Licence: Public Domain Mark
Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![one and tbe other. Every link is filled up by cases of varying in-jl tensity, from the very worst of cholera to the mildest of diarrluea.J The indications hy which we are guided, the characters of the J evacuations, the existence of collapse, and the suppression of J urine, are not directly connected ■with the essence of the disease,*] and do not show where the line is to he drawn. Hence it is thatJ one observer records a smaller mortality than another, becausM he includes a larger class of cases; and that the same treaty ment appears to be followed by such varying success in difierentl hands. I We have found the same obscurity in attempting to discnmi-1 nate different classes of fever. But, while we cannot yet fcell certain whether they arise from the same or from different cau.ses,J we have this remarkable difference between Asiatic cholera and I sporadic or English (diolera, that the one travels to us from thel tropics, and never takes its rise in temperate climates, while thofl other occurs every year among ourselves. On the other hand, justl as during the presence of an epidemic of typhus, there is extreme j difficult}'in distinguishing cases dependent on the epidemic in-^ fluence from those naturally springing from endemial causes,,] which might have equally occurred during its absence; so during,! an epidemic of cholera, there is often much difficulty in recognisJ ing a case of simply severe diarrhoea. In the one case or the other the J distinction is only based on the totality of the symptoms, placing 1 it rather under one denomination than the other; and until wei know something more of the real nature of the disease, we must J not forget to give its due weight to the a priori argument of its j universality and its transmission from one place or person to ] another. In my own experience I have found that, when attention j has been given to this point, distinctive characters have beeui ] observed which would otherwise have escaped notice. j Division II.—Eruptive Fevers. This class includes in our table of diseases four dis- . tinct forms :—1, measles; 2, scarlatina; 3, varioloid eruptions; 4, erysipelas. There may be much difficulty in deciding whether a case presenting itself with the general characters of fever, may not terminate in some cutaneous eruption. The pi’obability is to be learned from the chances of exposiu’e to infection, and also, in some measure, from the suddenness of the attack. The apjiearance of the eruption soon determines the point, and often has shown itself before the amount of febrile di.sturbauce has been such as to call for medical aid. It is of iin-](https://iiif.wellcomecollection.org/image/b24989812_0090.jp2/full/800%2C/0/default.jpg)
