FEVERS. 611 



cold winters and never warm summers. I learned from many 

 practitioners, that in the late war in America the Europeans 

 bore bleeding much better than the Americans. The winter 

 and spring seasons chiefly produce inflammatory diseases, and we 

 may therefore allow of blood-letting with more freedom from the 

 winter to the summer solstice, than in the other half of the year. 



" A difficulty however occurs here : Dr. Cleghorn who prac- 

 tised in a warm climate, at Minorca, seems to have been ex- 

 tremely free in the use of the lancet, and the diseases bore 

 bleeding better than might have been anticipated. But the 

 cases were chiefly purely inflammatory, such as pleurisies and 

 peripneumonies, and they occurred among soldiers from a north- 

 ern climate. Practitioners in the West Indies accordingly also 

 find, that people lately come from Europe will bear bleeding 

 better than those who have for some time inhabited the warm 

 regions." 



4. The degree of phlogistic diathesis present. " Where 

 the pulse is full, hard, and quick, where the heat of the body is 

 considerably increased, where there are most of the marks of 

 turgescence, as a fulness of the countenance, a redness of the 

 face, and a sense of distention in some measure over the whole 

 body ; but more especially where along with these symptoms 

 there are marks of topical determinations, where there are fixed 

 pains in other parts of the body different from those which 

 accompany fever more generally, such as, for instance, the 

 headach, which is not decisive, or a pain in the small of the 

 back, which appears even in the typhus, or a general com- 

 plaint of pains in the limbs or over all the body, which also 

 are not always sufficient to establish the inflammatory state 

 of the system ; if these pains are, on the contrary, any where 

 fixed about the thorax, or even occupy one particular joint 

 of the body, or are attended with the circumstance of some 

 tumor more distinctly and evidently of the rheumatic kind, 

 these are circumstances which indicate venesection ; and if 

 they are accompanied with catarrhal symptoms, as a fre- 

 quent, violent, and bound cough, they are still more distinctly 

 the marks of synocha or inflammatory fever ; and whatever be 

 the nature of the fever, I would say, that so long as these symp- 



