(seq. 179)

170

Materia Medica

Tonics

or by its tonic power increase the symptom of fever. I have bled
a patient eight times before I thought it proper to administer the bark
and in billious fevers weeks have passed before the barks could be
used, after it was the only remidy of efficacy. I think we should
do well to precede the bark with some evacuant, but there is no need
to excite the stomach actively by the use of Emetics, it is the activity
of the stomach that prevents the use of many medicines. Emetics
are improper when there is any disposition to vomit or where there
is a determination of blood to the head, they often increase the
irritability which is a verry difficult to manage. Since the fever
of 1793 of this City Emetics have been given less frequently than
before. Should any evacuants be thought necessary I should use
cathartics, the following I have found most useful, Calomel
either alone or combined with rhubarb, the root of May Apple
the Padophyllum peltatum of Linneus is a verry gentle cathartic and
may be advantageously combined with calomel, the dose of both
is about ℈i [1 scruple]. Jallap is generally preferred, I seldom employ it as
it is verry apt to excite nausea. I do not wish to exclude emetics
entirely as a remedy in fevers they are sometimes verry serviceable.
Evacuants have not only been of service in the commencement and