The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 4).
- Date:
- 1845
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 4). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![«the refrigerant effects of nitrate of potassa as a sedative, when given dissolved in even tepid drinks, such as whey, are known to every one. They certainly are not known to the writer; yet he has watched most carefully for them; nor have others been more fortunate. Dr. A. T. Thomson says, that the dose of the salt should not be dis- solved until the instant in which it is to be swal- lowed, {Elements of Mat. Med. and Therap., 2d edit. Lond. 1835); and Dr. Pereira {Elements of Mat. Med. and Therap., Amer. edit. i. 438,) ac- cords with him; whilst Dr. Christison {Dispen- satory, p. 741, Edinb. 1842,) expresses himself in a manner that still more strongly corroborates the views of the writer:— Its refrigerant action, gene- rally admitted by systematic writers on materia medica and by many practitioners, is of doubtful existence, having probably been inferred rather from the coldness it occasions while dissolving in water, than from actual evidence of its effects in disease. The sedative action ascribed by some to it has been probably inferred from its supposed re- frigerant property, and not from observation.] In haematemesis occurring in young and vigo- rous perons, the same assiduous employment of refrigerants is requisite as in haemoptysis; and when the bleeding is so violent as to threaten quickly serious consequences, the other refrigerant plans may be aided by injecting iced water into the rectum, and by the local application of cold to the epigastrium. In no species of hemorrhage is the sympathetic influence of refrigerants more strikingly obvious than in epistaxis. Thus dash- ing cold water on the genitals has sometimes in- stantaneously suppressed bleeding at the nose; and on the same principle is explained, what it is scarcely necessary to notice, the popular remedy of applying a large cold key or a piece of metal between the shoulders under the clothes. It is superfluous to say that, however useful refrigerants may prove in all cases of active he- morrhages, their employment in the passive is to be most carefully avoided. But it is in fevers that refrigerants under every form are to be regarded as the most valuable set of therapeutical agents. In continued fever, the vegetable acids largely diluted are internally administered, especially those found in fruits; and not unfrequently nothing is more grateful to fever patients than cold water slightly acidulated with either the sulphuric or the nitric acid. It is, how- ever, the general application of cold to the surface which proves the most useful refrigerant in con- tinued fever. In those forms of the disease which assume a typhoid type, ventilation and the free admission of cool air into the apartments of the sick are absolutely necessary: irritation is allayed, debility obviated, and the whole complexion of the disease often changed in a few hours, by the removal of the patient into a cool and well-venti- lated, from a close and filthy apartment. The most direct and effective refrigerant, however, in continued fevers is the cold affusion; but its employment requires certain cautions, without at- tention to which much mischief may be incurred. In the first place, the exact temperature of the body must be carefully ascertained. In this country, in the severest attacks of fever, it has rarely exceeded 108° Fah.; but in tropical climates it rises sometimes to 112°; the higher the temperature of the patient, the more benefit may be anticipated from the cold affusion. The temperature of the water should vary according to the season of the year and the feelings of the patient, the average range being from 40° to 70° Fah. The effect is to diminish the morbid heat of skin, to lower the force and retard the rapidity of the pulse, and to induce perspiration and sleep; and when such results follow, the cold affusion proves beneficial in any form of fever. The thermometer is employed to determine the temperature of the patient; but if he feel cold when that instrument indicates an augmented morbid temperature; or if he feel hot when the thermometer demonstrates that the heat of the body is below that of the natural standard ; then in neither case should this form of refrigerant be resorted to. It is also improper when the skin is bedewed with perspiration; or if the patient dread greatly its use ; nor is it less so during menstrua- tion, and in the latter months of pregnancy. In the advanced stages of fever, refrigerants of any kind are injurious. With respect to the kinds of continued fever in which refrigerants are indicated, we may enumerate six. 1. In inflammatory fever, {synocha,) a rare dis- ease when unaccompanied with topical inflamma- tion, the advantages to be derived from refriger- ants are well understood. The cold affusion is admirably adapted for rapidly abstracting the stimulus of heat, diminishing general excitement, and operating as a powerful sedative. In the more advanced stages of the disease, cool spong- ing is often substituted for the affusion ; but when the patient can bear the fatigue of the affusion, it is always to be preferred. The greater frequency of this form of fever among the ancients than the moderns explains their constant employment of cold drinks and cold bathing in continued fever. 2. In fevers of a typhoid type, the disease has been cut short by the cold affusion ; but in this case more perhaps is to be attributed to the shock and the reaction which follows, than to the refri- gerant influence of the affusion. 3. In synochus or inflammatory fever, gradually assuming the typhoid character, refrigerants in general, but more especially the cold affusion, are chiefly applicable to thie early stages of the disease; and, indeed, no form of remedy is more advanta- geous when there are no local determinations; but when these exist, particularly if the lungs be affected, much caution is required. 4. In remittent fevers, especially those of warm climates, and in their more intense and excited variety, the cold affusion may be employed with great benefit. In severe attacks, also, much advantage is derived from the application of ice or cold water to the scalp ; in the remissions, how- ever, the application of cold in any form must be suspended. In yellow fever, the safety of the patient frequently depends solely on the early ap- plication of the cold affusion. 5. If hectic be symptomatic of pulmonary af- fections, or determination to internal organs, the cold affusion is decidedly contra-indicated ; but even in such cases much benefit is often obtained by sponging the trunk of the body with cold](https://iiif.wellcomecollection.org/image/b21116799_0018.jp2/full/800%2C/0/default.jpg)
