Medical Inquiries and Observations, Vol. III (of 4) The Second Edition, Revised and Enlarged by the Author
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Title: Medical Inquiries and Observations, Vol. III (of 4)
The Second Edition, Revised and Enlarged by the Author
Author: Benjamin Rush
Release Date: February 27, 2019 [eBook #58861]
Character set encoding: ISO-8859-1
***START OF THE PROJECT GUTENBERG EBOOK MEDICAL INQUIRIES AND OBSERVATIONS, VOL. III (OF 4)***
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Project Gutenberg has the other three volumes of this work.
Volume I: see http://www.gutenberg.org/files/58859/58859-h/58859-h.htm
Volume II: see http://www.gutenberg.org/files/58860/58860-h/58860-h.htm
Volume IV: see http://www.gutenberg.org/files/58862/58862-h/58862-h.htm
BY BENJAMIN RUSH, M. D.
PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE,AND OF CLINICAL PRACTICE, IN THE UNIVERSITYOF PENNSYLVANIA.
IN FOUR VOLUMES.
THE SECOND EDITION,
REVISED AND ENLARGED BY THE AUTHOR.
PUBLISHED BY J. CONRAD & CO. CHESNUT-STREET, PHILADELPHIA;M. & J. CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN,CONRAD, & CO. WASHINGTON; SOMERVELL & CONRAD, PETERSBURG;AND BONSAL, CONRAD, & CO. NORFOLK.
PRINTED BY T. & G. PALMER, 116, HIGH-STREET.
CONTENTS OF VOLUME III.
|Outlines of a theory of fever||1|
|An account of the bilious yellow fever, as it appeared in Philadelphia in 1793||67|
|An account of the bilious yellow fever, as it appeared in Philadelphia in 1794||355|
|An account of sporadic cases of bilious yellow fever,as they appeared in Philadelphia in 1795 and 1796||435|
THEORY OF FEVER.
As many of the diseases which are the subjects ofthese volumes belong to the class of fevers, the followingremarks upon their theory are intended torender the principles and language I have adopted,in the history of their causes, symptoms, and cure,intelligible to the reader.
I am aware that this theory will suffer by beingpublished in a detached state from the general viewof the proximate cause of disease which I havetaught in my lectures upon pathology, as well asfrom its being deprived of that support which itwould receive from being accompanied with an accountof the remedies for fever, and the times andmanner of exhibiting them, all of which would haveserved to illustrate and establish the facts and reasoningswhich are to follow upon this difficult andinteresting inquiry.
I shall not attempt to give a definition of fever.It appears in so many different forms, that a justview of it can only be given in a minute detail ofall its symptoms and states.
In order to render the theory, which I am aboutto deliver, more simple and intelligible, it will benecessary to premise a few general propositions.
I. Fevers of all kinds are preceded by generaldebility. This debility is natural or accidental.The former is the effect of the sanguineous temperament,and exists at all times in many constitutions.The latter is induced,
1. By such preternatural or unusual stimuli, as,after first elevating the excitement of the systemabove its healthy grade, and thereby wasting a partof its strength, or what Dr. Brown calls excitability,and Darwin sensorial power, afterwards reducesit down to that state which I shall call debilityof action. Or,
2. It is induced by such an abstraction of naturalstimuli as to reduce the system below its healthygrade of excitement, and thereby to induce whatDr. Brown calls direct debility, but what I shallcall debility from abstraction. This general debilityis the same, whether brought on by the formeror the latter causes. When induced by the latter,the system becomes more excitable than when inducedby the former causes, and hence an attackof fever is more frequently invited by it, than bythat state of debility which succeeds the applicationof an undue portion of stimulating powers. Tothis there is an exception, and that is, when the remotecauses of fever act with so much force andrapidity as suddenly to depress the system, withoutan intermediate elevation of it, and before sufficienttime is given to expend any part of its strength orexcitability, or to produce the debility of action.The system in this state, is exactly similar to thatwhich arises from a sudden reduction of its healthyexcitement, by the abstraction of stimuli. Thisdebility from abstraction, moreover, is upon a footingwith the debility from action, when it is of achronic nature. They both alike expend so muchof the quality or substance of excitability, as toleave the system in a state in which irritants areseldom able to excite the commotions of fever, andwhen they do, it is of a feeble nature, and hencewe observe persons who have been long exposedto debilitating causes of both kinds, often escapefevers, while those who are recently debilitated, areaffected by them, under the same circumstances ofexposure to those causes.
That fevers are preceded by general debility Iinfer from their causes, all of which act by reducingthe excitement of the system, by the abstraction ofstimuli, or by their excessive or unusual application.The causes which operate in the formerway are,
1. Cold. This is universally acknowledged tobe a predisposing cause of fever. That it debilitates,I infer, 1. From the languor which is observedin the inhabitants of cold countries, andfrom the weakness which is felt in labour or exercisein cold weather. 2. From the effects of experiments,which prove, that cold air and cold waterlessen the force and frequency of the pulse.
2. The debilitating passions of fear, grief, anddespair.
3. All excessive evacuations, whether by thebowels, blood-vessels, pores, or urinary passages.
4. Famine, or the abstraction of the usual quantityof nourishing food.
The causes which predispose to fever by the excessiveor unusual application of stimuli are,
1. Heat. Hence the greater frequency of feversin warm climates, and in warm weather.
2. Intemperance in eating and drinking.
3. Unusual labour or exercise.
4. Violent emotions, and stimulating passions ofthe mind.
5. Certain causes which act by over-stretching apart, or the whole of the body, such as liftingheavy weights, external violence acting mechanicallyin wounding, bruising, or compressing particularparts, extraneous substances acting by theirbulk or gravity, burning, and the like. The influenceof debility in predisposing to fevers is furtherevident from their attacking so often in thenight, a time when the system is more weak thanat any other, in the four and twenty hours.
II. Debility being thus formed in the system,by the causes which have been enumerated, a suddenaccumulation of excitability takes place, wherebya predisposition is created to fever. TheFrench writers have lately called this predisposition“vibratility,” by which they mean a liablenessin it to be thrown into vibrations or motions, frompre-existing debility. It is not always necessarythat a fever should follow this state of predisposition.Many people pass days and weeks under it,without being attacked by a fever, by carefully oraccidentally avoiding the application of additionalstimuli or irritants to their bodies: but the spacebetween this state of predisposition, when it is recent,and a fever, is a very small one; for, independentlyof additional stimuli, the common impressionswhich support life sometimes becomeirritants, and readily add another link to the chainof causes which induce fever, and that is,
III. Depression of the whole system, or whatDr. Brown calls indirect debility. It manifestsitself in weakness of the limbs, inability to standor walk without pain, or a sense of fatigue, a dry,cool, or cold skin, chilliness, a shrinking of thehands and face, and a weak or quick pulse. Thesesymptoms characterize what I have called in mylectures the forming state of fever. It is not necessarythat a paroxysm of fever should follow thisdepressed state of the system, any more than thedebility that has been described. Many people,by rest, or by means of gentle remedies, preventits formation; but where these are neglected, andthe action of stimuli, whether morbid or natural,are continued,
IV. Re-action is induced, and in this re-action,according to its greater or less force and extent,consist the different degrees of fever. It is of anirregular or a convulsive nature. In common cases,it is seated primarily in the blood-vessels, and particularlyin the arteries. These pervade everypart of the body. They terminate upon its wholesurface, in which I include the lungs and alimentarycanal, as well as the skin. They are the outpostsof the system, in consequence of which theyare most exposed to cold, heat, intemperance, andall the other external and internal, remote and excitingcauses of fever, and are first roused intoresistance by them.
Let it not be thought, from these allusions, thatI admit Dr. Cullen's supposed vires naturś medicatricesto have the least agency in this re-actionof the blood-vessels. I believe it to be altogetherthe effect of their elastic and muscular texture, andthat it is as simply mechanical as motion from impressionsupon other kinds of matter.
That the blood-vessels possess muscular fibres,and that their irritability or disposition to motiondepends upon them, has been demonstrated byDr. Vasschuer and Mr. John Hunter, by manyexperiments. It has since been proved by Spallanzani,in an attempt to refute it. Even Dr.Haller, who denies the muscularity and irritabilityof the blood-vessels, implies an assent to them inthe following words: “There are nerves whichdescend for a long way together through the surfaceof the artery, and at last vanish in the cellularsubstance of the vessel, of which we have a specimenin the external and internal carotids, and inthe arch of the aorta; and from these do not thearteries seem to derive a muscular and convulsiveforce very different from that of their simple elasticity?Does not it show itself plainly in fevers,faintings, palsies, consumptions, and passions ofthe mind?”
The re-action or morbid excitement of thearteries discovers itself in preternatural force, orfrequency in their pulsations. In ordinary fever,it is equally diffused throughout the wholesanguiferous system, for the heart and arteries areso intimately connected, that, like the bells of theJewish high-priest, when one of them is touched,they all vibrate in unison with each other. Tothis remark there are some exceptions.
1. The arteries are sometimes affected withgreat morbid excitement, while the natural functionsof the heart are unimpaired. This occurs inthose states of fever in which patients are able tosit up, and even to walk about, as in pulmonaryconsumption, and in hectic fever from all its causes.
2. The heart and pulmonary artery are sometimesaffected with great morbid excitement, whilethe pulsations of the arteries on the wrists are perfectlynatural.
3. The morbid excitement of the arteries issometimes greater on one side of the body than onthe other. This is obvious in the difference in thenumber and force of the pulsations in