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from these counteracting powers, this vigour will not appear: hence a person in the cold bath will not experience these exhilarating and invigorating effects.
Death is produced by cold diminishing the sum total of the stimuli necessary to support the phenomena of life. In smallpox, where debilitating medicines are enjoined, cold is used as one, in which case it procures a free perspiration and proportional diminution of eruption. The same remedy is equally productive of good consequences in the measles, phrenites, and other diseases of high excitement.
Cold has been said to produce acute diseases, such as catarrh, acute rheumatism, pneumonia, &c., and therefore could not be a debilitating power; but these diseases arise from a too sudden application of stimuli after an exposure to cold; hence, when a person who has been thus exposed returns home after being for some time under the influence of cold, is seated near a warm fire, warm and stimulating food, spirituous liquor, &c., being administered, and lastly a warm bed with additional covering, this person will perhaps sleep very comfortably; but when he awakes it often happens that some one of these diseases is seen in its incipient stage, produced from the stimuli applied, not from the cold, but rather from the heat.
Since therefore, after the application of cold below what is called the agreeable point, shrivelling of the skin, a dislike to motion, symptoms of numbness and torpor, a failure of intellectual operations, drowsiness and sleep are produced, may we not conclude that cold below this point proves debilitating to all animals whatever, and exactly in proportion as is the diminution of heat?
These postulata being granted, I shall proceed to observe that previous to the Brunonian system being promulgated by its author, cold has been used in the treatment of fever in Italy and other warm climates; but as at that time practitioners had no regular data on which to found their practice, they were not generally successful.
Since the action of cold upon the human body has been more satisfactorily explained by those illustrious men Brown and Currie, the practice of giving cold drink and using cold ablutions at certain times and periods of fever became
more commonly employed, and has assumed a more decided systematic form.
Every practitioner, particularly in country practice, is well acquainted with the influence and effects produced in minds prejudiced against what is considered experiment and innovation; and hence, although he may have read the work of a Currie or a Brown with the greatest attention, and have the strongest reason, in cases of fever, &c., for recommending and endeavouring to enforce the trial of cold affusions, yet, as he cannot take upon himself to promise that it will certainly effect a cure, and the practice in itself appears terrible, many are the objections which will frequently be raised to oppose it; and if after making trial of the means he do not succeed, he will in future become more timid and will be inclined to wait until general practice remove prejudice, and the patient and friends attend to the advice with pleasure.
To obviate the inconvenience I have had recourse to a method in most instances equally beneficial, and certainly much less to be dreaded. As I presume Dr. Currie's book is in everybody's hand, as well as I should hope the Elementa Medicine, I shall not here attempt to abridge any part of it, but taking it for granted that the time when to employ the application of cold is well understood, if the patient or friends object to the affusion I have in several instances reaped great advantage from allowing the patient, during what I would call the acme of pyrexia, cold drink ad libitum, at the same time making use of tepid spongings with water heated to the temperature of 92° of Fahrenheit's scale, in which I have added zij of the following mixture to every pint of warm water:
B Aceti communis Ziiij
Natron muriatum 3vj m
But it is to be particularly and constantly held in view that when this practice is adopted the heat of the surface must be steadily above what is natural, not the smallest sensation of chilliness or tendency to perspiration being present. That species of fever termed typhus gravior has occasionally shown itself with us this spring and summer, and generally has been accompanied with petechia; but by far the most prevailing disease has been and is the typhus mitior, which commonly extends to
the twenty-first day and sometimes to the twenty-eighth or even longer; at any period of which, previous to the fourteenth, the depression of strength not being very great, but the heat accompanying the exacerbation being very considerable, I have found great benefit in pursuing this practice; and in some particular cases, attended with the most alarming and threatening symptoms, cold drink and tepid spongings had the effect in the opinion of. everyone present of shortening the duration of the exacerbation and curtailing the period of the fever.
This was remarkably evinced in the case of Mr. Ferrier, surgeon, of Kimbolton, who on Thursday, March 12th, 1801, being exposed to some of the causes producing fever, had a regular attack come on in the night, and continued getting worse until the eighth day, when his friends sent for me to visit him in consultation with Mr. Peak and Mr. Mackie. During the preceding evening the paroxysm of fever was very considerable, accompanied with excruciating pain of the head; and during the remission, though no complete apyrexia was ever present, he mostly continued in a state of torpor, dulness, or insensibility, and we had every reason, from observation and analogy, to suppose that the fever would continue to the end of the third week, or wear our patient out before.
From the time of my being sent for the cuticular heat had greatly diminished-I should presume from the effects of considerable perspirations; and during the height of the exacerbation I never could understand that the heat was so great as frequently shows itself. On this account, as the disease had advanced towards the ninth day, I thought it not advisable to recommend either the cold affusions or tepid sponging, and the more so as my patient was not in a state to acquiesce: still, as the exacerbations of the fever were very severe, and, when at the height, the heat and thirst and restlessness excessively troublesome, I allowed him, during the time the extreme heat was the greatest, cold water for drink in any quantity agreeable to him; and such was the refreshment and benefit he experienced from its use, that although very delirious at the time, yet he became attentive to the noise of the pump under his window, and apparently listened to it with uncommon pleasure. By persevering in this practice, and employing with it the means
generally made use of in these cases, this fever very unexpectedly terminated on the fifteenth day, and our patient very soon afterwards recovered.
I have had two cases since then in almost every respect similar, in which the same practice accompanied with tepid ablutions succeeded equally well.
Here I would call for the most serious attention of the Society in requesting them to be particular in recollecting that there is a species of fever in many respects similar to the synochus of Cullen, in which the whole thoracic viscera appears from the commencement more than usually unmoved, and catarrhal symptoms are frequently very troublesome. The senses of hearing, and taste, and feeling, are throughout the disease uniformly acute, and the heat of the surface frequently up to 108° or more of Fahrenheit's scale, with great restlessness, delirium, and almost incessant talking. Although the heat of the body is here so great, yet the patient invariably shrinks from and is hurt by the impression of cold. In fevers of this description, the practice of employing cold, in any form so as to prove inconvenient to the patient, has been found baneful and ought to be abstained from altogether. As this particular kind of fever differs from most, so it can hardly be confounded with any other, if the practitioner will take time to form a just diagnosis. Fortunately for mankind, this variety in fever is not very frequently met with, for although it is said to be never epidemic nor contagious, and its first attack mild when compared with many other forms of the same disease, yet in almost all the cases which Dr. Currie has met with it has generally proved fatal; and in the only well-marked instance I have met with, though called in early and favoured with an opportunity of paying daily visits, I could not discover that the established and generally successful mode of practice now in use afforded at any period of the fever the smallest degree of benefit, and the patient was carried off in the prime of life, towards the end of the fourth week of the disease.
After making an apology, gentlemen, for engrossing so much of your time, I shall conclude these observations with remarking that in those cases where I have employed the tepid spongings I have done it invariably with a view of diminishing
the heat of the surface, which must be at the time considerably above that which is natural; for, as during the evaporation of fluids from the surface of the body cold is produced, or, according to the present and more accurate method of conveying our ideas, the superfluous and oftentimes morbid accumulation of caloric is abstracted, so by adopting this practice, regulated according to existing circumstances, and agreeably to the directions above recommended, I should hope that in most instances the exacerbation of fever might be diminished in violence and curtailed in duration, and hence many of the distressing accidents so often occurring during the progress of a long-continued fever would be prevented, the period of the disease frequently shortened, or its course rendered far less dangerous and alarming. To enter more at large into the modus operandi of a known debilitating power or agent sometimes employed in fever, which is acknowledged to be a disease of the asthenic class, would be entirely foreign from the purpose of this paper; but I would wish it to be remembered that I consider cold here as acting upon the sensations of the human body and employed during the time that an increased excitement takes place upon its surface: and until we are better acquainted with the proximate cause of fever, any theory which might be advanced would be found extremely deficient and unsatisfactory. I shall therefore decline entering any further upon the treatment of fever, and conclude these observations with recommending the cautious and limited use of cold as a new agent in addition to our present means of opposing so dreadful a malady, trusting that every member of this Society will bring forward those practical remarks upon the subject which must contribute to general information, may ultimately lead to more beneficial and important discoveries, and render us all individually more useful and more happy.
"Felix qui potuit rerum cognoscere causas!"-TANTUM.1
1 We have reproduced this paper with faithfulness as to spelling and composition, no less than as to the curious half-metaphysical ideas with which it abounds. It is interesting to see that Currie and his followers shrank from cold water in what we call "hyperpyrexia.”.