CHAPTER I.

FEVER.

The term fever, in its original application, as is evident from the import of the corresponding word in Latin and in several modern languages, signifies heat. From this sense, however, a wide departure has long since been taken. When the nosological system of classification universally prevailed, the term was used to indicate a certain collection of symptoms, such as an abnornal degree of heat in the body, an accelerated pulse, a furred tongue, and a generally impaired state of the corporeal functions. Inasmuch, however, as very different pathological conditions may produce these symptoms, Cullen, at a somewhat later period, chose the the term pyrexia to mark these constitutional disturbances when arising from some local cause; and he limited the former term to the designation of similar symptoms, when the cause is some general and not well understood influence upon the physical system. It would be well now for the interests of medical science, if the profession would favor this distinction. At any rate, to avoid confusion of ideas, it is indispensible to remember, that the term is employed to indicate symptoms which arise from very dissimilar

causes.

When the cause is inflammation or any local disturbance, whatever, I call the constitutional excitement symptomatic fever, or pyrexia. On the contrary, when the cause is the existence of morbific matter in the current of the circulation (,whether this has been introduced from the atmosphere without, or by means of mal-assimilation within the system), I designate the disturbance as idiopathic fever, or fever more properly so called.

In the former case, that of pyrexia, the term employed is necessarily applied to the manifestations of disease; and, when the cause is purely imflammation of some part, the constitutional manifestations of that cause are sometimes characterized as inflammatory fever, the phrase being used in a sense somewhat more limited than that of symptomatic fever. In the sense of idiopathic

fever, the term should be understood to involve more immediately certain pathological conditions as giving rise to that constitutional excitement which manifests those conditions.

If this distinction should be rigidly observed, the term fever would distinctly characterize a class of diseases, pathologically considered; and all controversy, in regard to the recuperative efforts of nature as constituting fever, would be forever at an end. In this sense, however, the term embraces an extensive and important subject,-one which, though concer.ied, to some extent, with thoracic diseases, yet more appropriately belongs elsewhere, and which I design to discuss at length in another volume. In the sense of symptomatic fever or pyrexia, as the subject only involves directly the manifestations of existing local disease, it does not require any separate discussion.

CHAPTER II.

INFLAMMATION.

Inflammation is a term derived immediately from inflammatio, a Latin word, the root of which is inflammo, to burn or inflame. It is applied to a local disease, one prominent characteristic of which, is an abnormal degree of heat.

That some things, connected with the nature and manifestations of this disease, are complicated, and have, till of late, been involved in intricacy, I freely admit. In its most prominent features, however, it is exceedingly simple; and one cannot avoid the emotion of wonder, that numerous pages and even volumes have heretofore been written with little effect, except to make gross darkness the more visible. In the theories of medicine, indeed, as in those of theology, much talent has, on different topics, been wasted in dreamy speculations. The more acute have been the intellects employed, the more delicately, it is true, have hairs been split, but the less has been the amount of practical common sense exhibited. We need not historically come down to the days of Hahnemann, and of sugar globules, represented to possess power in proportion as they approach an infinitesimal division.

Homœopathy may be, indeed, the quintessence of professional nonsense; but that which is, at least, double-refined, has existed from an earlier period than any portion of the present century.

This lamentable truth has been made more evident on no subject than on that of inflammation. More than one hundred and fifty years since, Boerhaave taught the luminous doctrine, that inflammation is caused by viscidity of the blood, and an error loci of its particles, together with a morbidly acrimonious state of the fluids.. Next come the fanciful and frivolous notions of Stahl and Hoffman respecting the influence of the nervous system in producing inflammation. Passing forward to the middle of the eighteenth century, we find Cullen maintaining the theory, that, in inflammation, there is an obstruction of the blood, produced by "spasm of the extreme arteries, supporting an increased action in the course of them." Hunter, who was nearly contemporary with Cullen, supposed, that, when inflammation exists, there is "a distracted state of parts, which requires another mode of action to restore them to a state of health." This other and necessary mode he considered inflammation to be. Of course, in his opinion, it was a recuperative and not a morbid process.

Of late years, considerable controversy has been raised, by two conflicting and almost opposite opinions on this subject. Oue of these opinions makes inflammation depend on "increased action of the capillaries of the part;" the other, on "weakened action of the same vessels, and increased action of the trunks." In support of the one or the other of these opinions, English physicians, no less distinguished than Dr. Thomson, Sir Everard Home, Dr. Wilson Philip, and others of equal professional rank, have adduced their own experiments on living animals; but these experiments, though convincing to their authors, do not, as they are now viewed, establish either of the opposing theories.

Dr. George Hayward of Boston, late "Professor of the Principles of Surgery and Clinical Surgery," in the Medical Department of Harvard University, has been accustomed, in his Medical Lectures, to define inflammation to be "a diseased action of the capillary vessels, attended by redness, swelling, pain, and heat." In this definition, the Professor has certainly manifested talent, lying in one direction. In other words, he has shown ability to

speak with such vagueness, that, while he seems to utter an important sentiment, he really says nothing definite or of moment. Except those who embrace that absurd Hunterian notion, that inflammation is a process of recovery or increased physiological action, none, of course, can doubt, that, in it, there is an abnormal condition of the capillaries, and that redness, swelling, pain, and heat are phenomena attending the local disturbance; but What is the disease of the capillaries? and What is the proximate cause of those phenomena? These, and like questions, the only ones of importance in the case, are left wholly untouched. Besides, the same high authority has uniformly taught the medical students of the University, that, in the healing of a wounded part, the first recuperative process established is inflammation, and that, without this, neither an adhesion nor healthy granulations can be formed. In other words, the language, if I understand it, says, that, where, from any cause, there is a solution of continuity in any of the tissues, the first part of the curative process is a particular morbid action. So much for medical philosophy and consistency!

Having thus remarked upon the absurdities of those medical opinions which have, at different times, been entertained for nearly two centuries past, and having done this to show what inflammation is not, it becomes me now to attempt an illustration of what it is. I, therefore, immediately define inflammation to be a state in which the capillaries of the part affected are interrupted in their proper function, are morbidly relaxed, and are over-distended; and, in which the blood that is passing through them is first abnormally excited and chemically changed, and then stagnates and coagulates. This definition supposes a pathological and not a mere symptomatic view of the disease. Its symptomatology would merely say, that it consists in redness, swelling, pain, and heat, as these are the phenomena immediately attending it.

Here I would remark, that the nosological classification of diseases, formerly adopted by the profession, contemplated them, almost exclusively, as different groups of symptoms. The symptoms at any time existing, collectively considered, were called the disease. The causes of these symptoms were divided into proximate and remote. The proximate were what we now call the

disease itself, that is, the pathological condition giving rise to the symptoms. The remote causes were sub-divided into exciting and predisposing. The exciting were those which, by their immediate action, developed the pathological symptoms. The predisposing were all such influences as prepared the system to be affected by the action of immediate agencies.

In illustrating the disease now before me, I propose to consider its inherent nature, its causes, and its effects. In regard to the first of these particulars, I remark, that, when, for any cause, the nerves connected with the contractile fibrous tissue of the capillaries lose their power, the tension of the coats of the vessels is not preserved, and, as the consequence, the relaxation is immediately manifested by those vessels' becoming abnormally filled. This, I suppose, to be the usual way in which capillary congestion is effected. The relaxation is primary, and the over-distention secondary. The process may, however, and sometimes doubtless does, commence in the opposite direction. Arterial excitement, by increasing abnormally the current of the blood, may mechanically force open the capillaries, and the relaxation may occur, secondarily, as the effect of over-distention, in destroying the innervation. The former of these modes Dr. C. J. B. Williams calls that of congestion; the latter, that of determination of the blood. Both causes, may, indeed, exist at the same time. The vessels may morbidly relax and arterial excitement may occur simultaneously.

But, in whichever manner the fulness or congestion of the capillaries takes place, it can seldom be allowed long to remain without producing the characteristics of inflammation. There may, however, for a season, be capillary congestion without inflammation; but there cannot be inflammation without capillary congestion, as a primary part of the process. Capillary congestion is not inflammation, but inflammation is capillary congestion and something more.

In the commencement of inflammation, as the capillary vessels are beginning to be clogged, the onward current of blood is, of course, partially obstructed, and perturbation follows. When the part concerned is microscopically examined, the white globules and the red corpuscles are seen passing, for a time, in different directions, onward, backward, and obliquely. Soon the white