Qualities of complex fevers

Fevers are sometimes combined with one another. Often, varieties belonging to mutually distant genera come into combination, when, for example, dry fever is combined with putrefactive fever, but sometimes fevers that coincide and are close in genus are also combined; such are, say, combinations of various types of putrefactive fevers, for example, three-day and mucous, giving the so-called semi-three-day fever. The same is true for combinations of tumor fevers: sometimes different fevers of the same type are combined, for example, two three-day or two four-day fevers, or three four-day fevers are combined. Then two three-day periods apparently occur with the periodicity of mucous membranes, and three four-day periods - also with the periodicity of mucous membranes. Sometimes three three-day fevers are combined. If they replace each other, then the attack on the third day turns out to be the most severe, because then the period of the first day ends, but at the same time the period of the third day begins; the same thing happens on the fifth day. This combination is similar to a semi-three-day fever, while the combination of two three-day fevers is similar to intermittent mucous membranes. Therefore, in such cases, one should not give all the attention to the attacks and should deal more with the symptoms.

If such fevers are purely three-day ones, then their attacks sometimes seem to be in a hurry to shorten, so that the weaker fever disappears earlier. Sometimes the combination of these fevers is indicated by the return of goose bumps after the fever has subsided, and it is considered shameful for a doctor, knowledgeable in the signs and symptoms of any fever, not to recognize this combination from the first or second day. But the combination of dry fever and putrefactive fever is very difficult, because doctors, having repeatedly observed the weakening of the fever, the onset of chills and goose bumps and the return of perspiration, if it occurs, as well as special periods, believe that there is only putrid fever, continuous or combined with constant and intermittent, meanwhile the combination of symptoms continues, and it seems as if the fever is single, continuous, similar in manifestations and similar to synochus, and here it is no longer possible not to turn to the symptoms for diagnosis.

If the attacks of fevers are short, then they follow each other continuously only with a significant number of combined fevers, especially when the weakening of each individual fever is prolonged. When different fevers are combined, for example, with a semi-three-day fever, the more acute fever stops, and the chronic one remains in its pure form, or two intermittent fevers arise, or two intermittent ones, or intermittent together with the incessant one. Often, a semi-three-day fever is combined with another three-day or mucous, or black gall fever; if a three-day one is combined with a half-three-day one, then the three-day one stops and pure half-three-day one remains, and if the half-three-day one is combined with mucous or black gall, then the half-three-day one stops and what remains is mucous or black gall.

But sometimes the combination of fevers occurs in a different way, namely: two fevers are combined - intermittent and continuous, heterogeneous or homogeneous in origin, or two fevers of the same type, for example, three-day periodic with three-day continuous. Just as two intermittent fevers are sometimes combined, so sometimes two incessant fevers are combined.

Some argue that two continuous fevers do not combine like two intermittent ones, for if the matter is inside the vessels, then the quality of the putrefactive matter cannot be different, since the putrefaction immediately spreads throughout all the vessels. However, such an opinion, in my opinion, is not necessarily immutable, for decay certainly begins from any one place and then spreads; in the future, the qualities of intensification and weakening of fever are determined by the time of initial decay, and a corresponding movement is inherent in it. It is therefore quite possible for putrefaction to arise in two places, having the power to begin in part of the juices, but not having the power to give rise to another putrefaction, although sometimes it is even capable of beginning and giving rise to putrefaction, and it is characterized by periods of weakening and intensification, starting from a certain time.

There are three types of combinations of fevers: entry, change and plexus. When entering, one fever seems to enter into another, when changing, one comes after the other has stopped, and when plexus, the second begins together with the first. When you see that with a continuous fever there is chills and no perspiration - sometimes during many attacks of chills the perspiration appears once - then you can testify to a combination of fevers, just as in the case when you see excessive coldness and tightness of the limbs with a continuous fever. As for slight cooling and constriction, it sometimes occurs with one continuous fever.