668 PRACTICE OF PHYSIC. 



" 4. I put another case of fever that only happens in the 

 more advanced state ; when, after the seventh or some of the 

 following days, it appears pretty plainly that the synochus is 

 changed to a typhus, that the inflammatory is changed to the 

 nervous state. This we commonly ascertain more certainly 

 when we find that though the pulse grows more frequent, and 

 manifestly smaller and weaker ; when the heat, which had been 

 considerable in the beginning of the disease, becomes now more 

 obscure, and is only felt on pressing deep on any part ; when 

 the thirst which had been considerable before, is now manifestly 

 abated ; when there is a manifest drowsiness without succeeding 

 sleep ; when the confusion of head is increased, and a low de- 

 lirium has prevailed ; when, with these symptoms, there is a con- 

 siderable increase of debility in the whole of the animal func- 

 tions ; and when joined to that there is a tremor, and perhaps 

 subsultus tendinum. There are two other symptoms that may 

 be taken notice of the state of the tongue and of the urine ; 

 but I cannot make use of them very properly. One would ex- 

 pect that the extreme dryness of the tongue would be a conse- 

 quence of heat and the inflammatory diathesis ; but I find that 

 even in the most pure nervous fevers, it occurs to as great a degree 

 as in the other ; but if with the symptoms I have been just now 

 describing of considerable nervous affections, the tongue still 

 suffers very little change, and retains its usual softness, it may 

 be taken in as a mark of the diminution of the increased impe- 

 tus or force of the system ; but that is a very rare occurrence. 

 The other symptom that I speak of, viz. the state of the urine, 

 is as ambiguous. Taking the account of the ancients, they con- 

 sidered that the urine, from being very high coloured and turbid 

 becoming clear and thin, was a mark of a translation to the brain, 

 and of a more considerable affection of that part, but I do not 

 find that it applies that way in this part of the world ; and I do 

 maintain that the urine, from thick, turbid, and high coloured, 

 becoming more clear and pellucid, is generally a favourable ap- 

 pearance. But let us take the other symptoms that are suffi- 

 ciently, characteristic, and then it is evident that other measures 

 are to be pursued, viz. such as have the power of relaxing the 

 febrile spasm. Here it is that blisters have their proper place ; 

 and it is commonly necessary to support a succession of such 



