FEVERS. 669 



applications. The other remedy that is at the same time of the 

 most efficacy in relaxing the spasm, is the use of warm-bathing 

 or fomentations, as I have mentioned formerly. At the same 

 time, in view of the great debility, we are to attempt the use of 

 wine, or volatile alkali, under all the cautions and restrictions I 

 formerly mentioned. And I would add one other remedy : what- 

 ever doubt there may be with respect to the use of cold drink 

 in the beginning of the disease, it is undoubtedly one of the 

 most useful remedies at this period. 



" Such is our practice in what I may call the second stage 

 of fevers, which very commonly begins in the second, but more 

 certainly in the third week of the disease. As the disease ad- 

 vances, however, it is commonly with more symptoms of debil- 

 ity, and an affection of the nervous system ; and, therefore, 

 some other remedies are to be thought of adapted to the variety 

 of circumstances. Accordingly, 



" 5. I would here mention the case where petechiae appear, 

 or other symptoms of putrefaction are evident ; then, without 

 all doubt, our resource is immediately in the bark ; and it may 

 be made a question whether or not it may be used more early in 

 the disease. This is suggested by the practice of Dr. James, 

 who, when by means of his powder, he has at any period of the 

 disease obtained a considerable remission of the fever, then im- 

 mediately employs the Peruvian bark ; and I am very ready to 

 believe, that in such remissions it is a proper and effectual prac- 

 tice, and perhaps it is the surest means of cutting short the dura- 

 tion of fevers, if they admit of it at all. But I have not had any 

 proper experience of it ; for though I have frequently observed 

 some degree of remission both by the use of Jameses powder 

 and the emetic tartar, I have not had sufficient courage for the 

 use of the bark. 



" Another question is this, when in the advanced state, to- 

 wards the end of the second or the beginning of the third week, 

 there are considerable symptoms of debility, but without any di- 

 rect symptom of putrefaction, whether, in this case, the bark 

 is to be employed ? We have not often practised it, but I be- 

 lieve it ought to be ; and the further the disease is advanced be- 

 fore we come to this question, the more certainly I would de- 

 termine it positively. Of this indeed I have had some more 



