| Page. | ||
|---|---|---|
| Dedication | [i]. | |
| Preface | [iii]. | |
| CHAPTER I. | ||
| Further Investigation of Fever necessary | [1] | |
| Facilities afforded by the Fever Hospital for prosecuting the Study | [5] | |
| Antient Doctrines relative to the Nature and Seat of Fever | [7] | |
| Hippocrates, Galen, Sydenham | [8] | |
| Modern Doctrines relative to the Nature and Seat of Fever | [13] | |
| Cullen, Brown, Stoker, Burne, Clanny, Clutterbuck, Broussais | [14] | |
| Errors common to all these Theorists | [30] | |
| Questions to be solved before Fever can be understood | [33] | |
| Precise Object of Investigation | [34] | |
| Proper Mode of conducting it | [36] | |
| CHAPTER II. | ||
| Varieties of Fever | [41] | |
| Common Phenomena | [42] | |
| Importance of analyzing the Assemblage of the Symptoms, in order to ascertain the Common Phenomena | [43] | |
| Results of the Analysis | [45] | |
| Organs always diseased in Fever | [48] | |
| Functions always deranged in Fever | [49] | |
| Fever not Inflammation | [50] | |
| Distinction between Fever and Inflammation | [52] | |
| Common Phenomena of Fever exemplified in Plague | [53] | |
| in Yellow Fever, | [54] | |
| in the Varieties of Fever of Great Britain | [54] | |
| Different Varieties produced by different Intensities | [58] | |
| Received Classification and Nomenclature defective | [60] | |
| What is really meant by Genera and Species of Fever | [70] | |
| True Principle of Arrangement | [71] | |
| CHAPTER III. | ||
| Of Synochus | [77] | |
| Division into Synochus Mitior and Gravior | [77] | |
| Succession of Phenomena in Synochus Mitior | [78] | |
| Indications afforded of Disease in the Nervous, Circulating, Secreting, and Excreting Systems | [81] | |
| Progress of Disease consists in progressive Increase in the Derangement of these Functions | [85] | |
| Phenomena of Recovery | [91] | |
| On what the Transition of Synochus Mitior into Synochus Gravior depends | [93] | |
| Classification according to the different Organs in which the several Affections have their Seat | [95] | |
| Synochus Gravior with Cerebral Affection | [96] | |
| Subacute Cerebral Affection | [96] | |
| Acute Cerebral Affection | [107] | |
| Cases illustrating Synochus Mitior | [112] | |
| Cases illustrating Synochus Gravior with Subacute Cerebral Affection | [114] | |
| Cases illustrating Synochus Gravior with Acute Cerebral Affection | [116] | |
| Synochus Gravior with Thoracic Affection | [120] | |
| Cases illustrating Thoracic Affection | [123] | |
| Synochus Gravior with Abdominal Affection | [128] | |
| Cases illustrating Abdominal Affection | [137] | |
| Synochus Gravior with Mixed Affection | [142] | |
| CHAPTER IV. | ||
| Of Typhus | [148] | |
| Division into Typhus Mitior and Gravior | [149] | |
| Typhus Mitior, with Subacute Cerebral Affection | [149] | |
| Cases illustrating Subacute Cerebral Affection | [155] | |
| Typhus Mitior, with Thoracic Affection | [157] | |
| Typhus Mitior, Cases illustrating Affection | [159] | |
| With Abdominal Affection | [161] | |
| With Mixed Affection | [162] | |
| Typhus Gravior | [162] | |
| In what it really consists | [162] | |
| Dangerous nature of the Error that it consists in Debility | [164] | |
| CHAPTER V. | ||
| Of Scarlatina | [168] | |
| Characters by which it is distinguished from Continued Fever without an Eruption | [168] | |
| Division into Scarlatina Synochodes | [171] | |
| Typhodes | [172] | |
| Events which occasionally occur in Fever, but which form no essential part of it | [173] | |
| Preternatural Sensibility over the external Surface of the Body; Excoration and Sloughing; Erysipelas; Inflammation, &c. of the Glands; peculiar Affection of the Joints | [173] | |
| CHAPTER VI. | ||
| Of the Pathology of Fever | [176] | |
| Importance of connecting the Symptoms with the States of the Organs | [176] | |
| Pathology of Fever comprehends the Morbid Changes that take place in the Solids and Fluids of the Body | [178] | |
| I. General Pathology of the Solids | [179] | |
| External Appearances of the Body after Death | [180] | |
| Morbid Appearances in the Head | [181] | |
| in the Thorax | [184] | |
| in the Abdomen | [187] | |
| I. Cases illustrating the Morbid Changes which take place within the Head, or Cerebral Cases | [193] | |
| 1. Vascularity of Brain, Spinal Cord, and Membranes, with Gelatinous or slight Serous Effusion | [193] | |
| 2. Vascularity of Brain, Membranes, &c. with Effusion of Coagulable Lymph and Formation of Pus | [204] | |
| 3. Vascularity of Brain, Membranes, &c. with copious Serous Effusion | [210] | |
| 4. Vascularity, &c. with Preternatural Firmness of Brain | [218] | |
| 5. Vascularity, &c. with softening of Brain | [224] | |
| General Results established by preceding Cases | [230] | |
| II. Cases illustrating the Morbid Changes which take place within the Chest, or Thoracic Cases | [235] | |
| III. Cases illustrating the Morbid Changes which take place within the Abdomen; or Abdominal Cases | [246] | |
| General Results established by preceding Cases | [287] | |
| IV. Cases illustrating the Morbid Changes which take place within the Head, Thorax, and Abdomen, in the same individual, or Mixed Cases | [291] | |
| General Conclusion | [322] | |
| II. Pathology of the Fluids in Fever | [328] | |
| CHAPTER VII. | ||
| Of the Relation between the Phenomena of Fever; or the Theory of the Disease | [333] | |
| CHAPTER VIII. | ||
| Of the Causes of Fever | [348] | |
| 1. Of the Immediate, or Exciting Cause of Fever | [348] | |
| 2. Of the Remote or Predisposing Causes of Fever | [369] | |
| CHAPTER IX. | ||
| Of the Treatment of Fever | [375] | |
| Modification of Treatment required in prominent Cerebral Affection | [398] | |
| Thoracic Affection | [403] | |
| Abdominal Affection | [405] | |
| Treatment of Scarlet Fever | [408] | |
| Treatment during Convalescence | [418] | |
| Appendix | [425] | |
FEVER, &c.
CHAPTER I.
Further Investigation of Fever necessary: Facilities afforded by the Fever Hospital for prosecuting the Study. Ancient Doctrines relative to the Nature and Seat of Fever. Hippocrates, Galen, Sydenham. Modern Doctrines. Cullen, Brown, Stoker, Burne, Clanny, Clutterbuck, Broussais. Errors common to all these Theorists. Questions to be solved before Fever can be understood. Precise Object of Investigation: proper mode of conducting it.
On my appointment to the office of Physician to the London Fever Hospital, it was stated to me by the treasurer that, among the objects contemplated by the establishment of this institution, two things were conceived to be of paramount importance: first, the accumulation of facts by which the true nature of fever might be more certainly ascertained, and secondly the cautious trial of remedies by which a more sure and successful mode of treating this fatal disease might be discovered. During my connexion with this hospital I have faithfully endeavoured to the utmost of my ability to keep these objects in view, and I now venture to lay before the public the result of my observations, in the hope that they may contribute something, however little, to the stock of knowledge already accumulated.
When we consider how many circumstances connected with the origin and the propagation of fever are wholly unknown, which if known might have a most important influence in preventing its occurrence, in arresting its progress or in lessening its mortality; when we consider in what profound obscurity the very nature of the agents that produce it is still involved; when we consider how easy it is to swell the long catalogue of its symptoms, but how difficult it is to discriminate which, even among the most prominent of the train, are the essential and which the adventitious, and how still more difficult it is to ascertain which are the invariable antecedents and which the invariable sequents, or which the causes and which the effects; when we consider how few comparatively of the external appearances have been ascertained to be the sure and certain signs of any known condition of the internal organs, and how often the existence of several known conditions of the organs remains altogether unsuspected until the demonstration of it is afforded by inspection after death, and when finally on all these accounts we consider how vague the objects must be that are aimed at in the treatment, and consequently how uncertain, how indiscriminate, how fruitlessly inert, how perniciously active, how unsuccessful, how fatal that treatment often is, it must be admitted that fever still presents to us a vast field, in the culture of which the difficulties to be overcome are not slight, and the most diligent labour that can be bestowed upon it may by no means be attended with a sure reward.
Of many branches of science it is truly observed that much time and labour are necessary to establish a single important fact; of some parts of medical science this is eminently the case, but perhaps of none is the observation so just as of that which relates to febrile diseases. It is remarkable how entirely the most distinguished physicians of all ages who have treated of this subject coincide in the feeling, that with regard to this important class of disease it is impossible in the short life allotted to the most aged to do any thing more than add a little knowledge to the common stock. If there be any foundation for this feeling it can only be by every man faithfully endeavouring to contribute what he may be able, be the amount ever so small, that that stock can speedily become large or ever become complete.
In bringing to this common stock my humble mite, that the offering may not be wholly worthless, I have confined myself as much as possible to the detail of the facts that have been observed, and the statement of the results that have been obtained from experience. By giving a connected view of the phenomena I have hoped that I might possibly assist the actual practitioner to form a more adequate conception of the disease and guide him to that particular remedy which experience shews to be best adapted to each of the more important affections he is likely to encounter. Out of the means furnished for the accomplishment of these objects by the receptacle of fever for this great metropolis I have endeavoured to select such specimens of the disease as will place before him a vivid and faithful picture of the most interesting aspects it assumes, and such a detail of treatment as will shew what particular remedies afford the best chance of success in each type and stage, and in the most common and therefore the most important modifications they present. If I have at all succeeded in my aim he will find himself placed in a good measure in the same situation with myself; his attention will be directed to the same phenomena in the order in which they occur in the series, and hence he will have the like means of judging of the relations which these phenomena bear to each other, as well as of the accuracy of the analysis that has been attempted of the more complicated, and the soundness of the inductions that have been made from a comparison of the whole.
The London Fever Hospital is capable of receiving sixty-two patients: in most seasons of the year its wards are full: often there are numerous applications for admission which cannot be received for want of room: there pass through the wards from six to seven hundred patients annually. Two physicians are attached to the institution under whose care the patients are placed alternately in the order in which they are admitted: there is one assistant physician whose duty it is to perform the office of the ordinary physicians when either of these may be incapable of attending, and there is besides a medical officer resident in the house. A history of each case, containing an account of the age, occupation and residence of the patient, together with as full a statement of the symptoms of the disease and of the order of their succession as can be obtained is entered in the journal by the resident medical officer. Each of the ordinary physicians attends daily and enters in his journal a daily report of each of his own cases. The resident medical officer goes round the wards twice a day, namely, early in the morning and late in the evening, to observe if any change requiring attention may have taken place in any patient; and if any such change be observed by the nurses during the interval between these visits they are reported to him by the head nurse without delay; all such events with the modification of treatment they may have required are entered in the journals. Every case that terminates fatally is examined after death, and an account of the morbid appearances is entered in a book kept for the purpose. In this manner, in the progress of years a mass of facts accumulates relating to the statistics, the types, the symptoms, the causes, the diagnosis, the pathology and the treatment of the disease, whether successful or unsuccessful, which both on account of the fullness and accuracy of the record and of the extent of the period it embraces, cannot but be of great value.
I am encouraged in the attempt to make this record, as far as it has yet gone, useful to the public by observing the feeling that prevails among those physicians who have studied fever with the greatest diligence, and who have contributed most to our knowledge of it, that it is a disease which is still little understood and the treatment of which remains extremely vague and uncertain. Perhaps there is no disease so little understood as the ordinary fever of this country and none by the mismanagement of which so much life is lost. Dr. Clutterbuck appears to me therefore to describe the situation of the physician to such an establishment as the Fever Hospital, not more candidly than truly when he says—“It becomes a duty incumbent on those particularly who have been placed in situations favourable for observing the disease, to give the result of their experience to the public, should it tend, in any degree, either to prevention or cure. The enquiry is by no means exhausted, considered either in a theoretical or practical point of view. There is still a want of uniformity of opinion among physicians regarding the nature of the present epidemic, as well as of fever in general: while, I am sorry to add, in practice we are not much better agreed;” and when he further adds;—“To ascertain these modifications” (that is the modifications which require a modification of treatment) “is the great desideratum, which nothing but the most cautious observation, aided by much time, and the joint efforts of numerous individuals, can fully supply.”[[1]]