588 PRACTICE OF PHYSIC. 



debility are plain, this is a mark of very extreme debility. We 

 observe this most distinctly in the case of the excretion of the 

 urine, not when it is voided at considerable intervals, but where 

 there is a manifest incontinency. I should have observed that 

 the very cold sweats are an instance of the same relaxation and 

 debility. 



" This finishes the consideration of the state of debility ; and 

 as with respect to the former set of symptoms, those of increased 

 reaction, so here also a judgment is to be formed from the degree, 

 or rather it is by the combination of symptoms that we determine 

 the event. It is not from debility appearing in one or other func- 

 tion alone that there is the most certain danger, but where it ap- 

 pears universally. In concluding this subject, however, I must 

 observe, that Hippocrates has told us that the prognostics neither 

 of life nor of death are to be trusted to absolutely ; it is certain 

 that both are often liable to deceive us in the case of debility, and 

 I have met with surprising deceptions in that respect ; though 

 undoubtedly the combination of the debility in all the functions 

 commonly proves the most certain presage of death, yet there 

 are cases where it has gone a great length, and yet the person 

 has recovered, as in the advanced state of the typhus. Here 

 there is certainly a reaction which produces a crisis or a change 

 in the state of the disease, so that it ends in health, but so ob- 

 scurely that we cannot explain it, and I have not observations 

 sufficient to form any rule or to give any certain directions how 

 to judge when we may still retain hopes in the case of debility. 

 The only rule is this, where the heart continues to retain some 

 degree of its force, and particularly where the pulse is not weak 

 and frequent in proportion to the other symptoms, we hope for 

 a favourable determination ; when the pulse is under 120 in 

 the minute, I do not lose my hopes in fevers ; and I do not hold 

 symptoms of debility alone to indicate the most certain danger, 

 but when they are joined to marks of a topical affection of the 

 brain, they are especially decisive. That some inflammatory 

 state may be going on in the brain dissections very commonly 

 shew ; it is therefore when there are, with the marks of debi- 

 lity, marks of a topical affection of the brain, or of an extreme 

 degree of putrefaction, that we are to infer that the event will 

 prove fatal. 



