FEVERS. 587 



surface, and with the spasm that occurs there. I might add 

 now that the nausea and vomiting may indeed be considered 

 sometimes as depending in some measure upon substances in 

 the stomach itself, and upon their being more or less in a putrid 

 state. But whether these are to be considered as marks of 

 spasm or putridity, they all resolve into a state of debility ; and 

 accordingly, I have no doubt in marking them here as symp- 

 toms of debility, because I say, that abstracting from some to- 

 pical affection of the stomach which may happen to prevail, or 

 some irritation from the abdominal viscera, the anorexia, nau- 

 sea, and vomiting, are very generally in exact proportion to the 

 other symptoms of debility. The most obstinate vomitings, ac- 

 cordingly, are those that occur in the worst kind of fevers, as 

 the pestilential fever itself. In the natural functions, however, 

 we cannot easily find many symptoms of fever. It is not easy 

 for us to observe the state of the numerous secretions of the sys- 

 tem, and with regard to the principal function of nutrition there 

 is too short a space of time for any considerable change to occur. 

 It is only certain motions that belong to the natural functions 

 that we attend to, such as deglutition, which may be consider- 

 ed as a natural function ; but we only take notice of its debility 

 when it goes to a high degree, and the power of swallowing is 

 lost. When this depends upon a topical affection of the fauces 

 it is easily discerned ; but when it is without any thing of this 

 kind, it is to be considered as a paralytic affection of the fauces 

 and oesophagus, the Dysphagia paralytica of Sauvages, so to be 

 called when the symptoms of debility are so increased that the 

 parts are completely paralytic, and the swallowing ceases entirely. 

 " Under the same head we would mention, that when in the 

 natural functions the weakness affects those parts which are 

 especially endowed with a very permanent contractile power and 

 tone, as the bladder and rectum, and involuntary excretions fol- 

 low, which depend upon the loss of tone in the sphincter ; this is 

 a symptom of extreme debility. I have mentioned (page 578) 

 the ambiguity that occurs here, that the involuntary excretion 

 sometimes is rather to be considered as a symptom of coma and 

 insensibility than of the relaxation of the sphincter, and that we 

 know this from the retention of clysters, while the faeces pass 

 without the patient noticing them ; but where the other marks of 



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