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SPECIES I.

EPANETUS MITIS.

Mild Remittent.

PULSE REGULAR THOUGH FREQUENT; DEBILITY SLIGHT;

REMISSION DISTINGUISHED BY SWEATING OR A CLOUD
IN THE URINE.

This species occurs most frequently among persons of Gen. III. relaxed fibres, debilitated habits, and sedentary occupa- Origin and

Spec. I. tions; and is usually preceded by an irregular action of scope. the alvine canal, flatulency, abdominal tension, dyspepsy, or some other affection of the viscera of the lower belly; and is hence called by Professor Frank, as well in the Gastric ensuing as in the present species, gastric fever *, inter

Frank, mittent, remittent or continued, according to the type it assumes. It occurs at all seasons of the year, but more 'frequently in the autumn; the ordinary temperament of the season uniting with the patient's infirm state of health, and thus adding an exciting to a predisponent cause. 'Fatigue, cold, or long exposure to the rays of the sun, are also, at this time, powerful concomitants, and quicken the appearance of a disease, the seeds of which have for "some time, perhaps, been lurking in the system. *10. The patient complains of drowsiness, and feels lan- Diagnosis. guid; is occasionally chilly, and afterwards flushed, but without perspiration; for the skin is hot and dry, the thirst considerable, commonly with nausea and a total loss of appetite. In the course of the day, but usually towards the evening, the pulse quickens, the heat increases, and at length terminates in a sweat, which, however, is sometimes only partial, rarely free and copious, and never

* De Cur. Morb. Hom. Epit. Tom. 1. $ 50. 99. 8vo. Mannh. 1792.

Spec. I.

tent.

Medical treatment.

Ger.Ill. critical: for, on its ceasing, the skin is still dry and Epanetus

heated, and the pulse accelerated. Sometimes the ex-mitis acerbation occurs about noon, and sometimes in the Mild remit- middle of the night. Prognosis. If the disease be left to itself, the symptoms augment

in severity daily; the head occasionally, but more gene rally the liver, or some other abdominal viscus, gives proof of being loaded and oppressed, and the restlessness is intolerable; or a sudden cholera supervenes, and cárries off the complaint by a salutary crisis.

Nii This species seems to be primarily dependent upon torpitude, or obstruction in some one or more of the chylopoetic organs, and generally yields to a course of active purgatives, amongst which calomel ought to take the lead. These should be repeated two or three times a week, and the intervals be filled up with mild diau phoretics. The pulse will generally be found from ninety to a hundred strokes in a minute; but as soon as it sinks below this, and the heat and dryness of the skin have yielded to a general softness, columbo alone, or combined with sulphuric acid, will easily complete the cure; though the disease not unfrequently runs on for

ten days or a fortnight. Remittent The REMITTENT FEVER OP INFANCY, which is generally fever of infancy.

ascribed to worms, does not essentially differ from the present, regard being had to the greater irritability of the moving fibre in early life. Worms, there can be no doubt, are sometimes the cause of this infantile fever, but perhaps rarely; and there is no instance on record of their having been traced in the bodies of those who have

fallen victims to it. Dr. Hunter, indeed, expressly deOrdinary clares that he has often searched in vain. The ordi

nary cause is, crude accumulations in the first passages,

whence the digestion proceeds imperfectly; there is great Symptoms. general irritation, with considerable languor; the belly

becomes tumid and often full of pain; the food is nauseated; the head is hot, heavy, and often comatose ; as though there were water in the ventricles, which is some times suspected, though without foundation; the skin is

cause.

Spec. I.

tent,

pale or livid with occasional flushes in the cheeks. It is a Gen. III. singular fact, that if the exacerbation or increase of fever

Epanetus take place in the night, there is wakefulness and perpe- mitis.

Mild remittual jactitation; if in the day-time, drowsiness and stupor.

Dr. Butter recommends, as an aperient, small doses Treatment. of neutral salts, and, when the bowels have been opened, nitrate of potash; or, if there be considerable irritation, the extract of hemlock. Generally speaking, however, there is such a sluggishness in the peristaltic action of the bowels, as well as in the intestinal secernents, that neutral salts will not answer the purpose; and, in consequence, rather add to the irritation than carry it off. And hence, much stronger purgatives should be employed from the first; as calomel, resin of jalap, or gamboge dissolved in milk; and it may safely be prognosticated, that, till this plan is had recourse to, the discase will in most instances maintain its ground if it do not make a fearful advance. But with a course of brisk cathartics, in conjunction with perfect quiet, good ventilation, and light nutritive food, it will usually give way in a week or fortnight.

SPECIES II.

EPANETUS MALIGNUS.

poseba.leos. Malignant Kemittent.

PULSE SMALL, HURRIED, IRREGULAR; DEBILITY EXand 3 TREME; OFTEN WITH SIGNS OF PUTRESCENCY.

Spec. II Extreme

EXTREME debility may be inferred from the symptoms Gen. III. of great weakness and irregularity of the voluntary motions; weakness of sensation ; weakness, and wan- debility dering of the mind; weakness of the pulse and of how ex

denced. respiration ; coldness and shrinking of the extremities;

Gex. III. and a tendency to faint in an erect posture; nausea,
Spec. II.
Epanetus

vomiting, and a total disinclination to nourishment; malignus. difficult deglutition, depending upon an atony of the Malignat remittent.

muscles of the fauces; involuntary excretions, depending

upon an atony or paresis of the sphincters. Putres

A putrescent state of the fluids may be determined cency of the Auids how

from the following symptoms : pulse quick and tremuevidenced. lous; heat of the surface sharp and pungent, giving to

the finger a peculiar tingling for some minutes afterward; the skin parched, or soaked with sordid, fetid sweat; the smell offensive to a considerable distance; the breath hot and fetid; the mouth aphthous; the tongue clammy, fetid, livid, greenish-black; the lips swollen, puckered, cracked and purple; the urine brown or blackish, and offensive; black discharge often in profuse quantity from the stomach; the stools blackish, colliquative, very offensive, parted with profusely and insensibly; the mind wandering; twitching of the tendons; swelling and tension of the belly; petecchial spots, vibices, and hemorrhages from different parts, without proofs of increased impetus,

This species may be traced under four varieties, each sufficiently marked by its own symptoms :

a Autumnalis. Autumnal Remittent.
B Flavus.

Yellow Fever.
qy Ardens.

Burning Remittent. à Asthenicus. Asthenic Remittent. a E. malig- The AUTUMNAL REMITTENT is that which so frequently i shows itself in our own country, in the season from which

it derives its name, with a strong tendency to assume the tertian or double tertian type : or, in other words, with striking exacerbations every other day, or where the double tertian is imitated, every day, the exacerbations commencing at noon, and the duration being usually under twelve hours; the intervals consisting of remissions, which, however, are not always very clearly determined. Where the double tertian type prevails, and the patient has to labour with two distinct sets of

nus autumnalis. Autumnal remittent.

tumnalis. Autumnal

w distin

ar

tertian exacerbations, it is obvious that one of these must Gen. III.

SPEC. II. take place every day, as it must occur in the remission of the other. And this variety is, in consequence, often nus au" mistaken for a quotidian remittent. Bat a little atten

tion will point out the real nature of the disease. For remittent. while the one set will usually be found distinguished from Sometimes

mistaken for 'the other by evincing some difference in its duration or a quotidian its violence, both will be distinguished from the quo- remittent. tidian by the time of their attack, which is at noon, while Ho

guishable. the quotidian attacks in the morning; and by the comparative brevity of the paroxysm, which is always under twelve hours, while that of the quotidian runs on towards eighteen.

The perfect apyrexy which takes place in the interval of intermittent fevers gives the constitution a full power of recovering its energy and recruiting its sensorial supply; and we have hence observed that there is great

Return of difficulty in accounting for a return of the paroxysm: I oxysm dif

ficult to be mean in cases in which the patient is removed from the as miasmic atmosphere; for otherwise the cause that com- for in remenced the disease will be present to continue it. Habit may possibly effect this after a recurrence of several paroxysms; but this will scarcely apply to the second, in which no habit can with great strictness of language be said to have taken place. In remittent fevers, however, But less so something of this difficulty is removed, for the constitu- in tion, even during the remissive interval, is still struggling with disease, and has not an opportunity of recovering its sensorial power. There is no perplexity in accounting for a greater Fevers why

more fretendency to febrile affections towards the autumn than in any other quarter of the year: and this, whether we the autumn. állow the operation of a specific febrile miasm from marshes or not.' When the animal frame has for some months been exposed to the stimulus of a high atmospheric temperature, and not unfrequently, perhaps, to that of the direct rays of the sun, all its organs become relaxed and debilitated. The sensorial Auid is secreted less abundantly, perhaps less elaborately; or, in the lan

accounted

mittents.

in intermittents.

quent in

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