A Treatise on Fever

CHAPTER I.

Further Investigation of Fever necessary 1

Facilities afforded by the Fever Hospital for prosecuting the Study 5

Antient Doctrines relative to the Nature and Seat of Fever 7

Hippocrates, Galen, Sydenham 8

Modern Doctrines relative to the Nature and Seat of Fever 13

Cullen, Brown, Stoker, Burne, Clanny, Clutterbuck, Broussais 14

Errors common to all these Theorists 30

Questions to be solved before Fever can be understood 33

Precise Object of Investigation 34

Proper Mode of conducting it 36

CHAPTER II.

Varieties of Fever 41

Common Phenomena 42

Importance of analyzing the Assemblage of the Symptoms, in order to ascertain the Common Phenomena 43

Results of the Analysis 45

Organs always diseased in Fever 48

Functions always deranged in Fever 49

Fever not Inflammation 50

Distinction between Fever and Inflammation 52

Common Phenomena of Fever exemplified in Plague 53 in Yellow Fever, 54 in the Varieties of Fever of Great Britain 54

Different Varieties produced by different Intensities 58

Received Classification and Nomenclature defective 60

What is really meant by Genera and Species of Fever 70

True Principle of Arrangement 71

CHAPTER III.

Of Synochus 77

Division into Synochus Mitior and Gravior 77

Succession of Phenomena in Synochus Mitior 78

Indications afforded of Disease in the Nervous, Circulating, Secreting, and Excreting Systems 81

Progress of Disease consists in progressive Increase in the Derangement of these Functions 85

Phenomena of Recovery 91

On what the Transition of Synochus Mitior into Synochus Gravior depends 93

Classification according to the different Organs in which the several Affections have their Seat 95

Synochus Gravior with Cerebral Affection 96 Subacute Cerebral Affection 96 Acute Cerebral Affection 107

Cases illustrating Synochus Mitior 112

Cases illustrating Synochus Gravior with Subacute Cerebral Affection 114

Cases illustrating Synochus Gravior with Acute Cerebral Affection 116

Synochus Gravior with Thoracic Affection 120

Cases illustrating Thoracic Affection 123

Synochus Gravior with Abdominal Affection 128

Cases illustrating Abdominal Affection 137

Synochus Gravior with Mixed Affection 142

CHAPTER IV.

Of Typhus 148

Division into Typhus Mitior and Gravior 149

Typhus Mitior, with Subacute Cerebral Affection 149

Cases illustrating Subacute Cerebral Affection 155

Typhus Mitior, with Thoracic Affection 157

Typhus Mitior, Cases illustrating Affection 159 With Abdominal Affection 161 With Mixed Affection 162

Typhus Gravior 162 In what it really consists 162

Dangerous nature of the Error that it consists in Debility 164

CHAPTER V.

Of Scarlatina 168

Characters by which it is distinguished from Continued Fever without an Eruption 168

Division into Scarlatina Synochodes 171 Typhodes 172

Events which occasionally occur in Fever, but which form no essential part of it 173

Preternatural Sensibility over the external Surface of the Body; Excoration and Sloughing; Erysipelas; Inflammation, &c. of the Glands; peculiar Affection of the Joints 173

CHAPTER VI.

Of the Pathology of Fever 176

Importance of connecting the Symptoms with the States of the Organs 176

Pathology of Fever comprehends the Morbid Changes that take place in the Solids and Fluids of the Body 178

I. GENERAL PATHOLOGY OF THE SOLIDS 179

External Appearances of the Body after Death 180

Morbid Appearances in the Head 181 in the Thorax 184 in the Abdomen 187

I. Cases illustrating the Morbid Changes which take place within the Head, or Cerebral Cases 193

1. Vascularity of Brain, Spinal Cord, and Membranes, with Gelatinous or slight Serous Effusion 193

2. Vascularity of Brain, Membranes, &c. with Effusion of Coagulable Lymph and Formation of Pus 204

3. Vascularity of Brain, Membranes, &c. with copious Serous Effusion 210

4. Vascularity, &c. with Preternatural Firmness of Brain 218

5. Vascularity, &c. with softening of Brain 224

General Results established by preceding Cases 230

II. Cases illustrating the Morbid Changes which take place within the Chest, or Thoracic Cases 235

III. Cases illustrating the Morbid Changes which take place within the Abdomen; or Abdominal Cases 246

General Results established by preceding Cases 287

IV. Cases illustrating the Morbid Changes which take place within the Head, Thorax, and Abdomen, in the same individual, or Mixed Cases 291

General Conclusion 322

II. PATHOLOGY OF THE FLUIDS IN FEVER 328

CHAPTER VII.. Of the Relation Between the Phenomena of Fever; or the Theory of

Of the Relation between the Phenomena of Fever; or the Theory of the Disease 333

CHAPTER VIII.

Of the Causes of Fever 348

1. Of the Immediate, or Exciting Cause of Fever 348

2. Of the Remote or Predisposing Causes of Fever 369

CHAPTER IX.

Of the Treatment of Fever 375

Modification of Treatment required in prominent Cerebral Affection 398

Thoracic Affection 403

Abdominal Affection 405

Treatment of Scarlet Fever 408

Treatment during Convalescence 418

Appendix 425

FEVER, &c.

CHAPTER I.

Further Investigation of Fever necessary: Facilities afforded by the Fever Hospital for prosecuting the Study. Ancient Doctrines relative to the Nature and Seat of Fever. Hippocrates, Galen, Sydenham. Modern Doctrines. Cullen, Brown, Stoker, Burne, Clanny, Clutterbuck, Broussais. Errors common to all these Theorists. Questions to be solved before Fever can be understood. Precise Object of Investigation: proper mode of conducting it.

On my appointment to the office of Physician to the London Fever Hospital, it was stated to me by the treasurer that, among the objects contemplated by the establishment of this institution, two things were conceived to be of paramount importance: first, the accumulation of facts by which the true nature of fever might be more certainly ascertained, and secondly the cautious trial of remedies by which a more sure and successful mode of treating this fatal disease might be discovered. During my connexion with this hospital I have faithfully endeavoured to the utmost of my ability to keep these objects in view, and I now venture to lay before the public the result of my observations, in the hope that they may contribute something, however little, to the stock of knowledge already accumulated.

When we consider how many circumstances connected with the origin and the propagation of fever are wholly unknown, which if known might have a most important influence in preventing its occurrence, in arresting its progress or in lessening its mortality; when we consider in what profound obscurity the very nature of the agents that produce it is still involved; when we consider how easy it is to swell the long catalogue of its symptoms, but how difficult it is to discriminate which, even among the most prominent of the train, are the essential and which the adventitious, and how still more difficult it is to ascertain which are the invariable antecedents and which the invariable sequents, or which the causes and which the effects; when we consider how few comparatively of the external appearances have been ascertained to be the sure and certain signs of any known condition of the internal organs, and how often the existence of several known conditions of the organs remains altogether unsuspected until the demonstration of it is afforded by inspection after death, and when finally on all these accounts we consider how vague the objects must be that are aimed at in the treatment, and consequently how uncertain, how indiscriminate, how fruitlessly inert, how perniciously active, how unsuccessful, how fatal that treatment often is, it must be admitted that fever still presents to us a vast field, in the culture of which the difficulties to be overcome are not slight, and the most diligent labour that can be bestowed upon it may by no means be attended with a sure reward.

Of many branches of science it is truly observed that much time and labour are necessary to establish a single important fact; of some parts of medical science this is eminently the case, but perhaps of none is the observation so just as of that which relates to febrile diseases. It is remarkable how entirely the most distinguished physicians of all ages who have treated of this subject coincide in the feeling, that with regard to this important class of disease it is impossible in the short life allotted to the most aged to do any thing more than add a little knowledge to the common stock. If there be any foundation for this feeling it can only be by every man faithfully endeavouring to contribute what he may be able, be the amount ever so small, that that stock can speedily become large or ever become complete.

In bringing to this common stock my humble mite, that the offering may not be wholly worthless, I have confined myself as much as possible to the detail of the facts that have been observed, and the statement of the results that have been obtained from experience. By giving a connected view of the phenomena I have hoped that I might possibly assist the actual practitioner to form a more adequate conception of the disease and guide him to that particular remedy which experience shews to be best adapted to each of the more important affections he is likely to encounter. Out of the means furnished for the accomplishment of these objects by the receptacle of fever for this great metropolis I have endeavoured to select such specimens of the disease as will place before him a vivid and faithful picture of the most interesting aspects it assumes, and such a detail of treatment as will shew what particular remedies afford the best chance of success in each type and stage, and in the most common and therefore the most important modifications they present. If I have at all succeeded in my aim he will find himself placed in a good measure in the same situation with myself; his attention will be directed to the same phenomena in the order in which they occur in the series, and hence he will have the like means of judging of the relations which these phenomena bear to each other, as well as of the accuracy of the analysis that has been attempted of the more complicated, and the soundness of the inductions that have been made from a comparison of the whole.

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