214 
PATHOLOGY. 
place, nor lie upon the left fide, without an increafe of 
pain. When the convex furface of the liver is the feat 
of the inflammation, it is fometimes not very eafy todif- 
tinguifh the hepatic aflfeftion from pleuritis: but in the 
former uneafinefs is excited by prefling the hand under 
and above the falfe ribs, and there is generally fome pain 
at the top of the flioulder; circumftances not commonly 
obfervable in inflammation of the pleura: and further, 
the cough and dyfpnoea are not fo diftrefling as in the 
latter, while the abdominal fecretions, efpecially thofe 
of the liver, are much more vitiated.” 
The cough is for the moll part dry, but fometimes hu¬ 
mid, and frequently excites a pungent pain in the part 
affefted, with a tendency to naufea, retching, or vomit¬ 
ing. The fpirits and ftrength, particularly the former, 
are much deprefled ; the mind is apprehenlive, confufed, 
or flightly delirious, the pulfe quick and hard ; or low, 
intermitting, or opprefled; the breathing anxious and 
variable; the tongue covered with a dirty white, or yel- 
lowilh, more frequently with a brown fur; the urine 
fcanty and deep-coloured; the bowels are generally irre¬ 
gular; and the fasces dark, flimy, varied, and mixed 
with morbid bile. The heat of the Ikin, though fome¬ 
times only a little, is at other times much, above the 
ltandard of health ; it is fometimes jaundiced. Dr. Arm- 
ftrong Hates, however, that this fymptom often occurs 
without inflammation of the liver. 
It is to be remarked, that there is often much obfcurity 
in tracing the prefence of gaftric fever or inflammation 
in any part of the abdominal fever, when it aflumes a 
flow and mild form. But the exiftence of this Hate in 
any part of the belly may be inferred in continued fever, 
when, after the fupervention of the ftage of excitement, 
the ftomach remains uncommonly irritable; when there 
are conftant feelings, however trifling, of weight or un¬ 
eafinefs about the fcrobiculus cordis, when there is 
quickened or anxious refpiration ; a change always ob- 
fervable in abdominal, feldom in cerebral, irritations. 
We fliould alfo note the fmall and rapid pulfe, the in- 
diftinfl chills and heats, the dry or foul tongue, with 
thirlt, reftleflnefs, frequent erudlations, fenfe of internal 
heat, forenefs, or pain, in fome particular part; and an 
unufual quantity of dark, thick, fluid matter in the 
ftoois on the operation of a purgative. The progrefs, 
indeed, of fuch affedlions mull be traced by the above 
fymptoms; /or pain is not very confpicuous. But the 
bell method of finding out obfcure abdominal inflamma¬ 
tion is to prefs forcibly on the bowels at a time when the 
patient’s mind is occupied with fome other objeft. It is 
proper tofelefl this opportunity; for oftentimes patients 
complain of pain in reply to the queftion “ Does preflure 
hurt you ?” becaufe they expect that fuch will be the cafe. 
The mod important feature in the treatment of the 
gaftric complication of fever is its inertnefs. This is a 
fail not fufflciently dwelt upon in this country; and, 
though the too great dependance which our Gallic 
neighbours place upon medicated broths, eau fucre, &c. 
may be worthy of cenfure when fuch remedies are ap¬ 
plied to inflammatory complaints in general, yet, when 
the inflammation is confined to the mucous lining of the 
alimentary canal, the mere omiflion of irritating medi¬ 
cines, whether cathartics or Simulants, will do much for 
the cure of the difeafe. The nature of our treatment 
in abdominal inflammation will depend therefore upon 
whether the inflammation be confined to the above tube, 
or whether it more generally implicates the furrounding 
vifcera. In the firlt cafe, free general bleeding feems by 
no means called for, though leeching the abdomen is 
highly neceflary. As in this cafe a large quantity of ir¬ 
ritating fecretions have been colledted, to the great ag¬ 
gravation of the gaftric difturbance, it fliould be our firft 
care to evacuate them from the fyftem. In doing this, 
we fliould life fuch remedies as are mod likely to bring 
about the defired effefl without, by their own properties, 
irritating the inflamed membrane. In the firft place, am¬ 
ple dilution with acidulated drinks is to be had recourfe 
to ; an emetic is the next thing to be prefcribed, and its ef- 
fedl is often miraculous; but, after the firft time of giving 
it, its repetition feems by no means admiflible. The 
evacuation of the bowels is to be effected by a dofe of 
caftor oil, if the ftomach does not rejeft it, and by ene¬ 
mas : by the latter remedies, compofed of oleaginous 
(or in cafes of fevere pain of anodyne) decodtions, the 
alvine difcharge is to be regularly kept up. The medi¬ 
cines are to be fuch as at once diminifti the temperature 
of the ftomach; as, the common faline draughts, nitre 
largely diluted, &c. occafionally fmall dofes of antimony 
may be ufed. Nofolid food or animal broths Ihould be 
allowed; but cooling drinks may be taken in large quan¬ 
tities, together with fweet mucilaginous decoctions. 
Now, if the collatitious vifcera feems more deeply im¬ 
plicated, much will depend upon the Hate of the general 
fever. If the latter be highly manifefted, if the tempera¬ 
ture be high, and the pulfe ftrong, bleeding and after¬ 
wards cupping over the aflrefled part mull be had recourfe 
to without lofs of time. If, on the other hand, a vio¬ 
lent and intenfe inflammation fupervenes, while the ex¬ 
citement of fever is not marked, (and this is no uncom¬ 
mon occurrence,) we fliould endeavour to excite thofe 
parts of the body which difplay a diminution in the 
quantity of their circulating fluids. To this end a hot 
bath mud be premifed before we bleed ; and, in perform¬ 
ing the latter operation, we fliould carefully watch the 
riling of the pulfe ; an occurrence fo important, that we 
may occafionally endeavour to promote it by cordials and 
ftimuli. After this, finapifms to the feet, and other 
counter-irritants, will be found ufeful agents. It will 
be neceflary alfo to excite the fecernent fyftem generally 
by large dofes of calomel and opium. 
When inflammation of the liver is clearly manifefted, 
or when the mucous membrane of the bowels is threat¬ 
ened with ulceration, in additipn to the ufual revulfive 
meafures we fliould exhibit calomel in five-grain dofes, 
combined with half a grain of opium, every fix hours, 
till ptyalifm is induced. We may remark, that no gene¬ 
ral rules can be laid down as to the ufe of blifters : they 
are for the inoft part of the utmoft efficacy in relieving 
the local complications attendant on continued fevers; 
but they require to be applied with much care, as to 
the ftate of the fkin generally; for, when inflammation 
of the mucous membrane of the alimentary canal is at¬ 
tended with much heat and rednefs of the fkin, it is ge¬ 
nerally found that blifters increafe rather than alleviate 
the complaint: they alfo aft in a detrimental man¬ 
ner in cafes where exceffive nervous irritability is 
prefent. 
Befides the complications before mentioned, we fome¬ 
times find rheumatifm or angina united with fever. De¬ 
pletion may be pufhed to the utmoft extent in the for¬ 
mer; in the latter, quite the reverfe. 
In taking leave of the treatment of continued fever, 
we have to fay a few words on the management of conva- 
lefcents. It is too much the pra&ice even in this coun¬ 
try, and it is carried to a much greater extent abroad, 
to give bark and other ftrengthening medicines, as they 
are improperly called, to thofe who have efcaped from fe¬ 
vere attacks of fever. We have no liefitation in ftrongly 
reprobating this practice. We fliould anxioufly incul¬ 
cate, that ftrength is only to be attained through the me¬ 
dium of healthy digeftive organs ; and that, when thefe 
are ftrong, a very fmall ^quantity of fuftenance will pro¬ 
duce a high degree of nutrition, hjpw, as fudden ple¬ 
thora is proverbially “ a bad fign” when it fupervenes to 
fevers, we fliould be cautious of producing it by exciting 
in an unnatural manner the energies of the digeftive or¬ 
gans, and we fliould rather fuffer them to recover their 
tone (which they will generally do) in a gradual manner, 
and by means of their own powers. 
We now proceed to the confideration of Yellow Fe¬ 
ver; a difeafe at the prefent moment committing dread¬ 
ful 
