MEDICINE. 
however, without topical inflammation, is in 
this country a very rare occurrence, gene- 
rally commences with short fits of cold and 
heat alternating with each other, to which 
succeed an intense burning heat, head-ach, 
accompanied with throbbing of the temples, 
or tinnitus aurium, pains in the back, loins, 
and joints, and the patientfeels as if his body 
had been severely bruised : the face is full 
and florid ; the eyes are inflamed and inca- 
pable of bearing the light ; the skin, mouth, 
and throat are diy ; the tongue is covered 
with a white crust; the thirst is intolerable; 
the respiration is frequent, hurried, gene- 
rally oppressed, and attended with a dry 
cough ; there is anorexia, nausea, vomiting, 
restlessness, and delirium ; the urine is se- 
creted in small quantity, and is high co- 
loured ; the bowels are costive ; the pulse is 
frequent, strong, and hard, scarcely ever, 
however, exceeding 120 strokes in a mi- 
nute ; the blood, when drawn, is covered 
with a whitish or yellowish crust. In this 
countiy, after the symptoms have continued 
for some days, they begin generally to as- 
sume those of typhus, so that the whole 
disease is synochus. 
Causes. Suppression of the accnatomed 
evacuations ; cold by any means applied, as 
exposure of the body to the cold air, when 
it is in a state of perspiration ; exposure to 
the rays of the sun ; intemperance in eating, 
but more particularly in drinking ; topical 
inflammation ; intense study; great fatigue ; 
the premature repulsion of eruptions ; per- 
spiration suddenly checked, and violent 
passions of the mind. 
Diagnosis. This fever will be readily 
distinguished from the typhus mitior by the 
strength of the pulse, the intense heat, great 
thirst, violent pains in the back and joints, 
high coloured urine, and by the less de- 
rangement of the mental functions. 
Prognosis. It frequently terminates in 
a favourable manner about the seventh 
day, either by hemorrhage, a profuse 
diaphoresis, or by the urine depositing a 
copious lateritious sediment; the termi- 
nation by diarrhoea is a much more rare oc- 
currence. If the respiration be very labo- 
rious, if the head-ache be very severe, at- 
tended with delirium ferox, if the abdomi- 
nal viscera be much affected, if the urine be 
pale or limpid, and the skin assumes a yel- 
low tinge before the seventh day, we 
may generally expect an unfavourable 
issue. 
Treatment. The removal of this disease 
must be attempted by blood-letting, in pro- 
portion to the violence of the symptoms of 
increased excitement, strength, and former 
habits of life of the patient, and nature of 
the prevailing epidemic ; if, on the first 
blood-letting, the symptoms be consi- 
derably alleviated, and the pulse and heat 
become nearly natural, it will not be ne- 
cessary to repeat it ; if, on the contrary, 
the symptoms continue w'ith but little or no 
abatement, it will not only be advisable 
but indispensably necessary to repeat the 
operation, until we nearly reduce the pulse 
and heat to the natural standard; the blood- 
letting will be the more efficacious, the 
more suddenly we abstract the blood ; an 
emetic should then be administered, and in 
a few hours after its operation has ceased, a 
cathartic should be exhibited, for which 
purpose the phosphate or sulphate of soda, 
or the sulphate of magnesia, combined with 
the infusion of senna, with a small propor- 
tion of the tartarised antimony, will be 
the most efficacious ; calomel is a pre- 
ferable medicine to the others ; after the 
contents of the primae vi® are sufficiently 
evacuated, we should order the neutral 
salts, particularly the saline draughts every 
two or three hours, to each dose of which, 
from twenty to thirty drops of antimonial 
wine, with the same quantity of the spirit 
of nitre may be conjoined with advantage ; 
cooling mucilaginous liquors acidulated 
with the vegetable acids, or cold w'ater, 
should be freely allowed, when the heat of 
the surface of the body is steadily above the 
natural standard. It is of the utmost con- 
sequence, throughout tlie whole course of 
this disease, that the alimentary canal should 
be kept clear of feculent matter ; for which 
purpose the mildest laxatives should be em- 
ployed, or perhaps mucilaginous clysters 
would be preferable ; all exercise, both of 
the body and mind, must be studiously 
avoided, the patient must be kept quiet and 
in a horizontal posture, the light should be as 
much as possible excluded, there should be 
a free circulation of cool air through the 
apartment, the floor of which should be 
frequently sprinkled with cold water, the 
patient should be lightly covered with bed- 
clothes, all excremental matters should be 
speedily removed, and the patient should 
have frequent changes of dry linen. If the 
pain of the head be very violent, accom- 
panied with delirium, or, if the patient is 
oppressed with coma, blood-letting, both 
general and topical, will be necessary, pro- 
vided the strength of the patient is not too 
much exhausted; cathartics and laxative 
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