Our prognostic must then be taken from the degree of debility. This is obvious often to the sight: and the young practitioner should exercise his acuteness by careful and attentive observation at the bedside. Every circumstance which regards a patient in a fever will give him information. The situation of the patient is dangerous,if the character of the countenance is soon lost; if the eyes apparently glare on vacancy; if the answers are rambling and incoherent; if slight, partial, involuntary contractions occur in the features; if the tongue trembles, or is soon dry and dark; if he soon declines turning on his sides, lies on his back, and sinks down on his bed; if the extremities are cold and benumbed; if the tendons are particularly tense, and occasionally start; and if he appears to pick off or remove any dark spots on the bedclothes, or wishes some supposed dark object to be removed. Each of these symptoms is a mark of debility; and the earlier they occur in fever, the danger is greater.

In the vital functions there are many marks of considerable debility,which prognosticate a dangerous disease. These are a very quick, low, intermitting pulse; frequent faintings, particularly on being raised to an erect position; short and inefficient respiration. The frequency of the pulse is relative, and the degree which denotes danger uncertain. An irritable female will often, from the beginning, have a pulse from 108 to 120; and the pulse of a very old person, in a dangerous state, may not exceed 80. If, however, in the first eight or ten days of a fever, the pulse exceed 112, there is danger, unless the constitution be otherwise irritable. If, at any period, it exceed 120, serious apprehensions of the event may be entertained. If it strike the finger weakly, and can be stopped by a slight pressure, it is a mark of great debility. On the contrary, a weak pulse will be sometimes apparently strong. It seems to throb, or the artery, on its dilatation, hangs reluctantly on the finger, as if unwilling to leave it; and the apparent strength of the impression appears to be caused by irritation. This is a state, however, only to be learned by experience; and we would recommend the most careful attention to the state of the pulse in every period of fever, not the mere number counted by the stop watch. This is a little parade of which young phy-siciana are fond; but the experienced practitioner discovers more in the peculiar beat of the artery than any watch will convey.

In the natural functions, the symptoms which show considerable debility are sickness and vomiting; a difficulty of deglutition; and involuntary discharges. Of these the vomiting is least dangerous; and difficult deglutition most so. Involuntary discharges we have known to continue for more than a week, and the patients have recovered. Sometimes deglutition is difficult, merely from the state of the tongue, which is occasionally hard, shrunk, and immoveable. Formidable as this symptom may appear, we have not found it dangerous. At this moment a man is recovering, whose tongue was not only as just described, but of the most livid blackness.

We have mentioned, among the symptoms of debility, a partial palsy in the retina; for to this is owing the appearance of small black bodies which the patient wishes to pluck off. An equally, perhaps a more, dangerous symptom is double vision. Deafness has been esteemed a favourable sign: we can at least observe that we have not found it unfavourable. Depraved taste is very common, and offers no particular prognostic.

We have said that a putrid state of the fluids is a sign of considerable debility. This is ascertained by effusions of blood from the different organs, without any peculiar commotion in the system; dark spots on the skin, of different sizes; sometimes dark or livid stripes, like weals from the lash of a whip; effusions of yellow serum; but, above all, by a cadaverous offensiveness of the breath, sweat, urine, and the other excretions.

If, however, in a fever, the pulse, during the first ten days, does not exceed 108; if the expression of the countenance is unchanged; if the subsultus of the tendons do not come on; if the mind is steady and unruffled; the sleep, though short and interrupted, refreshing, and the patient is sensible of having slept; if the tongue is clean at the edges; the epigastric region neither tense nor painful; if the patient lies on either side, and awakes without hurry or confusion; we may prognosticate a safe termination. But every prognosis in fevers should be made with much hesitation and reserve. Many accidents occur in the progress, which the greatest acuteness cannot foresee, nor the most guarded caution prevent.

We have said "during the first ten days,"because we are convinced that fevers proceed in a regular course, and that the changes happen on the days usually styled critical, as already explained (see Crises). In the more usual cases of fevers that we observe, if the disease is properly managed in its earlier period, and the circumstances are on the whole favourable, there are few instances in which a salutary change does not take place on the fourteenth day. Where this is not observable, a gradual amendment takes place, which is clearly conspicuous on the seventeenth, and the fever has disappeared before the twentieth. In common fevers we have not found the disease grow worse after the tenth day; and if no aphthae or any unexpected accident occur from that period, we have usually led the friends to expect a favourable termination.

Prognostics are also occasionally derived from the pulse, the urine, and the tongue. We have already mentioned the judgment which we may form from the number of pulsations; but numerous other changes occasionally occur, scarcely to be conveyed by description, and which have been pointed out by the ancients as indicating particular critical discharges. Galen, it is said, on feeling the pulse, called immediately for a basin, which was scarcely brought when the blood gushed from the nose. Critical discharges are, in this climate, less common; nor can we easily distinguish the variety of pulses which authors have described. In general, the favourable signs are, a pulse more soft, somewhat fuller, and in a slight degree more slow: they seldom, at the first change, sink considerably in number. The unfavourable signs are, a more thready pulse, as if the artery was smaller, pulsations quick, weak, and irregular. The redoubled pulse, which strikes the finger twice during the space of one diastole, we have seen in two instances, without its being followed by any particular change.