FEVERS. 567 



particular topical inflammation has been formed. In short, we 

 must admit of degrees in this matter ; where the delirium has 

 been long continued, and attended with constant waking, &c. 

 it gives the strongest presumption of a topical inflammation of 

 the brain ; but every such appearance must not lead us to con- 

 sider the disease as desperate or irrecoverable. These are the 

 observations which I had to make with respect to the increased 

 impetus of the blood in the vessels of the brain. 



" B. Symptoms of the increased Determination to the Lungs. 

 The symptoms of Peripneumony are perfectly well known, and 

 I need not insist here upon those cases in which it is known 

 to be present ; but there are obscure degrees of it, which at 

 length prove dangerous and fatal, and over the appearances of 

 which we must watch in fever. The symptoms are, ' Ma 



" 1. A sensation of Anxiety in the thorax. The disagree- 

 able sensations in diseases are all reducible to the two heads of 

 pain and anxiety. Anxiety is an uneasy sensation, which is never 

 fixed in any confined spot as pain always is ; it occupies, as I 

 may say, a whole member, or the whole parts relating to a par- 

 ticular function. It arises universally, I think, from some dif- 

 ficulty which attends the exercise of certain functions. (See 

 Physiology, page 59.) So the anxiety of the thorax also 

 arises from a considerable debility affecting the organs of res- 

 piration ; or, the ordinary vigour of these functions being given, 

 it may proceed from a difficulty in the transmission of the blood 

 through the lungs, some degree of obstruction affecting its ves- 

 sels. It is rendered further evident by the frequent, laborious, 

 and difficult respiration. There is an ambiguity here, as the 

 difficulty of transmission may arise either from debility or from 

 increased impetus ; but I suppose that you .carry along with you 

 the marks of the excess of the stimulant power in general. If 

 each ordinary inspiration does not transmit the due quantity of 

 blood through the lungs, we endeavour to compensate that by 

 large inspirations. Ordinary inspiration depends upon the con- 

 traction of the diaphragm downwards, and the motion of the 

 ribs is hardly observable; but when the respiration is difficult, 

 the sternum and ribs are elevated to a greater degree, which is 

 therefore a mark of the larger respiration, and of its being more 

 difficult ; we may increase it still more by stretching out the 



