FEVERS. 673 



the most celebrated, and perhaps the most certainly effectual, is 

 the Peruvian bark, the tonic power of which we have endeavour- 

 ed to demonstrate above (CCXIV.), and have at the same time 

 explained its use in continued fevers. 



The same observation as made in CCXVI. is especially pro- 

 per in the case of intermittents : and, further, with respect to 

 these, the following observations or rules are offered here. 



1. That the bark may be employed with safety at any period 

 of intermittent fevers, providing that, at the same time, there 

 be neither a phlogistic diathesis prevailing in the system, nor 

 any considerable or fixed congestion present in the abdominal 

 viscera. 



2. The proper time for exhibiting the bark in intermittent 

 fevers, is during the time of intermission ; and where inter- 

 missions are to be expected, it is to be abstained from in the 

 time of paroxysms. 



3. In remittents, though no entire apyrexia occurs, the bark 

 may be given during the remissions ; and it should be given, 

 even though the remissions be inconsiderable, if, from the known 

 nature of the epidemic, intermissions or considerable remissions 

 are not to be so soon expected, and that great danger appre- 

 hended from repeated exacerbations. 



3. In the case of genuine intermittents, while a due quantity 

 of bark is to be employed, the exhibition of it ought to be 

 brought as near to the time of accession as the condition of the 

 patient's stomach will allow. 



5. In general, in all cases of intermittents it is not sufficient 

 that the recurrence of paroxysms be stopped for once by the 

 use of the bark ; a relapse is commonly to be expected, and 

 should be prevented by the exhibition of the bark, repeated at 

 proper intervals. 



" In case the bark is wanting, which happens in several parts 

 of the world, to the great prejudice of physicans ; or if it is 

 not of good enough quality, I think is to be wished that we 

 could find a substitute for it ; and I think from a great number 

 of experiments which are very certain, that bitters will very 

 often answer the purpose. Before the bark was introduced, in- 

 termittents were often cured by such bitters, and particularly by 

 Chamomile flowers, which were the remedy of Riverius; and Dr. 

 Pitcairn alleged that they were equally efficacious with the bark. 



VOL. i. SB 



