205 
PATHOLOGY. 
r&fts on a (table foundation, becaufe thofe difordered fe- 
cretions may be the refult of difturbance in the brain. 
It mult be granted, however, that the red appearance of 
the edges of the tongue, a fymptom this author particu¬ 
larly dwells upon, is a fign of inflammation ; but every 
one knows that this fymptom is often wanting in fevers; 
and, that all other appearances of the tongue may be 
produced by nervous irritation, altering the fecretion on 
the furface of that organ, is clear enough, from the ob- 
ferved and well-known effefts which the artificial inter¬ 
ruption of nervous power to a fecretingfurface invariably 
occafions. Now that inflammation of the mucous mem¬ 
brane itfelf may produce the various appearances of the 
tongue in fever, we cannot admit, becaufe local applica¬ 
tions, known to be capable of bringing on inflammation, 
do not caufe the difplay of fimilar appearances. More¬ 
over, if it were allowed that inflammation of the mucous 
membrane do exift, it were (till impoflible to (how by 
what influence general febrile commotion is produced ; 
becaufe inflammation in one part mull be the fame as in 
another to a certain-degree ; and hence fever might re¬ 
fult from inflammation of any organ of the body without 
implicating the digeflive tube, which does away with the 
theory. The effeft of ftimulants and tonics in fever does 
not require us to believe this theory, fince the intimate 
fympatby between the ftomach and brain offers a ready 
explanation of the faft. Independently of this, a few 
cafes have occurred in debilitated and generally-difeafed 
patients, in whom the exhibition of gentle ftimulants has 
produced highly favourable confequences. 
The ftrongeft faffs adduced in favour of the doftrine 
of Broufl'ais, is the red appearance of the infide of the 
ftomach on diffeftion, becaufe his opportunities for car¬ 
rying on diffeftions of that kind have been almoft un¬ 
limited ; but we think whoever attends to the clafs of 
patients from whom thefe diffeftions were made, and the 
climate they exifted under, will have no hefitation in be¬ 
lieving, with us, that this author has been led to form 
this fweeping conclufion as to the general fources of fe¬ 
brile ailments from having principally had under his care 
the gaftric form of fever, i. e. a complication (very fre¬ 
quently met with) in which the ftomach, fometimes fole- 
ly, fometimes in common with other organs, is in a (late 
of phlogofis. We have feen patients who have died of 
fever, in whom rednefs of the mucous membranes in the 
ftomach was not found ; and, though our very limited 
experience would feebly indeed counterbalance that of a 
Broufl'ais, we conceive that a very few unequivocal cafes 
overthrow the whole theory as to the effential caufe of 
fever. 
We have no hefitation in contradifting Dr. Harrifon’s 
affertion, that the intenfity of fever is in direft ratio to 
gaftric inflammation. We deny this from diffeftions; 
and we leave this and the above affertion, which we have 
made in oppofition to Broufl’ais, to be corroborated by the 
experience of our medical brethren. 
It muft be granted, after all, that gaftritis in various 
degrees of feverity, though ufually mild, is (rnoft pro¬ 
bably from the fame caufe which produces heat and red¬ 
nefs of the external (kin) a frequent concomitant of con¬ 
tinued fever; and that it always exifts in the Exanthema- 
ticae, or eruptive fevers. 
It will be feen, that Dr. Nicholls’s rationale of febrile 
phenomena is principally derived from the application of 
the two laws, that diminiflied fenfibility is followed by 
excefs of fenfibility, and the fame of contraftility (or, as 
he ftyles it, tonicity). The extenfive and accurate man¬ 
ner in which he has traced their operation in the long 
quotation we have given, will fave us from pointing them 
out further. It will be feen, however, that this author 
by no means enters into thofe queftions which the majo¬ 
rity of writers have contended about, and which we have 
before detailed. There are moreover many conclufions 
ftated of which Dr. Nicholls has adduced no proof; as 
where he fays, in fpeaking of the firft ftage of fever, that 
fulnefs of blood in the head will arife from want of ac¬ 
tion in the heart; and it is on this affumption that many 
of his reafonings turn. 
Upon reviewing thefe various theories of fever, not 
one of which has maintained altogether its ground, we 
neverthelefs fee much to admire; and we (hall now pro¬ 
ceed to cull the good parts of each and exhibit them in 
what appears to us to be the moll: Ample form. We (hall 
firft pafs in. review the caufes of fever. Thefe are of 
three kinds: inflammations of all parts; animal irritants, 
or contagious effluvia; and vegetable irritants, or marfh 
miafmata. A predifpofition of body is required to ena¬ 
ble thefe agents to produce the febrile ftate, fince all are 
not equally liable to undergo their operation. 
The ftate of body which feems to be moll: liable to be 
affefted by fympathetic fever, or that from local inflam¬ 
mation, is plethora ; though it is to be remarked, that 
this does not argue that fymptomatic fever is in plethoric 
habits the molt formidable. The ftate of the body which 
difpofes to the influence of contagion and miafmata, is 
a weakened condition of the nervous fyftem. Thus 
cold, bad living, fatigue, the depreffing paffions, Venus 
nirnia,' have long been accounted predifpofing caufes. 
They are alfo in conjunction, or long applied, exciting 
caufes, and will produce fever without contagion. 
From thefe well-known and generally-allowed ftate- 
rnents it follows, that the operations of febrile commo¬ 
tion is carried on through the medium of the nervous 
fyftem ; a faft long fince fliown by Cullen and others, 
but of which we have been long in making a proper ufe 
in the profecution of this fubjeft. We have feen that in 
fever the capillary fyftem betrays the firft fymptoms of 
derangement, principally manifelted in the (kin. Thefe 
fymptoms are generally coldnefs orrigor, the confequence 
of conftriftion of the capillaries. Now, to this gene¬ 
ral c-onftriftion (as is explained by Dr. Park in his Patho¬ 
logy of Fever) may be referred all the phenomena of the 
firft or cold ftage of fever. For, every part having a dif¬ 
ferent mode of feeling, and a different funftion to per¬ 
form, it follows that various effefts will refult in differ¬ 
ent organs from the fame change of circulation. And 
accordingly, that ftate of veffels which occafions a fenfe 
of cold on the furface is accompanied by the fenfe of 
navfed in the ftomach. The fame conftriftion in the ca¬ 
pillary fyftem of the brain produces diminiflied perform¬ 
ance of the fenforial funftions; or agents direftly debi¬ 
litating the brain may give rife to this conftriftion over 
the whole furface. However this may be, the atonic 
(fate of the brain muft be looked to as the caufe of the 
languor and laflitude, the lengthened mufcles of the face, 
the lofs of ftrength, fainting, &c. which are the conco¬ 
mitants of the firft ftage of fever. To the fame condi¬ 
tions of nervous torpor and capillary conftriftion, we 
refer the feeble fmall pulfe, the palenefoof the (kin, and 
the fhrinking and diminution of fize in the features, and 
every other external part, as well as of morbid fwellings. 
From the contrafted condition of the capillaries the other 
lecretions are diminiflied, through wanting a due fup- 
ply of blood. The mouth and tongue become dry from 
the fcanty fupply of faliva ; the pancreatic juice, the 
bile, the mucous and ferous excretions in the alimentary 
canal, being diminiflied, as well as the mufcular aftion 
of the bowels enfeebled, the faeces are not paffed for¬ 
wards, and coftivenefs takes place ; the urine is not 
only fmall in quantity, but of pale colour. The heat of 
the body is dependent on the due fupply of animalized 
blood and nervous power, and always increafed when the 
ratio of thefe fluids is increafed, is now diminiflied by 
their diminution. The diminiflied circulation of blood 
in the capillaries naturally throws a larger fupply on the 
heart; and to this circumftance the anxiety, and^fenfe 
of load about the region of the heart, the fighing, yawn¬ 
ing, and ftretching of the limbs, as well as the (hort and 
dilturbed refpiration, are to be attributed. 
All the fymptoms, then, of the on let of fever, con- 
ftituting 
