LECTURE II. FEVER. FEVER is known sometimes to be symptomatic of some local affection, as when produced by a wound, or injury of some kind, causing active inflammation, and affecting the whole system by sympathy. Some have concluded, therefore, that all fever is necessarily symptomatic. Indeed, so common has been this view, that some authors have been unable to conceive how fever can otherwise exist. They are unwilling to acknowledge that fever is, or can be, an essential disease, or a disease sui generis; and, for some reason unexplained and unexplainable, they prefer to consider it a mere symptom of some other disease. Hence the extraordinary efforts made to discover some one lesion, as the invariable cause of fever. This, as I have already shown you, is the high ambition of certain celebrities of the French school of medicine; but they are as yet unable to agree upon the particular lesion necessary, or even to designate any one which invariably exists, either as a condition precedent or concomitant. But, however strongly inclined to respect high au thority in these matters, we are forced by observation and experience to believe, that fever may, and often does, exist as a condition precedent, and that these local derangements and complications just as often follow attacks of fever as consequences. They are dependent for their locality in these cases, probably, upon epidemic influence, or upon some peculiar susceptibility of the organ or tissue affected. In winter, the action of the cold air, and sudden transitions of temperature upon the lungs, seem to predispose these organs to the disordering influences of febrile action, and we have pneumonic fever prevailing, to the almost entire exclusion of other forms. At other seasons, the brain, stomach, intestines, liver, etc., become the more susceptible and impressionable organs, and hence the more common complications-phrenitis, gastritis, enteritis, hepatitis, etc.; and the fever, after such development occurs, must be treated with special reference to the local lesion, wherever it may appear. The local lesion once begun, and sustained by the retroactive influence of the fever, may proceed to an extent dangerous to life. Reacting upon the whole system as a local irritation from any other cause, its tendency is to prolong, and in some respects to change the character of the fever to which it owed its origin. The suffering and danger resulting will depend upon the intensity of the fever, its duration, and especially upon the organ or tissue principally affected. The difference in the intensity and danger of cases may approximate very nearly to the difference existing between such local affections appearing as primary diseases. Many of the symptoms are, indeed, the same as in local inflammations proceeding from other causes, and the indications of cure are similar. But while contending for these local lesions as the common effects of fever, we must be careful not to ignore their existence as causes; although it is true that they rarely occur as such in this climate. Cerebritis, gastritis, enteritis, pneumonitis, etc., are rare diseases in this climate, except as local lesions of prevailing fever; but whenever they do occur from other causes, symptomatic fever may or may not attend upon them, being caused, no doubt, when it does appear, by the constitutional irritation resulting from the local disease. In such case, the local lesion is, of course, the primary, and the fever the secondary affection, standing in relation to each other as cause and effect. Now, all these things will appear to you as little more than truisms; and yet it seems to be necessary to state them, on account of the credit which is so largely given to the physiological doctrines, or the exclusive symptomatic system of modern writers. In the treatment of fever, it is of great importance to exercise a sound discrimination in regard to this matter of cause and effect, lest we may sacrifice human life by vain efforts to relieve a local affection, without due regard to the cause producing it. As well might we attempt the cure of ophthalmia, while the grain of sand which caused it is still in the eye. That all febrile excitement consists in morbid reaction, from a state of nervous depression, arising from some unknown cause, in idiopathic fever; and that, in all other cases, febrile action is caused by local irritation, affecting the whole system by sympathy with a particular part, will, I think, be denied by very few physicians in the South, whatever may be the opinions entertained elsewhere. And I judge from the writings of distinguished foreigners that the effects produced upon local organs and tissues by idiopathic fever here, are very much the same as in Europe. Thus we have, in winter, periodic fever, arising from some unknown cause, which, like the typhus and typhoid fevers of more northern latitudes as described by Stokes and others, almost constantly produce congestions and inflammations in the thoracic viscera; and with us, on this account, they are denominated pneumonia, pneumonic fever, etc., pneumonia in any other form being a rare disease here. So, also, in summer and autumn, for reasons not yet understood, the congestions and inflammations from the same cause appear mostly in the abdominal viscera, and our nomenclature is changed accordingly. This is said, also, to be the case in foreign countries, especially in Southern Europe. The fevers of Spain, Italy, and the South of France, as described by medical writers, are the same as in the Southern States, even to the occasional appearance of gastric or yellow fever, sporadic or epidemic; and, of course, they are attributable to the same cause. In Great Britain and Ireland there has been some dispute as to the general existence of the periodic feature in connection with fever; but there are physicians in those islands, not a few, who acknowledge its prevalence, and who adopt the antiperiodic treatment. Especially is this true of those physicians who have resided in southern colonies, and who have thus, from their own observations, become good judges of this matter. It seems to me not improbable that a difference of opinion may arise from the fact, that the different stages of fever in those northern countries are less distinctly developed; and it may be that the febrile lesions appear at an earlier period, reäcting upon the system by constitutional irritation, and thus exhibiting early signs of symptomatic fever, as an effect of this local disease. In the Northern States there is the same difference of opinion. The physicians of Philadelphia, who have given us pretty much all that is valuable in medical authorship in America, acknowledge the periodic character of their fevers, particularly those of summer and autumn; and they employ the bark and its salts scarcely less freely than we do in the South; while in New-York and Boston |