it would appear that this state of tongue is sometimes unaccompanied by other general symptoms of ulceration of the bowels, and is not always present when we believe ulceration to be going on. It seems to depend on a general cause, affecting most commonly the whole mucous tract, at least as far as the ilio-caecal valve, but sometimes more limited and local. The one condition is not to be presumed to be derived from the other.
The feces in this condition are thin, watery, curdy ; sometimes of an ochrey color, often very dark, and occasionally pitchy, from the presence of blood derived from an ulcerated surface ; always fetid and offensive. When consistent or natural in appearance, we may be sure that ulceration is not going on.
d. In addition to the severe kind.s of bowel ailment ac,com panying one of the more intense and well-marked forms of fever, an allied condition is found in milder cases, or what may be termed febricula, consisting of irritation of the mucous membrane, which may show itself in sore throat, or in gastric pain and ten derness, or in diarrhcea. In all these conditions the distinction to be drawn between local disorder per se, and such disorder arising out of, and accompanying a general state, must be arrived at simply on the principles already pointed out--first, febrile disturbance, out of all proportion to the local disorder ; second, its character being asthenic, as opposed to inflammatory fever.
The character of the fevers of the present day most unques tionably tends towards,debility ; and we rarely find a pulse that has even any degree of hardness, never one that suggests the propriety of bleeding; the powers of life are wholly prostrated, the nervous centres are partially insensible to impressions from without, are unable to exert steady muscular movement by ener getic stimulus from within. But, if we trust the observation of men of judgment and experience who have preceded us, it was not always so ; and at some future period the disease may again put on a more inflammatory character.
• The bowel complication so often seen has been a subject of considerable controversy of late years, with reference to the question of what circumstances determine its presence or absence. By the Vienna school, it is asserted, that
a typhous element exists which finds its outlet either by this or by other channels ; and, it is believed that, when typhous pneumonia or bronchitis exists, typhous exudation in the intestinal glands is more commonly absent. The French school, to whom we owe the name of typhoid, assumes the exist ence of two distinct diseases, as represented by typhus and typhoid fevers. To this has been added the distinction of fever spots already alluded to, which are supposed to be diagnostic of each.
These subjects afford scope for the observation of the student, and, ere long, will probably be definitely settled. For the present, I would warn him against placing unjustifiable confidence in any theory, and remind him that the question of importance in regard to the immediate treatment of any case is not which theory he shall adopt, but what phenomena are actually present, and how he may best meet them by suitable treatment; whether there be congestion of the lungs, or ulceration of the bowels, not whether he has got typhus or typhoid fever to deal with.
All the complications alluded to are apt to be overlooked or forgotten in the consideration of the existence of fever, and yet they are each of greater or less importance in treatment. And again, while exact knowledge of their true character is essential in arriving at the very important negative conclu sion, that inflammation of some particular organ does not exist, their very presence becomes an additional corroboration of the belief, that we have to do with a case of continued fever.
Under the general head of fever there are also classed, in the table of diseases, remittents, influenza, and epidemic cholera.
§ 2. The name of remittent fever is applied to a disease peculiar to warm climates. It is now very generally believed to be only typhus as modified by atmospheric influences and the condition of the nervous and sanguiferous systems of Europeans residing in tropical latitudes. It is unnecessary to enter on this subject in addressing students in this country. The same analogy holds with reference to the only fever of this type ever seen among ourselves—infantile remittent.