Encyclopaedia Britannica, or, a Dictionary of arts, sciences, and miscellaneous literature : enlarged and improved. Illustrated with nearly six hundred engravings > Volume 13, MAT-MIC

242 M E D I
Kebres. action of tliofe effluvia induces fever, and particularly
^ v why this fever returns in regular paroxyfms, are quef-
tions with regal'd to which we are ftiU totally in the
dark. Dr Cullen, with much ingenuity, attempted
to prove, that the remote caufes ot this, as well as of
other fevers, operate by inducing a ftate of debility j
that tliis debility gives rife to fpafm, which induces in-
creafed aelion, from which the phenomena are to be ex¬
plained. But this theory is liable to no lefs numerous
and un fur mountable objections than the exploded hypo-
thefes which had before been propofed by others. For
it is an undeniable truth, that debility often exifts, even
to the higheft imaginable degree, without any fever j
nav, that when fever has taken place, the debility is
often much greater after it is entirely gone than at
any period during its courfc. When fpafm and in-
creafed adlion do take place, we have no reafon to view
them in any other light than merely as fymptoms of
the difeafe ; and while they are often abfent in this
affeCHon, they frequently occur in others where the
ficknefs, anxiety, and other characterizing fymptoms
of fever are entirely abfent : and, upon the whole, a
probable or rational theory of intermit tents, as well as
of other fevers, ftill remains to be difeovered.
Cure. The treatment of all genuine intermittents,
whether tertians, quotidians, or quartans, being almoft
precifely the fame, the general method of cure appli¬
cable to all of them may be here given, to which it
will be eafy to refer when we come to deferibe the
others.
In treating intermittent fevers, phyficians have formed
indications of cure according to their different theories.
The followers of Boerhaave, Stahl, &c. rvho imagined
that the difeafe proceeded from a lentor or other dif-
orders in the blood, always thought it neceffary to cor-
reft and evacuate thefe peccant humours by emetics and
purgatives, before they attempted to flop the difeafe by
the Peruvian bark or any other medicine. Cinchona
indeed, among fome, feems to be held in very little efti-
mation : fince Vogel affirms, that this medicine, inftead
of deferving to have the preference of all other febri¬
fuge medicines, ought rather to be ranked among the
lowed; of the whole $ and for this reafon he aferibes the
cures, faid to be obtained by the ufe of the Peruvian
bark, entirely to nature.
According to Dr Cullen, the indications ef cure in
intermitting fevers may be reduced to the following:
1. In the time of intermiffion, to prevent the return
of the paroxyfms.
2. In the time of paroxyfms, to condufl thefe m fuch
a manner as to obtain a final folution of the difeafe.
3. To take off certain circumllances which might
prevent the fulfilling of the two firft indications.
The firft indication may be anfwered in two ways :
I. By increafing the aflion of the heart and arteries
fome time before the period of acceffion, and fupport-
ing that increafed aflion till the period of acceffion be
over, and thus preventing the recurrence of that atony
and fpafm of the extreme veffels, which he thinks give
occafion to the recurrence of paroxyfms. 2. By fup-
porting the tone of the veffels, and thereby preventing
atony and the confequent fpafm, without increafing
the aflion of the heart and arteries, the recurrence of
paroxyfms may be prevented.
The aftion of the heart and arteries may be increaf-
4
CINE. Praflice,
ed, 1. By various ftimulant remedies internally given Tertians,
or externally applied, and that without exciting fweat.v—y—J
2. By the fame remedies, or by others, managed in
fuch a manner as to excite fweating, and to fupport that
fweating till the period of acceflion be for iome time
pall. 3. By emetics, fupporting for the lame time the
tone and action of the extreme veflels.
The tone of the extreme veffels may be fupported
without increafing the adion of the heart and arteries,
by various tonic medicines ; as, 1. Aftringents alone.
2. Bitters alone. 3. Aftringents and bitters conjoined.
4. Aftringents and aromatics conjoined. 5. Certain
metallic tonics; and, 6. Opiates. A good deal of
exercife, and as full a diet as the condition of the patient’s
appetite and digeftion allow, will be proper during the
time of intermiflion, and may be confidered as belonging
to this head. Although many particulars in this plan of
cure are deduced from Dr Cullen’s theory, yet there
can be no doubt that the objed chiefly to be aimed at
is to employ fuch remedies during the intermiflions as
will prevent a recurrence of the paroxyfm. Of all the
remedies hitherto employed with this intention, the moft
celebrated, perhaps the moft certainly effedual, is the
Peruvian bark 5 or, to fpeak more properly, the bark of
the Cinchona offiema/is of Linnaeus. But it mult be
obferved, that good effeds are only to be expeded from
this medicine when employed in fubftance and in large
quantity ; and for its ufe the following rules or obferva-
tions have been given :
1. The cinchona may with fafety be employed at any
period of intermitting fevers, providing that at the fame
time there be neither a phlogiftic diathefis prevailing in
the fyftem, nor any confiderable or fixed congeftion
prefent in the abdominal vifeera.
2. The proper time for exhibiting the cinchona in
intermittent fevers is during the time of intermiffion,
and it is to be abftained from in the time of paroxyfms.
3. In the cafe of genuine intermittents, while a due
quantity of cinchona is employed, the exhibition of it
ought to be brought as near to the time of acceffion as
the condition of the patient’s ftomach will allow.
4. In all cafes of intermittents, it is not fufficient that
the recurrence of paroxyfms be flopped for once by the
ufe of the cinchona; a relapfe is commonly to be
expeded, and ftiould be prevented by the exhibition of
the cinchona repeated at proper intervals.
The advantage of adminiftering the medicine as early
as poflible, jvas fully afeertained by Dr Lind in the years
1765, 1766, and 1767, during an uncommon prevalence
of intermittents. When the difeafe was flopped by the
cinchona immediately after the firft or fecond fit, which
was the cafe with 200 of the Dodor’s patients as well
as himfelf, neither a jaundice nor dropfy enfued $ where¬
as, when the cinchona could not be adminiftered, on
account of the imperfed intermiflion of the fever, or
vfflen the patient had negleded to take it, either a
dropfy, jaundice, or conftant headach, were the certain
confequences, and the violence of the difeafe rvas in
proportion to the number of the preceding fits, or to
the continuance of the fever. By every paroxyfm the
dropfical fwellings were vifibly increafed, and the co¬
lour of the fkin rendered of a deeper yellow. When
the fever continued a few days without intermiffion, the
belly and legs generally fwelled •, a violent headach,
likewife, and vertigo, for the moft part diftreffed the
patient j.