We shall enumerate the principal of those in detail. The pulse weak, quick, fluttering, salient, irregular, intermittent, its systole duplicated, its velocity 130 or 140; tendency to faint or fainting in an erect posture; cold extremities: the respiration slow, laborious, quick, cold; all the subsidiary muscles of respiration labouring to distend the thorax; deep interrupted sighs, hiccup; particular noise in respiration, as if mucus plugged up the throat and lungs: the stomach very weak, with nausea, sickness, vomiting, desire of acids; deglutition difficult, struggling, and with noise; involuntary excretion of feces and urine; thirst; the tongue, teeth, and lips foul, and furred with a black gelatinous incrustation; the urine pale, red, black, fetid; intense burning heat in the abdomen; the belly tumid and puffed; fetid cadaverous smell and exhalations; clammy sweats, especially in the breast: the blood if drawn not coagulating: cutaneous petechiæ, like small bruises in different parts; subcutaneous effusions; hemorrhages: weakness, confusion, irregularity in the intellectual functions; the manners different from natural; in the speech or actions something unusual; loquacity; no sleep; coma or delirium furious, or low and muttering; in the countenance and eyes perturbation, agitation, amazement, despondency, despair, anxiety; attempts to rise out of bed; throwing off the bed-cloaths, incessant tossing about the bed; forgetfulness, loss of memory, so as not to know the nearest friend; refusing or exspuating food, drink, or medicines; moats floating before the eyes, and objects seen as through a cloud; total inattention to every object; twitching and spasms of the tendons at the wrist: catching and picking with the hands and fingers at the bed-cloaths, as if feeling for some object; starting of the muscles, convulsions; trembling of the hands and tongue when thrust out; supine posture; inability to support themselves erect or sitting; sliding down to the foot of the bed: livid nose; collapsed cheeks and temples; sunk and glazy eyes; dead, ghastly countenance, cold extremities.
It has been asserted by authors, that no certain febrile presages can be formed before the periodical crisis; but this is antiquated and erroneous. In tropical climates, the critical days are much more certain and evident than in northern regions: and as transmitted from the prognostical Alcoran of Hippocrates, are the 3d or 4th, 5, 7, 9, 11, 14, 17, 20; which amounts to rather more than one half critical, and the remainder non-critical. On such critical days the event is generally most decisive, whether salutary or fatal; in the non-critical it is a temporary respite. Besides, in tropical climates, the moon is observed to have considerable influence on febrile paroxisms, and crisis. As to the effect of febrile crisis on the human excretories, we have been sufficiently explicit. The favourable termination of fevers is chiefly discovered by cessation of delirium, abatement of the frequency of the pulse; mild sweats equally diffused; the urine depositing a sediment freely and copiously; coolness of the skin; return of natural sleep and appetite; and food recruiting the lost strength. The storm is then subsided, and the ship arrived at anchor.
The phlogistick group of febrile diseases
are now to be reviewed. The majority of these in their immediate causes and mode of cure, intimately anastomose; and the principal differences in the symptoms are to be ascribed to the different organs and parts enraged by inflammation. These are not like the generality of the preceding fevers, in which most of the corporeal functions participate: here, in many cases, one single portion of the human organization is originally transfixed with pain and commotion; and doomed to bear the brunt of the hydraulick torrent and inundation. After mature consideration, we imagined it would occasion less confusion and burthen to the memory, to detach a few diseases from the phlogistick legion. Inflammation of the ears, eyes, intestines, kidneys, and bladder, are incorporated amongst the other diseases by which those various organs are liable to be invested. I am aware that this does not quadrate with the stiff etiquette of nosological parade: but, without digressing into a critical disquisition on this subject, I shall content myself with simply acknowledging that I am no convert to any of those modern pedagogues in morbid arrangement and nomenclature. With similar and intentional omission, I avoid the technical subtilities of parenchymatous and membranaceous inflammation.
Inflammation of the Brain.
Phrenitis vera. As a primary disease, it is very rare in this kingdom. It is much more frequent in tropical and hot climates: and is the febrile calenture of those scorching regions. With us it is mostly symptomatick in different fevers: and may either affect the brain and medullary substance, or its investing membranes: and in the former case the delirium is said to be mild. Morbid dissections have proved, that when inflammation was believed to be present, none could be discovered; and in other cases, that the brain was inflamed, without expressing the usual symptoms. Of idiopathick phrenzy, the symptoms are, fever, excruciating and deep seated headach, restlessness, and want of sleep; intolerance of light and noise, with acute sensibility and irritability; red, prominent, ferocious eyes; audacious, and flushed countenance; contracted and languid pulse; throbbing of the temporal arteries; noise in the ears; change in the voice; impetuous delirium, and the patient, with difficulty, restrained in bed; dry parched tongue, but sometimes no complaint of thirst; costiveness; limpid urine. It is extremely dangerous and precipitate, terminating in a few days in recovery, death, or some other disease; and is rarely protracted beyond a week. The favourable crisis is various: by nasal hemorrhage, sweats, diarrhœa, turbid urine: but on any irregularity or intemperance, convalescents are prone to relapse. The predisposing and occasional causes are, warm climate; insolation, especially with the head uncovered; sudden suppression of the puerperal lochia; intoxication; violent passions of mind; ambition, anger, grief, profound contemplation, unremitting study; long deprivation of sleep; external injuries; erysipelas, or scald head prematurely repelled; violent exercise; symptomatick.
Angina:
cynanche, quinsey; and distinguished into the inflammatory; and into the putrid, gangrenous, or malignant. The mortality by quinsey and sore throat, appears in the London bills inconsiderable; and without discrimination of the inflammatory and putrid. Inflammatory angina is a general and frequent affliction in both sexes, and especially in ours and some northern regions. Adults more than infants; and some individuals more than others, are obnoxious to it: its reign is in spring and autumn, on the change and vicissitudes of the seasons, or of heat and cold. In that very different species, the Gangrenous Angina, the ancient authors are nearly barren of information: some years this is epidemick and contagious in different parts of our island; and is much more inimical to childhood and adolescence than to adults; discharging its venom on schools, and the younger branches of families.