GEN. III. SPEC. III. Epanetus Hectic fever. The lighter bitters are certainly serviceable in many cases, and may conveniently be employed in combination with the acids; but bark, though tried in numerous instances, and with great perseverance, has not been The lighter found successful. Dr. Heberden, however, says that he never saw it do any harm in the hectic fever, and his opinion is confirmed by that of Sir Edward Hulse, after having prescribed it for forty years. Yet neither of them ever obtained proofs of any beneficial result. bitters useful with acids. Bark, harmless, but of no avail. where the cause is local. A light and regular diet, regular hours, and gentle exBath waters ercise, are coadjutants of great importance. When the disease is dependent upon some local affection, the Bath waters have often afforded relief; but in idiopathic cases they usually augment the fever, aggravate the patient's sufferings, and hasten his death. GENUS IV, ENECIA. Continued Fever. ONE SERIES OF INCREASE AND DECREASE; WITH A TEN- GEN. IV. Alternated by slight fluxes and refluxes of Morning ing often distinguished by fluxes, especially the latter. and even We now enter upon the important genus of continued fevers, or those which run their course, not indeed without any change or relaxation whatever, as many of them were supposed to do formerly, and were distinguished symptoms. by the term continentes, but with occasional and slight fluxes and refluxes, which bear the same proportions to the exacerbations and remissions of the epanetus as these do to the paroxysms and intervals of the anetus or intermittent. When there are two tides or fluxes within the twenty-four hours, the one occurs in the morning, and the other in the evening. The last is always the most distinct; and takes place usually between five and six o'clock, which is somewhat later than the latest of the paroxysms of genuine intermitting fevers; that of the quartan, which is the latest of the whole, usually occurring before five o'clock. It should also be farther observed that where continued fever discovers but one augmentation in the twenty-four hours, it is always that of the evening. Dr. Fordyce attempts to show that, even Fordyce's in a state of the firmest health, we constantly discover natural evening parsome tendency to a little febrile affection every evening; oxysm. this he calls the natural evening paroxysm of fever; and to this habit he ascribes the existence of an evening increase of continued fever. GEN IV. Enecia. Continued fever. The genus, thus defined and characterised, includes the three following species: Sauvages's line of dis tinction be tween the different species of continued fever. Holds only generally. Sauvages draws a line of distinction between these three from their respective duration, as well as from their more essential symptoms, affirming that the cauma terminates in a week at the farthest; the typhus in two, though sometimes protracted to three weeks; while the synochus reaches beyond the second, and often beyond the third week. As a general rule, this remark is worth keeping in mind, but the deviations from it in all the species, are too frequent to enable us to lay hold of it in assigning their specific character. SPEC. I. Distin various names, SPECIES I. ENECIA CAUMA. Inflammatory Fever. HEAT GREATLY INCREASED; PULSE QUICK, HARD, AND STRONG; URINE RED; DISTURBANCE OF THE MIND GEN. IV. THIS species has been distinguished by a variety of names by different nosologists and other medical writers; the guished by chief of which are, imputrid synochus, which is that of Galen; imputrid continued fever, which is that of Boerhaave; imputrid continent, which is that of Lommius; sanguineous continued fever, which is that of Hoffman; and synocha, which is that of Sauvages, Linnéus, Cullen, and most writers of the present day. Of these, synocha, for reasons stated in the comment to the Nosological of which the worst is synocha. GEN. IV. SPEC. I. Enecia Inflamma tory fever. And hence above for exchanged Synopsis, is the worst; it has no clear or correct etymological meaning; it has been used in different senses by different writers, and approaches so nearly to synochus, used as extensively by most of the same writers, as to create a perpetual confusion in the minds of young students; and the more so, as the disease before us is expressly denominated synochus by Vogel, whilst most writers employ this term to import a different species of fever. On all which accounts I have judged it right to exchange synocha for cauma, a term already employed for the same purpose by Dr. Young, and which, derived cauma. from xaía, "uro", is etymologically significant of the καίω, character of the disease it designates. The common English term inflammatory fever is excellent; and is, in truth, a direct translation of the Greek term cauma. Dr. Fordyce denominates it general inflammation: by Importing which he clearly intimates that this species of fever bears flammation. a near resemblance to the symptomatic fever produced Fordyce's by the local affections called phlegmasiæ, or phlogotica, which constitute the next order of the present class, to which the term inflammations is now commonly limited ; but which Dr. Fordyce would distinguish by the term "local inflammations". general in name for it. between in fever and Whether it exists, ex cept from a local cause. In effect, inflammatory fever and the fever of inflam- Difference mations bear the same relations to each other as the flammatory idiopathic and symptomatic hectic: in both there may fever of inbe a general or a local remote cause, but the influence flammations. upon the constitution will be the same, whatever be the source of excitement. It has been doubted, however, whether cauma or inflammatory fever ever exists without a local cause; and Dr. Cullen, who does not allow that hectic fever is ever found without a local cause, distinctly affirms that he has never seen inflammatory fever existing under the same circumstances: whence Dr. Clarke, of Newcastle-upon-Tyne, who has too much generalized the subject, has struck inflammatory fever entirely out of the list of diseases, contending that even the term inflammatory ought never to be applied to fever, excepting when fever itself only exists as a concomitant of some Local cause various in its seat, as contemplated by supporters different of this doctrine. SPEC. I. Enecia Cauma. Inflammatory fever. Arteritis, what. In GEN. IV. local affection *: while Dr. Clutterbuck, as we have already observed +, has contended that this local cause is at all times, and under every variety of fever, an inflammation of the brain. If, however, a cause of this kind be ever fairly made out, a variety of facts of late detection, will be far more likely to fix it in an inflammation of the arteries, the ARTERITIS of the French writers, who have recently examined the subject at considerable length, especially MM. Portal ‡, Dalbant, and Vaidy§; and to which Dr. Frank has, indeed, already ascribed inflammatory fever in one of its forms |. But the subject is still involved in great obscurity, as it is doubtful whether the change of arterial structure which has been found after death in many cases of supposed arteritis, has been really an effect of inflammatory action. acute rheumatism it is probably a frequent cause or concomitant; but this is a question we shall have occasion to return to under that disease. How far either hectic or inflammatory fever may, under particular circumstances of human or atmospherical constitutions, occasionally originate from marsh or contagious miasm, it is difficult to determine; but as Dr. Cullen was peculiarly desirous. of reducing all fevers to these two sources; and as, to say the least, they are not obvious sources of either of the diseases in question, his mind appears to have received some bias from this fact in rejecting them from the list of idiopathic fevers. And as it has already been shown that this decision has laid a foundation for much of that "tug of war" in which many distinguished members of the profession have of late years been engaged, respecting the nature and treatment of particular species of fever, it is highly probable, also, that several of the more recent hypotheses concerning its proximate cause have originated from the same spring. * Observations on Fevers, &c. 8vo. London 1779. + Vol. 1. p. 61. § Dict. des Sciences Médicales:-Journ. Compliment, vi. Août 1819. |