/ X' ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 \imWri Section. Number .s&èÉLAAârJU. Fobm 113c. W. D.. S. G. O. epo 3—10543 (Rcvised June 13. 1936) S MEDICAL AND PHYSIOLOGICAL I jX COMMENTARIES. *-■ *• MARTYN PAINE, M. D. A. M. ----Vitte tam vires quam actioneg expono. — Biblia JValurœ. Morborum quoque te causas et signa doceo.— Virgil. IN TWO VOLUMES. VOL. IL ; ^ NEW-YORK: COLLINS, KEESE & Co. 254 PE A R L- S T REET. LONDON: JOHN CHURCHILL. 1840. w,. v. 2* . Bntered according to the act of Congress, in the year one thousand eight hundred and forty, by Martyn Paink, in the Clerk's Office of the District Court of the United States, for the Southern District of New-York. PRINTKD B? t5teoHttuvô 0) U-umiuià No. 111 Fulton-st. n. y CONTENTS OF VOL. II. I. PAGE PHILOSOPHY OF ANIMAL HEAT. ... 9 II. PHILOSOPHY OF DIGESTION. ... 77 AEPENDIX On «pontaneous génération......... . 123 III. THEORIES OF INFLAMMATION. . . .142 APPENDIX On the state t)f the circulation in fever....... .209 IV. PHILOSOPHY OF VENOUS CONGESTION. Section I.—First observations upon phlebitis. — Venous congestion ear- , ly regarded as an important condition of disease. — Opinions of authors as to the nature and causes of venous congestion......216 Section IL — Armstrong's doctrines considered. — The lungs, in their re- lation to the doctrines of obstruction and rémora. — Mechanical impedi- ments to the venous circulation not a cause of disease.....230 Section III. — Supposed obstructions to the venous circulation farther con- sidered. — Debility and relaxation of the veins. —Original case. . . 256 Section IV. — Inductions from the effects of remédies in venous conges- tion..............268 Section V. — Inductions from the causes of venous congestion. . . 276 Section VI. — Inductions from the symptoms.......281 Section VIL — Morbid anatomy of the veins. — What constitutes inflam- mation. — Ail tissues liable to this disease. — Hypothetical doctrines considered.............299 Section VIII. — Organization of the veins, &c......331 Section IX. — Analogies supplied by varix, hypertrophy of the veins, &c. — The exciting and pathological causes of varix, and venous hypertro- phy— Morbid products of varix. — Analysis of a case of venous hyper- IV CONTENTS. PAGE trophy, from Cruveilhier. — The doctrine of spontaneous formations in the current of venous blood..........337 Sectton X. — The veins possess the power of dilating actively. . • 379 Section XL — On the powers which circulate the blood. . . • 398 Section XII___Analogies resumed. — The doctrine of venous circulation applied to the philosophy of venous congestion. — The mechanical ra- tionale of the opération of bloodletting, &c., in venous congestion. — Louis' cases of " the typhoid affection." — The complications of venous congestions with idiopathic fever. The modifying, and other influences of the former condition. — Pus. — Active phlebitis variously considered in its relations to venous congestion. — Products found in congested veins. — Typhus fever. — Humoral experiments. — Phlebitis and venous congestions, induced by irritating injections into the veins, manifest some of the phenomena of typhus fever. — Puerpéral fever. — Puerpéral, and endémie erysipelas. — Endémie at the New-York Alms-housa. — Phleg- masia dolens constituted by venous or lymphatic inflammation. — Pur- pura hemorrhagica. — Scurvy. — Venous inflammation according to the nature of the remote causes. — Venous congestion as induced by narcot- ic poisons, carbonic acid gas, alcohol, &c. — Congestive asthma.—Mod- ifications of venous inflammation farther considered. — The philosophy of the predisposing causes of disease. — Contagion. .... 427 Section XIII. — Condition of the various tissues of a congested organ. — Incipient seat of venous congestion........514 Section XIV. — Venous congestion passes readily into inflammation of other tissues. — The rationale considered.......519 Section XV. — Active and passive inflammation and congestion.—No fun- damental distinction...........524 Section XVI. — Philosophy of spontaneous hemorrhage, and its applica- tion to the pathology of venous congestion.......546 appendix i. Démonstration of the disease..........569 appendix n. The importance ofanalogy and prineiples in medicine.....574 appendix m. Cold, as a cause of venous congestion........590 appendix IV. Pathology of erysipelas...........603 appendix v. Pathology of tubercle and scrofula. 608 CONTENTS. V PAGE APPENDIX VI. Melanosis, animal pigments, and the philosophy of adventitious growths. . 637 V. COMPARATIVE MERITS OF THE HIPPOCRATIC AND ANA- TOMICAL SCHOOLS......641 VI. ON THE PRINCIPAL WRITINGS OF P. CH. A. LOUIS, M. D. 679 ERRATA. Page 102, thirty-seventh line from 103, tenth " 108, seventeenth " 13!», twenty-third '< 178, thirty-fourth " 696, ninth " 700, thirty-ninth « 703, thirty-seventh « 708, twelfth '< 720, fifteenth " " thirty-first " " To note (3) Vol. ii. add i, for its acid, analysts, glutinous, caninomatous, renders tubercles, thickened, imperfectly descrihed, mucous, ougkt not to outweigh, roi. I p. 198, read it is acid. " analysis. " gluttonous. K carcinomatous. tt cvavTiùiv. il renders the prés- ence of tubercles. " thinned. II Buch imperfectly described. serous. oughtto outweigh. Vol. ii. pp. 36, 450. SUBSCRIBER'S NAMES. T. R. Colledge, Senior Surgeon to H. B. M.'s Commission in China. Alexander Fairbrother, Bristol, England. MASSACHUSETTS. Ephraim Bush, M. D. Boston. James Jackson, M. D. do. R. H. Salter, M. D. do. Geo. C. Shattuck, M.D. do. John C. Warren, M. D. do. John Ware, M. D. do. ALABAMA. William P. Dewees, M. D. Mobile. Simon Johnson, M. D. do. MARYLAND. James Davidson, M. D. Queen's Town, Queen Ann's Co. NEW-YORK. Thos. C. Brinsmade, M. D. Troy. Richard S. Bryan, M. D. do. John Clapp, M. D. do. George Marvin, M. D. Brooklyn. C. R. M'Clellan, M. D. do. Philip L. Jones, M. D. Lyons. CITY OF NEW-YORK. J. C. Beales, M. D. John B. Beck, M. D. G. S. Bedford, M. D. Francis E. Berger, M. D. James C. Bliss, M.D. Jacob H. Borrowe, M. D. Homer Bostwick, M. D. Thomas Boyd, M. D. James L. Brinckerhoffj Esq. Gurdon Buck, Jun. M. D. William P. Buel, M. D. Harvey Burdell, M. D. John Burdell, M. D. CITY OF NEW-YORK. Thomas C. Chalmers, M. D. Alonzo Clark, M. D. James Cockroft, M. D. John Davis, M. D. Edward Delafield, M. D. Jesse Delano, Jun. M. D. Nichol H. Dering, M. D. William Detmold, M. D. A. Sidney Doane, M. D. Samuel C. Ellis, M. D. Samuel M. Elliott, M. D. John W. Francis, M. D. Alfred Freeman, M. D. Seth Geer, Jun. M. D. Stephen R. Harris, M. D. Joseph Hawley, M. D. Patrick Houston, M. D. Richard K. Hoffman, M. D. Charles R. King, M. D. Charles A. Lee, M. D- E. G. Ludlow, M. D. James L. Lyon, M. D. J. M. Scott Mac Knight, M. D. Hugh Mac Lean, M. D. Isaac H. Merkel, M. D. J. S. Monroe, M. D. Samuel W. Moore, M. D. William J. OllifF, M. D. J. W. Ostrom, M. D. Cyrus Perkins, M. D. Alfred C. Post, M. D. William Power, M. D. Peter Pratt, M. D. Lawrence Proudfoot, M. D. J. Kearney Rodgers, M. D. Samuel Sargent, M. D. Charles Schussler, M. D. Nelson Shook, M. D. Gilbert Smith, M. D. Alexander H. Stevens, M. D. Charles Steane, M. D. LIST OF SUBSCRIBERS. CITY OF NEW-YORK. James Stewart, M. D. John O. Stone, M. D. William Sweetzer, M- D. Caleb Ticknor, M. D. Fédéral Vanderburgh, M. D. James Van Rensselaer, M. D. CITY OF NEW-YORK. James A. Washington, M. D. John Watson, M. D. Marinus Willett, M. D. Isaac Wood, M. D. Joseph Wooster» M. D. PHILOSOPHY OF ANIMAL HEAT. " We must allow the bodies of living animais and vegetables to form an original cause of heat, as m uch beyond our power of explaining as the source of the eun's heat."— Moore's Médical Sketches. " It is most probable that the power of generating heat in animais arises from a principle so con- nected with life, that it can, and does, act independently of circulation, sensation, and volition ; and is that power which préserves and régulâtes the internai machine." — Hunter's Observations on certain Parts of tke Animal Economy. (1) "The extrieation of calorie is a phenomenon exactly analogous to those of which the gênerai capillary System is the seat." "The disengagement of calorie is always subordinate to the state of the vital forces." " The state of respiration has no influence upon the actual heat of the body." " When we place on one side ail the phenomena of animal heat, and on the other the chemical hy- pothesis, it appears to me so inadéquate to their explanation, that I think every methodical mind can réfute it without my assistance." — BichaVs Qeneral Anatomy applied to Physiology and Médi- ane. (2.) SECTION I. Bichat, however, was clearly mistaken in the foregoing senti- ment. Vital physiologists, almost by common consent, hâve abandoned the subject of animal heat to the chemists. It is the only fimction of life, in which the forces of chemistry appear to the former to hâve any participation ; but such has been the interférence of the laboratory with every other, that chemistry has acquired plenary indulgence in this branch of physiology. The only connection, however, which has been reasonably shown, of the forces of chemistry with the process of respiration, relates to the décomposition of the air. From this, and from the ( 1 ) P. 91, 1786. (2) Vol. i, art. 1, f. 9. VOL. II. 2 10 ANIMAL HEAT. necessity of respiration to animal température, in common with the other products of vital actions, has followed the induction, that the génération of heat is a chemical process. In the first place, however, it is by no means certain that the décomposition of the air is not effected by the forces of life. Analogy is strongly in favour of this conclusion ; since we ob- serve in ail the secreted products from the blood, that décom- positions, and recombinations, more or less resembling the re- sults of chemical actions, are effected by the vital forces. The décomposition of the air takes place, also, through the médium of a highly organized tissue ; and vvhatever maybe said of endos- mose and exdosmose, the analogy will not hold, since they apply to dead matter, as we hâve endeavoured to show in another place. Every function, too, of the mucous membrane of the lungs is strictly vital. Analogy should be allowed to be very strong in this case, as well as in the génération of animal heat. We think that we shall hâve proved in our différent essays, by the showing of chemistry itself, that the forces of physics hâve no connection with any other function or product of organized matter ; and it would, therefore, be a very strange anomaly in nature, if the décomposition and absorption of air, the excrétion of carbon, and the élaboration of heat, were not vital processes. Again, respiration is less essential to the production of animal heat, than to many other living processes. It is intimately con- cerned, indeed, with every function of life ; and we might, therefore, equally argue, that every function is the direct resuit of respiration, and is of a chemical nature. Bichat, follf>wing the path of his great pioneer, has briefly, but ably, refuted the chemical théories of animal heat. Still they live and flourish as ever. One of the latest interprétations of this subject is set forth in the following typographical manner : » There is a perpétuai déposition, by the capillary system, of new matter, and décomposition of the old, ail over the frame, influenced by the nerves : in other words, the galvanic influence of the nerves, which occasions thèse dépositions and décompositions, keeps up a slow combustion. In this décomposition there is a continuai disengagement of carbon, which mixes with the blood returning to the heart at the time it changes from scarlet to purple ; this décomposition, being effected by the ekctric agency of the nerves, produces constant extrica- tion of calorie : again, in the lungs that carbon is thrown off and united with oxygen, during which calorie is again setfree ; so that we hâve in the Lungs a Charcoal Fire constantly burning, and in the Other Parts a Wood Fire, the one producing carbonic acid gas, the other carbon; thefood supplying, through the circulation, the vegetable or animal/ueZ, from which the charcoal ANIMAL HEAT. 11 is prepared that is burned in the lungs. It is thus that the animal heat is kept up." (') We believe something like the foregoing to be the prevailing doctrine ; at least, it has been often endorsed as a lucid exposi- tion of the subject. Thus, also, another distinguished physiol- ogist, Professor Elliotson : " The évolution of animal heat is a mère instance of combustion in the ex- trême vessels, — the union of carbon and oxygen, (taking place in thèse ves- sels) being always attended by an increase of température ; and we may equal- ly abstain from troubling ourselves about relative capacities for calorie." Again, our author says, " whether the theory be correct or not, the production of animal heat must be as evidently a chemical process, as changes of tempéra- ture among inanimate bodies." (a) (1) Billing's First Principles of Medicine, p. 21, 1838. (2) Is this conclusion justifiée by any remarkable analogies between the " produc- tion " of animal heat, and the "changes of température among inanimate bodies" ? What, too, can our author mean by saying, that " the fact of local heals above the température of the gênerai niass of blood proves that heat is evolved by local .pro- cesses"? Our author also says that "■habit has a great influence on the calorific powersof animais." And how shall we explain the effect of the nervous influence? Notwithslanding the well ascartained fact, that as much carbonic acid is evolved by the starving, as by the feasting, subject, — whilst the température of the former is always reduced ; and although the quantity of carbonic acid evolved is exceedingly variable in ail at différent hours of the day, and without any intelligible cause, this doctrine of the absorption of oxygen, — and its combination in the extrême vessels with carbon, is not only made by many the safe foundation of the origin of the un- varying animal température, but it is assumed as the basis of the modifications that are supposed to be generated by différences in external températures. Thus, it is said, that " in high températures we hâve less neccssily for the évolution of heat ; in low températures, more. Accordingly, in the former, the arterial blood remains ar- terial, — is nearly as florid in the veins as in the arteries, and the inspired air is less vitiated ; in low températures, the venous blood is extremely dark, and the inspired air more vitiated. Our author, however, states that " Sir A. Cooper placed a puppy and a kitten, some weeks old, nearly to the mouth in iced water, till they died ; and lhat the blood of the lips, nose, toes, mesentery, and left side of the heart, was of a fine vermilion hue." (o) It is also a well known fact, that if there be any différence in the colour of the blood in différent climates, it is darker in the tropical than in the northern ré- gions. Nevertheless, the décomposition of the air, the absorption of oxygen, its combina- tion with carbon, and the conséquent évolution of animal heat, are made to dépend on the mère contingencies of the varying slates of the external température, — and for the philosophical reason that the body requires more heat in low than it does in hi«*h atinospheric températures. But whilst we admire the simplicity of such a con- venient law, we think we discover something in other laws of the anirral bedy, and somelhing in those of chemistry itself, to contradict the hypothesis ; ai:d wlen we contend for an equal or even greater " évolution of heat " in high than in low tempê- ta) Elliotson's Human Physiology, Part 2, pp. 238, 242, 239, 210, 1837. See our Vol. I. p. 40. lK ANIMAL HEAT. ■ *. it is our purpose to examine the connection of respiration with animal heat, and to show its essential dependence on other causes by the experiments of chemical philosophers. We shall endeavour to sustain the conclusions of Hunter and Bichat, al- thbugh we see much to admire in the ingenious observations of those who départ from the doctrine of the vitalists. But, it is the ingenuity of mind, not its adhérence to nature, which imparts, in our estimation, the merit that may belong to other hypothèses. And hère their advocates hâve an apparent intel- lectual superiority over others who are alone concerned in form- ing their déductions from the pbenomena of nature. The proofs, which the latter enjoy, are so plain and intelligible, that one seems scarcely deserving praise who does but follow their indi- cations. And this, we apprehend, is one reason why so littlé respect is novv paid by many to the System of nature as expôun- ded by Hippocrates, Bacon, Sydenham, Hunter, Bichat, and other kindred spirits. On the contrary, however, artificial hy- pothèses, to be at ail plausiblej often require the highest efforts of genius ; and this is at once conspicuous in the management of facts, and the arrangement of assumptions, so that they shall borrow, as it were, a light from the facts. We hâve only to ad- duce the subject before us in illustration of our principle. To hâve inferred the dependence of animal heat upon vital actions from the plain phenomena of life, from the analogies supplied by ail other formations of the body, from the forces upon which it dépends resisting ail those causes which extinguish heat in inorganic matter, and from a like coïncidence in respect to the opération of ail chemical and physical forces upon the living or- ganism, would constitute but little merit, compared with that complex system by which the chemical doctrine has found its way to popular favour. Just so it is with the more extended plan of subverting the most sublime department of nature where everything is carried on by forces unknown in the inoro-anic world, and of substituting the laws of that world from which the former appears so remarkably exempt. The chemical hy- pothesis of respiration is only a part of the great plan of sub- version ; that of digestion is another ; in a word, the spontaneous ratures, from greater vaîcular excitement, Sic. in the former, we explain the continu- ed uniformity of heat on the ground, especially, that the redundancy is carried offby increased perspiration. ANIMAL HEAT. " * 13 génération of animais sums up the whole'. Who could acquire any éclat by simply maintaining that the gastric juice perforais digestion in virtue of its vital forces, and thus, also, bestows the first act of vitalization ; that the vessels then take up and com- plète the work of animalization ; that the sécrétions dépend up- on the same forces, and so on? On the other hand, however, it requires a power not inferior to that of the Creator Himself, to bring about a single one of the foregoing results by the agency of the chemical or any other physical forces. The temptation, therefore, is very great to wander from the luminç-us path of na- ture. But, when this path shall hâve become universally aban- doned, as at former eras, he will recéive and deserve the great- est meed of praise, who, like Bacon, shall restore the Hippocratic method of induction. At présent, however, there are some, who, as it seems to us, adhère with great tenacity to the path of na- ture ; and until this is lost, the discovery of which we speak cannot, of course, happen ; and when it cornes, there will be but few to enjoy the honour. But, when the light shall hâve once more been diffused, and great principles again established, and new avenues to honour must be struck out, — and seeing, also, that our chemical hypothèses of life will be as unprofitable to our successors as alchymy to us, what new Systems may be invented, we will scarcely présume to foretel. Ail that we can say of them is, they will make a great noise in the world, will triumph for awhile, and again hâve their exit. Sic ibimus, ibi- tis, ibunt. It is plain, therefore, should the rest of the world endure as long as it has hitherto, according to the geologists, there will be only now and then one whose name will be im- perishable. Or if, like Paracelsus, and others not to be named, a straggler should gain a niche, he will be rather cast there by the eccentricity of his orbit, than by any of those movements that are at ail subject to calculation. " Sic itur ad astraP There is no author more justly entitled to our respect and confidence in ail that he has disclosed respecting the depend- ence of animal heat upon respiration, than Dr. Edwards ; and none who has more ably defended the doctrine relating to res- piration. He lays down four fundamental points : 1. " The oxygen which disappears in the respiration of atmospheric air is whdly absorbed. It is afterwards conveyed, wholly, or in part, into the cur- rent of circulation." 14 ANIMAL HEAT. Hère, at the onset of the process, chemistry is at fault. The induction of Dr. Edwards is mainly contradicted by Allen and Pepys, (') and is only partially confirmed by Dupretz, (2) Dulong, Collard de Martigny, (3) Le Gallois, (4) Delaroche, (5) Coutan- ceau, Lavoisier, Nysten, Hassenfratz, La Grange, and others. The quantity, also, of carbonic acid expired is exceedingly variable at différent hours of the day, without any apparently modifying cause. (6) This shows its existence in the blood, m- dependently of the experiments of Magnus, and others, who ascertained its présence in the ratio of five cubic inches to a pound of venous blood. (7) Hère, then, the doctrine of a chem- (1) Philos. Trans. 1808, 1809, 1829. (2) Gmelin, Chimie, t. 4, An. de Chim. et Phys. t. 26. (3) Journ. de Phys ol. 1830. (4) Annal, de Chim. et Physique, t. 4, p. 115. (5) Journ. de Physique, t. 77. (6) Prout, in Thomson's Annals of Philosophy. vol. ii. p. 328 ; and many others. (7) Dr. Davy says, that " the results of his experiments appear to prove that blood does not absotb oxygen when fresh ;" so clearly, indeed, that " he does not consider it incumbent on him to controvert farther the commonly received opinion." " I thought it necessary," he adds, " to reconsider the évidence on the subject, and to make farlher experiments on many doublful points; and the conclusions to which the inquiry has led me are, biiefly, that the scarlet colour which venous blood ac- quires on exposure to the air, is not owing to any chemical change from exposure ; and that it is very doubtful if the différence of colour betvveen venous and arterial blood dépend on the action of air." (a) Again, Dr. Christison, in his critical review of Dr. Davy's experiments, remarks, that the absorption of oxygen, in the human species, is sometimes greatly less than at others, — and this, too, in cases of disease where the gênerai température of the body is much exalted. (b) We take no farther part, at présent, in thèse discrepancies of opinion amongst philosophers equally able, and ornaments of their âge, otherwise than to show that the exposition of the subject belongs rather to the physiologist than to the chemist. True, we hâve no doubt ofthe décomposition of the air, and the absorption of oxy- gen, by the lungs, and that this particular fact may be advantagpously shown bv ihe chemist, allhough, as we hâve seen, we hâve, in some distinguished instances, his own authority that il cannot be shown. But we may now remark, that this'does not prove that the décomposition and absorption are not vital processes. Ps'or is it any proof to the contrary, that atmospheric air is decomposed by the carbon of blood after its abstraction from the body, any more than other analogous changes which take place in dead matter. This subject we hâve examined fully in our essays on the Vital Powers, and Digestion ; and in other places. Since the foregoing was written, we hâve met with Dr. Davy's experiments upon the blood, recorded in the London Philosophical Transactions for 1838. They are entirely contradictory of his first séries of 1829, as it respects the absorbtion of oxygen. The only farther comment we shall now make is that of adducing thèse conflictin» results, as well as those obtained at différent times by Allen and Pepys, and others to sustain our facts and conclusions, as expressed in our essays on the Vital Powers the Humoral Pathology, and Digestion, against the pretensions of organic chemistry. The subject before us is the most simple connected with that pursuit, whilst the (a) Edin. Med. and Surg. Journ., 1830, p. 246. (6) Ibid. 1831, p. 94— 103. ANIMAL HEAT. 15 ical formation of carbonic acid in the lungs, by the combination of the carbon of the blood with the oxygen of the air, is invali- dated, and the élimination of carbonic acid from the blood placed, in another aspect, upon its true ground of an excretory process. The fbregoing fact is also farther shown by the experiments of Spallanzani and Edwards on kittens, which exhaled carbonic acid when deprived of oxygen. Even the skin possesses the function ; for Spallanzani(l) found carbonic acid in the atmos- phère of a torpid animal after its respiration had entirely ceased. Edwards subjected frogs to hydrogen gas ; when he found that the extrication of carbonic acid was as ereat in 8 h. 30 m. as in 24 hours when atmospheric air was respired. Spallanzani ob- tained the same resuit upon snails. Dr. Edwards, therefore, draws the conclusion that, " Carbonic acid is not formed at once in the act of respiration by the combi- nation of the oxygen of the air with the carbon of the blood, but is entirely the product of exhalation." "Nothing," he adds, "appears to me to prevent our admitting the principle as gênerai." same distinguished observers arrive at différent times at exactly opposite conclusions ; nor is there any satisfactory reason assigned for the* discrepancies. So, in respect to another simple constituent of the blood, free carbonic acid. Christison, Tiedemann, Gmelin, Millier, Mitscheilich, and others, deny that it can be extricated by the air pump, whilst Sir H. Davy, Brande, Home, Magnus, Bischoff, Bertuch, Sic, found it evolved in considérable quantities. Dr. Davy denied its présence in the blood in 1818, but affiimsits existence in a majority of instances, in 1838. This is undoubt- edly true, since the experiments of Magnus, particularly, aie affirmative, are too simple to be liable to déception, and cannot, therefore, be set aside by négative results. In another able paper,(a) Dr. Davy "is disposed to think that carbonic acid acts a very important part in the economy of life," and inclines to the crude spéculations of Dr. Stevens in supposing it to be "connected, when in excess, if not in Ihe pro- duction of particular diseases, at least with their modification and progress," &c. As to experiments, intended to illustrate the génération of animal heat, by com- bining atmospheric air with extra-vascular blood, or by other analogous processes, they are clearly too abstracted from physiological principles to justify any notice. It is remarkable that Dr. Davy affîrmed, at one time, that there is liltle or no change of colour on agitating venous blood with atmospheric air, and that the volume of air " is not changed, nor its composition allered." He sornetimes employed a pound of blood, and a flask of two or three gallons. (6) Yet, at a subséquent time, (c) this able philosopher concludes that oxygen is not only absorbed, but that the évolution of animal heat dépends upon a condensation of the gas. We hâve stated many absolute celf-contiadictions like the foregoing, in relation to organic chemistry. Which statement shall we receive as true ? Are we not right in our conclusions as expressed in vol. i. p. 676? (1) Mcmoria délia Respiraz. &c, and Littera al Sig. Senebier, &c. t. v. pp. 7, 43. (o) lbid. April, 1839. (6) Ibid. 1830, p. 243. (e) Philos. Trans. 1838. 16 ANIMAL HEAT. Gertanner,(') Collard de Martigny,(2) Bichat, (3) Dr. Davy,(4) Coutanceau and Nysten, (s) Fodera, Dutrochet, Broughton, Allen and Pepys, and others, hâve shown the élimination of carbon to be an excretory process. Nor will carbon alone décompose at- mospheric air or unité with oxygen at a lower température than 400° Fh. ; nor does a chemical union take place between oxygen and carbonic acid gas. The chemists having thus abandoned this old entrenchment, we shall take possession, and fortify it with the forces of life. We hâve shown, however, in another article, that there is still a fondness for the ancient error ; and that a kindred doctrine has been elaborated under the disguise of endosmose and exdosmose. Before going farther, we may say, that in having employed, as we shall continue to do, the established phraseology of chemical science, we hâve assigned many reasons in our first volume, as we shall others in our essay on Digestion, for believing that every product of the animal System, including the excrementitious, is differently combined in its éléments from such as resuit from the agency of the chemical forces ; that, what we find in our test glasses and crucibles has been really différent before, or at the time of, its élimination from the body. Chemical changes may accrue in excrementitious substances immediately after their élaboration ; and the ultimate combination may be uniform, where, as in carbonic acid, only two éléments are concerned. This will hardly be doubted by such as believe this exact sub- stance to be chemically formed in the blood, in the midst of so many other imputed constituents. The carbonic acid which is converted by vegetables into sap, wood, &c, becomes utterly dif- férent from itself or its éléments, till it is again reclaimed by the chemist. Nevertheless, however great rnay be the opposition of the vital to the chemical forces, there is a certain parallel between them ; and we think, in no other part of nature, do we see such an astonishing display of Unity of Design as in the constitution of thèse différent, conflicting, yet analogous, powers. Each is concerned in compounding and decompounding the éléments of the same matter, and the products of each consist of wholly dif- (1) On theLaws of Irritability. (2) Journ. Complément, t. xxxvi. p. 225, t. xxxvii. p. 168 ; and Journ. de Physiol. t. x. (3) General Anat. vol. iii. p. 101. Also, Sur la Vie, &c. p. 389—393. (4) Edin. Med. and Surg. Journ. vol. xxxiv. p. 243 ; and Philos. Trans. 1823. (5) Revision des Doctrines Physiol., etc. ANIMAL HEAT. 17 ferent combinations. Yet, when the organic forces cease their opération, their combinations beins: derived from the éléments about which the forces of chemistry are equally concerned, thèse may instantly begin their destructive process, and establish changes according to their peculiar laws. The ground of the analogy is therefore obvions, whilst the powers are as distinct as man is from vegetables, or reason from instinct. " 2. The oxygen," continues Dr. Edwards, " is replaced by exhaled carbonic acid, which proceeds wholly, or in part, from that which is contained in the mass of blood. " «3. An animal breathing atmospheric air also absorbs azote. This is like- wise conveyed wholly, or in part, into the mass of the blood. " 4. The absorbed azote is replaced by exhaled azote, which proceeds wholly, or in part, from the blood." (]) Hère, again, is another discrepancy at the threshold. Allen and Pepys saw no diminution of nitrogen. Davy, Pfaff, and Cou- tanceau found the volume diminished ; whilst Nysten, Despratz, Berthellet, and Collard de Martigny, ascertained an increase. It is also a fundamental principle with Dr. Edwards, that " respiration and animal heat stand related as cause and effect." And hère, again, is another important disagreement at the open- ing of this subject. " Dr. Holland lays it down as an axiom, that animal heat is in the inverse ratio to the quantity of blood exposed to oxygen in the lungs; and opposes the opinion ofDr. Edwards, that it is in the direct ratio to the quantity of oxygen consumed." (2) But we shall see that this conclusion is contra- dicted by facts. The experiments of Dr. Edwards contemplate a great variety of objects connected with animal heat ; but they hâve ail a direct bearing upon the question which relates to its essential cause. We shall use thèse experiments, especially, in forming our con- clusions. We hâve made many ourselves, but shall only state a few of the most direct and important, which may be easily repeated. It is remarked by Smellie, that the natural heat of the hiber- nating animais is generally above that of man ; but during tor- pidity, it descends to 30°, or 40°, Fh. It is also remarkable, that, although the ordinary cold of winter keeps them in a tor- pid state, yet exposure to a much lower température than that (1) Edwards, on the Influence of Physical Agents on Life, pp. 158, 239. Tr. (2) Dr. Edwards on the Influence, &c. p. 471, notes. VOL. II. 3 18 ANIMAL HEAT. to which they are commonly subjected, rouses them from it, ,and establishes the natural heat.^) De Sassy (2) has particularly investigated this subject. He ex- posed the hedgehog, the marmot, and dormouse, in their torpid state, and at a température of 39° Fh. to a northern air at 25°. In two hours, the température of the dormouse had risen to 97° ; that of the other animais was a little more graduai in its return. Nearly the same resuit has happened by exposing thèse animais, in their torpid state, to a température of 12° Fh. We cannot rest satisfied with simply admiring the benevo- lence of this provision and its final cause. Did the diminished température of the air continue to produce its original effect in the ratio of its decrease, it is obvious that the life of the animal would be soon extinguished. But, on the contrary, the increas- ing cold of the atmosphère restores the natural température of the animal. On what part of the System is the primary action of the cold exerted in rousing the hibernating animal from its state of tor- por? The organic forces are everywhere in an exceedingly prostrated state, and seem hardly in a condition to be stimulated into active opération by the cause which had laid them pros- trate. We naturally turn, therefore, to the nervous System as the médium upon which the flrst exciting impression is produc- ed, and through which it is transmitted to the brain. This or- gan of mystery then takes, as it were, the alarm, and sheds abroad its influence over those instruments which are every- where destined for the évolution of heat. (See Vol. I. pp. 474— 480, 568—572.) In an instant, too, its own température be- comes exalted, and its other functions are, in conséquence, start- ed into action. To appreciate the influence which is now exercised by the brain over the languid actions of life, it is only necessary to advert to the well known control which the cérébral influence exerts over the organs of circulation and other important viscera (1) Philosophy of Natural History, ch. 12, p. 298.—See, also, Hunter's Obser- vations on certain Parts of the Animal Economy, Exp. 16, p. 99 ; — Hunter's Prin- ciples of Surgery, ch. 8 ; — Reil's Archiv. fur Physiol. t. 12, p. 293 ; —Meckel's Ar- chiv. far Physiol. t. 3 ; - Gilbert's Annalen, Bd. 40, u. 41 ; -Prunelle, Recherches sur les phenom. et sur les causes du Sommeil hivernal ; — An. du Mus. t 18___ Philosopb. Trans. 1832 ; — Spallanzani, sulla Respirazione Mem. Terza t 5 s* 9 10,11,12; — Pallas, Reeve, Mangili, &c. » • » • » (2) Recherches Exp. anatom. sur la Physique des Animaux mammif. hibernans 1808. ' ANIMAL HEAT, 19 when sudden impressions are made upon the brain. — (Vol. I. p 157, et seq.) The subsidence of heat in the hibernating animais is the most extraordinary of ail the attendant phenomena ; and from the na- ture of the cause, undoubtedly forms a principal élément in the varions changes that take place during the accession of torpor. It may be said, too, if the génération of animal heat be wholly a vital process, its réduction in the hibernating animais would probably be attended, at ail its stages, with a corresponding fail- ure of ail other functions; and this is exactly the fact. When, therefore, in passing from the state of torpor to that of high animation, the respiration becomes increased, and the circulation accelerated, it seems to be probable that the principle which de- velopes the latter function is first in opération ; especially since the ratio in the increase of heat far surpasses that of the respira- tory movements, which, at most, are but feeble till the heat is established. It is stated by Dr. Edwards, that " the élimination of the tem- pérature and the respiratory movements take place at the same time under the influence of cold, and that cold is the cause of both phenomena." ■(' ) This is true in a gênerai sensé ; but what are the facts which analysis developes ? There is no principle in physiology which at ail explains the opération of cold in di- minishing the respiratory movements, till it has first reduced the température of the surface, and diminished the actions of the vas- cular System. Whilst the natural température remains, the res- piratory movements will be in no respect diminished ; and this is abundantly shown by the respiration of animais during the coldest weather in high northern latitudes. It is therefore évi- dent, that the diminution of respiration in hibernating animais is subséquent to the diminution of heat, and that they stand, so far, in this relation as cause and effect. Accordingly, it is ap- parent, that the réduction of température dépends essentially on other causes than diminished respiration, however this may ul- timately contribute to its décline, as it does to that of ail organic processes. The converse of this must be equally true ; and when heat, therefore, is restored, the first step in the process is an in- creased action of the capillary System, by which an évolution of heat is immediately started ; and then begins an increase of the respiratory movements. " We can always hasten respiration," (1) Op. Citât p. 157. 20 ANIMAL HEAT. says Bichat, » by making an animal suffer ; but the acceleraton of the puise is always prior to that of respiration, which appears to be determined by it."(') Heat is peculiarly a vital stimulus. Its action is directly upon the powers of life. Ils influence is exerted upon the actions of the sanguiferous capillaries, not upon the function of respiration, any more than it is upon the peristaltic movements of the intes- tines. Its abstraction from the surrounding médium of certain animais opérâtes as a removal of a necessary stimulus to those actions ; and hence the décline of température, according to the diminution of capillary action. This action being necessary to the spécifie functions of respiration, digestion, &c, thèse, also, décline in a corresponding manner ; and, as thèse again, are ne- cessary to capillary action, and sanguification, their subsidence hastens the décline of the capillary functions. A circle of influ- ences is thus established, which is constantly taking its depar- ture more or less, from the diminished température. But it also belongs to the constitution of hibernating animais, that an ex- cessive degree of cold shall become a stimulus to the powers of life ; and although we believe its primary influence is mainly exerted upon the organic forces through the nervous influence. it is still a philosophical induction that its action is also direcîly upon those forces. (See Vol. I. pp. 474—480, 568 — 572.) In the hamster, whose puise, in its natural state, amounts to 150 in a minute, it is, when the animal is torpid, reduced to 15. The natural pulsations of the heart in dormice can scarcely be counted ; but as soon as they begin to, pass into the torpid state, the puise is gradually reduced to 30, 20, 16, and becomes, final- ly, imperceptible from feebleness.(2) Who shall assume that the diminished température is owing directly to diminished respira- tion, and not to that of the organs of circulation ? Should we not equally argue, that the coïncident suspension of perspiration, of the sécrétion of bile, of urine, &c., are alike owing to dimin- ished respiration? So, also, vice versa, when the phenomena of respiration and circulation return, we may fairly infer that their restoration is especially dépendent on a change in the ca- lorific function. For hère again, also, there is no conceivable principle which will explain the opération of cold, at a tempera ture far below that of the torpid animal, in reproducing the res- (1) General Anatomy, vol. i. p. 418. (2) SmelUe< Qp CUat ^ ANIMAL HEAT. 21 piratory movements, but that of a primary impression upon the vires vitœ, whose first resuit is an évolution of heat. For hère, too, as in the case where a diminution of température must be antécédent to diminished respiration, it cannot be consistently supposed, that respiration précèdes the évolution of heat. If the former affirmation may be made, the latter conclusion must equal- ly follow. It is true, that hibernation, and the torpor which is induced by cold in other animais, are so far différent, that one is designed for préservation, and the other is destructive of life. It is a dif- férence which grovvs ont of eonstitutional peculiarites. But the final causes supply no light upon the subject. The efficient cause L.cold in either instance: and the same principles, al- though in a modifled way, are equally concerned in the phenom- ena. If what we hâve stated as to the philosophy of animal heat in its relation to hibernating animais be true, it is equally true-of ail other animais. The différences do not arise from différent fundamental laws. It is évident, however, that the peculiarity in the constitution of hibernating animais is only true of them in its most extended sensé. There are many other animais which approximate them in their feeble powers of maintaining température ; and others, again, which sustain an intermediate relation to the most perfect of the warm-blooded vertebrata. Thèse gradations carry us so connectedly up from one extrême to the other, that we are almost insensible of différences as we pass along. "The high température which seems to characteriz? the mammalia and birds does not belong to them exclusively, since examples of it are found among in- sects ; and on the other hand, among the mammalia themselves there are spe- cies, which, at certain periods, présent the principal phenomena of cold blooded vertebrata ; and, lastly, a great number of non-hibernating mammalia and birds, in the early periods of their life, show, as far as the phenomena of heat is con- cerned, a strong resemblance to the cold blooded animais." (*) Thence we infer a fortiori, that what is so remarkably conspic- uous in the torpid hibernating animais is only the resuit of a law that prevails throughout the animal kingdom. And if we now look at the facts and excellent philosophy of Dr. Edwards, we shall find that what reason suggests in this case is confirmed by observation. By a séries of experiments he ascertained, that the température of certain warm blooded animais varies accord- ing to the seasons ; ranging, from winter to suramer, from 105.4° (1) Edwards, Op. Citât, p. 237. 22 ANIMAL HEAT. to 110.7° Fh. « Hence," he says, " I judged that man, also, would expérience variations of température under the influence of seasons, if not to the same extent, at least within appréciable limits." This induction appears to be well ascertained by obser- vation. (') Now, to say that the foregoing phenomenon dépends on a dif- férence in respiration in sumraer and winter, or on the quantifies of oxygen absorbed, would not only be an assumption, but op- posed to expérience, and to the philosophy which is founded upon physiological analogies. The réduction of température, in thèse instances, is owing, as in the hibernating animal, to the abstraction of the vital stimulus of heat from the surrounding atmosphère. The calorific organs are less excited than in sum- raer, and, consequently there is a diminished production of heat in winter. The excess of heat goes off by perspiration in the former season. (a) Just so it is with some other sécrétions, espe- cially the perspirable matter. Besides, on another occasion, as we shall see, it is equally assumed that a frosty air is best cal- culated to evolve animal heat. This is true, under particular conditions of the forces of life, as we hâve seen especially in re- gard to hibernating animais. But it only coopérâtes with the former fact in showing that the process is wholly a vital one. The principle, therefore, upon which ail thèse phenomena dépend, appertains to the vital constitution of animais, is fonda- mental in their economy, and is everywhere of a common na- ture. For reasons and facts already stated, and others which are yet to appear, there can be no other intelligible connection of this principle with the function of respiration, than what sub- sists between respiration and ail other functions. We hâve spoken of the probable controlling influence of the brain over the génération of animal heat, under particular cir- cumstances. It may be more difficult to arrive at the extent of this influence in the natural state of the animal System. Like other secreted products, animal heat is, doubtless, primarily dé- pendent upon the organic powers. Thèse are variously influ- enced by varying conditions of the cérébral and ganglionic Sys- tems, and, of course, their actions, and the products of the secer- ning system, over 'which they préside, are affected in a corres- ponding manner, whilst they are also modified by the direct (1) Edwards, Op. Citât, p. 257. (2) See note forward. ANIMAL HEAT. 23 action of foreign agents. In the perfectly natural state, there is reason to suppose that the brain may hâve but little connec- tion with the phenomena, but may become powerfully instru- mental in modifying the powers, and actions, and products of life, when.unusual conditions exist, or when unusual impressions are transmitted to the brain. We shall see that analogy, as sup- plied by the vegetable kingdom, affords a presumptive évidence, that the brain may hâve no active participation in the élaboration of heat, in the natural condition of the body, whilst this induction is strengthened by what is known of other secreted products in both of the animated kingdoms. Still, in respect to the animal kingdom, the mère existence of the cérébral System, its remarka- ble properties and susceptibilities, and its intimate connection with ail parts of the organization, is, prima facie, conclusive that it détermines important influences upon the vires vitœ, and that its présence is indispensable to the integrity of every func- tion. This has been experimentally ascertained in relation to many ; and that unusual, or sudden impressions that are not unnatural, as the opération of the passions, for instance, may be extensively and profoundly propagated from the brain to other organs. It has been fully demonstrated that the natural condi- tion of the sécrétions dépends upon the integrity of the nervous connection betwixt the secerning organs and the brain ; whilst it has been equally shown that the organic functions, and ail vascular action, may be immediately and powerfully influenced by impressions made upon the brain. (See Vol. I. p. 157—179.) Assuming, then, that animal heat is also a secreted product, it would philosophically come under the common law ; and should it appear from experiment, that animal heat dépends more or less upon the présence of the brain, and may be influenced through it, the physiological analogy betwixt heat and other secreted matters will be quite apparent; whilst it will explain the re- markable effect of a low atmospheric température in developing heat in the torpid hibernating animal, and thus conduct us to the philosophy of the opération of other causes in modifying animal température. Now we hâve never seen the experiments of Sir B. Brodie, (') (1) Philosophical Trans. 1811, 1812 ; and in Edin. Jour. vol. viii. p. 447. Also, Brande's Manual of Chemistry; Thomson's Chemistry; and Earle, in Med. Chir. Trans, vol. vii. p. 173 ; who consider Brodie's experiments subversive of the chem- ical doctrine. 24 ANIMAL HEAT- Chaussât, (') and Emmert,(2) salisfactorily contradicted'tion 0f need scarcely say, that they ascertained that when the ac i the heart is maintained by artificial respiration in décapitai animais, the heat of the body cooled down rapidly l° al1 eq"" brium with the surrounding air. It is true, Le Gallois, ( ) - shal Hall,(«) and Philip, (5) hâve arrived at results more or less différent; but in none of the instances do we think that tne ex- periments of the former physiologists are affected. It has Deen also suggested to us by an eminent philosopher to whom this es- say has been submitted, that the experiments by Dr. Haie connict with Sir B. Brodie's, and we shall therefore assign our reasons for thinking otherwise, in a note below. (6) We may say, also, that (1) Mém. Sur L'Influence du Sys. Nerv. sur Chaleur Animale. This author shows, that injuries of the nervous system produce corresponding af- fections of the température and the functions of sécrétion. (2) Meckel's Archiv. vol. i. p. 184. (3) Le Gallois, Expériences sur la Principe de la Vie ; whose observations upon this subject are very indefinite, and liable to obvious exceptions. (4) Lon. Med. and Phys. Jour. vol. xxxii. 1824. See Brodie, IbiJ. p. 295. (5) Expérimental Inquiry into the Laws of the Vital Functions, p. 212—220. If thèse experiments do not sustain the conclusions of Brodie, they neutralize any proof they may supply against them. We shall see, however, that it is a doctrine with Philip, " that the maintenance of animal température is a function of the nervous system." This abstracts the question entirely from chemistry; as we believe Dr. Philip, and ail others, must abandon the supposed "identily of the nervous influence and "alvanism," and allow it to be purely vital. But, it ismanifest that "the main- tenance of animal heat" is not "a function of the nervous system,'' since, as we shall see, there is an absolute coïncidence betwixt the phenomena of animal and veg- etable heat. (6) Sir B. Brodie, in replying to Dr. Haie, states that " he had reason to bclievo that he had conducted his experiments with ail the caulion and attention to minute circumstances, which every physiologist knows to be absolutely necessary in such investigations, to enableus to arrive at any accurate conclusions." (a) It is, therefore, prima /acte, highiy probable, that Sir Benjamin arrived at accurate results, where nothing but care, skill, and integrity were necessary. We take it. that no one will deny either of thèse qualifications to this admirable man. Upon thèse principles, therefore, his experiments should stand, until they are unequivocally shown, by dif- férent observers who may be equally entitled to confidence, to hâve been imperfectly conducted. But Brodie's experiments hâve been confirmed by other physiologists in Europe. It appears, also, that Dr. Haie deviated in his experiments from those of Brodie, to which, as the latter afHrms, " they bear only a certain degree of analogy." Dr. Haie, in reply, (6) "doubts not that Sir B.'s experiments were perfcctly correct in ail their détails. Still it does not follow that similar results will be obtained from somewhat similar experiments, where some circumstances are différent." It is this ':différence in circumstances" which inakes the différence in the results obtained by thèse distinguished observers, and which farther inclines us to confide in Sir Beuja- (a) London Med. and Phys. Jour. 1814. (i) New England Med. and Surg. Jour. 1816, p. 25. ANIMAL HEAT. 25 Miiller thinks, that "Brodie's experiments are, for the main point, convincing ; " (>) (p. 23, note,} whilst it is well said by Magendie, "Remember, —once again let me warn you of this — that one well observed fact cannot overturn another of similar character. If such appear to be the case, rest assure d that our intelligence is not sufficiently enlightened to com- prehend the relation." (*) In connection with the foregoing resuit is another not less important, viz : that in decapitated animais the température went down more rapidly when artificial respiration was maintained, than when it was not ; thus showing, also, that the tendency of the air when admitted to the lungs is to depress the température of the body. This effect, however, is always more than com- pensated in the natural state of the subject by the part which atmospheric air perforais in the process of sanguification, &c. min's accuracy. If there be only a division of the spinal marrow, and the brain be left undisturbed, as in Dr. Hale's experiments, that organ will continue to exert a powerful influence upon the actions of life, whilst the circulation is maintained. (o) Dr. Haie adroits, too, that there was, in another respect, " a very considérable reason for the différence in our results." This déviation from Sir B.'s experiments consisted in the use of rabbits by one, and of cats and dogs by the other. To show what this différence may possibly be, Millier states that " the influence of respiration on the heart's action, in dogs, seems to be greater than that of the nervous system," whilst in frogs " the brain and spinal marrow are much more necessary to Ihe maintenance of the heart's action than respiration." (6) (See our vol i. pp. 650, 697, 698, &c.) Dr. Haie also observes, " it may, perhaps, be an inaccuracy oflanguage to call his experiments a répétition" of Brodie's. The question then arisès, will a " répétition" of Brodie's experiments upon dogs and cats afford results contradictory to those of Brodie upon rabbits ? There must certainly be a gênerai coincidence, if the expe- riments be in ail respects alike conducted ; and since Sir B.'s were attended by very definite results, we may expect that the coincidence will be found to happen. Whatever fundamental law may exist in one species of the warm blooded animais undoubtedly exists in ail others. There is probably no spécifie law peculiar to cer- tain species, although the laws be subject to peculiar influences and modifications in différent species. It is such modifications, natural and accidentai, which give rise to many opposite local results which might lead to the belief that they are determined by opposite laws. The dog digests better when he is lying down and asleep ; but man, when he is erect and awake. Magendie starved an ass with boiled rice, whilst he fattened a cock upon the same. There is an instance of summer sleep in the hedgehog, or tanrec, of Madagascar, similar to hibernation ; and ihese extrêmes are variously connected amongst other animais, in whom a similar, or somewhat similar, state is induced at various températures and seasons. Vital actions are more feeble in man when asleep, than when awake ; but it is just the reverse with some animais, as in the case of the dog now mentioned,— and this by the way, shows that respira- tion is only remotely connected with the phenomenon under considération. The same experiments upon the nervous system are well known to affect the func- (l) Eléments of Physiology, vol. i. p. 87. (2) Lectures on the Blood, p. 92. tr. (o) See Philip's Exp. Inq. into the Laws of Life, and the analogous experiments of others. (b) Eléments of Physiology, vol. i. p. 189. VOL. II. 4 26 ANIMAL HEAT. It appears, likewise, from Brodie's experiments, that when the sensibility of an animal is impaired by narcotics, and the lungs artificially inflated, the power of generating heat is as greatly destroyed as by décapitation ; whilst it is again restored in an exact ratio to the return of sensibility. This is shown by a nat- ural process. " From the observations of Dr. Nasse, and Mr. Dundas, on pathological cases, it appears that the diminution of température is more in proportion to the loss of sensibility than of the powers of motion." (') Analogous to the foregoing experiments, and of the same im- port, is that by Sir E. Home, who divided the nerves of an ant- ler, when its température fell immediately several degrees ; but, in a few days, became exalted beyond its natural state. Similar experiments, with like results, hâve been made by Elliot ; and every body knows that the température falls when the par vagum is divided. (See Vol. I. pp. 157 —179, 474 — 480, 568 — 575.) In ail thèse instances a pernicious influence is propagated upon the forces of life appertaining to any particular part whose nerves are divided. The first resuit is a décline of température ; but inflammation may ultimately spring up, (') and then follows a lions differently in différent animais, and even in the same animal, — as in crushing, irritating, or slicing the brain; whilst there is an analogy amongst the results of the whole which shows that they dépend upon common laws, modified in différent spe- cies. Thèse différences make up a part of the great séries of ascending analogies in the gênerai plan of Création. There is nothing exactly alike betwixt two distinct species of animais, however generically allied, either in respect to form, organization, functions, habits, instinct, &c. ; yet they may be ail essentially the same. So with their great vital laws ; though we think thèse vary less than organization. A great modifi- cation of the latter may be necessary to a slighter one of the former. Thus, modifying influences arising from a différence in the constitution of différent animais may sensibly affect the results of our experiments ; and without a careful référence to ail the circumstances, important facts may escape observation. It is said by a distinguished Review, that Dr. Macartney " quotes the expérimenta of Brodie, as if their fallacy had never been exposed, to show that animal heat doea not dépend upon respiration." We think, however, that the fallacies are rather on the side of Brodie's opponents ; though, as we hâve said in our text too much is allowed to the brain by that eminent observer. We think its relation to the produc- tion of heat of the same nature as in ail other organic processes. But our able re- viewer admits that " there can be no doubt that its évolution (animal heat) is greatly influenced by the nervous system."(a) This is exactly our own doctrine, and we con- tend for nothing more. We doubt not, too, that when physiology shall hâve been rescued from the trammels of chemistry, this admitted influence of the nervous system will place the génération of animal heat amongst other processes of the vital powers. (1) British and Foreign Med. Review, vol. iv. p. 425. (2) See Essay on Inflam. (o) British and Foreign Med. Review, July, 1839. p. 197. — See our Vol. I.p.lW. ANIMAL HEAT. 27 coincident exaltation of heat beyond the natural standard. We shall also see, that when the nerves are differently affected, as in certain diseases of this system, there may be a direct increase of température, without inflammation. The génération of heat, therefore, is variously affected, like other vital products, accord- ing to the nature of the injury the nerves may sustain. And although there be no reason to conclude that the évolution of animal heat is more dépendent upon the nervous system than other sécrétions, it is perfectly consistent with this view to sup- pose that it may be more influenced through that system. We think that we shall hâve shown ample facts to justify this con- clusion ; and, therefore, to render it even less probable that ani- mal heat is a chemical product, than other sécrétions. But to us it is perfectly unintelligible, that " animal heat should be in- fluenced by the state of the nervous system ; but never. except through the instrumentality of chemical changes." (') This is a candid admission of physiological facts with an uncompromising adhérence to the chemical doctrine. We may now say, that the foregoing considérations, with many others which we shall yet state, go to confirai the accuracy of Brodie's experiments. It is also worthy of remark, that the température of many new- born animais descends very rapidly to that of the surrounding atmosphère ; but, " the rapid progress which they make in ac- quiring the power of producing heat is wonderful." (2) Now the brain, in new-born animais, is but imperfectly organized, and undergoes great and rapid changes in that respect as the animal advances in life. In the human subject, the change is slowly progressive, and with it progresses, pari passu, its influence in evolving heat. In early life, Bichat says, the brain is " in expec- tation of action." But whether the brain hâve, or hâve not, any participation in the foregoing phenomenon, it is clear that the différence in the power of evolving heat can hâve but little con- nection with respiration. This function is as perfectly performed at the earliest as at more advanced periods of life ; and the only intelligible explanation of the " wonderful progress which young animais make in acquiring the power of producing heat" con- sists in the rapid development of the organic forces. Such, then, (1) Dr. Elliotson's Human Physiology, Part 1. p. 246. So, Philip, and others. (2) Dr. Edwards, Op. Cit. p. 74. 28 ANIMAL HEAT. being true of young animais, and the principle being fondamen- tal, it necessarily applies at ail other âges. (See App. on Anal.) The modifying influence, therefore, which the nervous system exercises over the génération of animal heat being established not only by experiments, but more especially by facts relating to morbid states of that system, to which we shall soon advert, and by ail that is philosophical in physiological science ; and when we consider, also, how rapidly the nervous influence is deter- mined upon the vascular system, and upon the organic viscera, we hâve an intelligible explanation of the opération of a very low degree of cold in recalling into action those vessels upon which dépends the exaltation of température in the torpid hiber- nating animal. That the intensity of the cold opérâtes, also, as a stimulus in a direct manner upon the organic forces, as in other instances of foreign. agents, is undoubtedly true. (') The law, also, being universal, explains the influences of other causes, in health and disease, in modifying animal température, and only regards the agency of respiration, like that of digestion, &c, as being instrumental in perfecting the blood, and thus adapting it to the uses of the various organs which are concerned in the élaboration of heat and other products. SECTION II. " The effect of graduai cold," says Dr. Williams, « seems to be to lower the function of the nervous system in such a way that (1) Our inductions, therefore, must be more or ltss founded upon the combined results of that organization of which a nervous system forms an élément, and that which appears to be destitute of the nervous apparatus, as in the vegetable kingdom. Where the former exists, it undoubtedly perforais an important, butTsubsidiary part; the organic forces being the essential principles, in ail organization, upon which the diversified phenomena of life dépend. (Vol. I. pp. 157, 474, 569.) The nerves are especially a médium of sympathy'; and although it may seem contrary to philosophy that this remarkable property should appertain to other organ- ized structures, there is yet reason to believe that in the vegetable kinadom, where the property is manifested, it belongs to a system which is more analogous to the organic than the nervous tissue. Analogies must hâve a limit, where they are con- cerned in supplymg inductions as to the vital properlies from the apparent structure of organized matter. The phenomena are better guides than the physieal appear- ances. The muscular fibre, for instance, is clearly not necessary to sensible motion • at least, so far as we may dépend upon sight.-See Essay on Venous Congestion Sec. 10. s ' ANIMAL HEAT. 29 the lungs and other parts do not feel the want of arterial blood ; but in their degraded state to be content with merely venous blood."(*) True ; and the varions actions of life are greatly de- pressed in conséquence. The sécrétions are ail suspended, in common with animal heat. The proximate cause is the same in relation to each ; but, will it be contended that the suspension of the former has been mainly owing to déficient respiration ? Diseases of the brain, and of other organs, supply many im- portant facts which illustrate our inquiry, and which are, at least, opposed to the hypothesis that concerns respiration. Thus, in phrenitis, one arm, or one side of the body, is colder than the other. " That the maintenance of animal température," says Dr. Philip, " is a func- tion of the nervous system, properly so called, appears from a variety of facts generally known ; the température either of a part or'of the whole body being lessened by any cause that impairs the action of particular nerves in the for- mer instance, or of the whole nervous system in the latter." (8) This, certainly, does not appear to conflict with Sir B. Bro- die's inductions, as has been more or less affîrmed of Philip's analogous experiments. Besides, if " the maintenance of animal température is a function of the nervous system," how is it, in any respect, a chemical phenomenon? (See Toi. I. p. 714.) The foregoing gênerai annunciation, coming from those who believe in the chemical doctrine, might be suflicient in a gênerai treatise ; but a critical analysis requires some spécifications to give it a proper exactness and authority. And we may now, once for ail, make this apology for any apparent minuteness of détail, whether in relation to facts or to comment, that might be out of place in less exact disquisitions. "That the température of a paralyzed part is generally below the normal standard is now universally admitted."(3) That this is owing to impaired vitality is, also, shown by the fréquent faii- ure of nutrition in the paralyzed part, as well as other coïncident phenomena. In a case related by Mr. Earle, he found the tempér- ature at 70° Fh. in the hand of a paralyzed arm, whilst that of the opposite hand was 92°. He could also effect a temporary restoration of température by electricity, and by blisters. " The circulation of the blood did not appear to hâve suffered, the puise at the wrist being synchronous, and equally strong with that of (1) On Diseases of the Chest, Lee. 3. (2) On Acute and Chronic Diseases, p. 48. (3) Brit. and Foreign Med. Rev. vol. iv. r .425. 30 ANIMAL HEAT. the other limb.'^1) In an injury of the sympathetic nerve, Chaussât saw the température fall from 104. 88° to 78. 8°, Fh. in ten hours.(2) On the other hand, there is a remarkable exaltation of tempér- ature in a part at the invasion of tic dolouroux. So, when the nerves are mechanically injured. There was a patient at St. George's hospital, whose température rose 11° Fh. in conséquence of an injury of the spinal column ; and this took place when the respirations did not exceed Jive or six in a minute. (3) It is stated by Dr. Macartney and other observers, that when the principal nerve of an extremity is divided, the température of the limb is immediately exalted several degrees. (4) The philosophy of this is well expounded by an able advocate of the chemical doctrine. " We should be disposed," he says, " to regard it as due to the temporary excitement of the molecular changes by the irritation produced by the section of the nerve, and propagated to its ex- tremities."(5) Now apply this language to the exaltation of tem- pérature in any inanimate substance, however produced, and we may appreciate the merits of the chemical solution in the former instance. " In some subjects of insanity," says Dr. Cox, of Fish-Ponds, " who were un- der strong coercion in the horizontal position, with the head much elevated, whose face was red and the vessels turgid, the différence of heat was very ob- vious, varying 10, 12, and even 15 degrees. (°) In apoplexy, the température has been known to rise, after death, a number of degrees abov.e the natural standard ; and its persistence has been found so uniform in apoplexy, that Dr. Cheyne regards it as a diagnostic symptom.(7) The température of a lawyer, dead of apoplexy, was so high at 24 hours after death, that Portai delayed an examination of the body. The same phenomenon is observed after death from other diseases,— especially when the nervous system has been unusually con- cerned in the morbid process. (8) " In opening dead bodies at the Hôtel Dieu," says Bichat, "I hâve observed that the time in which they lost their animal heat was very variable ; that a (1) Med. Chir. Trans. vol. vii. p. 173. See, also, Yelloly in Med. Chir. Trans. vol. iii- ; and Meckel's Archiv. t. 3. p. 419. (2) Op. Cit. (3) London Med. Gaz. June 1836. (4) On Inflammation, p. 13. (5) British and Foreign Med. Rev. July, 1839, p. 198. (6) Beddoes on Fever and Inflammation, p. 147. (7) Cases of Apoplexy, p. vii. See, also, Bichat's explanation of the phenomenon in General Anat. vol. ii. p. 51. (8) Portai sur l'Apoplexie, pp. 4, 239. Morgagni Ep. 5. s. 6, etc. ANIMAL HEAT. 31 body continues warm a greater or less time, especially among those who hâve died suddenly of an acute affection, in the paroxysm of an ataxic fever, for ex- ample, or by a fall ; for those who die of a chronic disease, lose almost imme- diately their calorie. The différence in the first is often three, four, or even six hours. This phenomenon arises from the fact, that whenever death is sud- den, it interrupts only the great functions ; (x) the tonic action of the parts continues for a greater or less time after. Now this action disengages a little calorie from the blood that is in the gênerai system." » When the disengage- ment of calorie has ceased in the body, that which remains in it becomes in equilibrium with that of the external air, according to the gênerai laws of this equilibrium. Now thèse laws being uniform, their effect would be the same in every case," (2) Again, sometimes the température in apoplexy is greatly de- pressed before death takes place, — and this, too, whilst the cir- culation is such as to admit of bloodletting. Two cases of vio- lent apoplexy, ("violentoparoxysmo,") are recorded in the Ephe- merides Germanii, (3) in which the xblood, as it flowed from the veins, was actually cold. Morgagni (4) mentions an instance of another affection in which the blood flowed "in an icy cold stream " from the arm. Thackrah (*)jsaw a similar phenome- non. So, also, De Haën. (6) We neeà scarcety say, also, that when respiration is extremely laboured and slow in apoplexy, the natural température is often either undiminished, or consid- erably exalted. Our familiarity with the fact, however, only increases its importance, and shows, by the frequency of the co- incidence, that respiration can be only remotely concerned with the génération of heat. Hère is another variety in apoplectic affections : » While a gentleman," says Mr. Hunter, " who was seized with an apoplec- tic fit, lay insensible in bed, covered with blankets, I found that his whole body would, in an instant, become extremely cold in every part, continuing so for some time ; and as suddenly would become extremely hot. While this was going on alternately, there was no sensible altération in his puise for sev- eral hours." (7) Hère is another case, from the same observer, not less fatal to the theory of respiration : «A man fell from his horse, and pitched on his head, and produced ail the symptoms of a violent injury. There was concussion, and perhaps extravasa- tion of blood. The puise was at first 120, but came to 100, and sometimes (1) This will dépend upon the nature of the causes. When death is suddenly produced by lightning, the vital powers are so completely extinguished, at once, that the élaboration of heat, and ail other vital processes, are instantly arrested. (2) Bichat's Gen. Anat. vol. ii. p. 51. (3) An. 1685, p. 271. (4) Ep. Art. 26. (5) On the Blood, p 87. (f>) Rat. Med. t. 3, p. 36. (7) Exp. on Animais with respect to the Power of producing Heat. 32 ANIMAL HEAT. to 90, and was strong, full, and rather hard. He was very hot in the skin ; but breathedremarkably slow, only half the common frequency." 0) The following case, by the same author, seems also to hâve been intended for our spécial purpose : « February, 1781, a boy, about three years old, àppeared not quite so well as common, being attacked with a kind of shortness of breathing in the mght. It had become excessively oppressive about five o'clock on Sunday mornmg, so difficult that he àppeared dying for want of breath. The common rate of breathing in such a boy is about thirty inspirations in a minute. At 10 o'clock, he was drawing his breath with a jerk, — about two and a half inspirations, or even less, in a minute. Puise sixty, faint, slow. On tying up the arm, the vein did not appear to rise in the least, so that the blood did not go its round. Body purplish, especially the lips. He had a fine warmlh on the skin ail over the body, although in a room without a fire, — not covered with more clothes than common in the month of February, with snow falling at noon." (") This, and the preceding case, appear to differ in some physio- logical détails. In the former, the disposition of the capillaries to generate heat seems to hâve been a good deal determined by the cérébral influence ; in the latter, the altération of the vital forces was probably owing to other causes. Like other cases, therefore, which we hâve recited, they serve, by their variety, to illustrate the vital nature of the principles which are mainly con- cerned in the production of animal heat. But, standing alone, they must either subvert the hypothesis which concerns respira- tion, or we must hâve a chemical theory for the natural state of the body, and a vital one for its morbid conditions. This would be clearly absurd ; at least, if there be any such thing as philos- ophy, or any consistency in the powers and functions of life. Thèse examples show us, also, how very probable it is, that ail our chemical hypothèses in relation to life are the mère offspring of habit, or imitation, or of narrow observation. It is certainly hard to give up the fruit of great toil and research ; but it is harder for others to endure it, who prefer to be instructed by the voice of nature, rather than by artificial results. (3) We shall présent other examples to the foregoing effect, as supplied by morbid conditions of the system ; since thèse, more than the experiments which are to corne, conduct us to the true philosophy of animal heat. (1) Hunter's Lectures on Surgery, p. 74. (2) Mr. Hunter, Ibid. (3) We commend, also, toour minute philosophers Mr. Hunter's experiment up- on the carp. It was partly intended to illustrate a vision of our author, by which, as he says, " like other schemers, he thought he should make his fortune." But our author had not only the good sensé to abandon it, but the magnanimity to hold it up as a weakness of the human understanding. ANIMAL HEAT. 33 Every physician is familiar with the variations of température in disease ; which, indeed, engage his attention in almost every case. It is often exalted when respiration is slow, and again de- pressed when breathing is hurried ; and it is one of the most common phenomena to find it différent, by many degrees, in dif- férent parts of the body, and under every variety of respiration and circulation. It will, therefore, be our purpose only to men- tion a few of the more unusual instances. Dr. Philip has known the température of the skin at 74° Fh. in the cold stage of an intermittent, whilst in the hot stage, it rose to 105°. Craigie found it at 107°, and 109°. Hère the res- piration and circulation are often most accelerated during the cold stage. This, with the vast différence in température, refers the dépression of heat to other causes than the mère constriction of the capillaries in the cold stage. Hère, too, as in ail analo- gous cases, we hâve a coïncident diminution of ail other sécré- tions. Piorry has seen the température in six cases of typhoid fever varying from 108° to 117° ; and in one of thèse, the blood was at 113°, Fh. In phthisis, he has known it at 114°, and in a case of pneumonia, the blood was HS0.^) Prévost found the température of the body at 110° in tetanus. (2) Granville says it sometimes rises in the utérine system to 120° Fh. and that it dépends on the degree of action in the organ. (3) In hydropho- bia, where respiration is probably always accelerated, Currie found that " there was no increase of animal heat in any one of five cases." (4) How is the natural température maintained in consumption, where respiration is sometimes so greatly impaired as not to be compensated by any accélération of its movements ? (5) Or, why is it, in this disease, without any previous réduction of tempéra- ture, it habitually rises in the afternoon, — and this, too, in nu- merous instances, without any increase of respiration 1 Why do the palms of the hands "burn," when the rest of the surface is cool ? Will chemistry explain 1 Why is it, that when the gênerai température of the body is at some 85° Fh. it may exista at the scrobiculis cordis at 106°, (1) Traité de Diagnostic et de Séméiologie, t. 3. (2) Dr. Edwards, Op. Cit. p. 490. (3) Philos. Trans. 1825, p. 262 — 4. (4) Med. Reports, 1, p. 179. (5) See Grœschen, Pulmonum cum Cute Commcrium, 1790 ; and Brandis, Phy- siologie, 1808, p. 316, etc. VOL. II. 5 34 ANIMAL HEAT. and upwards?(>) Mr. Malcolmson states, that in the Asiatic Choi- era, "the skin is sometimes colder during life than after death, and a partial rise of température over the trank is frequently a fatal symptom." We hâve witnessed the same phenomena. Mr. M. also observes, that béribéri supplies analogous instances ; and that when the température was extremely reduced, " it was not différent when the limbs were closely wrapped in woollen, or when the thermometer was held between the soles of the feet or hands, and free evaporation carefully prevented."(2) Is it not obvious, in thèse instances, that the power of generating heat was lost in conséquence of modified vascular action ; and if so, then the génération of heat dépends upon vascular action, and is, of course, a vital product. This, too, is most emphatically shown, in the instances hère and elsewhere stated, by the " partial rise of température over the trunk" just antecedently to death. It is anal- ogous to those cases in which profuse perspiration breaks out in syncope, or as patients are in the act of expiring. It grows out of a powerful impression determined upon the vires vitœ, by which a sudden change of action is induced in the elaborating vessels. Why is the température often exalted in congestions of the lungs, "where life is endangered by diminished communication with the air;" and why, in such a case will "the abstraction of blood diminish the power of producing heat,"(3) although, by this means we extend the communication of the lungs with the air? Or, again, in congestions of other organs, when the respi- ration is natural, the circulation in the lungs unobstructed, but the animal heat greatly reduced, why does it happen that the ab- straction of blood will at once exalt the température, without af- fecting the respiration, or even increasing the force or frequency of the gênerai circulation ? In the latter cases, the rationale appears to be, as we hâve en- deavoured to explain in our Essay on Bloodletting, that a direct change is exerted by the abstraction of blood upon the instru- ments of ail vital actions, by which the calorific, as well as other functions, are improved or restored. It is hère, animating thèse minute vessels, that we shall find the principles residing, by which we are to account for ail the remarkable phenomena of (1) See our Letters on the Choiera Asphyxia, and other authors upon this disease. (2) Prac. Essay on the Hist. and Treat. of Béribéri, p. 85. 1835. (S) Dr. Edwards, Op. Cit. p. 275. ANIMAL HEAT. 35 animal heat. As the opération of thèse forces is modified, whether by natural or artificial causes, so will be the phenomena which dépend upon them. This is universally true of ail the manifes- tations of the organic forces, whether they consist of vital phe- nomena, or of material products. The function of respiration is just as much concerned with one as with the other, and probably no more. It aids, like the chylopoietic viscera, in perfecting the great material from which bile, urine, the gastric juice, &c, are elaborated by the vital forces and their instruments. And just so is respiration concerned in the production of animal heat. Again, " sympathy," says Bichat, " as we know, has the greatest influence upon heat. According as this or that part is affected, there is disengaged in others more or less of this fluid. How does ail this happen ? In this way ; the affected organ acts sympathetically on the tonic forces of the part ; thèse being raised, more calorie than usual is disengaged. It is precisely the same as in sympathetic sécrétions or exhalations. Whether the vital forces are raised by a stimulus directly applied, or by the sympathetic influence they receive, the effect that results from it is exactly the same." And again, the same accurate philosopher: " Each system has its own degree of heat.'^1) This fact was not so well known in Bichat's time as now. But it was his induction from gênerai principles. We shall only advert to the example of the dog's nose, which is familiar to ail. Hunter, (2) however, rendered the fact suffîciently obvious ; — Davy (3) and others hâve confirmed it. Now, how exactly ail this corresponds with what is known of the vital endowments of particular organs. Where they are most strongly pronounced, there the température is apt to be highest, there the phenomena of organic life predominate, and there it is that morbific causes make their most fréquent and deep impressions, and develope the most exalted température.— See Essay on Venous Congestion, Secs. 8 and 9. Finally, we come to what we consider an experimentum crucis} supplied by an able philosopher, and by one of the most able de- fenders of the chemical doctrine of animal heat. He states that (1) General Anatomy, vol. ii. p. 47. (2) Animal Economy, ut. cit. And again, " from experiments on mice and upon the dog,'' says Mr. Hunter, " it plainly appears that every part of an animal is not of the same degree of heat ; and hence we may reasonably infer that the heat of the vital parts of a man is greater than either the mouth, rectum, or the urethra." (a) We hâve certainly no analogies in the common laws of calorie, or in chemical agencies, that will in the least explain the foregoing, and a thousand other analogous facts. (3) Philos. Trans. 1814, Part 2, p. 597. ( a) Hunter's Works, vol. iv. p. 140. 36 ANIMAL HEAT. great différences arise as to oxygen, during the respiration of atmospheric air : " The real causes are chiefly certain inhérent différences in the state of the venous blood, which are indicated, indeed, by other physiological facts, but by none so unequivocally as by this variety in the power of altering the oxygen of atmospheric air. The first cause is a différence in the degree of venosity or venalization of the blood in passing through the capillaries." The second and last " cause of diversity in the action of venous blood on atmospheric air is a différence in the proportion of colouring matter contained in the blood. Now, if the chemical doctrine hâve any foundation, its advo- cates should show that there is a greater, or, at least, as great a consumption of oxygen in those states of the system which are attended by an exaltation of température, as in the natural con- dition of the body. On the contrary, however, they show just the reverse of this. Thus, the high authority whom we hâve just quoted : " The inferior action of the blood on the oxygen of the air in its passage to the arterial state simply indicates, that it is less removed from a state of arte- rialization, that is, partakes less than usual of the characters of venous blood. Accordingly, the least altération of oxygen invariably occurs in those/eiriZe dis- eases where the circulation is much excited, and the respiration at the same time free. Thèse conditions exist most especially in acute rheumatism ; and it was, therefore, in cases of this disease that the four instances of slight action (on the air) formerly mentioned hâve occurred. On ail thesè four occasions the blood was evidently more florid than usual, and in the instance where the loss of oxygen was only 0.57 of a cubic inch, the stream from the vein was so bright, that the gentleman who opened it had at first some suspicion that he had opened the artery." (;) Hère, also, we hâve from a distinguished chemist, a philoso- phical resort to the modified condition of the system in disease, for an interprétation of the wonderful peculiarity of living or- ganized matter in manifesting the power of generating heat. SECTION III. We set about this subject with the intention of showing by the experiments of Dr. Edwards, that the élaboration of animal heat is a vital function ; but we hâve been unavoidably drawn away from the artificial to the processes of Nature, which is the only true school of instruction. We hâve thus already seen that the (1) Dr. Christison, in Edin. Med. and Surg. Journ. 1831, pp. 101, 102. ANIMAL HEAT. 37 hypothesis of Dr. Edwards, and ail others which immediately concern the functions of respiration, are surrounded by too many exceptions to come within the pale of nature. Thèse exceptions meet us everywhere in the habituai state of the animal, and in the history of disease they become almost as multiplied as the individual cases. Hère it is, that we may most successfully contemplate the law and its opérations, in the various modifica- tions which it sustains from the influence of remote causes, and those within the body. Amongst the latter, are the dérange- ments to which the lungs are liable, both in their gênerai and organic functions. But far more frequently, and more pro- foundly, is animal température directly exalted, or diminished, by affections of the stomach and the nervous system. We need scarcely say it would be absurd to hâve one theory to explain the phenomena of heat in health, and another in disease. It would be a violation of ail philosophy, as well as a reckless dis- regard of ail facts. (') According to the common designs of nature. there cannot be one law for the génération of heat in the healthy state of the body, and another which détermines the exalted heat of fever. Whilst the various functions proceed in their natural manner, the évolution of heat, like the other products, remains without any radical altération. But when the latter are dis- turbed in their natural character, the former is liable to corres- ponding variations, which can only be explained on the princi- ple that the power of generating heat is as much an attribute of vitality, as any that may be concerned in the process of disease. and that their various modifications are constantly determined by analogous causes. It is a broad, fundamental principle, that "the gênerai phenomena of the disengagement of heat remain always the same in animais with lungs, in those without them. and in plants, ail of which hâve an independent température. (2) Dr. Edwards produces the following fact to illustrate the con- nection which he supposes to exist betwixt heat and respiration. Frogs and some other batrachian animais will live a long time under water, whilst the température ranges between 32° and 50° Fh. The nearer the minimum température, the longer will the animais live ; and if the température be raised above the maxi- (1) See Strom, Theoria Inflam. Doct. de Calore Animali Superstruct. p. 30, etc. — Dupuytren, in Analyse des Travaux de l'Institute, 1807, p. 16. — Blumenbach, Spécimen Physiolog. Compar. inter Animantia Calidi et Frig. Sang. p. 23. <2) Bichat's Gen. Anat. vol. ii. p. 46. Also, Hunter. 38 ANIMAL HEAT. mum, the majority, unless they corne frequently to the surface, perish at times which bear a ratio to the exaltation of heat. But whilst they rise frequently to the surface, and thus increase^ their respirations, life will be preserved. " It is by this means," says Dr. E., » they préserve the equilibrium between the effects of warmth and the influence of the air." This is very true ; but it is only asserting a fact, without its philosophy. The philosophy is fatal to the doctrine of heat as dépendent on respiration. The water is alreàdy too hot for the frogs, and they corne to an atmos- phère which is still hotter,—and which opérâtes powerfully in raising the température of cold-blooded animais. According, also, to the chemical philosophy, the consumption of oxygen, which is now vastly increased, should contribute greatly in ex- alting the heat of the animal. We see, therefore, that respiration has a much more important object than the génération of heat, to which it has but a very subsidiary relation ; and that in the foregoing instance, as is ad- mitted, the accelerated respiratory movements, in ail probability, diminish the température of the animais, notwithstanding, also, the température of the air exceeds that of the water. According to the doctrine regarding the influence of respiration upon ani- mal heat, the frogs should avoid the heated atmosphère most, when their température is highest, if it be in reality their exalted heat, as it is said, which produces the "deleterious effects." Now we apprehend the philosophy of the foregoing phenome- non, as in ail analogous cases, to be this. When the animal is at its minimum température, the actions of life are more feebly performed than at its maximum heat. Less carbonic acid, or something analogous, (see p. 16,) is generated in conséquence ; and the blood is, therefore, longer fitted for the great purposes of life. But being otherwise when the température is high, the an- imal must respire more frequently to get rid of the deleterious matter, and this without any other relation to heat ; but, siroply for the purpose of maintaining the blood in a proper state for the various functions. The frogs, therefore, come up frequently to the surface to let off the carbonaceous matter. This is, doubt- less the greatest final cause of respiration. Thèse examples of cold-blooded animais, whose température is chiefly regulated by the surrounding médium, appear to us conclusive of the very subordinate relation of heat to respiration. ANIMAL HEAT. 39 Frogs are abundantly provided with a pulmonic apparatus, and yet their température is but slightly affected by respiration. An observation of Le Gallois furnishes proof that the forego- ing law, in respect to frogs, holds in the case of young mamma- lia. It is thus stated by Dr. Edwards : " The cutting of the êighth pair of nerves produces, along with other pheno- mena, a considérable diminution in the opening of the glottis ; so that in pup- pies recently born, or one or two days old, so little air enters the lungs, that when the experiment is made in ordinary circumstances, the animal perishes as quickly as if it were entirely deprived of air. It lives about half an hour. But if the opération be performed upon puppies of the same âge benumbed with cold, they will live a whole day. In the first case, the small quantity of air is insufficient to counteract the effect of heat, but in the other, it is suffiçient to prolong life considerably." (x) Now, according to the doctrine regarding respiration, by ex- tending the relation of the lungs with the air in the former case, the température should be maintained, rather than depressed ; by which, surely, the 'S effect of heat should not be counteracted." The true philosophy is the same hère as in the case of the frogs. Nor do we so clearly understand what is meant by " counteract- ing the effect of heat,"—especially by the means which are said to be fundamental in its génération. Indeed, we are told by Dr. Edwards, in another place, that " the accélération of respiration beyond the rate of health is a salutary reaction to increase the heat of the body, and counteract the influence of the cooling process." (2) We confess we do not understand it. It was shown by Buffon, that new-born puppies may be plunged for a long time under water of a low température, with- out any sensible inconvenience ; a much more satisfactory ex- periment than Le Gallois'. But, in the foregoing cases there appear to be other principles involved, than what relates to the decarbonization of the blood ; principles that are extensively concerned in the animal economy. There is a certain harmonious relation subsisting betwixt the great vital functions, especially those of circulation and respira- tion. A sudden and violent disturbance of either is liable to dérange the other, and to affect, profoundly, the vital actions of every other part. (See Vol. I. p. 157—160.) Ail this will be greater in proportion to the extent in which the cause reaches the vital powers of the great organs, as in the division of the pneumo-gastric nerves. (1) Dr. Edwards, on the Influence of Physical. Agents, &c. p. 148. (2) Ibid.p. 260. 40 ANIMAL HEAT. The more perfectly the great functions can be made to harmo- nize, where they are not invaded by absolute disease, the less will be the gênerai violence, when any disturbing cause may operate. In the observation upon the frogs, the higher the tem- pérature of the water, the shorter was the duration of life. The exalted température stimulated the heart and blood-vessels to violent action ; and so great was the unnatural relation betwixt the two most important functions of life, whilst the animais were immersed, that a greut violence was everywhere inflicted upon the vital actions ; and, as well for this as the accumulation of carbonaceous matter, the animais soon perished. On the other hand, if the water was reduced to 32°, and the stimulus of heat thus withdrawn, the animais lived a much longer time without respiring. The functions of the whole circulatory system were reduced by the sédative effect of cold to a greater correspondence with the pulmonary functions, than in the former instance, and the shock was wholly less from this cause, upon the gênerai powers and actions of the system. We may also add, that when the température is reduced, the susceptibility of the vital powers is depressed, and not only is less carbonaceous matter generated in conséquence, but other destructive agents are far less efficient. It is for this reason that when the température of young animais is greatly reduced, they bear with impunity, for some time, the respiration of otherwise pernicious gases. In the same way, also, including the varying demand of the blood for decarbonization, should we explain the phenomena at- tending hibernating animais, so far, at least, as respiration is con- cerned. It is the relations which we hâve now stated as subsisting be- twixt the functions of circulation, respiration, &c, and that betwixt the state of the blood and the organic actions, which enable us to explain the foregoing phenomena and those at- tendant on the accelerated respiratory movements which are produced by running, fébrile excitements, &c, upon a common principle. Next cornes the application of Dr. Edwards's philosophy to the treatment of some affections of adult animais, and the consé- quences are made, in opposition to some of his own experiments, and to well known facts, to sustain the doctrine of animal heat by respiration. «A person," he says, «is asphyxiated by an excessive quantity of carbonic ANIMAL HEAT. 41 acid, in the air which he breathes ; the beating of the puise is no longer sensi- ble, the respiratory movements are not seen. His température, however, is still elevated," " and is too high to allow the feeble respiration to produce upon the system ail the effect of which it is susceptible. The température must then be reduced, &c. Cold air is, aecordingly, successfully applied to the body, and cold water to the face ; whilst the application of continued warmth would be one of the most effectuai means of extinguishing life." Now ail this may be to a certain extent, correct, although we think in a différent sensé. But the réduction of température which is thus effected is only superficial ; it reaches not the great organs of life, where alone it can hâve any important in- fluence upon the restorative process. The opération of cold, therefore, in thèse cases, is upon the vital actions of the surface, by which salutary influences are propagated upon the great or- ganic viscera. So far as a superficial réduction of température is instrumental, it is mainly so in diminishing cutaneous action, and thus lessening the formation of carbonaceous matter, with which the blood is now loaded, and which is one great cause of the declining actions of life. The lungs are now carrying ve- nous blood in their arterial system ; and hence the advantage of a cold atmosphère, since this is denser and contains the largest quantity of oxygen in the smallest bulk. Thence, also, it is manifest, that heat to the surface, or warm air to the lungs, ope- rate injuriously by increasing the fatal amount of carbonaceous matter. (') But, after ail, if it be now the simple object of the foregoing means to reduce the température of the body, because the exist- ing heat is, per se, detrimental, by what consistent philosophy can we resort to the very means which are best calculated to es- tablish respiration; which, according to the hypothesis, exalts the température in the ratio of the increase 1 The whole phi- losophy consists in diminishing, for the moment, those vital ac- tions upon which the génération of carbon dépends, and in estab- lishing its élimination from the blood, (p. 16.) Whatever will best accomplish thèse purposes are among the best remédies for that affection. If the surface of the body be already cold, cold appli- cations are only admissible as agents which may, by their action upon the nervous system, détermine sympathetic influences that shall contribute to the return of respiration, and the establish- (1) This is in no sensé humoral pathology. — In our Essay on Venons Congés. lion, we shall show that Ihere is another important cause which contributes to the phenomena in subjects asphyxiated by carbonic acid gas. VOL. II. 6 42 ANIMAL HEAT. ment of the natural functions. The difficulty has consisted in a narrow view of the subject. Before leaving this question, we would, also, inquire if animal heat be so dépendent on respiration as is assumed, how it hap- pens that the heat of the subject, asphyxiated by carbonic acid, is not reduced when " the puise is no longer sensible, and the respiratory movements are not seen" ? This is the last example which the chemists should hâve brought forward, — since the température is not only " too much elevated " for the doctrine, but it is often actually as high, " when the beating of the puise is no longer sensible, and the respiratory movements are not seen," as it is in a state of perfect health, — sometimes above the natural standard. Moreover, cold air contains more oxygen in a given bulk than warm, and should, therefore, upon the chemi- cal hypothesis, still farther exalt the heat of the subject. Be- sides, it is altogether a fallacy to suppose that the gênerai tempe- rature of the body is reduced by the contact of cold air with the lungs, since the living system, in warm-blooded animais, resists the law of communication of heat which prevails in dead mat- ter. This is true even of the hybernating. We speak, however, of the ordinary states of the body ; for, cold when extensively applied and long continued, may so prostrate the vital powers, that it will not only diminish the calorific function, but may bring the system more or less under the law of interchange of heat. Why, in the choiera asphyxia, does the température often fall below 90°,—down to 80° Fh. whilst the respiration is per- fectly natural or greatly accelerated, and the lungs wholly free from congestion, or any other embarrassment to the circulation, as is also true of the lungs in asphyxia from carbonic acid?(1) The organs of circulation are greatly depressed in their action ; but not more so than in those instances of asphyxia from car- bonic acid, in which, according to Dr. Edwards, "the puise is no longer sensible." (2) The true reason for the différence of tem- (1) See Essay on Venous Congestion, Sec. II. (2) Dr. Babington tbinks that animal heat is mainly dépendent for its develop- ment upon the présence of red globules of the blood, (a) notwithstanding he regards the blood as a homogeneous fluid. We would rather say that it dépends upon a natural proportion of ail the constituents of arterial blood, and upon the natural ac- tions of the system, like every other sécrétion, and like them is subject to modifica- tions from analogous causes. (o) On Morbid Conditions of the Blood, p. 6. ANIMAL HEAT. 43 perature, therefore, in thèse cases, must be sought in the differ- ently modified actions of the capillary system of blood-vessels ; and it appears to be upon this principle alone, that we can ex- plain the infinité irregularities of température which are presented in numerous diseases. Referring to what was said of asphyxia from carbonic acid gas: " The same practice," says Dr. Edwards, " is pursued in sudden faintings ; the means of réfrigération must be employed, — such as exposure to air, venti- lation, sprinkling with cold water. The efficacy of this plan of treatment is explained on the principle just laid down. When the asthmatic expériences suf- focation, he opens the Windows, breathes a frosty air, and finds himself relieved." And yet, farther on, he remarks, "that when an individual expériences a change of constitution which diminishes his production of heat or consumption of air, he cannot endure that degree of cold, which previously would hâve been salu- tary to him, without experiencing, sooner or later, an altération in the rate of his respiratory movements," (') —meaning that their frequency would be diminished. The modus operandi qf cold, in the foregoing cases, appears to us to be entirely différent ; and, whilst in neither instance can we think our author's theory applicable, there are some consid- érations which conflict with the hypothesis of respiration. We shall first dispose of the case of the asthmatic subject, since this is analogous to that of the asphyxiated, though differing inasmuch as the organs of circulation are in gênerai opération. The contact of cold air opérâtes by diminishing the production of carbon, whilst, from the greater density of a frosty air, the lungs are more abundantly supplied with oxygen, and the blood thus most rapidly fitted for the great purposes of life. (2) Be- sides, according to the hypothesis which concerns respiration, there should be an immédiate exaltation of température the mo- ment the asthmatic " opens the Windows, and breathes a frosty air." The remedy, according to the hypothesis, is clearly un- philosophical, — since, if the patient require the " means of ré- frigération," he should be subjected to a rarified air ; though the most theoretical method would be, to suspend his breathing. The supposed modus operandi, therefore, of increased respira- tion, in either of the foregoing cases, is not only in conflict with (1) Dr. Edwards, Op. Cit. pp. 149, 155. (2) Whytt, reasoning naturally upon this subject, very justly says, that "tbe in- creased motion of the organs of respiration, in the fit ofan astbœa, are tbe efibrts of nature to free the body of something hurtful." (a) (a) Sympathy of the Nerveg, p. 72. 44 ANIMAL HEAT. the gênerai hypothesis, but it shows the hypothesis to be founded on assumptions. That it has no relation to the existing tempe- rature of the body may be practically shown by opposite condi- tions of the system, in which free respiration and a denser air are equally salutary. Thus, « In burning fevers, with a quick puise, red skin, and a large and quick res- piration, I hâve given relief," says Dr. Stephenson, " by opening a window, and admitting a stream of cool air to breathe in : the effects of which I hâve care- fully observed to be that, though the body continued close covered, in one min- ute the respiration became slower ; and very soon after, the puise abated of its fulness, and not only the face, but the whole body, of its fiery heat and co- lour." (') Hère, then, we hâve a dense air reducing the température of the " whole body," " in one minute," whilst " it continued close covered." It appears to us that the only intelligible rationale ofthe process must be sought in the vital impression of the cold air upon the lungs, and the sympathetic propagation of this im- pression over the entire powers and functions of the body, by which the élaboration of heat was suddenly diminished. There appears not the least probability, that the action ofthe air upon the blood had any connection with the phenomenon ; or, cer- tainly, in that event, if the chemical hypothesis be admitted, the température should hâve been exalted, since the air respired con- tained a greater amount of oxygen in an equal volume. The respirations, it is true, were diminished in frequency ; but this was compensated by the cause just stated ; whilst every one knows that under the circumstances of the case, more air was inhaled at each inspiration, after the frequency of the respiratory movements was lessened. And we may hère remark, that this considération is constantly overlooked ; it being assumed that as much air enters the lungs when respiration is rapid, as when it is slow. This will constantly vary, according to various modifying causes. , Moreover, it is well known that the respiration of cold air, in ordinary states of the system, has no tendency to diminish the production of heat in adults, however long it may be continued, — and least of ail in "a single minute." Hence, we must look for the principle in laws which are peculiar to living matter, both as it regards the persistence of température in the healthy subject, and its extrordinary vacillations in disease. In the latter instance, the cold opérâtes directly upon the morbid vital (1) Edin. Med. Essays and Obs. vol. i. p. 229. 1746. ANIMAL HEAT. 45 powers, — changes their action in " a single minute," and then follows, of course, a change in the products. In connection with the foregoing subject, it was well remark- ed, nearly a century ago, that, if animal heat dépend on the quantity of air respired, in the natural state of the body, " We should need less of the pulmonic function, when we are warm, or in a warm place ; the heat of our bodies, or of the atmosphère, doing so much of the office of the lungs ; and that we should want more of it, when cold, or in cool air. But when we are hot, and want to be cooled, we breathe full and quick ; and when we are cold, and want to be warmed, our respiration is slow and small ; contrary to what one would expect, if the action of the air on the blood in the lungs were to heat it." (l) Ail this is entirely true in respect to man, in a state of health, — however we may constantly meet with the affirmation, that cold air accélérâtes the respiratory movements in animais. Nor is it true in relation to man, as it was found by Dr. Edwards in regard to certain animais, that the respiratory movements are increased when cold has so far operated as to diminish the ab- solute température of the body. Man soon becomes comatose, and his respiratory movements are diminished. Ail the vital functions then become violently disturbed. And if the respira- tory movements be increased in adult non-hibernating animais, they are shorter and shorter, in proportion to their frequency, and the volume of air respired diminishes in a corresponding ratio, till, in the language of Dr. Edwards, "the powers, being exhausted, thèse movements, like ail the others, languish and fail." (2) This accélération of respiration is only one of the com- mon disturbances, and it appears to hâve no more direct con- nection with the maintenance of température, than the gênerai disturbance of the circulatory organs. We hâve, however, repeated thèse experiments of réfrigération, and the following has been the resuit. With new-born puppies, the first contact of cold air accelerated the respiratory move- ments ; which, however, were shorter in proportion to their frequency. But, as soon as the gênerai température began to fall, the frequency of the respiratory movements gave way, and soon became less fréquent than in health. The same was also true of adult non-hibernating animais. The first impression of cold was that of a stimulant ; but as soon as its influence was established it became a sédative. (3) Sensibility and irritability (1) Edin. Essays, ut supra, p. 230. (2) Dr. Edwards, Op. Cit. p. 157. (3) It will be seen, as we shall endeavour to show in an Appendix to our Ve- 46 ANIMAL HEAT. became obtuse ; respiration became less and less fréquent, just in proportion as other functions partially failed. And whilst yet the gênerai température was scarcely affected, respiration had become slow and languid. If the animal was disturbed, then the respiratory movements were increased, but soon sub- sided into their subdued condition. Small birds are not the proper subjects for thèse experiments. Excessive cold, especially with such as are not constituted for a winter climate, inflicts a violence upon the forces and actions of life, from which no in- ductions can be made of a sound physiological nature. Take the adults of small quadrupeds, that are constituted for a cold climate, or even dogs, and subject them to a low tempéra- ture, and they may supply some information as to the relation of respiration to animal heat. You will then see, that when the respiratory movements are increased, there is no increase of température; and as they décline in frequency, if the animal be not smaller than a mouse, the température scarcely sustains any diminution. Now reverse the experiment, and place the ani- mal, a dog for instance, in a warm apartment, his respiratory movements will be immediately accelerated, whilst there will be no increase of his gênerai température ; and the warmer the air, the more complète will be this démonstration. Then give him a sound flogging, and he shall pant for an hour without affect- ing in any degree the heat of his body. But it may be said that the redundant heat is carried off by perspiration. Then let the blows be inflicted after he has lain for 24 hours in a température at zéro, there will be the same panting, but no rise of tempéra- ture. True, it dépends upon a law of nature, by which the ope- ration of cold is resisted, and increased respiration has no effect. But chemical agencies know no such restraint in the ino manie world. If a certain process produce at one time a certain resuit, it will always follow under the same circumstances. If a mix- ture of one part of sulphuric acid with six parts of water evolve a heat of 5°, and two parts of the former to six of the latter, a heat of 10°, it will always do it, when the materials are at the same température, at ail atmospheric températures. Justso should it be with animal heat, if the chemical doctrine were founded in nature, so long as the température of animais is not reduced ; nous Congestion, that when a profound lésion is inflicted by cold upon the organic properties, it becomes apparently an irritant to those forces, and establishes an ac- tion analogous tothat of inflammation. ANIMAL HEAT. 47 and when exalted, then increased respiration should carry it pro- gressively still higher. It appears, therefore, that "the accélération of respiration, in- duced by cold beyond the rate of health," is no more " a salu- tary reaction to increase the heat of the body, and counteract the influence ofthe cooling process," Ç) than its accélération by the stripes is " a salutary reaction to counteract the influence of the " blows. And then we should not neglect to consider, in connection with the foregoing facts, what has been already stated ofthe phi- losophy ofthe expiring respiratory movements, and the coïn- cident abatement of other functions, in the hibernating animais, and how ail those functions are simultaneously restored by a still farther réduction of the external cold, when by its greater intensity, it has lost the nature of a sédative, and has, as during its earliest but momentary influence, become a stimulant. See Appendix to Venous Congestion, on Cold. Again, there are vertebrated animais in whom the respiratory movements are diminished by cold, as in reptiles, — where it " retards them progressively, according to its intensity, until it arrests them." (2) Hère, Dr. Edwards, as on other difficult oc- casions, is more or less of a vitalist. He refers the diminution of respiration to a peculiarity of constitution. It is in this peculi- arity that résides the secret of their diminished heat, and of their " conforming very closely to the external température," whatever be the rate of respiration. The whole opération of cold air, whether it act as a stimulus, or a sédative, is manifestly upon the sensibility of the nervous system, and upon the irritability of the skin and lungs ; in vir- tue of which the great functions of the body are very variously affected, — the température of the body being at one time in- creased, and at another diminished, when respiration is accele- rated, and this according to the existing condition or constitu- tional nature ofthe vital forces. Again the same vicissitudes in thèse respects occur, when other causes operate. Nor should it be forgotten, that in young animais, the réduction of température begins from the first moment after the cold is applied, and descends most rapidly when the respiration is most accele- rated, and cornes to a stand, when respiration has most abated. But however their constitution may differ, in respect to the (1) See Dr. Edwards, Op. Cit. p. 160. (2) Dr. Edwards, Ibid. Part 4, c. 9. 48 ANIMAL HEAT. power of evolving heat, from that of adult warm-blooded animais, if the décline of température be not counteracted by accelerated respiration in the former instance, it is not in the latter, at least, if there be any consistency in the great laws of nature. ( From ail which it is évident, that the principle cannot be maintained, that " the accélération of respiration beyond the rate of health is a salutary reaction to increase the heat of the body, and counteract the influence of the cooling process." (') If, also, this were a gênerai law in respect to the influence of respiration upon the cooling process, it would be fondamental in regard to animal température ; and the various modifications of respiration should, therefore, bear corresponding relations to animal heat under ail conditions of the body. But this we hâve already seen to be variously contradicted ; and the sequel will not fail to corroborate our inductions. Again, it is said by our author, that " The same practice is pursued in sudden faintings, as in cases of asphyxia from carbonic acid ; the means of réfrigération must be employed, such as ex- posure to air, ventilation, sprinkling with cold water. The efficacy of this plan of treatment is explained on the principle just laid down ;" that is to say "the température is still elevated, and is too high to allow the feeble respiration to produce upon the system ail the effect of which it is susceptible. The tempe- rature must be reduced," &c. Hère the whole physiological process is entirely différent, to our mind, from the supposed analogous case of asphyxia from carbonic acid. There is a simple suspension, or rather a great diminution, of the organic functions, and least of ail is a réduc- tion of the température of the body calculated to effect their res- toration. If cold air be bénéficiai, it is by its direct action as a stimulus upon the vital forces, in virtue of which the élaboration of heat is at once augmented, not diminished. Any remedy which should operate directly upon the principle laid down by our author would more or less defeat its intention. (See Yol. I. p. 175 —179.) There can be no condition of the body, short of absolute death, in which the température fails more rapidly than in syncope, and none in which absolute réfrigération can be more pernicious. Indeed, there will be no positive relief, till a re- production of heat again goes on ; and the gênerai hypothesis asserts that it is the direct tendency to cold, when it lessens ani- mal température, to diminish respiration. The foregoing is one ofthe practical errors that has grown out ofthe chemical theory (1) Dr. Edwards, Op. Cit. p. 160. ANIMAL HEAT. 49 of respiration. It is seen, also, by the results, that what we hâve said (p. 42,) as to the gênerai inapplicability to organized beings of the-physical law of interchange of heat is fallacious in thèse cases. But let us analyze the subject a little farther, since thèse prac- tical examples strike at the foundation of the doctrine, and ad- monish physiologists to protect their own department against the encroachments of a science which, however vast and impor- tant its legitimate objects, has never failed to engraft upon medi- cine the worst innovations, whenever it has laid its iron grasp upon the science of life. Now, it is known to every tyro in medicine, that a single drop of cold water falling upon the face, in a paroxysm of syn- cope, will often produce a convulsive inspiration, and may be sufficient to establish ail the functions. The effect, too, will be considerably determined by the force with which it may strike. It will be greater when snapped from the finger, than when a much larger quantity is dropped from the hand. Shall it be said that there is anything like the alleged réfrigération in this drop of cold water ? Woodall, a most intelligent and accurate observ- er, states that the best remedy for syncope is to obstruct respira- tion entirely, by momentarily confining the nose and mouth. "I hâve used this course," he says, " from my youth to this day." (') The philosophy of its opération is probably that of creating a " sensation of uneasiness in the sensorium," as Dr. Philip would call it. (2) " The muscles of respiration," says Mr. Bell, " are put under the guidance of sensibility." (3) This is a remedy (1) Surgeon's Mate, p. 29, 1617. (2) See his treatise on the Means of Preserving Health, p. 58, &ic. Also, Whytt on Vital Motions, s. 8, and Brodie's Exp. in Philos. Trans. 1812. (3) "The results,'' says Mr. Grangier, " prove first, that in parts of the body indis- putably deprived of ail feeling and power of voluntary motion, contractions may be excited in the so-called voluntary muscles, by impressions made on the skin. Scc- ondly, that this capability of exciting voluntary contraction, is not equally possessed by ail parts of the external surface of the body ; but that the sole of the foot, which, in walking, cornes in contact with the ground, is that précise part in which the action is excited in the most energetic manner." (a) Just so it is in syncope. The face is the part upon which the drops of cold water make their most efficient impression in rousing the respiratory muscles ; and the next most efficient impression upon the skin is tickling the soles of the feet. It helps réfrigération prodigiously. Thèse principles, we ail know from observation, are equally true of the viscera of organic life. (a) Observations on the Structure and Functions ofthe Spinal Cord, p. 95. vol. ii. 7 50 ANIMAL HEAT. apparently the reverse of that of respiring cold air ; and yet the principles upon which they operate are not very différent. In the same way, the most pungent stimulants applied to the nose, which are calculated to exalt, not to diminish heat, are often far more useful than a current of air, or sprinkling the face with cold water. The drinking of cold water is also useful ; but al- cohol or ammonia may succeed when the former fails. Each opérâtes upon a common principle,—that of exalting the forces of life either directly, or through the médium of a sudden and strong impression transmitted to the sensorium commune. In our essay upon bloodletting, we hâve pointed out other means of restoration from a paroxysm of syncope, none of which hâve any connection with the imputed principle of réfrigération ; but their tendency is directly the reverse. Carry the doctrine of réfrigération into absolute practice, and the entire surface of the body should be bathed with cold water in the most obstinate cases. Try it, however, and you will find it fatal ; not, however, by a direct abstraction of heat from the body at large, but by the pernicious impression of so gênerai an application of cold upon the functions of the skin, and by sympathy, upon the heart and other viscera. On the contrary, in thèse cases, we apply heat, and other uniform stimulants to the gênerai surface, and thus endeavour to rouse the vital forces and capillary action of the skin. This doctrine of réfrigération, therefore, must be sent back to the chemical school for reconsideration. It is not suited to the practical business of life. The whole of our philosophy is corroborated by Dr. Edwards, when he cornes to explain the manner in which an intense de- gree of cold rouses the hibernating animal from his torpid state ; for in this instance he regards it as acting upon the principle of a stimulus.(') So, also, "the immersion," says Dr. Edwards, " of a great part of the body in warm water, is frequently an efncacious means of exciting the movements of the chest, and reanimating a child just born without signs of life." (2) But what physiological différence is there betwixt this case and that of syncope ? Ail thèse cases, indeed, are analogous ; and whether heat or cold be the agents, they exert their effects as vital stimuli. Réfrigération has just as little to do with one case as with anoth- er, — as appears by our author's own showing in the instance last cited. (1) Op. cit. p. 159. (2) Ibid. p. 283. ANIMAL HEAT. 51 If we now revert to the experiments of Dr. Edwards on the combined action of air and température, we shall farther see that his conclusions do not appear to be sustained. The cold-blooded animais, from the very nature of the question, are in no respect proper subjects for the gênerai déductions which are made ; (see Vol. I. p. 698, &c.) though their phenomena are clearly opposed to the whole chemical theory of animal heat ; and, in regard to new-born puppies, they approximate so nearly the hibernating animais, that, in rendering them torpid, they sustain a loss of 40° to 50°, or more degrees of Fh. ; a réduction of température sufficient in itself to influence powerfully ail the great vital functions, and to place the animais in anything but a natural condition. Vital stimuli, and other natural agents, cease to manifest their natural developments whenever the organic pow- ers and functions are violently impressed. This standard of comparison is, therefore, inappropriate, however advantageous to our views. Our philosophy, so far as experiments are con- cerned, must be deduced from the phenomena of adult, warm- blooded, non-hibernating animais. And in respect to the prac- tical inductions, as intended to be exemplified by the foregoing cases of asphyxia, &c, the cold is not applied to the gênerai surface of the body, or at least, anything like absolute réfrigéra- tion would be pernicious ; whilst in the experiments which are carried up to the foregoing important objects where human life is immediately concerned in the true philosophy, cold is not only universally applied, but profound réfrigération is produced. If animal température dépend directly on the relative quanti- fies of atmospheric air to which the pulmonic circulation may be exposed, and it be true, according to Dr. Edwards, that, on the application of cold, " the accélération of respiration beyond the rate of health is a salutary reaction to increase the heat of the body and counteract the influence of the cooling process ;" or, if respiration " stand related to the production of heat as cause and effect," — then the whole reasoning as to the supposed effect of increased respiration in diminishing température in asthma is suppositious ; or, if true, is subversive of the whole theory ; whilst the statement which we hâve made as to the réduction of an exalted température by increased respiratory movements, or by the inhalation of a denser air, whether the exalted température hâve depended on natural or morbific causes, or natural or morbid states of the system, is utterly at variance 62 ANIMAL HEAT. with the chemical theory. We shall soon show, also, that the same statement is corroborated by the experiments ofthe chemical philosophers. If the principle just laid down by Dr. Edwards hâve any ex- istence, it is fundamental, and should apply, in a gênerai sensé, to at least ail warm-blooded animais. But we hâve seen that absolute exceptions exist, and many others are admitted. Amongst the warm-blooded vertebrata, exclusive of the hibernating, are many conditions, » in which the température progressive^ lalls, notwithstanding the accélération of respiration." (') Ail young animais, indeed, hâve their respiration greatly accelerated on the application of cold, whilst their température generally descends very rapidly, although the cooler aircontains a greater quantity of oxygen in a given bulk, than the warmer ; and it is remark- able that the fall is greatest at the beginning of réfrigération, when the respiration is most accelerated. According to Du- pretz, also, more oxygen is consumed by young animais, than by adults. (2) Dr. Edwards exposed " young birds, whose tem- pérature was about 100° Fh. to an atmosphère of 64°, when they cooled down to within one or two degrees of the external air." Others of the same heat were exposed to the high tem- pérature of 71° Fh. when they cooled rapidly down to within one degree ofthe atmospheric température." (3) Hère it certainly cannot be said that accelerated respiration had any apparent tendency " to counteract the influence of the coolinçf process ;" and, indeed, in this very conclusion our au- thor agrées. " Whatever," he says, "be the modifications of the respiratory movements of young unfledged birds, their cooling is always progressive until the limit at which the cold benumbs them ; and it is not at this period that we can discern the influence of respiration upon température ; but some days later, when they develope more heat, we frequently recognise by unequivocal indications, that the accélération of respiration beyond the rate of health is a salutary reaction to increase the heat of the body, and counteract the influence of the cooling process." (*) Now the whole of this matter appears to us susceptible of ex- planation upon plain physiological principles, and to place the chemical doctrine in its proper attitude. If there were the least foundation for the hypothesis, the younger birds should certainly manifest some évidence of its truth ; and that " if increased respiration and the development of animal heat stand related (1) Dr. Edwards, Op. cit. p. 161. (2) Annales de Chimie, t. 26, p. 360. (3) Dr. Edwards, Op. cit. p. 71 (4) Ibid. p. 160.' ANIMAL HEAT. 53 as cause and effect" in any one instance, there should be some manifestation of this connection in ail others. The law, being fundamental, is utterly baseless, if it be liable to palpable excep- tions. (See Vol. I. p. 626, note.) But we hâve the full admission, that in very young birds, the increased respiratory movements hâve not the least tendency to counteract the cooling process. Chemistry, therefore, is out of the question ; and we must look for the true philosophy in other principles. Thèse we shall find in certain laws which are as foreign from those of chemistry, as the contradictory facts are from each other. The organiza- tion of thèse young birds is not fully developed. The whole cérébral system, and every other part, are only yet in partial existence, and ail reason, as well as facts, assures us that there must be a corresponding analogy in respect to the forces of life. Therefore is it, that the moment the actions are only slightly subdued by the depressing influence of cold, the functions of the secerning vessels are more or less arrested, and along with other animal products there is a failure in the génération of heat. But even in thèse cases, as in that of the hibernating animais, there is a constitutional provision for the safety of life, by which the pernicious influence of cold is resisted, if the low tempéra- ture be not excessive. And when we corne to regard the condi- tion of the same animais " some days later," and see them resist- ing the influence of cold under the foregoing circumstances, we hâve a coïncident proof, in the converse phenomenon, and in the greater maturity of organization and the vital forces, that the greater development of animal heat is purely a vital process. But, supposing a state of absolute ignorance of physiological science, the contrast which appears in the immediately preced- ing cases, under the same circumstances of respiration and ex- ternal température, shows that the évolution of heat dépends, essentially, on some other cause than respiration. The foregoing results attended, also, similar experiments upon puppies ; and the same is more or less true of the young of ail animais. Will any one believe that the adult human subject, when his gênerai température is actually reduced, can elevate, in the least, the existing degree, by any voluntary accélération of respiration ? According to the hypothesis, it should be a fundamental remedy. On the contrary, however, stimulants of any description, that shall increase the action of the capillary vessels, will start the 54 ANIMAL HEAT. évolution of heat. Nor is the inefficiency of respiration owing to a want of circulation in the capillaries of the internai parts ; for when we corne to the subject of venous congestion, we shall show that it is the effect of reducing the gênerai température of the adult human subject, to détermine the blood upon the inter- nai capillaries. Besides, the experiments upon the birds, just re- cited, show that the phenomenon is not owing to an absence of blood in the internai capillaries ; since, otherwise, it should hâve been equally true of both cases. If respiration be performed in a deep and hurried manner, in a tranquil state of the body, there should be, according to the rule, an évolution of heat, and vice versa. By the foregoing act, also, not only a greater amount of air is supplied, but a greater volume of blood is determined upon the lungs. (') But every body knows that there is no attendant increase of animal heat. On the other hand, however, as we hâve shown, " when we are hot and want to be cooled, we breathe full and quick ; and when we are cold, and want to be warmed, our respiration is slow and small ;" and, as we hâve seen, it is admitted by the chemists, that respiration is increased by the stimulus of heat ; but then, the science has it, that " this increase of the respiratory movements is necessary to counteract, at least for a time, the effects of the external heat." (2) Is it said that respiration is ac- celerated by running, &c, and the température augmented ? Hère, the organic functions are increased ; and Becquerel and Breschet found that the température is affected 1°—2° Cent, by each contraction of a muscle. Ç) Ail the sécrétions are greatly augmented in a corresponding manner. The sweat flows pro- fusely, and the same cause is one of the most efficient means of increasing the bile. And then, in respect to the hibernating animais, we hâve not only opposite results to those just stated, but perfectly conflicting ones ; such, indeed, as are utterly incompatible with chemical philosophy. At an atmospheric température of 20° Fh. their heat goes rapidly down to near the freezing point, notwithstand- ing the accelerated respiratory movements ; and there it stands. ( 1 ) " Dr. Holland said, that he had made repeated experiments, and had invaria- bly found, that a séries of deep inspirations did always bring to the lungs a larger quantity of blood than previously existed." (a) (2) Dr. Edwards, Op. cit. p. 152. (3) An. des Sci. Nat. Mai, Oct. 1836. (a) Silliman's Jour, of Science and Arts, vol. xxxiy. p. 28. British Association for the Avance- ment of Science. ANIMAL HEAT. 55 But depress the température of the air still lower, down to zéro, and, although the respiration be scarce sensible, an évolution of heat begins at once, and the température of the animal rises rap- idly up to 97°, and that, too, without any remarkable accélération of respiration, there being only a slow return to its natural state. (') Now it is manifest, from the circumstance that accele- rated respiration did not counteract the décline of heat when the inferior degree of cold was applied, it had no connection, in a chemical sensé, with the great and rapid restoration of heat, when the intensity of the cold was increased. If you appeal to consti- tution, this is exactly our argument,—and that constitution con- sists in the adaptation of the vital forces to the évolution of heat according to the impression of vital stimuli. The peculiarities of the hibernating animais also supply an impressive illustration of the spécifie nature of the powers of life, as contradistinguished from those of physics, and of the variety which appertains to the vital forces. For thèse reasons, we dissent from the induction which is de- rived from thèse experiments, and which is expressed, as follows, by Dr. Edwards : " In thèse experiments," he says, " the exter- nal température had nothing to do with the restoration of heat, except by exciting respiration and circulation ; thereby showing that increased respiratory movements and the restoration of heat stand related as cause and effect." (2) We might equally make the same affirmation of any other returning function. One would be just as logical as the other. There is also another remarkable peculiarity respecting the température of hibernating animais. They maintain their heat, unlike the young of other animais, when the thermometer is pretty low ; and do not part with it till sleep takes place. Till this event cornes, they commonly bear ail degrees of température without passing into the hibernating state. This singular fact is a key to the whole philosophy. Their sleep is induced by a change which is established in the organic forces, and it is this change which arrests the génération of heat. It is coïncident with the altération ofthe vital actions. The sleep, therefore, has not the connection which has been supposed by Dr. Hall, and others, with the diminished élaboration of heat. Like the latter, it is only (1) Dr. Edwards, Op. cit. pp. 158, 159. (2) Op. cit. p. 158. 56 ANIMAL HEAT. one of the consécutive results which follow the change in the or- ganic powers, — or, if you prefer, the vital actions. ( ) We hâve just seen, that the young of certain non-hibernating animais, whose natural température is 100° Fh. when exposed to an atmosphère of 71°, or only 5° below summer heat, cooled rapidly to an equilibrium with the surrounding médium, not- withstanding the respiratory movements were simultaneously increased. This, being more or less true of ail new-born ani- mais, it is fair to establish an hypothesis upon thèse experi- ments as upon those which are made upon adults. We might maintain an equally fallacious induction, that the accelerated respiratory movements and the décline of température " stand related as cause and effect." Or. at least, we should hâve the conflicting théories, that in early life it is the effect of increased respiration to diminish animal heat, whilst the principle does not obtain with adults. The contradiction shows the absurdity of either induction. Experiments which aim at the discovery of any great law must be considered connectedly ; especially when that law is to be grounded upon their absolute results. The moment we départ from their indications, and explain diffi- culties and contradictions by other principles, we lose sight of true philosophy, and are in the wide field of conjecture, where we can only hope, like the alchymists, to stumble upon the truth. This truth may be as foreign from the immédiate object of our experiments, as the vital are from the chemical laws. What, then, is the cause of thèse remarkable différences as to variations of température under the influence ofthe same causes, amongst hibernating animais, and the young and the old of the non-hibernating? Respiration professes to explain it one way, in one instance, whilst its apparent effect is perfectly opposite in another. We apprehend, therefore, that respiration has only a remote connection with the phenomena. We think, rather, that the whole is to be explained by the différence in the condition of the vital forces in the différent animais, or at their différent âges. According to thèse différences, cold will make différent impressions upon their organic actions and variously modify ail (1) If diminished température take place in the natural state of an animal, the principle is the same; the actions of life are performed with less energy, than in a state of wakefulness. Dr. Edwards contends for the fact ; (a) but is it common, even with the young? Observe the infant, or the man, — you will find no gênerai dimi- nution of température. But respiration is more slowly performed. Will chemistry explain ? (a) Op. cit. Part 4, Chap. 17. ANIMAL HEAT. 57 the results. Accelerated respiration is the first in the séries. The philosophy of this we hâve endeavoured to explain. In ail, the various actions are more or less reduced, according to the constitution ofthe animais, and the intensity and continued opération of the agent, —often modified, however, by very acci- dentai causes. Amongst the numerous results, the génération of heat is, in conséquence, more or less diminished ; and dimin- ished respiration, circulation, &c. follow as other results. In certain small animais, a high atmospheric température over- comes the constitutional provision which establishes an exact measure of heat ; and, although in thèse cases, respiration is greatly more increased than by the application of cold, it should be just the reverse if the chemical philosophy were founded in nature, that on the application of cold, " the accélération of res- piration beyond the rate of health is a salutary reaction to in- crease the température of the body and counteract the influence of the cooling process." Delaroche and Berger exposed to the température of 122° and 200° Fh., a cat, a rabbit, a pigeon, a yellow-hammer, and a large frog. In about half an hour, they became agitated, and their respiration was progressively accele- rated for about three-quarters of an hour, when it became pant- ing ; and, at last, they died. Upon this experiment Dr. Edwards remarks, that " notwith- standing the diversity of species, and of classes, and of the de- grees of heat to which they were exposed, they ail acquired nearly the same increase of température, the limits of the varia- tion being from 6.25° to 12.92° Fh." Ç) Thèse are examples in which heat modifies the vital forces in such a way as to allow a partial communication of external heat agreeably to its physical laws ; and as soon as it détermines the complète extinction of the vital forces, an equilibrium of heat becomes established. Nor does this conflict, in the least, with what we hâve said at p. 42, as to the résistance of external heat or cold, since in the cases there supposed, the organic changes now contemplated are not established, and the application of cold was comparatively momentary. In our présent case, the continued and extensive application of cold will, like that of heat, induce the same vital changes, and ultimately bring the system partially under the in- organic laws of calorie, before the full extinction of life. The accélération of breathing by heat, Dr. Edwards states, (\) Op. cit. Part 4, ch. 14, b. 1 and 2. VOL. II. 8 58 ANIMAL HEAT. is "a gênerai phenomenon." (') If, then, " its accélération be- yond the rate of health be a salutary reaction to increase the heat of the body and counteract the influence ofthe cooling process," when cold is applied to the surface; what is its ob- ject when it arises with as much uniformity, and to a greater extent, from the action of heat? Dr. Edwards shall explain: " This increase of the respiratory movements," he says, " is necessary to counteract, at least for a time, the effects of the external température." (2) In one case, the température is ex- alted by the increased frequency ofthe respiratory movements ; in the other, it is depressed, or rather counteracted, by the same cause; or, as Dr. Edwards finally has it,—probably by way of escaping under the cover of a solecism, — " more air cornes in contact with the lungs in a given time, and réanimâtes what the heat depresses." (3) To such as may comprehend this explana- tion, we hâve only to say, that, agreeably to the doctrine, and, as we understand it, to the foregoing statement, the " reanima- tion" consists in an increase of heat by the respiratory move- ments, whilst the external heat depresses the animal tempéra- ture. But it is agreed on ail hands, that the direct tendency of a high external température is to raise the heat of the body, and the only wonder is that such is not actually always the resuit. Since, therefore, when heat is applied, we see not either what is " depressed," or how, by the chemical rule, the " effect of the external heat is counteracted" when "more air cornes in contact with the lungs in a given time," especially, also, as the air res- pired has an exalted température. It is clear, therefore, that the chemical doctrine must fall by the observations on which it pro- fesses to rest. Again, what is to be " counteracted" by the greatly increased respiratory movements which follow running, or which attend the immersion of the limbs in hot water, or any cause that ex- cites the organs of circulation ? By the chemical hypothesis the accelerated respiration should tend to increase the heat of the body, whilst it flatly contradicts the vital doctrine of the " vis conservatrix," whose " counteracting " aid it enlists in thèse ex- tremities. (4) Is not increased respiration, in ail thèse cases, • owing to a principle which préserves a harmonious relation amongst the great organs of life ; so that, if the action of the (1) Op. cit. p. 152. (2) Ibid, p. 152. (3) Ibid. p. 152. (4) Dr. Edwards, Op. cit. Part 4, ch. 9 and 10. ANIMAL HEAT. 59 circulatory organs be preternaturally excited, the lungs, from their mechanical, as well as vital relation to the gênerai circu- lation, shall adapt themselves to the change ; and this, as the facts show, without the slightest référence to température ? Take an opposite case, that of fear. Hère the circulation and respira- tion are often greatly accelerated; but this is an instance in which the température of the adult subject actually falls. (See Vol. 1., pp. 410 — 414, 422.) Or another, in which it was found by Martine, that long fasting reduces the température of the body several degrees, although respiration continue unaffected. The diminution of the body corresponds with the diminution of the blood. The philosophy seems to be obvious. The organic actions are langfuid ; and heat, in common with the other secre- tions, is diminished in conséquence. The blood, however, is oxydized in the usual manner, and the same quantity of carbonic acid is evolved as in the well fed subject. (P. 16.) Whatever irregularities, in health or disease, may arise in re- spect to température, they are susceptible ofan intelligible expla- nation, in exact conformity with ail the other results of life, by modifications ofthe vital forces and their actions as carried on by the capillary vessels, and as appears to us, by no other philosophy. The foregoing contradictions, and varieties, appear, therefore, not to be reconcilable by the fundamental principle which has been assumed ; and which is brought into a more embarrass- ing attitude by those, who, like Dr. Edwards, mix up with the chemical, in partial subserviency, the doctrines ofthe vitalist when chemistry stumbles. (See Vol. L, pp. 48, 49, 75, 85, and Essay on Digestion.) Every law of nature, whether in the ani- mate or inanimate world, produces consistent phenomena. There may be some apparent, but no real exceptions. (Vol. L, p. 626, note.) Whenever this is denied, it is always for the purpose of building up a doctrine with which nature is at war, and which has no stability. If" increased respiratory movements and the production of animal heat stand related as cause and effect," in a chemical sensé, in any one instance, it is a fundamental phenom- enon, dépendent on a universal law, and should not be contra- dicted by any palpable exceptions. And hère we may mention the curious fact, that the respira- tion of pure oxygen gas depresses the température of animais,^) —but not more so than it lessens the products of other animal (1) Allen and Pepys respired it without inconvenience. 60 ANIMAL HEAT. functions. This should not be so, but exactly otherwise, (') if the chemical doctrine had any foundation. But in the forces of life we find a perfectly intelligible solution ; the interprétation being even supplied by the various coïncident results which at- tend the dépression of heat. It is stated by Dr. Edwards, that every new portion of air which enters the lungs not only abstracts an amount of calorie suf- firent "to raise the whole mass nearly to the température ofthe body;" but, "in virtue of this acquired élévation, whatevermay hâve been its previous hygrometic state, it converts into vapour the liquid with which it may be in contact." And it should be recollected, also, that " air in a frost contains scarcely any wa- tery vapour ; so that, when raised to an equal température with the air in summer, the quantity of liquid dissipated by evapora- tion is much greater," than when already charged with mois- ture. (3) There will then hâve been abstracted from the lungs the sum of the free calorie acquired by the air, and the latent calorie employed in converting the liquid into a state of vapour. According to the observations of Lavoisier, and Seguin, the loss by perspiration from the skin and lungs is in the ratio of two to one. (3) The vapour expired being, also, at a much higher tem- pérature than cutaneous perspiration, it is apparent that the lungs must be a powerful abductor of heat. But neither pulmo- nary evaporation, nor the respiration of cold air, are capable of varying, in any essential degree, the natural température of adult non-hibernating animais. It is even difficult to reduce the tem- pérature of the smallest adult warm-blooded animais. In the month of February Dr. Edwards confined five adult sparrows in glass vessels at an atmospheric température of 32° Fh. and covered the lid with ice. In the course of an hour, they lost, on an average, 7° Fh. — some having lost none. Their tempéra- ture then remained stationary to the end of the experiment, (1) This was once admitted ; and upon the strength ofthe hypothesis, Dr. Bed- does " slept equally well under fewer blankets than usual, after taking oxygen gas at going to bed"! and Dr. Thornton " restored warmth to the feet of a patient" by this gas. (2) Dr. Edwards, Op. cit. pp. 179, 263. (3) Trait, de Chim. p. 228. See, also, to the same effect, Swammerdam, de Re- spiratione, s. 1, c. 1, § 9, and c. 3, § 4 ;—Boyle's Works, vol. i. p. 103 ; — Harvey, de Motu Cordis.Ex. 2, p. 194, and Ex. 3, p. 232 ; — Fabricius, de Respiratione, 1. 1, c. 6 j — Bartholin, Anat. p. 430 ; — Morozzo, in Journ. Phys. t. xxv. p. 120 ; — Le Gallois, in An. de Chim. et Phys. t. iv. pp. 5, 113, and Sur la Vie, pp. 20, 241 ; — Spallanzani, de Respir. &c. ANIMAL HEAT. 61 which lasted three hours. In another like séries of experiments, in the mbnth of August, the mean loss was 2.9° at the end of the first hour. Ç ) The extraordinary fact that man and animais maintain, in the arctic régions, an equal température at ail seasons, is abundantly established : " The thermometer," says Capt. Parry, " for seventeen hours, ranged be- tween 54° to 55° below the zéro of Fh. during which not the slightest incon- venience was suflèred from exposure to the open air." " No unusual sensations were experienced during the winter, though in going from the cabins into the open air, and vice versa, we were constantly in the habit, for some months, of undergoing a change from 80° to 100°, and in several instances of 120° of température, in less than a minute ; and what is still more extraordinary, not a single inflammatory complaint occurred during this particular period." (2) Mackenzie says, that some of the northern savages follow the chase in the coldest weather with only a slight covering. (3) Lewis and Clarke state, that two Indians slept upon the snow during the night in a light dress, when the thermometer was 40° below the zéro of Fh. The man was uninjured ; the boy had his feet frozen. (4) Now it is évident that no civilized man could sustain such an exposure. The phenomenon is owing to the power of habit in its relation to the forces of life, and is utterly insusceptible of explanation on any other principle. In the arctic régions, are the rein-deer, musk-ox, bears, foxeSj hares, birds, &c. living also upon half-frozen food ; yet maintain- ing under those circumstances the same température as when transported to southern climates. It is also important to remark, that the respiratory movements become accelerated in the warmer climate. In fifteen out of sixteen foxes, the température was 100° to 1061°, in the other 98° ; the thermometer ranging from minus 3° to — 32° Fh. (5) Capt. Lyon found that the tetro albus main- tained its température at 50° below the zéro of Fh. (6) The (1) Op. cit. p. 82. (2) Journal of a Voyage, &c. p. 121. (3) Mackenzie's Travels in North America, p. 94. (4) Lewis and Clarke's Travels in North America. (5) Parry's Journal of a Voyage, &c. p. 157. (6) Lyon, Sur Températures de quelques Animaux du Nord, &c. in An. de Chim. et Phys. 1825, p. 223. See, also, Gmelin, Flora Siberica, Prœf. — Barlow's Chro- nolog. Hist. of Voyages into the Arctic Régions, c. 2 ; — Dr. Aikin, On the At- tempts to Winter in high Northern Latitudes, in Mem. Manchester Philos. Socy. vol. i. p. 89, second éd. — Philos. Trans. Abd. vol. iii. p. 470. (Ice froze on lakes 12 feet deep.) — Martine, de Similibus Animal, et Animât, calore, 1740 ; — Pallas, No- vae Species duadruped. et Glirium Ord. 1774, and Travels in Russia ; — Hunter, in 62 ANIMAL HEAT. same résistance of cold is seen in the whale, who maintains a température of 102° in the frozen régions. It was equally so with the smallest birds ; whilst it is obvious that the cooling in- fluence of the atmosphère on thèse small bodies should be in- comparably greater than on the larger animais that inhabit the same région, but whose température is alike fixed at a lower standard. And then, on the other hand, are the well known experiments of individuals subjecting themselves to an excessively high tem- pérature, without sustaining any sensible variation of their heat. This was fully demonstrated by Blagden, Banks, Fordyce, So- lander, G. Home, Dundas, Dr. North, Phipps, Seaforth, and Dobson, who exposed themselves to a température of 260° Fh. (]) As to high natural températures ofthe air, the effect would, a fortiori, be the same. At a very extrême degree of atmospheric heat, Gov. Ellis "could never raise the mercury above 97° with the heat of his body."(2) Similar observations were early made by Lining, and Adanson ; and they hâve since been so generally repeated, that it is well ascertained that neither climate nor sea- son make a greater différence than 1° to 2° Fh. ; and it is impor- tant to remark, as showing the entire independence of this phe- nomenon of respiration, that the change does not take place till such as remove from one climate to another shall hâve been for some time subjected to the new condition of vital stimuli. It is the resuit of acclimation, and trivial as it may seem, it is full of the most instructive illustration to a reflecting mind. (See Vol. I. p. 691.) Some individuals, like Dr. Franklin, hâve a constitutional température of 96°, which remains without varia- tion under ail circumstances of external heat. Again, the power of resisting heat and cold appertains to cer- tain animal substances that are devoid of organic actions. This Philosoph. Trans. 1775, p. 446, and 1778, p. 7 ; — Davy, in Edin. Philos. Journ. Jan. 1826 ; — Braun, Nov. Comment. Act. Petropol. t. 13, p. 419; — Skjelderup's Dis. sistens vira frigoris incitantem, 1803 ; — Bauer and Becker, de Effect. Calor. et Fri- goris exteri. (1) Philos. Trans. 1775, pp. 111, 484, 463. See, also, Dantz, Exp. Calorem Ani- mal. Spectant. 1754— Duhamel and Tillet, in Mém. de l'Acad. des Sciences 1764 ■ (at 290°.) —Berger and Delaroche, Exp. sur les Effets qu' une forte Chaleur prôd. sur l'Œconomie, 1806 ; — Crawford, in Philos. Trans. 1781, p. 479 •_ Van Mons in Journ. de Physique, t. 68, p. 121, 1809- Dantz, Exp. Calorem Animal. Spectantia, 1754. * (2) Philos Trans. 1758. p. 755. ANIMAL HEAT. 63 was proved by Mr. Hunter, in respect to eggs, " in a degree equal to many of the more imperfect animais." The fresh egg posses- ses, also, the power of resisting putréfaction,— which farther shows the existence of a common principle upon which those phenomena dépend. Ç ) This, indeed, is an instance which ap- pears to dénote an especial dependence of animal heat upon the vires vitœ ; whilst its greater évolution is seen in the movements of organization, like the other phenomena of life, to be the resuit of those powers in active opération. The former condition is more incompréhensible than the latter, since we hâve no évidence of organic action in the unincubated egg. Still it is no more re- markable than the laws upon which the phenomenon dépends. It is a beautiful proof, also, of the distinct nature of life when regarded in its connection with organic matter ; that its laws are spécifie, and that life is an active, not a passive state. (See Es- say on the Vital Powers, Sec. I. and on Digestion.) We see, then, in the foregoing démonstration of the power of ail warm-blooded non-hibernating vertebrata to maintain a uniform température under the greatest vicissitudes of atmospheric heat that are compatible with life, a proof of a most astonishing law ofthe living body, in perfect conflict with the laws of calorie as they exist in the inorganic world. We know it as exactly as we comprehend the nature and opération of the most précise law in physics. It is, in itself, démonstrative of the government of living organized matter by spécifie forces,—establishes a positive distinction be- twixt those forces and the organized structure. If we are not right in this induction, let the ground of objection be shown. We mean not the usual déniai. The objection must be founded upon a broad and philosophical survey of ail the phenomena of heat that relate to living matter as they may be modified by nat- ural causes, or by morbid states of the system ; and the ground must cover the gênerai physiological condition of organized be- ings. It would be an unmeaning jargon to say, that the gén- ération of animal heat is a chemical phenomenon, but dépendent on certain other variable powers ; more especially since the very existence of thèse powers is denied even by those who retreat to their assistance, as if for the purpose of magnifying an absurdity. It is évident, that the foregoing extraordinary principle is mainly connected with the vital forces of the solids,—that it is (1) Animal Economy, ut. cit. Exp. 39, 40, 41 ; also, his Lectures on the Principles of Surgery, p. 22, Phila. — So, Mayo, in Physiology, p. 64, and others. 64 ANIMAL HEAT. an indispensable élément of life in ail warm-blooded animais, and that the direct function of generating heat cannot be sepa- rated from it. The power of resisting putréfaction is scarcely more a fundamental law of the animal economy, than that of maintaining a uniform température, as it respects warm-blooded animais ; and there would seem to be as much reason for referring the former to chemical influences, as the latter, and a fortiori, of resolving the whole living being into chemical agencies. Again we revert to the cold-blooded animais, as supplying, by the contrast, an equal proof that respiration, and oxygen gas, are only remotely connected with animal température, and not in the least in a chemical sensé. Their température is prin- cipally regulated by the surrounding médium, since " it differs no more than one or two per cent, from the external air through- out the various seasons ofthe year."(') Frogs, &c, hâve capa- cious lungs, and their remarkable subjection, therefore, to external heat is completely subversive ofthe chemical hypothesis. Respi- ration, too, is as indispensable to thèse animais as to man ; and they equally perish when deprived of atmospheric air. In their ordinary state as much oxygen is absorbed, and as much car- bonic acid expelled, as by warm blooded animais. It is true, they are rather more tenacious of life ; but, this is owing to pe- culiarities of those forces by which life is constituted, whilst the variety itself adds confirmation to our whole doctrine. There is nothing in physics that will explain it. Thèse animais will live for a time in hydrogen and carbonic acid gases ; and in connec- tion with this fact, it is important to observe that their tempéra- ture, according to Spallanzani, Edwards, and others, is no more affected by them than by atmospheric air. The fact, therefore, that the vast tribe of cold-blooded animais respire equally with the warm-blood, and that carbonic acid is also exhaled, though in variable proportions, whilst they gener- ate heat but very feebly, appears to dénote a great independence of animal heat of the direct agency of the respiratory function in the warm-blooded animais. Still the fact, that cold-blooded animais possess in a low degree the power of evolving heat, even adds to the force of our conclusions. Mr. J. Davy, in his South- (1) Edwards, Op. cit. p. 197. — This is an extraordinary fact in the animal econ- omy, and strikingly exemphfies ail that we hâve said in relation to the modifications of the forces of life in différent gênera of organized beings. See p. 24 and vol i dp 650,696—698, Sic. ' ' ' vv' ANIMAL HEAT. 65 ern voyage, found " the température of ail the fish he tried above that of the water, by two or three degrees, Fh."(J) Hère, too, we should contrast the température of the whale 102°, and that of the porpoise 100°, &c., with the frog, turtle, &c. If you resort to constitution, you resort to the vital forces, and utterly abandon your own ground. You say, in one case, it is because they are cold-blooded, and in the others, because they are warm-blooded, and soon. Such, indeed, is the fact. But is it not because the or- ganization and vital forces are not adapted to the same génération of heat, in one case, as prevails in the other ; and this, too, where organization may be in a high degree simple, as in the bee 1 Nor can any explanation be founded upon any known différence in the function of respiration, the constitution of the blood, or the changes effected in that fluid. (See pp. 24 — 26, note) Cold-blooded animais respire, also, as we hâve said, by the skin as well as by the lungs, gills, &c, which, by its great extent in thèse instances, farther shows the design of this function for other more important purposes. Some animais, like the cobitis fossilis, swallow air, and thus respire by their intestines. Even the embryos of frogs, toads, sharks, rays, and the sword-fish, are provided with external bronchi. In mammalia, the respiratory function of the ovum is constituted by the circulation of the parent. There are, also, spéculations whether the placenta and iiquor amnios may not serve the function of respiration to the ovum, whilst it is affîrmed that the température of the ovum dé- pends wholly upon the parent. But whilst frogs, and other cold-blooded animais, are peculi- arly subject to the law which régulâtes the distribution of heat in the inorganic world, they possess, (we must repeat,) as shown particularly by Crawford, a feeble power of resisting its influ- ence ; since " a living frog acquires heat more slowly than a dead one." (2) And yet, with this palpable fact, combined with the subjection of living frogs to the physical law of calorie, and their large respiration, Crawford went on to construct his ingenious and élégant hypothesis of the dependence of animal heat upon chemical agencies. It is, however, one of the rare instances in which false inductions will always find a passport to well merited applause in their great ingenuity. Hère was an appa- rent exaetness conformable to the précise laws of chemistry, a (1) Lon. duarterly Journ. of Science and Arts, No. 3, Art. 26. (2) Crawford, in Philos. Trans. 1781, p. 485. Vol. ii. 9 66 animal heat. beautiful simplicity, a harmony of elementary parts, and no mix- ingup ofthe forces of chemistry with those of vitality, to ex- pound a simple phenomenon of nature. It will remain forever a most honorable monument to the human mind, whilst it will be equally a lesson to warn us of the dangers by which reason is surrounded. Again, let us contrast with the cold-blooded animais, that re- spire with lungs, some of the minute members of the insect tribe, which hâve a very inferior respiration. Thus, Dr. Martine found that the thermometer rose to 97° in a hive of bees.(x) A greater resuit was obtained by Reaumur. (2) Huber says that the heat of a large hive is upwards of 90° Fh.(3) Mr. Hunter found the thermometer raised to 93° and 98° in a hive, in spring,—to 104° in summer,—to 82° when the air was at 40°, and to 73° in win- ter. (4) Newport's observations hâve been somewhat différent ; but he has ascertained that the law established by Dr. Edwards, or rather illustrated by him, that young animais hâve a more feeble power of generating heat than the mature, is equally ap- plicable to insects.(5) He also found that the power of genera- ting heat is exalted during their breeding season,(6)—though it might hâve been more difficult to ascertain that the amount of heat evolved is in proportion to the quantity of air respired. This phenomenon, we shall see, corresponds with our observa- tions upon vegetables. This observer states another fact, still more important to our views. He found that the température of an insect, which was similar to that of the surrounding air, sud- denly rose 20° Fh. when irritated, or became active from any cause. So précise are the laws of nature, that upon this simple fact alone it would be safe to found a gênerai induction as to the dependence of animal heat upon the forces of life. Nor is this principle in the least invalidated by the various modifications which occur, till we meet with some analogy in the cold-blooded animais, as it respects the law of slow communication of heat in the inorganic world. For, however frogs, &c. may be liable to the opération of that law, the principle is within themselves that is necessary to ail the emergencies in relation to the génération (1) Essays Med. and Philosoph. 1740, p. 331. (2) Hist. Nat. des Insectes, t. v. p. 360. (3) Mém. sur les Abeilles t. i. p. 305. (4) Lectures on the Principles of Surgery, p. 77. ' (5) On theTemp. oflnsects, &c. 1837. (6) Proceedings ofthe Royal Society, No. 28, June 15, 1837. animal heat. 67 of heat. And, since their organic processes are as well carried on at low as at higher températures, and the latter is no spécial embarrassment, we hâve not only a proof that heat is compara- tively unimportant to the cold-blooded race, and of a correspond- ing modification of the calorific function, but an élégant démon- stration that Unity of Design is never at fault ; since, thèse ani- mais being greatly abstracted from the uses of calorie which obtain in the warm-blooded race, nature has left them, in a measure, to the laws of calorie as they operate in the inorganic world. (See Vol. I. p. 67.) Dr. Buckland has been often commended for his philosophy in deducing the existence of light, at the era of the trilobite, (that first of created animais according to the geologists,)^) from the discovery of its eyes. This was well, — and perhaps a stretch of philosophy for one who may be supposed, without impugning his genius or knowledge, to be, like the chemists, but imperfectly acquainted with the science of physiology. It would hâve been, however, still better, had not Dr. Buckland afterwards exploded the light, and substituted "darkness," and an "atmosphère of dense vapours." And better still would it hâve been, had he not placed thèse ancient animais, and the vegetables which com- pose the great coal formations, "exactly organized like others of our own day,"(2) in an atmospheric température, that would, within the tropics, solidify an egg in three minutes. This is the plain statement of the important subject before us. Should a physiologist, who might hâve first discovered the frag- ment of a solitary palm leaf, organized like a leaf of the existing day, down in a granité rock within the polar régions, and ano- ther in a similar rock within the tropics, hâve inferred the exist- ence of a température of 215° Fh. within the tropics, to explain the appearance of the leaf in the northern régions ; or, should he hâve denied the existence of the same light and the same atmos- phère as now prevail, to rear up some hypothesis to explain other ill-digested facts, he would be held guilty by his compeers of a flagrant violation of three of the most fundamental laws of nature ; and, as a physiologist, would be considered in the high- est degree visionary. Whatever may appear to conflict with the laws that relate to organized matter must be laid aside for a farther development of facts. Better dérange " the music of the sphères," than disturb (1) See Bakewell's Geology, p. 24, 1839. 12) Buckland's Geology, ch. 2, &c. 68 animal heat. the fundamental laws of living organized matter. No philosophy can stand it for a day, that comes in conflict with the principle which we hâve fairly, though strongly, expressed. It has been often attempted ; but the assailants fell by the recoil of their own weapons. The subject which we hâve thus far investigated possesses pe- culiar clairns upon the physiologist, and presses him to the res- cue. It is one of no trifling import, since, more than any other, it has been employed to demolish the most stupendous and sub- lime system of nature. If the forces of chemistry were the foun- dation of animal heat, it would be a fair analogical induction that every other vital process is equally so, and the science of life would be condemned to the laboratory, and medicine would [be a burlesque upon the human mind. In examining the merits of this subject, we hâve found it most useful, as is our custom, to take with us the experiments, the ob- servations, and conclusions of one or more philosophers who differ from ourselves. If the right, therefore, be at any time upon our side, we get rid of a formidable barrier which is constituted by the facts and arguments of powerful opponents ; especially when we may eonvert their facts to our own views of the truth, In this essay we hâve taken, particularly, Dr. Edwards as our companion ; since we hâve thought it important to remove the difficulties which his genius has created. Nor is it a spécial ob- ject with Dr. Edwards, in his work, to establish the chemical hypothesis of animal heat. He aimed at practical results from his experiments, and often reasons as a vitalist. We hâve there- fore mainly regarded those experiments as they affect the chem- ical doctrine,—but little in their practical relations. The ex- periments, too, are ofthe greater value, since they hâve no favour- ite hypothesis in view, however they may hâve for their secondary object the chemical theory whenever difficulties may not require the substitution of the vital. (See our Vol. I. p. 52.) SECTION IV. We hâve seen that Dr. Edwards, unlike most ofthe chemical philosophers who hâve treated of animal heat, calls to his aid the "constitution" of animais to explain certain anomalies which ANIMAL heat. 69 defy the chemical hypothesis. We hear much about the " power of the system to generate heat," without being let into the secret in what that constitution, and that power, consist. To allow that the forces of life hâve a large and uniform share in the gén- ération of animal heat, would make a répulsive medley, in its connection with the chemical hypothesis. Now that " constitu- tion," and that " power," are something more than idéal ; some- thing différent from the organized structure ; for, in the latter case, many variable phenomena, in adults, proceed from unvary- ing conditions of structure. Let us inquire, then, a little farther into the nature of " constitution," and the " power of generating heat according to the constitution." We hâve not specially connected with the considération of this subject those influences which are said to arise, under par- ticular circumstances, from the relative proportions of air that may be actually consumed. Thèse cases, however, come under the gênerai rule. Where less air is consumed, if it be owing to the youth of an animal, it dépends on constitution, and it is the nature of the constitution, not the proportion of air, which makes the différence in the ability to maintain a uniform température when cold is applied. But, if young animais consume less air than adults, it is sufficient, in a temperate air, to maintain their naturally high température ; and when cold is applied, the accél- ération of respiration far beyond that of adults under similar cir- cumstances, should at least protect them against a décline of tem- pérature to that nearly of the surrounding médium, were there the slightest foundation for the chemical hypothesis. Just so is it with ail the varying conditions of animal heat. In health, the varieties are owing to peculiarities in the natural condition of the vital properties ; in disease, they arise, like ail the other changes, from morbid altérations of those properties ; and, if the blood sustain any want of its proper influences from defect of respiration, this will contribute towards the modifica- tions of température, in the same way that it affects the other re- sults of life, and, we apprehend, in no other. Although Dr. Edwards dérives some illustrations regarding the connections of the phenomena of animal heat with respira- tion, from certain morbid conditions of the body, as in asphyxia from carbonic acid, syncope, the cold stage of intermittents, &c", yet it is manifest that he looks upon disease as supplying facts which it is prudent not to investigate. " The question now is," 70 ANIMAL HEAT. he says, «what is the influence ofthe respiratory movements on the température ofthe body, when they are raised beyond the rate of health ? We cannot answer this inquiry by observations on the sick. The circumstances are then too comphcated to admit of our deriving conclusions from them." ( ) In this conclusion we do not at ail agrée. It is an unwarrant- able abandonment of nature for the contrivances of art. They are conditions, which, above ail others, give us a due to the true philosophy. The vital forces are altered by disease, and with them there is a change in ail the phenomena and results, of which the modifications of animal heat are one. Hence, it appears to us, that a very obvious " conclusion " may be deduced. In the experiments of reanimating the torpid hibernating ani- mais in an atmospheric température of 3.7° Fh. below the freez- ing point, the température of a bat rose from 39° to 80.6° Fh.; that of a hedge-hog, from 37.4° to 89.6° Fh.; that of a dormouse from 37.4° to 97° Fh. Upon thèse experiments Dr. Edwards re- marks, that " the external température had nothing to do with the restoration of the animal heat." This was plain enough ; but not so clear our author's induction of the fundamental law that they " thereby show that the increased respiratory move- ments and the restoration of heat stand related as cause and effect." But external heat, as we hâve seen, also accélérâtes the respi- ratory movements of vertebrated animais, — the hibernating, as well as others. " It is a gênerai phenomenon," says Dr. Edwards. "We then extend our re- lations with the air, and increase its vivifying influence. The respiratory move- ments become more rapid or more extensive, and thus more air comes in contact with the lungs in a given time, and réanimâtes what the heat depresses. This increase of respiratory movements is necessary to counteract, at least for a time, the effects of external température." We hâve already examined the conflicting nature of the fore- going facts, and hâve shown upon what common principle the température is exalted in the former, and either depressed, as in fever, or maintained, when natural, at nearly a uniform standard, in adults. Again : " Hère, then, are several cases," (alluding to a séries of expérimenta,) " in which the accélération of respiration above the type of health may hâve a sensible effect upon animal heat. In the first, the température of the body falls under the influence of the cooling cause ; but, by the réaction in question, (1) Op. cit. Part 4, c. 10. ANIMAL HEAT. 71 it rises a little, without however, being restored, and may afterwards faïl lower, presenting fluctuations. In the second, it diminishes, and afterwards returns to the point ofdeparture. Lastly, in the third, it does not f ail, and can not only support itself, but even rise above what it was at first." "There are individuals among hibernating animais which do not become torpid in the season of hibernation ; a fact frequently observed in the domestic state. It is sufficient in this case, that their power of producing heat should be increased ; a power, in ail animais, susceptible of varying between very distant limits. This change can be even produced at pleasure, in some, by suitàble food, and a graduated température." " When the faculty of evolving heat is not the same, the vitality will be dif- férent. Tirst, the relation to the external température will be changed. The need of warmth and the power of supporting cold cannot be the same where the internai source of heat has not the same activity." " A potent chill," in a particular case of exposure to cold water, " acted on the faculty of gênerating heat, producing a sensible diminution in it, greatly exceeding in duration the length of time in which the cold was applied." " The calorific function had not acquired ail its lost power." " Warm-blooded animais may be divided into two classes, in regard to the influence of the seasons ; viz. those whose constitution is perfectly in harmony with the climate, and those whose constitutions are not adapted to it. The first undergo changes corresponding to the season, which allow them the free use of their powers, and that enjoyment of life which constitutes health. Ac- cording as the température falls, their internai source of heat increases, until it attains its maximum in winter, and afterwards déclines with the élévation and duration of the external température. Hère, then, is a new élément which should enter into the explanation of the uniformity of animal température." " But the system only acquires this power of accommodating itself to the external température with the slow progress ofthe seasons. In summer, a degree of cold, which we bear in winter, would take the body, as it were, by surprise and unpre- pared. The power of producing heat being thus reduced to its minimum, the loss would be insufficiently repaired. In this respect, our states in summer and winter differ in the same manner, though not in-the same degree as young ani- mais differ from adults. In the former, the increase of the power of producing heat takes place through the progress of organization while under the influence of a mild température ; in the latter, by the influence of cold in degree and duration suited to their constitution." " Thèse changes, however, do not take place in ail animais. There are some whose constitution is not adapted to so great a range of external tempe- rature. The cold which they can sustain without inconvenience is much less, because they hâve not the same resources for repairing the loss of heat When reduced below this limit, a fall of température produces an effect the reverse of what has been above described. Instead of increasing the production of heat, it diminishes it." Q) The work from which we hâve thus quoted abounds with similar practical facts, ail of which concur in referring the gene- (1) Dr. Edwards, Op. cit. Part 4. ch. 2, 3, 5, 9, 10, 17. 72 ANIMAL HEAT. ration of heat to the vital forces, whilst they unequivocally dem- onstrate the existence of such forces. There is no possibihty of explaining them by any other facts or analogies, and, therefore, by none of the laws which appertain to the inorgamc world. They are perfectly sui generis ; completely isolated from every phenomenon in the world of dead matter. As to the vicissitudes that are occurring in the relative power of evolving heat in summer and winter, they hâve mamfestly not even an indirect connection with respiration, but dépend en- tirely upon différent modifications of the vital forces. Respira- tion is even more accelerated in summer than in winter, whilst it is said the power of generating heat is diminished atthe former season. (*) In respect to the natural différences in constitution that are* denoted by apparently contradictory facts in relation to animal heat, they are as clearly constituted by natural modifications of the same forces, which are as much, or more influenced by other causes than by respiration ; whose power of evolving heat in young animais is greatly and rapidly depressed by the opéra- tion of cold, notwithstanding the respiration is accelerated during the first stages of the décline of température ; but which, again, as the same animais advance in life, acquire the power of com- pletely resisting the same cause without the former accélération (1) We think that this can only be admitted in a qualified sensé. There is actu- ally more heat generated in summer than in winter under equal and natural circum- stances of atmospheric température, and ^especially when the température is low in the latter season. The différence arises from greater vascular excitement during the heat of summer ; and the uniformity of animal heat is then maintained in part by increased evaporation from the skin. De la Roche, and others, by placing animais in a heated atmosphère charged with moisture, raised their température several de- grees. On the other hand, the vital forces are so modified by the stimulus of heat, that when cold is suddenly applied, there is a Iesser évolution of heat than under equal circumstances in winter. The différence, therefore, is constituted by a différ- ence in the susceptibilities of the vital forces to the action of différent causes, at dif- férent seasons, from which resuit variable phenomena in respect to animal heat. It does not, therefore, appear to us proper to say that the power of generating heat is greater in winter than in summer; especially since the génération of heat is actually greater in the latter season, nor will atmospheric heat develope more animal heat at the former period. Power is wholly relative in thèse cases, and is only a contingent resuit ofthe opération of différent stimuli upon the forces of life, and varies at différ- ent seasons according to the nature of those stimuli. It is increased by the heat of summer whilst heat is in opération ; but more greatly depressed at that season by the sudden application of cold, than in winter. Thèse phenomena are insusceptible of explanation but through the médium ofthe vital forces. ANIMAL HEAT. 73 of the respiratory movements ; " the animais thus passing from the state of cold-blooded to that of the warm-blooded," whilst in the hibernating mammalia, diminution of heat still goes on al- though respiration hâve come to a stand ; or, when the cold be- comes intense, is carried to its highest pitch by the very cause which had produced its great décline ; which maintain an almost unaltered state of heat when the respiratory movements are greatly accelerated by external heat, and resisting equally the heat of the surrounding médium ; which actually abate the exalted heat of fever ; which are so influenced by season, that their power of producing heat is said to be less when its production is greatest ; which power " may be varied, in some, by suitable food and a graduated température ; " which " is generally diminished in nat- ural sleep, though modifications occur which change the rela- tion ; '' which is so modified in the choiera asphyxia, that the température may greatly fail whilst respiration is accelerated, and the lungs free from congestion ; or, is imdiminished in as- phyxia from carbonic acid, " when the respiratory movements are no longer seen ; " (') or, may attain, as in apoplexy, preternat- ural vigour after respiration and circulation hâve entirely ceased. " Constitution," then, and the " power of generating heat," manifestly relate to the vital forces, and to nothing else. The united opération of thèse powers, through their instruments of action, results in the élaboration of bile, gastric juice, heat, &c., from the blood. That particular détermination by which they eliminate heat, in ail parts of the body, may be called a law, though it is but the joint resuit of the vital powers, concurring in a certain manner to a spécifie effect. The resuit is variously affected by climatç, season, the quality and quantity of food, stim- ulants and sédatives, cold or warm air applied externally or to the lungs, by morbific agents, and other causes ; or, as the vital for- ces happen to sustain peculiarities in relation to individuals, âge, &c, so will the génération of heat be modified when respiration is exactly the same ; and along with those modifications of heat are variations, more or less coincident, of other products. The causes are obvious from the effects. The former are few and simple ; the latter are diversified without end. Most of the reasoning which abounds in authors who believe animal heat to dépend specifically upon respiration, or the resuit (1) Portai says that the heat has been known to remain very high in thèse cases, as in apoplexy, for many hours after death. — Sur l'Apop, VOL. II. 10 74 ANIMAL HEAT. of a chemical process, consists in reconciling difficulties by re- ferring them to the vital powers, and sometimes to the entire exclusion ofthe chemical hypothesis. True, they do not say vital powers. They would otherwise be non-conformists. They speak of "constitution,"—"the power of evolving heat," —yet turn into ridicule the only true philosophy, and the only possible thing which they themselves can mean. If they hazard the " term vitality," it " is employed for the want of a better," but " without any connection with the mystification which sometimes attends . its use ;" whilst others, like Dr. Elliotson, can see nothing in " animal heat," " but a peculiar state only :" and hère, as in the case of " vitality," Dr. E. " adopts the common language in speak- ing of animal heat," to make the subject intelligible. (Vol. I. p. 49.) It is from the blood, like ail other animal products, that heat is derived. And since decarbonization, and, perhaps, an absorp- tion of oxygen, is indispensable to the healthy performance of ail other functions, it is doubtless important to the génération of heat ; though manifestly less so in the latter instance, since we see the évolution of heat sometimes going on when respir- ation is nearly, or quite extinct ; whilst, in the cold-blooded animais it exerts but little, if any, influence upon température. Decarbonization of the blood, and probably the absorption of oxygen, are among the numerous processes by which its vivifi- cation is perfected, and by which it is prepared for an élaboration of the various animal products, and in animais of a certain con- stitution for the évolution of heat. When respiration ceases, • ail the most important functions immediately fail ; but it is re- markable that the évolution of heat appears to be the very last We conclude, therefore, that the élaboration of animal heat, and ail other sécrétions, are on a par in regard to principle. It is true, a certain proportion of latent heat may be extricated by the conversion of blood into the solid parts. But this would be counterbalanced by a corresponding change ofthe solids, particle for particle, into fluids. This appears to us to be fatal to a late doctrine which imputes animal heat to this cause ; as well, also to the condensation of gases. (') Besides, what becomes of the principle of condensation where the température rises after appa- rent death ? (P. 31.) Where is oxygen gas ? (1) It is said by an able writer, that « there is much évidence to prove that ani- mal heat is principally maintained by the chemical changes constantly takin* place in the tissues.'' (a) (a) British and Foreign Med. Rev., Vol. 5, p. 105,1838. ANIMAL HEAT. 75 SECTION V. We shall now state some experiments which we hâve made for the purpose of advancing this inquiry. It is well known that hibernating animais may be roused from their state of torpor by simple mechanical irritation. We had projected an experiment of rousing them by means of electricity, whilst they were surrounded by carbonic and hydrogen gases at a température below the subdued heat ofthe animais. But having failed of obtaining such an animal, we substituted new- born puppies. A rapid succession of strong sparks were passed through the body from head to tail, and although there was a sensible élévation of the thermometer, we do not rely upon the resuit. The experiment should be tried upon a hibernating animal, which should be in a state oîperfect torpor. If a mar- mot, in a torpid state at a température of 30° or 40° Fh. be .de- prived of atmospheric air, or even enclosed in a receiver with carbonic acid, at a much higher température, (53°) he will hâve sustained no injury, " nor," according to Edwards, " hâve shown any sign of uneasiness at the end of four hours." (') Spallanzani makes the same statement ; but complète torpor was maintained. He then established a slight respiration, and again put the ani- mal into a jar of carbonic acid; when it perished, as we infer, in a short time. (3) Mr. Hunter's experiments on the température of trees hâve àppeared to us décisive of the philosophy of the production of heat by organic matter. Some doubt, however, has been thrown upon their accuracy ; it having been assumed that the interior of an object so large as a tree would be more or less protected against the cold by the exterior. (3) We, therefore, undertook a séries of experiments of the foregoing nature. We selected periods when vegetable life was becoming progressively active, and before the development of leaves. On the 9th of April, 1839, we repaired to a forest in New- Ci) Dr. Edwards, Op. cit. p. 137. (2) Sulla Respir. Mem. ter. t. v. s. 11, 12. (3) See London Med. and Phys. Journ. No. 271, p. 265. 76 ANIMAL HEAT. Jersey, provided with very délicate thermometers, of Fahrenheit's scale, constructed for our object. The bulbs were no larger than the stem, the range of the mercury extensive, and the de- grees marked upon the glass. The stems filled exactly the bore of a small spiral augur ; and when the glass was introduced, the air was excluded by applying a silk handkerchief around the hole. The perforations were ail made on the northern side of the trees. Fifteen minutes, at least, were allowed for the subsi- dence of heat that arose from the friction of the perforator ; and the thermometer was generally reapplied at différent intervais afterwards. The perforations were made about four feet above the ground, and the diameters of the trees were ascertained at this part. When the diameter was five inches, or more, the per- forations were made to the depth of 2£ inches. When the diam- eter was less than five inches, the thermometer was introduced as far as the centre of the tree. Ail the observations are given that were made. Range of the thermometer in the shade, during the observa- tions, which lasted six hours, from 38° to 52°. Near freezing at sunrise. A dead, upright, dry tree was selected as a standard of com- parison. Its diameter was 12 inches. The température of this tree, at the close of our observations, was 45° at the centre, and in ail other parts. Juglans squaraosa, diameter 10 inches, 48° Buds slightly enlarging. Do. do. » 6 u 49° do. Fagus sylvatica, 10 II 49° Buds swelling. Quercus tinctoria, « 7 II 49° No budding. Castanea Americana, 12 <« 50° do. Betula nigra, 4 (( 51° Flowering. Salix Babylonica, 18 i( 53° Buds unfolded. Do. do. 18 11 53° do. Pinus Canadensis, 18 II 54° Platanus occidentalis, 18 II 50° No budding. Do. do. 6 II 54° do. Do. do. 4 (( 55° do. Juniperus Virginiana, 4 II 55° Robina pseudacacia, 3 II 62° do. Populus lsevigata, 4 (1 62» In bloom. Do. do. 4 It 64° do. Do. do. 3 II 63° do. ANIMAL HEAT. 77, Populus lsevigata, diameter 3 inches, 65° In bloom. Do. do. « 2 « 67° do. Do. do. « lf « 68° do. Believing that if our doctrine of the génération of animal heat were correct, we should find an élévation of vegetable heat as the warmth of the season increased, and the energy of vegeta- ble life became more exalted, on the 19th of the same April we made another visit to a forest upon the island of New-York. The same method was observed as on the preceding occasion, excepting in the perforation, which was always two inches when the diameter exceeded four inches ; otherwise it penetra- ted to the centre. Weather cold, and rainy, since last observa- tion. Range of the thermometer in the shade, during the observa- tions, which lasted five hours, from 40° to 65°. Température of two dead, dry, upright birch trees, one eight inches in diameter, the other six inches, at end of observation 60° in ail their parts. Température ofthe earth six inches below surface 47° in shade, at close of observation. Betula nigra, diameter 15 inches, 54° Buds swelling. Platanus occidentalis, ii 6 u 59° do. Quercus virens, u 8 ii 62° do. Do. do. ii H ii 73° Buds much more advanced. Do. tinctoria, n 18 u 65° Buds swelling. Do. do. u 6 u 66° do. Juniperus Virginiana, ii 5 u 64° Do. do. u 2 u 79° Acer rubrum, ii 12 ii 65° In bloom. Castanea Americana, n 4 u 66° Buds swelling. Cornus Florida, n 2 u 68° ) Flower-buds advancing ; \ no leaves. Fagus sylvatica, ii 12 u 68° Buds opening. Juglans alba, ii 4 u 75° Buds swelling. Do. do. d 1 ii 83° Buds larger. Do. do. n l ii 82° Buds opening. It is abundantly manifest from the foregoing observations that vegetables possess a vital power of generating heat, according to the activity of their organic forces ; and we carry the analogy to the animal kingdom. The température was not influenced byjthat of the earth, as seen by the preceding statement. The heat of the latter, however, was not ascertained at the first ob- 78 ANIMAL HEAT. servation. It appears, also, that « the power of generating heat is greatest in proportion to the youth of trees. This remarkable fact is not only especially indicative of the vital agencies in the génération of vegetable heat, but is worthy of notice on account of its opposition to what obtains in the animal kingdom in re- spect to âge. It corresponds, however, with observations upon herbaceous plants, where nutrition is more rapid. The différ- ence dépends upon the relative différence in organization at the corresponding periods of life. We hâve made no observations upon the température of herba- ceous plants, thèse having been already ample, and superseding, indeed, the necessity of the foregoing. Senebier saw the ther- mometer rise from 79° to 143° Fh. when placed in the midst of a dozen spathes of the arum cordifolium at the time of opening the sheaths ; and Huber, from 21° to 42° cent., the atmosphère having been, in either case, at the first mentioned degrees. (') (1) Op. cit. — See, also, Mayo's Physiol. p. 79 ; and Ellis on Respiration, p. 204. PHILOSOPHY OF DIGESTION. " Quiconque de natura humana amplius diserentes audire consuevlt, quam ejus ad medicinafn pertinet, huic non est commodum hune meum sermonem audiré." — Hippocrates de JVat. Hotn. "The opinions most generally received in physiology, those consecrated by the assent of ail cele- brated authors, often rest upon very uncertain foundations." " Examine ail the physiological and ail the pathological phenomena, and you will see that there is no one which cannot be ultimately referred to some one ofthe properties (vital) of which we hâve spoken." — BichaT's Anat. &c. (1) " Digestion is very différent from chemical solution, which is only a union of bodies by élective attraction, not a real change ofthe substances themselves, but of their properties. But, digestion is an assimilating process. It is a species of génération, two substances making a third ; but the curious circumstance is its converting both vegetable and animal matter into the same kind of substance or compound, which no chemical process can effect." « "Those who took it up chemically being ignorant ofthe principles of the animal economy, bave erroneously referred the opérations ofthe animal machine to the laws of chemistry." — Hunter's Observations on Digestion. " The changes which take place in the substances capable of giving nourishment, and therefore of being converted into the essential parts ofthe chylo, are totally différent from those changes which take place any where but in the stomach, duodénum, and jéjunum, when alive ; therefore no exper- iment made any where, excepting in thèse intestines of the living animal, can in the smallest degree influence tke doctrine of digestion." " Food, placed in ail the chemical circumstances that can be conceived similar to those in which it is placed in a living stomach, will never be converted into chyle, but will undergo other changes totally différent." — Fordyce on Digestion. " Spallanzani sort de l'estomac des animaux et du sien propre, pour former un estomac sur sa table." — Considérations sur la Méthode de l'Abbe Spallanzani, in Œuvres Spall. (2) "The application of principles requires more than simply the knowledge of the principle itself; and therefore those who cannot reason from analogy, or draw gênerai conclusions from a few con- vincing facts, and who require to hâve every relative conclusion or inference proved by an experi- ment, however unnecessary or fatiguing to the reader, must be pleased with Spallanzani." " We can hâve no very high idea of experiments made by gentlemen, (chemists,) and priests, who for want of anatomical knowledge, hâve not been able to pursue their reasoning even beyond the ■impie experiment itself." " There are in nature's opérations always two extrêmes ; and the mind of man eagerly adopts that which accords with some principle he isfond of, and with which he is best acquainted : but the in- termediate connections and gradations, being less striking, do not forcibly affect the superficial inquirer.1' — Hunter's Observations on Digestion. " If from great Nature's, or our own abyss Of tlre^ght, we would but snatch a certainty, Perhaps m^nkind might find the path they miss — But then 't would spoil much good philosophy. One system eats another up, and this Much as old Saturn ate his progeny." — Byron, fl) Vol. i. pp. 17, 445. — We nie the American éd. of 1822 ; and the Parisian of 1813. (2) T. ii. p. 334. 80 PHILOSOPHY OF DIGESTION. " The geniusef Hunter long ago explained the objections to other théories of digestion. Thèse hâve been turned into ridicule to smooth the way for hypothèses that hâve no better foundation. - Carswell in Hebdom. de Med. 1829. " In the depths of Physiology subsists an invisible world."-Dr. Hake on the Organic Corpuscle. Like the forges of Vulcan, every part is animated, and nothing moves or is struck into existence but by the agency ofthe vital forces.— " NATURE non hominis." Having hitherto seen that the various processes of life, and ail their results, whether healthy or morbid, with the single excep- tion of digestion, dépend exclusively upon powers which hâve no analogies in the inorganic world, but with which they hold an absolute hostility, we might safely conclude that the same powers are equally concerned in the initiatory step which pré- pares the material for ail their subséquent opérations. Yet, is this especially the ground upon which chemistry has reared its batteries, and from which it sends forth its artillery into the va- rious dominions ofthe organic world. Yet, is it hère, that vitality is exemplified in its most impressive and astonishing aspects, and where unequivocal démonstrations abound that fluids, as well as solids, are endowed with the principles of vital opérations. Fi- nally, it is hère, especially, that nature has illustrated her distinc- tion between the animate and the inanimate world, and established her chain of connection. The chemical doctrine is thus laid down by one of the most able and illustrious in the field of science. It has also the merit of being set forth to illustrate " the Power and Wisdom of God." « lst. The stomach," says Dr. Prout, » has the power of dissolving alimen- tary substances, or, at least, of bringing them to a semi-fluid state. This ope- ration seems to be altogether chemical. " 2d. The stomach has, within certain limits, the power of changing into one another, the simple alimentary principles ;" and " this part of the opération of the stomach, appears, like the reducing process, to be chemical ; but not so easy of accomplishment. It may be termed the converting opération of the sto- niach. «3d. The stomach must hâve, within certain limits, the power of organizing and vitalizing the différent alimentary substances." «It is impossible to ima- gine, that this organizing agency of the stomach can be chemical. The agency is vital, and its nature is completely unknawn." (') We would first inquire, although not very relative to our sub- (1) Chemistry, Meteorology, and the Function of Digestion, considered with ref erence to Natural Theology, b. iii. c. 3. PHILOSOPHY OF DIGESTION. 81 ject, how the foregoing account of the process of digestion en- larges our views of the " Power and Wisdom of God," any more than the ordinary process of putréfaction 1 Nor is this at ail an extravagant comparison ; for it has been seriously affirmed by the chemists, that the putréfaction of a muscle results in a substance resembling chyme. (') It is certainly true, also, that the same Power was necessary to establish those agents upon which putré- faction dépends, as the more exalted powers of life ; and the same Omnipotence is as positively manifested in an insect as in man. But the finite compréhension of the human mind is just as much enlightened as to the Power of Omnipotence by the contempla- tion of an ascending séries of principles upon which the various phenomena of nature dépend, as by tracing the analogous illus- trations of Power from the simplest éléments of matter up to the most perfect of sensible existences. It appears to us, indeed, that it is rather the laws, than the mechanism of nature, which most excite our adoration of its Author. There is more to admire in the opération of the principles which unité into atmosphère air and nitric acid the éléments of which they are composed, than in the éléments or the combinations themselves,—more in "the music ofthe sphères" than in the vast sublimity ofthe individual objects,—more in the powers which carry on the functions of organized matter, than in the organization itself. What were nature without its animation ? But this is nothing more than an émanation, in connection with matter, from the forces which we are considering. We believe the distinguished author whom we hâve quoted expresses the prevailing doctrine; which makes the reluctant admission, that the chemical product is in some mysterious way imbued with the properties of life. We say reluctantly, (Vol. I. p. 48,) because of the doubt which is raised by our able author, as well as by most others, in simultaneously adverting to the chemical process, and especially from the déclaration that " the nature of the vital agency is completely unknown." Now the nature of this agency is no more concealed than that of the chem- ical forces by which digestion is supposed to be wholly performed. We know nothing more of the latter than what we gather from their effects ; and since the results of the vital powers are incom- parably more diversified, we should be even better informed of their nature, and more certainly assured, as we hâve otherwise (1) Dr. Davy, ut cit. VOL. II. 11 82 PHIL9S0PHY OF DIGESTION. endeavoured to show, of their existence as something distinct from the matter which they animate. See Essay on the Vital Powers. Since, therefore, it is çonceded by philosophers who défend, in extenso, the chemical hypothesis of life, that there may be something appertaining to the stomach totally distinct from the chemical powers, and which is capable of imbuing the chyme with vitality and organization, it is quite a philosophical con- clusion, that this vital something has an important agency in preparing the material for the admitted exercise upon it of its vivifying or organizing power. Nor can we see any valid ob- jection to the supposition that this vitalizing power, which so far transcends the chemical forces, may not be fully adéquate to any transmutations the food may undergo ; and this induction is the more corroborated by the considération that matter already in an organic state must be better fitted for the process of vivifi- cation, than it can possibly be after its éléments are broken up and> recombined by forces with which those of life are in abso- lute opposition. Besides, the vitality of the gastric fluid, or the vital influence ofthe stomach itself, (') being fully admitted, and even capable of organizing the food anew, this, in itself, should protect the alimentary matter against any chemical agencies which hâve been supposed to operate. That this counteracting power, indeed, prevails to the full extent which we allège, appears to be rendered certain by the ordinary absence of any variety of chem- ical changes where numerous substances are mixed together in the stomach, and thèse often possessing strong affinities for each other, and their opération promoted by a high température. It cannot surely be that any feeble acidity ofthe gastric juice should not only surpass those affinities, and counteract the admitted (1) Although the gastric juice be the principal agent in the process of digestion, we know of no good objection why the stomach itself may not cOoperate in a direct manner. It is an untenable ground that we do not understand the modus operan- di. (a) The same, as we hâve said, may be affîrmed of every effect. It is not hère, as in chemistry, where the forces which operate out ofthe living body are the subjects of more précise démonstration ; nor do the latter supply any analogies from which we may reason to the results of organized matter. In the latter case, how- ever, we hâve an apparently strong analogy in the maintenance of vitality in the re- duced alimentary matter, or in blood, by its simple contact with the parietes of a large blood-vessel, or even with the cellular tissue. But that chemical décomposition shall be thus delayed, the substance protected mu3t possess vitality, since a correspond- ing effect is not exerted upon dead animal muscle. This, too, we hold to be another proof ofthe vitality ofthe blood. (a) See Bostock's Physiology, vol. ii., c 10, $ 4, p. 409. PHILOSOPHY OF DIGESTION. 83 vital influences, but résolve the heterogeneous mass into a ho- mogeneous substance. Chemistry must hère be consistent with itself, and not renounce, for the sake of hypothesis, those précise laws by which in its legitimate pursuit it lays open, with aston- ishing exactness, what had àppeared the arcana of nature. Hère, too,is presented an instance in which it must be necessarily assum- ed that the properties of life and the forces of chemistry must act together in concert in converting dead into living matter — one destroying and the other vitalizing; whilst the assumption is contradicted by ail that is known of the relations of thèse forces to each other. (Vol. I. p. 32.) Nor do we see with what reason it can be maintained that more is necessary to the various functions and results of living matter than the vital properties ; since it is admitted by the strongest advocates of the chemical hypothesis, that it will not explain a single phenomenon of life ; or, in the language of Dr. Prout, " There is no reason why the chemical changes of organization should result from the mechanical arrangements by which they are accomplished, neither is there the slightest reason, why the mechanical arrangements in the formation of organized beings should lead to the chemical changes of which they are the instruments." (l) It will he also readily conceded to us, that we make no unus- ual demand upon philosophy, in thus attempting to simplify causes, where one is perfectly adéquate ; and especially whejre it is admitted that ail the others are wholly inadéquate. (2) Let us now attempt an analysis of our subject ; beginning, after the philosophical manner of Dr. Prout, with a simple sub- stance submitted to the gastric action. Hère we think it will appear by the showing of the chemist himself, that physical agencies hâve had no connection with the change, and if not. hère, in no other instance. This conclusion will follow more and more irresistibly as we multiply the varieties of food, and; therefore, the chances of discordant results. The forces of chemistry, in the case supposed, would resuit in the séparation and recombination of the éléments of albumen, and the product, therefore, should be very différent from that sub- (1) Ut cit. "We adhère to Dr. Prout, inasmuch as he is the highest admitted au- thority in organic chemistry, and one ofits most candid and lucid expounders. (Vol. I. p. 36 — 42.) (2) "There is an observation,'' says Fordyce, "I beg leave to make with regard to a mode of reasoning which has been too oftén adopted in physiology and medi- cine ; to wit, that it has frequently been thought sufficient to prove that a thing Waa not impossible in order to ascertain its actually being true."— On Digestion, p. 104- 84 PHILOSOPHY OF DIGESTION. stance. But what says the chemist 1 " Through ail the appa- rent changes, the albumen has undergone no real change. What was introduced into the stomach as albumen is still albumen in the chyme ; at least chemists bave pronounced it to be so." (') (See Vol. I. pp. 529, 575 — 577, notes.) The same affirmation is made by Mr. Bird, who considers the albumen and the gastric product chemically identieal, and yet différent from each other, as do also Tiedemann, and Gmelin, and others. Hère, too, should be connected the statement as to the chemical identity of albu- men and fibrin ; (2) which, however, is only a very limited part of a long séries of close affinities which are admitted to prevail betwixt the foregoing substances, and a variety of other organic products, and which is wholly incompatible with the absolute distinction that prevails among the combinations of chemistry where the éléments are alike, but the proportions a little varied. But, if some vital change hâve been exerted upon the physical character of albumen, it should appear under a new aspect ; and we hâve it admitted by Dr. Prout, that "it has assumed an ap- pearance altogether différent from albumen." The chemist, however, may find the same éléments, in their proper propor- tions, which compose albumen, whilst they shall hâve undergone new combinations amongst each other, and in ratios which differ from. chemical compounds, in virtue of the vital influences of the gastric juice, This, we apprehend, is the great peculiarity ar> pertaining to the vital actions, whilst chemistry, allowing its ac- curacy, has not looked beyond the several éléments of which an organic substance may be composed. (3) Again, it is said by Dr, Prout, that another (1) Dr. Prout, ut. cit.—-It is proper, however, to say, that the suppositious quali- fication is made, that the "albumen has merely become chemically combinedwitfa a portion of water." But is this compatible with the doctrine, that the " reducing" agent of food is chlorine, muriatic, or some other acid ? Is it consistent with the supposition that other substances are completely decompounded by the same agent? Finally, however, we hâve the candid admission, that chemistry is not only uUerly unable to supply the rationale ofthe process, but the whole ground is abandoned and consigned to the «'vital agency, whose nature is completely unknown ;» for thus, our author : "In no instance do we appear able to invert the process, or to complété an organic compound, by again separating the water ; though such change within certain limits, seems to be to the organic agent just as easy as the reducing process."— (See our vol. i. pp. 56 — 60, 66.) (2) See Mr. Bird in Guy's Hospital Reports, No. 6, 1838, p. 48. Also M Denis Nouv. Expèr. sur le Sang, in Archiv. Gén. de Méd. Fev. 1838. (3) Dr. Prout supposes that the albumen of the blood is converted into -elatine by giving off a portion of its carbon, and that this is the original source ofthe car- PHILOSOPHY OF DIGESTION. 85 " Of the chief materials from which chyle is formed, namely, the oleaginous principle, may be considered to be already fitted for the purposes of the animal economy, without undergoing any essential change in composition." True, and therefore no.chemical change; but no one doubts that the resulting chyme " is altogether différent in appearance." Besides, we again ask why, if other less assimilated substances be subjected to great changes in virtue of the supposed chemical solvent of the gastric juice, the oleaginous principle should be so little liable to its action ? Is it from anything like intelligence on the part of the agent 1 lf, however, on the other hand, our vital forces are the agents in digestion, the changes should be slight in the foregoing substances, since their éléments are al- ready combined according to the laws of those forces. This appears to us an important argument, and to be entitled to considération. Chemical agents know no distinction between substances which may hâve been more or less assimilated to the animal organization ; but they alike décompose the élé- ments of each, though animal substances more readily than vegetable, or inorganic, and with greater resulting différences. In our " Vital Powers," we hâve stated many analogies where éliminations from the blood are nearly identical in their éléments, but where it is manifest they hâve undergone différent combina- tions which chemistry cannot explain. (Vol. I. p. 56, &c.) We find, therefore, in the incipient change of dead into liv- ing matter a full display of those powers which operate in the most elaborate organization, and an equal exclusion of the forces which appertain to dead matter. And hère may we stop, for a moment, to contemplate this wonderful exhibition ofthe "Pow- er and Wisdom of God," at the very threshold pf life ; this sanc- tuary, where neither inorganic matter, nor the forces which it obeys, can gain admittance ; where the line of séparation begins abruptly betwixt dead and living matter, but whose analogies are preserved in the conversion of one into the other, through new modes of combining the same éléments ; and doubtless our ad- miration would increase, should we mount along the entire functions of assimilation, and find, at each step of the ascending séries, that the whole agency has been committed to forces that bonic acid. (Our p. 16.) But it happens that as much carbonaceous matter is evolved during the process of starvation, as after feasting. Besides, scarcely any two analyses agrée as to the composition of albumen and gelatin, — especially in their relations to each other. And so we ever find it ;— one chemical fact being in col- lision with another. (P. 14.) 86 PHILOSOPHY OF DIGESTION. 1/1 • tint the whole is the hâve no existence in the inorganic woria , iua înt_rmediate harmonious resuit of a principle which may forrn an mtermedate link betwixt spirit and matter ; W«^^£)^ there is no power within our control by whicnwe the nature of the changes. Casting a glanée at ^f^™ world, we find the connection continued by other analogous links with elementary matter itself; but hère, as in the Ingher départ ment of nature, the Une of séparation is equally défined howeve low in the scale of analogy may be the properties of life whichhâve their beginning in vegetable organization. We shall say nothing more hère ofthe various facts appertaining to the two organized kingdoms, (see Vol. I. pp. 68, 594,) which illustrate this subject, excepting to remark that the researches of physiologists hâve shown that some vegetables are evidently provided with an apparatus corresponding to the animal stomach, which last is said to prevail universally. However we may scrutinize the process of digestion in either ofthe great kingdoms, we find that nature has provided intricate means for the purpose, and estab- lished analogies in their organization and phenomena that are unknown in the organic world. And, if we carry the analysis through the whole labyrinth of animal and vegetable création, we meet, at every step, with so much Unity of Design, such grad- uai modifications of structure and functions, and ail conspiring to a spécifie end, we must conclude that the whole are governed by forces peculiar to themselves. But, notwithstanding the astonishing Unity of Design, and the gradation of analogies which connect together the most dis- similar of the Systems which are designed for digestion, there are peculiarities attending each in every species of animais, which place at a remote distance the laws of chemistry. " An alimentary canal is observed in every class of animais, and almost in every species, and its form and structure vary according to the situation of animais in the scale, or according to the kind of food on which they are des- tined to subsist, and the extent of élaboration it requires to undergo. The pe- culiarities presented by the digestive organs are, therefore, intimately con- nected with the diversities of form manifested by the organs of animal life, and with ail the living habits and instincts of animais." (') — (Vol. I. p. 36, note.) We see, also, an extension of this principle in relation to cer- tain periods of life. In ruminating animais, for instance, the fourth stomach is alone employed during lactation. And yet, with ail this variety, there is but one common resuit, one homo- (1) Grant's Outlines of Comparative Anatomy, p. 306. PHILOSOPHY OF DIGESTION. 87 geneous chyle. The same principles, the same vital impulses, which ultimately develope and call into action the three first of the stomachs of the ruminantia, appear to be not less concerned in the consummation of their final cause. One of the most important arguments in favour of vital diges- tion consists in the remarkable endowments of the stomach, as manifested by its vital signs, and the sympathies which prevail between this organ and ail other parts. Thèse hâve been well expounded by Hunter, Abernethy, and many others, even by chemical physiologists. The final cause of this peculiar consti- tution of the stomach, this lavish supply of the forces of life, this subservience of other organs to its dominion, must be sought in its adaptation to the génération of a fluid that may bestow the first and most difficult act of vital ization upon dead matter. There would, also, hâve been something harsh and abrupt in nature, to hâve admitted into the recesses of her living organiza- tion mère dead matter. It is opposed to ail analogy, and is, therefore, opposed to ail reason. But, that a fluid should per- form this astonishing office, this first and great step in the as- cehding séries, it must possess in a high degree the forces of life. Mysterious as they may be represented, we must come at last to the admission of their existence. It is fair, then, to con- clude that an organ destined for such a high function should possess the necessary means; and the best évidences in favour of this a priori inference are to be seen in its diversified mani- festations of life. (See Venous Congestion, Sec. 8.) To deny the dependence of vital results upon the spécifie powers which we hâve hitherto considered, necessarily involves an exclusion of ail the évidence by which we infer the existence of gravitation on the intangible properties of matter ; or as well may we doubt the reality of spirit, or the Maker of the eye, because it cannot see Him that made it. We might go on with a variety of proof, derived from the chemical advocates of digestion, to show that the doctrine is founded upon indefensible premises. Thus-, it is supposed that chlorine is uniformly présent in the gastric juice, that it is the principal agent in the "reducing" process, and that "it mainlycon- tributes towards effecting the union of the food with the water." But, besides the objections already stated, we shall see that this is an hypothesis erected upon another, since the probable exist- 88 PHILOSOPHY OF DIGESTION. ence of chlorine is assumed, whilst it is fully admitted that the foregoing union is only surmised. Again, however, « We may close this section," says Dr. Prout, "by observing that there is strong reason to believe, that the solvent power, (chlorine) which we hâve described, or some power having a great resemblance to it, exists not only in the stomach, but in every part ofan animal body." « Before solid parts can be removed, they must be dissolved, digested in fact ; and such solution, in many instances, is probably effected, as it is in digestion, by combining thèse solid parts with water." — Ut. cit. Hère the conjectural nature of the chemical theory is various- ly exhibited ; whilst the foregoing rationale may be contrasted under a similar aspect with that of galvanism. Neither chlorine nor anything " having a great resemblance to it," nor the gal- vanic fluid hâve been detected in the blood or in the instruments of organic action, (Vol. I. p. 63,) whilst the objections we hâve already stated as to the want of analogies between the conver- sion of différent species of food, which should obtain were chlo- rine the " solvent power," are equally applicable in the présent instance. And farther on, (c. 4,) Dr. Prout argues with great force and effect, that the matter taken up by the absorbents is not wholly excrementitious any more than chyme ; but that a proportion of it is again appropriated, and undergoes "a pro- gressive organization " in the absorbent system, acquiring " a highiy animalized character." We hâve seen that the foregoing parallel is not sustained by any analogy between the supposed chemical agents of the gas- tric juice and the means which are concerned in the décompo- sition of the body, where the nature of any menstrua must be as various as that of the tissues, the organization, and the modi- fications of the vital properties, upon which the génération of the reducing substance dépends. This is conformable to ail analogies in organized matter ; and since the chemical agents should, therefore, be very various, (as appears to be implied by Dr. Prout when he speaks of a substance " having a great resem- blance to chlorine,") chemistry should not hâve wholly failed of detecting one or more of the number. Nor will it answer to as- sume, as is also done, that galvanism is a "reducing" agent in the process of vital décomposition, since this conjecture is opposed by the assumed analogy between the solvent power of the stom- ach, (or chlorine,) and that of the absorbents. Still the analogy in the foregoing processes, as pointed out by PHILOSOPHY OF DIGESTION. „ 89 Dr. Prout, certainly exists ; and the resemblance is so great, and so " strongly confirmed," as to induce him to apply the same term, digestion, to the function as performed by the absorbents and as it goes on in the stomach. We must, therefore, look for a strong analogy in the efficient causes, and this we may find, and only find, in the vital properties, whether acting through the médium of the solids, or the sécrétions to which they hâve been imparted. The gastric juice being designed, as is admitted by chemists, for a vitalizing office, reason suggests that it must possess the necessary powers of vitality ; and thèse we can easily imagine to exist in the gastric juice in greater development than in the blood itself, since it is the product of an organ endowed in the highest degree with the vital properties, and destined to make the first and most important impression upon dead matter. And what proves the vitality of the gastric juice, were it necessary to show the fact, is the endowment of the chyme with the proper- ties of life ; or, should the latter fact be questioned, we may say that its admission into the lacteals, and this almost exclusively and without stint, appears to us conclusive of its vital nature, since ail dead matter is known to be more or less obnoxious to the same vessels, whilst it is everywhere incompatible with the living organization. By the same reasoning we infer the vitality of the blood, as we do of both from their résistance of chemical agencies. (See Vol. I. p. 642, note.) There certainly can be no doubt, when the gastric juice is ab- stracted from the stomach, and divested of its vitalizing powers, it may exert direct chemical effects upon dead matter, and even upon a dead stomach; just as we shall soon see an artificial substance operate, which is supposed to be the gastric juice. This, however, is anything but digestion, as is sufficiently evin- ced by the gênerai admission that the vitalizing influence is necessary to the process. We confess that we were a little staggered in our views of digestion by the Médico-Chirurgical : " The transcendental vitalists," says this Review, « are loth to admit the opération of chemical agents at ail, and would seem to consider it derogatory to suppose that any changes, save the subtle ones effected by the powers of life, are worked upon the aliment." " The vital principle, whatever it may be, incessantly makes use of chemical and mechanical agents for its purposes ; and it is no more degrading to it to employ an acid liquid, and a triturating VOL. II. 12 90 PHILOSOPHY OF DIGESTION. process in order to digest the aliment, than it was to hâve recourse to bony levers, cartilaginous pulleys, and tendinous ropes," &c. O . Will our distinguishedReview maintain that "the vital prin- ciple incessantly makes use of chemical agents for its pur- poses"? Is not this" a begging ofthe question" at issue? Has it been fairly shown in a solitary instance ? The analogical in- duction, therefore, as it relates to the gastric juice necessanly fails. We humbly think, also, that the imputed analogy does not obtain in other respects ; since the bony levers, muscles, tendons, heart, blood-vessels, &c. are meré instruments acted up- on by the " vital principle," and hâve no part in the vital results except as they are the passive instruments ofthe forces of life. Not so, however, with the imputed agency of the gastric juice. Hère other and distinct forces are supposed to operate, and to take an equal part with the forces of life in one of the animal functions. Nor is this ail. Thèse chemical forces, or an équi- valent agent, are supposed to appertain to one of the products of living organized matter ; and through that product, and by that product, to operate independently of the vital forces, or, under their control. This view, we believe it will be admitted, is op- posed by the principle upon which the argument proceeds, since there is no analogical fact to warrant the induction ; and with equal truth may we affirm, that there is nothing to aid our con- ception of the coopération of the chemical and vital agents, (Vol. I. p. 32,) whilst ail that is known of their relations to each other proclaims their absolute independence. This fact we hâve more than once had occasion to express ; and that there may be no ambiguity as to our meaning, we would say that we speak of thèse forces as they are concerned in the décomposition and recombination either of the éléments of matter or the constituent parts of a compound substance. As to the influence of physical agents upon the forces of life, we hâve considered that subject in our "Vital Powers," as, indeed, we hâve the former.(3) But, again, it is the admitted final cause of the gastric juice to bestow life upon dead matter, whilst it is incontro- (1) Med. Chir. Rev. Lond. vol. xxix. p. 107. (2) We hâve endeavoured to show, in our " Vital Powers," many broad and irre- concilable distinctions between the forces of life and of chemistry. We there said that the chemical and oth.6r physical forces operate upon matter. and are not acted upon. The other operate exclusively upon living matter, and are also influenced by the former, and are acted upon by foreign causes. You may say that the distinction is not absolute, as manifested in the disposing effect of electricity, or some other third substance upon the affinities of two others. Hère it would seem that the chemical forces may be influenced in the way which we hâve denied. But it is PHILOSOPHY OF DIGESTION. 91 vertible that inorganic matter is insusceptible of any such in- fluence from gastric action. Every fact proclaims that nature has provided the vegetable kingdom for the purpose, especi- ally, of determining organic combinations out of inorganic sub- stances for the sustenance of the higher department of life. It is manifest, therefore, that it would be an absurdity on the part of nature to hâve ordained that chemical agencies should operate even at the very threshold of life, at the very foun- tain for which she had provided elaborate means to subvert the combinations of chemistry, and to bring them into new ar- rangements that should approximate those changes which they were destined to undergo from gastric action ; and far less prob- able is it, that the principle should be lost as she ascends in organization ; since every chemical resuit within the stomach would tend to reduce the aliment to inorganic matter, to coun- teract the final cause of nature, and, de facto, to render the means of sustenance more and more indigestible, and progress- ively liable to chemical changes of an inhérent nature. Never- theless, it is évident that the gastric juice is capable, according to its constitution in différent animais, of dissolving, though not of organizing, inorganic substances. However we may regard this subject of analogies, it is every where opposed to the conclusion that the gastric jûice is a chem- wholly différent from those impressions which are made upon the properties of life. In the former case, the principle is the same as when two substances are brought to- gether, and unité by chemical attraction. The combination of thèse only developes the opération of forces which are ever ready to act as soon as opportunities exist. You change the polarity, or vary the plus and minus of electricity in différent sub- stances, and in that way promote the opération of affinities. But in none of thèse instances, are the forces acted upon, or in any way influenced in their natural tenden- cies, or affected in their natural character. Again, by the aid of electricity, you résolve chemical combinations into their élé- ments. But hère the principle is the same ; for by the intervention of a third sub- stance of any peculiar properties, the éléments are so impressed that their attractive forces cease, and décomposition follows. Nor is there any analogy betwixt the opération of electricity upon living and dead matter. In the former case, it opérâtes upon the properties of life, —in the latter, upon the matter itself. That its action, in the first instance, is upon the vital forces alone, is abundantly manifest from its total failure to produce any of its phenomena after those forces cease ; but it will now produce the phenomena which distinguish its opération upon dead matter. We speak, of course, of what may be properly denomi- nated vital phenomena. But you say, it is a masterly agent in effecting combinations amongst the sécrétions, in governing the actions of organs, &c. Perhaps we hâve already said enough in reply, especially if it be not to the purpose, in another place. See Vital Powers and Jlppendix. 92 PHILOSOPHY OF DIGESTION. ical agent. This fluid is admitted to be organized and endowed with vitality. Like ail other parts of the organized body, it is the product of analogous forces and instruments. But, in no other part has it been shown, in the least, that there subsists an agent of chemical opération. That the contractions of the stomach facilitate the process of digestion, we cannot doubt ; but the former are of a vital nature, and the resuit, as it respects the aliment can be no other, nor is any other apparently supposed, than that of either disintegrating the particles, or of otherwise exposing them more freely to the vital agent. This auxiliary, therefore, is the same as the knife or the organs of mastication, and has no real connection with the digestive process. But, if the " vital principle " be capable of " making use of chemical agents," we see not why it may not be equal to the whole work itself. (') An adéquate power is certainly admitted by the foregoing supposition. One may be comprehended, whilst the other is mysteriously obscure. One is more agreeable to the rules of philosophy, and abolishes that inextricable confusion which attends the chemical hypothesis. Besides, what is meant by " making use of chemical agents ? " How are they brought into use, and how are they always maintained in one exact opér- ation in each particular process, of which there are multitudes going on in the same individual ? When do they begin to oper- ate, and what part do they perform, and what is the allotment of the properties of life ? Is there any known concert of action be- tween the two species of forces ? On the contrary, is it not every where demonstrated that the forces of life are in direct opposition to those of chemistry? (Vol. I. pp. 31, 32, 62, 99, 101.) Whatever be the construction, by uniting the two forces, we convert what is probably a most simple problem, like ail other processes of nature, into the greatest paradox that has been yet devised by the ingenuity of man. It is in vain to say that some of the organic compounds appear to be such as resuit from chem- ical affinities ; since chemistry is hère incapable of showing the identity of the combinations, and since every thino- else apper- taining to life appears to indicate the absence of the chemical forces. No one can affirm that the actions of life may not gen- erate combinations that may be analogous to chemical results, yet radically différent, according to our former explanation. Upon the same ground, it might be assumed, as it is in part, that (1) So says Dr. Prout ; see p. 84, note. PHILOSOPHY OF DIGESTION. 93 ail the motions of organized matter dépend upon physical powers, because we witness motion from gravitation, elasticity, attrac- tion, &c. The endowment of the forces of life with capabilities more or less analogous to those of chemistry would seem to be a necessary correspondence, in conformity with Unity of Design, since the éléments of organized matter are derived from inor- ganic, whilst dead organic matter is alike the subject of chemical destruction as of vital changes. (P. 16.) We now come to another argument of universal application to living matter, upon which we also especially rely. It appears to us fatal to every physical hypothesis of life. If digestion be admitted to resuit in part from chemical agencies, it can only be upon the ground that alimentary matter is divested of life, and therefore the subject of chemical décomposition. Eut this rule will not apply to any constituent part of the living body ; and since ail parts are derived from the blood, and this fluid is shown and admitted to be endowed with vitality, neither this nor any other vital part can be liable to the imputed chemical changes. In making this statement, especially of the blood, it should be well considered that the changes which are necessary to consti- tute many of the secreted products are of a radical nature, formed by elementary décomposition and recombinations ; such as chem- ical agents are supposed to effect among the éléments of com- pound substances. Nor will this be denied us, since it is the very essence of the catalytic and other chemical hypothèses of life. Admitting, therefore, the présence of any amount of galva- nism, or of any other chemical agent that can be possibly sur- mised, within the living organization, it would be utterly inca- pable of decompounding any living particle either solid or fluid ; not even the most watery part, since this is equally endowed with the resisting properties of life. (x) We are sustained in this posi- tion by every known phenomena of organized matter ; and let ( 1 ) In ail the analyses that are undertaken of the animal fluids, Sic. it appears to be considered that the several component parts, which appear in the hands of the chemist distinct combinations, are equally so in their natural state, and exist as simple intermixtures. But we apprehend that it is far otherwise, (allowing the apparent com- ponent parts to hâve a certain definite existence,) and that an intimate union is estab- lished amongst the whole at the moment of their formation ; at least, that such is true of ail the solids and fluids that may be endowed with vitality. This would be a substantial objection to the chemical hypothesis, and a reason why there has been no mutation of any one of the organized products. We doubt not, however, that the difficulty is more profound, and that the constituent which is displayed by the chemist has often no existence within the pale of organization. (See Vol. I. pp. 529,676, notes.) 94 PHILOSOPHY OF DIGESTION. the experiment be tried upon every part with any reason able de- gree of galvanism, or of chlorine, or other agent which imagina- tion may substitute, and the imputed décomposition cannot be effected. How much more impossible, therefore, the supposed catalytic effects of the vascular parietes ? (See Vol. I. p. 55.) Since, then, upon this single principle, we see not how the con- clusion can be avoided, that the décomposition ofthe living solids and fluids must dépend on other forces than those of chemistry, ail philosophy conducts us to a like conclusion that the recom- binations are effected by the same agents. And in this construc- tion are we also supported by the absence of those definite pro- portions of elementary principles which chemical agencies always establish, by the palpable mutations in organic products which chemistry identifies, and by the impracticability of restoring any organic matter when artificially decompounded. And that such appears to be truly the fact, is seen in the séparation ofthe éléments which are thus combined as soon as the vital powers cease their opération, and their universal disposition to unité into inorganic compounds, and in the definite proportions of chemistry. From the foregoing facts, it follows upon the ground of anal- ogy, which is strong upon the subjects under considération, that the gastric juice must be, as admitted, endowed with vitality ; that it can exert no agencies which are utterly foreign to other living matter ; and since, as we hâve seen it stated by chemists that the process of décomposition throughout the body is similar to that of digestion ; it follows, therefore, from the foregoing prem- ises, that the gastric juice exerts ail the changes to which ali- mentary matter is subject, in virtue of its vital powers ; whilst the stomach itself contributes to maintain the incipient organiza- tion, and probably by its influence upon the gastric juice after its sécrétion, to promote the process of vivification. And from ail that has been now said, it must be concluded that the gastric juice is a substance sui generis ; and since, also, its formation re- quires the agency of living blood-vessels, and being a vital fluid derived from another endowed with vitality, it should be admit- ted to be insusceptible of chemical manufacture. But such is not the conclusion, even of eminent physiologists who should look with jealousy upon any invasions upon the laws of nature, especially such as it is their peculiar province to illustrate. We are presented by thèse philosophers with artificial compounds, of an incongruous nature, and are told that each is capable of PHILOSOPHY OF DIGESTION. 95 the same précise results as the gastric juice, whilst the organiz- ing effect of that fluid is fully admitted. Spallanzani, who re- ceived so severely the rebuke of Hunter, was philosophical com- pared with the récent grotesque innovations. To the chemists, however, we should look, at least, for unanimity as to the spé- cifie nature of the reducing agent, since every variety of food is resolved into a uniform homogeneous substance. But hère, too, there is an equal conflict with fundamental laws. Free muriatic acid having been found, or supposed to exist in the stomach, it has been concluded that this must be the great agent in diges- tion ; whilst Dr. Prout, and others, affirm that " free muriatic acid more or less retards the process of réduction." (') Dr. R. D. Thompson, however, by digesting muscular fibre in dilute muriatic acid, produced a substance "exactly resembling chyme." (2) This matter had been presented in rather a différent shape by Eberle, (3) who found that the mucous membranes digested in muriatic or acetic acids, (4) formed a substance that would digest other alimentary matter. Schwann, Miiller, (6) and others, hâve prosecuted the inquiry, and there is a gênerai agreement that they hâve generated the true gastric juice ; the galvanism of oth- ers to the contrary notwithstanding. (6) More recently Todd, (1) Dr. Prout Op. cit. (2) Sixth Report ofthe Brit. Association, &c. (3) Physiol. der Verdauung, 1834. (4) Ed. Baynard states that "he remembers a man who died with a cheese in his belly, by drinking new milk upon sour béer, which, so frightened people from the use of milk, that ail forsook it but the wiser calves." (5) Mtlller's Archiv. 1836, p. 66. (6) The galvanists are equally confident, and exclusive, carrying their results far beyond the process of digestion. Dr. Philip, it is well known, in the very midst of his empire ofthe "vital laws," maintains the dependence of digestion and sécrétions upon galvanism ; and the practical Edwards descants, as we hâve already seen, upon the " artificial formation of chyme, milk, and the principal conditions of the sécrétions," by the same agent, and by that alone. (Vol. I. p. 52.) But thèse are only incipient steps towards a substitution of physical agencies for Creative Power. It had been already shown in the work shops of Priestley, Ingenhouse, Needham, O. F. Mûller, Tiedemann, Wrisberg, Treviranus, Monti, and, more recently, by B. de Vincent, Fray, Mœrklin, Nitzch, Cross, and others, that animais could be formed out of inorganic matter by macération in water, or by galvanism and other analogous processes ; though it be that animais require for their sustenance organic matter. We may also add, that thèse animais copulate and lay eggs ; and that Spallanzani found, that when animal infusions were boiled, and the air excluded, no animalcula were produced ; and Wrisberg stopped the process of génération by covering the sur- face with olive oil, and thus preventing the ingress of ova from the air. Yet he be- lieves the dead matter arranges itself into a complex living apparatus. Schulze states that each globule of blood, or of milk, or eerebral matter, is converted, by solution, 96 PHILOSOPHY OF DIGESTION- and Schweitzer hâve elaborated the gastric juice after the man- ner of Schwann,and hâve added some expérimental détails, which go with the rest in showing the chimerical nature of the enter- prise. (') But has it ever occurred to any of thèse gentlemen, to ascertain whether they could obtain from their chyme, even by the aid of nature's bile, a product resembling the intestinal fœces, or hâve they demonstrated any analogy between the natural and the artificial chyme, unless through the vague results of fire and acids ? Again, the digestive " mixture retains its solvent prop- erties for months," (2) whilst the gastric juice loses its solvent power soon after its abstraction from the stomach. And hère we may ask, whether it loses, also, its chlorine, or its muriatic acid? And what may seem equally to establish a total opposition be- tween the digestive mixture and the gastric juice, is the no small circumstance that the chemist may torture and extinguish " the digestive principle " of the former in a variety of ways, and then transmute it back in ail its vigour. Thus, according to Schwann, as sanctioned by Mùller, the "digestive principle," when neu- tralized by an alkali, " may be precipitated from its neutral so- lution by acétate of lead, and canbe obtained again in an active state from the precipitate by means of hydro-sulphuric acid." (3) This precipitate, we are told, when thus restored, and thus compounded of principles radically différent from the original mixture, is essentially the same as the gastric juice, and that the results of such artificial préparations must be taken as the test of the physiology of natural digestion ; that, abandoning nature, into many hundred animais, as full of life and motion as the best of us. See Appen- dix on Spontaneous Génération. But, we hâve wandered from our subject of galvanism. It is not remarkable that the spéculations which we hâve noticed should hâve led to the création of animais by this agent. The materials are taken, in imitation ofthe Almighty, out ofthe earth, and by aid ofthe potent fluid, our philosophers transmute silex into flesh and blood ; (a) whilst Dutrochet has created muscular fibres from albumen by the same " uni- versal agent." (6) The misinterpreted Bolingbroke remarks, that " the men who at- tempt to do this leave to God nothing more than they assume to themselves, except- ing a greater degree of power." (c) But our object was to show the harmony amongst chemical philosophers as to the nature of the agent which conducts the analogous processes of life. The several kinds assigned are as nearly allied to each other, as the "nervous influence" tothe galvanic fluid. (I) British Annals of Med. Nos. 16, 23. (2) Muller's Eléments of Physiol. vol. i. p. 545.' (3) Ibid. p. 546. (a) See Mr. CroBse's account of the process, and a représentation ofthe animais in American Journ. of Science and Arts, vol. 32, p. 374, July, 1837. (J) Ann. des Scien. Nat. 1831. («) Works, vol. v. p. 436. PHILOSOPHY OF DIGESTION. 97 we must look to the resources of the laboratory for any satisfac- tory account of her vital processes. cNordo we at ail exaggerate; for it is distinctly avowed that we knew nothing of digestion till the invention of the artificial mixtures ; that Schwann, for in- stance, " having discovered that the infusion Of (dry) mucous membrane with dilute acid, even after it is filtered, still retains its digestive power ; the digestive principle j therefore, is clearly in solution, and the theory of digestion by contact fails to the ground."^) Hère, a most important physiological induction is wholly founded upon a process which has not the most remote connection with organized matter ; and as to the chemical para- dox which involves the agencies of muriatic acid, alkalies, acé- tate of lead, hydro-sulphuric acid, and mucous membrane, it is certainly a burlesque upon the science of chemistry. As to the imputed " digestive principle," it may prove destructive to a goose, though we hâve great doubt whether it will digest a raw onion. The process which we hâve stated might be indefinitely carried on by other alkalies and other reagents, and still the " digestive principle " would come up on the development of an acid ; and should the " mixture," asit is well denominated, be occasionally subjected to the action of fire, we shall still find the mysterious " principle" unextinguished. We would prefer the old doctrines of attrition, or putréfaction, or even that of fire as maintained by Heraclitus and Hippocrates. Dyspeptics hâve only to swallow chlorine, muriatic acid, (2) or the "digestive mixture," (which has been most appropriately named by Schwann, and Mùller, pepsin,) and " throw physic to the dogs." Galvanism is " a rushlight to it ;" and though the stomach be no longer a galvanic troughj it is still among the wares ofthe laboratory. (3) Galvanism, indeed, after its signal triumph, is already in the wane. " But let it go : — it will one day be found With other relies of » a former world.' " It should be borne in recollection that every animal, however (1) Mtlller's Physiology, p. «45. (2) It should be recollected, however, that according to Dr. Prout, it is the pecu- liar misfortune of dyspeptics to hâve a redundancy of this kind of the " digestive principle." (3) Not necessarily so, however. Magendie, for instance, " proved by a multi- tude of experiments, that the stomach is of no use in vomiting, since when it was eut away, and a pig's bladder substituted, there was no différence in the effects !" ~-B}itish and Foreign Med. Rev. Oct. 1839, p. 537, VOL. II. 13 98 PHILOSOPHY OF DIGESTION. small, is said to possess a stomach. So far as the microscope may be trusted, we learn from Ehrenberg that the smallest monad, which is only ' of a line in diameter, has this apparatus Shall we believeTtherefore, that such. an organ is so universally provided, and so variously constructed, for the mère purpose of generating an acid, or any other chemical agent ? ( ) And nere our conceptions are aided'by analogies, since the same univer- salité and the same varieties, are found to prevail in respect to an urinary apparatus, whenever urine is secreted. So of the testes, mammse, &c. (See Vol. I. pp. 37, 591, notes, 588 — 59d, 676, &c.) Besides the philosophers of whom we hâve spoken, there are many others, as Tiedemann, Gmelin, Bostock, Carswell, Magen- die, Montègre, and, indeed, chemists and physiologists generally, who consider acidity an essential principle of the gastric juice, and that digestion dépends upon the chemical action ofthe acid ; or, according to Professor Dunglison, " the theory of chemical so- lution may now be regarded as completely established." (2) But has it been shown that the same acid is not generated after the division of the nervi vagi, when digestion ceases? We are told that the secreted fluid is apparently unchanged. It appears, also, that distinguished physiologists, who hâve devoted their attention to the science of life, Hunter, Haller, Willis, Spallan- zani, Fordyce, Dumas, Schultz, referring once more to Dr. Prout's system of life, as cited in our lst vol. p. 36, we see not why the term life should not be equally appropriate to any process that may be conducted in the laboratory. At least, we have a jealousy in this mat- ter, and should a little rather that the animal chemist would abandon life, and try and get on with the help of chemistry alone. The experiment, we think, would bring him over to the vitalists, and make him well content with their system of life. Still more to the foregoing effect is the manner in which Miiller has filled up his warp of life with the woof of materialism. This we have stated in our Vol. I. pp. 85, 86, and note. In answer to his interrogatory in that note, we re- ply in the sublime language of the heathen philosopher, that the soûl wears out her suit of clothes, and then départs to the world of spirits. (a) This is the philosophy of Lawrence, and Elliotson, who, throwing of ail disguise, would bring the religious sensé of the âge below that of the Grecian and Roman phi- (1) Bridgewater Treatise, Book 3, c. 4. (2) Socrates, Vide Phœd. in Platon. 134 APPENDIX TO PHILOSOPHY OF DIGESTION. losophers. Employed about those pursuits which forever lead them « to.look through Nature upto Nature's God," there can be no prête* for th.mart- ism with which they have imbued their expositions of the laws and phenomena ^We daim not the right to molest any private opinions; but when funda- mental doctrines are obtruded upon the world, and this, as we shall see in r,b- ald dérision of holier views, we exercise but a common right in protecting, at least, against the gênerai imputation of such opinions those observers who are engaged in the culture of natural philosophy. Mr. Lawrence's sentiments are well known to the médical public, from whom in respect to his genius and érudition, they have received an unwonted indul- gence. We shall, therefore, only présent one of his best examples of substan- tiating his views. « Some hold," he says, « that an immatenal principle, and others, that a material, but invisible and very subtle agent is superadded to the obvious structure of the body, and enables it to exhibit vital phenomena." This is ail very well ; but now comes the application in a higher sensé. « The former explanation," he continues, "will be of use to those who are conversant with immatériel beings, and who understand how they are connected with and act on matter." Our author then proceeds to make an indefensible appli- cation, as it appears to us, of Mr. Hunter's doctrine of the vital principle, and having thus brought it in aid of his own opinions, dismisses it under a shower of ridicule. (') After a similar strain of burlesque about the existence of the soûl in the human fœtus, he concludes that " the Roman Catholic Church has eut the knot which no one else could untie ; and has decided that the little mortal, on its passage into this world of trouble, has a soûl to be saved. It aecordingly directs and authorizes midwives in cases of difficult labour, where the death of the infant is apprehended, to baptize it by means of a syringe, &c., and thus to save it from perdition." (2) Little as we may approve this singular doctrine, if it be really practised, it affects in no respect our author's intended slur upon every thing that is connected with religion and the moral dignity of man. But, our author has one specious argument which deserves some notice. " If," he says, " the intellectual phenomena of man require an immaterial principle superadded to that of the brain, we must equally concède it to those more rational animais which exhibit manifestations differing from some of the human race only in degree. If we grant it to thèse, we cannot refuse it to the next in order, and so on in succession to the whole séries, — to the oyster, the sea anémone, the polype, the microscopic animalcules. Is any one prepared to admit the existence of immaterial principles in ail thèse cases 1 If not, he must equally reject it in man." (») In ou/ essay upon the Vital Powers, we endeavoured to show that brute ani- mais are endowed with an immaterial principle, which, in them, is the cause of instinct as the soûl is of the manifestations of mind in the human race. We also endeavoured to show how they are contradistinguished from each other, and how the former is probably perishable, whilst the soûl is immortal. (See (1) Lectures on Physiology, &c. p. 78, &c It is remarkable that Dr. Elliotson has done the same thing ; —having rendered Mr. Hunter subservient to his own interest, he turns him adrift after the example of Mr. Lawrence. — Human Physiology, Part I. p. 31, note. (2) Ibid. p. 97. (3) Ibid. p. 99. ON SPONTANEOUS GENERATION. 135 Vol. I. p. 86— 106.) We shall not therefore, review this ground, but limit ourselves to a few remarks upon our author's argument. The reasoning of our author is analogical, and we should admit the great force of it in establishing the identity of the soûl of man and the instinctive principle of " the highest order " of brutes, were it not manifest that our author has assumed a basis for his analogy which has no existence. But, there are certain phenomena common to both, which show us the immateriality of the instinctive principle, according to our proof in the foregoing place. (Vol. I. p. 97 — 98.) We agrée perfectly, therefore, with our author, though upon other analogies than assumed by him, that if we reject an immaterial principle in brutes that manifest any of the phenomena which are common to the spiritual part of man, we must equally reject in man also. But, this in no respect im- plies that the immaterial part is the same in both ; whilst, on the contrary, as we have endeavoured to show, their constitution is distinct. Starting with the fact that man is endowed with an immaterial soûl, and ad- mitting the assumption of our author, that certain animais of the " highest or- der " " exhibit manifestations of reason diffëring from some of the human race only in degree," we should then be inclined to believe that such animais are endowed with an immaterial principle more allied to the soûl of man, than we have been disposed to admit upon truer premises. But our author has not only violated the fair ground of argument in assuming premises that do not exist, but he has even carried his proof from analogy far beyond its most absolute limit. For, he says, " if we grant an immaterial principle superadded to the brain of those more rational animais which exhibit manifestations diffëring from some of the human race only in degree, we cannot refuse it to " the next in order," and so on down to the " microscopic animalcules." Hère, then, by admission, ail analogy ceases as soon as we leave " those more rational ani- mais" ; and, according, therefore, to our author's own reasoning, the rule is only applicable to " those animais," and not to such as exhibit "no rational manifes- tations." The argument fails of course, upon its own ground. But did our author ever refiect that his premises, ("manifestations of reason " being the basis,) and his mode of reasoning may he carried on in the other di- rection, and that angels and the Almighty Being must come in for their share of his materiality 1 " Of Systems possible, if'tis confess'd That Wisdom Infinité must form the best, Where ail must fall or not cohérent be, And ail that rises, rise in due degree ; Then, in the scale of reasoning life, 'tis plain, There must be somewhere, such a rank as man ; And ail the question (wrangle e'er so long) Is only this, if God has placed him wrong V (1) Seeing, therefore, that animais evidently stand in a class distinct from man, and that the rule of analogy should be applicable to the instinctive principle among ail animais, and that if there be any manifestations of reason amongst the highest order, they disappear as soon as we enter the lowest ranks, we infer, according to our author's rule of induction, that what are assumed to be " manifestations of reason in the highest" are, in truth, only the manifestations (1) Pope's Essay on Man. 136 APPENDIX TO PHILOSOPHY OF DIGESTION. of that principle of instinct which loses its illusory signs of reason among Iower orders. Indeed, the natural understanding of our author finally conducts him to this very conclusion, by which it appears that he was not sincère m his rep- resentation of the affinities betwixt the mind of man and the instinct of «su- perior animais;" since in his luminous discussion of a question more strictly physiological, he affirms that " though the external sensés of brute animais are not inferior to our own, and although we should allow some of them to possess a faint dawning of comparison, reflection, and judgment, tt is certain that they are unable to form that association ofideas in which alone the essence of thought con, sists." And again, « the peculiar characteristics of man appear to me so very strong, that I not only deem him a distinct species, but also put him in a sepa- rate order by himself. His physical and moral attributes place him at a much greater distance from ail orders of mammalia, than those are from each other res. pectively." (J) And so it is with every writer who has attempted to debase the human soûl, or the Attributes of its Creator. Analyze their arguments, and you find them a tissue of assumptions, which they fully admit by their palpable contradictions as soon as they come to the investigation of some kindred, but more philosophi- cal question. Our author " willingly concèdes to every man what he claims for himself,— the fullest range of thought and expression ; and it is perfectly indiffèrent whether the sentiments of others on spéculative subjects coincide with or differ from his own." (2) This might imply a right to propagate such doctrines as we have just examined. Were they of a " spéculative " nature, and had no tendency to impair the intellectual, religious, or physical condition of man, the right could not be disputed, but would be more or less commendable according to the opposite tendency of such " spéculations." But when an author comes forward with spéculations that strike at the foundations of society, and the fu- ture well being of man, and brings upon his associâtes in the walks of philoso- phy the imputation of infidelity, he cannot plead the right of independent thinking. We have no objection to his forestalling the critics as to opprobri- ous epithets, in saying that " the practice of calling hard names in argument has been chiefly resorted to by the fair sex, and in religious discussions ;" (*) but, we do complain that when he assails the settled opinions of the Christian world, — we had almost said the heathen, — he is regardless of his own rule, and substitutes, on almost ail occasions, sarcasm for facts and argument. As might be expected, and as prevails in ail analogous cases, our author's system of physiology is imbued with dérision of the Hunterian philosophy of life, and abounds with malédictions upon ail but the prérogatives of dead mat- ter. This construction of the properties of life, we may charitably believe, was antécédent to his adoption of materialism in a higher sensé ; and we put it forth among other instances, as showing the probable tendency of the physical sciences, when applied to the science of life, to lead to skepticism in graver matters. The progress towards infidelity is always slow, — at least apparently so in a Christian land ; and, whenever the consummation may take place, re- gard for réputation, and a more successful propagation of the doctrine, will surround it with réservations, insinuating analogies, and perhaps with some (1) Lectures on Physiology, &c. pp. 203, 117. (2) Ibid. p. 15. (3) Ibid. p. 21. ON SPONTANEOUS GENERATION. 137 show of religion, either for the affected purpose of an insinuating impartiality, or to furnish a loophole of retreat, should the enemy crowd hard. The last eminent physiologist to whom we shall pay our respects, as having contributed some share to the gênerai charge of infidelity against natural phi- losophers, is Dr. Elliotson. We certainly agrée with this writer, that the brain is the organ in which the soûl, if there be any, is seated, and that without brain there would be no acts of intellection. It is also manifest, that the fullest exercise of mind dépends not only upon the gênerai integrity of the brain, but on its perfect development. It is, too, an equally rational conclusion, that vigour of mind will be more or less commen- surate with the size of the organ ; and we think it probable that the phenome- na of intellection may be variously affected by the varying proportions of différ- ent parts of the brain. There is nothing in ail this that leads to materialism. On the contrary, to regard the soûl as a spécifie existence, or immaterial sub- stance, implanted in the brain, and acting in coopération with it, we think, in a gênerai sensé, is entirely supported by the common plans of Providence. And, although our author admits the possibility that "something immortal, subtle, immaterial, may be diffused through the brain," and that his " assertion does not imply that the résurrection from the dead is impossible, or even im- probable " ; (') nevertheless, the whole gist of his argument is intended to es- tablish the doctrine of materialism. This concession of possibilities, and even an apparent leaning towards Révélation, are matters of eltpediency with this class of writers, who have sufficient tact to understand that it is the only me- thod by which they can obtain a hearing from sincère believers, or carry their stratagem with the unsuspecting. " A physical inquirer," says Dr. E. " has only to do with what he observes. He finds this power, (the mind,) but attempts not to explain it. He simply says the living brain has this power, medullary matter though it be." " In con- tending that the mind is a power of the living brain, and the exercise of it the functions of that organ, I contend for merely a physical fact ; and no Christian who has just conceptions of the Author of Nature, will hesitate to look boldly at Nature, as she is, lest he should discover facts opposite to the pronunciations of révélation; for the words and the works ofthe Almighty cannot contradict each other." (2) Now, such may be the habits of the mère " physical inquirer ;" but they are not those of the rational physiologist. The latter observes in the phenomena of mind a thousand indications that a substance is connected with the brain upon which the intellectual results of that organ mainly dépend ; and this is forcibly demonstrated by the disappearance of ail those phenomena when death is produced in such a way as shall in no respect affect the organization of the brain. Nor can we permit you to argue, that so, also, disappear the or- ganic functions of the brain and the whole assemblage of vital actions. On the contrary, such is'the radical distinction betwixt the organic functions of the brain and the acts of intellection, that there must be great obliquity in him who does not see that they dépend upon existences which are to- tally distinct That the soûl and the vital powers disappear together at the moment of death, probably arises from the fact as we have endeavoured to (1) Human Physiology, Part I. pp. 39, 41. (2) Ibid. pp. 38, 39. VOL. II. 18 138 APPENDIX TO PHILOSOPHY OF DIGESTI explain in another place, of the former being connected with the brain through the médium of the latter ; and it is upon this circumstance that we have found- ed an argument as to the spécifie nature, and the real existence of the vital forces. (Vol. I. p. 96.) , Again, the manifestations of mind, by admission, appertain to the braui, nor can any other part of the body produce a single act of intellection. But the brain enjoys, also, in the highest degree, the powers and functions that belong to other complex organs,-has its circulation, nutrition, sécrétion, and présides, more or less over the organic functions of other viscera. All thèse are mani- festly organic functions, which have their analogies in various other parts. There is something, however, superadded to this organ, to which there is nothing analogous in the rest of organized matter ; whilst all other organs have the plainest analogies in their several functions. It is clear, therefore, that the phenomena of mind are the resuit of the combined action of that something, which rational philosophers call the soûl, and the material part The same arguments which are employed in another place to show that the powers of life are something, and not a mère matter of fancy, are equally applicable for demonstrating the real existence of the soûl as contradistinguished from noth- ing ; and we think the proof is the same, and as palpable, in one case as in the other. The sarcasm of our author, therefore, in the following involved sentence, is neither justified by #ie nature of the subject, nor by his own professions. " See- ing," he says, " the brain thinks, and feels, and wills, as clearly as that the liver has the power of producing bile, and does produce it, and a sait the power of assuming a certain form, and does crystallize, (observe the parallels) the physical énergies leave others at liberty to fancy an hypothesis of its power being a subtle, immaterial, immortal substance, exactly as they fancy'life to be a subtle fluid, if subtlety is immateriality and immortality ; elucidating the subject no more than in the case of life, and equally increasing the number of difficulties ; as though we were not created beings, or not altogether ignorant what matter is, or of what it is capable and incapable ; as though matter exhibited nothing but extension, impenetrability, attraction, and inertness"; (') and so on tothe end of the chapter. Ai-J yet our author has the temerity to say, that his "assertions" do not im- ply " that this power (the mind) cannot be a something immortal, subtle, im- material diffused through and connected with the brain." Finally, although we think " the argument of Bishop Butler, that the soûl is immortal and independent of matter because in fatal diseases the mind often remains vigorous to the last" is not true in its limited import, we do not con- sider it, with our materia^ist, "perfectly groundless." (a) There certainly can be no doubt that the mind is apt to be impaired when the organic functions of the brain are disturbed ; yet, who has not seen the former unimpaired during the most extensive organic lésions of the latter, and far beyond what has ever been known of the functions of the liver, the stomach, and the heart, in analo- gous lésions of those organs ? (3) Who does not know, that in the worst forms (1) Human Physiology, Part I. p. 39. (2) Ibid. p. 37. (3) We shall présent a few examples, mainly derived from a single periodical. In the Médico-Chirurgical Transactions, (a) Dr. Sims has furnished a table of 50 cases where (a) Vol. 19. ON SPONTANEOUS GENERATION. 139 of the choiera asphyxia, and in many cases ofthe dying, when all organic func- tions have nearly ceased, the mind often retains the exercise of its powers ? It appears, therefore, that an almost expiring state of the vital forces is suf- ficient to maintain the connection between spirit and matter, so that the former shall continue to manifest its functions fully, when those of the latter are nearly extinct. (See Vol. I. p. 96.) Under thèse circumstances, we must allow that the soûl may perform its functions actively, with a very feeble coopération of the material part. We have stated something analogous to this in respect to the vital forces, where the dried, and inflated heart of a fish pulsated till it crackled like parchment. (Vol. I. p. 17.) There are difficult mysteries attend- ing thèse associâtes with common matter ; but the more mysterious their ways, and discrepant with the ordinary results in physiology, the greater is our reason to consider them as distinct from the matter itself. there was an effusion of sérum or blood within the head, but no cérébral symptoms. — "A morbid structure ofthe brain," says Hutchinson, "may exist a long time without much inconvenience to the patient " (a) —"The brain," says Velloly, "has a remarkable power of accommodating itself to a graduai dérangement." (6)— Stranger relates a case in which no cérébral symptoms took place till a year after a blow on the head, when the patient suddenly died with coma. "Ten or twelve ounces of pus were found in the brain, and the vertébral canal was filled with the same fluid." (c)— The celebrated Saussure was affected with extensive disorganization of the brain for the space of five years without any sensible altération of the intellectual powers. (d) — Mr. Hunter, jr. states a case of fungus hematodes cerebri of four years duration, where the only remarkable symptom was an abolition of tho sensés, (e) — And so Cruveilhier of caninomatous tumours of the brain. (/) — In a case by Howship, four ounces of medullary substance were displaced by the présence of a tumour, without occasioning any remarkable symptoms. In another instance, in conséquence ofaslight blow on the head, the whole middle lobe ofthe brain was found in a state of scirrhus forty years afterwards. But, with the exception of occasional pain, the subject had no other symptoms till towards the décline of life, when she became gradually sleepy and stupid. (g) — Mr. Earle has rela- ted a case of extensive abscess ofthe brain, which was unexpectedly discovered on dissection ; (h) and, in another work, he présents an instance where seven large tumours of a firm consistence, (the largest ofthe size ofan orange,) were found in the brain of a child who had no cérébral symptoms till about ten days before death. (t) Dr. Eodgers relate», that the breech-pin of a gun, " three inches in length,and exactly three ounces in weight, was lodged in the brain for the space of 27 days, with- out coma or any serious mischief," — the patient having also lost a portion of his brain. (j) —" La- motte gives a case where, by the stroke of a sabre, the seuil was deeply cleft, the right pariétal bone to the depth of two inches, and the left to between three and four, nearly down to the ear. This severe wound was cured in less than three months." (k) — "S. W. aged 17 years had his head frac- tured by the limb of a tree, four and a half inches in diameter, which had fairly imbedded itself in the upper part ofthe head. The whole arch ofthe cranium was shattered into small fragments, from two inches square down to half an inch. To make him look more seemly, I put his head into something like its original shape, and left him to die." In three days after, a messenger was sent for the physician, who found his patient perfectly sensible ; and from that time his convalescence went rapidly on. (I) — Hère is a case which interests, also, certain physiological and phrenological doc- trines. A lad, aged 11 years, received a kick from a horse, which fractured the os frontis. "In two hours after, he recovered every faculty of his mind, and they continued vigorous for six weeks, and to within an hour of his death, which took place on the 43d day." " He sat up every day, often walked to the window, frequently laughing at the gambols of the boys in the streets," &c. On dis- section, in présence of other physicians, "the space ofthe seuil, previously occupied by the right anterior and middle lobes of the cerebrum, presented a perfect cavity, filled with sero-purulent matter ; the lobes having been destroyed by suppuration. The third lobe was much disorganized. The left kemisphere was in a state of ramollissement down to the corpus callosum. (m) — This case should be compared with the celebrated one by O'Halloran, where there was great destruction af the brain without any dérangement of intellect. (a) Ibid. vol. iv- p. 203. (4) Ibid. vol. i. p. 218. W Ibid. vol v. p. 24. (d) Ibid. vol. vii. p. 211. (e) Ibid. vol. jtiil. p. 31 (/j) Anat Palholog. liv. 8. p. 4. (g) Obs. io Surgeryîand Morbid Anat. pp. 78, 89. (A) Med. and PI17S. Journal, No. 132. (») Med. Chir. Trans, vol. iii. p. 59. (j) Ibid. vol. xiii. p. 281. (*) Henncn's Military Surgery, p. 284. (/t Western Jo ir. of Med. and Phyi. Sciences, vol. viii. p. 213 (m) American Med. Inwlligencer, vol. i. p. 1. See, au», inoiher case in Ibid. 140 APPENDIX TO PHILOSOPHY OF DIGESTION. The discussion with which we began this appendix naturally conducted us to that of » materialism." The subjects being intrinsically of a popular nature, we may, for a moment, descend from the altar of science and approach the pre- cincts of the pulpit. This we do for the purpose of saying that physiology should become an élément in the éducation of clergymen. The enemy of religion, or the well meaning cosmographer, takes advantage of your want of familianty with this department of knowledge. They tell you that the living system has no forces peculiar to itself, but that it is wholly amenable to such as rule in the inorganic world ; and they conduct you at last, by thèse premises, to an almost irrésistible admission that living beings may be created by their power. And we have already shown you, when thus prepared, how easy a matter it is to spread before you, without greatly shocking the religious sensé, a plan of cre. ation which ascribes the origin of animais to " spontaneous génération," as it is called in préférence to " chance." The steps are graduai from the incipient errors in natural Philosophy to a disbelief in the Mosaic Record of Création. When we have ultimately reached this brink of the précipice, there is but one dreadful plunge, and we are then in the vortex of atheism. We may begin, as we have said, by a simple déniai of the living powers of organized beings, when it will become, at last, an ea6y argument upon this, and analogous premises, that the Almighty had but very little, if any agency, in the most sublime part of existences. But when you shall look at physiology in its true aspect, you will see that the living, organ- ized kingdoms are governed by laws totally différent from anything that is known of the inorganic. This will assure you that there can be no "sponta- neous génération," — that the forces of physics can have had no lot in the cré- ation or in the perpetuity of animais ; but, on the contrary, it is their work to lay waste the whole fabric of Création. You come, then, to enjoy the undisturbed conviction, that the création of every original species of animais was a spécial Act of God, and that they are in every vital sensé contradistinguished from in- organic matter. And when you shall have thus studied Nature as she is, you will find her in perfect harmony with your religious impressions ; nor can she fail to exalt your religious fervor. When, however, comparatively little was known of the laws which govern organized matter, the Sacred Record was the basis of faith, and skepticism was less indebted for aid to physiological spéculations. The opération of the latter was essentially négative, till science became the work of all, and its principles were everywhere brought into practical application. Let philosophy interrogate nature to its fullest satiety, under the direction of its heaven-born principles ; but, let it be consistent, and maintain its dignity- And should it sometimes, as it must in its wide range of nature, come in con- tact with miracle, —this is its limit, contented that it begins at the confines of Création; yet still may it stretch into the régions of Eternity, — past and to come ; but now it is employed in its nobler work of sacrificing its relations to second causes, and in establishing relations with the First Cause of all. ON THE THEORIES OF INFLAMMATION. (') " The act of inflammation appears to be an increased action of the amaller vessels. It is com- monly supposed to be contraction of the vessels ; but I have shown that their elastic power also dilates them ; and I have reason to believe their muscular power has a similar effect." — Huhter on the Blood, ire. {i) SECTION I. It is usual, at least with many, to begin the considération of the theory of inflammation with an account of the blood-vessels, the circulation of the blood, and other anatomical facts, and to bring up the préface with a multitude of experiments where nature may be seen in her most artificial aspects ; but, most of all, with micro- scopical explorations. To the latter, under the auspices of the physical théories of life, are owing, mainly, the mechanical doc- trines of inflammation. Since the time of Hunter and Bichat, we hear but little about the philosophy which relates to the vital powers, either in the processes of disease, or in the healthy actions of the system. Consequently the inquiry is apt to ter- minate in the simplicity of physical results. The human organization is either regarded as " a chemical laboratory," or, " our philosophy would teach us that there is but little différence between a man and a sieve." The mechanism is considered the agent itself; whilst the invisible existence which truly présides over all the movements of life, and whose phenomena are so multifarious as to defy enumeration, and which no other power can résolve, is ridiculed as a création of (1) The substance of our remarks on the Théories of Inflammation was published 'n the American Journal of the Médical Sciences for May, 1838. (2) P. 278.—We use the éd. of 1794. 142 THEORIES OP INFLAMMATION. fancy, because, like the more sensible parts, it is not a subject for the scalpel or the microscope. (See Vol. I. pp. 11, 33, 36, 75, &c.) In prosecuting our inquiry, we shall be content with the knowledge that the process of inflammation is conducted by blood-vessels and other inscrutably organized instruments ; but most of all, that thèse instruments are actuated in all their movements and results by powers which have no analogies in inorganic matter. And were it our spécifie purpose to construct a theory of inflammation, we would take especially the vital phenomena as the basis. To thèse we would make the physi- cal appearances s"ubordinate ; yielding their aid where suscepti- ble of interprétation by our standard of life. But, it is less our object to substitute a theory of inflammation, than to speak of the fallacies by which the Hunterian doctrine has been opposed : and although we shall défend the vital, and therefore active, nature of this disease, we shall employ ourselves mainly about the physical facts in which the mechanical doc- trines have had their origin. By thèse facts we shall try the hypothesis ; and if they cannot abide their own test, the theory of vitalism must unavoidably ensue. In a practical sensé, if we except the humoral pathology, and, perhaps, venous congestion, there is no question in medicine of equal importance, and none which has so extensively exercised its sway as the théories of inflammation. It is also our object to render this article subservient to that which follows, on venous congestion. In treating of the latter disease we shall often have occasion to borrow illustrations from the phenomena of common inflammation. But thèse facts are more or less invalidated by the doctrine which imputes the pathology of inflammation to a mechanical condition of the blood-vessels. It is our désire, therefore, to remove as much ambiguity as we may ; and by endeavouring to show the vital nature of inflammation, to dérive from this source some impor- tant light upon venous congestion. Nor is it less our object to extend those analogies which prompt us to distinguish the actions and phenomena of life from the manifestations of common mat- ter ; by which we may see our way the more clearly in our interprétation of nature, and in applying the means by which we endeavour to direct her laws. Having trusted, in early life, to the gênerai accuracy of micro- THEORIES OF INFLAMMATION. 143 scopical observations, we were disposed to conclude that there is a languid state of the circulation in inflammatory affections. (See Appendix on Microscope, Vol. I.) Still we could as little reconcile the phenomena of inflammation with the princi- ples of mechanical or chemical philosophy, as those analogies that are supplied by other diseases. We were, therefore, irresis- tibly led to revert to the laws that govern living matter, when- ever we attempted an explanation of its results, or the modus operandi of remédies. We turned our attention to the expérience of différent observers with the microscope, and found but little agreement amongst them, excepting as to the dilatation of the vessels, and an increased volume of blood ; and even the latter phenomenon, like pain, is a contingent resuit, and not a necessary élément of inflammation. (See Essay on Venous Congestion, Sec. 7.) Nor is it a little remarkable, that the doctrine of Cel- sus, " redness, swelling, heat, and pain," C) has been copied and perpetuated to the présent day of anatomical research. It is said by one of Mr. Hunter's admirers, that— " It appears not a little singular that this great man should have contented himself with reasoning on the state of the vessels in inflammation, rather than attempting to ascertain by experiment their actual condition." (2) But it appears to us to have been characteristic of Hunter's genius, that he rested his views of inflammation upon great phy- siological principles, and the natural pathological phenomena. That this was the true process is rendered probable by the con- stant failure of experiments that are intended to imitate nature, or to illustrate her laws and actions, in her department of organic life ; and this is shown to be especially true of expérimental in- quiries into the nature of inflammation, by the exactly opposite results in the hands of différent observers. We shall take Mr. Earle's very lucid digest of the existing doctrines of inflammation (3) for our guide ; and shall consider that part of the theory of passive relaxation, which he has pro- pounded in regard to the products and supposed terminations of inflammation, as irresistibly resulting from the fundamental principles of the doctrine. We do not, therefore, advert so much to Mr. Earle's individual opinions, as to their distinct ex- position of a common and important hypothesis. That part of the doctrine which regards the essential condi- (1) L. 3, c. 10, p. 139. (2) Morgan's Principles of Surgery. (3) Lon. Med. Gazette, vol. xvi. 144 THEORIES OF INFLAMMATION. tion ofthe vessels immediately concerned in the process of in- flammation supposes, lst. A passive relaxation ofthe vessels, a suspension of their natural action when they are admitted to possess any, and an in- crease of their diameters. 2d. A progressive accumulation, stagnation, and coagulation of the blood within the vessels. 3d. An enlargement of the collatéral vessels, proportioned to the redundancy of blood transmitted to the part, occasioned by its présence and the force of the vis a tergo. 4th. That the blood is propelled through the collatéral ves- sels by the action of the heart ; though all do not assent to this proposition. 5th. That the vessels being paralyzed in their action, and me- chanically obstructed, can perform no part in generating the products, or in what is called the terminations of inflammation ; and thence follows the corollary which Mr. Earle has unavoid- ably deduced, and which, as will be seen, is common to Mayo, Alison, Philip, Nauman, and others. It may be proper, however, to state, in the language of others, a summary of the doctrine, as we believe it to be generally re- ceived : " The observation," says an enlightened writer, " which I have quoted from M. Gendrin, when taken in connection with the facts previously stated, simpli- fies the theory of inflammation, and satisfactorily explains the alliance of all its leading phenomena. The initiatory effusion of sérum and lymph, dépendent up- on the visible obstruction of the circulation ; the lymph, with attenuated inflam- matory fibrine ; the conséquent occasional mixture of blood with lymph ; the formation of pus, secondary to and later than the sécrétion of sérum and lymphi being the resuit of protracted inflammatory action ; the solid particles in pus, although larger, yet of the same remarkable figure with those of the blood, and doublless the same enlarged ; the occurrence of pus mixed with it in streaks, or generally diffused through it ; the organization of lymph by extension of ves- sels, some at first containing pus, others a thick red liquid ; and, lastly, inflam- matory gangrené, proceeding from the vessels being, in certain cases, irrecov- erably obstructed ; are phenomena which may be declared to be grouped un- der one law." (') « The resuit," says Dr. Philip, « was still the same. As soon as the inflamma- tion began, the vessels began to enlarge, and the motion of the blood became languid ; thèse changes going on till in the most inflamed parts the vessels were enlarged to» several times their original diameter, and the motion of the blood ceased altogelher." (2) (1) Mayo's Outlines of Human Pathology, p. 431. (2) Expérimental Inquiry into the Laws of the Vital Functions, p. 260, and 267. THEORIES OF INFLAMMATION. 145 Prof. Alison states, as " the gênerai results of microscopical observations," that there is, "lst, an accélération of the movement of the blood in the vessels of the inflamed part, sometimes attended with a distinct, though slight constric- tion of thèse vessels ; but, more generally, at least soon after its commence- ment, attended with dilatation of the vessels. 2d. Within a short time, the state ofthe circulation, in the part chiefly affected, gives way to retarded movement in the dilated vessels, and ultimately to complète stagnation in some of thèse. 3d. As the blood stagnâtes in the vessels of the most inflamed parts, it gradu- ally concrètes into irregular masses, in which the distinction of the globules is no longer perceptible. 4th. The serous effusion, and afterwards the effusions of lymph and pus from the inflamed vessels, take place chiefly while the move- ment of the blood is slower than usual." Of course, if the blood be complete- ly stagnant and concrète. " 5th. If the inflammation subsides without slough- ing, the blood in the part most inflamed is gradually set in motion again, its globules reappear, and the capillaries containing it gradually contract to their former dimensions. 6th. In the more advanced stages of inflammation, the ac- tual conversion of some of the decolourized globules of blood, which adhère closely together, into the larger and yellower globules of pus, which have a free mo- tion on one another, may be traced." "This transformation may go on either in the interior of the vessels, or in the exudations which have taken place from them." " It may begin almost from the beginning of the inflammation, and in other cases hardly takes place in any stage of it, however protracted." (') It is the opinion of Prof. Naumann, that " when inflammation is once estab- lished, the globules of the blood appear crowded together and motionless in the greatly dislended capillary vessels, which must, therefore, have become imper- méable." " At the seat of inflammation, circulation is at an end." (') By another it is said, "when inflammation succeeds to congestion of the ca- pillaries, the circulation is completely interrupted, the blood coagulâtes, clogs the vessels," &c. (3) And yet our author concèdes that the globules become " more numerous in the small veins." We believe that all of this school concur in saying, that the vessels become more and more obstructed with coagulated blood as inflammation advances, and less and less capable of any in- dependent action. (4) It appears, also, to be universally admit- ted, that in parts which carry red blood, a preternatural quanti- ty is transmitted in inflammations, either through the seat of the disease, or the collatéral vessels. This has been demonstrated by Mr. Lawrence, (5) and is shown by other unequivocal facts (1) Alison's Physiology and Pathology, pp. 431,432, 439. (2) British and Foreign Med.Rev. No. 5, 1837, p. 214. (3) Cyclopœdia of Prac. Med. Art. Inflammation, p. 713. Our italics, as they are in most instances. See vol. i. p. 418, note. (4) « That practical philosopher, Mr. Reeve, has anticipated the coming state of the profession, and we must shortly admit with him, that there is nothing stirring but stagnation." (a) See Appendix. (5) On Diseases ofthe Eye, p. 64. — This appears from the increased quantity of (o) Med. Chir. Rev. Lon. vol. xxx. p. 360. VOL. II. 19 146 THEORIES OF INFLAMMATION. which we shall ultimately mention. It is shown, also by the profusion of blood which often follows the application of leeches to an inflamed surface, and the high florid colour and throbbing ofthe part. Objections have been often made to scarifications in erysipelas, on account ofthe great hemorrhage to which they are liable. In phlegmon, the blood flows from the incisions in the same way and with increased force. If the blood of an in- flamed part be expelled by rubbing, it will return with unusual velocity. The preternatural génération of heat is an évidence ofan increase of vital action, and augmented circulation, as is, also, the profuse sécrétion of différent fluids, and their spécifie nature. The veins proceeding immediately from the part carry more blood than in the natural state, and this blood is more flo- rid than natural ; whilst it should be darker in proportion to its stagnation in the arterial capillaries. The serous membranes, in their healthy condition, contain no red blood. This, and some other sensible appearances, have led to a déniai of their organization. (See Venous Congestion, Sec. 7.) But, " in chronic and acute inflammations, they exhibit a vascular net-work, so full of blood, that their redness is often deeper than that of the muscles." Ç) So, also, of cartilage, ten- don, &c. blood which flows from divided veins that issue from a part inflamed, as well as from the communicating arteries. The former fact has been denied by Morgan, but with- out the least show of proof; whilst its truth is known to every physician who has bled from the arm, in an inflamed state ofthe hand. In Lawrence's experiment, the quantity of blood was three times greater than from the sound arm. (1) Bichat's General Anatomy, vol. ii. p. 7. Dr. Billing, and the school who maintain the identity ofthe " nervous influence" and galvanism, dispose ofthe phenomenon of blushing, which has been set forlhby the vitalists to illustrate the modified action of inflammation, by "attributing thia giving way of the capillaries to dérivation of the nervous influence (or galvanism,) which, being directed to or expended in the brain more freely by mental émotion, robs, for the moment, the capillaries ofthe face of their energy." (a) The mechanical theorists, finding that the simple conditions of mère matter are inadéquate to the results of inflammation, call in the aid ofthe nervous system; without, however, adducing even any remote analogy to illustrate the influence of the nervous power upon the supposed mechanical results. But this hypothesis, had it any foundation, is inapplicable to the essential principles upon which inflammation dépends; since all its phenomena may take place in parts whose nervous communi- cation with the brain is destroyed. Indeed, the division of nerves is an exciting cause of inflammation. Camerer, Magendie, Stanley, and Robinson, after dividing the par vagum and sympathetic nerves, found the mucous coat of the intestines or othet parts disorganized as after inflammation under ordinary circumstances» Conjuncu- (o) Principles of Med. p. 25 —29. THEORIES OF INFLAMMATION. 147 Again, no mechanical explanation has ever accounted for the throbbing of an artery leading to an inflamed part, (') much less for the gênerai pulsation which often attends the part itself. The former often begins at an early stage of inflammation, when it is considered that the seat of disease is least obstructed, and subsides at the very time when the circulation in the capillaries is said to be most completely arrested. This is subversive of the mechanical rationale. But we have other facts of a stranger and coincident nature. The pulsation of the communicating arteries is often greatest when the gênerai circulation is prostra- ted, as in local inflammations complicated with venous conges- tions ; and hère, again, the pulsation subsides, as the force of the gênerai circulation rises, whilst the local inflammation goes on increasing. The varying phenomena are clearly owing to successive changes in the vital properties of the vascular system. The cases of dépression, also, to which we have just àlluded, are the very ones in which gênerai bloodletting, &c. is most im- portant ; and it is familiar to all, that whilst the force of the gênerai circulation rises under the influence of the lancet, and val inflammation has been very rapidly produced by dividing the nerves, especially the sympathetic, by Cruikshank, (a) Dupuy, (b) Brachet, (c) Mayer, (d) Magen- die, (e) Petit, (/) &c. Bichat, by dividing the spermatic nerves, brought on "inflam- mation and a deposit of matter in the testicles." (g-) (Pp. 26, 29, 30, and vol. i. p. 687.) On the other hand, important nerves have been divided without any apparent in- jury to the parts which they supply. "I have always observed," says Bichat, "that in producing palsy, neither exhalation, absorption, or nutrition, have been impaired in any sensible or sudden manner in the palsied part." (h) A perfectly paralyzed limb may be nourished as well as ever, — as ever liable to inflammation, and to par- ticipate in constitulional fever. Thèse various results appear to confirm the principles which we have defended in relation tothe nervous and organic properties, (See vol. i. pp. 158, 474 — 480, 568 — 572, &c.) and to invalidate the nervous, as well as mechanical doctrines of inflam- mation. (1) The more this circumstance is considered, the more are philosophers convinced that no physical explanation can obtain. Thus, Dr. Graves : that " the larger arte- ries certainly dilate can scarcely be doubted by any one who has observed the state of the temporal arteries in phrenitis or apoplexy." (i) The supposed physical ob- struction necessary to such a resuit must be speedily fatal in such an organ as the brain. The carotid often beats more sensibly on the side adjacent to an inflamed tonsil than on the other. (a) Philos. Trans. 1795, Part 1, p. 177. Exp. 2, 3, 4. — (b) Journ. do Méd. t. xxxvii. p. 340. — (c) Fonctions du Système Nerv. Ganglion, c. 9, p. 368— 401.— (d) Grafe u Walther's Journ. t. x. p. 3.— (e) Journ. de Physiol. t. iv. p. 304.— (f) Hist. de l'Acad. Roy. des Sciences, 1724, t. i. p. 9. " M. Petit a fait un grand nombre d'expériences sur des chiens vivans à qui il a coupé intercostat. Ceux qui appartenoient aux yeux ont été beaucoup plus constans, la conjunctiva s'est enflammé," &c. (.g) Recherches Phys. sur la Vie, &c. p. 515. (A) Ibid. p. 521. (•') Lectures in Loo. Med. Gaz. July, 1838, p. 605. 148 THEORIES OF INFLAMMATION. although the local affection continue to increase, the action of the communicating arteries may have been sensibly reduced.(') (1) Mr. Mor-an, in his Principles of Surgery, thinks that this pulsation ofthe communicatin/arteries, "is, without exception, the most unfortunate argument that could have been brought forward ; and in place of being a sign of an increased eu- culation through an inflamed part, it is an obvious sign of obstruction." Abstract- edly considered, which is but too frequently the case with both parties, it appears to us to prove nothing. It may then be equally supposed to arise from a propagation of increased action from the capillaries, or it may dépend upon their supposed obstrue- tion. The fact must be connected with all the proofs which relate directly to the state of the capillaries, and with all the facts appertaining to living organized matter, which everywhere contradict tho application of mechanical principles to the prob- lems of morbid action. Till a part is dead, it continues to be under the direction of the vital properties. Nothing requires so much an enlightened and comprehensive survey of physiological premises. Above all, however, is it important to coneider the spécifie facts which we have stated in our text in connection with the morbid pulsa- tion of arteries. Still it is sufficient to have shown that an increased volume of blood passes through the capillaries, or even through the communicating arteries, to render the pulsation ofthe latter, as in whitlow, an absolute proof of increased action in both séries of vessels, certainly in the larger, and thence by analogy, as well as numerous facts and physiological principles, in the smaller séries. The author, too, whom we quote, has collected a variety of évidence to show that the arteries possess a " vital contractility, which consists in the power which the fibres of the middle tunic possess of shortening and elongating themselves, by which means the diameter of vessels is increased or diminished so as to admit more or less blood, and by which, also, the cir- culation of that fluid must be influenced ;" that " the évidence leaves no room to doubt that arteries possess a power of acting totally distinct from elasticity." Why then, départ from admitted principles which form the basis of physiology, to expound phenomena which, more than any other, illustrate and establish those principles. True, we hear of a physiological and a morbid condition of parts as something in direct opposition ; and this substitution of the former term for that of healthy has car- ried its illusion. Still we believe that sound philosophy can only recognise one state as a modification of the other, without any radical change of principle. We now come to an admission in behalfof nature, which we find to be common among able writers who more or less embrace the mechanical doctrines. " We be- lieve," says Mr. Morgan, " that every practical surgeon will acknowledge, that if the artery leading to an inflamed part be divided, as the digital branch in whitlow, the blood will be ejected to a greater distance and flow more impetuously than from a vessel supplying a similar healthy part. But, although an increased activity in the larger arteries is thereby distinctly shown, it does not follow that those at the seat of disease are similarly affected, and our objections hère are the same as those already offered. It is no proof ofthe state ofthe circulation through an inflamed part thatit contains more blood than one in a sound condition, for the contending parties admit that point without dispute ; nor is it any évidence of either one state or another, be- cause the blood flows more freely when an incision is made ; for were the vessels distended from whatever cause, the same thing would resuit on their division."(o) Hère then, is all we require, to settle our position, even upon the mechanical prin- ciples. Our able author has overlooked some important facts as to the immédiate instruments of disease, and appears to assume that the escape of a redundant quan- tity of blood from the divided part relates only to the excess that may exist in the {a) Morgan's Principles of Surgery, pp. 16, 25, 57. THEORIES OF INFLAMMATION. 149 Many spécifie facts might be brought to sustain our conclu- sions. Thus, in a case where Dr. Warren tied the right carotid on account ofan erectile arterial tumour situated at the internai angle of the right eye, this vessel and its opposite fellow and their branches pulsated with violence. The ligature on the right carotid removed the pulsation ofthe left, although « the vibrations were more conspicuous on the left than on the side originally deranged." " The perfect success, from tying the right carotid, showed that the affection of the left side was altogether sympa- thetic." (') Many observers positively déclare that the blood is accelerated in the capillaries when stimulants are applied to them ; and the alternate actions of contraction and dilatation have been often witnessed. (2) — (See Venous Congestion, Sec. 10 ; where this capillaries at the moment of the division. But this is not so. The excess continues for a long time, and the most so in those cases where the obstruction and stagnation are supposed to be greatest. Other circumstances which are not taken into considé- ration will appear as we advance with our text. (1) Surgical Observations on Tumours, p. 403. (2) Schwann has discovered that the capillary arteries possess a coat with circular fibres, similar to those ofthe larger vessels, and that they contract under the influence of cold. — Mullefs Archiv. 1836. Millier dénies the muscularity of arteries ; but he neglects the anatomical fact and relies mainly on the effects of galvanism. This, however, has often failed to excite the heart itself. He dénies, also, all independent action to the capillary arteries, and considers it " irrefragibly proved, that the motion ofthe blood through the capillaries is affected solely by the action ofthe heart.'' He subsequently states, however, that Baumgaertner observed the blood in the frog's foot continue in motion from three to five minutes after ligature of the artery. Our author also admits, that having de- Btroyed the vitality of the heart of a frog by«liquor kali, he could, by means of the microscope, for some time perceive motion of the blood in the capillary vessels. Again, " in the instantaneous injection of the cheeks with blood in the act of blush- ing, and of the whole head under the influence of violent passions, the local pheno- mena," he says, " are evidently induced by nervous influence. The active congestion of certain organs, of the brain, for example, while they are in a state of excitement, is a similar phenomenon." And again, " it is certain that nervous influence is the principal cause of the accumulation of the blood in the capillaries of a part during the state of vital turgescence."(o) This is all we contend for; and we value it the more as it is apparently the second thought of our enlightened observer. Hère is an unequivocal fact. Dr. Stevens, after plunging a bodkin into a rabbit's brain, opened the chest ; when he found the heart motionless, but a branch of a coro- nary artery was pulsating forcibly, and continued so till its blood was entirely expelled.(6) Haller, Bichat, Philip, Hastings, Hunter and others, have seen the blood moving (a) Physiology, &c. pp. 202,206,208,218 — 225, 233. (4) On the Blood, p. 57. 160 THEORIES OF INFLAMMATION. subject is farther examined, in connection with the action ofthe veins.) We entertain no doubt that the blood is often more or less coagulated by the experimenters in the délicate vessels of the freely in the mesenteric capillaries of rabbits, &c. sometimes for more than an hour after the removal of the heart. (a) Burns mentions an instance where the whole circulation must have been carried on mainly by the vessels ; since both ventricles of the heart were as fully ossified as the cranium, except about a cubic inch at their apex. (6) Johnson maintains that the leech has no heart. In any event, he " has seen a well marked systole and diastole in the abdominal, latéral and dorsal vessels, by the naked eye^"—about ten pulsations in a minute, (c) This is confirmatory of Dr. Hall's observations to the same effect, who thinks he has shown that " the apparent effect of alternate contraction and relaxation ofthe artery after the ligature ofthe aorta, ia certainly most powerful," and he has pointed out " an artery in the frog and toad which puisâtes independently ofthe heart." (d) Muller, however, says this is " a pul- sating lymphatic heart." — El. of Physiol. p. 203. — Nevertheless, it has the charatter of an artery; and since we have hère an instance where nature is ascending from a simple to a complex organ, and the former performing the functions ofthe latter, the analogy is very appropriate to our purpose. And again, he says " the dorsal vessels of insects, and the principal, though not all the vascular trunks ofthe annelides,— for instance, the leech, — certainly contract by muscular force. But thèse parts are hearts." " In the Iower animais, the heart is nothing more than a dilated part of Ihe vascular system endowed with contractility." And yet our author thinks that analo- gies of this kind " are of no weight;" and without any other show of proof than what is derived from the supposed failure of "galvanic and electric stimuli" lo pro- duce contractions in the arteries, (Venous Congestion, Sec. 10,) he concludes that all the imputed vital contractions of thèse vessels are fallacious, and résolves their actions upon mère physical principles.— (Ut cil. p. 205.) Very sensible contractions and dilatations of the arteries have been produced by Zimmerman, (e) Verschuir, (/) Lorry, (g-) Soemering, (h) Hastings, (i) Parry,(j) Dennison, (k) Vandembas, (l) Jones, (m) Bikkcr, (n) Thomson, (o) Hunter, (p) Spallanzani, Rossi, Guens, Aldini, and^ others, by irritating agents. Hastings states that " an increase of dilatation and contraction in the exposed part of the vessel, whilst the stimulus was applied, was not an uncommon occurrence ;" but, " the arteries do not contract from acids, &c. after death. This is more or less confirmed by the foregoing observers. The arteries, indeed, are well known to have contracted when irritated by the scalpel, (q) They sometimes close remarkably when divided in the living subject ; always more so than after death. (r) Verschuir has seen them move with increasing activity when exposed to the air. (s) When an irritating cause is removed, the contractions cease. (t) The arteries are strongly contracted byelec- (o) Philip's Exp. Inquiry, &c. Exp. 67. Hastings, and others, as cited in our Venous Conges- tion, Sep. 10.—(4) On some ofthe most fréquent and important Diseases ofthe Heart, p. 117- 120.-(e) On the Médicinal Leech, pp. 116,117.-(d) Hall on the Powers which circulate the Blood, pp. 54, 58, &c.-(e) De Irritabilitate. — (/) De Vi Arteriar. et Venar. Irritabil.- {g) Vandermonde Rec. period. t. 6. - (A) Gefesslechre, p. 67.- (i) Exp. Inquiry of the Nature of Inflammation. Exp. 38,39, 40, 41, &c. -(^Additional Exp. on the Arteries. — (k) De Vasorum Irritabilitate. - (0 Dis.de vivis human. Corp. solid. Exp. 10, &c.-(m) De Arteriœ sectse Con- eecutionibus, p. 29.- (n) Dis. de Natura Humana, p. 45. - (o) On Inflammation, &c p. 75-89.- (p) On the Blood, &c. p. 158.- (j) Hastings, ut cit. Exp. 2, 3, and Table lst. Verschuir, ut cit.- (r) Hunter on the Blood ; Verschuir, Exp.8.-(,) Op. cit. Exp. J7.— (t) Ibid. Exp 18. Alw Jones, Hastings, Hunter, Thomson, &c. THEORIES OF INFLAMMATION. 151 membranous parts to which the active chemical agents, or other penetrating matter, are applied, — especially heat. This is, pro- bably, one^ source of the déception. In such a case, the blood would readily force its way into the collatéral vessels ; whilst the others would remain clogged up till their vital forces may so far recover themselves as to overcome the obstruction. This, however, is any thing but a natural process of inflammation. The blood is not only chemically coagulated, but, probably, the organization of the capillary tissne is often simultaneously altered, and the minute extremities of the arterial and venous Systems completely astringed. The process of inflammation, therefore, is not carried on by thèse vessels till they may recover their action, but, by others in their vicinity where it is necessa- rily admitted the circulation is accelerated. Hence the reason is obvious, why, in this mixed state of things, the ultimate pro- ducts may be more or less analogous to those of natural inflam- mations, after the vital forces shall have thrown off the artificial results. If, however, the violence be carried beyond a certain limit, the vital properties are destroyed in all the vessels, the tis- sues crisped till they often become dry, the blood everywhere coagulated, and we are then told that this is the degree of in- flammation which produces mortification. The only parallel in the case, however, appears to consist in the death ofthe part, which has been brought about by direct violence in one case, and by the mysterious opérations of nature in the other ; just as we kill an animal in one instance by a blow on the head, and in another by exciting inflammation of the brain. We have seen that the prevailing hypothesis of inflammation ascribes a far greater destruction of the capillary circulation in tricity, (o) even when applied to the nerves ; (6) however some may have failed of this resuit. Home saw the carotids beat with violence, after irritating the sympa- thetic nerve with potass. Brodie obtained the same resuit by irritating the intercos- tal nerves. (c) Philip certainly influenced the action of the arteries by stimulants and sédatives applied to the brain. (d) The puise sometimes fails in one arm when there is no mechanical obstacle tothe circulation, and returns when disease subsides. This is particularly true of cérébral affections. Blood i3 projected from an artery during the disastole ofthe ventricles. It circulâtes where the heart is wanting ; and nutrition is fully performed in the fœtus that is destitute of this organ. (e) The in- dependent action of the extrême capillary arteries has been also experimentally shown by most of the foregoing observers. (o) Verschuir, Cuens, Bikker, Vandembas, ut cit. — (b) Guiulio in Mém de l'Acad. des Sci. de Turin, t. 4. p. 50.—(c) Philos. Trans. 1814. — (d) Exp. Inquiry, &c. ; and Essay on Sleep and Death, p. 72. (e) See St. Hilaire Hist. des Anomalies de l'Organization. 152 THEORIES OF INFLAMMATION. the living state of vessels, than when they are visibly dead. It is stated by Dr. Philip that « The motion of the blood in the smaller vessels continues for a long time after what we call death, although immediately after it a ligature be thrown round all the vessels attached to the heart" « An hour and a quarter after the heart had been removed, he brought part of the mesentery, which had long been quite cold, before the microscope, and still found the blood in some of the capillary vessels moving quite freely." (') Dr. Philip's proofs, abstracted from the microscope, of the in- dependent action of the capillaries, appear to us irrésistible. It is remarkable that the advocates of debility, and stagnation of blood, as the pathological state of inflammation, generally main- tain that the capillary vessels possess no action, and that their circulation dépends upon the power of the heart. This condition supposes even a removal of all physical contraction from the extrême vessels, and of all possible obstruction to the circulation. Nevertheless, they fully admit even much beyond our own doc- trine, the agency of the " nervous influence " in inflammatory actions. (See Vol. I. pp. 162, 163, and erratum, 157, 568 — 572 ; Vol. IL p. 26—28, et passim.) How far it is philosoph- ical to connect the nervous influence with physical agencies, we have endeavoured to show on various occasions. (See Vol. I. p. 714, Vol. II. p. 30, &c.) Again, if vital action did not exist, there should be no varieties of inflammation. The vital phenomena, and the physical products, should be always the same ; the same in all tissues, and constitutions. Nor should we have the remarkable and diversified sympathetic influences of inflamed parts upon the system at large, or upon some partic- ular organ that may naturally sustain peculiar relations lo the part inflamed. We need not say, how far it is otherwise, and how impossible it is to explain the foregoing phenomena upon any other principle than that which supposes the essence of in- flammation to consist in some modified state of the vital forces and actions. (VoL I. p. 575.) It is said by Dr. Davies, in his excellent work, that the doc- trine which ascribes an increase of vital power to the vessels in inflammation is " contrary to every analogy. It would be as- suming, contrary to known fact, that the effect of disease is to render the body stronger than it was in a state of health." And then follows a perfectly physical illustration about the action of (1) Exp. Inquiry into the Laws, &c. pp. 210, 269 ; et seq. THEORIES OF INFLAMMATION. 153 sulphuric acid upon carbonate of soda ; which is certainly the whole amount ofthe proof. He contends for a "weakening" of the vital powers by all morbific causes. (') We have introduced this subject on account of its importance, and the gênerai appli- cation of the foregoing philosophy. We may say, in the first place, that the doctrine which Dr. D. opposes does not " assume that the effect of disease is to render the body stronger than it was in health." It applies only to particular parts in a state of inflammation, not to the body whose vitality may be greatly de- pressed by sympathetic influences, or by gênerai fébrile action. But what are the facts in inflammation ? If they are opposed to " every analogy," it is because inflammation is an unique affection, and has no analogies excepting in such conditions as approximate it. How are irritability, mobility, sensibility, sympathy affected ? Certainly all more strongly pronounced than in health, and we find our author arguing at times in this very manner. The fact is obvious in almost every case of in- flammatory action during its positive stage. And have we not stated many proofs which show that "every analogy" is really in favour of our conclusion 7 But, this is a small part of the altered condition of the vital powers. They are actualiy altered in their character, and this, too, according to the peculiarities of every tissue, and the diversities in the remote causes. This is the foundation of rational pathology, and of the effect of curative agents. Thèse altérations have no necessary connection with strength or weakness, whilst either, in their proper physiolog- ical sensé, may be perfectly compatible with the changes in kind, and with whatever is known of the same properties in their natural state. Whenever, therefore, we may speak of an exalted state of the vital powers from morbific causes, we mean to imply more particularly that they are modified in their kind, though exalted in degree, when vascular action is necessarily increased. Strength and weakness are wholly inapplicable terms to express the condition of a vital part. They have been fallaciously bor- rowed from the properties of dead matter, and have not been a little instrumental in bringing living matter into its opposite condition. (See Vol. I. pp. 31—35, 81, 279—293, 311—326, 454 — 460, 693.) The only admissible sensé in which the fore- going terms can be applied to the properties of organic matter (1) Sélections in Pathol. and Surgery, &c. Part I. 1839. VOL. II. 20 154 THEORIES OF INFLAMMATION. is with certain qualifications, as in the following instances by Mr. Hunter:— "Fever shows powers of résistance; the other symptoms show weakness sinking under the injury. This is like the effects of the cold bath ; yet we see it cailing forth, or rousing up to action, some peculiarity in the constitution, or a part," &c. « The following case is another strong instance of great action in a weak, irritable habit." " It would seem that violent actions of a strong arterial system required less blood than even natural actions ; and even less still than a weak or irritable system ; from whence we must see, that bleed- ing can either relieve infiammatory action, or increase it, and therefore not to be used at random." " When I descrihed inflammation, I observed, that there was either an increase of life, or an increased disposition to use with more vw. lence the life which the machine, or the part was in possession of ;" C) and some other analogous expressions as noticed in our first volume, p. 242—246. And, how will the mechanical philosophers expound the weakening effect of bloodletting, and cathartics, in almost in- stantly imparting strength to the whole system when that strength has been greatly prostrated by disease ? Is not Hunter right when he says that there may be "an inconvenience" at- tending bloodletting ; " by bringing the inflamed part upon a par with health, the sound parts may be brought much lower, so as tobe too low"? We see, therefore, that there is no analogy between the exal- tation of power in inflammation and the natural state of the vital forces, and that it is wholly an assumption to affirm a weakness of the powers because they are invaded by morbific causes. The whole natural action ofthe inflamed part is subverted, and the only ground of reasoning in the case as to the exaltation or the dépression of the vital powers is the phenomena which may be manifested ; whilst an argument founded on the abstract fact that the part is diseased, or upon the action of sulphuric acid upon carbonate of soda, is an abandonment of nature.— See Es- say on Venous Congestion, Sec. 9. We shall recur to this inquiry ; and shall only now add, before proceeding to the mechanical principles which relate to the doc- trine under considération, that it is candidly admitted by some of its strenuous advocates, that "In opposition to the hypothesis of direct debility ofthe vessels, the exciting causes and treatment of inflammation coincide better with the idea of excessive, than of détective action." (2) Is not the whole weight of this proof in direct collision with (1) On the Blood, &c. pp. 334, 335, 336, 341, 398. (2) Cyclopaedia of Prac. Med. ut cit. THEORIES OF INFLAMMATION. 155 the modem doctrine? Does not the increased irritability dénote an active condition of the vessels ? (x) And may we not found an argument upon the nature of the vital properties ; and should not analogy be allowed to be very strong, since, if effusions, analogous to those of inflammation, which occur in health, dé- pend on vascular action, they must dépend upon the same cause under all circumstances of disease? If this be not admitted, phy- siology must be abandoned as inapplicable to pathology, and as having no consistency. We must look with new eyes upon nature, and renounce all respect for her gênerai laws. " What," says Bichat, " can we conclude from an isolated phenomenon, which is in contradiction to all those which nature daily présents ?" (2) Besides the obstacles which the microscope has opposed to the inductions which are prompted by all the natural phenomena of life, and even by such as appertain to inflammation, there is one other fundamental, though hypothetical, objection to the doctrine of vital action. It is thus stated by Prof. Alison : — It is difficult to understand, how an increase of the only vital power which we have reason to ascribe to arteries, viz. tonicity, or tonic power of contraction, can lead to distension of the vessels, and at the same time to an increased flow of blood through them." (3) We shall make but few remarks upon the foregoing objection, at présent, since we shall have occasion to examine at length the action of both Systems of blood-vessels in our Essay on Venous Congestion, (Sections 10 and 11.) We will only now say, that " it is difficult to understand," how the vital power of contracting can exist without a corresponding power of dilating ; especially since the vessels must otherwise exist in a state of permanent contraction, and, of course, without any vital action other than that which maintains them in a state of tonic spasm. This is no action, and must form an absolute obstacle to the circulation. If action mean anything, it means motion, and this means alter- nate contraction and dilatation. The difficulty in " understand- ing the tonic power of contraction " consists in having assumed that unintelligible condition. Nor can it be conceded, that the power of the heart would exert any adéquate effect, as an équiv- alent to the action of dilatation. The capillary vessels, then, performing at all times in health (1) Mr. Earle observes, "when I shall have occasion to say that a part is weak, I shall not deem it necessary to call it irritable." What affinity is there in thèse terms ? Is not the former as unintelligible as the latter is full of meaning ? (2) tien. Anat. vol. i. p. 341. (3) Outlines of Physiol. and Pathol. p. 435. 156 . THEORIES OF INFLAMMATION. the actions of contraction and dilatation through vital forces, there can be no reason assigned, why, when those forces are ex- alted, the contractions and dilatations should not be increased in a corresponding manner. A passive dilatation of the vessels supposes a state that facili- tâtes the transmission of blood. Nor is there any obstacle sur- mised that shall either counteract the effect of the enlarged diam- eters, or oppose the circulation before that enlargement takes place. Miiller, Carswell, and others argue, indeed, that «the blood must, cœteris paribus, flow more slowly in a dilated vessel than in one more contracted." (') This may be plausible enough ; but it cannot be conceded that the cœteris paribus exist, as will appear from our ultimate facts. Thèse facts demonstrate that the extrême vessels, as well as the larger arteries, acquire an increased action, so that the blood, as also shown by direct facts, may be more accelerated in the enlarged vessels than in their natural state. Besides, is it any proof that the blood coagulâtes because its momentum is moderately diminished ? On the contrary, is not the conclusion opposed by the results of ligatures upon the principal arteries of the extremities ? Does not the blood remain long fluid in a vein when arrested by two ligatures ? (2) Does not inflammation constantly spring up when the circulation is greatly accelerated ? Concurring, also, with the foregoing causes in promoting a free circulation of the blood is the more attenuated state of this fluid in inflammations, and its diminished tendency to coagulate. Thus, then, we have the affirmations, in opposition to mechan- ical laws, upon which the theory mainly rests, that the blood stagnâtes in the enlarged vessels in proportion as their diameters become increased ; although, too, the blood is urged on by their preternatural action, and by an increased force of the vis a tergo, whilst the blood may be not only greatly thinner than natural, but less disposed to coagulate. (3) (1) Muller's Eléments of Physiology, vol. i. p. 228.—Dr. Billing compares the current to the velocity of a river according to the width of its channel. But there is nothing shown by such comparisons but what relates alone to physical causes. Sup- pose, however, the narrower partof a channel to be upon a dead level, and the wider at an angle of 45°, we shall have a greater velocity in the latter instance. Just so il it in inflammation. We have hère, too, a power superadded. (2) See Hunter on the Blood, p. 25. — Sixty-five days in the t. vaginalis. (3)This diminished coagulability is denied by some ; but in opposition to common observation. See Muller's Physiology, vol. i. p. 116. The doctrine of résistance in proportioji to the increased force ofthe vis a tergo a THEORIES OF INFLAMMATION. 157 This, however, is only the beginning of the conflict of the mechanical laws. There is a preternatural volume of blood de- termined towards the seat of inflammation ; sometimes, as has been shown, at least thrice the usual quantity. This is said to find its way through the collatéral vessels. Of course, it must begin to enlarge thèse vessels before stagnation commences in the direct instruments of disease ; otherwise, the latter, being passively dilated, would permit the redundant blood to follow their channel, and no stagnation could happen. We see not how this difficulty is to be obviated ; since it would be absurd to sup- pose that dilated vessels can constitute an obstruction to the in- creased volume of blood which is constantly determined upon the part, and this, too, by an augmented vis a tergo. But the hypothesis also supposes that the dilated state of the vessels is not only adéquate to arrest the increased détermination of blood, and its increased momentum, but, that it is able, also, to over- come the résistance that is opposed by the tonic and elastic pro- perties of the collatéral vessels, (') whilst it is one of the most palpable laws in physics, that in proportion as a vessel dilates, obstacles are removed, and vice versa. It should also be consid- ered, that whilst the collatéral vessels are in full possession of their tonic forces, those of the diseased vessels are so enfeebled that they permit a passive dilatation from the beginning. Why the blood, therefore, should take a course in the direction of the greatest impediment, the mechanical hypothesis does not deign to explain. And hère we may say that the argument founded upon the supposed diminished velocity of blood in the dilated vessels, which are the instruments of disease, is farther shown to be worthless by the dilated state of the collatéral vessels, and in thus expressed by Mr. Morgan, who belongs to the school that allow the instruments of disease to be in a state of "increased action" in the first stage of inflammation ; which, it will be seen by our argument, only renders the mechanical hypothesis still more offensive to its own principles. Now mark the progress of results. As "the vis a tergo increases," says Mr. Morgan, " there is a graduai subversion ofthe phe- nomena présent, and a new and différent séries of morbid changes arises. The blood becomes more viscid, and this, with the more véhément action of the larger arteries be- hind, tends, in particular, to destroy the tonicity of the extrême branches, which be- come still farther dilated, and lose their control over the fluid within them. In many ofthe extrême vessels the blood is now at rest." (a) (1) True, Mr. Mayo assumes that the capillaries may have a ready power of re- laxing themselves. This might have been excused in Hunter ; but it will not hold in a theory so mechanical as the one under considération. Morgan, of the same school however, has answered the conjecture by six substantial objections, (b) («) Principles of Surgery, p. 46. (b) Ibid. p. 29. 158 THEORIES OF INFLAMMATION. which, also, it is admitted that the velocity is increased. But, since the collatéral capillaries become dilated, we ask for the rea- son why this condition should not equally occasion a stagnation and coagulation of blood as the like condition of the immédiate instruments of disease ? Upon what possible ground can it be assumed, that dilatation of one séries of vessels causes stagnation, and that the same state of others in immédiate contiguity is at- tended by an accelerated movement of the circulation ? We see not but our friends must consent to be impaled on both horns of this dilemma. The process of inflammation, according to the hypothesis which we are examining, appears not to have been systemati- cally traced beyond its primary stage, until Mr. Earle took up the principles on which the doctrine is founded, and explained the manner in which the various results take place. (-1) It appears to us, as we have intimated, that Mr. Earle's exposition is in perfect conformity with the laws which are supposed to operate in the introductory stage, and that the whole theory is perfectly consistent and unavoidable in all its parts. Various authors, how- ever, have more or less extended the philosophy through the ul- timate détails of inflammation, but no one had pursued it method- ically till undertaken by Mr. Earle. We shall, therefore, follow this observer along his well beaten path, in the hope that we may cull some flowers by the way to grâce the genius which présides over the destinies of life. But we speak not of Mr. Earle individually, but as the représentative of a prevailing and important doctrine. In conformity, therefore, with the foregoing premises, it is con- tended that sérum and lymph, arising from inflammation, are merely mechanical exudations from the blood ; and as to pus, Mr. Earle adopts the no less prevailing belief that " the opinion of its being a sécrétion cannot be admitted without carrying oui déférence to Mr. Hunter's authority to an unwarrantable ex- tent.'^2) And since the laws of life are supposed to have no connection with the formation of pus, it is considered, as by many (1) It has been said by an able reviewer, that "Mr. Earle's lunges against tbe doctrine of Hunter are like the exploits of Ajax." We only ask what Ajax asked from the gods, irapa \cvkLv tiaitepov,— "give us but light;" when we doubt notthat the arms of our modem Ajax will be again adjudged to some future Ulysses. (2) Essays in London Med. Gaz. vol. xvi. p. 136. This is only conformable with what we have seen to be alleged of many natural sécrétions, in our " Humoral Pathology." THEORIES OF INFLAMMATION. 159 others, to be a component part of the blood ; and this is consist- ently supposed to make its escape in a purely mechanical man- ner. Mr. Earle has illustrated this subject by a comparison. " Would it be a matter of astonishment," he says, "if the several parts of a fluid like the blood, upon being pressed through an excessively fine sieve, were to come through in the order of their fluidity ; that is, the finest and most fluid first, and the largest and coarsest last V (') Lest this hypothetical illustration might seem to be conclusive, we have seriously put it to the test of experiment. But every species of the finest texture was perméable by the sérum, and admitted, also, the passage of the red globules. (2) But we have seen that the vessels are clogged up and render- ed imperméable by coagulated blood; and without a chance, from the want of vital action, of relieving themselves. This must be especially the case, considering " The impossibility of detecting any pores, or openings in the sides of the minute vessels, the impossibility of the processes of nutrition and absorption being carried on through the coats of the vessels " ; and, that " there are no new vessels formed, nor any new disposition of the old, which can be termed gland ular." (3) In this condition of the vessels, therefore, it is difficult to un- derstand how even so thin a fluid as sérum should find its way from the extremities of the vessels, especially in any remarka- ble quantity ; and this diflîculty increases when we consider that no fresh supply of blood enters the obstructed vessels. We learn, also, from Professor Alison and others, that it is under this embarrassment that "the serous effusions, and afterwards the effusions of lymph and pus from the inflamed vessels take place." (4) But, besides this mechanical obstruction, the effusions, as well (1) Op. cit. p. 141. " Our philosophy," indeed, " would teach us that there is but little différence between a man and a sieve." (See vol. i. p. 75.) Professor Alison finds in the foregoing effusions a " strong indication ofan actual increase of vital action in the vessels of an inflamed part;" though it will be seen that he résolves them upon the mechanical principles. " The immédiate effects of inflam- mation on the contents ofthe vessels ofthe part," he says, "the exudation first of sérum and afterwards of coagulable lymph, are effects which may naturally be ex- pected from increased constriction ofthe coats of thèse vessels." (Outlines of Pa- thology, p. 434J But why not adhère to the philosophy of " increased vital action" which is so " strongly indicated " ? (2) Berzelius says they pass readily through filtering paper. — Trait, de Chimie, t. vii. (3) Mr. Earle, Op. cit. pp. 8, 142, 168. (4) Op. cit. p. 431. 160 THEORIES OF INFLAMMATION. as the hypothesis, have to contend with other obstacles. In a wound " there is a thin layer of parenchyma between the exter- nal air and the blood in the adjacent vessels, which is sufficiently dense to prevent the egress of blood as blood ; but it cannot prevent its exuding in détail." Then it is hypothetically stated, as we have seen, that the parts of a fluid, like the blood, upon being pressed through an excessively fine sieve, would come through in the order of their fluidity, the finest first, the coarsest last. Ç) But we have already shown, that although this be true in respect to a sieve, and the object for which it is employed, it does not hold good in regard to the blood. Could we have endowed our sieve with the powers and actions of life, we might have made out the parallel. (Vol. I. pp. 117, 659, note.) The conclusion, therefore, was forced upon us, that the simile is defective from the defect of the sieve in those endowments. Nor should it be overlooked, that the parallel of the sieve ap- pears to suffer another radical defect in the supply not being kept up, whilst there must be a constant renewal of the raw ma- terial in the inflamed vessels. In the former case, nothing re- mains at last but the coarser matter, whilst in the other instance, there is constantly presented the finer as well as the coarser to be perpetually strained off; and, therefore, in the latter case, according to the hypothesis, coarser matter should never exude. True, the hypothesis supposes that the vessels are so clogged, that there are no successive renewals of blood ; but the pro- digious effusions which often occur, when the vessels are sup- posed to be most obstructed, prove by the principles upon which the hypothesis is founded, that it has violated the most palpable laws in physics. (2) But we leave this matter to be settled by farther experiments, and pass on to other difficulties. Again ; after the sérum is strained off by the force of the (1) MOller makes, apparently, an ambiguous compromise with the vitalists. " The exudation," he says, " of the fibrinous fluid in inflammation might be explain- ed by the obstructed circulation, but the quality of the exuded matter dépends on other causes." (a) He does not say, however, that the other causes are vital ; and perhaps, therefore, the chemists have a right to the construction. (2) Aretœus appears to have anticipated the présent hypothesis, and our objection. Thus : " Sed magnum profecto miraculum, quomodo id fiât, ut ab exili tenuique membrana nihil crassitudinis habente, membrana inquam costas interius obtegentc tanta copia pueris effundatur, multum enim colligi in multis deprehensum est. H«- jus rei causa est inflammalio ex sangxdnis multitudine oriens."__De Diuturn. Affect. 1. i. c ix. (o) Eléments of Physiology, vol. i. p. 255. THEORIES OF INFLAMMATION. 161 heart alone, as is generally held, (impinging against " stagnant and coagulated blood,") through the vessels that are clogged up and farther obstructed by the external layer of parenchyma, and whilst also, according to the doctrine, the blood has become still more stagnant in the instruments of disease, coagulable lymph, a much grosser part of the blood, begins to follow its pioneer. But hère, it is manifest the order should have been reversed, if mechanical philosophy is to résolve the phenomenon. (') Besides, what becomes of $he sérum which is constanly presented, as from the beginning, along with the fresh supplies of blood ? What imparts to the lymph its new properties, its exalted vital- ity? " The surface," it is said, " now becomes covered with an amorphous déposition of coagulated fibrin, and becomes thicker, so that a greater impediment exists to the expulsion of the glob- ules than before." But whilst this, and other obstructions form an impediment also to the effusion of sérum, they are no ob- stacle to the expulsion of pus ; for it is said " the fluid now be- comes thicker, and assumes *the appearance which is known by the name of pus." (2) And, notwithstanding all thèse increasing obstacles, purulent matter is often poured out in a torrent, alto- gether exceeding the primary effusions of the more attenuated parts of the blood. (3) Indeed, the size of the globules of pus, which is stated by many to be twice that of the red globules, (4) (1) When it was observed that blood did not coagulate in inflammations, as it dropped from an orifice, the mechanical physicians explained it " in their own way, by supposing that the thicker part ofthe blood can flow out only in proportion as the orifice is large, the thinner particles being supposed to be thrown out towards the sides ofthe vessels, while the thicker blood circulâtes in the centre." (n) (2) Mr. Earle, Op. cit. pp. 141, 142. (3) In the serous and mucous membranes, however, we have other phenomena. Hère the " finer parts ofthe blood" are produced in such abundance as torender it equally certain that there is, at all times, a greatly augmented volume of blood cir- culating actively in the instruments of inflammation. And what is hère, too, re- markable, the " finer parts ofthe blood » are thrown out when inflammation is least, and the vessels are supposed to be least obstructed ; but the « coarser parts," or thé lymph and purulent matter, are only eflused from thèse membranes when inflamma- tion is more active, and the vessels are supposed to be in a more obstructed state. We would also oppose this last considération to the late hypothesis that the preter- natural effusion of lymph is the resuit of a healthy process. (4) M. Donné in Archives Génér. Août, 1836; M. Gendrin, Hist. Anatom. des Inflam. t ii. p. 489 ; and Dr. Hake^ut cit. (o) Zimmerman on Expérience in Physic, vol. i. p. 306. VOL. II. 21 162 THEORIES ON INFLAMMATION. and the increased density of the stratum are supposed to facili- tate their escape. (Vol. I. pp. 686, 702.) «There are two reasons," it is said, "why the globules are the last to be effused upon the surface of a wound. The first is to be found in their size, the second in the déposition of lymph, by which the thickness of the stratum through which they have to pass is increased." And again it is said, » the passage ofthe blood to the central point of the inflamed part, which was a< first perfectly free, now becomes gradually more and more obstructed and difficult. As this happens, the globules lose their colouring matter in passing through the tissue thus thickened." Q But, what strikes us as a far greater defect in this application of mechanical principles, is the arrest of the sérum, or " finest and most fluid part of the blood," after "the largest and coarsest parts " have opened a channel for themselves. Hère again, too, the sieve is brought in our way. It supposes that the vessels, containing nothing but coagulated blood, are as fully exhausted of sérum as the clôt of blood that had been mechanically filter- ed. But, if there be not a great and incessant renewal of blood in the instruments of disease, we again ask, whence proceeds the torrent of pus ? And if so, what keeps back the " finer parts"? Will the advocates of " stagnation " answer ; bearing in mind, at the same time, that effusions of pus sometimes continue for months and for years 'l Nevertheless, it is a rational conclu- sion that, if stagnation of blood be necessary to the first produc- tion of pus, it is equally so to the end of the year. Again, following up the idea suggested by the sieve, Mr. E. in behalf of his school, accounts for the removal of the colouring matter from the globules of blood in their conversion into pus, upon the ground that, " it is certainly possible that it may be merely mechanically wiped off in their progress "; and this opin- ion is variously enforced. (2) But we hère refer to our contra- dictory experiment, and to that of Berzelius with fil te ring paper; (p. 159.) Something may be also inferred as to the effect of fric- tion from the almost fluid nature of the red globules and that of (1) Mr. Earle, Op. cit. pp. 142, 188. (2) Op. cit. pp. 142, 188, 219. This, however, appears to have been suggested by Gendrin, who says, " ils se dépouillent de leur matière colorante qui parait par striés dans leur interstices." — Hist. Jlnatom. 8çc. t. ii. § 1471. The imputed process i» analogous to an opinion entertained by some, that the absorbent glands supply the central particle of the red globules, by straining it off from the lymph or chyle. Ac- cording to Hodgkin and Muller, the colouring matter is only disposed to leave tbe globules when water is applied. — Pogendorf's Annals, t. xxv. p. 513, and Philof Trans. 1818. THEORIES OF INFLAMMATION. 163 the tissue which composes the extrême vessels, as well as from the size ofthe globules, which Leuwenhoeck estimated at TlTT^iTTÏÏ part of a grain of sand, and which, according to later microscop- ists, would take 10,000,000 to make a square inch. Hewson saw thousands of them in an insect whose entire bulk did not ex- ceed a pin's head. (*) It should be recollected, too, Jhat this wiping by the blood-vessels is contradicted by the principles of the mechanical doctrine ; since, in rejecting entirely the vital theory of absorption and ulcération, it supposes that the surroun- ding tissues are broken down by the force of the vis a tergo : " The first effect of infiammatory infiltration," it is said, » being to destroy the original firmness and tenacity of every tissue in which it occurs, so as to cause it to be readily broken down and give way on the slightest pressure." (2) It is, therefore, the more difficult to imagine that degree of mechanical résistance or friction that must be necessary to de- tach the colouring matter from the globules of blood. And since the vis a tero-o is said to be sufficient to break down the inflamed o tissues, and to force an abscess to the surface, it is not a little singular that such a power should not occasionally expel the red globules into this unresisting matrix. But, if the colouring matter be wiped off, as supposed, what should prevent each succeeding globule of pus from pushing it out of the vessels ? Or, if it be still insisted that the colouring matter cannot folio w its globule, with the aid of the ejecting power of the succeeding globule, we then ask what disposition the hypothesis makes of the vast amount of colouring matter that ought to be accumulated in the " obstructed " tubes ? Can the hypothesis explain the long continued disappearance ofthe col- ouring matter and other principles ofthe blood but by admitting that pus is a new formation, and that it dépends upon forces and actions which have no analogies in the inorganic world ? Nor should it be forgotten, that at this stage of the process, it is uni- versally concluded that the blood has " concreted into irregular masses in which the distinction of the globules is no longer perceptible." (3) Suppose, however, that Home, Hodgkin,(4) Autenrieth, Brug- (1) See Appendix on Microscope. Zimmerman asks, "what would Aristo- phanes have said, had he seen the modems analyzing the blood of a flea ?" — On Expérience in Physic, vol. i. p. 1 11. (2) Mr. Earle, Op. cit. p. 189. (3) Alison, ut cit. p. 431. (4) Hodgkin says the globules of pus " bear no resemblance to those of the blood." 164 THEORIES OF INFLAMMATION. mans, Lister, and some others, are right in their statement that the globules of pus are formed from a gelatinous fluid that is first effused, it would be equally fatal to the hypothesis we are considering. (z) It appears to us, that, not only the exclusion of the red glob- ules from the suppurating vessels, but also from the serous and lymphatic vessels, may be most philosophically explained upon vital principles. Taking the mean of the estimated size of the globules, it is impossible to imagine the existence of organized vessels so small. In another, and more exact science, they would be called " mathematical lines." We are willing to allow that some conjecture may be formed as to the diameter of the red particles ; but we hold it to be absurd to attempt the measure- ment of vessels, which, according to the hypothesis, must be as invisible to the naked eye as the particles themselves. (2) But since the ultimate vessels must have their coats, and thèse their vasa vasorum, probably carrying also red globules, their sensi- ble dimensions must be admitted ; and we must, therefore, seek for another principle which shall explain the exclusion of the red globules from vessels of a greater diameter. This is to be found in the différent modifications of their irritability, in Hal- ler's, Hunter's, and Bichat's sensé of the word ; just as is mani- fested in the élective function of the excretory vessels of the liver, kidneys, &c, and, as seen in the refusai of the lacteals to take up bile, or cathartics. (3) (Vol. I. pp. 509, 526,548—575, 601 — 608.) Hence is it, that the products of inflammatory (1) The supposition that the globules are of extra-vascular formation is, prima facie, inadmissible. It violâtes a great principle in physiology; since it is estab- lished that all other animal globules dépend upon the action of vital forces. It ap- pears to us that such a law ought not to be sacrificed to the microscope. Moller has an assumption about it, founded upon the hypothesis that the capillaries have no ori- fices. — Eléments of Physiology, vol. i. p. 425.— See our Appendix on Endosmosis, vol. i. (2) Treviranus and others, make the diameter of some of the capillary blood- vessels only 0,0049 millimètres, whilst they estimate that ofthe red globules at 0,005 or 0,006 millimètres. — Hake says " the globules and capillaries are ofthe same size." (3) Bichat has given usa most intelligible explanation of this phenomenon, as exhi- bited in inflammations, in conformity with the laws of life.— See his Recherche! Phys. sur la Vie, et la Mort, p. 125 — 136. Breschet's idea, (Le Système Lymphatique, fyc. c. 3,) that the globules of blood are too large for the orifices of the lymphatic vessels is founded upon too many prem'ue» that are assumed. Besides, the globules of blood, and the larger ones of pus, are known to find their way into thèse vessels. Again, do they enter without correa- ponding orifices ? THEORIES OF INFLAMMATION. 165 action are constantly varying, or red globules escaping from the vessels, according to the modifications of the vital properties ; and thèse, again, are remarkably denoted by coincident variations of the vital signs. By some, it is admitted that the introductory stage of inflam- mation is simply one of arterial congestion, « Characterized, at first, by an increased activity of the vessels and influx of blood, various degrees of turgescence, &c. ; and, secondly, as the congestion increases, a laboured, slow circulation arising from the over-distension of the vessels, and an increased thickness and viscidity of the blood." It might be supposed, that an increased diameter of the ves- sels, (and whilst the blood is admitted to retain its fluidity, and the vessels to possess an increased action,) would be particu- larly auspicious, upon the mechanical hypothesis, to the various effusions, as well, also, to an undisturbed circulation of the blood. But, it is not so considered. " The period of inflammation," the writer continues, " is characterized by an entirely new order of morbid changes. The circulation is completely inter- rupted, the blood coagulâtes, clogs the vessels ; some of the vessels are rup- tured, (how ?) and there is an extravasation either of blood or of coagulated lymph in the parenchyma ; lymph and sérum are also exuded, and the déposi- tion of the new products leads to a decided change of structure." New vessels then appear, which are said, in philosophical conformity with the hypothesis, to be " mechanically formed." (') This writer. however, appears to adopt M. Gendrin's explana- tion of the formation of pus, which differs but little from that of Mr. Earle, but which is so far even less intelligible, considering especially the imputed state of the vessels. The reader will not fail to remark, also, the collision which exists hère in the report of the microscope and that which affirms the extra-vascular for- mation of purulent globules, and the absence of vascular orifices. " After the inflammation," he says, " has attained its height, the circulation remains for some time stagnant, the vessels and intermediate cellular texture being both filled with coagulated blood and lymph ; the colouring matter gradually disappears, the part assuming more and more an opal tint ; small, yellow, soft molécules may be seen interspersed through the coagulum, and some of them agglomerating in large globules evidently purulent. A slow degree of motion gradually becomes apparent by the oscillation of some of the globules in some of the vessels ; whilst a passage seems to be made for others through the softened lymph by the formation of new vessels, especially near the surface." (5) M. Gendrin, however, very justly supposes that in this state of the vessels there can be no vital action, and ascribes the forma- (1) Cyclopœdia of Prac. Med. Lon. Art. Inflammation, p. 713. (2) Ibid. p. 716. 166 THEORIES OF INFLAMMATION. tion of pus to a mère physical change of the blood, although we do not learn from him the philosophy of the change, nor how the blood begins to move, how the colouring matter is detached and disposed of, nor how the pus, all at once, makes its escape in such prodigious quantities from vessels which are receiving no fresh supply of blood, which are blocked up with the coagu- lum, and which are destitute of all independent action. Nor does it appear to us an improvement of the philosophy, that M, Gendrin admits that, in less embarrassed states of the vessels, pus dépends upon a vital process, and that it is then " une véri- table sécrétion morbide. (') Most of the able writers of the school with which we have now the honour of holding our argument, have agreed as to the intra-vascular conversion of the stagnated blood into globules of pus. Thus, Professor Alison : " It is by a subséquent transformation of globules of the blood which have stagnated, and been partially decolourized, that the globules of pus are formed." (») Nor do we see that Professor Naumann's explanation does more than confirm the difficulties. " The physiological rationale of the development of inflammation," says this philosopher, is " briefly as follows. The blood accumulating gradually in the capillary vessels, owing to the congestion in a part, becomes more and more a source of abnormal irritation to the nervous ramifications. The globules of blood become more and more crowded together. Owing to the impeded motion of the blood, its fibrin, (from its organic affinity to the cruor,) will be most easily held back, whilst the rarer parts will find their way into the venous stream. When the increasing stagnation ceases to admit of this, the sérum of the blood at length pénétrâtes the coats of the capillary vessels, and collects itself within the cellular texture, in the shape of what has been called puriform sérum. At the same time the fibrin and the globules are retained in close con- junction with each other in the capillary vessels." (3) The foregoing is also nearly the rationale of Mr. Earle, but wants its simplicity in bringing to the pure éléments of physics the " abnormal irritation of the nervous ramifications," without any intelligible connection. (Vol. I. p. 714, &c.) How the coarser fluids ultimately escape, does not appear in the journal from which we make the extract. But the Professor, being of Muller's school as to the non-existence of vascular orifices, was probably arrested by the mechanical obstacle. Mr. Earle, and (1) Hist. Anatom. de Inflam., t 2, § 1461, 1463, 1471, &c. (2) Outlines, Sic. p. 439. (3) British and Foreign Med. Rev. No. 5, p. 214. THÉORIES OF INFLAMMATION. 167 others, however, state that inflammation does not decrease with the suppurating process ; that Mr. Hunter was wrong in con- sidering this process a termination of inflammation, (x) and that, of course, the vessels remain obstructed as usual. And this is perfectly philosophical. For if stagnation and coagulation of blood were necessary to the first effusion of pus, it must be equally necessary so long as this product continues to be formed, however enormous may be the discharge. Such is ever the atti- tude of physiologists when they attempt to résolve the processes of life by physical laws. We may say, also, that it appears to have been overlooked, that when the effusions become most abundant, the force of the vis a tergo, which is the only agent the hypothesis acknowledges, is on the décline ; whilst there may be little or none when the heart is pulsating with the great- est violence. The same, too, may be often affirmed of haemor- rhages, the sécrétions of bile, urine, sérum, mucus, &c. The plain reason is, the motions of the capillary vessels are essen- tially independent of those of the heart and arteries, and are varied according to the existing state of their vital forces. (See Essay on Venous Congestion, Sec. 11.) We now come to that part of the prevailing doctrine of inflam- mation, which expounds the philosophy of the removal of parts (1) And yet, strangely enough, Mr. Hunter is represented by some as regarding suppuration as an absolute inflammatory process, when he everywhere désignâtes it as a " termination of inflammation." Mr. H. considered it a spécifie mode of action growing out of inflammation, as he did, also, that which results in a'preterna- tural formation of lymph. He did not regard the latter at any time, as some late writers have done, as exactly analogous to the process of nutrition, and therefore the resuit of a healthy condition of the vessels. The analogies, which have been brought by some philosophers from animais ofthe lowest organization and the vege- table kingdom, cannot obtain till it be more fully shown that the organization and vital properties of complex animais are equally allied to the former. "We allow a great latitude to analogies where organized matter is concerned ; but this is one of the results where the analogies must extend at least as far as organization to justify the induction. The attendant phenomena dénote a spécial modification of action, which not only require our premises to résolve the physiology into a process of nutrition, but, having obtained them, we see not then how the phenomena are to be set aside without a disregard of paramount facts. We may carry this doctrine a step farther, and affirm, in the language of Wilson, that although " another action arise in a diseased part, which has a tendency to restore it, this is différent from the natural action of the part ; and, although it be not in itself a diseased action, it takes place only in conséquence of disease." (a) We may find an easy solution of this apparent mystery by a proper référence to the nature of tho vital forces. (a) Wilson on the Blood, &c. p. 229. 168 THEORIES OF INFLAMMATION. interposed between an abscess and the surface, and which ex- plodes Mr. Hunter's theory of the agency of the absorbents. This hypothesis ascribesthe phenomenon to the previous results of inflammation, and the mechanical power ofthe heart, by which all surrounding tissues are broken down; although it is not shown how parts that disappear in this process are removed. It is said by the mechanical philosophers, that, — " As the course of the blood in the capillaries is, generally speaking, from the centre towards the circumference, such is the direction of the vis a tergo, and such must be the usual course of the pus. It cannot penetrate from the cir- cumference towards the centre, because there is no force by which it can be impelled in that direction." " The first effect of inflammatory infiltration is to destroy the original firmness and tenacity of every tissue in which it occurs, so as to cause it to be readily broken down, and give way on the slightest près. sure ; bone, cartilage, fibro-cartilage, are all affected alike." " It is évident, that, although there must be a gênerai yielding over the whole of the inflamed part, it will be most decided precisely upon that point upon which the greatest degree of pressure is exerted." (') In the first place, it appears to be hère overlooked that suppu- ration occurs " precisely at that point " where the instruments of disease are said to be most obstructed ; and, therefore, according to the hypothesis the least degree of pressure should be exerted upon this particular part. But this is certainly the only consist- ent solution that the mechanical doctrine of inflammation will admit. It must adhère to its fundamental principles, however facts may conflict with each other, and the principles with facts. A single exception, also, to the foregoing rationale must be fatal to it. In peritoneal inflammation, the force of the vis a tergo is as much towards the cavity of the abdomen as the surface of the body ; and yet, when suppuration takes place, the matter péné- trâtes through fascia, muscle and skin, although the peritoneum is the only obstacle to be overcome in the other direction. We may also suppose that the downward and increasing pressure of the accumulated matter is quite equal to the vis a tergo in the capillaries ; especially as the latter is generally supposed by the mechanical theorists to dépend wholly upon the heart. The same reasoning is applicable to many other parts, where the force of the vis a tergo is directed as much below an abscess as toward the surface. A striking instance exists in abscesses of the liver. As to the manifest agency of the absorbents, it is no more re- markable that their opération should be restricted to the anterior (1) Mr. Earle, Op. cit. p. 189. THEORIES OF INFLAMMATION. 169 wall ofan abscess, than that they should be limited to the absorp- tion of chyle in one part, or that blood should be excluded from the whole, or than many other peculiarities of the absorbent Sys- tem, which so clearly demonstrate the vital nature of its functions. We cannot interrogate nature as to the principles upon which her vital phenomena dépend, beyond the phenomena themselves, or their analogies. We must be content with the results, and through them to infer the existence of laws as indispensable to the phenomena, as the soûl is to thought or to voluntary motion. But we may find a satisfactory reason, upon vital principles, for the greater activity of the absorbents of the anterior parietes of an abscess in the greater activity of inflammation in this part; whilst some tissues, especially the serous, are but little liable to ulcération ; a phenomenon which is also greatly at variance with the mechanical rationale. Mr. Hunter is certainly ambiguous, when he ascribes the progress of an abscess towards the surface to a species of intelligence. Still it is a figurative explanation, and like his analogous illustration of the properties of life, was designed for reflecting minds ; as was also his exactly opposite, and more unhappy comparison of the organized system to the mechanism of a watch, and other contrivances which dépend upon physical powers. He appears to have been sensible of the philosophy, that the progress of an abscess towards the surface is the resuit of a gênerai law, by which inflammation is more readily excited, and ranges higher in superficial parts, than in the deep seated. (') We come next to the granulating process ; and this should be as much a mechanical one as the antécédent. Aecordingly it is said, — "The same simplicity reigns in this as throughout every preceding part of the process of inflammation." " It is as easy to explain the whole process of ulcération and mortification, as it was to account for the opening of an abscess, without even hinting at the existence ofthe lymphatic system." (1) This subject might be greatly amplified. We might inquire, " if it be the first effect of inflammatory infiltration todestroythe original firmness and tenacity of every tissue in which it occurs, so as to cause it to be readily broken down and give way on the slightest pressure," why this disintegration is so often absent in inflammations where great infiltrations occur; why it only takes place in the declining stage of in- flammation, and becomes most rapid after the force ofthe vis a tergo has more or less abated; why suppuration is always necessary to the formation of granulations on a superficial ulcer, Le. VOL. II. 22 170 THEORIES OF INFLAMMATION. And with scarcely more than this simple déclaration ; the ail- important subject of absorption is dismissed ; it being considered " Unnecessary, and would be very inconvénient, to inquire into the foundation of Mr. Hunter's opinions on the subject of absorption in this place." (') This is evidently a stumbling-block, and is wisely avoided by consistent philosophers of the mechanical school ; who see in the imprudence of some that have adopted Mr. Hunter's philos- ophy of ulcération, an admission that the antécédent stages of inflammation are likely to be as little dépendent upon mechani- cal causes. " As the fresh fibrin," it is said, " exudes through the original layer by the channels or perforations, it will coagulate around them in little heaps." (a) But we are not told upon what mechanical principle the fibrin, or the " little heaps," make their appearance, all at once, after an indefinite continuance of the suppurating process ; nor is there any comment upon the curious fact that the granulations them- selves émit a purulent matter. Itis stated, however, that "there can be no essential différence between suppurative and ulcera- tive inflammation." (3) But there is certainly this manifest dif- férence in the results, (as the terms are hère employed,) that pus is formed in one case and granulations in the other ; that one is a destructive, whilst the other is a restorative process ; though, in reality, the génération of pus and of granulations may go on simultaneously, and the latter become the instruments by which pus is produced. Nor should it be overlooked, that the mechani- (1) It is of no moment to our présent purpose, whether the lymphatics or the veins perform the office of absorption. Before the discovery ofthe lymphatics, absorption was attributed altogether to the veins ; and they are now supposed to be equally concerned in absorption by those who deny the spécial agency ofthe lymphatic sys; tem. The objection, therefore, which has been raised to the vital theory of ulcéra- tion upon the ground of error as to the function of the lymphatics is clearly untena- ble. (See Mr. Earle, ut cit. p. 218.) But the observations of Fohmann, Lauth, Hodg- kin, Lippi, Double, Breschet, Amussat, Meckel, Blizzard, Lobstein, Lizars, Mertens, Panizza, Werner, Caldani, Carson, and others, as to the termination of lymphatics in small veins, are likely to remove all ambiguity from this subject, and restore the doctrine of absorption as illustrated by Hunter, Hewson, and Cruikshank. We may say, also, that analogy is opposed to the doctrine of venous absorption. Every system of vessels, so far as known, has but one function, however that may be modified in différent parts, as seen in the lymphatics and lacteals. The distinction dépends either upon structure connecte^ with the modifications of common vital forces and their relative adaptation to the properties of the différent fluids ; or structure may be ap- parently less concerned than the latter, which is one of the most universal and im- portant principles in physiology. (2) Mr. Earle, Op. cit. pp. 218, 250, 219. (3) Ibid, p> m THEORIES OF INFLAMMATION. 171 cal hypothesis, true to its principles,' makes no distinction be- twixt pus and lymph. But suppose, instead of a healthy granulating ulcer, we con- sider a destructive one, such as the syphilitic or cancerous. How, we would ask, is the removal of parts effected in such instances? Why'is it often necessary to employ constitutional and local re- médies, sometimes mercury, and sometimes lunar caustic, to promote the effusion of coagulable lymph ? How are the sup- posed mechanical powers affected by thèse agents ? From whatever parts of the body granulations spring up, they have all originally the same appearance ; the same in bone as in muscle, &c. But they are ultimately changed into the na- ture of the tissue from which they proceed. We know not the cause, but we see the effect ; and this effect assures us of a spé- cifie action in the différent granulations, which, with other ac- cidentai, though analogous modifications of the vital properties, accounts, in part, for the différences in purulent matter, as well as its common generic nature, and dérides every attempt to solve the problem by chemical or mechanical laws. (Vol. I. p. 627.) Finally, we come to mortification. And hère we must not be surprised, having hitherto so entirely lost sight ofthe vital powers and actions, that they are allowed no part in the curious process that attends the séparation of the dead from the living substance. The vis a tergo, the heart alone, admirably counteracted by a complète stagnation and coagulation of blood in the seat of the mechanical opérations, is the only agent by which all the phe- nomena are carried on, from the beginning of inflammation to the ultimate stage of sloughing. But, it is said, " The séparation of the dead from the living parts has, since the time of Mr. Hunter, been supposed to be performed by the agency of the absorbing vessels • nor does any one (so far as known to Mr. Earle) doubt the correetness of this branch of Mr. Hunter's favourite doctrine." Our -author is the only philosopher who has carried out all the détails of the hypothesis in conformity with the rules of science and the laws of nature. With all others of the mechan- ical school, there has been some demand, in difficult emergen- cies, upon the powers of life, even by those who argue against the existence of such powers. But our author sees that their oc- casional introduction must be fatal to the whole hypothesis; and, aecordingly, we are told that the absorbents have no more to do with " the séparation of the dead from the living parts," 172 THEORIES OF INFLAMMATION. than they have with the process of ulcération. And the same reason for rejecting the absorbents that was before stated is hère repeated, viz. because " a full and complète explanation of every circumstance connected with mortification can be given, with- out even alluding to the existence of the lymphatic system." (') If nothing can be easier or more simple, certainly nothing can be more consistent. Fluids, as we have seen, are mechanically expelled. " The first effect," it is said, « is that of destroying the natural tenacity of the solids, of rendering them, as it were, rolten, so as to be easily broken down by the slightest pressure. Of course, this effect must be most apparent at the point where there is most effusion, which must be* exactly where the living touches upon the dead part. Thus it happens that the force of the vis a tergo, by whose pressure the effusion ofthe différent parts ofthe blood is effected, impinges precisely upon those points which are the weakest and most likely to give way; by which means the dead part is gradually detached from the living, and, as it were, washed off by the discharge." (a) Since we have endeavoured to show that the mechanical hy- pothesis, as applied to ulcération to explain a similar process, and indeed at every stage of inflammation, is not only déficient, but contradicted by facts, and by all analogies in relation to liv- ing organized matter, it may be considered equally groundless as it regards mortification. There is nothing more marvellous in the supposition that dead parts may stimulate the absorbents, whose action is already modified, and thus prepared to remove the contiguous living parts, than there is in any other vital phenomenon. The principle is admirably shown in the manner in which hepatization ofthe lungs gives way to a return ofthe healthy structure. But, it is important to recollect that the vessels in mortifica- tion, extending within the confines of the sound part, are sup- posed to be more than ever obstructed with coagulated blood, and that it is in virtue of this accident that the part dies. (3) It (1) Mr. Earle, Op. cit. p. 250. (2) Ibid. (3) It is a remarkable fact, that the experiment with quicksilver, by M. Cruveil- hier, is quoted by M. Andral, (a) and others, to substantiate this doctrine. Cruveil- hier " succeeded in producing gangrené of a limb, by injecting the minute arterial ramifications of the part with quicksilver." Doubtless ; and by thus mechanically destroying the actions of the vessels. But does it therefore follow that nothing but a mechanical cause can destroy their vitality ? Or, allowing that the hypothesis of stagnation may be possibly wrong, where is the analogy between blood and mercury? What shall be said of the admitted fact, that "gangrené, in numerous cases, is di- (a) Patholog. Anat. vol. i. p. 32. THEORIES OF INFLAMMATION. 173 does not, therefore, so clearly appear how the forcing influence ofthe heart is to reach the sloughing part. We might go on to illustrate this subject by analogies drawn from the vegetable kingdom ; and inquire how far the removal of their sloughing parts dépends upon the mechanical action of the vis a tergo ; how far their reproduction upon chemical or mechanical laws, &c. ; and, lastly, we might farther show that one hypothesis has been built upon another, and thèse resting upon assumptions, to account for the précise, yet diversified and unique phenomena of inflammation. As to the cause of mortification, we need not the aid of the mechanical doctrines, excepting so far as the circulation ceases when the part dies. It is as easy to understand how the life of a part may be destroyed by the altération of its powers and functions which constitutes disease, as to comprehend the fact of that altération, or the manner in wliich constitutional fever extinguishes, almost at the moment of its invasion, the entire life of the body. There is something, indeed, in the rapidity with which décomposition sometimes goes on in mortification from inflammation that is without any analogy in chemical phi- losophy, and which can be only explained, if we may hazard the expression, upon vital principles. (:) rectly proportional to the altération of the nervous influence." (a) May not the im- puted stagnation be the conséquence, and not the cause of death? Some philoso- phers do not consider that stagnation which constitutes inflammation, or the progres- sive opération of it3 cause, sufficient to explain the destruction of parts. Still the theory is made consistent. Thus, Sir C.Bell : " when phlegmon terminâtes in the death of a part, it is the effusion and infiltration into the cellular membrane which checks and hinders the action of vessels." (6) And so, Dr. Carswell. Mortification "dé- pends, in a great measure, on the mechanical influence exercised by the effused fluids on the capillary circulation. Thèse fluids must compress the neighbouring veins to a degree that will prevent the return of the blood poured into the capillaries." (c) But, is there any proof ofthe foregoing? Is the pressure, where effusion is great- est, in any degree comparable with what may be artificially exerted upon a part with- out inducing mortification ? Besides, mortification often occurs without any remarka- ble effusion, whilst another, and greater objection consists in the every-dav fact that far greater effusions, and thèse too of solid lymph, are suddenly takino1 place without producing the slightest tendency to mortification. But, after all, it appears to have been quite unnecessary to have superadded the foregoing case, since we are told by its advocates that " in the second stage of in- flammation, the blood which distends the capillaries ceases at last to circulate." (d) It is not said by any writer of this school, what maintains vitality afterwards. (1) " Even when the life of organic bodies is extinct, we should consider the quali- (o) Andral, Op. cit. p. 33. (b) Institutes of Surgery, &c. vol. i. p. 38. (c) Dlustrations of the Elément. Forms of Dis. Fas. 7. {d) Carswell, Ibid. Fas. 12. 174 THEORIES OF INFLAMMATION. In having thus endeavoured to sustain the vital doctrine of inflammation, we certainly do not recognise a vis medicatrix naturœ in the sensé in which it is ridiculed by Mr. Earle and others ; nor do we think that the construction which is forced upon those who adopt it is justified by any fair interprétation. Provident nature has so ordered many of the actions of disease, that they shall ultimately terminate in a sanative process ; and instead of the interposition of any latent and mysterious agent, the final resuit is brought about by the same vital powers, and by the same instruments, that had been engaged in the morbid process. " The good God that created the animal stamped upon his organization a tendency to actions, and a power of originating, adapted to the repair of a cer- tain amount of injury." (') This, we believe, is all that médical philosophers of the présent day, with rare exceptions, intend by the vis medicatrix ; nor did Mr. Hunter employ it in any other sensé, however he may have figuratively ascribed to it a principle of intelligence for the purpose of strongly illustrating those results which are more allied to the opérations of instinct than to any physical processes, We perfectly agrée with Mr. Earle, that, " although the pro- gress of improvement may be, for a time, retarded by too great a déférence to authority, it is impossible that men's minds should remain impervious to the direct évidence of simple facts." But, should it be otherwise, and the mechanical doctrine of inflamma- tion ultimately prevail, then every process of the living body, whether morbid or healthy, must be construed by the same rule; unless, perhaps, a différent principle be necessarily admitted to préside over the heart, just as the Berkeleyan skeptic is forced to the récognition of consciousness. Such, however, is our con- fidence in the principle of the foregoing extract, we are content that the whole subject of inflammation shall be tested by those mechanical laws which our friends have assumed as its founda- tion. We have seen, indeed, that the doctrine of passive relax- ation of the vessels, and the conséquent stagnation and coagu- lation of blood, is contradicted by its own premises ; by the phenomena of increased heat, — throbbing in the immédiate instruments of disease, when the force of the heart is even pros- ties which they possess, from the time of death to the complète resolution of organi- zation, as the results ofthe organic powers which have been active in them."— Tiède- mann's Comp. Physiol. p. 29. (1) Dr. Johnson, in Med. Chir. Rev. vol. 20, p. 328. THEORIES OF INFLAMMATION. 175 trated, — the greatly increased volume of blood circulating in thèse instruments, and its gênerai increased fluidity, — the augmented force with which the blood escapes from the vessels when divided, showing not only an undisturbed circulation, but a positive action of the vessels themselves, — the remarkable varieties of inflammation, and their peculiar products, — the effusion of sérum, lymph, pus, and finally, of blood, especially in the inverse order ofthe diameters of their globules.—the exclu- sion of the more fluid parts, whilst the grosser alone escape, — the disappearance of the colouring matter, — the extraordinary processes of ulcération, reproduction, and sloughing, — and, finally, the causes and curative means of inflammation. On the other hand, whilst the foregoing doctrine leaves nothing to the vital forces and actions, thèse are capable of explaining every phenomenon of inflammation. We shall now notice an experiment lately made by Professor Alison, since it is supposed to be an experimentum crucis. To ascertain whether " the arteries leading to an inflamed part are really endowed with a greater vital power of contraction than sound arteries," Professor A. at différent periods after killing the animal, compared the vessels of the inflamed limb with the corresponding ones of the opposite sound limb. At a second examination, sixteen or twenty-four hours after the first, the artery of the inflamed limb still remained larger than the other. That of the inflamed limb retained a considérable quantity of blood, whilst the other was almost empty. (') Hère is no room for mistake, no microscope, no vital forces to be equivocally ex- plored. We cannot think, however, that the experiment proves anything more than that the arteries contract after death, as is generally believed, partly by virtue of their elastic property. This property had been impaired by the diseased state of the vital forces ; and no induction can therefore be made from it as to the state of those forces which are nearly or wholly extin- guished. Indeed, it was a part of the experiment to prove that the elasticity of the artery of the inflamed limb was impaired. In the natural state of parts, that property is evidently modified by the forces of life ; and it may even be that it is increased in inflammation, however its manifestations are diminished after death. The error consists in supposing that the same morbid actions exist after death as before. Nor should it be overlooked (1) Lon. Med. Gaz. vol. xvi. 176 THEORIES OF INFLAMMATION- that the proportion of blood in the instruments of inflammation may be thrice as great as in the healthy capillaries, and, there- fore, to place them on a par after death, thrice the amount of contraction should affect the former. From the foregoing experiment a new hypothesis comes up ; that the vessels in inflammation are not only in a state of relax- ation, but that there is an increased action by which the blood is moved in the capillaries of the part, resulting from powers in- hérent in the blood itself, and independent of any contraction of the blood-vessels, " the action being not in the vessels, but within the vessels." This principle has been supposed by many to appertain to the blood since the time of Harvey, and Haller; but it is now asserted that it is increased in inflammation. (') The increased exertion of the powers of the blood leads to dis- tension, and a diminution of the tonicity of the vessels. How far this may be a matter of spéculation, or inferable from facts or from reason, we shall not atternpt to show. We cannot help thinking, however, that it is so diametrically opposed to the doc- trine of stagnation and coagulation of the blood, that it betrays the hypothetical nature of every theory which départs from the fundamental principles of life. Nor should we neglect to observe the imposing contrast which is presented by the déniai of all action, in inflammations, to those vessels upon which the forma- tion of blood and nutrition essentially dépend, whilst the blood itself is considered not only the cause of its own motion, but, through its increased velocity, of the loss of motion in the vas- cular system. Admitting that experiment has failed to demonstrate the actions (1) This hypothesis seems allied to that of Dr. Curry, who supposes that, in in- flammation, the circulation is promoted by an electric repulsion between the blood and its vessels. (a) But, as to any independent motion of the blood, as surmised by the foregoing physiologists, by Tiedemann, Dœllinger, Wolff, Gallini, Treviranus, Schultz, Dutrochet, Schrœder, Bohn, Carus, Pander, Prévost, Dumas, Bichat, Al- binus, Kielmeyer, Desterreicher, Alison, (b) Hawley, (c) and others, as well as by a class, especially the French observers, who regard the globules as animalcula, we may safely take the authority of Maller upon this question, who — " during the last ten years has examined the circulation of the blood in the most various parti, at every opportunity, and with différent instruments," but " he has not discovered tbe slightest appearance of spontaneous independent motion ofthe individual red parti- cles." Other conclusions he naturally supposes are founded on microscopical décep- tions, (d)— (See vol. i. p. 707.) («) Byllabu. of Lectures at Guy's Hospital, 1810. (4) Trans. Brit. Association, 1835. («) Edin. Joutn. Oct. 1836. (d) Eléments of Physiology, vol. i. p. 143. THEORIES OF INFLAMMATION. 177 of the extrême blood-vessels ; we are allowed, by the common rules of philosophy, to infer their existence from the phenomena. Thèse, indeed, as they are naturally presented, are the safest grounds for every conclusion. And why are the minute vessels so eminently endowed with the vital forces, unless for the per- formance of independent actions ? Coming to disease, we find new orders of vital phenomena, from which we rationally infer some change in the foregoing properties, which as clearly dénote corresponding modified actions. Thence we see how ground- less is the objection predicated of analogy by M. Sommé, and others, in saying " it has been supposed that the extrême arteries can be no longer under the influence ofthe heart, and a property has, therefore, been ascribed to thèse minute vessels which has been denied to the larger arteries,—that of contracting inde- pendently." (') Hère it appears to be overlooked, that the ex- trême vessels are mainly the seat of the vital phenomena, and that the larger vessels serve, principally, as conduits to the former. It is said by an able writer, that — " The question whether thèse (capillary) vessels do, by their vital contrac- tions, add directly to the force which propels the blood, is perfectly distinct from the question whether they do, by vital actions of some kind, regulate the distribution of the blood. The first question, we conceive, must be answered in the négative ; because, admitting them to possess a vital power of contrac- tion, the exercise of this power would antagonize the action of the heart, instead of aiding it" (*) The writer does not state the ground of this conclusion, and we think it would be difficult to establish it even by any process of reasoning. Analogies in respect to mère physics are out of the question ; and who shall say that the contractions are not conducted in such a manner as to subserve the gênerai circula- tion ? May there not, by possibility, be a corresponding dilata- tion, which is not taken into the account ? (See Venous Con- gestion, Sec. 10.) That we are right in this philosophy is shown by our author himself; for he answers the second ques- tion affirmatively. Thus— " If we consider the capillaries as endowed with a vital power (s) of diminish- ing their tube, and thereby lessening the quantity and augmenling the velocity of the blood which passses through them, and of dilating and thereby increasing the quantity and diminishing the velocity, we must admit that thèse vessels, by (1) Etudes sur l'Inflammation. (2) British and Foreign Med. Rev. Oct. 1839, p. 335. (3) We like this expression. See our vol. i. pp. 11, 714. VOL. II. 23 178 THEORIES OF INFLAMMATION. their vital actions, contribute most powerfully to the circulation of the blood," &c. " Do the capillaries, then, possess such powers ? We think there is evi- dence, little short of démonstration, that they do." Hère, then, are all the éléments that are necessary to inde- pendent action, and we see not why the " vital power," or as the reviewer has it in another place " the vital principle," should not produce a successive séries of alternate contractions and dila- tations ; and since the act of " diminishing the tube augments the velocity of the blood," we see not but it must follow that " the capillaries, by their vital contractions, add directly to the force which propels the blood," even if it were not ultimately admitted that they " contribute most powerfully to the circula- tion of the blood." (See Venous Congestion, Sec. 11.) If the vessels in inflammation be actually weakened, passively dilated, clogged up with coagulated blood, when does their tone return, and by what cause is it rëestablished ? If by the vital forces, when and how came they again in opération ? It being supposed that the vessels are weakened in inflamma- tion, it has been necessary to assume that the causes are debili- tating ; and it were well that the subjects, also, should be amongst the feeble instead of the robust. It seems, however, to be gene- rally in all respects otherwise. For instance, pneumonia affects mostly the robust and plethoric. Cold, when suddenly applied is one of its exciting causes, which, in its ordinary opération, is tonic. The subjects of fever are mainly of the same class, and inflammations are apt to supervene in proportion to the vigour of the patients. Stimulants and direct tonics scarcely fail, in thèse instances, of developing inflammation. Were the causes, also, really debilitating, or the pathology of the imputed nature, the remédies should be invigorating ; but, the only efficient ones consist of bloodletting, cathartics, tartarized antimony, &c. » Repletioni evacuatio, evacuationi repletio, labori quies succurrit, et quietia medelam ex labore reperias ; atque ut breviter dicam, contraria conlrariorum SUnt medicamina," (ra cvavria rwv cva/iTiuv tri" Iriuara.) (J) (1) Hippocrates, L. de Flatibus, ver. 25. —That most frivolous and perniciou» doctrine ofthe âge, homœopathy, has surieptitiously borrowed from Hippocrates one half of his philosophical principles as to the curative means of discase, whilst it has utterly perverted the other half in imputing it to the Hippocratic school as an exclu- sive dogma. We shall say nothing hère as to the suprême absurdity of the infini- tesmal doses of the Lilliputian school ; but proceed to quote from the illustrioui founder ofthe best principles of our art a passage which embraces the whole doctrine in its proper connection. It has never been surpassed in modem philosophy. Thus : " Febris, quae propter tumefactionem ex pituita fit, aliquando quidem ab iisdem THEORIES OF INFLAMMATION. 179 Nor can it be contended that debilitating means are neces- sary to remove the increased momentum of blood, since the fit, et sedatur ; aliquando autem a contrariis. Et si quis vult medicamentum biben- dum dare, alvum subducens, et vomitorium, eadem modo et a facientibus sedatur, et a sedantibus fit. Nain si quis honiini vomenti, aquam inultam bibendam dare vebt, eluentur ea, propter quae vomit una eum vomitu. Et sic quidem per vomitum vomitus sedatur. Rursus autem propterea quod sedatur, quia inferne procedere ipsi fecit, ei illo id, quod intus est, vomitum facit, et ambobus contrariis modis homo sunis fil. Et si quidem sio in omnibus haberet, stata sane ac cerla medicina essct. Ita alia quidem contrariis curare oportet, qualia tandem sint, et a qua causa liant ; alia vero similibus, qualia tandem sinl, et a qua causa fiant." — !, de Locis in Homine, s. 2, ver. 241 —248. And hère is an illustration of one part of the doctrine. " Q.uum vero omnis generis morbi tiunt eadem tempore, et palam victus singulos singulis causas esse, curam sane facsre oportut ex contrario instando adversus morbi causarn, quemad- modum et alibi a me relatum est," kc—Ibid. L. de Natura Hominis, ver. 180. All the writings of Hippocrates are imbued With the foregoing philosophy, which is also fundamental in modem physic. (a) (a) U has occasionally happened that gentlemen who belong to the science of medicine have so far recognised homœopathy as to justify an expérimental inquiry. But we have generally found that this tolorant part ofthe profession have either no definite views in physiology, or are prompted by what we cannot but regard as a mistaken liberality. (Vol. i. p. 388 — 389.; That we may not be suspected of any personal allusion of disrespect in what we have now 6aid, and that no facti- tious importance may be given to what we have considered a misguided liberality, we wiU say that it is wholly upon the latter principle that a distinguished professor ofthe New-York school of medi- cine was induced to suggest "the propriety of making the comparative merits of allopathy and ho- mœopathy the subject of a prize dissertation," (aa) thus, by implication, even conceding the possibi- lity of superior claims to the latter. From tho foregoing circumstance, and from homœopathy having obtained some considération in the city of New-York through the influence of its novelty, and having abandoued itself to that last expédient of charlatanry, ihe dissémination of its pretensions through popular journals and newspa- pers, and above ail, as it represents itself as still on the ascendeiicy in Europe, we shall quota from the Médico-Chirurgical Review of July, 1835, the following abstract of a discussion at the Royal Academy of Medicine, which had been recently held. in Paris : " M. Andral, senior, exclaimod, with much émotion, ' Imuch doubt whether the Minister has any right to require a report from the Academy on an absurdity. The Président should Write to the Minister, and expose the cheats and juggleries of thèse rogues, who call themselves homœopathists. I protest against the appointment of any commission, and, therefore, move the order ofthe day. "M. Londe. — Write to the Minister that they have been tampering with his credulity, and that the Academy cannot condescend to have anything to do with such charlatans, who will, no doubt, avail themselves of the very présent discussion to announce, in to-morrow's paper, that the Acade- my were engaged with the considération ofthe very important subject of homœopathy. " M. Lepelletier — Yes ! homœopathy is, indeed, a very imposture ; but hère we have an oppor- tunity of exposing and abolishing it. Let us accept the challenge that is offered. " M. Keraudren suggested that an application Bhould be made to some of the German societies, for information relative to the indigenous homœopathists. " M. Marc.— In Germany, homœopathy has fallen into the most utter contempt. A distinguished German professor assured me, the other day, that in Berlin there were only three homœopathists — one rogue and two fools. "M. Breschet. — I was lately at a meeting of upwards of 600 German physicians and surgeon», Some one wished to discuss the question of homœopathy ; but the proposai was rejected with such gênerai disapprobation, that even the bare mention of a subject, which is believed only by quacks and impostors, was immediately scouted." — (See our vol. i. p. 632, note.) Homœopathy having become extinct throughout Europe, we have thought it our duty to bestow only this notice as a record of its lingering existence in America, and as one of the signs of the times. A modification ofthe practical feature of homœopathy is undergoing an introduction to the (aa) Profcuor Mac Naughlon'a '' Annual Addreia" before the New-York State Médical Society. 180 THEORIES OF INFLAMMATION. whole inflammatory condition existed before the increased force of the gênerai circulation began ; (') whilst it often happens, as inflammation advances, especially when complicated with idio- pathic fever, that the vis a tergo is prostrated, but again roused by the lancet, which simultaneously overcomes the local affec- tion. Thèse are obstacles which no contradictory hypothesis can withstand. Finally, there can be no compromise with the mechanical doctrines of inflammation as attempted by some philosophers. (s) The hypothesis which allows an increased circulation in the primary stage encumbers the second, or period of stagnation, with greater difHculties, especially as it supposes that the in- creased momentum of blood is a concurring cause of its ultimate failure. The éléments of the hypothesis are so diametrically (1) Why does a more extensive inflammation " of an external part, than of a vital part, excite less increased action in the larger arteries of that part, and often none at all in those of the system in gênerai ?" (a) Why does inflammation often move suddenly from one part to another, when we see no cause either increasing the action ofthe capillaries ofthe inflamed part, or weakening those ofthe part secon- darily affected ? Why do thèse secondary inflammations spring up amongst remote organs which sympathize most with each other in their normal state ? Or why is in- flammation so apt to spread to neighbouring parts, between which and the part first affected there is no direct communication of vessels ? What produces the horror and rigor, and the sympathetic fever? Is there anything in the mechanical hypo- thesis, or in the doctrine ofdebility, that will explain the phenomena? If nervous agency be admitted, this is a full concession to the vitalists, in itself. It implies the ulterior agency of other forces than those of physics, since it appears absurd to sup- pose that the latter are controlled by nervous power. (2) " I shall consider inflammation,'' says Dr. Carswell, " as a disease, the essen- tial phenomena of which présent themselves in two successive stages or periods, each of which is referable to opposite conditions of the physiological properties or functions of the affected part." " In the first stage of inflammation, the circulation is accelerated, and a greater quantity of blood than natural passes into the capilla- ries ; in the second, the circulation becomes impeded, and the blood which distends the capillaries ceases at last to circulate." — Illustrations of the Elementary Forms of Disease, fas. 12. public, under the alluring name ofthe "American System of Homœopathy," at the moment our printer has reacbed this page ; and we even " stop the press " to announce the public rcnunciation of " allopathy," by Dr. C. Ticknor, and the appearance this day, (March 3, 3840,) of a popular defence of homœopathy from the pen of this gentleman in a letter addressed " To the Hon.-----." An attempt is made to show that it has some remaining ad vocates of considération in Europe. The names of such] as rfre at all recognised in médical science have no more respect for the doctrine, than we have seen to have been aflirmed of them by M. Andral, and others, in the foregoing quota- tion. Having thus dwelt, for a moment, upon this unhappy subject, we shall conclude with a sentiment addressed by Seneca to a certain part ofthe médical profession : — " Gravissima infamia est medici opus quterere, multi quos auxerant morbos, et incitaverant, at majori gloria sanarent, non potuerent discutere, autjcum magna miBerorum vexatione vicerunt."- L. de Benef. c 36. (See vol. i. p. 673.) (a) Philip'i Exp. Inquiry, &c. p. 362. THEORIES OP INFLAMMATION. 181 opposed, we cannot but think that it exposes the absence of the necessary data in both. Admitting the hydraulic illustration, so utterly inapplicable to living vessels, there is nothing in their simple dilatation that can tend to promote coagulation of the blood ; since it is mani- fest that the motion of the blood can be but slightly retarded upon the hydraulic principle, and it is well known that only a very slow movement of the blood is necessary to its fluidity ; whilst the enlargement of the vessels necessarily supposes an increased facility for the transmission of blood. But, it has been overlooked in this part of the mechanical hypothesis, that in- flammations often spring up when the circulation is going its round at the rate of 120 or 140 pulsations in a minute, and when the blood has been reduced almost to the state of sérum. In some constitutional fevers, it is a resuit to be apprehended almost in proportion to the velocity and force of the gênerai cir- culation. (See Appendix, on Fever.) SECTION II. We shall close thèse remarks with an argument in favour of the Hunterian theory of inflammation, drawn from the nature and formation of pus. If it can be shown to differ from the component parts of the blood, or to dépend on a secretory pro- cess, it would appear to substantiate an independent action in the instruments of inflammation. Mr. Earle, and the friends of the new school of inflammation, find it necessary to identify pus with a component part of the blood, and to explain its formation upon mechanical principles. They contend that neither inflammation nor pus being met with in the healthy system, pus is not, therefore, " A healthy sécrétion," and " it is as little entitled to be called a morbid sé- crétion, because by this term is understood some change or déviation from that which is usually recognized as the healthy condition of a sécrétion. The term morbid sécrétion, therefore, applies to black bile, and to diabetic urine ; but not to pus, which is an entirely new formation." (') This would appear, as we have said, to follow from the new (1) Mr. Earle, in Lon. Med. Gaz. vol. xvi. p. 137. 182 THEORIES OF INFLAMMATION. doctrine of inflammation. For sécrétion is a process that dépends on an active state of the vessels. But since the vessels are re- laxed and encumbered with coagulated blood, it is reasonable to conclude that pus dépends upon some other function more com- patible with such a state of the vessels, and that, therefore, it is not a secreted fluid. But there is nothing to show, save the objection we have stated ourselves, that new formations may not be as purely the resuit of a secretory process as bile or urine. We do not see the logic of the foregoing conclusion. Indeed, the universal admission that pus is a new formation is subversive of the mechanical hypothesis ; since all analogy in relation to other new products from the blood déclares the dependence of the supposed excep- tion upon the same forces that are concerned in the génération of all others. (Vol. I. pp. 56, 57, notes, 585—590.) Man may bestow names upon natural phenomena ; but in excluding analogous ones that may dépend on a new condition of the powers and functions of the body, he must show their incompa- tibility with those laws of vitality upon which the natural phe- nomena dépend. If there may be a morbid state of action, it seems very philosophical to suppose a morbid sécrétion. We cannot otherwise reason from analogies supplied by the healthy system, to diseased states of the system. In the latter case the modified power must be regarded as performing new functions. New products, therefore, may arise ; and however we may choose to restrict the term sécrétion to healthy products, it does not fol- low that the morbid ones, although wholly new, may not be equally entitled to that appellation. But do we not find in the very argument that is urged against the formation of pus as a secreted fluid, an illustrative fact that it is really the product of morbid sécrétion ? It is admitted that there may be morbid bile, depending upon a morbid process. Now healthy bile is one thing, and morbid bile another. One action is natural, the other unnatural. Morbid bile has no more existence in the healthy system than pus, and it cannot take place without the morbid process. We see not, therefore, why, in a uniform modification of the vital powers and functions, as in common inflammation, the natural sécrétions of the paren- chymatous capillary arteries may not be, in like manner, changed into pus. Mr. Earle and his friends consider pus the nucleusof THEORIES OF INFLAMMATION. 183 the red globules, and that nucleus is supposed to be coagulable lymph. And yet it is maintained that pus is a new formation. But, since it is admitted that pus is wholly a " new formation," we ask for the proof that such formations do not dépend upon a secretory process. An assumption has been made, and a syl- logism invented to sustain it. But this cannot pass in opposi- tion to a better syllogism ; and, as we believe, to direct and un- questionable facts that are supplied by analogy, as well as by the laws that govern the living body. Does bone ever form in the healthy membranes of the brain ; melicerous, steatomatous, carcinomatous, hsematodic, and other spécifie products, take place in any part of the body without spécifie conditions of disease, and that disease in all probability, of an inflammatory nature ? And will it be denied that thèse are the resuit of a secretory process ? Upon the hypothesis just quoted, we might, also, equally argue that pus is not separated mechanically from the blood, since such a phenomenon never occurs in the healthy system ; and it is not pretended that its mechanical origin is supported by any analogy in disease. Again, it is said, " There is this essential distinction between a sécrétion and pus ; the pro- ducts of the secernent function are différent in every membrane, texture, and organ of the body ; mucus is secreted from the blood in vessels of mucous membranes, &c. ; whilst no such variety is observed in the formation ofpus."(') Admitting the latter statement to be true, we cannot see the force of the analogy. The liver secrètes bile ; the kidneys urine ; the lachrymal, salivary, and cutaneous glands, produce tears, saliva, sweat, &c. ; because the several organs are made up in a distinct and complex manner for this purpose. For this reason we should say, à priori, that the products would be dif- férent, and would vary in their composition according to the complexity of the organs. But in inflammation, it is not the glandular apparatus that is concerned, but the circulatory, whose action must be supposed to be very similar in every part of the body. Muller, however his statements may be incompatible in respect to the sécrétions, (see our Vol. I. p. 56, note,) goes so far as to say that " The sole sécrétion, of which the constituents do not exist as such in the blood, but which can nevertheless be formed at all times and in all parts of the (1) Mr. Earle, ut cit. 184 THEORIES OF INFLAMMATION. body, is pus; the organ for its production beinggenerated anew in the process of inflammation." (') We should, therefore, in this case, also infer, à priori, that in the same conditions of inflammation, the products would be the same ; that in one condition we should have sérum, in another lymph, and in another always pus. And we may take from Mr. Earle, what he intended as an objection, another évidence that our conclusion is right. " As the blood is the same from what- ever artery it is taken, and also, as inflammation is essentially the same, in whatever texture it may occur, the effect thereof must be the same in all." (2) But we believe it is not true, that simple structures, which are admitted by our friends to perform a secernent function, do not have their natural products changed into pus by inflamma- tion. Take the very one quoted above, by which the adverse hypothesis is sustained. Do we not often find, in inflammations of the mucous membrane of the lungs, that the sécrétion of mucus is converted into a copious effusion of purulent matter, and this too, where there is no ulcération ofthe membrane ? And hère we should consider the analogy which exists between a suppurating sore and the mucous membrane, when simple in- flammatory action converts its natural products into common pus. The same fact may be affîrmed ofthe serous membranes. (3) That the liver never secrètes pus, except in its nutritive and cir- culating parenchyma, is highiy probable ; for hère the secernent apparatus is complex, the laws spécifie ; and the effusion of bile, or, in the kidneys, of urine, is a direct impediment to the forma- tion of that kind and degree of inflammation in the secerning apparatus, that are necessary to the formation of pus. And yet, in conformity with our gênerai law, " there is not one of the parenchymatous tissues in which pus has not been found." (4) " The term sécrétion, " say our friends, " ought never to have been applied to the fluid which is called pus ; for this term in its true signification is ex- pressive of something which results from the opération of the nervous influence on the blood. Now it has already been shown that the secernent function of the nerves is put a stop to, in the very commencement of inflammation, of which pus is only one of the results." (5) If we admit the latter proposition to be true, of which, how- (1) Eléments of Physiol. p. 475. (2) Op. cit. (3) Thus Bichat: " Sérum and pus very often flow at the same time from the seroui membranes without any kind of érosion."— General Anat. vol. 2, p. 14. (4) Andral's Patholog. Anat vol. i. p. 302. (5) Mr. Earle, ut cit. THEORIES OF INFLAMMATION. 185 ever, we are hardly satisfied, except in cases where the nervous communication has been uninterrupted, we must certainly reject the former. It will then follow according to the foregoing rea- soning, that since, as we shall show, the nervous influence is not necessary to the function of sécrétion in the natural state of a part, it is not necessary to it when the part is inflamed. Now, we doubt not that the sécrétion of any complex organ, like the liver, or the kidneys, would be suspended or greatly di- minished by cutting off the nervous influence. This influence is necessary to maintain a harmony of action amongst so many parts as are hère concerned in the process of sécrétion ; and it is but reasonable to suppose that when this concert of action is violently disturbed, we shall witness some remarkable change in the natural product. It has been also shown by Dr. Philip in more simple organs, as in the mucous membrane of the lungs and stomach, that the sécrétions of those organs are modified by a division ofthe par vagum, especially in the latter organ. But so far from the sécrétions being suspended in conséquence, they are actually increased, and this constitutes the main peculiarity in the lungs. Nor can any appréciable change from the natural state ofthe mucous or the gastric juice be detected; whilst there may be, also, simultaneously induced a state of inflammation by dividing the nerve. " The lungs," says Dr. Philip, whose au- thority is so justly invoked in this matter by ,Mr. Earle and his school, " Are found after death distended with a frothy fluid, which fills the bron- chia and air cells, and prevents the lungs from collapsing ;" and as to the stom- ach, " it deserves notice, that although the eighth pair of nerves have been di- vided, the food is found covered with apparently the same semi-fiuid which we find covering the food in a healthy stomach." (') Hère we are contemplating simple structures, though even less so than the apparatus of inflammatory action. We find the (1) Expérimental Inquiry, &c. c. 5, s. 1. —This is confirmed by Swan, (o) Reid, Bichat, (6) and others. Mr. Reid says, " the congested state ofthe blood-vessels of the lungs and the effu- sion of frothy sérum in the air cells and bronchial tubes, may be considered as the characteristic and only constant appearance after death from the section of the pneu- mosastrics." " When the bladder is paralytic, the mucous juices pour into it as be- fore, oftentimes more copiously." (c) It appears, too, that there is no reason to doubt that this increased sécrétion is ow- ing to a state of muco-pulmonic inflammation, induced by a division of both pneu- mogastrics. It is stated by Reid that animais do not appear to suffer any immédiate (a) On the Connection between the Action ofthe Heart and Arteries and Nervous Sy»tem. (b) General Anat. vol. iii, p, 222. (e) Bichat's Gen. Anat. vol. iii. p. 195. vol. n. 24 186 THEORIES OF INFLAMMATION. sécrétions at least not diminished by removing the nervous influ- ence ; and the only known change that takes place in those of the stomach is inferred from the food being more or less undigested. The whole matter, therefore, is resolved into the simple fact, that the nervous influence is necessary, and only ne- cessary, to impart to secreted fluids some unknown spécifie pro- perty that may be designed for some great final cause. This abstract fact has, of course, no relation to the ultimate effects which the privation of nervous influence may exert upon organic functions. Sooner or later, the independent properties of a part may suffer from its abstraction, as they may be suddenly and perniciously affected by impressions propagated through the nerves. (Vol. I. pp. 474 — 480.) A différence, also, in results will probably be determined by tying or dividing a nerve. But, that an organ may subsequently recover its perfect functions, is shown by the complète restoration of digestion after the abolition of the nervous influence, by exciting the organic properties ofthe stomach by some stimulant, as by galvanism, in Philip's experi- ments, (Vol. I. p. 109.) In dividing the rénal nerve, as in Bra- chet's experiments, blood is sometimes effused by the kidneys, to which the urine again succeeds. (') It being thus shown that the nervous influence is not neces- bad conséquences from a division of the pneumogastric nerves. (a) But, when in- flammation ensues, the increased product impliea, in itself, as in other cases, the existence of an active state of the blood-vessels, which may, therefore, exist inde- pendently ofthe nerves. We think, however, that few physiologists will agrée with Reid that digestion is not impaired by a division of the nervi vagi. That the dogs were nouiished for a definite time by animal food is not remarkable ; since vitality still remained in the stomach, and, therefore, this organ was doubtless capable of ex- ercising some vitalizing influence. As to the test which was proposed by Owen and Bird, — whether albumen was discovered in the thoracic duct, — we think it would prove nothing, since we have shown that chemistry is inadéquate to the explanation, The mistake is constantly made of supposing that Dr. Philip had demonstrated the dependence of the sécrétions upon the " nervous influence ;" and, what is more remarkable, it is as constantly made by himself. Bichat appears to have settled the facts. (1) " It may, we think," says a philosophical observer, " be stated as a gênerai fact, that even when sensation and volition have ceased their manifestations, and nervous energy is totally extinct, each one ofthe organic functions may continue as long as vital properties remain in the tissues which perform it, and the necessary means are supplied." — British and Foreign Med. Rev vol. v. p. 104. The nervous system appears to be no more necessary than the heart to complex ani- (a) Edin. Med. and Surg. Journ. 1837; and Trans. of British Association, 1838. Bre»chet,»nd Leuret, and Lassaigne had rendered the same probable. —Recherches pour servir àl'Hwt.d»1» Digestion, p. 133. THEORIES OF INFLAMMATION. 187 sary to the function of sécrétion, in its gênerai sensé, the same process, a fortiori, may go on in inflammation and resuit in the formation of a new product. By the foregoing facts and reason- ing, also, if the nervous influence be modified in inflammation, it is rendered more probable that a change should take place in the natural sécrétions of parts when inflamed ; that instead of sérum we should have lymph ; and purulent matter instead of lymph and mucus. It is also said " that whilst the utility of every part of the se- cernent function is obvious, no one has been able to offer even a probable conjecture as to the use of pus." (') Hère the implied analogy is obviously defective ; since the final cause of healthy sécrétion must be clearly différent from the morbid. As well, too, might we say, that vitiated bile, or diabetic urine, are not sécrétions, because their uses may be unknown. But if any final cause appertain to the sécrétion of pus, we shall, no doubt, find it bearing a strong relation to the curative means of inflammation. (2) And,* aecordingly, we find that it is actually instituted by nature for the removal of that mode of disease ; as is most distinctly evinced in all suppurating phlegmasiae. Who does not know that inflammation of the breast, of biles, &c. is greatly diminished as soon as suppuration has taken place ? Sympathetic fever déclines ; all the vital func- mals whilst they are nourished in utero, (a) It appears, therefore, especially designed for the uses of the body when it begins an independent existence ; and even then it is not improbable that its functions, in respect to organic life, are designed more to estab- lish relations among the various organs of the system, when independent life begins, than to subserve their spécial uses. Even, therefore, if the nervous system were not also immediately subservient to the organic processes, its interruption from the na- ture ofthe imputed office, must necessarily inflict a direct violence upon the actions of a part, and indirectly by impairing the sympathetic relations. In this inquiry it should be considered that the foetus has scarcely more than one function to perform, that of simple nutrition. (Vol. i. pp. 157 — 160, 568 — 572.) (1) Mr. Earle, Op. cit. (2) Mr. Earle says, " it is merely the inévitable conséquence ofthe original stag- nation of blood." (Op. cil. p. 190.) Perhaps it may be so, though it might be diffi- cult to show that it is. But may not the same be affirmed of every cause and effect ? It does not at all alter the question as to the modus operandi. (a) See Philos. Tran9. vol. Ixxx'iii. p. 154, 1793. In this case by Dr. Clarke, the whole nervous lyitem, and heart, are said to have been wanting. We may safely conclude ofthe former, that the deficiency was nearly équivalent to an absence ofthe nerves. True, it has been said, that where a nerve is wanting, so is its appropriate organ ; but facis must be hère multiplied to render them the ground of a gênerai law. Even then, however, it would not invalidate our view of the nervous functions. See, also, Brachet's collections of acephalous monsters, wanting the spinal marrow, in Kech. Sur le Système Ganglionaire. 188 THEORIES OF INFLAMMATION. tions more or less improve. Just so, too, with dropsical effu- sions that follow inflammation. So entirely is the vascularity often overcome by the effusion, that physicians frequently dé- clare that such cases have had no dependence on inflammation; and this, perhaps, in the very face of the most characteristic symptoms and the depleting treatment. That such is the final cause of suppuration is rendered farther obvious by the subséquent beginning of the restorative process, or the process of granulation ; which, indeed, never commences upon an exposed surface till a full suppuration has nearly re- moved the inflammation. It appears, therefore, that only a low degree of inflammation, or a différent action growing out of inflammation, is necessary to the formation of pus, or a morbid sécrétion of sérum ; and this may be maintained as well by the influence of habit as by other causes. Even the new granulations take on the suppurating action through the influence of sympathy. M. Donné considers pus a chemical product resulting from the action of an acid upon albuminous matter. With others he es- timâtes the globules at twice the size of those of the blood, and considers them of a différent shape and structure. (') Hodgkin says " they bear no resemblance to those of the blood." (2) Sir E. Home, (3) and Mr. Liston, (4) maintain that the globules are formed after the matter is secreted. M. Gendrin makes pus to dépend, in the most obstructed state of the vessels, upon a mère physical process, not yet well known ; being then wholly inde- pendent of any vital influence of the inflamed part. In less em- barrassed states of the vessels, he considers it a true secretio^ and often speaks of it as " une véritable sécrétion morbide." At other times he thinks that extravasated blood may be equally changed into pus. (s) This is nearly the opinion of Mr. Key, who believes, also, it may sometimes dépend upon the " break- ing up a tissue, and its graduai conversion into pus," and that secreted lymph sometimes changes spontaneously into that sub- stance. (6) Dr. Hughes thinks it " probably dépendent on degen- (1) In Archiv. Générales, Août. 1836. (2) Anatomical Catalogue of Guy's Hospital, Obs. on sec. ii. part 1. (3) Wilson on the Blood, Sic. p. 291. (4) Eléments of Surgery, p. 30. (5) Hist. Anatom. des Inflam. t. ii. s. 1461, 1463, 1443. Yet he thinks it similar to the nucleus ofthe red globules. (6) Med. Chir. Trans. vol. xix. p. 142, &c. THEORIES OF INFLAMMATION. 189 eration of fibrin," when occurring in fibrinous concrétions. (x) And thus Dr. Craigie : » But it also results from the phenomena of suppuration in the filamentous tissue, and in the substance of the glands, that portions, more or less exten- sive, may be converted into purulent matter by a species of destruction or dissolution of their tissue," &c. (a) But, has there been any attempt to show that this " destruc- tion of the tissues " is not wholly the resuit of an ulcerative pro- cess, or that the exception is not contradicted by analogy, and by the absolute opposition which exists between the forces of life and of physics ? Dr. C. indeed, makes all other lésions, even "softening," "induration," and "dry gangrené," to dépend upon inflammatory action. (3) So, too, Dr. Abercrombie : " In the former stage of tubercle, it is proba- ble that the part remains susceptible of active inflammation, and healthy sup- puration. In the latter stages, it appears to pass only into that peculiar state of softening, which arises from the décomposition ofthe tubercular matter." (4) This is a common doctrine in respect to the softening of tuber- cle, the fallacy of which we shall endeavour to indicate in an- other place. Dr. Carswell thinks that pus may be sometimes the resuit of vital action, and again of a spontaneous change of "extra-vascu- lar blood." But, he has "never met with an anomalous formation of pus, without finding, at the same time, inflammation and suppuration to a greater or less extent in some remote organ." (6) Professor Alison supposes that the " transformation of blood into pus may go on either in the interior of vessels, or in the exudations that have taken place from them." But we have » no satisfactory information," he adds, » how it comes to pass, that, in some cases, it begins almost from the beginning of the inflammation, and in other cases it hardly takes place in any stage of it, how- ever protracted." (") Hère the vitalist can supply the necessary light. De Haen, (*) Andral, (8) and others, believe, also, that pus may form itself al- together in the blood. The latter philosopher, and other physi- ologists, suppose that pus may be generated in the interior of a clôt of blood, or in polypiform concrétions. This phenomenon (I) Guy's Hospital Reporta, April, 1839. (2) Prac. of Physic, p. 400. (3) Ibid. p. 396 _ 4fJ2 (4) Edin. Med. Chir. Trans. vol. i. p. 686. (5) Illustrations ofthe Elementary Forms of Disease, fas. 8, pp. 5, 8. (6) Outlines of Pathology, &c. p. 439. (7) Method. Medendi. De Gen. Puris, t. i. p. 60. (8) Clinique Méd. t iv. p. 683 ; and Patholog. Anat. 190 THEORIES OF INFLAMMATION. has been well attested by De Haen, Rostan, Reynaud, Andral, Laennec, Hache, Flandrin, Gendrin, Legroux, Bright, and oth- ers. We have therefore endeavoured to show, in our Venous Congestion, Sec. 9, and to sustain our views of life in other as- pects, that all thèse substances have been organized through the médium of their attachment to the parietes of vessels, &c. ; and that when they had been found isolated, they have been detach- ed by différent causes. (l) Andral goes so far with thèse new views in physiology, as to suppose " that if pus exists in other parts of the body, it has been transferred to coagula by absorp- tion »! (2) Sir E. Home believes that pus is so highiy endowed with vi- tality, that " it becomes vascular like coagulated blood, and forms the granulations." (3) Dr. Young agrées with Mr. Earle and others, that "there can be little doubt, that the globules found in pus are the identical (1) We suppose the concrétions to be either generated by inflammatory action in the vascular parietes, or that a récent clôt of blood, by exciting that action, becomes attached in conséquence. In the venous system, there is great reason to think that they are the resuit ofthe former process ; and the transformations, which take place in those instances, reflect some light, by analogy, upon the suppurating concrétions, and the whole, conjointly, contribute no little force in establishing an universal law in respect to the génération of pus. In all the cases of suppurating aneurismal con- crétions by M. Gendrin, he found the walls ofthe sac the seat of inflammation. (n) Corvisart found a concrétion through a considérable extent ofan enlarged subclavian artery and its branches, which was perfectly Consolidated with the coats of the in- flamed vessehl. (b) It is stated also by Gendrin, that whenever suppuration is artifi- cially produced in sanguineous concrétions, it only takes place when the coagulum is récent, and a high degree of inflammation has been previously established in the vessel or cellular tissue which are the seat ofthe experiment. Can any mysterious influence be exerted by the inflammation, per se? The problem is easily resolved up- on two principles ; lst, there may be an union between the inflamed parietes and the clôt; or 2d, the parietes suppurating, the clôt is dissolved by the pus, which is capable of this action. The reasoning which identifies the vital and physical changes in relation to several products, is partly this. It is assumed that coagula of blood undergo, spontaneously, a conversion into pus. Nothing is easier, afterwards, than to apply the law of anal- ogy, which we admit to be of great power in the science of life. Thence we read, as a conclusion ofthe argument, that " there is, then, the closest analogy in the form- ation of phlebolites, and that of pus and scrofulous matter within coagula, and also the change of coagula in veins into various morbid structures." (c) But, how does analo- gy operate when we come to the same formations as depending upon the vital actions of originally organized parts ? (2) Dr. Hughes, ut cit. (3) Philos. Trans. 1818, p. 194. la) Hist. Anatom. &c. t. ii. p. 26. (j) Journ. de Méd. t xx. p. 210. (e) Crouneian Lecturei for 1835, lec. 2. THEORIES OF INFLAMMATION. 191 globules of the blood."(') And thus, Mr. Bird: "Pus very clearly resembles blood; like that fluid, containing large quan- tities of globules of albuminous matter in diffusion, as well as in containing a sérum, or aqueous solution of albumen." " It has also a large quantity of iron." (3) He thinks it nearly iden- tical with fibrin. (3) From what we have now seen, it is not remarkable that Dr. Hake should say, " it is not known whether pus is a dégradation ofthe blood globule or a new formation." But allowing that it is a "dégradation," still it is a new formation, since it is no lon- ger blood, and the altération has been effected through vital ac- tions. (See Vol. I. pp. 56, 675 — 677, notes, and Essay on Di- gestion.) Dr. Hake's observations, which have been " extensive," » do not afford sufficient data on which to décide the method of its formation." (4) The secret may be found in a former remark of this observer, that "in the depths of physiology subsists an invisible world." (*) And yet Dr. Hake uses the microscope, and in deliberating upon the question whether " pus is formed from the blood," he remarks that " there is this difliculty, that they (the globules) are gpeater in diameter than many of the vessels com- posing the plexus before described." There are some vessels, then, whose diameter the microscope excepts in favour of the globules. He says, also, that the "globules of pus are from one- third to twice the size of the blood globule." We have, also, from Dr. Hake what we had anticipated, " An Account of a New Form ofthe Pus Globule." (See Vol. I. p. 699, &c.) But, what is most essential, Dr. H. finds that they are generated in the vessels, or before exposure to the air. This is important as showing organic agency in their formation, and some consistency (1) Introduction to Med. Literature, p. 574. (2) Guy's Hospital Reports, No. 6, 1838, p. 45. (3) As to the spontaneous change of fibrin into pus, there appear to be différent claimants for this new law in physiology. Thus, Dr. Hughes : — "Justice, however, demands that I should state, that Dr. Addison has for some years strongly insisted upon this softening of fibrin giving rise to the puriform fluid found in the veins of persons affected with phlegmasia dolens ; and that Dr. G. Bar- rows, in his Croonian (Crouneian) Lectures, published in the 15th vol. of the Med. Gazette, mentions some experiments which he had made, and which he had ad- duced in support of his opinions." (o) (4) Treatise on Varicose Capillaries, &c. With an Account of a New Form of the Pus Globule, p. 11, 1839. (5) Hake on the Organic Corpuscle. (a) On Fibrinous Concrétions in the Heart, in Guy's Hospital Reports, April, 1839. 192 THEORIES OF INFLAMMATION. in nature, as well as the fallacy of the prevailing doctrine that the capillaries have no orifices. (x) (Vol. I. pp. 685 — 689, 703.) Nevertheless, without feeling disposed to be more skeptical than facts may appear to warrant, we may be permitted to have some doubt about thèse purulent globules. Observers equally good, with good glasses and better eyes, only discover them after the secreted fluid has been exposed to the air ; others find them be- fore such exposure can have happened, generated within the vessels, or out of decaying tissues, whilst the latest observer comes forward with " an account of a new form of the pus globule." (*) Added to this, we are justified in referring to the ex- tensive déception which grew out of the promulgation of Mon- ro's universal doctrine of " convoluted fibres." (Vol. I. p. 700.) Nothing can be more incompatible than thèse conflicting views with the common analogies of nature, or supply a stronger évi- dence that pus is a substance sui generis, and the propriety of looking to the vital forces for an explanation of its origin. If 11 the laws of physiology begin where those of the physical sci- ences end," it cannot be that pus is sometimes the resuit of a vi- tal process, sometimes formed by the degeneration of solid parts, or again a putrescent or other chemical change of extravasated or intravascular blood. It seems to us that pus must be regard- ed as a uniform resuit of vital action, or that we must consent to annihilate all distinction between living and dead matter. (Vol. I. p. 627.) " Since healthy physiology," says Bichat, " has been studied with method, a love of truth, and a désire only to collect facts, we have no longer been pre- sented with those extraordinary cases in which nature seems to départ from the laws which she has imposed upon herself." (3) But, how is it with the laws themselves 1 Or, has there not been some departure from that "methodical study of healthy phy- siology, and that love of truth," which Bichat so eminently ilhis- trated. (Vol. I. p. 626, note.) Since, however, chemistry has so greatly invaded the science of physiology, let us appeal for a moment to the light which has been reflected upon the composition of pus ; in which we may find a farther proof of its spécifie nature. The best observers, as we have seen of Mr. Bird, find it closely allied to the blood; and as far as chemistry goes, its composition appears to be nearly uniform under all circumstances. (1) Treatise, fcc. ut supra. (2) See, also, vol. i. p. 686, note 3. (3) General Anat. &c. vol.i. p. 341. THEORIES OF INFLAMMATION. 193 « It differs," says Mr Bird, " but slightly in its characters when obtained from secreting surfaces in différent parts of the body ; that, for example, expectora- ted in the last stages of phthisical disorganization, or during the natural cure of an empyema, differs from that obtained from an abscess only in the occasional présence of bronchial mucus." (') " There is certainly no obvious différence," says M. Gendrin, " between the pus of chancres, and that of simple wounds." Taking, therefore, the authority of chemistry, as to the unifor- mity ofthe composition of pus, we need not say that this identity of character refers its production exclusively either to vital or physical agencies. But, it appears that certain reagents establish an unknown dif- férence between pus and other animal products. The globules of pus are distinguished from all other animal fluids, with the exception of homogeneous blood, in being changed by sal am- moniac into a tenacious jelly. But this substance dissolves the globules of blood, whilst it has no such action on the globules ofpus. (3) Ammonia, according to Rayer, converts pus into a peculiar, ropy, slimy matter. When pus is combined with blood, coagulation takes place in the usual manner; but the coagulum soon after becomes fluid. (3) If a heated glass rod, according to Mauld, be plunged into pure blood, the rod will be covered by a red elastic membrane of fibrin; but, on the contrary, if a very small quantity of pus be mixed with the blood, no such forma- tion will take place. If a little more pus be added, the blood will not form into a clôt. (4) The globules of pus are said, also, to be twice the size of those of the blood. Pus précipitâtes in cold water, and, according to Gendrin and others, the globules are not affected. (5) Many regard it as simi- lar to lymph; but lymph coagulâtes spontaneously, and pus does not, whilst lymph is dissolved by sal ammoniac, besides other distinctions. Others consider it more like sérum, or mu- cus. Meckel says it is "so like mucus that we cannot distin- guish them by our reagents." (5) But pus is peculiarly affected by ammonia and sal ammoniac, and mucus, unlike pus, accord- ing to Gendrin and Bird, is coagulated by nitric and acetic acids ; (1) Ut cit. p. 44. (2) M. Donné in Archiv. Gén. Août. 1836. (3) Ibid. According to Sir E. Home, and olhers, pus retards the putréfaction of méat. (4) Revus Médicale, March, 1837. (5) Hist. Anatom. &c. t.ii. §1472. (6) Gen. and Patholog. Anat. vol. i. p. 334. VOL. II. 25 194 THEORIES OF INFLAMMATION. whilst, as stated by Bird, (') and others, pus is dissolved by ni- trie, and hydro-chloric acids. Pus also évaporâtes to dryness without coao-ulatino; • and if dissolved with mucus or sérum in sulphuric acid, the pus is precipitated by the addition of water. The latter, according to Beaumes, forms a red solution in sul- phuric acid, which soon becomes black, and a little water pré- cipitâtes it in the form of a grayish white substance : (2) whilst, according to Bird, (3) a solution of mucus in sulphuric acid be- comas "quite transparent by the addition of water." Pus is not coagulated like mucus by oxymuriate of mercury, and it is pre- cipitated by water from a solution in potass ; though in potass W3 have a substanca which is capable, in some degree, of denot- in2" the modifications which pus undergoes, since it sometimes changes it to a viscid substance, which Thomson compares to the mucus secreted by tli3 bladdar. (4) When pus has subsided in water, if the vessel be shaken, the mixture présents a uniform turbid whiteness. The effect of reagsnts, therefore, shows us that pus, although variable, is a substance sui generis, whilst its peculiar constitu- tion défies all chemical research. The reason is obvious; physi- cal powers have had no agency in its formation. But, being de- rived from the blood, and all parts alike capable of its génération under a common modification of action, when we come to its di- rect analysis, one has identified it with the red globules, anothei with fibrin, another with sérum, and another with mucus ; just as chemistry identifies starch, gum arabic, liquorice, sugar, and vine- gar; or the various préparations of "artificial " and natural chyme; and, according to Davy, (s) even the putréfaction of muscle, or ths product of certain cancers, and the albumen of eggs. Hère we must admit that the éléments and constituents are combined in peculiar ways by the agency of the vital powers, though we know nothing of the manner. (P. 122.) The farther, indeed, the chemist pushes his investigations, the more he multiplies proofs that the whole subject of organic products belongs, essen- tially, to another department of philosophy. (See Vol. I. pp. 56, 57, 62, 67, &c. and Digestion.) Although purulent matter possesses a generic character, it has been always observed to présent modifications according to vary- (1) In Guy's Hospital Reports, No. 6, p. 45. (2) Trait, de la Pthisic Pulmon. t. i. (3) TJt cit. (4) On Inflam. (5) On Organic Chemistry, p. 417. THEORIES OF INFLAMMATION. 195 ing conditions of inflammatory action : and this coincidence we hold to be sufficiently indicative of its dependence on vital agen- cies. Hippocrates says of it, " pus vera optimum est album, sequale et laeve, et quam minimum graveolens ; huic autem con- trarium pessimum." Aretaeus says there is no end to the vane- ties of pus. He states fourteen distinctions, and says that it is ab- surd to test such a varied sécrétion experimentalJy.(') The most enlightened modems, even such as défend the chemical and hu- moral doctrines, admit that " there are différences in pus which élude our means of investigation." This is the opinion of Gen- drin, (2) and Louis ; (3) and Andral has drawn a forcible picture of its varieties as determined by numerous modifications of the vital forces. Chemistry professes, however, to have done something to- wards illustrating the différences in purulent matter. Thus, the proportion of albumen, according to Carswell, is much greater when the product of the serons, than of the mucous, membranes ; and Gendrin found that in caries, it abounds with phosphate and muriate of lime; in scrofula, with a large proportion ofsoda and muriate of soda ; and in goût, with an excess of carbonate and phosphate, and a little cerate, of lime. (4) Every other dis- tinct tissue has been said to détermine some analogous modifi- cation ; all of which goes with our other proof of the vital ori- gin of pus. Again, one kind of pus turns litmus paper red, whilst another will turn it back again. The moment we recur to the vital relations of pus, we might go on to encumber our pages with their manifestations. We might say that one kind of pus is innoxious, and always so when the resuit of what is called healthy inflammation, (Vol. I. p. 523,) another produces smallpox, another covv-pox, another chancre, another gonorrhœa, &c. and each of thèse results1 will always follow respectively, when generated by either form of (I) "Ut species puris prope infimtœ sunt. Gluicunque vero aut igné, aut aqua humiditates explorant ac notant, hi haud ita multum phthoen mihi dignoscere viden- tur." — De Diut. Affect. l.],c.8. (2) Cependant il p.é sente d'autres différences, qu'il n'est pas donné de reconnoitra par nos moyens physiques d'investigalion." — Hist. Anatom. des Ivftam. t. il. §1473. Again, " On corçDit qu'il peut y avoir des modificaiions nombreuses dans la facili:c avec laquelle il est produit, puisqu'il tire évidemment son origine du sang qui pei:t Être aie è de bien des manières, et qu'il est subordonré à l'existence d'une pbleg- maslo d-ins la partie cù il se forme." — (§1463 ) Ile states, also, many facts that lead to this conclusion, as seen in caries, scrofula, goût, &c. (3) On Phthisis, sec 225 — 220. (4) Op. cit. §1471. 196 THEORIES OF INFLAMMATION. disease. The pus of smallpox injected into the veins ofan ani- mal proves rapidly fatal, whilst " laudable pus," is inoffensive. (Vol. I. p. 523.) It may be said with as much propriety that the never-varying matter of smallpox and cow-pox is a mère exudation from the blood, a breaking down of the tissues, or the resuit of some slight chemical change, as to make the affirmation of common pus, or other morbid productions. And, although it be hypo- thetically urged that the blood in smallpox may communicate the disease, this is certainly not true of cow-pox, or of chancre. We have stated a remarkable illustration ofthe peculiar charac- teristics of the smallpox and cow-pox virus in our first volume, (p. 535, note,) where, also, we have shown the fallacy ofthe hu- moral rationale. The late experiments in Britain, showing the affinity of both, through near approximations produced by vital actions, are a striking commentary upon the whole physical doc- trine. Is it not, then, the same with pus as with the almost infinité variety of other spécifie products that distinguish the animal and vegetable kingdoms ? Having now seen that pus is a product of vital action, and that all the results of inflammation are opposed to the hypothesis of vascular debility, stagnation of blood, and chemical agencies, the conclusion seems to us unavoidable, that every stage ofthe disease is conducted by the powers of life. That thèse, and the conséquent actions, are more or less exalted, and otherwise modi- fied, appears not only from the various facts already stated, but from the analogy which is supplied by all healthy and morbid sécrétions. In no other way can we explain the simple fact that pus and serum are often generated with great rapidity, and in vast abundance; whilst the plainest physiological results indi- cate the whole philosophy. If, for instance, the glandular or- gans be stimulated, and tfi3 action of their capillary system in- creased, the bile, saliva, urine, &c. are poured out in redundant quantities ; and again the same results will follow in morbid ir- ritations of those organs, and even when the subjects of inflamma- tion. So far as chemistry has been connected with the physical théo- ries of inflammation, its indications are universally opposed not only to the mechanical, but to the chemical doctrines. This is as true in respect to the analyses of serum, lymph, and mucus, THEORIES OF INFLAMMATION. 197 as of pus.(') Thèse are either essentially spécifie products, or spécifie modifications of the natural sécrétions ; whilst every change may be said at all times to correspond with certain vital (1) Thus, of serum t the products ofthe periloneum, pleura, the lining ofthe peri- cardium, the arachnoid, synovial bursœ and capsules, serous cysts, &c. ofier varietiea peculiar to each. (a) It is uporï thèse distinctions lhat Hodgkin founds his truly phi- losophical doctrine of analogies betwixt the serous and mucous structures. Again, thèse varieties are always modified by disease, the altérations corresponding with the vital signs. (6) Bichat speaks of them especially in relalion to peritonilis, Baudelocque says, that in puerp. peritonilis, " the serous effusion is so irritating, that when we make several successive dissections, the hands will become covered with large pimples, which inflame and suppurate. It is very difficult to get rid of them.';(c) The physical theorists assumed that the change was extravascular ; but it is too uniform and peculiar to the foregoing affection. And how is it with the excoriating nasal mucus in some varieties of catarrh? " There is reason to believe,'1 says Dr. Craîgie, "that the fluid discharged from the transparent membranes during inflam- mation, or as an eflfect of this process, is always specifically and chemically différent from that which is found in a healthy state."(d) Still our able author goes for tbe mechanical theory. There is a common assent as to the peculiar nature ofthe hy- drocéphalie fluid. We have seen, too, that serum passes by insensible degrees into pus. As to secreted lymph, there is a gênerai concurrence of opinion, that it partakesof the nature of ihe tissue from which it is effused; or as Hunter has it, " the blood changes into this or that kind of substance according to the stimulus ofthe surround- ing parts." (e) A striking illustration of this principle occurs in the reproduction of the crystalline lens, as described by Soemering in the human subject, and deter- mined experimentally on animais by Cottreau, Leroy d'Etiolés, and Mayer. (/) Great varieties are observed in mucus, especially in inflammation, and accordai»1 with the degree or other modification of that disease, and the situation ofthe mem- brane. Analyses afford différent results, and the sensible différences are more re- markable. In the latter instance, the coincidence with the modified action is very obvious. It is seen in the varied sécrétion from the schniderian membrane. " In the first, or most ordinary form of bronchitis," says Dr. Stokes, " we have a mucus and afterwards a muco-purulent sécrétion; in the second, a sécrétion bearincr the character o( lymph, as in some ofthe forms of croup; in the third, the sécrétion is principally serous, as in the différent forins of humid catarrh and asthma; whilst in the fourtb, there is little or no sécrétion, a disease which has rtceived the name of the dry catarrh." (g) And so distinguished humoralists, when studying the phe- nomena of life,—as thus Andral: "A diseased mucous membrane présents as many varieties in the composition of its sécrétion as there are différent degrees or modes of irritation in the membrane that fumishes it.» (h) And so M aller, (i) Hère, too (a) See Marcel in Med. Chir. Trans. Lon. vol. ii. p. 373 : A tabular view in Cyclopœdia of Prac Med. art.DropSy; Carswell on the Fluid Products of Inflamed Tissues.in Illustrations, &c Fas 12- Babington's Analysis of the Hydrocéphalie Fluid in Conquesfs Cases, in Lon Med Gaz March' 1838. Gendrin llut. Analom. des Inflam. t. i. p. 213, and t. ii. p.4S2-523- Hichafs Patholog' Anat. rol.u. p. 88: Davies on Diseases ofthe Lungs and Heart, p. 326: Laennec, t. ii : Hodgkin's lectures on the Morb. Anat. of Serous and Mucous Membranes, passim. (»} See citations, ut supra, (e) Puerpéral Peritonilis, p. 2.0. (rf, Pra'ctice of Physic, p. "93. (•) On the Blood, &c. p. £6. (/) Archiv. Cénérales, Jan. 1833. (g) Diieases of the Chest, p. 43. (A) Patholog. Anat. vol. i. p. 297. {i) Physiology, vol. i. p. 472. 198 THEORIES OF INELAMMATION. phenomena, not only as it respects the immédiate seat of the effu- sion, but often in a constitutional sensé. If the changes dépend on chemical principles, other products should be found ; inflammatory action should not be necessary to a particular resuit, nor should there be a uniformity in the particular modification which attends a sécrétion from a particu- lar organ, as in inflammations of the mucous membranes, and at a particular stage of inflammation, yet varying, though still uni- form, at other stages ; nor should there always be a distinctive character to the products of the several modes of inflammation ; nor should each organ manifest, in thèse respects, its own peculi- arities, as evinced by the sécrétions, and the coincident nature, in each part, of its own granulations. Chemistry can do no more than fulfil its legitimate office. The sécrétions being de- rived from the blood, should présent the éléments, and, perhaps, also., though variously combined and modified, the constituent of that fluid. But even the variable proportions of the natural constituents, as they may be determined by disease, can only be explained by the vital laws. The liquor sanguinis only séparâtes into its component parts, after the laws of vitality cease to operate. (') From which and the foregoing facts, and many others which appear in our seve- ral Essays, we infer that when lymph, serum, and all other pro- ducts from the homogeneous, living blood, take place, it can only bs through the agency ofthe vital powers. If, also, we allow vitality to the blood, it is but reasonable to conclude, that its va- An Irai açnes with Bichat, that "all thèse variétés arc especially owing to sympa- thetic in fluences." (a) The expectoration in simple mucous inflammation ofthe lungs is very différent from that of peripneumonia ; and ihe lalter is fo unique lhal Laenncc fnys " it rr.oy by itself enabb us to recognise the disease." (6) Dr. Forbes regards it as an im- portant diagnostic ; (c) as do, also, Dr. Stokes, (d) Williams (e) Andral, and others, Mr. Brett, who made an elaborate analysis of différent kinds of mucus, found that pneumonie expectoration differed from most other kinds of exppt torated matter. Phthisical expectoration was very various, but depended upon the stage of the discase, and the manner in which the actions became modified. (f) Finally, in their nalural state, "the mucous fluids are not the same in any two places. They vary in the principles that constifute them, as the membranes which furnish them vary in their structure." (g) The mucus of some parts is dissolved by potass, whilst it is rendered gelatinous from others. (I) Med. Ch>urg. Trans. vol. xvi. p. 293. (a) Bichat's Gen. Anat. vol iii. p 2"2. (b) Diseases of the Chest, p £20. (e) Ibid. (i) Ut cit. p. 321. (e) Lectures on Diseases ofthe Chest, lec. 10. (/) Trans. of British Association, 1837. (g) Bichat's General Anatomy, vol. iii. pp. £9,115. THEORIES OF INFLAMMATION. 199 rious component, as well as elementary parts, will be held to- gether by the powers of vital affinity till that power ceases to operate ; or, till it is overcome by the greater and united powers ofthe secerning vessels. And although the spontaneous sépara- tion of the component parts of blood, imply a décline or an ex- tinction of the vital forces, yet no such resuit may appertain to coagulable lymph when eliminated by the living solids ; but the process being a vital one, the vessels of sécrétion may even en- dow the lymph with greater vitality. It is an inference, also, not easily resisted, that since the vari- ous sécrétions of the body, in their natural state, dépend upon the vital powers, they are equally the product of those powers, when redundant in quantity, or when modified in quality. If physical laws were essentially concerned in the process, many of the facts which we have mentioned could have no existence. If chemical forces mainly operate, then should the products be widely différent from the constituents ofthe blood. Thèse forces are not concerned in diversifying the proportions of those con- stituents; but in separating their cléments and forming new compounds. (') Such apparently sometimes happens, as seen in the présence ofthe hydrocyanic acid and saccharine matter in the urine. Thèse form stumbling-blocks in our way, from be- ing rare and almost solitary évidences ofthe possible independent opération of chemical forces in the animal system ; its most ex- traordinary characteristic consisting in its abstraction from the laws of chemistry. Yet have we endeavoured to show, in our Humoral Pathology, that what is thus apparent has no real ex- istence, but goes to our gênerai conclusions as to the philosophy of life. The natural philosopher relies npon uniformity and univer- sality in the fundamental opérations of nature, and toils at ap- parent exceptions till they are reconciled to her gênerai laws. (Pp. 128, 133, Vol. I. p. 626, note.) But not so with the me- chanical inquirer when the phenomena of organized beings are the subject of investigation. « We find writers," says Dr. Aber- crombie. " talking of gênerai rules in medicine with exceptions to (1) So, also, " the great différence between the affinity of chemistry, and the force or vitality is this ; that, whereas the former in all the changes that it produces, acts by substituting one élément for another, the latter impresses changes without replac- ing the éléments which may be abstracted by its opération." (a) This was Hun- ter's doctrine ; (p. 122.) (a) Prof. Draper in Amer. Journ. of Med. Sciences, vol. xxi.p. 124. 200 THEORIES OF INFLAMMATION. thèse rules/'C) Do we not find them " talking " of fundamental exceptions to great laws in physiology? Do they not ascribe the same phenomena, and the same spécifie results equally to vital, chemical, and mechanical agencies, —to the whole collée- tively, or individually ? Or, if vitalism have the ascendency, do not eminent philosophers, like Hall, and Louis, ascribe all the phenomena, and the lésions of inflammation to totally " op. posite modes of action ?" But, however the effort be made to show that nature is not always consistent, the devions course, like the pursuit of alchymy, will ultimately conduct us to the truth. The doctrine of exceptions is the great bane of all philosophy. It supposes nature to operate by partial, not by universal laws, defeats the generalization of facts, and the practical advantages naturally arising from them. After the Hippocratic philosophy was lost, and before its restoration by Bacon, the ratiocination of physical and médical philosophers was alike. A multiplicity of causes was considered necessary to explain any of the phe- nomena of nature. The éléments of inorganic, and especially of dead organic, matter, are constantly combining spontaneously into spécifie compounds, again separating, and again uniting to form other combinations. Every part of the animal or the vegetable king- dom is alike composed of those éléments, though, as is said, not in definite proportions. And when the principle of vital affinity gives way, the being that had for years resisted the action of chemical powers may be speedily broken up, and the éléments may form a multitude of new combinations ; but they require for their reconstruction the agency of organized matter. For this purpose, nature has contrived a most elaborate system, in which she has introduced forces having an ascendency over the inorganic, as if to magnify the grandeur of her opérations. Nor is it an improbable conclusion, that "in the planets we distinguish, and in those that we cannot, différent forms and laws of life pre- vail." (2) We may trace the plan with increasing conviction, without a solitary hope for the materialist, from the infusoria up to man. And yet, with all the complex organization of animais, and all its superior endowments with the vital forces, and we (1) On Diseases ofthe Abdominal Viscera, Préface. (2) Med. Chir. Rev. Lon. vol. xv. p. 114.— See Voltaire's very graphie spécula- tions upon this subject, in Œuvres, t. xiv. p. 99 —101. 1771. THEORIES OF INFLAMMATION. 201 may add, with all the agency of the chemical powers, the élé- ments of what was once organized matter cannot yet be com- bined till they have felt the créative power of the vegetable world. Thèse laws are the foundation of an élégant distinction be- twixt the vegetable and animal kingdoms ; the former subsisting upon inorganic, whilst the latter live upon organic matter ;(') thus manifesting a gênerai final cause of vegetable life, in its supply of nourishment to the higher kingdom ; whilst a more spécifie is seen in the ultimate tendency of the whole process of végétation to resuit in means for perpetuating its own species. If the combinations which compose organic matter are appar- ently few, and of a spécifie nature, it only shows the absence of the chemical forces. It is the license of thèse forces, however précise they may be, to operate in the most unrestrained manner, and with only a fortuitous resuit. But in all living organized matter, the perfection of design is so manifest in its structure, in its functions and products, that we irresistibly admit that it must be withdrawn from the capricious influence of chemical or phy- sical powers. Had it been consistent with proper brevity, we could have wished to have illustrated the whole subject by analogies drawn from animais that are destitute of a heart, (2) and from the vege- table kingdom. Their healthy and morbid processes, their healthy and morbid products ; the infinité varieties that occur in thèse respects in the latter kingdom, according to the organi- zation and endowments of each species of which it is composed, and yet thèse varieties always the same ; the very limited num- ber of éléments that make up the endless variety of the spécifie products, as well as the organized parts, and many other corres- ponding facts, reflect a flood of light upon our subject. Hère circulation is carried on by the vessels alone, and by them are all the products détermine!. Nor is there anything in physics or chemistry that will explain a single resuit, in its proper con- nections. Like animais, all plants are subject to disease, and wounds heal in the latter as in the former. We engraft one plant upon another, just as we transplant one part ofthe most (1) See Mirbel, Trait. d'Anat. et de Physiol. Vegetables, t, i. p. 19 ; and Smith's Introduction to Physiolog. Botany, p. 24. (2) See, particularly, Haller's Elément Physiol. t. iv. s. 4, § 29 — 51, where this eubject is examined. vol. n. 26 202 THEORIES OF INFLAMMATION- perfect animal upon another. None can doubt the analogy of the processes, of the laws and actions upon which thèse common results dépend. The vegetable kingdom is full of thèse parai- lels ; and so are all animais whose circulation is only vascular. The next step brings us to the human fœtus which grows to maturity without a heart. It is in vegetables that we see the greatest simplification of the laws and functions of organic life. They are divested of those secondary influences which so con- stantly embarrass our inquiries in more complex organization ; and whilst they are, therefore, better subjects for expérimental research, the facts they supply, which are full of analogies, may be safely carried up as analogies to the most complex beings. Hère, too, we have an endless variety in the component parts of organization, yet invariably the same in every species. As in animais, growth, réparation and sécrétion, are the results of a secreting process, dep^nding on various modifications of action. (') And, as root, wood, bark, &c. with all their established varieties, are secreted from the sap in a fluid state, so are bone, muscles, tendon, nails, hair, &c. with all their determinate modifications, derived in a fluid state from the blood. (Vol. I. pp. 68, 594, 626.) Thus, every part is endowed with a secreting apparatus, and, in its normal state, with précise and unvarying modifications of common powers. In proportion, too, as the organization of parts approximate each other, so will the nature of their sécrétions ; and hence we find greater analogies among the products of the serous, mucous, and cellular tissues, than in more complex or- ganization. Do you speak of abnormal urine, abnormal milk, bile, &c. we refer you to what we have said on this subject in our Humoral Pathology. There is nothing analogous to the foregoing in the whole range of inanimate matter ; nor can thèse considérations fail of their natural connection with the subject we have been considering. Our présent knowledge is a fulfil- ment of the prophecy, — « Neque ideo Naturœ divitias exhauserimus, cum in fabrica intima plurima (1) It is the doctrine of many philosophers, M. Andral for instance, that " in gên- erai, the éléments are separated from the blood in certain organs, the peculiar struc- ture of which favours that séparation ; and that after the séparation, they are so uni- ted and combined in their respective organs, as to form the différent sécrétions." And yet our author, and numerous followers, maintain, at other times, the simple mechanical exudation of some ofthe very products which are alleged to dépend in ordinary cases upon a process of décomposition and recombination under the contre! of vital powers. THEORIES OF INFLAMMATION. 203 latere queant, quœ œternum nos sint fugitura." (') " Nec plures, sed unus est modus procedendi, et differentia quœ intercidit inter corpora oritur ex diversis illorum formis, propter quas dissimilia sunt corpora in operationibus, quamvis unica sil omnium causa ;" et " certum siquidem est, quod in operibus suis an- alogice Natura procedit." (a) Powerful attempts are now making to introduce a new phi- losophy into medicine and physiology, or to revive an exploded one. Whilst the unique process of inflammation and its results are to be expounded on mechanical principles, a coagulum of blood, long extravasated and long dead, is to be revived and or- ganized, and carry on an isolated life by its own independent resources ; and this, too, in the midst of venous blood. By this it is to be nourished, whilst it is known to be fatal when circu- lating in the nutritive system of other parts. The highest de- gree of vitality, a mysteriously vivifying influence, far exceed- ing the spiritus archœus, is thus given to the blood, when it is yet disputed whether it possess any vitality at all. Coagula of blood are, also, supposed to undergo every variety of spontane- ous change that attend the actions of living organized matter ; and which have hitherto been referred to the agency of the vital forces. They are said to undergo spontaneous conversion into pus, and by those who believe that pus is at other times a sécré- tion ; to change into calcareous matter arranged in concentric layers, although there may have been originally no lime in the clôt ; into carcinomatous, melanotic, lardaceous, haematodic, mammary, and scrofulous degenerations, &c. The glandular structures are to be mère strainers of the blood, and the sécré- tions, the matters strained. And to finish the climax, the hu- moral pathology is to simplify disease in such a manner, that according to a truly eminent physician, " Passing by this organ and that, and this function and that sécrétion, we penetrate the spring and source of all, even to the blood itself, and there find the séminal principle of disease ; and that this, in hitherto most fatal of all fe- vers, may be remediable by the simplest means, which are always at hand ;" (') this simple means being the muriate of soda. In what we have now said of the results of chemical tests, we have justly employed the means with which chemistry has sup- plied us for its own defeat ; nor do we find that it has in any re- (1) Haller, Elément. Physiol. t. iii. p. 423. (2) Baglivi, de Naturœ Analogismo. (3) Dr. Latham on " Subjects connected with Clinical Medicine,'' p. 53. 204 THEORIES OF INFLAMMATION. spect invalidated the conclusions of the soundest vitalist which were expressed when organic chemistry began its career. We have often demonstrated this fact ; and in relation to our présent inquiry we may quote Mr. Hunter, who has much upon the subject : " To ascertain," he says, " the properties of pus, or to distinguish it from mu- eus, it has, with mucus, been put to the test of chemistry." " Whatever my opinion might be, yet bold assertions, the resuit, of described experiments, made me avoid falling into the same error of describing what I had never seen. I made, therefore, some experiments on this subject ; and, in conséquence of having previously formed the above-mentioned opinion, I was more gênerai in my ex- periments. I made them on organic animal matter, as well as inorganic, and the resuit was the same in all. I took muscle, tendon, cartilage, gland, viz. liver, and braio. Also pus, and the white of an egg. I dissolved each in sulphuric acid, and then precipitated the solution with vegetable alkali. Each précipita- tion I examined with such magnifiers as plainly showed the forms of the preci- pitate ; all of which àppeared to be flaky substances. The precipitate by the volatile alkali àppeared to be exactly the same." And so of solutions in "ve. getable caustic alkali precipitated by muriatic acid, and examined by the mi. croscope, the appearance was the same," and so on. Ç) (P. 114 —122.) We do not, however, require the aid of chemistry to contra- distinguish purulent from all other formations, and to establish its exclusive dependence upon vital actions. Upon this question no chemico-mechanico-physiologist will controvert the exposi- tions which we have quoted from M. Andral in our first volume, p. 627. It was our purpose to have stated, at page 120, in connection with Fourcroy's, and Carpenter's views of the prospective career of organic chemistry, the coïncident expectations of a leading European Review, that nothing might be suppressed on our part which may be adverse to our own conclusions : » Our attention has been chiefly turned, our acuteness principally directed, to the conséquences and the symbols of disease, of the most obvious character, to symptoms and to structural changes which the unassisled sensé of vision could perceive. How gross those must be, how gênerai, how removed from the simpler and more elementary features of morbid action, need not, we can- ceive, be pointed out. The microscope is to he applied to the solids and fluids in disease, and to distinguish, as no doubt it will, the primary déviations from normal mechanical constitution, which disease must of necessity exhibit, and in which it may often, perchance, consist. And chemistry is to come with her wonderful analysis, outrunning the microscope far more than the microscope culruns the eye. When we contemplate the field of research before us, we cannot think ourselves sanguine in anticipating a fertile crop of discovery in t (1) On the Elood, Sic. pp. 430, 431. THEORIES OF INFLAMMATION. 205 the future." (') (~ee Vol. I. pp. 529, 676, 699, &c. and Essay on Diges- tion.) We cannot but think, however, as we have variously endeav- oured to show, that the habits of observation which are denoted in the first of the sentences which we have taken the liberty of marking in the foregoing quotation, must continue to form our sole dependence. From what we have now stated, it results that there can be no such condition as passive inflammation, as usually contra- distino-uished from active. Those who have made this distinc- tion, have founded it mainly upon the effects of opposite remé- dies, and, it appears to us, without a due considération ofthe principles which détermine their effects. The différence con- sists only in différent modifications of the vital forces, the ex- trêmes of which, in relation to remédiai agents, are connected together by varions intermediate gradations. The remédies must therefore be adapted to the précise changes in the vital properties, which constitute the true pathology of disease. We shall résume this subject in our Venous Congestion, Sec. 15. Having introduced the subject of homœopathy in a note, at page 179, we would say that we had great hésitation whether we should bestow upon it any farther comment than we had tran- siently made in our first volume, at page 673. But this work being especially designed as a guide to students in their search after truth, it has occurred to us that we neglected. speaking suf- ficiently ofthe fundamental error of that doctrine, and of the dis- tinguishing principles which direct the médical philosopher; since thèse are the first and most important that are concerned in the treatment of every individnal case of disease. The original import of " similia similibus curantur," were there any meaning in the expression, was that similar'diseases are cured by similar remédies. The only intelligible phraseology is similes morbi similibus remediis curantur. The homœo- pathist, however, having his peculiar latinity, we shall no longer differ with him upon the structure of language, but proceed' to state the absence of all pathological considérations in his applica- tion of the dogma as he understands it, and the important prac- tical errors which must constantly ensue. He prescribes only (1) Lon. Medico-Chirurg. Review, Oct. 1839, p. 349. 206 THEORIES OF INFLAMMATION. for a particular symptom. Let us illustrate the fact by the ex- ample which we quoted from Hippocrates. Vomiting is the dis- ease in the philosophy of homœopathy, and the dogma is' the cure. Tartar emetic is therefore to be given (' ) under all circum- stances ofthe remote and pathological causes. If cérébral symp- toms spring up, thèse must be equally met, each one, by some agent that will produce the symptoms, respectively, in health. And yet the latest advocates of homœopathy claim John Hun- ter as a disciple, (2) just as we have seen of the humoralists; (Vol. I. p. 634.) Whatever, therefore, may be the profession of homœopathy as to its respect for pathology, in a practical sensé it must reject it, in toto ; whilst its ostensible regard for the sci- ence, (which is the only basis of practical medicine,) is equally in conflict with its peculiar dogma. The moment it admits the absolute condition of disease as the ground of practice, it aban- dons the symptom, and identifies itself with "allopathy." There is a branch of the homœopathic school which strenu- ously défends the dogma, yet allows that many diseases must be treated " allopathically." But, we may say, that there can be no such thing as homœopathy contradistinguished from " allopathy," and yet cooperating together. The construction necessarily in- volves an absurdity ; since "allopathy" embraces as much the pe- culiar doctrine of homœopathy as the opposite principle. The following are the precepts which have prevailed in all méd- ical works of considération since the day they were promulgated by Hippocrates : " Contraria morborum contrariorum sunt med- icamina." Thèse are a cure, not the cure, for contrary diseases, Again, continuing the language of Hippocrates, (p. 179, noie,) " nam si quis homini vomenti. aquam multam bibendam dare velit, eluentur ea, propter quae vomit una cum vomitu. Et sic quidem per vomitum vomitus sedatur." In the same para- graph, therefore, Hippocrates, after saying that vomiting maybe relieved by direct sedation, or upon the principle of " contraria," &c. draws the important practical conclusion, "et ambobus con- trariis modis homo sanis fit ;" each being wholly déterminée! by the nature of the causes, and not by the mère act of vomiting. However, therefore, the man of science is constantly concerned (1) Ticknor's "Letter, &c. for Believing the Fundamental Principles of Homœo- pathy," p- 8. 1840. Hahnemann, and others. (2) Ticknor's "Letter," p. 30. — Channing's Discourse on the Reformation of Médical Science, Sic. p. 42. 1839. THEORIES OF INFLAMMATION. 207 about the foregoing principles, he can never know which may be applicable to any individu al case of vomiting, or of other dis- ease, till the exact pathology of the case is understood ; and whoever prescribes upon any other principle does it at random. Each of thèse principles, indeed, which are held bythe homœo- path to be contradictory, must be often applied in simultaneous connection, many examples of which occur, especially in our first volume, and where Mr. Hunter is introduced in his true as- pects. (Pp. 222, 242—245, Humoral Pathology, ôf-c.) Finally, the great doctrine similes morbi similibus remediis curantur, is of universal application in médical science, however it be liable to various modifications according to the varieties which may be determined in similar diseases by their remote causes, &c. We conclude, therefore, that the professions of homœopathy as to the " inductive philosophy of Bacon " have no foundation, but that, like the " numerical system," it excludes all principles and reposes alone on the contingency of the greatest amount of par- ticular results, as they may fluctuate one day after another, and compounded of the " expérience " of such as " blow in Chili," up to the philosopher who sélects his facts and exalts them to a science. (Vol. I. p. 400.) APPENDIX TO ESSAY ON THE THÉORIES OF INFLAMMATION. STATE OF THE CIRCULATION IN FEVER. (See pp. 145 note, 181.) It is only our purpose in this Appendix to consider the doctrine of " stagnation of blood " in its relation to idiopathic fever. Of course, we shall not go over any part of the ground we have just travelled, but simply regard the spécial foundation of the foregoing hypothesis. Dr. Craigie remarks in his valuable work on the Practice of Physic, that, "The blood in ague and fever generally moves more slowly than natural through the capillaries. I am aware that this may appear paradoxical to those who have been accustomed to hear and to speak of the accelerated circulation, and increased impulse of blood in fevers. Thèse expressions, however, I am prepared to show, are adopted with fallacious views of the circulation." Our author also states, in various places, that there is a " partial stagnation " of blood in the capillaries in rémittent and continued fevers, and " in all forms of fever " during the stage of excitement, — though we must say, not upon the ailthority of any facts, nor is it shown by any reasoning. In the plague, " there is a sudden, almost immédiate retardation of the motion of the blood in the ca- pillaries of all the organs, in all cases, and in the most intense and virulent, stag- nation more or less complète of the blood." It is affirmation, we mean it respect- fully, without proof. Exactly the same objection is made by our author to what is called " increased local détermination of blood ;" and, as in the foregoing case of fever, all have hitherto " agreed in representing the blood to be propelled with increased force and velocity," and all have been alike mistaken. It is said that there is hère, as in the hot stage of fever, the same capillary stagnation of blood. All the various proofs to the contrary that have been offered are " fallacious." (') We shall, therefore, take an entirely new ground of démonstration ; as wehave, also in our attempt to exhibit the error of the corresponding doctrine in regard to in- flammation. We may also premise, that in noticing this new hypothesis, we have far more in view the great objects which we have contemplated through- out our work, than any disposition to quarrel with the hypothesis itself. It will be seen, too, that it has a spécial bearing upon our next Essay. The question is, also, of great magnitude, in a practical sensé, and philosophy, as well as humanity, is deeply interested in its right construction. Our author (1) Practico of Physic, vol. i. pp. 95, 96, 246, 277, 278, 279, 281, 287, 329, 364, 355.—1836. vol. n. 27 210 APPENDIX TO THEORIES OF INFLAMMATION. is justly one of the leading guides of the day ; and we would not assume that he is wrong on a great physiological point, without endeavouring to prove him so. The foregoing doctrine, however, is not wholly original with Dr. Craigie. We find something like it laid down by Marshal, in his work on Hydrophobia. (') But our author considers it opposed to universal belief, and that "it may appear paradoxical." &c. We frankly admit that we are placed in the supposed di- lemma. This is not a matter of spéculative philosophy. In the stage of reaction, then, we find the heart beating with preternatural force, as admitted by our author.' 2nd. If the temporal artery be divided, the blood is projected with an in. creased momentum. 3d. If we puncture, or apply leeches to the skin, the blood flows with a profusion unknown in health, as is also admitted by our author; and this it often continues to do with unyielding obstinacy. The blood, therefore, which ultimately escapes, is not the blood which was original. ly contained in the capillaries ; but blood that is constantly circulating in them, and, of course, according to our facts, with increased velocity. 4th. If we look at the veins, we find in their turgid condition a proof that the blood is not only freely transmitted from the capillaries, but with an accelerated motion. This is shown by the projection of a stream on opening a vein. But, says our author, less and less blood will be expelled by the heart in a given time, in proportion to the frequency of its pulsations ; that " much more blood passes through the heart when it contracts 60 times in a minute, than when it contracts 70 times, and more when it contracts 70 than when it contracts 90 times, or 100, or 120 times. It must also follow, that the blood moves more slowly when the heart contracts with unnatural, than when it contracts with normal frequency." («) Hère the important fact is overlooked, that the dilatation of the cavities of the heart, and the force with which they contract, are constantly variable, under the same conditions of frequency. Thus, in one case, as in the sinking parox- ysms of phthisis, or organic affections of the heart, this organ shall beat 120 pul- sations, and the circulation may appear almost at a stand. The skin becomes cold and bloodless. Place your ear on the région of the heart, and you may scarcely hear its action. But, on the contrary, in the hot stages of fever, when you have the same frequency of puise, there is a florid, ardent state of the skin, and you may see the bed shaken by the commotion of the heart Is not the force of the heart greatly augmented by violent exercise, a paroxysm of an- ger, &c. whilst the frequency of the pulsations is as greatly increased! And who will deny, that under thèse circumstances, the velocity of the circulation is increased, and that the blood performs its entire circuit with increased rapid- ity ? Or can it be entertained that there is a stagnation of blood 1 But the cases are clearly parallel, as they concern the circulation, with the reacting stage of fever. Again, on the other hand, a paroxysm of fear, like that of anger, shall accelerate the action of the heart, whilst the vigour of the organ shall be depressed as in the cold stage of fever. The philosophy of thèse différ- ent physiological conditions we have endeavoured to expound in our Essay on Bloodletting. It appears to us that they have no connection whatever with mechanical principles, excepting that in the latter case, the action of (1) P. 106 — 122, &c. (2) Practiee of Phyiic, vol. i. p 95. THE SENSIBLE PATHOLOGY OF FEVER. 211 the heart is, in part, embarrassed by the central accumulation of blood, and by the vital constriction of the capillaries. It is apparent, therefore, that no- thing can be predicated of the force with which tho heart may dilate or con- tract, or of the rapidity of the blood in its circuit, by an abstract regard to the frequency of the pulsations. It is all relative ; and our conclusions must he founded on the facts in each individual case. Nor is there any thing opposed to thèse considérations by the philosophy of physics or mathematics. It appears to us an error upon any principle, to suppose that " more blood passes through the heart when it contracts 60 times, than when it contracts 120 times." More may he admitted to the heart at each dilatation in the former than in the lat- ter case ; but if the velocity of the circulation be twice as great in the latter instance as in the former, the same quantity of blood may have " passed through the heart " in a given time in both cases. But as we have seen, and may be shown upon the mechanical principles of our author, less blood actually " passes through the heart," in a given time, during the cold stage of fever, when the pulsations may be only 60, than in the hot stage, when they may amount to 120. In the former case, the heart is clogged and embarrassed by the accumulation about its cavities ; and the capillaries being also contrac- ted, the quantity of blood which passes through the heart is greatly lessened ; a large proportion remaining almost at a stand in the great internai vessels. But in the reacting stage of fever, thèse obstacles are entirely overcome ; and if the pulsations now amount to 120, it appears to be manifest that the heart having less blood to move at each pulsation, and with augmented power, will drive it forward with an increased force. Besides this mechanical view of the subject, the change in the state of the vital forces adds greatly to the momen- tum of the blood. Irritability and contractility are everywhere increased, not only in the heart, but throughout the vascular system; and the capillaries, so far from retarding the motion of the blood as in the case where there were but 60 pulsations, now coôperate with the heart in advancing the motion ofthe blood. But our author, in weaving his hypothesis, has borrowed the web of another, which we, for one, are in no respect disposed to admit. We allude to the doc- trine, long since nearly settled against him, that capillary circulation dépends upon the vis a tergo. Returning to the respective stages of fever, we find the pulsations generally less in the cold than in the hot stage. According, therefore, to our author's hypothesis, more blood should be sent out by the heart, and the circulation should be more active in the former, or cold stage, than in the latter. If this view of the subject be correct, we must have a modification of the existing the- ory of fever, as it has been universally received. Taking the premises of our author, we think we have sufficiently demonstrated, that, having too much re- liance upon "facts," we have been deceived as to the absolute nature ofthe différent stages of fever ; and that the cold stage should hereafterbe considered the hot, whilst we correct our préjudice in a corresponding mauner as to the hot stage. It is clear that " thèse expressions have been adopted from falla- cious views of the circulation," however " paradoxical it may seem to those who have been accustomed to hear and to speak of increased action " as the hot stage. The prevailing mistake is also farther shown by the superior effica- 212 APPENDIX TO THEORIES OF INFLAMMATION. cy, as it is said, of bleeding in what we have hitherto considered the cold stage of fever. Few have doubted, till of late, that this remedy is best adapted to the stage of excitement, or " increased action." And since first impressions are said to be generally the best, it follows, from the greater success of bloodlet- ting- in the cold stage, that this must be the true stage of « increased impulse" or " increased action." (Vol. I. p. 205 — 210.) It is due to our author to say, that his argument is not wholly spéculative ; but that he places a part ofthe burthen upon that capital resource for démon- strating the actions of life, — morbid anatomy. After saying, as we think rather mechanically, that » the weight and heaviness of the head, the oppressive lan- guor of all the muscles, and particularly in the back, the inability to retain the body or limbs in the erect position, and the natural désire for the horizontal posture, dépend, I conceive, entirely on the loadof blood with which the capilla- ries of the whole body, and all its organs, are oppressed," we have the following contribution from the débris of the various organs : — " The foregoing," says our author, " cannot be directly demonstrated by ana. tomical inspection, because it almost never happens that individuals are eut off on the first day or days of fever ; (1) and when the fatal event takes place, we recognise only the effects of the morbid action, and not the exact nature of the process itself. But it admits of as satisfactory évidence as any question of this kind, by comparing the appearances found in différent patients eut off at differ. ent stages, and, ihrowing aside those phenomena which are manifestly to be re- garded as mère effects, selecting those only, which, by their constancy, appear to be entitled to the character of causes." Ç) We are certainly not disposed to deny, that particular organs will appear more or less plethoric from inflammations that generally supervene in the pro- gress of idiopathic fever ; but even in thèse cases, we think that we have shown that ihe circulation could not have been retarded. This, however, is not the greatest concession that we have to make in behalf of morbid anatomy ; for we have no sort of doubt, that in fevers, and, we are willing to say, in all other diseases, the blood is more or less apt to stagnate in all parts of the vascular system when death is taking place, and especially so after that event has come. It is also not to be questioned, that, for an uncer- tain time antecedently tq death, the skin may be hot, whilst the action of the heart shall be languid, and beating with augmented or diminished frequency ; that, also, the capillaries, from the declining powers of life, notwithstanding the increased température of certain parts, shall have partially lost their power over their contents ; and that, therefore, the blood will move in them with diminish- ed velocity, and may undergo an accumulation. Examples of this nature were common in the choiera asphyxia ; where the skin at the umbilical région stood at a température of 108, or more degrees, after all pulsation had ceased for some time in the radial artery. (P. 29 — 35.) Before leaving our subject, we cannot forbear expressing, more distinctly, what we have already implied, the nature of the causes which so variously af- fect the movements of the circulatory organs, and especially the capillary blood-vessels, not only in fevers, but in all other diseases. Thèse, it appears to lus, are mainly the différent modifications of the vital forces ; and according as fl) Practice of Physic, vol.i. p. 97, THE SENSIBLE PATHOLOGY OF FEVER. 213 they may be exalted or depressed, or otherwise changed, so will be the forcible dilatation af d contraction of the heart, without regard to their frequency, and so will be t'ie action of the capillaries. In fever, without looking at the rernote causes, or regarding any hypothesis, we see that action is universally languid during, the cold stage, and it is equally évident that it is exalted in the hot. Howi-ver the vital forces may be affected in other respects,, there is abundant proo' that thèse powers are depressed in the former, and preternaturally excited in tne hot stage, whilst there are as evidently, and necessanly, corresponding degrees of action. In other affections, however, the remote causes shall have modified the vital /forces in a différent way, and according to thèse modifications will be the state of the circulation in the capillary blood-vessels, without the least connection with the frequency, and perhaps but little with the force, ofthe heart's action ; though in the latter case there is certainly, in most instances, a coincidence be- twixt vigorous action of the heart and that of the capillaries. This we have just seen to be true in the natural state of the organs, as in a paroxysm of an- ger, or when the circulation is excited and accelerated by violent exercise. This correspondence betwixt the action of the heart and that ofthe capillaries, betwixt the quantity of blood projected and its velocity in the capillaries, ap- pears to be almost fundamental in the animal economy. The final cause of this harmonious concert is abundantly obvious. Still it cannot be regarded as an absolute law. For in the first place it does not dépend upon the intrinsic na- ture of the vital forces ; and, again, it is liable to those disturbances from the influence of remote causes which more greatly embarrass the relations betwixt parts whose mutual dependence is less perfect. Nevertheless, the harmony is better preserved than among other parts ; and whether the impresaion of modi- fying agents be directly upon the heart or the capillaries, the influence of sym- pathy is extended to the other, by which a concerted action is maintained. (i) This we have seen to be remarkably manifest in bloodletting, which is a simple standard by which we may approximate the philosophy. In connection with the foregoing subject, and as having a relation to our in- quiry into the philosophy of life, we cannot avojd noticing, that our author has founded upon the mechanical doctrine of capillary "stagnation " of blood in the reacting stage of fever what appears to us a mistaken conclusion in regard to the causes which stimulate the heart to greater and more fréquent action. " The stagnation," he says, « affords a mechanical obstacle to the farther transmission of blood from the heart. This is the cause of the heavy lahouring action of the ventricles in fever." " The chambers of the heart are never completely emp- tied, and consequently, before the last stimulus has ceased to act, a new one is applied ; or, rather, to speak more to the matter of fact, the stimulus of the blood never ceases to operate. This is the cause of the fréquent ventricular contractions." (2) If such, then, be the real cause, should not the same phenomena predominate (1) There are some instances, especially where the nervous system is unusually concerned in the morbid process, in which the action of the heart greatly exceeds the apparent action of the arteries ; (vol. i. p. 356, Sec.) and this is a proof to us, when considered in relation to our foregoing remarks, that the capillary vessels have an independent action. We think that this conclusion results from our several essays, respectively. &) Ibid. p. 276. 214 APPENDIX TO THEORIES OF INFLAMMATION. most in the cold stage of fever, since hère there is a real obstruction in the con- tracted capillaries, and the accumulation of blood within the cavities ofthe heart is then undoubtedly greater ï But is it ascertained that " the cavities of the heart are never completely emptied," in the hot stage of fever, or as much so, at least, as when excited by exercise, anger, &c. 1 It appears to us that a variety of facts concur in showing that the increased labour and frequency of the heart's pulsations in the hot stage of fever are mainly owing to vital changes, whilst the foregoing considérations show that they are not connected with the supposed mechanical condition of the capilla- ries, or any peculiar relation of the blood to the heart. In the cold stage, how- ever, thèse causes have really an important effect upon the action of the heart, and it is sometimes a primary object to remove the constriction of the vessels and relieve the heart of its load. But even hère, much of the difliculty atten- ding the heart consists in the altération of the vital powers, which, however, are destined to undergo an important change in the subséquent stage of the par- oxysm. Again, when the heart is prostrated in simple venous congestion, not only from a morbid impression upon its vital forces, but from a preternatural déter- mination of blood upon its cavities, if we abstract blood freely, and thus modify the vires vitae, and take off the contraction of the capillaries by which the me- chanical obstacle was constituted, we shall at once increase the vigour and per- haps the frequency ofthe heart's action. (Vol. I. pp. 129 —134, 197 — 209, 224 — 232.) But, will it be contended that the resuit is now owing to the cause assigned by our author in an analogous case 7 Carry the bloodletting still far- ther, and take half the blood from the body, we may thus possibly still go on in- creasing the force and frequency of action. We do it, however, by increasing the irritability, directly and indirectly, of the heart, — not by accumulating any blood in its cavities. (Vol. I. pp. 239—248, 261, 267.) We have been thus candid with our author, since he unequivocally affirms that we are all in the wrong upon the foregoing subjects, without producing a fact to show us so. And since we have undertaken to défend a ground that has not been assailed by any weapons, we cannot forego the disposition to say, that in all our author's discussions of the great questions relating to fever, &c. we hear little or nothing of the vital forces, but everything is construed upon mechanical principles, — everything referred to the fulness and obstruction in the capillaries, just as we have seen of the prevailing théories of inflammation. Dr. Craigie's work, however, is full of rich érudition, and, as it appears to us, of practical remarks that contradict his hypothesis of fever, and which can only be founded on a close observation of nature. It is a learned, and valuable con- tribution to medicine, especially in its relation to the remote causes, the symp- toms, and the treatment of diseases. But, whilst minds like our author's may disregard, (as we have seen of the most illustrious of the humoral school,) their own hypothetical views in pathology, there are others who may take his word and carry his suppositious philosophy into the chambers of the sick. — See Ap- pendix L of Venous Congestion. PHILOSOPHY OF VENOUS CONGESTION. " Res obscur» et sensibus immanifestse ad possibile redigi possint. — Aristotle Metapkys. c. 4. " Physiology begins where the physical sciences end." —Magendie. "In organic bodies, the spirit of the théories should be wholly différent from the spirit of the théo- ries applied to the physical sciences."—Bichat's Gênerai Anatomy applied to Physiology and Medicine, vol. i. art. 1, s. 9. "It must be allowed just to join abstract reasonings with the observation of facts ; and to argue from such facts as are known to others like them."—Butler's Analogy of Religion, Src. Intro- duction. " Analogical reasoning, founded upon the uniformity of nature, is frequently employed in the in- vestigation of facts ; and we infer, that facts of which we are uncertain, must resemble those ofthe Bame kind that are known. The bulk ofthe reasonings in natural philosophy are of this kind." — Kaims, on the Progress of the Sciences, b. 3. " Induction and analogy are the guides by which a man of penetrative genius is conducted into the hidden walks of Nature, and much farther than the sensés will enable him to do. The whole art of physic dépends on this mode of reasoning." — Zimmermann, on Expérience in Physic, vol. ii. p. 41. " In investiganda alicujus morbi natura, causa, aut curatione, per analogiam ratiocinari, ac pro- cédera possimus ab aliquo morbo manifesto, apparente cum quo occultus similitudinem aliquam haberet. — Baolivi, de Naturœ Analogismo. " There is no more mischievous or mistaken spirit in philosophy, than that which is always seeking, on the appearance of new phenomena, for new principles to explain them, rather than attempting to refer them to others before established, and which are known to give rise to more or less similar effects." — Armstrong's Lectures on Acute and Ckronic Diseases, vol. i. p. 100. "The same disease yields diversity of symptoms ; which, howsoever they be diverse, intricate, and hard to be confined, I will adventure yet, in such a vast confusion and generality, to bring them into some order." — Burton's Anatomy of Melanckoly. [The substance of this article, embracing all its leading facts and arguments, was communicated simultaneously with that on Bloodletting, to Dr. James John- son as announced in the Medico-Chirurgical Review of July, 1837. (') We are not sensible that any variation of our opinions, or any new modes of inves- (1) The following is the notice to which we refer. " 33. In MS. to be presented to the Royal Medico-Chirurgical Society. " On the Philosophy of Bloodletting and Venous Congestion, by Martyn Paine, M.D. "The Society had just closed its sittings for the Session, when the ahove MS. 216 PHILOSOPHY OF VENOUS CONGESTION. tigating our subjects, occur in either. This statement is due to ourselveo for the purpose of showing that we have borrowed no opinions from any of the able observers to whom we shall refer, as entertaining certain coincident views, and whose writings have àppeared since the foregoing period.] SECTION I. We have reserved for this place the important subject of Venous Congestion, that we might have all the advantage of any light that may be reflected by the examination which we have be- stowed upon the natural and modified powers and actions of life in our preceding investigations. We have hitherto seen that it is the prevailing disposition of the âge to refer the phenomena of organized beings, whether in health or disease, to the agencies of chemical or mechanical powers ; but most of all to the former. This error, as we have endeavoured to show, has its deep foundation in confounding the vital with the properties of dead matter, and in yielding the sensés to the illusions of the microscope, or to mistaken analogies in chemical science. Mechanics has been largely introduced "to circulate the blood," and in some diseases, as in inflammation and its conséquences, it is the principal fulcrum. But we now approach an affection in which we lose sight of chemistry, and all vital agencies, and surrender the science of life to an unadul- terated mechanical philosophy. Hère we have " nothing but stagnation," (p. 145, note,) and the modus operandi of all our remédies is construed upon physical principles. Whilst every other tissue of the body has been, from the ear- liest records, the acknowledged seat of fréquent inflammation, the remarkable fact exists, that it is only within a few years that the veins have been suspected of being liable to this mode of disease. (') » Nearly a century and a half had elapsed," says Dr. Lee, « from the time was received. It will be presented in time for the ensuing Session." (p. 296.) We know nothing farther ofthe disposition ofthe manuscript; but can well sup- pose that it was mislaid in fhe midst of Dr. Johnson's multifarious engagements. (1) Venous inflammation} was wholly neglected till described by Mr. Hunter, as a conséquence of injuries, in the Trans. of a Society for the Improvement of Med. and Chir. Knowledge, vol. i. 1793. About the same time it was noticed by Schmuck, in Diss. de Vasor. Sang. Inflam. 1793 ; and by Sasse, in Diss. de Vasor. Sang. Inflam. 1797. PHILOSOPHY OF VENOUS CONGESTION. 217 when phlegmasia dolens was first clearly pointed out by Moriceau, until I as- certained by dissection the true nature of the complaint." (') Meckel, however, in 1797, described the symptoms and mor- bid altérations in utérine phlebitis, and attributed the fatality of the disease to the prostrating influence of venous inflammation. (2) Other observers have remarked, about the same time, a fréquent dependence of puerpéral fever upon inflammation of the womb. Lieu tau d describes a bad case of utérine phlebitis. The milky fluid, observed about the intestines and in the lungs, was evident- ly pus. (3) Kirk! and says, " It is évident that an inflammation of the utérus, and a conséquent absorp- tion of putrid matter from this part, will bring on what is now called puerpéral fever ; and that the inflammation of the abdomen, &c. is frequently the consé- quence of the fever thus brought on." " Whence it is évident, that we ought to make a distinction between the fever and the disease." (4) (Vol. I. p. 540.) In 1816, M. Ribes made some investigation of the nature of utérine phlebitis ; and ascertained, also, the existence of venous inflammation in erysipelas, and in some other instances. (5) The inquiry has since been diligently pursued, but mainly in référence to utérine and traumatic phlebitis ; from all which, " Il en résulte que la phlébite regardée autrefois comme très rare, elle est aujourd'hui donnée comme assez fréquente." (6) " Nécessitas medicinam invenit, experienlia perfecit." " If we permit ourselves," says Armstrong, » impartially to consider the vast importance ofthe whole venous system, we shall probably be led to conclude that its morbid states have byno means received sufficient attention." "Probably the anatomist may find in the peculiar structure of the venous apparatus ofthe head and the liver the cause why thèse organs should more often suffer in con- gestive fever than the rest." Q) In looking into authors for their opinions upon Venons Con- gestion, we have remarked a very gênerai silence as to its exist- ence. Some. who have noticed it, confound it with the results of common inflammation ; (8) whilst some one or two regard it as a post-mortem occurrence. (Appendix I.) (1) Researches on Pathol. and Treat. of some ofthe most Important Diseases of Womcn, p. 149. 1833. (2) Sasse, de Vasor. Sang. kc. (3) Anat. Med. t. i. p. 318. (4) On Child-Bed Fevers, pp. 66, 49, 47. 1774. (5) Mémoires de la Socicié Mèd. D'Emulation, t. viii. p. 624. (6) Dubois (D'Amiens) Pathologie Gén. t. ii. p. 322. (7) Qn Typhus Fever. (8) Whenever we speak of inflammation, or common inflammation, it refers to that which aftects other t.ssues than the venous. Whenever the term congestion may occur, we shall cmploy it as expressing a morbid fulness ofthe veins, arising from disease of their parietes; having no référence to the state ofthe arteries, and being wholly différent from that fulness of the veins which is conséquent upon a preternat • vol. n. 28 218 , PHILOSOPHY OF VENOUS CONGESTION- Even «'the congestive form of fever," says Dr. Armstrong, " is entirely unno. ticed by all our systematic writers on medicine, for this obvious reason, that they follow Dr. Cullen to the letter." Q We have already seen, however, in our Essay on Bloodletting, that Dr. A. was mistaken ; which may be attributed to the dis- inclination of this very original man to avail himself of the knowledge of others. We may also add, that the subject of venous congestion, in its simple conditions, and as exerting con- stitutional influences, was more generally investigated, and bet- ter understood by the physicians of the last century, than since morbid anatomy has had its unresisted empire. The three Ksempfs,(2) Stahl, (3) Hoffmann, (4) Schmidt, (') Koch,(') Fa- ber, (7) Élvert, (8) Juncker, (9) A. E. Buckner, (10) E. A. Nico- laus, (") Bertholdi, (12) treated of venous congestion, and ascribed to it important conséquences. They generally consider it the resuit of obstruction to the circulation. It is évident, too, that Hippocrates, (13) Aretœus, (14) and Alexander of Tralles, (") were as well acquainted with the affection as the modems. The two last treated the worst forms of it by bloodletting. The condition of the veins, which we are considering, being ural quantity of blood thrown upon them by the arteries under various influences, Nor do we recognise, in the least, as appertaining to this affection, that turgescence of the veins which is produced by obstructing causes. — (See vol. i. pp. 81, 204, notes.) We shall employ the terms acute and sub-acule, in a relative sensé, as it respecti the degree of disease ; and active will be synonymous with acute. We do nol recog- nise passive conditions till certain degrees of disorganization have taken place, or where some mechanical cause may obstract the circulation, and ihen only so far as it respects the direct effect of such causes. If we speak specifically of chronic in- flammation or congestion, we shall prefix the epilhet. Sub-arute inflammation, or sub-inflammation, may mean inflammation of short or long duration. Congestion al- ways means venous congestion. Inflammation, per se, always inflammation of other tissues than the venous. Phlebitis is intended to imply what is recognised as venoua inflammation. (1) Lectures on Acute and Chronic Diseases, vol. i. p. 187. (2) De Infarctu Vasorum Ventriculi, 1751 ; and De Morbisex Atrophia, 1756.— (3) Vena Porlœ, Porta Malarum hyperchon. 1705.— (4) Op. Om. Physico-Med. t i. s. 1, c. 8, de Sang. Cire. &c. ; and De Rat. Therep. Med. s. 1, c. 4, § 40, &c.c 5, § 38, 1748. — (5) De Concrement. Uteri, 1753. — (6) De lnfarc.tibus Vasorum in Infimo Ventre, 1752.— (7) Ulterior Expositio novœ Method. Kaempfianœ, 1755 — (8) De Infarctibus Venarum Abdominalium, 1754.—(9) De Congestionibus in Génère, 1718; and Diss. de Venae Portae, Porta Salutis, 1742. —(10) FundamenU Patholog. Gcn. ex Anatom. et physico Mechanicis Principiis, 1746. —(11) Bemu- hungen indem. Theoret. und Pract. Sic. 1749.— (12) Diss. prima; Linia: Morborum Vena? Portœ, 1777. —(13) L. de Fiat. ver. 107 et seq. and in many places.—(14) De Acut. Morb. I. 2, c. 8; and de Cur. Acut. 1. 2, c. 3 and 7. —(15) L. 12, c. 3. PHILOSOPHY OF VENOUS CONGESTION. 219 almost universally recognised, and too palpable to be doubted, we shall reserve for our first Appendix an examination of the objections to its existence ; and shall now endeavour to show, as "briefly as possible, that its pathology is not, as generally sup- posed, of a mechanical nature ; but that it is strictly vital, ex- erts extensive influences upon the whole system, and that the dilatation of the veins is often of an active kind. We may say, indeed, that the pathology of venous congestion has not been investigated, as we are aware of, by any writers ; and forming a subject of the deepest interest, it has àppeared to us to peculiar- ly invite discussion. If we have not misapprehended its nature, and founded our opinions on imaginary phenomena, or the re- sults of fortuitous practice, we must regard this disease as the most prévalent, most insidious, and most fatal to the human race. Indeed there can be no doubt that " phlebitis," in its acknowl- edged form, " is infinitely more common than is frequently sus- pected." (') Médical observers have agreed that there is a mys- terious something attending congestive fevers, and many are convinced that the unknown cause of their malignancy résides especially in the venous system, under the disguise of " an ob- struction to the circulation." Tissot says they " are more dan- gerous than they seem ; like a dog who bites without barking ;" (2) or as Cleghorn calis them, " fraudulent, deceitful fevers," with " insidious intervais," and " treacherous remissions." (3) M. Bail- ly in his Italian Fevers, notices very particularly the deceitful character of thèse fevers, and states a fact which has been ob- served of the yellow fever in America, that the patient may be walking about just previously to the accession of a paroxysm which is fatal in a few hours. M. Maillot speaks of the same insidious remissions in his African Fevers. In Texas, during a late épidémie of this character, "by common consent the malady was called the cold plagueX (4) (See Sec. 12.) In our south- ern and western states where congestive fevers are rife, and their fatality great, the disease is known under a variety of expressive epithets, such as " the battle-axe of death." Venous congestion, whether in its local forms, or connected with idiopathic fever, appears to be greatly owing to miasmatic (1) Jackson's Principles of Medicine, and Animal Organism, p. 25. 1832. (2) Avis au Peuple sur la Santé, c. 17, § 242. (3) On the Epidemical Diseases ofMinorca, c. 3, p. 103, and c. 6, p. 164—168. (4) Boston Med. and Surg. Journ. Jan. 22,1840, p. 390. 220 PHILOSOPHY OF VENOUS CONGESTION. poison ; and in thèse instances it manifests its worst modifica- tions. It therefore prevails most in particular latitudes, and in certain places. In America, north of the latitude of New-Haven, (Connecticut,) it is comparatively unknown, except when occur- ring in connection with typhus fever ; the true typhus being also limited. on this Continent, to the régions north of that line. Rémittent and intermittent fevers begin in that latitude, (with the exception of a few localities,)(') and are found over the whole continent south of it. (Sec. 12.) Local forms of venons congestion are generally rife in proportion to the prevalence of the latter fevers. Again, in some places where those fevers do not often originale, as in that part of the city of New-York which is covered with houses. local venous congestions some- times occur epidemically, especially before adult âge, and spo- radic cases are to be seen at all times. And again, in places where intermittents and rémittents prevail in autumn, local ve- nous congestions may occur epidemically, and independently of the fever, in winter. It often happens, however, when the lo- cal conditions of disease are neglected, or badly treated, that an explosion ofthe constitutional disease will sooner or later take place. (Vol. I. pp. 471 — 474, 541 — 545.) If venons congestion be complicated with idiopathic fever, it is commonly apparent after the gênerai explosion takes place ; though absence of pain, and perhaps of other striking symptoms, is apt to betray the unwary into a false security, or to begnile him into the fatal belief that debility is the worst attendant. This is especially true, if there have been, antecedently, a graduai ac- cess ofthe local affection, which often précèdes, even for many weeks, the invasion of fever. This preliminary condition, or when the disease maintains, throughout, a local character, is of- ten difficult of détection, in its early stages, to all but the man of sagacity and careful expérience. We once said to an intelligent physician of the western prairies, who had shut his eyes against congestive disease, regarding it as a fanciful hypothesis,- » What did you, and others, denominate the local form of the complaint when death so often unexpectedly made his invasion?" (1) Sec, particularly, Holmes' Prize Diss. on Intermittent Fever inNew-England, 1836. Dr. Craigie's statement that, "intermittents are abundant along the whole tract occupied by the States, as far north as the St. Lawrence," (a) is only applicable west ofNevv-Yoïk. U) Practice orPhygic, vol. 1. p. 73. PHILOSOPHY OF VENOUS CONGESTION. 221 "Oh," he replied, "we then called it being suddenly struck with death ; or, the vital organs were suddenly overichelmed ; or, the circulation had lost its balance. At other times, we re- marked a very altered state of the intestinal discharges ; and this being the most remarkable symptom, we regarded it as the disease itself, and we then called it a vitiated state of the sécré- tions, which only indicated cathartics for its removal, and tonics to sustain the strength ?" " But what, Sir," we continued, "did you consider the disease, when inflammations, or other sympa- thetic dérangements took place ?" " Then," said he, " we had always some more tangible ground, and called it by the name of the last in the séries of developments ; and hère we seemed to be sustained by morbid anatomy. Until I began to investigate the real condition of the congested organs, to note the often in- sidious local symptoms. and connect them with the equally ob- scure ones of a gênerai nature, at the early stages, my practice was wholly fortuitous, and without a solitary principle,' or a sound expérimental fact, to direct it. The sécrétions were vi- tiated, and, like most others, I gave cathartics to get rid of the offending matter, which, as I have said, we also considered the disease itself. But it generally happened that the sécrétions grew worse in proportion to the extent and activity of our ca- thartics, till a gênerai fébrile action set in. By this time, pros- tration of strength had also become another prominent symptom, or perhaps earlier, and our efforts were now directed to the fever and debility. We changed our practice to the spirit of Minder- erus in the evening, when the exacerbation was greatest, and to tonics and wine in the morning, when the excitement had aba- ted. This often brought about a more violent excitement, and the more violent it was, the better for our patients, for then we would sometimes bleed and thus drive the enemy from his am- bush." "And what, Sir, did you consider those cases, which were originally a < vitiated state of the sécrétions,' when they reached their fatal termination ?" " When death was not an early resuit, and constitutional sympathies had supervened, we pronounced them a rémittent, or a bilious fever, but more gener- ally considered them cases of typhus." That this is in no respect a suppositious case will not be doubted ; nor need we scarcely add that this able man now looks back with those sensibilities which are the surest évidence of conviction and a love of truth. 222 PHILOSOPHY OF VENOUS CONGESTION. » Are thèse things, then, necessities 1 » Then let us meet them like necessities." Great discouragements are certainly opposed to our inquiry, and not the least, the manner in which the discoveries relating to phlebitis have been received by many of the profession. « It would appear," says a reviewer, » from what we can gather in conver- sation, that many gentlemen regard the investigation of phlebitis and of secon- dary inflammation, as rather amusing than practical. They affect to smile at those who pursue it, as persons of a theoretical turn, who are diverted from studies of matters of daily interest, to the pursuit of novel and fanciful patho- logical researches. There cannot be a more palpable blunder than this; one which stamps those who commit it as ignorant and routine men, who are to- tally unacquainted with the nature of many cases they daily have occasion to treat." (') May not this neglect of the fundamental ground of therapeu- tics, account, in a manner, for the fatality of phlebitis, as well as of venous congestion ? And if, as implied, by our philosophical reviewer, the pathology of phlebitis, which is a comparatively rare disease, be a subject of momentous importance, venous con- gestion is equally recommended by its dangerous tendencies, and has the advantage, in our favour, of being " a matter of daily in- terest." In the prosecution of our subject, we shall again find ourselves oblio-ed to become the reluctant critic on the opinions of others, and, adopting the advice of Cicero, we shall still endeavour "to draw forth truth from the collision of différent views; or, at least, to approach to it by thèse means." But we need not say, that we disclaim every sentiment but that of respect for their genius and learning. We are sure, indeed, that it is a study of their writ- ings which has led us to many conclusions which we have hith- erto expressed. and which it is our présent purpose to continue, We shall endeavour to arrive at the results which we have proposed, by the scanty facts in morbid anatomy, by the phenom- ena of the disease, by its remote causes, by the effects of remé- dies, and by induction from collatéral facts. Wê shall examine the subject analytically and synthetically, ascending from effects to their causes, and returning by way of causes to their effects. We shall lay a broad foundation of analogies, which, indeed, are the great basis of médical science ; and, in this respect, we hope to exceed in our approximation to truth, the conclusions which would be justified by the lowest degrees of inductive philosophy, (1) Lon. Med. Chir. Rev. vol. xxix. PHILOSOPHY OF VENOUS CONGESTION. 223 and which we may as well express in the language of Butler in relation to a holier subject : —■ » In questions of difliculty," he says, " or such as are thought to be so, where more satisfactory évidence cannot be had, or is not seen ; if the resuit of exam- ination be that there appears upon the whole, any the lowest presumption on one side, and none on the other, or a greater presumption on one side, though in the lowest degree greater, this détermines the question, even in matters of spéculation ; and in matters of practice, will lay us under an absolute and formai obligation, in point of prudence and interest, to act upon the presump- tion or low probability, though it be so low as to leave the mind in very great doubt which is the truth." (') (See Appendix IL on Analogy.) The amount of information which may be obtained according to our method, surpasses any knowledge that morbid anatomy can supply, in a gênerai sensé, as to the pathology of disease. The facts which we investigate, dépend equally upon determinate laws, are very various, and offer a wide field for connected in- ductions which terminate in one conclusion. It is very far, however, from our intention to carry out — " The sublime hypothesis of the old philosophy, that by the circuit of déduc- tion all truth out of truth may be deduced ;" although " when we consider the wonderful connection and inter-dependence of all' knowledge, made more and more manifest by every day's advance in science, it would seem almost to prove the hypothesis by an accumulation of particular examples." (2) It will be, also, our early purpose to show that none of the ex- isting théories are compatible with the facts which relate to ve- nous congestion, or varix, and that their imputed causes have no real existence. The laws which govern venous circulation will also become a subject of considération ; so that, in our wide rano-e of inquiry we shall embrace many distinct and independent topics. We may also say, that by the term, venous congestion, we mean a strictly local disease, (p. 217 note,) upon which, however, constitutional sympathies, simulating fever, may attend ; as well described by Hippocrates, who concludes : « Hoc ergo modo, ut dixi, febres fiunt, et cum febribus dolores, et aliœ quœ- dam œgritudines." (s) We regard true fever as an independent disease. and in the sensé in which it is considered by Fordyce, (4) Pinel, (5) R. Jack- son, (6) Clarke, (7) Bichat, («) Southwood Smith, (*>) Morgan, (10) (1) Butler's Analogy of Religion, &c. Introduction. ar,(p. l^^lS!''3 °rati°n °" thC AdvantaScs and D*ngers ofthe American Schol- (3) L. de Flatibus, v. 132, &c. (4) Dissertations on Fever. (5) Nosolog. Philosoph. t. i. (6) On Fébrile Diseases. (7) On Fever. (8) Gen. Anat. vol. iii. p. 234. (9) On Fever. (10) On Prin. Surg. p.84. 224 PHILOSOPHY OF VENOUS CONGESTION. Armstrong,(') Craigie,(2) Senac,(3) Rush, (4) Sydenham, Hun- ter, &c. The able Senac, after discoursing of the " malignant inter- mittent fever," and stating that "at the termination of a parox- ysm, the terrible symptoms abate, and oftentimes entirely disap- pear," concludes from this and other circumstances, that " A rule of no small moment may be hère deduced in acute diseasee. It appears, for instance, that there may be great disorder in the functions of the body withont real inflammation or any fixed disease in the solid parts." «Yet those parts, which have experienced such deep and distressing affections may in a short time be entirely relieved." Should the patient die at the invasion of the first paroxysm of fever, we may look in vain for any physical évidence of dis- ease. The terms fever, constitutional fever, and idiopathic fever, we use in a common sensé. We shall pursue our usual method of first stating the opinions of distinguished writers in their own language, and this we do the more so at présent, to show that venous congestion is regarded as one ofthe common maladies of our race by the ablest philos- ophers. " The venous, or arterial system," says Dr. Copland, " having lost the princi- pal part of their tone or vital tension, react imperfectly upon the mass of blood injected into them by the heart's action, and become distended and conges- ted." (5) Dr. Barlow states, that " simple congestion évinces over distension ofthe ves- sels, and clearly implies debility of their coats." (6) Hère we suppose the doc trine is intended to apply indiscriminately to venous and arterial plethora. Dr. Hope thinks that " congestion of blood may resuit either from a passive accumulation connected with a sluggish vascular action, or from mechanical obstruction into the right side of the heart." (') Dr. Bright probably refers to both Systems of blood-vessels, when he says: " Inflammation is a state of excessive action, while congestion is a state in which the vessels being unable to free themselves from the blood which they have received, become gorged and overloaded ;" " they become distended be- yond their power of contraction." (B) " ' Behold,' says Magendie, « the character, and principal and gênerai fact of the blue choiera. The ventricles of the heart being debilitated, there results (1) On Typhus ; and Lectures on Acute and Chronic Diseases. (i) Practice of Physic. (3) De ReconditaFeb. Natura et Curât. (4) Médical Inquiries, &.c. (5) Die. Prac. Med. Ait. Congestion of Blood. (6) Cyclopœdia Prac Med. Art. ibid. (7) Principles and Illustrations in MorbirTAnatomy, p. 133. (8) Médical Reports, vol. ii. pp. 652, 654. PHILOSOPHY OF VENOUS CONGESTION. 225 cold, discolouration of the face ; and as the feebleness of the contraction pro- ceeds incessantly, the resuit is the very remarkable fact ofthe stagnation of the blood in the veins, and the blue colour of the skin.' — Leçons sur le Choiera Morbus, p. 13. In support of this hypothesis, M. M. brings forward the évi- dence of a similar colour produced by an experiment, where, by a mechanical impediment to the arterial circulation in the leg of a dog, he has found the stagnation of blood to occur in the veins." (') (Vol. I. pp. 397, 510 —519, 528, 539,567, 650, 697 —698.) '• Congestion," says Dr. Horner, " most frequently is the resuit of mechanical impediment to the venous circulation." (*) Dr. Biillie remarks that » the most common diseased appearance of the pia mater is that of its veins being turgid with blood. This dépends upon some impediment to the free return of the blood from the head towards the heart, which may arise from a variety of causes, and is very différent from an inflamed state of the pia mater. The smaller branches of its arteries, filled with aflorid blood, are not more numerous in this state than is natural, but its veins are much more distended with dark blood." (3) And so of all others. " The phenomenon next to be considered," says Professor Naumann, " is the morbid distension of the veins, which we observe at the seat of congestion. In thèse vessels circulation is not entirely suspended, though it becomes more and more inert from the arteries conveying to the organs an excess of blood, in relation to its depressed vitality. Since, then, the blood arrives in a very slow course through the intermediate capilliaries into the veins, thèse latter partici- pate less and less in any impulse from the heart. The blood thus accumulâtes and distends those torpid, unresisting channels, through which'its progression can only be affected by a mechanical repletion, or a species of overflowing so to term it. (4) Dr. Macartney observes that the most remarkable circumstance with respect to venous congestion, and the one which has not hitherto been descrihed, is, that arteries found in a congested part are smaller than their natural size, (5) and it is the fréquent vacuity ofthe arteries in congested parts after death, as in other cases where common inflammation has not existed, that led Dr. Clutterbuck to the belief that venous congestion arises from that contraction of the communicating arteries which takes place, ( I ) Dr. Horner, in American Journ. of Med. Sciences, August, 1835, p. 282, Dr. H. objects to the philosophy. (2) Horntr's Patholog. Anat. p. 135. (3) Morbid Anatomy, vol. ii. p. 379. (4) On the Theory of Congestion, in British and Foreign Med. Rev. No. 5, p. 21. (5) Lond. Med Chir. Rev. Jan. 1839. We should say, however, that this obser- vation appears to have been founded upon the results of ligatures to tbe jugular veins ; which is not an example of what we consider venous congestion, or oflny natural process. Nor, indeed, can we see any analogy between an experiment upon a rab- b.t, where the knife has been freely concerned, and the venous circulation completely obstructed by ligatures, and that spontaneous congestion ofthe human body, which ar.sss from miasmitic poisons, "the suppression or diminution of natural sécrétions,'» " déjection of mind, sedentary habits," kc. The fact, therefore, as to the state ofthe arter.es in the foregoing instance, is only offered for considération. But whilst con. VOL. II. 29 226 PHILOSOPHY OP VENOUS CONGESTION. more or less, after death. (') But will this explain the vast ac- cumulation of blood which often takes place in particular organs, and the fact of its limitation to particular parts, even though ad- mitted to be the seat of common inflammation ; when, in the most obvious cases of the latter disease no such venous injec- tion takes place 1 Dr. Stokes observes that " the simplest idea you can get of the condition of the brain in the congestive form, is to consider what its state is in persons who have been hanged. Thèse persons have the vessels of the brain loaded with blood from the violent interruption of the venous circulation." Then follows the axiom in regard to morbid plethora of the blood-vessels, — " now, this in- crease in the quantity of blood circulating in the brain, may arise from two causes ; one depending on the interruption of the venous circulation, the other produced by an increased action ofthe arterial system." We have adverted, in the preceding note, to the absence of anal- ooy in the foregoing cases ; and we shall endeavour to show hereafter, that there is no greater resemblance than between the ligature and the vital forces. But, we are hère reminded by Dr. Stokes, that " nothing shocks one so much as that which has a tendency to overturn and expose a favourite dogma." (2) " What is commonly termed congestion of the brain," says an able writer, " I have endeavoured to show is simply a détérioration of the blood caused by an imperfect aération, a prominent example of which occurs in the disease termed congestive typhus." (s) Portai supposes that hepatic congestion " dépends upon the large supply of blood through the hepatic artery and vena portarum, whilst its veins are pro- portionally smaller than in other organs." (4) But will this hypothesis answer for any other organ than the liver, and shall we have a distinct one for each organ f » Whatever takes off, or diminishes, the mobility of the nervous power," says Cullen, "may very much retard the motion ofthe blood in the vessels of the brain ; and that, perhaps, even to the degree of occasioning rupture." " I sup- pose that the disease (apoplexy) had diminished the action of the vessels of the brain, and thereby given occasion to a stagnation, which produced the appear- stant dissections show us that the arteries are often void, when the corresponding veins are turgid with blood ; on the other hand, we shall endeavour to show that there is a great tendency in acute forms of venous congestion to pass into common inflammation, and may become more or less complicated with it. Whenever thii happens, the capillary arteries, as well as the veins, will be more or less preternatu- rally full- (1) Cyclopœdia of Prac. Med. Art. Apoplexy. (2) Lectures on the Theory and Prac. of Med. pp. 249, 357. (3) Dr. Hooker, Essay on the Relation between the Respiratory and Circulating Functions. Boston, 1838. This leaves unexplained the cause of venous turgescence. (4) Obs. sur la Nat et le Trait, des Malad. du Foie. PHILOSOPHY OF VENOUS CONGESTION. 227 ance mentioned." (') What occasions « stagnation " in cérébral congestions where there is no apoplexy, and where, too, there is a manifest increase of the " mobility of the nervous power " î Professor Alison mentions two of "the most remarkable examples of the tendency to local congestions of blood, dépendent on pernicious diseases." First, «the stagnation of blood in the vena cava desendens, and appearance of various symptoms indicating compression of the brain, or sometimes bloody ef- fusion on the brain, conséquent on obstruction to the flow of blood through the heart, and, therefore, frequently succeeding to violent palpitations, however caused." Secondly ; " a similar stagnation in the jugular veins and congestion in the head, leading to various diseases in the brain, in cases of disease where there is obstruction to the free flow of blood through the lungs, although the heart be sound ; especially if there be fréquent exertions of coughing, as in bronchitis, hooping cough, or asthma." (*) Although we shall endeavour to show, that affections of the lungs never impede the return of blood from the head, we may now say that venous congestion of the brain is a very rare con- séquence of either of the foregoing diseases. Hamilton, (3) and Malcolmson, (4) say that the venous conges- tions of the liver, head, kidneys, etc. in berberi, are owing to ob- struction. Dr. Mackintosh, in speaking of the cold stage of in- termittents, re marks that,— « The term congestion implies that the balance between the arterial and ve- nous Systems is lost for the time, the latter being overloaded or congested ; and not that the circulation in any organ, or set of organs, is entirely obstructed, which, notwithstanding, does actually happen in those extrême cases in which reaction does not take place, and the individuals die in the cold stage." (*) "In congestion," says Dr. Wardrop, "the vascular system, more particularly the veins, of the affected part, are preternaturally distended with blood, whilst in an organ which is inflamed, there is a change in the condition of the arte- rial capillaries." He then proceeds to illustrate the former condition, by say- ing that " congestion of blood can be artificially produced in the arm by tying a ligature around it, and thus distending the veins." (e) And again ; " when from any disturbance of the circulation in the right heart, the veins of the brain become preternaturally distended, symptoms supervene," &c. (7) The Medico-Chirurgical Review, (8) in its notice of Dr. Macartney's Treatise on Inflammation, remarks, that " congestion, as Dr. M. rightly observes, belongs (1) First Lines, &c. s. 1119. Cullen evidently saw that the accumulation of blood in the brain cannot be explained on mechanical principles. But whatever be meant by a " diminution ofthe mobility ofthe nervous power," it seems to be évident that its imputed influence should be co-extensive with the venous system. (2) Outlines of Pathology, &c. p. 378. (3) Edin. Med. Journ. vol. ii. p. 22, &c. (4) On Béribéri, pp. 132,133, Sic. (5) Eléments of Pathology and Practice of Physic, vol. i. p. 53. (6) On Bloodletting, p. 64. (7) Wardrop on Diseases of the Heart, part 1, p. 87. (8) January, 1839, p. 135. 228 PHILOSOPHY OF VENOUS CONGESTION. o the venous system. It is caused by any mechanical impediment to the free motion of the blood in the veins ; such as obstruction to the circulation of the blood in the liver, the lungs, or other important organs, or by pressure of the trunk of any vein. It is also brought on by the suppression or dimunition of natural sécrétions, and by supplying the body with more nutriment than is ex- pended in growth or sécrétion. (Vol. I. p. 582, 611 — 625.) It is sometimes, in- deed, and always formed by déjection of mind and sedenlary habits, which serve to accumulate the blood in the venous system, and to embarrass the circulation. Every impediment to the passage of the blood in the small veins renders its passage slow. But the b!ood appears to be also very fluid; at least it trans- udes in many cases through the coats of the veins into the neighbouring cellu- lar membrane." (P. 225, note.) So far as there may be any increased fluidity of the blood, it appears to be opposed to the mechanical hypothesis in all its as- pects ; but, in point of fact, we think it is as often the other way. In respect to the escape of blocd from the veins, we re- gard it as important in illustrating the pathology of venous con- gestion, and shall therefore consider its bearing in a subséquent section. See, also, Vol. I. p. 180 — 183. No writers have described more accurately the symptoms of this affection when connected with idiopathic fever, or laid down a better plan of treatment, than Jackson and Rush; but we do not find any distinct expression of their opinion as to its pathol- ogy. The former, however, often speaks of " stagnation of blood " in the veins. We do not meet with the expression in any of Rush's works. " We do not find," says an erudite reviewer, " in this part of his Essay, any sufficient reason to change the opinions which we expressed in a former num- ber, that disordered circulation within the cranium, arising from increased ira- petus of arterial blood, or obstructed flow of venous blood, is frequently, of it- Belf, the immédiate cause ofthe symptoms both of irritation and of torpor." (') The doctrine which we shall offer will not interfère with the probability that cérébral symptoms are often owing, in part, to pressure constituted by congestion of the veins. Dr. Abercrombie entertains the common mechanical doctrine so far as venous congestion concerns all parts but the brain, and mainly so in this organ. Having adopted Monro's views asto the departure of nature from her unity of design in having pro- vided the circulation ofthe brain with distinct laws, he yields partially to this anomaly in expounding venous congestions of that organ. (Vol. I. p. 161.) Thus : — » There is, however, another source of serous effusion entirely distinct from this, viz. interruption of the circulation in the veins in any part of the body. In (1) British and Foreign Med. Rev. vol. iv. p. 437. PHILOSOPHY OF VENOUS CONGESTION. 229 this manner, we see a tightly bandaged limb become œdematous below the seat of the pressure, and we find anasarca of the whole or part of the limb produced by the pressure of tumours, and ascites' arising from induration of the liver. Whenever such interruption occurs in the circulation of a vein, it appears that increased effusion takes place from the exhalant branches of those arteries with which the vein is more immediately connected, depending probably upon a state of congestion in thèse parts, which in its effects is nearly analogous to inflammation. Such a state ofimpeded circulation evidently takes place in the brain from a variety of causes ; such as the pressure of tumours, chronic dis- ease of the sinuses, tumours on the neck, certain diseases of the lungs and of the heart, and probably from that very remarkable condition of the brain to which I have proposed to give the name of simple apoplexy. From serous ef- fusion produced by such causes as thèse, probably arise those affections which have been called chronic hydrocephalus, and serons apoplexy." Q) M. Andral, at the head ofthe anatomical school, considers ve- nous congestion as a " Mechanical " condition, and as "resulting from an obstacle to the venous circulation." « Pure blood," he says, may escape from the over-distended vessels, just as water transudes through the perméable sides of a vessel in which it suffers compression. To this cause are to be referred several hemorrhages and drop- sies produced by a simple transudation in a tissue mechanically congested ; and, although thèse effusions have really nothing active in their nature, yet they are considerably diminished, and sometimes altogeiher removed by bloodletting, which, in such cases, acts in a purely mechanical manner, by removing from the ves- sels the fluid by which their parietes were kept in a state of over-distension. Thèse pathological observations are quite exemplified in the majority of those cases of hœmoptysis, hsematamesis, ascites, and other affections, which are con- nected with organic disease of the heart." (2) (Vol. I. p. 180 —183.) Mr. Morgan says of congestion, that, — " In its most common acceptation, we understand the blood to be collected in the venous trunks, or in those branches of the capillaries which form the incipient veins, and in this sensé, only, we can comprehend its meaning." He also thinks that, " its importance and the frequency of its occurrence have been also grossly exaggerated, — that it seems to be ill understood, and, consequently, much absurd reasoning has been adduced re- specting it ; and it has given rise to great confusion in practical medicine."(3) So it is said of phlebitis, (P. 222.) Finally, the whole doctrine as to stagnation of blood, and the supposed dependence of the most formidable symptoms of ve- nous congestion upon that mechanical condition had its origin (1) Patholog. and Prac. Researches on Diseases ofthe Brain, &c. p. 41. See, al- so, p. 313—v326. (2) Patholog. Anat. vol. i. pp. 10, 42. (3) Principles of Surgery, p. 45. 230 PHILOSOPHY OF VENOUS CONGESTION. when less was known of the circulation, and the laws which govern organized beings. For thus, Hippocrates : « Conversa vero, et valde siccœ fientes venœ intendunlur, et inflammatœ afflu- entia attrahunt, Unde corruptio sanguine, et spiritibus non potent.bus natu- raies in ipso vias permeare, perfrigerationes fiunt ex stationc, et vertigines, et vocis interceptio, et capitis gravitas, et convulsiones. Hine morbi comitiales fiunt, aut apoplexia, si in ambientes locos fluxiones inciderunt. (') We know of no writer, ancient or modem, when speaking of the cause of venous congestion, who has not regarded it as a " stagnation of blood ;" and it is, in nearly all cases, referred to obstruction. Bichat condemned the latter doctrine. We may conclude this section by adverting to the remarkable fact, that the researches of the présent âge in morbid anatomy should not have resulted in exploding the mechanical doctrine of venous congestion, and should have shed so little light upon its pathology. It is plain to every observer that this state of the veins had been connected with the diseases of which their sub- jects had been the victims. But, with rare exceptions, a phe- nomenon so striking has been permitted to pass with the simple record that the veins of this pr of that organ " were injected with blood," or, " in a state of distension." This was not so, till the period of which we are speaking. From Hippocrates down, this condition of the veins had been supposed to have an impor- tant ao-ency in the disease, however their views of it may have been as mechanical as our own. We therefore hold up this fact as one among the many others which we shall state in another place, that it has been the prevailing tendency of morbid anato- my since the exit of Bichat to divert us from the phenomena of nature. SECTION II. With the exception of Dr. Armstrong, we have now cited the most philosophical observers who have fully expressed an opinion, as far as known to us, as to the pathology of venous congestion. Dr. Armstrong has investigated our subject more extensively than any other writer in relation to symptoms and treatment ; (1) L. de Viet. in Morb. Acut. b. 4, ver. 48. PHILOSOPHY OF VENOUS CONGESTION. 231 but, like all others, he considers the state ofthe congested veins in a mechanical sensé. « His theory of congestive typhus présumes that the functions or structure of some important organ are deranged by an almost stagnant accumulation of blood in some part ofthe venous system." (l) Nevertheless, we think it has been justly said by Dr. Boot, in speaking of " congestive fever," that, — " I claim for my deceased friend the merit of having elucidated this impor- tant subject moref distinctly than had been done before. He has enlarged, and at the same time simplified our views of fever, and has more satisfactorily ex- plained its nature : and though he has laid no claim to the prize of originality as to the discovery of facts, he has the merit of having reasoned upon those previously known, more sagaciously than his predecessors had done, and of more clearly developing and arranging, by his masterly power of analysis and generalization, the intricacies of an involved and difficult subject." (2) It is obvious, however, that Armstrong's mechanical doctrines of the pathology and treatment of venous congestion exclude the whole subject from the philosophy of life, and recognise no oth- er principles than such as prevail in the world of dead matter. This leads him to confound what is really mechanical with what is, in the most important sensé, of a vital nature. He therefore " simply places the loss of balance either in a morbid fulness of the veins or arteries locally, or in a gênerai change of capacity, relatively, between the venous and arterial Systems." (3) No essential distinction is made between the cause and condition of the local and gênerai affection. Dr. Boot thus represents Armstrong's views of the manner in which venous congestion arises in the brain : " When the lungs and mucous membranes of the bronchise are affected," " the heart and brain may become consecutively affected from this condition of the lungs, which présents an impediment to the ingress of blood propelled to- wards them by the heart. It consequently accumulâtes in the right auricle and (1) Cyclopaedia of Prac. Med. Art. Fever. (2) Boot's Memoirs ofthe Life and Médical Writings of Dr. Armstrong, vol i p 133. Dr. Boot pays a just and high tribute to the " Sketches of Epidémie Diseases in Vermont, 1815," by our distinguished countryman, Dr. Gallup. " The Ist section of his 5th chapter will show that his views of congestion were précise, and his treat- ment admirable." — P. 131. In the latter opinion we have already expressed our full concurrence ; (vol. i. p. 224,) and we will add that we consider the section, to which Dr. Boot refers, as an example ofthe best médical philosophy extant. Gallup, how- ever, leaned to the mechanical theory ; but it is apparent in this section that his eyes were fully upon nature, and not upon hypothesis. The whole work is an honour to the âge. (3) On Typhus Fever, p. 115. 232 PHiLOsopnv of venous congestion. ventricle, and is impededin ils descentfrom the brain, which thus becomes in iti turn congested." An effect is also ascribed to the unoxygenated blood. (') Again, " Under the term congestion," Dr. Armstrong says, "there are ten circumstances combined. Ist. The réduction of animal heat on the surface of the body. 2d. A recoil of blood from the surface to the centre of the body. 3d. A conséquent excess on the venous side of the circulation. 4th. A corres- pondent deficiency on the arterial side. 5th. The heart has sustained a shock then. 6th. There is, in conséquence of this, an impediment to the free return of venous blood, and that leads to the following as its necessary effect, namely ; 7th. An over accumulation of blood in some weak internai part. This canbe demonstrated by an examination after death. 8th. The respiration is weakened, &c. 9th. The constitution of the blood is thereby changed. 10th. A diminu- tion ofthe nervous and muscular power." (5) Nor can we regard the foregoing as descriptive of venous con- gestion. It is mainly an account of the physiological changes which occur during the cold stage of fever, or such as are ap- parently induced by local venous congestion, or by acute phlebi- tis, or by common inflammation when about terminating in sup- puration. This condition, by the universal contraction of the capillary system of blood-vessels, evidently forms an universal obstruction to the circulation. But the obstruction exists on the side of the arteries, and the accumulation of venous blood must therefore be about the right cavities ofthe heart and venas cavœ; and since the engorgement, which constitutes the disease undei considération, is often remote from the centre of the circulation, it appears to be évident that it cannot be determined by the cen- tral accumulation of blood, even could we understand the phys- iological condition which is implied by the term weakness, as employed in the 7th proposition. (P. 153.) This is apparent, also, from the fréquent independence of local congestions, as seen particularly in most cases of apoplexy, of any fébrile paroxysm; whilst, at other times, as we have said, they become the cause of a paroxysm analogous to the cold stage of idiopathic fever. That local congestions supervene on the invasion of fever is ob- vious enough ; but we shall endeavour to show that they then dépend upon causes as truly of a vital nature as the fébrile par- oxysm itself. Our author also supposes, in common with others as we have seen, that venous congestion results from a simply diminished energy ofthe heart and arteries, and that it must necessarily fol- low, when their energy is much impaired, that they cannot (1) Boot's Memoirs, &c. p. 130. (2) Lectures on Acute and Chronic Diseases, vol. i. p. 167. PHILOSOPHY OF VENOUS CONGESTION. 233 maintain the natural current of arterial blood, and that a pro- portionate accumulation takes place in the veins. (*) But hère, as in the former case, the accumulation must be about the right cavities of the heart, not in the venous system of remote organs ; and, as it respects the local effect ofthe obstructed capillaries, in either case there should be, upon mechanical principles, a di- minished volume of blood in the corresponding veins, since its transit is partially arrested. Our author, also, well states that " when suflicient évacuations have been made," for the purpose of restoring the gênerai equilibrium, " certain degrees of venous congestion may remain, partly from want of power in the heart and arteries ;" (2) this being the mechanical aspect of the cura- tive process. Thèse remaining " degrees " appear to us to con- stitute the real congestion, which bloodletting has failed to sub- due, and which may have been the essential cause of that de- pression of the circulation on which itself is supposed to dépend. This disturbance of the gênerai equilibrium of the circulation, as constituted by the cold stage of fever, or as induced by local congestions, we have considered at large in our Essay on Blood- letting, and have endeavoured to indicate the principles on which that remedy opérâtes in its removal. Our eminent author has a remark, sustained by common ex- périence, which shows the little probability that venous conges- tion, in our acceptation, has any direct dependence on a prostra- ted state of the arterial circulation, or that " the deo-rees which remain after sufficient évacuations, are owing, in part, to a want of power in the heart and arteries." « In the last stages of ty- phus fever," he says, " there are certain degrees of venous en- gorgement about the viscera, resulting from the universally in- creased action of the arteries throughout the second stage." (3) Both facts are certainly as stated ; but can it be admitted, that the congestion remains in one case because ofthe déficient arte- rial action, whilst it dépends in the other upon augmented ac- tion ? Hère we must disconnect all idea of common inflamma- tion from the congested organs. since their arterial system is of- ten found in a natural state. The gênerai circulation, too,- is now universally vigorous. There is no accu mulation of blood about the right cavities ofthe heart, no obstruction in the capil- laries. Again, — (1) On Typhus Fever, p. 159. (2) Ibid. p. 119. (3) Ibid. p. 53. vol. n. 30 234 PHILOSOPHY OF VENOUS CONGESTION. "I use the term congestion," says our author, "to dénote the state which exists from the influence of depressants in which excitement does not take place." If there be no congestion or inflammation of organs, and no excitement, " then we have a perfect example of what I call congestive fever." This, however, is nothing more than what happens in syn- cope, and in many other analogous affections. Thèse, and in- deed all fevers when introduced by a cold stage, should be, upon the gênerai principle, equally congestive fevers, whether reac- tion take place or not. As » a perfect example of congestive fever," Dr. A. speaks of " a gentleman who was travelling, and after eating some cold veal pie, fe'l on the floor in a stats of extrême congestion, of which he was relieved by an emetic." (') Hère, the illustration consisting in a central détermination of blood, produced by a gênerai contraction of the capillary blood- vessels, is only parallel with what we shall have seen affirmed of hanging, and ligatures to the veins. No distinction is made between those conditions and that in which venous turgescence of certain organs is productive of peculiar and remarkable phe- nomena. The various examples of congestive fever, which are adduced by Dr. Armstrong, and others, appear to us to consist in very différent pathological states ; agreeing only, in certain cases, in the gênerai détermination of blood from the circumfer- ence, which is made the type of venous congestion. In some of the cases, as*in that of an overloaded stomach, theshockofa fall, or of a surgical opération, of fever, &c. the central détermina- tion of blood arises from the prostrating influence ofthe brain upon the heart, in which a morbid condition of the capillary blood-vessels has no participation. When a person dies of a fright, there is only the mechanical influx of blood. Yet, " this," says Dr. Armstrong, " is what I call congestive fever." (2) In thèse cases, however, the shock may establish a prédisposition to venous congestions, or local inflammations, and may be ulti- mately foliowed by symptoms analogous to those of fever, aris- ing either sympathetically from the local affections, or from a gênerai violence done to the whole vascular apparatus. But we do not consider either of thèse conditions fever ; though they serve to enlighten us as to its philosophy, and the rationale ofthe attendant venous congestions. (Vol. I. pp. 205, 209.) (See Ap- pendix IL) The cases are analogous to that where the body becomes severely chilled by cold, and a state of reaction follows. And, to continue the parallel, if reaction do not soon follow, the (1) Lectures, &c. vol. i. pp. 171, 178, 179. (2) Ibid. p. 149. PHILOSOPHY OF VENOUS CONGESTION. 235 impression of the cold may be so great as to develope local con- gestions, and inflammations ; and this, where the subject dies without reaction. Cases of this nature will be examined here- after. (See Appendix III. on Effects of Cold.) In fever, which proceeds from truly morbific causes, the dé- termination begins at the circumference, and is owing to the pa- thological condition of the extrême vessels. (See Vol. I. p. 204.) And again, in the same fever, so far as any local venous con- gestion may influence the phenomenon, it dépends on the pros- trating effect of venous inflammation, or some analogous condi- tion, as we shall endeavour to show, both upon the heart and blood-vessels, but especially the former ; and, therefore, in thèse instances, at the invasion of collapse, the détermination of blood about the heart may proceed from causes acting conjointly up- on the centre and circumference. It is well stated by Professor A. H. Stevens, in relation to certain affections where the nervous system is especially con- cerned, that, " The same effects resuit from apparently opposite, but, in reality, similar conditions. Thus we have retching and vomiting in apoplexy from congestion or extravasation of blood in the head ; and the same symptoms in depressed skull, the same in crushed limb, the same after excessive bleeding, or an ex- tensive burn." Q) (See Motto, Burton, p. 215.) The primary constitutional symptoms may be alike in all thèse instances, for the reason that there is nothing specifically mor- bific in any of the remote causes, and from a common physiolo- gical change in the nervous centre upon which the phenomena mainly dépend. We have already seen, in our Essay on Blood- letting, that the immédiate resuit of its impression upon the brain is the transmission of the nervous influence to the heart and stomach, a reaction of those organs upon the brain, and other complex sympathies. In all thèse cases, too, the nerves which préside over organic life have sustained a violent shock of a common nature. The heart, becoming prostrated in its powers, transmits blood imperfectly to the brain, and all other parts ; and this is another cause of the phenomena. The blood, also, accumulâtes about the right cavities of the heart ; but, as yet there is no venous congestion, or other local disease. Subse- quently, however, either in cases of excessive bloodletting, of accidents, burns, cold, surgical opérations, &c. a state of venous (1) Lecture al the New-York Hospital, 1839. 236 PHILOSOPHY OF VENOUS CONGESTION, turgescence, or common inflammation, springs up, most probably in the brain. This may take place, in some of the cases, during the gênerai prostration of the vital forces, but more commonly after some reaction has begun. If the cerebial veins suffer, this is venous congestion, and grows out ofthe direct shock that had been sustained by the brain. It will probably be greater, too, in proportion to the duration of the stage of collapse, especially should much reaction follow. The reason is obvious. The longer the brain is affected in its gênerai circulation by the pros- trated state of the heart, the greater has been the direct injury of its powers, whilst they will suffer farther from the prolonged interruption of the circulation, and from the correspondnig in- fluence of sympathies. Violent reaction following, would lead, of course, upon our principles, to aggravate the venous conges- tion, and be very likely to transmute a state of venous congestion into common inflammation. This disposition ofthe former con- dition to pass into the latter we shall consider in our 14th Sec- tion, when we shall probably find in its philosophy a proof of our pathology of venous congestion. Again, the local developments will arise in other parts, espe- cially in cases of shock from fails. This may dépend upon con- tusion or direct shock ofsome internai organs, or may growout of the shock of the nervous centre, as frequently witnessed in congestions of the liver, after gênerai concussions, or a blow up- on the head. At other times, when the predisposing causes have been spé- cifie, as they are called, as in miasmatic affections, the nervous system is specifically impressed, as well as the vital powers of the other tissues, (Vol. I. pp. 474 — 478, 568 — 575,) and ve- nous congestions are more pervading, and their pathology, as we shall endeavour to show, more or less specifically modified. There being, also, no sudden and violent shock ofthe nervous centre, as in the former cases, or as happens in poisoning by the gas of charcoal, alcohol, opium, prussic acid, &c. (Sec. 12,) the vascular system of the brain may suffer no dérangement, and ve- nous congestions be as apt, or more so, to be determined in the liver, stomach, &c. It is also évident that when miasmatic causes operate, they alter more extensively and profoundly the vital powers, and make~ gênerai impressions on this or that organ which contribute largely to the venous congestions. This last, and analogous causes, are those, also, which induce the true PHILOSOPHY OF VENOUS CONGESTION. 237 congestive fever ; complicating venous congestions with a pro- found constitutional affection, but which are confounded with the mechanical déterminations of blood about the heart, as in cases of accidents, &c. or the local congestions, or the reaction, that may spring up in conséquence. Thèse différent cases, as was said of some other analogous varieties of disease, "may not be improperly compared to certain species of plants, by no means uncommon, which are liable to be confounded with others by an inattentive observer."^) There is often, also, a strong resemblance between the phenomena which attend the depressing effects of injuries, those of venous congestion at its stage of prostration, and those which distinguish the first period of constitutional fever. Our diagnosis may be, therefore, in the last instances sometimes difficult, and in cases rapidly fatal per- haps impossible. Again, according to Dr. Armstrong, simple congestive fever " consists exclusively of venous congestion, unattended subse- quently by excitement, and is a déviation from the usual law of nature." We should therefore look for some extraordinary vital modifications to establish such an apparent " déviation from the usual law of nature ;" or should, at least, regard the affection in a strictly local sensé. This want of the secondary stage, in the cases supposed, évinces the absence of that important élément of disease on which it dépends in constitutional fever ; and should reaction, or other sympathies ultimately supervene, the discrim- inating eye will readily separate thèse results from the phenom- ena of idiopathic fever. The congestion which is induced by spécifie causes is considered " the most formidable of all the va- rieties of fever ;" whilst the nine others which we have seen enumerated by our author are such as develope local rather than constitutional disease, and are the predisposing as well as the exciting causes. So far, therefore, as the resulting congestions are truly morbid, we include those causes amongst our évidences that the vascular turgescence is a conséquence of some morbid state of the venous tissue, and upon which the phenomena mainly dépend. D. A.'? account of the symptoms generally re- lates to what we regard as the second stage of congestion, or the stage of constitutional sympathies. (2) We need not speak of the momentous practical errors which (1) Abernethy's Préface to his Works. (2) See, also, Boot's Memoir ofthe Life and Médical Opinions of Dr. Armstrong, vol. i. p. 128. 238 PHILOSOPHY OF VENOUS CONGESTION. have evidently grown out of this confusion of différent patholo- gical conditions, however the treatment of either may have been empyrical. Bloodletting has been found, for unknown reasons, since it was first indicated by Aretaeus, (Vol. I. p. 323,) to be in- dispensable in congestive fevers attended by great sinking and prostration ; and for this, and analogous reasons, the same prac- tice has been largely and fatally applied at the invasion of those concussions which are produced by fails, and other mechanical injuries. Morbid anatomy, too, finding that venous congestions have ultimately supervened, has contributed its indiscriminating part. And we may hère ad vert to another, though less important error which is made by our author in common with most other writers, in confounding typhus fever with the affection which arises from dissection wounds, &c. (') In the latter case, either direct, pernicious inflammation of the venous or the analogous absorbent tissue is produced, or equally pernicious impressions are made upon the nervous system, &c. as we have already en- deavoured to explain. (Vol. I. pp. 397, 474 — 498, 515 — 522, 539 — 549, 563 — 575.) In local congestions which evidently grow out of spécifie causes, and in many of a chronic nature where the causes may have been complex and perhaps inscrutable, we constantly find that there have been numerous évidences ofthe existence ofthe congestion, for a longer or shorter period, preceding the devel- opment of those symptoms which are said to distinguish the first stage. Thèse phenomena dénote a radical différence be- tween true congestion and mechanical accumulations of blood, They may consist, according to the seats of the disease, of lan- guor, headache, flushed countenance, soreness of the eye-balls, tightness of the forehead, pain in the right hypochondrium, or in other parts, a morbid state of the sécrétions, &c. At this pri- mary stage of the disease, the puise is commonly excited, sensi- bly hard, and if blood be drawn with proper précautions, it is often buffed and cupped. Sometimes the puise is now preter- naturally slow, especially in hepatic congestions, and it is then apt to be intermittent or irregular, and this not unfrequently con- tinues after convalescence has begun. After an uncertain duration of the primary symptoms, there commonly takes place a sudden change in respect to the state of the gênerai circulation. The symptoms of excitement disap- (1) Lectures on Acute and Chronic Diseases, vol. ii. pp. 127, 147. PHILOSOPHY OF VENOUS CONGESTION. 239 pear ; the puise becomes smaller, but still its hardness may be generally distinguished; it is sometimes more fréquent, and again is slower ; if previously irregular, this irregularity often increases, or it may now be developed for the first time. The sanguineous capillaries become contracted, the surface more or less pale and cool ; prostration of strength, dépression of mind, &c. are suddenly augmented ; the blood darker, and for the first time trickles from the divided vein. It is at this stage, that the attendance of the physician is commonly required ; and it is, therefore, not so remarkable, perhaps, that thèse cases should be confounded with the collapse which is induced by fails, blows, wounds, &c. At other times, however, the phenomena which distinguish the primary stage of congestion go on increasing, till the disease passes into common inflammation, when the seat of plethora is more or less transferred from the veins to their communicating arteries. In thèse cases, of which luminous examples are given by Annesley in his Diseases of India, the only important change of symptoms which existed during the congestive stage, is that of their progressive increase ; being often, however, but little more severe after the congestion had passed into inflammation. If venous congestion précède an attack of idiopathic fever, the same symptoms of excitement generally forerun the stage of de- pression, though the local affection may ultimately contribute with the constitutional prédisposition in producing that first stao-e of the fever. In thèse cases, the stage of dépression may be pro- longea by the ultimately depressing influence of the venous af- fection. This, however, generally dépends more upon the spé- cifie nature of the predisposing causes of the constitutional dis- ease ; or, when the congestive affection opérâtes, much upon the nature of its own remote causes. We have seen that it is the opinion of Dr. Armstrono-, and of all others within our knowledge, that, » When the lungs and mucous membrane of the bronchia are affected, the heart and brain may become consecutively affected from this condition of the lungs, which présents an impediment to the'ingress of blood propelled towards them by the heart It consequently accumulâtes in the right auricle, and ventricle, and is impeded in its descent from the brain, which thus becomes in its turn congested." (') And again, it is said by Dr. Armstrong, that, « in examining the bodies of some patients, who had died of the most concentrated attacks of congestive fe- (1) Dr. Boot's Memoir of the Médical Opinions of Dr. Armstrong, vol. i. p. 130. 240 PHILOSOPHY OF VENOUS CONGESTION. ver, I have found the right side of the heart loaded with dark blood ; and in re- flecting upon the phenomena of all, am now inclined to believe, that their pa. thology is intimately concerned with the functions of the right ventricle. For when the action of the right ventricle is diminished, and when it is overloaded by too great an accumulation of venous blood, it must, by conséquence, occa- sion a rémora of venous blood in distant organs. (') (P. 232.) We have thus brought together the whole ground of the me- chanical doctrine of venous congestion. If it be supposed, in other instances, to be constituted by venous obstructions in par- ticular organs, the principle is the same ; and, indeed, the type of the whole pathology is commonly borrowed from the experi- ment of a ligature around a vein. But, taking the foregoing ra- tionale as something which prevails in natural congestions, es- pecially of the brain, the mind is at once struck with the assump- tion of conditions which never exist, and with the absence of all those great physiological considérations which should form the fundamental ground of every pathological view of disease, and of every remedy that may be applied for its relief. (Vol. I. p. 290, vol. n. 36 282 PHILOSOPHY OF VENOUS CONGESTION. et a paucis cibis repletur. In solo autem hepate dolor restât, et ipse aliquando fortis, aliquando quietus. Quandoque vero acutus corripit, et sœpe derepente œger animam efflavit." " Alius hepaticus morbus. Dolores quidem eodem modo premunt in hepar, et color differt a priore. Malicorii enim formam habet. In tempore vero ss. tatis maxime incidit. Fit autem a bubulœ carnis esu, et vini potu nimio. Hœc enim omnia isto tempore hepati sunt infestissima, et bilem maxime ad hepar adducunt. Hsec igitur œger patitur. Dolores acuti incidunt, et non deficiunt ulla hora, sed semper magis premunt. Aliquando etiam vomit bilem pallidam, et ubi vomuit, paulo melius sibi habere videtur. Si vero non vomuerit, bilin ad oculos pervenit, et fiunt valde pallidi. Et pedes intumescunt." " Si enim inebriatus fuerit intempestive, aut venere usus fuerit, aut aliud qu:d fecerit, quod commodum non est, hepar statim ipsi durum sit, et intumescit ac a dolore puisât. Et si quid facere festinarit, derepente hepar et totum corpus dolet." (') " Quando autem conturbatus, et secretus sanguis foras non procedit, quan- doque etiam sanguinem in venas corporis distribuunt, ut et venœ replelœ doleant, et tumores laxos producant." (a) " Venœ autem violenter perfrigeratœ, ad pulmonem, et cor assiliunt, et cor tremore concutitur, ut prœ hœc necessitate anhelationes incidant, et spiratio cervice erecta. Non enim spiritum suscipere potest, donec id, quod influxit, a sanguine superatum, et calefactum in venas fuerit diffusum. Deinde et tre- mor, et anhelatio sedatur ; sedatur autem, prout copia ejus fuerit. Si enim amplius influxerit, tardius ; sin minus, citius. Et siquidem densiores, ac cre- briores fuerint defluxus, crebirus comitiali morbo corripitur ; sin minus, rarius. Hœc itaque perpetitur homo, si ad pulmonem, ac cor fluxus processerit. Si vero in ventrem, profluvia alvi apprehendunt. Si vero ab his viis exclusus fuerit, et in venas, quas dixi, defluxum fecerit, mutus fit, et suffocatur, et spuma ex ore effluit, et dentés constringuntur, et manus convelluntur, et oculi distorquentur, et nihil sapiunt, aliquibus etiam stercus inferne secedit" (8) Hère is an example showing the enlargement ofthe liver which results from venous congestion, and its complication with fever; and that the popular phrase of the " bile passing into the blood? was held by Hippocrates " to be consonant with the science^ (4) (Vol. I. p. 605.) " Morbi a bile fiunt, quum bilis in hepar influxerit, et in capite constiterit Hœc igitur œger patitur ; hepar intumescit, et prœ tumore ad septum transvereum expanditur, et dolor statim in caput irruit, maxime vero in tempora et auribus non acute audit. Sœpe vero etiam oculis non videt, et horror, ac febris corripit Atque hœc quidem in principio morbi ipsi fiunt, intermittentia quandoque valde, quandoque minus. Quanto autem magis morbus progressus fuerit, tanto am- plior dolor in corpore existit." (6) (1) Hip. de Intern. Affect. s. 2. ver. 189 — 293. (2) Ibid. de Nat. Pueri, v. 98' (3) Ibid. de Morbo Sacro, v. 153 —164. (4) Compare his philosophy of hereditary diseases with the humoral rationale. Thus : — " Sic etiam puer vivit de matre in uteris, et quali mater sanitate prœdita est, talem etiam puer habet." — De JYat. pueri, v. 416. (Vol. i. p. 464 — 466.) (5) Hip. de Intern. Affect. s. 3. v. 208 — 214. PHILOSOPHY OF VENOUS CONGESTION. 283 Hippocrates dwells with great particularity, in numerous places, upon venous congestions of the liver, the brain, &c. Doubtless his attention was led to their investigation by his doctrine of the origin of the veins, and their supposed distribution from the liver. «Radicatio venarum hepar. Radicatio arteriarum cor. Ex his aberrant in omnia sanguis.*' (') He had a perfect knowledge of the mutual influences of the various organs upon each other, (Vol. I. p. 655,) f) and this, to- gether with the foregoing considération, gave him a clear con- ception of the manner in which congestions of the liver develope the same affection in the brain, and vice versa, and of the super- vention of autumnal fevers upon hepatic congestions ; upon all which subjects he is ample, and exact. Affections of remote parts often began in the liver :— «Quoniam omne hujusmodi ab hepate est, et ex hoc sunt hepatici in his morbi, et morbi regii ab hepate ad subalbidum calorem vergunt, et qui ex aqua inter cutem, et ex pituita alba laborant." (3) The lungs were often the seat of sympathetic affections, result- ing in haemoptysis : — " Quicumque sanguinem spumosum spuunt, dextrum prœcordium dolentes, de hepate spuunt, et multi pereunt." (4) (Sec. 16.) And hère is an example of modem hypothesis brought to bear upon venous congestion. " Morbus hic fit a pituita, et bile, quum in venas confluxerint ; venœ autem liœ sanguine plenœ. Si igitur quid alieni in ipsis prœterlapsum fuerit, œgro- tant" (6) He had a full knowledge of the influence of the passions in the production of disease ; and we speak of this fact to show that he had the usual understanding as to the manner in which the supposed venous congestions are produced by fear. Thus : " Quicumque vero fugil perterrefactus, sanguinem sisti significant." (6) (P. 234.) (1) L. de Alimento, v. 71. (2) Si vero harmoniam non assequunti fuerint, neque gravia acutis consona fiant, prima symphonia périt. Et si etiam secunda generetur, propterea quod unus per om- nia corruptus est, omnis tonus vanus est. —Hip. de Diata L i. v. 48. (3) De Morb. Pop. 1. 2, s. 1, v. 82. (4) Coac Prœnot. s. 2. v. 323. (5) De Intern. Affect. s. 1, v. 414. (6) Hippocrates évinces a far better knowledge of anatomy, healthy and morbid, than is commonly allowed. He describes, in a gênerai manner, every organ of the human body. He distinguishes between affections of the brain and its membranes ; and so of other parts. He constantly speaks ofthe anatomical conditions which re- suit from disease. We accidentally neglected speaking of Hippocrates in our summary notice of the vital principle, in our first volume, page 712. He defended and variously expound- 284 philosophy of venous congestion. Dr. Boot has given a most faithful summary of Armstrong's account of the symptoms of venous congestion, as manifested at particular periods of its existence. It is drawn from life, and is not only applicable to the disease in its local forms, but is often witnessed when venous congestions are complicated with idio- pathic fever. Thus : — " When congestion takes place in the liver and its associated veins, it is indi- cated by a sensé of weight, distension or pain in the hypochondriac région ; by a short, irregular, anxious, but not difficult respiration ; by nausea or vomiting of a colourless or bilious matter ; by diarrhœa, the stools watery or sanguine. ous ; sometimes there is constipation, the motions when elicited being light. coloured." " The symptoms vary in proportion to the degree of venous congestion. In its extrême form, there is a deadly coldness over the whole surface, a small indis- tinct puise, a weak respiration, complète prostration of strength and of sensi- bility, and a gênerai oppression in the functions of the parts implicated. (Vol. I. p. 201.) In an intermediate form, the animal heat is only sensibly diminished at the extremities ; the puise is slow, heavy and oppressed ; the respiration anxious and laborious ; the muscular power weakened, but not prostrate, and the functions generally less disturbed. In the milder form, there is merely a sensé of languor and lassitude ; the patient is fatigued by exertion, complains of a sensation of chilliness, of a weight and uneasiness about the head and prœ- cordia : the puise is languid, and the countenance pale and dejected. Thèse différent modifications dépend on diffèrent degrees of the same pathological con- dition, which is proved to exist by the concurring testimony of symptoms, of ed this principle. It may be thought that his exposition is sometimes fanciful, espe- cially in his Book Ist. de Diœta. But is it more so than some récent doctrines which we have examined in our essay upon that subject ? The following are examples of his clear method of reasoning : " Q.uisquis de his, quae in somnis obveniunt, recte conjectat, is magnam habere vim ad omnia ipsa reperiet. Anima enim vigilat, et quum quidem corpori inservit, in multas partes distributa, non sui juris est, sed partem aliquam singulis corporis par- tibus, sive sensibus distribuit, auditui, visui, tactui, gressui, actioni, ac omni corporis facultati. Ipsa autem animœ cogitatio sui juris non est. Q,uum antem corpus qui- escit, anima in motu est, et corporis partes perreptans, domum suam gubernat, et omnes corporis actiones ipsa perficit. Nam corpus dormiens non sentit ; ipsa vero vigilans cognoscit, ac visibilia videt, et audibilia audit, vadit, tangit, tristatur, ani- madvertit. In summa quaecumque corporis, aut animée munia, ea omnia anima ipsa in somno obit. (Quicumque igitur hœc recte judicare novit, magnam sapientia partem novit." (a) " Semper autem anima et majora, et minora habens, suas ipsius partes circumam- bulat non oppositione, neque detractione partium indigens, verum augmento et decre- mento earum, quae jam sunt, opus habens." (b) "Consistere autem possunt inter se et sœmella, et masculus, propterea quod anima quidem idem est in omnibus animatis. Corpus autem uniuscujusque differt. Mma quidem igitur semper similis et in majore, et in minore. Non enim alteratur nequeper naturam, neque per necessitatem." (c) (a) De Insomniis, v. 1 —12. (b) De Diaeta, 1. 1, v. 116—118. («) Ibid. v. 319 — 324. philosophy of venous congestion. 285 the effect of remédies, and by an appeal to morbid anatomy. The appearances, on examination after death, are simple and conclusive ; for more or less distinct traces of congestion are observable in those parts which are the most intimately connected tcith the fullest development of the venous system; and it is generally found attended by effusions of mucus, serum, or qf blood; but without those con- comitant effects which dénote the existence of inflammation. In many cases, however, the traces of congestion after death are not observable, from the blood retiring from the capillaries into the larger vessels, as occurs often in cases of common inflammation, (see Sec. 7 and 9;) and this may be expected in propor- tion to the degree and duration of the congestion." Ç) Who has not witnessed this array of phenomena where he has seen nothing in other respects analogous to idiopathic fever? Who has not imagined obstructed circulation in some particular organ, or vitiated sécrétions, (p. 221,) or a mysterious sinking of life, as the pathological condition? But, can it be entertained that a mère local "obstruction to the circulation" will produce such appalling phenomena as are often witnessed in venous con- gestions? We have shown you that it will not. (P. 253 — 255.) When, however, we come to speak of the symptoms of undoubted venous inflammation, the paradox will vanish. (See Sec. 9.) Nor can we so well advance the knowledge of this intricate subject, as by quoting, from Dr. Armstrong, his no less accurate account of the symptoms of typhus fever when complicated with venous congestions :— " The attacks of the most dangerous forms of the congestive typhus are gen- erally sudden, and marked by many remarkable symptoms :—an overpowering lassitude; feebleness of the lower limbs; deep pain, giddiness, or sensé of weight in the encephalon ; a dingy pallidness of the face ; anxious breathing ; damp, relaxed, or dry withered skin ; and those peculiar conditions of the tem- pérature which have been noticed above. The puise is low, struggling, and variable ; the stomach irritable ; frequently there is an inability from the first to hold up the head; and the mind is more often affected with dulness, appré- hension, or confusion, than with delirium. The whole appearance of the sick impresses the attentive practitioner with the idea that the system in gênerai, and the brain in particular, are oppressed by some extraordinary load Both the manner and look of the patients undergo early and great altérations Sometimes they slowly drawl out their words, or utter them in a hasty and yet .mperfect mode, like people who slightly stammer, when embarrassed • they not unfrequcntly seem as if stunned by a blow, half drunk, or lost in a rêverie • at times have the bewildered aspect of persons suffering under the first shock of an overwhelming misfortune. The eye is occasionally glary and vacant, without rednes.s; but at other times it is heavy, watery, and streaked with blood, as if from intoxication, or want of sleep. At the commencement, the .(lloBl°mMem0" °f the LifC and MediCaI °pinion3 of Dn Armstron& vol. i. 286 philosophy of venous congestion. puise is often less altered, as to frequency, than might reasonably be expected ; yet, in gênerai it. becomes very rapid towards the close. The tongue is usually little altered in the first stage, but, in the last, frequently rough, fou], and brown. The bowels are mostly very torpid in the beginning, and the stools procured, dark and scanty ; whereas, in the advanced stage, the bowels are gen. erally loose, and the stools copious and involuntary," &c. Then follows a cir- cumstantial and very accurate account of the various characteristic symptoms which are apt to spring up in this affection. (') Dr. Armstrong is so accurate and copious beyond any other writer in all that relates to the symptoms of venous congestion, that we shall quote some of his gênerai remarks from his last work upon this important subject. " The gênerai symptoms" of venous congestion, especially when complicated with idiopathic fever, are,— " Ist. More or less réduction of the heat of the skin. 2d. More or less pros- tration of strength. 3d. Diminution or oppression of the heart's action. 4th, More or less lassitude or torpor. 5th. Disturbance in the functions of some important organs." And as to " particular symptoms :" " Suppose the brain and its appendages to be the seat of venous congestion, there are four symptoms of such a condition on which you mayrely : Ist Con- fusion ; indifférence or insensibility to surrounding objects ; or giddiness, with pain. 2d. An intoxicated, a stunned, or an alarmed expression. 3d. A blanched state of the conjunctiva, with a watery appearance of the eye. 4th. Either a dilatation or a contraction of the pupil." The third of the foregoing conditions is only applicable to the early stages of the disease. The eyes often become injected quite early, especially in congestive fevers of much severity; or in uncombined cérébral congestions, as constantly witnessed in children. The fourth condition is not generally remarkable till some time after a full development of the disease, unless in apo- plectic affections ; and then other causes are concerned. (Vol. I. p. 342, &c.) "If the spinal cord and its membranes be the seat of venous congestion, you have the following symptoms : Ist. General convulsions or partial spasms. 2d. Wandering pains, or tenderness of the surface of the body." This is all very true ; but the first of thèse conditions is far more frequently witnessed as the effect of cérébral congestion, when the spinal cord may offer no mark ofthe disease ; of which we have constant examples in the cérébral congestions of chil- dren, and in " adynamic " fevers. " Suppose the liver and its associate vessels to be the seat of the congestion, what are the symptoms î Ist. Nausea, retching, or vomiting. 2d. Fulness, (1) On Typhus Fever, Sec. 3, p. 49, &c. philosophy of venous congestion. 287 with flatulence in the epigastric région.' 3d. Some uneasy sensé of load, tight- ness, fulness, or pain, in the région of the liver. 4th. Diarrhœa, or consti- pation. The tongue is most frequently moist, and covered with a ropy saliva, under all the forms of common congestive fever." «It usually happens, in common congestive fever, that one part is most affected ; but sometimes différent parts are simultaneously congested, and this will be known by the combination of the symptoms which I have mentioned above." O The last statement can only be received in a gênerai sensé. Some of the symptoms may be wholly absent where they are supposed to dénote the locality of the congestion, especially the first. The tongue, also, generally becomes more or less dry, and coyered with a variable coating, whilst there is no common inflammation. The condition of the tongue as stated by Arm- strong, however, is especially applicable where venous congestions are not complicated with idiopathic fever ; and it appears to us that he has so represented this symptom from having confounded local venous congestions, and turgescence of the veins from me- chanical causes, with congestive fever. (P. 231 — 243, 262, 273.) In all the foregoing account of the symptoms, and in the facility with which venous congestions may be recognised in this or in that organ by the local symptoms alone, who does not see the imposing contrast betwixt thèse affections and the resuit of liga- tures upon the veins, as we stated them in our second section ? We might cite other able observers to the foregoing effect ; and had we space to go more extensively into their analysis of the symptoms which appertain especially to the congested organs, and this, too, whether the disease be local or complicated, it ap- pears to us the mechanical doctrine should surrender upon this ground alone. Annesley, and Robert Jackson, have very graphie accounts of the congestive fevers of the East and West Indies. They trace their progress with systematic analysis from the in- cipient stages, where local venous congestions are often antécé- dent to the gênerai explosion, through their various intricacies down to the fatal catastrophe ; and, although the symptoms of local inflammation be strongly pronounced, venous congestion, and effusions of serum, or blood, are apt to be the only morbid appearances. Mr. Annesley, who distinguishes venous conges- tion of the liver with great accuracy, remarks that,— " With respect to pain, oppression, weight, and aching about the région of the liver, the epigastrium, and under the shoulder-blades, although also charac- (1) Lectures on Acute and Chronic Diseases, vol. i. p. 160—164. 288 philosophy of venous congestion. terizing inflammation of the substance of the liver, we tliink that they ai fre. quently mark congestion of the organ, particularly when they supervene sud. denly." Ç) So, also, Dr. Hope : — "Congestion ofthe liver occasions symptoms very similar to those of chronic hepatitis, except that they are less obstinate." (a) Professor Alison, in his entire chapter on "local congestion of blood," makes no distinction between the phenomena of venous and arterial plethora. (s) Sydenham and Gallup are excellent on congestion. (P. 231, note.) It is in venous congestions ofthe brain that the most unequivo- cal phenomena are presented. Hère we generally meet with the vital signs of inflammation, though often more subdued, whilst morbid anatomy may disclose only a turgescence of the veins. Dr. Mackintosh states the expérience of the best observers : " It is a nice matter to discriminate between a case of purely venous congestion of the brain and one of inflammation." (4) Dr. Arm- strong is copious upon the subject ; and where only venous con- gestions were discovered in the brain, the vital signs had been those of strongly marked cérébral inflammation. Our modem clinics are full of examples ; whilst, it is within the expérience of all, that cérébral diseases have been regarded and treated as strictly inflammatory, where dissections have disclosed nothing but a preternatural fulness of the veins, accompanied frequently with effusions of blood, or bloody serum, or serum per se. Mal- colmson, in speaking of the inflammatory symptoms of béribéri, remarks that, " when no decided inflammation could be detected, distension ofthe veins and ecchymosed spots have been observed on différent parts of the intestine and stomach." (*) We shall adduce a great variety of illustrations, where the character ofthe symptoms is modified according to the nature ofthe remotecauses. The symptoms of venous congestion will constantly vary in their intensity according to the severity of the disease, the na- ture ofthe affected organ, constitutional influences, and especially according to the nature of the remote causes. Différent varieties of miasmata, and spécifie poisons appear to induce, each one, certain peculiarities, depending probably as well upon their gen- (1) On Diseases of India, &c, vol. i. p. 348. (2) Principles and Illustrations of Morbid Anatomy, &c. p. 133. (3) Outlines of Physiology and Pathology, c. 5. (4) Eléments of Pathology and Practice of Physic, vol. ii. p. 28. (5) Essay on Béribéri, p. 222. philosophy of venous congestion. 289 eral influence upon an organ or the system at large, as upon their spécifie impression upon the venous tissue. Age is also an élé- ment, and in tropical climates the symptoms are more prominent than in the temperate. In the latter régions, they are rarely so strongly pronounced as the symptoms of acute inflammation, though often as much so as is generally characteristic of chro- nic, or of sub-acute inflammation. (Sec. 9.) The symptoms are greater in proportion to the rapidity with which the congestion takes place, and.vice versa, as in inflammations. When the ac- cess is slow the disease is exceedingly insidious, and perhaps a fatal extent of it, unattended by any constitutional malady, may exist before the subject is admonished of its présence. We have seen patients affected in this manner pursuing their ordinary avocations, and have the records before us. (P. 219.) There are other causes which contribute to modify the symptoms of ve- nous congestion in their relation to inflammation, that will be noticed hereafter. A fundamental one is the constitution of the venous tissue itself. Will it be said that any soreness and pain, that may be prés- ent, arise from the distension of the vessels? This is refuted by our objections to the mechanical doctrine, and would also ap- pear improbable from the entire absence of those symptoms, in the great accumulations of blood where pressure opérâtes on the principal trunks ofthe veins, as in cases of ligature to the jugular veins, &c. Nor do we suppose that the local symptoms ofvenous congestion appertain exclusively to the affected veins, but, as in inflammation, the irritation is propagated to the entire paren- chyma of an organ. Simple distension of vessels is not a cause of pain. Pain, however, is often entirely wanting in venous con- gestions of some organs. It is commonly attendant upon the brain. But its absence has its fréquent parallel in chronic in- flammations, and even in those of an active nature. " It is a fatal error in practice," says Dr. Armstrong, « to suppose that viscé- ral inflammations are always denoted by excessive pain and other striking Bigns." " The most destructive inflammation in typhus fever may go on in the brain and bowels without pain." Q) When this happens, Dr. Armstrong ascribes it to an imper- Ci) On Typhus Fcvcr, p. 150, &c. So, also, Huxham, (a) Johnstone, (b) and others; and Fothergill (e) affirma the same of angina maligna, —a fact well known lo all. (a) On FeYen, p. 281. — (b) Epidémie of Kidderminsler. — (c) Essay on, Sec. p. 47. vol. n. 37 290 philosophy of venous congestion. feet oxygénation of the blood, which then opérâtes as a nar- cotic.^) This is precisely what often happens in venous conges- tions. But we think that we shall have assigned other grounds for the phenomenon. We may now say, however, that pain is fre- quently wanting in pneumonia, and other common inflamma- tions, and especially so in phlebitis, and that it is the tendency of venous inflammation to render the system obtuse, not only in its sensibility, but in all the organic powers. It is for this reason that pneumonia supervening on typhus fever, or on delirium tre- mens, is often so indistinctly marked as to be wholly overlook- ed by tolerable practitioners. Nevertheless, characteristic local symptoms usually attend those affections, (and even the cérébral congestion which is induced by carbonic acid gas,) (2) but may not engage the attention of the patient himself. It is the opinion of Mr. Douglass, that the viscéral veins are more frequently the seat of inflammation than is commonly sup- posed. He has seen three cases in which the liver was concerned. In thèse, however, the inflammation was entirely more active than in ordinary congestion. (3) M. Andral, (4) and Dr. Dickeson^5) and others, relate similar affections of the liver. The origin of thèse cases was obscure. M. Ribes believes that hepatic phlebi- tis is produced sympathetically by disease of the intestinal mu- cous membrane ; and certainly we have ample proof that hepatic and cérébral congestions spring up in the same manner. We think, too, that this is not unfrequently true of jaundice. The liver may be often primarily affected, but as often sympathetical- ly. (P. 279.) Dissections show a congested state of the hepatic veins, (6) and " In many cases," says Dr. Stokes, "the intestinal mucous membrane has been so highiy engorged so to be almost black." (7) (1) Lectures, &c. vol. ii. p. 148. This opinion was suggested by Hunter, (a) and Bichat, (b) who call the venous blood a "sédative." William» appears to adopt the ïame view ; (c) and we have seen it, in our Humoral Pathology, the foundation of important théories. (See our vol. i. pp. 279— 280, 420.) (2) See Bichat's Physiol. Researches, p. 249. Rech. sur la Vie, kc. pp. 377,454. (3) On Phlebitis, &c. (4) Clinique Méd. t. ii. p. 307, &c. (5) Med. Chir. Rev. vol. xxxi. p. 273. (6) See Bright on Jaundice, in Guy's Hospital Reports, vol. i. p. 604. (7) Theory and Practice of Medicine, p. 108. (o) On tbe Blood, &c. p. 54, &c. (4) Rech. sur la Vie, *c. c. 6, p. 327 — 353 ; c. 6, p. 411. (c) Lectures on Diseases of the Chest, lec. 9. p. 85. philosophy of venous congestion. 291 Among the direct évidences of inflammatory action in simple venous congestions is a very fréquent bufnng and cupping of the blood, and this, too, where the action of the heart may be preternaturally slow, or the circulation prostrated. We are sen- sible that this has been denied by Armstrong. So it is said by Dr. Wardrop, in a systematic Essay on Bloodletting, that, « There is usually no appearance of the buffy coat in blood removed from persons affected with violent inflammations until the latter stage of the disease, and at the very period when the further abstraction of blood would be perni- cious." (') But in the instances to which Armstrong refers, the venous congestions have been complicated with idiopathic fever ; a con- dition of disease which, it is well known, may greatly modify the character of the blood. Much also dépends on the manner in which the blood is drawn. If it trickle from the arm, as is often the case in venous congestions, and especially in con- gestive fever, or the orifice be small, or the blood be received into a bowl, the inflammatory characteristics may be generally wanting, as they often are under such circumstances in com- mon inflammations. But we have commonly remarked, in sim- ple venous congestions, and in congestive fevers, that when the blood is received in a large stream into a wine-glass, as has been generally our custom, it has presented the foregoing appear- ances ; whilst they have been often wanting, especially the cup- ping, in the larger vessel. Most practitioners, however, are fa- miliar with the accuracy of our statement in certain instances of a purely congestive nature, as in purpura hemorrhagica, and " in apoplectic -affections. Lind, (2) Trotter, (3) Rouppe, (4) often found the blood buffed and cupped in the worst cases of scurvy, and this, too, according to Lind, near its fatal termination. Hamilton, (') Malcolmson, (6) Christie, (7) and others, affirm the same of béribéri. (See Sec. 7.) Thèse affections are especially distinguished by venous congestions. Even when typhus is attended by petechise, "we learn from expérience," says Mills, " that the blood is commonly observed hère, as in other inflam- matory disorders, cupped, buffed, and tenacious." (8) In our (1) On Bloodletting, p. 41. (2) On Scurvy, p. 512, &c. (3) Obs. on the Scurvy, p. 75. &c. (4) De Morb. Navigantium, 1. 2. c. 2. (5) Eden. Med. Chir. Trans. vol. ii. p. 22, kc. (6) On Béribéri, p. 128. (7) Hunter on Diseases of Lascars, passim. (S) On the Utility of Bloodletting in Fevers, p. 6. 292 philosophy of venous congestion. Essay on the Humoral Pathology, (p. 453-460,) we have <\nm,d other observers to the same effect in respect to "putrid," and "adynamic" fevers. A very accurate observer states, as the re- suit of his expérience, "that the blood in adynamic fevers pre- sents frequently, we might say generally, an inflamed surface." (') Dr. Rush, after having bled four times in a case of "inalignant fever," the weight of congestion was still so oppressive that the patient's " Hands and feet were cold, and her countenance ghastly, as if she were in the last moments of life. She was then bled again, and her puise rose. At the end of 3, 10, and 17 hours it fell, and rose again by three successive bleedings, The blood was always sizy. The puise afterwards acquired such a degree of vigour as to render 7 more bleedings necessary to subdue it." (J) (Vol. I. pp. 224, 231.) So also Southwood Smith,—the buff appearing especially after the circulation has been restored by the loss of blood. (Vol. I. p. 453 — 455.)(3) If there be an absence of buff during the depressed state ofthe circulation, in simple venous congestions, it is probably owing in part to the imperfect manner in which the blood flows from the orifice, as also to the modifying influence ofthe embar- rassed and contracted capillaries and the oppressed condition of the heart; whilst, as we have said, when congestion is associated with constitutional fever, the state of the blood is more or less modified by the latter affection. (Vol. I. pp. 195__196, 405— (1) Med. Chir. Rev. of Burnie on Adynamic Fever. (2) Med. Inquiries and Observations, vol. iv. p. 298. — Rush then comments on the fatal practice of attemptmg to raise a puise by stimulants that had been depressed by bleeding » in mahgnant fever.» They may be necessary, where great dépression occurs. We add a case from Sydenham precisely parallel with the fore-oina, not only to confirm the principles involved, but to show how genius, directed by an observation of nature travels a common road. We give it in the language of Southwood Smith. « Having descnbed,» says Smith, «in his own powerful manner, an excellent speci- men of congestive fever to wh.ch he was called, he states thatTre ordered the patient tobebled; that the bystanders regarded the suggestion with borror ; (Vol. i p. 292 ) that the man seemed at the point of death; that to them it àppeared that the ab- strachon ofblood must inev.tablyextinguish the last remaining spark oflife; whilst to h,m it was manifes that he patient was oppressed by an overwhelming load that demanded the abstracfon of blood. Aecordingly on the removal of some ounces, the state ot oppression ceased atonce and » c»»„ „„„ c . ■ „ r .i \a i e u- i. er arose of a true inflammatory na- ture, for the subdual of wh.ch repeated bleedings were required »- Ut ait Put this and Rush's case together and what becomes of the parallel " drawn by (Seefollo^ n,,) As t t e ultima^^ 9?3)WOn FeverTp. %" 7 Ven°US C°nge8ti°n P""8 int° -nammation" % philosophy of venous congestion. 293 407.) This, however, is not common in either case ; the blood being generally more or less buffed and cupped from the begin- ning, if abstracted in the manner we have suggested. On the other hand, the buff never appears in those simple déterminations of blood upon the right cavities of the heart, which arise solely from idiopathic fever, from the shock of a fail, or of other inju- ries, and where no local congestions exist of the nature we are considering. (P. 234.) (») ' But the buff may be absent in some fevers when attended by disorganizing inflammation, as in typhus and yellow fevers. In some of thèse instances, the blood will be so influenced by the action of the capillary vessels at large, that it will not even co- agulate ; and this very phenomenon has been assumed as a ground for the humoral pathology. But it also happens, in cases of congestive fever, where the blood had been "dissolved," that it afterwards became sizy, as stated by Rush, (2) Mackintosh,.(3) ) Dr. Mackintosh detected the nature of the lésions of the veins, and traced. them into the large vessels of différent organs ; though, in this respect, however uninteresting to the public, we must claim an originality to avoid the necessity of admitting that our views were not original. But, we are less interested in ascertaining the pathology of the malignant choiera, than in presenting a chain of analogical facts, which shall indicate the true pathology of venous conges- tion. If the venous turgescence in choiera dépend upon inflam- mation of the veins, it is an unavoidable conclusion, in the ab- sence of other apparent causes, that the same pathological state occurs whenever this phenomenon is manifested as a mor- bid condition. But, similar facts will multiply upon us, not only as it respects the congestions of the organic viscera, but those of animal life. As to choiera, there are two circumstances that are remarkably worthy of observation, and should not be forgotten in our subséquent inquiry. We mean the great rapid- ity with which disorganization takes place in the veins of choh era subjects, and the absence of all local symptoms that would imply the existence of such destructive inflammation of the ve- nous tissue. And putting aside our own pathological researches, to which we are now as indiffèrent as we were once anxious for their fate, the observations of Dr. Mackintosh, in a pure example of venous congestion, illustrate not only the rapidity with which low inflammation may disorganize the venous tissue, but exem- plifies its remarkable disposition to extend over the entire venous system of an organ. (Vol. I. p. 488.) The remaining facts of a direct nature, which dissections have disclosed, are the discoveries made by Dr. Cartwright in " malignant fever," by Dr. Hanney in purpura hemorrhagica, by M. M. Ribes and Breschet in typhus fever, and M. Rigaud in the plague. Some of thèse will be noticed when we speak more particularly of those affections. There is, however, scattered through many learned works a great amount of incidental proof that the veins often undergo great disorganization in their con- gestive affections. Thus, Dr. R. Jackson remarks that in some cérébral congestions of the West Indies — (1) Lectures on Acute and Chronic Diseases, vol. i. p. 164.— We generally un the American édition of 1837, and sometimes the original one of 1834. PHILOSOPHY OF VENOUS CONGESTION. 311 " The vessels are so much distended that, losing contractility, they appear gorged, so as to exhibit an appearance of gangrené at various points." Again »the choroid plexus is usually a clotted mass, in which the traces of organiza- tion are scarcely to be discerned." (') And thus, our able Cartwright, who is one of the few that has noticed the state ofthe venous tissue in congestive fevers: — "The portai veins, in every instance, were much engorged with dissolved blood." "The cellular substance investing the vena portae, and the délicate tissue surrounding the hepatic veins, were always more or less inflamed." " In most cases the liver was somewhat enlarged, and generally of a greenish co- lour. In two cases it was black." (') Thèse were the most uniform appearances. Dr. C. does not appear to have examined the inner tunic of the veins. Where mephitic gases operate with violence, but the sub- jects survive for some days, we find the pulmonary venous Sys- tem engorged, and "reduced to a dark brown, greenish, or livid softening." (3) The foregoing examples will readily call to the mind of the reader a multitude of similar records. How con- stantly, also, are other tissues of organs softened or broken down where venous congestion has existed. This cannot be the ef- fect of a passive or mechanical accumulation of blood. The changes in this respect are frequently more remarkable than from common inflammation. Dr. Jackson, in speaking of con- gestive fever in certain tempéraments, says that " the liver was often enlarged, distended with black blood, and its substance rotten — often lacerated." (*) The scurvy affords numerous ex- amples of a like nature. In the intermittent fever, Senac often found the liver " turgid with blood, and that very black." " In others, the vena portae was converted into a very large tube." (5) " That excellent anatomist, Dr. Macartney," says Cooke, " found that the morbid appearances in typhus fever were not those of common viscéral inflam- mation." Wherever they occurred, " according as the head, lungs, abdominal viscera, were engaged in the disease," they were those of venous congestion. " In some instances there was a mère pulpy, or swollen, and dissolved state of the mucous coat of the alimentary canal. Thèse congestions were always~of a purple or venous colour," (") &c. "In fevers of a low, nervous, and malignant type," says another, "the mu- cous membrane of the intestines, and chiefly of the colon, is sometimes found of a uniform dark-red colour, turgid and soft, in conséquence of an intense venous (\) Hist. and Cure of Fébrile Diseases, vol ii. pp. 78, 89, 136, 146. (2) American Médical Recorder, vol. ix. p. 40, 1826. (3) Williami, ou Diseases ofthe Chest, lec. 19. (4) Ut cit. vol. i. p. 89. (5) On Fevers, p." 154. (6) Cooke's Morgagni, vol. ii. p. 522, note ; where there is a condensed view ofthe facts. 312 PHILOSOPHY OF VENOUS CONGESTION. injection of a passive character, the black pitchy sécrétions of the membrane, resembling decomposed venous blood." (•) " I have examined," says Cleghorn, " the bodies of near a hundred persons, who perished with malignant forms of intermittent fever, and constantly found the cawl, mesentery, colon, &c. of a dark, black complexion." (a) Chirac states that he constantly found the veins of the liver, and those of the brain distended with grumous blood in the épi- démie fevers which he describes. (3) Nearly all authors agrée in stating that, in yellow fever, the liver is almost always large and gorged with blood. This, and the analogous gastric affec- tion, are the most remarkable lésions. It was found by Jackson, in the severe forms of congestive and yellow fever, when the disease " Was not opposed, or but feebly opposed by art," and as " drawn from a large field," "the blood-vessels which are spread over the membranes of the brain were generally numerous and turgid, often distended as if they had been artifi- cially injected. Lungs generally natural. Veins of omentum, stomach, and appendages, distended as if injected." " On the interior of the stomach, the veins were generally turgid." " Liver generally enlarged, and its vessels filled with dark fluid blood." "Spleen distended, gorged with blood." The same appearances, though to a greater extent, in the " concentrated fever of the West Indies." (*) In the " genuine yellow fever of authors," says Craigie, with many authori- ties before him, "in gênerai the blood-vessels (veins) ofthe cérébral membranes are numerous, distended, and filled with a dark-coloured blood." " The choroid plexus is often quite like a clôt of blood." " It resembles a clôt of black blood, more than an organized part." " The vessels of the stomach.are generally much distended with dark-coloured blood, the mucous coat abraded, loose," &c. So of the intestinal tube. " Liver distended, heavy, and generally larger than usual, of a spotted and variegated colour, like marble ; the blood-vessels filled with dark fluid blood." " Spleen generally distended, sometimes ruptured." (') We have more of the foregoing sort of facts from Dr. Craigie, in our examination of his objections to venous congestion. (Ap- pendix I.) But what is especially interesting to remark in this account of yellow fever is the statement that " the lungs never présent morbid changes unless accidentally in the open, violent, and simple tropical fever." This fact has an important bearing upon the doctrine of rémora. We should say, however, that it is unimportant to us whether the foregoing lésions are modified by climate. We regard them as imparting only a malignancy to yellow fever, the fever itself being a constitutional and inde- (1) Cyclopaedia of Prac. Med. Lon. Art. Inflam. p. 730. (2) On the Epidem. Diseases of Minorca, c. 3, p. 104. (3) Trait, de Fièv. Malig. et Pest. &c. (4) Op. cit. pp. 77, 78, 81, 82, 89, 94. (5) Practice of Physic, pp. 203, 211. PHILOSOPHY OF VENOUS CONGESTION. 313 pendent malady from the onset. Indeed, if we allow the cases described by M. Louis, as observed by him at Gibraltar in 1828, to have been yellow fever, which we are scarcely inclined to do the question would be settled against him as to the supposed de- pendence of this fever on any particular local affection. In respect to the plague, Rigaud observes of 68 dissections, that " the arteries are almost always empty." Q) « The veins, on the contrary, are distended and full of black clotty blood ; and while the inn6r coat of the arteries has presented no altération, that ofthe veins has been found spotted largely and irregularly, as if with ink." (*) Since the foregoing was written, it appears that Dr. Bulard has communicated to the Brit. and Foreign Med. Rev. (Oct. 1839, p. 350,) the results of his anatomical investigations of the plague during a résidence of six years in Turkey and Egypt ; as fol- lows : — "Sinuses of the dura mater and meningeal vessels generally very full of blood ; membranes themselves normal. Stomach frequently loaded with black- ish fluid ; internai surface marked with petechiœ. Liver loaded with black blood. Spleen treble or quadruple its normal size, loaded with black blood. Kid- neys twice or thrice their natural size, loaded with dark coloured blood, with an appearance of rénal hemorrhage in the pelvis. Pancréas natural." Mr. Boyle states, that in the épidémie fever of Sicily, the liver was morbidly large, softer than natural, and the entire system of the vena portae always crowded with blood. He regarded this as an essential feature of the disease. (3) From Dr. Mouat we learn the important fact of his having witnessed, in India, several cases of hepatic disease, in which there was a discharge of pus from the bladder, and other remote parts. In thèse cases, dissec- tion disclosed the existence of abscesses in the liver. The other effusions were " secondary," and clearly depended on venous in- flammation. (4) M. Malliat (5) found the brain the seat of congestion in most of the cases of the Bona fever, and concludes, therefore, that intermittents are constituted by lésions of the nervous system. But this induction is a fruit of exclusive anatomy. The intes- (1) This statement is made by others in relation to other fevers where venous congestions prevail. It is important as showing that it is not the tendency of " dark coloured blood to obstruct the capillaries," nor does it countenance the opinion of Dr. Craigie, that there is a stasis of blood in the capillaries during the hot stage of fever, &c. (P. 209.) The " clotty blood " should go with our facts, vol. i. p. 451 — 459, 668, &c. (2) Lon Med. Gaz. vol. xvi. p. 518. (3) Edin. Jour. vol. viii. p. 184, &c. (4) Calcutta Gluarterly Med. Jour. July, 1837. (5) Trait, des Fièvres, ou Irritation Cerebro-Spinalislntermit. en Afrique, &c. VOL. II. 40 314 PHILOSOPHY OF VENOUS CONGESTION. tinal canal was affected in 1000 or about half the cases. His dissections supply abundant proof of the connection of a modi- fied condition of the venous system of différent organs with the constitutional affection. In béribéri, " the liver is invariably described as being uncommonly large and very dark coloured. Mr. Marshall states that in his case, on removing it from the body, a great quantity, of dark coloured blood flowed from the large vessels, and that it then became ceduced in size, and natural in colour. The whole substance of this viscus is commonly gorged with blood." (') So also Mr. Hamilton, who regards its pathology as arising, " in a great measure, from obstructed circulation in the internai parts, more particularly the liver and lungs ;" and that it is not a disease of debility, as supposed by Colquhoun, Jdtun- ter, Chrietie, and others, "but a disease, in the treatment of which, venesection ' may be used with the greatest prospect of success." (2) Mr. H. was led to the use of bloodletting by the venous con- gestions ; and, on applying the remedy, he found the blood buffed. If the " obstructed circulation was the conséquence of conges- tion," (which appear to be the same thing in our author's sensé,) what occasioned the congestion ? Mr. H. says, a damp atmos- phère principally. This condition of the veins having been re- garded only as an accidentai circumstance, the pathology of béribéri has been a mystery ; at least, an important part of it. Mr. Malcolmson sustains our conclusion by his account ofthe symptoms, and predisposing causes ; but he was intent on spinal irritation, although there appears to have been but very few ana- tomical facts relatingto the medulla spinalis. (See Appendix I.) As to the liver he says : — " Few organs suffered more frequently, although there are seldom any severc symptoms. The most usual are a yellow eye, sallow complexion, and fœces of nrach discoloured bile, usually in too great abundance, but occasionally the stools are nearly white." " The liver is sometimes altered in its structure." " The disease is sometimes fatal in a few hours, but is often chronic, and in thèse the patient is liable to sudden death, to rapid aggravation of symp- toms, or supervention of new and more formidable ones, by which he is soon carried off; (3) and if be survive them, he may live a long time bedridden, dropsical, aud a true paralytic." » Other chronic disorders are apt to end in symptoms analogous to some varieties of béribéri ;" the symptoms of the latter being quite various, and drawn by our author in a graphie style. "New corners are most liable to it," and it prevails mostly on the coast, in the vicinity of rice fields, low swampy grounds, rich alluvial soil, and is promoted by a damp air. He constantly refers to analogies with European diseases of a (1) Cyçlopaedia of Prac. Med. Lon. Art. Béribéri. (2) Edin. Med. Chir. Trans. vol. ii. (3) See our Essay on Bloodletting, vol. i. p. 199. philosophy of venous congestion. 315 congestive character, — manifesting all their varieties. (') Mr. Howard, (*) and others, are also of the opinion, that béribéri " does not appear to possess any other striking peculiarity but the extrême fatality which attends it." All agrée that the powers of life are greatly prostrated in the acute forms. (P. 219.) The most judicious, like Hamilton, Scott, Marshall, Malcolmson, Stevenson, Macdonell, Paterson, Christie, &.c, employ bloodletting, — Marshall, very extensively. Wright, Horklots, and Campbell, are opposed to it on the ground of debility. (P. 261.) Paterson bleeds in the beginning, but "does not consider the disease at all inflammatory." (3) There is little doubt that the congestive affection in this disease, (which, modified in a peculiar manner by the remote causes, imparts its character- istic phenomena,) is often complicated with idiopathic fever. Malcolmson believes it generally local, but frequently connected with a gênerai fever. (4) (See Appendix I.) It is well' known that M. Ribes discovered an inflammatory state of the congestive veins in typhus fever, &c. " I am led," he say6, " to conclude that the veins, the venous blood, and the cellular tissue, are primarily affected in adynamic fevers, in scurvy, and in the plague." (s) His facts, though brief, are very important in establishing in- flammation in the congested veins ; but we neither assent to the humoral philosophy, nor to the doctrine of the locality of fever. M. Breschet, when speaking of the constitutional effects of phlebitis, states that he found évident marks of inflammation in the cérébral veins of subjects who had died of typhus fever. (8) M. Bouillaud entertains the same opinion ; and M.. Andral recites a case which he thinks opérâtes in favour of the doctrine. (7) In our 12th Section we shall introduce a variety of examples of venous congestion as produced by différent spécifie poisons ; where, also, the nature of the congestion appears to be more or less modified, as in inflammations of other tissues, according to (1) Prac. Essay on the Hist. and Treat. of Béribéri, pp. 24, 28, 42, 43, 54, 55, 132, 222, 223, &c. 1835. (2) Report, &c. Sept. 29, 1824. (3) Report for 1822. (4) Ut. cit. p. 39. (5) Mém. de la Sociélè Méd. d'Emulation, t. 8, p. 628. (6) De l'Inflam. des Veines, ou de la Phlébite, in Jour. Complimentaire de Diction. dea Scien. Méd. t. 2, p. 325 ; t. 3, p. 317. (7) Clinique Méd. t 2, p. 306. In this case, which M. Andral dénommâtes une fièvre continue grave, and subsequently calls une véritable phlegmasie de la système veineuse abdominale, the inferior mesenteric vein, and the trunk of the vena portas and its hepatic ramifications were in a state of inflammation, but not of suppuration. Another similar case follows immediately. 316 philosophy of venous congestion. the peculiar properties of the remote causes. See, also, Appen- dix III. on cold. The foregoing facts are sufficiently familiar to the profession ; but it is important to connect with an essay of this nature their gênerai summary. We shall also presesnt, from time to time, many analogous illustrations of our subject. It is in diseases like the foregoing, where a constitutional affection becomes so generally complicated with a certain local condition ofthe blood- vessels, under all circumstances of climate, constitution, and treatment, that pathological anatomy manifests its highest value. Hère is something almost invariable, which seems inséparable from the gênerai effects of the morbific causes, at least in such cases as have not an immediately fatal termination. Nor is it to any lésion of structure to which we are now looking, but to another physical condition of an important system of blood- vessels, which no ingenuity can refer to physical causes. If you allège an accumulation of blood about the heart and lungs, and a conséquent rémora, we have shown you already, that this is im- possible, and that all other supposed mechanical obstructions are wholly imaginary. In respect to the localities of the congested veins, we find the greatest diversity, — according, probably, to the particular susceptibilities of one organ or another in différ- ent individuals. Much, too, will dépend upon the stage of the disease. In typhus, and bad forms of rémittent fever, if the subjects die early, the great seat of venous plethora is in the brain, or, perhaps, in rémittents, in the liver also. When disease progresses longer, the same state of the veins springs up in the other parts, either from a development of prédisposition induced by the primary causes, or from the gênerai influence ofthe fébrile action, or from a direct sympathy with the veins antecedently diseased. (Pp. 279, 290.) In our essay upon the comparative merits of the Hippocratic and anatomical schools, and in our examination of the writings of M. Louis, we have endeavoured to show the superiority of the vital signs in marking the true pathology of disease. In no affection is this more clearly demonstrated than in venous con- gestion, especially when those signs are taken in connection with such as resuit from the influence of remédiai agents. On the other hand, an incautious dependence upon morbid anatomy has led many distinguished observers into false inductions ; and PHILOSOPHY of venous congestion. 317 although we believe that the progress of inquiry will continue to develope new physical proofs of the inflammatory nature of venous congestions, yet shall we endeavour to show, (as well for other purposes connected with our investigations,) that such proofs are not necessary to establish this pathological condition. It has never, for instance, been shown that the présence of the red globules of the blood is necessary to inflammation. On the contrary, it is well known to be compatible with a low state of inflammation, where the organic blood-vessels are very minute, that no remarkable appearance of vascularity shall exist. Inap- préciable degrees of it may give rise to all the phenomena of the disease, and even resuit in serious lésions of the part. It may be constituted by the white vessels, alone, which are manifestly concerned in all morbid products, and are, doubtless, the essen- tial instruments by which the changes are produced. When the vital properties are altered, inflammation has begun. The afflux of the fluids will then dépend upon the peculiar modifi- cation of the forces, the nature ofthe tissue, &c. It may, there- fore, be red blood, or it may be white. The latter condition may resemble the other in all its characters but the colouring principle. We know not, however, what it is ; but we know the phenomena, and may reason upon them. " Physicans," says Bichat, " have not pa;d sufficient attention to the différence of inflammations according to the différence of Systems ;" (') and we may add, that the more important influence of remote causes, whether external or constitutional, in modifying the nature of inflammation, is too often overlooked. The foregoing facts are often evinced in the serous membranes, and in all those parts where the sanguineous vessels are least ob- vious in their natural state. In the tunica arachnoides, according to Cloquet, Beclard, Louis, Bichat, and others, red vessels have never been detected when the membrane has offered every other proof of an inflammatory affection. (2) The same principle is seen in mollescence or other degenerations ofthe brain, (3) and of the mucous membrane, where their dependence on inflammation (1) Gen. Anat. vol. iii. p. 46. (2) Duchalelet and Martinet, Hope, and S. Smith, say otherwise ; but the vascu- larity was probably in the pia mater. (3) "The brain," says Mr. Hunter, "appears to be an exception to thèse gênerai tules, (vascularity, kc.) ; for in all diseases of the brain, where the effects were such as are commonly the conséquence of inflammation, such as suppuration from acci- dents, I never could find the above appearances."— On the Blood, fycp. 283. 318 PHILOSOPHY OF VENOUS CONGESTION. is shown by their obvious connection with it in other instances.(') In many scirrhous affections there is great disorganization, whilst the natural volume of blood is greatly diminished. We may readily see how unimportant is " vascularity " by observing that in the ligaments the vessels do but carry the colourless parts of (I) It is well known that some distinguished physiologists, as Rudolphi, Gendrin, Chaussier, Ribes, deny the existence of vessels in the serous membranes, notwith- standing the phenomena of their inflammations, their lésions of structure, and their obvious function of sécrétion, which analogy refers to the vital process. True, all thèse results are referred to a contiguous part, though tbe membrane itself be the manifest seat of the phenomena ; whilst it is generally true that tbe diseases of the serous membranes affect the organs they envelope less than those of other mem- branes. Bichat says, " I have seen tbe arachnoid membrane, in a subject that had been af- fected with chronic inflammation, evidently tbickened on tbe internai surface of the dura mater, without this having experienced the slightest altération." (a) Foville wit- nessed a like instance, as did also Hodgkin, (b) who giveacircumstantial account of the appearance ofthe arachnoid, from the incipient stage ofthe disease. Hope(c) haï found it as thick as a wafer. Hodgkin found adhésions with the dura mater. "The lung of a panther, who died of Phthisis, presented M. Bazin with a hypertrophied condition ofthe pleura pulmonalis, which, in the healthy state of the animal, ia not thicker than in man." (d) So also these membranes are said not to possess nerves, because they eludeour ob- servation. But, is not the exquisite and characteristic pain in all parts, which often attends serous inflammations, a better proof than a mère négative fact which resta upon the fallacious testimony of sight ? •" When the white organs are inflamed, they receive an augmentation of life, a superabundance of sensibility," &c. (e) Bichat undoubtedly " demonstrated," what analogy would suggest, the absorbents ofthe serous membranes ; that "their origins, a thousand times intermixed with each other, and with the orifices ofthe exhalants, contribute especially tofonn the texture;" and that, "the difliculty of distinguishing the absorbent and exhalant pores is no rea- son for denying their existence." (f) Cruveilhier, and Mascagni, suppose that the serous tissues are made up of absorbent vessels. Nor is this all. " If we irritate a serous membrane," says Bichat, " at thé end of some time, it will be covered with an infinity of reddish streaks, so numerous as to change its whiteness into the red colour ofthe mucous surfaces. It may be made wholly black by fine injections;" &c. " In chronic and acute inflammations, the serous membranes exhibit a vascular net work so full of blood that the redness is often deeper than that of the muscles." " We see that the blood is evidently containcd in the capillaries ofthe membrane." (g) And so Hodgkin.(h) "The non-vascular appearance of the tendons, cartilage*, ligaments, &c. in the living body, is illusory." (t) Analogy left no doubt of it, and experiment has now confirmed it. These are cases in which we are called upon to give up our sensés to the understanding, — to reject any négative observations by the microscope, or any method which art may devise. We have added the foregoing note for a variety of purposes, which will be more or less obvious in the progress of inquiry. See Appendix V. on Tubercle. (o) Gen. Anat. vol. iii. p. 141.— fi) Morbid Anat. of Mucous and Serous Membranes, vol. i. pp. 69, 75, 87. —(c) Principles of Morbid Anat. p. 278. — (d) Brit. and For. Med. Rev. vol. v. p. 221. - (e) Bichat's Researches on Life and Death, p. 201. — (/) Gen. Anat. vol. i. p. 341 ; vol. iii. p. 350 - 351. —(g) Ibid. vol. ii. p. 7.— (A) Ut supra, pp. 28, 37— (i) Bichat, ibid. vol. ii. pp. 7,9, 61. PHILOSOPHY OF VENOUS CONGESTION. 319 the blood in the early stages of inflammation, which are as well characterized by physical signs as the latter. » It is a great mistake," says Bichat, " to try to represent inflammation as being every where the same, as exibiting always the fluids, like their ves- Bels, in the same state. Boerhaave, for example, thought there could be no inflammation without an error loci. There is according to the state of the parts, their structure, their vital properties, a thousand différent modifications in the new anatomical order that this affection gives to the organs." But, he agreed with Hunter, that " the principle is always the same, it is always the Bame disease." (l) « In chronic inflammation," says one of the physical school of inflammation, » there is but a very slight degree of pain, and seldom much heat or redness. Sometimes the local symptoms are so obscure as to be perceptible only to the Bcrutinizing eye of an experienced observer." (s) Let us hear Mr. Hunter to the same effect : — " That the degree of inflammation which becomes the cause of adhésions gives but little pain, is proved from the dissection of dead bodies ; for we sel- dom or never find a body in dissection which has not adhésions in some of the large cavities, and in parts which the friends of these persons never heard men- tioned, during life, as the subject of a single complaint. " That adhésions can he produced from very slight inflammation is proved, in ruptures, in conséquence of wearing a truss ; for we find the slight pressure of a truss exciting such action as to thicken parts, by which means the two sides of the sack are united, though there be hardly any sensation in the part We also see, in cases where this inflammation arises from violence, that it gives little or no pain." (3) M. Dupuytren considers the white gangrené, as he does, also, the gangrena senilis, an inflammatory affection of the arterial ca- pillaries ; and upon this principle he restored a patient, "par en- chantment" by abstracting blood from the arm. The hands and and feet were the seat of the affection. The fingers and feet were blanched, and of an icy coldness, wholly insensible, im- movable, and dry as parchment. (4) This "white gangrené" is also particularly noticed by Dr. Graves, and referred to inflam- matory action. During the inflammatory stage the part has the appearance of " white wax." " Again, in urticaria, we often see some portions of the inflamed skin assume a while colour, and the same occurrence may be noticed likewise in the wheals caused by nettles or the stings of bées." (6) (1) General Anat. &c. vol. ii. p. 61. (2) Lon. Cyclop.of Prac. Med. Art. Inflam. p. 756. (3) Hunter on the Blood, and Inflammation, p. 2S7. (4) Rev. Méd. and Trans. Méd. 1833. (5) Clinical Lectures; lec 8, p. 301. Dr. Craigie, [Prac. of Phys. p. 402,) and other late writers, ascribe dry gangrené to inflammation. It is the only philosophical construction, however it may have grown out ofthe doctrine of " stagnation." See a remarkable case of recovery from dry gangrené in Lon.Medioo-Chir. Trans. 1839, Art. 17. It occurred in a child three and a half years of âge. Nature amputated 320 PHILOSOPHY OF VENOUS CONGESTION. The indefatigable Louis affords abundant proof that redness is not essential to inflammation, and that— " Paleness of inflamed structures takes place sooner or later, as is exemplified in the various shades of colour of hepatized lung." . So, also, frequently of "^oftening." " lt ought to be noticed, that continuous with a red and softened portion of mucous membrane, we often find another equally softened, but with- out redness. If the first, therefore, be inflammatory, it is probable that the other is also." (') (See Appendix on Analogy.) We shall have many facts like the foregoing in our examina- tion of M. Louis' doctrines. They are important in a variety of aspects. " In gênerai," says Dr. Graves, " we connect the idea of integumental inflam- mation with the appearance of redness, and this phenomenon is explained on the hypothesis that a preternatural quantity of blood is circulating in the inflamed parts. To what cause, then, are we to attribute the coexistence of increased vascularity, and a remarkable pallor of the parts ; a state displayed in a very remarkable manner inphlegmasia dolens ? It is easy to conceive that in certain stages of inflammation, the quantity of serous or white blood may be suddenly much increased, and that this increase may be accompanied by all the phenomena of inflammation except redness. The phenomena of phlegmasia dolens prove that a white inflammation may be quite as intense as red inflammation; a fact which I saw exhibited in a remarkable manner in the case of a woman labour- ing under p. dolens, and in whom the disease suddenly attacked the eye, and destroyed it in a "short space of time, disorganizing it rapidly without the super- vention of any redness during the destructive process." (f) Mr. Morgan maintains that inflammation may exist and prove fatal, without any " apparent altération " of the parts affected, and — » We are not to conclude, provided there was good évidence to the contrary during life, that a person may not have died of inflammation, simply because the part does not appear red." (») "Although the part may be perfectly one arm attheelbow, and the other between the elbow and shoulder, and the left leg above the ankle. "Stumps were formed which might shame many formed by th« operator's knife." (1) Researches on Phthisis, sec. 135, 136. p. 93. — We shall, however, have some- thing more to say on this conclusion of our author, in our brief examination of his vvritings. (2) Lon. Med. Gaz. March 18, 1837, p. 943. (3) Principles of Surgery, p. 58. — And yet we are told by this able writer, that "nothing satisfactory can be elicited by considering the symptoms during life, or ex- amining the altérations of structure left after death ;" and that, " there is one way only of arriving at the truth, and that is by inducing the disease in the transparent parts of an animal, observing with the microscope the changes which ensue," kc. — p. 33. — This had been abundantly done; but has it improved our philosophy, or rendered us more skilful ? PHILOSOPHY OF VENOUS CONGESTION. 321 blanched," says Prof. Gross, "yet this does not prove that this process (inflam- mation) is not, to a certain extent, présent." (*) The universal contraction, also, which affects the capillary system after keath, must be felt by the instruments of disease, and more or less of their contents must be expelled in consé- quence. From these, and other considérations, it is évident that redness, or vascular fulness, are contingent results, and not necessary éléments of inflammation. « I have said twenty times, and I repeat it again, that the only cause which prevents the red globules from passing into vessels with fluids, is the want of relation between the nature ofthe fluid and the sensibility (irritability) of the organ. The opposite opinion is of the school of Boerhaave." (2) Scirrhus, and its ulcération, appear to be excluded by some from the genus of inflammations, and, like another inflammatory product, tubercle, to be regarded as results of some mysterious "modification of nutrition." All their phenomena have yielded to the apparent absence of red vessels. Even Andral, (3) how- ever, as we shall show, assigns the latter at last to inflammation; as do, also Broussais, (4) Langenbeck, (5) Geddings, (6) &c. The erudite Dr. Craigie ascribes, in a gênerai sensé, (p. 189,) "sof- tening," "induration," "hypertrophy," "suppuration," and all the varieties of " gangrené," to inflammation. (7) That excellent pathologist, Prof. Gross, in his late work considers scirrhus, tubercle, ulcérations, softening, to be, invariably, the results of inflammation. (8) Abernethy defended the inflammatory nature of scirrhus. AU the foregoing, in a gênerai sensé, is still the doctrine of those who give the highest place to the phenomena of nature ; and we think the conviction strengthens when we consider the obstacle to a full avowal. of what a powerful class regard as heretical "notions." We may say, too, that in France, scirrhus is often held to be inflammatory by those who have not rejected inflammation as a disease. (9) Breschet, and his associâtes, whose authority we now quote, consider inflammation indis- pensable to scirrhus. If the vessels be almost obliterated, it is (1) Patholog. Anat vol. i. p. 99, 1839. (2) Gen. Anat. vol. ii. p. 74. (3) Précis d'Anat. Path. t. 1. p. 501. Die. de Méd. et Chir. Prat. t. 4. p. 444. (4) Prop. 196. (5) Nosol. p. 316. (6) American Cyclop. Prac. Med. (7) Practice of Physic, vol. i. p. 396-402. 1836. —He makes an exception some- times in behalf of suppuration. (8) Patholog. Anat. vol. i. pp. 84, 99, 162, 182, 1839. (9) See Art. on Cancer, by Breschet, in Diction, de Méd. VOL. II. 41 322 PHILOSOPHY OF VENOUS CONGESTION. owing to the spécifie nature of the inflammatory action, the de- position of lymph, &c. ; whilst on the other hand, when carcino- matous tumours are soft, as in fungoid disease, the vessels are large, and either of a bright red, or a venous livid hue. The opinion of Hodgkin is valuable on all that is connected with inflammatory diseases. He does not agrée with others, " In regarding those accidentai productions, to which the term » malignant ' has been applied, as so completely similar to the products arising from ordù nary inflammation." This is sound, and obvions doctrine ; the inflammation being of a spécifie kind, as expounded by Mr. Hunter. Our author also takes, as it appears to us, a luminous view of the affinities of " scirrhus and fungoid tumours." " Although, as I have endeavoured to show, these formations, by their struc- ture, mode of development, and, for the most part, by their influence on the system, are with propriety to be referred to one common type, and grouped into one family, yet, as we shall presently see, there are certain peculiarities, which will justify us in forming at least three spécifie divisions. Their limits, it is true, are so ill defined, and they pass so gradually into each other, that it is often difficult to décide to which of the species a particular spécimen should be referred. In the best marked cases, however, there is no difficulty of this kind.'0 FrQm these "best marked cases," we pass by insensible de- grees through all the varieties of carcinomatous affections, " We not only meet with the various intermediate gradations between well- marked, true scirrhus and the fungoid disease, but we also find the various combinations of thèse in the same subject." (*) Nay more ; it sometimes happens that we meet with some of the conditions, which are reputedly distinct, more or less associ- ated in différent parts of the same tumour. There is but " one common type," and this is inflammation, which, according to its shades of modification, gives rise to the diversified results. It will be seen, in our 12th section, that these considérations have an important bearing upon what we consider modifications of venous congestion, or phlebitis. They dépend, intrinsically, up- on the nature of the remote causes. Our author appears to incline to the inflammatory origin of tubercle ; and we see indications, in many quarters, of a déter- mination to rescue this subject from the trammels of morbid anatomy and chemistry. Mr. Williams, in speaking of tubercle, remarks, — (1) On the morbid Anat. ofthe Serous and Mucous Membranes, vol i. pp. 277, 347. 1836. (2) Ibid. p. 292. PHILOSOPHY OF VENOUS CONGESTION. 323 "If the resemblance is so perfect in the generalities, should some slight va- riation in particulars, still explicable from a différence of cause, by widely se- parating the two phenomena be made a pretext to multiply the objects that the mind should grasp ? If the fact may be referred to a simple and established law, shall we still leave it in the already burthened and unwiéldly lisl ofanoma- lous exceptions ?" (') (Pp. 119, 317—318 ; and Vol. I. p. 626, note; and Ap- pendix V. on Tubercle.) We are sensible that it will be the opinion of some that we are becoming too circumstantial, too prolix, for a subject so "well settled against us." This is indeed one of our objects for minute inquiry; though a greater one will be ultimately found in the important bearing which the whole of this investigation possesses in relation to venous congestion. There are various modifications of venous inflammation which will dérive illustra- tion from the varieties of inflammatory action as affecting other tissues ; (p. 300 ;) whilst we simultaneously effect our greater purpose of showing that we must make the dissecting knife yield, where it may appear to come in collision with the clearest évidences of truth. " It is not even certain," says Dr. Davis, " that we are yet acquainted with all the possible forms of inflammation, so as to be compétent to assert broadly and emphatically, that this or that variety of inflammation should have a natu- ral and necessary tendency to end in disorganization of structure." " Affec- tions, demoustrably inflammatory, may be sustained for years without producing malignant disorganization." " Many diseases, loosely attributed to irritation alone, are often characterized by symptoms which a more accurate diagnosis would enable us at once to ascribe to actual inflammation." (*) (Vol. I. p. 239 -278.) Meckel goes so far as to say, " all the anomalies of the vascular system arise from inflammation. All the regular or irregular formations of the abnormal state are produced by inflammation or an act analogous." (3) So also, Brous- Bais, (4) Dr. Parry. (5) It is apparently the surprise of a leamed critic, that " some physiologists still deny that all new formations dépend on inflamma- tion." (•) The last mentioned doctrine may not be wholly true ; but it can never be controverted, as lately attempted, by inductions from the peculiarities of the polypus, or the abnormal conditions of plants. We rather hold, that it is better to reason from analo- gies that relate to man himself, than to connect his physiologi- cal characteristics with plants and stones. And hère we bear (I) Rational Exposition, &c. of Diseases ofthe Lungs and Pleura, p. 165. 1838. (2) Principles and Practice of Obstétrical Medicine, part 20. 1835. (3) Gen. and Patholog. Anat. vol. i. p. 143. (4) Examen, &c. (5) Eléments of Pathol. and Therapeutics ; Collections, &c. (6) Translater of Meckel's Anat. ut cit. p. 144. 1832. 324 PHILOSOPHY OF VENOUS CONGESTION. aloft our motto, takfen from another chapter of nature, " jure possimus morbo alicujus partis, ad morbum alterius analo- gice disserere." We are fully sensible, however, that they who adopt the fore- going views of scirrhus, tubercle, &c. are considered, in the lan- guage of a leading review, as being " trammelled by the usage of an exclusive and erfoneous pathology ;" and, withal, « igno- rant ofthe late advances in the science." But, there are certain doctrines, which we shall subjoin in a note, that appertain more or less to the schools which differ from us as to the foregoing views of inflammation, to which, we think, some spécial objec tions might be made. However this may be, we have thought it may facilitate the judgement of the.reader in forming his con- clusions as to the relative merits of the Hippocratic inductions from the phenomena of nature, and the Systems which repose upon researches in morbid anatomy. It might have been suffi- cient to have left this spécial considération to the spécifie con- trasts we have had occasion to présent at différent steps of oui inquiry, since a single fundamental error in physiology may be- tray a vicious system of philosophy. (Vol. I. pp. 632, 635.) But, we have concluded, on the whole, that it will be more a mattei of fairness to group together some of the prominent doctrines to which we object. (') (1) It has been recently contended, for instance, that, " in tbe the présent state of médical science, it must be admitted" that scirrhous tumours are only a "lésion of nutrition." This doctrine has some powerful adhérents. " Dr. Carswell considers, that, in carcinoma ofthe stomach, the muscular and cellular tissues ofthe organ are converted, by the nutritive process of transformation, into a homogeneous mass." (a) " According to the récent views of organic science,'' (which means pathological anatomy,) says D'Amador, "medullary sarcoma, melanosis, cirrhosis, Sic. are to ba regarded rather as altered sécrétions ; but, it will always remain to be ascertained whether these morbid sécrétions may or may not have their analogies among the na- tural sécrétions." We agrée to the latter affirmation. M. Andral carries the humoral doctrine into the foregoing philosophy. We find the following under his division of " Lésions of Nutrition." After adverting to tbe " reigning fashion some few years back" as to "acute and chronic inflammations," he apostrophizes, — " and who will noto take upon himself to deny, that in certain tumours called scirrhous, there may not, as in the gênerai induration of the cellular tissue in new-born infants, be a concomitant altération of the blood ?" (b) And, as a contrast to what we have just queted in our text from Dr. William», we may state the following substitution, by another distinguished Frenchman, oft humero-chemico-microscopical pathology, for the Hippocratic and Hunterian philo»- (a) Hodgkin, on the Morbid Anat. of Serous and Mucous Membranes, p. 352 — (*) Patbolof. Anat vol. i. p. 151. PHILOSOPHY OF VENOUS CONGESTION. 325 He, who shall deny the présence of inflammation in venous congestion on the ground of the absence of vascularity in the ophy ofdiseased action according to modifications established by the nature of re- mote causes, constitution, kc. Thus : — " A question essentially obscure," says M. Velpeau, " but one ofthe most interesting in pathological anatomy, présents itself to the mind. Whence comes it, that, in a class of tumours, all resulting from the effusion of some ofthe materials transported by the circulating system, there are found two kinds of disease so profoundly distinct ? Might it be that the blood, the lymph, the milk, pus, or serosity, collected between the organic layers, might in time give rise equally to the gelatinous, hydatid, and se- ro-sanguineous cysts, and tho fibrinous, cheesy or milky, scirrhous, encephaloid, colloid, and melanotic tumours ? Or, are the last four species, primative éléments not pos- ■essed by the others, éléments not found in natural liquids? It is to be hoped that the microscopical researches of M. Donné upon the pus, urine, b'.ood, and other pro- ducts ofthe animal economy ; those of M. Turpin upon the transformations, a species of végétation, the multiplication ofthe globules ofthe milk, those of M. Bonnet, upon ths nature and composition of morbific productions, and those of Messrs. Beauper- thinand Adet de Rosseville on the animalcula of decomposed fluids or other animal matter, wi!l some day throw some light upon this obscure point. Until then, we must allow thàt we know nothing satisfactory upon the origin of these diverse pro- ductions." (a) (Vol. I. pp. 56, 57, notes.) But, do we, in reality, know anything more as to the pathology of smallpox, cow- pox, syphilis, measles, all kinds of fever, or of any other disease? The simple es- sence of the whole consists in variously modified conditions of the vital properties, and what are considered by our anatomist as the oauses, are only effects. The stu- dent may rest assured that the moment he yields to a spéculative philosophy like the foregoing, it will necessarily vitiate ail his theoretical and practical habits. Tho simple guide of nature will be lost, and he will find himself at the mercy of every va- rying breeze. It is for this reason that we find in the works of all authors, who have not a stability corresponding with the laws of nature, conclusions that are at varfance with each other on almost every page. This is the secret of Bichat's occasional self- contradictions, since even this great man was not wholly free from the blemish which we are considering. If there be not a consistent whole, there is some fundamental defect in principle ; and where there is unity in all parts, it is the best évidence that the writer is at the fountain of truth. , Again, it is said by a distinguished head ofthe anatomical school, that "red and uhitt softening, thickening, ulcération, and intestinal perforation, are owing at dif- férent times, to wholly différent causes," and, indeed, that their causes are as " oppo- site" to each other as the •' colours" are différent. (6) It is said, that pus may be formed indiscriminately by the actions of organized matter, by the physical dissolution of natural or morbid products, or of coagula of blood, or in the torrent ofthe circulation ; (p. 188, kc. ;) and yet, that purulent matter is so much like life, " we have arrived at the principle on which granulations are formed.'' (c) And so, Dupuytren, Laennec, Villermé. It is said that " Dr. Jahn, a man of undoubted learning and great talents," endea- vours to show that " the common conséquences of inflammation,—the adhésion of »erou3 membranes with contiguous parts, &c. — are normal conditions in several ani- mais." (d) This doctrine is extending in abnormal conditions. It is said, indeed, (a) Velpeau's Treatise on Diseases ofthe Breast, in American Med. Library, p 66, 1840. — (4) M. Louis. See références in Easay on, âcc. — (e) Sir E. Home, in Philos. Tran». 1818, p. 194 ; 1819, f-1 — U. — {d) BritUb and Foreign Med. Eev. No. 7, p. 126, «te. 326 PHILOSOPHY OF VENOUS CONGESTION. inner coat of -the vessels, so analogous to the serous tissues, must be equally skeptical of its existence in strongly marked that Mr. Hunter was totally wrong in all his views of inflammation, whether they respect the condition of the blood-vessels, or the " terminations " of the disease. That vital actions have no connection with the process, but that the work is carried on, from beginning to ending, by mechanical powers, and especially by " stagnation of blood." (Our Essay on Inflammation, Sec. 1.) We cannot recapitulate what has been done in organic chemistry, or how far the laws in that department of nature have been substituted for the laws of life. A view of the whole subject may be found in our former Essays, especially in those upon the Vital Powers, Digestion, and Section 2d, on Inflammation. It is said, that coagula of blood, long dead, may form for themselves a highiy vascu- lar organization, and carry on an independent circulation, and this, too, in the midstof venous blood ; (a) whilst others contend that venous blood is almost as good as ar- terial for the purposes of life, (6) however it may be regarded in the humoral pathol- ogy as the most prolific cause of " malignant fevers ;" besides many other similar anomolies. (P. 203.) It is said, that it is " an important question in gênerai physiology, whether plants and animais of a high degree of organisation may be capable of producing from va- rious parts of their tissues, being3, corresponding to those of the inferior orders of their kingdoms," whilst many maintain that the human machine is a spécial la- boratory for various insects. (P. 130, and vol. i. p. 706.) That, "M. Raspail is strongly impressed with the idea that many, if not all, of the exanthemata are, in truth, the resuit of insect opération on the skin ;" and that " cancer, tubercle, choiera, influenza, variola, and certain disorganizations of the liver, kidneys, kc. are the work of entozoa, or insects in the animal economy.'' (c) That Professor Schoen- lein of Zurich, supposes that the pustule of porrigo is a proper vegetable fungus. (d) That, intestinal worrhs are the products of inflammation, (e) That, the genitals of both sexes, when inflamed, are a laboratory of insects. (/) That, animais may be created out of silex by the action of galvanism, or form spontaneously in water, (pp. 95, 124,) or in a solution of muriate of barytes in distilled water. (g) That, hydatids of the utérus, though similar to those ofthe brain, are "the product ofa degenerated conception." (h) That, cancer dépends upon v. vesicular worm, being duly inducted into the syslema naturœ as the hydatis carcinomatosa ; (i) whilst others suppose that the différent kinds of carcinoma have their distinct species of worrns, such as the hydatis cruenla, h. lymphatica, h. carcinomatosa, &c, being the latest sub- stitute for the old doctrine of " remote causes," and for the " reigning fashion some few years back as to acute and chronic inflammations " being the cause of these and analogous affections ; (j) and that, the formation of granulations, kc. which takes place around the worms is intended by nature to protect tbe animais against any injury from the inflammation and suppuration they may excite, or from the noxious effects of dead hydatids in their vicinity. (k) That pulmonary tubercle is a degeneration, or something analogous, of another species of vesicular worm. (/) That, the red globules of blood are infusory animais. (Vol. i. p. 707.) That, " thick- ening" ofthe intestinal mucous membrane in typhoid fever is sometimes "the con- séquence of the reaction occasioned by the meteorism," having at such times no (a) See Sec. 9. — (4) Dr. Williams' Lectures on Diseases of the Chest, lec. 3.— (c) Lon. Med. Chir. Kev. Oct 1838.—(d) Lon. Med. Gaz. from Muller's Archives. — (e) Bremser, Rudolphi, été. — (f) M. Donné, and others. (The vibrio lineola and another species.) — (g) Retzius, in Frori- ep'e Notizen ; 5, p. 56. — (A) Velpeau, Nouv. Rech. sur l'Origine de la Grosscse, Hydatiqno, kc.— (t) Dr. Baron, &c— (j) M. Andral, ut supra. —(fc) Dr. Adami, «te. — (0 Carmichasl, Adam», Baron, sec. PHILOSOPHY OF VENOUS CONGESTION. 327 cases of phlebitis ; since, according to M. Cruveilhier, and others, (however the affirmation be only generally true,) the injection is confined to the outer tunic, and is less than in common inflam- mations, whilst " the deep red colour of the inner membrane, when it may happen to appear, is owing to an imbibition of the colouring matter ofthe blood, and takes place after death ?"(') (P. 313, Rigaud. " Arteries.") Not only may an absence of vascularity exist, but Tonellé states that the inner coat of an inflamed vein may be actually white ; and he maintains that this appearance, both in veins and lymphatics, is a full proof ofa state of inflammation. He also mentions that the veins thus affected in utérine phlebitis are in a state of great dilatation and tortuosity, and that these are often connected with others in a dependence upon inflammation, (a) That, the par vagum is not necessary to the process of digestion ; or, whether necessary or not, this vital process is carried on by the laws of chemistry, and may be just as well accomplished by chlorine, pepsin, oxalic acid, &c, and as well out of tbe stomach as in it, or even in fresh wounds, or by the putrefactive process. (Pp. 101, 105, 186.) That. typhoid fever, like the bouI of Des Cartes, has its peculiar seat in a gland of unknown use ; an analogy which may have been farther suggested by the doctrine of Gara, (b) Greding, (c) and Morgagni, (d) that the calculi of the pineal gland is sometimes the cause, and a^ain the effect of diseases of the mind, and this because they were found rather abundantly in the brains of a couple of fools. (e) And, were we to turn for a moment to some of the coincident improvements in therapeutics, we should find in animal magnetism, and in the profundities of the humoral pathology, a practical exeinplification of the wisdom of the âge. (Vol. i. pp. 397, 632 ) That the foregoing doctrines will continue to prevail, more or less, we have no doubt. New créations of inferior by superior animais, or the more uncom- promising doctrine of "spontaneous génération," will never want their advocates with those who recognise no " vital principal " in living matter, and, therefore «also, no uniform laws in diseases whose various phenomena and results are the same, or very analogous. The création of animais by gah'anism, &c. will still go on ; and, coming to the chemistry of life, it can scarcely be expected that a philosophy so uni- versal shall not be hourly heralded forth, and gravely approved by the magnâtes of the land. (1) Cruveilhier Anat. Patholog. liv. 11. 17. And so, not unfrequently, ofthe arte- ries. See Hope in Cyclop. ofPrac. Med. Jlrteritis ; and Laennec, and Dutrochet.— The absence of vascularity in the inner coat ofthe veins led Laennec, and some others of the French school, to the belief that it is not subject to inflammation. — Morgan sup- poses the colour, when présent, to réside in the vessels. — Principles of Surgery, p. 107. And so Bertin. — Diseases ofthe Heart, SfC.p. 46. —The vétéran Clutterbuck's state- ment is also entitled to a notice, who says that " the lining membrane of the larger veins is found to be highiy reddened, (in violent cases of fever,) so as to resemble' the tunica conjunctiva in an inflamed state." — Essay on Pyrexii, Sçc. p. 63. (a) M. Louis, in Researches on Typhoid Fever, vol. i. pp. 324, 363, &c. — (4) De Lapillis Glan- dulee Pinealis, Sec. 1753. —(e) Adversaria Med. t. ii. p. 522.— {d) De Caus. et Sed. Ep. 5, a. 12, ud Ep.61, a. 3, 4.__(e) See, also, Rhœderer, de Cerebro, 1758 ; and Wenzel, Obs. sur la Cervelet, te. p. 165. 328 PHILOSOPHY OF VENOUS CONGESTION. state of disorganization. (') This is conformable to a gênerai remark of Bichat, who says that,— "The serous membrane may have been very much inflamed during life,— the skin in erysipelas, — the cellular texture, — the mucous, as seen in anginai —and yet exhibit almost their natural appearance after death; and that he should have been often tempted in opening dead bodies to deny the existence of any affection which had been real." (*) (See Hunter, p. 319.) The foregoing remark is also valuable as showing the light in which morbid anatomy was regarded by the founders of the anatomical school. Hère is an example of what we have now said, from another source. In a case of crural phlebitis, — " At the point which was in contact with the pus, the internai coat was paler than it should be. Above, it was stained and discoloured as far as the iliac vein, and even to the cava." " It is singular that the coats of the vessel, which, for full three inches was filled with pus, should have been so unaltered as they were." (s) We seek in vain for other modes of action which détermine the symptoms, or the products, or the changes of structure which are allied to the results of inflammation, although there be want- ing some of the more usual characteristic phenomena. Analo- gies may be sometimes obscure ; but there may be Connecting média in the wide range of inflammatory actions which shall illustrate an instance of doubtful pathology, and rescue the case from an imputed " lésion of nutrition." We shall also find in the influence of remote causes, in the structure and physiology of différent organs, in constitution, &c. much that will explain the varieties. To these causes, also, are to be referred those modifications of inflammation which have been distinguished into sthenic and asthénie hyperœmia, whose loose or proper modes of treatment are held to be conclusive against the common nature of their pathology. But, although stimulants may aggravate, where depletion will subdue the affection, and vice versa, there are not wanting numerous instances, as in burns, colds, erysipe- las, &c, where either method may succeed. (Sec. XV.) Where common physical products arise, which are conceded in one in- stance to be the offspring of inflammation, least of all should they be ascribed in another case to an " opposite condition of disease," by those cultivators of morbid anatomy, who hold that this science reveals the secrets of morbid actions. (1) Des. Fièv. Puerp. Obs. à la Maternité, 1829, Archiv. Gén. 1830. (2) Gen. Anat vol. ii. p. 20. (3) Lond. Med. Chir. Rev. July, 1828, p. 426. PHILOSOPHY OF VENOUS CONGESTION. 329 The opération of the vital powers gives rise to all the pheno- mena of health. If the action of those powers be modified, the phenomena may be varied, and other results may follow, with- out any apparent change in the instruments of action. This is especially exemplified in idiopathic fevers ; and where a change occurs in the physical state ofthe blood-vessels, as in inflamma- tion, its various modifications, as in scrofula, lues, rheumatism, goût, phlebitis, croup, cancer, erysipelas, or from miasmata, the virus of snakes, bées, mad-dogs, &c. it cannot be inferred from any apparent peculiarities. Where so much is palpable, how shall we limit the phases of inflammatory action 1 The morbid products may alone afford a diagnosis in a generic sensé, which the symptoms, constitution, the seat of the affection, &c, had more clearly and specifically indicated from the beginning ; and in idiopathic fever, in the primary stages of smallpox, scarlatina, &c, it is through the vital phenomena alone that we attain.any knowledge of their pathology. And so in most of the "neuroses." The various narcotic poisons produce one uniform, and generally but one, anatomical lésion, venous congestion of the brain ; and yet how perfectly dissimilar may be the symptoms. The scal- pel discloses nothing to explain the causes of the peculiarities. Can we produce the inflammatory part of smallpox, measles,