On the 11th day a remarkable change took place: for two or three hours
he was chilly; to this succeeded heat of skin and flushing of the face;
what was very alarming, the colour of the flash was purple, while that
of the whole face was dusky; there was no cough, but the respiration was
short and hurried; the mind was confused and dull, though a coherent
answer might still be obtained to any question that was asked; the pulse
now rose to 120, there was little or no sleep, but great restlessness
during the night, in the course of which delirium appeared, and the next
morning there came on muscular tremor. As the day advanced the flushing
and heat disappeared; the mind became quite distinct, and the pulse fell
to 96. Towards evening he again became restless, the pulse rose to 104,
and about one o’clock, a.m. the increased heat, the flushing of the
face, the purple colour of the cheek, the dusky appearance of the skin,
the short and hurried respiration, and the convulsive action of the
muscles all returned, and in a greater degree, while the pulse again
rose to 120. From this state he never recovered in the least degree, but
became more and more dull, and at length nearly insensible; his debility
rapidly increased until it became extreme; he lay quite prostrate on the
back, with his arms extended, as if lifeless; the muscular tremor
increased; the respiration became extremely short and hurried; the
tongue became dry, red, glazed, and sticky; the bowels torpid; the pulse
130; and with these symptoms he expired on the 13th day of fever.
_Head._ Dura mater healthy; arachnoid thickened and opake; much
gelatinous effusion between it and the pia mater; substance of brain
highly vascular and firm; lateral ventricles distended with fluid, much
also at the base. _Thorax._ Mucous membrane of bronchi universally of a
dark red colour and lined with a tenacious fluid, which was slightly
sticky; bronchial tubes filled with frothy mucus; substance of lungs
perfectly healthy. _Abdomen._ Mucous membrane of small intestines
generally inflamed; lower part of ilium and commencement of colon filled
with large and raised ulcers, some of which were just forming, while
others had penetrated through a thick mass of adventitious deposit to
the muscular coat of the intestine.
Before closing these illustrations of the pathology of fever, it may be
proper to give an example of the modifications which take place when
this disease proves fatal in the state of gestation. If fever attack
during pregnancy, there is the greatest possible danger of miscarriage,
and the great majority of those who miscarry die. There is no
complication which requires a more delicate and cautious management; and
the management which experience shews to be the best will be stated in
the proper place: in the mean time, the following case is given as an
illustration of the morbid appearances which are found (and the
appearances are very uniform) when abortion is the precursor of death.
Public-domain text, read in full here on John Shaqi.
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