REMITTENT. 



dcrn writers bear their tcdimoiiy to the important auxiliary 

 operation of the cold and tepid aftufion ; although they ad- 

 mit that, alone, its effedts arc not fufficiently powerful or 

 permanent to be depended upon. Coolnefs ot the patient is 

 to be promoted by every means ; by the free ule of cold 

 aqueous drinks, by frequent wafliing, by the full adniiniun 

 of fre(h air, and by the ufe of few and light coverings on 

 the bed. 



Thcfe remedies (hould be adtivcly employed, and repeated 

 on the return or non-ceffation of the fymptoms of excite- 

 ment. For as an intelligent phylician has remarked, " the 

 great objeft is the removal of the local afteftion of the brain, 

 or other organ, and the produftion of a complete ramiflion 

 of the febrile fymptoms, in the Icail pofiible time, by which 

 the dangerous fymptoms of the latter ftages arc prevented 

 or greatly mitigated, and a perfeft and rapid recovery in- 

 fured." (See Dr. Burnett's Account of the Bilious Re- 

 mittent Fever in the Mediterranean, p. 22. Lond. 1814. ) 

 This obje6l is rather impeded, than aflifted, by the ad- 

 miniflration of emetics and fudorifics ; and altogether de- 

 feated by the ufe of bark, cordials, or Ilimulants of any 

 kind, whether in the way of food or medicine. With rc- 

 fpeft to emetics, they are objeftionable in all llages of the 

 difeafe ; tor they not only fail in removing naufea, but 

 aftually increafe that diftrefling fymptom : their operation 

 aggravates the afFeftion of the head, of which the naufea 

 appears to be fympathetic ; and as the tendency of the difeafe 

 is to augment irritability of the flomach, which often be- 

 comes extreme and diftrefling in the latter ftages, fo they 

 contribute to aggravate this and other dangerous fymptoms. 

 Sudorifics are alfo to be condemned ; for, in the firft place, 

 they are unneceffary, becaufe a natural perfpiration will 

 readily enfue, as foon as the excefs of heat above the ftandard 

 of health has been removed, which can be accomplifhcd with 

 certainty by the proper application of cold water to the 

 furface of the body ; and, in the next place, the fudorifics 

 which are ufed are apt to increafe the irritabihty of the fto- 

 mach ; and if they fail to excite a diaphorefis, they increafe 

 the heat and the determination to the head, and tend to 

 lengthen the paroxyfm. With regard to the bark and 

 cordials, they are invariably injurious in the firft ftage of 

 the fever. When a diftinft remiftion has taken place, fome 

 writers recommend the immediate adminiftration of cin- 

 chona ; but even thefe admit, that " if it be given when 

 there is a parched /kin, a hard pulfe, a dry tongue, great 

 heat and pain at the ftoraach, or delirium, it will gcHerally 

 be found to increafe and prolong thefe fymptoms." (See 

 Bancroft, loc. cit. p. 76.) On the whole, however, the 

 late experience in the Mediterranean led to the rejeftion of 

 the ufe of bark, while any febrile fymptoms whatever re- 

 mained. " Under its ufe," fays Dr. Burnett, " raartality 

 has been great, relapfe frequent, and (as in the cafes of the 

 Temeraire and Invincible) dyfentery attacked nearly all the 

 patients who had fever in a feverc form ; nor was there an 

 inftancc, as far as I could learn, that, when given during a 

 fuppofed remiflion of the fymptoms, it prevented a return 

 of the paroxyfm. Too often it has been given with wine at 

 the ):ommenccment of this difeafe, when the tongue has foon 

 put on a brown, dry, and furred appearance ; the anxiety, 

 delirium, and irritability of the ilomach, have been much 

 increafed ; the whole train of nervous fymptoms foon be- 

 came formidable, rcfifting every means of alleviation, till 

 dcatli has put a period to the fuffcrings of the patient." 

 Loc. cit. p. 34. 



If any thing were wanting to corroborate the foregoing 

 dedudlions from experience, in favour of the antiphlogiftic 

 a;id cvacuRnl plan of treatment, in the commcnccraent of 



remittent fevers, the detail of the appearances obferved on 

 dilledtion, after the deatli of patients in thefe fevers, would 

 amply fupport them, by the proofs which it aflords of the 

 inflammatory condition of various organs of the body it. 

 tl.efo fatal cafes. In different iuftaiices, inveiligattd by Dr. 

 Burnett and his colleagues in the Mediterranean, the veftch 

 of the brain were generally diftended, and in many cafes com- 

 pletely gorged, with blood ; the membranes of that organ 

 were cosfiderably inflamed, often preftnting what that 

 writer calls " a blood-fhot appearance," and depofitions of 

 coagulable lymph were feen among the convolutions : there 

 were occafionally alfo adhefions, and the ventricles were 

 often diftended with a fluid, fometimes limpid, fometimes 

 yellow. Appearances of high iriflummatirm prefented them- 

 felves in the cavity of the chcft, affecting the lungs, peri- 

 cardium, and diaphragm ; and thefe were connected with 

 depofitions of lymph and effufions of ferum. In the ab- 

 domen, the liver was generiUv found er.larged, and fome- 

 times exhibiting marks of inflammation ; the ftomach dif- 

 tended with air, more or lefs inflamed, and containing a 

 dark coloured matter ; and the inteflines in a fimilar condi- 

 tion, with frequent intus-fufception. 



Thefe appearances, which are in fact the efFeft of the 

 continuance of the febrile aftions in the organs in queftion- 

 fufficiently prove that the firft ftage is the time when active 

 remedies, of an anti-inflammatory power, can be chiefly ex- 

 pefted to produce a very decided removal of the difeafe. 

 When the fever is a httle more advanced, the principal ob- 

 jeft of the praftitior.er is to diminifti the violence of any local 

 aff^eftion that may be fevere. Thus, if head-ache remains, 

 with fiufhed countenance, fuffufion of the eyes, and a firrr. 

 pulfc, a fmall bleeding from the temporal artery (the pulle 

 being at the fame time carefully examined) may be employed 

 with advantage : a hliiler, applied to the head at this time, 

 is alfo manifeftly beneficial ; and daily evacuations of the 

 bowels fliould be procured by gentle laxatives, fuch :is 

 caftor oil, or glyfters, the powerful cathartics being now 

 laid afide. Jrritabihty of the ftomach, which is often dif- 

 trefling at this period, is relieved by the effervefcing 

 draught, and by the application of leeches, or of a large 

 blifter to the pit of the ftomach. A degree of ftupor fome- 

 times fupervenes, which is often removed by a blifter ap- 

 plied to the neck or forehead, or by the application of 

 leeches to the temples. If there is any obvious afl'eclion of 

 the abdominal vifcera, which fhould be carefully inquired 

 into, blifters, and, above all, the warm bath, (hould be re- 

 forted to, as well as copious emollient glyitcrs. 



If, however, from want of the means of relief, or from 

 the violence of the difeafe, it has advanced to that ftage, in 

 which the yellow fuffufion of the flcin appears, and various 

 nervous fymptoms, fubfultus, tremors, &c. come on, with 

 increafed uneafinefs about the ftomach, hiccup, or vomiting 

 of a dark matter, refembling coffee-grounds, with ifchuria, 

 and a finking or intormiffion of the pulfe, little more can be 

 done than to look on, and endeavour to obviate fympton^.s 

 as they occur. " Singultus," to borrow again the words 

 of Dr. Burnett, " is a dangerous, and commonly a moit 

 harafting fymptom at this time ; it %v!ll often be relieved by 

 camphorated julep, to which may be added opium and 

 aether. If the pulfe fink, the ftimuli mulk be increafed ; 

 and under thefe circumftances, I have found the carbonate 

 of ammonia, with aromatic confection, of lingular benent. 

 But while we endeavour to reftore the circulation, cars mujl 

 It talcn not to indues a Jlaie of jecondary cxcittnunt ; and as 

 the pulfe rifes, the ftimuli fhould be decreafcd. Conftant 

 attention muft ftill be paid to the daily evacuation of the 

 bowels ; but at a period, when the excitability of the fyf- 



tem 



