Fever

“ Fevers were classed of old as putrid diseases, and any one who has witnessed the prompt decomposition and the foul emanations of fever stricken beings, whether human or brute, can readily understand that it was no very India rubber like stretch of the imagination that led our forefathers to confound contagion with putrescence. ”

“ The evidence is as complete as observation during life and inspection after death can make it, that a morbid change does take place in a certain number of organs in every case of fever, from the most trivial intermittent to the most alarming continued fever, from the mildest plague to the most malignant typhus: that at the two extremes of this scale, and at all the intermediate gradations of it, there are certain organs which are always affected, and that the affection in all is similar. ”

“ All the ancient authorities held that a fever consists of a preternatural increase of the Innate, or, as it is now called, Animal heat, which they considered as the instrument by [188] which the soul performs all the functions of the body. See Alexander Aphrod. (de Feb.) Thus, Palladius defines a fever to be “a preternatural heat, which begins in the heart, and is diffused by the arteries over the whole body, sensibly injuring the actions of the body.” Hippocrates, Galen, Aëtius, Alexander Trallian, Psellus, Leo, and Actuarius give similar definitions. ”

“ However different the predisposing, remote, or exciting causes of fever may be, whether debility from abstraction or action, whether heat or cold succeeding to each other, whether marsh or human miasmata, whether intemperance, a fright, or a fall, still I repeat, there can be but one fever. I found this proposition upon all the supposed variety of fevers having but one proximate cause. Thus fire is a unit, whether it be produced by friction, percussion, electricity, fermentation, or by a piece of wood or coal in a state of inflammation. ”

“ Organs always diseased in Fever: Functions always deranged in Fever. Fever not Inflammation: Distinction between these two States of Disease. Common Phenomena of Fever exemplified in Plague, in Yellow Fever, in the Varieties of the Fever of our own Country. ”

“ The plethora and predisposition to disease which follow it are trifling, compared with preventing certain and sudden death.
[303]
22. Bleeding has been accused of bringing on an intermitting fever. This is so far from being an objection to it, that it should be considered as a new argument in its favour; for when it produces that state of fever, it converts a latent, and perhaps a dangerous disease, into one that is obvious to the senses, and under the dominion of medicine. ”

“ Sometimes also fewer signs of a fever appear than the nature of the disease requires, from a translation of the malignant cause, either to the nervous system, or to some other parts of the body, or to some of the juices not contained in the blood ”

“ The violence, danger, and probable issue of this fever, seem to be in proportion to the duration and force of the predisposing and exciting causes. However steady the former are in bringing on debility, and the latter in acting as irritants upon accumulated excitability, yet a knowledge of their duration and force is always useful, not only in [61] forming an opinion of the probable issue of the fever, but in regulating the force of remedies.
2. The signs of danger vary in different years, from the influence of the weather upon the disease. ”

“ A fever, the same in its causes, and similar to it in many of its symptoms, that is, the plague, has been extirpated, by extraordinary degrees of cleanliness, from the cities of Holland, Great-Britain, and several other parts of Europe. ”

“ Examples are found in the yellow fever, in catarrh or influenza, in nervous and putrid fever, and, among many other disorders, in miliary fever, a disease which first grew to a national pestilence in the 17th century, and which, in the kind and manner of its infecting power, approaches nearest to the sweating fever. ”

“ What are the events, the detail of which has occupied us so long? The account of the pathology of fever is the history of inflammation, and the description of the individual changes that take place in the organs that constitute the febrile circle, is an enumeration of various products of inflammation which are formed within them. There is scarcely a fatal case of fever which does not afford, in one or other of the organs of that circle, some inflammatory product; there is no considerable number of fatal cases which does not furnish a specimen of every inflammatory product. ”

“ The next attack of fever, which I beg to assure you cannot be prevented, will be his last, I fear. His temperature is now as high as any man can bear and live; his pulse is galloping and his lungs are under the maximum tension. ”

“ In fever all the functions are more or less deranged. In every considerable inflammation there is sympathetic fever, but in essential fevers there are generally fewer lesions of structure than in inflammation. Fever occasions great waste of the tissues of the body, and the refuse matter is carried away by the organs of secretion and excretion. The heat of the body in fever is generally diffused, the pulse is quicker, there is dullness, lassitude, chilliness, and disinclination to take food. ”

“ The precursors, or premonitory signs of this fever were, costiveness, a dull pain in the right [94] side, defect of appetite, flatulency, perverted taste, heat in the stomach, giddiness, or pain in the head, a dull, watery, brilliant, yellow, or red eye, dim and imperfect vision, a hoarseness, or slight sore throat, low spirits, or unusual vivacity, a moisture on the hands, a disposition to sweat at nights, or after moderate exercise, or a sudden suppression of night sweats. ”

“ Numerous maladies arising from various degrees and complications of disease in the lungs, heart, pleura, viscera of the abdomen and investing membrane, not belonging to fever, but adding to its evils, are found on examination after death, which often fully account for anomalous symptoms that aggravated the case during life. ”

“ Fever may become attendant upon inflammatory cholic, or upon a severe fit of the strangury, or spasmodic affection of the kidnies. In all INFLAMMATIONS of the LUNGS, the fever exceeds description; but these fevers are called SYMPTOMATIC, as being a concomitant, or distinguishing trait, of the DISEASE upon which it is founded, rather than a disease within itself.
The predominant symptoms of FEVER are, an agitated lassitude and debility of the whole frame, with evident disquietude in every position; quick and strong pulsation ”

“ When the fever comes on gradually, the patient generally complains first of languor or listlessness, soreness of the flesh, or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the mouth ”

“ I wish these symptoms to be remembered by the reader. They will form the corner stone of a system which I hope will either eradicate the disease altogether, or render it as safe as an intermitting fever, or as the small-pox when it is received by inoculation.
Frequent as these precursors of the fever were, they were not universal. Many went to bed in good health, and awoke in the night with a chilly fit. [95] Many rose in the morning after regular and natural sleep, and were seized at their work, or after a walk, with a sudden and unexpected attack of the fever. ”

“ Whether occurring as an accompaniment of inflammation or independently of it, fever is an unnatural elevation of the temperature of the body, the direct result of an excess of destructive chemical change in the blood and tissues, and more remotely of disordered nervous function. ”

“ CHAP. V. The Symptoms accompanying a Pestilential Fever are Yawning, Stretching, Coldness, frequently to the greatest Extremity, Shuddering, suddain Pains in the Head, Giddiness, Loathing, Vomiting, a low unequal Pulse, Trembling, great inward Heat, especially about the Præcordia, Coldness of the Extremities, uncertain Sweats, Inquietude, Stupor, Delirium, Watching, Convulsions, Carbuncles, Buboes, Livid Vesications, Purple Spots, Hæmorrhages, which three last are the certain Forerunners of Death. ”

“ Persons of weak constitutions are liable to get into better spirits at the access of the hot fit of this evening fever; and are thence inclined to sit up late; which by further enfeebling them increases the disease; whence they lose their strength and their colour.
2. The periods of hectic fever, supposed to arise from absorption of matter, obeys the diurnal periods like the above, having the exacerbescence towards evening, and its remission early in the morning, with sweats, or diarrhœa, or urine with white sediment. ”

“ Of the power of the living body, even when in sound health, much more when in disease, and above all, when that disease is fever, to produce a poison capable of generating fever, no one disputes, and the fact has never been called in question. ”

“ But as for Wine, which your Author commends in Fevers, I am utterly against it, unless the Fever proceed from a cold or crude cause, otherwise cooling Ptisans are most beneficial to those that are sick of a continual Fever, which for the most part is a general Fever throughout the whole body, one part infecting the other, until they be all infected, like as in the Plague. ”

“ If the Seeds of the Fever, which are cast out in part from the Blood, by reason of their crude and indigested State, are uncapable of breathing through the Pores of the Skin, but are caught and entangled in the small Strainers which they are unapt to pass ”

“ The Fever is not only heightened every Evening; but the smallest Quantity of Food, the gentlest Motion, a little Coughing, the lightest Agitation of the Mind, a little more than usual Heat in the Chamber, Soup either a little too strong, or a little too salt, increase the Quickness of his Pulse the Moment they occur, or are given. ”

“ Even these primary states of fever seldom appear in the simple form in which they have been described. They often blend their symptoms; and sometimes all the states appear at different times in the course of a fever. This departure from a uniformity in the character of fevers must be sought for in the changes of the weather, in the casual application of fresh irritants, or in the operation of the remedies which have been employed to cure them. ”

“ SYMPTOMS.——An intermitting fever generally begins with a pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and violent shaking. Afterwards the skin becomes moist, and a profuse sweat breaks out, which generally terminates the fit or paroxysm. Sometimes indeed the disease comes on suddenly, when the person thinks himself in perfect health ”

“ This explains, why at the commencement of the warm paroxysm of some fevers the patient is in greater spirits, or vivacity; because, as in drunkenness, the irritative motions are all increased, and a greater production of sensation is the consequence, which when in a certain degree, is pleasureable, as in the diurnal fever of weak people. ”

“ But the difficulty lies in discerning amidst the infinite diversity and contrariety of symptoms which the different modifications of fever present, when we may safely assure ourselves that we are in possession of all the essential phenomena. Our guide is invariableness of concurrence. If we can ascertain that a certain number of events invariably take place in every form and every degree of fever, these events will give us the particular phenomena which are common to all the varieties of the disease. ”

“ The Fever, in this Species of the Disease, is sometimes, very high; and the Shivering often endures for many Hours. It is succeeded by considerable Heat, and a violent Head-ach, which yet is sometimes attended with a Drowsiness. The Fever is commonly pretty high in the Evening, though sometimes but inconsiderable, and by the Morning perhaps there is none at all. ”

“ Fever in general is characterized by a combination of disturbances in the physiological processes of the body. Such processes are those concerned in the production and dissipation of heat, in respiration and circulation, digestion and secretion, and in mental, motor, and other sensorial action. ”

“ It may be considered then as established, that the primary morbid condition of the body, in fever, consists of an affection of the nervous system, which there is reason to believe is of a peculiar and specific nature, although that nature be at present wholly unknown. ”

“ No wonder we hear of spring fever and spring biliousness, and have thousands of nostrums for clearing the blood in the spring. All these things are the pantings and palpitations of a system run down under slow poison, unable to get a step farther. ”

“ Again, when they contend that debility is not only the essence of fever in general, but is really characteristic of every type of it, they affirm what is indisputable of fevers in particular seasons, in particular climates or in particular constitutions ”

“ The causes which predispose to fever by the excessive or unusual application of stimuli are,
1. Heat. Hence the greater frequency of fevers in warm climates, and in warm weather.
2. Intemperance in eating and drinking.
3. Unusual labour or exercise.
4. Violent emotions, and stimulating passions of the mind.
5. Certain causes which act by over-stretching a part, or the whole of the body, such as lifting heavy weights, external violence acting mechanically in wounding, bruising, or compressing particular parts, extraneous substances acting by their bulk or gravity, burning, and the like [1] . ”

“ Fever, as I have already indicated, is a kind of physical revolution, a state of excitation which, differing so widely as to cause, character and degree, cannot be judged according to any fixed rule. The temperature of a patient we may read from the thermometer; but the real nature of the fever we do not learn until we consider his constitution, his innate faculties and the strength to which his various organs have attained. ”