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of extending this energy to the extreme vessels, of restoring therefore their action, and thereby especially overcoming the spasm affecting them ; upon the removing of which, the excretion of sweat, and other marks of the relaxation of excre. tories, take place.
47. This doctrine will, as I suppose, serve to explain not only the nature of fever in general, but also the various cases of it which occur. Before proceeding, however, to this, it may be proper to point out the opinions, and, as I apprehend, the mistakes, which have formerly prevailed on this subject.
48. It has been supposed, that a lentor or viscidity prevailing in the mass of blood, and stagnating in the extreme vessels, is the cause of the cold stage of fevers and its consequences. But there is no evidence of any such viscidity, previously subsisting in the fluids; and, as it is very improbable that such a state of them can be very quickly produced, so the suddenness with which paroxysms come on, renders it more likely that the phenomena depend upon some cause acting upon the nervous system, or the primary moving powers of the animal economy. See Van Swieten apud Boerh. aph. 755.
49. Another opinion, which has been almost
universally received, is, that a noxious matter ina troduced into, or generated in, the body, is the proximate cause of fever; and that the increased action of the heart and arteries, which form so great a part of the disease, is an effort of the vist medicatrix nature to expel this morbific matter ; and particularly to change or concoct it, so as to render it either altogether innocent, or, at least; fit for being more easily thrown out of the body. This doctrine, however, although of as great antiquity as any of the records of physic now remaining, and although it has been received by almost every school of medicine, yet appears to me to rest upon a very uncertain foundation. There are fevers produced by cold, fear, and other causes, accompanied with all the essential circumstances of fever, and terminating by sweat; but, at the same time, without any evidence or suspicion of morbific matter.
There have been fevers suddenly cured by a hemorrhagy, so moderate as could not carry out any considerable portion of a matter diffused over the whole mass of blood ; nor can we conceive how the morbific matter could be collected or determined to pass by such an outlet as in that case is opened.
Even supposing a morbific matter were present; there is no explanation given in what manner the concoction of it is performed; nor is it shewn that any such change does in fact take place. In cer. tain cases it is indeed evident, that a noxious matter is introduced into the body, and proves the cause of fever: but, even in these cases, it appears that the noxious matter is thrown out again, without having suffered any change ; that the fever often terminates before the matter is expelled ; and that, upon many occasions, without waiting the supposed time of concoction, the fever can be cured, and that by remedies which do not seem to operate upon the fluids, or to produce any evacuation.
50. While we thus reason against the notion of fever being an effort of nature, for concocting and expelling a morbific matter, I by no means intend to deny that the cause of fever frequently operates upon the fluids, and particularly produces a putrescent state of them. I acknowledge that this is frequently the case: but, at the same time, I maintain, that such a change of the fluids is not commonly the cause of fever; that very often it is an effect only; and that there is no reason to believe the termination of the fever to depend upon the expulsion of the putrid matter.
51. Another opinion which has prevailed, remains still to be mentioned. In intermittent fevers, a great quantity of bile is commonly thrown out by vomiting; and this is so frequently the case, that many have supposed an unusual quantity of
bile, and perhaps a peculiar quality of it, to be the cause of intermittent fevers. This, however, does not appear to be well founded. Vomiting, by whatever means excited, if often repeated, with violent straining, seems to be powerful in emulging the biliary ducts, and commonly throws out a great deal of bile. This will happen especially in the case of intermittent fevers : for, as in the state of debility and cold stage of these fevers, the blood is not propelled in the usual quantity into the ex. treme vessels, and particularly into those on the surface of the body, but is accumulated in the ves. sels of the internal parts, and particularly in the vena portarum ; so this may occasion a more copious secretion of bile.
These considerations will, in some measure, account for the appearance of an unusual quantity of bile in intermittent fevers; but the circumstance which chiefly occasions the appearance of bile in these cases, is the influence of warm climates and seasons. These seldom fail to produce a state of the human body, in which the bile is disposed to pass off, by its secretories, in greater quantity than usual; and perhaps also changed in its quality, as appears from the disease of cholera, which so frequently occurs in warm seasons. At the same time, this disease occurs often without fever; and we shall hereafter render it sufficiently probable, that intermittent fevers, for the most part, arise from another cause, that is, from marsh effluvia;
while, on the other hand, there is no evidence of their arising from the state of the bile alone. The marsh effluvia, however, commonly operate most powerfully in the same season that produces the change and redundance of the bile; and therefore, considering the vomiting, and other circumstances of the intermittent fevers which here concur, it is not surprising that autumnal intermittents are so often attended with effusions of bile.
This view of the subject does not lead us to consider the state of the bile as the cause of intermittents, but merely as a circumstance accidentally concurring with them, from the state of the season in which they arise. What attention this requires in the conduct of the disease, I shall consider hereafter.
52. From this view of the principal hypotheses which have hitherto been maintained with respect to the proximate cause of fever, it will appear, that fevers do not arise from changes in the state of the fluids; but that, on the contrary, almost the whole of the phenomena of fevers lead us to believe, that they chiefly depend upon changes in the state of the moving powers of the animal system. Though we should not be able to explain all the circumstances of the disease, it is at least of some advantage to be led into the proper train of investigation. I have attempted to pursue it, and