting, and catharsis.
This can bear none of them. Even when the patient is
recovering, and on the very threshold of health, the single
injection of an enema of sugar and milk will bring it on afresh ;
whilst to fight against it by means of reiterated purges and

1
In the editions of 1666 and 1668 "
we find, perhaps upon due consideration
we determine that there are several kinds of mania," &c. And a little below,
shall
"
Sydenham writes thus Concerning the treatment, I shall at present say nothing,
:

although many know that I have dealt with it successfully ; nevertheless, I do not
feel that my attention has been proportionate to the importance of the disease.
Hence I cannot, with proper confidence, publish any doctrines concerning its cure."
94 MEDICAL OBSERVATIONS.

venesections, is to mitigate, indeed, the violence of the disease,

but to reduce the patient to a state of incurable fatuity. At
this no one will wonder who considers that, whilst one form
of madness arises from an exalted and over-vivid crasis of the
blood, this is produced by its
debility, and (if I may use the
term) its vapidity. The
has introduced a protracted
fever
fermentation, and the protracted fermentation has disabled the
spirits from the performance of their animal functions.
55. This symptom I manage in the following manner I :

give the patient a full dose of a generous cordial three times a

day, e. g. Venice treacle, egg electuary, the Countess's powder,
Raleigh's powder, &c., out of epidemic water or treacle water.
Other cordials may also be given, according to other formulae.
The must be kept up by moderate analeptic
patient's strength
diet, and somewhat generous drink. He must not go out of
doors. He must keep much in bed. The bowels, under this
regimen, will be somewhat confined. This and the use of
the heating medicines may raise fears of a fever. These are
vain. The animal spirits, almost exhausted by the previous
disease, are unable to kindle one. After a few weeks he will
gradually improve. The cordials may then be omitted for a
few days. The
analeptic diet, however, must regularly be ad-
hered to ; and, after a short intermission, the use of the
cordials also. He must persist in this until he enjoys his ori-
ginal health.
56. The aforesaid treatment has cured forms of mania
which have originated otherwise than in ague, viz. in cold and
infirm temperaments. Last year I was called to Salisbury to
consult with my learned and dear friend Dr. Thomas upon the
case of a lady whose faculties were seriously impaired. Although
she was pregnant, I used the above-mentioned remedies, and
she recovered altogether.
57. However, the common sort of madness which befals

healthy men, and which is not preceded by any fever, is

wholly of a different breed from the present ; and, in respect
to the use of evacuants, is to be treated upon wholly different

principles. Nevertheless, even here, it is not right to omit

those remedies which are restorative to the brain and animal
spirits. The cure of this has no place here. I am willing,
 INTERMITTENT FEVERS. 95

however, to append a notice of it to the preceding description,

simply for the sake of guarding against those errors, that the
likeness between the two diseases may lead to.
58. With young and with those of a sanguine
subjects,
habit, eight or nine ounces of blood must be taken twice or
thrice from the arm, with three days between each bleeding.
After this, blood must be drawn once from the jugulars.
Beyond the use of the lancet will promote idiocy rather
this,
than recovery. The patient must then proceed to a course of the
piL ex duobus. Of
he must take half a drachm or two
this

scruples, according to its effects, on a stated day, once a

week. Thus, if he begins with them on a Monday, he must
repeat them that day week exactly ; he must not take them
oftener ; and he must go on week after week for a long time
until he has perfectly recovered. By this method, the humours,
that in this disease would invade the citadel of the brain, are

gradually drawn off towards the lower parts, a fresh bias being-
given to them.
59. On the days when the patient does not purge, let him
take either the following electuary or some other medicine of
similar power and let him persist in doing so during the
;

whole course of the complaint :

R Conserve of monk's rhubarb,

Conserve of rosemary,
Venice treacle, aa 1j ;

Conserve of orange-peel,
Candied angelica,
Candied nutmeg, aa Jss ;

Syrup of cloves, q. s.
Make into an electuary ; of which a portion, the size of nutmeg,
must be taken twice a day. Drink upon it a small draught
of canary wine, with cowslip flowers infused cold.

60. The continued fever and the intermittents which I have

just described were nearly the only prominent epidemics
under the constitution of 1661, 1662, 1663, 1664. At what
earlier period they attained their predominance I am
first

unable to say. I only know that from 1664 to 1667 they

very rarely appeared in London.

61. I meant to have written upon the smallpox of these