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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![instances, it is of a pale colour, and so soft as to be very easily laccratcJ. The xpken is very generally altered in structure in fever. This alteration consists in unusual softness, in some instances to such a degree that the organ is reduced almost to a pulp, and breaks down on the slightest pressure: it is generally ac- companied with enlargement, though seldom to any considerable extent, while its colour is changed to a very dark purple or a reddish black. This softened state of the spleen has been ob- served in every stage of fatal cases of fever; in those who perish early, as well as in those in whom the disease is more protracted ; it does not appear to have an inllammatory origin, since its capsule is generally sound. From this extreme softness in some forms of fever, more especially typhoid fever, and in diseases of putrescency, such as scurvy, it is probable that a morbid condition of the fluids has a peculiar effect on the structure of this organ, though we know of no symptoms which indicate this particular lesion. In one case which came under the care of the writer of this article, at the London Fever Hos- pital, a small circumscribed abscess was found in that portion of the spleen which is connected with the diaphragm. In this instance symptoms of pleurisy of the left side arose in the progress of fever, which did not yield to the ordinary treat- ment. The patient eventually died ; and on dis- section, a small tumour of the size of an egg was observed in the centre of the diaphragm, which gave at first the idea of diaphragmatic hernia. On more close inspection it was discovered to be an abscess in the spleen, which had formed an attach- ment to the diaphragm, through which it had so far penetrated as to be covered only by the thin transparent pleura. It appeared just about to burst into the left side of the chest. The general structure and size of the organ were otherwise healthy. Patliology of the Fluids in Fever.— That the fluids are changed in fever is evident from the altered state of the various secretions, as well as from certain appearances which have been ob- served in the blood itself. This subject, though of the utmost importance, has been hitherto almost entirely neglected, probably in consequence of the pathologists of the present day being more dis- posed to investigate the morbid changes which take place in the solids, and consequently to trace the causes of the phenomena of fever to disease in them, rather than to any alteration in the blood itself. The doctrines of humoral pathology which pre- vailed for many centuries were not founded on direct experiments, but on vague conjectures, from observation of the constant and uniform vitiation In the fluids. Chemical analysis in those days had not attained the perfection necessary to dete'ct the various changes which the blood and fluids were supposed to undergo ; and, in later times, Ihe acknowledged difficulty of such experimental mquiries, with the zeal with which morbid ana- tomy is cultivated, will account for the slow pro- jjress of this department of pathology. That the blood does undergo changes in fever was always conjectured : that certain changes pre- cede its development, and that certain alterations in its component principles do arise in its progress, is not only highly probable, but, as has been al- ready stated, some modern pathologists do not hesitate to aflirm that a vitiated state of the blood is the origin, source, or proximate cause of the disease. It has been often observed by practical physi- cians, that the blood drawn from persons labour- ing under fever differs according to the type and the duration of the disease. In cases which beai the inflammatory character, the coagulum is firm, the fibrine abundant, or in greater relative propor- tion to the water and albumen : in some instances the coagulum is so dense that little or no serum is separated. This condition of the blood may or may not be accompanied with a buffy coat. There appears, however, in the progress of fever, to be a gradual diminution of the fibrinous principle ; the coagulum being not only small in proportion to the serum, but of a loose soft tex- ture. Upon what this diminution of the fibrine, and of the force of aggregation by which its par- ticles are kept together, depends, neither physi- ology nor chemistry has yet discovered ; all that in the present state of medical science we do know on this point, are the facts stated. Dr. Clanny has endeavoured by well-contrived experiments to determine with accuracy the relative loss or dimi- nution of fibrine at the various periods of fever, and certainly his investigations on this curious subject deserve attention. (Lecture on Typhus Fever.) [The examination of the blood drawn in the typhoid affection has not led to any decisive results. It was affirmed by M. Bouillaud that it does not resemble that of any other disease ; but this is denied by M. Louis. It would seem, however, from the observations of MM. Andral and Ga- varret and M. Raciborski, that it is generally less coagulable than in other morbid conditions. The quantity of fibrin is certainly decreased. (Andral^ Hematologie Pathologique, Paris, 1843; or Amer translation by Drs. Meigs and Stille, Philad, 1844.] The changes which take place in the secretions in the progress of fever, and which are so evident to the senses, depend in some measure on the general disturbance which takes place in every organ of the body, as well as on the condition of the blood. It is evident that if this fluid, from which all the secretions originate, be in a morbid state, the fluids which are eliminated from the parent source, must likewise be in an unhealthy state. The changes which the individual secre- tions undergo in fever have not been ascertained by chemical experiment, the knowledge we have of their vitiation being derived exclusively from observation. Crisis of Fever.—From the earliest periods of medicine, the termination of acute diseases, more especially fevers, was observed to be pre- ceded or accompanied by certain appearances or symptoms which indicated a favourable or unfa- vourable termination of the malady. Hence the origin of the term crisis (from Kph^, judgment), and the days on which these changes occurred were called critical days. The crisis was regarded as salutary when an evident amendment or complete cure accompanied or followed the change; perfect when there was an](https://iiif.wellcomecollection.org/image/b21116817_0172.jp2/full/800%2C/0/default.jpg)
