In the removal of this disease, if there be a considerable degree of excitement, attended with much coma or delirium, and a strong, full, and hard pulse, blood letting will be necessary, and it should be repeated according to the urgency of the symptoms, strength of the and state of the pulse ; an emetic should be given at the commencement of the fever, unless the head is affected, in which case it is at least a doubtful remedy ; cooling purgatives are particularly useful ; mild diaphoretics, assisted by the plentiful use of mucilaginous acidulated diluents, will be proper ; the antiphlogistic regimen must be strictly adhered to, and the pa tient should be placed in as erect a pos ture as be can bear without inconve nience; if the delirium, but more par ticularly the coma, be urgent, blisters should be applied to the shaved head, or between the shoulders; cupping should be advised, and mustard cataplasms should be upon the soles of the feet. The erysipelatous eruption sometimes shews itself in typhus, and increases the fever, in which case we must have imme diate recourse to bark, wine, cordials, the sulphuric acid, and the other remedies for that disease. When the eruption re turns periodically, issues and a low diet will frequently prevent it.
°Ansa IV. Hemorrhagic;; or SANW1113. 0173 FLUX58.
These are thus ordinarily defined ; py rexy, with a flow of blood without exter nal violence ; the blood, upon venesec tion, exhibiting the same appearance as in phlepnasie. The genera are : 1. Epic taxis; bleeding from the nose. 2. Ilemop tysis; spitting of blood. 3. Haemorrhois ; piles. 4. Menorrhagia ; immoderate men struation. These, for the most part, and when the profusion are not merely symp tomatic or critical, are a natural class of diseases; and, excepting in one or two instances, are to be attacked by a general plan of a similar kind and tendency. They are preceded, for a longer or shorter time, by a sense of fulness and tension in the parts whence the blood is about to issue : if those parts be visible, there is redness, tumour, a sense of heat or itching, and of pain and weight; internally, in the neigh bourhood, there is a limiter sense, weight, fulness, tension, heat, and pain; and when these symptoms have subsisted for some time, a cold fit comes on, attended with weariness of the limbs, pains of the back and bead, costiveness, and other febrile symptoms, succeeded by a hot fit, in the course of which the blood most com monly flows in a greater or less quantity, and after an uncertain time it ceases spon taneously ; during the hot stage, the pulse is frequent and full, and in many cases hard, but as the blood flows, the pulse becomes softer and less frequent, and the blood, when drawn from a vein, appears as in the cases of the phlegmasie. After an hemorrhage has once occurred, it fre quently observes periodical returns. The remote causes are, a plethoric and sanguine temperament ; the suppression or diminution of accustomed evacuations; changeable weather, as spring and au tumn ; considerable and sudden diminu tion in the weight ofthe atmosphere ; ex ternal heat; violent exercise of particular parts of the body ; whatever increases the force of the circulation, as violent exer cise, violent efforts, anger, and other vio lent active passions ; postures of the bo dy increasing determinations to, or liga tures occasioning accumulations in parti cular parts of the body; a determination to certain vessels rendered habitual from the frequent repetition of hemorrhage ; mal-conformation ofparticular parts ; and lastly, cold externally applied, as chang ing the distribution of the blood, and de termining it in greater quantities into the internal parts; or, perhaps, by its excit ing some degree of synocha. The proxi mate cause is supposed to be congestion in particular parts of the sangtuferous system, occasioning distention of these vessels, and violent reaction, the conse quence of which is a rupture of them.
Treahmera. When an hemorrhage has taken place, and threatens to go to ex cess, we must endeavour to moderate or check the flow of blood, and prevent its return ; the first indication will be an swered by a strict adherence to the anti phlogistic regimen, therefore the removal of every cause of irritation is always ne cessary, the patient must be kept quiet and stall, heat must be particularly guard ed against, he should be freely exposed to the cold sir, and should be allowed cold or iced water, or iced lemonade, to drink; every exertion of mind or body is to be avoided: a vegetable diet will be most proper, unless the strength of the patient is greatly exhausted, in which case, mild broths, and the mildest kind of animal food, may be allowed gentle cathartics, or laxative clysteral will be necessary to prevent any accumulation of the fccea, and blood.letting will be re quisite, if there is a considerable degree of excitement ; dry-cupping is frequently useful, and blisters may be employed with advantage : %omiting is a powerfUl reme dy in diminishing the action of the heart and arteries ; the digitalis, however, in our opinion, is a preferable remedy ; re frigerants should be ordered, as the sul phuric acid, nitre, cream of tartar, and the vegetable acids ; the first of which is, however, the most efficacious medi cine. Internal and external astringents must also be employed ; of the former class are the vitriolic acid, alum, and the sugar of lead, which is by far the most powerful remedy, and may occasionally be exhibited with advantage in small doses, but the long continued use of this reme dy is often attended with dangerous con. sequences, and it ;should be given in com bination with the opium pill, or some tena cious extract, in order to obviate its per nicious effects on the stomach and bowels. The external astringents in most general use, are, cold applied suddenly, cold wa ter in which salt has been recently dis solved, or powdered ice, or solutions of sugar of lead, alum, or white vitriol, &c. ; pressure is a powerful means of checking hemorrhage,when it can be applied to the part ; when the hemorrhage is very pro fuse, it is improper to employ any means to prevent syncope, unless it partakes very much of the passive state, in which case it must be prevented by every pos sible means; the cinchona, with chaly beates, are indicated under the same cir cumstances.When the phlogistic diathesis is taken off, either by the continuance of the hemorrhage, or by proper remedies, opiates may be given with advantage, and should subsultus tendinum or convul sions supervene, they are particularly ser viceable,combined with the campher,cas tor, and musk. The return of the hemor rhage is to be prevented by our counter acting or preventing a plethoric state of the system, by an abstemious diet, or by taking food of a less nutritious quality, by exercise, gestation will be generally more safe, than walking, by gentle cathartics, by cold bathing, bitters, and aromatics, which tend to prevent plethora, by in creasing the tone of the vessels, and by studiously avoiding the remote causes; tonics, which must increase the force of the circulation, although indicated, are doubtful remedies, in particular bark and chalybeates ; astringentv are in general more efficacious, particularly the sulphu ric acid, alum, &c. If the plethoric state, notwithstanding our endeavours, should become considerable, and a return of the hemorrhage is threatened, blood-letting, both general and local, and blisters, will be proper, when the vis a tergo is great, but when the habit is debilitated, it will be more advisable to employ only local blood-letting and blisters; it will be pro per to remark, that blood-letting should always precede the employment of blis ters.