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on the contrary, only evils to the organism. In my pupilage and the earlier years of my practice, I was contemporary with many practitioners of a former generation, who pushed mercurialization, in inflammatory fevers, to an absurd extent, and attributed the salvation of their surviving patients to the excessive ptyalism they had purposely inflicted; a claim as absurd in theory as it was injurious in practice.
While in plethoric patients and fevers of a high grade the anti-plastic effect of mercury is of priceless value, it must be borne in mind that anæmia and scorbutic patients, and those habitually badly nourished, do not generally tolerate its use; and if used in their diseases it must be prescribed with great caution and discrimination, and its effects carefully watched.
OF ARTERIAL SEDATIVES We have a numerous list from which to choose. From habit, extending over a period of a quarter of a century, at least, I rarely use any arterial sedative save tincture of aconite root, in half drop doses, repeated as occasion requires, and until its influence is felt. To each drop of the tincture are added two teaspoonfuls of water. Of this one teaspoonful given pro re nata in intervals of from fifteen minutes to two hours, more uniformly accomplishes better results than I have ever obtained from minute doses of tartarized antimony, nitrate of potassa, the sweet spirits of nitre, the neutral mixture or the effervescing draught. I always carry an ounce vial of it in my pocket, and dispense it at the bedside.
Ice water, or small pellets of ice, in sthenic fevers has always proven, in my hands, a valuable aid to recovery, and very comforting to the patient.
Of the anti-periodics, tonics and appetizers, SULPHATE OF QUININE is of acknowledged pre-eminence. In the treatment of fevers, of all kinds, in which periodicity of exacerbation is a feature, it is invaluable. It has been my privilege to note the triumphal progress of this medicine in the esteem of the profession, from the time when worthy practitioners feared to prescribe it, save in conditions of complete apyrexia, to this day, when its wonderful virtues have won for it high honor in the variety of uses to which it is put in the work of ameliorating human suffering and preserving human lives. But a short time before I entered upon my medical pupilage
DRS. FEARNE AND ERSKINE, Of Huntsville, Ala., had startled the conservatism of the medical world by announcing the success of the practice they had originated of giving heroic doses of quinine in the pyrexia, and the cold stage of paroxysmal fevers of malarial origin, as well as in the sweating stage.
DR. HARNEY, Of the U. S. Army, had also published the happy results of his own practice, in Florida, wherein he had given as much as eighteen (!) grains in one dose, with favorable results, in grave malarial fevers. It has been interesting to watch the discussions upon the propriety of the then startling innovation of Drs. Fearne and Erskine, and now, after the lapse of more than the third of a century, to recall to mind the many happy consequences of their bold use of this valuable medicine. It is foreign to the present purpose to enter into a discussion of the modus operandi of sulphate of quinine, and other constituents of the Jesuit's bark, or to point out the variety of indications, in the treatment of disease, they may be used to meet. Suffice it to say, that but for the bold and original practice of Drs. Fearne and Erskine much of the malarial regions of the Mississippi Valley would have been tenantless, where now there are broad plantations, beautiful farms, thriving villages and cities, and intelligent and refined populations. He that would excel in the treatment of fevers of every type, must study the powers of quinine, as an anti-periodic, and measure his doses thereof with wisdom and discretion. For whenever disease, of whatever kind or name, betrays a periodicity of nervous phenomena, quinine, timely used, is ever potent to palliate (if not to cure), by its anti-periodic influence.
The wise practitioner will ever be careful to avoid routinism, in using it, but in all cases have a due regard to the etiology, and pathology of each case of disease he may treat, and prescribe the quantity and the time of administration of the medicine in reference to the end he aims to reach by its aid.
In almost every case of fever, experience vindicates the time-honored practice of using demulcents, cold mucilage, of slippery elm, of Gum Arabic, of flax seed, or of the prickley pear leaf pared and sliced, proves more gratifying to a thirsty, feverish stomach than simple water, and affords a small amount of nutriment. Like lime water and sweet milk, it tends to relieve the collapsed walls of an empty stomach from annoying and nauseating friction against themselves. . Among the most valuable soothers of irritation of the muocus membranes of the alimentary canal, is
SUBNITRATE OF BISMUTH. The modus operandi of this medicine in abnormities of the mucous membrane of the alimentary canal, is doubtful; so much so, that many able medical men question its utility. But clinical experience vindicates its now common use, and as I think, upon plausible theoretical grounds.
Though it may not be absorbed into the circulation (and it is probable that it is not,) it no doubt soothes the irritated membranes in several ways. It furnishes a mechanical coating, thus soothing irritability of the mucous membrane, as it or starch, or lycopodium, or oxide, or carbonate of zinc and powdered clay are known to do, when applied to the irritated and abraded skin. As clay and chalk, it is antacid and absorbent. It acts chemically upon sulphuretted hydrogen, and thereby diminishes the volume of gas pent up in the bowels. This chemical action is shown in the blackening of the fecal matter discharged, when the medicine has been administered in sufficient quantity to make a show of this discoloration. Subnitrate of bismuth may be freely used in almost every case of fever, to soothe the irritability of the mucous membranes of the alimentary canal.
In former times, reputable practitioners used to report good results from heaping teaspoonsful doses of calomel, when excessive ptyalism did not occur. Since the introduction of subnitrate of bismuth, those large doses of calomel have been rarely advocated. Doubtless, in many of the cases, whenever enormous doses of calomel were administered without more evil resulting than was reported, much of the medicine failed to impress the organism more than any un-irritating heavy powder would do; and after answering, like bismuth, the purpose of a coating for the inflamed membranes, passes out of the body with the excrementitious matter, in which it became entangled. Of all the simple purgatives, experience gives preference to
CASTOR OIL, in every case of fever, wherein there is an indication simply to clear the alinientary canal of its contents. Though to many persons the most offensive, it is the mildest and most manageable of all purgatives, especially when the patient is confined to his bed. No safe substitute for it has ever yet been discovered. If it fails to purge, it is a food, and rarely irritates. Of diaphoretics and sudorifics in fevers, experience gives preference to
DOVER'S POWDERS. Prescribed with judgment and discrimination, it will more rarely disappoint the practitioner than any of the diaphorectics and soporifics of the pharmacopoeia.
Diuretics are not as often urgently needed in fever, as is the popular demand for them in private practice. Unless the urinary track is the seat of serious abnormity, medication addressed to it is not often needed; and in ordinary fevers, flax seed and watermelon seed tea (cold) may (innocent of evil) be allowed. Strangury generally promptly yields, if in addition to one or the other of the above mentioned teas, half a teaspoonful of Hoffman's Anodyne be administered every half hour. This old remedy has stood the test of time and experience as the most prompt soother of irritation of the neck of the bladder in fevers, as well as in those frequent cases of irritation of the neck of the bladder in pregnant females, and those laboring under diplacement, distortion and engorgements of the uterus. Much of this medicine upon the market does not contain the officinal amount of etherial oil. But if the requirements of the pharmacopoeia are rigidly heeded in its preparations, its prescriptions for the purpose mentioned, will rarely disappoint.
The fashion of the former generation of allowing fever patients to
SWEET SPIRITS OF NITRE almost ad libitum, experience taught me to condemn many years ago. It is not as cooling as was claimed for it, and after several doses are taken, it seems to increase rather than diminish thirst.
OF COUNTER-IRRITANTS, no attempt will here be made to exhaust the subject. Against the former habit of torturing young children and adult patients of a highly impressible nervous temperament with blisters, the sentiment of the body of the profession of the present day has long since entered its protest. The choice of the time and emergency, when blistering should be resorted to in fevers, involves a grave responsibility, too often thoughtlessly disregarded. The consideration to be had in concluding when and what indication in diseases call for blistering, are numerous and comprehensive.
In as much as a large blister often stimulates the organism generally, the proper time to prescribe one should be carefully chosen. When the skin is dry and hot, and the pulse full and strong, it is always of doubtful propriety. In grave cases of inflammation of the mucous membranes, in peritonitis or pleuritis, which have prolonged a fever, the most opportune moment at which to apply a blister, is when the skin begins to feel soft and moist, and the force of the circulation is moderating
Adjuvant to other diaphoretics and antispasmodics, a hot foot-bath at bed time, or oftener, is frequently indicated, the brain, if need be, being guarded from injury by the application of cold water to the head.
In a large number of cases of fevers, idiopathic and symptomatic, there is somewhere, of greater or less extent,
DESQUAMATION OF EPITHELIUM, a fact which, though recognized in the treatment of the sequela of the exanthemata, is often not thought of, or (if thought of) is disregarded in the management of continued and paroxysmal fevers. No doubt many a fever patient has succumbed, unnecessarily, because of this oversight. In consequence of this unheeded and unrepaired desquamation ulcerations vitiated and irritating secretions, and abnormal exudates often occur. If throughout, the whole alimentary track, and the air, urinary and genital passages, it were possible to make local application as successfully and intelligently as is done to the schneiderian membrane, the lining of the throat, larynx, vagina and uterus, our success in the treatment of the concomitants and sequela of fevers would prove much more successful than it now is.
In certain states of the inflammatory process in the conjunctiva, the urethra, the vagina and uterus, a flow of greenish secretions and abnormal exudates is often observed. But this greenish tint of the evacuation of the stomach and bowels is, by many practitioners, uniformly attributed to the presence of an abnormal quantity of bile, without a suspicion being entertained that some part of the mucous membrane of the alimentary canal is suffering from the inflammatory process, and that the green or greenish tint may be due to the acidification of the vitiated mucous and abnormal exudates, from the inflamed membranes. Thus the liver receives a large share of attention, and abnormities of the mucous membrane are not recognized as frequently as they ought to be, in the treatment of fevers.
The indications for the local treatment of inflammations and lesions of the mucous membranes, (among which latter desquamation of the epithelium is generally the first to occur,) are to secure rest to the part involved, by the timely removal of irritating ingesta, and other foreign bodies and irritating secretions and exudates, and to protect the diseased surfaces from their continuous contact. The scope of this paper forbids the attempt to enumerate all of the means that may be resorted to to meet these indications.