201 
PATHOLOGY. 
than in health for a fliort time; but, as the fenfe of 
cold increafes, it becomes fmaller, and gradually more 
and more frequent, and often irregular. While the con¬ 
tractions of the heart and arteries are thus feeble, all the 
fecretions of the fyftem are likewife diminifhed. The 
tongueand mouth becomedry and clammy,in confequence 
of the diminifhed fupply of faliva and of the mucus of 
thofe parts ; the fkin alfo becomes dry, as well as pale 
and cold, there being little or no matter of perfpiration 
poured out. The changes in the urine are Itill more re¬ 
markable ; the impaired adfion of the fecretory veffels of 
the kidneys is evinced by the diminifhed quantity of the 
urine at this period of fever, as well as by the palenefs 
of its colour, in confequence of its holding lefs of the 
mucilaginous and faline parts in folution than in health, 
and by the abfence of any cloudinefs or depolition when 
it cools. There is generally alfo a fmaller quantity of 
feculent matter evacuated from the inteftines at the 
commencement of fever, or in other words a degree of 
conftipation, which implies a deficiency of the fluids fe- 
creted from the inner furface of the alimentary canal, as 
well as of the bile and pancreatic liquor, by which the 
fseces are rendered more liquid and moveable, and the 
bowels are ftimulated to attion. Analogous to thefe 
changes in the ftate of the fecretions are the fudden and 
conliderable detumefcence of fwellings, which may happen 
to fubfift on the furface of the body, and the drying-up 
or ceffation of the difcharges from ulcers and wounds, 
during the cold ftage of fever. 
The refpiration alfo fuffers fome change in the attack 
of fever, being often (hort and frequent, and fometimes 
attended with a cough, more particularly in intermittent 
fevers. There is at the fame time a great anxiety, or a 
fenfe of weight, fullnefs, and great uneafinefs, in the 
bread. This diftrefling feeling, which has been thought 
by fome phyficians a pathognomonic fymptom of fever, 
and hence denominated febrile anxiety, is totally different 
from, and independent of, the general uneafinefs all over 
the body, which was before mentioned, and often occurs 
in a very difproportionate degree. It refembles that 
anxiety which takes place from grief, fear, and other de¬ 
prefling paflions of the mind, and which is alfo accom¬ 
panied by palenefs, and diminution of iize of the veins 
which are feen on the furface. The patient likewife re- 
fpires irregularly, as one under the influence of the 
paflions juft noticed, and frequently fighs deeply, as if 
to free himfelf from the load that opprefles the region of 
the heart. 
At the beginning of the attack of fever, fometimes as 
the very firft fymptom, but often later, a dull pain is felt 
in the fmall of the back, which feems to occupy the 
lumbar vertebra;, but is not accurately referred to any 
particular point. It is very fimilar to the pain which 
arifes from weaknefs or fatigue ; but, unlike that, ac¬ 
cording to Dr. Fordyce, it is equally felt in the hori¬ 
zontal as in the credit poflure of the body. The head at 
the fame time is affected with pain, which is commonly 
feated in the forehead over the eyes, and feels to the 
patient as external; fometimes it likewife occupies the 
back part of the head ; and occafionally it is felt all 
round the head. It varies much in degree, but com¬ 
monly increafes as the attack proceeds ; it is ufually at¬ 
tended with a fenfe of weight, and is often augmented 
by light falling upon the eyes. A fimilar pain generally 
arifes all over the body, which the patient often defcribes 
as feated in all his bones, without being able to parti¬ 
cularize in what part of the body it is felt. Sometimes 
it is more particularly confined to the larger joints; and 
it is occafionally attended with great forenefs, as from 
over-fatigue. Such forenefs, however, is more com¬ 
monly confined to the fubfequent periods of the difeafe. 
From the commencement of the attack of fever the 
natural funttions are always deranged. The changes in 
the appearance of the tongue are among the firft indica¬ 
tions of this derangement. At firft the tongue appears 
to be thinly covered on its upper furface with an extreme¬ 
ly vifcid fluid, efpecially in the middle and towards the 
root, the edges and point being nearly free from it. The 
under furface of the tongue, below the point, is fcarcely 
ever covered with this matter. Sometimes, at the very 
beginning of the diforder, the covering of the tongue is 
a folid cruft of a whitifh colour, adhering fo firmly as to 
be incapable of being (craped off; fometimes it verges 
towards a brown colour. At the approach of the cold 
ftage of fever the ftomach is commonly affected; the appe¬ 
tite for food ceafes, and averfion even to the fight or fmell 
of meat often takes place. Dr. Fordyce remarks, that he 
“ has known feveral inftances where perfons, fitting down 
to the table with a ftrong appetite, an attack of fever 
having fuddenly taken place, in lefs than two minutes 
they have been unable to eat any thing, and have been 
feized with perfedt averfion even to the fmell of food.” 
(Loc. cit. p. 93.) Sicknefs at the ftomach often comes 
on at the firft attack, and this is increafed occafionally 
to fuch a degree as to produce vomiting. More common¬ 
ly, however, this does not take place at the very com¬ 
mencement; but the difinclination to food increafes 
gradually to naufea, then to vomiting, which in fome cafes 
is very fevere, not only the contents of the ftomach being- 
evacuated, but likewife thofe of the duodenum, and of the 
glands, the fecretory ducts of which open into it. Bile, 
therefore,and the pancreatic juice, are thrown up, together 
with the contents of the ftomach, and the other fluids 
fecreted into the ftomach and duodenum. Of thefe fluids, 
however, the bile is the raoft confpicuous from its colour, 
tafte, and fmell; and it has therefore often been obferved 
by practitioners, while the gaftric and pancreatic anil 
other juices fecreted into the duodenum, as they are not 
very confpicuous from their fenlible qualities, have not 
been taken into the account. Combined with the fick- 
nefs and averfion to food, there is generally a confiderable 
degree of third.. 
Few other fymptoms, which are obfervable at the com¬ 
mencement of fever, remain to be mentioned. The ftate 
of the countenance is very peculiar and characteriftic, 
from the moment of the attack. It not only becomes 
pallid, or of a dirty hue, in common with the reft of the 
furface of the body, but it affumes an expreflion of dull- 
nefs or heavinefs, partly in confequence of the languid 
action or relaxed condition of the mufcles of the face, 
and partly from the fame condition of the mufcles of 
the eye-ball, by which ifs form and motion are altered, 
and its ufual brightnefs and quicknefs are impaired. 
The difpofition to deep is diminiftied or loft; or, if it 
occurs, the repofe is (hort and interrupted, and very im¬ 
perfect, fo that there is much dreaming, during which 
the ideas that prefent themfelves are nioftly of an un- 
pleafant kind. 
When the fenfation of cold, and the attendant fymp¬ 
toms, have continued for fome time, (the period being- 
very various in the different kinds of fever,) the cold 
becomes lefs violent, and is alternated with flufhes of 
heat. In the more fevere continued fevers, it frequently 
happens that the cold is not permanent for any length of 
time, but that this alternation of chills and heat takes 
place from the beginning. By degrees the cold goes oft 
entirely, and a heat greater than natural is extended, at 
firft unequally in different parts, but at length generally 
over the whole body ; but even when it is fo far advanced, 
that the heat, meafured at the axilla or under the tongue, 
is greater than the ftandard of health, a (light acceflion 
of external cold will produce a general chillinefs. There 
is no regularity in the reftoration of the heat to the 
furface; in fome parts the heat is above what is natural, 
while in others it remains below this ftandard ; and hence 
arifes that mixed fenfation of cold and heat, which every 
one acquainted with fever has experienced, in the tran- 
fition from the cold to the hot ftage of the paroxyfm. 
This inequality of the diltribution of the heat is lefs in 
the Ampler forms of fever, and greater in thofe which 
are 
