197 
PATHOLOGY. 
For thefe reafons Dr. B. concludes, “ that inflamma¬ 
tion occurs only occafionally in the brain ; that this or- 
jan is liable to inflammation only iri common with the 
other vifcera; and that inflammation is in all the organs 
a fecondary refult of fever, and not its eflential caufe. 
In this view of the fubjeft, all the arguments from ana¬ 
logy between fever and inflammation, which Dr. Clutter- 
buck has brought forward, may be (and indeed muft be) 
admitted ; while, at the lame time, they add no weight 
to his theory: for the analogy is equally favourable to 
the notion of a fecondary as of a primary occurrence of 
inflammation. And we cannot but obferve, before we 
take leave of thefe doCtrines, that the analogies which 
Dr. Clutterbuck has pointed out, as well as the various 
faCts which we have quoted from Riverius, Monro, Bed- 
does, and Lind, fend to confirm the hypothefis of Dar¬ 
win, under which thefe faffs, contradictory as they are, 
to the opinions of Dr. Clutterbuck, are reduced to a 
perfeCt coniiltency.” It may be added, that a doCtrine, 
according molt accurately with that of Dr. Cl. is taught 
by Dr. Ploucquet, in the univerfity of Tubingen. 
Now, (peculating upon this contention between the 
two molt eminent writers on the fever of this country, it 
will appear, that Dr. Ciutterbuck’s hypothefis is neither 
proved by himfelf nor refuted by his antagonift. For, 
fuch is the fympathy between all parts of the body, that, 
if inflammation of the brain be produced, a general in- 
creafed adtion of the heart and arteries occurs, and thofe 
parts predifpofed to inflammation will take on that ac¬ 
tion, or inflammation arifing on other parts will as furely 
difturb the cerebral. The fucceflion of fymptoms does 
not overthrow this theory, becaufe, though the firft 
fymptoms denote diminilhed energy of the brain, fuch a 
(fate is, according to a law before laid down, moll likely 
to be followed by the oppofite Itate. 
To the teltimonyof Lind and others, Dr. Clutterbuck 
objeCts, that we are not acquainted with the appearance 
of abrain perfectly found ; and the changes in that deli¬ 
cate.ItruCture muft often be infcrutable; and bethinks 
that few perfons die without fome morbidity of the brain. 
We are not, however, difpofed to advocate the opi¬ 
nion of Dr. Clutterbuck (principally for the laft objec¬ 
tion, which his anfw'er does not overthrow), but to ihow 
that it is not much afteffed by the arguments in queftion ; 
and we have no hefitation in faying, that, whetheras a caufe 
or a confequence, inflammation of the brain is more gene¬ 
rally found in the fevers of this country than anyotherkind 
of lefion, as indeed we fhould naturally expeCf to find in 
civilized fociety, where the brains of the inhabitants are 
for the molt part in a Itate of unnatural excitation. We 
fltould therefore pay thegreateft attention (atlealt in fe¬ 
vers of this country) to the occurrence of inflammation 
of the brain. 
With refpeCt to the gojiric origin of fever, hinted at by 
Dr. Bateman in the preceding extraft, and which when 
firit promulgated obtained few fupporters; it is remark¬ 
able, that it is now believed in (with fome modification) 
by many of the mod eminent continental pathologifts, 
among the firftof whom is Brouflais. This author con¬ 
ceives that the plague, and all varieties of fever, whe¬ 
ther adynamic, ataxic, typhous, or yellow, are nothing 
elfe than various fpecies of inflammation of the mucous 
membranes of the ftomach and (mail inteftines, differing 
in their degrees of violence, as well from the peculiar 
conftitution of the patient, as thecaufes which may have 
produced them. M. Brouflais terms thefe maladies goj- 
Iro-enttrites, not becaufe he believes that, in all cafes, the 
ftomach and inteftines are irritated in the fame degree, but 
becaufe the affeCtion which commences almoft conftantly 
in the firft of thefe organs is quickly propagated to the 
fecond ; and from the curative indications being the fame, 
whatever may be the part moll violently affecied. He 
endeavours, to point out, from the fymptoms, the princi¬ 
pal feat of irritation in the different llages of the difeafe. 
When it is violent, and has continued for a certain length 
of time, he has conftantly obferved that it has been com¬ 
municated throughout the whole extent of the fuperior 
portion of the digeftive canal. The large inteftines are, 
however, ordinarily free from diforder; and, when they 
are implicated, the particular fymptoms give notice of it 
to the attentive pradlitioner. In proof of this theory, 
Brouflais aflerts that all the modifications of the gnftro - 
enteritis prefent the following fymptoms: lofs of appe¬ 
tite; more or lefs of urgent third; on the centre of the 
tongue a coating, which is variable in thicknefs, denfity, 
and colour; and, about the point and lateral parts of 
that organ, a rednefs that varies in colour from a rofe- 
tint to the moft fiery hue : appearances always noticed 
by authors who have written of fever, but which M. 
Brouflais confidersas moft pcfitive and conftant figns of 
gaftric irritation. The heat of the Ikin being increafed, 
particularly about the abdomen and the epigaftric region, 
and its conveying a fenfation of roughnefs to the hand, 
is generally, according to this author, the effect of irri¬ 
tation of the mucous membrane of the digeftive organs. 
The morbid aCtions, manifelled in the nerves and the 
brain, as depreffion of fpirits, morofity, cephalalgia, even 
the moft profound ftuporand depreffion of the nervous 
power, or, on the contrary, the moft furious delirium, 
are confidered to be the refult of fympathy with the fto¬ 
mach and fmall inteftines ; as alfo the violent and almoft 
infupportable pains in the joints which attend fome 
fevers. 
In examining the moft frequent caufes of febrile dif- 
eales, M. Brouflais thinks we find evidence of exifting 
irritation of the mucous membrane of the ftomach and 
fmall inteftines, becaufe thofe caufes adt, either direCtly 
or indirectly, on the digeftive lyftem. Thus, repeated 
error's of regimen, tire ingeftion of acrid and irritating 
fubftances, the influence of putrid miafmata, &c. appear 
in the firft order ; amongft thofe of the fecond may be 
counted thofe miafmata which, being received into the 
fyftem through the Ikin, or by the refpiratory or digeftive 
organs, always evince their influence on the latter; ex- 
celfive heat of the atmofphere, which excites the Ikin, 
and fympathetically the ftomach and fmall inteftines, &c. 
Moreover, gaftric irritation, as all authors have obferved, 
is very often the precurfor of gnjiritis, in the common 
application of this term, or of gaftric, mucous, and atax¬ 
ic fevers, which fucceed each other in the above order 
in the fame individual. The caufes that produce typhus, 
yellow fever, and plague, fometimes confine their influ¬ 
ence to the determination of a flight degree of gaftric ir¬ 
ritation. In the progreffive increafe of the fymptoms 
which characterize the paflage of the malady from the 
moft trifling to the moft violent form, Brouflais thinks 
it is abfolutely impoflible to obferve any exaCt period at 
which the affeCtion precifely changes in its nature: every 
thing, on the contrary, indicates that it is the fame orga¬ 
nic lefion, acquiring more intenfity, and producing more 
alarming fympathetic affections. He therefore fees no 
reafon which Ihould authorize us to divide the collection 
of fymptoms into two, three, or more, feCtions, and to fay 
that two or three different maladies have fucceeded to 
each other. 
From the efteCts of medicines, which may lead us to 
recognize the nature of difeafes he (till fees further cor¬ 
roboration of the theory in queftion. Having Ihown that „ 
antiphlogiftic meafures are thofe which moft frequently 
fucceed in the maladies of which we treat, anti that, the 
fortunate refults he has obtained from their application 
are beyond any comparifon in extent with the fuccefs that 
has enfued from contrary modes of treatment; he ralhly 
infers, that tonics and ftimulants increafe the febrile com¬ 
motion, becaule they ftimulate the inflamed furface. 
But the ftrongeft evidence of the theory of Brouflais is 
drawn from his numerous dhTeCtions. “ On the termi¬ 
nation of gaftro-enteritis, or of the numerous maladies 
which 
