GEN. IV. SPEC. II. B E. Typhus gravior. Putrid fever. cially where the head is much affected; but the body should not be covered over with them, as is often the case from head to foot, so as to be highly distressing to the patient, and to exhaust the little irritability he has left. Cataplasms or bottles of hot water applied to the Blisters. feet, when the circulation is unequal, will often be a better practice. Treatment. Yeast, as an antiseptic, was strongly recommended to Yeast. be taken into the stomach by many practitioners about twenty or thirty years ago, and numerous cases were published of the wonderful cures which it performed. Of late it seems to have fallen into an unmerited neglect: it is a simple remedy, easily procured, and worth a more general trial. During the entire course of the fever, from the time Diet and the bowels have been sufficiently evacuated, the patient regimen. may be allowed animal broths and jellies in alternation with the farinacea: he should be lightly covered with bed-clothes; his chamber should be freed from all unnecessary furniture; his sheets and body-linen be frequently changed, and be instantly taken out of the room; as should also the egestions of every kind. lation. when peces Above all things, the chamber should be freely venti- Free ventilated, which is infinitely the best way of purifying the air, and dissolving the febrile miasm as it issues from the body: upon which subject we have already touched. Where the ward or chamber is large, or the sick are remote from each other, simple ventilation by opening the opposite windows, or the windows and door, will be sufficient. But where the wards are small, or may not admit Fumigations of sufficient ventilation, or the patients are numerous, fumigation with nitric or muriatic acid should not be neglected. At present we have no reason for a preference, except that the vapour of the former appears to be rather more volatile and penetrating. Of late years Lately dethere have been attempts to decry the use of fumigations, cried; and especially by M. Von Mons and Dr. Trotter, who conceive that they rather add to than diminish the septic matter of the atmosphere. On which account they rather sary. SPEC. II. GEN. IV. advise to sprinkle the room frequently with water, and maintain a good fire, believing that febrile contagion is much better destroyed by pure aqueous vapour than by other means. BE. Typhus gravior. Putrid fever. Treatment. but on false principles. How acid probably act. any But this conception is founded upon a double hypothesis, and an hypothesis apparently mistaken upon both points: first, that febrile miasm, and septon, or the elementary matter of putrescency, are the same thing: and, next, that this common principle is nitrous oxyde, or oxyde of azote, agreeably to the conjecture of Dr. Mitchell. Of septon, however, we know but little; yet from the established power of hydrogene in exhausting or destroying animal irritability, it is more probable that M. Morveau's conjecture of its being a combination of hydrogene with azote rather than of oxygene with the same, is the real fact. But be this as it may, we have no more reason for believing that febrile miasm consists of either of these, than that it consists of animalcules of a peculiar kind, as was once contended for by Dr. Chandler. Febrile miasm we have reason to believe is a peculiar fumigations and specific production; the chief properties of which I have already endeavoured to point out. Pure air unquestionably dissolves it; and hence there may be other gasses capable of dissolving it also, and even more readily; or which, combined with pure air, may render the latter a speedier and more powerful solvent. And it is probable that the vapours of the mineral acids act in this manner. In this respect they may be useful; but if ever employed to supersede ventilation, the opinion of Dr. Trotter, that they do more mischief than good, will be completely established. The aromas of volatile plants are of no benefit whatever; and if the fumes of tobacco were ever serviceable in the plague, it was most probably, as Dr. Cullen conjectures, from their exhilarating the spirits like wine or opium, and diminishing the irritability. Aroma of plants. Tobacco. SPECIES III. ENECIA SYNOCHUS. Synochal Fever. COMPOUNDED OF CAUMA AND TYPHUS : IN ITS COM- GEN. IV. The most tinued fever in the present day. character. Ir is not necessary, after our copious histories of the two preceding species, to follow up the present, which is a mixture of both, through a detailed description of its course. It is certainly the most common form under which continued fever makes its appearance in our own country; for it is but rarely that cases of fever occur which preserve a strictly inflammatory character from the beginning to the end. It is in fact an inflammatory fever General bent out of its proper career, often, perhaps, by the tem. perament upon which it has to act; but still more frequently, as Dr. Brocklesby has well observed, by confined and vitiated air, and hence dropping its inflammatory pretensions in the middle of its course. Its causes are therefore the same as those that produce inflammatory fever. Dr. Cullen has entered it into his catalogue of genera after Sauvages and Linnéus; but with a doubt whether he is correct in so doing. "Since many fevers", says he, "are neither altogether inflammatory, nor altogether nervous, they cannot be referred either to the synocha (cauma) or the typhus and I have hence inserted the genus synochus, whose type is frequently seen in this country. Yet between the typhus and synocha I cannot place any accurate limits; and I doubt whether they should in fact be deemed genera, or have a different place allotted them." And in his First Lines he observes, "I am disposed to believe that the synochus Supposed by Cullen GEN. IV. Enecia sy. fever. to be a variety of typhus, but is rather arises from the same causes as the typhus, and is therefore only a variety of it". To me it appears rather to arise from the same causes as the cauma, for it commences with the cauma-type. The proper rank för all of them appears to be that of species; and the present system in the text-book, in allotting them this character, steers just a middle course between Dr. Cullen's actual more nearly arrangement and his real opinion. And in this view it is distinctly regarded by Dr. Stoll, who sometimes describes it as an inflammatory fever assuming a putrid guise; sometimes as equally inflammatory and putrid; and sometimes as an inflammatory fever passing into a whence de saburral fever*. By Kausch, and other German pathologists, it is hence denominated febris inflammatorioflammatorio- putridat. It is, in many instances, the inflammatory typhus of Dr. Armstrong. related to cauma; nominated febris in putrida. Varies in course and symptoms. General character. Occasionally it shows a considerable tendency to terminate its course abruptly by a critical sweat; it is sometimes peculiarly marked with yellowness of the skin; sometimes with great stupor of the head; and sometimes with inflammatory tension of the peritonæum. And it hence furnishes us with four varieties: a Sudatorius. Sweating synochus. 8 Flavus. > Soporosus. Carried off by a critical sweat in an early stage of its progress. With yellowness of the skin, attended with a sense of burning heat. Accompanied with stupor from the beginning. Accompanied with an inflammatory tenderness of the belly: mostly occurring on the third day after childbirth. The symptoms of the FIRST VARIETY open with great * Rat. Med. 1. p. 97. 106. 113. iv. 61. + Gruner Almanach, 1788. p. 37. GEN. IV. SPEC III. a E. Syno chus suda fever. Treatment. violence. There is usually an intense pain in the head with a vehement vomiting and purging, which is rarely removed, and sometimes augmented, by an emetic: the skin is peculiarly dry and hot. The balance of the cir- torius. Sweating culating system is here greatly disturbed, and there is an synochal evident determination of blood to the head, and probably to the liver. Like the yellow fever, it rushes forward rapidly to a state of great sensorial debility; and is best checked in its progress by a free use of the lancet, which more than any thing else takes off the tendency to congestion, and the hardness from the pulse. A diaphoresis commonly breaks out soon afterwards, which proves critical, and should be maintained by diluent drinks, and small doses of antimonials or other relaxants. chus flavus. fever. In the YELLOW-TINGED SYNOCHUS there is a high degree 6 E. Synoof hepatic irritation, and consequently an excessive secre- Yellow tion of bile, part of which is resorbed and carried into synochal the system whence Galen denominates it synochus General biliosus*. It is found chiefly in the summer season character. among young persons of a bilious habit, and is generally produced, like the genuine cauma, by too violent exertion under a sultry sky. It is accompanied with intolerable thirst and sleeplessness. In few words, it is a causus or ardent fever without any apparent remission; its symptoms, with this exception, are the same, and the same mode of treatment is demanded: for which the reader may turn to the second species of the preceding genus. While the symptoms rage violently, there is sometimes y E. Synoa great determination to the head, with a sudden ex- rosus. haustion of sensorial power; and hence, notwithstanding Comatose synochal that this local affection is more severe and confirmed fever. than in the first variety, there is a dull and obtuse, rather than an intense and pungent pain. It is the SYNOCHUS SOPOROSUS of Guarinon and Sauvages, as well as of the present system; and the continual fever of Sydenham Sydenham's description. for the year 1763. Among the chief symptoms, says he, was a coma, for the patient soon became drowsy * De Differ. Febr. cap. II. De Crisibus, cap. II. chus sopo |