196 PATHOLOG Y. 
V. 
of fever not being diftinguifhable, on the whole, from 
rbofe which belong to phrenitis, as defcribed by authors. 
7. That the morbid condition of the brain, difcovered 
by difledtion, is fuch as implied previous inflammation. 
“ In the firft place,” fays Dr. Bateman, “ Dr. Clutter- 
buck, like other theorifts enamoured of a favourite doc¬ 
trine, appears to have laid too great itrefs upon thofe 
phenomena which fupport that dodtrine, and to have 
conceded lefs to oppofing fadts than they are entitled to 
claim. Hence, in retracing the delineations of fever, in 
the words of the mod creditable writers, he has diftin- 
guiftied by italics all thofe flgns which indicate derange¬ 
ment of the encephalon, by which they are made to Hand 
the molt prominent features in the pidture. Hence, alfo, 
he has afiumed the pofition, that the derangements of 
the natural and vital fundtions, which are nearly, if not 
altogether, as univerfal concomitants of fever as the dif- 
orders of the animal fundtions, are neverthelefs, in all 
cafes, fecondary fymptoms, originating from the primary 
affedtion of the brain. Thus the naufea, the vomiting, 
the total lofs of appetite and of the digeftive power, are 
believed to be always fympathetic of the affedtion of that 
organ ; fo likewife is the quickened adlion of the heart 
and arteries, and of the refpiration. That this, however, 
is a gratuitous afl’umption, may be fhown, 1. By attending 
to the very hiftories which Dr. Clutterbuck has quoted, 
in which the occurrence of the deranged condition of 
the ftomach is as conftantly mentioned as that of the 
diforder of the encephalon. 2. By obferving, that the 
fympathy between the brain and the ftomach is perfedtly 
reciprocal; fo that the brain fuffers in fympathy with 
the ftomach, not lefs manifeftly than the ftomach with 
the brain. 3. .Byremarking, that the fymptoms of dif- 
ordered ftomach are capable of being relieved or re¬ 
moved, while the fnfipofed caufe (affedtion of the brain) 
remains; the thirft being allayed, and the ficknefs re¬ 
moved, by changing theftate of thefkin only, the former 
by moiftening it with water, the latter by exciting fweat, 
as obferved by Sydenham. Whence Drs. Cullen and 
Darwin feem to be rather juftified in attributing the de¬ 
rangement of the ftomach, when it is affedled fecondarily, 
more frequently to its fympathy with the ftateof thefkin 
than of the brain. 
“Farther, the connexion of many of the leading fymp¬ 
toms with fome diforder of the brain, or common fenfo- 
rium, is admitted by all, and equally favours the hypo- 
thefis of the other authors, as well as that of Dr. Clutter- 
buck ; fince, whether the brain is primarily or feconda¬ 
rily affedled, certain phenomena in the nervous fyftem 
mult neceffarily enfue. We have juft ftated fome rea- 
lons for believing that it is often thus fecondarily affedt- 
ed ; and it now remains to offer our reafons for fuppofing 
that inflammation of the brain, when it does occur in 
fever, (to which we cannot confider it as efl’ential,) is 
commonly fecondary likewife. 
“ The firft fymptoms of the affedtion of the brain are 
by no means thofe which indicate inflammation or un- 
ufual excitement of the fenforium; on the contrary, 
they are fuch as indicate an oppofite Hate, which Dr. 
Cuilen has termed atony and collapfe, and Dr. Darwin 
torpor ; the head-ache itfelf, according to the obfervation 
of Dr. Fordyce, is altogether diftindt from the head-ache 
of inflammatory excitement, or of the hot ftage. Any 
fymptoms that can be interpreted as indications of local 
inflammations, fuch as rednefs of the eyes, protrufion of 
the features, fluftied countenance, throbbing of the arte¬ 
ries, and even delirium, are theappearances belonging to 
a fubfequent period of the fever. But at this fubfequent 
period, inflammatory congcftions are liable to occur in 
the other vifcera, if not fo frequently, at leaft not unfre- 
quently; as in the ftomach, for example, the inteftines, 
the lungs, and other organs. This fadt has been noticed 
by many phyficians of accurate obfervation. Riverius 
long ago remarked, that acute and malignant fevers 
fcarcely ever occur unaccompanied by inflammation in 
fome one of the vifcera; and he has ftated in another 
place in molt diftindt terms, that w f e ought aftiduoufly to 
recoiled!, that all thofe fevers, with which local inflam¬ 
mation is conjoined, are not fymptomatic, but often idio¬ 
pathic, and that the inflammation fupervenes, not being 
the caufe but the confequence of the fever ; quafebrem 
if am non effioit, Jed illi potius fuccedanea rjl. Thus, he 
adds, ‘ We frequently obferve in pradtice, that patients 
labour under continued fever for a day or two before 
pain of the fide and other fymptoms of pleurify appear ; 
thus alfo many perfons on the third or fourth day of fe¬ 
ver fall into inflammation of the brain, &c. Sic nobis 
Jiequenter in vfu pradico vide.re licet agrotuntes, ab initio 
Jebre continua laburantes per unam out alteram diem ante~ 
quam dolor lateris el alia pleuritidis Jigna appurcunt: J'tc 
multi tertia vel quarta febris die in piirenitidem incidunt, 
Sj-c.' (River. Prax. Med. lib. xvii. cap. i.) Dr. Donald 
Monro, vvhofe teftimony on fubjedts of morbid anatomy 
is of conliderable weight with Dr. Clutterbuck, remarks, 
when fpeaking of malignant fever, that ‘ this fever oc- 
cafions in general more or lefs rednefs (I do not know 
that we can properly call it true acute inflammation) of 
the membranes ; and the febrile matter is apt to fall on 
particular parts, and there to create abfcefles, particu¬ 
larly in the brain, the lungs, and the glandular organs." 
(Treatife on Military Hofp. vol. i- p. 237. and Dr. 
Clutterbuck’s Treatife, p. 172.) Obfervations to this ef- 
fedt might beeafily multiplied, and we have already enu¬ 
merated feveral in a former part of this article. It is 
fomewhat Angular, that Dr. Clutterbuck, who quotes 
the remark of Dr. Monro, fhould deem it favourable to 
his hypothefis of excluiive inflammation of the brain ; 
flnce it obvioufly proves an equal liability to inflamma¬ 
tion in other organs, if it proves any thing. Now, it 
mult be admitted, that, if fever depends upon inflam¬ 
mation of the brain, and is merely fymptomatic of fuch 
a ftate, this ftate mull be always prefent, when the fymp¬ 
toms of fever occur; one'clear negative example is lurely 
fatal to the theory. Dr. Beddoes coliedted a confiderable 
quantity of evidence from the hiftories of difledtions, 
made during the prevalence of feveral epidemic levers on 
the continent; from which it is proved, indeed, that 
congeftion, or fome other morbid appearance, was fre¬ 
quently oblerved in the brain or its membranes ; but it 
is alfo Ihowing, that abfcefles, gangrene, or other marks 
of inflammation, were not lefs frequently found in the 
vifcera of the thorax and of the abdomen, especially in 
the ftomach and liver. Thefe fadts we have detailed, 
when fpeaking of the confequences of fatal fevers, as 
difcovered by difledtion ; and it is unneceftary to repeat 
them here. Dr. Beddoes is fairly led (fuppofing the fadts 
accurately reprefented) to this inference, that, in idiopa¬ 
thic fever, the ftomach and contiguous parts have been 
found more conftantly and more deeply affedted with in¬ 
flammation, than the brain and its membranes. (Re- 
fearches, Anatomical and Pradtical, concerning Fever, 
See. by T. Beddoes, M. D. publilhed in 1807.) But, left 
the teftimony of authors of little note may bequeftioned, 
we (hall quote that of one of the molt able and experi¬ 
enced of our hofpital-phyflcians. Dr. Lind of Haflar. 
Speaking of a deftrudtive contagious typhus, which pre¬ 
vailed in the French fleet in 1757, he fays, ‘the fymp¬ 
toms of the fever were the fame as we have already given 
in the defeription of the gaol-diftemper. On difledtion, 
the brain of thofe who died was found perfectly found, 
though during their ficknefs the head had always ieemed 
greatly affedted : in two cafes only, out of twenty which 
were infpedied, the blood-veflels of it appeared a little 
enlarged. The lungs were generally found gorged with 
blood, and feemed to have a gangrenous difpolition. The 
abdomen more immediately luffered by the difeafe, parti¬ 
cularly the liver, ftomach, and inlejlines; in the inteftiries 
there was often found a green offenlive liquor, fometimes 
worms." (See Lind on Fevers and Infections, chap. iv. 
