222 
PATHOLOGY. 
ing en the one hand, and reftoring the balance of cir¬ 
culation on the other, as detailed in the quotation from 
Dr. Jackfon in our 209th page. If the raving delirium 
and increafed circulation be firft manifeft, our bleeding 
nudt .be ftill more free; and here let us caution our pro- 
feffional brethren againft thofe futile half-meafures which 
fyftematic writers in this country have been accuftomed 
to recommend. We repeat the opinion of the beft-in- 
formed practical writers on Indian maladies, when we 
quote Dr. J. Johnfon’s exprefiion “ Bleed boldly and de- 
cilively'till the head and prtecordia are relieved, or draw 
110 blood whatever.” Indeed it is effedr we muft look to. 
Thepulfe is fo changeable, that it is a bad guide; and, 
as to quantity, this is fo various in different perfons of 
the fame appearance, that the meafurement of ounces is 
ftill mors fallacious. Ninety ounces of blood have been 
drawn during the early ftage of this fever; and not 
until that quantity was extradled did the fymptoms 
abate. This meafure frequently relieves not only 
the head and abdominal congeftion and inflammation, 
but alfo the diftrefling and perpetual vomiting. In pro- 
iecuting it we muft let nothing deter us from our pur- 
pofe. Should mental impreflion caufe faintnefs, the pa- 
rientis to be fupported with a little wine and water; the 
bleeding reftrained ; and, as foon as animation is reftored, 
we muft again open the vein. When the head is vio¬ 
lently affedled, cold lotions are to be applied to it; and, 
if there is general and high excitement, water fhould be 
dallied over the whole body. Againft emetics ftrong tef- 
timony exifts ; and indeed, when the great irritability 
of the ftomach is confidered, we fliould naturally fup- 
pofe fuch remedies muft do harm. The only cafe in 
which an emetic feems at all allowable, is when a full 
meal of folid food has been taken foon after the accef- 
fion of the fever, and the ftomach has not rejedted it. 
Here it appears highly probable that the undigefted ali¬ 
ment mult excite more ferious inflammation than the 
tranuent ftimulus of the emetic. 
Purgatives in a condenfed form, as calomel with rhu¬ 
barb and jalap, may be next exhibited ; and thefe 
Ihould be aflifted in their operation by oleaginous or fa- 
line enemata. When the irritability of the ftomach is 
fo great that we fear the rejection of purgatives, a fcru- 
ple dofe of calomel combined with a grain of opium, is 
laid to reduce the difpolition to vomit in a rapid and afto- 
nilhing manner; after which the purgatives may again be 
perfevered in. When the bowels have been freely eva¬ 
cuated by purges, we muft have recourfe to calomel, a 
remedy which writers on this fever have floridly called 
their “ flieet-anchor.” This medicine, exhibited in large 
dcfes and combined with opium, has been found to be a 
remedy of univerfal application. Many have trufted to 
it alone; but though with thefe practitioners fome pa¬ 
tients were cured, and the lives of others confiderably 
prolonged, yet the rate of mortality which occurred du¬ 
ring the exclufive ufe of mercury fo far exceeded that 
which attended the practice of conjoining its exhibition 
with bleeding, that the latter pradtice is now reforted to 
in all violent cafes. This fadt may be explained on the 
ground that abforption does not readily take place when 
the blood-veffels are full, or on the ground that the ge- 
nerally-increafed momentum of blood keeps up inflam¬ 
mation in the capillary fyftem of the difeafed vifcera, 
notvvithftanaing the favourable adlion of mercury on the 
fecernents. At all events, it is almoft impoflible to im¬ 
pregnate the fyftem with mercury till ample depletion 
lias been ufed. Of the mode of adlion of mercury we 
have before regretted our ignorance, when fpeaking of 
cholera and dyfentery. In the fever in queftion, it feems 
to be chiefly effedtive by eftablifhing general fecretion ; 
and we find that, when this happy occurrence has taken 
place, (which is denoted by ptyafifm coming on,) then, 
and not till then, is the patient in a fair way of recover¬ 
ing. If the ftomach rejedts the calomel, mercurial in- 
undiion may be fubftituted. 
4 
The above-urged meafures ofcourfe require fome mo¬ 
dification. If the head be more exclufively affedled, and 
the liver in a trifling degree only, we need not always 
pufh the mercury to the extent of ptyalifm ; but we 
fliould carry the bleeding to the higheft pitch, and parti¬ 
cularly attend to the cold affulion. When the difeafe 
aftumes the mild remittent or intermittent form, the pa- 
roxyfm may becondudied by the fame means as before 
mentioned. During the intermiflion, calomel may be 
conjoined with bark, and the latter injedled per ano; 
but, ever keeping in mind to reftore the adlion of thofe 
parts which are deficient, and diminifh thofe motions 
which are exceflive, we fliould endeavour by blifters, by 
baths, and by local bleeding, to relieve topical inflam¬ 
mation, and reftore the balance of power of wdiich all the 
phenomena of this fever indicate a fevere derangement. 
It is fcarcely neceflary to add, that it is of importance to 
avoid the exciting caufes of the complaint, fince thefe 
invariably aggravate it. Thus the removal of loldiers 
into barracks at a diftance from peftilential effluvia, of 
tailors from on-board of foul or crowded veflels, &c. 
fliould, when pradlicable, be ftrongly urged. It is to be 
remarked, that fome have fuppofed the yellow fever fo 
be a difeafe which cannot occur twice in the fame indi¬ 
vidual ; but this is contradidled by the bell authorities. 
We muft now return to our nofological arrangement, 
which, for the obvious reafon that it entirely difagrees 
with the opinions we have adopted as to the identity of 
feveral fevers diftindtly named, we have thus far aban¬ 
doned. Dr. Good gives in the prefent order of Pyrexia; 
four genera. 
Genus I. Ephemera, [from the Gr. '^utpa, a day.] 
Ephemeral, diary, or Ample, fever. Generic charadters 
—Attack fudden ; paroxyfm fingle, and terminating in 
about twenty-four hours. There are three fpecies. 
1. Ephemera niitis, or mild ephemera : without prece¬ 
ding rigor; heat and number of the pulfe increafed 
flightly; laffitude and debility inconfiderable ; pains ob- 
tufe, chiefly about the head ; perfpiration and breathing 
pleafant. This fpecies is ufually produced by excefs of 
corporeal exertion, ftudy, or violent paffion ; by fup- 
prelfed perfpiration ; fudden heat or cold. 
2. Ephemera acuta, or acute ephemera : fevere rigor; 
great heat ; pulfe at firft fniall and contradled, after¬ 
wards quick and ftrong ; perfpiration copious ; great 
languor. It is frequently produced by a furfeit of eat¬ 
ing or drinking; or fome temporary organic obftruc- 
tion. Thefe two fpecies of Ephemera generally go off 
fpontaneoufly; or, at nidi, by the help of reft and ab- 
ftinence. 
3. Ephemera fudatoria, the fweating ficknefs: tenfe 
pains in the neck and extremities ; palpitation ; dyfpncea, 
pulfe rapid and irregular; heat intenfe ; intolerable thirft ; 
drowfinefs or delirium ; exceflive fweat. 
The hiftory of the rife and progrefs of this Angular 
and formidable difeafe conftitutes one of the moft cu¬ 
rious articles in the annals of medicine. Its origin is 
involved in a good deal of obfeurity; and much vague 
and inconclufive reafoning, concerning the mode in 
which it was propagated, is to be met with even among 
the moft authentic authors who deferibe its ravages. 
It feems, however, to be generally admitted, that it firft 
appeared in the army of the earl of Richmond, after¬ 
wards king Henry VII. upon his landing at Milford 
Haven, in 1485 ; and that it foon fpread to London, 
where it raged from the beginning of Auguft to the end 
of Odtober. Whether the troops, which were foreign 
foldiers, levied by the earl of Richmond, brought the 
difeafe with them from the continent, or whether the 
contagion was generated in the crowded tranfport-yef- 
fels on-board of which they were embarked, it is irn- 
pofflble, amidft the deficiency of evidence, to determine. 
It may readily be fuppofed, however, that a highly ma¬ 
lignant and contagious difeafe might have been generated 
under 
