134 
MEDICINE. 
Genera. Serepbula ; syphilis-; scorbutus.; 
■ elephantiasis; lepra; frambaesia; trichoma; 
-icterus. 
Class I. Order. I. — Fcbris. 
What is fever ? To this question it ap- 
pears difficult to give a precise and satisfac- 
tory reply. It is observed by the author of 
Zoonomra, that u the term fever is given to 
a collection of morbid symptoms, which are 
indeed so many distinct diseases that some- 
times appear together, and sometimes sepa- 
rate ; hence it has no determinate meaning, 
except it signifies simply a quick pulse, which 
continues for some hours;” in which sense 
Dr. Darwin employs the word throughout 
his ingenious work. 
On this head, however, we differ in opi- 
nion with the author just mentioned. An 
increased action of the sanguiferous system 
shall be induced sometimes by, and at other 
times independant of, a diseased irritation, 
without being accompanied with other pecu- 
liar feelings, which, not restricting ourselves 
to the etymological signification of the term 
fever, we purpose regarding as necessary 
constituents of this, as a distinct malady. 
In every proper fever, there is a feeling of 
depressed power, which essentially differs 
from actual debility. “ A diminution of 
strength in the animal functions,” which con- 
stitutes part of Dr. Cullen’s definition of the 
febrile state, is scarcely characteristic of the 
condition to which we allude. It is a feeling 
with which every one is more or less fami- 
liar, and appears to indicate rather obstruct- 
ed than exhausted strength. Dr. Rush en- 
deavours to illustrate this necessary consti- 
tuent of genuine fever as a distinct expression 
from simple irritation of the blood-vessels on 
the one hand, and mere debility on the other, 
by comparing it with the smothered sound 
which may be supposed to be emitted from 
a musical instrument, provided a heavy 
weight were applied to the chords ; which 
ought to be suffered to vibrate freely and 
without obstruction, in order to produce a 
full and harmonious sound. An illustration 
of a similar nature is likewise employed by 
Dr. Jackson. 
Dr. Brown defines fever, “ an asthenic dis- 
ease that disturbs the pulse.” In this, how- 
ever, there is the same want of distinction 
which we have just complained of in the de- 
finition of Dr. Cullen. Asthenic diseases are 
diseases of deficient excitement; but in fevers 
we have an interruption rather than diminu- 
tion of power. The faculties are locked up, 
not lost. 
Of the phenomena of fever. Dr. Cullen 
very properly selects the more ordinary cir- 
cumstances that present themselves in the 
course of an attack of intermittent fever, as 
an example of what occurs with more or less 
regularity in every case of genuine febrile 
disorder. 
“ The following,” he says, “ are to be ob- 
served in such a paroxysm. The person is 
affected with languor or sense of debility, a 
sluggishness in motion, and some uneasiness 
in exerting it, with frequent yawning and 
stretching. At the same time the face and 
extremities become pale, the features shrink, 
the bulk of every external part is diminished, 
and the skin over the whole body appears 
constricted as if cold had been applied to it. 
At the coming on of these symptoms, some 
coldness of the extremities, though little j 
taken notice of by the patient, may be per- 
ceived by another person. At length the 
patient himself feels a sensation of cold, com- 
monly first in his back, but then passing over 
his whole body : and now his skin feels warm 
to another person. The patient’s sense of 
cold increasing, produces a tremor in all his 
limbs, with frequent successions or rigors in 
the trunk of the body. When this sense of 
cold and its effects have continued for some 
time, they become less violent, and are alter- 
nated with warm flushings. By degrees the 
cold goes off entirely; and a heat greater 
than natural prevails and continues over the 
whole body. With this heat the colour of 
the skin returns, and a preternatural redness 
appears especially in the face. Whilst the 
heat and redness come on, the skin is relaxed 
and smooth, but for some tlmC continues dry. 
The features of the face and other parts of 
the body, recover their usual size, and be- 
come even more turgid. When the heat, 
redness, and turgescence, have ulcreased 4 and 
continued for some time, a moisture appears 
on the forehead, and by degrees becomes a 
sweat, which gradually extends downwards 
over the whole body. As this sweat conti- 
nues to flow, the heat of the body abates ; 
the sweat, after continuing for some time, 
gradually ceases, the body returns to its 
usual temperature, and most of the functions 
are restored to their ordinary state. 
Species of fevers. The general di vision 
of systematic^ is into continued and intermit- 
tent. The very correct description above 
given answers, as we have .stated, to a single 
paroxysm or lit of fever. It is not however 
often that the disorder terminates with the 
decline of the paroxysm. In the course of a 
certain time it is renewed; and according to 
the suddenness or tardiness of the paroxysm’s 
recurrence, the fever is called continued, re- 
mittent, or intermittent. Sometimes, indeed, 
the disordered actions recur with such cele- 
rity, that the fever appears to be one conti- 
nuous series; “the remission is inconsider- 
able, is perhaps without sweat, and the re- 
turning paroxysm is not marked by the usual 
symptoms of a cold stage, but chiefly by the 
exacerbation or aggravation of the hot one.” 
The disease in this last case is considered as 
a continued fever ; in which, however, there 
is, though not the distinct stages of an inter- 
mittent, almost invariably, especially in the 
earlier periods, a diurnal remission and re- 
currence of paroxysm. Of intermittent fe- 
vers, the paroxysms, such as we have just 
described, are always finished in less than 24 
hours, and most frequently are not extended 
to nearly this time. 
We are then furnished with a natural divi- 
sion of fever into intermittent and continued, 
which however have many circumstances in 
common, and often pass into each other ; 
thus, what is termed in the schools a quartan 
intermittent, formed by an interval of 72 
hours from the commencement of one to the 
commencement of another paroxysm, will in 
its course become a tertian ague, with only 
48 hours of interval: this again shall fall into 
a quotidian, characterized by an interval 
of only 24 hours. A quotidian shall pass into 
the state of a remittent, and this last be con- 
verted into a true continued fever. 
Besides, however, this leading distinction 
of fever, from the times of the recurrence of 
the fits, we have many others arising from 
the nature of the constitution of the indivi- 
duals attacked, the prevailing cond.tion of the 
atmosphere, and oilier extraneous circum- 
stances, and likewise (what is ascertained 
however with less exactness) the specific dif- 
ference of the exciting cause ; thus, common 
fever has sometimes the inflammatory, at 
others the typhoid, character. Thus ar,e 
presented the bilious remittent fever of damp 
and warm climates, the yellow fever erf the 
West India islands, the jail fever of crowded 
prisons, and the plague in Eastern countries. 
On Cullen's genera. It will be perceived 
that under the appellation of fever 've con- 
line ourselves to the consideration of what 
lias been by way of distinction termed simple 
fever, and perhaps with propriety regarded 
by Mr. Wilson as “ the only general dis- 
ease,” other diseases being either local, or 
general and local. Thus the sensit ve irri- 
tated fever of Darwin, which forms princi- 
pally the phlegmasia of Cullen, is a disorder, 
either symptomatic of, or at least supported 
by, local irritation. 
The genera of Dr. Cullen of continued 
fever, are, 
1. Synocha. “ Great heat, pulse frequent, 
strong, and hard ; high-coloured urine, the 
functions of the sensorium not much impair- 
ed.” Such character, however, does not 
answer to any case of simple fever; it is the 
definition of what Dr. Brown calls the sthe-r 
nic, which is opposed to the true febrile 
slate. 
2. Typhus. “ A contagious disease, the 
heat not much increased, pulse frequent, 
small, and weak ; urine little changed, sense 
much impaired, and the strength greatly di- 
minished.” T his definition approaches near- 
est to the more usual form of fever in this 
country. That part of the definition, how- 
ever, is extremely defective which describes 
the heat as not much increased. 
3. Synoclius. This is made by Cullen a 
kind of intermediate disease between synocha 
and typhus. 
Exciting causes of fever. On this subject 
the most opposite opinions prevail, it is 
imagined by some, that no case of genuine 
fever, beyond those ephemeral irritations 
which are of daily occurrence, can possibly 
originate without the previous application, 
either through the medium of the lungs, or 
the surface of the body, of a certain some- 
thing generated in the system of another in- 
dividual in the course of tire same disease. 
Others infer, from the daily observation of 
febrile diseases where no communication 
with the sick can ire traced or suspected, that 
although the febrifacient matter just spoken 
of be in many, it is not in all instances the 
cause of fever; that cold, damp, heat, putrid 
exhalations whether animal or vegetable, in- 
sufficient ventilation, the depressing passions, 
&c. are all, either singly or in conjunction, 
capable, under some circumstances, not 
merely of predisposing to, but of actually en- 
gendering, proper fever. Lastly, there are 
some who consider contagion, or the genera- 
tion in fever of specific febrifacient matter, 
as totally imaginary ; and conceive in in- 
stances w'here fever has spread by communi- 
cation, that either certain undetected condi- 
tions in the air, or the confined effluvia of ani- 
mal excretions accumulated by want of 
