204 
PATHOLOGY. 
returns lefs feverely at night; or, if the patient be deaf 
with fome ftupor, rhefe (ymptoms are little changed in 
the twenty-four hours, but remain until the whole of the 
difeafe has difappeared. The deprefiion of ftrength goes 
oft, but leaves real weaknefs behind. 'I'he urine depofits 
fometimes a copious lateritious fediment for a^day or 
two, and afterwards returns to its natural appearance. 
Sometimes there is a copious lateritious fediment in the 
urine made in the night, and a mucous one in that made 
in the dav-time. The coftivenefs goes off, and the fseces" 
return to their ordinary appearance; and all the fecre- 
tions become gradually increafed, not equally, but fome¬ 
times one more fpeedily, fometimes another. The eyes, 
unlefs when the delirium has ended in ltupor, begin to 
have a more healthy appearance, are more compofed and 
clearer, and exprefs a greater attention to the objefts 
around them. The deep returns, but not equally; the 
patient fometimes palling a quiet, at others a re file Is, 
night. The appetite returns, although feldom regular¬ 
ly ; fometimes it is voracious, but the patient is not- 
w’ithftanding fatisfied with a very fmall quantity of food; 
in the other cafes it returns very flowly. Although the 
deprefiion of ftrength fometimes goes off altnoft at once, 
yet it leaves the patient often with a greater feeling of 
weaknefs. Thus, however, the whole difeafe difappears, 
and the patient recovers his ftrength very quickly. 
But, although this favourable termination of fever oc¬ 
curs in a large majority of inftances in this country, it is 
neverthelefs a difeafe frequently fatal, and, under parti¬ 
cular circumftances, the caufe of great mortality. When 
fever terminates fatally, the fymptoms prefent themfelves 
chiefly under two different afpefts, but varioufly modi¬ 
fied, approaching to each other, or even partially com¬ 
bined. The individual varieties it is impofiible to depift; 
a knowledge of them can only be attained by perfonal 
obfervation of numerous cafes at the bed-fide of the lick. 
One of the forms, juft alluded to, confifts principally of a 
great aggravation of the fymptoms of the hot ftage. The 
heat of the fkin continues great and pungent, and its fur- 
face dry and parched ; the countenance is Unified, and the 
eye fuftufed with rednefs, and intolerant of light; the 
head-ache is fevere, little or no fleep is obtained, the de¬ 
lirium is augmented, and is accompanied with extreme 
reitlefinefs, often with vociferation, and even great muf- 
cular ftrength, fo that the patient is with difficulty con¬ 
fined in bed ; and the pulfe is frequent, with confiderable 
jhardnefs. About the end of the fecond week thefe 
fymptoms fuddenly change ; the delirium ends in an in- 
diflinffnefs or confufion approaching to ftupor, the arti¬ 
culation becomes indiftindi, the breathing laborious, the 
ftrength finks rapidly, cold l'weats and convulfive motions 
enfue, and the patient is cut off in a few hours. Some¬ 
times fymptoms of inflammation of the lungs fupervene, 
and, continuing together with the delirium, hot fkin, fre¬ 
quent pulfe, and brown tongue, the patient dies with 
fymptoms of fuffocation ; and fometimes inflammation of 
the inteftines, or other important organs, being l'uper- 
added to the original fever, accelerates and modifies the 
fatal termination. This has been called inflammatory 
fever. The other form of the difeafe, above mentioned, 
is extended more commonly to the third week, fome¬ 
times later, and the progrefs of the fymptoms is more 
gradual. The deprefiion of the mufcular powers conti¬ 
nues to increafe with the difeafe : the eyes become funk, 
dull, and liftlefs; the countenance dejeffed, and of a 
dufky hue ; the delirium is attended with a low mutter¬ 
ing, and the patient lies without the difpofition or the 
power of making any exertion, or he picks the bed¬ 
clothes; the tongue becomes crufted with a dark-brown 
or black matter, a fimilar fordes colledts upon his teeth 
and lips ; the pulfe is frequent, beating from izo to 130 
times in a minute, and is at the fame time fmall and 
feeble; the refpiration is alfo weak, generally frequent, 
and interrupted with fighing or a dry cough ; the voice 
becomes indiftinft or inarticulate; and there are flight 
convulfive twitches, or fubfultus tendinum. At length 
the proftration of ftrength becomes extreme; the patient 
lies on his back, being unable fo fupport himfelf in any 
other polition, and even Aides down towards the bottom 
of the bed ; he is altogether infenfible to external im- 
prefflons ; the fphindters, as well as the mufcles of vo¬ 
luntary motion, are relaxed, and he pa fifes his ftools and 
urine involuntarily in bed ; the pulfe becomes very feeble, 
tremulous, and fcarcely to be felt at the wrift; partial 
clammy fweats break out ; the eyes appear glazed and 
fixed, and the other features fhrink ; the patient is unable 
to fwaliow ; his breathing becomes irregular and labo¬ 
rious, attended with fome noife in the throat, as the fatal 
event approaches; the extremities grow cold ; and, often 
after fome. hours, the functions of life finally ceafe. 
When fever affumes this form, it eonftitutes typhus, or 
the nervous, malignant, Sec. fevers of authors. 
There are fome other appearances, which, though not 
the ordinary attendants on fever, occafionally occur, ef- 
pecially when the difeafe is of a fevere kind, and which 
have been confidered as evidence of malignancy, or of 
putrefcence. Generally in the fecond week of the dif¬ 
eafe, but fometimes as early as the fourth or fifth day, 
(fee Pringle on Difeafes of the Army, part iii. chap. 7. 
and Huxham on Fevers, chap, vii.) an eruption of fpots, 
not elevating the cuticle, of a red colour, fometimes pale, 
often darker, or even of a livid or purple hue, appears on 
the fkin: thefe fpots, or pelechice, are thickeit on the 
breaft anil back, lefs numerous on the legs and arms, and 
are feldom, if ever, feen on the face. They were firft 
defcribed, among the moderns, by Ingraffia of Naples, 
afterwards more particularly by Fracallorius, under the 
names of lenticula, punSlicula, or peticula; whence alfo 
the fame appellations were given to the fevers themfelves. 
(See Fracaftorius de Morb. Contag. lib. ii. cap. 6.) Pe¬ 
techias appear in fever, moll frequently in clofe and 
crowded fituations; formerly they were very frequent 
attendants on the fevers which occurred in the perfons 
under confinement in clofe cells, or crowded apartments 
in our prifons. Dr. Willan has ftated, however, upon 
the authority of the furgeon of Newgate, that, fince a ge¬ 
neral attention to ventilation and cleanlinefs has been 
adopted, petechias do not now appear in more than one 
cafe of fever in thirty in that prifon. He has alfo added, 
from the obfervation of Dr. Bateman, phyfician of the 
Fever Inftitution in London, that the proportion of cafes, 
in which petechiae occur in that inftitution, is about one 
in forty-two. (See Willan on Cutaneous Difeafes, order 
iii. p. 468.) Sometimes the purple fpots are of a large fize ; 
in which cafe there are often alfo livid blotches, or Itripes 
like the ftrokes of a whip, vibices, and haemorrhages, break 
forth from the internal parts, as the bowels, lungs, fto- 
mach, and wherever the furface is covered with a very 
thin cuticle, as from thenoftrils, thegums and mouth, &c 
A rafh of a different fpecies, which Dr. Willan has 
termed rofeola, “a rofe-coloured efflorefcence, varioufly 
figured, without wheals or papulae, and not contagious,” 
(Loc. cit. order iii. genus 4.) fometimes makes its appear¬ 
ance in fever of the typhous type : fometimes it precedes 
the formation of purple fpots and vibices, and in other 
cafes it is feen early in the fever, but remains only for a 
fliort time without any material confequences. Some 
other cutaneous appearances occafionally occur, as men¬ 
tioned by Huxham, (Loc. cit. p. 97.)'fuch as miliary 
puftules, a fcabby eruption about the lips and nofe, and 
aphthae. 
We have thus laid before our readers an ample account 
of the phenomena of fever, in order that the relation be¬ 
tween tliofe phenomena and our explanation of them may 
be more clearly feen. We proceed to examine the merits 
of the gaftric theory of fever. In the firft place, the afler- 
tion of Broufiais, that a furred tongue and other appear¬ 
ances of the mouth indicate inflammation, by no means 
refts 
