LECTURE X.

PNEUMONIC FEVER.

PNEUMONIC fever is another variety of febrile disease which requires special remark, because not only of the discrepancies in opinion regarding it, but on account also of the general prevalence of the disease in all the Southern States during the winter season. The common doctrine has been, that pneumonia is primarily a local disease, an idiopathic inflammation of the lungs, and that the fever which attends upon it is a secondary affection, or symptomatic fever, caused by the irritation proceeding from the local affection. And doubtless it is true of the lungs, as of other organs of the body, that they are liable to idiopathic inflammation, causing symptomatic fever. Perhaps in a large majority of cases in non-malarious regions, the disease is a local one in its inception and early stages, and sometimes this may be its character also in malarious districts. But it is undoubtedly true, that in these latter, with which we have to do in the practice of our profession, the fever is almost uniformly the primary affection, and the local lesion

which gives the disease its name is secondary, and the peculiar local lesion of the fever.

These views, which I have for many years held, and upon which I have constantly acted in the treatment of this disease, have, as some of you may chance to know, been called in question, and most ably controverted. A short and unpretending essay of mine upon this subject, first published in the New-Orleans Medical Journal, and afterward issued in a pamphlet form, had a principal agency in the production of a large octavo volume, by Doctor La Roche, of Philadelphia, one of the most elaborate and able medical writers America has produced. The exclusively local character of the disease is in that work most ably advocated, and at such length, as to quite exhaust the argument on that side of the question; but with the full acknowledgment that the local and general disease, the inflammation of the lungs, and the fever, are often most intimately blended; but not in such manner as to make it proper to direct our means of cure primarily to the relief of the general disease, rather than the local. The argument of Dr. La Roche on the origin and influence of malaria, in the work to which I refer, is very ample, eloquent, and comprehensive, leaving little to be said on that side of the question by others. But he has not proved, nor can it be proved, that malaria, or any other reputed cause of fever, does not give rise to a febrile affection, that

may have its most prominent local lesion in the lungs as well as in other organs of the body; the former being the primary and the latter the secondary affection.

In my brief essay, before referred to an essay of only seven pages-which was read before the Memphis Medical Society in 1851, I made the following observations, which were taken as a sort of text for the ponderous volume of my distinguished friend: According to my observations, the pneumonias which prevail in this country are really and substantially nothing more than a peculiar form of remittent or intermittent fever. This pro

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tean character of our fevers arises in part from the season of the year and the particular localities in which they occur; but mainly from the organs of the body which become involved in the diseased action, the predominance of inflammation, or congestion, and the character of periodicity. In the spring, we are apt to find these diseases assuming the names which have reference more particularly to this periodicity and general pathology. As summer comes on, the greater complication of the hepatic organs changes. the name, or adds an epithet to designate a prominent symptom. In autumn, the chylopoietic viscera become more strikingly involved in the diseased action; and this again is indicated by an ever-changing nomenclature. But when winter approaches, and the

subjects are exposed to sudden transitions of temperature, the thoracic viscera are called upon to bear the burden of local disease, and then it is that the names pleurisy, pneumonia, pneumonia typhoides, pneumonia biliosa, pleuro-pneumonia, bilious pleurisy, lung fever, etc., become familiar sounds."

Now, to show you that such views are not singular, you may see, on perusing this remarkable work of Dr. La Roche, that they have been sustained by many distinguished medical writers; such, for instance, as Lancisi, the great originator of the doctrine of miasm; Sydenham, the projector of the most convenient of all etiological theories, the "epidemic constitution of the atmosphere;" Cleghorn, the philosophical observer of the diseases of Minorca, so similar to our own; Rush, the father of American medicine, and the true expounder of the fevers of Philadelphia ; Copland, Good, Broussais, Watson, Chalmers of South-Carolina, and Condie, Wood, Bell, and others, of Philadelphia. Many other distinguished names might be added, but these are enough for my present purpose, which is to show you, that the doctrines which I am advocating are not peculiar to myself. I only claim the credit, if there be any credit in it, of discovering the applicability of these doctrines to the disease as it prevails in the South, and of calling to it the attention of physicians, and especially of physicians from the North practising in the South.

As in other forms of periodic fever, this disease comes on with a chill, passing through the different stages of the paroxysm; but in most cases, the early paroxysms are mild and transitory. These become more and more severe at every succeeding recurrence, and no signs of the pneumonic affection appear for several days. Condie says: "In many instances, it is only after the fever has continued several days that pain in the chest is complained of." Wood remarks, that "in those cases in which the fever is the primary affection, the chill and febrile symptoms generally precede those proper to the pneumonia for one, two, or three days, and sometimes a longer period." Bell, after speaking of the febrile symptoms, goes on to say: "To-day the patient complains of gastric symptoms; to-morrow, of a tendency to cerebral congestion; subsequently, of rheumatic pains; until finally the pneumonia discloses itself." Do these look like proper descriptions of idiopathic-pneumonitis? They describe the early stages of pneumonic fever very well, but the descriptions are equally well suited to the early stages of gastric, enteric, and hepatic fever. When periodic fever first assails the human constitution, no one can certainly determine what will be its ultimate character, and what particular organ of the body is destined to suffer most, except from a knowledge of the epidemic influences prevailing. Indeed, nothing is more common, than for other organs than