195 
PATHOLOGY. 
lymph comprefles out an unufu.il quantity of ferum 
from it, and the furface of the Jizy blood, as it is fre¬ 
quently called, is often formed into a hollow, the edges 
being drawn inwards. Thefe changes in the blood are, 
in fome cafes, a more infallible proof of the exiftence of 
inflammation than the pulfe itfelf. In peritoneal inflam¬ 
mation, the patient fometimes fee ms to be in the mod 
feeble (late, and the pulfe, abftraftedly confidered, would 
rather induce the pra&itioner to employ tonics and fti- 
tnulants than evacuations ; but, ftiould the continuance 
or exafperation of the diforder, or any other reafon, lead 
the furgeon to ule the lancet, then the huffy coat, the con¬ 
cave jurfuce of the blood, and the large quantity of J'erum, 
clear away all doubt concerning the exiftence of inflam¬ 
mation. It is important, therefore, always to infpeft the 
blood after it is cooled, with a view to the detection of 
this unnatural ftate. But every pra&itioner ought to 
hear in mind, that, in pregnant women, and in a few 
anomalous conftitutions, the blood, taken away by the 
lancet, always exhibits the foregoing peculiarities, though 
inflammation may not prevail. 
The above alteration in the quality of the blood has 
never been accounted for. As it is only obfervable in 
conftitutions where fome fource of nervous irritation is 
prefent, we fliould be inclined to refer its appearance to 
that irritation. We fliall hereafter have occafion to (how 
how important a part nervous excitement plays in deve¬ 
loping the phenomena of fever; and it is to be remarked, 
that, while inflammation is merely local, no change 
takes place in the ftate of blood in general; but no 
l'ooner has fever become eftablilhed, than the blood exhi¬ 
bits the buffy coat. Now, in the inftance of pregnancy, 
it will be allowed on all hands, that the gravid uterus is 
a perpetual fource of nervous irritation to molt females; 
and it has been remarked, that thofe anomalous confti¬ 
tutions in whom this appearance has been always met 
with have been perfons who exhibited excefllve fenfibility 
in the nervous fyftem, or were, in other words, of the 
nervous temperament. 
' The aftion of the nervous fyftem may produce this 
change in the blood by the difproportionate evacuation 
of the elements of the blood, as in excefllve fecretion, 
or by the undue retention of fome of thefe parts ; both 
of thefe difturbances being of courfe effected by the ac¬ 
tion of the nerves on the l’ecreting veffels. The prefent 
ftate of our knowledge does not permit us, however, to 
(how in what ftruftures this conjectured deprivation or re¬ 
tention is effefted. 
In confidering the next general fymptom of inflamma¬ 
tion, fever, we fliall enter into a full account of the febrile 
ftate, both idiopathic and arifing from this a£tion, or, as 
it is termed by furgeons, fymptomatic fever. We have 
gone fo far into the fubje< 5 t of inflammation, becaufe it 
was neceflary to the right underftanding of the febrile 
phenomena we have next to explain. Thefe general 
views having been taken, we fliall trace the various forms 
inflammation exhibits in the different ftrudlures, and the 
different changes in fecretion which accompany it, when 
('peaking of Phlogotica, the fecond order of this clafs. 
It is generally allowed that no general definition of 
fever, capable of embracing all its varieties, has been 
given. A general alteration is found in the organic, 
oftentimes in the animal, funftions, the former fuffering 
the firft changes. The fanguineous and mufcular fyf- 
tems are aifo altered ; and, when the difeafe is eftablifhed, 
all the functions feetn impeded together. This ftatement, 
that fever confifts in an alteration folely of almoft all the 
fun&ions of the body, is, it mull be confefled, extremely 
vague; yet it is the only one which will embrace all the 
varieties of fever; for cafes are recorded where the heat 
was not exalted without the pulfe being fenfibly aug¬ 
mented, and vice-verfa ; and fo on of every other func¬ 
tion. 
VOL. XIX. No. i*97. 
Order I. Pyrectica, [wvpelos,Gr. fromwup,fire.] Fevers. 
Here we have the heat and number of the pulfe preter- 
naturally augmented; ufually preceded by rigor, and 
followed by perforation; pains fixed and wandering; 
laflitude, debility of mind and of the voluntary mulcles. 
In our introduction we have mentioned fome of the 
snoft remarkable opinions as to the effential nature of fe¬ 
ver. The fpeculations of Brown and Darwin were no¬ 
ticed 1 and many havearifen fince; but there are few which 
we now deem worth detailing. The firft which, from the 
ftrong faffs by which it is fupported, is deferving of no- 
tice, is the theory of Dr. Clutterbuck. We fliall copy 
from the article Fever of Dr. Rees’s Cyclopaedia, Dr. 
Bateman’s (this gentleman being underftood to be the 
writer of that article) expofition of Dr. Clutterbuck’s 
theory, and his luminous objections; referving our own 
remarks for the end of it. 
Dr. Clutterbuck’’s Theory. —Fever has ufually been called 
a general difeafe, affefling all the functions, in contra- 
diltinCtion from local difeafes, in which fome particular 
organ is the primary feat of the diforder, and the affec¬ 
tions of the other functions are fecondary or fymptom¬ 
atic. But Dr. Clutterbuck denies the exiftence of ge¬ 
neral difeafe, and maintains that all general or extenfive 
derangement of the animal fyftem is referrible to local 
derangement in fome one organ. The organ univerfally 
affeCted in all the varieties of idiopathic fever; which 
differ but in degree, as well as in thofe which arife from 
fpecific contagion, as malignant fore throat, fcarlet fe¬ 
ver, fmall pox, See. is, in the author’s opinion, the brain . 
This is manifeft, he contends, from the fymptoms, as 
the head-ache, the depreflion of ftrength, and other de¬ 
rangement of the animal functions, the delirium, the 
tremors, failure of vifion, See. It is manifeft from the 
nature of the remote caufes which 'aft chiefly on the 
brain and nervous fyftem, as intoxication, fear, grief, and 
other paffions, external irritation, not to mention nmf- 
mata and contagion, of the operation of which we are 
ignorant; as well as from the predifpofing caufes, which 
probably confift in a deficiency of fenfibility, as in idiots, 
negroes, old people, and infants’, but it is more particu¬ 
larly manifeft from the confequences of fever, whether 
after recovery, or after death, afeertained in the latter 
cafe by diffeCrion. Among the confequences of fever, 
which are not uncommon after recovery, are an impaired 
condition of the fenfes 5 fuch as deafnefs, imperfeCt vi¬ 
fion, depraved tafte ; paralytic affeClions, or convulfive 
complaints, as epilepfy and chorea ; derangement or lofs 
of the mental powers, fuch as melancholy, great irrita¬ 
bility of mind, lofs of memory, or even complete fatuity. 
The confequences obferved on difleflion, after death 
occafioned by fever, are frequently vifible difeafe of the 
brain, of which feveral examples are quoted by the au¬ 
thor. He then proceeds to (how, that the local affection 
of the brain, thus manifeft, is in fafl inflammation of that 
organ ; or that fever, therefore, “ is nothing lefs than a 
fpecies of phrenitis, or topical inflammation of the 
brain,” and (hould be arranged in the order of Phlegma- 
fia, with pleurify,enteritis, and other fymptomatic fevers: 
but, as Phrenitis has been generally applied to a particu¬ 
lar form of inflammation of the brain, and implies deli¬ 
rium, which does not always occur in fever, although 
it is a frequent fymptom. Dr. Clutterbuck propofes the 
term Encephalitis as the denomination for fever. The 
arguments adduced in proof of the notion that the topi¬ 
cal affedlion of the brain, in fever, is inflammation, are, 
1. The analogy between the fymptoms of fever and thofe 
of inflammation, viz. pain, heat, throbbing, acute fenfi¬ 
bility, &c. being common to both. a. The occafional 
buff of the blood in both. 3. The fimilarity of feveral 
of the exciting caufes of both. 4. The occafional alter¬ 
nation of fever with inflammation. 5. The analogy in 
regard to the cure of the two difeafes generally, as by 
means of blood-letting, vomiting, fweating, purging, 
bli lie ring, and the application of cold. 6. The fymptoms 
3 E ©f 
