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Gex. II. in India, and indeed, all over the East, but especially
among the Tamul practitioners, as a most powerful alteIntermittent fever. rant, as we shall have occasion to notice more at large Ague.
when treating of syphilis and elephantiasis. It was protreatment. - 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 Pharmacopæia of the London Liquor arse- College, under the name of liquor arsenicalis. Sir Gilnicalis.
bert 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. Often de- The cases of success from the use of this medicine are cidedly use
so numerous, and its employment is now become so genot to all. neral, 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.
course of the day: and the directions are so broad, and Gen. II. at the same time so much within limit, that no actual
Intermitharm 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 Advantage
ously united apt to excite; and the bowels should be kept open by wit 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. It is a singular fact, and ought not to be passed by Remedial
power of without notice, that since the establishment of the large
of the large neighbourcopper-works which are now carrying on in Cornwall, ing copper
works. the 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 Result of offers by far the best remedy for intermittents of every th
vory the forego
Ying inquiry. 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. 7. 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
Gun. Il. dicines that possess them in far greater abundance than Anétus.
the bark, which have no claim to be put in competition Intermittent fever. with it as a febrifuge. In effect, of the three species of Ague.
cinchona used officinally in the present day, the lancetreatment. leaved, pale or quilled bark (c. lancifolia), heart-leased The most or yellow bark (c. cordifolia), and oblong-leaved or red brifuges bark (c. oblongifolia), the yellow, which, as we learn from possess, Mutis and Zea, is the genuine febrifuge of Spanish perty not
America, and whose superiority to the rest has been yet ascer abundantly proved in this country as well as on the con
tinent 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. Ordinary In administering the bark, little needs to be added to tion of the the rules laid down by Sydenham, and copied in a pre
ceding 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. II. Madrid, 1800.
Spec. II. Anetus.
measure. It is singular that Borsieri should have so Gen. II. 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 fever doses have, indeed, been given, and perhaps with advan- treatment. tage, but opiuin and old port, in large abundance, have been given at the same time. It will also be judicious to abstain from the use of bark Where it
should be in every instance in which any of the abdominal viscera appear to be labouring under parabysmic enlargements, froin. 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.
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 300 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 endemict.
SYMPTOMS STRIKINGLY EXACERBATING AND REMITTING;
BUT WITHOUT INTERMISSION; ONE PAROXYSM EVERY
Gen. UI. This genus offers the three following species, which will
be found sufficiently distinguished from each other by
MALIGNUS. MALIGNANT REMITTENT. 3. — HECTICA. . HECTIC FEVER. Additional In the last, the remission is perhaps more perfect than
in either of the others; and it serves to show how little miasm is foundation there is for referring all remittent as well as not the
all intermittent fevers to the individual cause of marsh• only cause.
miasm : 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 contagion that even here, and particularly in the second species, a cause : human contagion has also occasionally proved a cause, and espe- as it assuredly has in those cases of hectic fever prohectic or the
the duced by perpetually attending upon or sleeping with a third species, consumptive patient. :