Pyrectica. Fevers. Proximate cause. V. Organic disease. Fevers hereby confounded with inflammation. ORDER I. every kind, regarding them merely as so many varieties of one specific disease, originating from this one common cause*. But this is to confound fever with local inflammation, the idiopathic with the symptomatic affection. In treating of inflammation under the ensuing Order, we shall have sufficient opportunities of seeing that an inflamed state of almost any organ, and especially of membranous organs, or the membranous parts 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 peritonæum, and the brain, have an equal claim to be regarded as furnishing a proximate cause of fever when in a state of inflammation. Fevers identified with inflammations by Marcus. 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 Bavaria, who has contended with similar strenuousness for the identity of fever and inflammation, has regarded all 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 +. Treatise on Fever, 8vo. †M. Gaultier de Clanbry, Vide Journ. Gen. de Médicine, Avr. 1823, and M. Tacheron, Recherches Anatomico-Pathologiques sur la Medicine Pratique, &c. 8vo. 3 Tomes, Paris, 1823. Fevers. cause. to an iden The general answer, however, to pathologists of every ORDER I. description who thus confound or identify fever with in- Pyrectica. flammation, whether of a single organ or of all organs Proximate equally, is, that though fever is commonly a symptom v. Organic or sequel of inflammation, inflammation is not uncom- disease. monly a symptom or sequel of fevers. And hence, Objections though post-obit examinations, in the case of those who tification of have died of fever, should show inflammation in the inflammabrain, 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. Fordyce," is a disease that affects the whole system; 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." * tion and Fever as described by Fordyce. sult. Proximate cause little The result of the whole, as observed at the outset of General rethis introduction, is that we know little or nothing of the proximate cause of fever, or the means by which its phænomena are immediately produced. In the language known. of Lieutaud applied to the subject before us, they are too often atrâ caligine mersæ; nor have any of the systems hitherto invented to explain this recondite inquiry, hów * On Fever, Dissert. 1. p. 28. ORDER I. Pyrectica. Fevers. Remote causes of fever. Regarded by Cullen as sedative powers. Marsh and human cffluvia re mote causes. Auxiliary remote causes of Cullen. ever ingenious or elaborate, answered the purpose for which they were contrived. From the proximate cause of fever let us next proceed to a few remarks upon its REMOTE causes. Dr. Cullen, who has striven so strongly and so ingeniously to simplify the former, has made a similar attempt in respect to the latter. He first resolves all remote causes into debilitating or sedative powers, instead 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. These sedative or debilitating causes he reduces to two: MARSH and HUMAN effluvia. To the former of 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 contagions, and the power of producing continued fevers. 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 * Pract. of Phys. Book. 1. Ch. iv. Sect. xcvi. to the rest; "yet even this", says he, "is commonly ORDER I. only an exciting cause concurring with the operation of human or marsh effluvia."* Pyrectica. causes. Sufficient weight not We shall find, as we proceed, that these complemental causes may admit of addition; as we shall also that they 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. very them. between marsh and human effluvia of no great contagion, No great benefit, however, has resulted from endea- Distinction vouring to draw a line of distinction between these two terms, and hence it is a distinction which has been little attended to of late years. Miasm is a Greek word, importing pollution, corruption, or defilement generally; benefit, and contagion, a Latin word, importing the application of Miasm and 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 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 while to follow up the refinements of those writers who deny, and endeavour to disprove the existence of contagion under any form or mode of origin‡. Such spe * Pract. of Phys. Book 1. Ch. IV. Sect. XCII. 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. Miasm how applied by Sauvages. The denial of contagion hardly worth at tending to. ORDER I. Pyrectica. Fevers. Remote causes. All mias mata morbid ferments, of various kinds and from various sources. Those of exanthems distinct and specific. Those of marsh and culations may be ingenious and very learned and find amusement for a leisure hour in the closet, but they will 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 weight of his authority. All specific miasmata may be 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, 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 atmosphere and all salubrities of district, and travelling with the rapidity of the fleetest epidemy. They are of various kinds, and appear to issue from various sources, but we 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 subject of observation, differing only in circumstances that may be imputed to season, climate, and other external causes, or to the peculiar constitutions of the individuals 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. But can we say the same of the supposed two distinct miasms of marsh and human effluvia? Is it equally true that the former has never produced any other than interequally so; mittent fever, or the latter any other than continued? human effluvia not * Johnson, Influence of Tropical Climates, &c. pp. 20, 21. Third edit. 1822. Class 1. Ord. 1. Gen. 1x. Spec. 1. |