In Typhus and Typhoid Fevers, Calomel has been said to exercise a powerful and beneficial influence. It has been asserted that under its use the secretions assume a normal character; that the nervous system is soothed and calmed; the mouth, which was before parched, dry, and loaded, becomes clean and moist; that if diarrhoea be present, it is checked; and should the fever be complicated, as it frequently is, with gastrointestinal inflammation, that it subdues and relieves it. Its mode of operation is chiefly constitutional; its minor effect is upon the abdominal viscera. It was first employed in 1806 by Autenrieth, and its value was admitted by Drs. Armstrong, Elliotson, Copland, and other authorities. The idea, however, of administering Calomel or any other mercurial with the intention of producing its specific effect on the system, in either typhus or typhoid fever, is well-nigh exploded in the present day. The theories on which the practice was founded, together with the practice itself, are completely abandoned by English physicians. In the early stage of Typhus and of Relapsing Fever, a Calomel purge may be admissible.
1378. In uncomplicated Intermittent Fever, Mercury in any form is generally uncalled for, unless as a purgative at the commencement of the attack, when it may be advantageously com-
* Med. Times, op. cit. p. 213.
Lectures, vol. i. p. 234.
bined with. Pulv. Jalapae. When, however, hepatic congestion accompanies the fever, Quinine will often fail to develop its powerful anti-periodic virtues, until this state has been removed by the exhibition of mercurials; and when the fever becomes complicated with visceral inflammation, the latter may require Calomel and Opium, in the manner laid down when treating of acute inflammation.
1379. In the Remittent Fevers of the Tropics, and of India in particular, active treatment is necessary, or a fatal termination will ensue. Dr. J. Johnson* advocated the following outline of treatment, which for a time found many supporters. Bleed boldly and decisively till the head and prsecordia are relieved; and, immediately after, administer j. of Calomel, with gr. j. or gr. iss. of Opium. This will greatly tranquillize the nervous and vascular disturbance. In the course of a few hours, a purgative of Calomel and Colocynth, or Castor Oil, or Sulphate of Magnesia, should be given, which will rarely fail to bring away a most copious discharge of fetid bilious faecal matter, to the great relief of the head and epigastrium. Immediately after the operation of the cathartic, Calomel (gr. v. - x.), according to the severity of the symptoms, combined with Antimonial powder, should be administered every four or six hours till the mouth is slightly affected, when, according to the experience of Dr. Johnson, the safety of the patient will be secured in forty-nine cases out of fifty. Annesley, Ferguson, Twining, Bancroft, Copland, and some of the highest authorities, are advocates of a somewhat similar treatment; but it is now generally admitted, that, excepting perhaps in the early stage of the disease, Calomel is of comparatively little value, if not positively injurious. Its use should never be carried beyond establishing slight soreness of the mouth. During the remissions Quinine should be freely administered, unless contra-indicated by cerebral symptoms. Cold to the head, refrigerant,drinks, and aperient enemas, should be employed in conjunction with other treatment.
1380. In Bilious Remittent, or Yellow Fever, Mercury has had many advocates of talent and experience, whilst others regard it as useless, if not injurious. It cannot be denied that Mercury, as well as all other remedial agents, often fails to produce any impression on the disease, which, in spite of this and other means, steadily progresses to a fatal termination; but, as far as personal observation in Jamaica for two or three years entitles me to form an opinion, I believe that Mercury, given boldly and decidedly till salivation be produced (having, in the first instance, at the commencement of the attack, had recourse to one full bleeding) is the plan of treatment under which the fewest deaths occur.
* On Tropical Climates, &c., p. 110.
It is often extremely difficult to establish salivation; but, when this is produced, I have frequently witnessed an amelioration of the symptoms, and eventual recovery. The treatment advised in the last section in Remittent Fever has been, with some modification, adopted in this. The treatment by large doses of Quinine is reported to be more successful. (See Quinine.)