120 



To elevate the Bhades of colour, and the varieties of form of the 

 eruption to the rank of diagnostic phenomena, indicative of distinct 

 diseases, when the more striking and important phenomena are 

 unequivocally expressive of an identity of disease, is a refinement 

 which, it appears to us, no clinical observer can regard with favour. 



Nor are the diarrhoea and gurgling in the right iliac region worthy 

 of consideration, as signs by which the affection called typhoid fever 

 may be distinguished as a specific disease, ^r one different from 

 tvphus. These phenomena occur in cases in which the general symp- 

 toms of the two forms of disease, arising from disturbance of the 

 nervous, vascular, and secretory functions, are the same, and which 

 therefore indicate the affections to be one and the same. Gurgling 

 in the bowels is common to many diseases; and as to diarrhoea it 

 frequently occurs in fevers in which there is no follicular disorder 

 of the intestines; and though it is generally present in dothinenteritis, 

 it is sometimes absent. Dr. Swett, late President of the New York 

 Medical and Surgical Society, so well known for his devotion to 

 pathological studies, in discoursing on the cases of ship fever, treated 

 at the New York Hospital, at a meeting of that society on May 1st, 

 1847, stated that "in the case in which the ulceration was most exten- 

 sive, there had been no diarrhoea ; in the other case with ulceration 

 less in amount, though still considerable, the diarrhoea had been pro- 

 fuse."* Similar remarks are applicable to the meteorism and ten- 

 derness of the bowels ; they frequently occur in disorders different in 

 their character, and are occasionally wanting in typhus and typhoid 

 fever. With respect to epistaxis and delirium, they are totally des- 

 titute of any claim to the character of signs denoting a specific 

 difference between the two forms of disease in cpiestion. 



But though the rose-coloured spots, the diarrhoea, and gurgling in 

 the bowels, the meteorism, tenderness of the abdomen, epistaxis, and 

 delirium, taken severally, or any two or three of these phenomena 

 combined, do not enable us to distinguish typhus fever from the 

 typhoid affection of Louis, still, it may be asked, do they not, when 

 collectively present, that is, when grouped together in the sameea^e, 

 indicate these diseases to be essentially different '( \n regard to this 

 question it is to be observed, that, in discriminating fevers, the ablest 

 clinical physicians place more reliance upon the uniform constitu- 

 tional phenomena, as manifested in the morbid conditions of the ner- 

 vous, vascular, and secretory organ-, than upon those phenomena 



* Annalist, vol. i. p. 389. 





