Purging medicines are likewise useful and often necessary in intermitting fevers. A smart purge has been known to cure an obstinate ague, after the Peruvian bark and other medicines had been used in vain. Vomits however are more suitable in this disease, and render purging less necessary; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bowels by a dose or two of Glauber’s salt, jalap, or rhubarb.
Bleeding may sometimes be proper at the beginning of an intermitting fever, when excessive heat, a delirium, &c. give reason to suspect an inflammation; but as the blood is seldom in an inflammatory slate 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 Peruvian bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder.
Two ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient[[59]].
In an ague which returns every day, one of the above doses may be taken every two hours during the interval of the fits. By this method the patient will be able to take five or six doses between each paroxysm. In a tertian or third-day ague it will be sufficient to take a dose every third hour during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms[[60]].
The above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to patients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave it off, and begin again at some distance of time; by which means the disease gathers strength, and often returns with as much violence as before. A relapse may always be prevented by the patient’s continuing to take small doses of the medicine for some time after the symptoms disappear. This is both the most safe and effectual method of cure.
An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of camomile-flowers, and an handful of coriander-seed, all bruised together in a mortar, may be used in form of infusion or tea. About half an handful of these ingredients may be put into a tea-pot, and an English pint of boiling water poured on them. A cup of this infusion drank three or four times a day will greatly promote the cure. Such patients as cannot drink the watery infusion, may put two handfuls of the same ingredients into a bottle of white wine, and take a glass of it twice or thrice a day. If patients drink freely of the above, or any other proper infusion of bitters, a smaller quantity of bark than is generally used, will be sufficient to cure an ague[[61]].
Those who cannot swallow the bark in substance, may take it in decoction or infusion. An ounce of bark in powder may be infused in a bottle of white wine for four or five days, frequently shaking the bottle, afterwards let the powder subside, and pour off the clear liquor. A wine glass may be drank three or four times a day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of the bark, and two drams of snake-root bruised, with an equal quantity of salt of wormwood, may be boiled in a quart of water, into an English pint. To the strained liquor may be added an equal quantity of red wine, and a glass of it taken frequently.
In obstinate agues, the bark will be found much more efficacious when assisted by brandy, or other warm cordials, than taken alone. This I have had frequently occasion to observe in a country where intermittent fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aromatic. When the fits are very frequent and violent, in which case the fever often approaches towards an inflammatory nature, it will be safer to keep out the aromatics, and to add salt of tartar in their stead. But in an obstinate tertian or quartan, in the end of autumn or beginning of winter, warm and cordial medicines are absolutely necessary[[62]].
As autumnal and winter agues generally prove much more obstinate than those which attack the patient in spring or summer, it will be necessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an intermitting fever in the beginning of winter, ought frequently, if the season proves rainy, to take a little medicine, although the disease may seem to be cured, to prevent a relapse, till the return of the warm season. He ought likewise to take care not to be much abroad in wet weather, especially in cold easterly winds.