182 



FEVER. 



rhages, and hiccoughs denote the almost certain disso- 

 lution of the patient. The appearances usually 

 perceived on dissection are inflammations of the brain 

 and viscera, but more particularly of the stomach and 

 intestines, which are now and then found in a gan- 

 grenous state. In the muscular fibres there seems 

 likewise a strong tendency to gangrene. In the 

 very early period of typhus fever, it is often possible, 

 by active treatment, to cut short the disease at once; 

 but where it has established itself more firmly, we 

 can only employ palliative measures to diminish its 

 violence, that it may run safely through its course. 

 Among the most likely means of accomplishing the 

 first object is an emetic. Attention should next be 

 paid to clear out the bowels by some sufficiently 

 active form of medicine; and as the disease proceeds, 

 we must keep up this function, and attempt to re- 

 store that of the skin, and the other secretions, as the 

 best means of moderating the violence of vascular 

 action. The general antiphlogistic regimen is to 

 be observed in the early part of the disease, as 

 explained under synocha. In cases where the skin is 

 uniformly very hot and dry, the abstraction of caloric 

 may be more actively made by me;ms of the cold 

 affusion, that is, throwing a quantity of cold water on 

 the naked body of the patient ; which measure has 

 sometimes arrested the disease in its first stage ; and, 

 when the power of the system is less, sponging the 

 body occasionally with cold water, medicated, per- 

 haps, with a little salt or vinegar, may be substi- 

 tuted as a milder proceeding. But, where the evolu- 

 tion of heat is even deficient, such means would be 

 highly improper; and it may be sometimes advis- 

 able to employ the tepid bath, to promote the opera- 

 tion of the diaphoretic medicines. If, under the use 

 of the measures already detailed, calculated to lessen 

 the violence of vascular action, the vital powers 

 should appear materially falling off, recourse must 

 then be had to a more nutritious diet, with a moderate 

 quantity of wine, and cordial or tonic medicines. 

 There is generally an aversion from animal food, 

 whence the mucilaginous vegetable substances, as 

 arrow-root, &c., rendered palatable by spice or a 

 little wine, or sometimes mixed with milk, may be 

 directed as nourishing and easy of digestion. If, 

 however, there be no marked septic tendency, and 

 the patient be cloyed with these articles, the lighter 

 animal preparations, as calves-foot jelly, veal-broth, 

 &c., may be allowed. The extent to which wine 

 may be carried must depend on the urgency of the 

 case, and the previous habits of the individual ; but 

 it will commonly not be necessary to exceed half a 

 pint, or a pint at most, in the twenty-four hours ; 

 and it should be given in divided portions, properly 

 diluted, made, perhaps, into negus, whey, &c., ac- 

 cording to the liking of the patient. The preference 

 should always be given to that which is of the 

 soundest quality, if agreeable; but where wine can- 

 not be afforded, good malt liquor, or mustard whey, 

 may be substituted. Some moderately stimulant 

 medicines, as ammonia, aromatics, serpentaria, &c., 

 may often be used with advantage, to assist in keep- 

 ing up the circulation ; also those of a tonic quality, 

 as columba, cusparia, cinchona, &c., occasionally in 

 their lighter forms ; but more especially the acids. 

 These are hi several respects useful : by promoting 

 the secretions of the primae via 1 -, &c., they quench 

 thirst, remove irritation, and manifestly cool the 

 body ; and in the worst forms of typhus, where the 

 putrescent tendency appears, they are particularly 

 valuable from their antiseptic power ; they are also 

 decidedly tonic, and, indeed, these from the mineral 

 kingdom powerfully so. These may be given freely 

 as medicines, the carbonic acid also in the form of 

 brisk fermenting liquors ; and the native vegetable 



acids, as they exist in ripe fruits, being generally 

 very grateful, may constitute a considerable part of 

 the diet. In the mean time, to obviate the septic 

 tendency, great attention should be paid to cleanli- 

 ness and ventilation, and keeping the bowels regu- 

 lar by mild aperients, or clysters of an emollient or 

 antiseptic nature ; and where aphthae appear, acidu- 

 lated gargles should be directed. If the disease in. 

 clines more to the nervous form, with much mental 

 anxiety, tremors, and other irregular affections of 

 the muscles, or organs of sense, the antispasmodic 

 medicines may be employed with more advantage, as 

 ether, camphor, musk, &c., but particularly opium, 

 which should be given in a full dose, sufficient to 

 procure sleep, provided there be no appearances of 

 determination of blood to the head ; and it may be 

 useful to call a greater portion of nervous energy to 

 the lower extremities by the pediluvium, or other 

 mode of applying warmth, or occasionally by sina- 

 pisms, not allowing these to produce vesication. But 

 if there should be much increased vascular action in 

 the brain, more active means will be required ; even 

 the local abstraction of blood, if the strength will 

 permit; and it will be always right to have the 

 head shaved, and kept cool by some evaporating 

 lotion, and a blister applied to the back of the neck. 

 In like manner, other important parts may occasion- 

 ally require local means of relief. Urgent vomiting 

 may, perhaps, be checked by the effervescing mix- 

 ture ; a troublesome diarrhoea by small doses of 

 opium, assisted by aromatics, chalk, and other 

 astringents, or sometimes by small doses of ipeca- 

 cuanha ; profuse perspirations by the infusum rosce, 

 a cooling regimen, &c. 



Nervous Fever ; a variety of the typhus mitior of 

 Cullen, but by many considered as a distinct disease. 

 It mostly begins with loss of appetite, increased heat, 

 and vertigo ; to which succeed nausea, vomiting, 

 great languor, and pain in the head, which is vari- 

 ously described, by some like cold water pouring 

 over the top ; by others, a sense of weight. The 

 pulse, before little increased, now becomes quick, 

 febrile, and tremulous ; the tongue is covered with a 

 white crust, and there is great anxiety about the 

 prascordia. Towards the seventh or eighth day, the 

 vertigo is increased, and tinnitus aurium, cophosis, 

 delirium, and a dry and tremulous tongue take 

 place. The disease mostly terminates about the 

 fourteenth or twentieth day. See Typhus. 



Dengue Fever. This name has been given to a 

 disease which appeared in the years 1827 and 1828, 

 in the West Indies, and in the Southern States of 

 North America. It has also been called the dingee, 

 the danga, the dandy, the bouquet, and the bucket 

 fever. This disease was remarkable for the sud- 

 denness of its attack, the great numbers affected, 

 the severity of the symptoms, and the rareness of 

 death from it. It would seem, from the reports of 

 those who have seen most of this disease, and whose 

 judgment may be relied on, that the dengue has 

 some affinities with the yellow fever. The symp- 

 toms, as noticed in Havanna, were first great lan- 

 guor, chilliness, and pain in the tendons of the smal- 

 ler joints : following these were burning heat and 

 redness of the skin, pains in the muscles of the 

 limbs, or pain in the forehead, and a loathing or 

 vomiting of whatever was taken into the sto- 

 mach. The fever continued for one, two, or three 

 days, and then usually terminated with a free sweat- 

 ing, which freed the patient likewise from his pains. 

 But many, after leaving their beds, suffered by a re- 

 newal of their pains, which, in some, have become 

 chronic ; others have also had a renewed attack of 

 the fever. " The most usual mode of attack, how- 

 ever," says Dr Stedman, of Santa Cruz, " which 



