Imatges de pàgina
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Though mercury had, in this manner, such commanding influence over the disease, still experience here was not always uniform, for there were several vexatious instances where it failed. I do not speak of the fatal cases (for in them neither laxatives, astringents, fomentations, blisters, opiates, mercurial frictions on the abdomen, nor calomel pushed to salivation, ever were able to keep off the unhappy event), but expressly of those few instances where the patients, after being apparently cured, relapsed without any evident cause (I may observe, by the way, that relapses are more frequent, and more generally fatal, in this disease than in any other), or where ptyalism mitigated the symptoms somewhat, perhaps even suspended the disease entirely, until the mouth was well, and then it returned with much of its pristine violence. The disease thus ran into the chronic form, and harassed the patient for weeks, or even months, with the various symptoms arising from a weak irritable condition of the primæ viæ, irregular, hepatic secretion, and imperfect formation of the chyme. The chief of these symptoms were, vomiting after meals, night-sweats, febricula, watching, pains in the lower belly, occasional tenesmus, frequent costiveness, followed by spontaneous diarrhea and discharges of blood, attended with frequent prolapsus ani and difficult micturition.

In conducting the cure, very delicate management was requisite; in fact the disease required rather to be led than driven. A regulated diet, and the use of flannel next the skin, were of the highest consequence. At the same time, the patient was put under a gentle and gradual course of calomel, taking two or three grains morning and evening, and rubbing in a por tion of mercurial ointment on the belly and right side. Laxatives and astringents were employed occasionally; but, above all, the greatest use was made of opium, both internally and locally, per anum, and it really effected most conspicuous benefit. Sulphate of zinc 1 now and then tried; but from the nausea

better; had passed a more tolerable night; had less tormina and tenesmus, and a cleaner tongue. I increased the dose to one scruple night and morning; and thenceforth his improvement was perceptible from day to day. The pyrexia soon abated; and, in ten days, his dejections, from being green and fetid, had recovered the natural yellow colour, or nearly so. No complaint remained but a sore mouth. The patient is now living and likely to live, a witness to the superior efficacy of this mode of treatment. The above is merely one of many instances where I have seen calomel work rapidly, and like a charm.

As a proof with how little apprehension calomel may be given to persons of all ages, I may state, that, to a boy of 14, one hundred and fifty-two grains were given, during the acute stage of a most dangerous attack of dysentery, before his mouth became fairly sore!! He fully recovered.

which it excited, even in three-grain pills, morning and evening, and from its apparent inefficacy in the disease, I should scarcely, in future, be tempted to give it further trials. The tonic power of Peruvian bark was very useful, both as an astringent to the bowels, and as a restorative to the whole system. When the mouth was recovered from the first gentle mercurial course, if the complaint had not yielded, I did not hesitate to use calomel again in the same gradual manner, till the gums were slightly affected, and then gave tonics as before. This assiduous perseverance, and the patient attention which it implied, I am happy to say, were well rewarded. Many patients were thus recovered from a state, not hopeless indeed, but very precarious, and were reestablished in firm health.

I have been thus minute on the subject of dysentery, seeing it was the principal disease by which we suffered. The practice above detailed was not merely my own, but was pursued, though perhaps with minute variations, by most of the medical officers of my acquaintance on this expedition.

I have before mentioned, that, besides dysentery, many cases of intermittent fever and scurvy occurred; in truth, the latter diathesis was often very conspicuous in the patients affected with dysentery. Of the intermittents I need not speak, as nothing remarkable took place in their symptoms, and they were all easily cured by the usual means. Of scurvy, however, from the great number of the cases, and the fatality of some of them, it is necessary that I should give some account. Besides the customary symptoms of livid blotches, bleeding gums, and a slow healing of the small cuts or scratches accidentally inflicted, phlegmonic inflammation and suppuration sometimes occurred spontaneously on the leg, followed, when the abscess burst or was opened, by sphacelation of the cellular substance. Often, too, trivial sores would change in a night, and take on ulcerative action, with extensive sloughing of the integuments and muscles, and a most profuse ill-conditioned discharge. When the mere loss of parts was so considerable as to render it impossible to save the limb, and the resource of amputation was called for, the case did not often end well; for the stump, after doing apparently well, degenerated without any evident cause, and was seized with sloughing, a black thin fetid discharge, and a general melting away of the muscles, until they were insufficient to cover the bone. Hectic fever and exhaustion gave the patient his last release.

In this formidable complaint, which may be denominated VOL. XII. NO. 46.

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sloughing scorbutic ulcer,' many remedies were employed, both internally and externally. The internal ones were limejuice, bark-mixture, and mineral acid; but it would appear that the former, though adequate to correct a mere proclivity to scurvy, has little or no power in these more advanced and serious states of the disease. In fact, it was not to be so corrected; it was not merely vegetable acid, but esculent vegetables, fruits, refreshments, and repose, that were necessary. It was purely from the want of these that the people had suffered; for neither crowding, impure air, nor filth, had any existence in situations where this form of scurvy often appeared.

Equal parts of basilicon and oil of turpentine (melted and applied warm to the ulcer), mixtures of lime-juice, or rum and water, charcoal cataplasms, common poultices, bark decoctions, or bark in powder, were employed as outward applications to a sore; but though they kept it cleaner, they were often of no avail to arrest the sloughing process. A solution of two drachms of alum, in about a quart of water, was, upon the whole, an admirable local remedy, and seemed to possess wonderful powers in stopping the ravages of sphacelus, and giving a healing tendency to spreading ulcers. For the knowledge of this application, which is not more simple than efficacious, I am indebted to the liberality of Mr Boyd, surgeon of the Gorgon hospitalship, a gentleman of uncommon ability and experience in every department of the profession. *

The detail of this season of peril and pressure closes here. It, commenced about the middle of January, and its painful duration was upwards of two months. During the last week of March and first week of April, the main part of the expedition finally left those shores; therefore the observations I am about to make on fever, apply less to the armament in general, than to the force (chiefly naval) that was obliged to remain in the Gulf of Mexico for several weeks after the rest had proceeded home.

The frosts and cold rains which had lately prevailed on this coast were now at an end, and the weather rapidly mounted to the average standard of the torrid zone. During April and May, the thermometer was never below 80°, and often indeed rose much higher. This greatly augmented temperature soon began to tell on the people, and gave rise to many cases of cholera and of ardent fever,-the latter entirely confined to those who had previously been serving on shore, or exposed much to

*I trust Mr B. will excuse this unauthorized citation of his name and authority.

the sun and night dews while pulling in boats on the const, or in the river of Apalachicola. Of the former disease, not one instance, so far as I know, proved fatal. Large doses of ca. mel, with opium, and plenty of mild diluents, constituted the whole of the treatment. In ardent fever, however, the success, though great, was by no means so uniform. I here propose to throw together a few general remarks on this much agitated disease. To treat of it circumstantially, even were the limits of this communication to admit such detail, would, after the excellent works lately published on the subject by Dr Bancroft and others, be entirely a piece of supererogatory labour.

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In the Gulf of Mexico, the features of this fever were precisely such as I have been accustomed to see in the kausus, yellow-fever, so well known in other parts of this great western archipelago. It had the same premonitory and leading symptoms, the same proneness to excessive arterial action, irregu lar local determinations, and topical congestions of blood, with the same rapid and decided tendency to death. It was indeed a most formidable disease, and verified all that has been written about its danger. In the milder cases, one in five or six is about the proportion of deaths; but, in the highest grades, if one half survive, it may be considered success!

Modern medicine has nothing of which it can boast, with greater justice, than the improvement of late years introduced into the treatment of this disease; an improvement which has apparently given more enlarged views of febrile diseases in general, and communicated an analogical impulse of boldness to the treatment even of European fevers, which it never had before. The contrast abroad betwixt the present and the olden time,' is sufficiently striking. The imaginations of professional men in tropical climates, were formerly held in subjection by that bugbear debility, and its train of needless terrors. Systems of nosology had been pleased to style the disease in question Typhus icterodes; consequently active depletion was carefully shunned. The practitioner stood comparatively an idle looker-on during the early stage, prattling about the vis medicatrix naturæ, and fidgeting with his calomel and his James's powder. The disease, of course, took its hue from the species of treatment employed at first. The neglect of evacuations allowed the excitement to riot and revel unchecked; hence came petechiæ, vibices, hæmorrhages, and the rest of the direful con

Why is this word usually spelt with an initial C, since we all know it is derived from the aorist of the verb xaiw, xavow, xixxvxa, uro?

sequences of overaction; then, indeed, the disease was pronounced malignant, pestilential, and highly putrescent, and the golden opportunity arrived for throwing in (as the phrase is) his bark, wine, and orium, against that debility about which, at a wrong time, he was over solicitous.

That cabalistical word typhus, I verily believe, has slain its thousands and its tens of thousands. The effect of a mere word is often prodigious; for, as the famous Mirabeau once said in the French National Assembly, words are things;' terms signify ideas, these constitute opinions,—and opinions lead to acts. Every body is now convinced how improperly the term Typhus is affixed to the endemic fever of the West Indies; that it is applied with more propriety to the majority of fevers in our own country, is to me by no means clear. While I acknowledge that, in the made-up constitutions of artificial life,-amidst the squalid dregs of the population of a crowded and high-viced metropolis,-some cases of fever occur where the brain labours merely through sympathy with the stomach and biliary organs, and where the lancet, for several reasons, is unnecessary, or inadmissible.still in by far the greater part, I suspect the reaction is sufficiently violent. and the determination to the contents of the head and belly sufficiently marked, to require, and to be greatly benefited by, blood-letting, either general or topical, or both. The fever, however, is apt to be hastily pronounced typhus; and this sentence once passed upon it, typhus it must be: consequently, from day to day, the name of a disease is prescribed for with due solemnity and skill. To be sure, the morbid actions are fortunately seldom so concentrated as to resist the subordinate evacuations of purging and blistering; and so the patient frequently recovers in the end, after a protracted illness, which he, good easy man,' thinks has been quite unavoidable; charitably supposing all's well that ends well.' Even if we keep out of view the high moral responsibility for risks run, and sufferings protracted, which this inert treatment implies,— even if we speak of it with mildness,--we cannot, in conscience, bestow on it any other than the negative commendation, that by its effects neither the patient loses his life nor the practitioner his reputation!

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The same erroneous nomenclature which gave to ardent fever a typhoid character, in all likelihood originally produced the notion of its being contagious, a notion which has since been attempted to be maintained by a combination of learning and sedulous talent, that, by plausible reasonings and expertly laying hold of popular opinion, has sometimes had power to make the worse appear the better reason.' But the affinity which

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