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which are local and contingent. The former are esteemed the effi- 

 cient, and the latter the accessory means of diagnosis. Are not in- 

 termittent and remittent fevers known and distinguished by their 

 types and general phenomena, and particularly by the modes in 

 which the phenomena are combined or succeed each other ? In these 

 forms of fever there is often inflammation or engorgement of parti- 

 cular organs, and yet, notwithstanding such complications, each of 

 these diseases is readily recognized and distinguished. Even in 

 yellow fever, the course and form of the general symptoms, spring- 

 ing from derangement of the nervous and vascular systems, are 

 vastly more important as indications of the specific nature and dis- 

 tinctive character of the disease, than the symptoms immediately 

 connected with the gastro-intestinal lesions. These latter, it is true, 

 are sometimes valuable subsidiary means of diagnosis; and, indeed, 

 are occasionally essential aids in deciding in doubtful cases; but, 

 aside from the general phenomena, they would scarcely suggest the 

 idea of yellow fever; whereas, the constitutional symptoms are, of 

 themselves, sufficient, especially when the disease is epidemic, to 

 show the true character of the malady. The same remarks, in regard 

 to the symptoms depending on special organic lesions, are applicable 

 to every other essential fever. In the contagious exanthemata it is 

 otherwise. In these, the eruption is, with very few or no exceptions, 

 a constant occurrence, and is therefore regarded as one of their lead- 

 ing diagnostic phenomena. 



Now if we examine the phenomena of typhus as described by Eng- 

 lish writers, and compare them with those of typhoid fever as de- 

 scribed by M. Louis and others, are we not warranted in giving to 

 the general symptoms a higher value as diagnostics of the special 

 nature of these diseases, than to those which indicate an affection of 

 the glands of Peyer? Is not typhus distinguished in all cases by the 

 character and train of the general symptoms, rather than by any 

 disturbance of the abdominal organs, indicated by tenderness under 

 pressure, diarrhoea, gurgling in the right iliac region and meteorism ? 

 And is not the same true of typhoid fever? That such is the fact, 

 in respect to the latter disease, there can be no question ; for Louis 

 and others have recorded cases as typhoid fever in which the symp- 

 toms of follicular disease of the bowels were obscure or not conspi- 

 cuous. 



Idiopathic fevers, then,, are distinguished by the kind and charac- 

 ter of their general symptoms, and by the mode in which these are 

 grouped and successively developed. In comparing fevers with one 

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