44 
ON PUERPERAL FEVER. 
This difference in combination gives rise, in my opinion, to the 
variations we observe in the form of the disease as affecting differ- 
ent animals. Whether the energies of life are depressed only to 
an extent sufficient partially to overwhelm the powers of volition, 
in organs most remote and least under the influence of the primum 
mobile ; or, acting in a still greater degree, impair the already 
weakened state of organic nervous power — interfering with the 
various functions over which they preside ; or whether, from the 
extension and degree of existing morbid action in the ganglial 
and vascular systems, prominent affection of the cerebro-spinal 
nervous system is produced, still the disease holds the same in 
relation to its kind , only differing in degree. 
I conceive it most probable, that all these varying states and 
forms of morbid or diseased action can be assigned to have their 
origin in a deranged state of the spinal organic nerves. 
Viewed in its most fearful form, with prominent affection of the 
cerebral organs, attended with delirium, succeeded by insensibility 
and coma, and by death supervening, we can trace the effects, the 
ravages of disease ; but in searching for a cause we are lost. 
Why is this? Had we not present during life morbid excitement 
of the vascular system co-existent with depressed organic nervous 
tone — tone whence the heart derived its power — that power with- 
drawn, and the heart still continuing to propel the vitiated fluid of 
life along channels whose walls are no longer interlaced with the 
active “ principle of life” — filaments from the neighbouring plexuses 
of nerves destined to accompany them, depri ved of their integral 
power (but I will not, for I dare not, say that the blood is thus de- 
prived of the “ principle of life”), and urged on without guidance. 
But too true it is, that this morbid excitement gives rise to inflam- 
mation — asthenic inflammation — of the cerebro-spinal nervous 
tracts and their meninges. In one word, then, I consider these le- 
sions as the ejfect of the disease ; the immediate predisposing cause 
is derangement of the “ organic motor nerves,” and peculiarity of 
constitution ; and the more remote cause, any thing that tends to 
weaken the cohesion existing between life and structure. 
Treatment . — Much discrepancy in opinion here exists among 
practitioners as to the propriety of blood-letting, and which evi- 
dently proceeds from inattention to the existing state of the vas- 
cular and nervous systems; little regard appearing to be paid to 
the all-important fact of excitement in the one and depression 
in the other being able to co-exist, and both being at the same 
time of an asthenic character. During this state of delusion, occur- 
ring after invasion, during collapse, and before re-action has taken 
place, or when predominant affection of the brain exists, with 
coma threatening or already supervening, blood-letting is had re- 
