Imatges de pàgina

tremely small his tongue moist, and nearly clean; his skin cool and soft. He was bled to fourteen ounces, which he bore well; then he took two grains of calomel and an effervescing draught of magnesia, which medicines were both repeated after

three hours.

At 6 P. M. he told me that all his complaints had left him soon after the bleeding; his countenance was cheerful; his pulse natural, and tongue clean. His bowels required the aid of some laxative medicine once or twice afterwards; and he was detained, against his inclination, on the sick-list till the 13th of the month, when he returned to his duty in perfect health, fourteen days after his first attack.


JOHN MACKINNON, seaman, ætate 19, was affected, on Friday 23d June 1815, with headach, giddiness, and general pains His tongue was covered with a white fur; his pulse small and firm. He said that he had been unwell for several days before, that his appetite was not affected, and that his bowels were regular.

Fully forty ounces of blood were taken from his arm without the smallest appearance of syncope; but, in a few minutes after his arm was bound up, he was seized with convulsions, during which the blood gushed with violence from the wound, while the pulse at the wrist was remarkably strong and full. As soon as the fit was over, he took five grains of calomel, with fifteen of jälap, and, in an hour more, an ounce of sulphate of magnesia. At 4 P. M. he was much better; but, having had no stool, he took eight grains of calomel, with twenty of jalap.

He had two stools in the night; and, next morning, the 24th, his tongue had almost the appearance of health, and his head, though rather light, was free from pain. His diet was restricted; and, at 6 P. M. his first dose of calomel and jalap was repeated. On the 25th he took a scruple of pulvis rhei. On the 26th he had no complaint, but his tongue was pale. His first dose of calomel and jalap was again repeated.

On the 27th I permitted him to return to his duty, a step that afterwards gave me great concern; for he was seized, that night, with severe headach and vertigo, attended with nausea and shivering.

He did not complain to me, however, till next morning, the 28th, when his pulse was full and quick, and his skin very hot. A vein in his arm was immediately opened, but he became faint on losing eighteen ounces of blood. When sufficiently recovered, he took six grains of calomel, with eighteen of jalap. At

1 P. M. on opening a vein, only sixteen ounces of blood could be procured, on account of syncope.

At 6 P. M. he was less sensible of pain, but was extremely languid and distressed with the giddiness; his pulse was 130, small, and, when pressed slightly by the finger, was not to be distinguished without great difficulty. Though his bowels had been freely purged, his tongue was much furred.

After some deliberation, I resolved to bleed him once more. By the time I had drawn away twenty ounces, his pulse had fallen to 100, and it fell, in another hour, to 92, yet the vertigo continued, though without pain. At 8 P. M. he took two grains of calomel, with five of the pulvis antimonialis. At 11 at night he was in a sound calm sleep, his skin covered with a warm perspiration, and his pulse full, soft, and very little accelerated.

On the morning of the 29th, he still complained of slight giddiness; his tongue was moist, but covered with a slight yellow fur; his gums were gently affected by the calomel, and his pulse was 92, and very small. Having had no stool in the night, he took half an ounce of sulphate of magnesia.

On the 30th, he had no complaint remaining; but, on account of the state of his bowels, always inclined to costiveness, he took twenty grains of rhubarb.

July 1st and 2d. He took small doses of Epsom salts; but, on the evening of the latter day, he suffered a return of pyrexia; his pulse being 84, and full. He then took six grains of calomel.

On the 3d, he complained of griping; his pulse was quick and small; his tongue covered with a yellow fur. He took half an ounce of tincture of rhubarb, with twelve drops of tincture of opium, in a draught. At 6 P. M. the symptoms not being at all relieved, and the stools, though loose, being small in quantity, he took the following draught floating in half a wine glassful of water.

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Ol ricini 3vi. M. ft. haust. statim sumend.

He enjoyed a good night, and was free from pyrexia the next day, though his tongue continued slightly furred.

After this period, his bowels required several smart purgatives, and he had several threatenings of the invasion of an intermittent. On the 6th, 9th, 13th, and 20th, he had attacks of shivering, but no regular paroxysm was completed on either day. On the 5th, he began taking two ounces of infusum quassiæ twice a day. On the 8th, he began taking a drachm of

cinchona four times a-day, and five grains of the pilula hydrargyri every night, which last medicine was continued, with apparent benefit, till the 17th. On the 20th, he took fifteen drops of diluted sulphuric acid four times a-day, with the bark, which medicines were both continued daily till the 25th, when he returned to his duty perfectly cured; and, at the end of August, when the ship was put out of commission, he had every appearance of vigorous health.

These cases appear to me of considerable importance, as they demonstrate that those rules, by which restrictions are laid on the use of the lancet, on account of certain conditions of the pulse, or because languor, prostration of strength, or inability to sit up, seem to indicate a dangerous degree of what has been considered direct debility, may not only be sometimes violated with perfect safety, but that they ought to be disregarded, whenever we have reason to believe, that those outward signs of weakness are only sympathetic of the oppressed state of the organs essential to life, more especially the brain, which seems always to be the case, when such symptoms of extreme debility present themselves at the commencement of continued fever. -Mackinnon's case seems useful, besides, as it shews the benefi.cial effect of cinchona after quassia had failed, when the disease threatened to assume the intermittent form, and as it made me sensible, by the relapse which took place, of the serious imprudence I had committed in granting leave to the patient to return to his work, before his health had been sufficiently re-established after his first attack.

Besides those symptoms of fever usually considered as signs of debility sufficient to interdict the use of blood-letting, there are objections, or rather prejudices, against that mode of treating fever, derived from the particular habits and circumstances of the patient, which, I suspect, have hitherto generally possessed an undue influence in practice. The success of blood-letting among robust, well fed seamen, cannot, it is said, justify its application among the debilitated and poor inhabitants of cities; but I have sometimes had occasion to employ extensive bloodletting, for the cure of continued fever, in circumstances where, : perhaps, more of the ordinary objections against that practice were combined, than is usually the case, even among the inhabitants of the most confined situations in towns; yet the benefit received from it, in such cases, was no less conspicuous than in more healthy subjects, and the facility with which it was borne was generally still more surprising.

I have seen this exemplified in men of feeble and debilitated appearance, natives of London, or of the confined dirty streets

of some of the sea-port towns, whose having been a few months at sea, and fed on salted provisions, could not have much improved their originally unwholesome constitutions. A native of Plymouth, of a diminutive stature, and pale complexion, who had been at times affected with chronic bowel-complaints, being attacked with the yellow-fever, was more surprised than I to find that he had to be bled four or five times, from fourteen to twenty-four ounces each time, declaring, that he had never before escaped a fit of syncope, if he happened to draw blood even by the slightest wound of his finger. He bore the bleeding well, and was cured of the fever; but being soon afterwards affected with his old complaint, which assumed, at length, the appearance of chronic dysentery, he was sent from Bermuda to England. He was, nevertheless, in six months afterwards, in as good health as he ever enjoyed in his life.

The same practice has also been employed in persons of a different description, but who could, no more than the last, be termed strong, robust, or healthy; for every contrary epithet would have been more justly applied to men long accustomed to a sea life, wasted by habitual intemperance, and reduced to a state of great irritability and weakness, the effect of recent intoxication and debauchery. I have never seen any bad effect from liberal bleeding in such subjects, but, on the contrary, successful and speedy cures were regularly the consequence. The subject of the following case was a slender little man, whose whole body, I am persuaded, could not have weighed above 135 pounds, yet, on losing about two pounds of blood, his recovery was so rapid, that, from being in a state of actual delirium, he was able to resume his usual duty as a seaman on the sixth day; and, during three months that the ship continued afterwards in commission, he enjoyed a rather better than his usual state of health.


ROBERT MASTERS, ætate 29, seaman, was suddenly attacked, on Sunday 11th June 1815, in the forenoon, with cold shivering, vomiting of bilious matter, and occasional incoherency of language. He was affected with headach and vertigo, which he had felt, in a slighter degree, together with want of appetite and general disorder, for several days before. His skin was hot and dry; his pulse 80 and small; his tongue dry and furred; and his belly was said to be regular. He had not been on shore for nearly a week, and had attended muster about an hour before.

On losing above thirty ounces of blood, he was seized with

syncope, and, when he recovered, with much incoherent raving. As soon as he was placed in bed, he took ten grains of calomel, with twenty of jalap. At the end of two hours, he took an ounce of Epsom salts, which, after another hour, was partly rejected by vomiting. At 8 P. M. he was bathed in a profuse warm perspiration, felt perfectly easy, and his mind was tranquil ; but, having had no stool, he took six grains of calomel.

He had one large stool in the night, and next morning was free from all complaint, his pulse being 60 and regular, and his skin of natural temperature. That day, and the two following, the purging was kept up by medicine, and, on the 16th, he returned to his duty, in better health than, by his own feelings, he had enjoyed for many months.

The subjects of the two following cases were both habitually accustomed to drinking. Page, in particular, had indulged in debauchery, of more kinds than one, for some time before he was taken ill. He was rather short, of a thin make, and had the appearance of a person whose constitution had suffered from habits of excess. His whole weight could not have exceeded 145 pounds; yet it will appear, that 76 ounces of blood were, of necessity, abstracted from him, and with the greatest advantage, within the short space of four hours.


THOMAS PAGE, sergeant of marines, ætate 33, was reported to be ill on Sunday 13th August, at 4 P. M., when he was found breathing laboriously, with a dry burning skin; a red swollen face and eyes; a small quick and sharp pulse; parched and greatly furred tongue; and, as well as he could speak, complaining of headach, and of universal pains. On preparing to bleed him, he was found to have entirely lost the power of moving the right arm. He had, in the forenoon, attended the muster of the marines: but his messmates said that he had hardly eaten any thing for two days.

In my absence, the assistant-surgeon very judiciously took thirty-six ounces of blood from his arm, and then gave him six grains of calomel with twenty of jalap. At 7 in the evening, he repeated the bleeding to twenty ounces, and the medicine as before.

A little before 8 o'clock, I saw the patient literally panting for breath, with his skin of a burning heat; his pulse 100, regular, and full; and he had partly recovered the use of his arm. His medicine had had no effect.

In a horizontal posture, with his head rather raised, I drew away twenty ounces of blood from his arm. Before I had com

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