To conduct the paroxysm so that its solution shall finally remove the disease, is often beyond our power. An emetic, given at the first approach of coldness, will often lessen both it and the next stage; and we must repeat, what Dr. Fordyce tells us, that he has remarked the superior efficacy of the antinomial preparations to the ipecacuanha. When the hot fit come3 on it must be mitigated by cold, and by the cooling diaphoretics.

Opium, at this period. is said by Dr. Lind to lessen the heat, and hasten the sweat; and when the last stage has fully come on, the exhibition of the bark is said to render the sweating more effectual. Such are the observations of authors, which we can neither confute nor confirm. From what we have, however, read and seen, we suspect that these measures lessen the inconveniences of the paroxysm, but seldom put a stop to the disease.

In the intervals our chief exertoins must take place; and we have been lately accustomed to trust almost ex-clusively to the Peruvian bark. We have seen (see Cortfx Peruvianus) that we can derive little information from the sensible qualities of this medicine, or from its analysis, either in the milder or more forcible separation of its component parts, and we must rest contented with the fact, that the bark will usually cure in-termittcnts. We say"usually," for was it so certain a remedy as the language of authors would lead us to suppose, they would not fly from the common to the red and yellow kinds, to combinations of bitters and aroma-tics, to copper and to arsenic. As it is, however, the common remedy, we must direct its exhibition.

We have already spoken of the bark, given immediately preceding the fit, and in the sweating stage. We now speak of it as a remedy in the intervals. In general, then, it must not be given while there are any considerable infarctions of the viscera. We have already shown (see Febris), that fever almost consists in, or is constantly attended with, a disturbed balance of the circulation, and that the biliary system and the brain, from their structure and constitution, receive a large proportion of blood, which is confined to the larger vessels. Fever cannot, therefore, continue long without infarctions of the liver at least, if not excessive fulness of the cerebral system; and in this state the bark is certainly injurious. Physicians may colour this objection in a variety of ways, but they cannot elude it. Inter-mittents then, which continue usually some time without decisively showing their true nature, must be attended with at least fulness in each viscus, and this should be previously removed. We have already shown that emetics and cathartics are the chief remedies for this purpose; and hinted, that it was not without reason that physicians formerly condemned the cortex as the cause of these swellings; but, in reality, they should have blamed its injudicious use. These opinions are confirmed by another caution, universally laid down, that the bark is only admissible during a remission. In fact, at the time of the fit the fulness is most considerable: after its solution, that degree of fulness only remains which is owing to the dilatation of the vessels. Dr. Fordyce is so confident of its injury during the paroxysm, that he directs it to be omitted during the time that the paroxysm would have come on. In other words, if the fit is expected on a given day, which usually lasted from ten to four, or six, and if the bark, taken previously, has prevented the accession, the remedy must still be omitted during this period, though no accession really takes place. We find also that, in remittents, unless the remission is considerable, the bark is not always admissible; in continued fevers it is very rarely so.

Though the bark be confined to the interval, it is not necessary that it should be exhibited with equal freedom in every period of that interval. In a quartan, for instance, though given in the first day of intermission, its doses need not, during that day, be considerable, or often repeated. On the next, the medicine should be given in as large doses as the stomach will bear. In a tertian, the dose of the remedy should be greatly increased during the last six hours of the interval. What the dose should be must be determined by the judgment of the practitioner, and the constitution of his patient. Not less than an ounce of the powder will effectually stop a tertian; and a much larger quantity must be taken in the interval of a quartan. As the interval of the fits of a quotidian is short, we must be more active; but the disease should be lessened by emetics and cathartics before the bark is employed.

It is common and highly proper to recommend the removal of a diathesis phlogistica previous to the exhibition of the bark; but it is equally necessary to guard against its purging or its constipating effects. The former is most successfully opposed by combining a laxative, as rhubarb with the bark, and the latter by opium; but as the rhubarb adds to the bulk, and to the nauseous taste of a medicine, already sufficiently disagreeable, we may choose the period of the accession for the action of any quick purgative, as the castor oil with senna; the senna or jalap with cream of tartar, or the jalap with calomel. Should opium disagree, the bark may be taken in a strong decoction of logwood. When we have been most successful, we should not too soon abandon our remedy, as intermittents, except when continued from habit, are very liable to a relapse.

The bark, with every precaution, will not sometimes remain on the stomach, though joined with aromatics, with opium, or followed by an effervescing draught. In this case, we have been directed to quilt it in a calico waistcoat, to be worn next the skin; to bind it round the wrists; to inject it in a clyster; or to bathe the patient in its decoction. Each method is said to succeed; but what will not appear to succeed in the eye of its inventor ? If the bark is really useful in these ways, we should expect that it will not be employed in any other; but when we reflect on the quantity required to cure an intermittent in the stomach, an organ which so quickly sympathises with the extreme vessels, the brain, and the sensorial power, we can scarcely expect lesser quantities, applied less advantageously, to succeed. The advocates of this practice have quoted Dr. Alexander's experiments with some triumph, to show that bark applied to the skin is absorbed; but when large quantities have been given to check an intermittent at once, and vomiting has succeeded, the whole is apparently evacuated though the fit be stopped. If it be contended that the bark in this way is really applied to the extreme vessels themselves, the advocates for the practice must show how it passes the cuticle, except by the absorbents; and prove, what may be still more difficult, how in this way it can obviate the cause, viz. the atony of the sensorial power.