MEDICINE. 
be used when the heat, measured by the 
thermometer, is less than, or even only 
equal to, the natural heat, though the pa- 
tient should feel no degree of chilliness. 
This is sometimes the case towards the last 
stages of fever, when the powers of life are 
too weak to sustain so powerful a stimulus. 
5. It is also necessary to abstain from the 
use of this remedy, when the body is under 
profuse sensible perspiration, and this cau- 
tion is more important in proportion to the 
continuance of this perspiration. In the com- 
mencement of sweating, especially if it has 
been brought on by violent exercise, the 
affusion of cold water on the naked body, 
or even immersion in the cold bath, may be 
hazarded with little risk, and sometimes 
may be resorted to with great benefit. After 
the sweating has continued some time, and 
flowed freely, especially if tile body has re- 
mained at rest, either the affusion or immer- 
sion is attended with danger, even though 
the heat of the body at the moment of using 
it be greater than natural. Sweating is al- 
ways a cooling process in itself, but in bed 
it is often prolonged by artificial means, 
and the body is prevented from cooling un- 
der it to the natural degree, by the load of 
heated clothes. AVhen the heat has been 
thus artificially kept np, a practitioner 
judging by the information of his thermo- 
meter only, may be led into error. In this 
situation, however, I have observed, that 
the heat sinks rapidly on the exposure of 
the surface of the body even to the exter- 
nal air, and that the application of cold wa- 
ter, either by affusion or immersion, is ac- 
companied by a loss of heat and a de- 
ficiency of re action, which are altogetlier 
inconsistent with safety.” Under these re- 
strictions, the cold affusion may be used at 
any period of fever, but its effects will be 
more salutary in proportion as it is used 
more early. When employed in the ad- 
vanced stages of fever, where the heat is 
reduced and the debility great, some cor- 
dial should be given immediately after it, 
and the best is warm wine. Dr. Currie, 
when speaking of the internal use of cold 
water, vol. i. p. 92, et seq. directs that 
“ 1. Cold water is not to be used as a drink 
in the cold stage of the paroxysm of fever, 
however urgent the thirst. Taken at such 
times, it increases the chilliness and torpor 
of the surface and extremities, and produces 
a sense of coldness in the stomach, augments 
the oppression on the praecordia, and ren- 
ders the pulse more frequent and raore.fee- 
ble. 2. When the hot stage is fairly formed, 
and the surface is dry and burning, cold 
water may be drank with the utmost free- 
dom. Frequent draughts of cold liquids at 
this period are highly grateful ; they gene- 
rally diminish the heat of the surface several 
degrees, and they lessen the frequency of 
the pulse. When they are attended with 
these salutary effects, sensible perspiration 
and sleep commonly follow. Throughout 
the hot stage of the paroxysm, cold water 
may be safely drank, and more freely in 
proportion as the heat is further advanced 
above the natural standard. It may even 
be drank in the beginning of the sweating 
stage, though more sparingly. Its cautious 
use at this time will promote the flow of the 
sensible perspiration, which, after it has 
commenced, seems often to be retarded by 
a fresh increase of animal heat. A draught 
of cold water taken under such circum- 
stances will often reduce the heat to the 
standard at which perspiration flows more 
freely, and thus bring the paroxysm to a 
sjreedier issue. 3. But, after the sensible 
perspiration has become general and pro- 
fuse, the use of cold drink is strictly to be 
forbidden.' At tliis time I have perceived, 
in more than one instance, an inconsiderate 
draught of cold water produce a sudden 
chilliness both on the surface and at the 
stomach, with great sense of debility, and 
much oppression and irregularity of respira- 
tion. At such times, on applying the ther- 
mometer to the surface, the heat has been 
found suddenly and greatly reduced. The 
proper remedy is, to apply a bladder filled 
with water heated from 110“ to 120“ to the 
pit of the stomach, and to administer small 
and repeated doses of laudanum.” 
Dr. Cullen divides this disease into two 
varieties : typhus mitior, or low nervous 
fever, being that we have now described ; 
and typhus gravior, jail, camp, or hospital 
fever, far more violent in its symptoms, 
rapid in its progress, infectious in its efflu- 
vium, and fatal in its tendency. It becomes 
the medical practitioner, therefore, to be 
proportionably more bold and active: with 
which general observation the same mode 
of treatment may for the most part be pur- 
sued. The stimulant plan must be pushed 
to a much greater extent, and affusions of 
cold water are here of more use than in the 
preceding variety, and of course ought to 
be employed with the most liberal and un- 
hesitating attention. 
Synochus. — Symptoms. This, as we have 
already observed, is a fever compounded of 
those that characterise the first stage of 
synocha, or inflammatory fever, with which 
it commences, and of those which constitute 
