FEVER. 



181 



paired. This fever is so named from its being at- 

 tended with symptoms denoting general inflamma- 

 tion in the system, by which we shall always be 

 able readily to distinguish it from either the nervous 

 or putrid. It makes its attack at all seasons of the 

 year, but is most prevalent in the spring ; and it 

 seizes persons of all ages and habits, but more par- 

 ticularly those in the vigour of life, with strong elas- 

 tic fibres, and of a plethoric constitution. It is a 

 species of fever almost peculiar to cold and temper- 

 ate climates, being rarely, if ever, met with in very 

 warm ones, except among foreigners lately arrived ; 

 and even then, the inflammatory stage is of very short 

 duration, as it very soon assumes either the nervous 

 or putrid type. The exciting causes are sudden 

 transitions from heat to cold, swallowing cold liquors 

 when the body is much heated by exercise, too free 

 a use of vinous and spirituous liquors, great intemper- 

 ance, violent passions of the mind, the sudden sup- 

 pression of habitual evacuations, and the sudden re- 

 pulsion of eruptions. It maybe doubted if this fever 

 ever originates from personal infection ; but it is 

 possible for it to appear as an epidemic among such 

 as are of a robust habit, from a peculiar state of the 

 atmosphere. It comes on with a sense of lassitude 

 and inactivity, succeeded by vertigo, rigors, and 

 pains over the whole body, but more particularly 

 in the head and back ; which symptoms are shortly 

 followed by redness of the face and eyes, great rest- 

 lessness, intense heat, and unquenchable thirst, op- 

 pression of breathing, and nausea. The skin is dry 

 and parched ; the tongue is of a scarlet colour at the 

 sides, and furred with white in the centre ; the urine 

 is red and scanty ; the body is costive ; and there 

 is a quickness, with a fulness and hardness in the 

 pulse, not much affected by any pressure made 

 on the artery. If the febrile symptoms run very 

 high, and proper means are not used at an early 

 period, stupor and delirium come on, the imagination 

 becomes much disturbed and hurried, and the patient 

 raves violently. The disease usually goes through 

 its course in about fourteen days, and terminates in a 

 crisis, either by diaphoresis, diarrhoea, hemorrhage 

 from the nose, or the deposit of a copious sediment 

 in the urine; which crisis is usually preceded by 

 some variation in the pulse. The chief indication 

 in synocha is to lessen the excessive vascular actions 

 by evacuations, and the antiphlogistic regimen. Of 

 the former, by far the most important is blood-let- 

 ting. Purging is next in efficacy. As the disease 

 advances, however, we must attempt to promote the 

 other discharges, particularly that by the skin. The 

 antiphlogistic regimen consists in obviating stimuli 

 of every kind, so far as this can be done safely ; im- 

 pressions on the senses, particularly the sight and 

 hearing, bodily and mental exertion, &c., must be 

 guarded against as much as possible. The diet 

 should be of the most sparing kind. The stimulus 

 of heat must be especially obviated by light clothing, 

 or even exposing the body to the air, ventilating the 

 apartment, sprinkling the floor with vinegar and 

 water, &c. When the head is much affected, be- 

 sides the general treatment, it will be proper to take 

 blood locally, have the head shaved and cooled by 

 some evaporating lotion, apply a blister to the 

 neck, and, perhaps, stimulate the lower extremities. 

 In like manner any other organ, being particularly 

 pressed upon, may require additional means to be 

 used for its relief, which will be different in different 

 cases. 



Typhus (from TU^HS , stupor) ; a species of continued 

 fever, characterized by great debility, a tendency in 

 the fluids to putrefaction, and the ordinary symptoms 

 of fever. It is to be readily distinguished from the 

 inflammatory by the smallness of the pulse, and the 



sudden and great debility wnich ensues on its first at- 

 tack, and , in its more advanced stage, by the pete- 

 chiae, or purple spots, which come out on various 

 parts of the body, and the fetid stools which are dis- 

 charged ; and it may be distinguished from the ner- 

 vous fever by the great violence of all its symptoms 

 on its first coming on. The most general cause that 

 gives rise to this disease is contagion, applied either 

 immediately from the body of a person labouring 

 under it, or conveyed in clothes or merchandise, &c. ; 

 but it may be occasioned by the effluvia arising from 

 either animal or vegetable substances, in a decayed 

 or putrid state; and hence in low and marshy 

 countries, it is apt to be prevalent when intense 

 and sultry heat quickly succeeds any great inunda- 

 tion. A want of proper cleanliness and confined 

 air are likewise causes of this fever ; hence it pre- 

 vails in hospitals, jails, camps, and on board of ships, 

 especially when such places are much crowded, and 

 the strictest attention is not paid to a free ventilation 

 and due cleanliness. A close state of the atmosphere, 

 with damp weather, is likewise apt to give rise to 

 putrid fever. Those of lax fibres, and who have 

 been weakened by any previous debilitating cause, 

 such as poor diet, long fasting, hard labour, continu- 

 ed want of sleep, &c., are most liable to it. On the 

 first coming on of the disease, the person is seized 

 with languor, dejection of spirits, amazing depression, 

 and loss of muscular strength, universal weariness 

 and soreness, pains in the head, back, and extremities, 

 and rigors ; the eyes appear full, heavy, yellowish, 

 and often a little inflamed ; the temporal arteries 

 throb violently, the tongue is dry and parched, respi- 

 ration is commonly laborious, and interrupted with 

 deep sighing; the breath is hot and offensive, the 

 urine is crude and pale, the body is costive, and the 

 pulse is usually quick, small and hard, and now and 

 then fluttering and unequal. Sometimes a great heat, 

 load, and pain are felt at the pit of the stomach, and 

 a vomiting of bilious matter ensues. As the disease 

 advances, the pulse increases in frequency (beating 

 often from 100 to 130 in a minute) ; there is vast 

 debility, a great heat and dryness in the skin, oppres- 

 sion at the breast, with anxiety, sighing, and moan- 

 ing ; the thirst is greatly increased ; the tongue, 

 mouth, lips, and teeth are covered over with a brown 

 or black tenacious fur; the speech is inarticulate 

 and scarcely intelligible ; the patient mutters much, 

 and delirium ensues. The fever continuing to in- 

 crease still more in violence, symptoms of putrefac- 

 tion show themselves ; the breath becomes highly 

 offensive ; the urine deposits a black and fetid sedi- 

 ment ; the stools are dark, offensive, and pass off in- 

 sensibly ; haemorrhages issue from the gums, nostrils, 

 mouth, and other parts of the body ; livid spots or 

 petechiae appear on its surface ; the pulse intermits 

 and sinks ; the extremities grow cold ; hiccoughs 

 ensue ; and death at last closes the scene. When 

 this fever does not terminate fatally, it generally be- 

 gins, in cold climates, to diminish about the com- 

 mencement of the third week, and goes off gradually 

 towards the end of the fourth, without any very evi- 

 dent crisis ; but in warm climates, it seldom continues 

 above a week or ten days, if so long. Our opinion, 

 as to the event, is to be formed by the degree of 

 violence in the symptoms, particularly after petechias 

 appear, although in some instances recoveries have 

 been effected under the most unpromising appear- 

 ances. An abatement of febrile heat and thirst, a 

 gentle moisture diffused equally over the whole sur- 

 face of the body, loose stools, turbid urine, rising of 

 the pulse, and the absence of delirium and stupor, 

 may be regarded in a favourable light. On the con- 

 trary, petechiae, with dark, offensive, and involuntary 

 discharges by urine and stool, fetid sweats, haemor- 



