TYPHOID PNEUMONIA. 117 



Frequently the pulmonary symptoms yield suddenly, and a metastasis occurs ; 

 and this is another argument in favor of my opinion that tiiis disease consists ia 

 irritation and irritability, aflectinif the nervous system continuously with its ex- 

 istence. 



I remember one case in which the pulmonary irritation was very great for two 

 days, with much pain and difficulty of breathing; suddenly a most intense pain, 

 with great leiiderncss, attacked the peritoneal covering of the liver, and the cough 

 and pain in the chest ceased. Five grains of calomel, twice repeated, followed 

 by oil, gave relief, and no farther difficulty occurred — the girl convalesced di- 

 rectly. 



Where metastasis occurs to the bowels, and hemorrhage results, the discharge 

 is critical ; when to the peritoneum, it is usually fatal ; when to the brain, it al- 

 most invariably terminates in efl'usijn. If nmch depletion is used in the treat- 

 ment, the liability to metastasis is much increased, especially to the brain. 



The cases require to be carefully watched, as they, vary much in their course, 

 although the primary symptoms are similar, and usually yield to the general 

 treatment. ' 



On two occasions, where the pulmonary symptoms subsided, and metastasis to 

 the brain took place, with great congestion, I opened the temporal arteries, with 

 temporary relief, but deatii by effusion followed soon after in both. The conges- 

 tion was, no doubt, venous from weakness in the brain, and not arterial, which 

 is connected with high action. 



I do not think the distinction is sufficiently noticed between congestion and in- 

 flammation ; in the former condition, the distension of the veins, Avith symptoms- 

 of diminished sensibility in the nervous energy of the organ, is the predominant 

 symptom ; in the latter, accelerated arterial action, with increased sensibility, is 

 apparent. If the venous congestion is but temporary, and the nervous energy 

 not much depressed, active inflammation occurs, when by reaction an eiTort is- 

 made by the arteries to repair the effects of the temporary delay of the circulation 

 in the veins. If the nervous energy is free and cumulative, strong inflammation; 

 is the result. If congestion from a debilitating cause has occurred, and has re- 

 mained long enough to oppress still more the vital energy of the affected organ,, 

 the weakened power of the arteries, when they receive the transfer of the load 

 which reaction throws oft" from the veins, is such as to induce only a sub-acute 

 inflammation in the organ. This state is removable by diffusion, diaphoresis an'l 

 revulsion, at the same time that the nervous energy is restored, so as to prevent 

 again the recurrence of the congestion, which would arise from its deficiency. 



With the aid of nervous power, the arterial system repairs most of the injuries 

 to the organs ; if that is strong, too much action is developed by the arteries ia 

 this function ; if they have but little aid from it, their effort soon ceases, they 

 become rapidly exhausted, and effusion results. A proper balance can only be 

 restored to the circulation by the regular renewal of the accustomed supply of 

 nervous power. 



That this disease may and does assume a different form, requiring different 

 treatment, in other localities, I would not presume to deny ; but here, where I 

 have been familiar with it for a long time, and had extensive opportunities of 

 studying its phenomena, I am satisfied that facts will bear me out in my opin- 

 ion of its character. The type of this disease is tliat o[ adyiiafnin ; but, with a 

 debilitated nervous system, local inflammation of a sub-acute character arises in 

 congested orirans : and it is all-important to remove the latter condition by such 

 means as will not only not reduce the former, but support it. The s\miptoms in 

 the attack are often such as would indicate depletion as necessary — such as pain 

 in the head, giddiness, lethargy. Sec. — but, 



" Vascular energy is wholly derived from the nervous system. If, by any 

 means, the nerves destined to supply any vessel or set of vessels with this energy 

 become debilitated or destroyed, then these vessels cease to be capable of duly 

 performing the function of propelling the fluids to and from the heart ; and there- 

 fore it inevitably follows that turgescence, more or less severe, takes place, and 

 results in disease, depending on the organ affected for its particular character. — • 

 Thus a sudden, temporary suspension of nervous energy in the vessels of the 

 brain, rendering them for the moment incapable of propelling forward the blood, 

 may occasion giddiness, dimness or distortion of vision, &;c. ; and, if these symp- 

 toms are neglected, this temporary becomes a lasting loss of energy, producuig 



