Colonial North America: Countway Library of Medicine

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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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cause Marsh Miasmata, they often change into each other, for various other reasons I consider them as varieties of the same disease, the bark is verry serviceable in this disease, but its use is liable to many restrictions in the employment of it in intermittants, as there is seldom a well marked intermission in this disease we may often safely employ the bark during the paroxysm in Synocha. Inflamation being one of the characteristics of this disease the bark cannot be exhibitted with propriety unless it is in the latter stages of the disease.

Pneumonia. Sydenham and Booerhave advised it verry strongly in this disease, there is a disease in the southern states called a pleurasy of the head, from the pain being principally distressing in that part, it is attended with sticking in the side, it attacks the weak and debilitated and comes on with shivering. It now frequently attacks persons who are adicted to drinking, it is a remitting or intermittant fever and owes its origin to the same cause Mar. Mias. The pulse generally indicates bleeding but this is found to agrivate the symptoms it yields verry readily to barks and blisters applied near the pained part. In those pleuisies [pleurisies] which occur in autumn, Bark is the proper remidy

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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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must be injurious in all inflamitory diseases, gout and Rheumatism have been thought to be the same disease, they are however essentially different, though there may be some similarity in their symptoms, Sydenham thought the bark usefull in some cases of the gout, he used it himself morning and evening. Haller calls it a grand remidy, I think it can only be used in the regular gout with debility. But hardly ever when there is a translation of the affection to the hed or stomach, indeed it should never be used when the vital organs are affected, if the gout assumes the intermittant form the bark may be usefull.

Typhus fever. This is supposed to arise solely from human effluvia. But I have seen it arise from marsh miasm, and although we call the typhus a continued fever, yet I consider the intermittant remittant and typhus all of the same species it is in the first stage an inflamitory fever which lasts longer than any other fever, of course the bark must be at first improper, I would not recommend it while the pulse remains full the eyes inflamed &c. In its course it becomes a disease of debility and then the bark is proper.

Plague. Is a true Synochus or a fever in the first stage inflamitory and ending

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miasmata, Typhus by animal and the other by Vegitable Miasmata. Genuine Typhus has been known to be produced by a stagnant lake. Synochus and Typhus are in the beginning I will not say inflamitory diseases, but the febrile symptoms run verry high, for this reason I think opium must be improper, and Dr Cullen is of the same opinion, he says in many of the fevers of Scotland there appeared more or less of the inflamitory diathesis in the system, and during this state he holds and has often seen the use of opium to be injurious in the extreme, it neither induces sleep or relieves pain but agrevates the inflamitory symptoms and frequently determines to particular inflamation and proves fatal.

Yellow Fever. I believe the matter producing this to be the same with that of the Plague, after the inflamitory symptoms have subsided, opium may be proper, but wine is here more generally usefull, delirium often occurs with inflamitory symptoms and the wine does harm, but there is a delirium in Typhus which proceeds from debility where wine and opium will doubtless be proper. Sydenham says opium should not be given before the twelvth day of the disease, but I certaily should not wait