FEVERS. 617 



CXLVII. At the same time, as this evacuation may induce 

 a considerable degree of debility, so in those cases in which a 

 dangerous state of debility is likely to occur, purging is to be 

 employed with a great deal of caution, and more especially as 

 the due measure of the evacuation is more difficult to be applied 

 than in the case of blood-letting. 



CXLVIII. As we shall presently have occasion to observe 

 that it is of great importance in the cure of fevers, to restore the 

 determination of the blood to the vessels on the surface of the 

 body, so purging, as in some measure taking off that deter- 

 mination, seems to be an evacuation not well adapted to the 

 cure of fevers. 



CXLIX. If, notwithstanding these doubts (CXLVI. 

 CXLVII. and CXLVIII.), it shall be asserted, that purging, 

 even from the exhibition of purgatives, has often been useful in 

 fevers, I would beg leave to maintain that this has not hap- 

 pened from a large evacuation, and therefore, not by moderat- 

 ing the violence of reaction, excepting in the case of a more 

 purely inflammatory fever, or of exanthemata of an inflammatory 

 nature. In other cases of fever, I have seen a large evacua- 

 tion by purging, of mischievous consequence ; and if, upon oc- 

 casion, a more moderate evacuation has appeared to be useful, 

 it is apprehended to have been only by taking off the irritation 

 of retained fasces, or by evacuating corrupted humours which 

 happened to be present in the intestines, for both of which pur- 

 poses frequent laxatives may be properly employed. 



" I explain myself; the cases are of two kinds : first, where 

 the contents of the stomach and intestines are manifestly copious, 

 there having been a retention or suppression of the alvine excre- 

 tion for some time ; and secondly, where we have reason to suspect 

 that the contents are acrid, which we presume not only from a 

 want of evacuations, but also from the symptoms of the stomach 

 in the fevers called Bilious, from their being attended with an in- 

 creased effusion of bile. In the latter case, the evacuation by stool 

 is indicated, because it is the natural course of the bile. Some- 

 times the bile may not appear very copious either upwards or 

 downwards, and the actual effusion of it into the intestines is not 

 evident, but a considerable determination of blood towards the 

 abdominal viscera appears, in consequence of which congestions 



VOL. i. 2 x 



