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112

INTERMITTENT FEVERS, &c.

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such importance, that they often cure intermitting fevers withoutthe assistance of any other medicine.

Purgative medicines are likewise useful and often necessary inintermitting fevers. Emetics, however, are more suitable in thisdisease, and render purging less necessary ; but if the patient beafraid to take a vomit, he ought in this case to cleanse the bow-els by a dose or two of Epsom salts, jalap, or rhubarb, as may ap-pear best adapted to the constitution.

Bleeding may sometimes be proper at the beginning of an in-termitting fever, when excessive heat, delirium, &c. give- reason tosuspect an inflammation or congestion of blood in the external ves-sels of the head ; but as the blood is seldom in an inflammatorystate in intermitting fevers, this operation is rarely necessary.When frequently repeated, it tends to prolong the disease.

After proper evacuations, the patient may safely use the Peruvi-an bark, which may be taken in any way that is most agreeableto him. No preparation of the bark seems to answer better thanthe most simple form in which it can be given, viz. in powder. Itmay also, as required, be advantageously combined with other sub-stances, as, confection of opium, rhubarb, cinnamon also, in anyform ; e. g. in powder, etectuary, tincture, decoction, extract, &c.

Two ounces of the best Peruvian bark, finely powdered, may bedivided into twenty-four doses. These may either be made intoboluses, as they are used, with a little syrup of lemon, or mixedin a glass of red wine, a cup of camomile-tea, water-gruel, or anyother drink that is more agreeable to the patient.*

In an ague which returns every day, one of the above closes maybe taken every two hours during the interval of the fits. By thismethod, the patient will be able to take five or six doses betweeneach paroxysm. In a tertian, or third day, ague, it will be suffi-cient to take a dose every third hour, during the interval, and ina quartan every fourth. If the patient cannot take so large a doseof the bark, he may divide each of the powders into two parts, andtake one every hour, &c. For a young person, a smaller quantityof this medicine will be sufficient, and the dose must be adaptedto the age, constitution, and violence of the symptoms.t

The above quantity of bark will frequently cure an ague ; thepatient, however, ought not to leave off taking the medicine assoon as the paroxysms are stopped, but should continue to vise ittill there is reason to believe the disease is entirely overcome.Most of the failures in the cure of this disease are owing to pa-tients not continuing to use the medicine long enough. They aregenerally directed to take it till the fits are stopped, then to leave

* It has lately been observed, that the red bark is more powerful than that which hasfor some time been in common use. Its superior efficacy seems to arise from its be-ing of a more perfect growth than the quill-bark, and consequently more fully impreg-nated with the medical properties of the plant.

t In intermitting fevers of an obstinate nature, I have found it necessary to throwin the bark much faster. Indeed, the benefits arising from this medicine dependchiefly upon a large quantity of it being administered in a short time. Several ouncesof bark given in a few days, will do more than as many pounds taken in the course ofsome weeks. When this medicine is intended either to stop a mortification, or cure anobstinate ague, it ought to be thrown in as fast as the stomach can possibly bear it.Inattention to this circumstance has hurt the reputation of one of the best medicine*»f which we are in possession.