8. When the bowels are loose during the whole course of fevers, in this case we are most especially to warm the feet, and see that they are properly treated with cerates, and wrapped in shawls, so that they may not become colder than the rest of the body; but when they are hot, no fomentation must be made to them, but care is to be taken that they do not become cold; and very little drink is to be used, either cold water or hydromel. In those cases of fever where the bowels are loose, and the mind is disordered, the greater number of patients pick the wool from their blankets, scratch their noses, answer briefly when questions are put to them, but, when left to themselves, utter nothing that is rational. Such attacks appear to me to be connected with black bile. When in these cases there is a colliquative diarrhoea, I am of opinion that we ought to give the colder and thicker ptisans, and that the drinks ought to be binding, of a vinous nature, and rather astringent. In cases of fever attended from the first with vertigo, throbbing of the head, and thin urine, you may expect the fever to be exacerbated at the crisis; neither need it excite wonder, although there be delirium. When, at the commencement, the urine is cloudy or thick, it is proper to purge gently, provided this be otherwise proper; but when the urine at first is thin, do not purge such patients, but, if thought necessary, give a clyster; such patients should be thus treated; they should be kept in a quiet state, have unguents applied to them, and be covered up properly with clothes, and they should use for drink a watery hydromel, and the juice of ptisan as a draught in the evening; clear out the bowels at first with a clyster, but give no purgative medicines to them, for, if you move the bowels strongly, the urine is not concocted, but the fever remains long, without sweats and without a crisis. Do not give draughts when the time of the crisis is at hand, if there be agitation, but only when the fever abates and is alleviated. It is proper to be guarded at the crises of other fevers, and to withhold the draughts at that season. Fevers of this description are apt to be protracted, and to have determinations, if the inferior extremities be cold, about the ears and neck, or, if these parts are not cold, to have other changes; they have epistaxis, and disorder of the bowels. But in cases of fever attended with nausea, or distention of the hypochondria, when the patients cannot lie reclined in the same position, and the extremities are cold, the greatest care and precaution are necessary; nothing should be given to them, except oxymel diluted with water; no draught should be administered, until the fever abate and the urine be concocted; the patient should be laid in a dark apartment, and recline upon the softest couch, and he should be kept as long as possible in the same position, so as not to toss about, for this is particularly beneficial to him. Apply to the hypochondrium linseed by inunctions, taking care that he do not catch cold when the application is made; let it be in a tepid state, and boiled in water and oil. One may judge from the urine what is to take place, for if the urine be thicker, and more yellowish, so much the better; but if it be thinner, and blacker, so much the worse;but if it undergo changes, it indicates a prolongation of the disease, and the patient, in like manner, must experience a change to the worse and the better. Irregular fevers should be let alone until they become settled, and, when they do settle, they are to be treated by a suitable diet and medicine, attending to the constitution of the patient.
9. The aspects of the sick are various; wherefore the physician should pay attention, that he may not miss observing the exciting causes, as far as they can be ascertained by reasoning, nor such symptoms as should appear on an even or odd day, but he ought to, be particularly guarded in observing the odd days, as it is in them, more especially, that changes take place in patients. He should mark, particularly, the first day on which the patient became ill, considering when and whence the disease commenced, for this is of primary importance to know. When you examine the patient, inquire into all particulars; first how the head is, and if there be no headache, nor heaviness in it; then examine if the and sides be free of pain;for if the hypochondrium be painful, swelled, and unequal, with a sense of satiety, or if there be pain in the side, and, along with the pain, either cough, tormina, or belly-ache, if any of these symptoms be present in the hypochondrium, the bowels should be opened with clysters, and the patient should drink boiled hydromel in a hot state.
The physician should ascertain whether the patient be apt to faint when he is raised up, and whether his breathing be free; and examine the discharges from the bowels, whether they be very black, or of a proper color, like those of persons in good health, and ascertain whether the fever has a paroxy** every third day, and look well to such persons on those days. And should the fourth day prove like the third, the patient is in a dangerous state. With regard to the symptoms, black stools prognosticate death; but if they resemble the discharges of a healthy person, and if such is their appearance every day, it is a favorable symptom; but when the bowels do not yield to a suppository, and when, though the respiration be natural, the patient when raised to the night table, or even in bed, be seized with deliquium, you may expect that the patient, man or woman, who experiences these symptoms, is about to fall to fall into a state of delirium. Attention also should be paid to the hands, for if they tremble, you may expect epistaxis; and observe the nostrils, whether the breath be drawn in equally by both; and if expiration by the nostrils be large, a convulsion is apt to take place; and should a convulsion occur to such a person, death may be anticipated, and it is well to announce it beforehand.
