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ca. Fevers.

cause.

Order I. every kind, regarding them merely as so many varieties

a. of one specific disease, originating from this one comProximate mon cause*. But this is to confound fever with local

ic inflammation, the idiopathic with the symptomatic affecdisease.

tion. In treating of inflammation under the ensuing Fevers

Order, we shall have sufficient opportunities of seeing hereby

that an inflamed state of almost any organ, and especonfounded with in cially of membranous organs, or the membranous parts flammation.

of organs, is sufficient to excite some degree of fever or other, and not unfrequently fever of the highest degree of danger from its duration or violence. And hence, the liver, the lungs, the stomach, the intestines, the peritoneum, and the brain, have an equal claim to be regarded as furnishing a proximate cause of fever when in a state of inflammation.

A very striking objection to Dr. Clutterbuck's hypothesis, is his limiting himself to a single organ as the cause of an effect which is equally common to all of them.

And on this ground it is that Professor Marcus of Baidentified

m- varia, who has contended with similar strenuousness for mations by the identity of fever and inflammation, has regarded all Marcus,

inflamed organs as equal causes; and is hereby enabled to account, which Dr. Clutterbuck's more restricted view does not so well allow of, for the different kinds of fever that are perpetually springing before us, one organ giving rise to one, and another to another. Thus, inflammation of the brain, according to Dr. Marcus, is the proximate cause of typhus; inflammation of the lungs, of hectic fever; that of the peritonæum, of puerperal fever; and that of the mucous membrane of the trachea, of catarrhal fever : a view, which has lately been adopted by several French writers of considerable intelligence, as an improvement upon M. Broussais's hypothesis t.

Fevers

with inflam.

Treatise on Fever, 8vo. + M. Gaultier de Clanbry, Vide Journ. Gen. de Médicine, Avr. 1823, and M. Tacheron, Recherches Anatomico-Pathologiques sur la Medicine Prarique, &c. 8vo. 3 Tomes, Paris, 1823.

Fevers.

cause.

The general answer, however, to pathologists of every Order I.

Pyrectica. description who thus confound or identify fever with inflammation, whether of a single organ or of all organs Proximate equally, is, that though fever is commonly a symptom y. Organic or sequel of inflammation, inflammation is not uncom- disease. monly a symptom or sequel of fevers. And hence, Objections

to an identhough post-obit examinations, in the case of those who tification of have died of fever, should show inflammation in the inflamma

tion and brain, the liver, or any other organ, it is by no means a fever. proof that the disease originated there, since the same appearance may take place equally as an effect, and as a cause. Whilst a single example of fever terminating fatally without a trace of inflammation in any organ whatever, and such examples are perpetually occurring, is sufficient to establish the existence of fever as an idiopathic malady, and to separate the febrile from the phlogotic divisions of diseases. "A fever, therefore,” to adopt the language of Dr. Fever as

described by Fordyce, " is a disease that affects the whole system; Fordyce. it affects the head, the trunk of the body, and the extremities; it affects the circulation, the absorption, and the nervous system; it affects the skin, the muscular fibres, and the membranes; it affects the body, and affects likewise the mind. It is, therefore, a disease of the whole system in every kind of sense. It does not, however, affect the various parts of the system uniformly and equally; but, on the contrary, sometimes one part is much affected in proportion to the affection of another part.” * The result of the whole, as observed at the outset of General re

se sult. this introduction, is that we know little or nothing of

Proximate the proximate cause of fever, or the means by which its cause little phænomena are immediately produced. In the language of Lieutaud applied to the subject before us, they are too often atrâ caligine mersæ; nor have any of the systems bitherto invented to explain this recondite inquiry, hów

known.

* On Fever, Dissert. I. p. 28.

causes of

powers.

Order I. ever ingenious or elaborate, answered the purpose for Pyrectica.

which they were contrived. Fevers. Remote

From the proximate cause of fever let us next pro

ceed to a few remarks upon its REMOTE causes. fever.

Dr. Cullen, who has striven so strongly and so inge

niously to simplify the former, has made a similar atRegarded tempt in respect to the latter. He first resolves all reby Cullen mote causes into debilitating or sedative powers, instead as sedative

of being stimulant as they were formerly very generally considered, and as they are still regarded by many pathologists, and especially by those who contemplate fever and inflammation as identic. Whether this position of Dr. Cullen be correct or not, it was necessary for him to lay it down and to maintain it, or he must have abandoned his system of fever altogether, which supposes it to

commence in, and be primarily dependent upon debility. Marsh and These sedative or debilitating causes he reduces to

f two: MARSH and HUMAN effluvia. To the former of fluvia remote causes. which he limits the term miasmata, and the power of

producing intermittent fevers, which, with him, include remittent; while to the latter he confines the term con

tagions, and the power of producing continued fevers. Auxiliary It is true he has found himself compelled to take notice

of a few other powers, as cold, fear, intemperance in venery or drinking; but these he is disposed to regard as little or nothing more than sub-agents, or co-agents, scarcely capable of producing fever by themselves.

“ Whether fear or excess be alone,” says he, “ the remote cause of fever, or if they only operate either as concurring with the operation of marsh or human effluvia, or on giving an opportunity to the operation of cold, are questions not to be positively answered; they may possibly of themselves produce fever: but most frequently they operate as concurring in one or other of the ways above mentioned.”* To cold, however, he attributes a power of engendering fever more freely than

human ef

remote causes of Cullen.

* Pract..of Phys. Book, 1. Ch. iv. Sect. xcvu.

ica.

them.

to the rest ; " yet even this”, says he, “is commonly Order I. only an exciting cause concurring with the operation of

Fevers. human or marsh effluvia.” *

Remote We shall find, as we proceed, that these complemental

causes.

Sufficient causes may admit of addition; as we shall also that they weight not more frequently exist as independent agents than Dr. allowed to Cullen is disposed to allow. Yet there can be little doubt that the chief and most extensive causes of fever are human and marsh effluvia.

No great benefit, however, has resulted from endea. Distinction vouring to draw a line of distinction between these two

between

meSC Wo marsh and terms, and hence it is a distinction which has been very human ef

fluvia of no little attended to of late years. Miasm is a Greek word,

dy great importing pollution, corruption, or defilement generally; benefit. and contagion, a Latin word, importing the application of Miasm and

contagion, such miasm or corruption to the body by the medium what. of touch. There is hence therefore, neither parallelism nor antagonism, in their respective significations: there is nothing that necessarily connects them either disjunctively or conjunctively. Both equally apply to the animal and the vegetable worlds-or to any source whatever of defilement and touch; and either may be predicated of the other; for we may speak correctly of the miasm of contagion, or of contagion produced by miasm.

And hence it is that the latter term is equally applied Miasm how by Sauvages to both kinds of effluvia: “ Miasmata, tùm sponte in sanguine enata tùm extus ex aëre, in massam sanguineam delata.”+

In a work of practical information it is hardly worth The denial while to follow up the refinements of those writers who deny, and endeavour to disprove the existence of con- worth at

tending to. tagion under any form or mode of origin. Such spe

of conta

ardly

• Pract. of Phys. Book 1. Ch. iy. Sect. xcii.
+ Nosol. Method. Cl. 11. Febr. Theor. Sect. 79.

Lassis Recherches sur les véritables Causes des Maladies Epidemiques appellées Typhus, ou de la Non-contagion des Maladies Typhoides, &c. 8vo. Paris, 1813. Maclean's Results of an Investigation respecting Epidemic and Pestilential Diseases, &c.

VOL. II.

Remote causes.

Order I. culations may be ingenious and very learned and find Pyrectica.

amusement for a leisure hour in the closet, but they will Fevers.

rarely travel beyond its limits, and should they ever be acted upon would instantly destroy themselves.

It is a question of more importance whether we have yet the means ef realizing the distinction between human and marsh miasmata *, which Dr. Cullen has here laid

down, and which has been generally adopted from the All mias..., weight of his authority. All specific miasmata may be mata morbid ferments, regarded as morbid ferments, capable of suspension in

the atmosphere, but varying very considerably in their degree of volatility, from that of the plague, which rarely quits the person except by immediate contact, to that of the spasmodic cholera of India, which, as observed when treating of it t, works. its way, if it be really from a specific poison, in the teeth of the most powerful monsoons, despising equally all temperatures of the atmo

sphere and all salubrities of district, and travelling with of various the rapidity of the fleetest epidemy. They are of various kinds and

vari kinds, and appear to issue from various sources, but we from vari

can only discriminate them by their specific effects. These are most clearly exemplified in the order of exanthems : in which for some thousands of years they have proved themselves to be of a determined character in all parts of the world where they have been the sub

ject of observation, differing only in circumstances that Those of may be imputed to season, climate, and other external exanthems distinct and causes, or to the peculiar constitutions of the individuals specific. affected. Thus, the miasm of small pox has uniformly

continued true to small pox, and that of measles, to measles; and neither of them has in a single instance, run into the other disease, or produced any other malady

than its own. Those of But can we say the same of the supposed two distinct

sh and miasms of marsh and human effluvia? Is it equally true human effluvia not that the former has never produced any other than interequally so; mittent fever, or the latter any other than continued ?

* Jobnson, Influence of Tropical Climates, &c. pr. 20, 21. Third edit. 1822. + Class 1. Ord. 1. Gen. ix, Spec. 111.

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