WELLS’S FIFTH DISSERTATION ON FEVER. 
of the size of vessels. There is a certain 
extent, beyond which vessels cannot be 
mptied, and as we know that they pos- 
sess an elastic force, it is not improbable 
that this may be sufficient for producing 
i change of dimensions. When general 
inflammation occurs in intermittent fe- 
vers, the author conceives that there can 
pe no doubt of the propriety of blood- 
jetting, because the system has time to 
cover, and the vessels are enabled to 
all themselves before the next pardxysm; 
but in continued fevers, the practitioner 
ght to satisfy himself well on the pro- 
priety of the measure, from the existence 
of some urgent symptoms, such as de- 
termination to the head, before he have 
recourse toit. But when it is once re- 
solved upon, hethinks thatas muchshould 
a 
be taken at once as is necessary to remove 
she symptoms of general inflammation. 
The propriety beatae bleeding, in 
he continued fevers of this country, is 
Pat all times extremely problematical, if 
not decidedly improper, on account of 
reasons stated by the author; and it is 
#much to be doubted, whether the symp- 
joms of general inflammation, indicated 
ticularly by hardness of the pulse and 
a buffy coat to the blood, even in such 
cases shew themselves, without any de- 
gree of local inflammation. Several ir- 
egularities are particularized by the au- 
#thor as occasionally shewing themselves 
in continued fevers. The first of them 
fis the want of some particular symptom: 
Pwhich is usually present, or a dispropor- 
tion between the violence of some one 
§symptom and the others... This circum- 
fstance is frequently regarded as a fa- 
vourable one, but Dr. Fordyce is of opi- 
nion that in general it is not so, and enu- 
meérates the cases in which he has had 
} Occasion to make this. remark. 
“© Sometimes. a fever does not attack a pa- 
fplace. In this case most commonly ‘the sys- 
Pitem is not equally affected. In ‘the next 
place, it sometimes happens, that although 
the) fever came.on in such a manner, that the 
| patient can perfectly ascertain the time of the 
‘atta k, yet at that time he felt no sense of 
peoldness, or, as he generally expresses him- 
If, chilliness. If this should happen, the 
is in the former case. In the third place, 
yhen the attack coines on, the depression of 
Strength is sometimes in a much greater de- 
@ree than the appearances, of the contraction 
fof the smail vessels, and sometimes the re- 
}¥erse. If the depression of'strength be greater 
we: 
‘ 
er is often irregular ; Lut not so frequently 
719 
than in proportion to the contraction of the 
small vessels, there is greater danger of de- 
lirium, such as. has already been deserihed, 
at the beginning of the second week of fever. 
If the appearances of contraction of the small 
vessels be greater in proportion than the de- 
pression of strength, there is less chance of 
a crisis, anda greater probability of the dis- 
ease running out to a great length. In the 
fourth place, the symptoms net found in par- 
ticular parts of the body are the patient's 
being either totally free from head-ach, or 
very slightly affected with it; the tongue’s 
not being covered with a crust, not only at 
the begioning, but likewise through the first 
week of the disease ; there being no costive- 
ness, but rather too great evacuations from 
the intestines. This last symptom some- 
times tncreases toa diarrhea, which, besides 
the irregularity it shows in a want of equal 
affection in the disease, tends also very mucla 
to weaken the patient. The appetite not 
being totally lost is a very deceitful symptom, 
because it would give an inexperienced prac- 
titioner the idea, that food might be easily 
digested, and so the streugth be prevented 
from being exhausted during the progress of 
the disease. ‘I'he skin’s being soft and moist, 
and the sleep. not being at the beginning of 
the fever very much disturbed, are also to be 
regarded as irregularities, If one, or two, or 
three of these mild appearances should take 
lace, and all the other symptoms should not 
e equally mild, the fever is likely to run out 
for a great length of time, and ‘has a munch 
less chance of being terminated bya crisis. 
‘© 'This'is not‘only the case, but every at- 
tempt to carry off the fever by any remedy is 
frustrated... livery medicine, such as, prepae 
rations of antimony, ipecacuanha, &c. which 
tends to produce symptoms similar to those 
which take place in the crisis of fever, has 
ifs whole force exhausted upon those parts, 
in which the appearances of fever are slight, 
and does not av all affect those parts which 
are most aitlicted by the disease. For exaim- 
ple, if there shoal be considerable paiw in 
the forehead, and the skin should be soft’and 
moist, preparations of antimony being exhi- 
bited, the patient will fall into a profuse 
sweat, without the least relief of the pain in 
the forehead. 
* It is further to be observed, that not 
only if there’should bea want of febrile 
symptoms inany one particular part of the 
body, but /if even those appearances should 
arisg, which take place in a crisis, in some 
particular part of the body, and not in the 
whole at the same time, the mischief is much 
greater, and the patient in such a case rarely 
recovers. If, for example, there be a lateri- 
tious-sediment in the urine frem the begin- 
ning at the disease, or if it take place before 
the middle of the second week, and neithot 
the head-ach nor delirium is any. way dim’- 
nished ; if the skin should remain hot, cor- 
tracted, and dry, the tongue covered with a 
mucous crust, and the pulse continue of 
