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AND PARTICULARLY ON THE
INFLAMMATORY  CHARACTER
FEVER,
—306+30*—





   BY
LYMAN ^PALDING, M^ D.




        —sOs+sOe—
./VSJF-FOitfrr
C. H. Van Winkle, Printer.




        1817. 
•^
* •»**     \ 
REFLECTIONS ON FEVER, &c*
   From the first dawn of medical science, nosological
 arrangement of diseases has been the favourite  pursuit
 of most medical philosophers.   It has been the  fortune
 of the immortal Rush to sap this baseless  fabric,  and
 to prove,  that nosology is even worse than useless.
   "  I have said,"  says Rush,| " that there is but one
 fever;  of course, I do not admit of its artificial divisions
 into genera and species.  A disease which so frequently
 changes its form and place, should never have been de-
 signated, like plants and animals, by unchangeable cha-
 racters.  The  oak  tree, and  the  lion,  possess exactly
 the same properties which they did nearly six  thousand
 years ago.   But, who can say the same thing of any one
 disease ?  Again; the oak tree has not united  with any
 of the trees of the forest, nor has  the lion imparted his
- specific qualities to any other, animal.   But,  who  can
 apply similar remarks to any one disease V*
   Diseases have been variously classed by nosologists.
 Pirexia:,  however, have always  claimed their first at-
 tention.  This class  has been differently divided,  but
 always including the order febres, with genera, species,
 varieties,  &c.  making  from   two to eighty  different
 kinds of fever.
   We abandon nosology, because its arrangements are
 immutable, and altogether artificial ; while disease is
 changeable by ten thousand varieties  in  age, sex, con-
 dition,  climate,  occupation,   &c. and  by no  means
 capable of  being circumscribed by artifcial  classi-
 fication.

  * This is an abridgement of one of the chapters of the Institutes and Practice
of Medicine announced in volume 111. of the Medical Repository, new serie*
  f Rush's Medical Inquiries, Vol. III. p. 3& 
4
   We believe,  with Doctor Rush, that there is but one
 fever; or,  that fever is a unit;  but, then, it consists of
 three grand, imperial, overruling characters, which al-
 most amount to  so many separate and distinct fevers.
   These are the Inflammatory,  the Typhoid, and the
 Miasmatic characters of fever; in each of which,  the
 seat, the cause, the  symptoms, and the mode  of cure,
 if not diametrically opposed, at least, differ very essen-
 tially from  the other: and it is  for these reasons, but
 principally because the method of cure differs so essen-
 tially,  that we make  this division into characters.
   No apology is necessary for using the terms inflamma-
 tory and typhoid characters of fever; but the miasmatic
 character is a new term in  medicine; we think, however,
 that no objections will be made to this term,  when pro-
 perly explained.
  By fever  of an inflammatory character, we mean the
synocha, the causus of authors;  and all those  cases of
 fever, in which the inflammatory symptoms shall  be pa-
 ramount to the typhoid, or the miasmatic.
   By fever of a typhoid character, we mean the typhus,
 the putrid, the malignant, the  nervous  fever of authors;
and all those cases of fever  in which the typhoid  symp-
 toms shall be paramount to the inflammatory, or the mi-
asmatic.
   By fever of a miasmatic character, we mean  the  in-
 termittent, the remittent, &c.  of authors ; and all those
cases of fever  in which the  intermittent  or remittent
 symptoms,  arising from marsh effluvia, shall be para-
mount to the inflammatory or typhoid.
  Our arrangements will then,  at once, be  seen to be
founded in practice, and on the essential characteristics
of fever.
   The inflammatory character  of fever is liable to be
blended in endless proportion with the typhoid character,
till there shall be so  nice  an equilibrium  between the
two, as to render it impossible to say whether the  fever
 partakes most of the inflammatory or typhoid character.
  The same thing may be said of the blending of the in-
flammatory character with  the miasmatic; of the typhoid
with the inflammatory, and  with the miasmatic;  of the
miasmatic with  the inflammatory, and with the typhoid; 
*
and  it is  from this blending and mixing of these three
overruling characters  of fever, that arise all the genera
species, and varieties of fever described by  nosologists
Always bearing in mind, however, that the seat, and re-
mote cause of the disease ; the constitution,  age, sex,
condition, and occupation of  the  patient; the  climate,
season, and a thousand other incidental circumstances,
have an influence upon all diseases.

    OF  THE INFLAMMATORY CHARACTER  OF FEVER.

  Our plan for investigating  the  inflammatory charac-
ter of fever will be,
  1. To describe the disease.
  2. To divide the  description  into  stages,  suits  of
symptoms, symptoms, groups of symptoms, &c.
  3. To trace each symptom to its source, origin,  or
seat in some part of the body.
  4. By induction, to assign to each symptom its prox-
imate or efficient cause.
  5. To examine the symptoms in the  order of effect to
cause, i. e. from the last to the first, and see if they con-
stitute one continued chain of cause and effect.
  6. To assign a seat to the disease itself.
  7. By induction,  to  assign the  proximate cause of
the inflammatory character of fever.
  8. To treat of the cure of fever.
  9. To remark on  the cure  of  the inflammatory cha-
racter of fever.

  That we may not be  accused of describing this cha-
racter of fever in our own way, and  then explaining the
phenomena which we may choose to set down, and thus
evade thedifficult part of the investigation, we shall  se-
lect from  the  books the best description we can find.
  We have chosen Thomas's description of the inflam-
matory fever, or synocha,* for our investigation; because
it is the  most  accurate account we  could find in the

  • Hosack's edition of the Modern Practice of Physic, by Robert Thomas.
% 36. tec. 3. 
6
 books; and the symptoms are arranged in the order  in
 which they arise.
   " // comes on  with  a sense of lassitude and inactivity,
 succeeded by vertigo, rigors, and pains over the whole bo-
 dy,  but more particularly in the head and back ; which
 symptoms are shortly followed by redness of the face, throb-
 bing of the temples, great restlessness,  intense heat, and
 unquenchable thirst, oppression of breathing, and nausea.
 The skin is dry and parched,  the eyes appear inflamed,
 and are incapable of bearing  the light; the tongue  is of a
 scarlet  colour  at the sides, and furred  and white in the
 centre; the  urine is  red and scanty, the body is costive,
 and there is a  quickness, with  a fullness  and hardness of
 the pulse, not much affected by any pressure made  on the
 artery,   lis pulsations  are from 90 lo 130 in a minute,
 and when blood is drawn, it exhibits a  yellowish or buffy
 crust< on its surface.   If the febrile  symptoms  run very
 high, and proper means are not used at  an early period,
 stupor and  delirium come on at a more advanced stage ;
 the imagination becomes much disturbed arid hurried, and
 the patient raves violently.v
   This description of the inflammatory character of fever
 naturally resolves itself into two stages.
   First, the stage of morbidly diminished action, or de-
 bility ; corresponding with the cold stage of Doctor Cul-
 len.
   Second, the stage of morbidly increased action, cor-
 responding with the hot stage of that author.
   The first stage, morbidly diminished action,  which is
 thus described : [I.] It comes on with a sense of lassitude
 and inactivity,  [II.] succeeded by vertigo,  rigors, and
pains over the  whole body, but more particularly  in the
head and back; is divisible into two suits of symptoms.
   I.  The first suit, [1]  It comes on with a sense of las-
 situde [2] and inactivity,  is  composed of two distinct
 symptoms;  the first of which is lassitude.
   As much depends on a right understanding of the terms
 used, and as we shall lay much stress upon the word las-
 situde, we shall be excused, if we endeavour to ascertain
 its exact meaning, when used  in medical language.
   Motherby, we presume, is good authority,  and he, in
 his Medical Dictionary, says expressly, that lassitude is 
7
muscular debility; and in this definition he  is supported
by most of the celebrated lexicographers.
  Every writer on physiology and medicine  has either
alluded to this state of lassitude in the  system, or direct-
ly described it.   Many of them  say that lassitude is
peculiar to muscular structure; all  agree that muscular
structure is liable to it.
  We think then there is no doubt, that by lassitude is
meant muscular debility.
  Our next point to establish will be, that lassitude is
theirs* symptom in the  inflammatory character of fever.
  In proof of this position,  beside the authority of Tho-
mas, we have that of Burserius, Cullen, Rush, Fordyce,
Brown, Wilson, and a host of others,  as well  as the con-
current testimony of every practical physician.
    Evidence that lassitude  is seated in the muscular
                       structure.
  So far as we know, the muscular structure  is the  only
part of the body which is  liable to the sensation of las-
situde, weariness, or fatigue.  Certainly, the bones are
not liable to this sensation; neither is the skin, cellu-
lar  substance, absorbent system, nor the viscera which
have  no muscular structure, as the liver, spleen, kidneys,
&c.   We do not know that the nerves themselves  are
subject to the sensation of  lassitude.
  When a person has exercised his muscles continually
in walking, or labouring for a length of time, he feels  a
sense  of lassitude, i. e. he is wearied,  fatigued,  tired.
He feels an unwillingness  to  move, the muscles  often
swell, and become painful  to the touch.  No one, so far
as we know, ever attributed the seat of this sensation to
the structure of the nerves themselves  ; because, at this
time,sensation is acute; reflection, vivid ; volition, agree-
able ;  but the muscles, from over exercise,  show an un-
willingness  to obey the  commands of the will; and even
when these commands  are obeyed, there  is  a painful
sensation in the substance  of the muscles themselves.
  We have every evidence in the world, then, that  mus-
cular structure is the seat of this sensation.
  1st. The common consent of lexicographers in defining
lassitude to mean muscular debility. 
8
  2d. The proof that muscular structure is liable to las-
 situde.
   3d. The direct  proof that lassitude is seated in the
muscles.
  4th. That no other structure of the body is liable to this
sensation.
   We will now allude to the several component  parts of
muscular structure,  and ascertain which particular part
is liable to the sense of lassitude, so that we can locate
this symptom more definitely.
   A muscle is composed of absorbents, cellular  sub-
stance, blood-vessels, nerves, muscular fibres, &c.
   The absorbent and cellular systems are not  the seat
of lassitude; neither are the blood-vessels  nor nerves; but
that it is seated in the muscular fibre we infer,
   1. From the fibre  being the peculiar substance which
distinguishes muscular structure from all other parts  of
the body.
   2. From those peculiar functions of the muscles,  con-
traction and relaxation,  whence may arise lassitude, re-
siding in  the muscular fibre itself.
   3. From none other of the component parts of muscu-
lar structure being liable to this sensation.
  Wehave,then, traced  this first symptom in the inflam-
matory character  of fever,  lassitude, to its particular
seat, the fibrous structure of the muscular system.
   Our next business will be to assign the proximate cause
ef lassitude.
   To enable us to attempt this with  any probability of
success, we must examine not only the  functions,  mor-
bid actions, and vitiated actions of muscular fibres, but
also of the nerves and blood vessels which enter  into the
composition of muscular structure.
   To render muscular fibres fit to perform their functions,
it is necessary that th°y should possess,
   1. Life.
   2. That they should be supplied with  nerves.
   3. That they should  be supplied  with  red  arterial
blood.
   4. That they should possess,  in a state of integrity, the
several parts which enter into the composition of a  mus-
cle. 
9
  We shall not speculate on the matter of life; but con-^
sider it by its properties, its effects on the body, by which
animated matter is distinguished from inanimate.
  Upon duly considering  the functions of the nerves, it
is apparent that they cannot cause the sense of lassitude
experienced in the muscles, at the commencement of the
inflammatory character of fever.   The same result will
follow on an examination of the functions of the red ar-
terial blood.  It is presumed that the muscles possess an
integrity of structure; therefore, it is not necessary  to
investigate particularly this subject.
  We will now enter upon the consideration of the func-
tions of the muscular fibre itself; since neither the nerves,
blood-vessels, nor other component parts of the muscle,
are capable of producing that lassitude, which exists at
the commencement of the inflammatory character of fe-
ver.
  The functions of the muscular fibres  are contraction
and relaxation.
  These functions are liable to be increased  and dimi-
nished ; but neither this increased nor diminished action
passes the bounds of health ; therefore, neither of them
can produce that lassitude, incident to  the inflammatory
character of fever.
  The  contractions  and relaxations  of the muscular
fibres are liable to morbidly increased and  morbidly di-
minished action.
   In Thomas's description of the  inflammatory charac-
ter of fever, the first stage  is not morbidly increased
action; therefore, we need not compare the lassitude of
that stage with the class of morbidly increased  actions
of the muscular fibres.
 We will, then, compare the morbidly  diminished action
of the muscular fibres, with the lassitude in the inflamma-
tory character of fever, and see in what manner they will
correspond.
  The contractions and relaxations of the muscular fibres
are liable to morbidly diminished action, while the life
of the fibre remains in its common state.
   1. By  the  influence of the brain and spinal marrow
upon the nerves being inordinately small.
  2. By sedative applications. 
10
   These contractions and relaxations are liable to mor-
 bidly diminished action, while the influence of the brain
 and spinal  marrow upon the nerves is in its common
 state;
   By a very great diminution of the life of the muscular
 fibre itself.
   It is evident that the life of the muscular fibres, in the
 commencement  of the inflammatory character of fever,
 is not diminished by the influence of the nervous system,
 nor by that  of the sanguiferous system; because in both
 cases, this  would require some  change to have taken
 place in the system, before lassitude appeared, which is
 not the fact.
   In what manner can the life of the muscular fibres be
 diminished,  but through the medium  of the nervous, or
 circulating system ?
   By any cause whatever, which is capable of producing
 a powerfully debilitating effect upon  the muscular fibres
 themselves; such  as  sedatives  in general, and cold in
 particular.
   Cold, to produce its most powerful effects upon the
 muscular fibres, must  have been  preceded  by heat; and
 the effects produced are always in  proportion to the dif-
 ference of temperature, and the suddenness of the change.
   Every person  knows,  that if,  after violent exercise
 and much heat, he set himself  down  in  a cool place,
 where there is a current of air, that the life of the mus-
 cular fibres will be so changed that the  muscles  will
 scarcely be  able to contract.
   No one would presume that there was, in this case, any
 previous change in the nervous  or circulating system,
 which thus   diminished   the action of the   muscles.
 No, it is the effect of  the  change of temperature upon
 the life of the  muscular fibres.   Every person  knows
 that it is the muscles themselves,  which  thus  become
 stiff; and unless a more serious disease is to follow, that
 they will become limber again by a little exercise.
   We think that we have fully proved, that cold, i. e. a
 sudden  change from  a high to a low temperature, can
 greatly diminish the life of the muscular fibres, so as to
 produce lassitude and inactivity ; therefore, this  very
great diminution of the life of the muscular fibres, we con- 
11
       siderasthe proximate cause of the  sense of lassitude,
       in the commencement of the inflammatory character  of
       fever.
         We are supported in this opinion.
         1.  From  a  knowledge  that the life of the muscular
       fibre is liable to a very great diminution.
        2.  That this diminution will produce lassitude.
        3.  That no  other circumstance occurs at the  com-
       mencement  of  the  inflammatory character  of  fever
       which coidd cause lassitude ; since neither the nervous
       nor circulating system is primarily affected.
        4. That this diminution of the life of the muscular fibres
       may be caused by  cold;  and cold  generally precedes
       every attack of the inflammatory  character of fever.
        We will now  consider  the second  symptom of the
      first suit, viz :—
        2. Inactivity.
        Inactivity is  sluggishness,  unwillingness  to move,
      which is always the case when a person is tired or fa-
      tigued.
        It is so perfectly plain, that  this symptom is  also
      seated in  the fibrous structure of the muscular system,
      that it is unnecessary to make any examination.
        The proximate cause of inactivity is the same as that
      of lassitude,  a very great diminution of the life of the
      muscular fibres.
        II. The  second suit  of symptoms, [1]  succeeded by
      vertigo,  [2] rigors, [3] and pains over  the  whole body,
      but more particidarly in the head  and back, consists of
      three distinct symptoms.
        1. Succeeded by vertigo,
k       Vertigo, Motherby says,  is (swimming of the head,)
     in which the head seems to turn,  or at least all things
     about the patient seem to do so.
        The brain is  the  seat of sensation, and the nerves
     and blood vessels the media by which  impressions are
     made on the brain itself.   It is not very probable that
     vertigo arises from  the  nerves ; we will therefore  ex-
     amine what changes of circulation in the brain can  pro-
     duce it.  11 is well known that the suddenly taking off
     a distention from the brain will often produce vertigo ;
     as raising up  the head  suddenly  after  having held it 
12
down for some time.  The bleeding from a large orifice
while the person stands  erect, &c.  Then the  want  of
the accustomed stimulus of distention of the brain,  by
blood, will produce vertigo.
  We have traced this symptom to  its seat,  the  brain ;
its proximate cause,  a diminished circulation in the sub-
stance of the brain itself,
  2. Succeeded by rigors.
  Rigour, [rigor,  Latin,] a convulsive shuddering, with
sense of cold, says  Johnson.
  This symptom is resolvable into two parts.
  1. The sense of cold.
  2. The convulsive shuddering.
  Cold is a sensation which arises in the brain, in  con-
sequence  of a  certain  impression  being made  on the
sentient extremities of the nerves.   The sensation pro-
duced in the  brain does  not always correspond with the
real temperature of the  part; because  the influence of
the nerves is liable to be changed ;  and that function of
the brain,  which  is  to receive  impressions  from the
nerves,  is  also  liable  to be changed ; therefore, the
sensation produced may be less than the impression.
  The  sensation of  cold is  plainly referrible, by the
patient  himself,  to  the  deep-seated parts beneath  the
integuments of the body.  Chilled through, is a common
expression.
  We  have  already  shown  that lassitude,  a previous
symptom, consists in the great diminution of the life of
the fibrous structure of  the muscles ; which diminution
affects or vitiates the sentient extremities of the nerves
that are spent upon the  muscles, thereby producing  the
sensation  of cold.
  From the very definition of the term rigor,  a convul-
sive shuddering  with sense of cold  we  should say  that
this symptom must be seated in (he muscles, as they are
the only structure which is capable of convulsive ac-
tion.
  From all  that precedes,  it  appears  perfectly plain,
that the seat of rigors is the muscular  structure ; and it
is equally evident, that  the very great diminution  of the
life of the muscular structure is its proximate cause. 
13
   3.  Pains over the whole body, but more particularly in
the head and back.
   When all the functions  of the body are  duly  per-
formed,  so easy, agreeable, and pleasant  is  sensation,
that we are scarcely  conscious of our  existence ;  but
the moment any function  is illy  performed, then come
pains, aches, and a train of  woes which  fully remind
us of our frail state.
   There is no difficulty in tracing the seat  of this symp-
tom to the  muscular structure  itself.  The  slightest mo-
tion aggravates all the pains,  and convinces the patient
that the moving powers are  affected.   In fact, the mus-
cles feel sore to the  touch.   No  person could expect
them to remain free of pain, since their life  has been
almost destroyed.
   Proximate cause.  A very great diminution of the life
of the muscular fibres.
   Since the stomach  is muscular, and very powerfully
affected in the onset of fever,  we presume  that the ner-
vous connexion  which exists between that organ and
the back of the head and neck,  by means of the  par
vagum and spinal accessory nerves*, the intercostal and
cervicals,  will account for the pains being particularly
located in that place.
   Second  Stage.—The  stage  of morbidly  increased
action,  or  the hot stage,  is divisible into three suits of
symptoms.
   I.  Suit;  [1] which symptoms are shortly followed by
redness  of the face, [2] throbbing of the temples, [3] great
restlessness, [4] intense heat, [5] and unquenchable thirst,
[6]  oppression of breathing, [7] and nausea.
   This  suit is composed  of seven  distinct symptoms.
1. Which symptoms are shortly  followed by redness of
the face.
   The increase of colour of the surface of the body is
so evidently dependent on an accumulation of the blood
in the minute arterial  ramifications, that no investigation
becomes necessary, to assign the circulating system as
the seat of this symptom.
   The proximate cause is equally evident, morbidly in-
creased action of the  circulating system,  particularly  of
the minute  arterial ramifications. 
14
    2.  Throbbing of the temples.
    The seat of this symptom is clearly in the arterial sys-
 tem ;  for  it  is the temporal arteries which beat,  and the
 superficial branches may even be seen beating with the
 naked eye.
    The proximate cause, morbidly increased action of the
 circulating system.
    3  Great restlessness.
    By  this we understand a restless uneasy sensation, ac-
 companied with a  desire to move.   The patient feels
 the time gone through  infinitely  long; a minute  seems
 to him more  than an hour; he cannot  fix  his attention on
 any object;  he does not  lie easily,  and finds no relief
 in changing his posture.
   Doctor Fordyce says,  there are two causes  of this
 great  restlessness; the one an accumulation  of blood
 about  the  heart; the other, a  distension  of the  small
 vessels throughout  the system.
   Then we have no difficulty in locating this symptom in
 the circulating system.  Its proximate cause,  morbidly
 diminished action, when it arises  from an  accumulation
 of blood about the heart ;  morbidly increased  action,
 when it arises from a distension of the  collapsed vessels.
   4 Intense heat.
   This is a very important symptom,  no less so than to
 have given name to fever ; for Galen  defines fever, pre-
 ternatural heat.   But,  he says, the principal, and, as it
 were, pathognomic symptoms are, the ardent heat and
 excessive thirst.
   I believe it will not be doubted that  the  circulating
 system is the seat of this symptom, and that  its  proxi-
 mate cause is morbidly increased  action in that system.
   5. And unquenchable thirst.
   Thirst arises from a heat, dryness, parchedness, clam-
 miness, or peculiar irritation of  the  mouth and fauces.
 The seat of this symptom is apparent, the mouth and
fauces.  If we choose to ferret out this  symptom in its
 hiding places, and to locate it more definitely, we should
 find no difficulty in pursuing it  to the minute  arterial
 ramifications.
   The proximate cause  of thirst, whatever can  pro-
 duce a heat,  dryness,  &c. in the mouth and throat.  In- 
tense heat, and that of a morbid kind, will certainly pro-
duce all these effects.  We have  already examined the
production of this heat, and such is the affinity between
the mucous membrane of the mouth and throat,  and the
other parts of the body, particularly the skin, that what-
ever produces intense heat on the surface, or throughout
the whole body, must of course produce it in the mouth
and fauces; hence there can be no hesitation in as-
signing as the proximate cause of this symptom, morbid-
ly increased action of the circulating system,
   6.  Oppression of breathing.
   That  a hurried circulation  is  capable of producing
oppression of breathing, will be perfectly evident to any
one who will exercise violently for a few minutes.  No
doubt, the oppression of breathing, in fever, will differ
somewhat from that which arises  from violent exercise ;
because, in the former case, the muscles of  respiration,
the lungs themselves, and every part of the body, are la-
bouring under disease,  and  no  part performs  well its
functions; while, in the latter case, the whole  body is
supposed to be in health.
   This symptom is evidently seated in the lungs ; and its
proximate cause  is morbidly increased action of the cir-
culating system.
   7.  And nausea.
   Nausea is a less degree of the same  action,  which
produces vomiting.  Vomiting is an inversion of the
action  of the  pharynx, aesophagus, and stomach,  by
which the contents of the stomach are discharged by the
mouth.  Nausea is a less degree of inversion, or rather
a  tendency to an  inversion, in  which the  contents of
the stomach are not discharged, but there is a disposi-
tion to vomit.
   Vomiting, and of course nausea, are  opposed to the
common function of the oesophagus, deglutition,  which
is  performed by  the natural  and  successive  contrac-
tions of the fibres of the muscular coat of  the  pharynx
and aesophagus.
   Nausea being a disposition to an inversion of the re-
gular action of the aesophagus and pharynx,  there is no
difficulty in tracing this symptom to its seat, in  the mus-
cular coat of the stomach, cesophagus, and pharynx. 
16
   Vomiting and  nausea are well understood to  arise
 from the  exhibition  of  emetic drugs,  which  dimi-
 nish the life of the muscular membrane of the stomach,
 oesophagus, and  pharynx; from any cause whatever,
 which shall produce a great diminution of the life of this
 muscular membrane ;  from  offending matters in  the
 stomach, &c.
   Then  the proximate  cause of nause.n, in the inflam-
 matory character of fever, may be either a very great
 diminution  of the  life of the  muscular  coat oj  the
 stomach, cesophagus, and pharynx ;  or an accumulation
 of offending matters in the stomach.
   The diminution of the life of the muscular coat of the
 stomach, oesophagus,  and pharynx may  arise from the
 same cause which produces the diminution of the life of
 the muscles in  lassitude.  This is probably the proxi-
 mate cause of nausea,  when it arises as an early symp-
 tom of fever ; but when it comes on later, it is probable
 that the  returning sensibility  of the muscular coat of
 the stomach, (from the return of the circulation,) is ope-
 rated upon by the offending matters in the stomach.
   II. The  second suit of symptoms in the second stage
 of morbidly increased action.
   [1]  The skin is dry [2]  and parched; [3] the eyes
 appear inflamed,  [4] and  are  incapable of bearing the
 light ; [5]  the tongue  is of a scarlet colour at the  sides,
 and furred, and white in the centre ; [6] the urine is red
 and scanty, [7] the body is costive, [8] and there is a
 quickness, with a fullness and hardness in  the pulse, not
much affected by any pressure  made on the artery,   [9]
Its pulsations are  from 90 to 130 in a minute, [10] and
when blood is drawn,  it exhibits a yellowish or buffy crust
 on its surface.
   This suit is composed often distinct symptoms.
   1. The skin is dry.
   The skin is kept moist by a fluid, thrown out by the
exhalent arteries,  and called insensible perspiration.
   The functions of the exhalent  arteries  are liable  to
morbidly  increased  action,  producing  very  profuse
sweat; and morbidly diminished- action,  giving a very
dry skin.   The seat of this symptom  does not admit 
17
 of a doubt; the exhalent arteries, which  are a continua-
 tion of the arterial system.
   The proximate cause is, morbidly diminished action in
 the exhalent arteries, arising from the cold stage of the
 fever.
   2.  The skin is dry and parched.
   By a parched skin is  meant,  a  skin that is dry, and
 has a peculiar heat upon it.  We have just shown that a
 dry  skin is referrible to the exhalent arteries; and we
 have before traced the source of animal  heat to the cir-
 culating system; therefore, this  symptom is evidently
 situated in the  circulating  system.    The proximate
 cause is, a diminution of perspiration, from the exhalent
 arteries not having yet recovered their vigour; and an
 increase of heat  of a  peculiar nature,  arising from  a
 morbid increase of circulation.
   3.  The eyes appear inflamed,
 f  Inflammation is a well-known effect of the circulation ;
 therefore,  it requires no investigation on  our part to
 locate this symptom in the circulating system.  Its proxi-
 mate  cause  is equally well understood,  morbidly in-
 creased action.
   4.  And are incapable of bearing the light;
   This is well known to be the effect of inflammation,
 and is therefore referrible to the same seat and cause  as
 the last symptom.
   5. The tongue is of a scarlet  colour at the sides, and
furred, and white in the  centre.
   We have already shown that unquenchable thirst, one
 of the preceding symptoms, arises from a heat, dryness,
 parchedness, clamminess,  or peculiar irritation  of  the
 mouth and fauces.   The tongue, as composing a part of
 the mouth, is instrumental in  producing the unquench-
 able thirst.  The proximate cause of thirst is, increased
 action of the circulating system.  We presume that the
 changes in the tongue may likewise  be  referred to the
 circulation ; because the tongue has a disposition to be
 furred whenever  the.^jrculation is irregular,  although
 fever may not be present/ and  the red colour of every
 part of the body is owing to the blood.   But I  confess
 myself too ignorant of the pathology of those changes
 in the tongue, to be able to trace them to their particu-
                          3 
18
 lar  seat, or to assign to  them any  proximate  cause,
 which shall be satisfactory.
   The seat of this symptom is the tongue ; and its proxi-
 mate cause, is probably referrible to the circulating sys-
 tem.
   6. The urine is red and scanty.
   All the secretions are from  the blood, and are  more
 or less  under  the influence of the  circulation.   It is a
 welj-known fact, (hat when  the circulation is weak and
 languid, that the  urine is copious  and light coloured ;
 but  when the circulation is brisk and active, the urine is
 in less quantity, and of a higher colour.   It is not neces-
 sary then to go into a minute physiological investigation
 of the secretion of urine,  as we  presume no one will
 doubt that the kidneys, particularly their secretory arte-
 ries, are the seat of the symptom, and that the proximate
 cause is, morbidly increased action of the circulating sys-
 tem,
   7. The body is  costive.
   The seat of this symptom is apparent, the alimentary
 canal.   One function of this canal  is to discharge  the
 faeces at regular periods.   In order to  the due perform-
 ance of this function, it is necessary that the lower bow-
 els should be properly lubricated by the secretions from
 the mucous glands, situated in the coats of the alimenta-
 ry canal; by the glands situated without the  coats,  but
 whose ducts enter the canal; and  by the exhalations
 from the exhalent  arteries, which open into the canal.
   These secretions and exhalations are liable to be in-
 creased, diminished^ &c.  When increased, the contents
 of the lower bowels are augmented,  and purging follows,
 either from the stimulus of distention, or from the irrita-
 tion of the feculent  matter.   On the other hand, when
 these secretions and exhalations are diminished, the con-
tents of the lower  bowels  are not augmented  as usual;
 therefore, the stimulus of distention does not occur at the
 regular period, the  irritation of the feculent matter is
 not so great as usual, and from the want of lubricity, the
 contents do not so readily pass down ; hence costiveness.
  The seat of costiveness is the alimentary canal;  the
proximate cause, diminished secretion  and exhalation;
which arise from the morbidly  diminished action of the 
19
circulating system  that existed in the first stage of  the
lever.   It scarcely need be said, that the secretions and
exhalations are from the blood.   Perhaps the very great
diminution of the life of the muscular structure, which
existed previously, prevents the ready  action  of  the
muscular  membrane of the intestines.
   8. And there is a quickness, with a fulness,  and hard-
ness in the  pulse, not much affected by any  pressure
made on  the artery.
   The  seat  of this symptom is, the heart and arteries;
the proximate cause,  morbidly increased action.
   9. Its pulsations are from 90 to 130 in a minute.
   This symptom ought to have been connected with the
last.  It has the same seat and proximate cause.
   10.  And when blood is drawn, it exhibits a yellowish or
huffy crust on its surface.
   In our  reflections on the blood* we think we have
fully proved, that all  the changes in the blood take place
within the circulating system ;  and that the yellowish or
buffy crust is produced by the  morbidly  increased  ac-
tion of the heart and  arteries ; particularly, by the mus-
cular structure of the ventricles.
   Then we shall assign the heart and arteries as the seat
of this symptom ; and their morbidly increased action, as
its proximate cause.
   III. The third suit of symptoms in the stage of morbid-
ly increased  action.
   [1]  If  the febrile symptoms run very high, and proper
means are not used at  an early period, stupor and delirium
come on at a more  advanced stage ;  [2]  the imagination
becomes much disturbed and hurried,  [3] and the  patient
raves violently.
   This suit is composed of three distinct symptoms.
   1.  If the febrile symptoms run very high, and proper
means are not used at an early period, stupor and delirium
come on at a  more advanced stage.
   Stupor  and delirium have their seat in the brain.  On
reference  to the functions and actions of the brain, we
find that stupor and delirium will arise from a long con-

  ^Containedin the Institutes and Practice of Medicine, not yet published. 
20
 tinuance of morbidly increased action of the heart and ar-
 teries, which is their proximate cause.
   2.  The imagination becomes much disturbed and hur-
 ried.
   This symptom is in train with the last;  it is a part of
 the same diseased action, and is clearly referrible to the
 same seat, the brain; and to the same proximate cause,
 morbidly increased action of the heart and arteries,
   3.  And the patient raves violently.
   This is but one of the symptoms of delirium, and like
 that,  is located  in  the brain, and has for its proximate
 cause, morbidly increased action of the heart and arteries.
   Having assigned the seat and proximate cause to the
 several symptoms in the inflammatory character of fever,
 our next business will be to  endeavour to ascertain the
 seat of the disease itself.
   We shall  now examine the several symptoms in  the
 order of effect to cause, and see if we can find any one
 symptom, which can cause all  the others;  if so, what-
 ever is the seat of this symptom must evidently be  the
 seat of the disease.  In this investigation, we shall com-
 mence with the last suit of symptoms in the disease, and
 attempt to trace up the several symptoms from effect to
 cause; and  endeavour to generalize the seats and proxi-
 mate causes of the several symptoms in each suit.
   Third Suit of symptoms in the second stage. [1] If
 the febrile symptoms run very high, and proper means are
 not used at an early period, stupor and delirium come on at
 a more advanced stage, [2] the imagination becomes muck
 disturbed and hurried,  [3] and the patient raves violently.
   This suit consists of three distinct symptoms, which
 we have traced to their seat, the brain,  and shown the
 proximate cause of each to be morbidly increased action
 of the heart and arteries.
   We will now refer to the next preceding suit of symp-
 toms,   and trace this morbidly increased action of the
heart  and arteries to its source.
   Second Suit of symptoms in the second stage.   [1]
 The skin is dry, [2] and parched; [3] the eyes appear inflam-
ed, [4] and are incapable of bearing the light, [5] the tongue
is of a scarlet colour at the sides,  and furred, and white
 in the centre ; [6] the  urine  is  red and scanty, [7] the 
21
 body is costive, [8] and there is a quickness, with a fulness
 and hardness in the pulse, not much affected by any pres-
 sure made on  the artery,  [9] Its pulsations are from 90
 to 130 in a minute, [lOJ^anof when blood is drawn, it exhi-
 bits a yellowish or buffy crust on its surface.
   This suit consists of ten  symptoms; eight of  which
 have their  seat in the  circulating  system, and their
 proximate  cause is morbidly increased action  of  the
 heart  and  arteries.   The  other two are  local  symp-
 toms, and have  other seats;  the  proximate cause of the
 one is,  probably, morbidly increased  action of the heart
 and arteries; of the other,  their morbidly  diminished
 action,  which previously existed  in the system.
   The first  suit of symptoms  in the second stage, will
 next engage our attention, while we keep  in view this
 morbidly increased action  of the heart  and arteries,
 which appears to be the overruling state of the system
 in the third and  second suits of symptoms.
   [l]  Which symptoms are shortly followed by redness of
 the face. [2] throbbing of the temples, [3] great restless-
 ness, [4] intense heat, [p] and unquenchable thirst, [6] op-
pression of breathing, [7] and nausea.
   This  suit consists of seven distinct symptoms;  of
 which,  four are  seated in  the circulating  system, and
 their proximate cause is morbidly increased action of the
 heart and arteries.  The other  three  are  local  symp-
 toms, and have other seats;  but  the proximate (ause of
 two of them is referrable, directly, to the morbidly in-
 creased action of the heart and arteries; and the third,
 indirectly, to  the same source.
   The morbidly  increased action of the heart and arte-
 ries, then, is the overruling  state of  the system in  the
 third, second, and fir$t suits  of symptoms, which consti-
 tute the second stage in the inflammatory  character of
fever.
   We will now examine the  second suit of symptoms in
 the first stage, with  a view to ascertain the cause of this
morbidly increased action  of the heart  and arteries,
 which  appears to be the  overruling state of the system
in the  second stage of the  inflammatory  character  of
fever
   [1] Succeeded by vertigo, [2]  rigors, [3] andpains over
                         4 
22
the  whole body, but more particularly in the head and
back.
  This suit consists of three distinct symptoms; the first
is seated in the brain, and the second and  third,  in the
muscular structure.  The  proximate cause of the  first
is referrable to a morbidly diminished action of the heart
and  arteries ;  of the  second and third, to a very great
diminution  of the life of the muscular structure.
  The symptoms of this suit are directly opposed to all
those of the second stage.  There, the overruling state of
the system  was the morbidly increased action of the heart
and arteries ;  here, it is the morbidly diminished  action
of the >ame organs.
  At first view, it would appear, that we had completely
lost sight of our grand overruling  state of the system,
the morbidly increased action of the heart and arteries;
but,  such are the laws of the animal economy, that after
the morbidly  diminished action of the heart and arteries
has continued for  a time,  the system reacts upon itself,
and  produces a morbidly increased action of that heart
and arteries,  which were, just before, labouring under a
morbidly diminished action.
  This law of the  animal economy  is acknowledged by
all our best writers on medicine.  It is called re-action.
We shall examine  it particularly hereafter.
  The  overruling state of  the system in the  second
stage, then, is the effect of the morbidly diminished ac-
tion  of the heart and arteries in the second suit of symp-
toms of the first stage.
  The first suit of symptoms in the first stage will now
engage our attention, in order to ascertain the cause  of
this morbidly diminished action of  the  heart  and  arte-
ries, which appears to be the overruling state of the sys-
tem in the  second  suit of symptoms.
  [1] It  comes on  with a sense of lassitude [2] and inac-
tivity.
  This suit consists of but two symptoms ; both of which
have the same seat, the fibrous  structure of the Kuscular
system;  and   both, the  same proximate  cause, a very
great diminution of the life  of the muscular structure.
  The action  of the heart and arteries, is produced by
the muscular  structure of the ventricles;. consequently, 
23
this  morbidly diminished action of the  heart and arte-
ries  mu>t arise from the  lassitude and inactivity, which,
at the commencement of the inflammatory character of
fever,  pervade the  muscular structure of the ventricles,
in common with the whole of the muscular system.
   From the preceding investigation, is  it not perfectly
evident, that the muscular  structure must be the seat
of the inflammatory character of fever?
   This induction is drawn  from the following conside-
rations :
   1. The first symptom,  lassitude,  is seated in the mus-
cular structure.
   2. All the other symptoms are mere effects, produced
by the functions and morbid actions of muscular struc-
ture.
   3. The two overruling states of  the system, the mor-
bidly diminished, and  the morbidly increased action of
the heart and arteries, which cause all the symptoms, af-
ter the two first, are referrable directly  to  the muscular
structure.
   4. The symptoms, from the first to the last, are one con-
tinued chain of cause and effect, and are capable of be-
ing produced, by  whatever causes the  sense of  lassi-
tude.
   5. In the examination  of the symptoms from effect to
cause,  it has been clearly proved, that all the symptoms
emanate from the derangement  in  the functions of the
muscular fibre.
   We have then traced  the inflammatory  character of
fever to its seat, the fibrous structure  of the muscular
system.
   Having located  this character of fever, we shall en-
deavour to investigate  its proximate cause.
   " The proximate  cause of lever seems hitherto to have
eluded the  research of physicians;  and  I shy 11 not pre-
tend to ascertain it  in a manner that may remove every
difficulty."*
   It can hardly be  expected that we should be success-
ful in that which has eluded  Dr. Cullen, and all the other
great luminaries of medical science.   We may,  how-
* Cullen's First Lines,par. 38.
t First Lines,par. 34" 
24
ever, be permitted to make an humble attempt, since we
have laid a sdid foundation, by assigning a seat to the in-
flammatory character of fever.
  Doctor Cullen.f says, " As the hot stage of fever is so
constantly preceded by a  cold stage, we presume that
the latter is  the cause of  the  former;  and, therefore,
that the cause of the cold stage is the cause of all 'hat
follows in the course of the paroxysm; see Boerhaave,
Aph. 756."
  We have no doubt the doctor was correct in saying,
that the cause of the cold stage is the cause of  all that
follows in the course of the paroxysm.   And we believe
we can go further, and "ay,  thac, whatever produces the
first suit  of symptoms, the  sense of lassitude and inac-
tivity,  is the  cause  of all  that  follows in the course of
the paroxysm.
  We  have examined  Thomas's description of  the in-
flammatory character of fever, in  the order of effect to
cause,  and proved that all the effects may be produced
by whatever  causes the first suit of symptoms ; and, that
the train of symptoms is in reality cause and effect; it
follows then, that  whatever produces  the  first  suit of
symptoms, must be  the proximate cause of this charac-
ter of fever.
  We have shown that lassitude is seated in the fibrous
structure of the muscular  system; and  that its  proxi-
mate cause is a very great diminution of the life  of  the
muscular fibre.
  We shall now examine  the several symptoms in  the
inflammatory character of fever, by stages, and by suits
and groups of symptoms, and endeavour to ascertain if
a very grr at diminution of the life of the muscular fibre
can produce all the  symptoms.
  The second symptom, in Thomas's description, is inac-
tivity; this is well known to be the  effect of lassitude.
  Succeeded by vertigo.  The seat of this symptom we
have traced to  the  brain;  its proximate cause  is  the
morbidly diminished action of the  heart and arteries.
  We have now to  inquire  in what manner a very great
diminution of the life of the  muscular fibre can affect
the circulation.
  There is a certain consent,  or unison of action,  be- 
25
tween similar parts, throughout the whole of every sys-
tem of organs, or vessels, composing the human body;
which is well known to physiologists, and is sometimes
denominated sympathy.
            Proof of this consent of parts.
  Dr Cullen* says, " that a certain condition prevail-
ing in one part of the body, occasions a similar  condi-
tion in the other."
  The taylor, who has wrought all day with his needle,
finds every  muscle of his body fatigued and exhausted,
even to  his toes' ends, although he may not  have moved
from his seat for twelve hours.  The pedestrian, who has
walked  for a long time,  finds his superior extremities
nearly as much fatigued as his inferior.
  " If we fatigue one  limb by violent exertions,'' says
Wilson.f " we find that we have, though in a less degree,
diminished the power of every other."
  Point out to me a person who is tired all over his bo-
dy, with the exception of one hand.   Show me the man,
exhausted with labour, who does not prefer  silence  to
loquacity, although he may not have  spoken ten words
for the whole day.  Where is the orator that can address
an audience for six hours, and feel no fatigue, except  in
the organs of speech.   Till this is done, we deem it un-
necessary  to adduce further evidence,  in proof of our
position.
  Now, I presume, we are prepared to understand, that
a sudden and great change of temperature, acting upon
the surface, or any other part  of the body, so  as greatly
to diminish the life of the muscular fibres of  that part,
may, and will, affect  all the muscular  fibres of every
other part of the body;  consequently,  the  muscular
fibres of the ventricles will undergo a similar  change  in
life with  those  primarily affected.  And  as the cir-
culation corresponds very exactly with the muscular ac-
tion  of  the  ventricles; the effect of  a very great dimi-
nution of the life of  the muscular fibres of the  ventri-
cles of the heart, will be, a diminished, and probably, an
irregular circulation of  the blood.
  A diminished circulation, is then precisely what must

   * First Lines, par. 44. 5 '1     f Febrile Diseases, Vol. I. p. 2)3. 
26
 follow as the effect of  such a cause, for to lassitude and
 inactivity of  the muscles, naturally  succeed  languor,
 sluggishness, and unwillingness to move, which  is the
 condition, not with the ventricles alone,  but with every
 part of the body.
   Rigors.  The  seat of  this symptom is the fibrous
 structure of the muscular system ;  its proximate cause,
 a very great diminution of the life of the muscular struc-
 ture.   This is  a state  of the system which we have al-
 ready shown existed, and to which this symptom  is re-
 ferable.
   Pains over the whole body, but more particularly in the
 head and back.   This symptom has also been traced to
 the muscular system; and its proximate cause, to a very
 great diminution of the life of the  muscular structure;
 and, therefore, referrable to the same state of the system,
 as the last mentioned symptom.
   We have then proved, that all the symptoms, in  the
 first stage,  may arise  from a  very  great diminution of
 the life  of the muscular structure, producing lassitude.
   We will now examine the second stage, and  see if it
 be possible, that the overruling state of  the system, in
 this stage, a morbidly increased action of the heart and
 arteries, should  arise from  the previous  stage of mor-
 bidly  diminished action.  We shall, at  the same time,
 inquire  if the several symptoms in the second stage can
 also be  produced by this morbidly diminished action.
   The first suit  of symptoms in this stage is, [1] which
 symptoms are shortly followed by redness  of the face,
 [2] throbbing of the temples, [3] great restlessness, [4] in-
 tense heat, [5] and unquenchable thirst, [6] oppression of
 breathing, [7] and nausea.   Each of the symptoms  in
 this suit has been traced to its source, and its proximate
 cause assigned.   The  1, 2, 3, and 4, have their seat in
 the circulating system;  and their proximate cause is mor-
 bidly  increased  action.  The other three,  5, 6, and 7,
 are local symptoms, and have local seats; but their prox-
 imate  cause is morbidly  increased action of the circu-
lating system.    Then our whole attention, in this suit of
symptoms, will be directed to the circulating system as
the seat, and to  morbidly increased action as the proxi-
mate cause. 
27
   The overruling state of the system in the first stage,
we have already  proved to be the morbidly diminished
action of the heart and arteries ;  its proximate cause, a
very great diminution of the life of the muscular structure.
It would appear paradoxical, that this condition of the sys-
tem should produce the overruling stale of the system in
the second stage, the morbidly increased action of the
heart and arteries.
   It is not an easy matter to comprehend, in what man-
ner a morbidly diminished action of  the heart  and ar-
teries, should produce their morbidly increased action.
But, to the fact, we have the  testimony of almost every
medical writer.   Dr. Cullen expressly says,  the hot
stage of fever is  caused by the  cold stage.
   The seat of the first suit of symptoms, in the second
stage, being fixed  in the circulating  system, we have
only to inquire in what manner a very great diminution
of the life of the muscular structure can produce a mor-
bidly increased action of the  heart and arteries.
   In  another place,* we have  shown that the  arterial
circulation is produced by the muscular contraction and
dilatation of the ventricles of the heart, and wholly un-
der its influence.   Our wide field, then, is reduced  to a
single point.   In  what manner can a very great diminu-
tion of the life  of the  muscular fibres of the   ventricles
of the heart, characterized by a small and weak pulse,
produce a morbidly increased action of the same fibres,
which shall be characterized  by a full and strong pulse ?
This effect is what has been called  Reaction.  This
principle has been acknowledged  by all writers on me-
dicine;  but we are not able to trace  it to any of the
well known laws of the animal economy.
   The plain history of facts,  without  any varnishing, or
reference to preconceived theory, so far as I understand
it, is  this: The general life of  the  whole body is borne
down and oppressed by  some cause,  as in the stage of
morbidly diminished action of the inflammatory charac-
ter of fever, till it approximates that point where life must
quit this mortal  frame.  This  oppressing cause, how-
ever,  is not generally equal  to the  extinction of life;
* Institutes, not published. 
28
and when the opposing cause has gone the full length of
its power, the life of the system and  the opposing cause
remain, for a time, in equilibrium.   At length the vitali-
ty of the system gains ground, and reacts upon the op-
pression, till it produces that train of symptoms denomi-
nated the stage of morbidly increased action.
  Similitude proves  nothing, or  we  might instance  the
reaction of a bow, a  tense cord,  elastic bodies, &c.
  I would attempt to explain this principle of the animal
economy in the following manner.  The violence of the
action of the proximate cause of fever produces a shrink-
ing of the external parts of the body,* which forces  the
blood upon  the heart and larger vessels.   This unusual
quantity of blood in the heart imparts more stimulus to
its muscular structure, than what would be derived from
the usual quantity of blood ; or,  perhaps, the mere over
distention acts as a stimulant. The one, or both of these,
may possibly have a tendency to reanimate the muscu-
lar fibres of the heart, and to relieve them from their very
great diminution  of life, and thus produce what is deno-
minated the reaction of the system.
  In fact, rest, friction, and the genial warmth  of the
arterial blood, are precisely what common sense  would
dictate as being the  most likely to restore the very great
diminution of the life of the muscular fibres.  Since  the
heart is but secondarily affected,  by the proximate cause,
and  not so  powerfully as those  muscles which shudder,
we should suppose the heart would first regain its  dimi-
nished life.
  If this explanation of reaction  be correct, of which we
have but little doubt, then it will be seen that the  hot
fit follows the  cold, in the  order of cause and effect, as
conjectured by Dr. Cullen.
  We will give,  in  support of our opinion, a specimen
of reaction, of a different kind from that which occurs in
fever.   In concussion of the brain, from whatever cause,
there is universal prostration of strength; the pulse is
scarcely perceptible, life seems just ready to  quit  her
tenement.   The cordial treatment becomes necessary to
prevent immediate death.   The system is roused;  the
* Vide Cullen's First Lines, par. 40. 
29
patient soon  revives;  the pulse increases in  force  and
fulness;  a high state  of the  inflammatory  character of
fever supervenes, and many bleedings, purgings, &c. are
necessary to save, the patient.   Here is a powerful state
of reaction, evidently produced by the previous state of
depression.
  Dr. Thomas, in his description, goes on to say, [1]
The skin is dry, [2] and parched, [3] the eyes appear in-
flamed,  [4] and are incapable of bearing the light, [5] the
tongue is of a scarlet  colour at the sides, and furred, and
white in the centre, [6] the urine is red and scanty, [7] the
body is costive, [8] and there is a quickness, with a  ful-
ness and hardness in the pulse, not much affected by any
pressure made on the artery, [9] its pulsations are from
90 to 130 in a minute, [10] and when blood is drawn, it
exhibits a yellowish or buffy crust on its surface.  All the
symptoms of this suit, with the exception of one or two,
have been traced to their seat in the circulating system ;
and their proximate  cause proved to be  morbidly in-
creased action.   This whole  suit,  then, is  merely an
effect of the existing morbidly increased action  of the
heart and arteries.
   [1] If the febrile symptoms run very high, and proper
means are not used at an early period, stupor and delirium
come on at a  more advanced stage, [2] the imagination
becomes much disturbed and hurried, [3] and the patient
raves violently.  The seat of this suit of symptoms we
have already shown to be  the brain; and the proximate
cause,  the morbidly increased action of the heart and
 arteries.  Then it follows  that Dr. Thomas's description
 is a connected chain of cause  and effect; and whatever
 produces  the first symptom, may be  considered as the
 proximate cause of the disease ; and it also appears that
 all  the other symptoms are mere links in the same chain
 of cause and effect.
   We have already proved that a very great diminution
 of the life of the  muscular fibre will produce lassitude,
 and all the phenomena attending the  stage of morbidly
 diminished action ; and that the natural tendency of this
 stage is to produce reaction, whence arises the stage of
 morbidly increased action, and all the train of symptoms
 which follow; therefore, we infer, that a very great eft-
                           5 
30
 minution of the life of the muscular fibre is the proxi-
 mate cause of the inflammatory character of fever.
   This deduction is supported from a knowledge,
   1. That lassitude is seated in the muscular fibre.
   2. That the  proximate cause of lassitude is a very
 great diminution of the life of the muscular fibre.
   3. That the inflammatory character of fever is seated
 in the muscular structure.
   4. That a very  great diminution of the life of the
 muscular structure  will  produce  lassitude,  and all the
 other symptoms in Thomas's description.
   5. That no  other individual cause  can  produce all
 those symptoms.

                  cure  of fever.

   In our reflections on the cure  of fever, we  must go
 back to the very first moments of indisposition ; to that cha-
 otic state of the symptoms which existed before the dis-
 ease had taken on  itself any decided character.   This
period has been called the formative state of fever.  We
shall, then, divide the cure of fever into three periods
   1. The formative state.
   2. The  stage of morbidly diminished action.
   3. The  stage of morbidly increased  action.

          On the formative State of Fever.

   The formative state of fever is, in fact, the commence-
 ment of the stage of morbidly diminished action.   We,
however, choose  to  consider it  separately  from  that
stage ;  because, the treatment in the two periods should
be somewhat different,  and, also, for the purpose of im-
pressing the student  with the high importance of attack-
ing febrile action on  its first appearance, without waiting
for a regular development of its character.
  In most  cases of fever, there is a space of time   from
the very first approaches of indisposition, till the  cha-
racter of the fever is developed ; this is called  the for-
mative state of fever.  In this period, the symptoms are *•
a perfect chaos, and the most sagacious physician  may
not be able to decypher  what character of fever is to 
31
 take place.  The length of this  period  is very uncer-
 tain ; it varies from an hour, or perhaps less, to several
 days.   It is during this state, that the physician has the
 best chance of curing, or, rather,  of preventing  the
 disease.
   There are a multitude of diseases  and  slight indispo-
 sitions,  particularly colds,  that are  accompanied with
 febrile action,  in which no regular character of fever is
 ever formed.   At the commencement of these complaints,
 their  cure  will fairly  come  under the treatment of  the
 formative state of fever; because, under this head, we
 mean to treat, not only of the cure of the formative state
 of  the three regular characters of fever, but also of the
 cure of the  formative  state of every species of febrile
 action.   By this plan, the physician, when called to a
 patient labouring under febrile action, will not hesitate
 to prescribe, although  no regular disease has developed
 itself.

    On  the Cure of the formative Stale  of Fever.

  In our reflections on this subject, we shall include  the
 treatment of the early symptoms of every  fever before it
 developes itself, and of every species of febrile action ;
 yet not without a special reference to the character of
 the disease  which may be expected to follow.
  To judge of the character of fever which will proba-
 bly be formed,  we may consider,
  ]. The character of fever  which, at that time, is most
 prevalent.
  2. The  character of fever to which the patient has
 been most liable.
  3. The character of fever to which his recent expo-
sures would subject him.
  4. The character of fever that  the symptoms mostly
 indicate.
  After having decided on the character of the fever which
is most likely to be formed in this particular patient, the
cure is to be attempted by  general remedies; yet  not
without a special reference, in the.administration of each
remedy, to the character of fever which you expect will
succeed ; and also, to that remedy which  will most pro- 
32
bably prove efficacious in this particular case : therefore,
it will not be expected that all the means of cure here-
after named will be used, nor in the exact routine men-
tioned.   We shall place them in the order in which they
are generally prescribed by our best physicians.
  Perspiration.  In most incipient cases of fever, and
of febrile action, a  gentle perspiration  has a powerful
effect in  restoring health.
  When a gentle and  agreeable perspiration is produ-
ced over  the whole  body, you have evidence  that the
exhalent  arteries, a very  extensive  class  of vessels,
have returned to the performance of their functions ; or,
in  other  words, that they are in health.  The quantity
of fluid discharged may be of some  consequence,  when
there is a fulness of the vessels ; but the great advan-
tage to be derived from the perspiration, is the return of
the exhalent arteries to the performance of their healthy
action ; and the effect which  such  an immense number
of vessels, distributed throughout every part of the body,
and restored to their natural action, must have in influ-
encing other parts to take a healthy action.
  Vomiting.   Vomiting is one of the most useful reme-
dies in the formative state of fever.  Not so much for
the mere discharge of the contents of the stomach, as for
the shock* which is given to the whole system.
  Purging.  Cathartics  have a considerable  effect in
removing the formative state of fever, by exciting many
of the functions of the alimentary canal;  viz.  its mus-
cular motion, and the  action of the exhalent arteries,
and of the mucous and other glands situated on the ca-
nal and in its neighbourhood, by  which,  not only the
contents of the canal  are discharged,  but  also large
quantities of serum, mucus, bile, &c.
   Blood letting.   This  should  be  practised in the
formative state of fever, if there is nothing in the condi-
tion of the patient, nor in  the probably ensuing charac-
ter of fever, which forbids it.   Blood-letting is one of the
most powerful means of  preventing the  formation of fe-


 * To use a figurative expression, it is like the blowing up of the magazine
of fort Apalachicola, by sailing-master Basset, with the first hot shot which
was discharged at the fortress. 
33
ver, especially of the inflammatory character;  because,
the heart  and arteries are here primarily affected, and
the abstraction of their contents prevents them from ta-
king on a  morbid action.
   Ablution.   Doctor Currie has written a most valua-
ble treatise on the effects of water in fever.   There can
be no question that the  use of water, in all its forms, i*
highly advantageous in the formative  state of fever. The
particular manner in  which it is to be applied, in each
case, must rest upon the judgment of the physician.
   Mercurialization.   That affecting the system with
mercury has often  cured the formative state of fever,
the united voices of Rush, Warren, and  hundreds of
other American physicians, can testify ; but, that it has
destroyed many, our grave yards demonstrate.
   Blistering.  For local pains, blisters may be of ad-
 vantage ; but no great dependence can be  placed on
 them for  interrupting the formative state of fever.
    Sinapisms, although useful, have less effect than blis-
 ters.
    Wine, alcohol, and other stimulants, are sometimes
 found useful in peculiar cases.
    Opium is occasionally administered with advantage.
    Beside the foregoing  remedies, there are  a great va-
 riety of others  in use among  physicians,  but the most
 important, the most powerful, have been named.
    In the treatment of the formative state of fever, great
 judgment must be  used in nicely adapting  the  cure to
 the exact state and condition of the  patient.  It must not
 be thought  that all these  remedies are  to be  used in
 every  case; no, the  physician must have in view the
 character of fever which  will probably be formed, the
 age, sex, condition, strength,  &c. of his patient; and he
 must nicely graduate his remedies according to all those
 circumstances.  And notwithstanding  a  powerful onset
 is advised, the capability  of the  patient to support  thi^
 shock must  always be had in view, or he may be  in
 jured.
    The chance of curing, or rather of cutting short the
  duration of  fever in its formative  state, or after it has
  completely developed  its character, is as  an hundred 
34
 to one.  Hence the necessity of attacking every species
 of febrile action at its  commencement,  and with such
 powerful remedies as are most likely to destroy it, and
 prevent the formation of a fever.
   IVlany European  physicians  are of opinion, that they
 never cut short the course of a fever, by remedies, after
 it has completely formed its character, and continue for
 three or  four days.   Some Americans  hold a  different
 opinion.  Yet,  how few physicians are there  who at-
 tack the  formative state  of fever with vigour.   Oft times
 have I seen  some placebo  administered to amuse the
 patient, while the fever should develope itself.  Yea,  I
 have known physicians refuse to do any  thing in the for-
 mative state  of fever, and thereby lose the best oppor-
 tunity  of curing the disease.

     Cure of the Inflammatory Character of Fever,

  It is of no  small importance  to the safety of the pa-
 tient, that his physician should be able  to ascertain, on
 the first moment of indisposition, that his patient is at-
 tacked with the inflammatory character of fever.
  To decide this question, the following circumstances
 may be taken into consideration :
  1. The character of fever to which the  patient has been
 liable.
  2. Is this attack similar to his former ones ?
  3. The character  of fever  which prevails at that
 lime.
  4. The season of the year.
  5. The age, sex, condition, temperament, habits,  ex-
 posure, &c. of the patient.
  6. The character of fever which is most strongly in-
dicated by the symptoms.
  7. Every other concomitant circumstance.
  The cure of the inflammatory character of fever natu-
rally resolves itself into two periods :  the one, during
the formative state of  the fever, and through the stage
of morbidly diminished  action; and the other, from the
commencement of the stage of morbidly increased ac-
tion, to the encfof the disease.
  We have already treated of the cure of the formative 
35
state of fever  in general; but, if the remedies have not
been successful during this state of the fever ; or, if
none have been used, then a somewhat different, more
definite, and  more vigorous course, must be pursued.

■ Treatment of the  inflammatory Character of Fever dur-
   ing its  formative state, and through  its stage of mor-
   bidly  diminished action.

   We shall presume it to be a pure,  unmixed, simple
 case of the inflammatory" character of fever, having no
 tendency to typhoid action.
   The indications to be accomplished in this period of
 the disease are,
   1. To remove the proximate cause of the inflamma-
 tory character of fever, viz.  the very great  diminution
 of the life of the muscular fibre.
   2. To prevent'the reaction of the heart.
   It may  be extremely difficult to decide, on abstract
 principles, the remedy which, in  each particular case,
 ought to be  first used.   This must rest wholly on  the
 judgment of the  physician.   We  shall mention the re-
 medies in the order in which they are  most generally
 prescribed by our best physicians.
   Warm bath and perspiration.  If the physician is
 called at the first hour of the attack, and the symptoms
 should not be violent, the patient appearing only to have
 taken cold, pediluvium, semicupium, or general bathing
 in warm water, will often afford relief.   The object now
 to be obtained is the removal of tne proximate cause,
 i. e. to restore the very great diminution of the life of the
 muscular fibre.  The bathing should  be accompanied
 with friction, and motion of the limbs.  General bathing,
 a* being more extensive, is more efficacious,  than a par-
 tial bath.  It is the same with friction ; every part of
 the body should be well and  repeatedly Tubbed while
 in the bath.   Immediately after  bathing, perspiration
 should be promoted by warm teas, sudorifics, &c.  If it
 should be gentle, agreeable, and nothing contraindicates,
 it may be kept  up for six, twelve, or even twenty-four
 hours.      ' *- *-'                       .
   General bathing and friction are among the most pow- 
36
 erful and direct  applications to the parts, which  have
 been exposed to the remote cause of the disease, and
 which are, in part, the seat of the proximate cause, viz.
 the external muscles. It is not improbable, that warm bath-
 ing with friction, followed by a gentle perspiration, is the
 best means of restoring the diminished life of the muscu-
 lar system.
   Emetics.   Perhaps vomiting  may be spoken of next
 after the warm bath and perspiration.  The  object in
 giving an emetic is  to accomplish our first indication  of       ^
 cure.
   The stomach and oesophagus are surrounded by pow-
 erful muscular membranes.   The shock which is given
 to these membranes, and to the whole muscular system,
 when the  emetic operates powerfully, is  very  great.
 Every fibre in the whole body is agitated, convulsed.  It
 is principally from this effect on muscutar structure, that-
 we are to expect benefit from vomiting.  Although we
 shall not pretend to say that the emetic drug produces
 no good effects byemptyingthe stomach, when by chance
 it shall  be  gorged with noxious  matters, and in  dispo-
 sing to perspiration; yet, we affirm, that the salutary ef-       *
 fects arise  more from the concussion given to  the mus-
 cular system, thereby breaking  up any disposition  to
 morbid action in the muscular fibre, than in discharging
 a few pints of the contents of the stomach.
   Blood-letting.   If the  patient  is of a very plethoric
 habit, and  has been accustomed to lose  blood,  or if
 the symptoms strongly indicate blood-letting, it may be
 practised before either of the above-named remedies; and
 more especially, if the physician does not expect to vi-
 sit the patient again in a few hoars.  The great objects
 to be obtained by blood-letting are,                          \
   1. To promote our first indication of cure, by unload-
 ing the vessels, particularly the minute arterial and ve-
 nous ramifications,  that  they  may more readily  per-
 form their functions, and thereby assist in restoring the
 diminished  life of the muscular fibre.
  2. To accomplish our second indication, by  prevent-
ing the reaction of the heart.
  We^are now speaking of a period prior  to the mor-
bidly Increased action of the heart and arteries; there- 
37
fore, we cannot be guided in the necessity of blood-let-
ting by the preternatural fulness of the pulse ; nor in the
quantity  to be  taken,  by the  buffy  appearance of the
blood.  A full bleeding, from  a large orifice, should al-
ways be practised, or such a quantity should be taken
as the patient, under present circumstances, can,  with
perfect safety, bear to lose.
   Purging.  The  intention of purging is, to assist in
removing the proximate cause, by exciting, to an  unu-
sual degree, the natural action of the whole tract of the
alimentary canal, and  that of  all the exhalent arteries
which open into it, and of all the  glands which have the
same outlet.   Therefore,  we do not prescribe cathartics,
because we expect there  is a  quantity of sordes in the
alimentary canal.
   Ablution. Spunging, sprinkling, or washing the whole
body, or such parts as are preternaturally hot, with cold
water, or vinegar and water, has been  found of eminent
 service, by Dr. Currie, and others.   The object would
 seem to  be, rather to allay a local symptom, than to
answer either of our leading indications.
   Cold Water.  It  is supposed, that fever has  often
 been prevented, or cured, by drinking large quantities of
 cold water,  or cold acidulated drinks.   Perhaps both
 ablution and cold drinks may have a  tendency to prevent
 the violent reaction of the heart.
    Blisters, Sinapisms,  Cupping, and other  remedies,
 should be used to combat local symptoms.
    The apartment of the sick should be kept perfectly
 clean, cool,  well ventilated, and free from noise. No vi-
 siter should be admitted into his chamber; every person
 should be excluded, except his immediate attendants.
 The patient must avoid conversation; noperson should be
 allowed to speak to him, except the physician and the
 nurse ; and they should bold no further conversation with
 him, than to understand his disease, and administer to his
 wants.   He should take  no food, or next akin to  none ;
 a little thin  gruel might be allowed, but nothing  solid*
 The exercise of both body and  mind must be avoided.
 He must be abstracted from  every  thing like business;
 as also from fixed attention to any subject.
    The duration of the formative state of the inflamma-
                           6 
38
 tory character of fever is so short; the stage of morbidly
 diminished  action so soon over;  and the physician  so
 seldom called in season,  that an  opportunity  to pre-
 scribe many of the above remedies does not often oc-
 cur.   It will, therefore,  be obvious, that  the prescrip-
 tions must follow each other  in pretty rapid succession.
 When the system has recovered a little from the impres-
 sion  produced by one remedy, another  may be  admi-
 nistered.   They may be repeated, if occasion should re-
 quire.

 Cure of the inflammatory character of fever, from the
   commencement of the stage of morbidly increased ac-
   tion, to the end of the disease.

   If the patient shall not have been seen by his physi-
 cian  before the hot stage commences; or the remedies
 have not been successful, then a different indication pre-
 sents itself; which is,
   To overcome the reaction of the heart.
   In this one point  is concentrated the  disease.   The
 sheet anchor of  our hope is the lancet.  A large vein
 should  be opened with a free orifice, and so much blood
 drawn as will reduce the pulse to the standard of health.
 It is impossible to name the quantity which will be requi-
 site in every case ; from twelve to thirty-six ounces may
 be taken; and even a larger bleeding may be practised,
 if the pulse does not yield.   The  only  criterion  is,  to
 reduce  the  pulse  to its  common  standard.*  If it rise
 again in three, six, twelve, or twenty-four hours, a se-
 cond bleeding should be  prescribed.
   Twelve ounces of blood, taken from a  large  orifice
 in a full stream, has more effect in relieving the  minute
 arterial and venous ramifications from theirengorgement,
 than  thrice  that  quantity, drawn in a  small trickling
 stream; because, when the blood does not flow freely,
 the large  veins and arteries have  an opportunity  of
 gradually  contracting upon their remaining contents  as
 fast as  the blood is abstracted ;  and the minute  arterial
 and venous ramifications remain gorged with blood.  B^it,
 if the blood  is drawn  in a full stream, those vessels have
an opportunity, with the larger ones, of contracting and 
39
 disgorging  their contents, thus preventing organic le-
 sions in the vital and other organs.
   The ravages which the disease  is making in the sys-
 tem, arise more from the engorgement of the minute ar-
 terial and venous ramifications, than from the plenitude
 of the large vessels.
   If the pulse rises a third,  fourth, fifth, or more times,
 and, especially, if the last drawn  blood is covered with
 an inflammatory crust, the  pulse must be reduced by the
 lancet; because the only safety  for the patient  is,  in
 keeping under the violence  of reaction.   The  number
 of bleedings, and the quantity of  blood to be drawn
 at each time, must depend  entirely on  the pulse.  It
 must, however, be taken into consideration, that the in-
 flammatory character of fever is  seldom cured by one
 bleeding ; and, that a less quantity of blood will proba-
 bly reduce the pulse, at a third or fourth  bleeding, than
 at the first or second.  The physician must also have in
 view  the  inflammatory appearances of the last drawn
 blood, and the quantity of blood which his patient can
 bear to lose, without injuring his constitution.
   The plan of treatment, to overcome the reaction of the
 heart, is founded on this principle :  that  the reaction is
 produced and kept  up by  an increase in  the quantity,
 or of the  stimulating  quality of the blood  within the
 heart, acting upon its muscular  structure.   Reaction
 alone is the grand overruling symptom in this stage of
 the disease;  therefore, so much blood must be drawn,
 as  will subdue  the reaction, if it  can  be done with
 safety.
  As soon after the first bleeding as the  patient has re-
 covered a little from its immediate effects, say within an
 hour, there should  be  given  a solution of tartrite of an-
 timony.   If the patient have not previously  taken an
 emetic, or  not  within the  last  twenty-lour  hours, it
 should be given  in such quantities  as to produce three or
 four full vomitings; after which,or, in case the patient had
 recently taken an emetic, thesolution of tartrite ofantimo-
 nyshould  be given in such divided and repeated doses, as
 to keep up an almost  uninterrupted  nausea,  dispose to
perspiration, and  produce three or  four copious watry
stools. 
40
  The objects  are, to unload the stomach, to give a
shock to the body, and so completely  to  prostrate the
strength of the  whole muscular system, that  the  heart
shall  not have  left  sufficient muscular force to  pro-
duce reaction.   The discharging 01 the contents of the
stomach, and the concussion given by vomiting,  have
already been explained. The prostration of the strength
of the muscles of the alimentary canal, and, consequent-
ly, of the whole  muscular system, by the nauseating ef-
fects of the  tartrite of antimony on the esophagus and
stomach ;  and by its purgative effects on the intestines,
is astonishingly great.  A Sampson, who could ordina-
rily overturn temples by his mere muscular strength,
cannot, while labouring under the powerfully nauseating
effects of  the tartrite of antimony, lift  his hand to his
head.  There is no remady, if we except blood-letting,
which has so lasting and powerful effects in prostrating
the muscular powers of the heart, and overcoming its
reaction,  as the preparations  of antimony.   Nausea
should be kept up for twelve or more hours, out of eve-
ry twenty-four,  if nothing contra indicates.
  The grand indication which  we have in view,  is to
overcome the reaction of the heart, and prevent its re-
currence.   The lancet and tartrite of antimony are our
shield and helmet.  While we are practising these  reme-
dies for two  or three days, the combatting of local symp-
toms  must not  be omitted.   Blisters,  sinapisms,  local
bathing, cold and warm; drinking of ptisans,  cold wa-
ter, &c. may be prescribed.
  If the physician should not have been so fortunate, by
the end of the second or  third day after the first hot fit,
as to have overcome the fever, he must be contented to
let it  run  its course,  and  endeavour  to conduct his pa-
tient safely through the remaining part of his sickness,
with the least possible injury to his constitution.   This
will be best accomplished by alleviating the  symptoms
as they appear; always bearing in mind, that most of
those symptoms, if not all of them, arise, either directly
or indirectly, from the morbidly increased action  of the
heart.
  The inflammatory character of fever will  generally
terminate critically on the fifth, seventh, ninth, or four- 
41
teenth day;  and to this object our attention must be di-
rected.
  An unfavourable issue must be apprehended, if the
attack is  very  violent, and  the- symptoms obstinately
resist all remedies; and more especially'if typhoid symp-
toms supervene.
  The circumstances indicating a favourable crisis, are, a
less violent attack, an easy subduction of the symptoms;
and, if on or about either of the critical days, a sponta-
neous perspiration, diarrhoea,  haemorrhage, or  copious
deposit  from the urine takes place, accompanied with a
mitigation of the symptoms.  These evacuations are not
the concocted  matter of  the  fever thrown off, as was
once  supposed ; but the  earliest  evidence of a change
having taken place in the system.  If this  change is a
complete  overthrow of the fever, all the symptoms will
probably  appear mitigated ; but if it  be the triumph of
death, most  of them will be increased.
  Symptoms are the effects of the disease made manifest
through the  Junctions, or morbid  actions of the several
organs and parts of the body :  consequently, every or-
gan, and  every part of the  body must experience the
effect of a change in  health, or in disease, before it be-
comes apparent to the most sagacious physician. These
early changes in the action  of the heart, brain, tongue,
skin,  the  alimentary  canal,  the exhalent arteries,  and
the kidneys, produce a soft equable pulse ;  agreeable
sensations; a moist tongue, with a change in the fur on the
sides; a healthy, pleasant, and agreeable perspiration ;
a natural and  salutary discharge of offensive matters
from  the alimentary  canal; sometimes a flow of blood
from  the  debilitated  exhalents of  the  nose, or other
parts ; an abundant discharge  of urine, affording a copi-
ous deposit of lateritious sediment, &c.  It is perfectly
evident  that a change must  have  taken place in the ac-
tion of the organ itself, before  any alteration could  have
taken place  in its excretions.
  During the cure, the,patient must avoid every kind of
animal food, even animal  broths.   He must eat nothing
but weak gruel, barley or rice-water, sago,  arrowroot,
&c.   Solid food of eveiy kind must be proscribed.
  Immediately  on a favourable crisis taking  place, the 
42
patient should be  offered the aromatic sulphuric acid,
(elixir  vitriol,)  and water.  If in danger of  sinking,
during  the remittence  of fever,  he may be allowed  a
small quantity of-some delicate cordial; and if absolutely
necessary, a small  quantity of the infusion, or decoction
of Peruvian bark.   When the patient has passed the pe-
riod for the second paroxysm since  the crisis, and that
without much fever, he may be allowed a more liberal use
of the infusion, or decoction of bark, with small quantities
of animal  broth.  The patient's bowels must be opened
every other day.
   The  inflammatory character of fever has generally
one paroxysm in  each twenty-four hours;  that of  eve-
ry other day is, usually, the most violent.  These pa-
roxysms recur several times after  the  crisis is  formed,
but with diminished violence.  The depleting remedies
are used to the most advantage, at the approach of the
paroxysm, and the invigorating,  during  the  stage of
apyrexia.
   It must be distinctly understood, that we have been
treating of a highly inflammatory character of fever; in
which there is not only no prospect, but, in fact, no pos-
sibility  of its running into typhus.
   I am inclined to  think that this character of fever oc-
curs more frequently in  America  than on the  Eastern
continent.
   The  treatment which  we have  recommended is de-
cided, energetic, and adapted for a vigorous constitution.
In all cases, however, allowance must  be  made for the
age, sex, condition, &c. of the patient.
   It will be readily perceived that we have  most faith-
fully drawn our mode of treatment from the seat, and
proximate cause of the fever.
   The seat of the  inflammatory character  of fever we
have  shown to be  in the muscular structure;  and the
proximate cause, a very great diminution of the life of
the muscular fibre.
   Our first suit of  remedies is  applied, as directly  as
possible, to the muscular structure, with a view of re-
storing  its diminished life.   Since the  circulating  sys-
tem exercises an overruling  power upon the whole  of
the body,  and that power is supported by the muscular- 
43
ity of the heart; it is to this point, that our attention is
called in the second  place; and, lastly, to subdue local
symptoms as they arise.
  It is worthy of note, that the  mode of cure, drawn as
faithfully from the seal and proximate cause, as though
the writer had never  seen the disease, nor read any other
than Thomas's description of it,  should correspond so
exactly with  the treatment  which has been found  the
most successful by  every judicious practitioner, from
the days of Hippocrates,  whatever his theory of the dis-
ease might have been.  This single circumstance  is a
powerful reason for  believing  that the true seat and
proximate cause  has  been discovered.   Another  rea-
son  for the same opinion is, that  when the writer com-
menced this investigation, he had  a very different theo-
ry of fever, its seat,  and  proximate cause; but he was
irresistibly led to this inference, from  the weight of tes-
timony, as he proceeded.
  We do not pretend to have discovered, or even intro-
duced any new remedies; but we think we have shown
the rationale  of the old ones.   Have we not explained,
in the most satisfactory manner, the reason that the  va-
rious preparations of antimony  have been found so effi-
cacious in fever; and  pointed out more definitively the
objects to be accomplished in the  several periods of the
disease?  We think that  we shall have  given  to  the
practitioner a confidence in his own powers ; an  ob-
ject  to be obtained in  every period of the disease,  and
the best means by which it may be accomplished. 
 
Me<i.Hie,t.
    Ia/Z

-£734-r-
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