4. There are cases in which the pain of the head is equally severe as in synochus: but this may be justly considered as rare. In general it is less acute. Dullness, confusion, stupor, giddiness, are more common than severe pain, and are often the substitutes for it. Though some degree of pain be generally present, yet it is by no means uncommon for one or more of these sensations to occupy its place completely. Question the patient as much as you please, and he will tell you that he has no pain; but it is evident, from his aspect and his manner, that he has little sensation of any kind. The eye is dull, heavy, stupid, without lustre: the old English word “lac-lustre” expresses its character truly and strikingly. But it is remarkable, that while the pain in the head is only slight, the pains in the back, loins, and extremities, and, as the patient himself says, in the bones, are severe. 5. When pain is present it diminishes sooner and disappears more completely than in synochus: when it is not present, the advancement of the disease is indicated by increasing insensibility, and by the rapid transition of dullness or confusion into a state of stupor approaching to coma. The eye is already muddy, and it soon becomes injected and suffused. The skin over the body is generally warm, sometimes hot: over the head it is often hot. The face is usually pallid, but the pallidness frequently alternates with flushing. The change of dullness into insensibility more or less profound sometimes takes place as early as the second or the third day: it is seldom that it is as late as the seventh or the eighth: it is postponed, when not prevented, by active and appropriate treatment. 6. There is little or no sleep; the restlessness is great; there may be no violence; but there is abundance of inquietude. 7. Delirium is more constantly present than in synochus; and when it comes it comes earlier: its presence is not unusual as early as the sixth or the seventh day; and it may appear still sooner, but that is rare. It consists of low muttering incoherence rather than of loud and violent talkativeness; and is expressed in moaning rather than in screaming.