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2, The proper time for exhibiting the bark in intermittent fevers, is during the time of intermis, sion; and where intermissions are to be expected, it is to be abstained from in the time of paroxysms,
3, In remittents, though no entire apyrexia oc, curs, the bark may be given during the remissions; and it should be given, even though the remissions be inconsiderable, if, from the known nature of the epidemic, intermissions or considerable remissions are not to be soon expected, and that great danger is apprehended from repeated exacerbations.
4, In the case of genuine intermittents, while a due quantity of bark is to be employed, the exhibition of it ought to be brought as near to the time of accession as the condition of the patient's stomach will allow,
5, In general, in all cases of intermittents, it is not sufficient that the recurrence of paroxysms be stopped for once by the use of the bark; a relapse is commonly to be expected, and should be prevented by the exhibition of the bark, repeated at proper intervals.
293. Our second general indication for conducta ing the paroxysms of intermittent fevers, so as to obtain a final solution of the disease, may be answered,
1, By exhibiting emetics during the time of the cold stage, or at the beginning of the hot ;
2, By opiates given during the time of the hot stage,
234. The circumstances which may especially prevent the fulfilling of those two indications, and therefore give occasion to our third, are, a phlogistic diathesis prevailing in the system, and congestions fixed in the abdominal viscera. The first must be removed by blood-letting and the antiphlogistic regimen; the second, by vomiting and purging.
Where these measures are not immediately effectual, I hold it safer to attempt the cure of the disease by the means pointed out in general in 229, rather than by those in article second of the same paragraph.
OF INFLAMMATIONS, OR PHLEGMASIÆ.
OF INFLAMMATION IN GENERAL.
Of the phenomena of inflammation.
235. When any part upon the surface of the body is affected with unusual redness, heat, pain, and tumour, we name the disease an inflammation or phlegmasia. These symptoms of inflammation are never considerable, without the whole system being, at the same time, affected with pyrexia.
236. As the external, so likewise the internal, parts may be affected with inflammation; and we judge them to be so, when, together with pyrexia, there is a fixed pain in any internal part, attended with some interruption in the exercise of its functions.
237. We judge of the presence of inflammation also from the state of the blood drawn out of the veins. When the blood, after cooling and concreting, shews a portion of the gluten separated from the rest of the mass, and lying on the surface of the crassamentum ; as such separation happens in all cases of more evident phlegmasia ; so in ambiguous cases, we, from this appearance, joined with other symptoms, infer the presence of inflammation. At the same time, it must be observed, that as seyeral circumstances in blood-letting may prevent this separation of gluten from taking place in blood otherwise disposed to it; so, from the absence of such appearance, we cannot always conclude against the presence of inflammation,
238. I cannot easily give any other general history of the phenomena of inflammation than what is contained in the three preceding paragraphs; and the variations which may take place in its circumstances, will occur to be more properly taken notice of under the several heads of the particular genera and species to be hereafter mentioned. I proceed, therefore, to inquire into the proximate cause of inflammation in general.
Of the proximate cause of inflammation. 239. The phenomena of inflammation (235), all concur in shewing, that there is an increased impetus of the blood in the vessels of the part affected; and as, at the same time, the action of the heart is not always evidently increased, there is reason to presume, that the increased impetus of the blood in the particular part is owing especially to the increased action of the vessels of that part itself.
240. The cause of this increased action in the vessels of a particular part is, therefore, what we are to inquire after, and to consider as the proxi. mate cause of inflammation.
In many cases, we can manifestly perceive, that inflammation arises from the application of stimulant substances to the part. When the application of such stimulants, therefore, is evident, we seek for no other cause of inflammation; but as, in many cases, such application is neither evident, nor, with any probability, to be supposed, we must, in such cases, seek for some other cause of the increased impetus of the blood in the vessels of the part.
241. Many physicians have supposed, that an obstruction of the extreme vessels, any how pro.