FEVERS. 583 



other following symptoms of fever are to be in a degree higher 

 in proportion to the cold which occurs at the commencement. 

 Now, where the coldness is without horror, tremor, and rigor, it 

 may be considered as a mark of a strong sedative power produ- 

 cing the fever ; but it must always be taken with this quali- 

 fication, that the horror, tremor, and rigor are symptoms of a 

 reaction taking place which is excited for the solution of the 

 paroxysm. But there is no ambiguity when cold occurs in the 

 advanced state of fevers, whenever it affects what we strictly call 

 the extremities. It most readily occurs in the feet, as a mark 

 of the weaker action of the heart ; still more so when it affects 

 the hands, which are nearer to the heart ; but it is to a greater 

 degree still when it affects parts on the surface of the body 

 which are only a little prominent, such as the tip of the ear, or 

 tip of the nose, which are only a little more exposed to the air 

 than other parts. This is considered as a mark of extreme de- 

 bility, and very often is the symptom of approaching death. 



" To these symptoms some others are frequently joined, 

 which express in like manner the weaker action of the heart in 

 propelling the blood to the different parts of the system, such 

 as a pallid countenance, which is among the first expressions of 

 the approach of fevers. When the reaction is vigorous, this 

 symptom is not only absent, but a redness and turgescence of 

 the face appears ; and a paleness appearing instead of this, is 

 certainly a clear symptom of an increasing debility in the sys- 

 tem. In ordinary health, a number of red vessels appear upon 

 the adnata of the eye ; when they do no longer appear, this is a 

 mark of the debility prevailing ; very often, however, while the 

 countenance is pale, and there are other marks of debility in 

 the advanced state of fevers, we observe a considerable redness 

 in the adnata of the eye, which may be considered as a mark of 

 irritation in the brain ; for even though the action of the heart 

 is weak, there may be a considerable determination to the ves- 

 sels of the head, with which the vessels of the eye have more 

 communication than those of the face. Not only the paleness 

 of the countenance is a mark of the weaker circulation, but at 

 the same time there is a collapse of the features of the face, 

 which become not merely languid but flat, and the face appears 

 leaner. The turgescence of the skin in persons in health cer- 



