INFANTS. 



moiiiy makes ; and for tKe fame reafon, Hoffman gave it 

 the appellauon of Febr'u lenta infantum. 



The fever in queftionis moft commonly preceded for feme 

 d;\ys, and occaiionally for weeks, by fymptoms of in- 

 dilpofition, mu .li refembling the early fymptoms of maraf- 

 vuis. The child is obferved not to look well, and his colour 

 often changes. He is indolent, fpiritlefs, and fretful ; fre- 

 quently picks his nufc, lips, and fingers, even fometimes till 

 he draws blood : his breath is o.Fenfive, and he is affefted 

 with a fhort dry cough. If he can fpcak, he complains of 

 pain in his head, or belly, or both : and when ilill older, 

 he fays alfo that he is faint and weak. He has a defire fur 

 drink more than for food ; is much troubled with wind ; 

 and his belly is fometimes larger than natural. In his 

 lleep, he Harts, moans, and makes a grating noife with his 

 teeth. His urine puts on a milky appearance almoft as foon 

 as made, and, in a few miiuites, depofits a fediment of the 

 fame colour, leaving the body of the urine witli very little 

 colour. His bowels are generally in the extreme, being 

 eitlier coftive or loofe. 



After thefe fymptoms have continued for a longer or 

 fhorter time, the fever makes its appearance, fometimes pre- 

 ceded by a diftinCl cold fit, at other times, however, fo 

 gradual in its approach, that the commencement is not ob- 

 ferved. It always aflumes more or lefs of the remittent 

 form, when it is dillinftly feen, and the exacerbations are 

 long, and the remiffions ihort, in proportion to the violence 

 of the fever. During the exacerbation all the fymptoms are 

 jncreafed ; there is great heat of fliin, and the patient is drowfy, 

 andfleeps, but not foundly ; for he ilarts, moans, talks in- 

 coherently, and even fcreams in his fleeps. The wind is 

 particularly troublefome, makes a rumbling noife in the 

 Isowels, and is exploded copioufly both upwards and down- 

 wards, with manifeil relief The cough is more frequent, 

 and the breathing is quickened and opprefled. The patient is 

 often fick, and fometimes retches, and even vomits phlegmy 

 ttuff of various colours. The pulfe beats from a hundred 

 and forty to a hundred and fixty pulfations in the minute. 

 In the remifBons, all the fymptoms abate. The patient is 

 wakeful, is attentive to things around him, often inchnes to 

 be playful, and is in general averfe to lying in bed. What 

 fleep he has is ufually compofed. The pulfe beats from a 

 hundred and twenty to a hundi-ed and thirty ftrokes in a 

 minute. 



Thefe exacerbations and remiffions often occur with a con- 

 fiderable degree of regularity; the exacerbation generally be- 

 ginning in the evening, and the remiffion taking place in the 

 morning : but in the more acute form of the difeafe, there are 

 one or two (horter exacerbations during the day. In the 

 latter cafe, both in the exacerbations andremifGons the (Ivin 

 is commonly dry : when fweats happen, they are partial, 

 affefting only the head, breaft, or palms. The belly and 

 palms are always warmer than any other part of the body. 

 Where there is only thenofturnal exacerbation, it is ufually 

 terminated by a profiife fwcat ; and through the day, the 

 fkin is temperate, but feels dry and harfti. The patient 

 has no appetite, and fcarcely any thirll ; fo that in many 

 cafes, it is with great difficulty that he can be made to take 

 cither food or drink. The (late of the bowels is uncertain ; 

 but the ftools are always unnatural, either as to their colour, 

 eonfiftence, contents, or fmell : moll commonly they are 

 morbid in all thefe refpefts ; for they are either whiter or 

 darker than natural ; they are always more offcnfive ; are 

 feldom without a great deal of (lime, and fometimes confill 

 of nothing but flime : fometimes they froth and ferment hke 

 yeaft. 



The patients frequently pafs worms in the courfe of tlu« 

 fever, even when they were never known to void any before. 

 Thefe worms are not only thrown off by vomiting and llool, 

 but arc fometimes obferved to work tliemfclves out of the 

 body both ways, feemingly unaffitted by any exertions on 

 the part of the patient's organs. But in many cafes of 

 this fever, no worms are ever feen. 



When the lever is on the dechne, the exacerbations grow 

 milder and fhorter, and at length diiappear one after 

 another ; the appetite returns by degrees ; the fleep becomes 

 calm and refrerfinig, attended with a general moifture of the 

 flvin, and the ilools approach more and more to the natural 

 ilate, till they become as in health. The duration of this fe- 

 ver, in its more acute form, is from eight or ten days to a iort- 

 night or three weeks ; in the more flow and mild form, it 

 will lall for two or three months or more. 



That the caufe of this remittent fever of children lies in 

 the alimentary canal, and is of the fame nature with tliat 

 from which marafmus, and fevefal other infantile difeaics 

 originate, has not been doubted fnice it was fo well pointed 

 oul by Dr. Butter. It is proved, in the firft place, by the 

 fimilarity of the fymptoms with which it is preceded ami 

 ufliered in, and, fecondly, by the nature of the alvine dif- 

 charges during its continuance, but more efpecially by the 

 fuccefs of the pradlice, which is founded upon this princi- 

 ple, and confilis in carrying off the accumulation of mor- 

 bid excretions from the bowels, and augmenting their 

 ilrength. The fame caufe operating in different conftitu- 

 tions, will produce a difierent feries of fymptoms ; and 

 it is probably from the peculiar irritabihty of habit in 

 fome children, that this fever is produced, by the fame 

 morbid fecretion and accumulation in the prirrnt vi.f, which 

 give rife to marafmus, and other chronic maladies in 

 others. " It may be accelerated by cold, fatigue, or the 

 like;" fays Dr. Butter, (fpeaking of the remittent fever,) 

 " but the principal caufes are crude accumuk.iions in the 

 firft paffages, which, with a very irritable predifpofition, 

 draw the intellinal canal into fpafm, &c." whence the 

 irritation is communicated to the reft of the body, and general 

 fever induced. 



Cure of the infantile remittent fever. — The two principal in- 

 dicationsof cure are, to allay the febrile irritation, and to re- 

 move the great irritating caufe ; the former of which, although' 

 in a great meafure palliative only, is an objeft of con'iderable 

 importance. It is extremely defirable, therefore, that from 

 the fu-il occurrence of the febrile fymptoms, the child (hould 

 be kept Hill, and quiet, in a chamber which is of a cool 

 temperature; that all folid food and ftimulating drink fliould 

 be cautioudy abftained from ; and the fole fupport of the 

 patient be diluting and nourifliing hquors, fuch as fraall 

 broth, gruel, and barley-water. 



The fecond, or proper curative indication, is fulfilled by 

 fuch medicines as keep up a conftant gentle adtion upon the 

 bowels, and contribute at once to diflodge the morbid accu- 

 mulation, and to correct the morbid condition, of the alvine 

 excretions. This purpofe may be etfefted either by the 

 neutral falts, or by fmall dofes of mercurial laxatives, ef- 

 pecially in combination with abforbents. Dr. Butter gives 

 the preference to the former ; and commonly employs the 

 polychrefl fait, which promotes both urine and ftools. For 

 a child of five years old (and proportionally for a younger 

 or older fubjcct ) he dilfolvcs a drachm of this fait in a quarter 

 of a pint of water, fweetcning it with two drachms of fugar. 

 Of this mixture two fpoonfuls are adminiftered every four 

 hours, or at fuch intervals, when the child is awake, that 

 the whole may be finiflied in twenty-four hours. This me- 

 dicine is to be repeated daily, fo as to promote one, two, 



three. 



