200 PATHOLOG Y. 
generality of cafes, not from ceffation or diminution of 
contraiOion in thofe vefl'els, but from the increafed adfion 
of the heart enabling the blood to force its way into, 
and through, thefe arteries, in fpite of the oppofitiou 
which is offered by their contradfile power to that fluid. 
So that, in the fecond ftage of fever, there is, as it were, 
a continued conteft and ftruggle between the adiion of 
the heart and the contradlile power of the fmall arteries, 
the balance of power being conftantly in favour of the 
former. 
“ We now proceed to the confideration of the laft ftage, 
or the decline of fever. We obferve that, whenever a 
high degree of fenfibility of the nervous fyftem has ex- 
ifted for fome time, it is, fooner or later, fucceeded by a 
ftate of torpor, the degree of which is proportionate to 
the duration and the degree of the preceding fenfibility. 
Wealfofind that, when a high degree of adtion has been 
kept up for fome time by the heart, a languid adfion of 
that organ fooner or later fucceeds; the degree of lan¬ 
guor being proportionate to the duration and the degree 
of the preceding ftrength of adfion. When a high de¬ 
gree of refiftanceto the momentum of the blood has been 
offered, for a length of time, by the contradfile power 
of the fmall arteries, the exertion of that power will, 
fooner or later, become enfeebled, or will be fufpended ; 
the diminution of that exertion being proportionate to 
the degree and duration of its previous adtivity. 
“We have traced the various ways in which thofe 
ftates which characterize the fecond ftage of fever may 
be formed. Let us fuppofe that, in either of thofe ways, 
thefe ftates have been produced. The high degree of 
fenfibility of the nervous fyftem; the high degree of ac¬ 
tion on the part of the heart; the ftrong, but unavailing, 
refiftance of the fmall arteries, may feverally laft an un¬ 
certain time. The natural confequence of each of thefe 
liates will be, as we have juft feen, the formation of an 
oppofite ftate. The high degree of fenfibility will give 
place to torpor ; the powerful action of the heart will fub- 
fide into feeble contradtion ; the ftubborn refiftance of 
the fmall arteries will give way. Accordingly we find 
that thefe natural confequences are precifely the occur¬ 
rences which are met with in the laft ftage of fever. The 
fenfibility of the nervous fyftem becomes diminifhed in 
proportion to the duration and degree of its previous in- 
creafe. The adtion of the heart becomes feeble. Both 
thefe new ftates favour the increafe of each other. The 
contradtion of the fmall arteries gives way; the ftruggle 
between thefe veffels and the heart is at an end, fo that 
the contradtion of the heart, although enfeebled, may {till 
be able to carry on the circulation of the blood ; and 
thus an obfti-adted, or a ftagnant, ftate of the round of 
the circulation, which would otherwife refult from the 
languid adtion of the heart, may be prevented. 
“ It appears, then, that both in the firft and in the laft 
ftages of fever, the fenfibility of the nervous fyftem and 
the adtion of the heart are diminifhed ; while, in the 
early ftage, the contradtion of the fmall arteries is in¬ 
creafed; whereas, in the decline of fever, it is diminifhed 
or altogether fufpended. The different ftate of the con- 
tradtile power of the fmall arteries, then, appears to 
conftitute the leadingdiftindtion between thecharadter of 
thefe two ftages of fever. From the refult of our invefti- 
gation, it appears that the ftates which charadterize the 
iecond ftage of fever are the confequences of thofe ftates 
which uftier in fever; and that the ftates which confti¬ 
tute the third ftage are the natural refultsof thofe which 
are met with in the fecond ftage. It follows then that 
the ftates attendant on the third ftage, as well as thofe 
which mark the fecond ftage, are the confequences of 
thofe ftates which appear in the firft ftage of fever.” 
Before we proceed to examine the juftnefs of thefe 
views of fever, we (hall prefent to our readers a hiftory 
of thofe phenomena. It is now pretty generally acknow¬ 
ledged, that the divifion of the fevers of this country 
into fynocha, fynochus, and typhus, is not founded in 
nature, but engendered by hypothetical notions in the 
brain of Cullen. On this account we (hall proceed to 
fay, that, of fevers in general, the commencement is 
commonly marked by fome degree of languor, laifitude, 
and general uneafinefs; the patient feels himfelfill, with¬ 
out being able to refer his uneafy feelings to any parti¬ 
cular part of the body. There is alfoa liftleffnefs, or a 
defire frequently to change the pofture, but at the fame 
time the fenfe of wearinefs difpofes the patient to refift 
this inclination ; the motions when made are fluggifh, 
and frequent yawning and ftretching accompany the at¬ 
tempt. The mind is affeCted in a fimilar way ; it cannot 
reft upon any objeCt; the attention is not under the 
command of the will, but wanders from one fubjeft to 
another; and, as the ability of exerting the mufcular 
powers becomes diminifhed, there is likewife an inabi¬ 
lity of exercifing the faculties of the mind ; the patient 
cannot think or reafon, even upon his ordinary affairs, 
with his ufual eafe. Along with thefe fymptoms, but 
more frequently after them, he feels a fenfation of cold, 
commonly firft in his back, but afterwards over the 
whole body ; the fame kind of fenfation that he feels 
when furrounded by a colder medium than he is ac- 
cuftomed to: he willies, therefore, to go near a fire, or 
into the rays of the fun, or to put on warmer clothing. 
At the fame time the face and extremities are obferved 
to be pale, the features flirink, the bulk of every external 
part is diminifhed, and the (kin over the whole body ap¬ 
pears conftriCted, as if cold had been applied to it. This 
fenfation of cold varies much more in different inftances 
of incipient fever than the languor and laflitude before 
mentioned ; in fome cafes it is very flight, in others not 
at all felt or noticed ; whilft in many inftances, particu-' 
larly in the intermit’ent fevers, it becomes fo great as to 
produce a tremoror fhaking in all the limbs, with a chat¬ 
tering of the teeth and frequent rigors of the trunk of 
the body. In this ftate, the a&ual heat of the furface, 
whether meafured by the fenfations of a by-ftander or a 
thermometer, is confiderably diminifhed ; in the extre¬ 
mities in particular it is many degrees below the ftandard 
of health. Not only on the furface, as is generally ima¬ 
gined, but even over the whole fyftem, the heat is pro¬ 
bably diminifhed ; the air expired from the lungs feels 
cool to the back of the hand, held near the mouth. Dr. 
Currie ftates, that he has found the heat under the 
tongue, and at the axilla, as low as 94, 93, and 92, de¬ 
grees of Fahrenheit’s thermometer. (The healthy tem¬ 
perature of the human body, it may be obferved, is 
about 98° of the fame thermometer.) Dr. Fordyce 
affirms, that 94 0 was the loweft degree of heat that 
he had witnefl’ed under the fame circumftances. (Firft 
Diflertation on Fever, p. 40.) The fenfations of the pa¬ 
tient, however, do not always correfpond with the ac¬ 
tual degree of cold, as meafured by the thermometer, or 
by the fenfations of others ; for it has been remarked, 
efpecially towards the termination of the cold ftage of 
the fever, that the patient feels himfelf cold, even on 
thofe parts of the body which are fhown, by the applica¬ 
tion of a thermometer, to be of the natural heat, or even 
hotter than they ufually are in health. With this ftate 
of coldnefs, the fenfibility of thebody is confiderably di¬ 
minifhed; all the fenfations, but efpecially thofe of touch 
and tafte, are lefs accurate and diftinCt than in the healthy 
ftate. Dr. Fordyce remarks, that, “in the attack of fe¬ 
ver, fuch a degree of infenfibility, with a feel of coldnefs, 
has in many cafes taken place, that even hot fubftances 
have been applied in fuch manner as to coagulate, nay 
perform the chemical analyfis of the part, without any 
fenfation of heat having arifen in the mind of the pa¬ 
tient.” (Loc. Cit. p. 49.) The diminution of the fa¬ 
culty of fenfation is very various in different inftances of 
the attack of fever. 
Upon the firft approach of febrile languor the pulfe is 
not always altered in refpeCt to frequency, but it always 
becomes weaker than before j fometimes it is alfo flower 
than 
