The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![view, admitteJ, however, that from particular cir- cumstances, other organs became occasionally im- plicated. Though this theory evidently implied that fever was dependent on local inflammation, it gave the disease a wider range—it assumed in- flammation of the brain to be the source of fever, but that from the operation of certain causes, other irritations were in some instances superadded. Marcus and Clutterbuck have subsequently adopt- ed this view, and have severally adduced argu- ments in its favour. Admitting, however, that the various exciting causes of fever do in some instances exert their action on the brain, we have no evidence that they produce, in the first instance, inflammation in this organ : on the contrary, the symptoms denote that the nervous system has only received a peculiar and powerful impression. When, on subsequent re-action taking place, a general impulse is given to the circulation, and the nervous system is roused from its depression, inflammation of the brain does frequently take place, especially in young plethoric subjects, just as it may supervene in any other organ to which, from causes hereditary or acquired, the individual may be predisposed. It should also be impressed on those who are inclined to adopt this doctrine, that although in a considerable proportion of per- sons who die of continued fever, the membranes, and frequently the substance of the brain, bear unequivocal marks of inflammation, yet such morbid appearances are by no means invariably observed. We are next to advert to the doctrine which as- cribes the phenomena of fever to primary affection of the intestinal canal. Lesions of the intestines in fatal cases of fever had been long ago pointed out by those who devoted much attention to the study of morbid anatomy. Bonetus stated that on dissection of persons who died of malignant fever, he found the stomach and intestines inflam- ed. Bartholinus made a similar observation; and in the works of Sydenham, allusion is made to ulceration of the intestines in continued fever. Subsequently Roederer and Wagler (De Morbo Mucoso, Goettingffi, 1762) published a description of an epidemic mucous fever which prevailed at Gottingen, in which the appearances which were found after death in the alimentary canal are mi- nutely detailed. From these statements, it appears that the morbid appearances in the alimentary canal had attracted the attention of pathologists long before the promulgation of the theory in France, that fever was the result of inflammation of the mucous membrane of the intestines. This view, which was first maintained by Broussais more than twenty-five years ago, has become the prevailing opinion in France, though it has gained compara- tively few proselytes in other countries. (Examen des Doctrines Medicales et des Systemes de No- sologic, &c. Par F. J. v. Broussais. Prop de Mud. cxxxviii. cxxxix. Those who maintain the physiological doctrine of Broussais, contend that fever is entirely symp- tomatic of irritation or inflammation of the mucous membrane of the intestines. The leading principle of this theory is, that every irritation which is capable of producing an impression on the brain is reflecte'' by this organ on the mucous mem- brane of the bowels. Broussais applies it to other acute diseases; for instance, in small-pox or measles, the inflammatory excitement by which they are accompanied is supposed to be first con- veyed to the brain, and afterwards reflected on the mucous membrane of the intestinesi, and that thus inflammation (gastro-enterite), the supposed cause of these eruptive fevers, is produced. It is affirmed that inflammation and its conse- quences are invariably found in the mucous lining of the intestines, on examination of persons who have perished from fever, and that the treatment which is founded on this view is the most success- ful. Broussais, indeed, asserts with unparalleled boldness, that the tables of mortality declare in favour of the new doctrine, and that its influence on the population would be more favourable than vaccination itself. Though Roederer and Wagler, Prost, (La Me- decine eclairee par I'ouverture des Corps), Baillie, (Morbid Anatomy), and others, had previously delected morbid appearances in the bowels, in their dissections of persons who had died of fever, the theory of Broussais, that inflammation of the mucous membrane of the intestines is the cause of fever, had the eflfect of directing the attention of pathologists still more particularly to the condi- tion of the intestines in this class of diseases. In 1813, M. Petit and M. Serres* published the ac- count of a disease, very frequent in Paris in 1811, 1812, and 1813, which they called entero-mesen- teric fever, and which was characterized by all the symptoms of continued fever, but originated appa- rently in certain changes in the inferior portion of the small intestines and ileo-caecal valve, ac- companied with enlargement and suppuration of the corresponding glands of the mesentery. The precise anatomical lesion of the intestines, how- ever, was not ascertained by these laborious patho- logists, but subsequently by M. Bretonneau of Tours,! who, after investigating the subject with great minuteness, came to the conclusion that the primary source of fever was in the conglomerated mucous follicles, or glands, situated in the lower portion of the ileum and solitary glands of the cfficum. A most full and elaborate work has been lately published by M. Louis,^ in which the pathological views of Petit, Serres, and Bretonneau, as to the primary seat of fever, are confirmed. This author, moreover, has given a most minute account of the various secondary lesions which supervene on this supposed primary intestinal disease. These views of the nature of fever now prevail almost exclusively among the French pathologists. Mild fever is supposed to arise from gastro-enteritis alone, the various forms which it occasionally assumes being regarded as gastro-enteritis, with particular complications. For instance, inflamma- tory or ardent fever (a form rarely observed) uii * Traite (ie la Fievre Ent6ro-Meseiiterique ohservfee, reconiiiie, et signalee publiqiiemeiit a I'Hotel Dieu de Paris dans les ann6esl8]l, 1812, et 1813, par M. A. Petit, I'uti des M(idecins du dit Hopital, compose en partie par E. R. A. Serres, &c. f Trousseau, de la Maladie a laquelle M. Bretonneau a donnS Ie nom de dothin-ent6rite. Arch. G6n. de Med. X. 67. 1826. X Rpcherches Anatomiques, FathoHogiques, et Th6ra pcutiques sur la Maladie coiinue sui les noras de Giastrn Eaterite, &c. par P. Ch. A. Louis, M. D.](https://iiif.wellcomecollection.org/image/b21116817_0151.jp2/full/800%2C/0/default.jpg)
