Note 16 — Chapter I

Thus Dr. Stoker states that the remedies “may be arranged according to their relative importance in the treatment of fever, in the following order; viz. In mixed fever, 1. Cleanliness. 2. Ventilation. 3. Cool regimen. 4. Plentiful dilution. 5. Purgatives. 6. Topical bleeding. 7. Antimonial or James’s Powder. In Typhoid Fever. 1. Yeast or barm. 2. Wine. 3. Aperients. 4. Emetics. 5. Blisters. 6. Tepid or cold affusion. 7. Peruvian bark.”—Pathological Observations &c., p. 111. In neither of these catalogues is general bleeding mentioned at all: in the first, topical bleeding is mentioned, but it is placed the last but one in the list, while in the second, allusion even to topical bleeding is wholly omitted. And Dr. Clanny states that the first proposition relative to the cure is how to restore sanguification, or how to afford fresh chyle to the blood; that although in full habits, at the commencement of typhus fever, general blood-letting is often attended with good effects, yet we should remember that if we take one ounce too much, we may thereby prevent sanguification altogether; that therefore it is better to have a sufficient quantity of lymphatic blood in the system them to run the risk of having too little of the pabulum vitæ, for the purpose of carrying on the functions of life, and that in fact venesection is not called for in nine cases out of ten of typhus fever. Let me caution young practitioners, he adds, against the repeated use of the lancet, when the buffy coat shews itself, for in many cases, which have come under my notice, I have observed the buffy coat to be present after repeated bleedings, AND WHICH COULD NOT BE ATTRIBUTED TO ANY OTHER CAUSE THAN DEBILITY.—Lecture on Fever, pp. 21–2–3.