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ysms of intermittent fevers depends upon a recurrence of atony (35 and 36), so probably the bark, by its tonic power, prevents the recurrence of these paroxysms; and this is greatly confirmed by observing, that many other tonic medicines answer the same purpose.
215. If the operation of the bark may be thus explained, from its possessing a tonic power it is easy to perceive why it is improper when a phlogistic diathesis prevails; and, from the same view, we can ascertain in what cases of continued fever it may be admitted. These are either after considerable remissions have appeared, when it may be employed to prevent the return of exacerbations, on the same footing that it is used in intermittent fevers; or in the advanced state of fevers, when all suspicion of an inflammatory state is removed, and a general debility prevails in the system; and its being then employed is sufficiently agreeable to the present practice.
216. With respect to the use of the bark, it is proper to add, that good effects are to be expected from it, almost only when given in substance and in large quantity ;
217. Another set of medicines to be employed for obviating debility and its effects, are the direct stimulants (203). These, in some measure, increase the tone of the moving fibres; but they are different from the tonics, as more directly exciting and increasing the action of the heart and arteries. This mode of their operation renders the use of them ambiguous; and when an inflammatory diathesis is present, as so often happens in the begin. ning of fevers, the effects of these stimulants may
in the advanced state of fevers, when debility prevails, they may be useful.
218. What are the stimulants that may be most properly employed, I am uncertain, as the use of them in this age has been rare; but I am disposed to believe, that, of all kinds, wine is the best.
219. Wine has the advantage of being grateful to the palate and stomach, and of having its stimulant parts so much diluted, that it can be conveniently given in small doses; so that it may be employed with sufficient caution : but it is of little service unless taken pretty largely.
- 220. It may be supposed, and on good grounds, that wine has an operation analogous to that of opium and some other narcotic medicines It may indeed be said, that we can distinctly mark its stimulant power only, which renders its effects in the phrenetic delirium manifestly hurtful, and, in the mild delirium, depending on debility, as remarkably useful. But in all this, the analogy with opium is still obvious; and it is probable, that both wine and opium are more useful by their sedative and antispasmodic, than by their stimu. lant, powers.
221. These are the means of answering our second general indication (126, 2); and I now proceed to the third, which is, to obviate or to correct the tendency of the fluids to putrefaction.
222. This may be done,
1, By avoiding any new application of putrid or putrescent matter;
2, By evacuating the putrid or putrescent matter already present in the body;
3, By correcting the putrid or putrescent matter remaining in the body;
4, By supporting the tone of the vessels, and thereby resisting further putrefaction, or obviating its effects.
223. The further application of putrid or pu. trescent matter may be avoided,
1, By removing the patient from places filled with corrupted air ;
2, By correcting the air from which he cannot be removed;
3, By preventing the accumulation of the pa. tient's own effluvia, by a constant ventilation, and
by a frequent change of bed-clothes and bodylinen; .
4, By the careful and speedy removal of all excremental matters from the patient's chamber.
5, By avoiding animal food, or correcting it.
224. The putrid or putrescent matter, already present in the body, may be evacuated partly by evacuating frequently the contents of the intestines; and more effectually still, by supporting the excretions of perspiration and urine, by the plentiful use of diluents.
225. The putrid or putrescent matter, remain. ing in the body, may be rendered more mild and innocent by the use of diluents; or may be corrected by the use of antiseptics. These last are of many and various kinds; but which of them are conveniently applicable, or more particularly suited to the case of fevers, is not well ascertained. Those most certainly applicable and useful, are acescent aliments, acids of all kinds, neutral salts, and fixed air.
226. The progress of putrefaction may be considerably retarded, and its effects obviated, by supporting the tone of the vessels : and this may be done by tonic remedies; the chief of which are, cold and Peruvian bark, both sufficiently treated of above, (205 et seq.)
227. I have now finished the consideration of the three general indications to be formed in the cure of continued fevers; and have mentioned most of the remedies which have been, upon any occasion, employed in this business. It was necessary, in the first place, to consider these indications and remedies separately, and to explain the operation of the latter more generally : but, from what has been now delivered, compared with what was said above, concerning the difference of fevers, and the signification of their several symptoms in forming the prognostic, I expect it will not be difficult to assign the indication, and to select and combine the several remedies mentioned, so as to adapt them to the several species and circumstances of continued fevers.
I think it may be useful for my readers to have the whole of the cure of CONTINUED FEVERS brought under one view, as in the following table.
In the cure of CONTINUED FEVERS, the indica. tions are,
I. To moderate the violence of reaction. Which may be done, by 1, Diminishing the action of the heart and arteries, by A, Avoiding or noderating those irritations which
are almost constantly applied to the body; as,