Imatges de pÓgina




1. JULY 1816,




Observations on the Utility of Blood-letting as the principal Re

medy in Continued Fever ; with some cases of an Epidemic, in which it was practised with uniform and remarkable suc

cess. By John ALLAN, Surgeon, Royal Navy. A strong impression in favour of the practice which is the

subject of these observations, was first made on my mind by observing its beneficial effects in a few cases of sporadic fever, and was greatly confirmed last year, when I had an opportunity of witnessing its efficacy in the yellow-fever of the West Indies. The result of this practice in my hands, with the opinions to which its success unavoidably led, was submitted to the public in the Edinburgh Medical and Surgical Journal for July last, when I not only declared my belief in the necessity, and my confidence in the efficacy, of that simple mode of treating the yellow-fever, but even ventured to express a hope that it would soon be found not only admissible and safe, but the most effectual and successful practice in the common continued fevers of Britain.

The paper containing my observations on this subject had VOL. XII. NO. 47.


scarce quitted my hands, when some cases appeared on board his Majesty's ship Erne, to which I then belonged, of a continued fever, that afterwards became so prevalent, as to present me with many opportunities of realizing my preconceived hopes of the utility of extensive blood-letting in fevers of European origin. We had above twenty severe cases in a crew somewhat under 130 men, within about three months, in all of which the success of that practice was conspicuous and uniform. My own recent experience was strengthened, on this occasion, by the knowledge I had endeavoured to reap from more than one perusal of Dr Burnett's excellent treatise on the Mediterranean Fever, a publication which, wherever it succeeds in introducing a fair imitation of his enlightened practice, will undoubtedly do more good than any that this hackneyed subject has lately produced.

I was thus prepared to undertake the treatment of the late epidemic on board the Erne with some confidence in the use of extensive blood-letting, a confidence which happily has not been deceived; and, in offering the result of this practice to the public notice, I may indulge the hope, that, whatever may be thought of my reasonings, the cases cannot but be useful. They may assist some to decide who still hesitate about the propriety of such practice, or may procure some attention to a system

of treating fever which the bias of education has hithei to prevented from obtaining due consideration.

At the time that the disease which gave occasion for these remarks made its appearance, the ship had been about three weeks in Portsmouth harbour, and we afterwards remained there about five, that is, altogether, from the middle of April to the beginning of June last; during which period a certain num. ber of the men were daily on shore on leave, an indulgence attended, as usual among sailors, with various excesses, especially frequent intoxication. It was, however, in very few instances, that the disease took place immediately after the application of these causes ; for, though a few cases did occur early in the month of May, while we remained in the harbour, the greatest number, and some who had the most severe attacks, were not taken ill till several weeks after we had left that situation, and, indeed, we were scarcely without one or more cases of fever on the sick list till after the middle of August. The disease, therefore, must have owed its origin to some other cause besides the temporary irregularities just alluded to ; and marsh miasmata, the most frequent cause of uncontagious fevers, appear, in this instance, to have been no less active than usual. Our ship was so situated, during the time I have mentioned, as to be within

In se


forty or fifty yards of the extensive slimy mud-banks on the Gosport side of Portsmouth harbour, which are continually uncovered at low water, and from which, when the sun's rays were not interrupted by clouds, one might sometimes perceive exhaJations rising in the form of a whitish vapour,

But, besides the obvious and unavoidable opportunities thus frequently presented for the application of this generally active cause, there was, in the nature and character of the epidemic, something that evinced its origin from such a source. veral cases it manifested a distinct and decided tendency to as. sume the type of an intermittent, and, although the paroxysms were never regularly completed in all their stages, yet the occasional, and somewhat regular, recurrence of cold fits often summoned my attention, and gave reason to apprehend the formation of a regular remittent or intermittent, as the issue of the

Had such symptoms led to a relaxation in the use of the lancet, or had the cure been chiefly confided to bark, or to any other remedy, I cannot help believing that such must, in some cases, have been the result. I do not mean to say that bark was wholly useless, or without good effect; on the contrary, it will appear to have been administered, in some of the following cases, with decided advantage ; but the disease was in general so speedily cut short by the bleeding, as to leave the strength of the system very little impaired, and to render quite unnecessary the use of any tonic whatever.

The lancet was used as freely in this disease as it usually is in the yellow-fever, and sometimes most extensively, on account of other unmitigated symptoms, when the pulse was both frequent and feeble, and when other apparent signs of extreme debility were no less conspicuous; in short, (I wish it to be

particularly remarked), when circumstances, commonly supposed to forbid its use, were certainly not wanting.

CASE I. SAMUEL DIBBINS, private marine, ætate 18, of a slender make. I found him, on Monday 8th May 1815, at five P. M. lying in bed, affected with shivering and drowsiness, approaching to coma, unwilling to be disturbed, and complaining of general uneasiness, without particular pain. His respiration was laborious, with frequent deep sighing his pulse 102 and small, and his skin very dry and hot. He had just returned from the shore, where he had been taken ill the preceding day, his complaint beginning with headach and vomiting. He had used no medicine.

He was immediately bled to twenty-five ounces, and then

took a large dose of calomel and jalap, which caused some vomiting at first, but was soon followed by several loose stools.

At7 P. M. he was found to have lost a considerable quantity of blood in bed, but the symptoms had not abated, Fourteen ounces of blood were drawn from the same orifice, and then he took three grains of the pulvis antimonialis.

During the night he dosed a good deal, but perspired none at all; and, at 7 o'clock next morning, he was distressed with extreme languor and prostration of strength, and with such an insupportable feeling of fainting and vertigo, that he could nei, ther bear to sit, nor to be held in a sitting posture. His skin was excessively hot and dry, his tongue tremulous and moist, red at the point, but loaded near the root with a white fur. He complained of pain in his stomach and head, especially about the eye-balls; his thirst was very urgent, and his pulse 92 and small.

While he lay in a horizontal posture, apparently scarce sensible of what was going on, twenty-eight ounces of blood were drawn from his arm, which caused, at first, a convulsive sobbing, and, at length, actual syncope. As soon as he recovered he took twenty grains of jalap.

About 10 A. M. I attended him to Haslar hospital, when this young man, who, three hours before, could not bear to raise his head from the pillow, not only sat up in the boat, but, leaning on the arm of a seaman, walked from the landing-place, about a quarter of a mile, to his ward, and declared himself not at all fatigued by the exertion.

He was, in fact, from the above day, a decided convalescent ; and, after ten or twelve days more, returned to the ship in perfect health. The striking resemblance, in the practice and result of this case, strongly recalled to my remembrance that of John Hogg, published in this Journal for July last, who was landed by me in May 1811, at the same hospital, under very similar circumstances, and whose case was one of the first in which I witnessed the powers of extensive blood-letting in cutting short continued fever.

CASE II. JOHN JEFFRIES, private marine, ætate 28, complained, on Monday 31st July 1815, of headach and giddiness, with occasional rigors, and profuse perspirations. His tongue was white and ragged; his skin moist, and rather hot; his eyes red and watery ; and his pulse 100, but so small and feeble as to be counted with difficulty. He had had three loose stools by a dose of calomel and jalap, which he had taken on the approach of these symptoms, at 8 o'clock the preceding night.

In this state thirty-two ounces of blood were taken from his arm; he took half an ounce of sulphate of magnesia, and was ordered two drachms of the aqua acetitis ammoniæ every two hours, in a draught.

Soon after the bleeding his pulse became full and soft, and fell to 80 in quickness; during the day he had several loose stools, and, at six o'clock in the evening, appeared free from all complaint.

August 1.—He was directed to use spare diet; the sulphate of magnesia was repeated in the morning; and he took, at bedtime, two grains of submuriate of mercury with the same quantity of pulvis antimonialis.

He slept tolerably well in the early part of the night, but, towards morning, became hot and restless, vomited a quantity of green bilious matter, and was affected with languor, vertigo, and headach. At 8 A. M. his pulse was 100, and very small; his eyes red and watery, and his tongue white and moist.

He was bled to twenty-five ounces, then took five grains of calomel, and was ordered an effervescing * draught every two hours, composed with carbonate of magnesia instead of subcarbonate of potass.

. He soon had a stool, and then the vomiting ceased. At one P. M. his pulse was 100, and fuller than in the morning, and he perspired profusely; yet the headach and vertigo continued unabated. The bleeding was repeated to thirty ounces.

By 6 P. M. he had another stool; his pulse was 96, and soft, and his head much better, but the giddiness as before.

He had no stool in the night, and, next morning, the giddiness continued ; his pulse being 92, and soft. Eight ounces of blood were taken from the right temporal artery. He took five grains of calomel, with fifteen of jalap; and, afterwards, half an ounce of Epsom salts every four hours. At six that evening, though his bowels had been freely purged, the vertigo continued.

On the morning of the 4th, it still distressed him, and was attended with vomiting; his pulse was 92, rather sharp, but ex.

* This draught, which I believe not to be in common use, may be prepared with distilled, or even common vinegar ; but, when to be had, lemon-juice is to be preferred, and ought to be employed rather in excess, so as to produce a supercitrate of magnesia, which is exceedingly well adapted for quenching thirst, and allaying vomiting, while its cathartic powers seem more to be depended on than those of the citrate of potass.

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