211 
P A T H C 
were confined in a clofe and heated atmofphere, and when 
cordials and ftimulants, under the name of alexiphar- 
mics, were largely employed, fuch a train of fymptoms 
was by no means uncommon. At prefent, owing to a 
more judicious management of the patient, they are 
rarely feen. The treatment of patients under thefe cir- 
cumftances is difficult: little in fa£t can be done. It is 
to be remarked, that this Hate is never met with when 
proper antiphlogiftic meafures have been premifed. The 
patient, after having undergone their operation, always 
terminates his life in another manner; viz. either from 
a general wearing-out and exhaultion of the nervous 
fun&ions, or from local inflammation of a particular 
organ. 
With refpe£l to the period of this ltage at which 
bleeding becomes inadmiffible, this is very uncertain; for 
it has been often fuccefsfully performed even when the 
pStient appeared near his death. Dr. Clutterbuck fays 
that he has occafionally employed it with advantage at 
almofl every period up to the end of three weeks. He 
believes it may be fafely done at any time, as long as the 
fenforial fundtions are carried on in a tolerably perfedt 
manner; “ that is, while the external fenles are prefer¬ 
red, the intelledtual found, the voluntary powers merely 
impaired, without being disordered.” This author thinks 
that, contrary to what is generally fuppofed, “ the more 
the fenforial fundtions are dilturbed, particularly the 
greater the delirium, the lefs confidence can be placed in 
this evacuation.” The pulfe does not always indicate 
when it will be too late to bleed; for in numerous cafes 
Dr. Clutterbuck has found it weak and fmall, when 
bleeding has proved of the mol decided advantage. As 
a general rule, it may be Hated, that, while a full and 
wiry pulfe authorizes us to bleed in the mol ad¬ 
vanced ftages of continued fever, a fmall and contradled 
ftate of it fhould be a veto to fuch pradtice. Hardnefsof 
pulfe fhould alfb be particularly attended to. Dr. Clut- 
terbuck thinks, when it is “ foftand compreffible, blood¬ 
letting is altogether inadmiffible.” In the advanced 
ftage of fever, bleeding fhould be had recourfe to with 
much caution and referve, in regard to quantity; for the 
lofs of two or three ounces will, at fuch time, be pro- 
dudtive of very marked effedts. He alfo thinks that this 
pradtice fhould not hinder the very moderate ufe of lti- 
inulants, as wine, ammonia*, &c. Upon the whole, how¬ 
ever, we fhould attempt very little of the latter kind of 
pradtice, and fhould content ourfelves with the negative 
pradtice of abflradting all nervous irritants, as light, 
found, &c. and open the bowels and excite the kidneys ; 
always recolledting what Sydenham fays, “ ob nimia di- 
ligentia medici.” It is to be recolledted, that we are not 
now fpeaking of thofe cafes in which inflammation and 
diforganization takes place in a particular organ, this 
being the moll frequent mode in which continued fever 
terminates. 
A determination of blood to particular organs is a very 
frequent occurrence in epidemic fever. Sometimes thefe 
determinations happen very generally, from fome pecu¬ 
liarity in the nature or the caufe of the epidemic ; as 
when we fee inflammation of the lungs an almofl; con- 
ftant companion of the prevailing fever; or where in¬ 
flammation of the mucous membrane of the inteftines, 
conftituting dyfentery, prevails. Occafionally, however, 
while Ample fever is prevalent, the particular predifpo- 
fitions todifeafe which are prefent in theconftitution are 
manifefted by oppreffion of particular organs. As to the 
nature of thefe determinations of blood, we have no he- 
fitation in afcribing them to inflammation. It fhould be 
mentioned, however, that this is denied by a phyfician, 
the excellence of whofe defcriptions and treatment of the 
above difeafes forbids us to pafs over his hypothefis, 
which we fhould otherwife confign to the oblivion it 
muft.foon meet with, and for which nothing but the 
pradlical merits of its author has procured even an ephe¬ 
meral reputation. The hypothefis in queftion is that of 
Vol. XIX. No. 1298. 
LOGY. 
Dr. Armftrong, who confiders that congeftion of blood 
takes place in the veins of organs gravely aft'edted in epi¬ 
demic fever, and without any further diforder in the ar¬ 
terial fyftem than fimple excitation. Now nothing can 
be more bafelefs than the ftrudture of this theory. It 
refts, firft, upon the refults of difledtion ; that is, upon 
finding adtual congeftion of blood in the veins. Now 
the verieft tyro that ever took up a fcalpel knows that 
the laft adt of the arteries and the left ventricle is the 
propulfion of blood in the dead fubjedt, fo that the arte¬ 
rial fyftem is always empty, the venous fyftem full. And 
again, granting that an excitement of the fmall arteries 
exifted, and caufed diftention and enlargement of the 
veins; the fadl is pradtically unimportant, becaufe our 
endeavours mull be directed to the relief of the excited 
arteries, not to that of the veins, which are paffive tubes. 
Venous congeftion cannot, however, exift without de¬ 
rangement in the adtion of the heart; and if fuch de¬ 
rangement exifted, congeftions of the veins would exift 
generally ; occurrences which certainly do not happen. 
Many other arguments fuggeft themfelves againft this 
wild fpeculation ; but, as thofe we have adduced feem 
quite conclufive, we ffiall difmifs the fubjedt. We muft 
affert, however, that in no other work extant do we find 
fo good a hiftory, or fuch efficient treatment, of local in¬ 
flammation fupervening to fever, as in the work of Dr. 
Armftrong. From this gentleman’s work, and from that 
of Dr. Jackfon, we fhall principally derive the fymptoms 
of the following complaints. 
We (hall not enter into any difcuffion as to whether all 
fevers be of one kind ; and the .yellow fever, epidemic, 
dyfentery, &c. the fame difeafe, varying in intenfity, 
and deriving the peculiar charadter of thofe forms of dif¬ 
eafe from the predifpofitions which climate and other ex¬ 
ternal agents produce, though this feems a very probable 
view of the fubjedt; but we (hall confine ourfelves for 
the prefent to an account of thofe complications which 
are met with in the epidemic fevers of this country. The 
molt common complication is that of fever with inflam¬ 
mation in the lungs and its inveftments. In this cafe, in 
addition to the ordinary fymptoms of fever, a permanent 
pain is felt in fome part of the cheft, generally acute, 
though occafionally obtufe ; but, in either cafe, much in- 
creafed by deep infpiration. There is a fenfe of weight 
or conftridtion acrofs the breaft. The refpiration is al¬ 
ways laborious ; the thorax heaves, as if under fome op- 
preffive load; and the alae nafi are thrown into ftrong 
motion. The patient is extremely reftlefs, and has a 
frequent and troublefome cough, which augment's both 
the pain in the fide and the difficulty of refpiration, 
Moft frequently he cannot breathe with any degree of 
eafe when incumbent, but is obliged to have the trunk 
confiderably elevated. The features altogether indicate 
furprife, alarm, or anxiety; the eyes feem prominent; 
the cheeks and lips are generally of a deeper colour than 
natural, yet in fome cafes the face has a pale bloated ap¬ 
pearance. The tongue is commonly foul in the middle, 
and of a dark red round the edges; the pulfe is fome- 
times flow', full, and ftrong; and in other inftances, 
quick, fmall, and weak. As in almofl: all local inflam¬ 
mations, the temperature of the Ikin varies a great deal 
in the day, and partial perfpiration are not uncommon, 
efpecially wdien the pain of the fide is acute. A milder 
form of inflammation attacks the pleura, which is often 
infidious and unfufpedted. If the breathing be narrowly- 
watched, it is obferved to become quicker and more anx¬ 
ious, efpecially in the horizontal pofture; and cough and 
uneafinefs are almofl: always excited on a full infpiration. 
There is alio, for the moft part, pain or forenefs in the 
left fide, or under the fternum, with a feeling of weight 
or tightnefs in the breaft, often with little pain. The 
progrefs of the inflammation is, however, involved in 
confiderable obfcurity : but it may, neverthelefs.be traced 
by the continuance of uneafinefs in the cheft ; by the in- 
creafe of the cough, dyfpncea, and reftleflnefs; by the pa> 
3 1 tient's 
