FEVERS Fevers are divided in the table into three groups; two of which are characterized by well-defined symptoms common to the whole of each group, viz., the occurrence of cutaneous eruptions and of regular intermissions. The remaining group, which we take first into consideration, has no such common symptom, and to these we have applied the generic name of fevers. it comprises many diseases belonging to tropical regions--plague, yellow fever, eic. We shall consider those only which are more or less common in this country.
§ 1. Continued Fever.—Accurate diagnostic signs, which in their totality give pretty sure evidence of other dise,ases, scarcely exist in fever. Cases fall under our observation in which a state of general discomfort, with very slight febrile disturbance, lasting only a few days, with no disorder of any particular organ, must necessarily be called fever, or febricula; at the same time it is quite certain that, from ignorance, or from imperfect examina tion, many cases are so cla.ssed which in reality ought to be called by some other name.
The history of the case may occasionally show that the indi vidual has been placed in circumstances likely to engender fever ; the fact of a previous attack of the same sort neither increases nor diminishes the probability of the present illness being fever. Its mode of commencement is very various either there have been in the first instance some days of weaktiess and depression, and undefined feeling of illness, followed by rigor or cold chills ; or there has been a pretty smart shivering to begin with, followed by considerable heat of skin. Loss of appetite is invariable, and observed early ; thirst is later in its occurrence; headache is generally an early symptom, as well as a foul tongue and quick pulse.
In reviewing the general symptoms in detail, we find that the temperature of the skin is generally elevated, except just at the moment of a rigor, when it is peculiarly harsh and dry (cutis anserina). It has, in the majority of instances, a hot, pungent feeling ; but 'there are numerous exceptions, in which it is con stantly or occasionally moist, nay, whole epidemics in which it is invariably so. The pulse is always frequent. This may amount
only to very slight acceleration, or it may reach to more than double its ordinary rate ; it may be more or less large, but is always soft and weak, and sometimes very feeble. The tongue is invariably furred in the commencement ; subsequently, in some cases, it becomes peeled and chapped, having a tendency to be dry while fever lasts ; in other cases the fur thickens and adheres, especially to the centre, leaving the edges bright and red; in the severer forms of the disease this coating is often brown, or even black, and sordes collect on the lips and teeth ; thirst is com plained of in these cases while consciousness remains, and thus its presence or absence may be of good or evil augury, as it indi cates decrease of fever or diminution of sensitive perception.
The complications of fever as manifested in symptoms derived from the different regions, and the presumption they afford of its existence, will be referred to presently; but among the more direct evidences of fever we must regard the very common occurrence of derangement of bowels, as manifested in the diar rhoea dependent on enlargement and subsequent ulceration of the follicular glands of the intestine. When this is the case, the appearance of the stools greatly aids the diagnosis. Either thin and ochrey ; or darker, watery, and mingled with curdy solids ; or even black and pitchy, from admixture with blood: they are always highly offensive. Along with this there is very generally some tenderness in the =cal region, and a gurgling sensation communicated to the hand on making pressure there. But the circumstance that the motions are nearly natural in ap pearance, and the existence of a certain amount of constipation, must not be taken as a proof that the disease is not fever. The urine is generally scanty, the appetite always lost, and the desire for fluids increased.