Samuel Elder - Lecture Notes and Casebook

Pleurisy, yet the peculiarity of the Countenance and other symptoms will enable us to judge of Typhus. yet if these symptoms {pain in the head and lungs} appear we must undoubtedly be more cautious in the use of stimulants. Whan the pain in the head and lungs arise from local congestion we may bleed. Dr. Brown's theory has led to all this mistake among Physicians - but the whole of his system is as unfounded as that of Cullen's - With regard to cure, we know no way of counteracting the Contagion. when we find the disease we can alleviate, but cannot stop it - like the Small Pox it always has its course - I never saw Typhus stopped or cut short - With regard to its duration it is not uniform, as other contagious diseases are - there is generally no amendment untill the 14^th Day, some go 21–28–60 & 100 Days but the most change on the 14^th. the next 21 Day. In Brown's Theory we could cure it in the beginning by stiumulants, but I have always found strong stimulants bad - I dont know any medicine that has a preference to others- some physicians who give valerian and others and others simples which in the eyes of judicious Men would be considered equal to nothing, are successful - Emetics some

times do good, they appear to give Tone to the stomach. With regard to Emetics Ipecacuanna is preferable to Antimonials. A Dr in Mass told me if he could puke with Ipecac, his Patients all got well. I have been suspicious of strong Cathartics, they are apt to produce a diarrhia which we cannot command, we should just keep a healthy action through the Canal. Tonics have never been successfull in my hands. The good effects of Opium are doubtful, it frequently produces delirium and does injury. Wine and Bark are evidently good in the last of the disease, Mercury if it produce Salivation is good, but it has gained too much credit. If the Stomach is obedient to Stimuli other remedies may have as good effect as Mercury, however, in small doses I know no better Medicine.

With regard to Alkalies, I know of no Specific quality. Lime Water good with some, to others acids are more aggreeable. Neutral salts have no effect in Typhus. There is generally a preternaturel heat in Typhus and unequal, the head and breast are very hot, while the extremities are cold. Cold Water, in the stomach diminishes heat, but it should be administered in small quantities, especially in delirium. Cold Water and Cold Air Externally have a good effect.

No. 25^th. Dec. 6^th, 1811. P. Smith With regard to the Preternatural heat in Typhus the cause which produces it is the disease itself this superabundant heat is a dangerous symptom - I would apply water early in the disease to abort the heat and thus render it milder but it will not produce a solution of the disease- if it should appear to solve the disease - we may perhaps consider it not truly the Typhus - Attempts to produce a solution of the disease by powerful medicine in the beginning is attended with the worst of consequence. Thousands are cut off by Physicians endeavouring by powerful means to stop this Fever at once. All evacuants more than just to keep regular actions are dangerous - I have frequently seen Powerful Emetics prove fatal - it is common among Physicians, after their patients have appeared to gain, {by eating or exercise or some irregularity} the disease appears to return, to give a Powerful Emetic, thinking to throw off the disease at once, and thus kill the patient. In the application of cold Water there is no danger if applied discreetly - use it often, but little at a time - in the cold stage cold water would undoubtedly be bad - but always apply it

when the Patient is preternaturally warm - its better to pour it on or apply it with wet cloths, than to take the Patient out of bed and dash water on once, or to put them into a bath. The Patient is generally too feeble to bear such management. A young man was attacked with Typhus, he was bled 1 or 2 before I saw him. I then bled him again the next day his symptom were all aggravated quite a Subsultus tendinum. he was given over, the next day was excessively hot - I found him hot delirious unable to speak - I poured a Pitcher of cold water all over him and repeated it three or four times in the day - kept the Windows and Doors open through the night - the next day the Symptoms better. continued to apply cold water at night he was ale to speak, and called for more water - he soon got well.

I was called to Mr. Paine - he had been some time under Typhus- his pulse incessant - great heat and Thirst - I got a Pitcher of Water from a cold well and dashed on him - he had his senses - and in the habit of drinking two quarts of warm Tea in a night. but the cold water slaked his Thirst, cooled him, gave a pleasant sensation - and in the night became so easy that I was called out bed, the family supposing him to be dying, Cured.

I was called to a Patient who had been in the hands of an infamous Quack - his feet cold - head & breast hot - with tormenting Thirst - the Quack had forbid to change his linen- either of his body or his bed, or to clean the room - his feet were run out of bed, and had been poulticed untill they were covered with paste. I cleaned him, soaked his feet in hot water, poured cold Water on his head and breast, and washed out his room, gave some soda. the next day his pulse was much better and he soon got well.

It is not verry material about the temperature of the water. if the bed clothes are wet with warm water the evaporation will diminish the heat. No injury to the Patiend to have the bed clothes wet. Verry injurious to put the Patient into warm bath. Stimulating applications to the feet, as Mustard and hot Bricks are bad, it is better to rub them. If there is local affection Blisters may be good, they may be good even in inflamations, but if there a gangrenous disposition Blisters will certainly be bad. Opium is not good if any delirium exists, but it may be necessary to procure sleep. Opium is generally bad in Dyssentary.