TYPHOID PNEUMONIA. 115 



pepper tea (which is much used oa the southern plantations as a stimulant and 

 diaphoretic); he swallowed with ditficulty ; I directed cataplasms of mustard 

 and frictions of hot turpentine, with warm loddy internally. After a fevif hours, 

 much against my expectation, he w;is roused ; feeble reaction took place ; his 

 pulse never became full ; 1 directed the toddy to be continued, with two p^rams 

 of quinine every third hour. He improved slowly for several days, but con- 

 tinued very feeble ; gained a little strength ; was able to sit up for a short time ; 

 his tongue was r«;d at the edges, with a dry, brown crust; became moist after 

 three or four days ; an occasional mild laxative was given him ; but whisky, and 

 quinine, and soup were constantly given. I considered him doing well, and 

 slowly convalescing ; no pneumonic symptoms, but a very slight cough appeared : 

 a cold, rainy change of weather came on ; on that night he had a chill, and died 

 in a few hours." 



Frequently have T known cases convalescent, able to Avalk about, free from all 

 symptoms but debility, yield suddenly to a cold change of weather, and die in a 

 few hours — or linger several days with pneumonic symptoms. If a case has 

 been much enfeebled by a first attack, a second is very likely to prove fatal. A 

 cold and windy change often aggravates symptoms which were mild and favora- 

 ble. On one occasion I left live cases doing well, with no serious symptoms ; a 

 very cold, drizzling rain set in toward evening; on my visit next morning I 

 found three of theiTi with bad symptoms : one died on that day, seemingly of de- 

 bility ; the others were kept up by strong stimulants and large doses of quinine. 

 One of them continued very feeble for several weeks ; a large abscess formed on 

 the leg, which was opened ; it discharged very copiously, and exhausted her 

 so much that she died next day, in spite of tonics and stimulants. 



The following is a fair specimen of the severe form of the disease at its com- 

 mencement, and is a good illustration of my view of the treatment required. I 

 would here premise that I have known venesection practiced frequently in the 

 cold stage, and I have never seen a case recover, and rarely even if used after 

 reaction. I have heard physicians say, if they could get to the cases early, and 

 bleed, the patients were generally safe. Those cases winch hear hleeding ivou/d 

 get better without it. On one plantation, a few years ago, the first five cases 

 which occurred of this disease, commencing with pain in the head and chest, 

 were bled by the overseer, who undertook their treatment : every case termin- 

 ated fatally. He became satisfied that some other treatment was necessary. I 

 was sent for, and introduced the treatment by stimulants, opiates and revulsives, 

 and twenty-three cases which occurred all recovered. In this disease, if the pa- 

 tients are immediately attended to, it is found quite manageable, as much so as 

 an ordinary catarrh ; but beware how depletion is practiced ; if the symptoms 

 are neglected for twelve or twenty-four hours, and are at all aggravated, they are 

 very apt to die. 



'' Suntlaif, February I3lh, ]S-i2, Bess complained last night of headache j 

 did not sleep well ; early this morning was seen by the nurse ; was drowsy ; com- 

 plained of pain over the eyes ; pulse was small and skin cold ; whisky and in- 

 fusion of capsicum had been given, and sinapisms applied to the extremities. I 

 found her at 10 A. M. with skin cooler than natural, though not cold ; is now 

 sensible, but very giddy upon any attempt to raise her head ; complains of se- 

 vere pain over the eyes ; pulse is small and irritable, 100 by the watch ; feels 

 very weak ; tongue is red, looks like raw beef, very dry ; breathing rather slow ; 

 no cough nor pain in the chest. I directed 2 grs. camphor, 2 grs. calomel, and 

 5 grs. Dover's powder every two hours, until three doses were given, and the 

 whisky toddy to be given in small portions every hour, unless the skin became 

 hot; and after three powders, if the skin was not so, to continue them every 

 third hour until next day, with warm serpentaria infusion after each dose."' " On 

 Monday I saw her, and found her free from headache ; had slept well ; skin 

 was in good condition, soft and natural ; pulse 80. She took six powders : after 

 the third she perspired freely, and the headache went off; her tongue was now 

 moist aod with a whitish fur ; paler at the edges ; feels much better, but is 

 weak. I dirpctcd serpentaria and Epsom salts to be given this morning, and a 

 full opiate at night. On the next day she was convalescent." 



Such cases as this are very common, and, where the nervous power is soon 

 roused, and its tone restored by opium, camphor, &:c. and diffusible stimulants 

 excite the circulation and restore free capillary action, no pneumonic symptoms 

 (259) 



