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Local. Here Dr., Clutterbuck contends that there is no
“ A disease can only in strictness be termed general or universal”
Every one of the exciting powers always affects some part
The same reasoning is applicable to the morbific agents. “ The affected part is generally that to which any of the powers is directly applied.” Still we are of opinion, that the division of diseases into general and local is useful in practice, that we may not, as Dr. Clutterbuek observes, .be employed merely in the palliation of symptoms, but in endeavouring to remove their causes, wherever this is practicable.”
In the second chapter, Dr. Clutterbuck endeavours to assign the primary seat of fever in the body. In doing this, he examines the various phenomena of the disease— traces their order of occurrence, and their dependence on one another and on the exciting causes -- in order to show that the brain is the true seat of morbid affection in fever, and the source of all the symptoms which essentially belong to this disease, and which serve to distinguish it from other diseases. This opinion,, he thinks, will be confirmed by the consideration of the remote causes that, induce fever, and of the particular circumstances which seem to predispose
The third chapter is devoted to the consideration of the nature of fever. Here the author lays down his fundamental doctrine - "that the disorder of the brain, which takes place in fever, is either a state of actual inflammation, or at least a condition nearly allied to it.” This he endeavours to prove by a reference to the phenomena and causes of the disease, the effects of remedies, and the appearances on dissection.
We readily agree with our author, that “in fevers the functions of the brain are greatly deranged, and that many of the most formidable symptoms of the disease may be referred directly to this source.” But we cannot decidedly admit that this cerebral derangement is founded on inflammation, or that it is the proximate cause of fever, upon which the symptoms immediately depend.
Dr. Clutterbuck distributes the occasional causes of fever into three classes : -- First, those which act through the medium of the mind, as the mental passions and emotions; secondly, those which may be supposed to act by irritation, as cold, irritating, and indigestible matters in the prime vie, teething in infants, wounds, inflammation, &c.; and thirdly, such as are capable of assuming an independent material form, as the different contagions, marsh miasmata, putrid effluvia, &c.
may either be supposed," says our author, “.to act on the extremities of the nerves, to which they are at first applied, or to be taken into the system by absorption, producing their effect by direct application to the brain itself, or its vessels." P. 116.
In our author's opinion, however, there is no necessity for supposing infectious matters to be absorbed.
They may act on the brain through the medium of the mouth,
be supposed to act by irritation, as cold, irritating, and indigestible matters in the prime vie, teething in infants, &c.” on the sentient extremities of nerves."
In short, neither these causes nor "infectious matters” haye any di
in other cases the inhalation of carbonic acid gas, and of
rect operation, either on the brain itself or its vessels; and therefore it is difficult to conceive how they can produce inflammation in that organ,
Those occasional causes, however, “ which act through the medium of the mind, as the mental passions and emotions," certainly exert their energy directly and primarily on the brain. But while they operate thus, do they leave
the brain unchanged, and produce inflammation in its 1 vessels? We should rather suppose that they derange the
brain in the first instance; and that inflammation, if it really takes place, is a secondary effect of their operation.
" It is certain," indeed, " that the condition of the brain may be very powerfully and suddenly influenced by applications to remote parts of the body. Thus fainting, or a total loss of sense, is often instantaneously induced by the action of certain odours and effluvia on the organ of smell; while it may be as suddenly again removed by applications of a different kind.
“ Alcohol, opium, laurel-water, and some other vegetable poisons, kill almost instantaneously when taken into the stomach in Jarge quantities; and the bites of certain venomous reptiles prove fatal almost as soon as inflicted. Opium destroys the energy of the brain, inducing general paralysis by being thrown into the cavity of the abdomen; in frogs nearly as soon when the heart is removed, as when the animal is entire. The effect in this case must be produced through the intervention of nerves.
" The surfaces on which the nerves of the organs of sense are expanded, are more especially susceptible of external impressions ; and, when stimulated, more powerfully influence the state of the brain than other parts that are less plentifully furnished with nerves. It appears, from the experiments of the late illustrious Dr. Black, that carbonic acid gas kills. more speedily if inhaled through the nostrils, than if taken immediately into the lungs through the mouth only. I discovered,' he says, that this particular kind of air, • attracted by alkaline substances, is deadly to all animals that
breathe it by the mouth and nostrils together; but if the nostrils were kept shut, I was led to think that it might be breathed with
safety. I found, for example, that when sparrows died in it in ten • or twelve seconds, they would live in it for three or four minutes · when the nostrils were shut by melted suet.' This seems to show that the olfactory nerves are more susceptible of impression than those distributed on the surface of the bronchia and lungs, and is what, indeed, might have been expected to take place, considering the abundance of nerves with which all the organs of sense are supplied, and their proximity to and immediate dependence on the brain.
various other noxious effluvia, produces instant head-ach in many persons attended with a violent throbbing of the vessels of the head. * A phrénzy or delirium,' says Dr. Lind, is often the first and im
i mediate effect of a bad air.' Some of the gases, when inspired in a highly concentrated state, kill almost instantaneously before they could possibly have found their way into the general circulation. And it has often been observed, when the plague has been raging with great violence, that persons exposed to the contagion have dropped down suddenly, as if struck by lightning, and have died in, a short time." P. 117.
“ These instances sufficiently prove,” says Dr. Clutterbuck, “ that different noxious effluvia can exert their full action on the system without being taken into the mass of blood.” Granted : But do they prove that "certain odours and effluvia, alcohol, opium, laurel-water, and some other vegetable poisons, carbonic acid gas, or the contagion of the plague," produce either immediate disease or instantaneous death, by first inducing an inflammation in the brain ? It is plain that all these powers operate directly and primarily on the sentient extremities of the nerves. It is equally plain that most, if not the whole, of the exciting causes of fever operate also upon
the nervous system; and therefore, whatever may be their secondary or ultimate effects, that system must be primarily deranged. On these grounds we conclude, that the proximate cause of fever is to be sought, not in the sanguiferous but in the nervous system, and that if inflammation does actually take place in the brain, in fever, it is an effect of this sensorial derangement, like all the other symptoms.
Hitherto, the arguments which Dr. Clutterbuck has advanced, in support of the opinion that fever consists essentially in a topical inflammation of the brain, have been derived principally from analogy, and an investigation of the phenomena of the disease in relation to the peculiar functions of that
organ. He now attempts to come closer to his subject, and in the ninth section of this same chapter brings forward the evidence of dissection in support of his doctrine. Here, however, he finds it necessary to make a sort of compromise of the matter.
" It might naturally be expected,” says he, “that dissection of the bodies of those, in whom the disease had proved fatal, would remove all doubt from the subject;' and at once either satisfactorily establish or overthrow the opinion in question. But although much light is undoubtedly to be derived from this source, and we shall find in fact that every support is afforded to the supposition that could reasonably have been looked fo yet the evidence furnished by dissection is not absolutely conclusive, and that for different reasons."
Having stated these reasons, Dr. Clutterbuck adduces instances from Bonetus, Morgagni, Lieutaud, Werlhoff, Haller, Sir John Pringle, Dr. D. Monro, Vogel, Drs. Baillie, Jackson, &c. to prove that fevers of all descriptions very frequently leave behind them visible topical affections of the brain, demonstrating the existence of previous inflammation in that organ.
“ It is not, however, to be imagined,” says he, “that the ap-
“ That the symptoms of fever are the symptoms of inflamed brain, and that the latter is the immediate cause of the former; or rather that fever and inflammation of the brain are identical affections."! P. 178.
Upon the whole, we conclude with Dr. Fordyce, that what the real derangement in the system is which produces the external appearances in fever, is not at all known--it is a disease, the essence of which is not understood.” We have referred it, however, to a primary derangement of the nervous system; and this we think we are warranted to do from a review of the nature of its exciting causes, and their mode of operation.
In the fourth chapter, Dr. Clutterbuck brings forward the diagnosis of fever in conformity to his general doctrinem" topical affection of the brain founded in inflammation ; in a word, as a variety of phrenitis.". The term phrenitis, however, he considers to be objectionable, as expressive of delirium or alienation of mind; which, though a