Dr. Mac Culloch on Fevers, 45 



the pleura or intestines, or rheumatism in the muscles or 

 joints. If such symptoms exist with a very marked or 

 acute fever, the variety is termed an anomaly : if either the 

 fever is mild, or obscure, or if it is chronic, and if the 

 accessary symptom is the most conspicuous circumstance, or 

 if it is such that the fever is mistaken for the symptomatic fever 

 of such an inflammation for example, or in any case where 

 the practitioner overlooks or misapprehends the principal 

 disease, or fever, while he ranges the symptom with that 

 disease in which it is, in other cases, the principal one, the 

 term simulating is applied to it; while it is plain that the 

 simulation, in such a case, may depend solely on the igno- 

 rance or inattention of the practitioner. Or, to illustrate 

 this by example, if, with the fever, there is violent headach 

 of a phrenitic character, the marsh fever may be mistaken 

 for phrenitis; an error occurring daily to English prac- 

 titioners in hot climates; or otherwise, a rheumatic affection 

 of the intercostal muscles with a similar fever, mistaken for 

 a symptomatic one, may pass for pleurisy — an error of very 

 frequent occurrence among ourselves. 



Now the importance of these distinctions, of an accurate 

 knowledge of these anomalies and simulations, is very great : 

 because, whatever the symptom or simulation may be, the 

 remedy of intermittent, namely, bark, is still the remedy, as 

 blood-letting is pernicious or destructive : while it happens 

 daily, that from mistaking such a disease for true pleurisy, 

 or whatever else, this remedy is adopted, and with the most 

 serious evil consequences. On the whole subject, the author 

 has been very full and minute ; while giving authorities and 

 examples, which have also been tabulated at the end of the 

 work, and while also furnishing the most ample means of 

 discrimination : but as we could not pretend even to abridge 

 all this, we must content ourselves with giving an enume- 

 ration of these varieties, these anomalies and simulations ; 

 remarking only, that they may occur under any type of 

 marsh fever, and in the acute and chronic fevers, both : 

 varying, therefore, in violence and in the power of decep- 

 tion, while also producing varieties of effect, according to 

 the mutual balance of the fever and the accessary symptoms 

 or disease, for which the original must be consulted — though 

 much also must always be left to the practitioner himself. 



If we take the listof these simulating fevers which is given 

 in the table to which we alluded, we shall make our own 

 task at least easier, and also facilitate the researches of our 

 readers as to the original, to which we must refer for what we 



