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ANALYSIS OF  FEVER.
AN ANALYSIS OF FEVER,
                 BY







       CHARLES CALDWELL, M. D.







Professor of the Institutes of Medicine and Clinical Practice







                 IN






      TRANSYLVANIA UNIVERSITY,
                            A BY. ;*&)






          LEXINGTON, KY.




PRINTED, FOR THE AUTHOR, BY THOMA* *• *KIlXMAN.




               1825. 
 
        TO BENJAMIN W. DUDLEY, M. D.
 Professor of Anatomy and Surgery in Transylvania University,
 Dear Sir,
   The history of my life testifies, that I am as little
 addicted to flattery, as I am to a cold and cautious
 concealment of my sentiments of  those whose char-
 acters 1 esteem and admire, and to whose persons
 their attractive  qualities give me reason  to  be  at-
 tached.   On such subjects it is known to others that
 I speak/rec/y, and to myself that 1 always speak what
 I believe to be true.
  Permit me, then, with my accustomed sincerity and
 frankness, to tender thus publicly to you, to commu-
 nicate to my cotemporaries, as far as this  humble
 Essay may  circulate among them, and to transmit by
 it to  posterity, should its merits entitle it to outlive
 its author, an assurance of the exalted estimation in
 which I hold you, as a distinguished practitioner and
 teacher of your profession, and an individual of rare
 and preeminent worth.
   Whether  as a steady and resolute personal friend,
 or a colleague and fellow-labourer in a school of med-
 icine, had I  the world to select from, I know not  the
 man I should prefer to  yourself. The fortunate priv-
 ilege, therefore, of being associated with you in both
capacities, I deem an ample compensation for  many
disappointments,  which, in other  relations, it has
 been my destiny to sustain.     #;. 
IV
DEDICATION.
  That your life may be long and prosperous and
happy, and the brilliancy of your professional career
unclouded; that you may  receive from a just and
discriminating public, in wealth and fame, the rich.
remuneration to which your services entitle you, and
pass to a still higher reward in another state of  ex-
istence, is the heart-felt wish of,
         Dear Sir,
               Yoar sincere friend, and
                        Obedient servant,
                           CH.QALDWELL
  Lexington, Ky. January 1, 1826. 
PREFACE.
                     ^ S e>
  The author  of  the following Essay is perfectly
aware that, however select his words, or perspicuous
his modes of expression may be, a writer or  public
speaker has but little ground to hope that he will not,
by many,  be  misunderstood,  especially in the em-
ployment of terms of general abstraction.
  When such terms are used only for the designation
of a  class of facts or phenomena obvious to every one,
they are too generally, either through mistake or in-
tentional misrepresentation, reported to mean actual
substances, in proof of whose existence the individual
referring to them may be  called on to render them
manifest to the senses—to paint them to the eye, to
give to them elasticity  and a power  of producing
sound, or to bestow on them odour, tangibility, or taste.
   This obstacle to satisfactory and profitable results
in science, the author, in  common with  others, has
often had  the  misfortune  to encounter, in the course
of his discussions.   When his  object has  been only to
 designate  phenomena under a classified form, he has
 been represented  as speaking of substantial essences.
   To this misinterpretation he has been particularly
 subject  in his  attempts to communicate  his views of
 two important attributes of life, sympathy,  and the
 vis conservatrix et medicatrix natures.
   To prevent, if possible, the repetition of this occur
 rence, as far as the present Essay is concerned, he
 offers to the reader the following exposition. 
iv
I'REFACfc.
   Nature unfolds to us, connected with matter, three
 distinct departments of science, the mechanical,  the
 chemical, and the vital.  Each of these  presents  us
 with insulated classes of facts, governed by laws pe-
 culiar to themselves.  In referring to those  classes.
 we necessarily speak of them under different names.
  In mechanics, we see all bodies tending to a common
 centre, and express our sentiment of the general fact
 by  the term gravitation.  But by this we do not  ne-
 cessarily mean an existing substance.
   When we see  certain masses of matter, which had
 been bent, or otherwise deranged in their form, sud-
 denly regaining  their figure and appearance, we  ap-
 ply 1o the phenomenon the term elasticity.   But this
 word is not to be regarded as designating a substance.
   We attempt in vain to separate by a forcible pull
 a bar of iron or lead, and express the fact of its con-
 tinuing united,  in opposition to our efforts, by  the
 phrase attraction of cohesion.
  One bodv bends without breaking, and we call it
flexible and tough.  Another breaks suddenly and
 easily  without bending,  and we say it  is hard and
 brittle; by  all which words  we mean facts and  not
 substances.
  In chemistry,  the elementary particles  of matter,
 when intimately intermixed, rush together and unite,
 forming substances possessed of new properties, and
 we  express our sense of the phenomenon by the terms
chemical affinity.
  In another case, the  particles  of matter,  when
closely approximated, refuse to unite, and we apply
 to  the phenomenon the word repulsion.  But by nei- 
PREFACE.
ther of these terms do we intend to express the ex-
istence of a substance.
  In matter where vitality prevails, an impression  is
made on one part of a body, and a remote part acts,
or is, in  some way, affected, the intermediate ones
remaining unmoved.
  The impression is made pn the schneiderian mem-
brane, and the diaphragm  and intercostal  and  ab-
dominal muscles are convulsed, the effect of which
is coughing or sneezing.
  The impression is again made on the fauces or the
internal coat of the stomach, and contraction sud-
denly occurs in the muscular coat of that organ, and
in the diaphragm, the muscles of the  abdomen, and
those that move the pharynx and the tongue.  The
issue is vomiting.
  Is the impression made on the internal surface  of
the gravid uterus? The entire  organ contracts, to-
gether with the diaphragm and muscles of the abdo-
men, while other parts connected with the generative
system relax and expand. The result is parturition.
  In designation of these phenomena, and very many
other similar ones that  might be cited,  we employ
the terms sympathy or consent of parts, without  any
reference to an existing substance of which our sen-
ses can be made to take cognizance.
  In these several cases of deleterious impression on
the stomach, the uterus, and the schneiderian mem-
brane, the action  excited in the neighbouring parts
is peculiarly calculated to remove the irritation, and
prevent the mischief it threatens to produce.
  To the expression of this and other facts of rh.-. 
viii
PREFACE.
 same class, we appropriate the phrase vis conserva-
 trix natuiet.
   A bone is broken, or a muscle is divided by a cut-
 ting instrument.  The separated parts  are  brought
 together and retained in contact by a suitable appa-
 ratus.  Without any  further aid from the surgeon a
 cure is effected.
   An individual experiences a moderate attack of
 catarrh.  He uses no medicinal substances, but re-
 mains in his chamber, perhaps in bed,  avoids exer-
 cise of every description, and makes a plentiful use
 of diluting drinks, and recovers his health.
   The operation for  the popliteal aneurism  is per-
 formed on an adult subject. The small anastomosing
 arteries of the limb, which had long since ceased to
 increase in their dimensions,  take on  immediately a
 new growth, until, in a short time, their size is suffi-
 cient to enable them  to supply the leg and foot with
 the entire amount of  blood which they require.
   In expressing our sense of these facts, and many
 others of a similar nature, we  employ the terms vis
 medicatrix naturae, by  which no reference is made to
 any  thing substantial.
   The author will only add, that, according to  the
 meaning here attached to them, there is as much
 accuracy, intelligibility, and  propriety in employing
 the phrases sympathy, and vis consermtrix et midica-
 trix natures, as there is in the  employment of those of
gravitation, elasticity, attraction, affinity, repulsion, or
any  others  connected  with   material  philosophy.
 They are all equally abstractions, invented for the
 designation of classified facts. 
INTRODUCTION.
  Although the literature of medicine contains ma-
ny works  on fobrile diseases abundant in the fruits
of experience, judgment, and scientific research, and
not  a few  rich in the attractions of genius and learn-
ing,  yet, as  far as the author of this  essay may be
qualified to decide, he  feels authorized to say, that
a correct  analysis of  fever in the abstract, is  no
where to  be found.  By such an analysis  he would
be understood to mean, a distinct representation of
all  the  essential features of fever, accompanied  by
brief pathological expositions of them, and disen-
cumbered of every thing foreign or superfluous, that
might add, in any measure, to the complexity of the
subject, or distract the  attention in the examination
of it.
  To be rendered perfect, this delineation,  besides
being faithfully executed, should be reduced to a
form of such  limited  dimensions, that the whole
might be embraced at a single view. Under such cir-
cumstances the correctness of the picture  could not
fail to be recognized by every attentive and qualified
observer.  The addition of a succinct statement of ge-
neral curative indications, and the modes of carrying
them into  effect, would  augment not a little the value
of the production.
  Were a portrait of this description prepared with
ability and  presented to the public, its usefulness in
medicine  would be manifold and great. 
INTRObUCTION.
    Removing  from the  science  somewhat of the
 charges of uncertainty and defectiveness, which, in
 relation to the point under consideration, have hith-
 erto but too justly attached to it, it would enhance
 it in the estimation of the enlightened cultivators of
 general  philosophy, give to the profession  a more
 elevated standing, and become itself an object grati-
 fying to the pride, and encouraging to the ambition
 of the educated physician.  Nor  would  this be the
 entire extent of  its ameliorating influences.   In va-
 rious other points of view, both scientifical aud prac-
 tical, it would aid not a little in promoting the inter-
 ests of rational medicine.   To the teacher it would
 serve as a  valuable text-book, free from the elements
 of delusive hypothesis, and presenting to him  the
 topics on which he should chiefly dwell, in his efforts
 to expound and inculcate  with effect the doctrines of
 fever:  and to the philosophical practitioner it would
 furnish lights to direct him in most of his professional
 processes.   For fever being a disease of  the whole
 system, affecting every structure  and function  be-
 longing to  it,  a  thorough acquaintance  with it in-
 cludes a knowledge of all the principles  illustrative
 of the pathology, and applicable to the treatment, of
 most other  complaints.  Indeed  so extensive in their
 range, and  so engrossing  in their nature  are  febrile
 affections,  that the true science of Mem might well be
 denominated, with but slight exceptions, the science
of disease.  Like the sun to the minor and  dependant
orbs that  play around him obedient to his govern-
ment, it would serve, in relation to other  affections,
as a source of  light and a centre  of influence,  re- 
INTRODUCTION.
3
deeming them from darkness, and exhibiting if  not
retaining them  in the relation  and harmony of sys-
tematic arrangement.  A physician completely mas-
ter of the science of fever, has but little to  learn in
relation to that of other complaints.
  It is chiefly by considerations like  these, united to
a deep-felt want of a chart to direct him in the most
important part of his clinical instructions, that  the
author has been- induced to attempt the following
analysis of fever.
  But he doss not conceal that he experiences  the
influence of another motive, which, participatino- but
little of public considerations, concerns principally
himself.  Nor is it, as he flatters himself, either  cul-
pable in him to feel or unbecoming to avow it.
  It is upwards of twenty years, a period extending
almost to the commencement of his professional  life,
since  he first began to form and discuss the views of
fever  which he now entertains.  At that time, as far
as he possessed information on the subject, all living
physicians were opposed to  him  in  sentiment;  and
with the writings of Lindamus, Van Helmont, Bag-
livi, Rega, and a few other elead ones, whose notions
had been somewhat analogous to  his own, and from
whom he might have derived  certain seminal  ideas,
but nothing of system, he was unacquainted. Nor  had
he any knowledge even of the name of Prost, Clutter-
buck, or Broussais, neither of whom, he believes,  had
yet become a writer in  medicine.
   For the opinions, then, which he purposes to state
and endeavour to establish  in this  essay, he is  in- 
1
IM'R0DUCTI0>.
debted to no one.  True or false, injurious or useful,
he claims them as his own.
  With himself they originated, and  were strength-
ened  and matured  by his own  resources, derived
chiefly from a close and persevering attention to the
phenomena of fever in the sick, the  nature of  its
causes and the" parts and extent of the human sys-
tem with which they can come into contact, repeated
examinations of dead bodies, and the  fairest induc-
tions he was able to form from the facts thus collect-
ed*   While he willingly, therefore, assumes the en-
tire responsibility that may be attached to the pro-
mulgation of them, he  holds himself entitled to what-
ever consideration may be awarded to their author.
Recognizing it as at once a dictate of justice, and a
rule of conscience, never to usurp the reputation of
another, nor defraud him, in any way, of his literary

  *Within the last few years, the author has cer-
tainly  been  more thoroughly confirmed in his belief
of the opinions he had previously entertained, by  a
careful examination of the writings of others.  From
those invaluable sources he has derived much matter
of useful illustration and satisfactory  proof.  But he
honestly declares,  that as  far as he recollects the
origin of his knowledge, he is not indebted to them
for one original thought.  Much of the business of his
life has consisted  in a faithful endeavour to  inform
himself from the book of nature.  When correctly in-
terpreted, that volume never deceives,because God
is its author.  His fellow-men, who are fallible like
himself, will pardon him if he does not so fully confide
in them.  Nor does he presume to ask or expect any
confidence from them, except so far as they may find
feis opinions in harmony with nature. 
INTRODUCTION,
5
or scientific rights, he is no less determined to be the
assertor of his own.  And for this purpose, in part,
does he now present himself at the tribunal  of the
public.  Nor, conscious as he is of the rightfulness of
his claim, does he anticipate any bar to it from the
lateness of the hour at which he has preferred it. He
is not aware that, in relation to literary property, a
statute of limitation has yet been enacted.
   That Broussais wrote and published on fever before
him, the author of this essay readily acknowledges;
but that he conceived his ideas or made up his gene-
ral views on the subject at an earlier period, he has
no reason to believe.  Nor  does he deem the point
of uncertainty a matter of any moment.  He is not
contending for actual priority of conception, but  that
the conception was his own.  His object is  not to
make it appear that other writers are dependant on
him for any  thing, but that he is  not  dependant on
them for everything.   He  thinks it  not improbable
that the  pathologist of France and himself formed
their theory of fever about the same time; and  that
they are. entitled alike to the credit of originality,
neither being indebted for his sentiments to the  oth-
er, nor to anterior writers.   Which of the two may
have most efficiently cultivated the subject in ques-
tion, and given the most lucid and practical exposi-
tion of it, the profession will judge  when this analysis
shall have been submitted to their examination.
   Against Broussais the charge of plagiarism is, if
not openly, at least  by implication, preferred, by
some of the  writers of his own country.   Having first- 
6
RNTRODUCTION.
eontested with him in vain the correctness of his doc-
trines, their object now is to deprive him of the hon-
our of them.
  To say nothing of generosity, this procedure  ap-
pears to be a gross violation of justice, and ought to
awaken the indignation of the public against its au-
thors.  Yet all history attests that it is the  line of
conduct too generally pursued by the envy and ma-
levolence of jealous cotemporaries, to reduce to the
limited standard of their own, the loftier reputation
of original writers.
  Previously to the year 1808, the period at  which
he first published on the pathology of fever, Broussais
had been, from  the commencement of his  medical
career, almost perpetually engaged in military prac-
tice in different parts of the world; a course  of life
rich indeed in opportunities for observation and  re-
flection, but highly unfavourable to extensive or cu-
rious researches in professional literature.  If, then,
the views which he now claims as his own,  existed
at  that time in  antecedent writers,  in  a developed
and intelligible form, why were they not detected
and adopted by others, whose time was less engross-
ed by practical labors, and who had daily and unim-
peded access to the most extensive and best selected
libraries in the world? The facts that they were not
thus detected, and that they cannot now be  shown
in the works referred to,  except in  insulated  scraps
and scattered  fragments unfit to be united and mould-
ed  into  a system, amount to evidence which nothing
can invalidate, that Broussais did not derive  his 
INTRODUCTION.
7
views of fever from so meagre a source.*   Besides,
there are in the writings of that accomplished physi-
cian, a freshness, vigor, and independeuce of thought,
which  would seem to prove incontestibly the origin-
ality of his intellect, and its affinity for science rather
than learning—its propensity and fitness to  observe
and reflect, rather than to read, collect, and borrow.
To  such an intellect it is much more congenial, as
well as easier, to draw from the boundless treasures
of nature, than from the limited stores of antecedent
writers.  The rich and provident have no  tempta-
tion either to borrow or  plunder.  And if, from his
talents and industry, Broussais does  not possess
within himself such abundant resources as place him
far above a state of dependanee, then is the evidence
which his productions furnish eminently deceptive.
  That a  few preceding* writers  had in conception
approached the doctrines now maintained   by  that
pathologist, and that someofthemhad even enjoyed
a distant prospect  of the promised  land, but were

   * Admitting (which is the utmost that  can be
claimed) that Broussais derived many of his materi-
als from antecedent writers, he is certainly  the con-
structor of  his own theory.  He  erected  the  fabric,
while,  to say the most, others only supplied him with
the articles for building.
  But to classify and systematize requires much more
genius, and a wider compass of thought, than merely
to discover.   The latter may be the result of accident.
the former must be that of intellectual exertion.
  The. architect occupies a more elevated  sphere,
than those who prepare for him the brick and mortar 
s
INTRODUCTION.
prohibited  from entering it, is sufficiently probable-
And that the general condition of the present age in
relation to  medicine, had prepared the way for  the
full development of those doctrines, is  certain.
  But where is the discovery or the improvement of
importance in any  branch of knowledge, respecting
which as much may not be said?
  That, in  the extent and richness of their attain-
ments, one  or more individuals may greatly outstrip
all others of the  time, considered also  in their indi-
vidual capacity, is true.  But it is rare that they  sur-
pass, in any eminent degree, their cotemporaries col-
lectively.  Great  masses of intellectual light consist
of a concentration of scattered scintillations, rather
than of  a blaze from a single source.  Issuing from
a thousand  different points, the elements of additional
knowledge  are afloat, and" while the multitude, un-
conscious of  their agency in the  work of improve-
ment, are bent on  other pursuits,  the more highly
gifted and  fortunate  few, whose  business is study
and their object philosophy, collect and appropriate
them.
  For their discoveries and their greatness, as far as
greatness depends on knowledge, all men who have
rendered themselves illustrious, have been indebted
much more extensively than is generally imagined,
to the circumstances of the age in  which they have
lived.  They have, to an extent by no means incon-
siderable, performed the mere office of so many len-
ses, collecting to points of more intense brightness
the innumerable feebler lights that only glimmered
ground them.  They have, in fact, effected their dis- 
INTRODUCTION.
9
eoveries, amassed their attainments, aud succeeded
in their schemes of meditated improvement, because
they have availed themselves of the requisite advan-
tages placed at their disposal by  the  condition of
the times.  Situated in the  midst  of other circum-
stances, their characters, performances, and general
fortunes would  have been different; still, however*
corresponding with the  advantages afforded them.
Preeminent talents are derived from nature; but pre-
eminence in knowledge, achievment, and fame, from
industry  and accident.
  Had Columbus been born at an earlier period, he
would not have been the discoverer of a new world;
and had he never been  born, the  discovery would
have been made by some other navigator before the
middle of the sixteenth century.  The event was
ripe,  and, to make its  appearance, required but a
skilful and adventurous hand to pluck  it.
  Had Newton lived during the sixteenth century,
the glory of developing the  laws of gravitation, and
fascinating the  world with  the doctrines of light,
would have been reserved for another.  And, at the
proper time, another would  have arisen to effect the
discoveries.
  Had Franklin flourished during the  dark ages, he
would neither  have disarmed the heavens of their
lightning, nor a tyrant of his  sceptre—

     ^eripuit caUo fulmen, sceptrumque tyranno ;"

and yet the deeds would have been long since per-
formed. 
J04
INTRODUCTION
   Had Fulton been the cotemporary of Gallileo  or
 Copernicus, he would not have become the founder
 of steam-navigation;  and yet that art would  cer-
 tainly have  been discovered.  Nor, had  Broussais
 written during the age of Boerhaave, would he have
 given a full exposition of his doctrine of fever.  Even
 Bacon  himself,  had  he lived  under circumstances
 less propitious, would not have been the  author  of
 inductive philosophy.
   The periods at which they  flourished were preg-
 nant with discoveries, and those individuals, from the
 peculiar adaptation of their talents and habits to the
 existing condition  of  things, had the glory to bring
 them forth.  Had they  been all wanting, to some
 other worthies, of similar qualifications, would  the
 events have owed their birth.   To  accomplish her
 purposes when sufficiently matured, nature is never
 at a  loss  for  means.  Most palpably, then, other
 circumstances  besides  genius—and those circum-
 stances combined  may be denominated Fortune—
 contribute to render individuals illustrious.
   It will be observed that in the course of this essay
 the writer  has  rarely introduced authorities.  For
 this seeming neglect he  offers no other  apology, but
 that he does not rely on authority for the  establish-
 ment of  his opinions.  He  is  unwilling,  therefore,
 either to make a needless parade of learning, or  to
 trouble the reader with quotations or references.  If
 he cannot sustain his sentiments by the  force of their
own  intrinsic  evidence,  without the employment  of
factitious aid, they are incapable of being sustained,
or he is unworthv to appear as their advocate*  In 
INTRODUCTION.                1 I
either case the present effort deserves to prove abor-
tive, and cannot fail to meet its desert.
  Another reason, not without weight,  induces him
to wave the introduction of authorities.  In the wri-
tings of no author, those of Broussais not excepted,
has he been able to find what he deems a well exe-
cuted picture of fever.   Even though  most of the
requisite materials may be present, they are not ju-
diciously assorted and combined. The authors would
seem to have been writingybr themselves, or for indi-
viduals as thoroughly informed as  themselves, and
not for readers who, but moderately or not at all ac-
quainted with their subject, are in quest of informa-
tion.  Hence the representations given appear to the
author to be, in no small  degree,  defective.  They
are, at  best,  but partial outlines, to be  completed
and filled up by the readers, each one for himself, as
his  means may enable him, and his fancy and judg-
ment direct and approve.
-  For physicians who are already extensively versed
in the knowledge of medicine, and whose maturity of
intellect and habits of discrimination are such as  to
secure them from mistakes, this may be sufficient; but
not for the younger members of the profession, who are
still in quest of elementary knowledge, and who have
 erected, as yet, no well-tried  standard to test the
 correctness of the views that may be presented  to
 them.  It is chiefly, then, for the latter description of
 readers that the following analysis is intended and
 prepared. The pupils of Transylvania University,
 more especially those of the author's private classes, 
A12
INTRODUCTION.
will recognize in it  the principles of his lectures oh
the pathology of fever.
  Should he, on some occasions, be more minute in
his analysis, and more copious and diversified in his
illustrations than physicians accustomed to investi-
gation, and possessing within themselves the neces-
sary  means of exposition and proof, may deem requi-
site, it will be recollected, as his apology, that he is
in the habit of instructing youth, and that he is now
writing  principally for that  purpose..   Hence more
ample details, and more various presentations of his
subject  are requisite.
  But while compelled to be full, it is not his inten-
tion to be prolix or diffuse.   On the contrary, he will
always  endeavour to reach his object by the shortest
route, and finish his exposition  of it in  the fewest
words.  While conciseness of expression, therefore,
and precision of manner, as far as they may consist
with perspicuity of illustration, shall be his constant
aim, it is his purpose never to leave a topic that may
be important to  his general subject, until  he shall
have thrown on it all  the lights he can collect.  Ex-
perience has taught him that in  no other mode of
discussion can matters of science  be  rendered ac-
ceptable to the judgment, interesting to the feelings,
lasting in their impression, or useful in  their  effects.
To illustrate them partially  or  communicate them
obscurely, is tantamount to not communicating them
at all. 
SECTION  I.
        JVame and Definition of the Disease.

  The perfection of technical language consists in
its fitness so far to communicate  science by names.
as to designate correctly the nature of things, by the
terms employed to distinguish them from one another.
  This principle has long governed in part, and gov-
erns now entirely, the constructors of nomenclatures
in the different branches of knowledge.
  To such an extent is this true, and so universally
does it comport with the common sense  of mankind,
that, not only in civilized nations, but even in savage
life, among the aborigines  of our own country, the
peculiar characteristics of a warrior or a sachem are
designated by the name bestowed on him by his tribe.
  It is in Botany, Mathematics, and Chemistry, more
especially the latter in its  present highly improved
condition, that we witness  the most extensive and
successful effort to teach science by means of nomen-
clature.  Such is the perfection of technical language
in that department of knowledge, thaf, if acquainted
with the terms by which the primitive kinds of matter
are designated, we cannot  fail to recognize, by their
names, the nature of the chemical compounds which
they form.  And even in relation to many simple or
elementary substances, their leading properties are
expressed by  the terms by which the substances
themselves are made known. 
14
NAME AND DEFINITION
  In reference  to  fever,  a similar effort,  however
unsuccessful, appears to  have been universal.  At
the earliest period  to which the history of that com-
plaint can be traced, an  attempt was made to com-
municate a knowledge of its  nature and  character
by  the  name  bestowed  on it.  And the same has
been  repeated  by every  modern  nation in which
medicine has advanced to the rank of a science.
  Believing the essence of fever to consist in an aug-
mentation of the  temperature of the body, the an-
cient Greeks denominated it Puretos, the burning  or
fiery disease, from the word Pur, which signifies fire.
  For a similar  reason,  the Romans, who derived
from the Greeks a  great  proportion of their  profes-
sional knowledge,  called it Febris, from Fcbreo  or
Ferveo, to glow or be hot.
  By the  English  term,  Fever, the French, Fievre,
and the Italian, Febbre, precisely  the  same idea is
conveyed.
  Nor is any other interpretation to be affixed to the
Spanish Calentura, the German  Fieber, or the name
of fever in the Portuguese* language.   By each term
the designated  complaint is represented as consist-
ing in preternatural heat.
   However praiseworthy in  its object may be this
effou of the nomenclators of ancient and  modern
times, to characterize, by its name, the disease under

   *The reason why the  author has not inserted the
Portuguese  term  for "'fever," is that he is uncertain
as to the correct spelling of the word, and he has no
 Dictionary of the language before him. 
OF THE DISEASft.               15
consideration, the failure of it is obvious.  Its effect
has been, of course, rather injurious than useful, be-
cause it has contributed to the perpetuation of error.
And error is but another  appellation for ignorance
sanctioned by false reasons and fortified by prejudice.
   Fever consists of a succession of combinations or
groupes of coexisting phenomena,  each of which  is
alike essential  to it, and constitutes necessarily a
component part of it.  I mean that, in every case, the
$roupes are essential in the composition of fever, but
not every phenomenon  or  elementary part  of  each
groupe.  Of the phenomena referred to, an augment-
ed temperature is but one, which is  not at all times
actually present.  In some cases of fever there is no
increase of temperature,* from their commencement
until their close;  and in none does that  symptom
prevail universally throughout their whole course.

   *A natural temperature was one of the uthree natu-
rals^  mentioned by the late Dr. Rush,  as  marking
some  of the  worst cases of  yellow fever.  In  that
complaint  "a natural temperature, a natural pulse,
and a natural tongue" were considered by-that great
observer as uniformly indicative of a fatal result.
   Nor can the case be otherwise.   Those three  phe-
nomena testify to the destruction of sympathy—to the
dissociation from each other of some of the most im-
portant parts of the body.   Sympathy  being a  real
vital property, essential to  the existence of living
matter, they show that the work of death is already
begun; and in such a way, that it cannot be arrested.
Destroy sympathy, and practical medicine becomes,
in its  relation to  general  diseases, a mere name.  If
there exist a single exception to this, the author  is
not, at present, so fortunate as to recollect it. 
 10            NAME AND DEFINITION

 On the contrary, fever, when regular, is as uniformly
 marked,  in some of its stages, if not over the whole
 body, at  least in certain parts of it, by a diminution
 of temperature, as it is  by an increase of it.  In the
 early part of its course, in addition to its being  ac-
 companied by a sense of chilliness, some portions of
 the skin, at times the whole  of it, are preternaturally
 cold.  And this phenomenon is as essentially a com-
 ponent part of  the complaint, as the elevated tem-
 perature which is subsequently developed.   If, then,
 the disease is to receive its name from a mere symp-
 tom—and the increase o*f heat is nothing more,—that
 symptom  might be a diminished temperature as well
 as an augmented one.   Or it might be indifferently
any  of the other several symptoms that essentially
belong to it, the chief  of which  shall be  specified
hereafter.
  Fever consisting necessarily of a series of successive
 stages, each composed of its appropriate phenomena,
 some of  them the very oppositesof each other, it is
 impossible to  designate its nature and character by
 a single  term.  As well might you thus attempt to
 make known the characters of the different periods
 of the day, or of the successive and  discrepant sea-
 sons of the year.  As well derive the name of the
 year from heat, because the summer is hot,  from cold,
 because  the winter is cold, or from  flowers ox fruit,
 because  the spring  is the season of bloom,  and  the
 autumn of ripening.
   Unlike other forms of disease, this complaint has
 no one steady master phenomenon, which accompa
 nies and characterizes it  throughout its whole 
»F THE  DISEASE,
n
course—no single symptom whose presence consti-
tutes, and whose removal extinguishes it.
  A brief contrast of it with a few other complaints
will at once illustrate and establish this point.
  Apoplexy consists in a loss of sensation, intellect,
and voluntary motion.  Restores this loss, and  it is
apoplexy no longer.
  Epilepsy consists in certain convulsive movements,
beginning, progressing, and terminating, in a given
way.  Prevent or remove these, and the disease has
no existence.   Of St. Vitus's dance the  same  may
be said.
  Remove from asthma impeded respiration, and it
is asthma no more.
  Hydropic  affections are  formed essentially by
aqueous effusion, and are, therefore, sufficiently char-
acterized by the appellation bestowed on them.
   Diarrhoea,  cholera, diabetes,  and  mania,  being
constituted each by a prevailing symptom, may each
be designated, as to its character, by a single term.
   As much may be  asserted of  rickets,  jaundice,
lues venerea, and herpes.  To each belongs a  single
characteristic, by which it is principally constituted
 and known.
   With regard to  fever, the case is not only  differ^
 ent, but opposite. Composed of elements heteroge-
 neous and conflicting, as  no  single attribute consti-
 tutes its nature, no single name can designate it.  In
 it, the skin* by turns, is hot and cold, dry and  moist,
 rigid and relaxed; the pulse agitated or calm, strong
 or feeble, frequent or slow, corded or  yielding; the
 tongue crusted or clean, dry or moist, unusually pale.
                         C 
Iti
NAME AND  DEFINITION
possessed of its natural colour," or inordinately red;
the irritability and sensibility in excess or deficiency,
and the intellect shattered or sound.
  A knowledge of this,  long since extinguished in
physicians the  hope  of being  able to expound the
nature of fever by the name bestowed on it.  The
effort to  that effect,  therefore,  was abandoned  by
them in despair.
  Their next attempt was to include the phenomena
essentially characteristic of it within the limits of a
definition.
  Here, again,  they  were met and defeated by the
same difficulties. The striking diversity and contra-
dictory nature  of the symptoms  presented  by the
complaint, in its different stages, set definition at de-
fiance.
  To define, said an  ancient sage, belongs only to
the gods.  In relation to  fever, this is not  merely
figuratively but literally true.   To explain in  a few
words, and thus compress within the restricted com-
pass of a definition, the several different and warring
elements of this disease, does  not comport with the
powers of a mortal.   Involving, as it does, a palpa-
ble contradiction, it constitutes an impossibility, and
cannot, therefore, be effected by any power.
  For the further illustration of these  remarks, and
the establishment of  their  truth, sufficient evidence
may be derived from a brief survey of the extreme
difficulties experienced by the profession in their
attempts to define fever, and the several discordant
definitions of it adopted by some of the most distin*
guished physicians the world has produced. 
OF THE DISEASE.
19
  Galen pronounced fever to be,  a "change in the
healthy temperature of the body, accompanied by a
pulse preternaturally quick (he probably meant/re-
queni) and strong."
  Although that great physician  escaped  error  by
declining to say whether the change of temperature
was from a  lower to a higher degree, or the reverse,
yet his definition is so meagre  and indefinite, as to
convey to the reader no adequate idea of the subject
to which it relates.
  Waving  entirely any  remarks on the condition of
the pulse, Vogel states  fever to be, "a preternatural
augmentation of the internal heat, (innati caloris,)
with a dryness of the tongue, and  a heaviness of the
body."
  This definition, to say the least, is no improvement
on the foregoing.
  Without taking  any notice of the altered tempera-
ture, Bianchi thus defines fever: "A change in the
pulse, with a peculiar and painful lassitude  of the
whole body, and a sudden debility of  the  voluntary
muscles."
  This definition, although a little fuller, is, in  no
degree, more correct or conclusive than the others.
  Sennertus  defines fever, "a  disease consisting in
an increase of temperature alone."
  Silvius, C. Boerhaave, and Darwin, make it consist
in "an increased frequency of the pulse."  H. Boer-
haave, in  "an augmented temperature and an  in-
creased frequency of pulse, preceded by horripilation
and shivering." 
20           NAME  AND DEFINITION, om.
    Cullen defines it a disease ushered in by "languor,
 rassitude, and other signs of debility, succeeded by
 chilliness, a frequenl pulse, an increase of tempera-
 ture, and a derangement of several functions, espe-
 cially a feebleness of the limbs, without any primary
 local affection."
   To this definition, the best unquestionably that had
 been given, Sauvage, who may really himself be re-
 garded as the author of it, adds, "madore in dcclina-
 tione;" a sweat or cutaneous moisture on the decline
 of the paroxvsm.
    To the definition, as  improved by the French nos-
 ologist, Fordyce further adds, "some derangement of
 the intellectual functions:"  and another writer sub-
 joins, "a preternatural tension in  the tendons of the
 wrists."
    Clutterbuck pronounces fever to consist "essential-
 ly in topical inflammation of the brain or  its mem-
 branes."
   Although in one part of his  "Inquiries"  Dr. Rush
 asserts that fever cannot be  defined, he pronounces
 it, in another, "a convulsion  in the arterial system."
   Such are the various definitions of this disease
 given by the several authors whose names have been
 cited.
   Of the insufficiency of them all, besides the proba-
 bility to that effect afforded by  their discrepancy,
 abundant evidence is derived from the fact, that  by
 the aid of none of them individually, nor even by that
 of the whole of them  combined, can fever in all  its
 modifications, be known.  To a person unacquainted
^rith that disease, a case of highly congestive fevet 
ELEMENTS OF FEVER.
21
shall be presented, whose features he shall not be
able to recognize in any technical definition on re-
cord.   Yet, from the genius  and attainments,  the
ample experience and great sagacity, of the authors
quoted, it is doubtful whether any others will be able
to improve  on their efforts to define.
                  SECTION  II.

               Elements of Fever.

  Under the circumstances detailed in the preced-
ing section, all, perhaps, that can be  done in at-
tempting an analytical representation of fever, is to
throw together and arrange,  in  their proper order,
its natural elements, accompanying them with such
explanations and remarks  as may  be  requisite  to
render them perfectly intelligible;  to expound their
pathology, and show their importance as grounds of
practice.
  The elements of fever are so denominated, because  .
they are essential to its composition and  existence.
Their presence and combination form it, and with-
out them it can no more have  being, than any other
whole can exist without its parts.   It is  not  unim-
portant  to remark, that they afford incontestible evi-
dence of  the recuperative powers  possessed by the
living system, and show fever  to  be  nothing but an
effort of those powers to restore  health.
  Were this a  point of mere abstract speculation, it
would be of little moment, and might, without impro- 
A:
ELEMENTS OF FEVER.
priety, or culpable neglect, be passed unnoticed. But
being, as will hereafter more fully appear, essential
to rational prescription and successful practice, it
has an undeniable claim o.n the attention of the pro-
fession.
   The elements of fever are five  in number.  But
previously  to a specification of them, and to render
such specification the more satisfactory,  by placing
it on solid and tenable  ground, it is requisite  to ob-
serve, that fever arises necessarily from a morbid im-
pression.  That impression, as  will be demonstrated
hereafter,  is, in its primitive  s^ate, essentially local.
Without its deleterious influence fever could no more
appear, than an effect could, in any other case, arise
without a cause.
  Impression is either irritative, sensative, or mixed.
  An impression  simply irritative produces  action
without sensation.
  Examples of this we have in ift voluntary muscular
motion, the circulation  of the blood, healthy  diges-
tion, secretion, and nutrition.  In these instances the
action, which is natural and  healthy,  is the result of
impressions that are not felt*
  Examples of morbid irritative impressions we have
in those that give* rise to tetanus and hydrophobia.t

  *Thc vital properties from which this action arises,
are  the organic sensibility, the  insensible  organic
contractility, and the sensible organic contractility of
 Bichat.
   tThe morbid impressions on the mucous lining of
the stomach productive of the fevers denominated
 'idiopathic,  such af bilious fever in all its modifica- 
ELEMENTS OF FEVER.             23
Here, the impressions,  sensative at first,  become so
purely irritative, that  the accidents productive of
them  are oftentimes forgotten.   After a considerable
lapse of time, the diseases appear, and must have a
cause.  That the morbid irritation {irritative impres-
sion) continues during this interval, cannot be doubt-
ed, else would the complaints be absolutely causeless.
Did both it and the morbid sensation cease, the  part
injured would be  restored to a condition  perfectly
healthy, in which case  neither tetanus nor hydropho-
bia could possibly take place.  That  in  either  of
those complaints the blood is contaminated and dis-
ease generated  through that channel, is a humoral
notion too gross and groundless to deserve refutation.
But if it even were so—if sanguineous contamination
did occur, still would an impression simply irritative
be the cause of the mischief.
   Sensative impressions* produce at once sensation
and action.
   Of these, in a healthy state, instances innumerable
present themselves daily in the functions of all the

tions, pestis vera,typhus fever, and scarlatina; like-
wise  the impressions produced by the matter of small
pox, of meazles, and of influenza,  are also irritative.
The knowledge of their having been made is derived
only from their deleterious  effects, some time subse-
quent to an exposure to them.
   Still, like the impression productive of tetanus, they
must exist during the interval, otherwise they could
not engender fever.

   *These impressions are made through the medium
of the animal sensibility of Bio hat. 
24             ELEMENTS OP FLYER.
external senses.  The examples of heat  and cold,
light and  sound, and the impressions of  taste, pro-
ductive as they are of both sensation and motion, fur-
nish on this point satisfactory illustration.
  Instances of morbid sensative impressions present
themselves in wounds, burns, bruises, and other ex-
ternal  mechanical  injuries.  These, when  severe,
prove the causes of fever.
  The first'element of fever, then, is  morbid impres-
sion* irritative or sensative, from which, as a root,
the complaint arises, and without which  it could
have no existence.  Conformably to a law of living
matter, the disease  results  from the morbific cause
acting locally on an irritable  or sensible  part of the
system.  I repeat, that from the fundamental princi.
pies which govern the human system endowed with
life and all  its properties, the diseased action can
take place in it in no other way.
 *This element has as real an existence as the others,
and is as distinct from them as they are from each oth-
er. In evidence of the truth of this, it usually prevails
some time, occasionally a considerable time, previous-
ly to the occurrence of the second element. It is, more-
over, as palpably  the cause of the second element, as
that is of the third, the third of the fourth, or that
again of the fifth.   But  that the several elements  of
fever stand related to each oth^r as cause and effect,
is, to the inquiring and  analysing mind, a truth as ob-
vious  as any embraced  in the science of disease.   In
the strictest sense of the terms, they  bear to each
other  the uniform relations of precedence and conse-
quence,  aptitude  and proportion, and  these are the
characteristics of cause and effect. 
               "ELEMENTS OF FEVER. .            25

  From the first, as a cause, arises, by sympathy of
parts, the second  element of fever, denominated its
access, in which uneasiness, languor, lassitude, debil-
ity and dulness, unfitting the diseased for all exertion,
whether corporeal or mental, constitute the predom-
inant and characteristic symptoms.
  During this stage of the complaint, the capillaries
of the skin are deprived  of a portion  of the blood
which  they usually contain, as appears f«om the pal-
lid hue, and shrunken condition of that organ, as we\\
as from  the  diminished  size of the nose, ears, and
extremities, and, in violent cases, of the whole body.
  The blood thus removed from the skin and extrem-
ities is thrown  into the more  central  parts,  giving
rise  to broken and irregular circulation, excitement,
andheat.  The condition produced in the system, in
relation to its vital and active properties, appears to
be, a preternatural diminution  of the muscular, nerv-
ous, and intellectual powers—in  more technical lan-
guage, of the general energy of the nerves and brain.
The practical indications suggested by this state of
things will be  stated hereafter.
  The third element of fever is the rigor, chill, or cold
stage,  in which the skin, excited to the process of real
contraction, exhibits the appearance called cutis an-
serina.   By means of this contraction, the cutaneous
capillaries  are more completely emptied of their
blood, the extremities and all projecting parts of the
body are further diminished in size, and a general
tremor,  often  increased  to  a severe shake, attacks
the  system.
                        D 
2t>             ELEMENTS OF FEVF.r.
  During this condition of things, the pulse is small,
frequent, and somewhat  corded,  the  natural  and
healthy action of the capillaries, in every part of the
body, appears to  be suspended, and those  vessels
manifestly labor under a spasmodic  affection, more
or less violent  according to circumstances.  Hence
secretion generally is checked—in the skin, the liver,
the kidneys, the lungs, the pancreas, and the entire
tract of the alimentary  canal; cutaneous ulcers, if
any exist, cease to secrete pus, and, if the system be
under the influence of mercury, the salivation dries up.
  Respiration is  now anxious, restricted, and  fre-
quent, and the sick feel conscious that  that process
is not productive of its natural and salutary effects.
The air expired does not possess either its usual
amount of moisture or its customary temperature,
being, at once, preternaturally cool and dry, and the
blood ceases  to be completely arterialized.
  It is now that, from the augmented derangement
of the  nerves and  brain,  the  general sensibility  is
most diminished, and the intellect suffers deep dete-
rioration.
  From the symptoms which predominate at the pre-
sent period, it is sufficiently manifest, that the equi-
librium of circulation is still further broken, and the
accumulation of blood in the heart and internal  ves-
sels generally, greater  and more  oppressive in this
stage of fever, than in that which  had  immediately
preceded it.   In the conflict* which evidently exists

  *ln this struggle or civil war of the system, the
capillaries, by contraction, throw  the blood from the 
ELEMENTS OF FEVER.             2?'
between the capillaries and  the larger organs, the
former have, as yet, a decided ascendancy.  Hence
the distressing labor, anxiety and oppression which
are experienced within, and  the absolute necessity
of the vigorous reaction of the heart to remove them.
  This salutary and necessary slate of resistance we
find in the fourth element of fever, which is usually
denominated the hot stage, or stage of excitement.
It follows immediately  the cold stage, and, as alrea-
dy represented, appears to be produced by it.
  It is now that, by means of awakened reaction, the
heart makes an effort  to restore the equilibrium of
circulation that has been lost.  The arteries,  espe-
cially the carotids, begin to throb, a proof of the re-
sistance the  blood has to encounter, the face be-
comes flushed, severe headach and perhaps delirium
ensue, the temperature of the skin is augmented, but
still that organ, from a want of its secretory actionw
is harsh and dry, a  distressing thirst prevails, from a
similar want in  the  membrane lining the mouth,
tongue, and  fauces, and secretion generally contin-
ues restricted.
  Corresponding with the augmented temperature of
the body, the air expired is now preternaturally  heat-
ed, the secreting surfaces make an effort to regain
their  healthy action,  and  the lost sensibility and
powers of intellect are  partially  restored. Every.
thing begins  to announce, that in the struggle which

circumference and  extremities of the body towards
the centre, while the heart labors, at first in vain, m
project it back again. 
!tt
ELEMENTS OF FEVER.
exists between the deleterious impression and the
recuperative energies of the system, and between the
capillaries  and the  larger organs, the  latter  are
likely to gain the ascendancy.  This ascendancy is
at length effected in the occurrence of
  The fifth element of fever, which is usually  deno-
minated the sweating stage.   But as the  glandular
organs and surfaces generally,  as well as the skin,
begin now to act, viz. the liver, the kidneys, the pan-
creas, the salivary glands, and the membranes cov-
ering the tongue,* and lining the fauces, lungs,  and
alimentary canal,t this clement would be named with

  *The membrane covering the tongue secretes also
during Jever, as appears from the  crust or coat depos-
ited  on that organ.   But  the  secretory action pro-
ducing it is morbid.   It becomes healthy only on the
solution of fever, when the other glandular structures
begin to act in a natural manner.  The febrile crust
begins then to disappear, the  tongue becomes  soft
and  moist and clean, and the thirst, which had been
troublesome, declines or ceases—a manifestation of
the healthy secretory action of that organ.

   tThe author does  not mean that in the solution of
every case of fever all the emunctories of the body
begin to act at the same time with equal strength.
Some one of them always takes an ascendancy over
the others, as is uniformly the case even in  health.
But  they are all  in a condition to act, and really do
act in a much higher degree, as well as much more
naturally, than they  had  done in the antecedent sta-
ges of the disease.
   Of the several emunctories, the skin would seem
to predominate most frequently in  the secretion of
sweat.  Next, perhaps,  are the liver and  the othtr 
ELEMENTS OF FEVER.
29
m.uch more propriety the secreting stage.  The suda-
tory discharge being more obvious to sense, as well
perhaps as more abundant in quantity than either of
the others, is  the only reason why that evacuation
has given its name to the present existing state  of
action.
  This stage constitutes the critical  discharge  in fe-
vers—an occurrence which, far from  being what ma-
ny have pronounced it, a phenomenon existing only
in the imagination, is a solid reality, and takes place,
in some shape, and to some  extent, in every case of

secreting structures that pour their products into the
alimentary  canal.  Then come  the kidneys, and,
lastly, the schneiderian membrane in the secretion
of mucus.   These are the four secreting sources that
contribute most essentially to the solution of fever.
  No sooner do they begin to act  to a sufficient ex-
tent, than all evidences of preternatural internal con-
gestion  and excitement, and all irregularity in the
circulation of  the blood,gradually disappear.
  From having been  contracted, harsh, dry, and
sometimes pale, the skin  becomes soft,  a moisture
appears on it,  and  its natural colour  returns.
  The pulse, no longer small, restricted, or irritated,
indicates, by its softness, freedom, and  easy expan-
sion, that the blood meets with  no obstruction  in its
passage to the extremities.   Respiration, which had
been anxious and  oppressed, becomes natural and
pleasant, and nausea, vomiting, uneasiness in the ep-
igastric region, and all other evidences of gastric ir-
ritation, are soon at an end.
  All these are but so many manifestations of the
return of centrifugal action, and the  restoration at
that equability of circulation and excitement which
fever had deranged. 
30             ELEMENTS OF FEVER.
fever that terminates favourably.   In reality it must
take place, else will the disease prove inevitably fatal.
It announces, that for the  time being,  at least,  the
heart has gained the victory over the capillaries. It
indicates the solution, partial or entire, of the febrile
paroxysm; such solution  being nothing more than
the victory specified—the conversion of general cen-
tripetal into general centrifugal action.
  Into the  five foregoing elements,  more  or less
strongly manifested, and bearing to each other, in
different cases, very different  proportions,  is  every
febrile paroxysm resolvable.
  This is equally true, whether the complaint con-
sist of one simple and short paroxysm,  as  in com-
mon ephemera, of a succession of such paroxysms,
as in a regular quotidian or tertian,  or  of one long
compoutbd paroxysm, as  in the continued  bilious, the
yellow, or the typhus fever.
   Analyse these several paroxysms, and it  will  be
found that they are ail made up of the same compo-
nents—that they all consist of  an  original local  and
morbid impression,  an access or  stage of depression, a
cold stage, a stage of excitement  or reaction, and a se-
creting stage*
   As already stated, these elements, in different
cases, bear to each other very  different proportions

   *In many cases of fever, especially during the pre-
valence of epidemic diseases, so rapid is the transi-
tion of the system to the  stage of excitement, that
the first three  elements are scarcely noticed.  They
notwithstanding exist,  and can be recognized  with
certainty by a careful attention  to the complaint from
its commencement?. 
ELEMENTS OF FEVER.              3 1
Their relative  proportion is,  perhaps, most natural
and perfect, in a regular  paroxysm of tertian inter-
mittent, where neither of them is long, and all of them
are strongly marked.
  In a quotidian, the third element, or cold stage, is
comparatively shorter, and the stage  of excitement
of greater length.
  In a quartan, this proportion is reversed, the cold
stage being protracted, and that of reaction short.
  In  continued fever  the access is of considerable
duration, the cold stage for the most  part short and
usually slight, and the stage of  excitement greatly
protracted.
  But whatever may  be their relative proportion, in
duration or violence, to the composition of a parox-
ysm of fever they are  all essential; when  they suc-
ceed each other in the foregoing order they constitute
fever; and when the first  of them  takes place, it ap-
pears to be a law of nature that the others must follow.
  The febrile cause,  whatever it may be, produces
the original deleterious impression, that produces the
access or stage of depression, the access gives rise to
the rigor or stage of strong capillary spasm, the rigor,
by throwing the blood in preternatural quantities on
the heart, rouses it to the stage of excitement, and
that proves the cause  of the secreting stage, which,
carried to the proper  extent, terminates the parox-
ysm, as naturally and necessarily, as the several pre-
vious stages had produced each other.
  This series of states or modes of action, observing
thus a uniform succession, seems to constitute one of
the laws of nature in relation to  the human body in 
32
ELEMENTS OF FEVER.
a diseased condition, provided the morbid impression
be sufficiently powerful.  It is as much a compound
or consecutive process,  and is as obviously govern-
ed by a settled  rule, as that  of deglutition,  chymi-
fication, chylification,  sanguification  and nutrition.
Like all other processes of nature, then, under the
governance of established  laws, it must be intended
and calculated  for the accomplishment of some use-
ful purpose; for nature never works but to effect such
purpose.
   In  the present instance, that  the object  held  in
view is the restoration of health, does not appear to
admit of a doubt. Let the original malign impression
be made with sufficient force, and unless the other
stages or states of action follow, health will not be re-
stored, but the  patient will sink under  the primitive
injury.*                            •             *
   In plague  and yellow fever, the truth of this asser-
tion is often  demonstrated.   In the  most suddenly
and certainly fatal cases  of those complaints, such
  *If to this  proposition  any exception exist,  it is
found in  the  phenomena of cholera morbus and di-
arrhoea, more especially the former,.  In that  com-
plaint the pathological condition of the system  is ve-
ry nearly the same as in bilious fever.  The same kind
of local deleterious impression, and an equal degree
of hepatic  and abdominal congestion exist.  There
is also, for  the most part, if not always, more or less
of the ri^or or cold stage.   But the  stage of  secre-
tion takes place,  without the intervention of that of
excitement.  It does not, therefore, amount to fever.
  Even this complaint, however, shows how essential
the stage  of secretion is  to a recovery.  Unless it 
               ELEMENTS OF FEVER.             33

is the overwhelming force of the original impression,
that the system cannot react.   The consequence is,
that the individuals attacked die in the access of the
disease.  They sink into an apoplectic or lethargic
condition, from which nothing can recall them. Were
reaction possible, the termination  of the complaint
might be favourable; because, by the usual and sal-
utary process, the effects of the original impression
might  be thrown  off. In treating cases of this de-
scription the paramount duty of the practitioner is to
excite  reaction by whatever means may appear to him
most effectually calculated for the purpose.
  In relation  to malignant  intermittents, the same
thing  is true.  So overwhelming, at times, is the pri-
mitive impression of the poison producing them, that
the system  is prostrated by it below the point of re-
action.  Here, as in pestilence and yellow fever, the
patient dies in the access of the paroxysm, the stage
in  which death uniformly occurs in malignant inter-
mittents that prove fatal *   When, on the contrary,

takes place, death is inevitable, as is proved by that
form of cholera denominated mal de chien, in which
no bile appears in the evacuations. It is chiefly by
the bilious and abdominal secretions that this dis-
ease is removed.
  When these secretions can be excited, the patient
may recover.  When they cannot, he must die. Here,
the bile and other  abdominal secretions constitute
the critical discharge.
  In the morbid  chain but one link is wanting to
constitute fever;  and  even  that is often  supplied.
Many cases of cholera are marked by all the symp-
toms of a febrile affection.
  *We are told that in these complaints, as well as
                        D 
34
ELEMENTS OF FEVI.r
the system reacts, and  the several stages  succeed
each other regularly, the resolution of the paroxysm
may be confidently expected.
  In no other point of light, then, can the  different
elements or stages of fever be rationally considered
but as so many requisite modes  of action, adopted
by the  recuperative powers of the system,  to throw
off the  original deleterious impression, and  reestab-
lish health.  If, in the present state of medical  sci-
ence, we cannot satisfactorily explain this,  it is  phi-
losophy to adopt it as an ultimate fact.  The reason
urging  us  to such adoption is, that the  march  of a
paroxysm of fever is  always the same, and the issue
of it more or  less favourable, according as its  ele-
ments are more or less regularly  developed.
  Nor let the excess to  which the  stage of excite-
ment often rises, and the fatal congestions it too fre-
quently forms or confirms, be regarded as furnishing
evidence in any degree contradictory of  this view of
things.  We do not contend for either the  omnipo-
tence or perfection of the recuperative powers of the
human system.   On the  contrary,  we acknowledge
that their efforts are  often fruitless, sometimes  per-

in other forms of fever, death is sometimes produced
during the stage of  excitement, by the bursting of
blood vessels in the  brain, and the consequent op-
pression of that organ by an effusion of blood.
  That this event may take place, the author neither
affirms nor denies.  He  will only observe that it has
never fallen under his notice, and that, being, at fur-
thest, both rare and accidental, it  does not affect the
general principle for  which he is contending.  It is
not to be  regarded as constituting  a natural link in
the chain of events that usually occur. 
ELEMENTS OF  FEVER,             3^"
 haps injurious.  But  we maintain  that they exist,
 that their exertions are generally useful,' and  that
 their failure to prove  so, is only  an exception to a
 general rule.   Extinguish them, and every complaint
 will prove fatal.
   Of the elements of fever, the secreting stage being
 the last, is peculiarly  influential in  the solution  of
 the paroxysm, and the restoration of health. Of this
 the reason is sufficiently obvious.  The pathology of
 the complaint consists principally" in a want of equi-
 librium between the capillaries and the heart;  and
 it is not until  the formation of  the secreting stage,
 that this equilibrium is perfectly restored.
   It is to be distinctly understood, that the  salutary
 effects of the stage of secretion do not arise  from ei-
 ther the nature or amount of the fluids discharged ;
 but from the equalization of excitement and circula-
 tion.   Centripetal is converted into centrifugal ac-
 tion, internal congestion is  removed,  the spasm of
 the capillaries is resolved, and  the heart  and large
 blood vessels are relieved from the inordinate fulness
 that oppressed them.
   From the preceding  remarks,  an important rule of
 practice is deducible.  In the  treatment of fever, the.
 chief aim of the practitioner, whose  business it is to
 observe and follow nature, should  be the production

  *I say "principally," not entirely.   In every febrile
paroxysm  the state  of derangement  extends to  the
nervous and other tissues, as well  as the vascular.
But the want of equilibrium and  harmony in  the cir-
culatory system appears to be the source from which
danger is chiefly to be apprehended.   It constitutes
 the most striking and threatening derangement. 
»ft
ELEMENTS OF FEVER.
 of the secreting stage.  This object  he must effect
 with great caution, and by suitable means.  He must
 attain it chiefly by the judicious management of the
 other stages or elements of the paroxysm, more es-
 pecially that of excitement.   He must bring  the ac-
 tion of the system to the secreting point.  If the  ex-
 citement, as is sometimes the case, be below that
 point, it  must be raised;  and if above  it, which, in
 the commencement of  fever, it usually is, reduced*
 For, unless at a given point of excitement, the glan-
 dular structures  will not secrete—certainly not in a
 salutary maimer—by any means that can be adopted;
 but, that point being  attained, secretion  will take
 place, if not spontaneously, at least in obedience to
 very moderate means.
  The elements of fever  being general of compound
 phenomena, include under them many special  or sin-
gle ones, denominated symptoms.
  Although, as already stated, the, former, as consti-
 tuting its component parts, are necessarily present in
 every febrile paroxysm, the case is otherwise in rela-
 tion to the latter.  On many occasions,  not only  are
 the symptoms exceedingly different, but those which
 predominate in  some  cases, are wanting  in  others.
 Yet in all instances are the elements alike complete,
 their perfection,  as to form and essence, being in no
 way impaired by greater or less intensity or fulness.
 The absence of a few symptoms creates no deficien-
 cy in the element or stage of fever in which they  are
 wanting.
  Symptoms which may or may not be present, it
 being practicable for fever to exist without them, are 
ELEMENTS OF FEVER.             =37
   sickness at stomach, a soreness or sensation of burn-
   ing in that organ, gastric and intestinal spasms, head-
   ache, delirium, coma, epileptic convulsions, pain in
   the u  ;k and loins,general soreness, augmented tem-
   perature, furred tongue, cutaneous eruptions, preter-
   natural coldness, and several others of minor impor-
   tance.  As no one of these forms an indispensable
   part of fever, each of them singly, or several of them
   together, may be  wanting, and still  the febrile par-
   oxysm be complete.
     To demonstrate more clearly the variations in the
   phenomena produced by the natural progress of this
   complaint, from its commencement as a local, to its
   prevalence as a general affection, and thence to the
   termination of the paroxysm in the secreting stage,
   it is believed that the  following summary may be
   useful.
     Fever is a disease  of association, beginning  in a
   local deleterious impression, either irritative or sen-
   sative, made on some part of the solids, and spread-
   ing until it becomes general  through the medium of
   sympathy.
     To render this analysis the more accurate and in-
   telligible, let the human body be considered as divid-
   ed into the following systems, which sympathy unites
   into a  living whole, and  which, but for sympathy,
   would consist of a collection of insulated organs. The
   cutaneous system, the digestive, the nervous includ-
<   ing the brain and  spinal  marrow, the  muscular, the
   vascular, the absorbent, and the glandular; the lat-
   ter including every secreting structure. 
38
ELEMENTS OF FEVER.
   Let the disease selected for illustration be  bilious
 fever, which appears to originate in an irritative im-
 pression made by a peculiar poison on the digestive
 system.   Thence the affection travels  by sympathy
 in the following order.
   First to the nervous system, thence to the muscu-
 lar, thence to the cutaneous, thence to the heart and
 vascular system, especially  the  arterial, and finally
 to the glaadular, where its career terminates.
   That this is the course which the disease pursues,
 appears from the uniform succession  of its symp-
 toms—I might say, of its elements.
   The commencement of  the access or second ele-
 ment of fever, which follows  immediately the morbid
 impression, is  marked by such uneasiness, hebetude,
 and general derangement of feeling and intellect, as
 indicate conclusively, at this early period, a diseased
 affection of the nerves and brain, while the  preter-
 natural debility and unfitness for  motion which soon
 follow, announce with  equal certainty  a similar af-
 fection of the muscles.
  The rigor, constituting the third element of fever,
 has its seat chiefly in the skin, as the characteristic
 symptoms of it appear to evince,  which  shows that
 when it occurs the disease has reached that organ.
  That the stage of excitement,  or fourth element,
proves the complaint to have invaded the heart and
blood vessels,  will not be questioned;  nor  is it less
obvious and certain that, under the fifth element or
secreting stage, the disease  has  found its way into
the glandular structures. 
               ELEMENTS OF FEVER.-            39

  The consideration that  the phenomena or ele-
ments of fever thus regularly succeed each other in
the different systems  of  the  body,  satisfactorily
proves the complaint to be local  in its origin, and
sympathetic in its character.  It seems also sufficient
to authorize the belief, that, in becoming general, it
pursues the march already  designated.
  That the phenomena do  thus occur successively,
and  do not  all take place at once, is  a fact which
must be familiar to every observer.  And that they
occur in other parts of the  body before making their
appearance in the  vascular  system, is a circum-
stance fatal  to the  humoral  pathology.  Were an
original contamination of the blood the cause of fe-
ver, on the heart and blood vessels would its primary
effects be  necessarily manifested.
  For the further illustration of this subject,  let  the
febrile cause bca change in the temperature  of  the
atmosphere from  heat to cold, or from dryness to
moisture.
  By this cause the  primary deleterious impression
is made on the skin.  Thence it travels to the digest-
ive system, which must be more or less deranged, else
no febrile  affection can take place.  From this point
it pursues, until  the close of the paroxysm, the same
course already indicated—first, to the  nerves and
brain, thence to the muscles, thence back to the skin
under another form of action, thence to the heart and
blood vessels, and lastly to the secreting structures
generally.
  Is the primary local affection a gun-shot wound, a
cut with a sabre, ©r any ether mechanical insuny ? 
•10'              FEVER  A DISEASE
Ex  mine the march of the fever that ensues, and you
will find it the same.
  In the production of every acute febrile affection,
it does appear, as already intimated, that the cause,
whatever  it may be, must subdue the resistance of
the digestive organs, and implant disease there,be-
fore  it can extend  its deleterious influence to the
other parts of the system.
                 SECTION III.

        Fever a Disease of the whole System.

  From whatever cause it may arise, or whatever
course it may pursue  in becoming so, fever, when
formed, is a disease  of the whole system.*
  It invades the head, the trunk and the extremities,
deranging there the  nerves, the muscles, the skin, the
chylopoietic organs, the heart and blood vessels, the
absorbents, the membranes,  the genital organs, and
the glandular system generally.  It injures also the
brain, and deranges, of course, the intellectual func-
tions.

  *This expression  must  be taken, perhaps, with
some limitations.  As far as  our observation informs
us, there are  certain tissues  of the, body which  ap-
pear to be very little if at all affected in cases of or-
dinary fever.  These are the osseous tissue, the car-
tilaginous, the tendinous, and a few others.  But all
the more extensive  and highly vitalized tissues and
systems evidently suffer. 
              Of THE WHOL£ SYSTEM*            41

  Although in the preceding section,* a few  facts
have been  stated  confirmatory of the proposition,
that fever is a disease of the whole system, a further
detail of evidence on this topic is somewhat impor-
tant to the nature and object of the present inquiry.
  Of the derangement of the nerves, in every case of
fever, although in  some it is much  more  strikingly
manifested than in others, the  testimony is, at once,
abundant and satisfactory.
  To say nothing of the strong manifestations to this
effect, in the modification of disease denominated ty-
phus, the general and often indescribable uneasiness,
amounting at times to a soreness of the whole body,
experienced by  every individual attacked by  fever,
is conclusive on the subject.  That this arises from a
derangement of the nerves, particularly of those be-
longing to  the internal parts of the body, and consti-
tuting  what is  denominated a sense of self or of be-
ing—well-being or ill-being—no  pathologist will be
likely to deny,
  Nor is the  evidence derived from the altered con-
dition of the external senses, less satisfactory.  There
are few cases of fever of any severity, in which  vision
and hearing are  not more or less  deranged.   The
acuteness of those senses is either heightened or di-
minished, or their sensibility is so altered, that most
things seem different to the eye, and most sounds to
the ear, from what they do in health   For the truth
of this,  an appeal may  be  safely and confidently
made to the experience of the sick.
  In relation to smell, taste, and  touch, the same
thing may be said.  Those senses  also are materi-
                        F 
42
FEVER A DISEASE
 ally changed'in their  susceptibilities and functions,
 by the disease under consideration.
   To  febrile  patients many  odours, agreeable  in
 health, become exceedingly  offensive; so altered
 also is their taste, that their favourite  articles  of
 food and drink are insipid or nauseating to them:
 and such is the derangement of their nerves of feel-
 ing, that many objects of touch produce sensations
 altogether  unnatural.
  The pain so distressing which febrile patients often
 experience in the back, especially in the lumbar re-
 gion, would seem to be the result, at least in part, of
 a diseased condition of the spinal marrow.  Nor can
 a doubt be admitted that the defective and anxious
 respiration which forms  such  a prominent symptom
 in the access of fever, is-essentially connected with
 nervous derangement.
  Of the intellect of those attacked by fever, it may
 be safely asserted that it is  always affected.  If it is
 not deranged, in the usual acceptation of the term, it-
 is  preternaturally diminished  or  increased in  its
 strength and intensity, or in  some  way perveited
 from its healthy condition.
  Indeed radically dependant as it is on the state of
 the brain—as much  so  as the bile  is on that of the
 liver, or the urine on that of the kidneys—it is not
 possiblethat the case can be otherwise.  If an un-
 sound liver be always accompanied by unsound bile,
 or  by a quantity of it .preternaturally increased or
 diminished, so will a diseased brain be always pro-
ductive of a diseased intellect.  But, that an organ
sp large, and possessing such an extensive  range of 
               OF THE WHOLE SYSTEM.            13

sympathies as the  brain does, should remain  unin-
jured amidst  the universal commotion of fever, is
impossible. To the truth of this, the symptoms  of
the sick, in common with the appearances exhibited
by dead bodies,  bear  ample testimony.   Indeed if
there are any organs more certainly affected by fe-
ver than others, they are  the  brain and nerves, the
stomach and liver, the heart and blood vessels,  the
skin, and the secreting structures generally.
  To offer further evidence of the existence of gas-
tric derangement in febrile affections, might  seem
superfluous.  Such derangement is satisfactorily in-
dicated by every  phenomenon that bears on the sub-
ject.  Anorexia,  flatulency, nausea, vomiting—.sore-
ness, burning, or distress about the  scrobiculus cor-
dis, or some other form of gastric affection, are uni-
versal attendants on paroxysms of fever.  This af-
fection consists at times in  an appetite preternatu-
rally keen and craving.
  So powerful a  protector, as has been already sta-
ted,  is  the stomach to the other parts of the sys-
tem, that unless its  functions be disordered, and its
resistance previously subdued, no febrile disease can
be formed.  In its progress  from local to general, fe-
ver must pass through that organ, generating de-
rangement there, as an essential link  in  the  chain
of disease.  If that link be wanting, the chain  is in-
complete.
  While the digestive apparatus continues sound, its
healthy sympathies  sustain in health the other parts
of the body.   Derange it, and its sympathies become
deleterious to other  parts,  in  the  same degree, in 
¥
FEVER A DISEASE
 which they had been salutary.  It is thus a centre of
 sympathetic  governance, from which  fever receives
 its charter of existence, and  by which that charter
 may be modified or revoked.  Hence its supreme
 importance as an object of attention to the practical
 physician. Keep it in a healthy condition, you pre-
 vent fever; act on it skilfully during the disease, you
 do much towards its removal.
   The general debility and inaptitude  to  motion,
 always experienced during the paroxysm of fever,
 has been alreaily referred to as a phenomenon indi-
 cative of derangement in the muscular system.
   To the  same, in part,*  may the imperfect vision
 of febrile patients be, in some cases, attributed.
   Objects cannot be seen with the same perspicuity
 and distinctness at different distances,  unless the po-
 sition and figure of  the eye  be  so altered as to be
 accommodated alike to each of them.   But such  al-
 terations are necessarily effected by muscular action.
 During the severity of a febrile paroxysm, the  mus-
 cles of the eye, in common with the other muscles  of
 the body, lose their facility ancl perfection of  motion.
 Hence they necessarily fail to produce in that organ
 the several conditions of compression, shape, and  di-
 rectiou, adapted to  perfect vision at  different dis-
 tances.
  The frequent want of lustre and  vivacity in the
febrile eye is also attributable chiefly to the inaction,

   ¥lsay "in part," because the optic nerve may suf-
fer at times, in common with the other nerves of tbr
bodv. 
              9F THE WHOLE SYSTEM.    ,        4.:)

from debility  or torpor, of its  muscles of motion.
That for its varied expression, that organ is indebted
chiefly to muscular action, will not be denied.  When
that action, then, is feeble or wanting,  the expres-
sion must be defective in a corresponding degree.
  There is reason  to believe, that a  deficiency of
hearing, in cases of  fever,  is owing, at times, to an
inability in the muscles concerned to give the  requi-
site tension to the   auditory apparatus.   At  other
times, to a deranged condition of the auditory nerves.
  Costiveness, a frequent symptom of fever, is attri-
butable, in part, to a want of action, or an enfeebled
action, in the muscular  coat of the intestines.
  From a similar condition of the muscles of the blad-
der, febrile patients  oftentimes  evacuate their urihe
with difficulty.
  To occupy the time of the reader by an exhibition
of further evidence of the fact, that this disease at-
tacks and deranges  the skin, which often receives
the  first impression of the febrile cause, would be
superfluous.  Such  evidence presents  itself abund-
antly to every observer.  To wave considerations of
fiigher  moment, the increase  of temperature, in
which, with other parts of the body, the skin partici-
pates, is alone conclusive on the subject.
  That  febrile  affections  extend  to the absorbent
system their deleterious influence, satisfactorily ap-
pears from  the  rapid progress  of emaciation—the
effect of excessive absorption—which occurs in most
x>f them, and from hydropic  depositions—the result
of diminished absorption—which take place in a few 
lb
FEVER A msEASt
   That fever reaches also the genital system, is de-
 monstrated by the failure of the functions of the or-1
 gans that compose it, during the continuance of that
 disease.
   Of the uniform and deep affection of the heart and
 blood vessels which fever produces, evidence is pre-
 sented abundantly in the stage of excitement.
   That the glandular system participates also in the
 general derangement, is proved alike by  the pheno-
 mena of the commencement and close of the disease.
   In the access of fever, glandular action  is  deficient,
 a,s we learn from the disappearance, during the time,
 of the various secretions of the  body, not excepting
 that of pus from open ulcers, and of saliva during the
 constitutional  affection from mercury.   In the decline
 of the disease, the action of the glands is excessive, as
 js manifested  by the superabundant amount of se-
 creted fluids, which, in that stage of fever, usually
 occurs.  This  derangement of the system further
 appears from the novel and vitiated condition of the
 several products of secretory action.  To the exist-
 ence of such vitiation, the bile, the urine,  and the
wiucous secretions amply testify.
  These remarks may be regarded as  applying  to
 ♦he membranes of  the body, all  of which are of a
 glandular character, and experience, both  in their
 structure and functions, the changes incident to other
 glands.
  Even the osseous  and the pilous systems, being
essentially connected with secretory action,are often
participators in the ravages of fever.  If  the source
 he disordered,  the product must suffer. 
OF THE WHOLE SYSTEM.        '    47
    From the interest attached to it, as a topic in pa-
 thology, and its great importance as a guide in prac-
 tice, the  diseased pulse, which constitutes  such  a
 prominent symptom of fever, is entitled to a few ad-
 ditional remarks.
   For its preternarural frequency, fulness, and force,
 it is indebted to the action of the heart.   Its tension
 and hardness, as well  as its  contracted  and wiry
 character, arise from the peculiar state of the arte-
 ries.   When in a healthy condition, the large arteries
 do but little to  promote  the circulation of the blood,
 that function through them being performed almost
 entirely by the action of the heart;  when diseased,
 their agency tends to impede it.
   In the number and times of its beats, the pulse ne-
 cessarily corresponds with  the contractions of the
 ventricles of the heart.   Bearing towards each other
 the relation of cause and effect,  these  movements
 are and must be, alike in frequency.   Nor is it true, as
 is often asserted, that the pulse, in one arm, is ever
 more frequent than it is in the other.  In both arms,
 and in every other part of the body,  it  moves only in
 obedience to the contractions of the  heart j conse-
 quently its beats are, in  all parts, synchronous with
 those contractions, and with each other.  When, there-
fore, the  heart  contracts frequently,  the pulse is
frequent, and the reverse.   If the heart contract with
such vigor and effect as completely to  empty its ca-
vities of their blood, the  pulse is full, and usually
strong.  When the cavities are not thus emptied, the
volume and force <A the pulse are jnoportionably di-
minished. 
4$               ^EVER A DISEASE
  A preternatural frequency  in  the contractions of
the heart arises generally either from an excess of ir-
ritability in the organ itself  or a superabundant accu-
mulation of blood in its cavities.  The former condition
of it would seem to exist in carditis, or inflammation
of the heart, as well as in some  of its  sympathetic
affections;  the latter, in fever generally, more espe*
cially in its stages  of access and rigor*.  During those
stages of every febrile paroxysm, the cavities of the
heart are surcharged with blood, which, by the mor-
bid and irregular action  of the system,  is  forcibly
thrown  from the circumference  towards the centre,
and, in some measure, confined there.  Struggling
to free itself from the oppressive  load, the  organ
contracts with frequency and  all the force it  can
exett; and hence  the formation of the stage of ex-
citement. If the heart empty itself completely at each
exertion, its contractions are less frequent; but more
so, if it empty itself but partially.  When, as already
observed, that organ is inflamed,it is preternaturally
irritable,  for  the same  reason  which  accumulates
irritability in  every  other  inflamed organ.   In  this
case, without any superabundance of blood  in its
cavities, its contractions must  be necessarily  pre-
ternaturally frequent.
   The  tension, hardness, and  wire-like feel of the
pulse, arise from  an actual contraction of the arte-
  *In the stage of excitement, when the system is
passing to a state of collapse, and, in a particular
manner,  during the existence of collapse, the fre-?
quency of the pulse is explicable on the same ground. 
OF THE WHOLE SYSTEM.           4$
    ry—a condensing of its parietes,  and a lessening of
    its caliber, which  prevent the blood from flowing
    freely through it.   Hence  a hard  and tense pulse is
    rarely a full one.
      This spasmodic condition—for such it appears to
    be—of the larger arteries,  cooperates with the con-
    traction of the capillaries  to throw the blood super-
    abundantly on the heart.  Yv'hen accompanied by a
    quickness or short jerk in the beat of the pulse, it
    testifies to the existence of topical inflammation; a
    point of information in  no  small degree important in
    practical  medicine.
      On this subject it may not be without some interest
'    further to observe, that, contrary to general belief in
    relation to it, the  leat  of the pulse appears to be ex-
    clusively  the work of the heart; and does not depend
    on any active expansion and contraction of the ar-
    terial tube.   However heterodox the  assertion may
    appear to many, it is notwithstanding true, that, in
    the circulation of the blood, the larger arteries expe-
    rience neither an augmentation nor a diminution of
    their diameter.  At each  contraction of the  heart,
    they are perceptibly elongated; but,  in the dimen-
    sion of  their  caliber, they suffer  no visible change,
    nor can  any  pulsation  be  felt in them,  unless
    under  a  pressure  which  narrows their diameter.
    That, from their tonicity, they have a constant tend-
    ency to contract, cannot be doubted.  And that they
    do  contract, when partially or entirely  emptied of
    their blood, is known to every physiological observ-
    er.  Nor is it less certain, as can  be  easily made to
    appear, that the tendency  or constant  effort of the ar- 
&
FEVER A DISEASE
 teries to contract, contributes its part to the circula-
 tory  process.  The  expansion of  these tubes could
 be produced by nothing but the influence  of a force
 or power stronger than their disposition to contract,
 and acting in opposition to it.  But such a power the
 heart cannot apply, unless the  circulation of the
 blood be impeded.
   When in a  healthy condition, the arterial lubes
 offer no  resistance to the circulation  of  the blood,
 because they are in  harmony with the action of the
 heart, the influence  of their tonicity or tendency to
 contract  being centrifugal.   But during  a febrile
 paroxysm the  case is otherwise.   By a contraction
 or lessening of their  diameters, they  unite  with the
 capillaries in their conflict  with the heart, and by a
 state  of action now  become centripetal, prevent  the
 blood from flowing in the quantities requisite, to the
 surface and extremities of the body.  To subdue this
 contraction  and  general retrograde or centripetal
 tendency, constitutes a leading object in the treat-
 ment of febrile diseases.
  As  far as he has  proceeded in this analysis,  the
 author ventures to hope, that both the general course
 he has  pursued,  and the particular  expositions  he
has given, are calculated for the attainment of the
end he  has in view—the  development of correct
principles in relation to  the pathology, and correct
rules of practice  with  regard to  the treatment,  oi
febrile complaints.   It is only, as  he conceives, by
proceeding  as he has  done—by commencing with
the primary impression of fever, advancing with it
through its  successive stages, marking its progress 
             •  QF THE WHOLE SYSTEM,           51

from one system of the body to another, and accom-
panying it to its termination in the stage of secretion,
that its true philosophy can be fully understood and
developed, and a successful plan for its removal de
vised.
  Observe a case of fever during the stage of excite-
ment, or during any other given insulated stage, and
it is an object so obscure,  and of such uncertainty,
that but little of useful knowledge can be acquired
from studying it.   Examine in this way each of its
stages or elements singly, without attending to their
succession and  relative  connection, and the  result
will be the same—the information received from the
inquiry will be exceedingly limited in a pathological,
and by no means important in a practical  point of
view.  Consider all its stages singly but progressively,
as a regular series of  phenomena bearing  to each
other the  relation of cause and effect, and not a little
of the darkness that enveloped the  subject is  re-
moved.  Under this mode of examination the seve-
ral elements or members  of the disease, shedding on
each other their mutual lights, disclose a sufficiency
of the  form, character, tendency,  and uses  of the
whole, to  indicate  the object which nature  has in
view in the composition of the complaint.  It is thus
that by examining in its totality an animal or  a well
formed machine, we discover with facility the  struc-
ture, the philosophy, and  the uses of each, while an
inspection of them in detached fragments, imparts to
us no useful knowledge of either.  If it is true, that.
as practical physicians, we act most rationally and
to the  best effect when we follow nature, it is no less 
i2
OF THE DIVISION
 -; so, that to be enabled to follow her, we must learn
  her course by tracing her footsteps.  Nor is there any
  other procedure that can lead us to an acquaintance
  with genuine  science,  which  is  but another form of
  expression <" ;r a knowledge of what nature docs, and
  of the manner in which she does it—a knowledge of phe-
  nomena, and the laws that govern them.
     The author is, therefore, encouraged in the belief,
■» that the plan he is pursuing,  if executed  with suffi-
  cient ability, is well calculated to  throw on the pa-
  thology of fever, and  the general  indications as to
  its treatment, such lights and illustrations,  as  may
  best qualify the educated physician so to direct and
  vary his practice, as to adapt ft to all the modifica-
  tions of the disease.



                    SECTION IV.

               Of the Division of Fever.

     On this topic it  is the intention  of the author  to
  be very limited, in  his remarks.  Into the considera-
  tion of it he will enter so far only, as may be requi-
  site for the further  development of  the philosophy of
  the disease.   He purposes, therefore, to confine him-
  self chiefly to  an examination of that arrangement
  which divides fever into Idiopathic and Symptomatic.
     By the former is meant, in the words of a great
  uosologist, "Pyrexia sine morbo locali primario;" a fe-
  ver which, not arising from a primary local affection.
  is general from the  beginning. 
OF FEVEE-.
53
   By the latter, a fever which does arise from a pri-
 mary local affection, the general disease being no-
 thing but an assemblage of symptoms of the local.
   It is a question of no little interest, as a  matter of
 science, and of equal moment in relatiou to practice,
 whether,  consistently with these  definitions, there
 exist such a disease as an idiopathic fever? Wheth-
 er, according to the nature of deleterious causes, and
 the principles on which vital phenomena depend, it
 is possible for a febrile disease  to exist, except  as
 the  consequence of a primary local  affection?
   To these  inquiries a negative reply may be confi-
 dently rendered. That such a complaint as that  re-
ferred to, under the denomination of idiopathic fever,
has no existence in nature, and ought not,therefore,to
find a place in the vocabularies of medicine, appears
satisfactorily from the following considerations.
   1. All fevers begin in the solids, inasmuch us they,
surrounding and  completely  protecting the fluids,
are  alone exposed to the first impression of febrile
 causes.
   This proposition is so perfectly obvious, that sim-
ply to state  it  is definitely to prove it.  To every
physician who is even moderately versed in the sci-
ence of his profession, and free from  the prejudices
of the school of humoralism, it can scarcely  fail  to
be intuitively plain.  To dwell, therefore, at present,
on the  illustration and establishment of it, would  be
a waste of time.
   2.  No febrile cause can act primarily on the solids
 of the body, beyond the sphere of its actual contact. 
54
OF THE DIVISION
   This proposition being self-evident, will not be
controverted, but must be regarded in the light of an
axiom in medicine.
   3. No febrile causes with which we are acquaint-
ed, can come into contact with any but a very limited
portion of the solids.
   There are butybwr parts with  which such causes
can come into contact at all, so as to  make on them
a. primary impression.  These are, the slcin, the inter-
nal surface of the  primce vim, the schneiderian mem-
brane generally lining the nares, trachea, and lungs>
and the brain.   To no other portion of the solids can
they have immediate access.
   That this proposition also  is true, will appear con-
clusively from a brief examination of it.
   The chief,  if not the  only causes  productive  of
those  fevers denominated idiopathic, are infection,
and, as some allege, contagion, in a gaseous or liquid
form, heat, cold, vicissitudes in the atmosphere, hu-
midity, unwholesome food and drink, poisonous  mat-
ters swallowed accidentally or  by design,  and the
passions of the mind.
   To enlightened and philosophical physicians, who
examine the relation of cause and effect, this enume-
ration alone must  prove  satisfactory as to the truth
of the proposition to which it relates.
   All liquid and gaseous substances, whether con-
tagious or infectious, poisonous  or  otherwise, are
necessarily confined in their immediate contact and
primary action to the  skin, the schneiderian /mem- 
OF FEVER.
55
firane, and the internal lining of the alimentary ca^
nal.*
  Heat, cold, vicissitudes  in the  atmosphere, and
humidity, can act primarily oh the skin alone; or, at
furthest, on the same parts with liquid and  gaseous
substances.   Beyond  this their immediate contact
cannot extend.
  Unwholesome food  and drink, and poisonous mat-
ters swallowed, in whatever form, or for whatever
purpose, are  necessarily  confined, in  their primary
action, to some portion of the alimentary canal.
  These several propositions are so  clear in them-
selves, that to offer proof of them, would not only be
superfluous, but would  weaken their claim to our
belief, by admitting the possibility that they may be
unfounded.
  Nor is it less obvious and certain,  that  the first
impression made by the passions of the mind, is con-
fined  to the brain, which is at once their organ and
seat.
  If there be any other causes productive of fever, it
can be satisfactorily shown,  by  a fair examination
of them, that, in their primary  action, they are as
necessarily local as those that have been cited.
  From tbese considerations, regarded as premises,
the inference is  irresistable, not only that fever is

  *We are constantly swallowing air with our food
and our saliva.  If, therefore, there be afloat in the
atmosphere a gaseous poison, that also must be ne-
cessarily swallowed,  and brought into contact with
the mucous lining of the stomach, and other portions
of the primse vise. 
ojb
ol  THE DIVISION
always accompanied by a primary local affection, but
that it is necessarily produced by it.  Without such an
affection, no more can the disease arise and  spread,
than a tree can spring from the ground  and  flourish
without a root, a stream flow without a  fountain, or
any other effect take place, without the influence of
its proper cause.
  Will it still be alleged, as it often has been, that
through the  skin,  the lungs, or some portion of the
alimentary canal, febrile poisons gain admission into
the blood, corrupt that first,  and afterwards produce
disease in the solids?
  To this the  reply  is obvious and conclusive.  If
those poisons, in passing through the solids, in a pure
and undiluted state, do them no harm, they  will not
be likely to act more powerfully and produce greater
mischief, after they have been weakened by a mixture
with the blood.  To contend  that  they  do  or might
thus act, is to turn sophist and advocate an absurd-
ity.*  As well might  it be maintained that, in any
other case, a weaker cause may effect what a strong-
  *When strictly analysed, the proposition of the
humoralists, on this topic, may be thus expressed.
  Febrile poisons in a slate of purity cannot injure
the solids when first passing through them to reach
the blood.   But  having gained  admission into that
fluid and mingled with it, they return, in this state of
dilution, and produce disease in parts which  were
proof against their action when undiluted.
  If there be in this statement any misrepresenta-
tion, let the  humoralists  show  .vherein it consists.
And if ihere  be none,  it is incumbent on them to
make it appear that the propo=',t'"'vr» »« st-tort rr>™ 
                    OF EEVE.R.                 *$3

r.r one cannot—that a drop of sulphuric acid diffused
through several gallons of water, is better calculated
to irritate and inflame a denuded portion of the cutis
vera, than an undiluted drop.
  But, far from  being true that, without injuring
the solids through which  they  pass, febrile poisons
first enter the blood and then create disease, there is
no reason to believe that they ever  pass into that
fluid at all.  On the contrary, that the opposite opin-
ion  is true, may be satisfactorily proved.
  Before the actual  formation of fever, no one ven-
tures now to contend that the blood is contaminated.
Nor, even during the existence of the disease in  its
highest degree of malignity and violence, has a poi-
sonous contamination of that fluid ever  been detect-
ed.   The humoral notions of its putrefactive and  ac-
rimonious conditions are too visionary to be seriously
considered.  Inoculate with the  blood of a febrile
patient, or introduce it into the veins of a person in
health, and in  neither way can you succeed in com-
municatingthe existing complaint.  But, it might seem
superfluous to  add, that were  it impregnated with
the poison of the disease, the case would be other-
wise.
. In further defence of the ground here assumed, it
may be stated as a truth, amounting, perhaps, to an
axiom  in physiology, that  through neither of the sup-
ports with reason.  If they can do neither, their only
alternative is, to  abandon their  hypothesis and em-
brace  truth, or obstinately adhere to demonstrate^
error. 
            \
 W               Ot  THE DIVISION

 faces with  which they can  come into contact—the
 skin, the schneiderian membrane, or the mucous lining
 of the alimentary canal—are poisonous substances
 permitted to enter the blood in an active state.  If
 they  enter it through  those channels at all, it is not
 until,  by the mutative  and assimilating powers  of
 the living solids through which they pass, they  have
 been  completely deprived of their deleterious quali-
 ties.
   In relation to heat, cold, moisture, and vicissitudes
 in the atmosphere, no one  will deny that they,  in
 their primary action, are confined exclusively to the
 surface of the body.  Whether the climate be torrid
 or frigid, or the weather hot, cold, or variable, until
 the fever is  formed, the blood and  all the  internal
 solids maintain with uniformity the same tempera-
 ture, and exhibit the same degree of humidity.   To
 the skin alone is the primitive  action of the causes
 limited.
  That during fever the blood sustains certain morbid
 changes, is  obvious to every one.  But these are the
 effect of the disease, not  its cause.   The blood  is as
 really the creature of the solids, as the fruit is of the
 tree that bears it,  the machine, of the  artist  that
 formed it, or the stream, of the fountain from which
 it flows.  That fluid, as a fluid, is literally created by
 the action of the solids, and cannot be  sound if  that
 action be morbid.  But it suffers secondarily by the
 diseased action of the solids alone, and not by means
 of an original contamination.
  That disease may  be aggravated, modified, and,
in a Jew cases, perhaps, extended, by the deleterious 
OF FEVER.
D\>
changes which the fluids of the body undergo »n con-
sequence of the morbid action of the solids,will not
be denied.
  The blood  and  the  secreted  fluids, when thus
changed and vitiated, become themselves morbific
agents, capable of producing malign  impressions on
those parts of the body  with  which  they come into
contact.   On this ground they may be  instrumental
not only in aggravating and extending existing dis-
ease, but even, perhaps, in the production of a new
one.  But for  whatever deleterious  properties they
may possess, they are indebted exclusively to  some
deteriorating influence of the solids.  Without such
influence they would remain healthy, as certainly as,
when not assailed  by accident, sound fruit  is the
product of a sound tree, or as any other effect cor-
resDonds with its cause.
   Fever resulting from infection or contagion, is pro-
duced by an  impression  exclusively  irritative—an
impression,  which, not being felt, its existence is re-
cognized, not by the senses, but by the powers  of
reason and philosophical research.*  On this account
alone its existence isno* universally  admitted, while
the existence  of sensative impression  is.   All men
feel; but all men do not reason as philosophers. While,
therefore, they admit, without hesitation,  and  in ev-
ery instance, the evidence of sense, they receive  re-
luctantly, or entirely reject or misinterpret that evi-
dence, which, disclosed and collected by a laborious
  *Perhaps its  existence is established still more
\onclusively by post-mortem examinations. 
&
OF THE DIVISION
 process of inquiry, is cognizable only by the power;
 of the intellect.
   Reverse this state of things, so that all men shall
feel little and reason much, and the issue will be  not
 only different but opposite. The evidence of sense will
 then  be often  rejected, and that of reason universally
 received.  The existence of irritative impressions
 will be promptly admitted, and that of sensative ones
 held  in doubt or'entirely discredited.  It will then be
 conceded that bilious fever in all its variety, includ-
 ing yellow fever and pestis vera, typhus fever, scar-
 latina, small pox and measles, arise from a primary
 local impression, but that those fevers resulting from
 burns and mechanical injuries do not.  Of course the
 latter will be  called idiopathic, and the former symp-
 tomatic.
   Examine a febrile disease, of any description, that
 can be traced with accuracy and certainty to its ori-
 gin, and it  will be found to  be derived from a  pri-
 mary local affection.
   Let the example selected be a fever produced by
 the swallowing of oxid of arsenic, muriate of mercu-
 ry, or any other mineral poison.  This arises indu-
 bitably  from  a primary morbid impression on  the
 stomach, the phenomena, or secondary affections that
 give  character to it, being as purely symptomatic, as
 if the whole had resulted from a wound produced in
 that organ by a bayonet or a  bullet. Yet, so similar,
 in all respects, is this complaint, to those originating
 from marsh miasma, that the  author has  known a
 case of disease arising from the swallowing of muri-
 ate of mercury, to be mistaken by a  physician of 
OF FEVER,
V
great experience, sagacity and judgment, for yellow
fever.  It perfectly resembled that  complaint, when
highly malignant, in its access and stage of  excite-
ment, the colour of the skin, the discharges from the
stomach and bowels, the appearance of the eyes and
countenance generally, and in  the occurrence of
hemorrhage from  various parts  of the  body.   But
if, by a local impression on the stomach, muriate of
mercury can produce  a malignant fever, why not  a
poison of any other description, provided it posses^
sufficient strength? Why  not the poison of common
bilious fever, typhus fever, scarlatina, or the plague?
If there exist any reason why, in the one case, the
deleterious substance should produce disease by act*'
ing locally on the  stomach, and in the others  by
making its  way into the blood, the author  confes-
ses  himself unable  to discover it, and will  feel
obliged and instructed by those  who  may indicate
it to him
  Is the fever, which is the subject of inquiry, gene-
rated by the influence of the passions of the mind?
Examine carefully its rise and progress, and its ori-
gin will be found in a primary morbid impression on
the brain, communicated, by sympathy, to the  digest-
ive system, and thence, on the same principle, to the
other parts of the body.  It  would  be an outrage On
sound physiology to allege, that, in the first instance,
any other part but the brain can be affected by the
passions  of the mind.
  As a further evidence of the local origin of fever,
every one attacked by that complaint,  who is  suffi-
ciently observant of his own feelings, is conscious of 
ixil
OF THE DIVISION
the existence of a primary local derangement.   His
conviction to this effect arises from pain, uneasiness}
or preternatural feelings of some description, which
he experiences in the stomach, the head, the thorax?
the back, the skin, or in itome other part of the body,
previously to the occurrence of the general affection.
For the truth of this, an appeal may be  confidently
made to the recollection of those who have suffered
from disease.
  Indeed when the subject is deliberately examined
and faithfully analysed, a belief in the original lo-
cality of fever would seem to be  a primitive feeling
of the mind.  The  proposition is so palpable that it
is instinctively received as soon as it is presented to
the inquirer, and, like other fundamental truths, may
be considered, in the impression it produces, as im-
mediate, universal, and irresistible.
  The feelings of the sick satisfactorily indicate, that
no fever runs  its course without being marked by
some local affection; and that no one can prove fatal
without it,post-mortem dissections abundantly testify.
  There exist still other considerations, tending to
the establishment of a belief in the  local origin of
febrile diseases.
  Every phenomenon  which bears on the subject
shows, that fever arises immediately horn congestion,*

  * According to the part in which the congestion is
situated, is the character  of the disease  which it
produces.
  In those febrile complaints that have been usually
denominated  idiopathic, viz. bilious fever in all its
varieties, yellow fever, pestis vera, typhus fever, and 
OF FEVE.R.                  63
produced by a primary deleterious impression.  But
congestion is necessarily a local affection.  It consists in
a preternatural accumulation of blood  in some part
of the body.  A general congestion can  have no ex-
istence.  If a superabundance of blood be thrown into
any one part of the body, it must be done by produc-
ing a. deficiency of it in some other part.   And to re-
verse the position, a deficiency in one part indicates
a superabundance in some other.
  The paleness of countenance, shrinking of tha fea-
tures, diminution of the extremities, and the retreat
of the blood from the surface of the body generally,
which always take place on the approach of fever,
scarlatina, whether excitive, inflammatory, or con-
gestive, the congestion exists in the portal circle ge-
nerally, its more immediate seat being the mucous
lining of the stomach.
  In pneumonic febrile affections,  it is situated in
some part of the  thoracic viscera—the  pleura, the
substance of the lungs,, or  the  schneiderian mem-
brane which lines them.
  In true cephalic fever, its  situation  is either  the
substance or  membranes of the brain.
  In genuine  rheumatic fever, its seat is in the mus-
cular system  or its appendages, or  in some of the
membranes connected with the joints.
  If asked in what way the  original deleterious im-
pression produces congestion, my answer would be,
that, in addition to its generating a morbid irritation,
it so far debilitates the vessels of the part where it
is made, that they are unable  to  act. with sufficient
vigor to force the blood onward in its couifee of cir-
culation as rapidly as it is thrown into them.  Henc^
;t must necessarily accumulate. 
eti
OF THE DIVISION'
 are demonstrative of the existence of internal con*
 gestion.   If,  by a state of centripetal action, the
 blood be repelled from without, it  must necessarily
 be accumulated in the  internal parts.  Without a
 congestion thus produced, no fever could ever make
 its appearance. Nor would it be either requisite, or
 consistent with the economy of nature that it should.
   Fever, as already stated, is an effort of the healing
 or restorative  powers of the system to remove  a
 morbid  affection.  That  affection is  internal conges-
 tion.  If the congestion did not exist, the effort would
 not be made, as nature never engages in an unneces-
 sary struggle.  That  this is true appears from the
fact, that when the congestion is removed, the strug-
gle ceases.
  In  relation to this point,the example of a paroxysm
 of intermitting  fever would  seem conclusive.  At the
 commencement of that  complaint,  every circum-
stance connected with it  announces the existence  of
internal congestion.   But  as soon as that affection is
removed by means of the stages of excitement  and
secretion, for  which  purpose they  are particularly
intended, the paroxysm terminates.
  The same  is true of fever in general.  Every feb-
 rile complaint,  as heretofore stated, consists of one
or more  paroxysms.  The paroxysm  is the result of
interna! congestion produced by the primary morbid
impression.   By nature, the curative powers are
called into action to  resolve this congestion.  Nor
does the effort cease until, by secretion, the object is
effected, or the  system sinks exhausted in the strug-
gle.  Whether the paroxysm be long or short—be itf 
OF FEVER.                 65
duration twelve  hours, eighteen hours, three days,
five days, seven days, or three weeks, its cause and
origin are the same, it is governed by the same prin-
ciples, and terminates for the same reason.
   If the internal congestion be removed entirely,* the
febrile commotion ceases altogether, and the state of
apyrexia that follows is complete.  This is exempli-
fied in simple intermittents.
   But in case the congestion be removed only in part
the febrile commotion abates but in part, and the
state of apyrexia is incomplete.  Of this we have an
example in remitting fever.
   In the long compound paroxysms of yellow fever,
typhus  fever, and, scarlatina, the same  principles
prevail.  In  each of them the febrile commotion ex-

   *Whether, at the time  of the termination of a
paroxysm of intermitting fever, the internal conges-
tion which produced it be completely removed, is doubt-
ful.   A slight uneasiness which  still remains in the
system, shows that all within is not right.
   Admitting the congestion to be removed, the so-
lution is but temporary.  Owing to  the  weakened
condition of  the  vessels of the part, united to some
remaining irritation, it  soon returns.  And cotem-
poraneous with  its return  would be  that of another
paroxysm, were it  not that the exhausted excita-
bility  of the system requires some time before it  is
sufficiently  restored to admit of another course  of
febrile  action—perhaps I might say, to  make an-
other recuperative effort.
   Why under one  form of intermitting fever twelve
hours only  are  requisite for this restoration, under
another twenty-four hours, and under a third, thirty-
six, is, in the present state of medical science, a point
of transcendentalism, which cannot be resolved.
                        I 
66
OF THE DIVISION
 cited by congestion, continues with but little abatcj
 ment, until nature gives way, or  the  congestion is
 removed by the stage of secretion.
   As an inference from the foregoing considerations,
 it may be  confidently stated, that, if there be any
 thing certain in pathology,  it is, that fever arises
 from a primary  local affection, and  is essentially a
 disease of association  or sympathy.   In  the  usual
 acceptation of the term, then, an idiopathic fever has
 no existence.  If the disease be called symptomatic
 in one case, it should be so Called  in every case; for
 it is always a general derangement proceeding from a
 local cause.
   But the local affection is not always inflammatory.*
 Those who contend that it is, are mistaken.  It  is
 marked by three grades, only one of which is truly
inflammatory.
   The first and  mildest form of the local affection is
 a degree of congestion below that  of inflammation.
This can be resolved by a mere increase of excite-
ment, without any true  phlogistic action.
   The third and highest degree of the local affectioi
prevents reaction, by paralysing the system, and is,
therefore, beyond the point of inflammation.  Unless
relieved by skilful  treatment, this  grade is  always
fatal.
  It is the second or middle degree alone that gives ,
rise to inflammation.  Here, the congestion, not so
  •• By some of the most distinguished pathologists
of the day, topical membranous inflammation is con-
sidered essential to the production of fever. 
OF FEVER.                  gj
 excessive as to paralyse the system, is too deep to
 be removed by reaction short of inflammalory*
   Of these three grades of congestion and disease,
 examples present themselvesin the three well known
 forms of scarlet  fever.
   In scarlatina simplex, there is  no inflammation,
 because the primary  local affection is too  slight to
 produce it.
   In scarlatina inflammatoria there z's inflammation,
 as the term itself imports, because the  primary af-
 fection is severe.
   In  scarlatina  congestiva,  usually denominated
 scarlatina maligna, the primary affection is so malig-
 nant and paralysing, as to prevent that degree of re-
 action in which inflammation consists.
   A regular paroxysm of intermitting fever furnishes
 evidence sufficient to convince us that that complaint
 does not arise from an affection of the stomach actu-
ally inflammatory.
  Real gastric inflammation cannot, like  the local
affection producing intermitting fever, be removed in
  #This view of  the original local impression pro-
ductive of fever,  resembles not a little the division
of that  complaint by  Dr. Armstrong into excitive,
inflammatory, and  congestive.
  But, to those who received his instructions in med-
icine it  is psrfectly known,  that the author  enter-
tained and inculcated the same view several  years
before  the  verv  excellent writings  of Dr.  Arm-
strong had made  their appearance.
  To those productions he is  much indebted  for
their  support of his opinions, but not for originally
suggesting them. 
Ufc             OF THE TREATMENT
a few hours, by any process that man or even nature
herself can institute.  Nor is a paroxysm of intermit-
tent necessarily marked by that irritability, burning,
and soreness  of  the organ, nor with  that  peculiar
state of the pulse, which  always accompany inflam-
mation of the stomach.
  The remedies, moreover, that cure the complaint,
are incompatible with the true phlogistic diathesis.




                  SECTION V.

            &/* the Treatment of Fever.

  To give a succinct view of the leading indications
of cure that claim the attention of the  practitioner in
the  treatment of febrile diseases, and the  general
means of answering them, constitutes the  object of
this section.
  As preparatory to this, and that the philosophy of
the  subject may be  the  better understood, it is im-
portant to observe,  that  there are  four attributes or
modes of action of living matter, through which alone
the cure of fever can ever be effected.  These are
Irritability, Sensibility, Sympathy, and the Vis medica-
trix or recuperative power.
  Extinguish irritability  and sensibility, and remedi-
ate agents can make no impression.
  Remove sympathy,  and every impression will  be
necessarily a local one, the system at large bring in,
r>.o  degree affected by it. 
                     OF FEVER.                  6$

   Destroy the recuperative or healing power  of na-
 ture, and the cure of disease will be rendered impos-
 sible.   For by that  power is the actual cure in every
 case completed.  Remedies weaken existing morbid
.action, or transmute it into that of a different descrip-
 tion ; but nature alone  can finally eradicate it,  and
 institute healthy action in its place.
   If administered during health, all effective medi-
 cinal substances prove  injurious.  By  none of them,
 therefore, can the real action of health be restored.
   The laws and powers of these attributes, then, all
 physicians  should carefully  study; because, to be-
 come enlightened  and  successful practitioners, they
 must be acquainted  with them.
   On this topic the  author will only further observe,
 that by irritability he means a mere susceptibility of
 impression, united  to a capability of organic action.
   By  sensibility, a susceptibility of sensative impres*
 sion, i.e. impression connected with feeling, together
 with the action,  nervous and cerebral, necessarily
 associated with it.
   By  sympathy,  that  attribute  of  living  matter,
 according to which,   impression  or  action in one
 part, produces impression or action in another.
   By the  vis medicatrix  naturce, that properly ac-
 cording to which the various parts of  a  living being
 unite in their action to  prevent or remove a noxious
 impression, or repair the injury it has produced.
 These several terms are intended to be expressive of
 classes of phenomena presented by living matter, as
 gravitation, repulsion, attraction and magnetism are,
 of those that dead matter presents. 
70
OF THE TREATMENT
  By indication is meant a manifestation of the course
 to be pursued, or the change to be produced, with  a
 view to convert diseased into  healthy action.  By
 means, the remediate agents employed for that pur-
 pose.
   From this presentation of the subject, it may pos-
 sibly be  supposed, that both  the  indications and
 means will be represented as greatly diversified, the
 modes of  curing and alleviating fever being regarded
 as very numerous.
   This is a mistake, injurious  alike,  as the  author
 apprehends, in  science and practice; because, in-
 stead of concentrating  the views of the practitioner,
 and  rendering them determinate, the sentiment tends
 to scatter and unsettle them—It directs them loosely
 to many points, instead of fixing them with intensity
 on a few.  It is an  error similar to that which an un-
 skilful commander of  a besieging army would com-
 mit, were he, in order to effect a breach, to direct his
 artillery to play on a large extent of wall, instead of
 concentrating its.fire on a small one.
  If, under the numerous modifications it may  put
 on, and all the various aspects  it may present, fever
 be regarded as  so many distinct  diseases,  to be
 treated through an equal number of indications, and
 by means possessing supposed specific corresponden-
cies to them, then will both the  view and the treat-
ment of it be greatly  diversified, and confusion  in
 principle  and a want of success in practice, cannot
fail to be the result.  To proceed thus in relation to
it, would be to turn the attention from  internals to
'jlcmals,  and  from causes to effects> not to say from 
                     OF FEVER.                  /]

 -realities to mere appearances. It would be to prescribe
 for symptoms  instead  of  their sources—to  lop  the
 branches of the  tree, in attempting to destroy  it, in,
 stead of vigorously assailing its root.  It would  be,
 m fact, to  deal in that puny detail, which, originat-
 ing in a want of the knowledge of principle, degrades
 those who practise it, and  leads, for the most part,
 to an unfavourable issue.
   But if, instead of such detail, the subject be viewed
 through the general principles that evidently govern
 it, the  indications  in fever will be found  to  be few;
 and its treatment simple.
   If the disease arise from a state of broken  and un-
 balanced circulation and excitement, the leading in-
 dication is to restore and equalize them.
   If it be marked by a state of centripetal action, giv-
 ing rise to internal congestion or accumulation of
 blood, the indication is, to resolve that  congestion,
 by rendering the action of the system eentrifugal.
   If it be accompanied by  a want of secretion and a
 drying up of the different emunctories of the body, in
 consequence of a war or state of conflict between the
 capillaries and'the heart, the indication is to termi-
 nate  the conflict, by removing the spasm  from the
 capillaries,  and thus restoring to the secretings.tr> :.
 tur&s their natural action.
   To include these several views in one, if fever con-
sist in a state of oppression of the internal and  im-
portant  parts of the body,  by a superabundance  of
blood forcibly  thrown  on  them  from  without, by.
means of morbid external action, the  indication is to
relieve  those parts, and recall  the blood -^ its.pro- 
*'•
OF THE TREA'IMFNl
j)er channels, by changing the action which forced it
from them.  In relation to the best mode of effecting
these objects,  nature is  our surest and safest  in-
structress.
  For the ultimate removal of the internal conges-
tion from which fev£r  arises, she evidently has re-
course to the secreting stage of that complaint.   To
the production of that stage all her efforts in febrile
diseases are evidently  directed.   The rigor or cold
stage augments the congestion,  from  which it  has
itself originated, that augmentation gives rise to  the
stage of excitement, and  the stage  of excitement
produces, by  a  process intelligible and natural, the
stage of secretion.
  In his treatment of fever, then, let the practitioner
of medicine,  in imitation of nature, aim at the pro-
duction  of the secreting stage*   Let him so regulate
the other stages, and so manage  all concomitant cir-
cumstances, as to attain  this with the greatest  cer-
tainty, expedition and safety.
  For the effectuating of  this general and governing
indication, a  few subordinate ones must  be faith-
fully executed.
  1. If the remote or the exciting causes of the dis-
ease be still  in  action, they must, if practicable, be
removed, or patients should be carried beyond the
sphere of their influence.   Could this  be effected
  ^Whatever remediate agents tend to the produc-
tion of this stage, call them by any name you please,
are true febrifuges.   Those  that do not thus tend,
ought not to be so denominated, because  they have'
no in'fluence in the removal of fever. 
OF FEVER.                  #3
in yellow and other forms of bilious fever,  without
too much agitating and fatiguing the sick by the re-
moval, it would contribute not a little to their reco-
very.   That the continued operation on the system
of the same poison that produced the disease m  ist
aggravate and protract it, can tcarcely be doubted.
  2.  All  irritating impressions,  whether  they  be
made on the internal or the external parts of the bo-
dy, should be carefully withdrawn.
   3. In a particular manner, the arterial action must
be so regulated, as to be brought  to  what may  be
denominated the secreting point.   Unless this be  ef-
fected, secretion cannot be excited without the em-
ployment of such means as will render it prejudicial
rather than useful,  Secretion of a salutary charac-
ter rarely takes place in an adult, if the pulse exceed
ninetv beats in a minute, or the temperature of the
body be above 100 degrees of Fahrenheit. The same
is true, if either the pulse or temperature or both be
below the standard of health.   If to this rule excep-
tions occur, they are  but exceptions, and should be
so considered.
   In relation to the removal o/ the causes of fever,
no specific directions  can be  here detailed.  That
object must be attained by an adoption of measures
suited  to the  nature and circumstances of particular
cases.   And in concerting and applying those mea-
sures, the judgment of the physician in attendance
must direct.
   Irritating and aggravating causes, apart from pro-
ductive ones, may act on  the skin  or  the  external
senses.  Such are temperature either too high or top
                        K 
74
tfF THE TREATMENT
low,  improper clothing or  bed-covering, light  ov
sound in such a degree as to be painful or disagreea-
ble, and strong or offensive odours  or  tastes.   All
these should be so regulated as not  too powerfully
to impress the system, and add fo the general amount
of  excitement.  So must  exercise,  corporeal and
mental,  both  of which, in undue  quantities,  prove
highly  prejudicial.   Under  this  head is included
conversation, by  an indiscreet indulgence in which
febrile patients are oftentimes injured.
   The same is true of diet and drink, which, unless
skilfully adjusted, prove the worst of irritants. W'hen
unsuitable either in quantity or quality, no medicinal
articles can prevent or counteract their  pernicious
effects.   In  fevers of excitement, more especially  if
inflammation exists, it is impossible to err  by render-
ing them too mild.  That  diet  be very  limited in
quantity, is  also essential.
   Another  class  of irritants exceedingly injurious
consists of certain depraved secretions acting on the
stomach, and other portions of the alimentary canal.
These are to be removed by emetics and cathartics,
judiciously  selected  and administered  with  skill.
A proper amount of diluting drinks is well calculated
to aid in theis removal and to weaken  their action.
In  addition to their salutary  influence in cleansing
theprimae viae, emetics and cathartics, well  chosen
and exhibited with judgment, contribute to the pro-
duction  of the secreting stage.  They, in a particular
manner, tend to restore to a healthy condition the
skin and the secreting structures that pour their pro-
. ducts into the alimentary, canal.  On this  ground 
of fever.                   75
these remedies do much more towards the reestab-
lishment of health, than merely evacuating the con-
tents of the stomach and bowels.  When, to use the
fashionable language of the profession, they perform
the office of alteratives, they do it chiefly by correct-
ing morbid secretory processes.  To  do  this,  they
produce  new  impressions, which give rise to new
sympathies,  and new states of action in associated
organs, and thus reunite the broken circle of health.
   But, for the attainment of  the stage of secretion
with the greatest certainty, and under circumstances
best calculated to render it useful,the most important
measure is the proper regulation of arterial excite-
ment.*
   As already stated, it may  be viewed in the light
of a maxim in  physiology, that except at a  certain
point of  vascular action, salutary  secretion cannot

   #The character of the stage  of excitement, being-
only an effect,  depends necessarily in  no  small de-
gree, on that of the stage  immediately preceding if,
which is its cause.
   Hence a strict attention to the regulation of the
stage of rigor is of great importance as a practical
expedient.  If likely to prove severe and protracted,
and thus to endanger the safety of the system by the
depth and force of venous congestion, it ought,  by
the use of warm diluting drinks, united at times with
laudanum, and the judicious application of external
warmth, friction,  and other stimulating applications
to the skin, to be limited as much as possible both in
intensity and duration.
   By this course  of  management, a disease threat-
ening to prove a fever alarmingly congestive, may bt
transmuted into one excitivc or inflammatory 
7b
OF THE TREATMENT
take place.  When the action is above that point, it
must be reduced, and when below it, raised, until, in
either case, it attains it.  In that state ofexcitement
only can sudorifics, expectorants, diuretics, and other
articles productive of secretion, act with effect. The
action  of .the system being at the requisite standard,
secretion is much more likely to occur spontaneously*
than by the use of medicines, if it be at any other.
  By these principles will the practice of the edu-
cated physician be  regulated.  He will  elevate or
  *The morbid excitement being reduced to the pro-
per standard, the disease is brought within the con-
troul of the recuperative powers of the system,  which
are now sufficient of themselves to complete the cure.
Those powers, when not  impeded, can always  re-
move, without the aid of medicine, a moderate com-
plaint, such as a mild catarrh or a slight attack of
rheumatism or peripneumony;  but they are not com-
petent to the removal of a very  severe one.  They
must, however, and do,  complete the cure of every
disease that terminates favourably.
  The practitioner never completes a cure.  The ut-
most he can do is to bring the  complaint  within the
controul of the recuperative powers, and leave the
rest to them.   He merely weakens  morbid action  or
excites a new one, they institute that which is healthy.
  All effective medicines, if exhibited during health,
would  produce disease.   Witness emetics, cathar-
tics, narcotics and blisters.  Although blood-letting
does not induce actual disease, it reduces the vigor
of health.   How is it possible, then, for those agents,
which are actually at war with health, to resiore it,
if exhibited during disease?  I  repeat, they do not re-
store it; they merely weaken  or  change morbid ac-
tion, thus facilitating the operation of other remedies, 
                    OF FEVEH.                 7'

 depress, awaken or tranquillize arterial action, ac-
 cording to the standard at which he finds it.
   Is the fever to be treated  a disease of simple ex-
 citement or of real inflammation?  In either case the
 action is excessive, and the antiphlogistic course of
 practice must be adopted.
   In the/ormcr,*no blood need probably be drawn;
 but, in the latter, it must, and the operation be repeat-
ed, or not, according to circumstances.  To  this is
 to be added, in such extent as the case may require,
 other corresponding and cooperative remedies.t
   When, by a  due  perseverance in this course of
practice, the excitement is reduced to  the proper

 and rendering  the complaint  controllable  by  the
powers of nature, which themselves  furnish  the
cure—They convert a violent disease into a mild one,
which nature then cures, as if it had been mildyrom
the beginning.

   *In fevers of simple excitement, emetics, cathartics,
and diluent drinks, with cold applications to the sur-
face of the body, are sufficient to produce a solution
of the disease.  Antimonial preparations, both when
they produce vomiting  and when they do not, are
powerful not  only in the reduction of febrile  action,
but in exciting secretion.   Preparations of ipecacu-
anha, although less effective,  may  be rendered, by
skilful management,  highly tributary to the same
ends.   So may mercury under several forms, more
especially those  of calomel and the blue pill.

  tThe remedies to which allusion here is particu-
larly made, are  the same  that are indicated in the
preceding note, viz. diluents, the application to the
Surface of the body of cold, and in some cases of tepid 
7'4             OF TH«E TREATMENT
standard, if the secretory process does not take place
in the  requisite  degree, remedies calculated  more
particularly  to promote it may be safely employed.
These are what are usually denominated sudoriflcs;
but they acton other emunctories as well as on the
skin.*   A  detailed account  either  of the  articles
themselves or of the mode of exhibiting them, would
be inconsistent with the plan  of this essay.  Nor is

water, antimonials, mercurials, and preparations of
ipecacuanha.  When, by a due perseverance in the
antiphlogistic plan of treatment, inflammatory fevers
have been  reduced  from general to local affections,
blisters become  useful.   But if applied  while the
febrile symptoms prevail, they act as irritants,  and
do mischief.
  *Medicinal  substances taken internally,  with  a
view to promote secretion,  to serve as tonics, or  to
produce any other remediate effect, always act pri-
marily on some portion of the alimentary canal, chief-
ly the stomach, and on other organs or on  the system
generally, through the medium of sympathy.  If they
pass into the  blood  vessels at  all, it is not in  their
medicinal capacity, but in a state of assimilation,
which reduces them to the  condition of  alimentary
articles.  The blood can no more be  medicated by
salutary substances, than adulterated by deleteri-
ous ones.
  Medicinal,  like noxious agents, are limited in their
primary action, to the alimentary canal, the  skin,
the schneiderian membrane, and the brain, the affec-
tions of the mind only acting primarily on the latter.
Like fever, therefore, the curative process begins lo-
cally, and becomes general by means of sympathy.
  Of all the organs, whether for the production or
the cure of fever, the stomach  is the most powerful
sympathetic centre. Itsdifferent susceptibilities and 
«F FEVER;.                 70
it at all necessary, as there are few practical works
that do not contain it.
  When the degree of action is below the secreting
point, an opposite course of practice must be pursued,
until it has been raised to the standard required.
sympathies, therefore, in different conditions, cannot
be too thoroughly studied by the practitioner.
  It is by some physicians very strangely alleged,
that if a medicinal article acting on a given organ,
say the stomach or the skin, produces by sympathy
a salutary effect on a  distant  part  labouring under
disease, the same  article would necessarily produce
a similar effect on the same suffering part, if con-
veyed and applied immediately to it, through the me-
dium of the blood.
  An error more gross and palpable than this  can
scarcely  be  imagined,  as  might be  satisfactorily
proved by examples innumerable.
  Tartar emetic acting on the stomach, relieves ca-
tarrh, asthma, and other affections of the respiratory
apparatus,  as well as rheumatic  affections of the
joints.  Apply it by the blood to the parts diseased,
and  it will prove deleterious.
  By acting on the alimentary canal, mercurial pre-
parations promote the secretion of bile, and  in that
way  remove hepatic congestion.  Inject them into
the liver through the vena portee, and if serious in-
flammation do not ensue, certainly  nothing salutary
will be effected.
  In the practice  of  medicine it  is a general rule,
that remote impressions give much more relief to dis-
eased parts by sympathy, than impressions made im-
mediately on such parts do by their direct and primary
action.   So true is this, that where one complaint is
cured in the latter mode, fifty are cured in the former. 
80
OF THE TREATMENT
  There are two conditions  of  the  system, very
widely different from each other, in both of which its
action is below the secreting point.  These are the
states of exhaustion, or collapse, and oppression*  The
former takes place at  the close of fever, and the de-
bility in it is real.  The latter, at the beginning, and
  *As these two diseased conditions of the system
are essentially different from each other, and require
very different modes of treatment, it is important that
the  practitioner be  able to distinguish them.   In
making this  distinction  the following suggestions
may be somewhat useful to him.
  As already stated in the text, oppression occurs at
the commencement,  and exhaustion towards  the close,
or at least in an advanced stage, of fever.
  In oppression the pulse  is labouring, irregular, and
marked, in some of its strokes, with considerable vo-
lume- and force.  In oppression,  it is  less irregular,
and labors less, but is feeble and small.
  In exhaustion the patient is  generally much ema-
ciated, and his tongue is  thickly covered with a
brown or  dark  coloured crust.  In oppression, his
emaciation is less, and the covering of his tongue
of a lighter colour and not so thick—At times this
covering is entirely wanting in an oppressed state of
the system.
  In oppression, there are, as the term imports, deep-
er anxiety and distress in breathing, and about  the
preecordia; in exhaustion there is a sf -ngf:i mani-
festation of general debility and languor.
  In oppression, the complexion is sometimes pur-
plish or livid, the eyes protruded, and the counte*
nance full.   In exhaustion the face is  pale, the eyes
hollow, and the cheeks sunken.  In this latter state
of the system, the  teeth are often covered with a
dark  sordes. 
OF FEVER,.
81
#te debility accompanying it is only apparent.  The
strength is overpowered,not extinguished. The heart
still struggles, but struggles in chains;  while in col-
lapse it has partially submitted and ceased to resist.
  For the removal of these two affections, the means
to be employed are  as different from each other, as
are the conditions of the body in which they are ex-
hibited.  Yet in both the object is the same—to raise
the action to the level of secretion.
  When exhaustion prevails, the practice consists in
stimulation alone.  In oppression, it consists in stimu-
lation and depletion judiciously united.
  In the former case, the  system resembles a vessel
in a stormy ocean, likely  to be overwhelmed by thte
waves for want of sails to urge her through the wa-
ter.  In the latter, it resembles the same vessel about
to sink from the weight of her  burthen.
  To save the ship in the first instance, spread more
canvass.  In the  last, lighten her, by throwing over-
board a portion of her cargo.
  Is the system, in an advanced stage of fever,  pros-
trated, by exhaustion, far below the secreting point?
Stimulate, both externally and internally, until  the
requisite degree of excitement is attained.
  The means to be used in this process, being fami-
liar to every one, need not be specified.   The most
active of them are, wine, ardent spirits, laudanum,
sinapisms,  rubefacients'generally, and blisters.*

   *ln cases of this description volatile alkali, musk,
camphor, and ether, are much employed.  But in the
practice of the author they have never deserved the;
reputation they possess. 
OF THE TREATMENT
  Is the system, in the commencement of fever, sunk
by  oppression  greatly below the standard of secre-
tion? Is the pulse labouring, the blood almost stag-
nant, the skin entirely cool or its temperature in dif-
ferent parts unequal and irregular, and the strength
overwhelmed as by an insupportable load, with op-
pressed respiration, deep sighing, and great anxiety
about the prascordia?
  As remedies here, while  stimulants  are employ-
ed,* especially  external ones, as if the case  were
marked by exhaustion, let evacuations  be produced
—but with great caution, that their  effects may be
  *The external stimulants most to be relied on are,
the warm bath rendered more active by salt, pepper,
mustard, or ardent spirits thrown into it, the  nitro-
muriatic acid bath, a free and pure atmosphere of a
suitable  temperature, frictions, and sinapisms witb
horse-radish or garlic; the latter to  be applied to
the abdomen and extremities.
  Blistering, although recommended by high author-
ity, does not, in  cases of deep  congestion, awaken
action either  so suddenly,  certainly, or safely,  as
Other stimulants, which  serve  only as rubefacients,
but may be applied more extensively to the surface
of the body.
  To act as further aids in producing excitement,
warm diluting drinks  should be  always exhibited,
and, in cases of great obstinacy and peril, these may
be advantageously rendered more stimulating by the
addition of wine, brandy or laudanum.
  Venesection, while the patient is  in  the  warm
bath, and under  the influence of friction and rube-
facients, proves often successful in exciting reaction.
So do warm stimulating injections. 
OF FEVER,                 83
observed—both from the blood vessels and the pri-
mae viae.
  If the pulse rise and expand, let the blood continue
to flow, until the oppression is relieved, and the ex-
citement  and strength are  sufficiently developed.
But if it sink further and labour more, the vein should
be closed, lest the patient expire in the midst of the
operation.
  In this practice, where evacuation and stimulation
are thus united, there is no inconsistency or want of
reason.
  The blood is partially stagnating, because it is too
voluminous and weighty for the heart, oppressed and
overwhelmed, to put in motion.*  In consequence of
this, it has lost, in part, its arterial character, and with
that  its fitness as a stimulus to  the heart.   Throw it
again into  active circulation, by  diminishing  its
quantity and weight, and  exciting the heart by arti-
ficial stimuli, and by thus  passing  it through the
lungs, its arterial  character,t and  its aptitude as a
stimulus  are  both restored.  The heart and  blood

   *Added to the diminution which it effects in the
volume and weight of the  blood, venesection aids
not a little  in producing a  resolution  of the spasm of
the  blood vessels, especially the capillaries, which
conflicts  directly  with the action of the  heart, and
impedes circulation in the extremities and in the su-
perficial  portions of the body.   To resolve spasm, as
well of the  blood vessels as of the muscles, consti-
tutes one of the most prominent effects of venesection.

   tOn opening a vein in a case of fever  highly con-
 gestive, the blood, now nearly stagnant,  is, when it 
84
OP IHE TREATMENT
once more perform towards each other their healthy
offices.  The laftr, stimulating the former to the re-
quisite degree of action, receives from it in return a
sufficiency of  motion to throw it through the lungs,
and thus preserve its arterial and natural character.
  In this mixed process of evacuating and stimulat-
ing, the heart loses nothing of its real power to move,
while the blood loses much of its weight to be moved,
and, their spasm  being weakened, the capillaries of-
fer less resistance.  Hence, in relation to the effect
it has to produce, the vis movens, or moving power^
virtually increases in strength and  efficiency, in pro-
portion to the diminution of weight in the fluid  it has
to put in motion, and of the other resistance  it has
to overcome.   While reason  and  sound pathology
seem  to  recognize the  correctness of  this view of
things, actual experience gives it its sanction.
   When, by these modes of practice, the action of
the  system is raised, no matter whether from oppres-
 sion or exhaustion, to the point of secretion,  that
 process, if it  does not occur spontaneously, is to be
 promoted by the  remediate agents already indicated.
 Whether the excitement has  been increased or d$-
begins to  flow, of a deep modena colour;  but, as its
circulation becomes more active, it acquires  the  fine
arterial scarlet.  This  dark blood, kept by  itself,
scarcely  coagulates; while the scarlet coagulates
speedily and firmly.  Blood drawn from  the same
patient a few hours afterwards, exhibits frequently,
on  coagulating, a thick covering of inflammatory
size.  By admitting the doctrine of the vitality of the
blood, these phenomena may be  easily  explained*
.Reject it, and they are inexplicable. 
OF FEVER.
85
minished, the standard to which it has been brought
is the same, and the same course  must now be pur-
sued to produce centrifugal and secretory action, and
bring the complaint to a favourable termination.
  Sometimes the system, thus awakened and roused
to excitement from a state of deep  preceding con-
gestion and torpor, takes on  a  degree  of action  so
high and inflammatory, that further evacuations from
the vascular system become requisite to reduce  it
The  practitioner first bleeds, as a  means to create
reaction, and afterwards to subdue it.
  The fever being removed,  the patient is  found  to
be reduced to a state of great debility.  Hence, for
the restoration  of his strength,  tonic remedies are
usually prescribed; and, in the estimation of  most
physicians, such articles are essential to his recov-
ery.
  That this opinion is not correct, and that the prac-
tice founded on it has done much mischief in conva-
lescence from fever, reason and  experience unite to
testify,
  Unless  internal congestion be  entirely  resolved,
tonic remedies  are always injurious; and if it be re-
solved, they are almost always unnecessary.   They
may do  much mischief,  and  can, in  general,  do but
little good.
  If morbid  action be  completely  eradicated, the
patient,  no longer diseased, has nothing to contend
with but weakness; and that, in general, can be most
gertainly and speedily removed by diet and regimen.
  To all general rules exceptions do and must exist.
But it may  be  confidently pronounced the  general
rule, that convalescence from fever can be much bet- 
^t>              OF THE TREATMENT
ler conducted without tonics than with them.  Being,
for the most part, disagreeable to patients, they are
taken with reluctance.   They sometimes impair the
appetite, but more frequently increase it.  In the
former case, they prevent convalescents from taking
the requisite amount of food, and, in the latter, in-
duce them to take more  than their systems  require,
or their digestive organs can assimilate.  It is but
seldom that they increase the real digestive energies
of the chylopoietic viscera.
   When their complaints  are perfectly eradicated,
convalescents have, for the most part, an appetite
preternaturally keen, which ought not to be indulged
to the extent of its  craving.  Under these  circum-
stances, the administration of tonics would be highly
injudicious.
   If, on the contrary, their appetite is defective, the
presumption is strong,  that some internal congestion
still remains, which would  be rendered worse by the
action of  tonics, and perhaps re-converted into seri-
ous disease. In such a case the most safe and efficient
practice is, to sustain  the  system by the  amount of
suitable nourishment which the appetite calls for,
until  the congestion is entirely  resolved, either  by
nature herself, or with  the aid of remedies, when the
desire for food will increase, digestion and nutrition
be duly performed,  and substance and  vigour re-
 stored to the body.
   To attempt, in convalescence, to create an appe-
tite by means of tonics, is  like  attempting in  fever,
during high excitement, to force  a sweat  by heating
 remedies.  In either case,  the powers of nature will 
OF FEVER.
87
 be roused to excessive action, congestions or wrong
 determinations already existing will be strengthened
 and  rendered more obstinate, new  ones, perhaps,
 formed, the system further debilitated, and the dis-
 ease extended in duration and increased  in danger,
 and, probably, urged to a fatal  termination.  In ei-
 ther case, mischief will be prevented by withholding
 medicine, and health restored by a little delay.
   The  practice of the skilful and successful physi-
 cian is  characterized by vigour and intrepidity in the
 commencement of fever, and  by caution towards its
 close.  The same judgment and experience that di-
 rect the one, will not fail to recommend the other.
   To withhold medicines, contrary to custom, when
 the exhibition  of them would prove injurious, re-
 quires much more sagacity and decision, than to ad-
 minister them, according to custom, when the practice
 is correct.  The professional tyro can  do the latter,
 while none but the enlightened  and independent
 practitioner will risk the former.
   The author wishes it to  be distinctly  understood,
 that no sentiment here  expressed is to be construed
 into an entire proscription  of  tonics.  In  convales-
 ce«ce from certain  chronic diseases,  their employ-
 ment is, perhaps, essential.  But, in convalescence
from  fever, to which  disease alone this  essay  re-
lates, where the only desideratum is the recovery of
strength, it is confidently believed that their exhibi-
tion has done much more harm than good.
   The judicious exhibition of bark, and other stimu-
lants, in the treatment  of intermitting fever, does no:
fall within the compass of this discussion.  Yet even 
88
OF THE TREATMENT
those remedies, when injudiciously  administered,
have done incalculable mischief.*
  That solution of fever which is usually called the
sweating, has been denominated,  in this  essay, the
secreting stage.  For this departure from the custom-
ary nomenclature, it is believed that a satisfactory
reason can be rendered.
  The skin is but one  of the many emunctories that
are. thrown into action on the decline of fever.  Sweat
is, therefore, but one of the many secretions that now
begin to flow.  Cotemporaneously with the appear-
ance of that discharge, the bile also is produced in
larger quantities, urine is secreted in greater abund-
ance  and of a  different quality, expectoration be-
comes more free, the  tongue  moister, and  the saliva-
  * Administer bark in intermitting fever during any
one of the elements of the paroxysm, and, to say the
ieast, you in general do  no  good.   The reverse  is
usually true.
  Suffer the state of apyrexia to take place, and,
provided it be complete, you have then, instead  of
fever, nothing, perhaps, to encounter but topical de-
bility predisposing  to a recurrence of internal topical
congestion.
  This debility may be removed  and the threatened
congestion prevented, by bark, opium, arsenic, spi-
der's web, wine, the passions of the mind, suitable
warmth, and  various other active stimulants, exter-
nal as well as internal, provided  they be exhibited
with judgment and skill.
  Prevent the recurrence of internal torpor and con-
gestion, by maintaining a vigorous circulation, and
exciting a state of centrifugal action, and you effec-
tually prevent the  recurrence of the  paroxysm. 
OF FEVER.                 89
ry and even the lachrymal glands secrete more copi-
ously.   In  fact, provided the solution of fever be
complete, every secreting structure of the body re-
sumes  its healthy function, which, during the disease,
had been in some way deranged—altered in charac-
ter or diminished in extent.
   What is  here called the secreting stage of fever is
tantamount to that which has long been denominated
the "critical discharge."*

   * Although every secretory evacuation  is  salutary in
every febrile disease, yet particular evacuations of this
description  are more salutary in some forms of fever
than in others.
   In fevers  arising from deep abdominal congestion,
hepatic and pancreatic secretions,and those effected
by the mucous lining of the alimentary canal, are
most favourable;  fevers depending on thoracic con-
gestion are  most immediately relieved by mucous se-
cretions  from the  schneiderian  membrane; while
those radicated in  the cerebral membranes are usu-
ally brought to a favourable issue by secretions from
the kidneys and the  liver,  the  schneiderian mem-
brane,  and  sometimes from the salivary glands.  Cu-
taneous secretion, to a certain extent,  is* essential to
the cure of every fever.
   It should  never be forgotten that in  the treatment
of bilious fever, in all its  varieties, much more de-
pends on rectifying and regulating the  abdominal
secretions generally, than on merely producing evac-
uations from the stomach and.bowels.  Let the se-
creted  fluids be poured into the alimentary canal in
sufficient quantity and of proper qualities, and they
will rarely fail to evacuate themselves.
   Tartar emetic and  calomel are oftentimes highly
salutary in their action when they neither puke nor
purge.
                       M 
90
OF THE TREATMENT
   While  the reality and the necessity of this dis-
charge have been questioned by some, its existence
has been  positively denied by others.  It has been
confidently  asserted,  that  many  febrile complaints
have  come  to a favourable termination without  it.
But the doubt, the denial, and the assertion, appear
to the author to be without any solid  foundation  in
truth.
   That every febrile complaint which does not prove
fatal must terminate by a critical evacuation of some
sort, and that it cannot terminate favourably without
it, is as much a law of nature as it is that it must be-
gin with a spasm and a chill, and be marked in its
course by a stage of excitement.  No matter how in-
considerable in quantity, or of  what description the
evacuation may be, perspirable matter, bile, pancre-
atic liquor, urine, serum, or mucus, provided  it be a
secreted fluid, it  is sufficient.*  The emunctories  of
the body  being in unison with each  other, the oc-
currence  of the discharge  from any  one of them is
indicative of a return of general centrifugal action*
of a natural condition of the  system of capillaries
and of the reestablishment of harmony between them
and the heart.
  The solution of the fever does not depend on the
mere evacuation of the secreted fluid.  That evacua-
tion is only an effect, but a necessary effect, of the re-

   *The seeming exception  to this rule presented by
the sudor  anglicanus, and a few other complaints, ia
which morbid secretions afford no  relief,  is  but an
exception, and do<*s not in any degree invalidate the
rule. 
OF FEVEfl.
91
storation of that equilibrium of^ction and circulation
in which  health consists, and the derangement of
which had constituted the disease.
  Writers inform us that the critical evacuation may
be, and  at times  is, a real  hemorrhagic  effusion.
This appears  to be  a  mistake.  The hemorrhagy
does not constitute the critical  discharge, hut prepares
the way for it, by bringing the system to the secreting
point.  Let observation on the subject be kept suffi-
ciently awake, and the hemorrhagic evacuation will
be found to be succeeded by the appearance of some
secreted fluid, small, perhaps, in quantity, but differ-
ent in its character from what it was during the dis-
ease.  Nor does  convalescence fairly  commence
until after its occurrence.
   To this  the menstrual  evacuation, which forms, at
times, the  critical discharge, constitutes no excep-
tion.  That, when healthy, is a secreted fluid; and
when the evacuation from the uterus is not healthy,
but truly hemorrhagic, it does not form  the critical
discharge, but, like any other hemorrhagy, prepares
the system for  it by bringing  it to the proper point of
action.   The  secreted  discharge,  which  alone is
critical, follows as a thing of  course.
   On the subject of critical days, the author does not
feel prepared  to offer an opinion.  However inclined
he may himself be to a belief in their existence, he is
not, perhaps, provided with a sufficiency of evidence
to prove it to others who may hold it in doubt.   He
will only add, that many facts and  all analogy ap-
pear to him to favour the doctrine.  Nor is he  ac-
quainted with a single argument of pertinency  and 
92             OF TWE TREATMENT
 weight, which he  considers opposed  to it.  Tha't
 many anomalies and seeming exceptions to the ge-
 neral rile exist, cannot be denied.  But to regard
 them as exceptions and nothing more, comports best
 with general analogy, and does not appear to be at
 war with fact.
   To exhibit a more condensed and single view of
 the principles contained in this essay, the following
 summary of it is given.
   Fever is a compound  disease, made up of morbid
 affections of all the various  sub-systems or tissues
 belonging to the body.   It is, therefore, if not in the
 literal acceptation of the expression, at least in  a
 much higher degree than any other complaint, a dis-
 ease of the whole system.
   It originates always and necessarily in a primary lo-
 cal affection* of some solid part of  the body, which,
 through the  medium of sympathy, excites ultimately

   *The practical benefit resulting from the  doctrine
 of the original locality of fever is obvious.
   Learn, at an early period of the disease, the organ
on which the deleterious  impression is made, and by
 acting on it  promptly and forcibly  by a suitable re-
 mediate agent, the impression may be extinguished,
and the general affection entirely prevented,or great-
ly curtailed  in its duration and reduced in its vio-
lence.
  The local impression productive of bilious fever is
made on the mucous lining of the stomach.   Hence
an emetic administered at the commencement of the
complaint,  is often  instrumental in its  immediate
suppression.
  In peripneumony and catarrhal fever, the deleteri-
ous impression productive of the disease  is made on 
OF FEVER.
'9$
        into morbid action all the other parts.  It is, there-
        fore, essentially, a disease of sympathy.
           The primary local affection does not  necessarily
        imply inflammation, but may be merely irritative, i. e,
        marked only by excitement below inflammation but
        above what is natural, sensative and inflammatory, or
        so deeply congestive as to be beyond the point of in-
        flammatory reaction.
           This affection is not necessarily seated in  the sto-
        mach,* although it is usually there;  and the resist-
        ance of  that  organ must be  always overcome, before
        fever can  be  formed.  The immediate sent of the ori-

        the skin by humidity or cold.  Hence the warm bath
*       and friction, at the proper period and to the requisite
        extent, oftentimes prevent the febrile affection.
           The same  thing is true in relation to most febrile
        diseases, provided the immediate seat of the impres-
        sion productive of them be certainly known.  Act on
        the part, directly or  indirectly, with judgment  and
        force, at a period sufficiently early, and you do much
        to prevent or weaken the complaint.
           *The author means that a febrile disease may re-
        sult from a primary local affection not seated in any
        part of the alimentary canal.  The affection may be
>        situated in the membranes of the joints, as in rheuma-
        tism, in those of the thorax,  in pleuritis vera, in those
        of the brain, in phrenitis, or in the skin, as in a febrile
        complaint produced by a burn.
          But those diseases  more technically  denominated
        fever, are seated in the alimentary canal.  These are
        common bilious fever in its  various forms, intermit-
        ting, remitting, and continued, yellow fever, pestis
        vera, and typhus fever.
          Most of the exanthemata have also a gastric ori-
        gin, especially scarlatina,  erysipelas, and casual 
94
OF THE TREATMENT
ginal  affection is generally a membranous structure,
and oa the nature of the structure, and the particular
organ to which it belongs, does the character of the
disease materially depend.  A fever  radicated in a
serous, differs, in many respects, from  one seated in a
nwucous membrane, while the disease produced by an
affection of the fibrous or  muscular structure, is dif-
ferent from both.
  A fever, again, arising from an inflammatory affec-
tion of the dura matter or the tunica arachnoides, pre-
sents many points of difference from one produced by
a similar affection of the pleura or  diaphragm, and a
fever originating in an inflammation of the peritoneum
is as dissimilar to either of them, as they are to each
other.   Yet  all  these are  serous and fibrous mem-
branes.  So fertile and powerful, in  varying febrile
complaints, is the modifying influence of diversity of
organic structure, diversity of local impression, and
diversity of sympathy.
  The mucous tissue of the alimentary canal consti-
tutes the seat of the most formidable fevers.  Con-
nected, however, with  the affection of  that tissue is
an extensive congestion of the abdominal blood ves-
sels.  Fevers radicated in this mucous  structure  are
small pox.  Although measles throws itself seconda-
rily on the schneiderian membrane, and then on the
skin, it is also gastric in its origin, and usually termi-
nates with more or less  of a gastric or intestinal af-
fection.
  There is reason to believe that every eruptive febrile
affection is radicated in some portion of the digest-
ive apparatus. 
«F FEVER.
4*5
those in which the nervous and cerebral systems are
most deeply affected.  When situated in the mucous
membrane of the trachea and lungs, or in serous mem-
branes, they are of a character more purely vascular
or inflammatory.  The recollection of every physician
will supply him with examples confirmatory of this.
   To the existence  of fever, internal congestion and
centripetal action are  essential.  These imply a state
of warfare between the arteries, more especially the
capillaries, and  the  heart. In this condition of things
all the emunctories of the body cease to perform their
natural functions, and participate of disease.
   The internal congestion, itself the result of centri-
petal action,  is the cause of- the febtile excitement
which follows.  That excitement is the cause of the
secreting stage, which, produced by the return  of cen-
trifugal action and the natural harmony between the
heart and blood vessels, resolves the paroxysm.
   All febrile diseases consist of one or more  parox-
ysms, which, whether long or short, simple or com-
pound, originate  in the same way, pass through the
same stages, and terminate in that of secretion.
   If, by this stage, the internal congestion be entirely
removed, the resolution of the paroxysm is complete
and a state of perfect intermission or apyrexia ensues.
But if it be removed only in part, the paroxysm is but
partially resolved, and nothing  follows but  a state
of remission.
   Fever, then, in its several stages, is an effort of na-
ture to eradicate a morbid local affection, which be-
ing eradicated,  the fever  ceases.   But this eypm 
Jk)             OF THE  TREATMENT
never takes place until  the occurrence of the secret-
ing stage.
   Instead of an origmal, fever is always and necessa-
rily  a symptomatic disease,  the phenomena  which
constitute it being'the result of a primary  laesion,
irritative  or sensative, functional  or  organic.  An
idiopathic fever has no existence.
   If the primary affection  be slight, the  symptoms
which follow moderate,  and the constitution  of the
patient sound and vigorous, nature herself, if not in-
terrupted, will  complete the cure, with but little or
no assistance from art.  This she will do by a resto-
ration of the broken balance of action  and circula-
tion.   In this case, it is the chief duty of the physi-
cian to be a mere looker-on, attentively observant
of the process before him, and careful that nothing in
the course of it go wrong.
  But if the  complaint be severe,and the issue doubt-
ful, the practitioner must interfere, with the resources
of his art.
  In doing this,, he must still be a faithful follower of
nature.  Like her, he must aim at  the production of
centrifugal action, that  a general equilibrium  may
be restored, and the paroxysm resolved in a secret-
ing stage.  To aid with all his skill in the production
of that stage must be his object; and  to that issue
must all his exertions be directed.
   In his efforts to effect this, his course is plain. Na-
ture herself has drawn the outline of it, and set him
the example how to follow.
   He must not permit the action of the system to be
either too high or too low. but must so regulate it as 
                    OP FEVER,                  97

to bring it directly to the secreting point.  This be-
ing done,  his  next duty is to administer secretory
remedies,if the process does not spontaneously occur.
   The means to be employed by him, in regulating
the action of the system, are plain  and simple.  He
must,according to circumstances,evacuate, cool, and
reduce, or stimulate, raise, and give warmth, or em-
ploy, at the same time, both  modes of practice skil-
fully united.  Let him use every expedient that expe-
rience and invention can suggest, judgment approve,
and art apply, to resolve spasm, produce general cen-
trifugal action, and induce secretion, and his duty is
performed.  If, under these  circumstances, the dis-
ease proves fatal,  it is on account of its being, from
some consideration, beyond the control of the pres-
ent state of medical science.
   The fever being subdued by the entire removal of
irritation and internal congestion,convalescence will,
in general, be most successfully conducted without
the exhibition of tonic remedies.  A scheme of diet,
drink  and general regimen, skilfully directed, and
 faithfully observed,  constitutes now the means in
which confidence may be most safely reposed. The
 patient is feeble and emaciated, but not diseased.  Let
 the points specified, then,  receive the attention to
 which they are entitled, and the powers of the con-
 stitution will accomplish  the rest, by bestowing co-
 temporaneously substance and strength.
THE END, 
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