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

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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$ports an intense degree of this lesion; t'ne adynamic (typhus mitior) is regarded as gastro-enteritis which has assumed such a degree of intensity that the general powers decline, while the intellectual functions are more or less disturbed. The more malignant forms of fever (typhus gravior) are supposed to be gastro-enteritis complicated with irritation of the brain, from sympathy with the state of the alimentary canal; and when fetor of the breath, perspiration, and stools are observed, the disease becomes what has been termed putrid fever,—that is, putrid symptoms are superadded to the primary gastric inflammation. It cannot, however, be conceded that in every form of fever this local disease does exist, as it has not been universally, nor even in the majority of instances, discovered on the most minute exami- nation of the intestines in fatal cases. The more probable inference is, that this gastro-enterite, or follicular disease, occurs only occasionally, and that it is much more common in some places than in others. We know that it is observed more frequently in the fevers of France than in those of Britain ; very rarely, if ever, in the epidemic fever of Ireland ; and that it is only occasionally met with in the epidemic visitations in the northern districts of England and Scotland. From its being observed in a greater proportion of cases in London and Manchester, it is probable that there are some local causes or circumstances in particular places, which produce this intestinal affection. Whether in those cases in which it has been found after death, (for we maintain that the pathognomonic or diagnostic symptoms by which it has been supposed to be indicated are by no means uniform or satisfactory,) it be the cause or effect of the febrile symptoms by which it is ac- companied, is still a question about which there is great difference of opinion, though the majority of British physicians regard these intestinal lesions as only the sequeloB or consequences of fever. [Of late years, many of the French, and some of the American, pathologists have maintained, that the intestinal follicular lesion, referred to above, is characteristic of one form of continued fever—the typhoid. To this view reference will be had hereafter. It is not uncommon in the United States. Dr. Bartlett (^Hisfori/, Diagnosis, and Treatment of Typhoid and of Typhus Fever, &c. p. 86, Philad. 1842) considers the red-tongue fever of Kentucky to belong to it.] The assertion that the treatment founded on the gastro-enteritic pathology is the most success- ful, is only an assumption; indeed, it may be fairly inquired how many hundreds annually sur- vive the treatment calculated to increase gastric inflammation — how many are daily stimulated with bark, wine, and ammonia, and yet recover 1 Besides, how can this doctrine be applied in ex- planation of the phenomena of intermittent fever? In France as well as in this country, periodic fevers are successfully treated by stimulants — bark, and even arsenic ; not to allude to the com- plete suspension of the febrile paroxysm for twen- ty-four, forty-eight, seventy-two hours, or even longer. These circumstances, when duly weighed, must :n our opinion disprove the general conclusion, lh«« pvery form of fever is the result of gastric inflammation. On the other hand, we are bound to admit the occasional existence (more frequent in some localities than in others) of the various intestinal lesions, which have been so minutely and elaborately described by the French patholo- gists, to whom, if this discovery be not entirely due, the merit must be conceded of having, with indefatigable labour, followed up the few hints which previous writers had thrown out, and thus brought to perfection one of the most important pathological facts connected with the morbid ana- tomy of fever. The celebrated Pinel took a more extended view of the nature of fever than any preceding writer of the continental school. He distinguished symptomatic from primary or essent'al fevers, and comprehended under this latter class, acute dis- eases in which there is a quick pulse, hot skin, and disorder in the various functions, the symp- toms being independent (as he supposed) of local disease. While he admitted, however, in his classification, the existence of fevers without pri- mary disease in any organ, he evidently localised the varieties when he stated that the seat of in- flammatory fever {angeio-tenic) was in the organs of circulation ; that the origin of bihous fevers (^meningo-gasfric) was in the mucous membrane of the intestines; that a particular form of gastric fever (^adeno-meningeal) depended on disease of the mucous follicles alone ; that in another variety (iitaxic') the brain and nervous system were chiefly affected ; another type (^udynainic') being charac- terized by great prostration or depression of the vital powers, and often complicated with symp- toms which have been usually referred to pu- tridity. These views have been since partially adopted, and have evidently given origin to the doctrine entertained by a large proportion of physicians of the present day, that fever is an essential disease, that is, the symptoms are independent of primary organic lesion ; though it is admitted that in the majority of cases, local inflammations become de- veloped in its progress, and constitute the principal source of the severity or danger of the disease. The doctrines of Brown, which had obtained, as we have stated, comparatively few converts in his own country, made a strong impression in the north of Italy. Rasori, who had visited the medi- cal school of Edinburgh, was so enamoured with the Brunonian system, that, on his return to Italy, he published a compendium of this system, (to which the learning and ingenuity of Darwin had given a new impulse,) as well as a translation of the celebrated Zoonomia of Darwin. A few years afterwards, however, a petechial fever appeared at Genoa, in which the stimulating treatment recommended by Brown was evidently so injurious, and positively fatal, as to induce Rasori to reconsider the theory. He then became convinced of its inconsistency and error, and ulti- mately acknowledged this conviction in an account which he published of the epidemic of Genoa. (Storia della Febre Petech. di Genoa. Del Prof. Giovanni Rasori.) This epidemic, from whatever causes it arose, had many of the characters of what Brown termed an asthenic disease, and was consequently treated by stimulants. From thf numbers who perished under this plan, and from$