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CHAP. V.

OF THE CURE OF FEVER GENERALLY, IN RELATION TO THE FOREGOING DOCTRINE.

I AM at present to speak of the cure of fever in a general way only, and chiefly as theoretically deducible from the pathology of the disease above laid down. The treatment of the particular varieties will be more fully fpoken of hereafter.

When it is confidered that the treatment of this disease has engaged the attention of the most enlightened phyficians of all ages, and that the best established practice has been rather the refult of reiterated obfervation and experience, than the offspring of any fpeculations refpecting its nature and origin, it is hardly to be expected that any theory, however juft in its principles, will, at once, materially improve the cure of fever, or detract much from its danger and fatality. Nor is it to be expected that at this time of day any new remedies can be fuggefted; for the whole materia medica has been often Part I.

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ranfacked for the purpose. Yet it cannot be queftioned that great advantages in regard to practice must always accrue from the establishment of a juft theory respecting the nature and origin of diseases. It ferves to guard us against the employment of fuperfluous and frequently hurtful remedies; and if it hold out no new nor more fuccefsful means of cure, it at least teaches us a more precife and advantageous ufe of those already in our hands: while the want of it leaves us in doubt and uncertainty respecting the real powers and effects of remedies, and leads us often to the empirical and indifcriminate employment of those of various and oppofing tendencies.

This may be exemplified in inflammation of the intestinal canal, as produced by strangulated hernia, in comparison with fever. In the former cafe, the nature of the disease is obvious, and the indications of cure at once prefent themselves. The patient is not teazed by the exhibition of numerous and frivolous remedies; the object aimed at is clear and precife; the means of attaining it are fimple, and their mode of acting well understood. But in fever, the reverse of all this is the fact. We neither know the nature of the affection, nor even its feat:

and the uncertainty we are in with regard to the effects of our applications, obliges us, in our anxiety to do fomething, to make the patient undergo the routine of medical practice: he is in turn vomited, purged, fweated, and stimulated in a thoufand different ways, under the idea of ftrengthening; and, laftly, bliftered from head to foot, without any precise object in view; one means being reforted to after another, for little other reafon, it would feem, than because the former had failed. The patient, to be fure, in a number of inftances, recovers; but he probably owes his recovery lefs to art, than to the powers of refiftance of the conftitution, the vis confervatrix nature, which is often not only an overmatch for the disease, but for the doctor alfo.

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If there be any foundation for the doctrine of fever here brought forward, much of these evils undoubtedly will be prevented. The disease may ftill prove difficult of cure, and, notwithstanding our beft endeavours, terminate on many occafions fatally but the feat and nature of the disease being known, the indications of cure will be obvious, and the means of fulfilling them fimple, if not effectual: the object of the practitioner will be clear, and his efforts at least well directed.

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It is a peculiar feature of the present doc. trine, that it is not, as far as I am able to judge, at all at variance with any established mode of cure, the utility of which experience has fully fanctioned. The hypotheses that have from time to time prevailed with regard to the nature of fever have, without exception, when applied to practice, been found de fective. They have either furnished indications which have been inadequate to the purposes of cure, or have fuggefted the employment of means which experience has Thewn to be prejudicial. Of this it were easy to adduce abundant proofs. Whether we look to antient or to modern times, we fhall find reafon to be convinced, that medical hypothefes have not a little tended to vitiate medical practice.

Those who believed in the existence of lentor and obftruction as the cause of fevers, naturally inclined to the copious ufe of diluents, and of medicines fuppofed to be of a refolvent nature, as neutral and volatile falts, and faponaceous compounds. Those who supposed the existence of a predominant acidity in fevers; or, on the other hand, an alkalefcent state of the fluids; infifted, of courfe, upon the ufe of remedies of an opposite description. Thofe, again, who look

ed upon morbid excess of heat as the effential part of fever, fhould, to be confiftent, have confined their attention chiefly to the means calculated to reduce this: yet it is certain that fevers are, on many occasions, best and moft speedily cured by heating and stimulating remedies; being, by these, sooner brought to a critical termination :-" licere febres parvas augere," fays Celfus,—“ fortaffe enim curatiores fient; et cum magis corpus incaluit, fequatur etiam remiffio.'

Upon the idea of SPASM of the extreme veffels being the most effential link in the chain of febrile phenomena, antifpafmodics in general, and naufeating dofes of antimonials in particular, have been liberally and affiduously adminiftered. While thofe, again, who faw nothing but DEBILITY in the character of fever, have been led to the ufe of opium, ftrong drinks, and ftimulating and tonic remedies, as calculated to roufe the fuppofed dormant energies of the system.

All these various modes of cure, with many others that might be enumerated, have been employed in the treatment of fever, and too often carried to a pernicious length. Patients, in innumerable inftances, have been fweated or purged to death by the

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