PATHOLOGY. 
*202 
are more complicated and irregular. In general the 
fenfe of cold predominates, even after a morbid heat has 
taken place at the axilla, under the tongue, and in diffe¬ 
rent parts of the thorax and abdomen. Atlength, how¬ 
ever, the heat of the furface becomes general and uni- 
tonn, riling to 102, 103, 104, and fometimes 305, of 
Fahrenheit’s thermometer. Different authors indeed 
fpeak of febrile heat four or even five degrees higher than 
this ; but fuch heat never occurred under the obfervation 
of Dr. Fordyce or Dr. Currie, the beft authority on this 
fubje£l : Dr. Bateman alfo had frequently employed the 
thermometer, in cafes of continued fever, and never oB- 
f'erved a higher temperature of the body than 104 in 
intermittent or continued fever, the patients being in cool 
apartments, with very light bed-coverings. The fenfa- 
lion of heat becomes at length ftrong and Heady, and 
the accefiiou of external air does not produce a return of 
chillinefs as before; this ferifation is moll powerful in the 
extremities, particularly on the palms of the hands and 
loles of the feet. 
The increafe of the circulation takes place at the fame 
time as the returning heat, and often in the fame unequal 
manner, being evidently greater in fome particular parts 
than in others. Thus it frequently happens, that one 
part lhall become red and enlarged, one arm, for inftance, 
while the other is pale and contracted ; the veins of the 
one being full, and the blood flowing in them more ra¬ 
pidly, while thofe in the other remain contracted. This 
lhall continue for fome time, when the parts become af- 
feCled in the oppofite way ; the arm which was florid and 
diftended becoming pale and contracted, and vice verjd. 
This fhifting, however, remains but a fliort time in Jimple 
fever, perhaps not above half an hour ; in the paroxyfms 
of intermitlents it continues longer, and (till longer in the 
firft attack of continued fever. Univerfal rednefs at length 
takes place; the features of the face and other parts of 
the body recover their ufual fize, and become even more 
turgid ; and the fuperficial veins evince the greater cir¬ 
culation now going on through them by their fullnefs 
and increafed fize. The fkin is relaxed and fmooth, no 
longer exhibiting the goofei-flein appearance by its con¬ 
traction round the little glands and roots of the hair; 
but it continues for fome time dry. The pulle now be¬ 
comes f uller and ftronger, and its frequency continues 
or is Hill farther increafed ; in Ample fevers, it beats oc- 
cafionahy at the rate of 140 or 150 llrokes in a minute, 
wjth a confiderable degree of fullnefs and hardnefs 
(Fordyce) ; but in the hot llage of intermittents, and 
in the heat of continued fevers, it is moll commonly from 
90 to no at this early period of the difeafe ; fubjeCl, 
however, tp great variation according to the conllitution 
of the patient, and the type of the fever. The refpira- 
tion, though more free than during the chillinefs, conti¬ 
nues llill frequent, and accompanied by a fenfe of load 
and anxiety, which the patient endeavours to remove by 
occafional laborious efforts, and deep fighing. The fe- 
cretions Hill remain diininifhed; the <kin is parched, no 
perfpiration breaks forth; the tongue and mouth are alfo 
dry and parched, and the fur on the former becomes 
thicker; the urine, though it becomes higher coloured 
than in the cold Hage, remains tranfparent, and depofits 
nofediment; and the bowels are coflive. The thirff is 
confiderably increafed as the heat advances; the naufea 
and vomiting gradually diminilh, but the averfion to food 
is augmented. 
The corporeal ffrength and the mental powers become 
more oppreffed ; the lenfibility, however, is refiored in 
general with the returning circulation and warmth of 
the furface ; fometimes it becomes even more acute than 
in the healthy Hate, fo that the fkin is more ealily irri¬ 
tated, the eyes are offended with the light, and the leaff 
3 ioife is heard with pain, and greatly dilturbs the feelings 
of the patient. The attention becomes lefs under the 
control of the will, and the faculty of recollection and 
the reafoning power are exerted with difficulty, and im¬ 
perfectly, fo that fome confufion of thought takes place, 
-which often arifes to delirium - , when the hot Itage is 
completely formed : occafionally, indeed, a degree of 
delirium occurs in the beginning of the cold Hage, but 
more frequently in the fubfequent periods of the fever. 
The numerous and dillrefling dreams, which conffantly 
recur in the diffurbed and unrefrelhing fleep which takes 
place in the firff ftages of fever, may be confidered as the 
flightell degree of delirium. In the next degree, the pa¬ 
tient, when he awakes, is fome time before he can attend 
to the impreffions made on the organs of fenfe: he does 
not know his bed, his bed-chamber, or his attendants, for 
a few minutes, but feems to awake as it were a fecond 
time, and becomes perfectly fenfible. If the delirium is 
in ! a little greater degree, the ordinary impreffions of ex¬ 
ternal objedts produce no effeCl : the ideas, which float 
in the mind rapidly, feem to be excited without train or 
connexion ; the affociation being carried on by the in¬ 
ternal impreffions alone. If the attention of the patient, 
however, be llrongly excited by external impreffion, he is 
capable of diltinguilhing the furrounding objeCts, and of 
returning correct anfwers to queffions put to him ; but, 
that ffrong impreffion being withdrawn, he relapfes into 
his delirious dream. As the delirium increafes, with the 
advance of the fever, the faculty of diltinguilhing the 
objeCls that furround him gradually diminilhes; he be¬ 
gins to exprefs his ideas in words, i. e. to talk incohe¬ 
rently; the ideas which prefent themfelves rapidly, and 
without apparent connexion, are generally diffagreeable 
and diftrefling. He is fometimes in a church-yard among 
tombs, fometimes falling from a precipice, fometimes 
purfued by wild beaffs, in the midff of conflagrations, 
See. The delirium increafing, he becomes completely 
infenfible to external objeCts. This is a common pro- 
grefs of the alienation of mind in fever, beginning on 
the fecond or third day, or later, and increafing to the 
fourteenth or fifteenth, if the patient furvive fo long; at 
firft being only obvious in the night, or during the im- 
perfeCl (lumbers, or in the waking moments, when ex¬ 
ternal impreffions are fewer, or almoll entirely excluded ; 
but afterwards continuing night and day without inter- 
miflion. 
With the beginning of the hot Hage, the head-ache is 
commonly increafed, and appears to be diflimilar from 
that which took place in the cold Hage. The latter pain. 
Dr. Fordyce remarks, “always feels to the patient as 
external; it is clearly a pain affeClingthe integuments of 
the head, perhaps the fkin alone, at moll the pericranium ; 
but the pain which arifes in the fecond llage is felt by 
the patient internally, and gives him the idea that there 
is fomething diftending tire head or the brain, fo as to 
attempt to burft the cranium.” (Firft Dill, on Fever, 
pp. 85 and 228.) In the mean time the carotid and 
temporal arteries beat full and ftrong, the eyes are rather 
red, and the face is flulbed. Connefted with thefe fymp- 
toms, which obvioufly imply an increafed quantity and 
impetus of the blood carried to the brain, the organs of 
fenfation, while fully capable of conveying impreffions tu> 
the mind, neverthelefs produce fometimes erroneous im¬ 
preffions. Thus the patient can fee, but he millakes ob- 
jedls ; he fancies one individual is another, or that a man 
is a poft: and his organs of hearing, which are alfo more 
readily affedled, do not convey the fame perceptions 
which the fame founds would excite in health. The 
fame thing happens with regard to his other fenfes. 
All the fymptoms above enumerated increafe from the 
fecond day of fever. The tongue grows more foul, and 
the cruft which forms upon it thicker, until the middle 
of the fecond week. Towards the end of the fecond 
week this cruft often difappears more or lefs, and the 
furface of the tongue looks raw when moift, and when 
dry has a polilhed glaze, efpecially about the middle, 
fome of the cruft remaining upon the fides towards the 
edges. 
Before thefe fymptoms, however, have advanced to tile 
degree 
