GASTRIC FEVER, CATARRHAL AND BILE-FEVER. 633 



influences that could cause gastric and intestinal catarrh, in doubtful 

 cases the presumption will be in favor of gastric fever. If, on the 

 other hand, there have been numerous cases of typhus in the city or 

 vicinity, and no errors of diet can be discovered as causes of the dis- 

 ease, we should suspect typhus. Secondly, the increase of the bodily 

 temperature is not so regular in gastric fever as in typhus. Thirdly, 

 catarrh of the finer bronchial tubes, with cough and sibilant rhonchi, 

 indicates typhus rather than gastric fever, although bronchial catarrh 

 may occur in the latter also ; such cases are usually termed gastro- 

 catarrhal. Fourthly, an eruption of herpetic vesicles about the mouth 

 almost certainly excludes typhus. Fifthly, and lastly, a perceptible 

 enlargement of the spleen, and the appearance of roseola spots on the 

 upper part of the abdomen at the end of the first week, speak against 

 gastric and in favor of typhus [typhoid] fever. 



Cases occur where from the great general disturbance the gastrio 

 symptoms are thrown so much in the background, that we may doubt 

 whether the disease is venting itself in the intestinal canal, and 

 whether the fever and the symptoms caused by it can really be re- 

 garded as symptoms of gastric and intestinal catarrh. It is such cases 

 that have led to the formation of the class called simple (essential) 

 fever, fievre simple continue, or synocha. I doubt the propriety of 

 believing that fever can occur as the sole effect of the action of any 

 injurious influence on the body. It seems much more probable that 

 even in such cases there is structural change, which we cannot at 

 present discover, in some organ or other. I consider this hypothesis 

 justifiable from the well-known fact that, in numerous cases of pneu- 

 monia, erysipelas, and severe nasal and bronchial catarrhs, the fever 

 and great general disturbance appear before the local symptoms. It 

 is very difficult for me to believe that here also there is at first an 

 essential fever, to which a local affection is subsequently added ; and 

 the more so, as, after this occurs, the fever and local disease keep step, 

 and the former disappears when the latter has run its course. Now, 

 if the delicate organic disease do not reach so high a grade as to 

 cause evident functional disturbances, according to my hypothesis we 

 have the state usually called essential fever. In any fever there is 

 slight dyspepsia ; and simple want of appetite, slightly-coated tongue, 

 etc., do not justify us in designating a febrile affection as gastric fever. 3 



Even more decidedly than in the case of gastric fevers does 

 Griesinger say that the rare but very regular and characteristic 

 disease called catarrhal fever, febris pituitosa, is also a typhus dis- 

 ease, which has, it is true, a peculiar and unusual course. I do not 

 know whether Griesinger himself has made a large number of autop- 

 sies in cases of this disease, or whence he derives his authority for say 



