1. Irritative fever, described in Cla.s.s I. 1. 1. 1.

2. Inirritative fever. Cla.s.s I. 2. 1. 1.

3. Sensitive fever. Cla.s.s II. 1. 6. 1.

4. Sensitive irritated fever. Cla.s.s II. 1. 2. 1.

5. Sensitive inirritated fever. Cla.s.s II. 1. 3. 1.

As the sensitive irritated fever attends all the diseases enumerated under the genus about to be described, it is placed at the head of it. And as the sensitive inirritated fever accompanies the greatest number of the species enumerated under the third genus of this order, it is placed at the head of them. And as the sensitive fever attends the diseases of the sixth genus, it is placed at the head of them. But as every febrile paroxysm consists of disordered tribes or trains of a.s.sociated motions, it may be doubted, whether they ought not all to have been placed in the fourth cla.s.s, amongst the diseases of a.s.sociation. See Cla.s.s IV. 2. 4. 11.

All the subsequent species of this genus are attended with sensitive irritated fever; there are nevertheless some superficial inflammations, which affect the same situations without much fever, as the scrophulous ophthalmy and spurious peripneumony, which belong to other genera.

Inflammation is uniformly attended with the production or secretion of new fibres const.i.tuting new vessels; this therefore may be esteemed its essential character, or the criterion of its existence. The extension of the old vessels seems rather a consequence than a cause of the germination, or pullulation, of these new ones; for the old vessels may be enlarged, and excited with unusual energy, without any production of new ones, as in the blush of shame or of anger.

When these new vessels are formed, if they are not reabsorbed into the circulation, they secrete a new fluid called purulent matter; which generally opens itself a pa.s.sage on the external skin, and produces an ulcer, which either gradually heals, or spreads, and is the cause of hectic fever; or they secrete contagious matter, which has the property of exciting the same kind of inflammation, and of producing the same kind of contagious matter, when inserted by inoculation into the skin of other persons. These contagious matters form ulcers, which either heal spontaneously, or by art; or continue to spread, and destroy the patient, by other kinds of hectic fever.

In this genus there is an increase of the sensorial power of irritation as well as of sensation; whence great arterial energy is produced, and the pulse becomes strong and full, as well as quick; and the coats of the arteries feel hard under the finger, being themselves thickened and distended by inflammation. The blood drawn, especially at the second bleeding, is covered with a tough size; which is probably the mucus from the inflamed internal surface of the arteries, increased in quant.i.ty, and more coagulable than in its natural state; the thinner part being more perfectly absorbed by the increased action of the inflamed absorbents. See Sect. x.x.xIII. 2. 2. This is rendered more probable, because the hard feel of the pulse, and the abundance of coagulable lymph commence, exist, and cease together.

Great heat is produced from the new chemical combinations arising in the secretion of new fibres, and great pain from the distention of old ones, or from their increased action. The increased quant.i.ty of sensation from a topical inflammation or phlegmon is the immediate cause of the febris sensitiva irritata, or inflammatory fever; as when it arises from the pain of pleurisy, or paronychia; but generally an irritative fever precedes this topical inflammation, which occurs during the hot fit of it; and then the irritative fever is changed into a sensitive irritated fever, by the additional cause of the sensorial power of sensation besides that of irritation.

SPECIES.

1. _Febris sensitiva irritata._ Sensitive irritated fever, or inflammatory fever. Phlegmasia. A strong full pulse, with inflammation of the coats of the arteries, const.i.tutes this disease. It originates from some topical inflammation, which, if the fever is not subdued, terminates in suppuration; and differs from irritative fever in respect to the painful sensation which accompanies it. For as pleasurable sensation is the cause of the growth of the new vessels, and distention of the old ones, in the natural enlargement of the body during our infancy; so a painful sensation is the cause of the unnatural production of new vessels, and enlargement of old ones in inflammatory diseases.

When matter is thus formed in any internal viscus, or in the cellular membrane, as in the lungs or liver; so long as this abscess remains without admission of air, this inflammatory fever is liable to continue, receiving only temporary relief by bleeding or emetics, or cathartics; till the patient, after a month, or two, or three, expires. But, if air be admitted to these internal abscesses, this kind of fever is changed into a hectic fever in a single day. It also sometimes happens, that when the abscess remains unopened to the air, if the matter has become putrid, that hectic fever supervenes, with colliquative sweats, or diarrhoea; the matter in both cases is sometimes absorbed, and the sides of the abscess grow together again without an external aperture. See Cla.s.s II. 1. 4. 1. and 2.

Another termination of inflammation is in gangrene, but this belongs to the inflammation of the external skin; as the production of purulent matter belongs to inflammation of the internal or mucous membranes. Thus when the external skin is the seat of inflammation, as in erythema, or erysipelas, and produces sensitive irritated fever, no collection of purulent matter can be formed; but a material oozes out, and lies upon the surface, like that in the confluent small-pox, and the cuticle at length peels off, or gangrene supervenes. It must be noted, that these kinds of inflammation can exist together; and some parts of the cellular membrane may suppurate at the same time that the external skin is affected with erythema, or erysipelas.

M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath?

See Sect. XII. 6.

The increased arterial action in this sensitive irritated fever is not simply owing to the increased irritability of the arterial system, or to the stimulus of the distention of the vessels, but also to the increased acrimony or pungency of the blood; which has now so far changed its nature as to become more fluid, more dense, and to be loaded with coagulable lymph. Hence it becomes necessary not only to lessen the quant.i.ty of blood by venesection and by cathartics, but also to dilute its acrimony, or pungency, by the introduction of aqueous and mucilaginous fluids, such as barley water, cream and water, sugar and water, weak broths; to which may be added so much of some vegetable essential oil, as may render them grateful to the stomach, and thus promote their absorption, as by infusing parsley or cellery and turneps in the broth; or by balm, mint, or sage teas.

The following species of this genus only distinguish the situation of the part previously inflamed, and which is the remote cause of the sensitive irritated, or inflammatory fever, which attends it.

2. _Ophthalmia interna._ Inflammation of the eye is attended with the production of new vessels, which spread over the tunica adjunctiva, and over the cornea; these new vessels are easily seen, as they lie on a white ground, and give ocular demonstration of their production in inflammation.

When this inflammation of the cornea suppurates, it is liable to leave little ulcers, which may be seen beneath the surface in the form of little excavations; and as these heal, they are liable to be covered with an opake scar. This scar, in some months or years, is liable to wear away, and become transparent, without the a.s.sistance of any polishing powder, as of very finely levigated gla.s.s, as some have recommended. But when the cornea is affected through all its thickness, the return of its transparency becomes hopeless. See Cla.s.s I. 1. 3. 14.

In violent degrees of ophthalmy the internal parts, as the retina, optic artery, iris, ciliary process, become inflamed, as well as the external ones; hence the least light admitted to the eye occasions intolerable pain.

This curious circ.u.mstance cannot be owing to the action of light on the inflamed vessels of the cornea; it therefore shews, that the extremity of the optic nerve or retina is also rendered more exquisitely sensible to light, by partaking of the inflammation; and I have been told, that red colours are in these cases sometimes painfully perceived even in perfect darkness. This shews that the retina is excited into motion by the stimulus of light; and that, when it is inflamed, these motions give great pain, like those of other inflamed parts, as the muscles, or membranes. And secondly, that the ideas of colours consist in the motions of the retina; which ideas occasion pain, when the extremity of the moving nerve is inflamed.

M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the eye with cold water by means of a rag. Cool airy room. Darkness. When the inflammation begins to decline, white vitriol gr. vi. in an ounce of water is more efficacious to moisten the eye than solutions of lead. Tincture of opium diluted. New vessels from the inflamed tunica adnata frequently spread like a fly's wing upon the transparent cornea, which is then called Pterigium. To stop the growth of this, the princ.i.p.al vessels should be cut through with a lancet. When the inflammation begins to decline, after due evacuation any stimulating material put into the eye increases the absorption, which soon removes the new red vessels; which has given rise to a hundred famous eye-waters, and eye-doctors; if these stimulating materials are used too soon, the inflammation is increased by them. See Sect. x.x.xII. 2. 10.

There is another ophthalmia, which attends weak children, and is generally esteemed a symptom of scrophula, as described in Cla.s.s II. 1. 4. 1. and another, which is of venereal origin, mentioned in Cla.s.s II. 1. 5. 2. both which may be termed ophthalmia superficialis.

3. _Phrenitis._ Inflammation of the brain is attended with intolerance of light and sound; which shews, that the extremities of the nerves of those senses are at the same time inflamed; it is also attended with great pain of the head, with watchfulness, and furious delirium. The violent efforts, these patients are said sometimes to exert, are owing to the increased secretion of sensorial power in the brain; as all other inflamed glands have a greater circulation of blood pa.s.sing through them, and a greater secretion in consequence of their peculiar fluids, as in the hepat.i.tis much more bile is generated.

M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water for hours together. Or with warm water. Cool airy room. Afterwards cupping on the occiput. Leeches to the temples. When the patient is weakened a blister on the head, and after further exhaustion five or six drops of tincture of opium.

4. _Peripneumonia._ Inflammation of the lungs. The pulse is not always hard, sometimes soft; which is probably owing to a degree of sickness or inaction of the stomach; with dull pain of the chest; respiration constantly difficult, sometimes with erect posture; the face bloated and purplish; cough generally with moist expectoration, often stained with blood.

When the difficulty of respiration is very great, the patient is not able to cough; in this situation, after copious bleeding, the cough is liable to return, and is so far a favourable symptom, as it shews some abatement of the inflammation.

A peripneumony frequently occurs in the chin-cough, and destroys the patient, except immediate recourse be had to the lancet, or to four or five leeches; when blood cannot be otherwise taken.

The peripneumony is very fatal to young children, especially as I believe it is frequently mistaken for a spasmodic asthma, or for the croup, or cynanche trachealis of Cullen. Both which, however, when they occur, require immediate venesection by the lancet or by leeches, as well as the peripneumony.

The croup is an inflammation of the upper part, and the peripneumony of the lower part of the same organ, viz. the trachea or windpipe. See Cla.s.s I. 1.

3. 4. But as the inflammation is seldom I suppose confined to the upper part of the trachea only, but exists at the same time in other parts of the lungs, and as no inflammation of the tonsils is generally perceptible, the uncouth name of cynanche trachealis should be changed for _peripneumonia trachialis_. The method of cure consists in immediate and repeated bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in subtepid water, and in breathing over the steam of warm water, with or without a little vinegar in it. And lastly, by keeping the child raised high in bed.

Inflammation of the lungs is also liable to occur in the measles, and must be attacked by venesection at any time of the disease; otherwise either a present death, or an incurable consumption, is the consequence.

The peripneumony is frequently combined with inflammation of the pleura, and sometimes with that of the diaphragm; either of these may generally be distinguished, not only by the pain which attends inflammation of these membranes, but by inspecting the naked chest, and observing whether the patient breathes more by elevating the ribs, or by depressing the diaphragm.

A crisis happens in children about the sixth day with much pale urine, which must be waited for after evacuations have been used, as far as can be done with safety; in this situation the warm bath twice a day, and small blisters repeatedly in succession, are of peculiar service.

After the termination of peripneumony a collection of coagulable lymph is frequently left in the cavity of the chest unabsorbed; or a common anasarca of the lungs occurs from the present inaction of the absorbent vessels, which had previously been excited too violently. This difficulty of breathing is cured or relieved by the exhibition of digitalis. See Art. IV.

2. 8.

M. M. The lancet is the anchor of hope in this disease; which must be repeated four or five times, or as often as the fever and difficulty of breathing increase, which is generally in the evening; antimonials, diluents, repeated small blisters about the chest, mucilage, pediluvium, warm bath. Is a decoction of seneka-root of use? Do not neutral salts increase the tendency to cough by their stimulus, as they increase the heat of urine in gonorrhoea? Children in every kind of difficult breathing, from whatever cause, should be kept as upright in bed as may be, and continually watched; since, if they slip down, they are liable to be immediately suffocated. After the patient is greatly debilitated, so that no further evacuation can be admitted, and the difficult breathing and cough continue, I have given four or five drops of tincture of opium, that is, about a quarter of a grain of solid opium, with great advantage, and I believe in several cases I have saved the patient. A greater quant.i.ty of opium in this state of debility cannot be used without hazarding the life of the person.

This small quant.i.ty of an opiate should be given about six in the evening, or before the access of the evening paroxysm, and repeated three or four nights, or longer.

There is a peripneumony with weak pulse, which may be termed _peripneumonia inirritata_, as described in Sect. XXVII. 2. which belongs to this place.

See also Superficial Peripneumony, Cla.s.s II. 1. 3. 7.

5. _Pleuritis._ Pleurisy. Inflammation of the pleura, with hard pulse, pain chiefly of the side, pungent, particularly increased during inspiration; lying on either side uneasy, the cough very painful, dry at the beginning, afterwards moist, often b.l.o.o.d.y.

One cause of pleurisy is probably a previous adhesion of the lungs to a part of the pleura, which envelops them. This in many cases has been produced in infancy, by suffering children to lie too long on one side. Or by placing them uniformly on one side of a fire, or window, to which they will be liable always to bend themselves.

When matter is produced during peripneumony or pleurisy in one side of the chest, so long as it is a concealed vomica, the fever continues, if the disease be great, for many weeks, and even months; and requires occasional venesection, till the patient sinks under the inflammatory or sensitive irritated fever. But if air be admitted, by a part of the abscess opening itself a way into the air-vessels of the lungs, a hectic fever, with colliquitive sweats or diarrhoea, supervenes, and frequently destroys the patient; or the abscess heals the lungs adhering to the pleura.

M. M. The lancet must be used copiously, and repeated as often as the pain and difficult respiration increase. A blister on the pained part.

Antimonial preparations. Diluents. Cool air. Do neutral salts increase the tendency to cough? Pediluvium or semicupium frequently repeated.

6. _Diaphragmitis._ Inflammation of the diaphragm. Pain round the lower ribs as if girt with a cord. Difficult respiration performed only by elevating the ribs and in an erect posture. The corners of the mouth frequently retracted into a disagreeable smile, called risus Sardonicus.

Those animals, which are furnished with clavicles, or collar-bones, not only use their foremost feet as hands, as men, monkies, cats, mice, squirrels, &c. but elevate their ribs in respiration as well as depress the diaphragm for the purpose of enlarging the cavity of the chest. Hence an inflammation of the diaphragm is sudden death to those animals, as horses and dogs, which can only breaths by depressing the diaphragm; and is I suppose the cause of the sudden death of horses that are over-worked; whereas, in the human animal, when the diaphragm is inflamed, so as to render its motions impossible from the pain they occasion, respiration can be carried on, though in a less perfect manner, by the intercostal muscles in the elevation of the ribs. In pleurisy the ribs are kept motionless, and the respiration is performed by the diaphragm, as may be readily seen on inspecting the naked chest, and which is generally a bad symptom; in the diaphragmitis the ribs are alternately elevated, and depressed, but the lower part of the belly is not seen to move.

M. M. As in pleurisy and peripneumony. When the patient becomes delirious, and smiles disagreeably by intervals, and is become so weak, that evacuations by the lancet could be used no further, and I have almost despaired of my patient, I have found in two or three instances, that about five or six drops of tinct. thebaic, given an hour before the evening exacerbation, has had the happiest effect, and cured the patient in this case, as well as in common peripneumony; it must be repeated two or three evenings, see Cla.s.s II. 1. 2. 4. as the exacerbation of the fever and difficult respiration and delirium generally increase towards night.

The stimulus of this small quant.i.ty of opium on a patient previously so much debilitated, acts by increasing the exertion of the absorbent vessels, in the same manner as a solution of opium, or any other stimulant, put on an inflamed eye after the vessels are previously emptied by evacuations, stimulates the absorbent system, so as to cause the remaining new vessels to be immediately reabsorbed. Which same stimulants would have increased the inflammation, if they had been applied before the evacuations. See Cla.s.s II. 1. 2. 2. Sect. x.x.xIII. 3. 1. When the sanguiferous system is full of blood, the absorbents cannot act so powerfully, as the progress of their contents is opposed by the previous fulness of the blood-vessels; whence stimulants in that case increase the action of the secerning system more than of the absorbent one; but after copious evacuation this resistance to the progress of the absorbed fluids is removed; and when stimulants are then applied, they increase the action of the absorbent system more than that of the secerning one. Hence opium given in the commencement of inflammatory diseases destroys the patient; and cures them, if given in very small doses at the end of inflammatory diseases.

7. _Carditis._ Inflammation of the heart is attended with unequal intermitting pulse, palpitation, pain in the middle of the sternum, and constant vomiting. It cannot certainly be distinguished from peripneumony, and is perhaps always combined with it.

8. _Peritonitis._ Inflammation of the peritonaeum is known by pain all over the abdomen, which is increased on erecting the body. It has probably most frequently a rheumatic origin. See Cla.s.s II. 1. 2. 17.

9. _Mesenteritis._ Inflammation of the mesentery is attended with pains like colic, and with curdled or chyle-like stools. It is a very frequent and dangerous disease, as the production of matter more readily takes place in it than in any other viscus. The consequence of which, after a hard labour, is probably the puerperal fever, and in scrophulous habits a fatal purulent fever, or hopeless consumption.

M. M. Venesection. Warm bath. Emollient clysters.