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Inflammatory fever, as it has often occurred in the GEN. IV. author's own practice, and in that of others who have described it, usually commences with the symptoms of Cauma. an acute ephemera, and may in fact be contemplated as to the same disease running on from four or five to about History of eleven days without intermission or a renewal of the symptoms. cold fit. It commences with a sense of languor and ine aptitude for exertion, with a disrelish for food, which continues for a day or perhaps two. There is then chilliness and soreness over the surface, with nausea and head-ache, succeeded in the evening by a great increase of heat, and at night by perspiration, with great thirst, restlessness, and sometimes delirium: sometimes in young persons, convulsions with a stupid drowsiness. The bowels are usually costive, the urine high coloured, and the pulse quick and hard.
With Dr. Fordyce the grand pathognomic symptom of Pathognocauma is hardness of the pulse. This accompanies it from first to last in its simplest and in its severest state. ness of the
pulse. When the disease is mild, it is hard alone; when more violent, it is at the same time full, strong, and frequent. the pulse The obstructed pulse is often confounded with the hard, and it is not easy to distinguish them without consider- plained. able practice. There is a rigidity of resistance to the finger in each, but of a different kind. In the hard pulse, it is much firmer and tenser; and is supposed by Dr. Fordyce to result from such an increase of arterial contraction as to over-balance its correspondent dilatation. It indicates, in his opinion, a very high degree of living power, and is peculiarly characterized by a tardy coagulation of the blood when drawn freely into an hemispheric bason, in consequence of which the red particles have time to subside, and leave the surface colourless or with a buffy appearance. In the obstructed pulse, How differs
from obon the contrary, the blood coagulates at once; and, the structed red particles not having time to separate, the surface is pulse. , of the same hue as the cake below.
The disease sometimes terminates abruptly and with Progress of a critical sweat, or some other evacuation on the fourth caum. or fifth day : but more usually increases in violence,
Gen. IV. though with occasional declinations, for a week longer;
Spec. I. Enecia
during which time, the pulse rises to a hundred or a Cauma. · hundred and ten strokes in a minute, but continues reInflamma
et gular; the nausea subsides, and the patient will take and tory fever.
retain whatever is offered to him of simple nutriment or medicine : the thirst is less violent, but the tongue is
deeply furred, and the lips are parched. Termina The disease is not often dangerous; and about the
eleventh day gradually subsides, or yields to some critical discharge, which is usually that of a free and alleviating perspiration. The pulse soon sinks to eighty,
and the chief symptom is weakness. Different During the course of the fever, every organ suffers organs differently
from its morbid and increasing impetus; but they do affected. not all suffer alike: for in some parts there is, occasion
ally, a greater spasticity or tetanic resistance in the bloodvessels to the flow of the circulating fluid than in others, whence that acute pain which is often complained of in the head or the side; in the latter case, sometimes amounting to pleuralgia. And, not unfrequently, the vessels of one part will give way more readily than those of another, and there will be a sense of heaviness and oppression in the head, the heart, or the lungs: as though some effusion had taken place, which is perhaps actually the case in some instances. If the head be much affected, delirium is a frequent result, with raving and vio-' lence, rather than the low muttering incoherence of
asthenic fevers. May some. From the history already given of the malignant Cau-' times, per
sus, or ardent malignant remittent, it appears probable from febrile that inflammatory fever may sometimes be produced miasm;
from febrile miasm, though it is commonly derived from but more other sources. Of these the stimulus of violent passions frequently, from violent is, perhaps, one of the most common; and especially passion, exercise, or "pon a M8
upon a vigorous and plethoric habit, which is the usual heating
temperament in which inflammatory fever makes its apfoods;
pearance. Undue muscular exercise, heating foods, or excesses of any kind in the same habit, are also frequent causes; while another may be found in the suppression of any accustomed discharge, as that of menstruation,
epistaxis, or periodical blood-letting. Suddenly sup- Gen.IV.
mon pressed perspiration is, in like manner, a frequent, per
Spec. I. haps the most frequent cause of any; especially when Cauma. the body is very hot, and the change is affected by ex
tory fever. posure to a temperature of great cold, applied externally
suppression or internally, as that of a current of cold air, a large of accus
tomed disdraught of cold water, or plunging into a river.
charges, or Some writers, as Sennert and Crichton, have sup- sudden perposed inflammatory fever to be occasionally produced
Whether by by an absorption of bile into the blood-vessels under the a resorption excitement of a tropical sun, or of a torrid summer in of bil milder regions; and they suppose that the bile is, in this case, possessed of a more than ordinary degree of acrimony, and that the symptoms are varied by a more pungent heat and more intolerable thirst, with a more scanty secretion of urine, preternaturally acrid and highcoloured. That bile of this description is often forced back into Inflamma
tory fever the system under the circumstances here supposed, is a frequent unquestionable ; as it is also that inflammatory fever is concomia frequent accompaniment of this morbid change. But, sorbed bile, notwithstanding the above authorities, such fever seems less attributable to the reflux of bile into the blood, than to the insolation or solar excitement; which, by unduly stimulating the liver has been the cause of an overflow of the bilious secretion. How far a more irritant or exalted acrimony may be communicated to bile thus operated upon, or what may be its effect upon the system admitting it to take place, it is difficult to determine; but but perhaps there is much reason to doubt whether genuine bile in the sanguiferous system is ever a cause of fever, or stimulates the heart or arteries to increased action. For if this were the case, jaundice would always be accompanied with inflammatory fever. Instead of which, however, we find it accompanied with atony instead of entony, or diminished instead of increased power.
Sauvages gives a case in which inflammatory fever Produced was produced by a mechanical irritation of the meninges of the brain, by a lodgment of vermicles in the frontal frontal
tant of re
cles in the
Spec. I. Enecia Cauma,
Gen. IV. sinus, of which seventy-two were discharged during a
fit of vomiting and sneezing, from which time the patient
began to recover. Inflamma
These vermicles were most probably the larves of tory fever.
some species of the oestrus or gad-fly, which had crept up into the frontal sinus, after being hatched in the nostrils in which the parent insect had deposited her minute eggs. This is a very common affection in grazing quadrupeds, and especially in sheep, which are often peculiarly tormented, and sometimes driven almost mad by the violence of the irritation.
Stoll gives a case in which the brain, on examination after death, was found deluged with serum-diluvium serosum *. But such an appearance is rather to be regarded as an effect than a cause of the disease; as an instance of cephalitis profunda, in consequence of the brain having suffered more than any other organ from the inflammatory impetus.
Hence the following varieties are noticeable under the present species : a Plethoricum.
Produced in a plethoric haPlethoric inflammatory bit by great mental or fever.
muscular excitement, or heating foods; or by a sudden suppression of perspiration, or of other
accustomed discharges. B Biliosum.
Accompanied with an excesBilious inflammatory sive secretion of bile ahfever.
sorbed into the sangui
neous system, Pleuriticum.
Accompanied with a violent Pleuritic inflammatory stitch or pain in the side.
fever. à Cephalalgicum. Accompanied with acute pain Cephalalgic infiamma in the head.
* Mat. Med. 111. p. 294.
As an inflammatory diathesis constitutes the essence Gen. IV.
Spec. I. of this fever, the cure must depend altogether upon a Enecia reduction of the vascular, and especially of the arterial Cauma.
Inflammaentony: always bearing in mind the possibility that the
tory fever, disease may suddenly lose its inflammatory character, Remedial and rapidly pass into that of a typhus. Regulated by
Venesecthis view, we should generally commence with bleeding tion. and cooling purgatives. There are a few cases, indeed, Cathartics. in which bleeding may be dispensed with, as when the habit is by no means plethoric, and the pulse is obstructed rather than hard; but these are cases that rarely occur. Diaphoretics, or relaxants as they are denominated by Dr. Fordyce, may then be employed with advantage. Of these the tartarized antimony, the antimonial powder, Relaxants. or James's powder, are chiefly to be relied upon; and may be given alone, or, which is often better, in saline draughts; and particularly those formed of the acetate of ammonia. And it may not be amiss to observe here, a
ve sel, acetate of that the acetate of ammonia is sometimes prepared in the ammonia. form of crystals, and sits more easily on the stomach in this than in any other shape. When given as a liquid, it is of importance that the solution should retain the carbonic acid gass of ammonia as largely as possible; and for this purpose the union should take place in a strong close vessel. According to Bergman, nearly half the weight of ammonia depends upon the quantity of this gass which it contains; so that in a pint of the solution of the acetate of ammonia, comprising four drachms of the latter, there will be extricated, if made in the manner here recommended, little less than a hundred and sixty cubic inches of air. As the stomach is for the most part but little affected, Emetics
how far emetics, if used at all, can only be employed for the pur- useful. pose of determining to the surface; but as we can do this by the antimonial and other diaphoretics just referred to, as also by diluent drinks, it is hardly worth while to irritate the stomach in order to accomplish the same purpose. Perfect rest of body and mind, a reclined position, and a light liquid diet, destitute of all
tricate Sing for of the