Ordinary nomenclature slight

from.

III. EPANETUS.

IV. ENECIA.

DIARY FEVER.

INTERMITTENT FEVER.

REMITTENT FEVER.

CONTINUED FEVER.

To each of these belong several species, and to most of the species several varieties, as will be noticed in their respective order.

Some slight deviation from the ordinary nomenclature be observed in the generic names above: but the may ly deviated reader can have no difficulty upon this head, as he will find the changes that have hereby been occasioned are in every instance founded upon a principle of correctness and simplification; and consequently calculated to disentangle rather than to add to his incumbrances, and to facilitate his progress in the labyrinth before him. The term Ephemera, is, indeed, well known to every one. Anetus and Epanetus are Greek terms, importing intermittent and remittent, from ἀνίημι and ἐπανίημι. Enecia, from the same tongue, denotes continued action, and is a derivation from vexns.

Prelimina

necessary

to be noticed.

Before, however, we enter upon the practical part of ry inquiries this subject, it appears necessary to make a few remarks upon one or two other questions that have very largely occupied the attention of many pathologists, and especially concerning the proximate and remote causes of fever; and the tendency which fever has been supposed to evince of terminating suddenly, either favourably or unfavourably, at fixed periods of its progress.

Morbid causes of

diseases various.

Proximate and remote causes are rather terms of recent than of ancient writers. In early times the causes of diseases chiefly contemplated were PROEGUMENAL or predisponent, and PROCATARCTIC or occasional. Proegume. Thus, an hereditary taint, or habitual indulgence in nal cause high living, may be regarded as a proegumenal cause of Procatare- gout; and catching cold, or an unusual exertion of muscular exercise, may form its procatarctic cause: both of which are absolutely necessary; for it is clear that the latter without the former, would not produce the malady;

what.

tic what.

ORDER I.

Fevers.

Exciting

and it is just as clear that the former might remain harmless in the constitution for years, were it not to meet with Pyrectica. the co-operation of the latter, which is often, on this account, denominated an exciting cause. Generally speak- cause ing, the first was regarded as an internal, and the second as an external cause; and in the instance selected they are so; but they are not so always.

what.

and remote

To be acquainted with causes of these kinds is always useful; and, in guarding against the approach of diseases, it is often of the utmost importance: but they give us very little information upon the real nature of diseases, and the mode of managing them when present. And hence another set of causes have been adverted to, and have of late been chiefly studied, and particularly in the case of fever. "That only", says Gaubius, "de- Proximate serves the name of a physical cause which so constitutes the disease, that, when present, the disease exists; while what. it continues, the disease continues; when changed or removed, the disease is altered or destroyed." It is this which constitutes the PROXIMATE cause, and is, in fact, the essence of the disease, the actual source of all its effects. The REMOTE cause is that which directly produces the proximate; as a specific virus in syphilis, or a specific miasm in influenza, or epidemic catarrh.

In fever we can often trace the remote causes; though we are still too little acquainted with the nature of several of them to be able to restrict them to a specific mode of action; of the proximate cause, we know but very little at present, and it will probably be long before we shall know much more.

Let us, however, begin with the PROXIMATE CAUSE as that which has most excited the attention of physicians in all ages. Upon this subject, indeed, a great deal of learned dust has been raised, and a great deal of valuable time consumed. Ancient speculations, for they are not entitled to the name of theories, have been overthrown and modern speculations, in vast abundance, erected upon their ruins; which, in rapid succession, have also had their day and expired. It is an inquiry,

causes

Proximate cause has given rise

to various specula

tions.

Pyrectica.

ORDER I. therefore, not likely to prove very productive; yet, as forming a part of medical science of which no student should be altogether ignorant, it seems necessary to carry it into a brief survey of the most popular doctrines which have been advanced upon the subject in different

Fevers.
Proximate

cause.

Humoral

and nervous

ages.

Fevers, then, in respect to their proximate cause, have pathology. been conjectured to originate from a morbid change, either in the composition of the blood, or in the tone or power of the living fibre. The first view has given rise to various hypotheses, that rank under the common division of the HUMORAL PATHOLOGY. The second has given rise to other hypotheses appertaining to the common division of the FIBROUS or NERVOUS PATHOLOGY.

Chief hypotheses that have

been offered

upon the

subject of a proximate

cause.

The hypotheses derived from the one or the other of these sources, that are chiefly entitled to attention, are the following: of which the first two belong to the former division, and the remainder to the latter.

I. That of the Greek schools, founded on the doctrine of a concoction and critical evacuation of morbific matter.

II. That of Boerhaave, founded on the doctrine of a peculiar viscosity, or lentor of the blood.

III. That of Stahl, Hoffman, and Cullen, founded on the doctrine of a spasm on the extremities of the solidum vivum, or living fibre.

IV. That of Brown and Darwin, founded on the doctrine of accumulated and exhausted excitability, or sensorial power.

V. To which we may add that fevers have, by some physiologists, as Dr. Clutterbuck and Professor Marcus, been identified with inflammation; and their proximate cause been ascribed to increased action in some particular organ.

I. Hypo- I. It was the opinion of Hippocrates that fever is an thesis of concoction: effort of nature to expel something hurtful from the body, doctrine of either ingenerated, or introduced from without. Beholding a violent commotion in the system, followed by an evacuation from the skin and kidneys, with which the

the Greek schools.

ORDER I.

Fevers.

I. Doctrine

tion.

paroxysm terminated, he ascribed the commotion to a fermentation, concoction, or ebullition, by which the Pyrectica. noxious matter was separated from the sound humours; Proximate and the evacuation to a despumation or scum which cause. such separation produces, or rather to the discharge of of concocthis morbid scum from the emunctories that open externally. Galen supported this view with all the medical learning of his day; and it is the only explanation of fever to be met with in medical writings, through the Extent of long course of three thousand years; in fact, till the time of Sydenham, who still adhered to it, and whose pages are full of the language to which it naturally gave birth.

its range.

with the

It blended itself almost insensibly with the dialect of Blended the chemists of the day, notwithstanding the professed chemistry of hatred of Paracelsus and Van Helmot towards the the day. whole range of Galenic doctrines, and the solemn pomp with which the former had condemned and burnt the entire works of Hippocrates and Galen. And hence, under the influence of chemistry, at this time assuming a soberer aspect, the supposed animal despumation was contemplated as possessed, according to different circumstances, of different chemical qualities and characters; and particularly as being acid, alkaline, effervescent, or charged with some other acrimonious principle, too highly exalted, or in too great a proportion.

genious and

This doctrine, considered merely hypothetically, is Highly innot only innocent, but highly ingenious and plausible. partially It is in unison with several of the phænomena of pyrectic correct. diseases; and derives a strong collateral support from the general history of exanthems or eruptive fevers, in which we actually see a peccant matter, producing general commotion, multiplying itself as a ferment, and at length separated and thrown off at the surface by a direct depuration of the system.

There is no writer, perhaps, in our own day who has carried this view of the subject farther, or even so far as Professor Frank, who regards typhus, plague, petecchial and all pestilential fevers, and indeed nervous

How far

Frank.

carried by

Pyrectica.

Fevers.

Proximate

cause.

I. Doctrine of concoc

tion.

ORDER I. fevers of every kind, whether continued or remittent, not only as proceeding from specific contagions in the same manner as exanthems, but from contagions producing a like leaven in the system, and matured and thrown off through the various outlets of the body, by the same process of depuration; and hence, after describing all the varieties of malignant nervous fevers under the character of pestilential, he tells us, "non aliter hæc methodus in ipsâ PESTE tum in PESTILENTIALI, sic vocatâ, febre, profuisse visa est: ubi, maturo satis tempore, CONTAGII PER CUTEM EXPULSIO solicitè à medentibus absolvebatur *.

In what re

rect.

So far however as relates to exanthems, the opinion is spect incor- sufficiently correct. But the moment it is brought forward as the proximate cause of fever properly so called, in which there is no specific eruption, it completely fails.

Sometimes followed by an injurious practice.

For first, no explanation is here given as to the means by which any such concoction or fermentation, or multiplication of morbific matter in any way takes place. Next, there are many fevers produced evidently by cold, fear, and other excitements, as well mental as corporeal, in which most certainly there is no morbific matter introduced, and wherein we have no reason to conceive there is any generated internally; while the disease, limited perhaps to a single paroxysm, closes nevertheless with an evacuation from the skin or the kidneys. And, thirdly, we sometimes behold fevers suddenly cured, as Dr. Cullen has observed, by a hemorrhage so moderate, as for example a few drops of blood from the nose, as to be incapable of carrying out any considerable portion of a matter diffused over the whole mass of the blood; while we are equally incapable of conceiving how such diffused morbific matter could collect itself at a focal point, or pass off at a single outlet; or of tracing in the discharge, after the minutest examination, any properties different from those of blood in a state of full health.

I have observed that this hypothesis is, however, harm

* De Cur. Hom. Morb. Epit. Tom. I. p. 130. compare with the § p. 127.