Division III. Class IX. Refrigerants—Antipyretics.
Refrigerants are defined to be those agents, which, when taken internally, or applied externally, lessen the morbid temperature of the body. This they may effect in two ways; first, by checking the process of combustion; and second, by the direct abstraction of heat.
Heat is produced in the animal body by the oxydation of certain components of the food and of the tissues of the body; the heat produced bearing a direct ratio to the amount of oxygen consumed, or to the amount of carbonic acid gas exhaled, and water formed by the union of oxygen with hydrogen. Though oxygenation first takes place in the lungs, yet we do not find an increased amount of heat in them, but the reverse; the constant evaporation of water in expiration tending to keep their temperature below some other portions of the system. Arterial blood is a carrier of oxygen, as is proved by its altered color after its passage through the lungs, and this color, the effect of oxygenation, continues until it has passed through the smaller capillaries. In the capillary system, then, we may look for the oxygenation of such material as will answer the process of combustion; and in this system of vessels we doubtless have the evolution of caloric. Heat, then, is very equitably distributed through the body; the parts, however, furthest distant from the center of circulation being somewhat the coolest. We find also that in health the system possesses within itself a regulating power, by which the combustive process is augmented in activity when increased calorification is required, or slackened when the temperature becomes too high. This is accomplished by an appetite for certain varieties of food which furnish a proper pabulum for combustion, and an increased activity of the respiratory organs in the one case, and for articles of diet of an opposite character, and decreased respiratory action in the other.
"The means provided by nature for cooling the body," says Dr. Carpenter, "are of the simplest possible character. From the whole of its soft, moist surface, simple evaporation will take place at all times, as from an inorganic body in the same circumstances; and the amount of this will be regulated merely by the condition of the atmosphere, as to warmth and dryness. The more readily watery vapor can be dissolved in atmospheric air, the more will be lost from the body in this manner. In cold weather, very little is thus carried off, even though the air be dry; and a warm atmosphere, already charged with dampness, will be nearly as ineffectual. The skin, as already mentioned, contains a large number of glandules, the office of which is to secrete an aqueous fluid; and the amount of this exhalation appears to depend solely or chiefly upon the temperature of the surrounding air. Thus, when the external heat is very great, a considerable amount of fluid is transuded from the skin; and this, in evaporating, carries off a large quantity of free caloric, which would otherwise raise the temperature of the body. If the atmosphere be hot and dry, and also be in motion, both exhalation and evaporation go on with great rapidity. If it be cold, both are checked, the former almost entirely so; but if it be dry, some evaporation still continues. On the other hand, in a hot atmosphere, saturated with moisture, exhalation continues, though evaporation is almost entirely checked.—We learn from these facts the great importance of not suddenly checking exhalation by exposure of the surface to cold, when the secretion is being actively performed; since a great disturbance of the circulation will be apt to ensue, similar to that which has been already mentioned, as occurring when other important secretions are suddenly suspended."
In febrile diseases the abnormal increase of the temperature may arise from two pathological states of the system; first, from any cause that will produce increased disintegration of the tissues, a more rapid circulation of the blood, and increased respiratory action, and consequent oxygenation; and second, from any cause that obstructs or diminishes cutaneous transpiration, which is the great frigorific means of relieving the system of superabundant heat. In inflammation the increased heat is probably dependent upon the increased amount of blood sent to the part, and upon the increased chemical changes going on in it.
We have already noticed the fact that if, from any cause, an increased disintegration of the tissues should occur, or if the vitality of the circulating fluids was depressed, either by the retention of an excretion, or other cause, an increased amount of combustible material would exist, and increased oxygenation would be necessary. To burn this and fit it to be eliminated, an increased respiration and rapidity of the circulation would be necessary, and the consequence of this would be an increased evolution of caloric; this gives us the principal symptoms of fever.
Action of Refrigerants.—Refrigerants act in four different ways: first, by directly diminishing the process of calorification; second, by the direct application of cold; third, by increasing the action of the skin, thus relieving the system of its superabundant heat; and fourth, by an artificial evaporation from the surface, for the same purpose.
Among the agents that act directly in diminishing the process of calorification, we might call attention to the class of direct sedatives already considered, and to all agents whose secondary action is sedative. A sedative diminishes the generation of heat in the body, by diminishing innervation, by controlling the action of the heart and lessening the rapidity of the circulation, and consequently of the respiratory apparatus. These effects are invariably followed by a reduction of the temperature, as the evolution of caloric in the system requires active innervation, circulation and respiration.
We have another class of agents, however, which, though not as efficient in this particular, yet are designated by the term refrigerants. These are the vegetable and some of the mineral acids, and the supersalts of the vegetable acids. These agents act, it is probable, in two different ways: First, they furnish a combustible material to the blood, which requires much less oxygen for its combustion than the nitrogenized tissues of the body. Then if the amount of heat evolved bears a direct ratio to the amount of oxygen consumed, these agents would prove direct refrigerants. Dr. Headland says: "In fact, I suppose that in fevers the supply of natural blood fuel is deficient; that the nitrogenized tissues are then oxydized to maintain the animal heat, causing not only wasting, but tending to keep up the fever by the excessive amount of oxygen demanded for this abnormal combustion; that in such a case the vegetable acid is well adapted to take the place of lactic acid, the natural fuel. For though in health the ingestion of such an acid is immediately followed by increased acidity of the urine, when used in fevers it does not pass into the urine. It is then disposed of, or burnt, in the blood." Second, they act as antiseptic, preventing or retarding the chemical changes going on in the blood and solids of the body, and thus directly prevent oxygenation and the consequent evolution of heat. We understand by the term disintegration or decomposition, when applied to the tissues of the body, a chemical change from a higher to a lower grade of organization. Such a change always gives rise to an evolution of heat, as we witness in the color mordaux, or increased heat of the dead body, caused by rapid decomposition. These agents check this disintegration of the tissues, and consequently lessen the morbid heat of the body. Thus they prove very beneficial in typhus or typhoid fevers, and in all low forms of disease in which there is a typhoid or septic condition of the blood.
The direct application of cold, is among our most powerful refrigerant measures; and not only so, but it is also one of the most agreeable to the patient when there is an excessive generation of heat. In fever, when taken internally, it operates as a direct refrigerant, reducing preternatural heat, lowering the pulse, and disposing to sweating. There are very few cases in which cold water, if desired by the patient, may not be taken in moderate quantities. Even in cholera infantum, where drinks of all kinds, though constantly desired, will be immediately ejected, we have found ice, or icewater, in small quantities, to be of the greatest utility. The practice of physicians in former days, and even some at this time, of prohibiting entirely the exhibition of cold water, was certainly the most cruel, if not the most unphilosophical mode of treatment that could have been adopted. "We have now the most vivid impressions, from actual experience, of what it was to have a fever in those days. Suppose a person with dry mouth, parched tongue—literally burning up—and with a thirst that might be called horrible, begging for but a spoonful of cold water to wet his parched lips; yet this was positively prohibited, upon the ground that it would probably kill the patient, or produce "salivation." If we had to take our choice between cold water, or a doctor with his lancet, calomel, ipecac, tartar emetic and Dover's powder, the regular saddlebag contents of former days, we should certainly prefer the first and omit the last.
Cold applications are employed with advantage in all inflammatory affections where there is general febrile reaction. In many cases they will be found to give more satisfaction than the "hot fomentations" so commonly employed. The rule that we observe in their use is, that if the system is in such a condition that a chill will not follow their application, and if the part to which they are applied is much above the ordinary temperature, they may be used with advantage; but if the contrary is the case, we apply warm applications. In the first stages of inflammation of the eyes, we may often entirely arrest the disease by the application of cold. Care, however, is required that the cold is not continued long enough to produce such a degree of refrigeration as will endanger the tissues of the eye. In other superficial inflammatory affections, cold may be often employed so as to speedily remove the disease. Cold applications to the head in phrenitis, in determination of blood to the head, etc., is one of the most common means resorted to, yet we have found that refrigeration by evaporation is much the best method of removing the heat in these cases.
Cold applied to the entire surface in febrile diseases, is often an important means of subduing or lessening the abnormal heat of the body. Its primary effect is that of a depressing and sedative agent; thus it lessens the heat of the surface, causes constriction of the capillary vessels, lessens nervous irritability, and diminishes the activity of the circulation. If long continued, it causes a determination of blood to internal organs, which are oppressed in their action. Its secondary effects (reaction) are the opposite of the primary effects: thus, there is determination to the surface, the skin is relaxed, and perspiration frequently results. External refrigerants are generally more effectual than those need internally. They are brought in direct contact with an extensive, highly vascular, sensitive and strongly sympathizing surface, and through this sympathy they exert a sedative influence upon the entire system.
The refrigerant effects of cold, in fevers, are obtained in two ways: by exposing the body to a draught of cold air, or by the application of cold water.
Cold air is frequently beneficial as a refrigerant; if the body is exposed to a draught of cold air, the increased evaporation and consequent refrigeration is grateful and salutary in its influence upon the system. It is necessary, however, that the entire surface should be affected alike; for if the air strikes but a portion of the body, a severe cold, with aggravation of the disease, will be very likely to result. Exposure to the air at a temperature of fifty or sixty degrees, without draught, is much safer, lowering the temperature of the body and reducing excessive vascular action. In febrile diseases, we always direct that the patient be lightly covered when the skin is hot, and, if possible, keep a free circulation of air in the room. We have found this especially useful in the treatment of scarlatina. In the first stages of the disease we keep the patient lightly covered, use the cool alkaline bath, and refrigerants internally; but as soon as the fever commences to subside, we direct them to be warmly covered, and mild diaphoretics administered to produce perspiration.
Cold water is employed as a refrigerant in the form of a bath, affusion, shower-bath, douche, wet-sheet pack, and as a wash.
The temperature of the cold-bath ranges from 88° to about 75°; when below 50° it may be considered very cold. Its primary effects are a sensation of cold, paleness of the skin, contraction of the cutaneous vessels and to some degree of those deeper seated, and diminished rapidity of the circulation. This is soon followed by reaction, the pulse becomes full and frequent, there is determination to the surface, with a softened state of the skin and perspiration. It has been employed as a refrigerant in fevers of a sthenic type, and many cases are reported in which it has immediately broken up the disease. Owing, however, to want of facilities to employ it, and the natural objections of patients to such rough treatment it is rarely used.
The cold affusion, shower-bath and douche, are rarely employed for their refrigerant influence, being better adapted to the treatment of local or chronic diseases, (see Hydropathy, Part I).
The wet-sheet pack is one of the most valuable modes of applying cold as a refrigerant in fevers. Its primary action is the same as the cold-bath,—diminishing the heat of the surface, lessening the rapidity of the circulation, and acting as a sedative to the entire system. Here, however, the analogy between the two ceases; for instead of a high reaction as is the case with the cold-bath, it is generally but sufficient to produce an agreeable degree of warmth; the pulse assumes its natural standard, the skin is relaxed, and perspiration established. We have often seen what promised to be a severe attack of fever, entirely subdued in its incipient stage, by the employment of the wet-sheet pack; and if it were not for the almost insuperable objections of patients to its use, we have no doubt that a majority of such cases would yield to its use with but little medication, if employed in the early stages. After the disease has progressed for some time we should not expect it to prove so decidedly curative, yet it will be found of great utility when not contra-indicated as an accessory means of treatment. The rules that we observe in its employment, are, that when the skin is hot, the pulse quick but not small, and perspiration suppressed, it may be used with advantage.
Sponging the body with cold water, as far as a simple refrigerant is desired, is a valuable mode of application, and much less objectionable to the patient than either of the others mentioned; there is no shock, the fluid being left to evaporate merely cools the surface, and by persevering in its application, the cooling effect is fully obtained and rendered permanent. When water is ueed in this manner, its temperature, as a general rule, should be but little helow that of the body; but this is best regulated by the feelings of the patient. One great advantage of the sponge-bath is the facility of limiting the extent of the effect to the feelings of the patient, and of applying it even when lying in bed; as soon as the patient feels chilly, he should be carefully dried with brisk friction and warmly covered up in bed.
Dr. Thompson notices six varieties of fever in which the refrigerants named are indicated and prove useful:
"1. In inflammatory fever (synocha), a rare disease when unaccompanied with topical inflammation, the advantages to be derived from refrigerants are well understood. The cold affusion is admirably adapted for rapidly abstracting the stimulus of heat, diminishing general excitement, and operating as a powerful sedative. In the more advanced stages of the disease, cool sponging is often substituted for the affusion; but when the patient can bear the fatigue of the affusion, it is always to be preferred. The greater frequency of this form of fever among the ancients than the moderns (?) explains their constant employment of cold drinks and cold bathing in continued fever.
"2. In fevers of a typhoid type, the disease has been cut short by the cold affusion; but in this case more, perhaps, is to be attributed to the shock and the reaction which follows, than to the refrigerant influence of the affusion.
"3. In synochus, or continued fever, gradually assuming the typhoid character, refrigerants in general, but more especially the cold affusion, are chiefly applicable to the early stages of the disease; and, indeed, no form of remedy is more advantageous when there are no local determinations; but when these exist, particularly if the lungs be affected, much caution is required.
"4. In remittent fevers, especially those of warm climates, and in their intense and more excited variety, the cold affusion may be employed with great benefit. In severe attacks also, much advantage is derived from the application of ice or cold water to the scalp. In the remissions, however, the application of cold in any form must be suspended. In yellow fever, the safety of the patient frequently depende solely on the early application of the cold affusion.
"5. If hectic be symptomatic of pulmonary affections, or determination to internal organs, the cold affusion is decidedly contra-indicated; but even in such cases much benefit is often obtained by sponging the trunk of the body with cold water, mixed with vinegar, while the lower extremities are kept warm in bed. We must, nevertheless, bear in mind that, under any form of hectic, although general refrigerants are useful auxiliaries, yet the cold affusion can scarcely be regarded as admissible.
"6. In eruptive fevers, except measles, the body should be freely exposed to cool air; and even the cold affusion may be safely and advantageously prescribed, should the state of the surface require it, nor should the presence of the eruption operate as a reason against its employment. The Hindoo physicians plunge their patients, during the eruption of small-pox, into cold water, and with the best results. It diminishes the fever, lessens the number of the pustules, and is said to prevent pitting. The writer of this article has long been in the habit of employing the cold affusion in scarlatina during the hight of the eruption, and has seen the severity of the disease instantly checked by it.
"In intermittent fevers, when the skin is dry and parched, and the general heat greatly augmented, cold in every form applied to the surface, and cold acidulated fluids taken into the stomach, are of the same value as in continued fever, and greatly favor the accession of the sweating stage."
The skin, as has been already stated, is the great refrigerating organ of the system; and when it is in a perfectly healthy condition, its functions being normally performed, it would be almost, if not entirely, impossible for an excessive degree of heat to exist. It must then be apparent that if by any means we can obtain a normal action of this tissue, refrigeration would be the consequence, and the agents employed for this purpose might be termed refrigerants. Thus diaphoretics and diaphoretic measures would become important agents of the class we are now considering. It is not our intention, however, to do more than merely refer to the importance of these agents as refrigerants in this place, as they have already been fully considered. The various external applications referred to not only act as direct refrigerants, but also indirectly in promoting the cutaneous secretion. As a very important mode of cleansing the skin, and stimulating it to increased action, as well as of producing direct refrigeration, we would here refer to the alkaline bath, so well and favorably known to Eclectic practitioners. Nothing, with which we are acquainted, so successfully cleanses the skin, removes the detritus of perspiration, and fits it for normal secretion. It is employed in all stages of febrile disease with perfect safety; its temperature being governed by the condition of the system.
Evaporation from the surface is one of the most powerful modes of refrigeration, heat being rapidly conducted from the system by the change of a liquid to a gaseous form. Thus in fevers where the skin is very hot, it may be soon brought down to a normal temperature, by sponging the surface with luke-warm water, and promoting evaporation by a current of air or by fanning. It is not in general disease, however, that it is employed with the greatest advantage. In inflammatory affections it proves more useful than any other form of external refrigeration, rapidly reducing the temperature of the inflamed part. We employ it in phrenitis, determination of blood to the head, etc., in preference to ice or ice-water; for we have found by experience that it reduces the heat as rapidly, is more agreeable to the patient, and there is no liability to that reaction which always follows the application of cold, if by any carelessness upon the part of the attendant, it is not continuously applied. In inflammation following injuries, it will also be found preferable in many cases to the direct application of cold. In some cases, as in injuries of the joints, if we wish to produce a more rapid refrigeration than can be obtained by the evaporation of water, we employ agents that evaporate very rapidly, as the sulphuric ether, chloroform, etc.
As was remarked in the general description of this class, sedatives occupy a prominent place in the list of refrigerants or antipyretics. There is a direct relation between the temperature and the pulse; as the one goes up the other goes up; as the one comes down the other comes down; with each increase of one degree of heat, the pulse is increased in frequency ten beats per minute. The high temperature is associated with an equally frequent pulse; if the pulse is brought down, the temperature is brought down with it.
It is of no special importance to us to theorize upon this relation, the well established fact being a sufficient basis for therapeutics. That the nerves controlling calorification are intimately associated with those controlling the circulation, is a sufficient explanation of the interdependent of the two. As has been remarked, we control the processes of burning and the amount of heat produced.
Veratrum.—With a full and frequent pulse and high temperature we prescribe Veratrum (see Sedatives) and as the pulse comes down the temperature is reduced. Of course, if Veratrum does not diminish the frequency of the pulse, it will not lessen the temperature, but if the indications are followed the results are quite certain.
Aconite.—The pulse is small and frequent, the temperature high, and we select Aconite as the arterial sedative and antipyretic. In infantile fevers I have seen the tempeature brought down from 105° to 100°, in six or eight hours, by the administration of this remedy alone. Of course we do not expect so marked or so speedy a result in fevers produced by a blood poison, as scarlet fever, or where there is an active process of inflammation. Still Aconite is so certain in its action that it stands at the top of the list.
Gelseminum.—The face is flushed, the eyes bright, the pupils contracted, the patient restless, and the temperature markedly increased. These are the evidences of irritation of the cerebro-spinal centers, and which is met by the administration of Gelseminum. As the nervous system is relieved, the patient rests, the pulse comes down, and the temperature comes down. I have seen as marked antipyretic effects from this as from any remedy I have employed.
Belladonna.—The skin is flushed, bright or dull, and when the finger is drawn across it a somewhat persistent white line is left. There is capillary congestion of the skin, and it is not in good condition to regulate the temperature. There is congestion of the basilar brain—the patient is dull, sleepy, comatose, and in consequence of this respiratory innervation is deranged, and the temperature runs high. In either of these cases Belladonna exerts a direct influence in lowering the temperature. In the one case it relieves congestion, and puts the skin in condition to remove the excess of heat; and in the other it regulates the fires of life.
Rhus.—The patient complains of burning heat, the pulse is frequent and sharp, and the skin dry. Rhus relieves the peculiar excitement of the nerve centers, lessens the frequency of the pulse, puts the skin in better condition, and thus lowers the temperature. When indicated it is one of the most direct of antipyretics.
It may seem a little strange to talk about reducing the temperature by the administration of stimulants, but it is a means to be thought of in low grades of disease. The patient is maintaining a high temperature by burning his body. The nerve centers are irritated by this burning, respiration is frequent, the secretions are arrested, and the skin is so harsh and dry, that the heat can not escape. The digestive organs have been so impaired by the disease and by medicines that food can not be taken.
If the patient is to recover the temperature must be brought down, and to do this, combustion of the tissues must be stopped. As we can not give food we give alcoholic stimuli—whiskey largely diluted, brandy diluted, wine, and rarely malt liquors. This furnishes material for combustion, relieves the body, lessens irritation, and diminishes the temperature
Whilst this accounts for the antipyretic action of alcohol in many cases, it may be further stated that it directly reduces the temperature in other cases when there is no need of calorifacient material. I have already noticed the fact that sweet spirits of nitre is a sedative, and this, as well as many of the ethers and alcohols, directly lower the temperature.
All the direct antiperiodics exert an antipyretic action in some conditions. But unless directly indicated they do harm rather than good by this influence. It is a very great mistake to think that because the calorifacient function can be depressed by poisonous doses, the depression will be an advantage if the life is impaired as well.
Quinia Sulphas.—Of late years, it has been taught that quinine is an antipyretic, and students and physicians have been advised to use it for this purpose. There is a small amount of truth in this, but it is associated with a great error.
We understand that there is a peculiar cause of disease which gives rise to periodicity. This is a distinctive feature in intermittent and remittent fevers, and is met by an antiperiodic—by quinine. This cause has been given the name of "malaria," but as we do not as yet know what malaria is, it is well to give our attention wholly to the expression of disease—periodicity.
If a fever has this element, quinine is antipyretic. I have seen the temperature fall from 107° to 100° under the influence of twenty grains. Whilst it may thus reduce the temperature at any stage of the fever, it is well to follow the teaching of Prof. I. G. Jones. "In a remittent fever with high range of temperature and brief and scarcely noticeable remission, commence the administration when the fever (temperature) has reached the highest point, or when the first evidence of a decline is noticed. Now if quinine is given in five grain doses there is a remarkable fall in the temperature, and probably "with the third dose we reach 100° or it may be 98°; with two or three days of such action the fever is arrested and the patient convalesces."
This should be clear enough to intelligent men, but to doctors it reads something like this—Smith has a fever (remittent) with high temperature, I give him quinine and the temperature is markedly reduced and the patient is cured. Jones has a fever (continued or typhoid) with high temperature, and because quinine lowered the temperature in the case of Smith I will give it to Jones—result, irritation, restlessness, and further impairment of function. The difference between a remittent and a continued fever has not been estimated.
Reasoning from false premises in this way, our neighbors have given quinine for everything in the shape of a fever. They have boldly taught that if the moderate dose of five grains does not lower the temperature, then give the drug in ten or twenty grain doses. Recently some of the more intelligent teachers have seen the error and expressed doubts as to whether there are any antipyretics.
In rheumatic fever and acute inflammatory rheumatism a high range of temperature is a prominent feature. In this case, as in that requiring antiperiodics, there is a specific cause upon which the temperature as well as other symptoms depend. If this cause is destroyed, removed or antidoted, the teraperature falls, so that in these cases the antirheumatics are real antipyretics. I think the reader will have no difficulty in seeing the relationship between the special cause, the increased temperature, the special remedy and the reduction of heat.
Salicylic Acid.—It has been claimed that Salicylic Acid was a direct antipyretic, and that the temperature in fever and inflammation might be controlled by its use. As usual, the doses have been largely increased until ten to twenty grains were given; now it is conceded that it was all a mistake, and there are no antipyretics.
But there is a rheumatism that Salicylic Acid will cure, and if these cases had been thoroughly studied, instead of theorizing, we might have had the special symptoms pointed out, that we could use the remedy intelligently. When it is antirheumatic it will be found to lessen the temperature when administered in the ordinary dose of two or three grains.
Salicylate of Soda. Salicylate of Potash.—In many cases we prefer these salts to this acid itself. In prescriptions we frequently order: Rx Salicylic Acid ʒj., Acetate of Potash ʒij., water ℥iv.; dose a teaspoonful. Rx-Salicylic Acid ʒj., Bicarbonate of soda ʒij., water ℥iv.; dose one teaspoonful.
If in rheumatism the tongue has a bluish pallor these preparations are likely to be successful. In rheumatic fever and inflammatory rheumatism I have seen the heat reduced from 103° or 104,° to 99°, and held there until the patient was freed from the rheumatic poison.
Macrotys.—The rheumatism is uterine or ovarian, or the pains are muscular, or seem to be intensified by muscular contraction. In such cases Macrotys, by opposing the rheumatic cause, and relieving irritation, brings the temperature down to the normal standard.
Bryonia.—The pulse is full and hard, the pain sharp and lancinating, the serous membranes are involved. Here Bryonia is sedative, lessening the frequency of the pulse, taking away its hardness and giving a better circulation. At the same time it is antipyretic, reducing the temperature by its direct action. The same result will be obtained when the remedy is given in pleuritis, pleuro-pneumonia and peritonitis, the indications for this remedy being present.
The same is true of other remedies which influence the rheumatic poison—Apocynum, Phytolacca, Sticta, Rhus, Colchicum, etc.
We have a group of remedies which antidote the zymotic causes of disease, or oppose zymotic processes, and these are markedly antipyretic when indicated. It is a repetition of the same story. The zymotic poison is the cause of fever, and the frequency of pulse, the excited nervous system, and increased temperature are dependent upon it. If this cause is removed or destroyed the effects cease. We have remedies that possess this antizymotic power, and they are of first importance in these cases.
Phytolacca.—There is soreness of the throat with diphtheritic exudation. The pulse is frequent and the temperature high. In this case we find that phytolacca not only relieves the irritation of the throat and strengthens its tissues, but it lessens the frequency of the pulse and the temperature. No remedy exerts a more marked antipyretic action than does this in a case of diphtheria with high temperature.
Baptisia.—The face has a bluish appearance like one who has been exposed to severe cold; the tongue has a like fullness with purplish coloration. This describes a condition met with in zymotic and some other forms of disease. The pulse is frequent and the temperature high, and the usual sedative and baths do not exert their usual influence. We note the indications for Baptisia and give it with the effect of lessening the frequency of the pulse and bringing the temperature down.
Sulphite of Soda.—The tongue is broad, pallid and dirty, and with a frequent pulse we have a high range of temperature. In this case the ordinary means will fail to produce sedation, and bring down the temperature. Now if sulphite of soda is given in five, ten or fifteen grain doses we find the patient is impressed in all directions. The temperature is lowered, the pulse reduced in frequency, the nervous system relieved, and secretions established. In this case the sulphite of soda is a most powerful refrigerant.
Sulphurous Acid.—The tongue is red, moist, and covered with a glutiness mistiness, the temperature is high. In this case Sulphurous Acid will bring down the temperature, lessen the frequency of the pulse, and put the patient in better condition in every function.
Chlorate of Potash.—The lochial discharge is offensive, and from the absorption of putrescent material, there is an exalted temperature with frequent pulse, and excited nervous system. I take a special case because it illustrates the action of the remedy. If now, chlorate of potash is given, a most marked influence will bo observed in bringing down the temperature and pulse, relieving the nervous system and restoring the secretions.
Muriatic Acid.—The tongue is dusky-red, dry, fissured, and covered with a brown soldes, the patient is suffering from continued or typhoid fever, and carrying a temperature of 104°. Sedatives have been used without good effect. Baths do not serve the purpose of putting the skin in condition for the removal of the surplus heat. All medicines are suspended and the patient is freely supplied with water acidulated with Muriatic Acid, and soon we notice an improvement. The pulse comes down, the temperature comes down, the secretions are better, and the patient takes food. The antipyretic influence is so marked that no one can mistake it.
Acids.—We observe the same effects from other acids. Our Irish fellow citizen drinks his whey and lessens the burning. A Jerseyman takes kindly to cider, and finds that it cools him off. The patient in the South has lemonade or orange juice, and feels the better for it.
Alkalies.—The tongue is broad and pallid, the patient is carrying a high temperature, and the ordinary remedies fail to give relief, we give a weak solution of bicarbonate of soda freely, and the patient is relieved and everything acts kindly. Under the influence of the soda the temperature falls two to four degrees in twelve hours.
It must not be forgotten that in many diseases when a high temperature is maintained, the body is being burned, and in consequence of the irritation from this burning, the processes of calorification are increased. If by any means we are able to lessen the burning of the tissues, we diminish the temperature. Whether we slow the fires by the use of the arterial sedatives, lessening nerves excitability, or furnish material for combustion, we reach the same result.
Thus, we say that in these cases the patient should have a steady supply of calorifacient food to take the place of the burning body. As we furnish it, and see that the digestive apparatus is in condition to receive it, we find that the temperature falls. It may seem singular that a body will be cooled by furnishing good material for burning, but it is none the less a fact.
In idiopathic or symptomatic fevers, with high temperature, if we can give the patient a constant supply of food, we can control the temperature. If food can not be taken, or the physician prefers medicine to food, there is a probability that the patient will be burned up. Hot milk is a standard food in these cases. Not that we oblige every one to take it, for if there is a distaste for milk, we can select other foods of similar character. But if the patient takes his milk kindly, we are sure we are getting along well.
This applies to chronic deaease in which increased temperature is a prominent feature. Take a case of pulmonary phthisis, and with a temperature of 102°, the patient is going to his funeral as fast as he can. Bring the temperature down to 100° or 99°, and all the unpleasant symptoms are relieved. This is sometimes accomplished by cod-liver oil, or by cream, or by whisky, but in the majority of the cases a supply of calorifacient food, properly appropriated, will be a prominent means of amendment.
Baths have been fully considered in the introductory remarks, and we have only to add that the means directed to the skin should be carefully studied. Nothing gives greater success in the practice of medicine than the ability to adapt means to special conditions. A good condition of skin is to be sought for in all diseases having an increased temperature as a prominent feature.