4-74 PRACTICE OF PHYSIC. 



or effusion of the halitus that is constantly thrown into the 

 cavity of the abdomen. This we may trace to some resist- 

 ance to the motion of the blood in the veins of the abdomen, 

 which may have for its cause a congestion of blood in the liver, 

 arising, again, from a suppression of the haemorrhoidal flux ; and 

 this, lastly, may have been produced by the external applica- 

 tion of cold. Every link of this chain, again, may be said to 

 be a cause of the ascites, some links being more immediate, and 

 others more remote ; yet physicians would, in this case, con- 

 sider only the cold applied as the remote cause, and the sup- 

 pression of the haemorrhoidal flux, the congestion of blood in 

 the liver, &c. as parts of the proximate cause. 



" A scientific practice of medicine is founded upon the know- 

 ledge of the indications) of the changes to be produced in 

 the body in order to cure a disease : whatever gives this in- 

 dication is a part of the proximate cause ; whether there be 

 a series of causes and effects, or whether they act concurrent- 

 ly at the same time, if they continue to operate, and have a 

 share in the effects observed, they are all considered as the 

 proximate cause. It is often very difficult to assign the limits 

 between remote and proximate causes. A remote cause may 

 continue to form a part of the proximate cause : thus the splin- 

 ter which I formerly mentioned, may strike a man's body, 

 and then be still fixed in the body, so as not to be easily 

 extracted ; and so long as it continues to be an irritant, and 

 prevents the healing of the wound, it is to be considered as 

 a part of the proximate cause, A plethora also is common- 

 ly considered, and may be considered as the remote cause of 

 a haemorrhagy that afterwards arises ; but whenever that ple- 

 thora continues, it is to be considered as a part of the proxi- 

 mate cause of such haemorrhagy. The only good definition 

 of a proximate cause, is that given by Boerhaave, (Institut. 

 . 7^0.) ' Causa proxima morbi appellatur, totajlla simul 

 quae totum jam praesentem directe constituit ; hnec semper est 

 integra, sufficiens, praesens, totius morbi, sive simplex fuerit, 

 sive composita. Hujus praesentia ponit, continuat morbum. 

 Hujus absentia eum tollit.' He adds, ' Est fere eadem res 

 ipsi integro morbo ;' and indeed this definition of the proximate 



