A clinical treatise on the endemic fevers of the West Indies : intended as a guide for the young practitioner in those countries / by W.J. Evans.

  • Evans W. J. (William Julian)
Date:
1837
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on the endemic fevers of the West Indies : intended as a guide for the young practitioner in those countries / by W.J. Evans. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    slight, and the use of quinine afterwards effects a cure. It does not always happen that the disease is conquered so easily; the symptoms, on the contrary, sometimes continue; the pa- tient is as ill on the third day as he was before. We then, by comparing the obstinacy of the symptoms with the active measures employed, prognosticate a fatal result, in spite of everything we can do. But we must always bear in mind this comparison, because the disease may continue either in consequence of our efforts not having been sufficiently ener- getic, or because we have combined them with others which have counteracted the good effects which we might have otherwise obtained—I mean calomel and purgatives. The British practitioner is haunted with these medicines; he is often nervous and fretful if he has not removed the consti- pation which is occasionally almost invincible by the whole class of purgatives, and only gives way with the disease. He thinks one dose of calomel, at least, should be tried ; it can do no harm, he says; but it does do harm, and not unfre- quently has turned the scale in the wrong direction. If, there- fore, any of these reasons have prevented the patient from feeling relief on the third day, we must act accordingly; if he require bleeding from the arm, we must bleed him, but local bleeding is now preferable; forty or fifty leeches should be applied to the stomach, and repeated as often as necessary; fomentations should be kept constantly on the ab- domen, the flannels piled up if the patient can bear them, if not, warm-baths may be substituted. Should the intempe- rate use of purgatives have been the cause, they must be discontinued. Towards the close of the third day, or beginning of the fourth, and all through the latter, a change for good or evil can generally be observed. If the patient is to die, the pulse becomes smaller, the fever is less violent, the skin becomes cool, or positively cold ; the patient is restless, and the vomit- ing continues ; mucus is thrown from the stomach, and the straining is great; there is often a sense of burning in the stomach, the inflammation of the organ has reached its maxi- mum, and the circulation is determined, and concentrated