Colonial North America: Countway Library of Medicine

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parts of the body, we cannot in any other way accout for its sudden operation in the cure of intermittants it has been advanced and with some degree of probability, that it cures fever by exciting a new action in the stomach system. I proceed to speak now particularly of its use in fevers, hence a question has generally arisen, at what time or period of the disease will it be proper to administer the bark. Dr Booerhave's maxim was not to administer it untill the disease had lasted some time, Cum morbis jam aliqua tempora duravit, but this rule is not always correct for it is sometimes disagreeable to employ it at the commencement of fevers. I have known some cases prove fatal the second paroxysm which might perhaps been prevented by the use of the bark, this absurd delay originated among the Egyptians who supposed a certain fermentation must take place before any remidy could be given, and it was a law among them never to give medicine untill the third day after the attack. Dr Sydenhams opinion that a morbid matter must be evacuated has never been prooved and is by no means probable. In tertians it should be given after the first paroxysm. Dr Lind found it of great use when administered in a fever. In the year 1765

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he says a tertian was prevented after the second paroxysm, and it was neither followed by Jaundice or Dropsy, but if it was permitted to run longer, one or the other of those diseases were sure to ensue, and in proportion to the number of fits was the violence of the disease, but I believe when the fever will permit the barks to be given in the first instance, neither of the above diseases will follow. This last question involves us in another of almost equal importance — Whether the bark may be administered without any previous preparation, which may fit the body to receive it with great advantage. Dr Cullen observes that bark in small doses is not apt to disturb the natural functions and if the presence of bile or indigestible substances in the stomach do not demand them, the bark may be given in urgent cases without previous evacuations, but otherwise it would be better to prepare the stomach for the quantity of bark that is necessary, by a gentle Emetic or Cathartic. I would remark the most simple intermittants are frequently of an inflamitory type arising from stimulus, Marsh Miasmata &c. And in such cases it would be verry improper to administer the bark without previous depletion or bleeding, Emetics, Cathartics &c. If given before it will be rejected

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intermissions of the paroxysms, while the state of the system is as near that of nature as possible, another question presents itself may the bark be given during the hot stage. From the high authority of Dr Cullen I am led we should be led to believe the bark may be given in any stage, my own experience has never extended beyond a single case, and from the ill effects of this case, I should not be tempted to give it again, many writers says that there is some kinds of intermittants where the bark may be used with efficacy during any stage. Belfour who practiced in Bengall was of opinion that it might be given during every stage of the fever. I believe if there is any it is such as occurs in Topical Climates, that the bark may be used with advantage during the hot stage, and not then without there is a moist skin, there is less objection to giving the bark in paroxysm of continued fever. We are sometimes able to procure remission by it, the bark is verry efficacious in that species of intermittants termed by some authors Appoplectic Tertians, but I think venesection should proceed its use.

Remitting fevers. It has been disputed whether Intermittant and remittant fevers are distinct or the same disease, the latter I think is pretty certain, they both arise from the same

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and may be given with the greatest advantage Mr __ Informs us he had a number of pneumonial patients all whoom died who were bled, at last suspecting the cause to be miasmata, as they lived near stagnant water he gave bark in preparations of bark and other stimulants which he found of great service, in true inflamitory pneumonia the lancet is proper, but in those cases the pain often remains after bleeding, to remove which blisters are verry efficacious. It sometimes partakes of an intermittant type, recurring at regular hours every day, here the bark is verry usefull to be given about the coming on of the paroxysm, there is a fact respecting the cure of the plague with the bark which deserves mentioning, it is related by Dr Brown, that from one hundred men with plague he took 100 ounces of blood and only eight of them died. The plague sometimes makes its appearance in tertians, quartans, &c in which case the bark may prevent the fatal termination, if given plentifully.

Rheumatism. This disease is commonly attended with an inflamitory diathesis. Dr Cullen found the bark hurtful, it sometimes periodical then the bark may be of service, it sometimes appears without fever. I know nothing of its effects from experience but I think it certainly

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for the most part from the same cause as remitting or intermitting fevers, Dr Cullen thought it improper in the first stage but this opinion was not drawn so much from experience as from his theory of the cause of the disease which he supposed to be a spasm of the colon, this I have before controverted and said it depended on an inflamation or febrile action in the intestinal membrane of the lower intestines. Dr Cullen thought when dysentary puts on the tertian type bark is necessary, and it frequently assumes an intermittant type; and this circumstance induced physicians to use the bark in this disease. Dr Morton used the bark and opium combined in dysentary and he deserves credit for using opium first in this disease he gave it in the intermission of the parexia. Cleghorn observed the simularity between tertian and dysentary and hence employed the bark in the latter, some have given it merely to prevent mortification, in the year 1745, 6 and 8 in, Philadelphia, Dysentary expressed the form of tertian fevers, and I think it much more connected with fever than at present. Cholera Morbus verry often requires bleeding, but sometimes yields to diluents and opium, it is sometimes of