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As there were many unexpected deaths from the hydropie complaints, so there were several very unexpected recoveries from this. Of this I could relate many examples. This recovery, however, appeared the more extraordinary, when we compared the dreadful rayages the disease had made on those who died of it. On inspecting their bodies, the larger intestines were almost always inflamed, thickened, covered with ulcers, and in many places sphacelating.
Icterus very frequently appeared as a symptom of this disease, but was scarcely ever observed as an original complaint. It even appeared in one instance, where the patient was undergoing a slight salivation, and what was most remarkable, there was no appearance of any bilious effusion until the mercury began to act. It also subsided in a ratio corresponding with the disappearance of the salivation. This case shews more fully the peculiar action of mercury on the liver.
Another very troublesome symptom of this disease was ardor urina. Many were so much afflicted with this complaint, as to discharge frequently a quantity of blood either immediately before or after micturition. Large round worms from six to twelve inches long were often voided by vomiting. These had often induced the most distressing symptoms.
These were the most common forms of this Proteus-malady, for a more particular account of which, I must refer to Dr. Dayis's Treatise, and shall now beg leave to proceed with 2 cursory view of the means which were used to counteract its progress. Jei tainer
TREATMENT OF THE WALCHEREN FEVER. As the disease appeared under so many different forms, the treatment was, of course, various, for which reason s shall follow the three forms mentioned above. & art is the time Intermittents and Remittents, &c. ** ?? In these complaints it was usual first to exhibit a cathartic,
and afterwards to administer the bark in such quantities as the stomach would bear, either in substance, decoction, ex.. tract or tincture. This supposed specific frequently succorred, but it also frequently failed when unassisted by other remedies. When, however, it was given at the same time with calomel and occasional cathartics it proved highly usca ful, especially in all those cases where visceral disease seemed io crist. When the patient underwent the slightest salivation, the paroxysms, during the mercurial action, were completely suspended, but as soon as the ptyalism began to
subside, so soon did the paroxysms again recur, and often with greater violence than formerly. This fact became familiar to every medical officer present. '
The sulphate of copper and zinc were both frequently tried, but without the desired effect; the former sometimes, however, changed the type of the disease from quotidian or tertian to continued fever, with sickness, vomiting, and not unfrequently delirium. The latter was used in combination with the extract of cinchona as a general tonic, and in this way was found often useful after the paroxysms had subsided, and great debility remained. It was not, however, found to check the regular paroxysm, although often given with that intention. When the discase became continued, and either threatened or assumed the typhoid appearance, antimony and aromatic confection were used with success. In this case, camphor and ammonia were also very efficacious remedies. Yeast was likewise used in many desperate cases with the best effect. By this alone I have often seen patients recover when their bodies were covered with petechiæ, and when syngultus had subsisted for two or three days, and the stomach rejected every thing, even wine. Nitric acid was found very useful in almost all those cases in which mercury had been exhibited, and after the action of which the paroxysms bad again returned. In these cases it not unfrequently effected a cure either alone, or given in some bitter decoction. Opium, either with or without æther, given in large doses at the approach of the fit, always shortened the cold stage, and often completely subdued the paroxysm. Venesection was also often found useful when the disease was combined with pulmonic affections, which very frequently happened. I used this remedy very often, and must confess without ever observing the least injurious consequence, but on the contrary the most speedy relief... :
The objections which were most frequently urged against this most extensive and potent remedy (as Haller calls it) i were that, as debility was the most prominent feature of the disease, the abstraction of blood under such circumstances appeared paradoxical. This reasoning at first appeared satisfactory in theory, but not in practice, as I was snfficiently convinced. Its salutary effects, I think, may be thus explained. The men when apparently free from disease, but in a very weak and debilitated state; were often unavoidably * exposed to the vicissitudes of weather, and were very liable
to be affected with the slightest change of any kind, in their languid state. This immediately produced a relapse, which in general was attended with inflammation of some of the vismera. This conclusion is sulficiently warranted from the de
predations made on these organs, as the subsequent dissections will amply shew.
The symptoms were pyrexia, pain of the head, dificult respiration, troublesome cough, and pains of the sides or breast, but more frequently the latter. In this state I immediately used the lancet, which, in general, gave so much relief, as seldom to require a repetition. Diluents and laxatives were now continued for some days, till the inflammatory diathesis seemed subdued, then in the convalescent stage aromatics and bitters were found highly useful, and soon completely restored the enervated frame.
When lately perusing Sydenham, I found that the practice in some measure coincides with that laid down by that experienced physician in the treatment of chlorosis. In this disorder, though in general considered a disease of debility, he found that the most successful mode of treating it was, by commencing the cure with the loss of some blood, and afterwards administering tonics.
Haller, and Sir John Pringle, mention also a similar prace tice in intermittents--but to return. I have also tried the effects of ligatures on the extremities, with a view to check the fit, but never observed any beneficial result except in one case, where imagination and not the ligature appeared to produce the effect; the particulars of which were as follow. Going into a Ward where the experiment had not been made, and finding a man shivering horribly with gnashing teeth, Í requested the Orderly to bring me a tourniquet. As soon as it entered the Ward, the patient's eyes were fixed on it, and he began, as he afterwards informed me, to wonder what I was about to do with him. I now proceeded to fix it on his arm, when the paroxysm immediately subsided, and the subsequent hot stage was very slight from the short duration of the cold. I afterwards tried it repeatedly, screwing one on opposise extremities, but without the least effect.
Epithems of nicotiana were also used with the same intention, but seldom produced any good effect, and if continued for any length of time, they did much mischief by the sick. ness and vomiting which they produced.
Treatment of the hydropic complaints. These were only another form or stage, and consequence of the original disease. Debility, and consequent loss of tone of the absorbent and exhalent vessels, which is the proximate cause of this disease, were the effects of the former. In this, as well as the last, a variety of remedies were had recourse to, the chief of which were squills, digitalis, submuriate of mercury, acetate of potash, nitrate of potash, and
the the supertartrate of potash; elaterium, horseradish, mustard, and camboge were also frequently used with success. By the use of these separately, or in combination, the greater number were evacuated of the superabundant fluid, and the cure was completed by the administration of decoctions of quassia, serpentaria, senega, and other bitter and astringent tonics. None of these remedies operated with so much effect, or with such immediate relief to the patient, as those which possessed both a purgative and diuretic quality. Of these camboge and elaterium were the chief. They were often used with remarkable success, especially the former.
In all cases where the disease attacked suddenly, causing considerable distension of the abdomen with edema of the legs, its exhibition was attended with the greatest success, one dose being, in general, sufficient for the evacuation of the water. It often produced vomiting, purging, and copious diuresis.
The patients thus suddenly relieved, were seldom observed to relapse into a similar state, as mentioned by authors, after the administration of these drastic hydragogues, but this might be, in part, owing to the tonics and bitters which were always exhibited after the evacuation of the water. * There were a few cases, in wbich the patients being nearly exhausted by the continuance of the disease, the use of these remedies was probibited. Some of these were tapped as a dernier resource, but the fluid soon collecting again, eventu. ally proved fatal. Others, of several months continuance, were speedily relieved by the spontaneous occurrence of a diarrhæa or dysentery, which, in general, however; proved fatal. Of this I could mention several examples, but one will suffice.-Johines was first attacked with the fever, from which having recovered, he was discharged. Soon after he relapsed, and was now attacked with a violent pneumonia, which was, with some difficulty, subdued, by the loss of between forty and fifty Ounces of blood, and other proper res medies. Being again convalescent, he was afflicted with a dropsical complaint ; he swelled to an amazing size, and continued so for five or six months in despite of all our hydropic remedies.. About this time he was first seized with a diarrbæa, which, by continuance, degenerated into a dysentery, and of which he died four or five days after its appearance, completely destitute of any dropsical complaint.
With respect to the dysenteric affections, which form the third most common termination of this malady ; it did not appear to be contagious, but originated sporadically in dif
ferent parts, and seldom or never infected those in the same -- Ward with the patient. It was, indced, sometimes induced
by by the accumulation of putrid animal effluvia, of which the following are sufficient examples :
Mr. B. surgeon, was in the habit of dissecting much, and making anatomical preparations. The room in which he dissected and kept his preparations, adjoined and opened into that in which he slept. Another medical collegue whoattended some of these dissections, brought his child once or twice with him to this anatomical theatre. It was seized in a day or two after with dysentery and died; the body was inspected and left no doubt of the disease. Mr. B. continuing his investigations, was soon after attacked with the same complaint, which remained very violent for several days, notwithstanding every means were used to check its progress. Soon after, finding no abatement, he was removed from this room to other lodgings, where the disease abating, he soon recovered.
These cases show that it arises, in general, more from pus trid animal effluvia, than from any peculiar matter generated during the progress of the disease.
The treatment pursued in this disease was varied accord. ing to symptoms; laxatives were often given in the commencement or inflammatory stage. When it resisted these, opium and compound powder of ipecacuanha were found very efficacious; infusions of rhubarb and small doses of ipecacuanha were also useful. When the pain of the abdomen was very great, a blister applied to the bypogastric region, often relieved very desperate symptoms. In one instance, in which the complaint bad continued very violent for several days, resisting every means that could be devised, the patient was seized with vomiting, which returned on the intro. duction of any thing into the stomach, and thus prevented the exhibition of any medicine in this way. Injections of opium and starch were often given him without any beneficial effect. In this desperate state, a large blister was applied to the lower part of the abdomen, which drawing well, he was found next morning, free from both purging and vomiting. From this time he soon recovered without any other medicinc, except a few occasional doses of Dover's powder. Flannel rollers were also found useful for the support of the abdomen against that distressing symptom tenesmus.
In some iustances where the disease assumed a chronic form, mercury was used, but never having witnessed its effects in such cases, I am unable to speak decisively with regard to its success.
Having thus completed my remarks with regard to the cure, I now proceed to point out the ravages the disease en