Fevers. cause. IV. Accu mulated or exhausted Farther illustration. accumulation and exhaustion: yet not, like the nervous ORDER I. energy of Dr. Cullen, under the direction and guidance Pyrectica. of a vis conservatrix et medicatrix naturæ distinct from Proximate the matter of the organization itself, but passively exposed to the effect of such stimuli as it may chance to meet with, and necessarily yielding to their influence. excitability Upon this hypothesis excitement is the vital flame, and exexcitability the portion of fuel allotted to every man at hausted. his birth, and which, varying in every individual, is to serve him without any addition for the whole of his existence: while the stimuli by which we are surrounded, are the different kinds of blasts by which the flame is kept up. If the fuel or excitability be made the most of, by a due temperature or mean rate of blasts or stimuli, the flame or excitement may be maintained for sixty or seventy years. But its power of supporting a protracted flame may be weakened by having the blast either too high or too low. If too high, the fuel or excitability will, from the violence of the flame, be destroyed rapidly, and its power of prolonging the flame be weakened directly; and to this state of the machine Dr. Brown gave the name of indirect debility, or exhausted excitability. If the blasts or stimuli be below the mean rate, the fuel, indeed, will be but little expended, but it will become. drier and more inflammable; and its power of prolonging the flame will be still more curtailed than in the former case; for half the blast that would be required to excite rapid destruction antecedently, will be sufficient to excite the same effect now. This state of the machine, therefore, the author of the hypothesis contra-distinguished by the name of direct debility, or accumulated excitability. divided and treated. Upon these principles he founded the character and Doctrine of mode of treatment of all diseases. They consist but of fevers, how two families, to which he gave the name of sthenic and asthenic; the former produced by accumulated excitability, and marked by direct debility; the latter occasioned by exhausted excitability, and marked by indirect debility. The remedial plan is as simple as the arrange Pyrectica. ORDER I. ment. Bleeding, low diet, and purging, cure the sthenic diseases; and stimulants of various kinds and degrees, the asthenic. Fevers. Proximate cause. IV. Accumulated or exhausted excitability. Wherein sis fails. In respect to inflammatory fever. Fevers, therefore, under this hypothesis, like other diseases, are either sthenic or asthenic: they result from accumulated or exhausted excitability. Synocha, or inflammatory fever (cauma under the present arrangement), belongs to the first division, and typhus to the second. Let us try the system by these examples. The first symptoms of inflammatory fever, like those the hypothe- of all others, evince, as I have already observed, debility or languid action in every organ,-let the debility be distinguished by whatever epithet it may. The vital flame is weak, and scarcely capable of being supported ; and yet the fuel is more inflammable than in a state of health, the excitability is accumulated. This scheme, therefore, completely fails in accounting for the origin or first stage of inflammatory, or, in Dr. Brown's own language, sthenic fever. In respect to typhus. Typhus pestilens, or jail-fever, is arranged by Dr. Brown as an asthenic disease; and, as such, we have reason to expect debility as characteristic of its entire progress. Yet what is it that produces this debility? The blast or stimulus is here contagion; and the excitability is exhausted by the violence of this blast or stimulus; but there is no means of its becoming exhausted without increasing the excitement: the fuel can only be lessened by augmenting the flame that consumes it. Yet in typhus, according to this hypothesis, the fuel is expended, not in proportion as the flame is active and violent, but in proportion as it is weak and inefficient. The excitability is exhausted, and the debility increases in proportion as the excitement forbears to draw upon it for a supply. The blast blows hard, but without raising the fire, and yet the fuel consumes rapidly. This scheme, therefore, completely fails, in accounting for any stage of low or asthenic fevers of every description. Inadequacy Dr. Brown, however, was not a man of much practice; of Brown's his writings show that he was but little versed in the Pyrectica. IV. Accumulated or cause. exhausted excitability. ment. symptoms of diseases; his descriptions are meagre and ORDER I. confused: and hence, when he comes to assort diseases into the only two niches he allots for their reception, he Proximate makes sad work; and maladies of the most opposite characters, and demanding the most opposite mode of treatment, are huddled together to be treated in the same manner, in many cases with no small risk to the patient. descriptions. Thus, among the sthenic diseases are associated rheu- and arrangematism, erysipelas, scarlet and inflammatory fever; and, Opposite among the asthenic, gout, typhus, apoplexy, and dropsy. The Brunonian hypothesis, nevertheless, offers one principle that is unquestionably founded on fact, and is ple worthy peculiarly worthy of attention; I mean that of accumu- of notice. lated excitability from an absence or defect of stimuli; in colloquial language, an increase of energy by rest. And Hypothesis it is this principle which forms the hinge on which turns the more finished system of Dr. Darwin. diseases united. of Darwin. animation Cullen. Sensible of the objection that weighs equally against Spirit of that part of the system of Dr. Cullen and Dr. Brown, modified, which represents the energy or excitability of the living doctrine of frame as capable of recruiting itself after collapse or exhaustion, without a recruiting material to feed on; he directly allows the existence of such a material; regards it as a peculiar secretion, and the brain as the organ that elaborates and pours it forth. The brain, therefore, in the system of Dr. Darwin, is the common fountain from which every other organ is supplied with sensorial fluid, and is itself supplied from the blood as the blood is from the food of the stomach. Improve- All this is intelligible; but when beyond this he endows his sensorial fluid with a mental as well as a corporeal faculty, makes it the vehicle of ideas as well as of sensation, and tells us that ideas are the actual "contractions, or motions, or configurations, of the fibres which constitute the immediate organ of sense", he wanders very chargeable unnecessarily from his subject, and clogs it with all the errors of materialism. Zoonom. Vol. 1. Sect. 11. ii. 7. ment upon with mate rialism. ORDER I, Pyrectica. Fevers. Proximate cause. IV. Accumulated or exhausted excitability. Doctrine explained. How ap plied to fever. Fails in accounting for the oxysm. He supposes the sensorial power, thus secreted, to be capable of exhaustion in four different ways, or through four different faculties of which it is possessed: the faculty of IRRITABILITY, exhausted by external stimuli affecting simple irritable fibres: that of SENSIBILITY, exhausted by stimuli affecting the fibres of the organs of sense: that of VOLUNTARITY, exhausted by stimuli affecting the fibres of the voluntary organs acting in obedience to the command of the will; and that of ASSOCIABILITY, exhausted by stimuli affecting organs associated in their actions by sympathy or long habit. By all or any of these means, the sensorial power becomes evacuated, as by food and rest it becomes replenished, often, indeed, with an accumulation or surplus stock of power. In applying this doctrine to fever, he considers its occasional causes, whatever they may be, as inducing a quiescence or torpor of the extreme arteries, and the subsequent heat as an inordinate exertion of the sensorial power hereby accumulated to excess; and, consequently, the fever of Dr. Darwin commences a stage lower than that of Dr. Cullen, or in the cold fit instead of in a collapse of the nervous energy lodged in the brain. Now, allowing this explanation to account for the cold and hot stages of a single paroxysm of fever, like the entire par- spasm of Dr. Cullen, it will apply no farther. For when the sensorium has exhausted itself of its accumulated irritability, the disease should cease. It may, perhaps, be said that a second torpor will be produced by this very exhaustion, and a second paroxysm must necessarily ensue. Admitting this, however, for a moment, it must be obvious that the first or torpid stage only can ensue; for the system being now quite exhausted, the quiescence that takes place during the torpor can only be supposed to recruit the common supply necessary for health; we have no reason to conceive, nor is any held out to us, that this quantity can again rise to a surplus. Yet it must be farther remarked, that in continued fevers we have often no return of torpor or quietude whatever, and, consequently, no means of re-accumulating irrita Fails in accounting for conti nued fever. Pyrectica. bility; but one continued train of preternatural action ORDER I. and exhaustion, till the system is completely worn out. And to this objection the Darwinian hypothesis seems to Proximate be altogether without a reply. cause. IV. Accu exhausted excitability. It is not necessary to pursue this subject further. mulated or Other conjectures more or less discrepant from those now examined have been offered, but they have not acquired sufficient notice, or evinced sufficient ingenuity to be worthy of examination. mate cause placed in some local disease. of Frank: V. There are other pathologists who have referred the V. Proxiproximate cause of fever to a morbid affection of some particular organ, or set of organs associated in a common function. Thus, Baron Haller alludes to several in his day, who ascribed it to a diseased state of the ve- Vena cava. na cava*: Bianchi pitched upon the livert, Swalve on Liver. the pancreas ‡, Rahn on the digestive organization gene- Pancreas. rally. Professor Frank has divided the different kinds Doctrine of fever between the digestive organs, the arteries, and the nerves, each in a particular state of diseased action; so that with him all fevers are nervous, inflammatory or gastric. The Italian pathologists eagerly caught up this view, and modified it in various ways; and M. of BrousBroussais has of late given it another modification, by placing fever in the mucous membrane of any of the viscera, but chiefly in the mucous membrane of the digestive canal; and consequently gastric fever with M. Broussais, takes the lead of all the rest both in variety and vehemence of action: the particular character or intensity of the fever being resolvable into the temperament, idiosyncrasy, or other circumstances of the individual¶. Dr. Clutterbuck has still more lately in our own country, and with far more reason and learning, brought forward the brain instead of the stomach; to doctrine of an inflammation of which organ he ascribes fevers of * Bibl. Med. Pr. 1. p. 112. Pancreas, &c. p. 141. + Hist. Hepat. p. 112. $ Briefwechsel, Band. 1. p. 150. De Cur. Morb. Hom. Epitome, Tom. v. 8vo. Mannh. 1792-4. Par F. J. V. Broussais, D.M. 8vo. 1821. sais. Inflamed brain, Clutterbuck. |