Colonial North America: Countway Library of Medicine

60

Materia Medica

Astringents

stimulant are improper in that stage, there are some cases in which they prove serviceable in curing dropsey, as when they check the paroxysms of fever on which the dropsy may depend, a patient under my care with typhus fever became dropsical, I became alarmed gave bark, wine &c, to remove the fever which they did and with it the dropsical swellings, many cases of a similar nature have occurred in my practice. Dr Lind used to say he who used bark plentifully during aprexy of Intermittant fevers seldom had dropsy to follow, astringents have been universally employed to stop hemorrhages, but as these are allowed to depend on the verry different state of the arterial system, we must at once perceive the impropriety of employing this remidy indiscriminately in every case. Dr Cullen has I think verry properly divided hemorrhages into active and passive, or such as are owing to increased arterial action, or such as ensue from debility, it is only in the latter kind that we expect any advantage from astringents. I believe its owing to Dr Cullens failure in the indiscriminate use of this remidy that he was led to make this just distinction in this disease,

127

Diaphoretics

arterial action is reduced by V.S. or cathartics at which time they mitigate the action, the cordial medicines are now laid aside, and mild cooling medicines, cool air &c are substituted. In these forms of inflamitory fevers after the necessary depletion mild Diaphoretics are indicated to solicit not to force a sweat by the latter we debilitate the patient and often aggravate the disease.

The Typhus fever. They are verry usefull tho much caution is necessary in their exhibition, in the Gravior and Mitior of Cullen mild purgatives, with cold affusions to excite a moderate reaction is verry necessary. The true Typhus of European Towns are little known among us. Tho the yellow fever there succeeded a new modification of Typhus of a verry interesting nature, the symptoms of which I will now give you as it appear’d to me. The disease so Protaeus like deffies any name or arangement. It first began

131

Diaphoretics

the patient sinks into coma and lethargy; and this Course there it has prevaild among the Students from the Southern states in a new and mitigated form, commencing with a chill and fever, pain in the side and breast, difficulty breathing, expectoration of blood, great gastric distress, vomiting of bile to an enormous degree, pulse full but soft and quick, this form resembles verry much billious plurasy deceiving the practitioner for a day or two, the symptoms of a well remarked Typhus occurs. The pneumonia becomes agrivated and the patient sinks into coma, the tongue and fauces dark brown colour, dry and hard to the touch, though this symptom is not uniform, (sometimes the tongue continues natural through the disease,) more advanced it assumes the form of Typhus Gravior, skin parched or hot, or moist and cold, at this time it is insensible to the most powerfull Stimuli and if reaction is not

133

Diaphoretics

Soon procured the patient is in imminent danger, great determination to the head without any previous pain in the extremities, chill, languor, fever, with dry skin, pulse feeble and quick, Tongue the natural becomes in one night colour’d, and no assistance being rendered the disease becomes much agrivated, throbbing of the temples, tension of the forehead, watchfulness, or drowsiness with delirium and confusion of thought, extreme dejaction, sighing great uneasiness about the stomach, and speedy dissolution. Thus Gentleman I have given you the symptoms of the most hidious forms of Typhus fever, tho what name to give it I know not, there being no active inflamation, and the symptoms not belonging to Typhus alone. Dissections show inflamation of the liver in small dark black spots, erosion also like incipient gangrene,

135

Diaphoretics

in the brain effusions of lymph of a pus like nature, and taking all the symptoms into consideration it appears to be Typhus combined with Erysipelatous Inflamation. "Treatment". The Practitioners seem generally to have adopted two modes of practice, "first" the profuse use of direct stimulants, and the "Second" The sweating plan. I have tried both and have now no hessitation in deciding in favor of the latter, and in fact nearly all agree to it now. Among the most active means to procure diaphoresis none are so efficacious as the Dovers Powders, Wine Whey, fomentations, and hot Toddy. I have always affected a cure where I could induce perspiration, when any topical affection supervene blisters to the parts will remove it, in the last stage the free exhibition of Vol. Alkali is the "Anchor of Hope" 10 grains