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SPEC. I. Enecia

Inflamma

tory fever.

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 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 inaptitude 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.

mic symptom, hard

ness of the pulse.

Hardness of

described

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. 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, a 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 he-. mispheric bason, in consequence of which the red par-. ticles have time to subside, and leave the surface colourless or with a buffy appearance. In the obstructed pulse, How differs on 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.

from ob

The disease sometimes terminates abruptly and with Progress of a critical sweat, or some other evacuation on the fourth

or fifth day but more usually increases in violence,

:

cauma.

GEN. IV. though with occasional declinations, for a week longer; during which time, the pulse rises to a hundred or a hundred and ten strokes in a minute, but continues re

SPEC. I.

Enecia

Cauma.

Inflamma

tory fever. gular; the nausea subsides, and the patient will take and 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.

Termination.

Different organs differently affected.

May some

times, perhaps, arise

miasm ;

but more

:

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.

During the course of the fever, every organ suffers from its morbid and increasing impetus; but they do not all suffer alike: for in some parts there is, occasionally, 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 violence, rather than the low muttering incoherence of asthenic fevers.

From the history already given of the malignant Cau-' sus, or ardent malignant remittent, it appears probable from febrile that inflammatory fever may sometimes be produced' from febrile miasm, though it is commonly derived from other sources. Of these the stimulus of violent passions frequently, from violent is, perhaps, one of the most common; and especially exercise, or upon a vigorous and plethoric habit, which is the usual temperament in which inflammatory fever makes its appearance. 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,

passion,

heating foods;

GEN. IV.
SPEC. I.

Enecia

epistaxis, or periodical blood-letting. Suddenly suppressed perspiration is, in like manner, a frequent, perhaps the most frequent cause of any; especially when Cauma. the body is very hot, and the change is affected by exposure to a temperature of great cold, applied externally or internally, as that of a current of cold air, a large draught of cold water, or plunging into a river.

Some writers, as Sennert and Crichton, have supposed inflammatory fever to be occasionally produced by an absorption of bile into the blood-vessels under the excitement of a tropical sun, or of a torrid summer in 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.

Inflammatory fever. suppression of accus

tomed dis-
charges, or
sudden per-
Whether by
spiration.
a resorption

of bile.

tory fever

concomi

tant of re

sorbed bile,

That bile of this description is often forced back into Inflammathe system under the circumstances here supposed, is a frequent unquestionable; as it is also that inflammatory fever is a frequent accompaniment of this morbid change. But, 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 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 was produced by a mechanical irritation of the meninges of the brain, by a lodgment of vermicles in the frontal

but perhaps

never produced by it.

Produced

by vermi

cles in the frontal

sinus.

GEN. IV. sinus, of which seventy-two were discharged during a fit of vomiting and sneezing, from which time the patient began to recover.

SPEC. I.

Enecia

Cauma.

Inflammatory fever.

These vermicles were most probably the larves of 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:

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GEN. IV.
SPEC. I.

Enecia

Inflamma

tory fever.

process.

Venesec

As an inflammatory diathesis constitutes the essence of this fever, the cure must depend altogether upon a reduction of the vascular, and especially of the arterial Cauma. entony: always bearing in mind the possibility that the disease may suddenly lose its inflammatory character, Remedial and rapidly pass into that of a typhus. Regulated by this 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 Crystallized of ammonia. And it may not be amiss to observe here, rate 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.

Emetics

how far

As the stomach is for the most part but little affected, 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

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