PATHOLOGY. 
violent; thofe who were near the end where there was no 
firediedin great numbers, though the fymptoms of the dif- 
eafeoften appeared to be moderate. The air near the fire 
was comparatively light,and notoftenfive; near the remote 
end it was heavy, unpleafant, almoft infupportable to the 
tranfient vifitors. The influence of ftrong heat from fire, 
in a fick apartment, appeared to be f’o ufeful, at leaft fo 
agreeable, in the prefent cafe, that large fires were or¬ 
dered to be made in all the huts and flteds on the out- 
fide of the fort which were occupied by the fick. The 
air in thefe huts, though filled with fick to overflowing, 
was not offenfive, the progrefs of contagion was not ac¬ 
tive, and mortality was comparatively moderate ; in faff, 
on the lowed fcale. From that and other more recent 
experience, I am difpofed to confider the action of the 
heat of fire as a molt important mean of ventilation, 
mainly conducive in arrefting the progrefs of contagion ; 
the chief truft, in fadf, in damp, foggy, and Hill, weather, 
through which we can expect to preferve the air of hofpi- 
tals, as filled with febrile fick, from a dangerous vitia¬ 
tion.” 
Feveris generally fatal from the occurrence of inflam¬ 
mation of fome part or texture of the body ; and diflec¬ 
tions fliow, according to the type of the reigning epide¬ 
mic, diforganizations of the mucous membranes of the 
brain, the lungs, the liver, or other vifcera. In a few 
cafes, however, no topical congeftions are found ; and 
the patient feems to be worn out by continued exhauftion 
of the fundtions of the nervous fyftem. 
The treatment of fever naturally grows out of the hif- 
tory already given of its caufes, adrions, and confe- 
quences. We fhall confine ourfelves to a mere outline 
of it, from a convidlion that the peculiar varieties in 
character, and confequently in the treatment, of epide¬ 
mics, are only to be learnt by experience of the particu¬ 
lar fever which happens to be prevalent; or, in other 
words, that epidemics continually vary, as was indeed 
the opinion of Sydenham. For fimilar reafons we fhall 
omit all notice of a vaft ftore of drugs which in particu¬ 
lar cafes have had the merit of curing fever; e. g. yeaft, 
carbon, muftard, with many others which occur to us 
even at this moment. 
A diftindtionis to be made between feveras itis Ample, 
and as it is complicated with inflammation of particular 
organs. Firft of Ample fever. This requires fome dif¬ 
ference in treatment, according to the ftage it has ar¬ 
rived at; the ftages being three ; viz. the cold ftage, the 
hot ftage, and the declining ftage. This divifton, it is 
proper to obferve, is in fome meafure arbitrary, and has 
no exadt relation to time : for, as the whole duration of 
the difeafe is extremely various, extending from a few 
days to as many weeks; fo the continuance of the diffe¬ 
rent ftages, both individually and relatively to each other, 
is not lefs various ; and it becomes impoflible to aflign a 
determinate extent fo any one of them ; added to which, 
they often run imperceptibly into each other. A fuf- 
ficient difcrimination, however, may be made between 
them for the purpofes of pradtice; which is the point of 
chief importance. 
The application of contagious virus is firft made, in 
the majority of inftances, to the ftomach ; and there feems 
good reafon to think that it remains there, and produces 
local effedls before it is carried into the circulation. It 
is probably on this account that an emetic often efFediti- 
ally prevents the development of the febrile movements : 
this remedy fhould therefore be ufed in early cafes; and 
purging fhould likewife be reforted to, becaufe it is fome- 
times difficult to eftablifh thefe adlions in the hot ftage of 
fever. When the hot ftage is newly formed, it is ftill 
often defirable to change the order of fympathetic actions 
which are eftablifhed. For this purpofe, the abftraftion 
of blood till fainting eufues, followed by a brifk purge, 
will often entirely prevent a fevere fever from running 
its courfe. 
In the more fevere forms occafionally met with in fo¬ 
209 
reign pradlice, the meafures for arrefting the progrefs of 
the malady muft be peculiarly energetic. The expe¬ 
rienced Dr. Jackfon, fpeaking of a fevere and complica¬ 
ted form of fever, which he characterizes as prefenting 
itfelf with appearances of violent irregular vafcular ex¬ 
citement, and local determinations which threaten con- 
vulfion and apoplexy, fuffocation or engorgement of in¬ 
ternal organs, lungs, liver, or fpleen ; fornetimes with a 
ftrong, or what may be called a concentrated, general ac¬ 
tion, thickened and conftricled fkin,- ardent as a live coal; 
a condition, which threatens to fubfide by internal con- 
geftion, or to explode by local external gangrene of va¬ 
ried form, viz. petechise, ftreaks of ecchymofis, or exten- 
five and deep blacknefles;—gives the following judicious 
directions. When a certain quantity of blood, only 
meafureable by the phyfician as fuperintending the pro- 
cefs, has been abftraCted from the arm, it is advifable 
that the patient be ftripped naked and immerfed in a 
warm bath of moderate temperature, the immerAon con¬ 
tinued for fifteen or twenty minutes, the ikin (trongly 
fcrubbed with brulbes and foap while under immerAon. 
At the expiration of twenty minutes, the condition is to 
be examined with care ; and, if it be then found that the 
mode of adtion has not changed, that is, if the movement 
has not become general and equal, it will be advifable to 
re-open the vein, and to allow blood to flow, while the 
patient remains in the bath, until the objedl in view be 
attained : that is, until the circulation be in fome manner 
equalized. When that is done, cold water is to be af- 
fufed copioufiy upon the head and flroulders, while the 
lower extremities remain in the warm bath. The courfe 
of the difeafe will, in moll cafes, be fufpended, if not 
perfeftly arrefted, by the effeCt of the proceedings now' 
recommended; and when that is done, the body, being 
removed from the bath, is to be wiped dry, and laid in 
bed ; blifters, as means preventive of return, are to be 
applied to the head, neck, back, or fides, according to the 
predominance of the local fymptoms. FriCfion with warm 
oil will be ufeful ; emetics and purgatives promife the 
fame benefit here, after the cafe is Amplified, as in the 
preceding. A bolus of camphor, nitre, tartarized anti¬ 
mony and fnake-root, with half a grain of opium, and 
two or three grains of calomel, given every five or fix 
hours, with plentiful dilution, frequent ablution, and 
frequent change of bed and body linen, conduce, if the 
courfe of the difeafe be not totally arrefted, to maintain 
the movements in an equal tenor until the febrile cir¬ 
cle be completed, when healthy adtion may be expected 
to re-appear. The outline of pradtice now fuggefted, 
varied according to circumftances, applies to the cure of 
the difeafe in all its conditions. 
Thefe violent meafures are feldorn refortable to in 
private practice, nor are they generally required in the 
fevers of this country; fo that, if tolerably adtive bleed¬ 
ing and purging do not arreft the difeafe at its onfet, we 
let it run its courfe, endeavouring to condudt it favour¬ 
ably to its termination. 
It is well known that fome thirty years back the treat¬ 
ment of febrile difeafes confifted in ftimulating and ex¬ 
citing the body to the higheft poflible pitch. The folly 
of this plan has been of late feverely reprobated; but a 
fliadow of defence has been inftituted, on this ground ; 
that, as epidemics are always changing their charadter, 
what was ufeful and right formerly has ceafed to be fo. 
But this is mere delufion ; for Hippocrates, Sydenham, 
and Huxham, and indeed all judicious practical men, bled 
in fevers; nor can the nature of fever itfelf be fo chan¬ 
geable, as to be cured by contrary remedies, though in¬ 
deed its variations in charadter may require a correspond¬ 
ing variety in treatment. We muft therefore refer to 
the well-known hypothetical notions of debility, &c. 
the fatal pradtice of our immediate predeceflors. 
Bleeding is now on all hands agreed to be the chief 
agent in fubduing the violence of fever, though there is 
much difagreement as to its modus operandi, and as to 
the 
