blage of symptoms in the first are precisely those which it is intended to comprehend under the term synochus the assemblage of symptoms in the second are those which are designated by the term typhus thus scarlet fever exhibits at one time the synochoid, and at another the typhoid type; the first being what is commonly termed scarlatina benigna, the second scarlatina maligna; and each type is capable of existing in two degrees of severity, one of which may be conveniently distinguished by the term mitior, and the other by that of gravior.

In like manner small-pox is a fever attended with a peculiar eruption upon the skin, which eruption modifies the disease in a very remarkable manner, and gives it a history and progress peculiarly its own; but it is as much a genuine fever as typhus, and ought no more to be taken out of this class on account of the eruption upon the skin, than scarlatina, which likewise modifies, in a very considerable degree, the whole train of febrile symptoms, and is attended with a peculiar condition of some exceedingly important internal organs. Small-pox, like all the diseases of this class, occurs in two widely different forms; the one mild, the other intensely severe in the first the concourse of symptoms are precisely those of the synochoid, in the second of the typhoid type.* And the same I am

* In scarlatina the affection of the skin modifies the febrile

satisfied is true of the plague, of the yellow fever, and of all the different forms which this great disease, of many aspects and names, but of one uniform and unchanging nature, presents.

These distinctions and names then, though it were easy to raise objections against them, may serve for all useful and practical purposes. They tend to impress upon the mind the great fact that all the modifications of the disease are still only modifications, and do not affect the identity of its nature; and they afford convenient sections under which to detail the symptoms that attend and discriminate the

symptoms, as has just been said, considerably: in small-pox exceedingly. If, on this account, any one enamoured of nosological distinctions should wish to separate these varieties of disease, it might be done by dividing continued fever into

and so on of all the Exanthemata.

Although the eruption may, and without doubt does give rise to some peculiar symptoms and so modifies the fever, yet the true character of the disease, or the disease as a subject of medical treatment, depends entirely on the nature, that is in truth on the intensity of the fever. If, therefore, the Exanthemata can find no place under the genus fever consistently with the principles of nosological arrangement, it appears to me that these artificial distinctions ought to be abandoned because it is better to reject nosology, than to overlook or to mistake pathology.

important diversities in degree as they present themselves in practice; to exhibit the condition of the organs upon which those diversities depend, and to explain the treatment which experience teaches to be appropriate to these several states.

The present work will be restricted to the consideration of the modifications of fever which we have proposed to designate by the terms synochus, typhus, and scarlatina.

ཎྞས་

CHAPTER III.

Synochus: Division into Synochus Mitior and Gravior. Succession of Phenomena in Synochus Mitior. Indications afforded of Disease in the Nervous, Circulating, and Excreting Systems. Progress of Disease consisting in progressive Increase in the Derangement of these Functions. Phenomena of Recovery. On what the Transition of Synochus Mitior into Synochus Gravior depends. Classification according to the different Organs in which the several Affections have their Seat. Hence Synochus Gravior with Cerebral Affection-Subacute-Acute: with Thoracic Affection with Abdominal Affection: with Mixed Affection.

IT has been stated that, for the purpose of forming into distinct groups certain assemblages of symptoms which it is important to distinguish, because they bear an important relation to practice, it will be convenient to divide the synochus, the term by which we propose to designate the common fever of this country, as it presents itself in its mild aspect, into two sections, namely, synochus mitior and synochus

gravior. For reasons already assigned, it will likewise be important, in treating of these different modifications of fever, to notice in each both the phenomena which form the assemblage, and the order in which they succeed each other.

On careful examination it will be found that the first symptom which denotes the commencement of the ordinary fever of this country, in its mildest form (synochus mitior), is a loss of mental energy. This is by no means the first symptom which attracts attention: it is commonly overlooked for some time, and excites little notice until it has become distressing. Patients in general are incapable of analyzing their sensations or of determining the order of their succession; but if medical men, who are but too subject to be attacked with this disease, will take the trouble to reflect on the order of events as they occurred to themselves, they will probably be satisfied, after the most attentive consideration, that the first indication of disease they felt was a want of power to conduct their ordinary mental operations with ease and vigour. Such at least, perhaps I may be permitted to mention, was the fact in my own case; for, having suffered a severe attack of fever, I have a distinct and vivid recollection of the dulness, confusion, and want of mental energy which I experienced for a considerable time before I was conscious of corporeal debility.

any

This affection of the mind consists particularly in