531

it—induces it to hunt, to exercise it : after

hunting it for four hours, he brings it homeand kills both the dogs. The one that washunted has all the flesh in his stomach,softened a little, but not digested ; the other,which had been suffered to do what Naturedictated,—that is, to lie down by the fireand go to sleep, has all his food digested, ’,and is found in the high road into the bloodvessels ; the lacteals are all full of the chylewhich they have absorbed.Now these things deserve the particular

attention of medical men ; because, what isthe chief object of medicine, in a great num-ber of cases, but to give strength to pa-tients ? For my own part, I can see no

permanent source of strength but in di-

gestion. You may give bark ; aye, and ifthe stomach will digest it, it will givestrength, but I know not how it will give strength otherwise. We ought to give cau- tion to patients, not to take too much exer-cise after eating ; to keep themselves quiet,and not to allow their minds to be dis-turbed, for you know the eighth pair ofnerves comes from the brain to the stomach,and if the mind be agitated and disturbed,will the stomach digest food, or will it evenreceive it No; 0, there is a great sym-pathy between the mind and the stomach :if a man has received some intelligencewhich really distressed or annoyed him-thoroughly distressed him ; if a merchantheard of the loss of a great adventure atsea ; if a surgeon heard that a patient of hishad died in whose fate he had taken greatinterest, who he thought would have re-covered, and by whose recovery he wouldhave had credit secured to himself ; or, if alover heard that his mistress had cheatedhim (laughter) just at the time lie was sit-

i ting down to dinner, would he eat hisdinner do you think? 0, no ; or if he heard of the tidings just after he had dined,would what he had taken digest ? 0, no.Well, to secrete, there must be vital actionsregulated by the nervous system ; and, inevery part of the physical body, you willsee that fact proved. Now I go on : thefood is digested, but what does it become ?Not chyle in the stomach, but a kind ofpulpy adhesive sort of matter-sticky sortof matter, of no very pleasant odour. Peoplevomit after they digest their food, whenthey have had a blow on the head; andwhat are we to call that ? 0, it is gene-rally called chyme. The stomach digests thefood, and it is certainly called chyme. I mayinform you, that there have been opinionsentertained that the right end of the stomachis more calculated for food, and the left forthe fluid. But these are things, I believe,concerning which we have no absoluteknowledge ; and, therefore, we are ignorantof them.

LECTURES

ON THE

Diseases of the Nervous System,

BY

DR. CLUTTERBUCK.

LECTURE VIII.

On the Varieties of Idiopathic Feve1’.

NOTWITHSTANDING the obvious impro-priety of the term idiopathic fever, accordingto the view I have given of the subject, Iam nevertheless compelled to employ it atpresent, on account of the constant use thatis made of it by writers. In proportion,however, as the real nature of the diseaseis understood and admitted, it will be lessand less necessary to use terms that are not

only unmeaning, but which often tend tomislead.

Idiopathic fever has been usually dividedinto a great number of species, each of whichis supposed to differ essentially from therest ; as if they were of absolutely differentnatures. Besides the common and generallyadmitted division of fevers, into continuedand intermittent—epidemic and endemic—con-taoious and infectious—other minute distinc-tions have been made, founded upon cir-cumstances of a trivial nature, and whichcan be considered in the light of varietiesonly, depending upon causes that are acci-dental, and foreign to the disease itself.Sometimes the distinction has been founded

upon degree merely ; whence the terms,mitd and malignant—sometimes, upon dura-tion; ; as in the ephemeral or diurnal fever, ascompared with the slow or protracted cases( febris lenta)—sometimes, upon the predo-minance of a particular symptom, and thatperhaps accidental ; as the comatose, cephal-algic, catarrhal, gastric, nervous, bilious, rheu-matic, sweatiii,&jevers3 and many others:-sometimes again, upon the place or situa-tion in which the disease has most fre-

quently appeared ; as the gaol, hospital, ship,and marsh fever. These numerous, and forthe most part, unimportant distinctions,(unimportant, at least, in regard to thenature of the disease) have rendered thesubject altogether obscure and difficult.

This, as it appears to me, can only be ob-viated by the adoption of some general prin-

ciple, that will serve to connect the whole; together into one simple and common sys-(,tem. Such, I think, is the one I have

532

Mideavoured to lay down ; where the par-ticular seat and nat11,re of the disease are

assigned, and which’will be found to em-brace all the different genera and species, asthey have been deemed ; as well as to ac-count for the almost innumerable varieties,the occurrence of which is casual and acci-dental only. In the details I am about tooffer to your notice I shall take anatomyand physiology for my guides, as far as pos-sible ; for whatever is not consistent withthese is unworthy of our regard.Now after giving a short explanation of

the terms in ordinary use to distinguishparticular kinds of fever from one another,such as epidemic and endemic-contagious andinfectious-cnmrnon and spec2fic-I shall at-

tempt an arrangement of the subject which,I trust, will render it sufficiently simple andintelligible ; and having done this, I shalldescribe more minutely the different speciesand varieties, as far at least as is necessaryfor the purposes of practice.An epidemic. disease then, is one whichspreads widely through a country, and some-times over a great part of the globe ; theresult of some general influence, commonlyascribed to the atmosphere, the natural con-dition of which has been supposed to haveundergone some change, in respect to tem-perature, elasticity, or other less obvious

quality ; or to the admixture with it of somenoxious agent, the nature and origin ofwhich are wholly unknown. The most

striking example we have of this kind offever, is the epidemic catarrh, or influenza, asit is usually denominated, a peculiar com- bination of idiopathic fever, or brain affection,with catarrh or inflammation of the mucousmembrane of the air-passages. Many otherdiseases of a common kind are observed toprevail with extraordinary frequency, atcertain times and seasons ; while their oc-currence at other times, is rare. Such isthe case with pleurisy, rheumatism, and hepa-titis of the acute kind ; all of which areobserved to prevail after a cold east windhas blown steadily for some weeks. Tothese, as well as others, the term epidemicis applied. Even the fevers termed specific,that is, such as arise only from particularcontagions, as small-pox, measles, searlatina, andothers, are evidently -at times under theinfluence of some epidemic cause, whichoccasions them to be much more rife andfatal in some seasons than in others.

Endemic diseases, on the other hand, arethose which are confined to a particular dis-trict of country, and which depend uponsome local cause, commonly an emanationfrom the soil. Thus iutermittents and remit-tents are endemic in marshy situations. The

yellow fever, as it is called, is endemic in the

West Indies, North America, Gibraltar andmany parts of the Mediterranean, as well asin various other parts of the world; andevidently depends upon miasmata arising fromthe soil of those places, and generatedunder the combined influence of heat andmoisture. The plague itself seems not im-probably to belong to this class of endemicor miasmatic fevers.

The terms contagious and infectious, as ap-plied to fever, have given occasion to muchdispute, as to the sense in which thoseterms are to be employed. And to thisdifference in regard to the use of terms, isowing, I believe, much of the differenceof opinion that subsists among practitioners,with respect to the contagiousness or non.contagiousness of certain diseases. Cmhf-gion has not always been sufficiently discri-minated from either epidemic or endemic in.fluence ; though there is a wide differencebetween them. The terms we employ onthese and other occasions, can seldom betaken in a strictly literal sense; but aremore or less figurative or metaphorical intheir signification ; the use of them accord.

ingly is always in a degree arbitrary; whichmakes it necessary they should be accu.

rately defined, in order to guard againstmisapprehension. Now I think the least

objectionable idea that we can attach to acontagious disease, is, that it is one. whichis is

produced by a peculiar virus or poison, gene-rated in the body of an animal, while labotir.ing under a peculiar form of disease ; andwhich 1,irus has the property of exciting asimilar disease in others to which it is ap.plied-whether in a solid, fluid, or gaseousstate, seems quite immaterial. Now thereis a considerable number of such, with the

general characters of which we are prettywell acquainted ; and possibly there are

many others, that operate from time to time,so as to excite peculiar modifications of dis-ease, but which escape our observation,-

Some of them excite diseases, unattendedwith any febrile symptoms, or geneyildis-order of system; this is the case with the

syphilitic, psoric, and others. Many again,are marked by much febrile disorder, andwhich therefore are termed the febrile cnn-tagion ; such as those producing small-por,measles, scarlotina, and several others. Theselatter are to be considered as perfect ex-arnples of coratagioccs feuer to which, there-fore, as a test, we ought to refer, whendiscussing the question of the contagiousnessof particular fevers.

The term infection has been often usedsynonymously with contagion; and indeedthe distinction between them is altogetherarbitrary, since the fevers called contagious,might, with equal propriety, be termed rn-fectious, as in fact they have often been,

533

Still, there is a difference of opinion as tothe sense. in which these terms ought tobe employed. This however is a subjectI shall again have occasion to allude to,when I come to speak of ordinary continuedf’ever, and its mode of propagation.

The terms common and specific, as appliedto fever, are sufficiently understood. Theformer is applied to fevers that proceed fromcommon causes ; such as exposure to cold,atmospheric changes, spirituous drinks, nar-cotic substances swallowed, mechanical in-juries, violent exercise, or, in short, any ofthe common causes of inflammation of thebrain : while the latter is used to denotesuch causes as are peculiar in their natureand origin, and which act by peculiar laws,so as to generate fever with distinctive cha-racters, and which proceed from such causesonly. Hence small-pox, measles, and the restof the exanthemata, or eruptivefevers, are thechief examples of specific fever. The terms

contagious and specific fever, may be con-

sidered, therefore, as nearly synonymous.-It will be a question for our considerationhereafter, whether ordinary continued feverproperly belongs to the class of contagiousfevers ; that is, whether it is propagated bya peculiar virus generated in the body of thesick, as is the case in small-pox ; or whetherin some other* way. At present we are tomake an arrangement of fevers altogether,confining ourselves to such as have beencalled, by way of distinction, idiopathic.You will perhaps best understand the

varieties to which fever is liable, if I firstpoint out the causes upon which this diver- Isity depends. Now there are several causesthat have this effect of varying the charac- !ter of fever; as,—1st. The degree of the in-flammation existing in the brain. 2dly. Theparticular part of the organ in which theinflammation is seated. 3dly. The stage ofthe disease. 4th. Season, climate, situ-ation, age, individual constitution, and modeof life. Ath. Complication with other dis-eases. 6th and lastly, The nature of the

exciting cause. These all require notice, inorder to a perfect understanding of thesubject.

1. The first circumstance tending to varythe character of fever, is the degree of in-flammation present in the brain, in whichthe disease is supposed essentially to con-sist. Inflammation of the brain, like thatof other organs, might naturally be expectedto give rise to symptoms more or less acute,in proportion to the actual violence of thedisease. In comparison, however, withother organs, a striking difference will befound to exist here ; and that both in regardto the local characters of pain and disturbanceof function, in the part primarily and essen-

tially affected ; and also, in the state of thegeneral system.Thus pain, from the degree of which, in

most other inflammations, we infer the vio-’lence of the disease, is, in the case of fever,most equivocal: so much so, that the painin the head (the part primarily affected) isnot uncommonly in an inverse proportionto the real violence and danger of the dis-ease, and is generally less and less com-plained of, as the fever is advancing in itscourse, till it soon ceases to be felt or ac-

knowledged altogether. This is -easily un-derstood, when we consider the little sensi-bility the brain naturally possesses; andfurther, that the patient soon becomes un-conscious of, or incapable of expressing, hissensations. Other organs, again, commonlyexhibit greater disorder in the state of theirfunctions, in proportion as the inflammationis’more violent ; whereas, in the brain,.from the peculiar disposition of parts, andespecially its confinement in an unyieldingbony case, the effect of inflammation whenextensive and violent, is first to induce arte-rial fulness, and, as a consequence of this,compression of veins ; whereby the circu.lation through the organ is impeded, andthe functions interrupted, in the manner Ihave before explained to you. It fact, it isonly in the slighter and more partial affections

of this organ, that a great and active dis-turbance of its functions is observed. Inthe more violent and extensive inflamma-tions of the brain, the organ is soon renderedincapable of carrying on its functions, and astate bordering on apoplexy takes place ;as we see in the latter stages, and the mostaggravated forms, of both hydrocephalus,phrenitis, and idiopathicfever.

There is a great difference, likewise, inthe state of the general system, in cases’ofcerebral inflammation, as compared withothers. This difference arises from the

paramount influence exercised by the brainover all other parts. When other organsare suffering inflammation in a considerabledegree, so as to excite constitutional dis-order, the affection (pyrexia) is, for the mostpart, simple in its form, consisting in littlemore than an excited state of the generalvascular system, indicated by a quick andgenerally hard pulse, increase of animalheat, a white fur upon the tongue, and sup-pressed or altered secretions. The state ofthe system, in idiopathic fever, is far otherthan this ; and, at the same time, it differswidely, according to the degree of diseasein the brain. In very mild and simplestates of fever, where the brain is so slightlyaffected as to be able to carry on its func-

tions in a tolerable manner, the generalsystem is affected nearly as in other inflam-

534

mations : that is, the pulse is strong andfull, in proportion to the general strength ofthe patient, the tongue whitish, and the.heat of body great. This is observed in.what is called inflammatory fever, the M/Hoetffbefore mentioned, a form of fever of greatapparent violence, and alarming to the by-standers, but in reality attended with littledanger; since the violence exists only in re-gard to the secondary symptoms; while theorgan in which the disease is primarilyseated, is comparatively but little disturbed.But in cases where, the inflammation in thebrain is violent and extensive, (the violent ormalignant fever,) the arterial fulness thattakes place, as one of the consequences ofthe increased arterial action, by makingpressure on the veins, soon interrupts moreor less the circulation of the brain, and, inthe same degree, impairs its functions;which, accordingly, are oppressed often inthe highest degree, producing, as I have ejust remarked, an apoplectic state of theorgan, differing from common or simple apoplexy, in being combined with the symp- toms of inflammation. Now, in this case,the effect is not confined to the brain itselfand its own special functions ; but, in con-sequence of the dependence of every partupon the brain, is extended universallythroughout the system. Not only is the

general sensibility of the body nearly lost, thevoluntary power annihilated, and the mentalenergy in a great measure destroyed, but thewhole vascular system, with its depen-dencies, suffers. The heart and arteriesare enfeebled in their actions ; the pulse isweak and soft ; the circulation imperfectlycarried on; and the blood in the extremeparts nearly stagnant ; acquiring the darkor venous character, and losing, at the sametime, in a great measure, its power of

coagulating ; while the vessels themselves,in consequence of their diminished vitality,lose their power of retaining the blood inthem, so that it escapes into the surround-ing cellular texture, giving rise thus to

vibices and other defœdations of the skin; or it issues from the mucous surfaces of the

alimentary canal or other parts, in the wayof haemorrhage ; the blood that escapesbeing always dark in colour, and little dis-posed to coagulate. Should inflammation

(to which there appears a great dispositionthroughout the system) arise, the inflamedpart evinces its want of vitality, by the dis-ease quickly ending in gangrene, followedby sloughing, and this again by ulceration,that shows no tendency to heal, till thebrain is restored to its natural state, andenabled to resume its functions : in otherwords, till the fever ceases. The secretioizs

every where show the same tendency todecomposition ; whence the black and foetidsordM that accumulate about the mouth ;

the offensive discharges from the ilite6fines i

and kidneys, and even from the skin.Such an extreme prostration of the ani-

mal powers altogether, seems at first incod-sistent with the notion of active inHamma-tion ; but when it is considered that thebrain is the seat of the disease-that, at the

outset, there are the strongest signs of in.creased vascular action about the brain,

such as redness of the eyes, flushing andheat of head, and throbbing of arteries,-and that the natural result of this increasedvascular action, and determination of blood

to the brain, is a state of oppression of theorgan, which renders it unfit to carry on itsfunctions,-it is not to be wondered at, thatthe influence of this should be felt thrnuah.out the system-or that the vitality of thewhole should be impaired, and especiallythat of the more remote parts. The brainand the rest of the system are, in fact, iuopposite states. In the former, the vascularaction is increased, in the latter diminished;while, from the state of oppression that soontakes place in the brain, the rest of the

system is, as it were, paralysed.Another cause of diversity in the cliorac.

ter of fever, is the particular seat of thedisease in the brain. In most cases, tLewhole organ appears to suffer in some de.gree ; as all its functions are more or lessdisturbed. There is, however, great in-equality in this respect. In some cases,the sense of vision is particularly disturbed,as evinc8d by the intolerance of light; inothers, the same is observed with regard to

hearing. Sometimes the voluntary pcuer isirregularly exerted ; (as where subsaltus ten-dinum takes place ;) but not in others. In

some, delirium appears at an early stageof the disease ; while, in many cases, this

symptom is altogether wanting. In somefevers, not otherwise remarkable, the pulseis extremely quickened; in others, it is too

slow ; while there are many instances offever, even-of a violent anddangerouskind,in - which the pulse, during a considerable

part of the disease, deviates but little fromthe natural standard. Some fevers again,set out with vomiting, hardly to be restrainedby art; in others, this symptom is not ob.served. These varieties in the chal’1lcter offever, and which are occasionally met within all the different species of the disease.are only to be explained upon the principlelaid down, namely, the locality ofthe in.flammation, and the different degree inwhich different parts are affected at diffe-rent times.

It is well known how greatly fever iiliable to be varied by the circumstances season, climate, situation, age, and the indiu-dual constitution of the patient. In tbt

535

spring, for instance, fever is apt to prevailwith inflammatory symptoms, that is, withstrong and full pulse ; in the autumn, it ismore likely to assume the malignant shape.In hot climates, fever is violent, and runsquickly through its stagesy often to a fataltermination : in cold ones, the disease is

milder, and, at the same time, more pro-tracted. In large towns, and in an impurestate of the air, fever of the low or nervouskind is apt to prevail ; while in the country,and in elevated situations, we more com-monly meet with fever of the inflammatorykind.

The age of the patient is another circum-stance that merits consideration, especially in a practical point of view. The suscep- !tibility, with regard to all impressions, is i

much greater, generally speaking, in youngthan in old subjects. This is to be ascribedto the greater vascularity of the brain inearly life, and its greater tendency to in-flammation in consequence. In infants, theslightest causes, either applied directly tothe brain (such as mechanical injuries ofany kind) ; or, acting indirectly, by irrita-tion of other highly sensible or irritable

parts; are sufficient to excite inflammationin this organ, and which, when once ex-cited, runs rapidly through its course ; soas either to terminate fatally within a veryshort period, or to end in serous accumula-tion, by which a new train of symptoms isinduced. This peculiarity in the brain ofinfants, serves to explain what ha3 beenoften asseited with regard to them, namely,that they are not liable to fever strict:y socalled. All that can be justly said, how-ever, in regard to this point is, that fever ininfants has not the same regular and pro-tracted course, as in adults ; and that forthe reason I have just stated. Agreeably with this you will find, that the older thechild is, the more the disease resembles atfirst ordinary fever, both in its symptomsand duration. This tendency of the brain inyoung subjects to a more active state of dis-ease, makes it of double importance to haveearly recourse to decisive measures ; andthat even in slight affections of the sort ; forhowever mild the disease may be at its out-set, it is apt to increase from day to day,while our power over it regularly diminishesas the disease proceeds. I do not hesitateto avow to, you (for you may profit by theconfession), that I have more than once hadoccasion to regret the neglect of early andactive measures in the case of young per-sons attacked with fever ; such as boys atschool ; having been lulled into a false secu-rity, by the mildness of the early symptoms.In old age, on the other hand, the brain isless readily reused into inflammatory action,but, as a counterpoise to this, slight degrees

of disease are apt to prove fatal, life in suchbeing held by a feeble tenure.’ As in all other diseases, the constitution ofthe individual materially influences the dis-ease. The disposition to fever is very strongin some individuals, and they suffer in conse-quence repeated attacks: and the disease insuch is commonly more violent, and attendedwith greater danger. There are others, onthe contrary, who appear to be nearly ex-empt from this disease altogether ; a dif-ference that is to be ascribed to the diffe-rent susceptibility of the brain, in regard tothe ordinary causes of fever.

It is easy to understand, that modes of life,may have their influence upon the disease ;and, in no small degree also, the medicaltreatment, and general management of thepatient. In persons much addicted to theuse of strong drinks, fever is always dange-rous ; for in such persons the brain is alreadyin a state of preternatural excitement, if notof actual disease, by which its dispositionto. inflammation is increased. By an earlyuse of stimulants in the cure of fever, thedisease is aggravated ; and that which mighthave been mild in its form, is converted intothe violent and malignant: whereas, the adop-tion of the antiphlogistic practice at the veryoutset of the disease, tends powerfully tosecure the patient against a fatal result. It

prevents, in general, the occurrence of thetyphoid state, as it is unmeaningly called.

Another cause of variety in the charac-ter of fever, is its complication with otherdiseases. There are numerous instanceswhere fever preserves its simple characterthroughout; and that, whether it be mildor violent in degree. In such cases, the

symptoms all refer themelves to the brainand its functions, or to such parts as are inmore immediate dependence upon this or-

gan ; such as the heart and stomach. Theseare apt to have their functions more or lessdisturbed, but only in a secondary way, andwithout themselves becoming actually dis-eased. But, in the complicated states of feverto which I am now directing your attention,there is inflammation in some other part,combined with that whicii is going on in thebrain itself. In these cases, the two sets of

symptoms are easily to be distinguished ;though they tend in a degree to modify eachother. In hot climates, fever is ant to becombined with inflammation in the cavity ofthe abdomen. The stomach becoming in-

flamed, enormous vomitings take place,sometimes of a bilious kind, sometimes darkand grumous, (the black vomit as it has been

called;) sometimes the intestinal canal is thesuffering part, and dusentery appears, in con-

, junction with the proper symptoms of fever

or brain affection. The lirei’ is another part

536

that is much disposed to disease in hot cli-mates, and inflammation in this organ ac-

cordingly, is a frequent concomitant offever ; giving rise in some cases to an exces-sive discharge of bile by vomiting or stool(cholera) or, the discharge of it into theintestines being impeded, absorption is theconsequence, and jaundice appears ; as inwhat is termed yellowfever; this appearance, however, being by no means constant oressential to the disease.

In cold climates, fever is most frequently, found in combination with thoracic disease ;

as catarrh or pulmonic inflammation; some-times, with ligamentolls inflammation, in theform of rheumatism. But even in this cli-mate, few cases of idiopathic fever provefatal, without the occurrence of inflamma-tion in the abdomen, in the form either ofdiarrhœa or of peritonitis ; the latter, when itoccurs, adding greatly to the danger of thedisease.

These occasional complications of feverwith other inflammations, modify consider-ably the character of the disease ; in manyinstances, with the effect of mitigating thecerebral affection, and in this way lesseningthe danger altogether ; as where catarrh,or diarrhœa, or rheumatism, constitutes thesecondary disease. But when gastritis, orenteritis, or peritonitis, takes place in fever,(these being in themselves formidable statesof disease), the danger altogether is greatly enhanced. Sometimes, too, it happens, thatthe proper fever or brain affection subsideswholly, the secondary affection alone prov-ing fatal. In this case, dissection provesnothing with respect to the brain, thoughthis had been the part primarily affected.

The varieties of fever hitherto mentioned,depend upon accidental circumstances, fo-

Teign to the disease itself. There are others,however, that are essential to the fever, soas to make a part of its character. Such isthe case with the fevers termed eruptive, theexanthemata of the nosologists : where, withall the symptoms that are essential to fever ’iin general, and that serve to mark the ex-istence of the disease, there is found ameparticular form of inflammation on the sur-face, by which those diseases are distin-guished from common fever, and also fromone another. The peculiarity of fevers ofthis description, is not only observed in re-gard to the obvious appearances, and thewhole course and termination of the disease,but extends also to the treatment, which isgoverned by different principles. There isabundant reason, therefore, for making suchfevers the subject of a separate class, andwhich, on account of their peculiarity, areproperly termed specific.

Thus then, the whole tribe of fevers,strictly so called, the idiopathic fevers of au.thors, may be methodically arranged accord.ing to the principles just laid down. The efirst division of the subject is into comnwvand specific, in the sense above stated. Thesewill form two great classes, which will befound to embrace all the cases of proper oridiopathic fever, however diversified in theircharacter or circumstances.

The first class, or common fevers, may bedivided into simple and complicated; the dif.ference between which, you will readily un.derstand, after what YQU have already heardon the subject.

Simple fever again, may be divided into thecontinued and periodical forms ; the latter in.cluding both intermittents and remittents,which appear to differ from one another

only in degree.

Lastly, the simple continued fevers may, forpractical purposes, be divided into the in.flammatory, the mild, and the violent forms;corresponding with the synocha, typhus,mitior, and typhus gravior, of Dr. Cullen’ssystem. These, though mere varieties, de.pending upon foreign and accidental cir.cumstances, require some difference of treat.ment, and therefore must be separately con-sidered.

In conformity with the plan above sug-gested, I have constructed a table, for themore compendious display of the subject,and which you may consult at your leisure,and, perhaps, think it worth your while totranscribe. [The Lecturer here laid on thetable a scheme of fevers, digested in the orderabove stated.] The arrangement of thesubject most useful with regard to practice,will, I think, be the following, and whichis the order I intend to pursue.

1. Simple continued fever, including tlleinflammatory (synocha)-the low nervous fever(typhus mitior)-and the violent or malignant(typhus gravior). This will be immediatelyfollowed by a consideration of the complica-tions to which they are respectively liable,

2. Periodical fevers, including intermittentsand remittents, with their varieties.

3. Specific fevers, the exanthemata or erup-tive fevers of authors ; with which, I think,hydrophobia may be properly classed.