Treatments
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Treatment of Fevers*
Bleeding
Bleeding was without doubt the principal method of dealing with all kinds of fever. Almost every text discussed the theory and practice of bleeding in some way, though few, perhaps, gave such detailed instructions as William Cockburn as to the timing and amounts of blood to be let. His ‘An Essay on Bleeding, and the Quantities of Blood to be Let in Fevers, in any of their Periods’, may be found in Worth’s copy of Cockburn’s Sea Diseases (London, 1706):
“Wherefore I shall endeavour, in this Essay, to explain the times of Bleeding, and the quantities to be let in all Fevers as far as our present Subject will permit. To do this with greater exactness, It would be necessary to trace this affair of Bleeding from its foundation, and to apply those abstracted notions as particularly to Fevers, as their Circumstances can require: But the first being almost completed by the Learned Bellini, and the nature of Fevers being not sufficiently inquired into in this Treatise (because it requires no such Exactness) neither is it proper to determine this affair so particularly at this time; yet, this Subject shall be considered as Minutely as these General accounts do allow.…I shall first put them in mind that Bleeding claims a chief Consideration among other evacuation, that are necessary for the Cure of Fevers: For they being necessary this is the most compleat, and the most simple evacuation, h.e. it is the evacuation by which we have the quantity we demand with the greatest certainty, without introducing parts of unaccountable operations to be mixed with the Blood….
This being premised concerning the benefit of Bleeding, and that the time and use of it may be made more clear, and the reasons of the Cure more evident than by any other sort of Medicins, I may justly proceed to enquire into these rules that are to be found on the records of Physick, for our Direction in practising Bleeding with the greatest Safety. These are, 1st. That the Blood may be let in any quantity, till the sick Person Faints away, 2dly. Till the Colour of Blood is changed from worse to better, from being black till it is red, 3dly. Till we take away enough, 4thly. To take such a quantity that the strength of the sick Person is not impaired. Lastly, till the fulness of the Vessels is depleted…’
Cockburn, Sea Diseases (London, 1706), pp 251-4.
Cockburn’s advocacy of bleeding was based on a mechanical view of the circulation of the blood (similar to his great hero Lorenzo Bellini), but if his theoretical basis for bleeding a patient was underpinned by late seventeenth-early eighteenth century mechanistic theory, the practical approach of bleeding for fevers had a very long history indeed as the following sixteenth-century woodcut illustration of the practice demonstrates.
Image of bleeding from Dioscorides, De medicinali materia (Frankfurt, 1549), p. 116.
Peruvian Bark
If Cockburn’s initial treatment had ancient and medieval precursors his advocacy of quinine, then called either ‘Jesuits Powder’ or ‘Peruvian Bark’ showed his openness to new methods of treatment. Peruvian Bark was undoubtedly a new medicine, introduced into Europe in the sixteenth century and associated with the discoveries in the New World. By 1677 it had gained such approval as to be included in the third edition of the London Pharmakopeia. One reason for this was because doctors such as Cockburn were intrigued by its effect on the blood: as he says, ‘we see how the sinking and languishing Pulse is rais’d by the taking of it, and that without any burning and extraordinary warmth… therefore the Jesuits Powder, Quinquina &c answers our desire, and gives us what we require.’ One of the foremost promoters of the use of quinine was Francesco Maria Torti, whose Therapeutice specialis ad febres quasdam perniciosas (Modena, 1712) was collected by Worth. Torti (1658-1741) advocated the use of quinine in the treatment of ‘intermittent fevers’, known today as malaria. Its other name, ‘Cinchona’, was a reference to the Countess of Chinchón whose mythically miraculous recovery from fever by its use had served to popularise it throughout early modern Europe.
Acids
Not all agreed on the utility of ‘Peruvian Bark’ as a cure-all for fevers. Worth also collected the work of Sir John Colbatch (1666-1729), who had presented a number of case studies in 1699 advocating the (highly dubious) use of acid in the curing of fevers:
Some Medicinal Observations Concerning the Cure of Fevers, &c By the means of Acids.
Observation the First.May the Fourth, 96. I was sent for to a Gentlewoman of great worth; who for som months had bin subject to a Hectic Fever, with a continual Faintness, and a depression of her Spirits. About the 24th of April she was taken with a violent inflammatory Fever, which had som small remissions; she was treated by another Physician with Cortex Peruvianus and Bezoardis in extravagant quantities, and brought just to Death’s door by ‘em. She had frequently very violent Convulsions; and when they went off, a continual languor: she was fainty and weak to the last extremity, even so weak, that she could not turn her self in her Bed; and tho she had every night taken Diacodium largely, she had not slept for eight or ten days and nights, not so much as one hour, her Spirits being put into such a hurry and confusion. Her Physician had given her over for dead, and I was brought in only to look upon her, and see her expire. But seeing her Relations all in Tears, bewailing the great loss they were like to have, I told ‘em there were still som sparks of hope, and that plentiful quantities of Acids might go near to retrieve her; upon which they immedieatly beg’d me to try what might be don: so I prepared her the following Medicins.
R, Tart. Virtiolati dracm. Tres; Crem. Semis; Rad. Peoniae dracm. Unam; Castorei dracm. Semis; Sacchari Alb. Dracm. Sex. M. f. Pul. in sex chartulas distrib. ex quibus cap. unam tertia quâque horâ in Cochlear. Julap sequentis, superbibendo haust. Ejusdem.
R., Aq. Pulegii, Rutae, ana unc. Sex; Gas. Sulphuris unc. Quatour*; Aq. Hister. p. 357 –
unc. Quatour; Castor. in Nod. Inclus. Scrup. Duos M.f. Julap.
R., Sp. Lavendulae, Gas. Sulphuris, ana uncias duas; Aq. Hister. uncias quatour. M. f. Mixtura, cap. Cochlear. unum in Languoribus.
The Fifth in the morning I visited her, and found her Symptoms greatly abated….
Colbatch’s advocacy of the use of acid to cure fever might have raised more than a few medical eyebrows but he was not alone in his condemnation of ‘Peruvian Bark’. Worth’s copy of John Woodward’s The state of physic also sounded a note of caution concerning the use of ‘The Jesuit’s Powder:
‘The Jesuit’s Powder is a great Absorbent; tho’, as ‘tis withall Stiptick, and a potent Astringent, as will be manifest to those who rightly observe all its Actions and Propertyes, it hath the Effects, recounted of the former Tribe, in a much higher Degree. But, unless in Youth, or where there is great Vigor of Constitution, the Ills that follow upon it, if given in Quantity, and not in due Time cast forth again, are, in Proportion to its higher Powers, numerous, and great. ‘Tis true, by means of it, intermitting Fevers may be sometimes repress’d: and the Principles that cause them, stifled.’Woodward The state of physick: and of diseases (London, 1718), p. 247
It should also be remembered that fever, in some cases, might be viewed as more a benefit than a curse. Some early modern physicians argued that heightening the patient’s temperature, as can be seen in this illustration of the fever-bed sweating technique, would ultimately lead to the expurgation of ‘morbifick’ causes of other diseases. Here fever is being treated as a treatment for another disease, not a disease in itself:
Patient in a feverbed: Courtesy of the National Library of Medicine.
*Disclaimer: These treatments should not be attempted at home.
Selected Reading
Bruce-Chwatt, L. J. (1988), ‘Three hundred and fifty years of the Peruvian fever bark’, British Medical Journal 296, pp 1486-7.
Cockburn, W. (William) (1706), Sea diseases: or, a treatise of their nature, causes, and cure. Also, An essay on bleeding in fevers; shewing, the quantities of blood to be let, in any of their periods (London).
Colbatch, John, Sir (1699), A collection of tracts, chirurgical and medical, viz… V. A treatise of the gout, wherein both its cause and cure are demonstrated; with some medicinal observations concerning the cure of fevers, &c. by the means of acids; with an account of experiments, and the medicines, with their preparations (London).
Cook, H. J. (2004), ‘Colbatch, Sir John (bap. 1666?, d. 1729)’, Oxford Dictionary of National Biography, Oxford University Press, 2004; online edn, Jan 2008.
Jarcho, Saul (1993), Quinine’s Predecessor: Francesco Torti and the Early History of Cinchona (Baltimore: John Hopkins University Press).
Sigal, S. L. (1978), ‘Fever Theory in the Seventeenth Century: Building Toward a Comprehensive Physiology’, The Yale Journal of Biology and Medicine 51, pp 571-82.
Woodward, John (1718) The state of physick: and of diseases (London).
Torti, Francesco Maria (1712) Therapeutice specialis ad febres quasdam perniciosas (Modena).
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