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was hurried into battle with an active and unrelenting enemy before he had buckled on his armour, or prepared himself for his defence. Like Julian, he will feel his vantageless condition when it is too late, and will pay dearly (if he has sensibility), or at least his patient will pay dearly, the forfeit of such neglect; for be it remembered, that, in medicine no less than in politics, "Quicquid delirant reges, plectuntur achivi.”
In this disease, therefore, it is indispensable to bleed again and again: It is the main stay,--the sheet-anchor of hope. Without it, many, very many must infallibly be lost;-would that I could say that by it all are saved! But when it is recollected how often inflammation, even of parts not vital, foils all our exertions at resolution, it cannot be wondered at, if bloodletting is often incompetent to remove inflammation of the brain or abdominal viscera, organs endowed with high sensibi lity, extensive sympathy, and functions whose right performance is essential to life.
I cannot undertake to go minutely into all the happy results* of this decisive practice; in fact, it is the less necessary for me to do so, as it obtains so generally amongst surgeons employed in the service of their country in tropical climates, and has become such a favourite method, that, instead of an unguarded hortatory tone, it would perhaps be well to put in a caveat against the abuse of this most potent remedy. Of such abuse, I cannot say I have seen any example; but some friends, on whose judgment I place great reliance, have informed me that they have occasionally witnessed detraction of blood pushed to an unseasonable and improper length. This I can well believe, having felt by experience, that the great difficulty in treating this fever is to say when active evacuations ought to be laid aside. The exact decision of this point requires considerable
* It is remarked that patients who have been ill of fever are apt afterwards to die of dysentery or chronic complaints. Though thirty-seven of the crew of the frigate to which I belong laboured under ardens fever on the Jamaica station, and though the ship afterwards suffered a good deal from dysentery in the gulf of Mexico, none of the thirty survivors died of that or any other subsequent disease. It is therefore another praise of the depletory practice, that it leaves no visceral obstructions to be a source of after danger.
I shall here mention a farther indirect advantage arising from this method. In the early stage of ardent fever there is often a torpor of the bowels, which renders them insensible to the stimulus of purgatives. When bleeding is practised, either while the blood flows, or immediately after recovering from syncope, the cathartic previously given produces urgent calls to the seat and full purging. Venæsection certainly renders the body more susceptible of the action of blisters also.
tact, and a previous acquaintance with successive phenomena of the disease.
Purging, free purging, I have not hitherto mentioned, its necessity being so much a matter of course. A stimulus ought to be kept up constantly on the bowels, if with no other view than to relieve the head. Blisters and the cold affusion I have found to be valuable auxiliary remedies:-I call the latter by the subordinate epithet of auxiliary, for to attempt (as some have fondly hoped) to extinguish this most violent fever by it, is like attempting to extinguish the crater of mount Etna by water! It, however, reduces heat and invites sleep, and (what is of very great consequence) by its bracing power on the skin, it gives tone to the stomach, lessening nausea, and checking vomiting, a thing so much to be dreaded in every stage of this disease. With the latter view, also, I have found saline effervescing draughts, and small oft-repeated doses of calomel, highly useful.
These remedies are mentioned in succession according to their relative efficiency, but, in actual practice, their application must be contemporaneous. Bleeding, purging, cold lotions to the head, shaving the scalp, and general refrigeration by the cold bath, must be drawn up together in array against the disease, and must make a combined attack. A first or even a second disappointment must not rob us of our perseverance. Courage and constancy will in the end often succeed against great seeming odds. In short, the violent excitement must be got under by all means, ordinary and extraordinary.
I have never either tried or trusted to calomel as a sialagogue in this disease. The blind confidence in its supposed specific power has, I believe, nearly faded away before the better lights and the more speedy results which the depletory practice has afforded. * In ardent fever, where there is a morbid activity of the arterial, with a proportional inactivity (almost amounting to torpor) of the venous and absorbent systems, it is a matter
An attempt has lately been made to clap up a match betwixt the depletory and mercurial methods, and to call in the aid of both in the same case. The most respectable, if not the original proposer of this incongruous union, is Mr Johnson, in his valuable work before referred to (see note, p. 136.) What table of affinities suggested this coalition, it would be vain to conjecture.
However ingeniously devised this combined system may be, it will never stand. Like the famous image in the vision of the prophet Daniel, it is formed of repulsive materials: the iron and clay will not coalesce-cannot amalgamate, but the baser matter will crumble to dust, leaving the other part to the enjoy ment of proud perpetuity. The separation doubtless will be spontaneous, and the sooner it takes place the better.
of extreme uncertainty, whether mercurials can find their way into the system, until the paroxysm of fever is dissolved. Its action, even were it absorbed, would be rather burtful, as favouring that depravation of the solids and solution of the fluids, which, with the effect, putrescency, are so much to be feared in the latter end of continued fevers. Upon the whole, longer time and trials have only given additional strength to the opinion which Dr Saunders pronounced on the inutility of mercury in the endemial fevers of tropical countries.
In the cases that came under my care, I have been in the habit of giving three or four grains of calomel after the primary stage of fever, every three or four hours, with the view of deriving from the head and viscera, by keeping up a constant action on the intestinal canal, as also to carry off sordes, and to prevent vomiting. I preferred calomel, because, from the precarious state of the stomach, more bulky or more nauseous cathartics could not, in all likelihood, be retained. When low delirium, coma, torpor, or the like, occur, it may be desirable, as a last resource, to place the system under the influence of mercury; but, even under these circumstances (though the mouth was fairly affected), I have never been so fortunate as to see it of any avail in saving life.
Much has been said about the prophylactic virtue of this mineral in warding off the attack of fever. No one will deny that a mercurial course, by lowering the tone of the constitution, lessens the liability to this as well as all other inflammatory diseases; but some cases in point have fallen under my care, where men have been suddenly attacked with severe symptoms of the endemic, whose systems, for a week before, had been saturated with mercury on account of a venereal complaint. I therefore suspect that the influence of this metal, as a preventive of tropical fever, is like that of the eruption of prickly heat (Lichen tropicus) on the skin, founded in error: the latter, I know from repeated experience, has no other basis than hasty popular opinion.
It would be easy to extend these remarks on fever to a greater length; but I have endeavoured to confine myself to leading points, and to those opinions of late authors which seemed to admit farther elucidation. I am not altogether without hopes, that, notwithstanding the low standard of merit in which this communication must rank itself, perhaps I have furnished here and there a raw material, which may be worked up into something of utility; or a hint which, even without any such expectation on my part, may be converted by others to the improvement of our profession, for which, in my humble sphere, I trust I am not without zeal and devotedness. At all events, a delinea
tion of disease on a great scale, and a detail of practical facts, can never be wholly useless; and I can only say, that I have described such facts and occurrences accurately, as far as my means of information reached.
*Though the length of this narrative has already far exceeded my expectation, I cannot, in closing the history of this unfortunate expedition, refuse myself the pleasure and the pride of applauding the manly conduct of our unrivalled country throughout all the checquered events of war. Her sobriety is not to be staggered by hundreds of victories, and her elastic spirit rises under a failure with unabated magnanimity. In battle, and council, amidst the deep agitation of general danger, and in the appaling spectacle of kingdoms falling or fallen, Britain has invariably comported herself with a wisdom, self-confidence, and greatness of heart, truly characteristical of a great and intelligent people. We have fought and we have bled, sustaining, amidst sacrifices, very painful to be sure, but honourable, a paroxysm of glory, and an agony of fame. From the Ganges to the Mississippi,-from the regal Pyramids of Egypt, to the limits of the Hyperborean wilderness,-from the solitary straits of Magellan to the perpetual snows of Labrador,-every "kindred and tongue and nation" have learnt to appreciate our power, sublime in victory, and venerable even in defeat. It is impossible to foresee the revolutions, in future centuries, which chance or destiny may cause; but we may venture to believe that the achievements of Great Britain, in arts and arms, have given to the passing current of time a flavour and a colouring, which will confer upon her (humanly speaking) an eternity of renown, and make known to the latest posterity that political and intellectual grandeur, compared with which the boasted glories of Greece or Persia, Rome or Macedon, will fade into insignificance as specimens of childish strength,-the "rattles and the straws" of an infant world:
-Οὐκ ἀμνηστον, ἀθλια Πατρίς,
His Majesty's Ship
* I have this moment heard of the glorious result of the new war in Belgium and France, and cannot help indulging myself in the triumphant reflections that follow. Their slender connection with the purport of my essay breaks the unity of the communication, and will give the jaded reader reason to say, that with my other faults, I have no skill in those "calidæ juncturæ” so indispensable in every piece of composition. To all this, and more, I am content to plead guilty, even before I am formally accused.
Observations on the Utility of Blood-letting and Purgatives, in a Fever which prevailed in the Russian Fleet. By D. J. H. DICKSON, M. D. F. L. S. Physician to the Fleet, and formerly Superintending Physician of his Imperial Majesty's Squadron in the Medway.
HE following observations, so far as they relate to the general utility of early blood-letting and purgatives, in a fever which, on two occasions, prevailed in the Russian squadron in the Medway, under my superintendence, were written upwards of eighteen months ago; but, being then with the North-American fleet, I deferred the final consideration of the subject until my return.
In the meantime, I sent my remarks to Drs Douglas and Dobson, who, from having had the charge of the Argonaut and Trusty hospital-ships, appropriated to the reception of the sick, were peculiarly qualified to appreciate their correctness; and I requested to be favoured with such alterations and additions as their experience should suggest.
I have much satisfaction in bearing testimony to the skill, humanity, and attention evinced by these gentlemen in the very arduous situation in which they were placed; and I am bound equally to acknowledge their zealous co-operation on all occasions, and the readiness with which they have subsequently given me every information in their power. As their opinions are communicated to me as "the entire result of practice and observation, unwarped by prior predilection for any particular theory," I may fairly hope, that their coincidence with my own, as to the practical results, will give these greater weight than, individually, I could have expected them to possess. My object is simply to detail, with all the fidelity in my power, the features of the disease, and the success of the treatment adopted, a duty which seemed, in some respects, to devolve upon me, and of which ill health, and other irrelative circumstances, have prevented the earlier fulfilment.
I have occasionally adverted to different authors as they occurred to me, in support or illustration of these remarks; but I have also frequently omitted to do so; and, from unwillingness to extend my references unnecessarily, have oftener alluded to