As soon as the system is properly prepared for the use of the bark, it may then be given in such doses as the stomach will bear, and at such intervals, that six or eight doses may be taken during the intermission. Should it disagree with the patient in substance, give it in some other form, as the cold infusion, decoction or tincture. See Dispensatory

In the mean time, strict attention must be paid to the habit of body: for in vain shall we expect to cure intermittents, if the bowels be not kept open and the skin moist.

When, therefore, the Peruvian bark produces costiveness, five or six grains of rhubarb, or some mild purgative, should be added to each dose; and in case of cold phlegmatic habits, with a dry skin, the addition of ten or fifteen grains of Virginia snake-root is peculiarly proper.

In some constitutions the bark produces severe and copious purging. This debilitating effect may be prevented by adding five or six drops of laudanum to each dose. And when the patient is troubled with sourness on the stomach, flatulence and pain, take the bark in lime water, or conjoin with each dose, eight or ten grains of salt of tartar, or magnesia.

Notwithstanding every precaution, the bark will not sometimes remain on the stomach, and with children it is often difficult for them to swallow this medicine. With such patients it should be employed externally as directed below.+

Some patients are subject to profuse sweats, from debility. In such cases the bark should be united with a few grains of the rust of steel, or ten or fifteen drops of elixir vitriol, and taken in wine. But when these evacuations proceed, as they often do, from an inperfect cure, accompanied with great and intense heat, during their prevalence, we must immediately resort to the preparatory remedies, as blood-letting, cathartic and diaphoretic. Sometimes the fever will not yield to the bark, even

†Take a piece of Holland, cut in form of a waistcoat, and for the lining, get humhums of an open texture. Between these cloaths, from three to six ounces of bark must be closely quilted, and then the waistcoat applied on the naked skin. Every two or three days, it will be necessary to rub the jacket between the hands. It is sometimes proper to unite snake-root with the bark, in proportion of one ounce of the former to four of the latter,

when all the usual preparatory medicines have been employed. In such cases we may justly suspect the liver to be diseased, particularly if the countenance be either livid, or pale, or of a yellowish cast; and in that event, the use of the bark should be suspended until those obstructions be removed.

For this purpose one of the mercurial pills should be given. night and morning, until ptyalism, that is, a soreness of the mouth with increased spitting, is produced, which will generally succeed; and when it fails, the nitric acid diluted, and given in its usual doses may be depended on. After a ptyalism is effected, recourse must be had to one or other of the strengthening remedies, to give tone to the system.

From the tenor of these observations it follows, that the Peruvian bark is not a remedy to be employed in every case of intermittent fevers, but that much caution is necessary in the use of it, lest it be turned into abuse. For unless the system be properly prepared by suitable remedies, the administration of bark, or any other tonic, is an error fraught with the most serious mischief.

The Peruvian bark being so costly and not always to be had pure, it must afford much pleasure to the benevolent, to learn that the black oak bark of America possesses the same virtues of the Peruvian, as has been verified by repeated experiments, not only in the cure of intermittents, but other diseases hitherto treated with the Peruvian bark alone. It may be taken in the same manner, only in rather larger doses. In substance it is most efficacious, and if well pulverised it will be found more palatable than the Peruvian bark, and not so apt to excite vomiting.

Another mode in which this remedy may be employed to great advantage, from its abundance in our country, is by bathing twice or thrice a day in a strong decoction of it; which to children, and patients whose stomacks will not retain medicine, will prove exceedingly beneficial. When the black oak

*See Dispensatory.

bark is not convenient, the red oak bark, though less efficacious, should be substituted, as I have often witnessed the happiest effects accruing to debilitated persons bathing in a strong decoction of it, about lukewarm, particularly in the last stage of fevers. Hence this remedy well deserves the attention of the planter.

Professor Barton assures us that he has employed the bark of the Spanish oak in gangrene, with the happiest effect, and that he considered it, in powder, equal to the best Peruvian bark. See ОAK. Materia Medica.

The common dog-wood bark, of our country, is also an excellent substitute for Peruvian, particu arly in the cure of intermittents; so is the bark of the wild cherry-tree, and of the lyriadendron tulipifera, or American poplar, all of which may be given in the same forms and doses, as the Peruvian bark. See Materia Medica.

The columbo root, an admirable corrector of bile, is a most useful medicine in this complaint, and will often be retained by the stomack, when the bark in every form has been rejected. It is likewise an excellent remedy, joined with steel, as in the form of the tonic powders or pills,* for patients disposed to be dropsical, or who have a swelling and hardness of the spleen, called ague cake; especially if a purge or two have been previously employed, and some mercurial action excited in the system, by one or two grains of calomel, taken every night and morning for a few weeks.

Another valuable medicine in the cure of agues, and which has frequently succeeded when the bark failed, is white vitriol. But like other tonic medicines, it requires that the stomach and bowels should be freed of their morbid contents, before any good effects can result from its use. Therefore, some evacuating medicine is always necessary; after which, one of the vitriolic pills* may be given every three or four hours during the intermission of fever, gradually repeating the dose, or increasing it, as the system becomes habituated to its action.

*See Dispensatory.

Charcoal powder in doses, from a tea to a table spoonful given three or four times during the intermission, has often interrupted the expected paroxysm and cut short the disease.

A scruple of the spider's web, it has been said, in many instances hath proved successful, given an hour before the fit of an ague and an hour after it.

But among the remedies of intermittents none is more infallible than the solution of arsenic, which may be given with perfect safety to persons of every age, beginning with the smaller doses, and proportioning them to the age of the patient.

Stimulants administered before the fit, by inducing a salutary change in the system, have frequently overcome the disease. It is in this way that emetics are considered useful in the coming on of the fit, so is active exercise, and other stimulants. Cataplasms of mustard seed and garlic, or horse radish, applied to the wrists and ankles an hour or two previous to the unexpected fit, will excite a degree of inflammation so great as to increase the heat as well as the circulation, and have often succeeded.

I have frequently, in obstinate intermittents, prevented the recurrence of the fit, by giving a large dose of laudanum or æther about an hour before the expected paroxysm. But when an inflammatory disposition prevails in the system, this remedy should not be resorted to, as it may convert the intermittent into a continued fever.

An emetic given previous to the return, while the perspiration is supported by the volatile alkali or Dover's powder* in their usual doses, with warm drinks, have also succeeded in obstinate cases. It should be observed, however, that when we attempt to prevent the paroxysm of an intermittent by sweating, this mode of relief must be continued till the period of the paroxysm is at an end; or at least till the time when the sweating stage would have otherwise commenced.

Those means which excite terror, surprise and horror, by producing a train of new emotions will prevent the return of

See Dispensatory.

paroxysms. A man has been pushed into the water; fire has been cried; the most distressing tidings invented and communicated. All these remedies fill the mind with such dread as to counteract the impression of the cause; but in general they are dangerous, and when we wish to prevent the fit, we depend rather on tonics, the stimulants, and the sudorifics.

Dr. Kellie, an ingenious surgeon of the British navy states, that many instances have occurred of the good effects of compression by tourniquets or bandages applied so as to obstruct the circulation in two of the extremities. The plan pursued by him was to apply the instrument on one thigh, and on one arm, of opposite sides, at the same time. In two minutes after the application of the tourniquets, the shaking and other symptoms of the cold stage entirely ceased, a mild hot stage was immediately induced, and the patient found himself quite relieved. After suffering the instruments to remain on for about fifteen minutes, they were removed, and the cold symptoms did not return. He further states, that, if the tourniquets be applied previous to the accession of the paroxysm, the cold stage will entirely be prevented; and that, where the cold stage of an ague is either thus shortened, or altogether prevented, the following hot stage will be rendered both milder and of shorter duration.

As agues are liable to recur, one excellent mean of prevention, as well as cure, is to wear flannel next to the skin, and to exchange the situation where the disease was contracted, for another, even though not of a healthier air. This alone has often effected a cure. In like manner a change of medicines is as necessary as a change of air, that the body may not become habituated to any one mode of treatment. Therefore, it ought to be remembered, that neither bark nor any other tonic medicine, should be continued longer than a fortnight at a time, but should be changed for another article whose virtues are nearly the same. After a week or two, the former may be resumed, in case the disease should prove obstinate; and to bring about the necessary changes in the constitution, larger doses should be given.