564 PRACTICE OF PHYSIC. 



means evident. What we are therefore to attend to, are those 

 symptoms which, though not decisive, give a presumption of a 

 determination to these parts. 



" A. Of the symptoms which mark out the Determination to 

 the Head and Brain. With respect to these we must observe, 

 that, in Intermittent fevers, where the cold fits are attended with 

 a very considerable constriction, which is continued for a long 

 time, we find that the determination is chiefly to the abdo- 

 minal viscera ; whereas, in the case of that application of cold, 

 which produces cough and catarrh, the determination is to the 

 lungs ; but, abstracting from these circumstances, the chief and 

 most common determination is to the Brain. The cause, how- 

 ever, is not very evident. We may/ however, observe that the 

 arteries carrying the blood to the head are in larger proportion 

 than those sent to the other parts of the system, and the course of 

 the blood through them is more potent and direct, which may be 

 partly owing also to the heart being nearer to the brain than to 

 the inferior parts. Whether it is owing to these circumstances, 

 or to this, that the cause of fevers operates in a more especial 

 manner upon the brain and produces a reaction there,' I shall 

 not determine, and you may, at your leisure, consider the sev- 

 eral circumstances, which may lead to^ an "^explanation, why," 1 in 

 continued fevers, most commonly and universally the increased 

 impetus of the blood is towards the head and brain. But we 

 have the proofs of the fact, first, in the pulsation or throbbing 

 of the temporal arteries, or of the principal arteries of the brain 

 and carotids as they lie upon the os petrosum. The internal 

 carotid artery communicates a vibration which may affect the 

 organ of hearing, but which, in consequence of custom, is not 

 perceived in ordinary health ; it may be perceived, however, by 

 applying the fingers to the temporal arteries Tit is readily ob- 

 served when the head is pressed upon a pillow, whereby the vi- 

 bration being resisted, it is more directly felt ; and it becomes 

 very evident when there is a stronger impulse in these arteries 

 leading to the brain. 



" In all fevers that are not of the lowest nervous kind, we 

 commonly have another symptom of this determination, viz. a 

 considerable redness and turgescence of the face. This may, 

 however, be produced either by the increased impetus of the 



