Observations on Cullen's system and doctrines of fever, shewing the necessity of their being abandoned ... forming the third communication on fever / [John Mackintosh].

  • Mackintosh, John, -1837
Date:
[1828]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on Cullen's system and doctrines of fever, shewing the necessity of their being abandoned ... forming the third communication on fever / [John Mackintosh]. Source: Wellcome Collection.

    9/10 page 279
    He then proceeds, in the following paragraphs, to state the circumstances in which sweating is to be avoided, and his reasons why it is injurious in some cases ; and in the 166th paragraph he is com¬ pelled to make the following clumsy ex¬ planation :—“ In these cases, it is pro¬ bable, that either an inflammatory dia¬ thesis is produced, which increases the spasm on the extreme vessels, or that, from other causes, the spasm is too much fixed to yield easily to the increased ac¬ tion of the heart and arteries ; and, upon either supposition, it must be obvious, that urging the sweat, is ready to produce a hurtful determination to some of the in¬ ternal parts, and maybe attended with very great danger.” It is an axiom in life, that he who tells one falsehood is fre¬ quently under the necessity of sinning an hundred times to support the first error. In like manner, it will be seen, on a careful perusal of Cullen’s whole system, that he is obliged, in every page, to com¬ mit outrages upon common sense to sup¬ port his first error. Having formed cer¬ tain opinions, he endeavours in vain to make the facts fit them. This is well seen, if his definitions of diseases are contrasted with nature at the bedside. I must crave a little patience from my rea¬ ders, while I examine the plain unsophis¬ ticated meaning of the expression “ spasm of the extreme vessels ,” as used by Cullen and others—the importance of this point will be presently admitted. I shall allow for the sake of argument, that the ex¬ treme vessels have mouths, even that they are ^ part of an inch in diameter, and that they are provided with muscular fibres, although even Dr. Gregory con¬ fesses no anatomist had ever seen them. Allowing all this, the term “spasm of the extreme vessels” surely means nothing else than a morbid contraction of these vessels. But Cullen, in the last sentence of the 44th paragraph, and likewise in the 45th also, speaks of an “ atony of the extreme vessels.” What is the meaning of this term ? Is it not a defect of muscular con¬ traction of the same vessels ? Can these two opposite morbid conditions exist at the same time ? Can a morbid contrac¬ tion (spasm) and a morbid relaxation (atony) co-exist in the same vessels ?— Gentle reader, if you feel your under¬ standing rather insulted by these queries. the injury is not inflicted by me, but by Cullen and his disciples. Attend to Cul¬ len’s statement, first, with respect to the existence of spasm as an essential part of the proximate cause of fever. “ The idea of fever, then, may be, that a spasm of the extreme vessels, however induced, proves an irritation to the heart and arteries, and that this continues till the spasm is re¬ laxed or overcome,” &c.—par. 41. And, again, in the 40th paragraph, as I have formerly shown, he speaks of an universal spasm on the extremities of the arteries during the cold stage ; that this spasm continues and supports the hot stage, “ for (says he) this stage ceases with the flowing of the sweat, and the return of other excretions, which are marks of the relaxation of the vessels formerly con¬ stricted.” But the following strange con¬ tradiction will be found in the last sen¬ tence of the 44th paragraph :—“ From the whole we have now said on the sub¬ ject, I think it is sufficiently probable, that the symptoms of anorexia, nausea, and vomiting, depend upon, and are a proof of, an atony subsisting in the ex¬ treme vessels on the surface of the body, and that this atony, therefore, now ascer¬ tained as a matter of fact, may be con¬ sidered as a principal circumstance in the proximate cause of fever.” This atony we suppose to depend upon a diminution of the energy of the brain, and that this takes place in fevers we conclude, not only from the debility prevailing in so many functions of the body mentioned above, but particularly from symptoms which are peculiar to the brain itself.” .1 deem it unnecessary to make any comment upon these strange and contra¬ dictory statements ; they always surprised and confounded me when a student, and, however ingenious some people may still think the doctrines of Cullen, I cannot help expressing my honest conviction that they are downright nonsense. If Cullen meant any thing, it must be ac¬ knowledged to be erroneous, to say the very least of it. But, it may be said, he meant nothing. In either cas'e, why should the profession cling to such a rotten system of pathology? It is necessary now to put two questions ; 1st. to Teachers of Medicine. Why do you so generally laud this system, as being the most splendid edifice in medicine, and insist on students-
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image