Anetus. Intermit GEN. II. in India, and indeed, all over the East, but especially among the Tamul practitioners, as a most powerful altetent fever. rant, as we shall have occasion to notice more at large Ague. when treating of syphilis and elephantiasis. It was proMedical treatment, bably introduced into European practice by the medical students under the brilliant caliphate at Bagdad: and seems to have been first appropriated to the cure of intermittents by the Jewish physicians of Poland *. In Sir George Baker's time, we have seen already that it was in extensive use, but productive of such very different results, that, however successful it might prove occasionally, this distinguished pathologist thought it a worse evil than any ague whatever. At that period, however, it does not appear to have been tried in its most commodious forms, which are those of an arsenite or arseniate of potash. M. Macquer recommends the latter; Dr. Fowler, many years ago introduced and gave abundant proof of the utility and general commodiousness of the former; and under this modification it has at length found its way into the Pharmacopoeia of the London Liquor arse- College, under the name of liquor arsenicalis. Sir Gilbert Blane tells us that it was used with great success in our unfortunate expedition to Walcheren, where the stomach could not retain the bark: but was combined with opium, and in most cases with bitters and aromaticst. nicalis. Often decidedly useful though not to all. The cases of success from the use of this medicine are so numerous, and its employment is now become so general, as to render it unnecessary to advert to particular authorities in proof of its febrifugal power. With many constitutions there can be no question that it disagrees very considerably; and there are numerous instances of its failure: but it is a medicine of real and inappreciable value in many diseases, and in none more than in intermitting fevers. Dr. Fowler advises it to be taken in doses of from two to twelve drops, according to the age and strength of the patient, once, twice, or oftener, in the Gilibert, Adversar. Pract. Prim.-Slevogt, Pr. de permissione Prohib. et prohibitione Permiss. Jen. 1700. † Select Dissertations, &c. p. 105. Lond. 8vo. 1822. Intermit Medical ously united course of the day: and the directions are so broad, and GEN. II. at the same time so much within limit, that no actual Anetus. harm can occur from following them literally. It will, tent fever. however, often be found advantageous to combine a few Ague. drops of tincture of opium with each dose, to guard treatment. against the vomiting and griping which it is sometimes Advantageapt to excite; and the bowels should be kept open by with opium. warm aperients during its use. Under the French Directory a similar preparation of arsenic formed a part of the political constitution of the day; for an edict was formally published, commanding that the surgeons of the army of Italy should, within the course of two or three days, cure the vast number of soldiers suffering from agues caught in the marshes of Lombardy, by the use of this medicine, under pain of military punishment. power of works. It is a singular fact, and ought not to be passed by Remedial without notice, that since the establishment of the large neighbourcopper-works which are now carrying on in Cornwall, ing copperthe intermitting fevers which were almost constantly present in the neighbouring marshes, are now rarely to be met with in any shape. It should hence seem that the Explained. atmosphere is armed with a specific by becoming impregnated with metallic oxydes or carbonates: and that Cornwall should be the spot recommended for change of air in many cases of chronic or other obstinate intermittents. The result of this general survey is, that the cinchona offers by far the best remedy for intermittents of every kind; that arsenic is its best substitute; and that where these fail, as fail they will occasionally, or particular circumstances should prohibit their use, we must throw ourselves upon such other medicines as unite intrinsically, or by combination, a bitter and an astringent principle with a certain proportion of aroma or stimulant warmth. It is at the same time clear that a bitter and astringent principle are not the only, nor even the most effectual qualities for the cure of an intermittent; for the arsenical preparations contain neither of these in any prominent degree; while, as already observed, there are many me Result of ing inquiry. the forego GEN. II. Anetus. Intermit tent fever. Ague. Medical treatment. The most active febrifuges possess some property not yet ascer tained. Ordinary administra tion of the bark. dicines that possess them in far greater abundance than the bark, which have no claim to be put in competition with it as a febrifuge. In effect, of the three species of cinchona used officinally in the present day, the lanceleaved, pale or quilled bark (c. lancifolia), heart-leaved. or yellow bark (c. cordifolia), and oblong-leaved or red bark (c. oblongifolia), the yellow, which, as we learn from Mutis and Zea, is the genuine febrifuge of Spanish America, and whose superiority to the rest has been abundantly proved in this country as well as on the continent of Europe, is very considerably less bitter and astringent than the red, and not more so than the pale bark: it has less resin than the first, and less gum than the second. Dr. Cullen preferred the red, but Zea's communications upon the subject were not then published; and he was not in possession of the experiments by which the statement of the latter has been confirmed. Sir George Baker, as already noticed, found the red bark produce so much oppression and nausea that he was obliged to discontinue its use. It affords however the largest portion of quinine. In administering the bark, little needs to be added to the rules laid down by Sydenham, and copied in a preceding page. Dr. Home has sufficiently shown, not only that the best time for commencing the medicine is soon after the paroxysm, but that it should be discontinued some time before a recurrence of the cold fit, since, if persevered in till its accession, this fit is almost uniformly rendered more violent t. If in the proportion of half a drachm or two scruples to a dose, as recommended by Dr. Sydenham, or such other quantity as may sit without uneasiness on the stomach, it should not succeed, it should be tried in combination with some aromatic, or omitted altogether; and ́ by no means be increased to the enormous quantities some practitioners have ventured upon, who seem to have conceived that they could force the system to yield to its powers by the overbearing arms of weight and • Annal. de Hist. Nat. Tom. 11. Madrid, 1800. GEN. II. SPEC. II. Anetus. measure. It is singular that Borsieri should have so far lost sight of moderation, as to have prescribed occasionally from four to six drachms of the powder in a Intermitsingle draught. In the extremity of the yellow fever such tent fever. doses have, indeed, been given, and perhaps with advan- treatment. tage, but opium and old port, in large abundance, have been given at the same time. Medical should be It will also be judicious to abstain from the use of bark Where it in every instance in which any of the abdominal viscera abstained appear to be labouring under parabysmic enlargements, from. whether antecedently to its employment or during its use; and, in these cases, to alternate small doses of calomel, with whatever tonic may be found to agree best with the system. the Cam Among the endemic intermittents of the present day Malaria of that are more particularly worthy of notice, are those pagna. which appear in the neighbourhood of Rome, and especially about the Pontine marshes, which have often been drained to carry off the decomposing animal and vegetable materials that spread their aria cattiva, as it is called, over the whole of the Campagna. The disease hence produced is named, from its source, malaria. It is also found in like situations, and has the same name, about Syracuse, and other parts of Sicily. M. Rigaud How guardde l'Isle has asserted that the miasmic particles which ed against. infect the air in these places are heavier than the air in its loftier and lighter strata, and may be separated from it. He tells us that he has found an elevation of 200 yards, at the Pontine marshes themselves, a complete security from infection; and he proposes for those who reside lower to sift the air which they breathe, by wearing a fine silk gauze over the mouth and nostrils". M. Brocchi has successfully employed the same remedy, and hence recommends sleeping under a fine mosquito-net in all places where intermittents are endemic†. Mem. de l'Institut. Royal de France, March 24, 1817. VOL. II. L GENUS III. EPANETUS. Remittent Fever. SYMPTOMS STRIKINGLY EXACERBATING AND REMITTING; GEN. III. THIS genus offers the three following species, which will be found sufficiently distinguished from each other by Additional proof that marshmiasm is not the only cause. In the last, the remission is perhaps more perfect than in either of the others; and it serves to show how little foundation there is for referring all remittent as well as all intermittent fevers to the individual cause of marshmiasm for it would be difficult, though, perhaps, not impossible, to find a single example of a genuine hectic Yet still the originating from this source. Marsh-miasm, however, is the most common cause of the second, perhaps of the first species; though we shall presently find it probable that even here, and particularly in the second species, human contagion has also occasionally proved a cause, as it assuredly has in those cases of hectic fever produced by perpetually attending upon or sleeping with a third species. consumptive patient. common cause. Human contagion sometimes a cause: and especially of hectic or the |