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An Essay ON UNHEALTHY INFLAMMATIONS.
SEPTEMBER
22,
1849.
down to him. What ample confirmation does not the practice of modern days afford of these far-sighted truths! What ON hosts of valuable lives (and let us not forget that every life is valuable in the eye of Him who gave it) are there not hourly UNHEALTHY sacrificed by the outrage offered to these counselsi The witty distich attributed to Dr. LetsomBY M. BROKE GALLWEY, ESQ., " I bleeds, I purges, and I sweats ’em; ASSISTANT-SURGEON ROYAL REGIMENT OF ARTILLERY. I repeats; they dies-1 Let8am’ ’is a miserable I HAVE selected the above heading, as a title to this paper, reality, I fear, in the hands of many practiwith a view of distinguishing the several members of that tioners, even still more particularly of those who assail us with they deem a tower of strength-theirexperience;" who large and important branch of the family of Inflammation what which are the local manifestations of a morbid poison upon have practised, peradventure, for thirty years and more, upon different structures of the body. In assuming such -title, I the principles (Heaven save the mark!) which they boast that have no intention of claiming the merit of its parentage, the they imbibed from Alma Mater; and to whom the revoterm unhealthy as contradistinguished from healthy, inflam- lution that has since overtaken the science we profess is absomation, having been employed and insisted on before. My lutely a thing they have never heard of! Litera scripta manet present business is rather with the thing itself than with its it is with them indeed. One of the most eminent physicians denomination; and a very interesting and important thing it of this country is wont to say," when confronting a case of pleuis. I shall treat the subject somewhat discursively, address- risy in its first development, Bleed that man largely, and his But in what ing myself to a few only of the morbid states of the system; thorax will be filled with fluidofby to-morrow"! whom I spake above be dis. illustrative of the subject which more immediately appear to light, I ask, would the gentry posed to regard the mental organs of my respected and accompossess claims to oar notice. Amidst the varied difficulties which assail the young prac- plished friend, could they hear him propound the principle, titioner at the outset of his career, I know of none more per- that a pleurisy and the loss of half-a-dozen pounds of blood should have their time-honoured relationship burst asunder, plexing-more disheartening-than those which he meets with, and that the depletion should stop short of the utter annihilaat every turn, in his dealings with the inflammations. Launched, the in troubled of a waters " little tion of pain. The remedy does very often annihilate the pain, peradventure, upon practice France" or in Smithfield, he prepares to encounter them on in their hands, but it annihilates something else at the same the principles instilled into him at the schools, and nothing time. The varieties of unhealthy inflammation are characterized doubting of the safety, as guides, of those ancient landmarks, the " rubor tumor et calor cum dolore." With these four re- by this in common, and in which they differ fundamentally healthy; that they are the results of a morbid poison presentations of a familiar monster he is determined to hold from the the the upon no terms. have been welfare system. I know of no exception to the statement. conspirators They against of mankind from as early a period as the days of the sage They are also distinguished from them by another striking of Cos, and are not to be compounded with now. Half-and- feature, which I consider to be equally evident with the half measures are not the arguments to bring them to reason; former, and that consists in their direct dependence upon, and they must be knocked on the head at once. But in knocking consequent alliance with, an adynamic condition of the body. them on the head in such regions as I have individualized, he They are manifestations of disordered action, in which the is surprised to find, very soon, that he knocks on the head nervous system plays a prominent part, and may not inaptly be termed, as Mr. Travers has designated erysipelas, "nervous the subjects of them as well. In the wide domain of pathology, there is not a more in- inflammations;" and, as such, are illustrations of a principle I venture to lay down as of general application--viz., teresting field for reflection than that arising out of a com- which that wheresoever nervous matter is prominently involved- in under of the two conditions notice-the and healthy parison the unhealthy inflammations. They are things, as their signi- the operation of morbific influences on the system, -there is to fications import, of a totally opposite nature, and in our be found asthenia in company with it. I cannot offer, I think, forcible example of the truth of this position, than is dealings with them demand as opposite a mode of treatment; atomore in the local inflammations which we meet with in be found as much a so as the of individual disorders -just healthy a disease pre-eminently characterized by diminished require to be treated on a different principle from those of influenza, an unhealthy one. This great truth has been slowly recognised power, and all the phenomena connected with which point to poison upon the nervous systemfandby the body of the profession, though now beginning to assert the operation of a morbid its place as an acknowledged rule of action among us. We particularly upon the nervous system of animal life, as the Yet, in the are awakening to a susp cion that bleeding, purging, and earliest link in the chain of morbid phenomena. bronchitis which is frequently associated with this starving (a hideous triumvirate, whose hands are red with the capillary we recognise all the physical symptoms as well as blood of ages) are not specifics for every form of inflamma- disorder, the substantive signs of an inflammation of the bronchial tion,-if, indeed, they are absolutely necessary for any. mucous membrane; and in the hands of those practitioners Sydenham, two hundred years ago, foreshadowed, and not in who dubious language, the important principle, that diseases of a prescribe for the names rather than the phases of disease, similar class, very nearly resembling one another in their and who look upon inflammation as an entity, there is ample warrant to be found, in those symptoms and in those signs, for common characters, and ranked under a common nomenclathe same remedies to the morbid condition before ture, may nevertheless be very different in their essence, and addressing stand in need of an opposite mode of treatment. This great them, as it is the fashion, in systematic treatises, to recommend and good man, could he look down upon our principles and for bronchitis in its idiopathic form. The same may be said connexion with the inflammatory abdominal complications practice in modem days, would stand aghast at the presump- in tion with which we have ignored the fundamental truths which occasionally accompany influenza. These complications, which he associated inseparably with all his descriptions of on the other hand, are nothing more than local manifestations of the particular blood-poison giving rise to influenza, which disease, and upon which he laid such eloquent stress, as a selects (we know not why) the mucous membrane of the necessary principle to be held in view in our study of themto wit, that our maladies observe a " natural history;" that bronchi and intestinal canal for their stage of operation, the symptoms by which they are characterized are nothing through whose agency to eliminate itself from the body. If this be the rational view of the matter, what man in his senses more than expressions of the means which Nature adopts for their progress and development; and that those symptoms would expect to get rid of this poison by diminishing the quantum of blood in circulation through the vessels, and by are not to be obscured, on their appearance, by violent interference on the part of the physician; and lastly, that the withdrawing, as a sequitur, a direct amount of power from disease itself is an evidence of Nature’s endeavour to expel the physique of his patient, already palpably below par.* If my argument be of correct application to influenza, with some noxious* matter from the body; and that she is herself, how much more significance does it not hold good in the local the the best in great majority of instances, physician for that of typhus ? a disease in which the poison exerts object-a maxim which Hippocrates himself had handed derangements an extremely noxious influence on animal life, and where it * I need scarcely say, that I do not mean to be understood as giving exists in a highly concentrated form, affecting, as Dr. Fordyce Sydenham the credit of having originated this idea. It is to be found throughout the works of the ancients, from Hippocrates downwards. The has happily remarked, "the whole system, the trunk of the
An Essay
INFLAMMATIONS.
favourite conceit was, that acute diseases had their origm in the presence of something noxious in the blood ; and that in the effort of the system to expel it, a violent commotion was set up in the humours. We have yet, I think, to prove them in the wrong. t Novawv &phgr;&ugr;&sgr;∈ enroot. Enid. vi. 5. 1. t. iii. n. 606.
No. 1360.
*
°‘ Many lesions, apparently inflammatory, are far from depending simply local morbid state, but being connected with certain conditions of sanguification, can be removed only by a return of that process to its natural on a
condition."—Andral.
308
body, the head, and the extremities, the circulating, absorbing, nervous systems, the skin, the muscular fibres, and the membranes, the body, and likewise the mind." That so general a contamination of all the tissues and organs of the can owe its origin to nothing less than the circulation of body a poison in the blood is acknowledged, I suppose, by every individual of the present day who has escaped the infection of Broussaism and Clutterbuckism ! "The source and primary seat of typhus fever," says Andral," is proved to be in the blood, inasmuch as they are caused by the introduction of deleterious substances, such as animal or vegetable effluvia, into that fluid. " In assuming the presence of a blood-poison, as the fons et origo mali in typhoid fevers, and, indeed, in
will array against me in support of an opposite position. I do not deny my close adherence to Brunonianism, in attaching vastly more importance to the general condition than to the local determinations in fever, and that, in the face of such a bastinado as poor Brown has experienced in modern days from high authority on this subject.* " Dr. Brown attended more to the state of the general excitability than to
pathologists)
and
the condition of the organs; he maintained that both sthenia and asthenia could never exist together in the same individual ; so that if an individual presenting signs of general debility was seized with pneumonia or hepatitis, the local affection, however severe, was attributed to debility, and treated by stimulants." (I quite agree with Dr. Brown in fevers of every denomination.,* I have no intention of opening this, and if it be treason to medicine to say so, I " glory the large and vexed question of sanguineous versus nervous in my shame.") He asserted, that the diseases of direct system, as to which is first impressed by the morbid agent. and indirect debility so greatly preponderate over those of The subject has been very ably treated in some recent num- the opposite class, that out of every hundred cases there bers of THE LANCET by Mr. Todd, of Evenwood, and I shall were scarcely three of genuine inflammation ; there were, only remark, by the way, in connexion with it, that the argu- "accordingly, only two classes of remedies, and these perments advanced on the two sides of the question appear to nicious principles necessarily led to a most incendiary system of practice." It will appear great presumption on my part, I me to be double-edged, and capable of cutting in both directions, according to the ingenuity of their respective champions. fear, to doubt the validity of Dr. Crawford’s apprehensions as A single example will suffice to illustrate my meaning. Thus, to the mischievous tendency of the Brunonian doctrine in its Mr. Todd, in contending for the primary operation of the foregoing application. But I verily believe those apprehenand am sanpoison on the nervous centres, observes-" The first symptom sions to be more visionary than well-founded; which characterizes the mild form of continued fever is a guine enough to believe, from my own limited experience in loss of mental energy; then succeeds lassitude, and that such cases, that the tendency of medicine at the present day peculiar febrile malaise, which no words can describe, but is rather in the direction of Brown’s hypothesis "than the rewhich, when once experienced, can never be forgotten. Posi- verse. I think, in fact, that there is an evident decline" in tive pain soon succeeds, first in the back, and then in the the empire of the lowering system at the present day, in our limbs. The countenance changes, and expresses dejection, own country; and I do not despair of myself beholding its the features being shrunk, and the tint pallid. The skin has " fall." How many of our most judicious writers already dean increased sensibility to external agents, and diminished inprecate the treatment of such diseases even as pneumonia, ability to resist their influence; chilliness is felt even in a peritonitis, pleuritis, &c., by the lancet, even when they ha e heated room. These symptoms are all clearly referrible to to deal with them idiopathically; from which, I think, I em derangement of function in the nervous system. There is yet justified in drawing the inference, that observant minds are no affection of any other organ obviously, or, at least, much devebeginning to recognise more of the Brunonian " direct and indirect debility" in connexion with the diseases of the circuloped. The circulating system is just beginning to be affected," &c. (Vide THE LANCET, June 30, 1849.) The italics are my own. latory system, than has been the custom heretofore. Another Now, I quite agree with Mr. Todd, that in the passage I have systematic writer in the " Cyclopaedia of Practical Medicine" quoted from his paper, he has made out a case for a palpable has directed a smart cannonading against poor Dr. Brown and implication of the nervous system, and particularly, for the his ill-fated doctrine of fever, which I take the liberty of innervous system of animal life, the ganglionic centres; but I troducing in this place. After informing us that the humoral recognise no proof all the while (in the assertion that views of Brown took their origin in a feeling of " resentment" "the circulating system is just beginning to be affected;") that against the " solidists," we are informed by this writer, that the blood has not been impressed already by the poison, and Rasori, one of the earliest admirers of our countryman, that it is not precisely the influence of that altered blood upon adopted the stimulating treatment of Brown in his dealings the ganglionic centres or its branches, (bathed as they are, with a " petechial fever" at Genoa, which " was evidently so so to speak, in its depths,) that occasions them to be mesinjurious, and positively fatal, as to induce him to re-consider sengers of evil through the frame ! I do not consider it an the theory. He then became convinced of its inconsistency and error, and ult.imately acknowledged this conviction in an answer to my objection, that the physical condition of the bloodvessels has not yet betrayed any altered action; for account which he published of the epidemic of Genoa. This until the nervous apparatus, under whose immediate control epidemic, from whatever causes it arose, had many of the their actions are directed, has taken cognizance of the poison characters of what Brown termed an asthenic disease, and administered to it through the blood, the vessels themselves was consequently treated by stimulants. From the numbers would be unaffected. But this is a long digression from my who perished under this plan, and from observation of its subject. I shall therefore compress what I have to say in symptoms and progress, during which, local inflammations not relation to the local derangements of fever (for I wish to be unfrequently occurred, Rasori was induced to substitute a understood as applying my observations to fevers in general) modified antiphlogistic, or, according to the language of the within a very narrow compass. I believe that, with very, Italians, a contro-stimulant, treatment. Bloodletting, in the very few exceptions, the visceral complications arising in the commencement of the disease, when the patient was young and vigorous, and when the symptoms demanded it, was found course of fever have received an undue amount of importance in the eyes of physicians; and that they may be regarded as decidedly beneficial; and in less severe cases, saline purga‘of secondary consequence in comparison of the injury inflicted tives, antimonials, more especially the tartar-emetic, in upon the system at large by the circulation of a poison through liberal doses, (doubtless more, Rasori,) and acidulated drinks, the nervous centres and the vital organs in general. I am not were employed," &c. Now, considering that petechiæ are not insensible to the censure which such a view of the subject will in general associated with a sthenic state of body, but are procure me from the great majority of practitioners, nor do I themselves an evidence of a want of power in the vessels, and close my eyes to the very many weighty names which the of a dissolved state of the fluids, I confess that I accept these medical literature of this country (not to speak of the French assertions of Rasori with considerable reserve. I have myself seen something of Italian practice in acute diseases of late * It is still, I believe, a question sub judice, whether typhus and the years, and amongst their best physicians, and must confess varieties of " continued fever" are results of a common poison influencing that I am sceptical of their merits as practitioners, even in the body in different degrees according to the dose (so to speak) that has the palmy days of Rasori and Tommasini. We are all of us been introduced into the system of the recipient, and the powers of the physic to resist it; or, on the other hand, whether they owe their individual familiar with the miraculous cures of consumption by tartarpeculiarities to the impress of as many causes distinct from one another. emetic, in the hands of Rasori. In respect to the continued fevers of this country, and of northern Europe * Cyclopaedia of Practical Medicine, vol. ii. p. 702; article, "Inflammagenerally, the researches of the last twenty years seem gradually, but cer- I Adair Crawford. tainly, tending to the opinion, that under the term * contimed fever’ several tion," by Dr. t Dr. Tweedie, article Fever, vol. ii. p. 162. perfectly distinct diseases have been included. From the heterogeneous ’i .and contradictory accounts of the systematic writers of the last generation, Brompton Barracks, Kent, August, 1849. it is clear that they had no idea of this separation. But already three, if ’, (To be continued.) not more, distinct forms of disease have been designated, which are distin"
guished by differences and differences
as
in course, differences in symptoms and treatment, to the influences exerted upon them by locality and
general or special atmospheric conditions."- Vide British and Foreign Nedico- Cltirurgical Revieu, for July, 1849, on Dr. Peacock’s work, On the influenza or Epidemic Catarrhal Fever of 1847-48," p. 99.
’ ’
APPOINTMENT.—Dr. W. B. Carpenter has succeeded to the chair of Medical Jurisprudence in University College, lately rendered vacant by the demise of Dr. Anthony Todd Thomson.
22,
1849.
down to him. What ample confirmation does not the practice of modern days afford of these far-sighted truths! What ON hosts of valuable lives (and let us not forget that every life is valuable in the eye of Him who gave it) are there not hourly UNHEALTHY sacrificed by the outrage offered to these counselsi The witty distich attributed to Dr. LetsomBY M. BROKE GALLWEY, ESQ., " I bleeds, I purges, and I sweats ’em; ASSISTANT-SURGEON ROYAL REGIMENT OF ARTILLERY. I repeats; they dies-1 Let8am’ ’is a miserable I HAVE selected the above heading, as a title to this paper, reality, I fear, in the hands of many practiwith a view of distinguishing the several members of that tioners, even still more particularly of those who assail us with they deem a tower of strength-theirexperience;" who large and important branch of the family of Inflammation what which are the local manifestations of a morbid poison upon have practised, peradventure, for thirty years and more, upon different structures of the body. In assuming such -title, I the principles (Heaven save the mark!) which they boast that have no intention of claiming the merit of its parentage, the they imbibed from Alma Mater; and to whom the revoterm unhealthy as contradistinguished from healthy, inflam- lution that has since overtaken the science we profess is absomation, having been employed and insisted on before. My lutely a thing they have never heard of! Litera scripta manet present business is rather with the thing itself than with its it is with them indeed. One of the most eminent physicians denomination; and a very interesting and important thing it of this country is wont to say," when confronting a case of pleuis. I shall treat the subject somewhat discursively, address- risy in its first development, Bleed that man largely, and his But in what ing myself to a few only of the morbid states of the system; thorax will be filled with fluidofby to-morrow"! whom I spake above be dis. illustrative of the subject which more immediately appear to light, I ask, would the gentry posed to regard the mental organs of my respected and accompossess claims to oar notice. Amidst the varied difficulties which assail the young prac- plished friend, could they hear him propound the principle, titioner at the outset of his career, I know of none more per- that a pleurisy and the loss of half-a-dozen pounds of blood should have their time-honoured relationship burst asunder, plexing-more disheartening-than those which he meets with, and that the depletion should stop short of the utter annihilaat every turn, in his dealings with the inflammations. Launched, the in troubled of a waters " little tion of pain. The remedy does very often annihilate the pain, peradventure, upon practice France" or in Smithfield, he prepares to encounter them on in their hands, but it annihilates something else at the same the principles instilled into him at the schools, and nothing time. The varieties of unhealthy inflammation are characterized doubting of the safety, as guides, of those ancient landmarks, the " rubor tumor et calor cum dolore." With these four re- by this in common, and in which they differ fundamentally healthy; that they are the results of a morbid poison presentations of a familiar monster he is determined to hold from the the the upon no terms. have been welfare system. I know of no exception to the statement. conspirators They against of mankind from as early a period as the days of the sage They are also distinguished from them by another striking of Cos, and are not to be compounded with now. Half-and- feature, which I consider to be equally evident with the half measures are not the arguments to bring them to reason; former, and that consists in their direct dependence upon, and they must be knocked on the head at once. But in knocking consequent alliance with, an adynamic condition of the body. them on the head in such regions as I have individualized, he They are manifestations of disordered action, in which the is surprised to find, very soon, that he knocks on the head nervous system plays a prominent part, and may not inaptly be termed, as Mr. Travers has designated erysipelas, "nervous the subjects of them as well. In the wide domain of pathology, there is not a more in- inflammations;" and, as such, are illustrations of a principle I venture to lay down as of general application--viz., teresting field for reflection than that arising out of a com- which that wheresoever nervous matter is prominently involved- in under of the two conditions notice-the and healthy parison the unhealthy inflammations. They are things, as their signi- the operation of morbific influences on the system, -there is to fications import, of a totally opposite nature, and in our be found asthenia in company with it. I cannot offer, I think, forcible example of the truth of this position, than is dealings with them demand as opposite a mode of treatment; atomore in the local inflammations which we meet with in be found as much a so as the of individual disorders -just healthy a disease pre-eminently characterized by diminished require to be treated on a different principle from those of influenza, an unhealthy one. This great truth has been slowly recognised power, and all the phenomena connected with which point to poison upon the nervous systemfandby the body of the profession, though now beginning to assert the operation of a morbid its place as an acknowledged rule of action among us. We particularly upon the nervous system of animal life, as the Yet, in the are awakening to a susp cion that bleeding, purging, and earliest link in the chain of morbid phenomena. bronchitis which is frequently associated with this starving (a hideous triumvirate, whose hands are red with the capillary we recognise all the physical symptoms as well as blood of ages) are not specifics for every form of inflamma- disorder, the substantive signs of an inflammation of the bronchial tion,-if, indeed, they are absolutely necessary for any. mucous membrane; and in the hands of those practitioners Sydenham, two hundred years ago, foreshadowed, and not in who dubious language, the important principle, that diseases of a prescribe for the names rather than the phases of disease, similar class, very nearly resembling one another in their and who look upon inflammation as an entity, there is ample warrant to be found, in those symptoms and in those signs, for common characters, and ranked under a common nomenclathe same remedies to the morbid condition before ture, may nevertheless be very different in their essence, and addressing stand in need of an opposite mode of treatment. This great them, as it is the fashion, in systematic treatises, to recommend and good man, could he look down upon our principles and for bronchitis in its idiopathic form. The same may be said connexion with the inflammatory abdominal complications practice in modem days, would stand aghast at the presump- in tion with which we have ignored the fundamental truths which occasionally accompany influenza. These complications, which he associated inseparably with all his descriptions of on the other hand, are nothing more than local manifestations of the particular blood-poison giving rise to influenza, which disease, and upon which he laid such eloquent stress, as a selects (we know not why) the mucous membrane of the necessary principle to be held in view in our study of themto wit, that our maladies observe a " natural history;" that bronchi and intestinal canal for their stage of operation, the symptoms by which they are characterized are nothing through whose agency to eliminate itself from the body. If this be the rational view of the matter, what man in his senses more than expressions of the means which Nature adopts for their progress and development; and that those symptoms would expect to get rid of this poison by diminishing the quantum of blood in circulation through the vessels, and by are not to be obscured, on their appearance, by violent interference on the part of the physician; and lastly, that the withdrawing, as a sequitur, a direct amount of power from disease itself is an evidence of Nature’s endeavour to expel the physique of his patient, already palpably below par.* If my argument be of correct application to influenza, with some noxious* matter from the body; and that she is herself, how much more significance does it not hold good in the local the the best in great majority of instances, physician for that of typhus ? a disease in which the poison exerts object-a maxim which Hippocrates himself had handed derangements an extremely noxious influence on animal life, and where it * I need scarcely say, that I do not mean to be understood as giving exists in a highly concentrated form, affecting, as Dr. Fordyce Sydenham the credit of having originated this idea. It is to be found throughout the works of the ancients, from Hippocrates downwards. The has happily remarked, "the whole system, the trunk of the
An Essay
INFLAMMATIONS.
favourite conceit was, that acute diseases had their origm in the presence of something noxious in the blood ; and that in the effort of the system to expel it, a violent commotion was set up in the humours. We have yet, I think, to prove them in the wrong. t Novawv &phgr;&ugr;&sgr;∈ enroot. Enid. vi. 5. 1. t. iii. n. 606.
No. 1360.
*
°‘ Many lesions, apparently inflammatory, are far from depending simply local morbid state, but being connected with certain conditions of sanguification, can be removed only by a return of that process to its natural on a
condition."—Andral.
308
body, the head, and the extremities, the circulating, absorbing, nervous systems, the skin, the muscular fibres, and the membranes, the body, and likewise the mind." That so general a contamination of all the tissues and organs of the can owe its origin to nothing less than the circulation of body a poison in the blood is acknowledged, I suppose, by every individual of the present day who has escaped the infection of Broussaism and Clutterbuckism ! "The source and primary seat of typhus fever," says Andral," is proved to be in the blood, inasmuch as they are caused by the introduction of deleterious substances, such as animal or vegetable effluvia, into that fluid. " In assuming the presence of a blood-poison, as the fons et origo mali in typhoid fevers, and, indeed, in
will array against me in support of an opposite position. I do not deny my close adherence to Brunonianism, in attaching vastly more importance to the general condition than to the local determinations in fever, and that, in the face of such a bastinado as poor Brown has experienced in modern days from high authority on this subject.* " Dr. Brown attended more to the state of the general excitability than to
pathologists)
and
the condition of the organs; he maintained that both sthenia and asthenia could never exist together in the same individual ; so that if an individual presenting signs of general debility was seized with pneumonia or hepatitis, the local affection, however severe, was attributed to debility, and treated by stimulants." (I quite agree with Dr. Brown in fevers of every denomination.,* I have no intention of opening this, and if it be treason to medicine to say so, I " glory the large and vexed question of sanguineous versus nervous in my shame.") He asserted, that the diseases of direct system, as to which is first impressed by the morbid agent. and indirect debility so greatly preponderate over those of The subject has been very ably treated in some recent num- the opposite class, that out of every hundred cases there bers of THE LANCET by Mr. Todd, of Evenwood, and I shall were scarcely three of genuine inflammation ; there were, only remark, by the way, in connexion with it, that the argu- "accordingly, only two classes of remedies, and these perments advanced on the two sides of the question appear to nicious principles necessarily led to a most incendiary system of practice." It will appear great presumption on my part, I me to be double-edged, and capable of cutting in both directions, according to the ingenuity of their respective champions. fear, to doubt the validity of Dr. Crawford’s apprehensions as A single example will suffice to illustrate my meaning. Thus, to the mischievous tendency of the Brunonian doctrine in its Mr. Todd, in contending for the primary operation of the foregoing application. But I verily believe those apprehenand am sanpoison on the nervous centres, observes-" The first symptom sions to be more visionary than well-founded; which characterizes the mild form of continued fever is a guine enough to believe, from my own limited experience in loss of mental energy; then succeeds lassitude, and that such cases, that the tendency of medicine at the present day peculiar febrile malaise, which no words can describe, but is rather in the direction of Brown’s hypothesis "than the rewhich, when once experienced, can never be forgotten. Posi- verse. I think, in fact, that there is an evident decline" in tive pain soon succeeds, first in the back, and then in the the empire of the lowering system at the present day, in our limbs. The countenance changes, and expresses dejection, own country; and I do not despair of myself beholding its the features being shrunk, and the tint pallid. The skin has " fall." How many of our most judicious writers already dean increased sensibility to external agents, and diminished inprecate the treatment of such diseases even as pneumonia, ability to resist their influence; chilliness is felt even in a peritonitis, pleuritis, &c., by the lancet, even when they ha e heated room. These symptoms are all clearly referrible to to deal with them idiopathically; from which, I think, I em derangement of function in the nervous system. There is yet justified in drawing the inference, that observant minds are no affection of any other organ obviously, or, at least, much devebeginning to recognise more of the Brunonian " direct and indirect debility" in connexion with the diseases of the circuloped. The circulating system is just beginning to be affected," &c. (Vide THE LANCET, June 30, 1849.) The italics are my own. latory system, than has been the custom heretofore. Another Now, I quite agree with Mr. Todd, that in the passage I have systematic writer in the " Cyclopaedia of Practical Medicine" quoted from his paper, he has made out a case for a palpable has directed a smart cannonading against poor Dr. Brown and implication of the nervous system, and particularly, for the his ill-fated doctrine of fever, which I take the liberty of innervous system of animal life, the ganglionic centres; but I troducing in this place. After informing us that the humoral recognise no proof all the while (in the assertion that views of Brown took their origin in a feeling of " resentment" "the circulating system is just beginning to be affected;") that against the " solidists," we are informed by this writer, that the blood has not been impressed already by the poison, and Rasori, one of the earliest admirers of our countryman, that it is not precisely the influence of that altered blood upon adopted the stimulating treatment of Brown in his dealings the ganglionic centres or its branches, (bathed as they are, with a " petechial fever" at Genoa, which " was evidently so so to speak, in its depths,) that occasions them to be mesinjurious, and positively fatal, as to induce him to re-consider sengers of evil through the frame ! I do not consider it an the theory. He then became convinced of its inconsistency and error, and ult.imately acknowledged this conviction in an answer to my objection, that the physical condition of the bloodvessels has not yet betrayed any altered action; for account which he published of the epidemic of Genoa. This until the nervous apparatus, under whose immediate control epidemic, from whatever causes it arose, had many of the their actions are directed, has taken cognizance of the poison characters of what Brown termed an asthenic disease, and administered to it through the blood, the vessels themselves was consequently treated by stimulants. From the numbers would be unaffected. But this is a long digression from my who perished under this plan, and from observation of its subject. I shall therefore compress what I have to say in symptoms and progress, during which, local inflammations not relation to the local derangements of fever (for I wish to be unfrequently occurred, Rasori was induced to substitute a understood as applying my observations to fevers in general) modified antiphlogistic, or, according to the language of the within a very narrow compass. I believe that, with very, Italians, a contro-stimulant, treatment. Bloodletting, in the very few exceptions, the visceral complications arising in the commencement of the disease, when the patient was young and vigorous, and when the symptoms demanded it, was found course of fever have received an undue amount of importance in the eyes of physicians; and that they may be regarded as decidedly beneficial; and in less severe cases, saline purga‘of secondary consequence in comparison of the injury inflicted tives, antimonials, more especially the tartar-emetic, in upon the system at large by the circulation of a poison through liberal doses, (doubtless more, Rasori,) and acidulated drinks, the nervous centres and the vital organs in general. I am not were employed," &c. Now, considering that petechiæ are not insensible to the censure which such a view of the subject will in general associated with a sthenic state of body, but are procure me from the great majority of practitioners, nor do I themselves an evidence of a want of power in the vessels, and close my eyes to the very many weighty names which the of a dissolved state of the fluids, I confess that I accept these medical literature of this country (not to speak of the French assertions of Rasori with considerable reserve. I have myself seen something of Italian practice in acute diseases of late * It is still, I believe, a question sub judice, whether typhus and the years, and amongst their best physicians, and must confess varieties of " continued fever" are results of a common poison influencing that I am sceptical of their merits as practitioners, even in the body in different degrees according to the dose (so to speak) that has the palmy days of Rasori and Tommasini. We are all of us been introduced into the system of the recipient, and the powers of the physic to resist it; or, on the other hand, whether they owe their individual familiar with the miraculous cures of consumption by tartarpeculiarities to the impress of as many causes distinct from one another. emetic, in the hands of Rasori. In respect to the continued fevers of this country, and of northern Europe * Cyclopaedia of Practical Medicine, vol. ii. p. 702; article, "Inflammagenerally, the researches of the last twenty years seem gradually, but cer- I Adair Crawford. tainly, tending to the opinion, that under the term * contimed fever’ several tion," by Dr. t Dr. Tweedie, article Fever, vol. ii. p. 162. perfectly distinct diseases have been included. From the heterogeneous ’i .and contradictory accounts of the systematic writers of the last generation, Brompton Barracks, Kent, August, 1849. it is clear that they had no idea of this separation. But already three, if ’, (To be continued.) not more, distinct forms of disease have been designated, which are distin"
guished by differences and differences
as
in course, differences in symptoms and treatment, to the influences exerted upon them by locality and
general or special atmospheric conditions."- Vide British and Foreign Nedico- Cltirurgical Revieu, for July, 1849, on Dr. Peacock’s work, On the influenza or Epidemic Catarrhal Fever of 1847-48," p. 99.
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APPOINTMENT.—Dr. W. B. Carpenter has succeeded to the chair of Medical Jurisprudence in University College, lately rendered vacant by the demise of Dr. Anthony Todd Thomson.