PATHOLOGY. 
210 
the extent to which it may be carried with fafety. Of the 
various explanations which different authors have given 
of the beneficial operation of bleeding we (hall not (peak, 
becaufe they will naturally be underitood from the ge¬ 
neral fpecnlations of the pathologifts already palled in 
review. According to the notions we have adopted, 
that a general diftention of the capillaries of the fyltem 
is thecaufe of fever, and that an increafe in the produc¬ 
tion of nervous power in the brain and fpinal marrow' is 
the caufie which perpetuates this diftention from one 
part to another, and moreover fufpends the aftions of fe- 
cretir.g veffels;—bleeding mult of courfe be advifed as a 
meafure which relieves that diftention. If diftention be 
the ftate of the capillary fyftetn in fever, this ftate muft be 
evidently increafed by the increafed action of the heart, 
the vis a tergo thence derived affing as a perpetual dila¬ 
tor of the aft’efled veffels. The diftention is alfo of courfe 
increafed by the quantity of blood. Bleeding therefore 
relieves diftended capillaries by taking from them two 
caufes of their unnatural condition : firft, it takes away 
the quantity; and fecondly, as the adftion of the heart 
depends fomewhat on the quantity, it takes away the 
diftending force of the latter vifcus. The latter effeft is 
llill further increafed if bleeding be carried ad deliquium 
animi, or till circulation of blood in the brain be fufpen- 
ded. Now', deeming as we do, that the diftention of the 
capillary lyftem occurs alfo in the brain and fpinal 
marrow, and thus excites the nervous fymptoms, we con- 
iider bleeding on the fame ground a great and direct af- 
liftance to the revival of the nervous functions, and 
hence to the reftoration of fecretion. The benefit of 
bleeding is alfo to be explained on other grounds ; i. e. 
on. the luppofition of the increafed contradficn and dila¬ 
tation of the capillaries in fever. It may in fuch cafes 
operate by relieving plethora, the ftimulus to contradfi- 
iity, and by diminilhing the produdlion of nervous 
power, the refult of increafed circulation in the brain 
and fpinal marrow. Whatever fide of the .queftion we 
take, the propriety of early bleeding in fever is fhown. 
It muft be remarked, however, that a low nervous fever 
is often formed, in which we have no right, from the 
produdfs of dilfedtion or from realoning, to infer en¬ 
largement of the cerebral capillaries ; in which, however, 
a high degree of nervous irritation exifts, and in which 
local bleeding is alone admiffible. It is in this form of 
fever that counter-irritants are very ufeful. 
From the above conliderations the propriety of bleed¬ 
ing as early as poffible in continued fever muft be confi- 
dered fully eftablifhed. As to the quantity to be taken 
away, no dogmata can be laid dowm on the fubjedf; for 
neither the pulfe, the fize, the age, nor the temperament, 
of the patient, are unequivocal guides to our pradlice. 
The confideration of thefe conjointly muft diredt us in 
general. The firft bleeding ftiould be carried on til! the 
patient faints. As to the propriety of repeating the ope¬ 
ration, the fizy appearance of the blood noticed in fever, 
and a certain degree of inflammation of the lips of the 
divided orifice in the arm, will indicate to us the affirm¬ 
ative; while the diminished produdlion of heat, and di¬ 
minution of the pulfe, will point out when it is time to 
difcontinue the ufe of this potent meafure. 
Purging at the commencement of fever is of the higheft 
utility ; and will often, according to the teftimony of 
Drs. Clutterbuclc and Bateman, cut fhort the difeafe. 
It (hould be excited by the moil adlive means; e. g. by 
cathartics of gamboge, elaterium, fubmuriateof mercury 
and jalap, &c. (we have generally ufed elaterium.) The 
excitement thus produced on the bowels relieves the 
fever, both by emptying the fecreting veffels, and by ex¬ 
citing an irritation vicarious to that exifting in the brain. 
As the difeafe advances, (that is, about the (ixth day,) 
this ftrong purging lfiould give way to milder or laxative 
yncdicines, the adminiftration of which (hould not be 
puftied further than to procure two motions in the four- 
znd-twenty hours. The reafon for not perfifting long in 
the life of draftic cathartics is left inflammation be in¬ 
duced of the mucous membrane of the bowels; a circurn- 
ftance much to be dreaded. 
Digitalis is a medicine of great ufe in controlling the 
adlions of fever. It feems to operate in the fame way as 
bleeding ; viz. by diminilhing the adtion of the heart and 
larger arteries, it prevents the undue diftention or ex¬ 
citement of the difeafed capillaries. But it is a medicine 
which requires to be carefully watched. There is no 
rule to be laid down as to its ufe. We are contented, in 
ordinary cafes, to give from five to ten drops of its tinc¬ 
ture every four or fix hours; but thefe doles may be 
quintupled in ardent fevers of great intenfity, as we fee 
the Italians are in the habit of doing, not only with im¬ 
punity, but with fuccefs. (See p. 53 of this article.) 
As to the dietetic treatment of febrile patients, we have 
fcarcely any thing to fay. The parched mouth and nau- 
feating palate of the fufterers in queftion fo clearly an¬ 
nounce the painful violation of feelings which thofe muft 
have undergone who were fubjedled to the difeipline of 
the Brunonian fchool, that one almoft wonders that the 
common fenfe and prejudices of mankind did not run 
again!! the injurious regimen of wine and ftimulants. 
In the majority of cafes our patients need eat nothing; 
a variety of cold drinks, as barley-water, lemonade, &c. 
may be provided for them, and allowed in the moft unli¬ 
mited quantities. Acid fruits may be taken freely; and 
this is in general all that is defired. Should fuftenance 
be wifhed, thin gruel is all that (hould be allowed; for of 
the heating and ftimulating effects of broths, bSef-tea, 
See. every one is fufficiently aware. At the fame time 
the free current of air through the apartments in the 
houfes of the poor, and the removal into another room 
of the huddled-up and dirty furniture, are alfo indifpen- 
labiy neceflary. The bed-clothes, linen, &c. of the pa¬ 
tient, ftiould be changed at leaf! every other day; and 
fponging the body with water (when maternal or 
anile prejudices do not oppofe it) (hould be ordered. 
And let no one defpife one iota of thefe fimpl’e (and, 
when uncombined, inefficient) meafures ; for they have 
faved the lives of thoufands, and may be confidered (in- 
fignificantas they are in themfelves) among the proudeft 
refults which have arifen from the philofophy of the pre¬ 
rent age. To the cold effufion ef pecially we are indebted 
for the prefervation of many of our moft efficient veterans 
at a time when the ufe of bleeding was not eftablifhed. 
Cold applications to the head are often of much avail 
in the removal of the nervous fymptoms of fever. Dr. 
Clutterbuck thinks “they are moft ferviceable where 
the pain and throbbing are the moft violent, and the heat 
of body generally much increafed.” Where, on the 
contrary, the face is pale, and the extremities cold, as is 
often the cafe in feeble fubjedls, and in advanced ftages 
of difeafe, the ufe of warm fomentations to the head from 
time to time feems more beneficial. 
The laft lfage of fever is marked at once by great dif- 
order in, and imperfeft performance of, all the fenforial 
functions. The patient is nearly infenffble to impref- 
fions ; there is extreme proftration of ftrength, indicated 
by the fupine pollute, and the continual Aiding of the 
body towards the .bottom of the bed; together with invo¬ 
luntary tremors of the hands and tongue; and laftly, early 
delirium, followed by an almoft total annihilation of the 
powers of mind. The pulfe is commonly fort and com- 
preffible, though often with confiderable fulnefs; and 
the heat of the body is generally confiderable. 
It is in this ftage, that black fordes colled! about the 
mouth and teeth ; that the tongue turns black on its fur- 
face ; and that petechias, purple fpots, and vibices, with 
dark-coloured haemorrhages, are apt to occur; Succeeded 
by involuntary and foetid dilcharges by (tool and urine. 
It is to fever marked by fuch fymptoms, that the terms 
putrid and malignant were formerly and erroneouily 
applied. 
In former times, when perfons labouring under fever 
were 
