MEDICINE. 
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be familiar not only to the most unlearned 
of the profession, but well known to the 
, communlt v at large.” (Dr. Bateman.) 
Its application with that of another fact 
immediately to be mentioned, has already 
gone a considerable wav towards the actual 
extermination of febrile contagion. 
.This second feet is, that although infec- 
tious matter be rendered almost immediate- 
ly inert by exposure to the air, it is capable 
of being rendered concentrated, and eve - .] 
transported to an unlimited distance, when 
made to conic in contact with any material, 
even “ a rag or a bit of lint,’ it sffeh ma- 
terial be excluded from the air. From 
these, one should expect unquestionable 
premises, separate receptacles, apartments, 
and houses, have been exclusively devoted 
to the admission of the sick in fever, and, 
as we have just observed, with the most evi- 
dent and extended benefit, particularly to 
the inferior classes of the community. 
The example of fever institutions was set 
to the metropolis by the very active and 
laudable exertions of provincial physicians. 
In Chester, Manchester, Liverpool, Dublin, 
Cork, and other large towns in the British 
isles, the plan of thus separating the infec- 
tious fevers from other diseases, had al- 
ready been adopted, and at length an es- 
tablishment of this kind was founded in 
Gray’s-inn-lane, in London, and with the 
happiest effects. Among the internal regu- 
lations of these houses, the following are the 
most important ; — they have been adopted 
in th e fever wards of common hospitals, and 
apply in a general manner to private practice. 
Every patient when admitted into the 
bouse, is to change his infections for clean 
linen ; the face and hands are to be washed 
clean with warm water, and the lower ex- 
tremities fomented. “ The effect which 
this salutary change has upon the patient be- 
fore any medicine is given, is otten more 
beneficial than those which all the febrifuge 
drugs in the world could bestow.” All dis- 
charges are to be speedily removed. The 
iloors of the sick room are to be washed 
twice a week, and near the beds every day. 
The clothes which the patient brings with 
him are to be carefully purified by washing 
the linen, and exposure for a length of time 
of the other habiliments to pure air. 
Blankets and other bed-clothes are to be 
exposed to the open and fresh air before 
they are used by another patient. Several 
windows of the apartment to be constantly 
opened in the day, unless the weather is 
very cold and wet ; and some of them should 
not be shut in the night, if the patients are 
numerous, and the weather moderate. 
By a due enforcement of these regulations, 
the necessity in general may be obviated of 
employing the acid fumigations recommend- 
ed by Morveau, Carmichael Smith, and 
others, which have been ingeniously, and 
we think justly, imagined to operate upon the 
same principles with atmospheric or pure air, 
viz. by oxidating, and thus destroying the 
virulence of the contagious effluvia. 
By cleanliness then, and procuring a free 
circulation of air, by guarding against the 
lodgment of contagious matter, and by 
keeping as much as possible from actual con- 
tact with the sick in fever, every cause is ob- 
viated from which infection can be commu- 
nicated. The individual who resides in the 
house adjoining to a fever institution is equal- 
ly out of the sphere of contagious influence 
with one at fifty miles distance ; nay, in the 
contiguous apartment, and even in the sick 
room itself, the immunity is precisely the 
same : such are the preventive as well as 
the sanative effects of cleanliness and venti- 
lation, which, whether in sickness or in 
health, cannot be too highly appreciated, o. 
loo extensively adopted. 
Order II. — Phlegmasia', Inllammations. 
When any part of the body has an unusual 
beat and redness, with pain and swelling, it 
is said to be inflamed. To constitute this 
state of a part, an inordinate action and di- 
latation of vessels have generally been es- 
teemed sufficient. Such opinion, however, 
lias been questioned by the author of Zoono- 
mia. “ Inflammation,” says Dr. Darwin, 
“ is uniformly attended with the production 
or secretion of new fibres, constituting new 
vessels; this, therefore, may be esteemed its 
essential character, or the criterion of its 
existence. The extension of the old vessels 
seems rather a consequence than a cause of 
the germination or pullulation of these new 7 
ones ; for the old vessels may be enlarged 
and excited with unusual energy, without 
any production of new ones, as in the blush 
of shame or of anger.” On the contrary, 
however, we are disposed to regard the for- 
mation of new vessels, which does not per- 
haps take place in every case even of genu- 
ine inflammation, to be subsequent to, and 
not the occasion of, capillary dilatation. The 
case which Dr. Darwin puts in opposition to 
this theory is not in point. It is permanent 
and forcible, not transient and slight, exten- 
sion of blood vessels, which constitutes the in- 
flamed state. 'Fhe eye may be exposed to 
a vivid light, its vessels consequently act 
with more than ordinary excitement, and 
this to a certain extent without actual in- 
flammation; but if such excitation be ex- 
tended beyond a certain point, the small 
vessels of the organ shall be deprived of their 
proper resistance, and thus shall not merely 
transmit a more than due quantity of blood, 
but such blood shall in a manner become 
congested in their vessels, and shall cause 
pain, unusual redness, heat, and tumour. 
This induced weakness of the capillaries, 
ought then, perhaps, according to the opinion 
of some modern physiologists, to be regard- 
ed as the proximate cause of inflammation ; 
the too great or too little excitement on 
which it may have depended the remote cause; 
and the increased action of the larger 
vessels of the part, the proximate effect. 
The augmented action, if considerable, is ac- 
companied by an irritation of the whole 
system ; such irritation constitutes the “ sen- 
sitive irritated fever” of Dr. Darwin, which 
is distinguished from simple, or what we have 
considered genuine fever, by its being a se- 
quente of local affection. 
Sthenic and asthenic inflammation. The 
disturbance of the system does not correspond 
more with the magnitude of the local disor- 
der, than with the constitutional character 
of the individual affected. Of two persons 
that are the subjects of inflammation, as of 
the mucous membrane of the nostrils, consti- 
tuting inflammatory catarrh, or a cold ; of the 
pulmonary vessels, occasioning inflammation 
of the lungs ; or of the joints, forming rheu- 
matism ; one shall previously have possessed 
much constitutional vigour, the other shall ‘ 
have been languid and feeble — the former 
will have a sthenic, the latter an asthenic 
disease. This distinction in practice will be 
found of immeasurable importance. It was 
first distinctly pointed out by Dr. Brown. 
We believe, however, that this author was 
mistaken in the mode in which the inflamma- 
tion of a part, and the disorder of the sys- 
tem, are connected ; fur the purpose of con- 
firming his favourite tenet of sthenic and 
asthenic disorder, he laboured to prove that 
the systematic in many cases of inflamma- 
tion actually preceded the local disease 
— this is not the case. Even in the most vio- 
lent forms of pneumofiia, the disorder of 
the lungs precedes that of the system ; and 
indeed sthenic disorder, independanlly of lo- 
cal irritation, is in some measure a contra- 
diction in terms. High excitement, to what- 
ever extent it may be carried, while there is 
no irregularity or want of balance in any of 
the corporeal or mental functions, and no 
affection of a part, cannot be properly re- 
garded as a disease, however it may pre- 
dispose to the diseased state. 
Termination of inflammation. Inflamma- 
tion is said to be resolved when the natural 
state and action of parts are renewed with- 
out disorganization. If, however, the in- 
flammation has existed for any time, or 
has been violent, an unnatural secre- 
tion takes place from the vessels inflamed, 
which is called pus ; this when collected or 
confined, constitutes abscess, and when the 
inflammation ends in this manner, it is said 
to terminate by suppuration.. In cases of 
much weakness, constitutional or induced, 
the vascular action in the part shall cease 
altogether, its excitability be irrecoverably 
exhausted, and what in scholastic language 
is termed gangrene be the consequence, 
which extending, shall form sphacelus, or 
mortification. Resolution, suppuration, gan- 
grene, are therefore the usual modes in 
which inflammation terminates. There are 
others, however, which are peculiar to cer- 
tain parts; tints, an inflammation of the lungs 
often ends fatally by a copious effusion of 
a watery matter into the cellular texture of 
these organs ; thus, an inflammation of 3. 
gland shall end in schirrus, or hardness of 
the parts, depending perhaps upon the depo- 
sition of matter which remains unabsorbed. 
Species of inflammation. T his disorder 
is systematically divided into two leading 
species — phlegmonous and erytliematic. The 
first is defined by Dr. Cullen, “ an inflam- 
mation of a bright-red colour, with a circum- 
scribed pointed tumour, and tending to- 
wards suppuration.” The erythema has a 
less vivid colour, with scarcely any tumour, 
spreading irregularly, burning rather than 
throbbing pain, and terminating in vesicles. 
These species are principally established 
by the difference of part upon which the in- 
flammation may happen to fall. Thus if the 
disorder be seated superficially, or in any 
internal part where there is an uninterrupt- 
ed expansive or cellular texture, it will be 
erytliematic or spreading ; if it be more 
deeply lodged among muscular substance, 
it will be for the most part phlegmonic. 
Indications of the disorder’s decline. It 
scarcely requires to be observed, that a cessa- 
tion of pain, a reduction of tumor, a loss of 
redness and heat, a diminution of the syste- 
matic disturbance, are all evidences that the 
inflammation is about to terminate. It, ho»> 
