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of the cold fresh leaves of the sand-box tree, or cephalic vine, about the temples, and rubbing the arms with lemons, or limes, cut transversely.
"Indeed the salutary effect of calomel, and James's powder, where the latter is admissible (the state of the stomach, in this country, frequently prohibiting the use of any preparation of antimony) may in a great measure be referred to their cooling effects; for these medicines, by opening the bowels, and increasing perspiration, must tend to prevent the accumulation of morbid heat, as well as by removing congestions, on which the febrile heat depends. And I have never found it expedient to continue the use of either calomel or antimonials, in fevers, after the skin becomes soft; the tongue moist, and the belly open, unless with a view of preventing, or removing, topical affections of the viscera, which I am confident that bark, either too early or too copiously administered, is apt to give rise to, or to confirm."
To Dr. Robertson I am also indebted for some communications, made to him by Dr. Davidson, of St. Vincent's, of which the following is an abstract:
*' In 1791, and 1792," says Dr. Robertson,
** we had at St. Vincent's, a low nervous fever, which evidently seemed to be the offspring of contagion. It began in the- small island of Beguia, and it was alledged there to have been brought from Guadaloupe. One of my patients brought it from Beguia, and died on the 11 th day. Soon after, a brother of Dr. French, of St. Vincent's, was attacked with fever. The remissions were at first very evident, observing the double tertian type. The usual evacuations being premised, the bark was thrown in, but without any good effect, as it disagreed with the patient's stomach. All his symptoms increased, with delirium, subsultus tendinum, quick low pulse, dry skin, and great heat. The cold bath was administered. After drying the surface and putting the patient to bed, a dose of tincture of opium was given in warm wine and water. He got into a profound sleep, with profuse sweating, and next day was in a condition to take the bark. A repetition of the bathing completed the cure.
"I had three other cases at the same period 5 two of which were attended by my lamented and much esteemed friend, Dr. Mackie, of St. Vincent's, who despaired of their recovery. But the cold bathing proved successful in them all."
In these cases Dr. Davidson used cold bathing in the advanced stages of the fever. He however mentions, that the heat was still great, and the skin dry, and to these circumstances his success is no doubt to be attributed. In the malignant yellow fever, which raged in St. Vincent's, and the neighbouring islands, in 1793, Dr. Davidson changed his plan of administering the remedy, of which a more distinct account is contained in .a letter, which be wrote at that time, to Dr. Brown, of Baltimore, than in his letter to Dr. Robertson; and of which, as it is given iri an American publication of 1794, we shall therefore avail ourselves.
It appears, that Dr. Davidson, having heard of the great mortality in Philadelphia, in 17.93, from the malignant yellow fever, thought it might be useful to communicate his experience of the proper mode of treatment of a similar disease, which had recently occurred in St. Vincent's. "I have observed with uneasiness and concern," says Dr. Davidson to Dr. Brown, "that an epidemical fever, nearly similar to that which we have had in this island, for six months past, has appeared in Philadelphia. The disease, as it occurred with us, attacked with more violence, and proved more fatal, than I ever recollect to have seen in any
other other instance, during a residence of twenty-two years in the West Indies, and part of that time at St. Lucia, where I had an opportunity of seeing the fever among the troops, and sailors, in all its forms.
"Early in April, the yellow fever made its appearance, both on shore, and on board the shipping. The young, plethoric, and those lately arrived from a cold climate, were chiefly affected. The inflammatory symptoms ran high. Bloodletting, blisters, and gentle and constant purges^ answered at first; but in the farther progress of the disease, the weather still continuing hot, the marks of inflammatory diathesis became less eviand the pulse sunk on blood-letting, The vomitting did not appear on the first days, and sooner ended in black vomitting. We found it necessary to alter our practice; but I must candidly confess, that till I adopted the use of cold bathing, under the circumstances which indicated a typhus type, our endeavours to cure the fever were attended with little success. In the inflammatory state the disease was more at command, but in the other, the irritability of the stomach was such that we could not use tonics. Neither bark, wine, nor opium, could be retained. Upon a general review of the ill success which attended
the practice of the medical gentlemen in t^^ island, as well as in Grenada, and Tobago, I was inclined to try the effects of cold bathing, which I had used with success in the advanced stages of remittent fever. At first I tried the effects of cold bathing in the advanced stages of this fever also, but without success; but as every other plan equally failed, I began with the cold bathing in the commencement. Warm tamarind tea, or cream of tartar and manna beverage, was given immediately after the application of the cold bath, to excite sweating, and to open the body, if this last effect was not already produced by clyster; and the instant that a sweat appeared, bark, mixed with the beverage, was given in as large quantities as the stomach would retain, without paying any attention to the fever, or state of the patient's pulse. When, however, the stomach rejected the bark, and there appeared to be an increase of headach, heat, and other symptoms of febrile affection, I had again recourse to the cold bathing alone which was commonly repeated evening and mornings, till the patient was out of danger. JT am happy to announce, that this mode of treatment has been attended with the utmost success. The cold bathing seemed to take off the determination to the brain, to remove irritability, and to determine