IT will appear necessary in the first place to lay down the symptoms generally attendant on the fever alluded to, throughout its different stages.—And this end may be best accomplished by a detail of its various symptoms, by quoting the following case ^* which came under the immediate eye of the publish­er, in the line of his practice; and at the same time, lay down the curative part and the regimen which he pursued.

On Monday the 23d of August, 1796, the pati­ent complained of non-appetency, naucea and vomit­ing, fulness, tension, and pain at the stomach; the viscera tense and full; the tongue clammy and foul; the state of the pulse irregular and sluggish; together with lassitude and prostration of spirits. Had re­course to a gentle emetic of the Vin: Ipecac: & An­tim: and in the evening to a lenient purgative, both [Page 2] of which respectively operated well, and in the course of the day supplied the diseased plentifully with light attenuating and diluting drinks.

24th. The symptoms (as above recited) seemed to increase; perspiration became impeded; chill ri­gours were succeeded by flushing heats. The pulse at times high and changeable; pains in the extre­mities, and between the scapula's, which extended seemingly under the plate of the sternum to the sto­mach and belly; the urine reddish and small in quan­tity; purged freely, the stools of a darkish hue; had recourse to antiphlogistics, and supplied plenti­fully with diluting and attenuating drinks.

25th. The symptoms nearly the same as yesterday, excepting that the pulse rose from seventy to ninety-eight; was changeable, and attended at times with a tremulous motion and great stricture. The tongue scruffed over with a thick yellow mucus, and li [...]ed on each margin with lists of a darkish hue; the uvula and tonsils red and much inflamed; the head much engaged; the urine red and small in quantity. Had free recourse to purgatives and the antiphlogis­tic line, although no visible abatement took place in any of the symptoms.

[Page 3]26th. The pulse this day seemed weak and tremu­lous; the tongue much as before described; the heat of the body great; the urine reddish; nau [...]ea frequent; the head much engaged; general lassi­tude; the thirst urgent; and petechiae appeared over the surface of the skin. This day had recourse to the antimonial wine; purged freely; gave also the antispasmodic medicines, and drank plentifully of light diaphoretic and diluting drinks.

27th. The pulse much lower at times, with an obstructed tremulous motion, and again its vibrati­on quicker, in so much, that little dependence could be placed on their irregular state. The head, at times, much engaged and distracted; the tongue dry and scruffed; the urine reddish; the heat of body much increased; the state of the viscera continued tense and painful to the touch. Had recourse to free purgings; the antispasmodic line; neutral salts, and gave plentifully of light attenuating and diaphoretic drinks.

28th. The pulse unequal and changeable, at times quick and weak; again sluggish and tremulous; the heat of the body great, and the petechiae over the surface of the skin; the urine turgid and still small in quantity; the stomach and neighbouring viscera [Page 4] tense and sore to the touch. Purged copiously, and followed the same line as yesterday was adopted.

29th. The state of the pulse very irregular and unequal in measure; the heat of body great; the lassitude and prostration of spirits infinite; the urine turgid and small in quantity, and the tongue dry and listed; the head much engaged with delirium, and no remission or intermission appeared in anywise indi­cative of a state at this time; the antispasmodic line pursued until about twelve o'clock, when the pain in the head increased over the coronal suture [...] ▪ down to the sphinoidals, and extended along the os frontis, so as to become intolerable, which was fol­lowed with delirium, &c. At this time the pulse be­came tense and tremulous, and at other times, quick hard and irregular; the viscera continued hard, full and painful to the touch, although perfectly open. Now had recourse to the cardiac and diaphoretic medicines, castor, camph. mosch. rad. serpent. virg. &c. with plentiful draughts of light attenuating and diluting drinks, until about eleven o'clock at night, at which time a critical and most profuse sweat broke out, which continued for two hours, and relieved the pains of the head, delirium, &c. The perspira­tion dried off, and returned in two hours after, and continued until half past five o'clock on Monday the 30th, which produced a favorable and perfect state.

[Page 5]It is not unworthy of our attention to remark, that none of the symptoms in this fever had ever abated, but rather went on uniformly increasing until about the time of the crisis being had, except a mitigation of the pains in the extremities, and lu­cid intervals of those in the head. The state of the pulse variable and uncertain, and at times very little or no dependence to be relyed on their state. The tongue constantly scruffed over, dry and listed; the heat of body great; the stomach and viscera tense, and sore to the touch; the urine turgid, reddish, and small in quantity.

In fine, every expedient was tried, and every mode adopted, which a regular line of theory might direct, or a judicious course of practice point out.

From the recital of the above case, the symptoms of this fever (as alluded to) may easily be discovered, and in order still to throw as clear a light as possible in this point, it may not be improper if we examine into the primary causes of fevers, and also into the state of the blood, and its circulating powers; and how it may be actuated upon by blood-letting, and various other causes.

[Page 6]At the same time lay down a regular line for the curative part and regimen most expedient to be adopted in this fatal disease.

The causes which principally may give rise to this fever (as a learned author says) seems to be in some cases owing to a plethora, supposed to owe its origin to a preternatural fulness and distention of the san­guineous vessels from too great and increased a quantity of blood and juices in general.

But upon a more minute enquiry it will appear to be owning to a superabundant quantity of the fibrous crassamentum, or more sizy parts of the blood, in proportion to the ferous or thinner; which becomes difficult to be circulated through the smaller and mi­nute capillary vessels; or propelled from the extre­mities of the arterial into the venal system, whence distention and dilitation of the arteries, an impedi­ment to free, easy, and ready circulation of the blood, and an increased resistance to the force and action of the heart are the consequences.

The curative part much depends on deplating the vessels and attenuating the blood. This can best be effected by gentle and moderate bleedings, lenien [...] purgatives, the volatile and neutral salts, and plent [...] of diluting and attenuating drinks.

[Page 7]This malady may also originate from obstructed perspiration, or a stoppage of the cutaneous excre­tion by cold, which often proves to be the cause.

To obtain that much desired relief resolution bids the fairest, as our first attempt should be to reduce the febrile impetus to proper and moderate bounds and to remove or diminish the cause of the disease by judicious blood-letting in the beginning, which should be repeated as the urgency of the case may require, and the violence of the symptoms direct.

Many causes may be assigned as the parent of this disorder, and other classes of fevers.

In every fever the pulse becomes quicker than na­tural, and the functions of the body more or less impaired or viciated. The causes of fevers will then be such as by their irritation can quicken the circu­lation, and excite spasmodic constrictions in the se­veral parts of the body; and those may be distin­guished into general and particular. The general or epedemic fevers may effect a whole family or city, and for the most part depends on putressent mias­mata, or infectious particles lodged in the air, or upon its manifest qualities, such as heat or cold, moisture or dryness, &c.

[Page 8]The particular causes of fevers, or such as affect individuals only, may be referred to three classes.

1st. To purulent fomes from confined matter within the body, the consequence of suppuration.

2d. To a putressent, acrimonious state of the juices, occasioned by putrid bilious fomes.

3d. To obstructed perspiration.

From fevers of the first class, belong those hectical and and colliquative. From the second class, those of the putrid malignant kind. From the third class or obstructed perspiration, acute, inflammatory, (according to the habit of body of the patient,) low nervous, rheumatic, and intermittent fevers.

The curative indications in fevers in general may be thus reduced.—The first to correct and expel the causes which by its irritation it originated. The se­cond will depend upon proper management and a just regulation of the powers of nature, keeping the febrile impetus within due bounds for the proper coc­tion of the febrile matter. The third will consist in providing for the relief of the most urgent symptoms.

The symptoms in fevers most frequent and trou­blesome are—In the beginning cold shiverings suc­ceeded by flushing heat, nau [...]ea and vomiting, thirst, [Page 9] anxiety, a diarrhea, petechiae, profuse sweatings, watchings, delirium, comatose affections and con­vulsions. These being the effects, as that is abated will often cease, but by removing and weakening the cause which produced them, we arrive at a per­fect state.

The symptoms attendant on the present fever de­pends on an inflammatory or spasmodic affection of the several organs, a quickened circulation, or too dense and vissid a state of the fluids.

The cold shiverings strongly indicate a spasmodic stricture of the smaller or capillary vessels; the heat that succeeds depends on the increased and quickened circulation, and sometimes upon an intestinal moti­on, or putressent fermentation in the blood and juices.

The heat is to be mitigated by abating its cause. If from an increased circulation, by evacuations and antiphlogistics; if from a putrid cause, by anticeptics and gentle diaphoretic medicine, such as vegetable acids, neutral salts, bark, together with a proper cardiac regimen, &c.

A nausea and vomiting will be owing to either an acrimonious, putrid, bilious matter, collected in the stomach and prima viae villicating their coats and ir­ritating to excretion, or slight convulsive motions [Page 10] excited in the stomach and neighbouring viscera, by a determination of the febrile cause to these parts; and is best relieved by emetics, the antimonial and ipecucuanha wines, &c. and afterwards by anodine and cardiac draughts.

Anxiety may be occasioned by any cause that may impede the circulation through the lungs, and prevent the free egress of the blood from the ven­tricles to the heart. This will depend either on in­flammatory or spasmodic affections of the lungs; when owing to the former cause the antiphlogistic regimen should be adopted; but when owing to the latter, the warm cordial and antispasmodic line ought then to be pursued.

The petechiae or exanthemata which often breaks out on the skin in febrile diseases, may be critical or symptomatic; in this fever they seem to be symptoms only, and neither lessen or increase the disease, for as the fever abates the petechiae will gradually disap­pear.

Profuse sweating often proves injurious by weak­ening the patient and depriving the blood of its thinner or more aquaous parts; especially in the lat­ter end, in weak constitutions or habits, which be­come [Page 11] coliquative and weakening, and tend greatly to sink the patient, and prevent recovery.

Watchings or want of rest in this fever is to be relieved by abating the cause of restlesness; the irri­tation and unusual contraction and tention of the maninges and nervous [...]ibillae of the brain, or by administering those medicines which allay irritation; opiates in various forms claim the first place.

Delirium, if from inflammation, or too increased an impetus of the circulation, the antiphlogistic regimen bids fairest and most expedient. If from spasms and too languid a circulation, which in general is the case, it will be found necessary to keep up the circulation, and resolve the spasms by cordial, cephalic and anti­spasmodic remedies, by bark, mosch, castor, cam­phor, serpentaria and assafoetida, &c.

Convulsions and twitchings of the tendons, the last stage in fevers, depend on some irritation or in­jury done the brain or its coverings, from preceding inflammation, suppurations, and the like, also on ex­treme weakness from innanition.

The causes of delyria and pervigilia may prove the cause of convulsions also. Warm cordial stimulants, [Page 12] mosch, castor, serpentaria, &c. bid fairest to answer the desired end.

This fever may be judged of from the constitution of the patient; a quick, full and tense pulse, inflam­mation, great heat and thirst, and acute pains in the head, back and limbs, &c. It naturally seems most expedient to lower the circulating powers, and to moderate properly the febrile impetus; this is to be effected by evacuations and antiphlogistics. The an­timonial wine proves serviceable when judiciously administered in the first stage of this fever; the cool­ing diaphoretics and neutral salts, with plenty of light diluting and attenuating drinks, to promote a gentle diaphoresis; and about the seventh or eighth day a salutary crisis most probably may take place, by sweat, turbid urine or loose stools.

But if at the latter end of this disease, the pulse should flag, the antiphlogistic medicines must be discontinued and a cordial regimen substituted: and if an intermission should happen▪ or even a remission, with gentle sweats and a turbid urine, the bark should be thrown in as our sole dependence.

It may appear worthy of atttention, that this fever was for the most part confined to Europeans and [Page 13] transient persons▪ who had arrived here from different parts, or came from other parts or states in the union. To all such it proved most mortal; and where bleedings was most copiously had, still lesser advantages resulted.

It may not be improper in this place if we should make a few remarks on the state, course, and circu­lation of the blood, and at the same time endeavor to prove how far bleeding may prove useful or pre­judicial.

First, let us observe, that it is from the blood all the other juices of the body are secreted, and lest it should coagulate or stagnate, is in perpetual mo­tion through every part of the body; and that all its offices depend on the circulation of the blood, which cannot be suppressed for a few minutes, without being attended with the most direful effects. The blood, in its progressive motion, is conveyed from the heart to the arteries, to all parts of the body, and brought back again by the veins, into the sinus venosus; it is then protruded into the right or superior auricle and ventricle; from the right ven­tricle of the heart it is forced into the pulmonary artery, and after circulating through the lungs, is returned by the pulmonary vein into the left or [Page 14] inferior auricle and ventricle; from the left ventricle it is expelled into the aorta, by whose converging branches it is transported from the extremities of the small arteries▪ into the nascent or insipient veins, through them passes into their larger branches until it arrives at their termination, the heart, from whence it is as before discharged into the arterial system, again in a perpetual round to traverse the body.

The blood returning into the cavoe and pulmo­nary veins, and rushing into the heart by its cavities, will, in such manner, stimulate and affect its sensible nerves and fibres, as to bring it immediately into contraction; if the blood should become acrid, as from infectious miamata, an impeded excretion of the acrimonious perspirable particles, an absorbed purulent matter, &c. by its increased stimulus, it will excite the heart to quicker motion or vibrations, febrile symptoms must take place; or by heat or exercise of body, which ratify the blood and cause it to be more determined to the heart; more copi­ously the cavities being distended, its contractions will be more frequently repeated, and the contained fluids expelled with more force, and circulated with an increased velocity through the body.

The systole, or contraction of the heart is imme­diately followed by its relaxation or diastole, for [Page 15] the ventricles, by their action, having expelled the blood which they contained into the aorta and pul­monary arteries, their componant fibres will lose that tension and firmness which the moment before they were possessed of; at this time the contraction of the arteries begins:—For the blood being expel­ed from the heart, with a force considerably exceeds the resistance they can yield, will dilate them, dis­tract their fibres, and may slightly stimulate their internal supersicies: This their dilitation and the change, from a less to that of a greater capacity, thereby occasioned, is called the pulse, the diasto [...]e of which is an expansion of the artery beyond its natural circumference.

The arteries thus distended and irritated by the stimulus of the forcibly impelled blood, from an inherent contractile power, which is natural and common to them, as consisting of circular elasti [...] fibres, are immediately constringed and return to their former diameter, by expressing a quantity of blood into the venous system, proportionable to that with which they had been dilated beyond their or­dinary capacities; and the arteries, by this means, being disengaged from the wave of blood emitted by the ventricles, the distention and stimulus thereby [Page 16] occasioned, will cease, till they are again overstretch­ed by the blood protruded into them at each systole of the heart, in consequence of which they are again excited to contract themselves.

And this alternate motion and contraction must continue, whilst life and the circulation of the blood endure.

From what hath been already advanced, it will appear, that from the pulse may be had much cer­tainty to form a judgment as to the circulating pow­ers; a full strong pulse will denote that the blood abounds in the body, and that it is expelled in large quantities at each contraction of the heart into the arterial system; as on the contrary, a weak languid pulse will evince that the blood does not exceed in quantity, nor is it circulated with too great an im­petuosity through the body. A quick and strong pulse will argue that there is a disposition to a ple­thora, at the same time a stimulus to excite to more repeated contractions the circulating powers, as a quick and weak pulse will prove that there is rather a deficiency in the quantity and consistence of the fluids; but at the same time a stimulating acrimony, or a disposition to irritability in the so­lids themselves, beyond the necessary bounds.

[Page 17]The actions of the heart and blood-vessels will variously affect the circulating fluids, as they are per­formed with a greater or a lesser degree of strength and elasticity.

It is to these that we are indebted for the con­version of chyle into milk, and at length into blood; and this will vary in its density and prin­ciples, according to the strength or weakness of the system of the solids, and the circulation is per­formed with greater or lesser vigour.

The strong elastic vessels act forcibly upon their contained fluids, whence a greater friction and attrition of the blood and vessels against each other, an increased heat and dissipation of the more watery particles, the crassamentum is wrought up to a higher degree of density, and abounds in full pro­portion to the serous parts.

The blood and juices in such constitutions be­come, for this reason, more dense, compact and viscid, which will be manifested by examining the blood of a robust man who uses much exercise, which always will appear of this kind.

Even in diseases in which the vital actions are too much encreased, as in ardent fevers and inflamma­tory [Page 18] diseases the mass of blood is soon rendered dense and tenaccous, and covered with a phlogistic lentor.

On the contrary, where the vessels are too weak and the circulation lunguid, the fluids of the body cannot be sufficiently acted upon, or wrought up to a degree of density and a proper consistence, whence the blood has the appearance of a dissolved watry fluid, not sufficiently prepared for the strength and nourishment of the body, or the purposes of the animal economy, nor circulated with a force suffi­cient to preserve and maintain the vital heat.

And hence arises a petuitous lentor in the serum, which under these circumstances is not sufficiently attenuated, or its particles divided; whence con­cretions in the vessels, cachecxies and innumerable other complaints succeed. In diseases likewise in which the vital actions are depressed, the pulse is small and weak, the heat of body lessened, and the texture of the blood dissolved with a superabundant quantity of serum.

To the circulation of the blood rightly and agree­ably performed, we are indebted for life, health, and at last a gradual decay or old age. But if by [Page 19] any means the blood in its rotatory motion should be impeded or disturbed, it will become certainly the natural parent of diseases and of death. So long as the blood and humours are circulated through the ducts and canals of the body, an animal will live, but no sooner does the circulation cease and become extinguished, than death succeeds life. If the circu­lation through every part should be performed free­ly, aequably moderately and agreeably, so long we remain sound and healthy; but in every disease we find the circulation too much increased, decreased, immoderate or unequal; and morbific causes in a great measure is productive of diseases, by disturb­ing and impeding the economy of the vital motions, and perverting the secretions and excretions.

From what has already been advanced on the sub­ject of phlebotomy, when it becomes useful and ne­cessary, and when it is to be avoided. For as the circulating powers may be variously affected by an evacuation of blood, as sometimes in a plethora, where the vessels are too much distended, a moderate blood-letting will greatly tend to a free and easy motion of the fluids. On the contrary, we know of no remedy that will so speedily weaken the powers of nature and impetus of the circulation, and produce [Page 20] so immediate and universal a weakness. For as the influx of the blood into the cavities of the heart ap­pears to be the cause which excites it to action (as before observed) it must follow that when the vital fluids is exhausted, the quantity to be returned to the heart will be lessened, therefore the strength of its muscular contraction will be impeded. The re­action of the arteries now not sufficiently distended, will be abated; the circulating powers will flag, and may be reduced to any degree at pleasure.

As bleeding weakens and destroys the action of the vessels and organical parts, upon the same ac­count it lessens the heat of the body and the motion and impetus of the blood throughout the whole vas­cular system. For as the friction and attrition of the fluids against the solids are a chief cause of heat in living animals, it is evident that by taking away the cause which excites the heart to action, the force and strength of its muscular contraction may be diminish­ed to any degree; and further, it may be said with certainty, by blood-letting alone we may reduce the motion and impetus of the humours and give so great a check to life and the circulation, when too impe­tuous or beyond measure excited in acute diseases, as to induce a general langour, and by procrastinating [Page 21] the evacuation, can bring on a deliquium animi, of even death itself, by which both heat and motion will most effectually be stopped, and cease.

It will therefore appear evident what effects are consequent to blood-letting, and those can only be from the following:

In a plethora, a moderate bleeding must tend to deplate and free the vessels and organical parts when over distended, with a thick, dense blood, by which means it promotes and increases the circulation of the fluids, the easy, free contractions of the arteries, and the elasticity of the vessels, at the same time conduces to the attrition, attenuation and motion of the blood; restores the natural and ready exer­cise of the body; depraved by a superabundant quantity of humours, distending the vessels and clog­ing the circulation, and by those means relieves in many and various diseases, and produces many and great changes in the animal economy.

On the other hand, bleeding will prove of all others the most speedy and efficacious to weaken the action and elasticity of the heart and arteries, and to lower the impetus of the circulation; for instance, in acute inflammatory diseases, where the blood is [Page 22] too rapidly and impetuously propelled, will afford an immediate and speedy relief, but if profusely, in­judiciously and unseasonably used, where there is neither a real plethora or increased impetus of the circulation, by lowering the vis vitae, will retard the cure of many diseases, and at the same time relax the solids and lessen the bodily heat; retards the circu­lation, diminishes the strength, dissolves and thins the fluids, and is productive of various evils, by the body becoming weak, infirm and cachectic. In fine, in all cases from a relaxed state of the solids, a dis­solved state of blood and a weak languid circulati­on, blood-letting should be avoided, as increasing all the symptoms and contrary to all the intentions of cure.

Much hath been advanced on this subject, and it now becomes necessary in the last place to observe that in most seasons, about the autumn of the year, fevers of the putrid and inflammatory classes, manifest themselves in South-Carolina, which, according to the state of the weather become more or less violent and prevalent. It would therefore be found most ad­viseable in persons coming from Europe or elsewhere, not to adventure here during those months, or any but from the middle of October until the first part of [Page 23] June, as in a great measure they might become ha­bituated to the climate, and have less to dread from the sudden and frequent transitions so common here.

Transient persons who come and stay but a short time, have not that danger to dread, and those who arrive here in future, would find it infinitely service­able and beneficial to them, immediately on their arrival, to make the proper evacuations by emetics, cathartics, and other necessary evacuations or excre­tions, according as the habits of body or constituti­ons respectively, might seem most expedient.