'!. CONTINUED. 



FEVER, CONTINUED. 



' 



bowels, enlarged liver and spleen, high-coloured 

 urine, frequent pulse, hot akin, and occasionally by jaundice, and 

 terminating in apparent convalescence in from five to eight days ; in a 

 week a relapse (IA) a repetition of the symptoms present during 

 the primary attack. After death, spleen and liver are found conside- 

 rably enlarged ; slusncs of marked congestion of internal organs. 



Frrer. A disesin arising from a specific cause, attended 



by rigor*, chilliness, headache, successive cropi of rose spot*, frequent 

 pulse, soooroui rale, diarrhaja, fulness, resonance, and tenderness of 

 the abdomen, gurgling in the right iliac fossa, increaeed splenic 

 dulness, delirium, dry and brown tongue, and prostration, anil ter- 

 minating by the 3(ith day. After death enlargement of the tneaenterio 

 gland*, aisnw of Peyers pttchei, enlargement of the spleen, dinaeiui- 

 nated ulcerations, disseminated inflammations. 



" Tfpktu Firtr. A di tense aruing from a specific cause, attended 

 by rigon, chillineea, headache, mulberry rash, frequent pulse, delirium, 

 dry brown tongue, and prostration, and terminating by the twenty- 

 ftnt day. After death, disseminated and extreme congesti 

 young persons, enlargement of the spleen." (' Medical Times,' 20th 

 1 



We may take, for the convenience of describing the condition of the 

 system in the state of continued fever, the ordinary continued fever of 

 this country, the disease denominated Common Continued Fever 

 (Synochus Hitior). The phenomena which take place in this disease, 

 and the order in which they succeed each other, are the following : 



The first event in the series it: the derangement of the functions of 

 the nervous system. There is reason to believe that this derangement 

 takes place primarily in the organic system of nerves, that system 

 which presides over the nutrition of the organs, and consequently that 

 the very first effect of the noxious agent, whatever it bo, which pro- 

 duces fever, ut to disorder the health of the organs, and thereby to 

 impair their energy. 



Though it is probable that a disorder of the organic nerves is the 

 first event that actually takes place in fevers, yet the first event of 

 which we become conscious would seem to be a derangement in tho 

 second portion of the nervous system, the great nervous centres in 

 which sensation, intellectual operation, and voluntary motion hare 

 their seat, namely, the brain and spinal cord. The organic fin 

 being carried on without consciousness, wo can know that they are 

 disordered only by their producing disturbance in some part of the 

 sentient system. The organic portion of the nervous system ia most 

 intimately connected with the sentient portion, and any disorder of 

 the former is quickly extended to the latter. In an attack of fever the 

 disordered condition of tho br.-iiu in indicated by a loss of mental 

 energy. But this loss of mental energy, though it is probably the very 

 first indication of fever of which any one can be conscious, is by no 

 mean* the first symptom which usually attracts attention. In general 

 the loss of mental power is not observed until it becomes distressing, 

 which does not often happen until the progress of the disease is further 

 advanced. The lues of mental power i.s indicated by the inability to 

 perceive clearly the trains of idea*, and to attend closely to their 

 relation ; whence result indistinctness and confusion of mind, and the 

 want of capacity to form a sound judgment. 



As this state of the mind depends on the disordered condition of the 

 organ in which the mind has its seat, the brain, and as the servant of 

 the mind, volition, lias its seat in the same portion of the nervous 

 system : closely connected with this mental weakness, is the loss of 

 energy in the muscles of voluntary motion. Lassitude ia the result. 

 The movements of the body are feeble and unsteady, as tho energy of 

 the mind is impaired. 



From this morbid condition of the brain and of the muscles of 

 voluntary motion, there results an uneasy sensation, of which no idea 

 can be conveyed by words ; it must be felt to be understood. It is not 

 pain, it is more distressing than pain ; even the mere restlessness which 

 accompanies, and which forms so large a ]>art of it, any one would 

 gladly exchange for intense pain : it is this state which has been appro- 

 priately and expressly named ' Febrile Uneasiness.' 



But very soon there is superadded to this uneasy sensation positive 

 pain. In general pain is first felt in the book and loins, and in the 

 limbs. It is rare that this symptom is absent in the commencement 

 of this form of fever, and it often occasions more distress to the patient 

 than anything else during the tirt stage of the diiresn 



The remaining part of the history of an attack of common continued 

 fever has been thus given by a physician who has had the moat 

 abundant opportunities of witnessing the progress of the disease : 



Already a remarkable change is commonly visible in the < 

 nance, lu expression is that of dejection ; it isoften strikingly t-iiiiilar 

 to that of a very weak person suffering from fatigue. The colour of 

 face ia pallid, and the features are somewhat shrunk; but it* general 

 aspect it so peculiar and characteristic, that an experienced eye can 

 distinguish the disease, even at this early period, and without asking a 

 single question. The skin partakes in a remarkable degree of tin- 

 debility which so early shows itself in the muscles of locomotion. 

 This i* indicated in a Mriking manner by its increasing sensitiveness to 

 the physical *gents by which it is surioumlcd, and by iU inabi ity t" 

 nee. Ordinary degms of temixrature produce a sensa- 

 tion of cold which ia sometimes intolerable ; chilliness is felt evi n in a 

 boated room, or in ,a warm bed ; hence the sensation of cold, some 



times increasing to shivering, which has been considered one of the 

 moat constant signs of fever. But this feeling of chillinea* 

 means depends on external temperature : it is increased by cold, but it 

 exist* in spite of an elevated temperature fit arises from an internal 

 cause, and is not to be counteracted by external heat. 



While tho patient experiences the sensation of cold, there is no 

 diminution of the quantity of caloric in the system. 'I 

 meter applied to any part of the body commonly rises as high a* in t ],, 

 state of health ; and the skin, touched by the hand of another person, 

 communicate* not the feeling of wild, but ..iVn. on the contrary, that 

 of preternatural heat. There is nb positive abstraction of ualorii 

 the body, nor any failure in the process, whatever it be, by which 

 animal heat i* generated : there is only altered ^sensation, in conse- 



Jueuce of derangement in the function of the skin. In this form of 

 vcr tho chilhnebs in many cases never amount* to . 

 others there i* an attack of well-marked rigor, and in others, again, 

 - either no feeling of cold, or it is so slight that it esoapw 

 observation. 



The symptoms now enumerated are all clearly referriblv to derange- 

 ment of the functions of the spinal cord and brain. There is as yet no 

 affection of any other organ obviously or at least much developed. The 

 circulating system, it is true, is jutt beginning to be affected. The 

 pulse is no longer perfectly natural ; it is more languid than in the 

 state of health ; sometimes it is also quicker ; at other times it in 

 slower; now and then it is scarcely changed in frequency, but its 

 action is invariably weaker than in its sound state. 



At the same time the respiration i* affected in a corresponding 

 degree; it is shorter and quicker than natural; the chest does not 

 expand BO freely, and compensation seems to bo sought in an addi- 

 tional number of respirations. OftentiuuM neither the pulse nor the 

 respiration appears to be much altered, if the patient remain perfectly 

 -till; but if he M8o and walk across the room the pulse instantly 

 i>a rapid, and the respiration is quickened almost to fainting. 



The transition from the affection of the nervous and censorial to 

 that of the circulating and respiratory systems is thus clear and 

 striking. Physiology teaches us how closely these systems are con- 

 nected, and how mutually they are dependant one upon the other, the 

 closest observers and the ablest experimentalist* candidly confessing 

 that they are scarcely able to determine which is the least dependant, 

 or the action of which is the least necessary to the oi ! i mance 



of its functions. The nervous system being first deranged, it . 

 consonant to what we know of the healthy function of the animal 

 economy that the circulating and the respiratory systems should be the 

 next to suffer. 



How long the nervous system may continue thus deranged before 

 any other organs are involved, excepting the circulating and the respi- 

 ratory, to the extent just stated, is uncertain. There can be no doubt 

 that in this mild form of fever the range of the duration of this 

 isolated state of disorder, if we may so express it, is from a few ho\irs 

 to several days. The rapidity or the slowness with which other systems 

 of organs become involved seems to depend very much upon the acute- 

 ness of the attack. In general, the more acute the fevt r. tin- more rapidly 

 the individual phenomena succeed each other, and the entire series 

 becomes complete. But this is not, and it is important to bear in 

 mind that it is not, invariably the case, for experience teaches us that 

 the severity and danger of the disease are not diminished by tho slow- 

 ness of it* approach ; and that cases occur which are slow in forming, 

 and which do not for a while excite alarm, that ultimately become 

 truly formidable. 



It has been stated that the circulation languishes with the dimi- 

 nished energy in the sensorial faculties, and the loss of power in the 

 muscles of locomotion. After a while tho pulse, which was ; 

 than natural, becomes more full, more strong, and generally more 

 quick than in a sound state; and now the skin, which was cold, 

 become* pretenmtu rally hot. The previous cold consisted, for the 

 most part, of altered sensation, there being little or no loss of caloric ; 

 but the feeling of heat, on the contrary, is the result of an actual 

 increase of temperature : for the heat in the interior of the body, as 

 well as on the surface, rises in some cases several degrees, as is aseer- 

 tained by tbo thermometer, the range of increase being from the 

 natural standard 96 to 10S, beyond which it is seldom found to 

 augment in this form of fever. The heat is at firxt not uniform over 

 the entire surface of the body : it often happens that some part* are 

 cold while others are burning hot. The heat is oftentimes particularly 

 intense over the forehead or over the back part of the head, or over 

 the whole scalp, while the cheeks are commonly flushed. All these 

 HviiiptoniH denote a morbid condition in the action of the heart and 

 arteries. Since the generation of animal heat is so intimately con- 

 nected with the circulating anil the respiratory functions, it is probable 

 that the increase of temperature is the result of some morbid o> 

 the capillary vessels belonging to these systems. What the disordered 

 action of these vessels is which produces increase of temperature 

 we do not know ; but the object of scientific observation is in some 

 degree accomplished when it is ascertained that one condition of these 

 us i* invariably connected with a morbidly diniimtjud tempe- 

 rature ; another with a morbidly augmented temperature ; and another 

 with the temperature of health. 



Immediately the circulation is thus excited, the functions of tec 



