Bleeding rendered the action of the mercury upon the mouth more speedy and more certain, but I saw several cases in which a salivation was excited in the most malignant forms of the fever, where no blood had been drawn. It will not be difficult to explain the reason of this fact if we recur to what was said formerly of the prostration of the system in this fever. In its worst forms, there is often a total absence, or a feeble degree of action in the blood-vessels, from an excess of the stimulus of the remote cause of the fever. Here the mercury meets with no resistance in its tendency to the mouth. Bleeding in this case would probably do harm, by taking off a part of the pressure upon the system, and thereby produce a re-action in the vessels, that might predominate over the action of the mercury. The disease here does that for us by its force, which, in other cases, we effect by depleting remedies.
Where the mercury showed a disposition to pass too rapidly through the bowels, I observed no inconvenience from combining it with opium, in my attempts to excite a salivation. The calomel was constantly aided by mercurial ointment, applied by friction to different parts of the body.
Now and then a salivation continued for weeks and months after the crisis of this fever, to the great distress of the patient, and injury of the credit of mercury as a remedy in this disease. Dr. Physick has discovered, that in these cases the salivation is kept up by carious teeth or bone, and that it is to be cured only by removing them.
From the impracticability of exciting a salivation in all cases, I attempted the cure of this fever, after bleeding, by means of copious sweats. They succeeded in several instances where no other remedy promised or afforded any relief. They were excited by wrapping the patient in a blanket, with half a dozen hot bricks wetted with vinegar, and applied to different parts of the body. The sweating was continued for six hours, and repeated daily for four or five days.
In those cases where the fever put on the form of an intermittent, I gave bark after bleeding and purging with advantage. I gave it likewise in all those cases where the fever put on the type of the slow chronic fever. Laudanum was acceptable and useful in many cases of pain, wakefulness, vomiting, and diarrhœa, after the use of depleting remedies.
I applied blisters in the usual way in this fever, but I think with less effect than in the yellow fevers of former years.
To relieve a vomiting, which was very distressing in many cases about the fourth and fifth days, I gave a julep, composed of the salt of tartar and laudanum. I also gave Dr. Hosack's anti-emetic medicine, composed of equal parts of lime-water and milk. I do not know that it saved any lives, but I am sure it gave ease by removing a painful symptom, and thus, where it did not cure, lessened the sufferings of the sick.
The diet and drinks were the same in this fever as they were in the fevers formerly described.
Cool air, cold water, and cleanliness produced their usual salutary effects in this fever.