§ 23. Synochal or simple inflammatory fever.

A better knowledge of human diseases and an almost boundless experience have convinced modern physicians that a pure synochal fever either does not exist, or at any rate that it does not exist long without affecting a special organ, and that it occurs especially as an accompanying symptom of inflammation. Not being an idiopathic disease, it is not subject to any fixed therapeutic rules. We have long meditated on the subject whether a pure synochal fever ought to be mentioned in a work on pathology. In treating of the special diseases we found ourselves frequently obliged to repeat certain general remarks, and we therefore concluded to devote a few pages to the pathology and treatment of that class of fevers, in order to be able to refer to that chapter whenever occasion should require. The synochal fever occurs not only as an accompanying symptom of inflammatory diseases, but also in young, vigorous, plethoric subjects, after wounds, burns, etc., in the shape of a febris irritativa, and as such requires the attention of the physician. The simple, benign, acute, ephemeral fever requires no medical treatment, except when the fever assumes a different form in consequence of the reaction of the organism having been interrupted by the indiscreet conduct of the patient. Another fever arising from an irritation of the organism, is the fever of dentition, which is more closely related to a synochal fever than is any other kind of fever.

* The Germans are in the habit of using feather-beds as a covering, which ought not to be tolerated in the sick-room, except when the patient complains of excessive cold, in which case a very light feather-bed may be used.

According to Schoenlein the synochal fever is of the species of phlogosis; he places it under the head of arteritis and phlebitis. Our opinion is that Schoen-lein's view is confirmed only in a few cases, and that the synochal fever is scarcely ever sufficiently developed to deserve the appellation of either arteritis or phlebitis.

All the symptoms of an inflammatory fever show that the irritable sphere is principally affected, the heart and the blood vessels are irritated, their power being apparently increased, and the temperature of the body being considerably elevated. The nervous system and the digestion are less affected, hence it is that the sensations of the patients are correct, definite and clear, and that he is fully conscious of his complaints and feels his sufferings intensely. When the cerebral irritation is considerable from the very commencement and the delirium is more continuous, there is ground for apprehending a typhoid fever.

The fever commences with a violent chill, followed by continual heat, the pulse is hard, full, accelerated, not easily compressible, the tongue is dry, slightly coated, and the skin is dry; the dulness and heaviness of the head, which exist in the commencement of the paroxysm, soon pass into an aching and pulsating pain, especially in the forehead; the face becomes red, hot, the eyes shining, and, in sensitive subjects, the erethism increases even to spasms and delirium. The breathing is hurried, anxious, the breath hot and dry the arteries throb, the secretion of urine is diminished and the urine itself is red and fiery; the thirst is excessive. The restlessness and anxiety increase, alternating with interrupted slumber and stupor. The appetite disappears, but the heat and dryness of the mouth occasion an increasing desire for cold water. Perspiration affords relief, but the skin is generally dry and hot. The symptoms are worse in the evening; their violence begins to abate after midnight, and is least in the morning.

A general inflammatory fever seldom exists without some local inflammation, especially when there is a congestion of blood to a special organ in the commencement of the disease, in which case the pulse is contracted, small, but hard. These fevers are frequently accompanied by bleedings, especially from the nose, which, however, afford a good deal of relief.

Synochal fevers seldom last long unless they have become complicated by the supervention of some other affection, or have passed into a different form of fever; they frequently terminate after a short duration by a critical sweat, and a turbid urine depositing a sediment.

§ 24. The prognosis of an inflammatory fever is favourable. Such a fever is never fatal of itself. It may become so, however, by passing into another disease or by terminating in exhaustion, which is the case when the fever becomes complicated with inflammation of a noble organ, of the veins or arteries, or when a typhoid condition supervenes. In giving a prognosis the physician has to consider the peculiar character of the disease in the case of his patient, and the individuality of the latter.

Among the exciting causes we may notice the following: the tendency to epidemic diseases and the peculiar character which diseases are disposed to assume, more particularly in spring and winter when north-westerly winds prevail; the excessive use of stimulating and heating food, producing a corresponding excess of animal life; suppression of the activity of the skin and of other secretions, echauffement, violent exercise, abuse of spirituous drinks, contagia, wounds, burns, dry and cold air, not to forget violent emotions, such as fright, fear, chagrin, anger; or the violent irritation which children suffer during the period of dentition.

§ 25. In treating these fevers we have, in the first place, to consider their character and course. At the commencement of the fever, it is not very difficult to select a remedy. The business of the physician is to allay the fever before the local inflammation has developed itself. There is no better remedy to allay the fever than Aconite. The physician is scarcely ever sent for during the chill, as it is supposed that this chill, which sets in suddenly and without any precursory symptoms, is a merely transitory symptom the end of which ought to be awaited first before sending for a physician. If the physician were sent for during the chill, it would not be advisable that he should administer a remedy before the second stage has made its appearance; for in that stage it is much easier to select a remedy, inasmuch as the symptoms of the case have become more numerous and more characteristic. In general it is not advisable to exhibit the homoeopathic remedy during the chill, as we have abundant evidence of the fact that, by so doing, the disease is considerably increased.