218 
P A T H 
ver fometimes pafles by almoft imperceptible gradations 
into a periodic intermittent 5 or the exacerbation, be¬ 
coming in its returns more tardy and mild, terminates in 
an equable and moift tranfpiration ; the ftools become 
copious, pultaceous, and natural; and the urine depo- 
fites a copious reddifh-white precipitate. 
“ In the more mild and (low forms of the fever, the 
patient, on riling from deep, feels little refrefhed, is lift- 
Jefs and morofe, and his mouth and fauces are loaded 
with phlegm ; he has fetid eruftations, and copious mu¬ 
cous expectoration, with naufea 5 has little relifli for 
food, but does not altogether loathe it, though after eat¬ 
ing he complains of weight, fulnefs, drowfinefs, flatus, and 
obftruftion of the bowels. He has a flow, weak, and 
fometimes a full and rather-hard, pulfe, with little third. 
Cold (hivering is fucceeded with wandering flufhes, and 
dry fqualid (kin, or (light fweating; leaden heavinefs of 
head, and murmuring and ringing in the ears, caufing a 
degree of (lupidity. The vifcidity, in fuch cafes, of the 
mucus in the ftomach and inteftines is often fo great as 
to obltruft the orifice of the biliary dutt, and give rife 
to jaundice. The abdomen fwells, and feels painful to 
the touch in confequence of flatus, and of the inertia of 
the bowels. Singultus and difficult deglutition fucceed 
to great anxiety and oppreflion of the ftomach; but in 
a few days numerous aphthae are obferved to fpread from 
the fauces over the whole cavity of the mouth, which 
foon (lough off, and are replaced with a frefh crop. Some 
patients are alfo diftrefled with difficulty of breathing 
and cough, which is firft dry, and afterwards acco'mpa- 
nied with abundant and vifcid expe&oration. In this 
(late of things we can fcarcely call the difeafe fever, un- 
lefs there is greater proftration of ftrength, pains in the 
joints, increafing towards night, burning of the (kin, or 
eruptions frequently breaking out immaturely ; and 
more particularly if there are diftinft evening exacerba¬ 
tions, fucceeded by lefs diftinft remiflions, vertigo, vigi- 
lia, flupor, delirium, frequent fyncope, with recurrent 
diarrhoea, rapidly undermining the powers of the fyftem. 
In other cafes, great quantities of worms, fometimes liv¬ 
ing and fometimes dead, or nearly putrid, are ejefted 
both from the mouth and anus, accompanied with pecu¬ 
liar fcetor of the breath, and the ufual fymptoms of ver- 
minofe irritation; fuch as wandering pains, lancinating 
pains of the joints, itching of the nofe, tremor, fainting, 
naufea, tenefinus, and copious dejections of putrid mucus. 
“When the attack of the fever is more fudden, we 
generally, though not always, obferve the cold (hivering 
to extend beyond an hour, and to recur by turns, being 
followed by heat, which is for the molt part parching, 
andincreafed towards night, often accompanied with fu¬ 
rious delirium. In fome cafes a flight remiflion occurs in 
the morning ; in others none. The pulfe is weak and 
indiftinCt, collapfing after it has at firft been full and 
fomewhat hard. There is much naufea and birternefs of 
the mouth, and fo great tumefaftion and oppreflion of 
the ftomach, that the very touch or weight of the bed¬ 
clothes is painful. Towards evening there is again an 
exacerbation, correfponding fometimes to femi-tertian 
intermittent; and the yellownefs of the eyes, fiuftiing, 
head-ache, vigilia, anxiety, fcetor of the breath, and 
delirium, are increafed ; and the third:, and longing for 
acids, is fometimes intenfe, but occafionally is flight. 
The urine, at the accefs of the paroxyfm, is brown, thick, 
turbid, and foetid ; during the remiflion, it is watery 
and crude. The ftools are exceedingly offenfive. Abun¬ 
dant but vifcid perforation gives no relief. The tongue 
is tremulous, and, with the teeth, is loaded with a brown 
vifcid matter; or it is fcabrous, almoft black, very dry, 
and can fcarcely be extended beyond the teeth. The 
flupor and vigilia increafe; blood ru(hes copioufly from 
the noftrils, or is paffed with the urine and faeces ; fluid, 
grumous, and preceded by pain extending to the pubis. 
Now large quantities of aeruginous and vifcid bile are 
®je£ted from the ftomach, agreeing in this almoft with 
O LOG It. 
the yellow fever of America and Siam. The ftools be¬ 
come more liquid, green, brown, frothy, and very 
offenfive; and there is feldom power remaining either to 
void or to retain the natural difcharges. The patient, 
notwithftanding, fays he is very well, and attempts to go 
to his friends, whom he imagines are abfent. He picks 
the bed-clothes, or mutters to himfelf5 and fometimes 
burfts out into fits of furious delirium. This is fucceed¬ 
ed by fubfultus tendinum, comatofe flupor, violent pul- 
fation of the carotids, great difficulty of refpiration, col¬ 
liquative diarrhoea, cadaverous breath, hiccup, cold ex¬ 
tremities; cold, profufe, and vifcid, fweat ; very rapid, 
and fcarcely perceptible, intermittent pulfe; lethargic 
deep, convulfion, and death.” 
In our climate, though occafionally the gaftric fever 
arrives at the fame violence as above, upon the whole 
gaftric irritation is more (low in its prog refs. It gene¬ 
rally happens that the ftomach and inteftines fuffer toge¬ 
ther, and that the inflammation implicates the whole 
ltrufture of thofe parts, while in the accounts juft ren¬ 
dered we often perceive a phlogofts of the mucous mem¬ 
brane only. In this cafe the complaint is generally at¬ 
tended with deep continued pain, and forenefs of the 
integuments, increafed on preflu re ; retching, vomiting, 
or anorexia, defire for cold acidulous drinks; (hort quick 
refpiration, fulnefs as well as flatulence of the bowels, 
great proftration of ftrength, reftleffnefs, and anxiety. 
The patient almoft invariably lies upon his back, fre¬ 
quently tolling his arms about, moving his feet, or 
changing the pofition of his head. If defired to turn 
upon his fide, it gives him confiderable uneafinefs in the 
abdomen; and, if fuddenly raifed into the upright pof- 
ture, he generally begins to erufl, retch, or vomit. 
The pulfe is fmall and (harp, and in fome cafes very 
quick, but in others below an hundred in a minute ; the 
tongue foul in the centre ; the mouth clammy ; the tafte 
vitiated; the bowels are, for the molt part, bound; the 
lips parched and pale, or fomewhat livid ; and the coun¬ 
tenance exprefles much did refs. The pain of the belly 
is augmented by yawning, by coughing, or by drawing 
the breath deeply down, and fometimes even by the 
blandelt liquids, which are ufually rejected, unlefs taken 
in fmall quantities at once. If the pain be acute, the 
(kin is often of a pungent heat about the bread and 
abdomen ; While the forehead and face, expofed to the 
atmofphere, are fometimes damp and even cold. 
During the advancement of the abdominal affe&ion, 
the pulfe grows fmaller and quicker, the vomiting more 
urgent, the belly tumid; the third, fenfe of internal 
heat, and reftleffnefs, being all aggravated. Upon the 
approach of fuppuration, of effufion, or of gangrene, 
there are rigors or flight chilly fits, with much abate¬ 
ment of pain ; but cold copious and clammy perfpira- 
tions come on, attended with (hort agitated breathing, 
with an hurried undulating pulfe, frequent dark lax 
ftools, and inceffant vomiting. Soon after this, the pa¬ 
tient dies. For the mod part, however, inflammation of 
the ftomach or bowels terminates fatally before it has 
advanced into aftuai gangrene; the patient finally finking 
under the accumulated force of exhauftion and of irrita¬ 
tion. 
It has been mentioned, that in mod fevere cafes of 
gaftric fever a great derangement of the functions of the 
liver is found. Sometimes, however, the latter circum- 
ftance exifts alone. But we are not always to infer that 
morbid adfion of the liver exifts becaufe we meet with 
copious vomitings of bile ; for the act of vomiting it- 
felf will induce copious difcharge of bile from the health- 
ieft individual. We again quote, chiefly from Arm- 
ftrong, the hiftory of the fymptoms of this complication. 
“ If the liver be attacked with inflammation, giddi- 
nefs, load about the bread, ficknefs, and vomiting, are 
often among the primary fymptoms; and the patient, 
complaining of pain and forenefs, with weight about the 
right hypochondrium, can neither bear preffure in that 
place,. 
