V 
PATHOLOGY. 
108 
which reprefent the different degrees of that affe&ion, 
we always find the-confequences of inflammation of the 
digeftive canal; but the afpedl and nature of thefe re¬ 
mains of organic irritation prefent feveral varieties, the 
knowledge of which is of confiderable importance. 
When the difeafe has been but of Ihort duration, we 
fometimes find the tunics of the ftomach and inteftines 
injected with blood, and prefenting throughout their 
whole extent, even on their external furface, a rofe-co- 
loured hue that is not natural to them, without difcover- 
ing manifeft inflammation of any determined portion of 
the mucous membrane. This Ihows that thefe organs 
have been the feat of irritation that has occafioned an in¬ 
ordinate afflux of blood to thofe parts, but that inflam¬ 
mation had not developed itfelf. We may compare this 
ftate to that of apoplexy, where the veffels of the brain 
are found diftended with blood, without any eft'ufion 
having taken place. It would not, however, be right to 
reprefent to ourfelves the mucous membrane as little co¬ 
loured with blood during life as we may find it after 
death : the tongue is very often of a bright red colour in 
the patient, but becomes pale and dilcoloured in the 
dead body. It feems that irritation mull have conti¬ 
nued for a confiderable length of time to render the co¬ 
lour of the parts permanent after death ; that is to fay, 
to combine a certain quantity of the red fluid with their 
tifl'ue.” 
In general, whatever may have been the diforder ob- 
ferved in the fuperior parts of the inleftinal canal, the 
inferior portion (that is, the large inteftines) is unaf¬ 
fected. But, when gaftro-enteritis has been accompa¬ 
nied with diarrhoea or dyfentery, we find traces of inflam¬ 
mation of the latter parts alfo ; this extent and compli¬ 
cation of organic lefion conllitutes the epidemic dyfen¬ 
tery. 
A theory fimilar to this has much obtained in Ame¬ 
rica. Dr. Chapman, profellor of medicine in the univer- 
lity of Pennfylvania, (in his Elements of Therapeutics,) 
Hates, that “ fever, whatever may be the caufe, is always 
a difeafe of fympalhy, having the primary link of its ulti¬ 
mately lengthened and complex chain in the ftomach. It 
is upon this organ that contagion, marlh-effluvia, and 
other noxious matters; aft ; and hence, precifely as in 
the cafes of poifon, a local irritation at firlt occurs, 
which, if not at once arrelted, fpreads itfelf, by multi¬ 
plying the trains of morbid aflociation, till the difeafe 
becomes general, involving more or lefs every part of the 
animal economy.” 
Dr. Harrifon (in the Gulftonian Lefture for the year 
1820) has adopted a theory identical with that of Brouf- 
I'ais. He fays, “ Fever I confider to be a derangement 
of certain funftionsof the body, dependant on irritation 
of fome particular part, which becomes a caufe of dif- 
turbance to the reft of the fyftem by means of the fym- 
pathy exiftingbetween its feveral organs. But irritation 
of any part will not give rife to fever; and it appears, 
that it is irritation of one organ folely that will produce 
this eft'eft, and that organ is the mucous membrane. The 
funftions deranged in fever are thofe of the fecretory or¬ 
gans : hence the morbid ftate of the fecreted fluids, and 
the alteration of the temperature of the body. From 
the derangement of thefe funftions arife all the effential 
phenomena of fever. The increafed frequency of the 
aftion of the heart and arteries, and the dijlurbunce of the 
intellects, which ordinarily accompany it, are accidental 
phenomena, and are not neceflary in order to conftitute 
fever. The intellefts are often not difordered ; and we 
not unfrequently obferve typhous fever run its whole 
courfe without any increafed frequency of the pulfe. 
“ Difturbance of the funftions of the brain is a gene¬ 
ral attendant on all fevere febrile.diforders, and, as it is 
here (hown, is an effeft of the local difeafe already de- 
feribed ; the delirium being in a dire .61 ratio with the in¬ 
flammation of the mucous membranes; as indicated by 
4 
the inflamed conjunftiva, and other evidences of tins 
ftate.” Dr. H. likewife afferts, that the moft ftrongly 
marked cafes of inflammation of the mucous membrane 
of the ftomach often commence'in this way. The pa¬ 
tient at firll fuffers an inordinate craving for food, which 
is not immediately removed by the introduftion of ali¬ 
ment into the ftomach ; it however ufually fubfides in 
about half an hour or fo; but it re-appears foon after¬ 
wards with increafed violence ; and in a fliort time, as a 
few days, efpecially if ftimulating food is taken, it be¬ 
comes a fenfe of abfolute pain, attended with naufea, 
vomiting, and difguft for every kind of alimentary mat¬ 
ter, except cool and unirritating liquids. This has often 
been obferved in yellow-fever, the origin of which is one 
of the moft fevere forms of inflammation of the mucous 
membrane of the ftomach and duodenum. The diforder 
of the ftomach above deferibed is not unfrequently the 
only fign of the approaching difeafe for one or two days; 
and we may often witnefs the fame circumftances in the 
feveral forms of fever that occur in our own climate. 
“Fever does not immediately refult from irritation of 
any other part. We find extenfive and very fevere in¬ 
flammation of ferous and cellular membranes, and of the 
fibrous and bony ftruftures, and no fever exifts : but, if 
the irritation of any of thofe parts be participated by the 
mucous membranes, all the phenomena of fever imme¬ 
diately appear.” 
This theory has been by fome confounded with the lu¬ 
minous one of Dr. Jackfon; but it certainly differs 
widely in this point. Dr. Jackfon Ihows that the mucous 
membrane of the ftomach is the part which ordinarily re¬ 
ceives the impreflion of contagious effluvia, and that the 
fame membrane does frequently take an inflammatory ac¬ 
tion ; but he is far from afferting with Brouflais and Har¬ 
rifon, that inflammation of this membrane is the effential 
caufe of fever; i. e. that without which it cannot exift. 
Again, M. Brouflais is confcious that the firll impreflion 
giving rife to the phenomena of fever always aftefts the 
mucous membrane of the Jlomuch, either from the exciting 
caufe having been immediately applied to this organ, or 
from its fympathifing with fome remote part in a ftate 
of irritation ; and, unlefs fuch a fympathy happens in 
the latter cafe, he confiders that real fever cannot arife. 
Dr. Jackfon equally inculcates the doftrine of the local 
origin of contagious fever, but he does not fix this ori¬ 
gin in any part exclufively; and he, befides, confiders 
that theJkin itfelf, properly fpeaking, or the cutaneous' 
envelopment of the exterior of the body, as well as the 
mucous membrane of the lungs and alimentary canal, 
may be the part firft affefted ; and that the irritation of 
this organ may excite in the fyftem the whole of the phe¬ 
nomena to which the generic term fever has been applied, 
without the mucous membrane of the ftomach being ne- 
ceflarily interefted in the produftion of the feries of 
fymptoms; though he dates that fuch an implication 
does take place in by far the greater proportion of in- 
ftances. 
The other point of difference, is the part of the ner¬ 
vous fyftem which forms the medium through udiich the 
fymptoms are developed ;' though the reality of a differ¬ 
ence in this refpeft is not very evident. Dr. Jackfon de- 
fignates it as the fenforium; by which it appears he means 
the cerebral fyftem: though he may intend only to fig- 
nify the principle of fen/ibility generally, without fpecify- 
ing the particular parts in which it may be feated. M. 
Brouflais confiders the ganglionic nerves as the effential 
organs by which the fympathies in queftion are pro¬ 
duced. 
The next pathologift whofe theory of fever demands 
our attention is Dr. Nicholls. We quote from his ex¬ 
cellent “ Pathology.” A particular and methodic ana- 
lyfis of the fymptoms which conftitute the feveral ftages 
of the morbid condition of the fyftem which is thus 
termed, leads him to conclude that the early Jlage of it 
refults 
