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©f an intermittent fever, as this is most commonly formed.
lO. The phenomena to be observed in such a paroxysm are the following: the person is affected, first with a languor or sense of debility, a sluggishness in motion, and some uneasiness in exerting it, with frequent yawning and stretching. At the same time, the face and extremities become pale; the features shrink; the bulk of every external part is diminished; and the skin, over the whole body, appears constricted, as if cold had been applied to it. At the coming on of these symptoms, some coldness of the extremities, though little taken notice of by the patient, may be perceived by another person. At length the patient himself feels a sensation of cold, commonly first in his back, but, from thence, passing over the whole body; and now his skin feels warm to another person. The patient's sense of cold increasing, produces a tremor in all his limbs, with frequent succussions or rigours of the trunk of the body. When this sense of cold, and its effects, have continued for some time, they become less violent, and are alternated with warm flushings. By degrees, the cold goes off entirely ; and a heat, greater than natural, prevails, and continues over the whole body. With this heat, the colour of the skin returns, and a preternatural redness appears, especially in the face. Whilst the heat and and redness come on, the skin is relaxed and smoothed, but, for some time, continues dry. The features of the face, and other parts of the body, recover their usual size, and become even more turgid. When the heat, redness, and turgescence, have increased and continued for some time,, a moisture appears upon the forehead, and by degrees becomes a sweat, which gradually extends downwards over the whole body. As this sweat continues to flow, the heat of the body abates; the sweat, after continuing some time, gradually ceases; the body returns to its usual temperature; and most of the functions are restored to their ordinary state.
11. This series of appearances gives occasion t« -divide the paroxysm into three different stages,
which are called the Cold, the Hot, and - the
SWEATING STAGES OVjltS.
In the course of these, considerable changes happen in the state of several other functions., which are now to be mentioned.
12. Upon the first approach of languor, the pulse becomes sometimes slower, and always weaken than before. As the sense of cold comes on, the pulse becomes smaller, very frequent, and often irregular. As the cold abates, and the heat comes on, the pulse becomes more regular, hard, and full; and, in these respects, increases till th$ sweat breaks out. As the sweat flows, the pulse becomes softer and less frequent, till, the sweat ceasing altogether, it returns to its usual state.
13. The respiration also suffers some changes. During the cold stage, the respiration is small, frequent, and anxious, and is sometimes attended with a cough. As the hot stage comes on, the respiration becomes fuller and more free; but continues still frequent and anxious, till the flowing of the sweat relieves the anxiety, and renders the breathing less frequent and more free. With the ceasing of the sweat, the breathing returns to its ordinary state.
14. The natural functions also suffer a change. Upon the approach of the cold stage, the appetite for food ceases, and does not return till the paroxysm be over, or the sweat has flowed for some time. Generally, during the whole of the paroxysm, there is not only a want of appetite, but an aversion from all solid, and especially animal, food. As the cold stage advances, there frequently comes on a sickness and nausea, which often increases to a vomiting of a matter that is for the most part bilious. This vomiting commonly puts an end to the cold stage, and brings on the hot. As the hot stage advances, the nausea and vomiting abate; and when the sweat breaks out, they generally cease altogether.
15. A considerable degree of thirst is common* . Iy felt during the whole course of the paroxysm.
During the cold stage, the thirst seems to arise from the dryness and clammyness of the mouth and fauces; but, during the hot stage, from the heat which then prevails over the whole body; and, as the sweat flows, the mouth becomes moister, and the thiyst, together with the heat, gradually abates.
16. In the course of a paroxysm, there is often a considerable change in the state of the secretions. The circumstances just now mentioned shew it in the secretion of the saliva and mucus of the mouth; and it is still more remarkable with respect to the urine. During the cold stage, the urine is almost colourless, and without cloud or sediment. In the hot stage, it becomes high-coloured, but is still without sediment. After the sweat has flowed freely, the urine deposits a sediment commonly lateritious, and continues to do so for some time after the paroxysm is over.'
17. Excepting in certain uncommon cases, which are attended throughout with a diarrhoea, stools seldom occur till towards the end of a paroxysm, when commonly a stool happens, and which is generally of a loose kind.
18. Analogous to these changes in the state of
the secretions, it frequently happens, that the tumours subsisting on the surface of the body suffer, during the cold stage of fevers, a sudden and coo» siderable detumescence; but generally, though not always, the tumours return to their former size during the sweating stage. In like manner, ulcers are sometimes dried up during the cold stage, and return again to discharge matter during the sweating stage, or after the paroxysm is over.
1Q. Certain changes appear also in sensation and thought. During the cold stage, the sensibility is often greatly impaired; but when the hot stage is formed, the sensibility is recovered, and
often considerably increased.
20. With respect to the intellectual functions, tohen the cold stage comes on, attention and recollection become difficult, and continue more or less so during the whole paroxysm. Hence some confusion of thought takes place, and often arises to a delirium, which sometimes comes on at the beginning of the cold stage, but more frequently not till the hot stage be formed.
21. It belongs also to this place to remark, that the cold stage sometimes comes on with a drowsi* ness and stupor, which often increases to a degree that may be called comatose or apoplectic,