In external phlegmone, and all inflammations of the joints, cold is a more doubtful remedy. It has never, we believe, been employed in rheumatism; and in gout we still think it must be injurious. In strains, in the white swellings of the knee, and in the morbus coxarius, cold, in the early stages, is advantageous; and it is rendered more effectual, by increasing the momentum of the water, the form in which it is usually employed, by pumping, which also regularly renews the cold application to the part.
In the Haemorrhagiae, with scarcely, if any, exception, cold is useful; and cold drinks, cold air, cold applications, are of the greatest importance. Even in haemorrhages from the lungs it may be employed with little apprehension; and nitre, a remedy so powerful in every case of haemorrhages, acts only by the cold which it produces. Hemorrhages from the uterus are restrained by cold, though they often require it in the most active degree; and, perhaps, iced injections into the rectum would be serviceable. Cold injections in the haemorr-hoides are powerful and efficacious remedies. Cold is, perhaps, best adapted to the active haemorrhages; but even those from debility and tenuity of the blood reap little less advantage from its use.
In the exanthemata, cold is also a very useful remedy. In the small pox, we know it is freely and advantageously employed in the form of cold air and cold drinks. Accident has even shown, that cold bathing, in the worst kinds of the complaint, has preserved the patient from the most imminent danger. If, however, cold is used in these eruptive diseases, it must be employed with steadiness and perseverance. Slight cold, soon discontinued, will be rather injurious than beneficial. The effect of cold in these cases is to moderate the too active determination to the skin; which, pouring the fluids under the cuticle faster than they can be transmitted, are detained, and by their irritation produce the peculiar pustules. When this determination is restrained, moderate perspiration, or the insensible halitus, which we have before called, with Chenot, the diapnoe, succeeds. The eruption of the small pox may be thus in a great degree, or even entirely, suspended with safety: we scarcely dare to say the same of the other exanthemata.
In measles, the poison is directed to the eyes, the bronchial glands, and often to the breast. These affec-tion, have prevented the free use of cold. In peripneu-mony, the advocates for its use can only allege, that when cold has been employed in other diseases with which the peripneumony was complicated, it has done no injury. In catarrh we find a few instances, but from a suspicious source, in which it is said to have been useful; but, on the whole, we find little foundation for pronouncing cold even generally safe in affections of the breast. We must, therefore, dissuade the practitioner from employing it in measles; nor is it necessary, when we find that we can easily diminish all the dangerous symptoms by cathartics. In scarlatina, the experience of Dr. Currie, and the decisive conduct of Dr. Gregory, have established the utility of cold affusions. They are employed to counteract the heat, and must be continued while any considerable heat remains.
In the miliaria, the use of cold drinks and cool air has been long established; and such is their success, either in preventing or removing the disease, that we seldom want actual cold: at least such has been the fortune of the author. In violent cases, there is certainly no objection to actual cold.
In crysipelas, some apprehensions have been entertained of the effects of cold as a repellent; we believe without foundation. When, in this disease, the brain is affected, subsequent to the tumour and inflammation of the face and head, the latter does not subside: it is a continuance of the same affection, or rather a greater extent of disease; and authors of credit have employed it with success.
In the plague, if it be really a genus of this order, our late experience in Egypt has fully established the advantages of cold applications, cold air, and cold affusions. These are particularly said to prevent bubos; and it is highly probable that considerable and continued cold would be useful to anthrax and other situations. The practitioner should, however, recollect, that anthrax is sometimes apparently critical.
Proftuvia, the next order, contains but two genera; and in one of these, catarrh, we have said that cold is inadmissible: yet in the epidemic catarrh, cool air and cool drinks have been generally useful. We know not that the application of cold has been carried further.
In dysentery, cold affusions are recommended by Dr. Lind. An Italian physician, Signor Rosa, recommends clysters of the coldest water.
In the sanguineous apoplexy (of the order Comata), cold applications will undoubtedly be useful; but we find little authority for their use. In the hydrocephalus, which has been lately classed under this genus, the coldest water applied to the head is said, by Dr. Rush, to be serviceable; but it is not easy to say in so early a stage what the disease really is. Little danger will. however, probably ensue from cold applications in any kind of headach. The apoplexy from narcotic poisons is always greatly relieved by cold applications. (See Bathing) Tissot mentions the good effects of cold affusions in the coup de soleil. In partial palsies, pumping on the affected limb, and then covering it with warm flannel, is often serviceable; and in weak joints, a similar remedy is equally beneficial.
In the spasmi, cold is chiefly useful in the form of cold bathing, which we have already noticed. In colic and cholera, cold drinks will be useful; but they should be administered with caution in small quantities, frequently repeated.
The success of cold, in every form, in maniacal cases, is well established by a great variety of the most respectable evidence; particularly of cold applications to the head. In tympanites it is recommended by Dr.
Cullen; and in ischuria, placing the patient on a wet stone floor, on his naked feet, has often removed the obstruction. It has been common to recommend bathing scrofulous tumours with sea water: but the effect is apparently from the cold; and we have often employed common water with similar success. In burns we have already mentioned the utility of cold water. See Combustio.
It may not be amiss to add an account of some easy methods of producing a considerable degree of cold. When ice or snow are to be procured, we want no further assistance, for we can cool water only to the freezing point. When these are not at hand, water from a deep well will be found to be at the heat of about 50°. By adding gradually a mixture of nitre and crude sal ammoniac (muriated ammonia), in the proportion of 8 to 5, this water may be gradually cooled down to about 38°. When we reflect that the heat of the body is 98°, and that of the diseased part at least 104°, even the first degree will be considerable; and by repeating the application we shall often obtain the expected relief. From the water artificially cooled, the benefit may be increased. But if this water be put into a bladder, and moistened with ether, spirit of wine, or indeed with common water, in a free current of air, the temperature will be nearly that of ice, and fully equal to any of the indications before laid down. The greatest extremity of cold required, is in some cases of puerperal uterine haemorrhage. In this we have known the patient exposed to the severest winter cold, covered only with a sheet, which has been kept constantly wetted; and life has been only preserved by such severe treatment. But we must repeat that in every case, where cold is indicated, its use must be steady and constant.