FEVERS. 641 



I can by no means concur with certain authors, who main- 

 tain that, in Synochus, as soon as the primse viae have been 

 cleared by an emetic and purgative medicine, we may immedi- 

 ately employ the bark, and trust the cure of the disease entirely 

 to it. I have frequently observed the mischievous consequences 

 of such a practice, from its aggravating the inflammatory state 

 of the system, and determining to local and fatal inflammations 

 of the brain and lungs. M.M. 



CCXVI. With respect to the use of the bark, it is proper 

 to add, that good effects are to be expected from it, almost only 

 when given in substance and in large quantity. 



" To be more precise, no less than 5ss. of bark has any sens- 

 ible effect in any disease, but particularly in the case of fevers ; 

 the smallest quantity that I have found to cure an intermittent 

 is at least 3vj. during an interval ; but it is much more effec- 

 tual if we go the length of i. or more ; very often iss. or Jij. 

 only are to be depended upon ; and when by the negligence of 

 physicians in giving it, or the aversion of patients to take it, we 

 fail, we attribute to the mischievous effects of the bark what was 

 merely owing to the not giving it in sufficient quantity. For this 

 practice I may refer you to Dr. De Haen ; it is one of his corol- 

 laries that the bark only operates in large quantities ; and I would 

 observe, that it may be given in many cases in very large doses. I 

 have known frequently ss. given at one dose without any incon- 

 venience felt in the stomach; I shall allow, however, that this is 

 rare, that most stomachs will refuse such a quantity, few will 

 bear 3ij. at, once, but most stomachs will bear 3i- at a dose. 

 With regard to this circumstance, of the quantity necessary to 

 be given, I must observe, that by the accounts we have of the 

 first practice when it first appeared, much smaller doses answered 

 the purpose than we now find to be necessary. They often 

 cured intermittents with the quantity of 3\j- r I GSS '> this is 

 taken notice of by De Haen, but to what it is precisely owing 

 he does not pretend to determine. I imagine it is owing to the 

 different condition of the bark, for I can observe in different 

 parcels of bark a difference in the quality, which very much de- 

 pends upon the fineness of the grain ; this is farther confirmed 

 by the taste ; for when there is a stypticity along with the bitter, 

 even approaching somewhat to the aromatic, one drachm will 



