The circumstances which prevent our fulfilling the two first indications are, in flammatory diathesis, accumulation of bile in the stomach, and of that and feces in the intestinal canal. The first circumstance will be removed by blood letting; and if, curing the paroxysm, any urgent symptoms indicate the presence of that diathesis, it will be attended with the greatest prospect of success, if the operation is performed during the hot stage, when the excitement is most con siderable : the latter causes will be remov ed by the administration of emetics and cathartics : if there be a great degree of debility, the system must be strengthen ed by a generous diet, the moderate use of wine, gentle exercise, the cold bath, and change of air. As in this disease re lapses very frequently occur, it will not only be advisable, but necessary, to con tinue the use of the bark in doses of a drachm four times a day, for two or three weeks : at the same time the patient must most studiously avoid all the exciting causes, and every irregularity in diet. Vernal are less liable than autumnal in termittents to become continued fevers, and are rarely attended with alarming symptoms, or followed by dangerous ob structions. The taste of the bark will be concealedin a great measure, by exhibit ing it in milk, buttermilk, or infusion of liquorice ; and if the stomach should pos sess a considerable degree of irritability, opium, administered either by itself or combined with camphor, will, in general, succeed in enabling that organ to retain the bark. The paroxysm may be gene rally prevented by administering a full dose of the tincture of opium, in mulled wine or hot diluted spirits, about an our previous to its expected return.
Continued Fever. This is either inflam matory (synocha) ; putrid or gaol (ty phus) ; or mixed (synochus.) Symptoms of Synocha. This fever, which, however, without topical inflammation, is in this country a very rare occurrence, generally commences with short fits of cold and heat alternating with each other, to which succeed an intense burning heat, head-ach, accompanied with throb bing of the temples, or tinnitus aurium, pains in the back, loins, and joints, and the patient feels as if his body bad been severely bruised : the face is full and florid; the eyes are inflamed and inca pable of bearing the light ; the skin, mouth, and throat are dry ; the tongue is covered with a white crust; the thirst is intolerable ; the respiration is frequent, hurried, generally oppressed, and attend ed with a dry cough ; there is anorexia, nausea, vomiting, restlessness, and deli rium ; the urine is secreted in small quan tities, and is high coloured ; the bowels are costive ; the pulse is frequent, strong, and hard, scarcely ever, however, ex ceeding 120 strokes in a minute ; the blood, when drawn, is covered with a whitish or yellowish crust. In this coun try, after the symptoms have continued for some days, they begin generally to as sume those of typhus, so that the .whole disease is synochus.
Causes. Suppression of the accustom ed evacuations; cold, by any means ap plied, as exposure of the body to the cold air, when it is in a state of perspiration ; exposure to the rays of the sun ; intemper ance in eating, but more particularly in drinking; topical inflammation; intense study ; great fatigue ; the premature re pulsion of eruptions; perspiration sud denly checked ; and violent passions of the mind.
Diagnosis. This fever will be readily distinguished from the typhus mitior by the strength of the pulse, the intense heat, great thirst, violent pains in the back and joints, high coloured urine, and by the less derangement of the mental functions.
Prognosis. It frequently terminates in a favourable manner about the seventh day, either by hemorrhage, a profuse diaphoresis, or by the urine depositing a copious lateritious sediment; the termi nation by diarrhea is a much more rare occurrence. if the respiration be very
laborious, if the head-ach be very severe, attended with delirium ferox, if the abdo minal viscera be much affected, if the urine be pale or limpid, and the skin as sumes a yellow tinge before the seventh day, we may generally expect an unfa vourable issue.
Treatment. The removal of this dis ease must be attempted by blood-letting, in proportion to the violence of the symp toms of increased excitement, strength, and former habits of life of the patient, and nature of the prevailing epidemic ; if on the first blood-letting, the symptoms be considerably alleviated, and the pulse and beat become nearly natural, it will not be necessary to repeat it ; if, on the contrary, the symptoms continue with but little or no abatement, it will not only be advisable, but indispensably necessary, to repeat the operation, until we nearly reduce the pulse and heat to the natural standard ; the blood-letting will be the more efficacious, the more suddenly we abstract the blood ; an emetic should then be administered, and in a few hours after its operation has ceased, a cathartic should be exhibited, for which purpose the phosphate or sulphate of soda, or the sulphate of magnesia, combined with the infusion of scnna, with a small propor tion of the tartarised antimony, will be the most efficacious ; calomel is a pre ferable medicine to the others ; after the contents of the prime via are sufficiently evacuated, we should order the neutral salts, particularly the saline draughts, eve ry two or three hours, to each dose of which, from twenty to thirty drops of an timonial wine, with the same quantity of the spirit of nitre, may be conjoined with advantage; cooling mucilaginous liquors, acidulated with the vegetable acids, or cold water, should be freely allowed, when the heat of the surface of the body is steadily above the natural standard. It is of the utmost consequence, throughout the whole course of this disease, that the alimentary canal should be kept clear of feculent matter; for which purpose the mildest laxatives should be employed, or perhaps mucilaginous clysters would be preferable ; all exercise, both of the bo dy and mind, must be studiously avoid ed, the patient must be kept quiet and in a horizontal posture, the light should be as much as possible excluded, there should be a free circulation of cool air through the apartment, the floor of which should be frequently sprinkled with cold water, the patient should be lightly co vered With bed-clothes, all excremental matters should be speedily removed, and the patient should have frequent changes of dry linen. , If the pain of the head be very violent, accompanied with delirium, or if the patient is oppressed with coma, blood-letting, both general and topical, will be necessary, provided the strength of the patient is not too much exhausted ; cathartics and laxative clysters must be ordered, the head should be shaved, and cooling applications, as vinegar and wa ter, os, a solution of the volatile salt of hartshorn in vinegar, and the like, must be employed ; blistering the head, and fomenting the lower extremities, will also be of service. If the respiration should be much oppressed, and attended with a short dry cough, we must immediately have recourse to blood-letting, both ge neral and local; blisters should be appli ed to the thorax, and we should direct a liberal use of mucilaginous diluents. Should abdominal viscera be attacked in the course of the disease, the same ge neral means of blood-letting and blister ing must be employed, together with lax atives or fomentation of the lower extre mities. In this climate, after a short pe riod, the symptoms generally begin to assume the typhoid form, therefore some degree of caution will be indispensably necessary in the liberal employment of evacuations, lest we should induce a de gree of fatal debility.