22 



PRACTICE OF MEDICINE. 



mittent ; and although often a quotidian, is more frequently tertian in 

 its type. 



Sy77iptoms.—ln some cases the organic functions are most affected ; 

 then the evidences of disease are presented chiefly in the organs of 

 digestion, respiration, circulation, calorification, and secretion. In 

 other cases the blow falls upon the animal functions, then the brain 

 IS the organ most affected. Of the or^janic functions, sometimes one 

 is selected m preference to the rest. Thus the force of the morbific 

 cause appears to fall, in some instances upon the heart, in others, 

 upon the alimentary canal, in others again, upon the surface of the 

 body, either in its function of secretion or calorification. 



Sometimes it approaches like an ordinary intermittent, at others, 

 with its own peculiar features. It may occur at any hour of the day 

 or night. *^ 



When the disease is fully formed and exists primarily in the organic 

 functions, the face and hands are of a livid paleness, the features 

 shrunk and expressive of alarm, the skin contracted and shrivelled 

 like a washerwoman's, the extremities, the trunk, and sometimes 

 even the breath are cold. The surface is, at times, moistened with 

 a clammy perspiration, or bathed in a profuse sweat. The tongue 

 is pale and cold, sometimes dry, sometimes unaltered; there is 

 epigastric tenderness, with great' internal heat and intense thirst. 

 Nausea and incessant vomiting are present, with constipation, or the 

 reverse. In the latter case the discharges consist of bloody serum, 

 sometimes of blood, either coagulated or not. The respiration is 

 characteristic, the breathing consists of deep sighs, and with two 

 inspiratory efforts to one expiration. Sometimes it is hurried, 

 irregular, and panting. The pulse is small, irregular, sometimes 

 corded, but oftener feeble, fluttering, and sometimes intermittent. It 

 IS almost always frequent, amounting to as much as 120 or even 

 160 in the minute. With all these symptoms there is great restless- 

 ness, the patient attempting to rise from his bed to reach the door or 

 window. 



The duration of the paroxysm varies ; sometimes it will extend 

 over two or three days, mingled with attempts at reaction, sometimes 

 it will last but a few hours, and then reaction comes on, though in 

 no degree equal to the preceding depression, and the patient seems 

 as if about to be restored to health. At other times a slight degree 

 of fever remains ; it is only a remission that has taken place. 



If not arrested, the same train of symptoms recurs the next day 

 or the day after with increased violence, the second paroxysm often 

 proving fatal, though sometimes a third occurs, before death takes 

 place. 



Sometimes the whole force is spent upon the heart, then the promi- 

 nent phenomena are those of excessive prostration of the circulation. 

 In some cases coldness is the prominent symptoms ; in others an 



