GEN. IV. SPEC. II. E. Typhus gravior. Putrid fever. Treatment. have a small bucket of water, containing about two gallons, poured briskly on his head, and repeated four or five times in the course of the twenty-four hours, when the surface of the body is hot and without perspiration. In many cases this plan alone has proved successful, and the fever has been cut short in a day or two from its commencement. But the method is too violent and exhausting to be employed after the first three or four days Regulations of attack; after which it will generally be most useful to restrain ourselves to epithems about or all over the head, the hair being removed for this purpose, or to sponge the body generally: and if the sensorial debility be extreme, we should prefer tepid to cold water, or mix with the cold water a little brandy or other spirit. When this method succeeds, the usual salutary effects are, a considerable diminution in the number of the pulse; diminution of heat and head-ache; natural sleep, and a breathing perspiration. in the use of it. On what principle the prac ficial. Whether the water operates as a tonic? It does not appear to me that the principle has yet been fully explained by which the external application tice is bene- of cold water becomes thus unequivocally beneficial. This is generally referred to its tonic power in exciting a reaction as the result of its chill. But though affusion often produces not only a chill, but even horripilation, sponging the body with tepid or even with cold water produces no chill of any kind; and there are many cases of extreme debility in which, if a chill were to take place it would be most mischievous, and certainly would not be succeeded by any heat or reaction whatever. Independently of which, the refreshment takes place too speedily for such an effect, and is of a different and more tranquillizing kind than the excitement which follows upon the chill of cold bathing in a state of health. And I cannot, therefore, but think it probable that much of the good effects of the external application of cold water in typhus and other complaints depends upon a decomposition of the water; though whether by an absorption of caloric or of oxygene, alone or in conjunction with any other principle hereby set free, is by no means easy to Whether by decomposition? determine. GEN. IV. SPEC. II. 6E. Typhus There is yet much to be learnt upon the cause of that beneficial excitement which the decomposition of water exhibits in various bodies, both organic gravior. Putrid fever. and inorganic, with which it comes in contact. We see plants instantly revived, the fire in the blacksmith's forge Illustrated instantly quickened, and not only tile-eels and other ani- analogically. malcules, but even snails, apparently dead, and that have been kept as dried preparations from five to fifteen years, start instantly into new life upon the application of cold water. Yet no chemist or physiologist has hitherto satisfactorily explained by what means these effects are produced. And I throw out the hint, that so instructing a subject may be followed up by those who have time and ingenuity for experiments in relation to it. Upon internal medicines we can place but little de- How far inpendence, except where they have pretensions to a tonic ternal repower, are moderately cardiac, or tend to equalise the use. sensorial or circulating fluid. medies haavian feeble: and have yielded to cinchona : now itself slighted by many; The chief tonics in use among the Boerhaavians were Tonics of the serpentaria and contrayerva, on account of their the Boersystematic objection to the bark. The tonic power of school these, however, is but feeble; by their stimulant property, they sometimes prove diaphoretic: but even as cardiacs their place is better supplied by other medicines; and in proportion as the bark has established itself, they have gradually fallen into disrepute. Yet even this last seems to be following the same track in the opinion of some practitioners of the present day, who have withdrawn all confidence in it, and undertake to affirm that it has uniformly done more mischief than good. But this is but without strangely to set aside the wisdom of former times, and to misconstrue the train of phænomena before them. Bark, like every other medicine, is necessarily injurious when injudiciously made use of; but there are few, if any, medicines of more importance, even in typhus, when there is a fit opportunity for employing it. Where the stomach is irritable, and will not retain it, or so feeble in Spalanzani, Hist. Nat. Tom. I. ch. iii. Phil. Trans. 1774, p. 432. sufficient reason. SPEC. II. 6E. Typhus Putrid fever. GEN. IV. its secernent power as not to digest it, and, particularly, where there is a tendency to local accumulations, it ought unquestionably to be avoided, till these symptoms are subdued by other means. But where there are no such objections it cannot be begun too soon, though it should not be pressed in such large doses as in the more rapid course of yellow fever. And where the bark cannot be made to sit easy on the stomach, its place may be well supplied with columba, either in powder or infusion. I need not add that the sulphate of quinine is its best form. Columba. Combined with neutral salts, camphor and wine. Camphor highly prized combina tion. Its bene ficial effects. If the skin be greatly heated and dry, either of these medicines may be combined with nitre or a solution of the acetate of ammonia, the first of which was a favourite compound with Baron Haller and his disciples *: and if the prostration of strength be considerable, we may employ camphor or wine in conjunction with tonics. Camphor has, indeed, been united with medicines of very different powers; as with large doses of nitre which alone, or in Haenel seems to have found highly serviceable +; or nitre and calomel, which was at one time a favourite practice in Germany; or, which is far better, with cinchona, a combination peculiarly recommended by Lasonne as increasing the energy of each, in which opinion he is joined by Dr. Cullen. Camphor, however, is in itself a highly valuable medicine on the present occasion, and cannot well be given too soon. It calms the low delirium, produces a genial glow on the surface, and seems to act as a steady, permanent cordial. It was chiefly trusted to by Professor Hildenbrand during the late war, though he often united it with arnica; and, believing that no practice whatever could shorten the natural course of the disease, endeavoured to sustain the system by these remedies almost exclusively. Rarely given in sufficient doses. In our own country, however, it is rarely employed in doses sufficiently large to be of service, as I have already Haenel, Epist. ad Haller. † Epist. ad Haller. 11. Abhandlung von der Wirkungen des Camphors und Calomels in anbaltenden Fiebern. had occasion to observe. Gieske was accustomed to begin with half a drachm, and increase the dose to a drachm, three or four times a-day or oftener *. It was given with equal freedom by Stoll †, Salle ‡, and Chambon de Montaux §: and Collin after several hundred trials affirms, that he has never in a single instance found the pulse quickened, or the heat of the body increased, by giving it to the amount of half an ounce a-day. It is singular after this that Hildenbrand, notwithstanding his peculiar attachment to camphor, should limit its employment to not more than ten or twelve grains a-day. It has by many practitioners been united with some acid; and the form of an acetum camphoratum was at one time a very favourite, and no doubt effective, medicine in Germany |. GEN. IV. SPEC. II. GE. Typhus gravior. Putrid fever. Treatment, action. Wine: how Acids, indeed, of all kinds, and acidulous drinks, are Acids: their of great benefit in typhus. They allay the heat, tranquillize the restlessness, support the strength, and oppose the tendency to putrescency. The muriatic was preferred by Sir William Fordyce, but the sulphuric appears to be equally efficacious, and is much pleasanter. The best cordial is wine, and it must be given in proportion as the living power flags. We must be cautious, however, in first administering it; for its very stimulus produces exhaustion, and consequently increased torpitude and we should invariably recollect, that when we have once commenced with its use, we can never leave it off; and should hence begin with such doses only as may be safely persevered in, or even increased if ne cessary. best em ployed. formerly. Under the influence of Dr. Brown's name, both wine Spirit of and spirits were lately given in enormous quantities; and wine given it is possible that in a few instances the practice may have been successful: but the risk is great and empirical; yet the practice by no means of so late an origin as Dr. * Abhandlungen, &c. N. Beitrage, 1. 171. + Rat. Med. 11. 89. || Ludwig, Adversaria, 1. i. N. 1. Bonnevault, Hantesierk Recueil, 11. p. 228. GEN. IV. SPEC. II. 3 E. Typhus gravior. Putrid fever. Cured by ebriety. Brown's name would incline us to believe: for Borelli, Chambon de Montaux, and Reidlin gave it quite as largely, and at least with as much success. Borelli prescribed it Treatment in injections; Reidlin assures us that he cured a patient by administering a large dose of spirit of wine †, upon which Brown does not appear to have ventured; and we are told by another writer long before Dr. Brown's time, that he completely succeeded in conquering a typhus by making his patient drink wine to ebriety on a critical Phosphorus. day. Of phosphorus, which was also a famous cordial at one time, I can say nothing §. Opium. Best in union with camphor. Antimoni useful. The same remark will apply to the use of opium, which appears, in many cases, to be of less service in typhus than in many other species of fever, and by no means entitled to the unmeasured eulogy bestowed upon it by Dr. Home, who contended that in every case of typhus it was the most useful medicine we can have recourse to; that it procures rest without any inconvenience; and that it is more to be depended upon than camphor, castor, the sedative salt of Homberg, or any other medicine of the same class ||. It is best given in combination with camphor; and there is ground for the assertion of Lasonne and Halle, that, thus united, it produces less confusion of the head and disturbance in the dreams and, so far as I have seen, it agrees better with the young than with those of middle life. Hildenbrand reserves it in every instance against distress from dysentery or diarrhoea. Antimonials are a doubtful remedy: they tend to throw als not often the action towards the surface; but, as relaxants, they tend at the same time to diminish the tone of the muscular fibre. It is not often that they can be employed with advantage. Blisters, judiciously interposed, will be found, in many instances, a useful auxiliary, and espe Blisters. Cent. I. Obs. 55. + Lin. Med. 1695. P. 220. Eph. Nat. Cur. Dec. 1. Ann. III. Obs. 145. § Vater, Diss. Phosphori loco medicamenti adsumpti virtus medica. Witteb. 1751.-Thomas, Diss. de usû Phosphori. Regiom. 1762. Clinical Experiments, Histories and Dissections. 8vo. Edinb. 1780. |